Kidney Stones (Renal Calculi)

[Guest moth1351]

Background; I got back from a mission and on the third day of my crew rest I was in the ER, discovering I had a kidney stone. I tried to pass it for 3 weeks but wasn't able to, so they went in and got it. However, during the pre-op CT scan, they informed me that I have "multiple stones in each kidney." They (Urologists at a nearby Army hosp) obviuosly needed more tests to be done but I had to wait a month to recover. During this time I did my research and found the Waiver Guide on Brooks web page. I gave a copy to the docs so they knew what tests to do for my waiver request.

Present; I have completed all of the tests needed for waiver submission. Here's the interesting parts... The urologist explained that my IVP showed "something that may be a stone" but needed a radiologists opinion to conclude that, plus you can only see it from straight on, not a side view. So, how did I go from "multiple stones in each" to maybe only one?

Anyway, I completely understand that if the stone(s) are in a certain part of the kidney with a relative certainty that they will not escape the renal calyx, I should be good to go. What if I try for the waiver like this and get denied, can I try to get another one after I get the stone removed? Should I get the stone removed first?

The docs are doom/gloom about it but it seems simple to me... if I have a stone where it shouldn't be, remove it and get me back flying!

[Guest doctidy]

Kidney stones in trained aviators were doom and gloom previously, but new treatments allow aviators to get back on flying status. Perhaps they are doom and gloom that it may not happen tomorrow...but it will happen. You haven't flown your last AF mission...promise.

[Guest moth1351]

Thanks for the encouraging words...

I just got a call from the urologist explaining that the IVP came back negative. Since I only had the one stone taken out, do I need a waiver at all? Or do I still need to apply for one even though I don't have retained stones?

[Guest doctidy]

I'll let you read the waiver criteria and figure out where you stand:

A history of stone is compatible with waiver as long as there is not an underlying cause predisposing the individual for further stone formation or a therapy necessary that is incompatible with waiver.

Unrestricted waiver is also allowed for retained stones provided they are in the renal parenchyema or in a calyceal diverticulnoium where there is relative certainty that they will not escape the renal calyx, that metabolic and renal function are normal and they are asymptomatic. Class IIA waiver is possible in borderline cases and in cases where the calculus is retained in a papillary duct or more distal part of the collecting system provided metabolic and renal function are normal. All cases of retained renal calculi will be fully evaluated by a urologist prior to forwarding case for waiver.

[Guest moth1351]

Rage,

I hope this will be my last question/post on this subject...

I had my annual physical two weeks ago and talked with my flight doc about my "no stone" status and all of the tests I had completed per the waiver guide. Everything was normal (even the on the spot urinalysis) except the 24 hour Urorisk, which had multiple abnormalities. He had me take it again just to be sure.

I got a call from him this morning explaining that there were still abnormalities and I had to call the urologist to discuss a possible treatment. My guidance from the flight doc is this...

1. If no treatment required, the AF doesn't require a waiver for the abnormalities and I can fly today.

2. If I need a treatment, meds or something, it will DNIF me, at least until I get a waiver for the meds.

3. I can be retested in 6 months, can fly during that time w/ no waiver.

Does this jive with you? I haven't spoken to the urologist as he is gone until Monday and I'm not the type that likes to sit around and wait for info.

Basically, without knowing my exact test results, do I need to be concerned about flying again? Would this be a condition that "predisposes" me to stones?

[ 26. July 2006, 14:46: Message edited by: moth1351 ]

[Guest doctidy]

Regarding what your FS told you:

#1 - totally concur

#2 - totally concur

#3 - he can probably get away with that...there's probably enough wiggle room. (I think you got a pretty sharp one there)

You are going to have to be the one in a million case before we aren't gonna put a C-17 guy back in the cockpit for kidney stones or even a condition which predisposes someone to kidney stones. (I haven't done a query, but I can't remember ever saying "no" to kidney stones)

[Guest baileyf16]

I just found out that I have 4 kidney stones. 1 in transit, the other 3 still inside the kidney. I am currently at UPT, about 1/3 of the way done. I have been DNIF'ed and the flight doc didn't know for how long yet. One of the major concerns is that I have a higher than normal calcium level. I have a 12, where the max normal is a 10. (I don't remember what the units are) They say that this is why I have developed the stones. They sent off my blood work to see if the high calcium was thyroid related.

My questions are:

If for some reason my calcium level returns to normal and I get the stones out, how long will it be before I can fly? (Can I fly with the 3 stones in the kidneys?)

If they find that the thyroid is the problem and they remove it and the calcium level returns to normal, how long will it be before I can fly?

If it's not thyroid related and they can't find the reason for the higher than normal calcium level, would I be able to fly with the likelihood very high that I will get more stones?

I am very anxious to know what I am up against. Thank you for any info.

[Guest doctidy]

Originally posted by flyer:

My questions are:

If for some reason my calcium level returns to normal and I get the stones out, how long will it be before I can fly? (Can I fly with the 3 stones in the kidneys?)

If they find that the thyroid is the problem and they remove it and the calcium level returns to normal, how long will it be before I can fly?

If it's not thyroid related and they can't find the reason for the higher than normal calcium level, would I be able to fly with the likelihood very high that I will get more stones?

I am very anxious to know what I am up against. Thank you for any info.

When the stones are out, the calcium is under control, and any medication used to control has been used for ~30d...you should be able to get a waiver. Even if you need to have parathyroid surgery you can get back into training.

You aren't the first with kidney stones with high calcium...you won't be the last.

[Guest baileyf16]

Rage_:P,

Thank you very much for taking time to respond. For all I knew I was on the brink of being medically downed for good!

[Guest Albert]

I have a couple retained kidney stones. From the CT scan, the urologist was unable to determine if they were completely in the 'meat' of the kidney, or in the collecting tube. My flight doc is uncertain what the waiver people will say, does anyone know what will happen from this point? Since it uncertain, will they want me to have the stone removed just in case? Thanks

[Guest P27:17]

I'm not a doc so I'll give you input based on my experience with these types of waivers for IFC I.

A single stone is usually waived if a CT Scan 6 to 12 months after the episode shows no new stones.

Having multiple stones or having a stone in each "tube" is very difficult to get waived.

Hopefully one of the Docs on here can shed light on your chances...especially if you are already a trained asset.

Good luck

[Guest F16PilotMD]

I have only done waivers for trained assets with retained stones. Key is length of time without symptoms and documentation of no progression of the disease. That's pretty generic. Check the waiver guide. If I were to do this waiver I would get urologists to document NO CHANGES over 6-12months, repeat CT scans to prove no further stones and no stone migration, IF metabolic cause---fix it. Not sure how it would be received for IFC-1...you are a set-up for future problems if no medabolic cause can be found and corrected.

[Guest CMPUMP]

Just curious how if an individual that has just recently gone in for the third time for kidney stones (still awaiting the CT to be sure) will be affected for flying. Already has a waiver for 2 episodes of passing kidney stones. I have heard it may the end but I have heard it is not. I looked through the medical reg and read that, but it doesn't explain it all to me. Flight Engineer and 3rd time for stones.

[Guest CIVILENGINEER04]

I just found out today I have another kidney stone #2. My last one was about a year ago. I passed the last one and this one is 1/4 of the size so I should pass it with no problem. I'm a civilian wanting to go for OTS and then UPT to Active Duty. From what I can tell on the waiver guide (and it seems pretty clear) if you have a recurrent (2 or more) kidney stone you can not get a waiver for FC1. Is this correct? I've had no military physicals to date. Thanks

[Guest jubilee]

Since we're on this topic...I saw a few years ago the post about the guy and his parathyroid glands causing his elevated calcium levels - bringing it to a 12 instead of under the range of 10. My husband is a recent pilot select and had 1 kidney stone 6 years ago and no problems since. Well his elevated calcium levels were discovered (a 12 as well) during his flight physical due to the additional testing his kidney stone warranted. That, combined with high levels of PTH, confirmed the diagnosis. They are going to have him get some imaging tests done to see which of the 4 glands are enlarged, or which has the adenoma causing this calcium imbalance.

My question is this: parathyroid dysfunction is of course on the list of "disqualifying conditions" for an FC1. I read the waiver guidelines for conditions that can be waiverable and he falls into these guidelines as he is not symptomatic whatsoever. The flight doc is going to arrange these imaging tests and then have my husband go into surgery to remove the offending gland(s). He said after the 'recovery time' and his levels are back to normal, that he can submit a waiver for this with his physical and that it's likely that it won't be a problem. We've read that after surgery 95% of people are basically cured - so do we still need a waiver if it's a condition that no longer exists? Or is the waiver to show the lack of symptoms in the past, and the high likelihood that problems will not occur in the future due to the surgery to remove the problem - ?

PLEASE and thanks for any help!

[Guest J-Bones]

I recently had two unilateral kidney stones (in one kidney only) and the urologist gave them about a month to pass, which they did not. I had them both removed via uereteroscopic lithotripsy. The flight doc said that had it only been the kidney stones there would have been no waiver required to get me back on flying status (I also did 24 hour urinalysis - no issues raised by calcium levels or parathyroid abnormality). The urologist stumbled accross and remove a cancerous tumor in my bladder, this was a disqualifying situation. I am pursuing a waiver and will post again when results come back on the tumor/kidney stone issue.

[Guest ColGuard]

I had one kidney stone a little over a year and a half ago and no others on the CT scan and no symptoms or other stones since. Shortly after I had the stone (~2 months) I applied to the OTS boards to be a pilot and was selected. Unfortunately my recruiter at the time told me that since I had passed the stone there were no issues and I didn't have to put it on any medical forms. Long story short, I was medically DQ'd for another reason that has since been fixed and I am looking at reapplying and don't know if I should bring up the stone issue since I haven't had any problems since and as far as I know, there are no more stones in there. If I do put it down as an issue is that going to keep me from getting back in?

Thanks for any input.

Edited June 9, 2009 by ColGuard

[Hot Dogs!]

According to the waiver guide (https://airforcemedicine.afms.mil/idc/groups/public/documents/afms/ctb_071808.pdf pages 713-720), no waiver is needed for a single episode of a kidney stone, but it says "a full workup should be reported on FC I/IA physical". Does anyone know what is included in a "full workup"?

[Catbox]

Hopefully we haven't chased away all the Docs and Med pros here yet because I could use some bro to bro advice.

After 3 bouts of kidney stones and working through the Aeromedical Review Board at Brooks I was taken off of flying status in 2010. A decent flight doc gave me some "off the record" advice that if I was symptom free for 2 years she would start the process again. 2+ years later I'm making those initial forays into getting back to flying.

This is the question...the AFI (and I apologize I'm not sure which one because I just looked at excerpts that the Doc had printed out and didn't catch the number) says in a table that multiple occurrences of kidney stones is not waiverable. However in another section the AFI says that 13 people have re-applied for flight status after having stones and 5 have been approved. Obviously this tells me there is some gray area that the AFI does not cover. Since gray area is usually up to interpretation is there any way to better make my case to the Techs, Docs and reviewers who will be looking at my condition and history?

I'm happy to email, PM any relevant info if you have it...and I will ship beer across the country for help.

[Guest]

The standard you saw is the Aircrew Waiver Guide; I used to link to it in my signature, but it appears the AF locked down access to medical personnel only. The standards "Renal and Ureteral Stones" section hasn't been updated since Jun 2010. That standard makes your chances seem bleak, however it looks like it needs an update.

Looking at Jan 2011 to present for FC 1/1A, 7 waivers submitted, 2 disapproved, 5 approved. Note that some of these are probably extensions/renewals from before 2010, which may have had different standards and were grandfathered with the old criteria.

Talk to your doctor, say that you know the Waiver Guide says it isn't waiverable but you know some personnel were approved. Tell them they can check AIMWTS if they want to see other specifics of approved/disapproved waivers for the condition. Realistically, your chances of waiver are highly dependent on the severity and history of your condition, and whether the FSO wants to take the time to process a waiver that the reg.s say are not possible (but your a clever flyer who knows people, right?).

Remember, when it comes to waivers, nothing is certain until you get a response from the Approval Authority. Until then, miracles (or unexplainable, unknowable, calamatous disasters) can happen.

[Motrin]

Table 1 – Waiver criteria for renal stones

Flying Class Category Waiver Potential

Waiver Authority

I, IA Single episode

Recurrent, bilateral, or

retained

No waiver required, but

full workup required on

FC I/IA physical.

No

AETC

II Recurrent or bilateral#

Retained*#

Yes

MAJCOM

Yes

MAJCOM

IIU Recurrent or bilateral

Retained*

Yes

AFMSA

Yes

AFMSA

III Recurrent or bilateral

Retained*

Yes

MAJCOM

Maybe

MAJCOM

ATC/GBC Recurrent or bilateral

Retained*

Yes

MAJCOM

Maybe

MAJCOM

SMOD Any evidence of stone

disease

Yes

AFSPC

* Stone in renal parenchyma or cyst, with no possibility of movement into collecting system, waiver

likely for trained asset.

# If flyer is a pilot, and there are any retained stones, then FC IIC and AFMSA is waiver authority.

AIMWTS review through January 2010 and revealed 532 submitted cases for stone disease. There

were 13 FC I/IA cases, 294 FC II cases, 2 FC IIU cases, and 223 FC III cases. Within the total were

51 disqualification dispositions: 8 were FC I/IA, 7 were FC II, and 36 were FC III. Of the 51

disqualification cases, 21 were disqualified primarily for diagnoses other than the stone disease and

30 were primarily for the stone disorders. Included in this total were cases of recurrent stone

formation, retained stones, and multiple symptomatic episodes.

I'll echo what deaddebate said. The table I posted is right from the USAF waiver guide. Waivers for trained assets with recurrent episodes or retained stones are possible, but reviewed very carefully. I would be more concerned about the underlying disease process; why is this individual getting recurrent stones? Sometimes there is a problem we can fix, but most of the time there is not. If you can read the table above, FC II (trained aviator) waivers are more common than disqualification.

I won't ask you to divulge specifics about your case in a public setting, but in general, if you are disqualified outright from flying status, it is hard to get back on. Again, sometimes individual cases have particular stipulations made by the governing authority; your best bet is to discuss it with your new flight doc. You would need to re-accomplish an initial flying class physical, but if you are lucky they will hold you to FC II standards. It never hurts to try. Best of luck to you.

[Catbox]

Thank you both very much...Motrin that was exactly what I saw this morning and appreciate having the text to refer to. Essentially my uric acid levels are naturally out of whack and while I'm on a med called Urocit-K (just pottasium citrate, same as in old fashioned cokes as I understand it) everything with my renal function is normal. One of the main issues that I've had with this is that I have probably seen 5 different urologists, both military and civillian. The civillain guys think its no big deal, the military guys can't ever imagine me sitting on an airplane again. Each one of them seems to have a different take on what would work, be it diet, meds, water, beer (yes beer was an official remedy perscribed by a doc in Germany) and often the completely contradict what a previous doc said. This most recent med seems to be working to keep me healthy and hopefully its enough to convince the SG that I can in fact do my job. I've got a great flight doc who is more than happy to press ahead with this which is a great first step.

thank you again....

[thoma015]

Strange case here.

To clarify Im not rated

In college I had a kidney stone. Once on AD I wanted to apply for pilot so I got a FC1 accomplished, no problems with that. Never ended up being selected, but after getting approved for the FC1 I had a second stone. Fast forward to today. My original fc1 is expiring so I go to the doc to re accomplish because I have been selected to go fly for the reserves. Now he says I may be DQ'd because of the second stone. Anyone have any advice or thoughts on this, it would be greatly appreciated.

[deaddebate]

Short answer, yes, you'll likely need a waiver. Read the Waiver Guide linked in my signature block. Should tell you everything you need to know. I'm at home now, so if you have a more specific question, ask it tonight and I'll answer it tomorrow.

[thoma015]

Will this waiver need to be approved by AFRC or AETC? Also what is the usual timeline for a response?

Edit. Looks like the waiver guide says AETC. It also says waiver potential "no", does this mean I'm dead in the water, or can I still submit and cross my fingers? Any idea on a timeline?

Edited September 18, 2014 by thoma015