389 Benadryl, Zyrtec, and More: FAA Wait Time Rules for Pilots with Dr. John Trowbridge
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This could be the most important episode you ever listened to because it could save your life. Did you know that common over-the-counter medications, like ones you probably take, are a factor in perhaps 30% or more fatal accidents?

In this episode, I'll talk with Dr. John Trowbridge about the FAA's no-go list for over-the-counter medications. He'll break down the FAA's five-times dosing interval rule and explain how many hours or even days you may have to wait after taking common drugs like Benadryl and Zyrtec. If you want to be a safer pilot, probably the number one thing you can do to reduce your chances of an accident is to know how long you need to wait before

before flying after taking these medications. Hello again, and welcome to Aviation News Talk, where we talk general aviation. My name is Max Trescott. I've been flying for 50 years. I'm the author of several books and the 2008 National Flight Instructor of the Year. And my mission is to help you become the safest possible pilot.

Last week in episode 388, we talked with Dr. Catherine Kavagnaro about how thoughtful altitude and routing choices can make cross-country flights safer and more efficient. So if you didn't hear that episode, you may want to check it out at aviationnewstalk.com slash 388.

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And that's a link to a PDF on the FAA website called What Over-the-Counter OTC Medications Can I Take and Still Be Safe to Fly? So you may want to download that and save it for future reference. And now our law firm, which is Scud Run and Hope, has asked us to tell you this. The views and opinions expressed in this episode are those of the guest and do not necessarily reflect those of the host or the Aviation News Talk Network.

This content is provided for informational and educational purposes only and should not be considered medical advice. Always consult with your personal physician and aviation medical examiner before taking any medication or making decisions that may affect your fitness to fly. Thanks for reading that, Kelly. And now let me tell you a little about Dr. John Trowbridge. First, he is a longtime patron mega supporter of the show. Those are the supporters who donate $50 or more per month to support the show.

Each of these episodes takes around 20 hours to produce, and your donations help offset the time I spend away from giving flight instructions so I can bring you these shows.

And so my thanks to John and everyone else who helps donate to make these shows possible. Now, John served as a FAA Senior Aviation Medical Examiner or AME for more than a decade. And he was the chief medical consultant to Texas International Airlines, which bought and merged into Continental Airlines. He's the author of the book, The Yeast Syndrome. And he has a website for pilots at clearedfortakeoff.info. And now here's our conversation with Dr. John Trowbridge.

John, thanks so much for joining me here today. I'm so happy you're here. Oh, Max, you're one of my podcast heroes, and I'm thrilled for the invitation. Thank you. Well, thanks for coming on and talking about this topic, because I think what we're talking about is probably the number one problem that pilots can learn about to avoid a fatal accident. And I'm willing to bet that

Everybody listening right now has taken at least one of the substances we're talking about today and didn't know it was on the FAA's no-go list.

Absolutely. 110% on that. Yeah. No, I think that's true. I think this is one of these areas that pilots just don't know enough about. In fact, it ought to be on the private checkride to have some knowledge on this topic, I would think. That's a great idea, actually. Yep. So just how serious is the problem of pilots taking both illicit and over-the-counter medications? There are a number of fatal accidents every year. You know, about, what is it, about 400 a year in general aviation or so.

And the problem is that about 40% of the time, the investigation of the accident shows that the pilot was taking something, either an over-the-counter or prescription or even illicit drugs and such was contributory to the accident itself because he was cognitively or coordinatively impaired. He wasn't able to function as pilot in command to safely conduct the flight.

So, yeah, it's a pretty important thing. Yeah, it's interesting that the NTSB talks about loss of control as the number one factor. I would say that taking drugs and over-the-counter medications and not knowing that they're banned and not permitted could possibly be the number one factor in accidents. What do the studies tell us in terms of the trend? Are we doing better? Are we getting worse? Max, I was a little confused.

startled when I was reviewing information to talk with you today. The studies are showing a substantial increase in the documentation of medication use by pilots. Now, that could be over-the-counter, could be prescription, could be illicit drugs and so on, but the numbers aren't just a smidge up.

They are factors up in some cases. And when we're talking about something where a fatal accident investigation might show 35 or 40 percent of the pilots are taking something, you go,

Whoa. I don't think that means 35 or 40 percent of the pilots flying are necessarily doing it, but certainly the ones getting in trouble are doing it. This is 100 percent avoidable complication to leading to an accident.

You have to know the drug situation and avoid it. Yeah. And unfortunately, this is not just thinking, oh, I've got a new prescription drug. I should check it out. A lot of this is over-the-counter medications. Absolutely. So what's the FAA's general rule for wait times for medications on their no-go list? When you look at a medication,

And it says, you know, dose yourself every six hours or so. It doesn't mean if you skip the next six hour, one after that, you're okay. It's a five times multiple. So let's say if it's every six hours, multiply that by five, 30 hours is your wait time from the last dosage taken. And that might not be enough depending on other factors in your world.

But it's certainly a minimum. Yeah. And I think the thing that people really don't realize is that when they take a medication that says, hey, this is good for 24 hours, that means you need to wait five days. Totally. Exactly. You try and bring that up to people and you go, but I'm really, I feel okay. You know, it's not an issue for me. I got that part.

but you're remembering that your brain is the one assessing whether your brain is having an issue. And that is not a good situation because you do not necessarily feel that you're having a problem, but you can be documented

for cognitive impairment. And that can be several different kinds. Your thinking isn't quite right. Your assessment of problems, your memory isn't quite right. Your coordination isn't quite right. Your attention span or attention to details is not quite right. All of those things, of course, are critical for piloting an airplane.

And if you are slightly impaired at just the wrong time, that's when the Swiss cheese holes line up. And that's when you're on the line to an accident.

And accidents, of course, end up fatal. People don't have a respect for that. Yeah, you raise a good point, which is a lot of the reason these are on the no-go list is because they're impairing judgment. And if your judgment is paired, how can you use your judgment to determine that you're impaired? You can't. So basically, you need to go by these guidelines and wait at least five times the dosage period. Now, how many people do you think are doing that? Yeah, probably.

Probably most don't know. Well, let's go through this no-go list that the FAA has put together. The first category is antihistamines. Tell us what's on the go list and what's on the no-go list. Let's start with the no-go first. The problem with the antihistamines is they're so readily available over-the-counter, okay? Now, when things are available over-the-counter, they must be safe, right? I mean, that's the concept. Otherwise, they wouldn't sell them over-the-counter.

The problem is for piloting, there's a whole different set of concerns and antihistamine is not an antihistamine is not, they're not equivalent. Okay. And so first generation antihistamines and the classical one is Benadryl, absolutely a no go. And that's because it has a sedating effect.

Sedation is very simple. What it means is that it's blocking down your attention, your cognitive ability. The reason I brought that up, Benadryl is the most common over-the-counter medication that is found in fatal accident pilots.

Wait a minute. Benadryl, I don't take Benadryl. No, but you can take a sleep aid that has Benadryl. And it's very common as an included item in a number of over-the-counter medications, diphenhydramine. Who knows what that is? You know, that's Benadryl.

And you don't even have to take Benadryl. You can just have a cousin to it. And all of those have the same sedative effect that impairs your judgment, your coordination, your thinking, and so on. Now, of course, the pilots are supposed to say, well, what can I take? Well, okay. That's where we have to start dealing with judgment issues again, because

If you realize that you can do some things preemptively to where you really don't need to be taking antihistamines for allergy, congestion and stuff. And that's some of the stuff I deal with on my website. We can talk about that later. But the deal is also you can learn about antihistamines that have less of a sedative effect and are generally considered safe.

And that's something, of course, you have to ground to test is what the FAA calls it. You have to take it way ahead of time so that if it will cause you any issues, you're becoming more aware of it personally. In addition to Benadryl, which is the classical one,

and involved in more over-the-counter products than you would imagine. There are a number of other sedating antihistamines. Dimetap is one of the very classical ones that's been around for so long. Chlorotrimetan is another one of those. These are all sedating in a very specific way like the Benadryl is. Zyrtec is a recent one. Zyzal is a recent one.

And the opinions on these I have sometimes seen differ. Oh, well, you know, it's okay if you tolerate these and you can take them. In my worldview, the way they work, they are absolutely out okay. And there are also other side effects to be concerned about with those. And that is the frequent use of the antihistamines, especially the first generation like the Benadryl, Dimetab, Chlorotrimetan and so on.

that they are associated with an increased risk of dementia as you get older. And you go, wait a second, that sounds like a real cognitive impairment. And it is, okay. But what people don't realize is that a number of sleep aids employed the sedative effect of the antihistamines as their primary mode of action. You don't necessarily realize that because you're not buying an antihistamine, you're buying a sleep aid.

Well, okay, that's the problem with the over-the-counter episodes. And some of these can have really long cycles with creating grogginess hours and hours after their use, which is why the FAA talks about the five times, you know, the dosage interval, because that will take most people to a much clearer sense of thinking. And as I look at the list here, I see a couple of other sleep aids mentioned as well. So I think you mentioned Sucrex.

Z-Quil, I'm also seeing NyQuil, Tylenol, PM, and Unisom, all of which are used as sleep aids, and all of which are on the no-go list, which means you're going to have to wait for, what, a day or two? I mean, you can't just take this overnight and go flying the day you wake up, right? Exactly. You will wake up, but you might feel a little bit groggy, but you'll attribute that to something else.

And the real concern about that is that people are not aware of what they are actually taking. That's why, you know, when I say they have all these different brand names, but if they're all pretty much Benadryl or diphenhydramine, of course, you have to know about reading that one. But if the label says may cause drowsiness or be careful when operating machinery or driving a motor vehicle, of course, an airplane would be a significant motor vehicle, those

Drugs are more modern antihistamines, often are other sedative type patterns.

The problem with that is they don't tell you, they don't give you that hint that that's what you're dealing with. And so you have to be very suspicious when you read the label. If it says that, I can guarantee you it's going to be in the no-go list. No question. So let's flip over and talk about the go list. What are the good antihistamines that pilots can take and still fly immediately? In my worldview, I don't feel comfortable with any of them because antihistamines

People have what's called idiosyncratic reactions. That's personal to you, not necessarily broad-based to anybody else. And so Allegra is one that has been around a while. Claritin

is one that has been around a while. Those are in a generally accepted to fly kind of thing. If indeed you are able to take it, you've ground tested it, you've talked with your AMA and you don't have any issues with it, then those would be a couple that you could probably take for sleep while on a trip or before flying and such.

My concern is that people have turned too much to the antihistamine or sleep sedative patterns when there are much better ways to help with sleep. And some of these are very strictly not over-the-counter drugs. On my website, that's clearedfortakeoff.info, I have

large presentations on various topics. So for instance, the antihistamines are dealt with in the nose and sinus presentation. The sleep and fatigue presentation talks about ways in which you can help bring sleep from nutrition. So for instance, magnesium is

is an excellent way, sometimes calcium, another excellent way to help give sedation that is restful sleep without having side effects associated with the over-the-counter drugs. And so the problem with all of this is it's not a simple yes or no or one size fits none is what I call it situation because people respond differently and it's great to find out what works for you. Some people tell me that taking a Tylenol or

on aspirin at bedtime or naproxen, Advil, something like that. And they get good restful sleep. Those folks actually talking about controlling inflammation in their body that they're not really necessarily aware of, but it is something keeping them more awake and such. So finding a sleep pattern. And again, I have a, it's a rather large presentation on the website, giving options like that, because the drugs in my worldview, like I say, I'm just not

about taking them. And part of the reason is dosage, because some people will...

Take more than the quote suggested dosage. And other times you will have difficulties detoxifying it. You won't literally remove the drug from your circulation and from impacting you. And therefore you are showing a different detox pattern. And therefore the drug is hanging around more for you. And that's personal. Okay. And I see that there's only one sleep aid product, which is listed on the FAA's goat list. Tell us about that.

Melatonin is suggested as a goalless thing. Now, there is a caveat on that, and that is melatonin in some people is sedative.

substantially sedating, okay? In others, it's very minimally so. The key is, number one, you want to make sure you have a clean, crisp melatonin product, not mixed with, because there are a number of sleep aids that use melatonin and something else, and that something else is often an antihistamine. But melatonin in low dosages and taken appropriately is...

very acceptable for many people. Okay. And it doesn't generally tend to have a daytime drowsiness or a morning grogginess type effect, but again, which is why it's critical. Anything that you think you want to try, you do a ground test first, not on your trip, not when you're going to be exercising pilot duties. So under the nasal steroid and nasal decongestant category, there's actually nothing listed under the no-go list.

though they do mention a lot of things that are on the go list. And for some of them, they say considered safe and recommended dosages. So tell us what's on the go list and anything you can about recommended dosages. Sure. So the real deal about nasal decongestion and sinus issues, you want to protect your ears. That is the fundamental part of

the system up here that is challenged as you get to altitude and you're changing altitude and stuff. And so decongesting becomes very important. Now, a little story aside, when I was the chief medical officer for Texas International Airlines, I taught my pilots how to do saltwater rinses to their nose. We called it saltwater snizzles.

You can use a little nasal infant nasal syringe, make up a little salt water solution and just kind of gently squirt it and blow your nose afterwards and such. And I'd have the pilots do it before they take off halfway through the flight or more often if needed and such. And for years, I would see pilots telling me, you kept me flying. That was kind of important because we didn't have enough airplanes at Texas International before not having a pilot taking a plane out.

And so the deal is, is that more commonly people are reaching for over-the-counter decongestants. And, you know, Afrin is kind of the classical nasal spray that people use. Sudafed, which is pseudoephedrine. And, you know, they have all these names. You have to be very careful when you're purchasing things because you won't recognize a generic name. The real thing about Sudafed is it's...

It has potentially lots of other non-nasal side effects. It can raise your heart. It can raise your blood pressure. It can give you a sense of not quite well-being and such like that. We don't need that kind of thing. The deal is, is that decongesting can be done so easily with nutritional things, with the saltwater rinses that we talked about. And there's actually another little trick we use is called Cool Vapor.

where we have you make up a solution. Basically, it's eight ounces of water and a teaspoon to a tablespoon of hydrogen peroxide, just regular peroxide, and then a cool vapor inhaler, not a hot vapor. And you put it right in front of your nose and breathe in. And it can be remarkable in helping to open your sinuses, your nose and all that stuff. And

And especially people who have, and often they don't know, have nasal polyps or other issues with regard to changes in their anatomy there. And sometimes just getting these solutions, either the salt water rinse or the cool vapor can do dramatic help with clearing and opening those without using a drug like Sudafed or Afrin or such. Let's move on down to the cough category. It says that most cough medications are safe for flight, but...

caution for combination products with sedating antihistamines. Tell us what pilots need to be looking out for if they're using cough medication. Over-the-counter stuff, everybody's trying to find something for cough. And Yfenazine, which is the Mucinex or Robitussin, that actually can be very, very effective taken in enough dosage.

A lot of people in my patient experience, you know, 600 to 1200 milligrams twice a day has been extremely good because what it's doing is loosening the stuff up, getting it out so you're not needing to cough all the time. OK, the problem is that numbers of formulas over the counter have what's called dextromethorphan in them or the brand name is Delsim. Now, they won't print that on every label. That's just a brand label for Delsim.

Dayquil, which is a very common one that people reach for. You know, there's the NyQuil for nighttime, the Dayquil for daytime and such. These are no-go's because...

because they can be sedated. Now, when you're uncomfortable, you're just trying to control a symptom, you don't recognize that a side effect is the sedation, and you might feel so much better you don't realize the sedation is taking over. So you have to be very cautious. Chlorosetine is

allowed it. There's no chlorpheniramine, which is an antihistamine in it. And if you are very careful in making your choices, you can probably get away with it. The problem again is usually the combinations. You also have to be very careful with any antihistamine or cough product that has a dash D on it because that has a decongestant in it. And depending on the decongestant, that might not be legitimate for you. Okay.

And again, that would be like Mucinex D would have a decongestant with it. So it makes it more effective in the over-the-counter purpose, but not for piloting. Yeah, I see. They also mentioned that if it says nighttime or it says PM, that puts it on the naughty list.

Absolutely. And then, of course, now I just took it at night, so I'm OK in the morning. No, if it says, you know, every eight hours or 12 hours or multiply that by five. Now you might be several days out before you can legitimately exercise pilot duties.

And I don't recall if we mentioned NyQuil or not, but that's also on the no-go list. Definitely. Okay. Well, let's move down to a not-so-fun category, urinary tract infections, something we all love to talk about. Sure. And, you know, pilots have an interesting issue because a lot of times you're trying to fly, putting your knees together so that, you know, you really need to stop and pee, but you're still in the air. Yeah.

And it's just a little bit further, another 45 minutes and you'll be down. No, that's one of these situations where not good for you. However, part of the problem is you get dehydrated when you're flying. If you drink coffee or tea or water or soda pops or whatever before you go flying, you have more need to go pee. And as you hold it, that's not good. Well, people learn not to drink as much. Of course, if you just swish water around in your mouth and

Keep your mouth kind of wet. That's pretty good while you're flying. But there's something that I have used with great success with pilots and that any of the Azo, like they call them then Azo pyridine or Azo standard. So that's the brand name that is called is Azo. That one is generally safe because what it does is makes a chemical change in the urine that decreases Azo.

the interest of bacteria to growing there. There's another over-the-counter thing called D-mannose, a very simple thing over-the-counter, generally as a powder you can get as capsules and stuff. That discourages bacteria from attaching to the bladder wall. So, you know, these things can keep you out of trouble because really there's no other easy situation when you're up there. Now,

Let's assume you have a urinary tract infection. You get put on antibiotics. First of all, confirm with your AME that this is not going to be a contraindication, but there's no reason for you not to fly if the antibiotic has adequately helped control your symptoms. If not, then, you know, you don't want to be stuck up there, needn't like to relieve yourself and not able to. But Azo works quite well. D-mantles works quite well. These are very good. There's not specific no-goes, but

Again, confirm with your AME if you're on a medication. And don't fly with a urinary tract infection that's untreated. And especially if you're older. Older folks with urinary tract infections, it can really zing them out. Ouch. Doesn't sound like fun, but it's nice to find a category where there's nothing on the no-go list. So here's a category that everybody can identify with. That's our aches and pains category. Tell us about that.

Oh, aches and pains, fun stuff. And it's so common because, you know, as we go through life, we're getting bumps and grinds and whatever. And so it's not uncommon to have old sports or old accident injuries and stuff just kind of resurface up as we're going through life and feeling uncomfortable. The problem is that pain medications that are prescribed,

Okay. Often have a codeine base or something similar to that. And those are absolute no-goes. Okay. No question about it. Now,

Let's talk about what you could take. Well, there's aspirin, there's Tylenol, ibuprofen, that's Advil and Motrin. There's Naproxen, that's called Naproxen is the generic. Naproxen is the prescription, but Aleve is the half dose. You just take two, now you're at that level. And even though it's generally considered safe, there are potential serious side effects. Now, you have to be really careful on any of the pain medications that have a PM with them, because that's what people take for

sleep or rest and whatever. So Advil, PM, Tylenol, PM, most of those contain Benadryl or something similar to that. And that's, again, that moves it over to the no-go category. Now, in terms of other conditions, some people actually find that caffeine, coffee, sometimes tea, actually relieves headache patterns. That's something that's a trick that's found in Excedrin or some of these other headache products.

formulas and such. Again, if it's just aspirin or Tylenol, incidentally, there was a drug, yeah, many, many years ago, there was a combination of aspirin and Tylenol. They pulled it from the market because I think people figured out, well, I'll just buy that and just take one of each. And indeed, that's one of the secrets that we have used for many years, telling patients, if you want really good pain relief, take one Tylenol, one aspirin same time, rather than two of either.

And it's much more effective. It has an enhanced effect. And that's really quite good. Okay. You can also use lidocaine patches. Those are available and they also make lidocaine gel and lidocaine cream that you can rub on. That's a topical pain relief. And that can be startlingly successful in some people with a knee or an elbow pain or shoulder pain, something like that. But

But again, the aches and pains that are prescribed, those medications are almost always going to be in the category of don't fly with that. And definitely in those cases, observe the five times dosage schedule for restricting because you will not realize the sedating effects of the coding class of drugs.

Okay. So we'll definitely watch out for our PMs when we're dealing with aches and pains. Absolutely. What about skin rashes? This actually looks like a fairly straightforward category. It really is. Almost everything is allowed. The thing is, is that what you have to be careful of is if you get a prescription that for some reason is just

different, new or whatever. I have to be honest with you. There's a couple little tricks you can learn about skin rashes. Number one, the coconut oil can be exceptionally relieving as a skin rash treatment. Okay.

And another one is vaginal yeast cream that's over the counter. And sometimes if you have, you know, a scratchy little rash right there and you put vaginal yeast cream, if it disappears, it's a yeast or fungus thing. I wrote the book, The Yeast Syndrome, 39 years ago. And that is just such an easily available treatment. And it can be quite good. Incidentally, coconut oil is itself anti-inflammatory, anti-yeast, antibacterial and so on.

So skin rashes, just as long as the underlying condition is not something that's giving you other issues, it's pretty easy to take care of those. Now, one of the problems is itching. Let me address that. Because some skin rashes are associated with a great deal of what we call pruritus. That is the itch factor, okay? And that can drive you crazy if you really need to scratch. Unfortunately, the anti-itch medications are all antihistamines.

And one of the most effective ones is called Atarax, and that's a definite no-no in terms of antihistamines with regard to flying. So you have to be very careful. If you're just treating the rash, fine, but if you're treating the itch, that's a whole different ballgame. Good. Let's move down to gastrointestinal disorders next.

Let's talk first about nausea, vomiting, and diarrhea. That would be the three big hits. Yes. Those actually are some of the most common, period, that regular everyday people will have and such. And most of those medications are actually pretty good. Everybody knows about Pepto-Bismol or Kaopectate. That's

Bismuth is the active ingredient. Now, you've got to be careful with Pepto-Bismol because it also contains aspirin. And if you overdose, you can put yourself into a situation where you bleed easily or bruise easily and whatever. But for the most part, that's not a problem. The real issue is

People reach for Imodium or Lomotil, which is another prescription item on that. Those are no go, no flies on those. And the reason is that they definitely will help control the diarrhea, but they have potential side effects like sedation.

dizziness, things like that. And you have to be careful with, you know, if you're having nausea, vomiting, diarrhea, such that you don't dehydrate. Dehydration can get you in real trouble because not only does it interfere, you know, muscle cramps and stuff, but it can impair your cognitive abilities a lot when you dehydrate.

So there's a lot of interaction stuff there. But overall, you know, I tell people if you go overseas and you're worried about not getting Montezuma's Revenge and stuff, carry Pepto-Bismol tablets. And then as you're traveling overseas, take two or four a day if you need them just to control it until you get back to this country. And it can be very effective to avoiding the Montezuma's Revenge and not having other drug side effects. Now tell us about indigestion.

That is such a common thing, okay? Indigestion is normally treated because your doctor says, oh, well, we're going to just suppress some of the acid in your stomach. Now, the common thing about acid in your stomach is antacids like Tums. That's another one is milk of magnesia. Another one is Maalox. That's magnesium aluminum hydroxide.

hydroxide and such, these are pretty good for, I call them kind of topical treatments. You put it in, it kind of buffers the acid in your stomach. And generally, those work out pretty well. People generally don't have a problem. Now, you got to be very careful because if you take magnesium hydroxide, most people get away with that. If you're not careful and you take magnesium chloride or some of the other formulations, that can create loose

bowels. Okay. So that's not just effectively an antacid. You got to be careful that you're reading the label as to what you're getting. Now, the more common ones that people are getting prescribed, they fall on the, what's called the protein pump inhibitors. That's a fancy name, but the brand names are Nexium and Provacid and Pratosec Protonix.

acid effects, very unusual acid. That's not common anymore. But then there's H2 blockers, Tagamet, Pepsod, Axid, and Zantac. Now, H2 is histamine 2 blockers, okay? And so those, in my experience, people generally tolerate well.

But now you're starting to tickle the histamine system. So when you're dealing with blockers, I get a little shy about people having their own personal antihistamine activity, which could indeed lead to more sedative effects and such. The real deal with taking any of these, the H2 blockers or the PPIs that I've listed for you, is that people just they take them all the time.

Why? Well, because the underlying condition is not getting diagnosed. And so that means you can have

ulcer that's just kind of sitting there and fizzling along for quite a while. You can have other more serious issues than that. You can have infections. And there's even rare instances, people have cancer brewing in there and such. And what they're doing is they're covering the discomfort. And so using these on a brief basis within the dosage range, getting the relief, I'm not worried about that. And in general, the FAA doesn't worry about it either. Dr.

The glitch in the system is when you abuse the medication by using it long-term or higher dosage, frequent episodes, which is really not what it's designed for.

So that's kind of why I tend to like more simple things. Incidentally, aloe vera is a wonderful thing. Drinking aloe vera liquid or gel can be very soothing to your gut. And I recommend that a lot. Papaya enzymes or even pineapple enzymes, bromelain, can be very soothing. And those come in tablet form and such. And people can find great relief with that without having to resort to a drug pattern with potential side effects.

Okay. So the good news, if there is any, on indigestion is that everything we've talked about is actually on the go list with some of the caveats that you've just mentioned there. And the only real thing then on this is the Imodium and that's for diarrhea. But you probably not want to fly if you really have significant diarrhea. You just don't want to overdose with the Imodium or the Lomotil is another one. Yeah. And I think the over-the-counter medications that we've talked about are probably the things that pilots are least familiar with.

They're definitely familiar with alcohol, and there's a surprising number of fatal accidents that involve alcohol. Tell us about that. The real issue with alcohol is, well, I didn't drink very much. And I stopped quite a while back and said, because, you know, in our common experience,

You know, pilots also drive cars. So in our common experience, 0.08 is the alcohol limit for driving a car. And you get tagged with that. You got a DUI. And incidentally, the EFA takes that very, very seriously. And that's a great way to lose your tickets. Okay.

0.04 is considered kind of a maximum limit of being able to fly and such. And I'm going, I don't know, because 0.02 was way low down there. It has been documented as impairing vital functions. Night vision for easily, boom, that gets nailed real quick. But even at 0.02, 0.02

There's two things that happen. Number one, there's the cognitive effects. It's sedating your brain somewhat and coordination and all that thing. But the other thing is interaction. Alcohol interacting with higher altitude, which is lower oxygen levels. Alcohol interacting with over-the-counter drugs. Alcohol interacting with prescription drugs or illicit drugs. Now you've got a cocktail where all bets are off.

because those are not studied. And the fact is, I think a lot of people get in trouble with that because they don't realize that little level of blood alcohol concentration has a profound effect in your ability to fly if you have anything else going on as well. Yeah, and in one study, now it's an older study from accidents 1994 through 1998, found that alcohol greater than 0.04 was present in 7% of fatal pilot crashes and that 3%

had both drugs and alcohol in your system. So if you think about the numbers that we've talked about in all these studies, it looks like somewhere in the neighborhood of 40, maybe 45% of all fatal accidents involve some type of medication that we've just discussed or alcohol. Easily. And you know what the problem is? Some of these things might be gross underestimations because you can only say, oh, it was present. If you can document, you found it.

and the test wasn't done or it wasn't done on time or wasn't done right, it's not counted as a positive. So I am very suspicious that numbers of these things

are involved that we really don't know about. And I'll give you another example. Under-reporting is a real issue. Pilots, we all want to fly. We don't want to lose our ticket. And if you report, I'm taking this or whatever, you might end up having to wait months to figure out how to rescue your ticket and such because you get ground up in the FAA system there. The problem is

Now you believe it's okay because you got past your examination, you're fit to fly, but you're taking something that you don't realize.

Just a smidge of alcohol might amplify the effect of that quite dramatically. The antihistamines for sure fall in that category. We're talking about sedation and confusion and blurred focus and all this other stuff. And if you have people take, you know what they're called, the benzodiazepines, the things that they use as sleep medications, Valium and Ambien and stuff like that.

Those can really amplify with the effects of alcohol. And, you know, you start putting in cocktails of two or three different items that are readily available over the counter. You can really be impairing yourself. Getting away with it is not a good idea. So I think there's a real dilemma and challenge that pilots face anytime they get a new prescription or anytime they take an over-the-counter medication. First off, I suspect that most doctors don't.

are not aware of what's on the FAA's no-go list. So how would you suggest pilots proceed anytime they get a new prescription or anytime they're about to take a new over-the-counter medication? That's a tough question because that has so many, you know, alleyways you can go down. And, you know, we get seven pages of tiny type with every prescription now. But if on there it talks about sedation at all or interaction with sedative things,

You have to be very cautious because if you've been able to take an antihistamine like we were talking about earlier, if you've been able to do that, but it says caution with those, this new prescription might actually aggravate things. It's certainly something to give you pause about thinking about whether you should be drinking alcohol or otherwise having issues while you're taking the medication. The problem is that...

There are resources, you and I have talked about that, where there are lists of suggested medications that are probably okay and such. Really, the AME is the ultimate arbiter. And the reason I say that is because hopefully you have an AME who's actually paying attention to who you are as a patient, not just a list of checkboxes and such, because it really does matter

And your ability, okay, you know, I'm an older pilot, so I consider, you know, everything that I do has a suspicion associated with it because those things could have more of an effect on me than they might on someone else. And, you know, younger pilots, of course, are indestructible.

We've all been through that phase where there's no problem. And I think that's a very dangerous category as well, because we may not realize that, well, I'm fine. I don't have any problem. I heard other people have problems. I don't have problems taking that. Maybe not so. So I think number one, reading the material that you get and the internet, you know, you can do a search about sedation and this particular drug and such. Cognitive impairment is

cognitive. And that means you can't think about it very well because you're thinking thing is the one assessing it. And coordination, we all know that there's flight moves that you want to be making when you're managing the airplane. You don't want to have discoordination or slow reflexes or slow attention to what's happening and such, because at any time it can all turn funny. You know, I had a fuel starvation accident a couple of years ago.

that's the exact time you do not want to have any cognitive impairment at all. So any medication, I think you have to be suspicious. And particularly, you will not realize that the medical issue that you have, well, that doesn't have anything to do with cognitive impairment. No, but the drug might. Okay. I'll tell you the other thing, a resource that I don't think is used often enough is your pharmacist.

Because you can peg them down. Now, they may not be cooperative and happy about it, but they can really look deeply into their database and produce interactions with other medications you're taking. Very important thing to find out, like we were talking about the alcohol interacting with all those things. So drug interactions and does this drug have any particular reports of cognitive impairments?

And I think those are absolute things. And again, don't fly without clearing it through your AME if you have any question, period. Yeah, I suspect that a lot of pilots just figure, well, my doc gave me a prescription or, well, it's over the counter. It's going to be fine. I actually take the exact opposite position. Anytime I've got something new, I assume that there is a problem and I start researching it. So, for example, I have some allergies. Yes.

And I find that every time I'm in there, my allergy doctor, who actually used to be in the Air Force, is talking to me about, oh, here's some Zyrtec. And I have to remind him. And he says, oh, that's right. You're a pilot. You can't take that. So I think it's really incumbent upon pilots to

to take full responsibility for doing the due diligence to make sure that what they're taking is not on the FAA's no-go list and is not going to affect their flying. And what you're doing actually is the pre-flight exam on your fit to fly.

That's the I'm safe checklist and such. And I have a lot of patients still because I was a senior AME for a dozen years. I have a lot of leftover pilots in my practice and such. Whenever I prescribe something, I'm very careful about saying you could or could not fly. And if it's a could not, what are your restrictions taking this? And it's really important. And a lot of people on

on long-term medications. Now we have chronic illness medications that we did not used to have 30, 40, 50 years ago. And those have their own set of biological interactions inside people and with other medications. And it's not uncommon to have older patients come in and they're on three, four, five, six, seven medications. And I can look down that list very carefully. And I have called

called pharmacies to say, give me a printout on the interactions on these. The programs are sophisticated. I don't have access to it, but they do. And being suspicious, like you say, very important. So my recommendation is always don't until we prove that you can do. Yep. Good advice. And that prove you can do should be based on some evaluation, some study, some experience.

Excellent. Well, thanks for walking us through all of the no-go medications. If you would, tell us a little bit about your clearedfortakeoff.info website. How did you end up creating that, and what will people find in it if they visit it? Oh, you know, that's fun. Thank you, of course, for asking. For years, as I said, I was taking care of pilots as a senior AME, and I had to develop hacks and tips and stuff because the real clear thing about flying is

you want to avoid drugs and surgery if you want to keep your medical, but you also want to stay healthy if you want to keep your medical. You don't want to be impaired by the illness itself. You're just not taking care of it. And so I had to develop all these tips and hacks and tricks and all this. And I was thinking, you know what? I did all this on a one-on-one basis as my pilots came in and developed all that. But wait a minute, I can actually write up

all of these hacks that I have developed over 46 years of practice and make them totally available to people. And so it occurred to me that

if a pilot just has information. That's one thing we're very good at. You know, we've learned to study the pilot operating handbook and stuff. Well, it's kind of like your own personal operating handbook if you can assess your condition and potential treatments for it. And so I thought, I need to put this together and have this kind of information readily available literally around the world. And so I started with the key

features that pilots are most concerned about. Pilots get in trouble with stress, with sleep, with nose congestion, sinus congestion, ear congestion, bronchitis, all that sort of stuff, neck and back pains, other joint pains. And so I started creating these presentations that literally go through, here's the standard kind of things and here's

concerns with those and here's integrative medicine kind of things. And that, that takes integration is the classical views along with newer views, as well as old homespun remedies and such.

things that keep you avoiding drugs and avoiding surgery. But I wrote a book 39 years ago called The Yeast Syndrome. Bantam Books still sells it. They call it a strong backlister because it is amazing how many illness issues are related to yeast and fungal infection inside people. I mean, literally in 2017, the CDC said, if you've got a confusing situation with a patient, think fungus.

Okay. And the deal is, is that as I get more and more details on the website, I've got a lot on there about yeast right now, but as I get more of it, I will relate more and more of the quote medical problems that people don't think are related. A lot of quote so-called cancers that are diagnosed actually are fungus. And some of the

that patients respond exceptionally well to intensive antifungal treatment. Who would think, okay? The heartburn and ulcers often related to fungus and such. So the deal is, is that clearedfortakeoff.info gives you the info you need to go look at your problem from a completely different perspective. One that your doctor, I can assure you, is not familiar with because they dispute me all the time. And I hope that the book was out 39 years ago, guys. And

It's extensively referenced and there's a lot more out now. So it's kind of fun because I can really reach and touch more people. And especially I like the idea of pilots and controllers and Marine captains and others who really need to be on the top of their game. They can do this without drugs and surgery because they get informed.

And information, this is the information age. If you get information, you can be powerful even more so than your doctor because you can ask for treatments that they don't know about and you can effectively help take care of yourself. Well, the website is clearedfortakeoff.info. Dr. Trubage, thank you so much for spending time with us here today.

Excellent. You know, Max, this is such a pleasure. I enjoy every one of your podcasts. And you get all these wonderful experts on who have these little kernels of information. And I just took those away and I have enjoyed so much. You've improved my flying. How's that? And I've been flying since 1977, 78.

Well, I'm glad you're finding the show helpful, and thanks for being a patron supporter as well. Absolutely. I enjoy that a bunch. Thank you, Max. And my thanks to Dr. John Trowbridge for joining us here today. You can find out more about him at his website, clearedfortakeoff.info, and I'll include a link in our show notes to his book, The Yeast Syndrome.

And just a reminder that I love hearing from you and I read many of your emails on the show. If you'd like to send me a message, just go out to aviationnewstalk.com, click on contact at the top of the page. That's absolutely the best way to send me a message. And of course, I also want to thank everyone who supports the show in one of the following ways. We love it when you join the club and sign up at aviationnewstalk.com slash support to

To support the show financially, you can also do that at aviationnewstalk.com slash PayPal. We also love it when you leave a five-star review on whatever app that you're listening to us on now. And of course, if you're in the market for a headset, please consider buying a Lightspeed headset and using one of the links in our show notes, because if you use those links, they will donate to help support the show. So until next time, fly safely, have fun, and keep the blue side up. And remember that you can always go around. Go around.

Coming down to your side, baby, sliding upside down. You can all.