AOPA Pilot Magazine - February 2013 - 26

FLY WELL

BY DR. JONATHAN M. SACKIER

Avoid crud
Tires, grist, and exhaust pipes

DR. JONATHAN SACKIER

is an expert in aviation
medical concerns and
helps members with
their needs through the
AOPA Pilot Protection
Services plan (www.
aopa.org/pps).

REMEMBER OLD-FASHIONED bicycle tires? If a weak
spot developed, the inner tube bulged out. Doctors’ $100
word for that is diverticulum and troublesome colonic
“tics” is diverticulosis. Your colon is a twisty tube that
takes a circuitous route around your belly down to your
exhaust pipe. Its job is to store excrement while extracting water prior to sending it off to sea.
Rare before grist mills replaced roller mills around
150 years ago—because earlier flour production did
not remove most dietary fiber—diverticulosis is now
rampant in Europe, America, and other industrialized
nations. One in three people over age 45 probably have
these pesky pouches waiting to cause mischief; and
in the UFO population (United Flying Octogenarians,
not Martians) the number is closer to two out of three.
Smoking, obesity, sedentary behavior, and too much
alcohol and caffeine also contribute.
Swallowed plant fiber holds water and salt, keeping
stool bulky and soft. Conversely, low-fiber diets cause
smaller, drier feces requiring more expulsion effort,
thereby raising colon pressures. Eventually, the colon
gets more muscular, shorter—and tics protrude through
weak spots where arteries pierce the wall.
Although many people are asymptomatic, hints
that you may have problems with your internal bicycle tire should be suggested by reaching a certain age
and remembering what you have eaten. Dull, chronic
abdominal pain—maybe with changed bowel habit, flatulence, blood in the stool, or bloating—may indicate that
you have diverticulosis. Classically, temporary improvement might follow passage of a motion or flatus.
Diverticula have small openings from the main
colon channel and food can get stuck inside, causing
localized infection, or diverticulitis. This medical emergency presents with marked tenderness, fever, vomiting,
and diarrhea. It potentially can perforate into the belly,
causing peritonitis, or form a fistula—an abnormal and
unwanted connection from colon to skin or bladder.
The artery next to an inflamed tic may be compromised,
leading to passage of a large volume of blood and buying
you a high-speed ambulance ride. Recurrent episodes
with cyclic inflammation and healing can result in a narrowed segment of bowel, which eventually might cause
obstruction. About 15 percent of people with diverticulosis will have one of these major problems.

26 | AOPA PILOT February 2013

Diagnosis is based on medical history, examination,
and studies such as a contrast CAT scan or ultrasound.
Sometimes asymptomatic diverticulosis is picked up
during a screening colonoscopy—which everyone over
age 50 should undergo. Any change in the way your
bowels are behaving merits a visit to your physician—
many symptoms of diverticulosis are similar to those of
colon cancer, so it’s better to be safe than sorry
In symptom-free diverticulosis, adopting a highfiber, higher-fluid diet with other lifestyle modifications
may suffice. While there’s scant evidence that avoiding
foods that could theoretically get stuck in the orifice of
a tic (popcorn, seeded fruit, nuts) will help, I am oldfashioned and recommend this. If inflammation or frank
infection is suspected, antibiotics are administered and
intravenous fluids may be required. Recurrent episodes
might suggest the need for electively removing the mischievous section of bowel, which now can often be
performed under laparoscopic guidance, obviating the
need for a big incision. Occasionally, emergency operations are required to drain abscesses, close a fistula,
or control bleeding. At such times, most affected bowel
usually is removed; ideally the two free ends are joined
together, although sometimes surgeons have to fashion
a temporary colostomy where the bowel drains into a
plastic bag affixed to the belly wall.
If you fly into lousy weather you may be able to deal
with the consequences, but avoiding crud is preferable.
So here’s the key message: Eat more fiber. The average American eats much less than the recommended
1.3 ounces a day. Some elect to take a daily dose of a
supplement (e.g., psyllium powder with water), but I
think these are much less pleasurable and pricier than
munching on veggies, beans, or apples—one a day really
can keep the doctor away.
Assuming you got “tic’d off” and want to get back to
flying, you will need a thorough gastrointestinal workup
and all hospital records, including an operative report if
appropriate. Having a colostomy is not a barrier to flight.
Given the pilot population demographic, there could
be 100,000 or more of you out there with this condition, so keep your exhaust pipe working and avoid those
blowouts.
AOPA
EMAIL jonathan.sackier@aopa.org

http://www.aopa.org/pps http://www.aopa.org/pps

AOPA Pilot Magazine - February 2013

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