Identification
Maj William S. Longshed is a 33yo male T-1 pilot (ASC not listed). He has ? years active service and a total of 230 flying hours with 50 logged in the past 6 months. He is currently assigned to the 45th Flying Training Squadron (AETC), ?? AFB. He is disqualified from Flying Class II duties IAW MSD 10 Sep 2019 I25 for ulcerative colitis and mesalamine. Request is made at this time for a waiver.
HPI
For two years, Maj Longshed has had mild occasional diarrhea, which he first mentioned on his annual flight physical on Jul 2019. Upon further questioning, he had also had intermittent bloody stools and fatigue for the past 4 weeks and occasional mild abdominal pain upon defecation. He ascribed the fatigue to family-related stress – he had a 4mo daughter at home. He had self-medicated with PPIs and antacids to no avail.
He was referred to a GI specialist due to an episode of abdominal pain and bloody diarrhea that prompted him to request him being taken off the flying schedule and seek a flight medicine consult. The GI specialist established the diagnosis based on a colonoscopy done 2 mo ago, revealing findings indicative of ulcerative pancolitis. He was started on mesalamine 800mg po tid two months ago with subsequent improvement and no idiosyncratic reactions nor side effects. He is negative for complications of UC, including DVT, primary sclerosing cholangitis, arthritis, ankylosing spondylitis, anterior uveitis and skin manifestations.
Physical Exam
Mild LLQ tenderness without any other untoward findings on abdominal exam. DRE normal.
FOBT negative. WBC 5,2x10E9/L, Hb 10,2 g/dL, Hct 40,5%, Plt 255x10E9/L. ESR 2,0 mm/h. CRP, albumin, LFTs normal.
Endoscopy upper GI tract normal. Lower GI endoscopy performed upon diagnosis with findings of diffuse pancolitis without skip lesions. Histology of biopsy speciments obtained revealed mild inflammation without signs of malignancy.
Repeat endoscopy performed without signs of inflammation.
GI consult: mild UC responsive to mesalamine monotherapy 800mg po tid, no need for steroid therapy nor surgical resection. Follow-up consults and surveillance endoscopy recommended yearly. CBC, ESR, CRP recommended q6mo.
Diagnosis
K51.00  Ulcerative pancolitis without complications
Recommendation
Maj Longshed has been diagnosed with UC that is well controlled on mesalamine. The granting of waiver is not expected to compromise mission completion, flying safety, or individual health and well-being. I recommend Maj Longshed for a waiver of mesalamine and ulcerative colitis.