Overdrive Magazine

January 2020

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48 | Overdrive | January 2020 Dr. Alexander E. Underwood works at KT Health Clinic, a mile from I-44's Exit 80 near Springfield, Missouri. He can be reached at 417-832-8678 or mail@kthealthclinic.com. O ne of the most complex medical issues for commercial drivers is a neurological con- dition. Certified Medical Examiners often have to reach out to the Federal Motor Carrier Safety Administration for guidance on certifying drivers who've had a stroke, ministroke or seizure. Obviously, the most important issue is whether the driver will have a sudden loss of consciousness or a sudden loss of ability to control the truck. While most circumstances require a cautious approach that in many cases involve lengthy wait- ing periods, the U.S. Department of Transportation has agreed with medical advisory boards that not all neurological conditions preclude a driver from a safe driving career. STROKES. Diabetes and high blood pressure (hypertension) are significant contributing fac- tors to the development of strokes or ministrokes, known as transient ischemic attacks (TIA). It's no surprise that commercial drivers have an above-av- erage incidence of TIAs and strokes, as they do with hypertension and diabetes. If you suffer a stroke or TIA and are left with permanent disabling effects such as paralysis, severe weakness or vision loss, you will not be cer- tifiable as a commercial driver. Otherwise, in the majority of cases, you will be able to resume your driving career if you're willing to wait. After initial recovery from a stroke or TIA, you must wait at least a year before being eligible for a medical certificate. If you have a more severe stroke or brain bleed that involves a middle cere- bral or anterior cerebral artery, guidance to medi- cal examiners suggests waiting five years. If you pass the medical exam, you will be certi- fied for up to one year at a time. Before taking the exam: • You will need clearance from your neurologist and supporting paperwork. • You must be free of seizures and convulsions. • You may be asked to complete an on-road driving evaluation comparable to what's given a new CDL applicant. SEIZURES. It used to be that anyone taking antiseizure medication for a seizure disorder was automatically medically disqualified. More recent- ly, FMCSA has been able to grant a waiver for those taking long-term antiseizure medication. To qualify, you must be seizure-free with or without medication for eight consecutive years. If currently taking medication, you must be on the same stable medication regimen for at least two years. Further, a driver with a history of epilepsy may be qualified without a waiver if seizure-free and medication-free for 10 years. However, many seizures are not the result of epilepsy or another seizure disorder. If you have a single episode of a non-epileptic seizure or a loss of consciousness from an unknown cause, and the incident did not require antiseizure medication, the rules are much less stringent. The decision to certify you will be left up to the individual examiner, though official guidance is to wait at least six months. You may be qualified if there are no further seizures, no antiseizure med- ication is required and clearance is provided by a neurologist. Another circumstance involves suffering a single seizure due to a known cause, such as a high fever, a drug reaction or an infection. In such a case, you may be certified with no specific waiting period if there are no residual symptoms and neurology clearance is provided. What happens after a stroke or seizure A stroke occurs when the blood supply to part of your brain is reduced, depriving brain tissue of oxygen and nutrients. A sudden, severe headache can indicate you're having a stroke. It may be accompanied by vomiting, dizziness or confusion.

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