VP shunt disqualifying?

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racedoc1

VP shunt disqualifying?

Post by racedoc1 » Thu Jan 23, 2014 5:02 pm

Patient had VP shunt placed at age 10 due to "anatomic abnormality." Has not seen neurologist in years. Does not know if it is functioning or not. Guidelines state that dural penetration surgery should be considered "equivalent to severe TBI" and "Should not be considered eligible for certification. " I denied certification. Is this in line with other examiners are doing?



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Re: VP shunt disqualifying?

Post by Robert Swotinsky MD » Mon Jan 27, 2014 4:26 am

As per the post, the FMCSA Medical Examiner Handbook states:
Surgical procedures involving dural penetration have a risk for subsequent epilepsy similar to that of severe head trauma. Individuals who have undergone such procedures, including those who have had surgery for epilepsy, should not be considered eligible for certification.
The post asks what other medical examiners have been doing. Myself, having done hundreds if not thousands of DOT physicals, I don't recall encountering this situation in the past. Disqualification is consistent w/the Medical Examiner Handbook. And, it is usually (and some would say always) best to follow guidelines like those in the Handbook. An alternative approach in this particular setting would be to tell the driver that he needs a current neurology assessment that addresses (a) risk of seizures, and (b) degree, if any, of cognitive impairment from the underlying condition. If the neurologist signs off on both as low/nonexistent, you'd be more inclined to certify the patient.

Has he been driving and medically qualified in the past? In theory this shouldn't matter when the concern is an unpredictable, sudden event like a seizure. But, as a Medical Examiner it seems one should be especially considerate about finding someone disqualified if they're already driving w/o known incident.

racedoc1

Re: VP shunt disqualifying?

Post by racedoc1 » Tue Jan 28, 2014 12:18 pm

Patient stated he has never had a CDL and this was a new certification. But his drivers license shows CDL. Denied "Head/Brain injuries, disorders, or illnesses on DOT form, yet reported vp shunt placement at age 10 when specifically questioned about surgeries. Denied illness/injury in the last 5 years on form, yet during exam stated his shunt was "checked" 7 months ago after MVA with head injury when I asked him about the last time shunt was checked. Stated he was being hired to drive a forklift, but company stated he would be driving 18 wheeler. Based on patient unreliability and in accordance with guideline I disqualified him. Thanks for your help.

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