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Health, Smoking, and Stress
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Contents:
Medicine; ...Alcohol; ...Carbon Monoxide; ...Cold Weather; ...Dehydration; ...Hyperventilation; ...Hypoxia; …More on Hypoxia; …Time of Useful Consciousness; ...Night Effect on Vision; ...About Hypoxia; You Won't Know Hypoxia; ...Smoking; ...What Is the Risk of Smoking?; ...Coffee; ...Coffee Has Some Negatives; ...Bends; ...Motion Sickness; ...Spatial Disorientation; ...Stress; ...Alter-ego flight; ...Stress Under Duress; ...Failing to Cope; ...Coping with Stress; ...Some Safety Standards; ...Stress Reducing Skills; …You fly as Well as You Eat; … Health Hazards of Flying; …Stress Management; …Hypoxia Factors; …Nicotine Withdrawal and Flying; ... Smoking Can Impair Your Vision; ...2005 Yale Study; ... 


Medicine
Any over-the-counter medication whose name ends in "ine" should be checked in a flight medical examiner for use before flying. Beware of any medicine that is supposed to make you feel better. At altitude the effects may be damaging to flight safety. Medicine taken is just as likely, even more likely, to be the basis for grounding a pilot than is the ailment itself. Medicinal side effects are both variable and unpredictable. Virtually all medications have side effects. Never take a medication for the first time and then fly. Make the safe decision if you are sick.

Alcohol
FAR 61.15 requires you to report within 60 days any vehicle action involving drinking and drugs. This is in addition to you admission on the medical questionnaire. The report must include full identification, address, certificate number, type of violation, date of conviction or administrative action (plea bargain), the State, and whether this is part of a previously reported action. In an FAA enforcement action, the FAA will argue the strictest interpretation of the FARs.

Carbon Monoxide
The blood cannot absorb oxygen when carbon monoxide is available with its 200 times greater affinity to hemoglobin. A smoker's CO poison level is from three to ten percent which means that they can retain this poisoning for a half day which is COs half life.

A pilot is most likely to become CO poisoned because of heater muff leak. Symptoms are initially being able to smell exhaust fumes. A feeling of sluggishness, warmth and tightness in the forehead that is followed by a headache occurs in sequence.

CO reduces ability of blood to carry oxygen. Symptoms are similar to hypoxia. Headache, drowsiness, dizziness should initially be corrected by opening outside air vents. First, everything that is happening feels as though it is happening far away. You feel sick to your stomach and get very sleepy. Things lose their importance. Problems cannot be solved. Recovery takes considerable time.

Carbon monoxide exists as an odorless, colorless and tasteless gas resulting from incomplete combustion. CO is lighter than air and mixes quickly. For the thousand accidental deaths there are three and a half times as many suicides. Ten times as many survive as die accidentally. CO has a half-life of five hours in the living. Dead, CO lasts for three days.

Given the choice between carrying oxygen or carbon monoxide our red cells will chose CO 200 to 1 oxygen. This differential causes hypernic hypoxia by a low oxygen release to the cells and tissues of the body. The toxic effects initially cause the brain to increase the respiration rate. At 10% there are no appreciable effects but your are functioning at sea level as though at 5000'. At 20% we lose night vision, display shortness of breath, have a headache and tingling in the extremities. At 30% the previous symptoms become more pronounced along with vomiting, difficult in making decisions, irritability, and flushing. At 40% all of the above plus disorientation and unconsciousness. Brain damage and death follow. At 60% breathing ceases followed by death. Any CO poisoning requires that the NTSB be informed of crewmember inability to perform.

Most CO accidents are cause by heater defects where the muff about the exhaust pipe has leakage. The best defense besides continual inspections is to have CO detector detectors.

Is poisoning due to the exhaust fumes resulting from carbon burning with insufficient oxygen to produce complete oxidation. The resulting gas has one atom of carbon and one atom of oxygen. CO is odorless, colorless and cannot be tasted. CO poisoning may not be distinguished from fatigue or hypoxia except that the occurrence can occur at any altitude.

Engine exhaust in an aircraft has 7% CO. Very small amounts of CO over a period of time will reduce a pilot's ability to fly safely. It is the length of exposure as well as the amount that makes the critical difference. Susceptibility to CO poisoning increases with altitude due to the propensity of CO to enter blood. CO is 200 times more attracted to the blood hemoglobin as is oxygen. As little as one part CO to 20,000 (.005%) parts of air is enough to begin the death process of the brain.
Above 10% CO poisoning you will suffer from a headache. Above 20% you will be sleepy and sick to your stomach, HEADACHE, vision and speech problems. You will be incapacitated above 40% and dead at 70%. If you get a headache while flying, open the window and shut off heater.

CO has a half-life in your body of about five hours. It will take a full day to recover. 70% of exhaust system failures result in CO poisoning. CO prevents the hemoglobin from both carrying and releasing oxygen. Antihistamines, alcohol, lack of sleep, or blood deficiency will exacerbate CO poisoning. Prevention of CO poisoning is directly preventable by proper aircraft maintenance. Club aircraft require extra alertness.

If you suspect CO exists in your cabin air as you might smell some engine exhaust fumes.
--Get a detector.
--Put a checklist by the detector.
--Shut off the heater
--Use any oxygen
--Descend
--Land ASAP
--Get medical treatment
--When in doubt, get on the ground.

Cold Weather
Hot or cold temperatures affect the quality of the preflight. In the winter, as your body cools you tend to mentally and physically slow down. Flying in an unheated aircraft in the winter will drastically decrease your flying efficiency and effectiveness.

Dehydration
Human need for 2-4 quarts of water a day. You become thirsty with a deficit of 1.5 quarts of body fluids or 2% of body weight. The deficit causes a reduction in blood volume and triggers thirst. Thirst arrives too late and can be mollified too easily. At 3% of body weight fluid loss fatigue and weakness occurs. Symptoms are headache, sleepiness, dizziness and weariness. Avoid diuretics such as coffee and alcohol. Don't rely on thirst as drinking trigger. Measure fluid intake daily.

Research shows that people told to drink as much as they can, will only take in about half of what they need. Water is the great transporter within your body--nutrients, oxygen, and waste. Water is the medium for chemical reactions it cools and cushions. Our bodies are less solid and more a mobile aquarium in which your organs slosh about. The water in our body weighs 8.3 pounds per gallon and we are more than 50% water. You figure.

We lose two pounds of fluid overnight so drinking before bedtime is beneficial. Even so you are going to be in liquid deficit when you get up in the morning. Chronic dehydration is common. A sedentary lifestyle requires a half-gallon of water per day. Eight x eight ounces, that is. Dehydration makes you tired and listless. The more fit you are the more likely you are to feel these effects because fit people perspire more readily. Those who exercise should over-shoot their water intake by 50% just to break even.
In most cases a sports drink is better than water because they supply carbohydrates and sodium. One chemical provides energy and the other keeps you drinking while helping the body absorb water. The color of your urine is an indicator of the body's hydradration. Lighter is better than darker.

Hyperventilation
Stress, anxiety and fear cause hyperventilation. The person begins abnormal rapid breathing. Reduction of carbon dioxide causes suffocation, drowsiness, tingling, lightheadedness, and coolness. This leads to spasms, incapacitation, and unconsciousness. Symptoms resemble hypoxia. Can be corrected by controlled breathing in a paper bag.

Hypoxia
There is a little known partial solution for the pilot or person who is at an altitude where oxygen deficiency is likely. You can increase the air pressure in you lungs and thereby aid the absorption of oxygen in your lungs by the following process. You can partially pressurize your lungs by only breathing out through 'pursed' lips. You must purse your lips and blow out instead of exhaling normally. Inhale normally but pressurize your lungs when exhaling.

An adult will breath in 3,000 gallons (by volume) of air per day. This includes 600 (20% of total) gallons of oxygen. Your blood system has 25+ trillion (12 zeros) red blood cells (hemoglobin). Each one is capable of loading up four oxygen molecules for distribution throughout the body. when returning to the lungs for a refill they unload CO2 first.

Movement, fear, and anxiety will increase the oxygen requirement. Fatigue and medicines accentuate hypoxia. By the time you have visual problems it is too late. It is up to the pilot to anticipate and prevent hypoxia by the use of supplemental oxygen.

Hypoxia symptoms will vary with the individual. While night vision will begin to be affected at 5000 feet, at 10000 a pilot may feel that everything is just fine-hypoxia. Breathing and respiration are affected but most affected is the brain. The brain uses 20% of the oxygen used by the body. Of the brain the cortex suffers the most and with it goes good judgment. The victim is the last one to know that anything is wrong. Individuals will display completely different physiological and psychological symptoms. By undergoing an altitude chamber flight you can learn the symptoms peculiar to just you.

Mankind evolved expecting to breathe air containing 21% oxygen under 14.7 pounds of pressure. Once man has enough money to fly, this 21% at higher levels of lower pressure this 21% becomes inadequate. Symptoms of hypoxia will occur in the altitudes over five thousand feet. Age is a factor as are the life-style factors of fatigue, drinking, and smoking. The condition of hypoxia because of altitude can become magnified and compounded by human individual factors. Hypoxia is caused only by reduced atmospheric pressures caused by altitude and not by other density altitude factors. As altitude increases arterial blood oxygen pressure lowers so that less oxygen is available to the blood for transfer to the brain. A change of only 4% is sufficient to affect mental function. Once you experience hypoxia and have identified your symptoms you will be more apt to recognize them next time.

Hypoxia is oxygen starvation. Lack of oxygen impairs the whole body but most importantly the brain. The first part of the body to show significant effect from oxygen deficiency is the retina of the eye. Every individual is affected but in different ways and to different degrees. The danger in hypoxia is that it occurs insidiously below the conscious threshold. Hypoxia makes you happy and such happiness in the cockpit is dangerous. The best warning indicator for hypoxia is the altimeter. You will quickly recover by descent to a lower altitude.

Since hypoxia is due to reduced barometric pressure, low-grade hypoxia begins on takeoff. The percentage of oxygen is same but less is reaching the blood stream. Any stress or increase in activity requires more oxygen, up to 8 times more. Pilot performance deterioration begins at takeoff, as well. Slowed response times and inability to deal with complexities due to hypoxia compromise safety. Noticeable oxygen deficiency effects begins at 4000' as safety margins are beginning to erode. The hypoxic symptoms of difficulty breathing or headache may not be obvious or may not occur at all even though there are the foregoing changes in mental status.

I have seen complete personality changes occur after a couple of hours around 12,000'. Symptoms occur such as headache, drowsiness, dizziness, euphoria, tingling, perspiration, or belligerence are typical. Tunnel vision and blue fingernails occur with times as little as 15 minutes above 15,000'. At 16,000' disorientation, lapses of judgment, loss of impulse control, risk-taking behavior, decreased problem solving abilities, impaired memory, mood disturbances, and lowered coordination are common. Unconsciousness occurs in 10 minutes at 20,000'.

All effects are made worse and happen at lower altitudes with fatigue, age, smoking, health habits, and drinking. Oxygen recommended above 10,000 day and 5,000 night. If oxygen is being used, being knowledgeable about the operation of the system and be able to recognize his and the system's warnings of oxygen deficiency is essential. FARs require oxygen if one-half hour above 12,500', crew above 14,000', everybody above 15,000'.

We take 20,000 breaths a day that take in oxygen and exhale carbon dioxide. At altitude the air expands and there is less oxygen available per breath. Above 10,000' supplemental oxygen is recommended. At night 5000' is the recommended level.

There are no reliable signals for the use of oxygen. The brain suffers first and affects the judgment. Oxygen deficiency gives you a high along with a headache, lightheadedness, dizziness, tingling and warmth, poor coordination, impaired judgment, and tunnel vision.

Hypoxia begins when your cells become oxygen deficient. The brain cells are first to be affected. You have two kinds of measures for oxygen deficient performance. Effective performance time (EPT) which is an average charted for many people. Your experience may vary. Time of useful consciousness (TUC) is based on altitude chamber research. Again, your experience may vary. With good training and a good system the hazard of hypoxia is low. The symptoms of carbon monoxide poisoning disappear more slowly than do those of hypoxia.

A hypoxic carpenter would measure ten times instead of twice and cut five times instead of once. Judgment is indecisive and slow. Caffeine, tobacco, dehydration, respiratory problems, age, fatigue, alcohol and nutrition all affect the onset and severity of hypoxia. The most common of all these deficiencies in the general flying population will be dehydration. Take water when you fly and drink it while you fly.

High altitude performance decreases within in 20 to 30 minutes at 18,000'. You have enough time to take defensive measures and descend. At 25,000' your EPT will be less than five minutes. Using oxygen at night and even during the day at lower altitudes will improve flight performance. For the G. A. pilot the nasal cannulas with an oximizer offers the best bang for the buck.

Above 10.000s feet pilot judgment is affected unless supplemental oxygen is available. At night, vision deteriorates above 5000 feet. In good health you normally have 95% oxygen saturation. Below 85% judgment is affected. Nausea can be an early symptom of oxygen deficiency.

More on Hypoxia
Hypoxia - the absence of an adequate supply of oxygen to the tissues that always results in impairment of function. FOUR things must happen to get oxygen to the tissues. The four types of hypoxia each correspond to the failure of one step The last two are unlikely in pilots but possible in passengers, especially while doing any kind of Air Ambulance work.

There are 4 different types of hypoxia:
1. Hypoxic - caused by a reduction in oxygen tension in arterial blood due to altitude or hypoventilation. (i.e. lack of oxygen in the lungs). Get O2 into lungs [failure = hypoxic hypoxia]
2. Hypaemic - a reduction in the oxygen (O2) carrying capacity of blood. Some causes: drugs, anaemia, carbon monoxide in the blood, hemorrhage, smoking. (i.e. not enough O2 in the blood) . Get O2 from lungs into blood [failure = Hypemic (American spelling) hypoxia]
3. Stagnant - reduced blood flow through the tissues. Some causes: the flu, vaso-vagal syncope (fainting), cardiac failure, G-forces (most common). Get O2 around body to tissues [failure = stagnate hypoxia]
4. Histotoxic - the inability of tissues to use normal O2 supply. Causes include: alcohol, narcotics, cyanide, carbon monoxide. Get O2 from blood into tissue [failure = histotoxic hypoxia].
Symptoms:
Personality changes, lack of insight, loss of judgement/memory, euphoria, mental/muscular unco-ordination, sensory loss, cyanosis (purple coloring of skin), hyperventilation, semi-consciousness leading to unconsciousness.
Factors:
Altitude, rate of ascent, duration of exposure, environmental temp, individual tolerance, physical activity, and fatigue.

Time of Useful Consciousness (TUC)
Item: A person who smokes a cigarette before getting into the airplane starts out at a TUC of 3000 feet.
At 18000', it's 20-30mins, at 22000', 10mins, at 25000', 3-5mins, and if you ever get to FL400 it's 15-30seconds.

Effect on night vision:
Altitude............% decrease in visual acuity if O2 is not used
4000...............5
6000.............10
8000.............15
10000...........20
12000...........25
14000...........35
16000...........40

Night Effect on Vision.  
Acuity Threshold - the distance from your eye at which it reflects enough light to stimulate your eye. Your focal (foveal) vision provides high visual acuity, good color vision, and resolution of fine detail & object recognition but demands conscious awareness. Your peripheral (ambient) vision provides low visual acuity, poor color vision and doesn't necessarily provoke conscious awareness but it is sensitive to low light levels & movement. (Hence, if you're looking for something in the distance (e.g. another aircraft), scan the sky using your peripheral vision - it will pick up relative movement before your focal vision). The foveal vision uses the cones whilst peripheral uses the rods. The first area of the eye to be effected by lack of oxygen is the rod, and as it is these, which are sensitive to low light levels, it results in a degradation of visual acuity at night.

About Hypoxia
20% of every breath intake is oxygen that gives hemoglobin 90% saturation. When the level of saturation reaches 85% on intake your judgement is affected. This is hypoxia and you will be unaware of its effects.

You can give parts of your body hypoxia by shutting off the flow of blood. During this stagnant hypoxia you will feel the tingling of parts of your body as though they were recovering from being 'asleep'. In the presence of carbon monoxide (CO) you have hypemic hypoxia because the hemoglobin fills with CO instead of the oxygen. When the hemoglobin contains CO it cannot use the oxygen that it does have. This inability to use the oxygen is called histotoxic hypoxia. The kind of hypoxia, related to high altitude flying, is called hypoxic hypoxia.

When hypoxic the body tries to compensate by increasing the rate of breathing, increasing the depth of breathing as well as upping the pulse rate. These changes work only to a limited extent below 12,000 feet. Above 8,000 feet without supplemental oxygen a pilot is more likely to make mistakes without being aware of them. There are residual effect of hypoxia that can carry all the way through the instrument approach and landing.

Sea level oxygen saturation may be as high as 99'%. Hospital patients are normally maintained into the low 90s. At 5000 feet saturation is 95% and at 10,000 you are down to 90% and can decrease to 80% with time. Hypoxia is there whether you are aware of it or not. There is a $300 finger clip that will give a digital readout of your saturation level. The FARs do not adequately address the supplemental oxygen problem.

You Won't Know Hypoxia
--Symptoms are excessive happiness, sense of well being, or aggressive anger.
--Poor judgment, impaired vision, forgetfulness, decreased attention and coordination also occur.
--All of the foregoing can occur individually or in concert with any of the others.
--Physically you may have blue skin, purple fingernails, blue lips, a headache or dizziness.
--Over time hypoxia will cause unconsciousness.
--The worst part of hypoxia is that the victim will be totally unaware of the sequence from beginning to end.
--While crew must use oxygen, passengers have the right of refusal.
--Use of oxygen is best begun at 10,000 day and 5,000 night.

Smoking
The smoking of tobacco is a form of self imposed physical and psychological stress that constitutes an immediate and on-going threat to health and safety. A long-term suicide activity. A smoker may deny that drugs are a part of his life. He lies in the face of facts. The whole purpose of a cigarette is to get a nicotine fix. Different from cocaine or heroin? How? The person who smokes is a health and economic hazard to everyone. The residue remains on his person, clothes, possessions, and associates.

Nicotine is an addictive psychotropic that can either stimulate or depress. Immediate side effects can be constriction of blood passages, visual degeneration especially at night, reduced lung capacity and nicotine and coffee together multiply the harmful effect of each. The individual ability to assess the effect of any drug is reduced in the taking. Drug interactions are a most common difficulty.

The smoker will die younger, have poorer health, and will suffer considerably in the process. Smoking makes worse the negative effects of radiation, carbon monoxide, and lack of fluids. Smoking deprives the heart of oxygen, constricts the arteries, alters nerve impulses to the heart and lungs, weakens muscles, causes abdominal cramping, and nausea. Nicotine itself decreases the body's ability to adapt to stress. Nicotine withdrawal symptoms include depression, irritability, difficulty in concentration, decreased heart rate, fall in blood pressure, tension, and impaired performance.

These symptoms are worse if withdrawal occurs. It is not possible to avoid withdrawal while flying commercially since cabin pressure is kept at 8000'. Recovery from withdrawal can occur in as little as eight seconds after inhalation of nicotine-laden smoke. This is both a physical and psychological release. The victim has been sucked into an addiction by a combination of governmental and economic interests. The addictive process is entirely deliberate. Cigarettes were sold at four cents a pack in World War Two. The military still gives a ten-minute smoking break every hour. College 'Judas Goats' were paid handsome sums just to attend college functions and give away free cigarettes. Free distributions were made at fairs and other public functions mostly frequented by the young. The Federal Government has through its agricultural agencies and congressional mandates required that tobacco farmers produce tobacco of a relatively high nicotine content.  Because of their high nicotine content American cigarettes are favored the world over by the addicted.   It is illegal to produce and sell tobacco that is below a very specific level of nicotine in the U.S. . Another government sponsored health program?

Psychological advertising and selective groups have been targeted by the cigarette industry to get as many addicted as possible. Government subsidies have supported these activities both directly and indirectly. The recovery from nicotine withdrawal carries with it the side effect of carbon monoxide poisoning. The carbon monoxide (CO) of cigarette smoke combines with the hemoglobin in blood at a rate of 250 to 1 times more easily than does oxygen. As little as one part CO to 20,000 (.005.%)parts of air is enough to begin the weakening the thought processes of the brain.

A flying smoker starts with as much as 10% carbo-hemoglobin level. This means a smoker is halfway to the 20% level, which can cause a headache, confusion, dizziness and impairment of judgment. CO poisoning is fatal and smokers are already 1/3 of the way there. Perhaps smokers should wear CO detectors on their microphone. Engine exhaust can have as high as 7% CO. Do not fly if you smell exhaust fumes, which are always accompanied by CO, which has no odor. The CO level of a smoker is usually between 4 and 10 percent just after a cigarette. A frequent smoker can have up to 10% CO saturation at all times. Any additional CO from another source would compound the problem of the smoker.

You can't do anything to recover from carbon monoxide poisoning caused by smoking; it's there just as though you had a direct connection from an exhaust pipe into your lungs. Engine exhaust in vehicles has 7% CO. Working around cars, even in partially closed spaces, can be doubly hazardous the one's health. If your work can be a matter of life-or-death your smoking may well cause a problem. CO poisoning reduces visual acuity, brightness discrimination and dark adaptations to a significant degree because of hypoxia. At sea level, three successive cigarettes gives a night driving vision capability identical to what the non-smoker has at 8,000' in the mountains. Reversal of these effects will not occur until five hours after your last cigarette.

Susceptibility to CO poisoning increases with altitude due to the propensity of CO to enter blood. This prevents the blood from being able to transport adequate oxygen to the body's cells. The hypemic hypoxia of the smoker reduces his oxygen intake by 5-10 % of normal capacity. The fact that smokers are hypoxic means that we can expect smokers to feel anxiety, forgetfulness, irritability, confusion, and altered judgment with every cigarette. Judgment, math ability, and reasoning will be affected. The indication is that smokers are more likely to enter into personal arguments and show lack of both good judgment and logical reasoning ability in those arguments. Very small amounts of CO over a period of time will reduce a person's ability to perform safely. It is the length of exposure as well as the amount that makes the critical difference. This lack of oxygen to the brain impairs judgment and diminishes the ability to make reasoned decisions. The pack-a-day smoker will have a chronic 10% CO level. CO effects are accumulative so that any additional automotive pollution or altitude will increase the percentage of CO.

Any onset of sluggishness, warmth, and tightness across the head is an early symptom of CO poisoning. A headache, weakness, dizziness and dimming of vision comes next. You won't be aware when you lose strength, vomit, convulse, and enter a coma. A breath of fresh air will not revive you. Several days may be required for full recovery. The smoker is betting against a CO impairment that has already occurred and can only become worse. Carbon monoxide and other toxins in tobacco smoke interfere with the oxygen-carrying capacity of red blood cells. Less oxygen means less energy. Smoking causes an accumulation of mucus in the windpipe and bronchial tubes, constricts blood vessels and reduces the supply of oxygen to cells.

Cigarettes are given trace amounts of several heavy metals such as lead, cadmium, arsenic, nickel, and polonium. Cadmium has been directly traced to hypertension, anemia, baldness, and scaly skin. Lead, an accumulative poison migrates to the nervous system, brain, bones, glands, kidneys, liver, heard and hair. Lead is a known cause of impotence, infertility, anemia, colic, and mental disturbance. Arsenic affects the muscles, brain, lungs, liver, esophagus, and skin. Effects are headaches, drowsiness, back pain, gastrointestinal problems, convulsions, vomiting, diarrhea, baldness, impaired thinking, hearing loss, poor vision, fevers, weakness and bloody urine.

The radio active residue from cigarette smoke (radium-226, radon-222, lead 210, and poloniun-210) remain in the lungs as hot spots for up to five years. A smoker of 1 and 1/2; packs a day, will ingest into his lungs a radiation level of 8000 millirem just from cigarettes in one year. 500 millirem annually is the top of the "safe limit" for nuclear workers. Such a smoker exceeds the safe limit by 16 times. This is equivalent to 300 chest X-rays a year.

There is statistical evidence that smokers have more vehicle accidents. Most of these accidents likely caused by not detecting traffic to either side. The peripheral vision of the smoker is reduced by about 39% from what normally would be available. Peripheral vision is a major physical separation factor between talented athletes and everyone else. The smoker, flying in the mountains, is far more likely to have a judgment-related accident than is the non-smoker. Smokers are poor judges of what is probable. Casinos have resisted establishment of non-smoking areas since their income is based upon probability. Smokers do not know odds. Smokers lose much more than non-smokers do. Otherwise, they wouldn't smoke and casinos would have lower profits.

Regardless of age, a smoker is eleven times more likely to die or be killed than a non-smoker is. This is because side effects of smoking affect life style and judgment. The smoker, on the average, dies 10 years before the average non-smoker. Every 53 seconds in the U.S. a smoker either quits smoking or quits breathing. One cigarette takes seven minutes off your life expectancy. Just about the length of time it takes to smoke a cigarette. Smoking directly causes 1/3 of cancer deaths.

The children of a smoker will learn at an early age that smoking is the 'adult' thing to do. Growing up is the name of the game. The highest proportions of school dropouts are the children who smoke. The smoking student and one from a smoking household will miss 25% more school days due to bronchial and lung problems than will a child from a non-smoking environment. There is scientific evidence that being susceptible to either a smoking or drinking addiction may have a genetic basis.

If one cigarette is supposed to take four minutes off your expected life span, just think how much you won't be able to do. The probability of becoming a pulmonary cripple, and not being able to enjoy our later years, alone makes it worthwhile stopping. If there is not a direct relationship as to your intelligence and the care you take of yourself, there should be. You will do everything better if you don't smoke. If you are with smokers for one hour you are breathing in the equivalent one cigarette, radiation and all.

The pilot who smokes is a hazard to himself and other pilots. The fact that smokers are hypoxic at relatively low altitudes means that we can expect smoking pilots to feel anxiety, forgetfulness, confusion, irritability and altered judgment at relatively low altitudes. The applicable question is should smoking pilots have any more right to fly than drinking pilots? Know your limitations. Don't fly if not 100%.

What Is the Risk of Smoking?
350,00 people die before their time due to the direct effects of smoking every year in the U. S. 1/3 of these deaths are lung cancer but smoking greatly increases the probability factor of cancers of the head, neck, throat, larynx, mouth, lip, tongue, bladder, stomach, kidneys, pancreas, and cervix. 1/4 of the nation's heart attacks has been directly attributed to smoking.

A cigarette contains up to four thousand known toxic carcinogens. Cigarette tars cause 80% of all human cancers by damaging DNA molecules and fomenting mutation. Acetaldehyde, related to the embalming chemical formaldehyde, causes aging damage to body tissues such as arteries, skin, and lungs. Smokers do age more rapidly in these and other specific body tissues.

As a psychoactive alkaloid, nicotine is highly addictive. It increases blood pressure, constricts blood vessels, and increases blood cholesterol fats. Inhaled nicotine causes near instantaneous increases in the heart rate. Pumping faster means the heart is working harder. Above a certain level nicotine acts as a depressant and increases anxiety levels of perception. Nicotine has been identified as an essential distribution trigger for the spread of cancer.

Like cocaine, heroin and alcohol, nicotine affects the central nervous system. It creates physical dependence by giving pleasurable sensations and below certain levels it causes irritability, cramps, depression, anxiety, headaches, and cough. Basically, a smoker is a drug addict.

Cigarette smoke has a collection of gasses such as carbon monoxide and nitrogen oxide. Monoxide reduces the ability of the blood to carry oxygen to the heart, brain and lungs. The oxides have direct links to the DNA mutation process. Hydrogen cyanide is the chemical trigger to the cigarette cough.

Smoking affects women by causing earlier menopause decreased fertility and more frequent still births, spontaneous abortions and premature deliveries. Infants born of smoking mothers have smaller birth weight and are more susceptible to complications. Men find that smoking affects the function of the smaller blood vessels that determine peripheral vision and penis erection.

The urge to smoke only lasts three to five minutes. You should find an activity that will distract you from lighting up. One cigarette takes seven minutes off your life expectancy. Just about the length of time it takes to smoke a cigarette. 1/3 of cancer deaths are caused by smoking; 1/3 from diet, and 1/3 from life style choices.

Coffee
Half of the American population is addicted to coffee. 25% drink ten or more cups a day. Quitting coffee is both difficult and painful. At age 71  I dropped coffee primarily to lower my blood pressure. I had a two-week headache. Now I take afternoon naps. The lure and temptation of coffee still exists.

Coffee has some negatives:
1. Raises the adrenaline level.
2. Blocks adenosine, a brain chemical that calms you down.
3. Can cause panic attacks by increasing lactate in the body.
4. Increases risk of stroke by increasing blood pressure.
5. In conjunction with diet, cold, anti-depressants will dramatically raise blood pressure.
6. Can addict babies whose mothers drank during pregnancy.
7. Contains at least five cancer causing compounds.
8. Contains pesticides that are not allowed in the U.S.
9. Linked to heartburn and ulcers.
10. Leading cause of sleep disturbance.
11. Constricts blood vessels of the eyes.
12. Contributes to iron loss, zinc loss, and sex drive loss.
13. Causes excretion of calcium, potassium, magnesium and sodium before they can be used by the body due to diuretic effect

Caffeine stimulates the central nervous system. Its psychotropic effects are addictive. Effects are individualized with possible side effects being a rapid heartbeat, irritability, tension, insomnia and frequent bathroom visits. Withdrawal causes headaches, stomach upset, nervousness and irritability. I had one week or more of all of these someeight years ago when I quit coffee. I lowered my blood pressure ten points. The attraction of coffee still exists since my wife is still addicted. She drinks coffee and I now take naps.

Bends
Symptoms of BENDS (decompression sickness)
Severe pain in both shoulders
Itching over a good portion of the body
Vision difficulties
Numbness in the tongue
Mild headache and nausea

Motion Sickness
Airsickness
Airsickness is more than a reflection of our inner ear sensors becoming confused. Inner ear confusion sends conflicting position signals to the brain. Fear alone can send conflicting position signals to the brain. The first stage of airsickness is silence. Silence is quickly followed by denial; a refusal to accept that one is about to get sick.

Airsickness is caused, as is seasickness, when the brain receives differing messages from sensory organs. If the inner ear and balance organs differ in sensory perception from what the eyes sense the brains initial reaction is to get even by making us sick. Every person reacts differently so there is no sure way to forecast or prevent. Motion sickness, or airsickness, can be lessened or improved if the person can be placed in control of the aircraft. An upset stomach can cause motion sickness. Get fresh air into the cockpit. Carry a plastic bag or a non-mesh hat. The only positive cure is to get on the ground as quickly as possible. I took a ride in the FAA rotating chair (It has a name) just before lunch one time and I was unable to eat.

There are medications available that, when taken prior to flight, reduce the sensitivity of the inner ear and balance organs to motion. The pilot should not take them. I have always advised my passengers to look as far away as they can toward the direction of flight. Chewing a bit of crystallized ginger candy has been a historical preventive of nausea. Accupressure bands found in boating supply houses have been found effective when placed correctly on the wrist.

Here some airsickness solutions for you to try.
1. For $90 the Woodside biomedical relief band provides adjustable shocks to the wrist.

Emetrol is a non-prescription sugar solution from the drugstore that seems to work.

Ginger
Airsickness is similar to seasickness. An old herbal remedy was to use ginger. You can purchase a crystallized ginger candy that will provide some relief if eaten thirty-minutes prior to flight. Ginger also comes in capsules and powder. It does not appear on the FAA list of no-no's.

Pills: (opinion)
JOYRIDES. Available from the British drugstore. A child's travel sickness tablet for children aged 3 to 12. Because of this they don't cause drowsiness and to be honest you forget you have taken them. I have never had to cut a flight short because of illness since using them.

Accupressure:(opinion)
I finally decided to try the pressure points, within a minute or so the feeling had almost completely disappeared. I could actually look out the window again and appreciate the view, as we circled for the Nth time. Removing the pressure, the feeling would come back, so by the time I landed, I had some sore wrists but I was intact.

There are accupressure points on your wrists that will alleviate motion sickness if you apply pressure. The points are about 1" away from the wrist joint, adjacent to your tendons below your little finger. I'm not making this up.

Of course, you can just apply pressure with a thumb on the other wrist; only one wrist seems to be enough to do the trick. Since this seems to mostly be a phenomenon among students, it can be a helpful stopgap measure if you are flying with someone who can take over. Otherwise, spend a couple bucks for the wristbands.

Wrist Band
I have found great relief from motion sickness with "Sea Bands" which can be found at a marine supply store. They were given to me by the captain after almost losing my lunch on a business meeting on a yacht. I put them on to be nice and after 30 minutes...cured.

They are an elastic band (like a sweatband) with a plastic bulb inside each one, which applies pressure to a point in your wrist which controls motion sickness. I know they sound strange and people have told me it's psychological but if you've ever had severe motion sickness -WHO CARES!!!

Ginger Ale
How about Ginger Ale? Seems like that would taste a lot better and probably a lot cheaper too! There's even a new ginger-based soft drink that is gaining popularity on long range fishing boats to combat seasickness. All of this sounds better than taking Marazine or Dramamine. I found that Vernors Ginger Ale works for me. Other Ginger Ale soft drinks that I have tried did not work.

Spatial Disorientation
Spatial disorientation is the No. 1 cause of fatal accidents. Even the best pilot will become disoriented under the right conditions. Effects on inner ear can cause a mentally and physical compelling move in a given direction. This can be the after effect of a gradual turn, spiral, spin, acceleration, leveling off, updraft, false horizon, autokinesis, (lights that move), runway illusions.

Stress
Human performance is mitigated by physical stresses such as fatigue, fitness, sleep, food, age and illness. Psychological stressors such as personal family problems, work load, situational awareness. External dynamic stresses can be due to weather, turbulence, aircraft performance and time factors. Stress is the result of events that cause preoccupation reducing external awareness and making activities subject to distraction. Stress causes the taking of risks that would otherwise be unacceptable.

Stress in moderate amounts is both necessary and desirable when flying. Stress prevents boredom and inhibits fatigue. The other extreme of stress leads to panic and impaired capability. Accidents happen when flying requirements exceed capability. Time in the air will decrease capability and lower the stress/panic threshold.  69%  of accidents occur in the landing phase of flight operations. This is when time in the air is greatest and the stress/panic threshold lowest.

Whenever excessive tension exists, the ability to make considered judgments deteriorates. The concepts of what is best or safest become an emotional decision based more on fears or concerns rather than realities. Under tension the ability to make correct decisions deteriorates and compounds both the tension and the reliability of the selected solution. The pilot MUST recognize areas of tension and undertake an instructional program to raise a proficiency level to where competence reduces tension. Failure to resolve a tension-producing problem will eventually lead to erroneous decisions capable of producing an accident. The instructional program must expose the student to those tension producing situations before the student goes solo. Stress exposure is a form of stress inoculation.

The most common tension producer is through use of the radio. At a given point in airspace the student knows that he should be prepared to say a given sequence of communication facts. Where to start talking, what to say, in what sequence, and the fear of the unknown ATC create tension. After being lost or disoriented the most dramatic tension producer is x-wind landings, next I would place unfamiliar airports, especially if they are small, followed closely by radio procedure uncertainty. Night flight over unfamiliar terrain certainly raises cockpit temperature. Turbulence produces tension in the best of us as does proximity to the ground. All of these tension producers can be reduced or eliminated by gradual programmed exposure. Stress reduction, according to one expert, can be achieved by only landing at airports and peeing every chance you get.

Being lost or disoriented seems to be the most mentally debilitating factor of all. The presence of hills and mountains to a person more familiar with flat lands can create tension. A 1900' hill in California can cause a flat land pilot to subconsciously change course first to avoid and then to keep it in sight. Students have been known to nearly fly around a mountain in this manner. Inversely, a mountain-raised person may tend to challenge rugged terrain not realizing the value of an airport vicinity route via the valleys.

Alter-ego flight
There are studies that show how outside influences affect your driving and flying. No matter how competent or skilled, a major personal calamity should warn you against flying. The hidden and unseen effects of certain events associated with emotional fatigue, stress, or distraction are there.

Stress under Duress
Your personality derived from both environment and heredity in a large measures dictates how you will react to stress. An emergency is a stress situation and the instruction you receive seeks to train you to react in a planned preconceived manner. Flying is inherently stressful because being high in the air is not a natural human environment.

Every positive or negative event of our lives will influence the way we fly. We all carry a great deal of baggage from our previous lives into our flying life. It there is any imbalance in this accumulation that clouds our life control, values, goals and priorities it will show in the progress we make in learning to fly.

As humans and pilots we differ in the way we deal with stress and danger. We have preferences in the way we receive and interpret information. We differ in our preference for sequencing what is important and unimportant. Each pilot must meditate into the deeper recesses of behavior and feelings to find out just why we think, feel and react the way we do under stress.

No two people put the same importance on dress, color, time, order and neatness. These variations cause stress between people and more stress in some than in others. We are not being contrary; we are just being ourselves. In many situations of life and flying, there is only a wide range of acceptable behavior and procedure. There is no 'one way' except in the mind of the beholder. In flying, smoothness in reaching a particular performance level is just as important and getting there.

Pilots as a group believe that they have control of their lives. The older and more experienced the pilot the stronger this belief. This perception is just as important to excellence flying as is actual control.

A big part of being a precise pilot is the ability you have to be trimmed for that precision so that a distraction can be handled merely by releasing the yoke without any loss of precision. Close enough, good enough, that looks about right, and good enough for government work means that you are probably not ready to release the yoke, yet.

A pilot can be prepared and even inoculated against the fears that affect a person's pleasures in flying. Fear is a very important safety mechanism. But irrational fears prevent us from doing what is necessary. Everyone has different fears. We have difficulty understanding or accepting the fears of others. Each person must develop his own degrees of immunity from fears.

The extrovert and introvert have different levels of tolerance of risk. Risk foments excitement and anxiety. The mixture of personality traits are found in good pilots. Too much of one personality trait will make it difficult to accept and cope with emergency situations.

Instructors must discuss fears with students. The student's background colors the way they feel and react to situations. A pilot facing a critical flight situation becomes focused mentally and emotionally on one thing. Thought processes slow, mental inertial takes over, accompanied by an increase in heart rate, blood pressure, perspiration and tension. Intellectually a pilot knows what to do, what must be done but fear limits the response. Paralysis is not an acceptable option. Yet we have people who through childhood experience freeze in critical situations.

There is a solution. You can be inoculated against your usual reaction to fear. The first step is to acknowledge that you have some areas related to flying that bring to the surface some long held fears. You have some way of reacting to fears that are not compatible with the need to do something in an emergency. Fear inoculation is a training process where repeated simulations are used to reduce the stress, the increase in blood pressure, and the unproductive anger that often results in doing nothing in an emergency. The situation is visualized in a series of ever increasingly stress situations. A series of stressful situations are created by visualization in gradually increasing intensity. This can be made more dramatic in a ground cockpit environment.

The student must orally talk through the situation by saying aloud positive statements, which provide the solution to the problem. Touching the controls and instruments to show the situation and the recovery process is crucial to acknowledging the problem and the solution. There is a thin line between carelessness and confidence and even a thinner line between caution and confidence. Crossing the lines are frequency the result of little things. The wrong little things can and do result in serious consequences. You have been taught to notice little changes in the nose, the airspeed, the altitude, the radio, and your control movements. Safe flying is the sum total of how you understand and handle the little things.

Fear-inoculation and visualization can help pilots reduce the symptoms and increase the ability to perform under stress. It is important to believe that some fear and stress will improve your performance. The recognition of fear reduces its impact. Thinking about the 'what-ifs' in the pattern will help prepare your mentally for possible emergencies.

All fear cannot be overcome. A certain amount is very necessary. What you can do is to perform in the safest manner possible. Safe flying depends on many factors mentioned below.

Failing to Cope:
--Accept that close calls, stupidity, and carelessness happen.
--A success can bring as much stress as a failure.
--There is a low probability that a pilot will discuss the situation
--Anxiety, insecurity, and uncertainty happens.
--The above cause pilots to needlessly quit flying
--Stress affects the ability to use good judgment.
--Stress can become chronic.
--Denial, suppression, rationalization and chemicals are reactions not coping.
--Life has no joy, much hostility, poor health, and no future.

Coping with stress:
--Find for yourself or with help the source of the stress.
--Plan a program of action. This will not be easy.
--Develop your flying skills to the point where flying is not a part of the problem.
--Create a set of inviolate standards that will make flying as safe as it can be.
--Accept the fact that life is made up of 'furtherances' and 'hindrances'.
--Consider a form of meditation.
--Learn to unwind. Flying works wonders.

Some safety standards:
--Know the operational parameters of the aircraft.
--Altitude, airspeed, and fuel are forms of insurance.
--Know where you are in relation to airspace, traffic, and obstacles.
--Obey the FARs because they are created by accidents.
--Fly defensively.
Physical:
Altitude, noise, vibration, motion G-forces, temperature, air quality, and sunlight.
Physiological:
Fatigue, sleep deprivation, illness, fitness, diet, dehydration, weight, drugs, medication, caffeine, tobacco.
Psychological:
Mental, emotional, person-environment interaction, life changes, health,

Some stress is needed to be healthy, motivated, and alert. Only accumulated stress is excessive and harmful. Knowledge, understanding, and experience are stress reducers. Excessive stress is shown by anxiety, irritability, excitability, impulsiveness, aggressiveness, overreaction, insomnia, depression, inattention, loss of memory, self-doubt, fatigue, trembling, weakness, diarrhea, indigestion, need to urinate, migraines, cold sweats, smoking or overeating.

Stress reducing skills:
--Find the stress source.
--Get professional help.
--Finding solutions.
--Selecting a solution
--Taking corrective action
--Evaluating results.
--Making changes and trying again.

The Holmes/Rahe Life Change Scale as a series of 42 factors that range in value from 100 (death of a spouse) to 11 as a minor traffic violation. When the total score of an individual reaches 150 there is a 37% chance that there will be physical symptoms. At 200 there is a 50% chance of stress-related illness or accident. At 300 there is an 80% chance for such an occurrence. See AOPA Pilot's Handbook.

You Fly as Well as You Eat
Poor nutrition will be evident by drowsiness, hyper-activity and nervousness to be followed by depression and fatigue. All of these forms of discomfort mean collectively and individually you will not fly well. A caloric deficiency will tell your body to slow down. Initially reactions are not affected but energy reserves Your reaction time will slow and drowsiness may be all conquering.

The proper food eaten on a regular basis will maintain energy, memory recall and information retention. The side and after effects of a junk-food meal can include headache, weakness, faintness and lethargy. The best food to eat is the bagel. Even the proper food, over-eaten can be damaging to your ability to concentrate and utilize recall memory. Carbohydrates enter the blood stream in about 20 minutes. Proteins can take up to an hour. Fats may take over three hours. The more fats eaten the longer it takes to help you. The slower you eat will be beneficial since your body takes about 15-minutes to get word to the brain that you are full.

If you are a coffee drinker, drink coffee in moderation. A diuretic you will find the need to urinate resulting from coffee is a dangerous distraction to your flying. The darkness of your urine is indicative of your level of hydration. When the color gets beyond pale yellow begin eating fruit and drinking fluids.