Diabetics Doing Aviation 2 with John Roth

[00:00:07] Rob Howe: Welcome to the Diabetics Doing Things podcast. We've been telling the amazing stories of type 1 diabetics all across the world since 2015, and we have over a thousand years of living with T1D on the podcast. The interviews range from incredible feats to everyday victories, and we celebrate them all just the same. Thanks for listening. And if you want to get involved even further, just send me an email at rob at diabeticsdoingthings.com. What's up, everybody? Just wanted to say thank you for listening to this podcast. It's been an amazing journey thus far, and I have a lot of really great stuff coming up in the future. so I'm going to do something that I haven't asked before if you're listening to this podcast a I would love it if you would subscribe to the podcast just so you get the notifications whenever we publish new episodes because if you've been listening for a while you know I don't always publish them consistently sometimes I'll publish five in a week sometimes it'll be only a couple in a month and you need to know when these episodes drop so be sure to subscribe and if you like the podcast, be sure to go to your preferred platform like iTunes and leave a review. I would love to boost my reviews and I've never asked you guys to do that before. So I figured you don't ASK, you don't G E T. I would love a review from you. So I want to hear from you there. Also, we are now available on Spotify. Turns out I was just submitting it to Spotify incorrectly, but I corrected that. So now we're on Spotify. So if that's your preferred listening platform, be sure to subscribe on there. Also just want to let you know that in 2019, we have an awesome new program coming called Tools of Type 1s. It's going to be on this podcast, so you don't have to subscribe anywhere new, but it's going to be an entirely new form of programming with some of your favorite Type 1 personalities. So they're going to be two a week starting January 8th. Be sure to tune in and I'm going to blast all the messaging I can all around. So be sure to listen to Tools of Type 1s launching January 8th, and thank you for continuing to listen to this podcast. This podcast is sponsored by Health IQ, and if you don't remember Health IQ from the previous episodes that they've sponsored, Health IQ is an insurance company on a mission to improve the world's health by rewarding runners, cyclists, weightlifters, swimmers, yogis, well-managed diabetics, and other Americans living a healthy lifestyle. They're actually the first insurance company rewarding patients with type 2 diabetes who manage their A1c with a healthy diet and exercise with large savings on their life insurance. To support the show and get a free quote, go to healthiq.com slash DDT. Hello and welcome back to another episode of Diabetics Doing Things. We are telling the amazing stories of type 1 diabetics from all across the world. And I'm very, very excited to introduce you to my special guest today, John Roth. Welcome to the show, sir. How are you? Great. How are you doing? I'm doing great. I'm really glad that we got time for this. You and I tried to link up before the holidays and I believe you first heard about my podcast on Vinnie Tortorich's show. And I'm really glad we were able to make the connection.

[00:03:34] John Roth: Absolutely. Yeah, I was kind of surprised at the, I guess, the promptness you got back to me. I I don't really know how some of the various folks that are involved with the podcast world work. And, yeah, it was great to hear back from you.

[00:03:49] Rob Howe: Well, I try to stay as current on email as possible. And I say try because there are some that slip through the cracks. But, yeah, I think my platform is built on the amazing guests that I get to have on. So anytime I get an email inquiry or an Instagram message or any kind of communication, I try to get to respond as quickly as I can. So happy to do it. Excellent. So why don't you just kind of introduce yourself a little bit, tell us about you, and then tell us how you found yourself in the type 1 diabetes family.

[00:04:23] John Roth: Right. So I guess just for starters, my initial interest and or introduction into the whole type 1 diabetic community began about three years ago, was diagnosed at age 36, which is, from what I understand, is a fairly late age, not unheard of, but a fairly late age to get a diagnosis. And, you know, my ultimate, I guess, endpoint was, of course, involved in emergency room, which was not ideal. And prior to that, you know, I had a very, I guess, full life before that without diabetes. So it's definitely enabled me to see kind of both sides of the coin, so to speak, and has given me a little bit of perspective, you know, moving forward. and from that point on, it's just been a constant progression of, I guess, education and then also the diagnosis of diabetes has had a pretty profound effect on my career because I'm in one of the very few professions where an insulin-dependent and or type 1 diabetic diabetic is a disqualifying event for my chosen career path.

[00:05:53] Rob Howe: And why don't you tell us a little bit about what that was like? Because like you said, I think, you know, being diagnosed later in life than normal, obviously, like you said, not unheard of. But at an age like 36, like you have a profound memory of life before type 1. Oh, yeah. And, you know, in that time, you know, you worked in a profession as a commercial pilot, correct? Yes. And that's not something that you just wake up and decide to do. There's a lot of training and schooling and part of that process. Sure. So walk us through kind of the days leading up to or the weeks even leading up to the diagnosis and then immediately after when you sort of had to realize, oh, no, a lot is going to change.

[00:06:41] John Roth: Sure. So, you know, as you said, I was a commercial airline pilot. Still, I guess, technically am. I actually still function as a instructor pilot with the same company that I was previously flying for. So at least that portion of my career didn't completely evaporate. But, yeah, you know, the probably months leading up to it, you know, it gives you a lot more perspective once you've been diagnosed and you start recognizing some similar stories and, you know, you become a little bit more familiar with the, um, you know, I guess the warning signs or the symptoms, I suppose you could say. Um, and I, I believe it, it started probably, um, in the November, December timeframe, um, of, uh, let's see, would have been, well, it would have been 2015 now. And then 2016, going into, you know, January is when, you know, all those symptoms really started to pile up. You know, probably three to maybe four months prior to my diagnosis, I started to, you know, have some minor issues with my vision. I started to have a little bit of blurred vision, not significant, but just enough where I thought maybe my prescription on my contacts were changing or was changing and went into not an ophthalmologist, but just a regular optometrist. And they made a couple adjustments and that worked out okay for a little bit. And then it seemed right, but then it changed again. And, you know, all those, you know, that was, of course, I think the some of the initial signs, you know, followed by, you know, more and more fatigue. My wife and I both, you know, maintain a really active lifestyle. And, you know, I enjoy, you know, physical fitness and, you know, being in the gym and outdoor sports and all that. and it just became you know more and more fatiguing to do a workout or you know to do a ride or a run or anything like that that was just an everyday thing for me and that um you know it was a little strange um but uh you know the fatigue to start to get more prevalent and then um I started to come back from trips, um, you know, I'd be gone for three to four days sometimes. And, um, you know, my, my wife, you know, started to notice, you know, that I was losing weight and, um, you know, became concerned. Um, and I would say just prior to going into the hospital, um, you know, I guess I'm kind of sitting at about 170 pounds right now and about six, two, um, I'd lost almost 20 pounds. So it was significant. Um, yeah. And then, so finally I was, uh, my wife was coming home from my night shift. She's a veterinarian and, um, you know, I was down in the kitchen, you know, just trying to get some breakfast and, uh, get ready to head back out for another three day trip. And, you know, I just didn't feel right. And, uh, you know, I told her, I said, you know, I think I'm going to call in, uh, what we call it, call in fatigued or, uh, unfit to fly. i.e. sick, because I just, I don't feel right. And she kind of saw me and, you know, in her words, you know, I looked like death warmed over. And she said, no, you're not just calling in sick. We're also going to the emergency room right now. So, yeah. So, and off we went, you know, down the road and, you know, went into the emergency room and kind of gave them a brief description of you know while was there um and uh you know they they did a uh finger stick and of course the meter that they had used at the front desk basically uh it was off the charts and you know they started to kind of part the ways in the emergency room which you know of course at that time i was like well that's not good right so it's kind of it's kind of amazing how quickly that happens, right? Oh yeah. Yeah. I mean, you know, they basically, as soon as I'm sure they saw the, you know, high or whatever it read, you know, immediately they were like, you come back

[00:11:08] Rob Howe: here with us. So now something I hear a lot with, uh, with people who are diagnosed around the same age as you were, even, even down to like age 20 sometimes, uh, is a little bit of misdiagnosis because of, you know, the either predisposition, you know, the popularity of type 2, I guess, and, you know, just the age sort of misinformation that type 2 only happens to, or type 1 only happens to children. Was there any of that at your diagnosis or were they like, no,

[00:11:38] John Roth: this is pretty much clearly type 1? No. So luckily I got into a really good hospital um and uh no they took me right back to the ICU and and uh you know I think um after they had already begun some of the treatment um if I recall my blood sugar was 793 you know somewhere in that range so yeah so it was it was definitely up there um and of course you know all the electrolyte imbalances and weight loss, they, they didn't seem to have really any question of the fact that it was type 1. They did seem to be rather surprised that I was, I had walked in there instead of, uh, come in and a stretcher in her wheelchair. So I don't know, but, um, no, they, they, they were pretty, you know, they, they knew what it was right away. Um, and that could have been, you know, the advantage of going to a full fledged hospital straight away, versus maybe like more of a standalone ER and some of those, you know, the various urgent cares that are around now. You know, sometimes they might struggle a little bit more with a definitive diagnosis. But no, that night or that day, I should say, you know, there wasn't any gray area there. So, yeah.

[00:13:06] Rob Howe: Yeah, I think, you know, know, it's always interesting, the, the circumstances around, you know, those diagnosis, I think, you know, for you, your wife saying, Hey, you know, you're not just calling in sick, you're going to go to the hospital. Like you can, the ability to like, look at someone and tell that something's so wrong. For me, that was my mom. You know, I came, I came downstairs on New Year's Day, and she was like, No, we're going now. And then you get you get there. And it's just like, It all happened so fast. I think something for me that I remember after I got into the emergency room, after the initial shock and all these explanations, I remember them filling me up with saline solution and insulin. I just felt so good that there was a little bit of almost like reassurance. I was like, okay, well, this is definitely what was wrong with me. Do you experience any of that kind of early on in your hospital stay? Yeah, absolutely. Um, you know, like you said, it's, it's hard to, I guess, see, you know, see yourself,

[00:14:09] John Roth: I guess when it's kind of like a progression and, you know, I guess some of the other things I had going on, of course, you know, I was like getting up, you know, multiple times a night to go pee and like, you know, couldn't make it more than a couple hours without having to, you know, go hit the can, that kind of stuff. Um, but, um, yeah, you know, like when, when I get, got to the hospital and, you know, they got me hooked up to some IVs and, um, you know, started, I guess, treatment per se. Um, yeah, it was, it was, there was definitely like a sense of, you know, one, it was, I kind of describe it as one cloud was lifted and another one moved in, you know, because being at the age and in the position I was in my career, the, the cloud of, you know, that fatigue and just sense of not doing well. I mean, I was almost thinking that I was going to go in and they were going to say that I had some cancer or something, you know? Um, and that kind of got alleviated. But then while I was in the ICU, you know, I started to pull up, you know, the FAA webpage while I was sitting there just basically waiting for this stuff to, to work and come around. You know, I looked it up and I kind of knew right from filling out my medical or first class medical papers that you have to do once every two years or once a year generally as an airline pilot that one of the things that they specifically ask you about on there is diabetes. And so I looked it up and of course, insulin dependent diabetics, you know, was in a disqualifying event. So So that second cloud moving in was basically the evaporation of my career as I saw it. So that was kind of an odd feeling.

[00:15:56] Rob Howe: Yeah, I imagine sort of like a little bit of relief at the, you know, hey, we caught this, I'm going to be okay. And then immediately the dread of, okay, well, this is going to be a little bit life changing here.

[00:16:09] John Roth: Right. Yeah, exactly.

[00:16:10] Rob Howe: So what were the next few days, moments like for you from a professional standpoint? I mean, obviously you called in and you go to the hospital and you know that this is there. What was next? How did those next sort of conversations go? Yeah.

[00:16:31] John Roth: So, you know, I spent that night in the hospital, actually in ICU. you. Um, and you know, um, of course my wife stayed with me for, you know, until early evening time. And I kind of asked her just to go home and get some sleep because she had come off a night shift and, you know, she didn't need to be hanging out in the hospital with me. I figured I'd, you know, had it under control, so to speak. And, um, but, uh, you know, I guess that night and then the next day in the hospital, you know, I just kind of started to go through the process of like, yeah, you know, how, how is this going to affect work? And, you know, how, you know, how do I need to go about, you know, informing people? So, you know, luckily, you know, through my employer, you know, I had short and long-term disability. So, you know, I got that, you know, underway, I talked to my chief pilot and just told him that I was going to be out for a prolonged period of time due to a medical issue that was still kind of at play right now and that I wasn't sure what the ramification was going to be, you know, acute or, you know, looking forward. And then, you know, started to, I guess, use some of the references, not really references, but resources through our pilot group. It's not really a pilot union where our airline is non-union, but it's a pilot representative group for our company and started to talk with them as far as how I needed to go about addressing this. And yeah, I just started that ball down the road, so to speak. Um, so it's, it's one of those things where in aviation, because of the fact that various medical conditions could have such a significant effect on your ability to fly, you know, um, most people in the aviation industry will identify with the fact that pilots in particular, you know, tread lightly around medical issues. It's not that we're trying to hide anything. we just don't want to disclose something or start something in a particular direction that it doesn't need to get started if that makes sense.

[00:18:54] Rob Howe: Right. And so I imagine that is a, you know, fairly stressful or at least, you know, playing cards close to the vest type situation where you're, you know, just trying to make the right move from a career standpoint and still, you know, make the right moves personally and for your health as well. Sure. So, I mean, but did everything work according to the plan or were there ever hiccups or was there ever, you know, difficult conversations? How did that all play out?

[00:19:31] John Roth: Yeah, I mean, I guess it was one of those deals where you kind of have to, you know, improvise as you go along. because, of course, up until that point, I was physically fit, kind of made it a point in my life to include fitness and health. And it was one of those things where luckily I had a lot of the insurance and disability and good standing with the company and all that kind of stuff in place, but I didn't know how it all worked, so I had to kind of fish through that. So that was definitely a very aggressive learning curve. I did have a distinct advantage in my situation in that my chief pilot, his son was actually diagnosed with type 1 diabetes, I believe when he was 11, if I recall. and so once you know I made it clear to him that that's what I was dealing with you know Rob had always been a very very good manager and you know is now one you know a good friend of mine and he said you know well you know I I definitely understand that and at the time I didn't know that his son was a type 1 dieback but he told me at that time. And he said, you know, you take all the time you need, you know, the company isn't going to leave you out, twist it in the wind, you know, get your health figured out and, you know, get back to me when you can. So, you know, that, that alleviated some of the initial stress, which was good. Um, so, you know, and then from there, it was just kind of a matter of, um, once I kind of realized I wasn't going to be able to fly, um, I kind of switched over into, okay, uh, you know, now what, or now what can I do is, is there any other facet or function I can serve in the company to stay with the company? Because it's, you know, one that, um, at that time I was with, um, with them for seven years and, uh, you know, I, they had been a great company and, you know, I didn't really want to leave besides the fact of, you know, and, and this is something I've heard folks talk about on your show and other shows, when you leave one profession to another, you know, of course, then you get into that whole insurance debacle. And, you know, that was, of course, heavily on my mind as well. So, so I kind of immediately started to send out emails and kind of work my way up the food chain. Ultimately, you know, at the, basically the CEO of the company and, you They just said, here's all the company openings, apply for them, and we'll do the best we can to find a good fit for you and get you to interviews within the company. That's ultimately how I ended up in the training department as an instructor. So it worked out. So it was – I'd say it was about a six-month process by the time it was all said and done.

[00:22:49] Rob Howe: So, yeah, I mean at that point a lot of patience. And then, I mean obviously you had done the work to build the relationship and the equity in that company, I guess for lack of a better term, for them to do that. But, you know, a big step of faith and, you know, a great company move for them to, you know, find a place for you. Right. And you hear horror stories of employers that don't that don't take that approach. Sure. I mean, I imagine you felt pretty empowered by that, you know, them at least helping you out and placing you in a in a place where you could, you know, continue your career with them. Right. And obviously, like it didn't end there. You know, you, you know, obviously you're, uh, you know, fly, you still fly on some level, just not the same as you did before. Am I right? Um, yeah.

[00:23:45] John Roth: So actually just in the last six months, um, through, um, another organization that, um, is called aviation, um, or, uh, paramedical service, um, they specialize in helping pilots, you know, submit paperwork through the FAA if they have what's called a special issuance medical. And there's three different levels of medical certificates for pilots. Just a brief overview for, you know, the other folks. You kind of have two facets. You have your pilot certificates that require all the training and knowledge and tests and, you know, and so on for various levels of flying, kind of starting off with your just private pilot's license, which is you want to go up and fly your own airplane or rent an airplane with your friends and family and there's no money involved. Like you're not being, it's not for hire. And then you kind of move on to your commercial pilot's license. And then from there you have what's called an ATP, which is the airline transport pilot. Well, everything above, at and above as commercial airline pilot, or excuse me, commercial pilot's license requires a second or first class medical. And there's three different classes. The third class medical is kind of the lowest level. And that's what's required for a private pilot. And that's what I was just most recently able to regain because they, the FAA does have allotments to get a special issuance for a third class medical for private pilots. But currently, And that's what, you know, myself and many other pilots are advocating for is that they extend those criteria to allow for special issuance for a second or first class medical. And that would therefore allow an insulin dependent diabetic to still be an airline pilot. it. Um, so, um, I, I can still fly privately, um, you know, smaller aircraft or not for hire, um, which, which is, is nice. I was able to, you know, take my wife up this summer and, you know, do a little bit of fine on the side for just recreational purposes. But, um, as far as professionally, you know, I'm able to do, um, non-flying like observation flights and our company aircraft, like all commercial airline jets have a jump seat, which is in the flight deck, but it's not one of the pilot positions. So I'll do that, and then I do training on our ground schools for this one aircraft type that I teach on, and then some of the non-motion flight simulators and some of the flight simulation just before they go on to their final stages of training for this type of airplane.

[00:26:40] Rob Howe: what was what was that like i mean i guess two times like what are two questions sure the first time after your diagnosis that you got you know in the cockpit and you took and you flew the a

[00:26:53] John Roth: plane any plane what was that feeling like yeah oh you mean the like the first time i yeah when i first began flying?

[00:27:04] Rob Howe: No, no, no, no. After your diagnosis. So like getting back in the saddle. Oh, right. You know, obviously not in the same capacity as before, but, you know, just knowing that it was, you know, jumping through all the hoops, passing the right medical boards, and then saying, getting cleared to fly. Right. It was great.

[00:27:28] John Roth: I mean, you know, one of my other friends at work, one of the other captains I work with, you know, he was able to go up with me just to get what's called a flight review just to, you know, get me current, so to speak. And, yeah, it was great, you know. So, you know, it was kind of funny. We were both joking that, you know, probably the most dangerous, you know, pilots in the sky are airline pilots that are in a small airplane because we're, you know, used to flying, you know, three times as fast and, you know, five times as high. So, you know, that was pretty comical, you know, because like our – the jets, you know, that we fly commercially, you know, land at 150 miles an hour, for example. and, you know, the small airplanes landed 60 miles an hour. So it was kind of entertaining. But, no, it was great to get back at it, you know, and it's just one of those feelings of when you've done it as long as I have, you just kind of feel like, you know, I mean, it's a far cry from where my ultimate goal is, which is to be back in, you know, a commercial or on seat. But, you know, you just kind of get that feeling like, oh, yeah, this is where I'm supposed to be. you know it would be maybe similar to you for like if you went out on an injury playing basketball you rehabbed it and you got back on the court and you just kind of were

[00:28:53] Rob Howe: back in your place you know yeah and you know you feel feel at home and kind of validates all the work that you've done right yeah exactly yeah that's that's a good feeling i uh and you mentioned that you know you're you're not back towards your ultimate goal um right obviously I feel like it would be ideal or something that you would want is to find a way to change the legislation or I guess the rules for the FAA to allow insulin-dependent diabetics to safely take whatever measures necessary to fly a commercial aircraft. Are you underway? Are those conversations being had? I know in some countries, from my conversation with Jeremy Robertson earlier in 2017, that there are countries, and I think there are advocacy groups in like the UK and Australia, and I know there's a couple in the US as well, where in some countries they do now allow commercial pilots to have type 1. What's the process look like? How are those conversations going? And how are you involved in those types of things? Right.

[00:30:08] John Roth: Right. So, yeah, well, as a comparison, you know, for some of the non-diabetic listeners or even, you know, the diabetic listeners, the most other countries besides the U.S. actually do allow commercial airline pilots to be insulin dependent diabetic pilots. um ICAO, which is our International Civil Aviation Organization allows it and that covers most of the countries in Europe as well as air transport Canada allows it Australia allows it New Zealand allows it most of the countries down in South America allow it as well. And just on a sidebar, of those countries that have allowed it, and most of them have actually allowed it for approaching 20 years now, they've never had a single instance of an insulin-dependent pilot having an issue in flight. The safety record is basically 100%, meaning they've never had an in-flight issue because they have certain criteria and parameters that have to be met for those people to be in the flight deck. And they're very, very rigid with maintaining those parameters. And that's one of the big data points that we use as an indicator to the FAA to say, look, you know, and when they have had meetings regarding this, you know, that's brought up and they're well aware of it. And so, you know, part of my involvement has been this aviation and aeromedicine department that is the medical portion of a group called Airline Pilots Association, which is ALPA. They're the biggest pilot union in the entire country. You know, they represent most of the major airlines and a good portion of the regionals as well. And so they have a lot of pull and or frequent meetings with the FAA on the aeromedical side of things to address various issues regarding aviation safety and on the medical standpoint. so as this all started i got in touch with them um and started to work with uh basically their chief or head um uh um era or um plate surgeon and um you know started to send in all my data um you know cgm stuff uh blood glucose measurement stuff for my endocrinologist and all this stuff and And I kind of got put on the sidebar, not really sidebar, but rather was kind of partitioned as being someone that they wanted to use as a representation of what is possible. And it's not because I'm, you know, some, you know, super diabetic or something like that. It's just, you know, you know, leading up to this, I had spent as much time as I possibly could educating myself on how to best control the disease and tried to implement everything that I learned. And it's, you know, given me, you know, in my opinion, pretty good, you know, management. And so they wanted to use that along with the CGM data as a case to show the FAA of what is possible. When I first started with advocating with the FAA, they had no idea that the capabilities of CGM, like the Dexcom, I use a Dexcom and the ability to basically send real time or reports to them that are uncorruptible. If you use the Dexcom Clarity and you send them a report, there's no way for me to tamper with that. And I can send that to them once a week if they really want it. And they just weren't aware of the capabilities there and some of the technology that's come around. um so you know with that you know i've been working with that organization um and basically have opened up you know all of my medical records and they've actually used um a lot of my cgm data you know my blood glucose values you know i even will put in there some of my various um bike races and you know show them you know what happens during exercise and um and how you can control it and how you can stop a high and stop a low and that type of thing so that they can take those data points and use them in presentations at these aeromedical symposiums to advocate for this because coronary or basically coronary artery issues, diabetes, and a couple various brain and neurologic conditions are kind of the top three issues that are, I guess, in the forefront of the aviation medical field. And, you know, the reason why they're looking so closely now at diabetes isn't so much because of the type 1 gamut, because, you know, as you and most of the listeners know, it's a very small portion of the total number of diabetics, but it's the prevalence of type 2 diabetes and not just type 2 diabetes, but insulin dependent type 2 diabetics. And when you take a look at the statistical data, you know, when you transfer that over into the commercial airline population that's, you know, well in excess of, you know, three or 400,000, it's statistically impossible that those people, you know, that there isn't going to be a portion of that population that's not going to be affected by type 2 particularly. So the angle there is that, you know, if this isn't changed in some degree, you know, there's a potential to, for all intents and purposes decimate the airline population or the airline pilot population because of the rising rates of type 2 diabetes.

[00:36:55] Rob Howe: Wow, that's really interesting. Because, you know, I'm sure you've read the studies and all the numbers point to a rapidly growing percentage of type 2 diabetics, especially in the Western world.

[00:37:12] John Roth: Oh, yeah, it's massive. I mean, some of the numbers I've read is back in the 1950s census, there was something like 1.3 million reported cases of type 2 diabetics. And in the, I believe it was the 2013 census, there was 413 million.

[00:37:32] Rob Howe: Wow. I mean, it's huge. Just the, yeah, the, I think they were saying in, uh, by 2020, one in every three Americans will have some sort of type 2 diabetes complication or pre-diabetes. It was, yeah, just staggering the numbers. So, yeah, I mean, if it's one in three Americans, I mean, if that, some reasonable expectation could be one in three airline pilots, right? So there's got to be some sort of education and legislation adjustment or, like you said, there will be a huge shortage.

[00:38:11] John Roth: Yeah. Yeah, absolutely. And, you know, a little, not to go way off on it, you know, down the rabbit hole, so to speak, but, you know, the premise of the original Code of Federal regulations that prohibits insulin-dependent diabetics was put on the books in 1964. So, you know, as a type 1 diabetic in 1964, I absolutely agree that an insulin dependent diabetic had no business being in a flight deck.

[00:38:46] Rob Howe: Yeah, without a doubt.

[00:38:49] John Roth: You know, and even I think I could even stand behind that argument probably until maybe the last 15 to 20 years because of, you know, the rapid advancements in technology that's occurred. But at this day and age with this technology that we have combined with proper education and knowledge on the part of the user or the pilot in this case, I think it's something that can be done safely. because my entire career has revolved around ensuring safety of the flying public. And when I was instructing, making sure that those that I instructed held the safety of the flying public in the utmost and highest regard. And I wouldn't hesitate for a second to walk away from a 30-year career, 25 year long career if I thought for a second that it was endangering the safety of the people sitting behind me. And I honestly feel like that's not an issue if you're properly controlled and you

[00:39:54] Rob Howe: understand how to manage the disease. And I think that's what's so interesting to me about this particular change that's happening is because, like you said, the pilot's primary function is to ensure the safety of the flying public. And so when you take your own emotions and your own feelings out of the equation and you say, factually, there's still no danger for this person to do this, I think that's a really powerful message to send, not just in this industry, but across others as well. And like you mentioned at the very beginning of the episode, there aren't very many prohibitive spaces for type 1 anymore which is good there are a few still and they make sense military for example I believe is one certain portions certain jobs in the military and I think that's a really strong thing because a kid somewhere can grow up and want to be a pilot it. Um, and you know, like kids do, right. You know, that I think that's still one of the things that you can fall in love with really early. Um, and, and, you know, and still have type 1 diabetes and say, Hey, I, this is still my dream for my life is still possible. So I think, I mean, it's really important. Obviously these things take a lot of time. And I think, especially in the medical world, um, that's something that I've just had to make peace with over the last five to 10 years or so is, you know, when you hear about a piece of research or you hear about a new piece of technology, it's going to take nearly a decade before it's, you know, be able to be used at large by the public. And I imagine that it's similar in this case, but it seems like there's at least some positive momentum because of people like you and different organizations here throughout the world that it's reasonable to say that in the next 10 years or so, we could see

[00:41:57] John Roth: something like this, you know, changed. Right. Yeah. No, I mean, I, I definitely, you know, and that's, that's kind of been our whole focus, you know, you know, I guess to give some folks an idea of what we're up against right now, you know, one, one, one of the flat surgeons is that when they were meeting with the federal air surgeon, they were in a meeting, and they were discussing this issue of insulin-dependent diabetics and type 1s in particular, and the federal air surgeon basically made a comment, I'm paraphrasing a little bit, and they were to say, well, as a type 1 diabetic, but you can't guarantee me that this guy isn't going to be walking down the hall, you know, two minutes from now and have a severe hypoglycemic event and basically go into a seizure. And what if that were to happen in the flight deck and the reply, you know, from the, you know, air surgeon that I'm working with, um, that's advocating for this, um, for, you know, allowing it, his, his comment was to say, well, that's not a very informed, you know, comment because you can't guarantee me that you are not going to have a heart attack walking down those stairs over there right now. So you, you can't say, you know, you can't make those likenesses, you know? Um, and, and, and his, you know, further reply to that was when it comes to diabetes with the technology that we have now, you know, with, you know, CGMs and as long as you're, you know, how to, you know, um, uh, we are working and recognize it correctly and use it, you know, correctly, you're, you almost have far more, uh, you know, a far greater safety margin than other, you know, types of issues, you know? Um, so it's, it's definitely an uphill battle and, and it's kind of getting rid of some of the stigma, um, behind it. And on a kind of final note regarding the FAA, they, they themselves put together a medical review board in 2013 to basically, you know, of which had people from the ADA on there, some of their own flight surgeons, a number of practicing endocrinologists, and some general practitioners to basically come up with a final ruling to say, is this something that we should even consider? And at the time, the FAA on the medical branch was biased, and they basically did this thinking that this medical review board was going to just crush it and say, no, this is completely preposterous. They have no business being in a flight deck. Well, the medical professionals actually came up with recommendations at the absolute farthest end of that, which means to say they came up with a system and a set of criteria and recommended that if a diabetic type 1 or type 2 can maintain these parameters and is well controlled, can prove it through their endocrinologist and has their, you know, data to back it up, you know, there's absolutely no reason why they shouldn't be allowed to continue. And they kind of were taken aback by that. And that's one of the things that we're, you know, directing them towards to say your own medical review committee, you know, you know, said that this should is safe under these parameters. So why can't we move forward with this. Well, and I think like you said at the very beginning of the episode,

[00:45:38] Rob Howe: this is a lot about education and put ourselves, take type 1 diabetes out of our immediate circumstances and we would be in the same position as some of these other people. A lot of times I see a lot of emotional rants and posts from people in the type 1 online community especially. And, you know, sometimes it's hard to remove yourself and remember that you used to not know anything about this. Oh, yeah. And, you know, you would pass somebody on the street and not give a second thought. You know, if you saw them testing their blood sugar or, you know, with an insulin pump, you wouldn't know any of the day to day details. So, you know, I think having a little bit of patience with even with these experts and, you know, people who hold a lot of power and influence, you know, it's a different it's a new thing to them. And, you know, they obviously don't have the the personal interest that we all had when it was introduced to us to learn it. So it takes even more time at some time. So it's, you know, it's it's interesting to see, you know, it come into the public eye. on one hand you know it's a little bit it's it's disheartening to me that there are more type ones than there ever have been but the but then i think the only reason that that is is because we're living longer we're able to diagnose it earlier and there's more treatment options so people aren't dying of you know whatever they thought they were dying of before sure and so which which i think is encouraging and and so you know now that there are more of us and there's a little bit more bigger mouthpieces in the community and better organizations focused on education and advocacy, we're able to get a little bit more publicity and change some things.

[00:47:22] John Roth: Yeah, absolutely. And folks that I work with, they always kind of joke that I'm one of the fittest people in the building and yet I'm the only one in the building that doesn't have a medical. And they say, friends of mine, they say, man, how do you not get frustrated and, you know, I guess upset with this. And I said, well, there are definitely days when I get frustrated, but not because it's like it comes from a position of anger or, you know, malice or anything like that. It's just because, you know, I miss doing what I want to do, you know, as a career. But on the other hand, you know, it's like you said, you have to have that perspective of the people who are in these positions, they just don't know you know they they just they they don't they've never had to deal with it you know and until we take the time to try and educate and expand their knowledge you know that's where your energy is best spent not you know like you said becoming um adversarial or you know um rattling the saber so to speak you know you you know you're you just need to you know, put your efforts and your energy into, um, what can be done positively to move forward, you know?

[00:48:46] Rob Howe: Yeah. And I think that's the most important thing, you know, to, to keep in mind if you're, you know, out there as a, as a type 1 or a parent of a type 1 or somebody who's advocating for more education is to just take a step back sometimes and just realize that, um, You know, this is a new thing and it takes time and, you know, every conversation makes a difference just one at a time, you know, to change the perspective overall. It's, you know, the work. I'm really glad that there are people doing work that like that you're doing that we would never necessarily hear about. It's not highly publicized, but I'm happy that we have the opportunity as a community to get behind it and know that there are people advocating for, you know, type ones to do what they want to do and live the lives that they want to live. And, you know, hopefully before long, those things will get those obstacles will get moved out of the way and they'll be able to do it.

[00:49:46] John Roth: Right. Absolutely.

[00:49:47] Rob Howe: Do you long for the day This is your captain speaking Is that going to be Your peak moment Your Olympic medal Whatever That Everest for you

[00:50:05] John Roth: I guess On a You know for my own Selfish purposes Sure But I think It will also have a lot more, I guess, it'll mean more than that to me to say, you know, something significant has been accomplished here and it's opening up doors for, you know, people currently in my condition, which there's 11 that I know of that were current airline pilots and were diagnosed late after they were already at an airline. But it will also open up the doorway for more transparency and more honesty amongst pilots in the FAA and actually serve to increase, you know, safety and transparency, which, you know, I think is, you know, a best case scenario.

[00:51:03] Rob Howe: Oh, totally. Totally agree.

[00:51:06] John Roth: so yeah and it's it yeah you know but that that would definitely you know it would be it would be great you know um and it's just one of those things where you know i just have to you know be patient and be thankful that you know um i i do have the position with the company that that i'm at and so you know if we move forward on this it's literally going to be an issue of you know a matter of weeks and I'll be back in the flight deck. Um, and that would be, you know, great, but you know, that's, that's the long game, so to speak, you know, like the short game is, is like, you know, and that's why I've kind of turned to, um, doing a few of the podcasts, you know, I, I just, I want to get the word out to people to be proactive with their own treatment and care and to, and, you know, I don't know how much time we have left, but, you know, just some of the techniques or things that I use to, you know, try and ensure, you know, your own health, you know, you have to take ownership of this and no one or no piece of technology is going to do it for you, you know, and.

[00:52:18] Rob Howe: Well, with that, with that in mind, what are some of those things that you, you know, some tactics, so to speak, that you use to take control? Well, you know, before I was diagnosed,

[00:52:32] John Roth: you know, it was, you know, I had a minor in sports nutrition and physiology and so on. And, you know, kind of started to go back and look at some of those facets in more detail once I was diagnosed. And, you know, of course, came to understand that, you know, diabetes is a disease of not just blood glucose, but insulin control and hormonal control and how all those factors, you know, play into your body chemistry. And so as I started to do more research, you know, I started to look more and more closely at, you know, how diet can be used to add stability to a type 1 diabetic. and I've kind of found my way into basically not really the ketogenic type diets, but a very low carbohydrate, higher fat, moderate protein diet approach. I've kind of honed in on that more and more throughout the last three years. in the last year, I've been fully on to what Vinnie Tortorich talks about is no sugars, no grains. We don't eat any grains. There's tremendous health effects for even non-diabetics, of course, but the ramifications on what I've seen on my own control of diabetes is that it's had a massively positive effect on it. Um, and, uh, yeah, I mean, you know, just removing the vast majority of carbohydrates, you know, like I, I usually stay below 50 grams of carbohydrates a day. Sometimes if I'm really active or doing a mountain bike race or out backpacking or something like that, yeah, I might bring it up to 80 or so, or, you know, maybe even a hundred, but, um, It's kind of that idea of I like to deal with hills instead of mountains if possible. So with blood glucose control, if you're dealing with 20 grams of carbohydrates, that's a lot smaller of a potential hill than 80 grams of carbohydrates. You know what I mean?

[00:54:51] Rob Howe: Yeah, and I find personally riding those hills rather than the mountains, like you say, I have better energy throughout the day. Oh, yeah. Whether I'm whether I've worked out that day or not, I work out pretty consistently three days a week. And on my off days, I eat less carbs. And, you know, just man, it changed my life. Like the way that I, you know, when I was an athlete, I was young. So I ate a lot of crap. and you know sometimes i think man if i had just like applied any of the actual things that some of my nutritionists would tell me maybe i would have been in uh you know made better strides in my career in terms of conditionings but that's neither here nor there but now you know in the last couple years experimenting with whole 30 and no sugar no sugar no grain type ketogenic thinking and now kind of dipping into intermittent fasting a little bit and still eating the no the low carb, um, you know, whole food type diet, no grain. And, you know, it sounds really boring sometimes, but man, I just feel so much better. It's just a marked difference. And, um, I would encourage anybody to, you know, to go down that path and find something that they like, uh, because there's so many different plans now, uh, you know, that are easy to follow and have tons of communities of their own that you can connect with. Um, and I, you know, I was just talking to my girlfriend the other day. There's so many, three years ago, you did a whole 30, you had to make every single meal yourself, but now there are multiple services that you can order meals and get them delivered or whatever the case is. And, you know, make, just makes it easier on you. It's, it's good stuff. Um, yeah. And I'm a huge believer in, uh, you know, that type of Vinnie Tortorich style, uh,

[00:56:38] John Roth: diet planning. Sure. And, you know, there's just, there's, there's a lot of out there, you know, and, you know, there, there's also a lot of bad information out there too. You know, there, you really have to take the initiative to, you know, get good sources of information and then, you know, figure out what works for you. Um, you know, but just across the board, you know, I'm a huge, and even on the, you know, American Diabetes Association, they, they've recently put this on the website from what I can tell. They even mentioned, you know, the lower carbohydrate type diets, you know, and, you know, right from the get go, I just kind of, it made sense to me to say, well, if carbohydrates make your blood sugar go up, and if the type of carbohydrates, you know, kind of can determine how rapidly it goes up. Well, if you start removing some of those from your diet, wouldn't it make this constant tug of insulin and, you know, carbohydrate load easier? I don't know if easy is the best way, but more manageable, I guess. Yeah. You know, and it just started to make sense. And I've, you know, seen those positive things, you know, you know, like on the Dexcom clarity reports, you know, like, if I pull mine, And consistently for the last over a year and a half, I'm in range about 93% to 98% of the time. And my range is 70% to 120%. That's pretty impressive.

[00:58:13] Rob Howe: That's proof in the pudding right there, man.

[00:58:16] John Roth: Right. And I don't say that to be braggadocious or anything. I more say it as I have the numbers to say, look, this works. and it's not to like be come from a standpoint of I'm right you're wrong but I get so you know I have to bite my tongue out of these Facebook groups because you see so many people out there that the Dexcom graph of just their blood sugar is moving so rapidly that the Dexcom can't even keep up with it you know it just and and they're they're asking for help and yet the information sometimes they're getting from some medical professionals and, and, and some just general bad information or, you know, dogma that's been around for a while is making their life so frustrating. And I just, that's kind of why I've wanted to go and start doing a few podcasts if possible to just get that word out there so that people can go and start looking around for other options that will alleviate some of that burnout and stress that we all, you know, deal with.

[00:59:23] Rob Howe: It is. And I, you know, diabetes burnout is tough because it's so psychological as well as as well as physical. And I think sometimes those, you know, Facebook groups or Instagram contribute to that a little bit because, you know, you see a lot of diabetes. and you know sometimes that's good and I think a lot of times it can be but sometimes it's tough too and you know I was kind of curating and I did some selective unfollowing and it was nothing personal for some people but I just had to get some diabetes out of my feeds because you know I'm a person too and I was like if this gives me a negative feeling I need to kind of just need to get it away from you and cleanse it a little bit. And, uh, and yeah, that, I mean, it, it helped. I had to remind me that, you know, I, they're, I'm doing this to help people. Um, but you talked a little bit about ownership earlier and you got to take some of that for yourself as well, because if you don't, who else will? Um, sure. And, you know, I think that's a big thing for, um, for people in those groups and just, that's just a general, um, you know, if I had to give somebody one piece of advice and I'm going to ask you what that, what you would say to someone in a second, but use your voice and speak up and ask for help, but also get involved. Do your, do your research, study your maps and, and you find what works for you because you can find something that works for you. There is something out there, no matter who you are, no matter what you like, no matter what you like to do, there is a solution out there for you to live well with diabetes. And I just believe that. So, you know, whatever that is, use your voice, speak up and find it. So now, because my question that I always ask everyone takes place in an airport, I get to at least rib myself a little bit over here and kind of laugh behind the scenes. So picture yourself in an airport, which I'm sure has happened before. They're going to shut the door to your gate In 30 seconds and for whatever reason Maybe it's you're flying the plane You can't miss this flight But you run into somebody Who's either been recently diagnosed Or is struggling with their type 1 And you You have 30 seconds to tell them What's the one thing that you tell them

[01:01:52] John Roth: Okay Yeah there's so much You know um, but yeah, I wouldn't say it's a tough one, but it's just one of the things where, you know, there's so many things you'd like to say, but I would just, uh, you know, let them know that if they take the initiative and, you know, um, you know, just take the initiative to educate themselves, it will get better, you know, if they're struggling and it will get better and that they just have to, you know, the old phrase, stay the course, you know, um, keep those blood glucose values in check, you know, educate yourself, um, and look, you know, play the long game, so to speak, um, look for your long-term health and, you know, Don't become too defeated by occasional frustrations that are involved with diabetes. And don't let it become overwhelming in your life. and just let them know that if you can understand it and control it, it will become less of a portion of your life so that you can enjoy everything else that life has to offer. And in that same time frame, I'd probably be writing my name, phone number, and email down and said, you know I gotta go now but in two hours I'll be on the ground again and if you ever have any questions please feel free to get in touch

[01:03:39] Rob Howe: with me I love it yeah there's a there's a couple ways people answer that question and you almost really hit all three so I love it they either give one quick piece of advice they you know either missed maybe missed the flight I've had a couple people say I'll just get another one and then they leave their contact information. So hit two out of three. Really loved all that. That's very true. And I think sometimes, especially the part about not letting it overwhelm you, which is easy to do. And sometimes I got to remind myself of that as well.

[01:04:14] John Roth: Yeah, yeah.

[01:04:15] Rob Howe: John, thank you so much for coming on the show, my friend. And I really think I'm going to invite you back when you make that first flight or when that FAA legislation gets changed. I'm just believing that. So whenever that is, I imagine I'll still be doing some sort of diabetes related stuff. So let's make it happen.

[01:04:35] John Roth: Absolutely.

[01:04:36] Rob Howe: Cool. For anybody that wants to connect with you online, are you involved in social media of any kind? Is it an email? What's the best way to get in touch?

[01:04:46] John Roth: Yeah. So I actually have just recently in the last six months do Twitter. However, do keep in mind that I'm not a professional Twitterer. whatever you want to call it. Great. So it's just a capital T, one capital D flyer is my Twitter. And then, yeah, the email, my email that you have, if you want to include that with the show notes.

[01:05:18] Rob Howe: Definitely will.

[01:05:19] John Roth: You know, again, just do keep in mind that, you know, I have another job outside of, you know, outside of this gamut. So hopefully I don't get bombarded, but I'll do my best to get in touch with folks if they have any questions. And, yeah, you know, I'll do the best I can to help you and, you know, just let people know what's worked for me and, you know, hopefully help out some folks that are, you know, wanting to have questions about, you know, diet, nutrition, exercise, you know, do a lot of endurance stuff and strength training. So, yeah, feel free to get in touch with me.

[01:05:59] Rob Howe: Definitely will. Thanks, John. I appreciate your time and for coming on and great insights. And we'll be in touch.

[01:06:07] John Roth: All right, great. I appreciate it.