CMV DRIVER GUIDANCE REGARDING MEDICAL CERTIFICATION

When you are provided a license to driver a commercial vehicle (Class A or Class B licenses) you are essentially, thereafter, a professional driver. But that license is not a pat on the back or an award. It is more like a thumb on your back, with the licensing agency saying, “Conduct yourself as we want you to, or we will just pull your license and shut you down.” In order to maintain a commercial driver license (whether it is fair or not) you are required to be fit. This may not have occurred to you previously, but this effectively makes fitness a professional obligation, essentially, it is now part of your job. For first responders or RV drivers or anyone else required to be medically certified, this information is still important for you, as well.

I think it is important to remember why there is a physical certification. The purpose is to make the driver aware of any health issues that could, without prior awareness or warning, suddenly render him unconscious or otherwise unable to safely drive. The truth is, I don’t want my wife or children to be sharing the road with someone suffering from a unknown health threat that is like a ticking time bomb just waiting to let go. And I know that NOBODY wants to be that driver, either. But the statistics for commercial vehicle crashes dictated the need for this process to ensure that drivers get the medical treatment they need to continue to safely perform this critically important job.

Now, I have professional licenses as well, each with its own renewal requirements, that I have to fulfill just like you do. From my own experience, my best recommendation is that you try to over-achieve when it comes to meeting the requirements for license renewal. Don’t ever allow yourself to try to “get by” the medical re-certification requirement or else you will just create a lot of unnecessary stress for yourself and could easily end up in a last minute urgent fire drill if there is anything that presents as a problem during the certification exam that you weren’t already aware of.

So, if you accept that fitness is part of your job, then, really, you should be getting a regular checkup with a primary MD on some recurring basis. And, if you are going to do that, then it would make a LOT of sense to time that checkup to occur about a month or 90 days before your current physical certificate is due to expire. This way, you get to find out about any problems that you aren’t aware of in time for your doctor to do something about it before you find yourself disqualifed by the medical examiner. Basically, with some planning, you have an opportunity to put it all in your doctor’s lap and ask him to “do his job” and help you address any health issues so that you pass your upcoming exam. Just tell them, “Hey doctor, I have a DOT physical coming up in the next month or so and I wanted to make sure I am good to go since this is my living. Please make sure …

That I DO HAVE

  1. An FMCSA prescription form completed for any current medications to bring to my certification exam in case that examiner is not trained in pharmacology (e.g. chiropractor).
  2. The ability to see 20/40 or better in both eyes together AND from each eye individually (either with or without corrective lenses is fine). Note: If you are even close, you should take this opportunity to see an eye doctor and get prescription lenses. You may not need a license restriction to wear them, but that doesn’t mean you shouldn’t have them anyway. And you will have this taken care of in case you have a “bad eye” day during your certification exam.
  3. Blood pressure lower than 140 over 90 (both must be lower)
  4. The ability to hear a forced whisper from over 5 feet away (either with or without hearing aids is fine).

IMPORTANT: you have to have items 2, 3 & 4 at all times in order to be certified or to remain certified. If any of these are not the case for you, you must notify your employer immediately and stop driving until you can be re-certified after appropriate treatment.

And that I DON’T HAVE

  1. either of my ears obstructed with ear wax (if so, or if not sure, get some Dobrox, or equivalent, at Target and clean your ears before your certification exam).
  2. any unexplained heart murmurs or abnormal heart sounds
  3. any abnormal lung sounds
  4. any blood, protein or sugar in my urine
  5. any physical limitations or other conditions which may not be managed properly.

If there are other items that the doctor finds or already knows about, which might raise questions with a screening examiner, but which they feel would NOT compromise your ability to safely perform the duties of a commercial vehicle driver, go ahead and ask them to write a note on office letterhead as to his findings to provide to the FMCSA examiner.

Finally, I want to go over things you can do to naturally lower your blood pressure readings at the time of your DOT physical exam. You can’t fake normal blood pressure, but you can affect it…

  1. Regular Exercise – Start exercising if you aren’t already. Begin by walking 30 minutes per day and increasing your speed until you get up to about 2 miles in 30 minutes. Below are some exercises specifically found to be effective for lowering blood pressure
    1. Train the diaphragm – Use a breathing trainer (available on Amazon for as little as $30) to exercise your diaphragm with inspiratory exercises, 30 inhales at a time, twice a day. The diaphragm’s whole job is to manage the pressure in your chest (thoracic pressure) to facilitate breathing. The heart and lungs are both integrally affected by thoracic pressure changes that diaphragmatic function produces. In a small 2019 study, those doing these breathing exercises enjoyed a 10 mm Hg drop in systolic blood pressure while those that did not had no change at all.
    2. Isometric exercise – Do isometric exercise (meaning contracting muscles without movement), such as something so simple as the daily clenching of both fists for two minutes followed by a 3 minute rest and repeated 3 more times . You don’t even need to squeeze hard as the 1992 study that used this approach demonstrated a reduction in blood pressure with the participants only contracting 30% of their capacity. Several studies since the 1992 have demonstrated improvements of 12 to 15 mm Hg in blood pressure resulting from isometric exercise.
    3. Stretches – Perform stretches of the calves, quads and hamstring muscles. A 2020 study concluded that this causes a stretch of the arteries triggering remodeling of the inner lining of those arteries and improvement in their production of nitric oxide, better allowing them to normally relax, and significantly improving the participants’ blood pressure.
  2. Quit Smoking – at the very least, don’t smoke the day of your exam as nicotine interferes with blood vessel function and jacks up blood pressure.
  3. Switch to Decaf – decaffeinated coffee is not healthier than caffeinated coffee. But coffee will raise your blood pressure. So if you don’t drink a lot of coffee, just quit until after your exam so you aren’t feeling “off” on the day of your exam because you didn’t drink any. If you do absolutely need to drink coffee, then switch to decaf until after your exam.
  4. Cut the Alcohol – If you are drinking beer, wine or spirits daily, this is a low hanging fruit. Stopping for sever weeks will unload the liver, reduce your calorie intake and improve your hydration level as well.
  5. Hydrate like you mean it – drink lots of water. This will help kidney function and that will help maintain normal blood pressure. Water is great for every organ system, so this is a good practice all the time. But make sure you aren’t getting caffeine from even the non-alcoholic things you shouldn’t be consuming, like sodas, energy drinks, etc. Those are bad news, too.
  6. Get plenty of sleep – Go to bed early the night before your exam. Trying to perform with a sleep deficit can raise blood pressure. In general, you should do everything you can (a different subject completely) to get a minimum of 7 hours of sleep per night. 8 hours is ideal but anywhere from 7 to 9 hours is great.
  7. Practice – Don’t come in blind. You should know before you show up for a certification physical if you have a blood pressure problem. If you didn’t get the checkup I recommended above in time before your exam, at least go get your blood pressure checked. If you go to a pharmacy, they will often have self service blood pressure machines for you to check out where you are. You can even practice some biofeedback to see if you can lower it with the way you breath, or meditate, or relax, or whatever. Every little bit helps.
  8. Empty your Bladder – you will need to provide a urine specimen for your exam. But try to have your blood pressure taken AFTER you have provided your urine sample as a full bladder can increase blood pressure.
  9. Bring a sweater and dress in layers – blood pressure can be affected by the stress of being too hot or too cold. Plan ahead and bring something warm in case you are cold in the exam room.
  10. Be quiet – while the pressure is being checked, relax completely, and don’t talk or laugh. Close your eyes and pretend you are dozing off after a big lunch.
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