Valuable Tips To Help Drivers Pass Their DOT/CDL Physical: Advice From A Certified DOT Medical Examiner
Help Your Drivers Pass Their DOT Physical Exam
In addition to being a Transportation Lawyer, I also am a practicing Medical Doctor and Certified DOT Medical Examiner. Therefore, I am happy to share this information with my readers so they can help their drivers and themselves get past the DOT/CDL physical exam (hopefully for a 2 year certificate).
Even in the best of circumstances, truck driving is a stressful job, and unfortunately, truck drivers have higher rates of medical problems such as diabetes, high blood pressure, obesity, cardiovascular disease, etc. than the average population. In this day and age where it is hard to find qualified commercial drivers, anything trucking companies can do to help drivers get through their DOT physical exam is unquestionably valuable. Therefore, I am writing this article to help drivers get through the process.
Is your personal physician a certified DOT medical examiner?
As much as I would be honored to perform your DOT physical, the reality is I probably don’t know you as a patient, and you probably don’t know me as a doctor. If your personal physician is certified to perform DOT physicals, I think it’s a good idea to have them perform the evaluation. Your personal doctor should know everything about you to help streamline the process. In the event that is not possible, let’s discuss some important points to help you get that two-year certificate.
So what are DOT examiners concerned about?
DOT physical examinations focus on blood pressure, diabetes, and cardiovascular, respiratory, neurological, and musculoskeletal systems. There is also some attention given to psychological disorders, drug abuse and alcoholism, and medication and drug use.
Let’s Keep That Blood Pressure Under Control!
Blood pressure is definitely one of the biggest reasons drivers either fail the exam outright or get a restricted permit. My suggestion is to avoid caffeine, energy drinks, over-the-counter cold medication (including pseudoephedrine which can be obtained without a prescription) for at least 24 to 48 hours before the examination. Indeed, excessive caffeine, energy drinks, and certain cold medications (think “decongestants” especially) can raise blood pressure 20 to 30 points. That means a patient with a blood pressure of 120/80 (normal) can end up with a pressure of 140-150/100-110. Now you have to worry about getting a restricted license. If your blood pressure was 140/90, these products could make it rise to 160/110 and now you are disqualified.
Here is another tip on blood pressure: avoid eating salty foods for at least 48 to 72 hours prior to your examination, and make sure you are well hydrated before the exam (drink plenty of water for a few days before your exam). This will lower sodium levels – good because sodium can elevate blood pressure. Also, potassium rich foods like bananas can help lower blood pressure.
If you are on blood pressure medication, make sure you take your medication as directed for at least seven days prior to your evaluation, and especially take it the morning of your exam. Of course, you should always take your medication as directed, but this is especially true heading into a DOT Physical Exam.
Stay calm and don’t talk while your blood pressure is being checked. If you are stressed or talking while your blood pressure is being checked, it may be falsely elevated.
Keep your body in a relaxed and neutral position while your blood pressure is being tested. Do not cross your legs and keep your back straight and relaxed against the back of the chair.
Make sure the blood pressure is not checked with the cuff over your clothes. Also, if you are a big person, you may require a large blood pressure cuff.
Finally, here’s a little trick I have learned to help reduce a blood pressure reading: Close your eyes and relax and take very slow and very deep breaths in and out while your blood pressure is being checked.
Also, having a full bladder can elevate blood pressure. Therefore, always request that your urine test to be done before your blood pressure checked. If I’m the doctor doing your physical, I will make sure my clinic staff accommodates this request. The Urine Test (usually a dipstick) checks for Protein, Sugar or Blood in the urine which may be an indication for further testing to rule out any underlying medical problems. We do not test for drugs in a DOT physical exam (however – your employer can separately require a drug test which you cannot refuse if you want to drive).
Here’s the lowdown on the DOT blood pressure rules:
Prehypertension: Prehypertension blood pressure is 120-139 systolic and/or 80-89 diastolic. Prehypertension blood pressure readings will also certify you for a two year period.
Stage 1 Hypertension: If you have hypertension blood pressure you will be medically certified for one year. Stage 1 hypertension blood pressure is blood pressure of 140-159 systolic and/or 90-99 diastolic. If you have stage 1 hypertension blood pressure you will have to test every year or until you get it into the prehypertension or normal range.
Stage 2 Hypertension: If you have stage 2 hypertension you will be given a one time medical certification of three months. Stage 2 hypertension is between 160-179 systolic and 100-109 diastolic. You will be given a three month certificate so that you have time to lower your blood to the prehypertension or normal range.
Stage 3 Hypertension: If you have stage 3 hypertension you are disqualified. Stage 3 hypertension corresponds to greater than 180 systolic and 110 or more diastolic. You will not be allowed to drive a commercial vehicle until you get your blood pressure into the prehypertension or normal range.
Do you really need that cigarette?
Tobacco use can result in a failure. And for that matter, vaping is not much, if at all, better. Nicotine is a potent cardiovascular stimulant, and is a chemical known to raise pulse and blood pressure. Also, smoking can adversely affect your lung function (duh) , possibly to the point where you may be restricted or fail because your lungs simply aren’t up to the job of getting adequate oxygen from the air into your bloodstream. Ideally, if you can can quit smoking for 30 days prior to your exam, you’ll improve your chances of passing the examination. Smoking and Nicotine is bad for your examination and bad for you. Quit!
And while your at it, avoid alcohol too
Alcohol can raise blood pressure and have a profound effect on metabolism – avoid it for as long as possible before an exam.
Keep those lungs working.
If you are asthmatic or have COPD, make sure you are taking your medications as directed so when the doctor listens to your lungs, hopefully all he or she will hear is air moving in and out of the lungs clearly. If the doctor hears wheezing, congestion, or anything that would suggest inadequate or poor lung function, you could end up with a restricted permit or failing. Furthermore, if your asthma or COPD is not well treated, your blood oxygen levels (checked by a Pulse Oximeter in our office) could be diminished to the point of failing your exam or requiring further testing.
Speaking of breathing, if you use a CPAP machine, Bring your CPAP machine to the exam and a compliance letter from your doctor. Sleep apnea is a big deal for commercial drivers, and has been blamed on numerous fatal accidents. If you have sleep apnea, make sure you can convince the doctor that your sleep apnea is under control and won’t affect your ability to drive.
Bring your prescriptions and recent lab work.
It is always a good idea to bring your medications in their original bottles to the DOT exam to show the doctor. If you are being treated for an unusual illness, a letter from your doctor stating that you are compliant with treatment can be very helpful. Bringing copies of recent lab tests is very helpful.
If you have serious health conditions, bring the name and contact information for the doctor who treats you for each condition. Medical conditions like hypertension, diabetes or sleep apnea often require additional paperwork such as sleep test results or stress test results.
Don’t overeat before your exam.
A big meal, especially one with lots of sugar or starch, can result in spilling of sugar into your urine. This is especially true if you are diabetic. If sugar is detected in your urine, you’ll probably need a blood sugar test and a Hemoglobin A1C test by your family doctor. This may result in disqualification pending treatment or a restricted permit.
So eat a light, low calorie, low salt diet for at least one week prior to your exam. I recommend that you eat and drink as healthfully as possible for one week before your exam. This also means reducing or cutting out caffeine, salt, sugar and junk food. You are what you eat – healthy living is good for you and your DOT Exam will reflect that.
Now is not the time for Non-compliance
Take all of your medications as directed, and preferably on a regular schedule. Also make sure you do not run out of prescribed medications before your physical exam. Sudden withdrawl of a medication can affect your test.
Make sure your contact lenses or glasses are up to date, and obviously bring them with you to the physical.
Now is the time to see clearly
At least 20/40 vision in both eyes is required with or without corrective lenses. At least a 70 degree field of vision in horizontal meridian measured in each eye. Also, if you wear contact lenses or glasses it will be noted by the medical examiner.
Do You Hear Me?
You will pass the hearing test if you can hear a forced whisper from 5 ft. away in your better ear with or without the use of a hearing aid/device or your average hearing loss is less than 40 dB in your better ear with or without a hearing aid
Try to relax.
Going to a clinic for a DOT physical sucks. While I go out of my way to make it as pleasant as possible for drivers, I realize it is still a hassle. Therefore, try to get a good night’s rest before your physical. Also, try to get to your appointment a little bit early so you’re not stressed about running late. I do my best to make sure scheduled DOT physicals are performed on time. That said, sometimes, despite our best efforts, we run a little behind. Try to stay relaxed while waiting: Bring a good book, practice a little meditation, or use one of the relaxation apps which are easily obtained on a smart phone. This will help pass the time if you have to wait.
Don’t Go To Your DOT Exam when you are sick.
If your allergies are acting up or if you have a cold, try to hold off on having your DOT physical until the allergies are controlled or your cold is resolved. Having a cold or bad allergies can make your vision blurry and affect other aspects of your exam. Similarly, if you are on antibiotics for an infection, try to hold off on the exam until you have completed your antibiotics and the infection is resolved.
Goldilocks would appreciate this advice:
Don’t let yourself get too cold or too hot. Cold temperatures can also negatively affect your vision and blood pressure. If the office is cold, it’s a good idea to bring in a jacket with you while you’re waiting for your exam. Again, you don’t want to be too hot or too cold, but “just right”.
Call The Clinic To set up your DOT exams (for individuals or the whole company)
If you want me to perform your DOT physical or DOT physicals for your trucking company, please contact Mary Kidwell at Meridian Urgent Care at 760-242 -7707. The good folks at Meridian can set you up with in-clinic appointments in our High Desert clinics (Hesperia, Apple Valley or Barstow) or can arrange for on-site DOT exams. I would be happy and honored to help you, your company and your drivers through the process.
Sincerely, G. Spencer Mynko, M.D., J.D.