3rd class with spinal cord stimulator?

K

Kallyjk

Filing Flight Plan
Joined
Aug 22, 2015
Messages
12
Display Name
Display name:
kallyjk
So I can't seem to find anything online that will answer my question. I am trying to get everything in order for my exam, but cannot find anything on neuro stimulation. I have a spinal cord stimulator implanted that helps manage some nerve pain in my legs. I don't need it all the time, just when my legs get to really hurting. There is no medication involved, I don't use it when driving, etc.

Anyone have any insight on this or could point me where to start looking or who to ask?
 
One of the best folks to consult with is Dr. Bruce Chien of Peoria, Ill. (www.aeromedicaldoc.com)

Dr. Bruce is well known for helping with "challenging cases) and helping the airmen to achieve their medical with minimum fuss and delay.
 
Does the device (or the pain) handicap you in any way?

Presumably the answer is "no". Therefore, if you're fully able bodied, and the device induces no impairment, why would you be unable to get a 3rd class medical?

If the answer is "yes", all bets are off.
 
No impairment from the device, it helps with the impairment. Just trying to be prepared when I walk in for my exam so I don't stumble into any hiccups or questions I can't answer.
 
You will be deferred and then denied. When I retired in 2010 I was one of only two AMEs in the system who was a board certified implanter (of all 3 brands of spinal devices). The index case was a 757 captain who, after 3 back surgeries, was finally gotten off all the dope and brain c_ap, with the install of a DCS. He was again functional, but was denied. When I inquired I was informed that Dr. Tilton denied it because of the black box warning from both Medtronic and St. Jude, "Do not operate a motor vehicle when this device is operational". His denial withstood NTSB challenge.

Now all the implanters know, and that this is a sensory device only (even though electrode arrays do migrate some-but if well implanted, NOT suddenly to the motor locations) and that in the lumbar location (n=~110,000) we still do not have a single motor vehicle accident attributed to a dorsal column device. But is is far more complex than Mr Honeck would make you believe. We all know that that black box was a "liability dodge" and EVERY patient I ever implanted, when told about the label would respond, "are you kidding me- that's why I have the device!!"

But the authorities are not to be moved.
I would not go for any flight physical with this device present. I would wait for any hint of success of PBOR-2.
 
(Thanks, Dr. Bruce for providing this information)

Kalmyk, one important bit to take away is that, if you do apply for the medical and are denied, this removes just about all of your opportunities to fly a powered aircraft*. Forever. So take Dr. Bruce's advice and don't apply.

*there are a few exceptions such as single seat ultralight. But if your aim is to fly 2 seat or larger aircraft, a denial will end that dream quickly.
 
Well ouch. Never really thought about this causing an issue. Talk about a dream killer.
 
Learn to fly gliders. More fun than virtually anything else that flies, in the long run far cheaper, and you only need to certify you are healthy enough to fly.
If the rules ever change and you are allowed to fly power planes, the transition should be easy, since gliding teaches you the basics of flight and you'll be better than many pilots who have never experienced powerless flight.
 
RotorDude said:
Learn to fly gliders. More fun than virtually anything else that flies, in the long run far cheaper, and you only need to certify you are healthy enough to fly.
If the rules ever change and you are allowed to fly power planes, the transition should be easy, since gliding teaches you the basics of flight and you'll be better than many pilots who have never experienced powerless flight.
Click to expand...

As a glider instructor and after reading Doc Bruce's post, I would want more information. What happens if the devices fails, incapacitating pain? Or what if it over stimulates? Would I end up with a student that could not complete a landing or not be able to get out of the aircraft?

Becomes critical if solo, there is no curb to pull over to and let the pain subside before landing.
 
BillTIZ said:
As a glider instructor and after reading Doc Bruce's post, I would want more information. What happens if the devices fails, incapacitating pain? Or what if it over stimulates? Would I end up with a student that could not complete a landing or not be able to get out of the aircraft?

Becomes critical if solo, there is no curb to pull over to and let the pain subside before landing.
Click to expand...

I agree with all that, of course. And you forgot to mention that, as a tow pilot, you wouldn't want the tow-ee to suddenly pitch up in pain (or device malfunction) and slam you into the ground. So it boils down to the pilot's real health and sudden incapacitation risk, and it sounded as if Dr. Bruce, who has installed many of these devices and knows a thing or two about flying and health, personally thinks it's safe. But certainly IMSAFE still applies, as always.
And maybe he should stick to winch tows. :)
 
I don't really have a sudden incapacitation risk. I can turn the stimulator off and on at will. There is a small remote I carry and can turn it on/off, turn the power up/down etc. I have never had it on while driving, even though I'm told most people don't abide by that. I have had it on in the car as a passenger and have never had a single issue with it hitting bumps etc.

If I have it off I am still physically capable performing every task I would with it on, or even if I didn't have it. We opted to go this route because it wasn't drugs. Using drugs to maintain back/leg pain is a slippery slope and very easy to end up addicted, as I did. My condition has improved over the years, but not completely gone, hence keeping the stimulator for when I need it instead of taking drugs when I need them.
 
So what should a guy in his position do? What if the device is removed? Are there other options? RF neurolysis? I guess it depends on the origin of the problem but lots of guys have low back pain so lots of guys may benefit from more information.
 
Kallyjk said:
I don't really have a sudden incapacitation risk. I can turn the stimulator off and on at will. There is a small remote I carry and can turn it on/off, turn the power up/down etc. I have never had it on while driving, even though I'm told most people don't abide by that. I have had it on in the car as a passenger and have never had a single issue with it hitting bumps etc.
...
Using drugs to maintain back/leg pain is a slippery slope and very easy to end up addicted, as I did.
Click to expand...
That's likely to be a big issue for the FAA as well if there is documentation of this.

In any case, what do you want to do as a pilot? Travel far and fast with the whole family? Or, just be able to get up and enjoy the sky?
Are you aware of the Sport Pilot option and it's privileges / limitations?
 
I have looked into Sport Pilot, and while it might fit part of my goals of simply flying, it wouldn't accommodate my main mission.
 
Sorry forgot that part. I have a family of 5, so small vacations, day/weekend trips to airports in the mountains of VA, trips to dc, and an occasional flight from VA to WI or MN to visit family. Along with having others experience flying with me, taking friends up and joining EAA to fly young eagle flights, Angel Flights, etc.

Eventually, I want the ability to fly wherever my children might move to visit. That could be done with a sport pilot in retirement, but I'm still at least 8 years from he last kid reaching 18 and being able to travel with only two seats.

Also, to be able to take my dad to our families cabin in Alaska.
 
Last edited:
So I called the office of Harriet Lester, the Eastern Regional Flight Surgeon. I proposed the scenario of getting a spinal cord stimulator implant and how would that affect a third class medical. The lady I talked with said that it would affect it some, as I would need to have a letter from my doctor explaining why I needed it, what it was to correct, etc. Also a current status report would be needed. Not sure if that falls under the same letter from the doctor or not.

She said she had dealt with only one case of a stimulator but they did issue the third class medical to the pilot. So it would appear that I could get the third class medical, it just might take a lot more paperwork and time for it to get approved.

Any other thoughts?
 
Kallyjk said:
So I called the office of Harriet Lester, the Eastern Regional Flight Surgeon. I proposed the scenario of getting a spinal cord stimulator implant and how would that affect a third class medical. The lady I talked with said that it would affect it some, as I would need to have a letter from my doctor explaining why I needed it, what it was to correct, etc. Also a current status report would be needed. Not sure if that falls under the same letter from the doctor or not.

She said she had dealt with only one case of a stimulator but they did issue the third class medical to the pilot. So it would appear that I could get the third class medical, it just might take a lot more paperwork and time for it to get approved.

Any other thoughts?
Click to expand...

The guy on here that knows the most about it, Dr. Bruce, said you would be denied (he has worked closely with the FAA and has been involved in developing many of their protocols and is a senior HIMS AME). It sounds like the lady who worked for Harriet Lester may have seen it approved, but you don't know the details or circumstances of that approval and it is a safe bet that the lady you talked to is not a medical expert. If you are denied, then Sport Pilot is off the table forever (unless the rules change). I understand your current mission requirements, but you are rolling the dice on ever being able to fly as PIC. They are your dice to roll, though.
 
The lady you spoke with.... Was she the actual RFS who knows the current rules, how they might apply to your individual case, and will do the exam while being your coach and advocate to obtain the medical? Or a well meaning office worker without a medical degree or the specific AME training, but has a memory of a single applicant be issued?

There is a BIG difference between the two.

And remember, if you go with that office, rolling your dice, and cr@p out by being denied, then you have burned your dream of operating a powered aircraft. Forever.

Dr. Bruce Chien (bbchien) who responded in post #5 is one of the few folks in the nation who will be a coach and advocate for difficult case. So it is worth seeking his guidance and adding him to your team. If he will take you on. But as he indicated in post# 5, he has experience with devices such as yours as the treating physician, so he is very familiar with what they do, how they work, and the aeromedical aspects. And he says the outcome will be a denial.

(Edit: John is very spot on about how well Dr. Bruce knows the current rules and guidelines of aeromedical certification. As hard as he works in office assisting his clients, he works as hard or more away from the office in an advocacy and improvement role. During one fly-in, he shared with me what he does to make sure we don't get trampled by the Federal machine and to create new opportunities such as the SSRI protocol. It's a huge amount, and if you look up "hard worker" in the dictionary, Bruce's photo is definitely there.)
____________________________________________________

With any AME, never go in for a live "fill out the official paperwork" exam until you know with 100% certainty that FAA will grant you the medical certificate. Until that time, you need to keep this as an "off the FAA books" consult (still pay the AME their fee) to find out items such as, what documentation is required, is the documentation you obtained adequate, will the AME recommend your approval, will the AME always be your advocate should the application get stuck in channels, etc. Only once the AME (general, senior, senior difficult case, RFS, or FAS) will do that for you and say you will be approved, should you submit to a live exam.

Consultative, the FAA isn't officially aware of the effort and your flying privileges aren't in jeopardy.

A live exam is a confirm or deny outcome, even if deferred to OKC for review.

And if denied, even after deferral...........well, we've covered that territory.
____________________________________________________

So as others are saying.... either go with Sport Pilot, or wait/hope for passage of PBOR2
 
Last edited:
Talking to a Program manager in an RFS's office is a good strategy. They know their stuff. But in this case she said the outcome was unknown. That's a no-go in my book.

I'd still like to know about implant removal and pursuit of alternative treatments.
 
Could you see an FAA doc on a "consultation" basis only?
 
Technically speaking if you know you have a DQ condition for standard airman's medical status isn't that a DQ for sport pilot?
 
Stewartb said:
Talking to a Program manager in an RFS's office is a good strategy. They know their stuff. But in this case she said the outcome was unknown. That's a no-go in my book.

I'd still like to know about implant removal and pursuit of alternative treatments.
Click to expand...

Implant removal isn't an option right now. Wouldn't be cleared by the wife and honestly, I prefer the stimulator to any form of medication. We went with this solution after meds, PT, shots, creams, etc. My condition has gotten better over the last couple years to where I don't need the stimulator on all the time. Physically I am the best I have been in a long time and why I decided to pursue my PPL now.

AggieMike88 said:
The lady you spoke with.... Was she the actual RFS who knows the current rules, how they might apply to your individual case, and will do the exam while being your coach and advocate to obtain the medical? Or a well meaning office worker without a medical degree or the specific AME training, but has a memory of a single applicant be issued?

There is a BIG difference between the two.

And remember, if you go with that office, rolling your dice, and cr@p out by being denied, then you have burned your dream of operating a powered aircraft. Forever.

Dr. Bruce Chien (bbchien) who responded in post #5 is one of the few folks in the nation who will be a coach and advocate for difficult case. So it is worth seeking his guidance and adding him to your team. If he will take you on. But as he indicated in post# 5, he has experience with devices such as yours as the treating physician, so he is very familiar with what they do, how they work, and the aeromedical aspects. And he says the outcome will be a denial.

(Edit: John is very spot on about how well Dr. Bruce knows the current rules and guidelines of aeromedical certification. As hard as he works in office assisting his clients, he works as hard or more away from the office in an advocacy and improvement role. During one fly-in, he shared with me what he does to make sure we don't get trampled by the Federal machine and to create new opportunities such as the SSRI protocol. It's a huge amount, and if you look up "hard worker" in the dictionary, Bruce's photo is definitely there.)
____________________________________________________

With any AME, never go in for a live "fill out the official paperwork" exam until you know with 100% certainty that FAA will grant you the medical certificate. Until that time, you need to keep this as an "off the FAA books" consult (still pay the AME their fee) to find out items such as, what documentation is required, is the documentation you obtained adequate, will the AME recommend your approval, will the AME always be your advocate should the application get stuck in channels, etc. Only once the AME (general, senior, senior difficult case, RFS, or FAS) will do that for you and say you will be approved, should you submit to a live exam.

Consultative, the FAA isn't officially aware of the effort and your flying privileges aren't in jeopardy.

A live exam is a confirm or deny outcome, even if deferred to OKC for review.

And if denied, even after deferral...........well, we've covered that territory.
____________________________________________________

So as others are saying.... either go with Sport Pilot, or wait/hope for passage of PBOR2
Click to expand...

I wouldn't plan on going into an actual exam until I had everything prepared. Obviously I don't know how to find out, or if I can, the circumstances the person with an SCS implant was in when they issued the medical. Dr. Chien seemed to think that no one has been issued a medical with an SCS implant, at least that was my understanding of his post and subsequent email. So to have the RFS office state that they have issued one, made me think something had changed since Dr. Chien had done an SCS case (which I assume are rare, since SCS's seem to be pretty rare).

I am absolutely sure he knows more about this than I do. I also know it took 10+ doctors and 10 years to figure out my L5 vertebrae was broke which is why I have to ask this question in the first place. I am trying to be the most informed I can be before I make the decision that will ultimately allow or destroy this dream.
 
With regard to SP, I wonder if the "Black Box" warning on the device could be interpreted as a limitation on the DL, which would also put the kibosh on SP. It seems to my non-medical, non-bureaucratic mind that a plain-English interpretation of the black box in the context of the SP rule would mean that it's okay to have the thing implanted as long as its not operational while driving (and by extension, while flying, if using the DL as a medical).

In the case of the 757 captain that Bruce related, however, either that finer point was missed by the FAA and NTSB, or the airman in question actually needed the pain relief while flying and therefore would be turning it on during flight, or the FAA and NTSB didn't trust him when he said he wouldn't be turning it on while in flight. One way or the other, FAA doesn't seem to like those devices very much, and in this case NTSB backed them up on it.

If I were in OP's position, and if I were confident that underlying condition would continue to improve to the point that the device would not be needed in a few years (and that there were no other DQing conditions), I would keep quiet about it and start SP training with the intention of upgrading to PP after the device was removed. I would not seek an opinion from anyone at the FAA. A reasonable-man interpretation of the black box warning suggests only that it should not be "operational" while driving (or flying, by extension, under the SP rule). But given the history that Bruce related and the fact that that case went to NTSB, I wouldn't go stirring up any hornets by asking for an official opinion. I'd take the common-sense, rational-man interpretation and run (and fly) with it.

I also would use a CFI rather than a CFI-LS for SP training so all the dual would count toward PP. (The solo time and any other PIC time would count anyway.) But again, it would all hinge on whether I was confident that the device could be removed in a few years, and that there was nothing else that would DQ me from getting a medical.

Rich
 
sitting in a pain clinic right now. asked about implanted devices and why it would DQ a pilot. the Doc figures its because SCS machines interfere with nerve signals to the brain while other treatments deal with blocking pain locally.

From the Medtronic website re: implanted stimulators. Interesting.
Postoperative Activity Restrictions
Postoperative activity restrictions emphasize that maintaining lead position is critical. The patient should understand that abrupt movements may shift the implanted lead position, and small movements may produce significant changes in neurostimulation.

To maintain lead position, the patient should avoid:

  • Lifting their arms overhead
  • Lifting more than 5 lbs (2.3 kg), stretching, reaching, pulling, or twisting
  • Electromagnetic interference (MRI, lithotripsy), postural changes or other activities (e.g., driving, operating power tools) that could cause an unexpected jolt or shock*
Click to expand...
 
Last edited:
RJM62 said:
With regard to SP, I wonder if the "Black Box" warning on the device could be interpreted as a limitation on the DL,
Click to expand...
Interpreted by whom?

If you have a limitation on your actual driver's license, then you have to observe that. 61.303 B 01

If you and/or your personal doctor determine that you are not able to operate an LSA in a safe manner, then u b hosed. 61.303 B 04 and 61.53 B

Otherwise???
 
Capt. Geoffrey Thorpe said:
Interpreted by whom?

If you have a limitation on your actual driver's license, then you have to observe that. 61.303 B 01

If you and/or your personal doctor determine that you are not able to operate an LSA in a safe manner, then u b hosed. 61.303 B 04 and 61.53 B

Otherwise???
Click to expand...

Interpreted by FAA if they were asked about it, which is why I said that I wouldn't ask if I were in OP's situation.

OP mentioned that he'd called FAA regarding the possibility of being certified with the device, which I guess is fine; but I would strongly advise against calling them again regarding the device's implications for SP eligibility. Why look for problems by asking about a device that FAA has already opined disqualifies an airman from medical certification, especially considering that that opinion was upheld by NTSB? Nothing good could come from that.

Also, if OP were to call, he'd have no way of knowing who would answer or whether or not they'd know what they were talking about. But if their answer was "NO!", whether they were right or wrong, the OP would still be stuck with that answer, which in turn would affect his ability to truthfully self-certify for SP.

The simple solution is not to ask. The rule is clear, and any reasonable reading of the warning suggests that it only applies when the device is actually being used. So don't go looking for problems.

Rich
 
It is my experience that the FAA does issue special issuance medical certificates to airmen, who have the misfortune of needing a SCS implant, on a case by case basis. There is a group of ex-FAA medical examiners called the Aviation Medicine Advisory Service (AMAS), based in Colorado, who specialize in helping Airmen obtain a special issuance medical certificates. Call and ask to speak with Dr. Carrigan. If you want to fly, she is your best bet. It will be the best $400 you have ever spent. How do I know........ I'm living the dream!
 
If the door has been really opened, it would be a great service if your could redact your auth. letter and post it. I always knew this day should come. Has it really?

Former Implanter
Petitioner for the SSRI protocol
 
Yes Sir this day has come. Actually it came for me in March of 2014. A 1st class special issuance (SCS implanted 01/2014) valid for 12 months re-issued dependent on currant status report from treating physician and meeting current 1st class FAA medical requirements. I am now on my 3rd, 1st class re-issuance. I don't feel comfortable posting a redacted FAA letter but will gladly discuss it with you if you would like to send PM details or you can call the Aviation Medical Advisory Service (720) 857-6117 and ask to speak with Dr. Carrigan. She will confirm the FAA now approves 1st, 2nd and 3rd class medicals for Airmen, with implanted spinal cord stimulators, on a case by case basis. I hope this helps.
 
This is awesome news! I will get in touch with them for sure. I've still been training and doing physical therapy. My physical condition had improved dramatically since my implant. I've even gotten to the point where I can ride a bicycle again, something I haven't done in about 10 years.
 
Kallyjk said:
So I can't seem to find anything online that will answer my question. I am trying to get everything in order for my exam, but cannot find anything on neuro stimulation. I have a spinal cord stimulator implanted that helps manage some nerve pain in my legs. I don't need it all the time, just when my legs get to really hurting. There is no medication involved, I don't use it when driving, etc.

Anyone have any insight on this or could point me where to start looking or who to ask?
Click to expand...
 
Blank response Tim Bowman.... did you wish to add to this thread?
 
I’ve always wanted to learn how to fly and have dreamed of someday being able to fly my family on vacation. In November 2017 I was injured, somehow fractured a vertebra in my neck and started suffering from sever nerve pain. After almost 2 years of pain medications I got a spinal cord stimulator implanted and about 90% of the nerve pain is now gone.

After reading the posts on this thread I’ve started thinking my dreams may never come true - now after getting the SCS. I would like to know if the person who started this thread was able to get the license or if the SCS kept from it.

While searching the internet about the SCS and FAA regulations regarding it I came across an article from the Mayo Clinic about a commercial pilot who had been injured and grounded due to the pain meds, he got the SCS and was able to start flying again. It will not allow me to post the link to the story, but it was posted of February 7, 2016 with the headline: “Back in Flight After a Long Bout With Chronic Pain”

Flying has been a dream of mine since I was a teenager but the nearest training location (that I’m aware of) is almost 2 hours away. Due to this and the costs associated with it I’ve never pursued my dream - now I’m almost 40 and still hope that one day I will be able to get my license and purchase a plane.
 
Glen870 said:
would like to know if the person who started this thread was able to get the license or if the SCS kept from it.
Click to expand...
The last time the originator of this thread was seen on the forum was June of 2016. So unfortunately we don't know if he or she returned to flying.

However, as mentioned in the thread, one of the best folks for you to consult with on aviation medicine and the implant you have is Dr. Bruce Chien. He can be reached through his "How to Start" page at http://www.aeromedicaldoc.com/how-to-start.html
 
AggieMike88 said:
The last time the originator of this thread was seen on the forum was June of 2016. So unfortunately we don't know if he or she returned to flying.

However, as mentioned in the thread, one of the best folks for you to consult with on aviation medicine and the implant you have is Dr. Bruce Chien. He can be reached through his "How to Start" page at http://www.aeromedicaldoc.com/how-to-start.html
Click to expand...

Thank you!
 
Glen870 said:
I’ve always wanted to learn how to fly and have dreamed of someday being able to fly my family on vacation. In November 2017 I was injured, somehow fractured a vertebra in my neck and started suffering from sever nerve pain. After almost 2 years of pain medications I got a spinal cord stimulator implanted and about 90% of the nerve pain is now gone.

After reading the posts on this thread I’ve started thinking my dreams may never come true - now after getting the SCS. I would like to know if the person who started this thread was able to get the license or if the SCS kept from it.

While searching the internet about the SCS and FAA regulations regarding it I came across an article from the Mayo Clinic about a commercial pilot who had been injured and grounded due to the pain meds, he got the SCS and was able to start flying again. It will not allow me to post the link to the story, but it was posted of February 7, 2016 with the headline: “Back in Flight After a Long Bout With Chronic Pain”

Flying has been a dream of mine since I was a teenager but the nearest training location (that I’m aware of) is almost 2 hours away. Due to this and the costs associated with it I’ve never pursued my dream - now I’m almost 40 and still hope that one day I will be able to get my license and purchase a plane.
Click to expand...

I have not been able to continue flying for unrelated reasons. Work, selling farm, moving, and other life events. I talked it over with my wife and she agrees this year is a good time for me to focus on this again. I have just recently started looking into different flight schools to plan the financial part of it. Once I have that figured out I am going to see if I can get in contact with the doctor and group posted a while back to answer the medical questions.

I am at a place now where I think I could have my SCS removed if it was required, though I would rather not. I would definitely love to hear of any more stories of pilots getting an SCS and retaining their medical or obtaining a medical after having one implanted.
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top