Flying after a stroke

E

Engineer Pilot

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About two weeks ago I had a stroke. It affected only a small area of my left lateral lobe. I had trouble speaking for a few days, and spent a few days in the hospital. I have a follow up with a neurologist tomorrow. I would estimated I have regained 98% - 99% of my speaking ability. I have zero other side effects. The stroke did not impact my balance or motor skills. I didn't have any face drooping or drooling. My class 3 medical expires at the end of August this year, but obviously I have self-grounded per 61.53.

My question is how do I resume flying at some point in the future? I believe I would be eligible for basic med since I have already been issued a class 3 medical previously. But even basic med requires a physician to sign off, and when I tried to talk to my family doctor about it, he referred me to his colleague/friend that is an AME.

The AOPA article linked below suggests I will probably need to wait at least two years to be eligible for a special issuance of a class 3 medical. I would have to answer yes to questions L and U now.

Can I fly after a stroke?

Generally, an airman who has been diagnosed with a stroke cannot obtain consideration for medical certification until two years after the event. This is because there is an increased incidence of a recurrence during that time period.
www.aopa.org

I don't really know what to do at this point. I'm a mid career engineer. I had hoped to become a CFI and flight instruct in my spare time and work as a CFI when I retired early. I am not sure if I can do that now.

Can I just have a general consultation with an AME? Could I see an AME for a basic med signoff outside of the form 8500 medical process? If I see an AME for a basic med signoff, would he be required to report my medical status to the FAA?

To re-iterate, I am currently self grounded per 61.53 and I have basically resigned myself to the fact that I am going to have to probably take a year or two minimum off from flying and am looking for general guidance with my situation.
 
This is probably going to need a SI even for basic med:

  • A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
    • Epilepsy;
    • Disturbance of consciousness without satisfactory medical explanation of the cause; or
    • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
The last two will get you I think. Hopefully, you have a good AME. This is going to take some work (including MRIs, etc...).
 
Engineer Pilot said:
I don't really know what to do at this point. I'm a mid career engineer. I had hoped to become a CFI and flight instruct in my spare time and work as a CFI when I retired early. I am not sure if I can do that now.
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No opinion on the rest of it, but note that instructing doesn’t require a medical if the trainee is qualified to act as PIC and you’re not a required crew member (I.e.safety pilot.)Somewhat limited utility, but still possible.
 
MauleSkinner said:
No opinion on the rest of it, but note that instructing doesn’t require a medical if the trainee is qualified to act as PIC and you’re not a required crew member (I.e.safety pilot.)Somewhat limited utility, but still possible.
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Indeed. I had a friend who was a CFI without a medical and I could use him for things like flight reviews if I was still qualified to be PIC.
 
flyingron said:
Indeed. I had a friend who was a CFI without a medical and I could use him for things like flight reviews if I was still qualified to be PIC.
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I want to say about half of my 2000 hours of instructing could have been done without a medical.

Most instrument training, typically all Commercial single training (especially now that a complex aircraft isn't required), a little bit of Commercial Multi training, and then all the avionics upgrades. Most of the insurance training too.

Note most of my instructing has been with aircraft owners, so they are already rated and endorsed to act as PIC in their own airplanes.
 
flyingron said:
This is probably going to need a SI even for basic med:

  • A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
    • Epilepsy;
    • Disturbance of consciousness without satisfactory medical explanation of the cause; or
    • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
The last two will get you I think. Hopefully, you have a good AME. This is going to take some work (including MRIs, etc...).
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The last two have an important "without satisfactory medical explanation" clause. He has an explanation. It's been treated. If his symptoms are adequately resolved, then he should be able to do basicmed (at least according to the quoted section. I have no idea if there are other applicable clauses.)
 
172andyou said:
The last two have an important "without satisfactory medical explanation" clause. He has an explanation. It's been treated. If his symptoms are adequately resolved, then he should be able to do basicmed (at least according to the quoted section. I have no idea if there are other applicable clauses.)
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What is the medical explanation? He doesn’t mention one in the OP.
 
172andyou said:
The last two have an important "without satisfactory medical explanation" clause. He has an explanation.
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Furthermore I would assume that, for Basic Med purposes, "satisfactory medical explanation" means satisfactory to the physician who will sign the Basic Med form, not some OKC doc, since the form doesn't go to the FAA.
 
Eh….I don’t think that counts. A stroke isn’t an explanation for stroke symptoms. In this case, a medical explanation would be something like a paradoxical embolism through an atrial septal defect.
 
OneCharlieTango said:
Eh….I don’t think that counts. A stroke isn’t an explanation for stroke symptoms. In this case, a medical explanation would be something like a paradoxical embolism through an atrial septal defect.
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Seems like that would explain the clot and its migration, but the stroke already explains the loss of neural function. There are lots of people with unexplained losses of consciousness. The rule seems to be aimed that that.
 
172andyou said:
The last two have an important "without satisfactory medical explanation" clause. He has an explanation. It's been treated. If his symptoms are adequately resolved, then he should be able to do basicmed (at least according to the quoted section. I have no idea if there are other applicable clauses.)
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I don't think that's what that means. None of the doctors know the cause of my stroke. I have seen a half dozen doctors in the last two weeks and all of them say, "Why did this happen, you are perfectly healthy."
 
No, that’s circular reasoning. “His stroke is explained by a stroke” is like “his loss of consciousness is explained by passing out.” I see what you’re saying, but no doctor would think that way.
 
OneCharlieTango said:
No, that’s circular reasoning. “His stroke is explained by a stroke” is like “his loss of consciousness is explained by passing out.” I see what you’re saying, but no doctor would think that way.
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No, it's not circular. The "transient loss of control of nervous system functions" was caused by a stroke. A stroke is not a "transient loss of control of nervous system functions" it is a loss of blood flow, usually due to a blood clot. Whatever, we have some AMEs on here, if they tell me I'm wrong, so be it, but I think the plain reading of the text is satisfied by the stroke diagnosis.

Engineer Pilot said:
I don't think that's what that means. None of the doctors know the cause of my stroke. I have seen a half dozen doctors in the last two weeks and all of them say, "Why did this happen, you are perfectly healthy."
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Yeah, clots (assuming that's what caused yours) can be caused by a million different things, including simply sitting for too long. They may never figure it out. Blood pressure, afib, diabetes, drinking, etc are all risk factors. But if one needed to identify specifically what caused the clot that caused the stroke in order to pass a medical then almost no one would be able to qualify again.
 
Never mind the dancing on the head of a pin.

For a stroke FAA requires TWO years down.
Objectively, a stroke that affecs the wernicke area (speech, expression) is gonna have VERY tough time on the required cogscreen (done at the end of the 2 years).

At the end of the two years you'll need yoru enitre recrod (Admission note, Discharge summary, an after 24 months Neurologist's visit and new MRI;

Stress treadmill (echo rec'd) Echo
Lipid Profile
Fasting Gluose or HbA1c
If there has EVER been ANY AFib in your record, get an implanted loop recorded at month 18. FAA requires that you EXCLUDE totally any Afib with a 6 Month recording that is NULL for AFib. Insurance will cover this toothpick sized device!.

Get your CAD (atherosclerosis) risk factors under control.

Dr. B
 
Dr B, what about BasicMed in this circumstance? Is “a transient loss of control of nervous system functions without satisfactory medical explanation of the cause” adequately explained by “stroke, not otherwise specified?”
 
OneCharlieTango said:
Dr B, what about BasicMed in this circumstance? Is “a transient loss of control of nervous system functions without satisfactory medical explanation of the cause” adequately explained by “stroke, not otherwise specified?”
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You MUST win a special first. That was the intent of the Congress when Basic was discussed in early 2016.What we know for Sure about stroke, is that within 2 years of the first one the second one is about eight times more likely. NOT GREAT odds.
 
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