Flying after a stroke

E

Engineer Pilot

Guest
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.
 
OneCharlieTango said:
What is the medical explanation? He doesn’t mention one in the OP.
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He wrote that he had a stroke. That's a medical explanation for his symptoms, "A transient loss of control of nervous system functions"
 
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. What we know about stroke: For the two years after one, the next one is about 5x more likely, during the two years.
Objectively, a stroke that affects 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 your enitre record (Admission note, Discharge summary, and 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
 
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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.

A Stroke is NOT a "satisfactory medical explanation of the cause" of loss of control. Like Aristotle, giving a name to a thing does not explain the cause.
 
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Hey everyone. I am the OP. I decided that I no longer need to be anonymous about this. There are only two or three people here that know who I really am.
@bbchien (and others) - Thank your for all your comments and support. Question -

I have returned to work now where I work as an Aerospace engineer. My speech has recovered about 99%. Once or twice a day I have to take a deep breath and pause for a moment or two to figure out which words I should use. I have no other residual symptoms.

I have an appointment scheduled with an AME and I'll begin working with him to gather all of the necessary documents so I can apply for the special issuance in another 23.25 months. :)

For the time being, I am going to try and work on my tail wheel endorsement. I should be able to do that as long as my instructor has a medical.

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!.
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They installed a Medtronic heart monitor in me in the hospital.
 
The medtronic ILR is a good thing. They are trying to conclusively exclude AFib, whcih if you've had a stroke requries a SIX MONTH recording with NO AFib.

If you have any A Fib and a stroke, you are CHADS class 5 and not certifiable.
 
RussR said:
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.
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You can't do much instrument training as you can't put the student under the hood without a medical.
 
RussR said:
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.
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just saying

As CFI-I you are the required safety pilot under 91.109, which makes the CFI-I a required crew member.

(b) Operations not requiring a medical certificate. A person is not required to hold a medical certificate—
(7) When exercising the privileges of a flight instructor certificate if the person is not acting as pilot in command or serving as a required pilot flight crewmember;
 
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Clip4 said:
just saying

As CFI-I you are the required safety pilot under 91.109, which makes the CFI-I a required crew member.

(b) Operations not requiring a medical certificate. A person is not required to hold a medical certificate—
(7) When exercising the privileges of a flight instructor certificate if the person is not acting as pilot in command or serving as a required pilot flight crewmember;
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Yes, I have already acknowledged my error.
 
Brad Z said:
Unless of course you're conducting all of your instrument training over the desert on dark, moonless nights.[/S]
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Or if the student already has an instrument rating, is current, and you do it in actual.
 
172andyou said:
A stroke is not a "transient loss of control of nervous system functions"
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That’s exactly what a stroke is, but we’re always going to have people that will interpret the basic med rules how they would like to so as to continue using basic med whether actually eligible or not (and that’s not at all directed at the OP).
 
mryan75 said:
That’s exactly what a stroke is, but we’re always going to have people that will interpret the basic med rules how they would like to so as to continue using basic med whether actually eligible or not (and that’s not at all directed at the OP).
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Nope. A stroke is the asphyxiation of parts of the brain due to a blood clot or a hemorrhage. A symptom of a stroke is loss of control of nervous system functions. So the diagnosis of it being a stroke is the explanation of the transient loss of nervous system functions. Another reason could be an infection. Another reason could be seizure. Another reason could be diabetes. Another reason could be low blood pressure. Another reason could be drug OD. Another reason could be choking. Another reason could be getting hit on the head.

All of these would be satisfactory explanations for a disturbance of consciousness or loss of control of nervous system functions. Some of them would be/should be disqualifying for a medical. Others not so much.
 
I understand what you’re saying, but I doubt any doctor would see it that way. Strokes are caused by a variety of things. The cause of the stroke is the “explanation” in question here.
 
FWIW, if I was in the same situation, I would go Sport Pilot and not look back. You won't be able to instruct, but you will still be able to fly and the final MOSAIC rule could potentially make your sport flying indistinguishable from your current flying...
 
I am currently 90 years old, and possibly 5 minutes from my first stroke.

Due to my age, my friends tend to be old too, and not surprisingly, in the last 24 hours, I have had conversations with 4 people who have had small strokes.

Not one of them is competent to decide if they are safe to drive a car, 2 actively believe they are safe, and NONE are actually safe.

3 of the 4 think they have no after effects, they are completely back to normal. The one who acknowledges diminished mental skills has had 3 small strokes, each one affecting a different part of her brain, and she has adjusted to the reality of less than normal life.

It is hard for close friends and family to sort out the level of diminished mental function, and impossible for someone who is a stranger, but a series of tests by a skilled physician can document the damage. A close friend of 60+ years probably had a small stroke, and my wife and I are discussing with him and his daughter the changes in his response to the world around him. He is going to a doctor tomorrow, and his daughter will have what we have observed at meals with him, and the symptoms he has discussed with us. He seems to be in good enough mental condition to continue to live independently, but that is a close call. We live in a retirement community, and alternative accommodations are available.

Those here who are arguing with medical opinion that say they should not fly should listen more carefully to the actual medical experts, not their desires to fly again.

Life is full of setbacks, but the wrong response can be deadly.
 
172andyou said:
Nope. A stroke is the asphyxiation of parts of the brain due to a blood clot or a hemorrhage. A symptom of a stroke is loss of control of nervous system functions. So the diagnosis of it being a stroke is the explanation of the transient loss of nervous system functions. Another reason could be an infection. Another reason could be seizure. Another reason could be diabetes. Another reason could be low blood pressure. Another reason could be drug OD. Another reason could be choking. Another reason could be getting hit on the head.

All of these would be satisfactory explanations for a disturbance of consciousness or loss of control of nervous system functions. Some of them would be/should be disqualifying for a medical. Others not so much.
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You're not asking why enough times. In order to satisfactorily explain why I couldn't talk that day, the doctors performed an MRI and saw that I had an Ischemic stroke. They determined that in the first hours. Then I spent the next three days in the hospital being subjected to all kinds of additional testing to answer the next "why". Why did I have an ischemic stroke? That is the real question that all of the doctors want to answer, and they don't have an answer to that question.

And even if I believed I qualify for basic med, I'd still have to convince a doctor. And if you ask any of the dozen or so doctors I've interacted with over the last three weeks if we have a "satisfactory medical explanation of the cause" of my "transient loss of control of nervous system functions", they would say no. Perhaps I could go doctor shopping to try and find a licensed physician that would sign off on my basic med, but I'm not really comfortable doing that.
 
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