Pilot Protection Services Medical Mailbag- February Q&A

QUESTION: Can you please explain the categorization of some of the types of pacemakers and their subsequent restrictions please?  

ANSWER: The heart has a built-in pacemaker, a group of special cells that function as an electrical generator and wiring loom, if you will, that disseminate impulses around the organ and ensure coordinated pump action.

Artificial pacemakers are used when a person has an abnormal, and potentially life-threatening cardiac rhythm abnormality. This might include the aftermath of a heart attack, a problem one was born with, an infection or other issues. A small metal box, about the size of a wallet (only this wallet costs thousands of dollars) is implanted under the chest wall and electrical leads are positioned inside the heart to ensure your ticker keeps ticking properly. They have saved and improved countless lives.

I sincerely hope you have heard all of us at AOPA tell airmen many, many times that one must take care of your health first and then, and only then, address medical certification!  However, you are being smart by finding out ahead of time if there are any pitfalls.  I can think of only one as far as permanent pacemakers go.  Some pacemakers these days have the capability to "shock" your heart out of a serious cardiac rhythm disturbance – in other words, instead of just permanently keeping your heart ticking, this type can sense an impending disaster and put a life-saving jolt through your heart.  This part of the pacemaker device is called an "implantable defibrillator".  If your physician inserts such a device, the FAA will deny your medical.  The issue is not only the device, but the medical condition that they are treating you for.  The rhythm disturbance that such devices are used for is to shock a person who goes into cardiac arrest (meaning a heart rhythm that, if untreated, can lead to death).  So, hopefully, you can see why the FAA does not allow this.  

QUESTION: I wish to obtain a 2nd Class Medical Certificate, 8 years from receiving my last one. Since then I have endured kidneyfailure, dialysis and then a successful kidney transplant. How should I proceed with the FAA Medical certification process?

ANSWER: Great question!  The FAA does accept airmen for all classes of medical certification who have had a kidney transplant for kidney failure.  You need to be 6 months post transplant, and it sounds like you are almost there, and be stable, which it sounds like you are!  You will need to provide a letter from the Transplant surgeon or your Kidney specialist (Nephrologist) that states what kind of kidney failure you had, explains that you had the dialysis, the date of the transplant, how you are doing at the 6 month time period, gives a list of all your current medications, and provides laboratory studies including complete blood count, renal function studies, electrolyte count.  The FAA also accepts all the common transplant medications.  Keep on flying!

QUESTION: In October 2010, I underwent removal of the upper lobe of  my right lung secondary to a very early adenocarcinoma which was found serendipitously secondary to a CT Scan performed when I had a motorcycle accident. It was very small and had thankfully not spread. Since that time, I have had CT scans and checkups with my Thoracic Surgeon and Pulmonologist.  All scans have been negative and there have been no signs of recurrence.  This past October, 2015, I was declared “cured” by both of those doctors.  These same MDs, as well as my local physician, have written annual letters to the FAA attesting to my health, physical fitness, and my approval for flying as part of the medical certification process. I received my ticket in April of 2013 and each subsequent April, I have gone through the continuance process and received my one year extension.  My question is, after more than 5 years of being cancer free, will I be able to get my Medical from my AME or will I have to jump through some hoops again to receive a medical clearance for flying.

ANSWER: Generally, the FAA only follows someone with a cancer for five years.  At the time you provide your 5th year follow up note, send  a cover letter that requests the FAA to discontinue your follow up requirements.  

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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