Medical Question - Hernia

[Redbean]

Has anyone been diagnosed with a hiatal hernia and chosen to undergo the surgery? How did transport view the condition in your case? They seem to be pretty clear on not allowing hernias in general. I assume that once a doctor has decided it is serious enough to operate on, that my medical would be pulled until full recovery from the surgery was made. I can control the symptoms fairly well through very careful diet etc but the condition is gradually worsening with age (50 years) and not going to go away. I think I am going to have to accept some down time in order to get this fixed.

Anyone had any experience with this issue?

Thanks for all thoughts and comments!

[Castorero]

Redbean,

The commonest type of Hiatal hernia is the sliding kind. This is where the lower end of the food pipe and the upper part of the stomach "slide" up into the chest during swallowing. This scrambles the relationship between the normal anatomy and the pressures that keep food and stomach acid from leaking up into the lower food pipe causing heartburn etc.
This type of hernia often responds to both physical and medical therapy and rarely requires surgical intervention.

The other type of Hiatal hernia is the "paraesophageal" where part of the upper stomach bulges up into the chest and comes to lie beside the esophagus, or food pipe.
This type requires surgery.

From what you have said, you likely have the garden variety sliding hiatal hernia, which typically tends to become more symptomatic with increasing age and increasing girth.

Whether or not this hernia requires surgery depends on a number of factors, including size of the hernia, failure of simple measures and failure of medical therapy in the face of increasing severity of symptoms such as heartburn and regurgitation of stomach contents.

That being said, it is important that at age 50, with symptoms related to the area in question, that one gets thoroughly investigated in order to confirm the diagnosis and to rule out more serious pathology.
Only once more serious pathology has been excluded, should one assume that the hernia alone is to blame, and treatment initiated.


An upper Endoscopy looking directly into the esophagus, stomach and just beyond, is a good start, along with a barium swallow to delineate the confines of the anatomy.
Additionally, pressure studies carried out by the appropriate specialist are of value before surgery is contemplated.

A garden variety sliding hiatal hernia is not going to give your CAME or Transport Canada heartburn.

This is not the type of pathology or hernia that will incapacitate you in flight, unlike other hernias like an Inguinal or abdominal wall hernia, where bowel may become stuck, causing an acute bowel obstruction and hence, a medical emergency.

Be sure that you have had the proper tests already, then request a visit to a gastroenterologist before seeing a surgeon, all in that order.

My bet is that in the absence of more serious lower esophageal pathology as evidenced by objective investigations, you may be able to live quite comfortably with a hiatus hernia given the efficacy of modern medical treatment.

I hope this sheds a bit more light on the subject, and as always, this is a conversation that you will want to have face to face, with your MD.

C.

[Redbean]

Many thanks for your detailed response, C!
I am getting it checked out tomorrow!
RB

[Shiny Side Up]

A garden variety sliding hiatal hernia is not going to give your CAME or Transport Canada heartburn.

This is not the type of pathology or hernia that will incapacitate you in flight, unlike other hernias like an Inguinal or abdominal wall hernia, where bowel may become stuck, causing an acute bowel obstruction and hence, a medical emergency.

Not so sure about that. My father suffered from one of these once and had to undergo emergency surgery, though by the sounds of it his was a pretty rare occurance, it did result in incapacitating pain when it occured. I should note that he was diagnosed with it in his forties, but problems with it because acute in his mid fifties (I think he was 54 when we had to take him to the hospital for the emergency surgery). I should note that he's also one of the healthiest old bastards I know, a non smoker who is largely just a knot of muscle and meaness.

[Castorero]

SSU,

This is the problem when one answers a generic medical question on an internet forum... You cant really cover ALL the bases and account for ALL possible complications without having a warm body in front of you.


I addressed the 'garden variety' sliding hiatal hernia and I stand by my comments on that. However, there is an exception to every rule, no?

I am hard pressed to imagine what would have necessitated Emergency surgery on a sliding hiatus hernia without having had lots of warning signals of either concomitant pathology, aggravating factors such as a lot of stress, excessive alcohol intake , bleeding or what have you, which could have led to an acute condition developing all of a sudden. Acute esophagitis and ulceration on top of an existing hernia can certainly be very painful.

Did your dad have a paraesophageal hiatus hernia, perhaps?

This is a different kettle of fish that is much more prone to strangulation resulting in loss of blood flow to the affected area, which is a true surgical emergency.

The 50 year old pilot who knows he has a sliding hiatus hernia requiring treatment will take care of it, and I doubt very much that he could become incapacitated because of it, unless other pathology comes along to muddy the waters.

I would be interested in knowing some more details of your dad's condition at the time and I am willing to bet that he had a paraesophageal hernia or a variant thereof... You can PM me if you wish.

C.

[Shiny Side Up]

Wasn't meant to critique. My father did suffer from the sliding variety, as in diagram C. He did aggravate it though so that it was apparently stuck and was larger than usual - heavy lifting being the cause, my uncle found him in the shop, unable to breathe.

[Castorero]

Boy, that must have been distressing!

There is only so much room in the chest after all...

Thanks for the info, SSU.
Medicine is so much like Flying...If you live long enough you will see some pretty unusual stuff.

[Bobby868]

Redbean,

I had a hernia a couple of years ago. I went in and got it repaired. I was walking with the assistance of pain killers after 1 day, off the pain meds after day 3 or 4. Walking ok after 1 week. By week 3 I felt pretty good could. Week 4 I could have been back to work but took an extra 2 weeks off.

If you're in Ontario go to the Shouldice clinic, all they do is hernia operations. They are the best and very fast in terms of getting you in for diagnosis and booking treatment. I would say they are worth travelling across Canada for.

http://www.shouldice.com/

I wasn't flying at the time so didn't consult with my aviation medical doctor. I did mention it 6 months later when I went in for my cat 1 and he didn't seem concerned at all.

[Redbean]

Thanks All for the responses.

I am getting checked out today. I will post anything interesting I find out!

[Canoehead]

I agree with Bobby868.

Don't know where you live Redbean, but Shouldice is world-renowned (my 'room mate' was from Europe). What is amazing is how many patients go to Shouldice to get previous hernia repairs... repaired.

I had an inguinal hernia, but they repair all makes and models

[swordfish]

That was a very interesting and informative discussion, Castorero. I sure appreciated that.

I have in fact 2 hernias which are going to be repaired in mid-November (inguinal and umbilical). The doctor I have been seeing for my medicals has finally suggested that he won't approve my medical unless I get it (umbilical) fixed as it has been present for some time (2 years).

You're evidently a Doctor, and you seem to be experienced in these types of conditions. Rare to find someone who has knowledge and is willing to impart it on a forum. Nurses in emerg here won't even talk to you when you call up asking for advice or direction with some simple symptomatic treatment, rather than going to the hospital and waiting for 3 hours in the early morning.

Thanks. Appreciated!

[Castorero]

Nah... Swordfish, It's Google and Wikipedia, mostly. The rest is old fashioned horse#%%&.

[Changes in Latitudes]

[wotai139]

Goodluck to you