Hernia Information

[Guest comanche]

go look at wedmd if you haven't https://www.webmd.com/hw/hernia/hw170935.asp

[Guest prazors]

already been to that site. I would rather know some specifics, and preferably from F16PilotMD. I don't feel any pain. I had a groin sprain several years ago that scared the life out of me. I thought it was a hernia, but luckily was not.

What is THE key symptom docs look for?

[ 14. November 2005, 16:06: Message edited by: prazors ]

[Guest doctidy]

Key symptom...there isn't one. You need an examination. Go see your doc.

Rage, MD, MPH

[Guest navwannab]

For anyone out there with knowledge or advice-

I was selected as a Nav for OTS back in May, still haven't left yet, waiting for full approval on my flight physical. Since then, I have found out that I have an Umbilical Hernia and I think I need surgery. Here are my questions:

1. Does this require a waiver?

2. Is this disqualifying in any way or for any type of aircraft?

3. What is the USAF's mandatory recovery period?

4. Do I need to take any paperwork into the surgeon for pre- and post-op analysis?

Thank you to anyone that can help.

[Guest P27:17]

A doc will correct me if I'm wrong...but any hernia (current) is disqualifying until corrected.

Where it gets iffy is the next item in AFI 48-123 says "history of open or laproscopic abdominal surgery during the preceding 6 months is disqualifying"...so I think it will be a situation of if you have a hernia it's disqualifying until it is removed. After a healing process of 6 months you can be cleared to full duty with out needing a waiver. Now what isn't clear is how firm the 6 month rule is and how limited you will be in Nav training post op.

[Guest F16PilotMD]

Not that big of a deal, really. Get it fixed, recover, wait the mandatory time, get off DNIF.

[Guest Kegger]

I'm looking for opinions from anyone, but especially from those who are familiar with hernia repair and the regs.

I am currently in line to start UPT soon -- I already have my orders and am pretty much ready to go. A little while ago (~3 months) a small portion of my belly button popped out during the day -- it was pain free and pretty small, so I didn't think much of it. After the symptom didn't go away I started doing some research and I think that I have a small umbilical hernia. If if is that, the best recommended treatment is surgery where they put a piece of mesh under the skin in the spot of the hernia, re-enforcing the muscle lining. It is a short out-patient surgery, but they will have to cut me open a bit to fix it.

With that I have a couple questions. First, would getting this surgery delay my start in UPT? I'd imagine surgery would affect when I could start flying. Second, since this is pain free and not getting worse, do I need to get this taken care of right away (meaning can I wait until after UPT to fix the problem)? Third, if I seek a doc's opinion using Tricare, will that in any way force me to get the treatment? And finally, if I don't seek treatment and go ahead with UPT as planned, could I be getting myself into further trouble (according to AF regs)?

Any advice would be much appreciated.

Edited September 6, 2007 by Kegger

[HossHarris]

I've had 3 hernia repairs now ... one umbilical and one inguinal when I was young (12-18 mos) and the last inguinal when I was in the middle of T-38s. I guess I got the lucky genes. I ended up with a patch and plug on the most recent repair

Here's what I took away from it all.

(1) The flight docs will find out about it eventually, probably at the worst possible time (middle of 38s). Mine was also "small" and no pain at all. Still became a "must fix now" issue for the flight docs.

(2) Manage your care. I let them send me from CBM to Maxwell so an AF doc could do the operation (I guess he needed the practice) and I was supposed to drive my own happy ass home a day or two later. Bad Idea. I could have had it done in a perfectly good and modern hospital no kidding 300 yards from my apartment. What the AF saved in the doctor bill they wasted in per diem and travel costs. I was young and didn't know much better, but I should have put up a huge stink BEFORE getting shipped off to MXF. Also not great if you have complications after the fact and your surgeon is 5 hours away.

(3) You don't realize how much you use your abdominal muscles until someone cuts on them. It was fairly uncomfortable for a few days. I was walking normally in about a week and able to fly high-g (for the 38) in 2.5-3 weeks. Not a huge setback to the timeline and I was able to stay with my class.

(4) Take it easy for a few days afterwards. If you do a little too much and something bleeds a little, guess where that blood drains? Think about a GIANT (in my case) pouch like appendage in your lap. Ever watch a bruise turn blue to green to black over time? It's more disconcerting when it's that appendage turning colors. Also a good risk for infection with pooling free blood. If that happens, see a doc. Also see a doc if you have any numbness after (shouldn't be a problem with an umbilical, but they displace nerves and such with an inguinal).

(5) You notice and feel the patch or plug ... for a while. You get used to it, and it goes away.

(6) Arthroscopic is an option for a quicker recovery ... do your research and talk to some surgeons. There are pros and cons.

(7) It's a safe, simple surgery ... the highest risk is the general anesthetic.

[Guest awfltdoc]

I'm looking for opinions from anyone, but especially from those who are familiar with hernia repair and the regs.

I am currently in line to start UPT soon -- I already have my orders and am pretty much ready to go. A little while ago (~3 months) a small portion of my belly button popped out during the day -- it was pain free and pretty small, so I didn't think much of it. After the symptom didn't go away I started doing some research and I think that I have a small umbilical hernia. If if is that, the best recommended treatment is surgery where they put a piece of mesh under the skin in the spot of the hernia, re-enforcing the muscle lining. It is a short out-patient surgery, but they will have to cut me open a bit to fix it.

With that I have a couple questions. First, would getting this surgery delay my start in UPT? I'd imagine surgery would affect when I could start flying. Second, since this is pain free and not getting worse, do I need to get this taken care of right away (meaning can I wait until after UPT to fix the problem)? Third, if I seek a doc's opinion using Tricare, will that in any way force me to get the treatment? And finally, if I don't seek treatment and go ahead with UPT as planned, could I be getting myself into further trouble (according to AF regs)?

Any advice would be much appreciated.

A4.20.1.4. Hernia, other than small asymptomatic umbilical or hiatal.

Small asymptomatic umbilical hernia is not disqualifying. If the umbilical hernia is not hurting or causing any problems. I personally would not worry about it.

[Guest johnny]

A3.17.7.2. History of open or laparoscopic abdominal surgery during the preceding 6 months

(P54) is disqualifying.

I'm hoping to get a more detailed explanation of this regulation.

My situation: Potential pilot candiate for March AFRES pilot selection board (already interviewed with sponsoring unit, waiting on verdict) I have a minor inguinal hernia, and am planning on having it surgically repaired ASAP.

My question is what exactly will I be DQ'd from by having this surgery. Will I have to wait 6 months before starting OTS or SUPT? Or will I not even be eligible for the March AFRES board until 6 months after the surgery?

It is my understanding that if approved in March my first step will be OTS, no earlier than the summer, which is plenty of time. Will my sponsoring unit tell me to wait until the September AFRES board when I tell them about the hernia.

thanks very much guys.

[Guest awfltdoc]

AFI 48-123v2

Attachment 3

MEDICAL STANDARDS FOR APPOINTMENT, ENLISTMENT, AND INDUCTION

A3.17. Abdominal Organs and Gastrointestinal System.

A3.17.7. Abdominal wall.

A3.17.7.1. Current hernia, including, but not limited to uncorrected inguinal (550) and other

abdominal wall hernias (553), are disqualifying.

A3.17.7.2. History of open or laparoscopic abdominal surgery during the preceding 6 months

(P54) is disqualifying.

AFI 48-123v3 (Attachment for flying duties)

A4.20. Abdomen and Gastrointestinal System.

A4.20.1. Flying Classes I, IA, II and III.

A4.20.1.4. Hernia, other than small asymptomatic umbilical or hiatal.

I am assuming you have not been commissioned as of yet and that you are not enlisted in the military at this time. If you are a civilian and trying to get hired by the AFRES then you would fall under Attachment 3 as well as Attachment 4 if you are applying for a flying job. In this event you would need to get the inguinal hernia fixed because A3.17.7.1. states having an inguinal hernia is disqualifying for enlistment, induction, or appointment to military service in the AF. Also, getting it repaired will delay any enlistment, induction, or appointment into the AF by six months. You may have to check with the AFRES medical unit at the base though. There might be supplimental information that I am not aware of being that I am Active Duty. I know the Guard does this some.

If you are in the military already and are either enlisted or commissioned then you would only fall under Attachment 4, Attachment 2 is a non-issue in this case. If you are already in the Air Force in some capacity then only Attachment 4 A4.20.1.4. applies and you just need to get it fixed. No issues with the timelines etc.

[Guest johnny]

thanks for the info awfltdoc, and you are correct I am a civilian applying for a flying job and not yet commissioned.

my follow up question is: If approved at the AFRES board in March, how soon afterward would my actual commission date occur? (I'll probably post in the ANG/AFRES subforum as well)

The next time I speak with someone at the squadron I will inquire about supplemental information regarding my situation.

Edited October 1, 2007 by johnny

[Guest awfltdoc]

thanks for the info awfltdoc, and you are correct I am a civilian applying for a flying job and not yet commissioned.

my follow up question is: If approved at the AFRES board in March, how soon afterward would my actual commission date occur? (I'll probably post in the ANG/AFRES subforum as well)

The next time I speak with someone at the squadron I will inquire about supplemental information regarding my situation.

I can't really answer that one. I just don't know. Hopefully, someone in the ANG/AFRES subforum can help.

[Guest denton]

i had a inguanial hernia 3 years ago age 14. as a result of my hernia iv had a swollen testicle ever since. doctor said its from some liquid near around my hernia and that it may have droped. she said she can get the exess fluid out with some needle thing but i have a 40% chance of the fluid returning. she said testee is normal tho and everything seems well, its just huge. can swollen testee get me DQ? should i fix it now (high school)?

[Guest goducks]

i had a inguanial hernia 3 years ago age 14. as a result of my hernia iv had a swollen testicle ever since. doctor said its from some liquid near around my hernia and that it may have droped. she said she can get the exess fluid out with some needle thing but i have a 40% chance of the fluid returning. she said testee is normal tho and everything seems well, its just huge. can swollen testee get me DQ? should i fix it now (high school)?

Surprisingly a swollen testicle is not covered specifically in the waiver guide. However, I noticed that you can get a waiver for Hypogonadism and Testicular Cancer (pending remission) so I would think that you've got nothing to worry about as long as you don't have any lingering effects- ie. pain, movement restrictions, etc. Not a definitive answer, but this is a little bit usual so it's hard to come up with something more definite.

GD

[dbleplay]

Got a question for a flight doc:

I'm about halfway through my deployment at a base in Southwest Asia. About 75% sure I have an inguinal hernia (I had one a couple years ago, got it repaired the hard way, not laproscopic and this feels the same). I'm not having pain, just a little discomfort and feeling a little abnormal in the junk region. I'm not a single seat flyer and I've had no symptoms that it might be strangulated. I'm a little nervous about going to a flight doc here as I don't want to have to stop flying for something that's not really bothering me all that much.

Do you feel like this could be a safety of flight issue? Is it something that I need to go see a doc about if it's not really hurting? Also, can I still workout if I do cardio and lighter weight for higher reps?

I'd appreciate any input you have.

Thanks,

dbleplay

[Guest mentoneflyer]

Question about hernia repair records:

I'm a civilian just picked up for a UPT slot with a Guard unit. I had an inguinal hernia as infant. The hernia was repaired, but I have no records for the procedure. Do I need to track down records before I go to my initial class 1 physical? I only know where the procedure was done, but don't know the doc that did it. It was 27 years ago, so I'm not sure if records still exist. Wanted to try to check before I start digging for records. Thanks.

[jcj]

Question about hernia repair records:

I'm a civilian just picked up for a UPT slot with a Guard unit. I had an inguinal hernia as infant. The hernia was repaired, but I have no records for the procedure. Do I need to track down records before I go to my initial class 1 physical? I only know where the procedure was done, but don't know the doc that did it. It was 27 years ago, so I'm not sure if records still exist. Wanted to try to check before I start digging for records. Thanks.

(Disclaimer - I am not a Flight Surgeon. I am a pilot and a practicing general surgeon, I also work in hospital administration of a large university hospital - I work with medical records every day)

If you know what hospital your surgery was done at, your best bet is probably to try to get a copy of your medical record from that hospital (if the record and the hospital still exist). The record will have the operative report, maybe a discharge summary and whatever other information is there. It will also show who your doctor was. You are entitled to receive a copy of the entire record (if it still exists) although they will ask you to sign a release and they may charge you for the copies.

The department at the hospital to contact is the medical records department (sometimes called health information management or HIM). They are used to getting copies of old records for patients so they will know the drill - they may even have a specific release of information desk. It's pretty streamlined and except for having to sign a release and shell out a little $, it's painless.

There is a certain time frame after which hospitals may destroy old records and they may not still have records from 27 years ago - but the statute of limitations for medical malpractice in most states doesn't start until age 18 or 21 for pediatric care. For this reason hospitals keep medical records of pediatric care for a really long time so you may be in luck.

If they've purged the record, you can report the surgery with the name of the hospital and that records have been purged.

Either way, I think you'll be fine. Infant hernia repairs are very common and if you've had no problems (and don't have a recurrent hernia) it won't be an issue.

Edited September 17, 2011 by jcj

[ViperDriver114]

Looking for some info from a flight doc.

Talk about bad timing. I think I may have a hernia, the discomfort started a couple days ago on my lower abdomen, then tonight I noticed a lump (it looks like the right side of my ab that runs diagonally down towards the groin is raised more than the other) along with some gastrointestinal discomfort. I am going to get it checked out tomorrow.

So here is the bad timing part, I have my FC1 coming up at the end of November (exactly one month from today). I know that a hernia is not a DQ once its fixed. My question is, lets say it IS a hernia and I have to have it fixed. What does this do for my FC1? Will they push back my FC1? Will they let me do the rest of the exam but wait for post op exams to clear me?

I am starting AMS at the end of January, I am assuming it wont effect that date but I just want to know some experienced advice.

Thanks in advance guys

[Guest]

Sounds like the very common inguinal hernia. Get seen, get referred to a gastroenteroligist/urologist, and see about surgery/wait-and-see. Inguinal hernias are NOT always disqualifying and you MIGHT still get approved, with the potential for surgery at some later date, or maybe never. It all depends on the specifics of your case. Just try to speed along the referral/consult as much as you can.

[ViperDriver114]

Went to a doc this morning. She said it was either a very minor hernia or maybe even just a strain or tear in the ab muscle. She said the protrusion would be a lot larger and lower, down into the testicle region if it were anything that required surgery. She likened it to the same kind of hernia's that alot of women get when they give birth (spare me the birth jokes). She said to not workout and rest for a week and it should heal itself, but if it gets worse to come back in.

[Guest]

Glad to hear it was less serious than initially expected. Hernias are often less serious than people than people think, however even if it is, as I said before, it is by no means a deal-breaker. Hope it turns out to be a strain, and get your AF 469 and see the HAWC for an AF 422 as necessary.

[clemfreek5]

Epigastric hernia question - does anyone have any info on epigastric hernia repair? DNIF time period, etc. There is quite a bit of info on inguinal hernias, but I haven't been able to find anything on epigastric hernias. Currently on a 6 month deployment to southwest asia and slated to get back to my flying assignment in July. Any advice on recommended course of action for an ejection seat flyer and surgery info would be most appreciated.

Edited April 29, 2015 by clemfreek5

[jcj]

Epigastric hernia question - does anyone have any info on epigastric hernia repair? DNIF time period, etc. There is quite a bit of info on inguinal hernias, but I haven't been able to find anything on epigastric hernias. Currently on a 6 month deployment to southwest asia and slated to get back to my flying assignment in July. Any advice on recommended course of action for an ejection seat flyer and surgery info would be most appreciated.

(I'm a general surgeon and AME and I fix these regularly as a part of my practice). The specific terminology is of some importance. Epigastric hernia is the diagnosis that is usually given when you have a small hernia in the midline just above or below the umbilicus (bellybutton) and you've had no prior surgery in the area. An umbilical hernia is a hernia in the umbilicus when you've had no prior surgery in the area. I mention it because although epigastric and umbilical hernias are technically different entities, sometimes they're hard to tell apart and practically it doesn't matter much regarding decision for repair or outcome (however the usual technique for repair of an epigastric hernia is a little different from that of an umbilical hernia).

Usually these are small hernias that are fixed in outpatient surgery, and for someone in good health and with a reasonable BMI (certainly someone within or close to mil ht/wt standards) the operation is straightforward and recovery is quick. I'm not a flight surgeon so the DNIF question is best to others on the board, but I advise my patients limited lifting for the first couple of weeks after surgery advancing up to unrestricted activity six weeks postop. That may be a little overkill - although I don't see ejection-seat aviators. This assumes no complications with the surgery, but if you are reasonably young (60ish or less) and meet military medical standards your risk of complications is extremely low.

If you've had prior surgery where your hernia is, then by definition you have an incisional hernia. If so the repair is a little more complex and the recovery might be a little longer (but you still should be GTG at 6 - 8 weeks).

Good luck & if you have other Q's, feel free to ask.

Edited April 30, 2015 by jcj

[jcj]

I meant to add - once one develops a hernia, it's there until it is repaired (exception - umbilical hernias in newborns often close up early in life. We fix those if they aren't closed by age 5).

There is no medicine or exercise regimen that will correct a hernia. Once a hernia exists, it will either remain the same size or slowly grow larger until fixed. There is also the possibility of getting a piece of bowel trapped in the hernia & having its blood supply cut off. When this happens it's a big problem - but this is pretty uncommon. They usually just slowly grow larger.

Today we can fix almost all hernias with very good results. It's straightforward surgery and once it's over and healed up there is no problem with return to civilian or military flight status.

Edited April 30, 2015 by jcj