Hiatus Hernia

[Sixsquid]

Originally Posted by sas steve

It looks like we could have a separate Hernia forum from the replies so far.

Yes
Mine was diagnosed when I was 23 and it seems some hiatus hernias, which are a malformation, can be genetic rather than a result of getting a bit older, fatter and having a fun life
In a perverse kinda way, it's quite reassuring hearing many other divers have/had a hiatus hernia

No-one anywhere along the line mentioned any issues diving post op to me and this gastric rupture is new to me.

I can understand where it comes from (I think) but I would only think it applied if you started diving soon after the op as you're not prohibited from ever burping/belching again ! 6 months on have a swig of coke and see what happens.
Sadly the burp is not as satisfying as it once was and some 'gas' has to make the long journey the other way, which can be extremely painful. Still better than all that acid, regurgetation and disolved enamel though

[ChrisP]

Originally Posted by Daz217

As i say obviously everyone is entitled to an opinion but how can professionals in Diving Medicine vary so vastly in advice on the same subject. You would have thought the answer would be the SAME from every Doctor.

Hi
You raise a very interesting question which could be debated forever!
Medicine is often not as scientific as many would think. We try to develop guidelines and protocols based on research evidence but often the research is just not there to guide us. We may then rely on analysing case histories and this can be very helpful but also can muddy the waters.
Diving medicine is also often not precise and often the research is just not there to guide us. So guidelines are developed based on what we know and understand about the physiology of diving and examples of people diving with a particular problem.
In the case you raise there simply is not the research evidence to guide us on what the risk level is. After fundoplication many people find they have trouble belching for a while but often this recovers in time to some extent. Now a doctor has to make an assessment of what the potential risks are and when it is safe to resume diving if ever. In the absence of good research evidence their advice will be affected by their own individual experiences and that of colleagues they have spoken to. Therefore you could easily get opposing opinions. However if the doctor is doing his job correctly he will explain how he has come to his conclusion so compare these two responses.
1) "There is a theoretical risk of gastric rupture after the sort of surgery you have had because it interferes with your ability to bring up wind. However I have never heard of any reports of gastric rupture in divers after this sort of surgery. As you can belch reasonably well albeit differently to before your surgery I think it would be safe for you to dive but you should do lots of shallow build up dives and see how you go and let me know".
2) "There is a theoretical risk of gastric rupture after the sort of surgery you have had because it interferes with your ability to bring up wind. Although I have never heard of any reports of gastric rupture in divers after this sort of surgery I am aware of someone who did have considerable difficulty during a dive and I think was very lucky not to have a gastric rupture. Despite the fact that you can belch reasonably well, it is different to how you belched before your surgery and I think it would not be safe for you to dive".
There are lots of instances of differences of opinion between doctors on advice for divers.
We do try very hard to be as consistent as possible though. I think sometimes it is down to a difference in the acceptability of a certain level of risk. I might find a level of risk OK which someone else does not. What is important is to try and share the debate about that level of risk with the person as best we can.

[Sixsquid]

Originally Posted by ChrisP

We do try very hard to be as consistent as possible though. I think sometimes it is down to a difference in the acceptability of a certain level of risk. I might find a level of risk OK which someone else does not. What is important is to try and share the debate about that level of risk with the person as best we can.

Sounds very fair and without definitive research divers would just be pissed off if told they can't dive where there is reason to consider it unfounded.
In my experience most doctors nowadays recognise the mental and physical health benefits of 'quality' of life. We only get one and being happy and motivated goes a long way to keeping the bugs away That's my opinion anyway.

Personally I prefer to have such things explained to me, including risk and allow me to be responsible for my life and decisions

Thank you, good post

[Daz217]

Thanks Chris very balanced approach. Sorry to have sounded off at the Docs it was nothing personal just frustration and impending panic at being denied clearance to Dive.
I have decided for now to stay on the Meds and see how we go. I get no reflux to mention, mainly Belching and a little stomach discomfort.
I have been cleared to dive like this so at the minute i don't want the OP and then be declared unfit.
Provided my symptoms remain bearable i'll live with it. If not i may re visit the question at a later date.

[ChrisP]

Originally Posted by Daz217

Sorry to have sounded off at the Docs it was nothing personal just frustration and impending panic at being denied clearance to Dive.

I did not read yours, nor anyone elses posts as an attack. You really do raise a very interesting point.
How can the same evidence and the same illness result in such diverse opinion?
The point I really wanted to make was that doctors, however good, will bring their own personal experience and bias to the problem. This is why I think it is so important that doctors give an explanation with their advice that way it can be discussed or challenged.
Most medical advice is not black or white but various shades of grey.
By the way Proton Pump Inhibitors (ppi) drugs have transformed the management of Hiatus hernia and reflux disease and the majority of people can be helped / cured with them and lifestyle advice.
All the best