Ulcers

[xj220]

I ran a search and checked the waiver guide to no avail. Are ulcers an NPQ item or at least a downing item? Does anyone have any experience with them as well? Thanks any help.

 

[jt71582]

Can't answer your question but you may want to specify - gastric ulcers?

 

[DSL1990]

I ran a search and checked the waiver guide to no avail. Are ulcers an NPQ item or at least a downing item? Does anyone have any experience with them as well? Thanks any help.

http://navmedmpte.med.navy.mil/nomi/nami/WaiverGuideTopics/pdfs/Waiver Guide - GI.pdf , p.12

 

[feddoc]

What kind of ulcer? Who diagnosed it?

 

[xj220]

I haven't seen the doctor about it yet so this is only me guessing based on how I've been feeling and what I've been reading regarding them. I just wanted to get an idea of what to expect if I did see the doc and did have one. If it is one, it feels like it'd be a peptic ulcer.

 

[feddoc]

Symptoms?


'Course, you should realize that medicinal advice over the internet is worth what you pay for it.

 

[Flash]

I haven't seen the doctor about it yet so this is only me guessing based on how I've been feeling and what I've been reading regarding them. I just wanted to get an idea of what to expect if I did see the doc and did have one. If it is one, it feels like it'd be a peptic ulcer.

Doc might disagree with me on this but.......if it is not that much of an issue then I would not worry about it now, especially if you can manage it. I have had issues with heartburn for years and I have learned to manage it, mainly by not often eating foods that trigger it (tomato sauce, orange juice, etc.). If that is not good enoguh for you, then I would advise seeing a civilian doc first. Going to a Flight Doc can be like playing Russioan roulette in a case like this.

One small piece of advice though, hang out by the bathroom if you drink a barium shake, that stuff goes right through and there is little stopping it when it comes out.......

 

[feddoc]

Yup, Flash I do disagree. IF USN finds out about this problem later, assuming it turns out to be a huge problem, they will wonder why xj220 did not fess up earlier.

It is much better to get this diagnosed earlier rather than later, especially if it turns out to be GERD. A little prilosec now beats Barrett's Esophagus later.

The civilian doc idea is not bad...but, whatever xj220 decides as a course of action, it should include a visit to a real USN doc in person.

 

[BACONATOR]

I always thought bypassing the Navy and going to a civilian doc was a huge no-no? Especially as an aviator?

 

[feddoc]

BS, I don't see it as a no-no, as long as USN is kept in the loop.

 

[Flash]

I always thought bypassing the Navy and going to a civilian doc was a huge no-no? Especially as an aviator?

Depends on what it is for. I went to civilian opthamologist after a Navy doc told me after 2 minutes of examination that I had permanent eye damage from wearing my contacts, and then walked out without another word. I went to a civilian doc the next day who laughed, then showed me that I did not have permanent damage. Having already told Ops that I may not go on the next deployment due to med issues, the CO talked to me and he said he regularly went to civilian eye docs because he had some bad experiences with Navy eye docs too, he was as blind as I am.

So I would not suggest it to someone lightly, but for certain things I think it is a wiser way to go. Now if you are like the former Tomcat guy in my EP-3 squadron who was graying out when he came to the merge, then see the flight doc. He had some blood circulation issues that eventually barred him from Tacair, and he ended up having to switch to VQ in the end. You shouldn't put you or your fellow aviators at risk. If you got some minor issue though, some flight surgeons can cause you to have more than just some heartburn.......just ask Masterbates.

 

[MasterBates]

Can you make it til winging? I'd see a civilian doc just to make sure its not "bad" and if you can control it with diet, avoid the FS like the plague. Some docs are good and want to keep you up, other seem to think "number of pilots grounded/npq'd" are FITREP bullets.
It is MUCH easier to stay flying post winging than pre, if you have something that is bad but waiverable.

If what I am fighting now had happened to a SNA, it would be game over, go enjoy being a SWO.

 

[MasterBates]

Oh, and as an add on, your FS at your squadron is one of the NPQ'd pilots = FITREP bullet guys, just so you know. I've dealt with him. I've had to really resist the urge to implant my boot into his lower colon.

 

[SH-60OB]

OB
SOAPBOX

If you found something you thought was out of limits on preflight I'm pretty sure that you would down the bird, get it inspected, verify it was out of limits, if it was get it fixed, and FCF'd before you even thought about taking it flying. Yet you are willing to self diagnose, potentially putting yourself and your crew in jeopardy over the fear that you might be downed? If you have an issue, and apparently you think you might, get it properly diagnosed and fixed. Period.

As someone who is in month 8 and counting of dealing with the medical bureaucracy, over a condition which I personally know 6 people who have approved flight waivers, I can empathize with the pain/aggravation involved but where do you draw the line?

From the MAYO CLinic:
Left untreated, peptic ulcers can cause internal bleeding and can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis). Peptic ulcers can also produce scar tissue that can obstruct passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight.

From the Waiver Guide:

7.9 PEPTIC ULCER DISEASE ​

AEROMEDICAL CONCERNS:

[FONT=Times New Roman,Times New Roman]The major concern is the risk of acute hemorrhage or perforation in flight. Chronic blood loss can cause iron deficiency anemia, which can then lead to cardiorespiratory compromise in flight. [/FONT]

WAIVER: ​

​

[FONT=Times New Roman,Times New Roman]Waivers may be recommended for single, uncomplicated ulcers once healed for 4-6 weeks. Waivers for recurrent ulcers are considered on a case-by-case basis. Healing should be documented by endoscopy. Waiver recommendations are readily made, but are particularly appropriate when the condition was in response to a known precipitant such as aspirin or other nonsteroidal anti-inflammatory drug. Maintenance medication, limited to H2 blockers or Carafate QHS, is waiverable. [/FONT]

INFORMATION REQUIRED: ​

​

1. [FONT=Times New Roman,Times New Roman]
2. 1. Gastroenterology or internal medicine consult[/FONT]
   [FONT=Times New Roman,Times New Roman]
3. 2. Endoscopy report[/FONT]
   [FONT=Times New Roman,Times New Roman]
4. 3. Pathology report (if applicable)[/FONT]

TREATMENT:​

[FONT=Times New Roman,Times New Roman]Treatment with full antiulcer doses of H2 receptor blockers requires grounding because of the risk of mild sedation and drowsiness. Maintenance therapy is CD, waiver possible for QHS doses only. Successful surgical treatment may lead to unrestricted waiver, provided there is no evidence of post-surgical complications. [/FONT]


Or as FEDDOC Previously mentioned could just ber GERD

7.10 G​

[FONT=Times New Roman,Times New Roman]ASTROESOPHAGEAL REFLUX DISEASE/HIATAL HERNIA​

[/FONT]

AEROMEDICAL CONCERNS:​

[FONT=Times New Roman,Times New Roman]Retrosternal pain associated with either condition can be distracting in flight. Exposure to -Gz may exacerbate the symptoms of both esophagitis and hiatus hernia.​

[/FONT]

WAIVER:
Applicants:​

1. 
   [*]• Symptomatic GERD currently requiring medication is CD
   
   
   [*]• Waiver may be requested if symptoms controlled on stable dose of medication.
   
   
   [*]• Mild symptoms in the past that were controlled with H-2 blockers or proton pump inhibitors (PPI's) but are currently asymptomatic with lifestyle changes alone or only intermittent over the counter (OTC) antacids may be recommended for a waiver. Waiver packages will be considered on an individual basis with proper documentation of prior treatment.
   
   
   [*]• If any of the below 'five warning symptoms of complicated disease' are present, a waiver is not recommended
   [FONT=Times New Roman,Times New Roman]
   
   [*]• [/FONT][FONT=Times New Roman,Times New Roman]Asymptomatic hiatal hernia that does not require therapy is NCD.
   [/FONT][FONT=Times New Roman,Times New Roman]
   
   [*]• [/FONT][FONT=Times New Roman,Times New Roman]Symptomatic hiatal hernia is CD, waiver not recommended.

[/FONT]

Designated:​

1. 
   [*]• [FONT=Times New Roman,Times New Roman]Individuals with mild GERD ([/FONT]none of the below criteria of complicated disease listed below[FONT=Times New Roman,Times New Roman]) whose symptoms are controlled with lifestyle modifications or intermittent antacids are PQ
   [/FONT][FONT=Times New Roman,Times New Roman]
   
   [*]• [/FONT][FONT=Times New Roman,Times New Roman]GERD controlled with H-2 Blockers or PPI's is CD and requires a waiver
   [/FONT][FONT=Times New Roman,Times New Roman]
   
   [*]• [/FONT][FONT=Times New Roman,Times New Roman]Individuals who have any of the five warning symptoms of GERD should be grounded and worked up as indicated below.
   [/FONT][FONT=Times New Roman,Times New Roman]
   
   [*]• [/FONT][FONT=Times New Roman,Times New Roman]Asymptomatic hiatal hernia that does not require therapy is NCD
   [/FONT][FONT=Times New Roman,Times New Roman]
   
   [*]• [/FONT][FONT=Times New Roman,Times New Roman]Symptomatic hiatal hernia is CD, waiver may be considered after successful surgical repair

[/FONT]

INFORMATION REQUIRED:​

1. [FONT=Times New Roman,Times New Roman]
2. 1. Documentation regarding the presence or absence of the following five warning symptoms
   
3. 2.

[/FONT]

Warning Symptoms of Complicated GERD​

1. [FONT=Times New Roman,Times New Roman]
2. 1. Dysphagia or odynophagia
   
3. 2. Symptoms which are persistent or progressive on therapy
   
4. 3. Bleeding or iron deficiency
   
5. 4. Unexplained weight loss
   
6. 5. Extra-esophageal symptoms (cough, choking, chest pain, asthma, etc.)

[/FONT]U.S. Navy Aeromedical Reference and Waiver Guide Gastroenterology - 14

Work-up/treatment:​

[FONT=Times New Roman,Times New Roman](Designated)​

1. 1. Evaluation and treatment per the attached algorithm.
   
2. 2. Individuals should be grounded and not recommended for a waiver until asymptomatic.
   
3. 3. Individuals with uncomplicated GERD (typical heartburn) or who have mild intermittent dyspepsia may be given a trial of therapy without endoscopic evaluation
   
4. 4. Surgical repair of hiatal hernia is CD, waiver considered once asymptomatic, 30 days post-op and cleared to full duty by operating surgeon
   
5. 5. If any of the five warning symptoms mentioned above are present then waiver package must include:
   1. a. Endoscopy results
      
   2. b. Gastroenterology consult
      
   3. c. Documentation of symptom relief on therapy

[/FONT][FONT=Times New Roman,Times New Roman]

Follow-up endoscopy is generally unnecessary and is restricted to the patient whose symptoms fail to respond to therapy.​

[/FONT][FONT=Times New Roman,Times New Roman]

H-2 blockers and PPI's are CD; waiver may be recommended if patient remains asymptomatic on medication.​

[/FONT]​

 

[xj220]

Thanks for all the help. Unfortunately, I don't think this is something I can put off until winging. I'd like to go to a civilian doc, but being a young stud with little power, I'm afraid something will go wrong or I'll get in trouble for it. I'll try and see the flight surgeon tomorrow and what happens happens. I don't think things are bad enough to be an ulcer and since I'm in ground school yet I have some cushion time before flying. My biggest concern is the big NPQ.