Hello Late_rendezvous,
It certainly appears that you do indeed have a hiatal hernia.
However, this answer is for informational purposes only, and not
intended to replace sound medical advice from your physician.
Kudos to you for not smoking!
I have gathered numerous sources for you about hiatal hernias.
Because of copyright restrictions, I can only post a small amount of
information from each site. Please read each site for complete
information.
?Hiatal Hernia has been called the "great mimic" because it mimics
many disorders. A person with this problem can get such severe pains
in their chest that they think they are having a heart attack. They
may think they have an over acid stomach because they will regurgitate
stomach acid after they eat, or their stomach may hurt so badly they
will think they have an ulcer. This is just a sampling of the symptoms
that may occur from this disorder.
What is a Hiatal Hernia?
When you swallow, your food passes down a long tube known as the
esophagus into the stomach. This tube must pass through a muscle known
as the diaphragm, which is located near the bottom of your rib cage.
This opening in the diaphragm, which permits the esophogus to pass
through, is regulated by a sphincter muscle (or "valve") which relaxes
and opens when we swallow to permit the food to pass through the
diaphram and into the stomach. This sphincter then closes to prevent
stomach acid from coming back up into the throat. A hiatal hernia
occurs when the top of the stomach rolls or slides up into this
opening and becomes stuck there.?
?The hiatal hernia will also interfere with the movement of the
diaphragm muscle. This muscle normally pulls downward to expand the
chest capacity and inflate the lungs. Since the hiatal hernia
interferes with this movement, the person may be restricted to shallow
breathing, or will resort to using the chest and shoulders to expand
the lung capacity and take a deep breath.?
http://www.joyfullivingservices.com/hiatalhernia.html
?Hiatal Hernia results from a weakness in part of the breathing
muscle called the diaphragm. This weakness in the muscle allows part
of the stomach to pass through the diaphragm into the chest (see
picture below).?
http://pfrc.med.nyu.edu/handouts/pdf/proced/hiathern.pdf#search=%22shortness%20of%20breath%20%20%2B%20hiatal%20hernia%22
??although a hernia can theoretically develop almost anywhere, most
are in the abdominal area. This includes hiatal hernias ? also known
as diaphragmatic hernias ? which form at the opening in your diaphragm
where your food pipe joins your stomach.?
Self Care
? Eat small meals. Large meals can distend your stomach, pushing it
into your chest.
? Avoid problem foods and alcohol. Try to avoid alcohol, caffeinated
drinks, chocolate, onions, spicy foods, spearmint and peppermint ? all
of which increase production of stomach acid and relax the lower
esophageal sphincter. Even decaffeinated coffee can be irritating to
an inflamed esophageal lining. Also try to limit citrus fruits and
tomato-based foods. They're acidic and can irritate an inflamed
esophagus.
? Limit fatty foods. Fatty foods relax the lower esophageal sphincter
and slow stomach emptying, which increases the amount of time that
acid can back up into your esophagus.
? Sit up after you eat. Wait at least three hours before going to bed
or taking a nap. By then, most of the food in your stomach will have
emptied into your small intestine, so it can't flow back into your
esophagus. Eating a bedtime snack stimulates acid formation and
further aggravates acid reflux.
? Don't exercise immediately after eating. Try to wait at least two to
three hours before you engage in any strenuous activity. Low-key
exercise, such as walking, is fine.
? Lose weight. If you're overweight, slimming down helps reduce the
pressure on your stomach. This may well be the most important thing
you can do to relieve your symptoms.
? Stop smoking. Smoking increases acid reflux and dries your saliva.
Saliva helps protect your esophagus from stomach acid.
? Avoid certain medications, if possible. Medications to avoid include
calcium channel blockers, such as diltiazem; the antibiotic
tetracycline; nonsteroidal anti-inflammatory drugs, such as aspirin,
ibuprofen and naproxen sodium; quinidine; theophylline; sedatives and
tranquilizers; and alendronate. If you take any of these medications
and suffer from heartburn, talk to your doctor. You may be able to
take other drugs instead.
? Elevate the head of your bed. If you elevate the head of your bed 6
to 9 inches, gravity will help prevent stomach acid from moving up
into your esophagus as you sleep. Using a foam wedge to raise your
mattress also may help. Don't try to use pillows, which tend to
increase pressure on your abdomen.
? Avoid tightfitting clothes. They put pressure on your stomach.
? Take time to relax. When you're under stress, digestion slows, which
makes GERD symptoms worse. Relaxation techniques such as deep
breathing, meditation or yoga may help reduce acid reflux.
http://www.cnn.com/HEALTH/library/DS/00099.html
?A hiatal hernia can crowd the chest area giving the lungs less
room to work. Eating smaller meals can help since a full stomach also
crowds the lungs causing increased shortness of breath. Often this is
worse with any movement that would cause you to bend forward at the
waist since it further crowds your lungs into a smaller space.?
http://www.medhelp.org/forums/RespiratoryDisorders/messages/1676.html
?For most people, a hiatal hernia by itself causes no symptoms.
? Chest pain or pressure
? Heartburn
? Difficulty swallowing
? Coughing
? Belching
? Hiccups
? Pain: At times, a hiatal hernia causes chest pain or upper abdominal
pain when the stomach becomes trapped above the diaphragm through the
narrow esophageal hiatus.
Although it is true that hiatal hernia or GERD can cause chest pain
similar to angina (or heart pain) including chest pressure that can
radiate to the arm or neck, do not assume that such pain is caused by
the less serious condition of the two. When in doubt, it is safer to
be seen by a doctor immediately in order to rule out more serious
problems first.?
http://www.emedicinehealth.com/hiatal_hernia/page3_em.htm#Hiatal%20Hernia%20Symptoms
?In severe cases, difficulty breathing, swallowing difficulties,
and severe chest pain can occur.
It is possible for a hernia to become so large that as much as
one-third of the stomach protrudes into the chest. This can make it
difficult to breathe. Rarely, a hernia becomes twisted and cuts off
the blood supply to the stomach, making it difficult to swallow, and
causing severe chest pain.?
http://merck.micromedex.com/index.asp?page=bhg_report&article_id=BHG01GA27§ion=report
?The effectiveness of medications used to control symptoms of GERD
depends on the severity of your symptoms. Nonprescription medications
may not be strong enough to control your symptoms, and you may need
prescription medications. Keep in mind that some of these medications
are not as effective for some people; they may need to try other
medications or consider surgery. If your symptoms cannot be controlled
with medications, or if you have severe symptoms caused by the
regurgitation of stomach juices into the esophagus, surgery may be
necessary.?
http://www.questdiagnostics.com/kbase/dp/topic/aa56508/dp.htm
?Symptoms:
-produce few symptoms when small, which is why the defects are large
when discovered
-long history of postprandial distress/discomfort
-substernal fullness and belching
-true dysphagia uncommon
-absence of heartburn/esophagitis
-pulmonary complications are common: recurrent pneumonia; chronic
atelectasis; dyspnea classically after a large meal?from pleural space
compression by the huge hernial sac
-ulceration of the herniated stomach with resultant bleeding and anemia
-incarceration, obstruction, torsion, gangrene, and perforation
-most feared and lethal complication is gastric volvulus with
strangulation which usually occurs post-prandially?this is a true
surgical emergency if the stomach cannot be decompressed. Almost 30%
of paraesophageal hernis present in this fashion. The stomach becomes
twisted and angulated in its midportion just proximal to the antrum.
Most prominent manifestation is the inability to swallow or
regurgitate.?
http://www.ctsnet.org/doc/5948
You *may* have what is called a ?Sliding hiatal hernia?
?Sliding hiatal hernias are common. The clinical significance of a
sliding hiatal hernia is uncertain. Most patients with a sliding
hiatal hernia do not have gastroesophageal reflux, but reflux
esophagitis is found more commonly in patients who have a hiatal
hernia than in those who do not.?
http://www.emedicine.com/radio/topic337.htm
?There are 3 main types of hiatal hernia: sliding, paraesophageal,
and mixed. A sliding hiatal hernia is the most common type and is
generally not a serious condition. Paraesophageal and mixed hiatal
hernias may progress and are more serious.?
A hiatal hernia is often caused by weakened muscles and connective
tissue within and around the hiatus. In a sliding hiatal hernia, a
small portion of the stomach pushes upward through the diaphragm at
the hiatus and becomes positioned above the abdomen, inside the chest
cavity?
?If you have shortness of breath or pain in the area of your
breastbone, you need to make sure it is not caused by a heart problem.
The burning sensation caused by acid reflux usually occurs after
eating. Pain from your heart is usually felt as a pressure, heaviness,
weight, tightness, squeezing, discomfort, or a dull ache that occurs
most often after activity. If you are not sure of the source of chest
pain, seek medical attention immediately.?
http://health.yahoo.com/ency/healthwise/hw239946
?A hiatal hernia ? sometimes called a diaphragmatic hernia ? is
movement of the stomach into the chest via a hiatus (a hole) in the
diaphragm. Anatomically, the diaphragm muscle is between the stomach
and the chest. The hiatus is the opening in the diaphragm where the
esophagus or food pipe joins the stomach. A hiatal hernia, then,
occurs when the stomach moves into the chest via the diaphragm. There
are two types of hiatal hernias: a sliding hernia is when the stomach
slides up into the chest and back down; a fixed hernia is when the
stomach slides up into the chest and stays there. Both can be quite
painful conditions, although some minor hiatal hernias can cause mild
to no pain.
Because the stomach assumes space in the chest, leaving less room for
the lungs to function at capacity, yes, hiatal hernias can cause
shortness of breath.?
http://www.goaskalice.columbia.edu/3523.html
?The hiatal hernia will also interfere with the movement of the
diaphragm muscle. This muscle normally pulls downward to expand the
chest capacity and inflate the lungs. Since the hiatal hernia
interferes with this movement, the person may be restricted to shallow
breathing, or will resort to using the chest and shoulders to expand
the lung capacity and take a deep breath.?
http://www.earthtym.net/ref-hiatal-valve.htm#03
Tests:
======
?Your doctor may suspect that you have a hiatal hernia based on your
symptoms and risk factors (age, obesity, smoking, occupation that
requires heavy lifting). To confirm the diagnosis, your doctor may
order one or more of the following tests:
? Chest X-ray ? A simple X-ray may show a large hiatal hernia.
? Esophagoscopy ? A viewing tube is inserted down the throat to
inspect the esophagus.
? Barium swallow ? You swallow a fluid containing barium, which
appears white on an X-ray. The path of the barium can outline the
position of the hernia in the chest, or it can show that stomach
contents are leaking backwards into the esophagus.
? Manometry ? This test measures pressure, to diagnose abnormal muscle
movements inside the esophagus.
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/20753.html
Treatment
=========
?Successful treatment of hiatal hernias usually involves treating the
symptoms of gastroesophageal reflux disease (GERD) that are triggered
by the additional pressure in the abdomen.
Treatment includes making lifestyle changes, such as:
? Losing weight if you are overweight, and maintaining a healthy weight
? Having a common sense approach to eating, such as eating moderate to
small portions of foods; and limiting fatty foods, acidic foods (such
as tomatoes and citrus fruits or juices), foods containing caffeine,
and alcoholic beverages
? Eating meals at least 3-4 hours before lying down, and avoiding bedtime snacks
? Elevating the head of your bed by 6 inches (this helps allow gravity
to keep the stomach's contents in the stomach)
? Not smoking
? Taking medications, such as over-the-counter antacids, Gaviscon, or
H2 blockers (such as Pepcid AC or Zantac).
Note: If you take over-the-counter medications for longer than two
weeks without any improvement, see your physician. Your physician can
prescribe a stronger medication, and/or pantoprazole (Protonix),
rabeprazole (Aciphex), esomeprazole (Nexium), H2-receptor antagonists,
proton pump inhibitors (omeprazole [Prilosec], lansoprazole
[Prevacid]).
If medications are not effective in treating your symptoms, diagnostic
tests may be performed to determine if surgery is necessary. Surgery
is rarely needed to correct the disorder.?
http://www.clevelandclinic.org/health/health-info/docs/2500/2537.asp?index=9622&src=news
?The treatment for hiatal hernias is focused on diet and surgery is
rarely necessary. Doctors recommend restricting your intake of spicy
and acidic foods and beverages, caffeinated beverages, and chocolate;
elevating your head when lying down to prevent gastroesophageal
reflux; remaining in an upright position after eating; and using
antacids and acid-reducing medications. Patients with hiatal hernias
find that symptoms are reduced if they eat frequent small meals
throughout the day. Surgery is necessary for a strangulated hiatal
hernia and very large hiatal hernias that cause severe
gastroesophageal reflux. This procedure may be performed through
laparoscopic surgery, in which the surgeon uses a special viewing
instrument called a laparoscope, inserted through a small incision in
the chest or abdomen. The laparoscope is like a tiny video camera that
gives the surgeon a clear view of the abdominal area. Other small
incisions are made to insert the surgical instruments used to pull the
stomach back down into the abdomen and repair the weak muscle or make
a smaller opening between the diaphragm and the esophagus.?
http://www.hmc.psu.edu/healthinfo/h/hiatalhernia.htm
Surgery
=======
?For an open hiatal hernia repair, an incision is made in the abdomen
while the patient is under general anesthesia. The stomach and lower
esophagus are placed back into the abdominal cavity. The hiatus is
tightened and the stomach is stitched in position within the abdominal
cavity. The upper part of the stomach (fundus) may be wrapped around
the esophagus (fundoplication) to reduce reflux. Sometimes the surgeon
will place a temporary tube from the stomach through the abdominal
wall to keep the stomach in place.
In some patients, this operation can also be performed
laparoscopically (also known as "keyhole" or "telescopic" surgery). In
a laparoscopic fundoplication, small (1 cm) incisions are made in the
abdomen, through which instruments and a fiberoptic camera are
passed.?
http://health.allrefer.com/health/hiatal-hernia-repair-info.html
?What Type of Surgery is Done for a Paraesophageal Hiatal Hernia
Hiatal hernia surgery is commonly done as a laparoscopic procedure.
The laparoscope is a thin, telescope-like instrument with a camera on
the end that enables the surgeon to view the inside of the abdomen.
With this type of surgery, small incisions are made in the abdomen.
The laparoscope and surgical instruments are inserted through these
incisions. During the surgery, the stomach is repositioned and the
hiatus is reinforced.?
Here?s a nice but technical slide show on hernias. The illustrations
may be useful to you:
http://medschool.umaryland.edu/surgery/general/resident/website/docs/resident_conf/fall_2006/esophageal_disord_guzzo.swf
Prilosec (Omeprazole) is an effective medication to reduce stomach
acid and gastric reflux disease. It should help you avoid acid (reflux
heartburn), but won?t help with the breathing difficulties.
?What is omeprazole?
? Omeprazole decreases the amount of acid produced in the stomach.
? Omeprazole is used to treat ulcers, gastroesophageal reflux
disease (GERD or heartburn), and other conditions involving excessive
stomach acid production.
? Omeprazole may also be used for purposes other than those listed
in this medication guide.
http://www.drugs.com/omeprazole.html
Additional Information on hiatal hernias, with an illustration
http://www.everettclinic.com/kbase/topic/mini/hw239946/overview.htm
There you go! I hope this has answered your question! If not, please
request an Answer Clarification and allow me to respond, before rating
this answer.
I am not an MD, but I am a health care professional and an online
medical and health researcher.
Sincerely, Crabcakes
Search Terms
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SOB + hiatal hernia
Dyspnea + hiatal hernia
Shortness of breath + hiatal hernia
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Clarification of Answer by
crabcakes-ga
on
12 Oct 2006 09:07 PDT
Hello again Late_rendezvous,
You will find contained in my answer, or on the links I provided,
that an x-ray alone can't diagnose a hiatal hernia. However, when
using an x-ray for diagnosing a hiatal hernia, the patient drinks a
chalky drink that contains barium, a contrast media. This site
explains it best, and contains illustrations:
http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm
http://merck.micromedex.com/index.asp?page=bhg_report&article_id=BHG01GA27§ion=report
As to how long it takes to go away... that depends on the patient.
If lifestyle changes, as found in my original answer and links, don't
cause symptoms to resolve, then surgery is the next step.
As far as why the first doctor didn't diagnose you - I can;t
accurately answer that. I do know that many doctors will attempt to
treat the symptoms before resorting to fluorscopy ( x-rays with the
barium contrast media). This test is very expensive, and if the
symprtoms can be treated without utilizing such a procedure, then
there is no need. If you went to a doctor who listened to your
symptoms and recommended that you lose weight, eat a healthy diet,
exercise, and take antacids or a prescription acid-blocking medicine
and you found no relief after closely follwoing the doctor's
recommendations, then the doctor might order further tests.
As patients, we want our docotrs to use all available technology to
diagnose us. Many conditions can be diagnosed without them however,
and doctors are trained to recognize a group of symptoms and figure
out what is causing them. I would not be upset that the first docotr
did not immediately diagnose a hiatal hernia. How many times did you
visit her/him?
"For approximately 50% of individuals with a hiatal hernia,
symptoms are not present. For those who do experience symptoms, it is
usually caused by heartburn, or acid reflux. Many individuals with a
hiatal hernia also have gastroesophageal reflux disease, or GERD. For
them, their doctors may prescribe a treatment plan that is similar to
the treatment for GERD.
For those individuals who don't have any symptoms, they don't require
any treatment for their hiatal hernia. For others, lifestyle changes
and medications will control their symptoms. It is only for a minority
of patients who experience severe symptoms of reflux despite lifestyle
changes and medications, or who develop complications such as
stricture, bleeding or an obstruction, will surgery be considered."
http://heartburn.about.com/od/hiatalhern2/a/treathiatalhern.htm
The causes of muscle weakness, allowing a haital hernia to occur is
mostly unknown. This too is discussed in my original answer and links,
but I'll post additional information here:
" What Causes a Hiatal Hernia?
Most of the time, the cause is not known. Some people develop a hiatal
hernia after sustaining an injury to that area of the body; others are
born with a weakness or an especially large hiatus. Some experts
suspect that increased pressure in the abdomen from coughing,
straining during bowel movements, pregnancy and delivery, or
substantial weight gain may contribute to the development of a hiatal
hernia."
http://www.webmd.com/content/article/45/1815_50331
"Some of the possible causes of Hiatal hernia are included in the list below:
* Obesity
* Pregnancy
* Tight clothing
* Physical exertion
* Weight lifting
http://www.wrongdiagnosis.com/h/hiatal_hernia/intro.htm
* Obesity
* Pregnancy
* Tight clothing
* Physical exertion
* Weight lifting
* Straining
* Coughing
* Abdominal injury
* Congenital abnormality
http://www.wrongdiagnosis.com/h/hiatal_hernia/causes.htm#underlyconditions
I hope this has fully answered your questions. Please check each link
I posted, as I am unable to post entire site content.
I would not worry about reporting the doctor who did not diagnose a
hiatal hernia, unleass you followed her/his recommendations and
returned for a followup and reported that you found no relief and
asked for a further workup. Doctors do not "fix" haital hernias unless
there are severe problems, as lifestyle changes often alleviate
symptoms.
Good luck!
Sincerely, Crabcakes
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