The "Cough Test"
 

When you go for your class 1 medical, does any know the purpose of the "cough" test? Why is it necessary for the medic to grope around your groin while you cough?

I understand it to be something to do with hernias but I'd be interested in any detail, especially as to how it relates to one's ability to fly.

Also, do women pilots have the same test?

Looks like Parris on to us boys and girls! I think you're refering to the "whoop..whoop..pull up" test, but maybe those experienced in carrying out such a procedure can elaborate here. My role would be purely as observer and noting any post traumatic stress symptoms that might require debriefing. :}

Does this answer your question?

A hernia is when part of the intestine, or bowel, pushes down inside the scrotum from the abdomen. If a person has a hernia, this part of the bowel can become trapped inside the scrotum, causing serious problems. The physician checks for this by having the male cough while feeling inside the scrotal sac. Hernias may be felt as the person coughs and the bowel is pushed downwards. Hernias can be corrected with surgery.

From a medical website.

And I always thought they want to find out whether one has got the balls to become an airline pilot... :D


GAF4139

We are talking inguinal hernias here.

The best way to visualise this problem is to think back to the bad old days when your mode of transport was a bike. Rmember when the tyre got so worn down that the inner tube came through?

Well that is what in effect happens with a hernia.

The muscles and tendons of the abdominal wall have given way to the pressure of the contents of the abdomen and they are now peeping through. There is of course still fatty tissue and skin overlying the contents. You can imagine if the hernia gets big enough that part of the bowel can slip through and become trapped.

When you get asked to cough (or blow on the back of your hand) you are making additional pressure in your abdominal cavity and if there is a hernia you can feel the bulge over the hernia ports (when present)

The reason why blokes are more prone to these is that we are born with a bit of a weaker area in the inguinal canal. Our testes get formed near the kidneys and during the latter stages of our foetal life migrate from there via your groin to the scrotum. The idea is that this canal heals up afterwards but this does not always happen.

In those unfortunate enough to have an ongoing weakness there it is a matter of exposure to the wrong sort of things (overweight/heavy lifting/persistent cough/bad luck) for this to open up and voila you have a hernia. This is called an indirect hernia. You'll understand from its origin that this flavour is less frequently found in females.

The other type is the direct or femoral hernia which is a weakness in the abdominal muscles/tendon which can make the earlier mentioned contents pop forwards. This is a less frequent variant and the sort which can strike both females and males.

There used to be umpteen repair methodes for hernias with varying successrates. More recently most get repaired laparoscopically (key-hole surgery) with some mesh (fancy gauze).

Other than the hernias mentioned here you can have a hiatus hernia; umbilical hernia; incisional hernia and a hernia in your back but they are all different things.

That's it for today.

FD

FD - very thorough response, but there is one more type of hernia (and I know 'coz I had one!) and that is an epigastric hernia. I'd assumed it was an umbilical hernia because it was a golf-ball like swelling over my umbilicus. The surgeon said it was actually an epigastric one.

You get these from lifting 38 kg of wriggling, aging German Shepherd Dog into the back of a car!!

Anyway, back to the original sport of testicle grabbing.... ;)

CB

I always leave one out. Don't want to look too clever!

:D

FD

Thanks for the info everyone. Just a couple of points though...

Are these hernias common? If you get one, how does it affect your ability to fly? Is it just the pain?

AP

Yes, the key question is how would a hernia affect your flying? Presumably you can quite happily have a hernia and not really notice?

I recall having my teeth checked at my (class 2) medical. Which is nice, as I haven't got around to registering with a dentist. I remember wondering at the time what possible effect your teeth could have on your fitness to fly? I look forward to being enlightened...

Hi,

Funny that you refer to the teeth as the other subject for which you would like to find out why it is important that things are A1OK.

The most obvious thing is that both the hernia and the teeth if not OK can cause pain.

However have you considered the consequences of decompression when flying and more in particular the result of a rapid decompressio nwill have on any cavity which has trapped air in it.

Teeth with decay and or leaking fillings can have trapped air under them. And your bowel obviously has air in it. When you get exposed to a sudden drop in ambient pressure that air will expand and in the case of the teeth give you sudden and excruciating pain. And the same will happen to any hernia which has popped outside the abdominal cavity.

Now you will say that this is not a likely scenario for the average PPLer but your class 2 will give you the opportunity to fly the sort of machines which make these issues worthwhile considerations.

FD

...unless of course, your doctor happens to be Sir Lancelot Spratt in which case the conversation would go something like this:

Spratt: (handing a marker to an intern) "Right. This one's an appendectomy. Mark where you'll make the incision".

Intern makes than elegant mark, about an inch long in the appropriate area.

Spratt: (snatching the pencil off the intern) "No no no no no. We'll have none of that damn keyhole surgery. Make it here...and here." And with that he swishes a blue line on the patient from the groin to the throat and another from hip to hip.

The patient faints.

Made me smile!

You sometimes get patients complaining about the bed-site manner of those in the surgical specialities. I suggest that if they want a good chat they go to the psychiatrist.

:D

The lack of communication skills of surgeons is a bit of a standing joke but what people should realise is that although we are all doctors that people choose specialities based on their personal preferences. And a good thing too! I would be depressed if I had to spend my working life with my hands buried in other people's tummies.

It's like flying some like gliding others like microlighting and the third will enjoy flying IMC approaches.

And some of us like a bit of variety.

That's me.

FD

I've heard from some sources that bad teeth (decay, not uneven) can also indicate heart problems or other health problems, so its advisable to have nice white nashers...

No, it's that bacteria in bad teeth can sometimes cause heart problems, specifically infection, in those with an underlying heart condition, such as a leaky valve or a hole in the heart.

QDM

Thanks for the info. Yes, you do tend to think of the average PPL as someone who will be bimbling around the countryside at 2000'. I suppose there is always the possibility of doing something a little more exciting than that!

Women don't have to do it but we do have the 'joy' of a breast examination with a girl who comes in especially to chaperone in case of, well, the obvious I guess...

Penguina - what, in case the AME tries to show you his sea horse impersonation??!! ;) ;)

You blokes are blowing smoke out your bums!

I know because........
For 15 years my doctor has been cupping my balls- the 'cough test'.
At the end of my career, at my last medical, I felt free to ask the question.
'Listen, doc, er what's the story...er what's it prove?'
He replied, 'Well nothing really, I just like doing it'.
The filthy buggr

I wasn't game to ask him about the prostrate check. I was out of there. :D