Compartment syndrome is an emergency situation
Dear Dr. Roach:
Two months ago, my husband fell down a flight of stairs and fractured six ribs and a vertebra in his neck. He is 65 years old and was in good health before this accident. He was hospitalized in a level 1 trauma center and was doing well until 10 days after the accident, when his abdomen became very swollen. He was rushed to the emergency room and was diagnosed with abdominal compartment syndrome; he needed emergency surgery to address the swelling of his major organs.
He had an ileostomy and later needed another three major surgeries, including one for a collapsed lung. Breathing issues have been a major problem; he had a breathing tube inserted for three weeks. His voice has changed. No more surgery is planned, and he is now in rehab. What causes the abdominal compartment syndrome that did so much damage, and how could it have been prevented?
— B.E. Answer:
A “compartment syndrome” is when the pressure inside a closed system becomes high enough to affect the contents of the compartment. A compartment is a section of the body walled off by anatomic structures.
I am most familiar with compartment syndromes of an extremity. For example, there are different compartments of the arm and leg. Severe damage to a muscle can cause it to swell, increasing the pressure in the compartment so much that not enough blood can get to the injured muscle. It is a surgical emergency, requiring the opening of the compartment.
The abdomen itself is a compartment, with the anatomic structure being the lining of the abdomen. There are many possible causes for abdominal compartment syndrome. Trauma, such as what your husband suffered falling down the stairs, is among the most common. Surgery, sepsis, severe liver disease and burns also may cause ACS.
ACS can cause compression of the lung, as you note. With poor blood supply to the intestine, it can lead to tissue death.
ACS is hard to diagnose, as it most commonly happens in critically ill people who cannot communicate. The physical finding of a tense, distended abdomen suggests ACS but may have many other causes, so the physicians do not always think of this condition. It’s not common; only 1 percent of trauma patients have the condition.
ACS is diagnosed by measuring the pressure in the abdomen. The easiest way to do this is by measuring the pressure of the bladder. Treatment is to open the abdomen to relieve the pressure, and the abdomen usually is left open while the organs recover. The earlier the syndrome is considered and diagnosed, the better the chances of recovery without permanent organ damage.
Dear Dr. Roach:
When at the office for a routine checkup with an appointment, how long should a patient be kept in a room waiting for the doctor? My doctor thinks it is OK to be 20 to 30 minutes past the appointment time. My last office visit was 30 minutes over time, making me late for another appointment. Do patients have any recourse or a patient bill of rights?
— G.G. Answer:
I think a doctor should be on time, unless there is a medical emergency.
A patient’s time is valuable, and I think being habitually late is unprofessional. Getting the first appointment of the day is sometimes helpful, but your ultimate recourse is to find a doctor who will treat your needs more respectfully.
One by one, Thi MIAMI — Squire plucks ruby heirloom tomatoes off the vine and picks dark wine-colored lettuce leaves from the soil.
The ingredients are destined to be tossed in a kale salad sprinkled with beets and baby carrots; fresh mint leaves will be mixed into fruit-infused water that is served to patients at Homestead Hospital.
“Why do we do this? There’s tons of data that says if you eat more fruits and vegetables you are less likely to get sick, regardless of the ailment,” said Squire, who works as the garden’s manager for the hospital, which is an extension of Baptist Health Systems. Squire said Homestead Hospital is one of just a few medical centers in the nation that has the ability to grow their own food.
“A lot of hospitals have partnerships with local farms, but very few have a farm on their actual campus,” she said. “One reason is because not many hospitals have the actual land.”
About three years ago, Baptist set aside 10 acres of unused land adjacent to the hospital. The goal was to create educational programs that would give patients access to organic, sustainable foods. Squire leads the efforts in providing meals to patients with serious illnesses and putting on workshops for staff, students and the community on how to cook with natural, non-processed foods.
“The goal is that they don’t show up at the hospital and get admitted for their chronic disease to begin with. We don’t really want people to show up just to get an organic meal, but instead have them go home with knowledge; that they can learn how to go home and make a dish low in sugar and salt and actually enjoy it,” Squire said.
Dubbed Grow2Heal, the garden is in its start-up phase and operating on about a quarter of an acre. It gathers about 10 student volunteers a month from local high schools and colleges and puts together about 2,500 meals during harvest peak times, typically November through May.
“We anticipate that when the garden is farmed out on all 10 acres, we’d be able to serve approximately 100,000 meals a year,” said Jennifer Pages, a spokeswoman for Homestead Hospital.
The farm also has a greenhouse, a new beehive to harvest honey and a sunflower garden where the blossoms are placed in patients’ rooms.
The parcel of land has produced dozens of fruit and vegetable varieties including radishes, bananas, red oak lettuce, cucumbers, collard greens, Swiss chard, squash, watermelon, blackeyed peas, kidney beans and green beans. Squire also grows herbs such as lemongrass, rosemary, French sorrel and oregano. In season this month? Tropical fruit, mostly mangoes.
Claudia Marquez, a 23-year-old Florida International University graduate student and volunteer at Grow2Heal, says the unique farm-to-table experience is a creative solution to the ongoing challenges with chronic disease management and preventive healthcare.
“I gained the cooking skills to be confident in dishes I never knew I can make from simple fruits and vegetables,” Marquez said. “I was able to see what I planted come to life and how to incorporate what I learned at home. I really have seen major changes in my eating habits, which is the goal for those that come across the garden at Baptist.”
One of the hospital’s main field trip programs is called “Grow Your Lunch,” in which visitors plant seeds, harvest fruits and vegetables, and cook their own lunch under Squire’s guidance. The food is also used to educate the community through health fairs, cooking demonstrations, wellness workshops and support groups.
Julia Lemus, a guest services representative at Mariners Hospital in Tavernier — another extension of Baptist — says the garden has had a far-reaching impact.
“It’s priceless. Who thought a hospital would be at the forefront of trying to keep you away from the hospital by focusing on preventive care like fixing how you eat?” Lemus said.
The hospital spends $150,000 a year to operate the farm, Squire said. “It’s not an immediate cost saver for our cafeteria. That’s not the mission, even when we do end up operating on the full 10 acres. The savings is quantified by better quality products and giving our community access to them.”
But it’s easier said then done.
“If you’re low income, you’re less likely to have a car, and if you don’t have a car — and because MiamiDade has such poor public transportation — it becomes extremely difficult to get your hands on non-processed foods,” Squire said. “And if you live near one of few farm stands, and live in one of the few pedestrian-friendly pockets of the county, chances are that stand doesn’t accept food stamps.”