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Single Site: The Scarless, Painless Surgery (KMEG)

Single Site: The Scarless, Painless Surgery (KMEG)

Single Site Surgery has become a new advancement in the medical world.

It’s the newest trend in minimally invasive surgery: the single incision laparoscopic procedure.

“All of our instruments go through this one sleeve into the abdominal cavity as opposed to three or four separate sleeves with traditional laparoscopic surgery. So this would require a slightly less than a one inch incision to place this and then our instruments would go through these ports and all go through one incision,” said Dr. William Rizk, General Surgeon at Midlands Clinic.

And Dr. William Rizk says that makes the cosmetic effect dramatically better.

“Some people refer to it as a scarless surgery because the way we make our incision in the belly button, really hides the incision surprisingly well.”

Dr. Rizk says those who have undergone this procedure experience less pain.

“This is the actual sleeve that goes, creates a tube that goes into the body and then we tighten it up against the muscle wall.”

And Midlands Clinic in Sioux City is the only surgical group performing single incision on gallbladders.

“I personally have done over 120 of these procedures. We’ve had great success. As with any laparoscopic surgery, the recovery is rapid. Most patients are back to work in one to two weeks similarly with a single incision, patients have a very rapid recovery, a return to work in one to two weeks and are very happy with their cosmetic appearance after the surgery,” said Dr. Rizk.

Siouxland News – KMEG 14 and FOX 44

Read the full story HERE.


Heartburn: A Common Problem

Heartburn: A Common Problem

Heartburn: A Common Problem

Jeffrey Michalak, DO, Gastroenterologist
Midlands Clinic, PC

Have you suffered from repeated bouts of heartburn and sour tasting fluid in your throat?  These are classic symptoms of a common health problem called gastroesophageal reflux disease or GERD. This is a condition in which the esophagus becomes irritated because of acid flowing back from the stomach.

Your Anatomy

The esophagus is the tube connecting the throat to the stomach. When food is swallowed, it travels down the esophagus, past a sphincter that joins the esophagus to the stomach, and into the stomach. Smoking, caffeine, and alcohol all increase the level of acid in your stomach, which can make your symptoms worse. Eating certain foods or medicines can also add to the problem. 

Symptoms of GERD

  • A burning sensation in the chest (heartburn)
  • A bitter or sour taste in the back of your mouth
  • Burping
  • Pain in the lower chest/upper abdomen
  • Chronic cough and hoarseness
  • Worsening of the above symptoms when bending over or lying down flat

Causes of GERD

The exact cause of GERD is unknown. The following are contributing factors that may weaken the lower esophageal sphincter, resulting in reflux:

  • Lifestyle: Use of alcohol or cigarettes, obesity, poor posture (slouching)
  • Medications: Calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, antihistamines
  • Diet: Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acidic foods such as citrus fruits and tomatoes, spicy foods, mint flavorings
  • Eating habits: Eating large meals, eating quickly or soon before bedtime
  • Other medical conditions:  Hiatal hernia, pregnancy, diabetes, rapid weight gain

When to Seek Medical Care

Many people experience the signs and symptoms of GERD on occasion.  When the signs and symptoms occur at least twice a week, or interfere with daily activities, it is time to call your doctor. It is advised to try and relieve GERD symptoms by changing habits, diet, and lifestyle, prior to consulting a health-care professional.

  • Call your doctor when symptoms of GERD occur frequently, disrupt your sleep, interfere with work or other activities, or are not relieved by lifestyle change or over the counter medications. 
  • Inform your doctor of your lifestyle changes and  if you are using over the counter medications so that it can assessed as to how well these changes are working for you. 

If you have any of the following, go immediately to the emergency department:

  • Severe chest pain or pressure, especially if it radiates to your arm, neck, or back
  • Vomiting followed by severe chest pain
  • Vomiting blood
  • Dark, tarry stools
  • Difficulty swallowing
  • Shortness of breath

Your Medical Evaluation

The goals of treatment are reducing reflux, relieving symptoms, and preventing damage to the esophagus.  This can be done a number of ways.  The first thing your doctor will do is a thorough physical exam and request diagnostic tests.  These tests may be performed by a gastroenterologist, or GI doctor.  A gastroenterologist specializes in treating digestive problems.  The following are tests that may be performed to identify what is causing your GERD discomfort:

  • Barium Upper GI- a series of xrays to evaluate how your digestive tract works.
  • Esophageal endoscopy- allows the doctor to see inside your esophagus through a tiny flexible tube.
  • Esophageal manometry- measures the muscle tone in the sphincter between your esophagus and stomach as well as the muscle tone of the esophagus.
  • pH monitoring- test that monitors the acid in your esophagus for 24-72 hours
  • Ruling out gall bladder problems through ultrasound

Life After Treatment

GERD can often be managed through a combination of lifestyle changes, medication and sometimes surgery.  Your doctor can help you find the option that is right for you.  With the appropriate treatment, you can return to living a full and healthy life, eating the foods and doing the activities you enjoyed before your heartburn started.

Dr. Jeffrey Michalak, Gastroenterologist at Midlands Clinic, PC, sees patients for GERD and other digestive disorders.  To make an appointment with Dr. Michalak, please call 605-217-5500.


Midlands Clinic doctors implement ERAS protocol

Midlands Clinic doctors implement ERAS protocol

This article was originally published in the Sioux City Journal.

For the past year, Drs. Lawrence Volz and Robert Anderson at Midlands Clinic in Dakota Dunes have been implementing a new protocol that significantly improves outcomes for patients undergoing colon surgery.

The protocol, Enhanced Recovery After Surgery (ERAS), is a multi-step program that starts several days before the operation and helps prepare patients for surgery. ERAS also involves multiple changes in the way these patients are managed from the operating room to the nursing unit after surgery until they are seen in follow-up in the surgeon’s office.

ERAS protocols are designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counseling, optimization of nutrition, minimizing narcotics pain medication, early feeding and mobilization.

“These protocols have been going on in Europe for 10 years or longer,” said Dr. Lawrence Volz, a general surgeon at Midlands Clinic since June 2006. “By following the protocol, surgeons there found that patients experienced less complications, mortality is less, the length of stay in the hospital is less, and patient satisfaction is better. All outcomes are improved, saving hospitals money and improving the outcomes for patients.”

Click here to read the rest of the story.


Dr. Abraham Quoted in Lightning Strike Article

Dr. Abraham Quoted in Lightning Strike Article

Our very own Dr. Mark Abraham was quoted in an article that appeared in the Des Moines Register this weekend, about a Des Moines storm chaser that was struck by lightning in Sioux City on August 31st.

Click the link below the excerpt to read the full article!

Danny Murphy drives a forklift for a living. He heaves massive tractor tires into place on the John Deere assembly line in Waterloo.


But last week he barely could lift the fork off his plate of roast beef and mashed potatoes as he winced with pain on the eighth floor of Mercy Medical Center.


Murphy, 49, is the amateur storm chaser you may have heard about who was struck by lightning Sunday, Aug. 31, along the highway near Denison.

Read the rest of the story here.


Common care products cause skin irritations

Common care products cause skin irritations

This article originally appeared in the Sioux City Journal, and was also published in the May 2014 issue of Siouxland Life Magazine.

April 11, 2014 11:28 am • DOLLY A. BUTZ
(Photograph by Dawn J. Sagert)

Indy Chabra’s patients often think the red, itchy rashes on their skin are related to something they ate. They don’t usually suspect that the things they wear, touch or clean themselves with could be causing the problem.

“They waste so much money going to the allergist and getting prick testing,” the Dakota Dunes dermatologist said.

Nickel is the most common cause of allergic contact dermatitis in the United States. But everything from sofas made in China to volleyballs and formaldehyde-based products, Chabra said, can cause rashes which are often treated with a strong topical steroid.

“If you look at the back of shampoo bottle or any product, it’ll say DMDM hydantoin or a bunch of other allergens,” he said. “When you’re allergic to any of this stuff you often have cross allergies.”

Annually, the American Contact Dermatitis Society selects a contact allergen of the year. The 2013 allergen of the year is Methylisothiazolinone (MI), a powerful preservative increasingly found in cosmetics and toiletries, including wet wipes.

Infants and young children present at Midlands Clinic, 705 Sioux Point Road, with rashes after parents have tried numerous over-the-counter treatments. Chabra asks them if they’ve been using wet wipes. They stop. The rash clears up.

“Every time they use it, that’s when the rash comes. You stop it, the rash goes away,” he said.

Chabra asks patients suffering from allergic contact dermatitis if they’ve recently changed skin or hair care products. The answer is often, “No.”

“Companies change the specific ingredients of products without telling people,” he said. “Second, our immune system changes. Third, the skin changes. If the skin is broken down, the chances of it developing an allergic contact dermatitis is higher.”

Chabra performs a T.R.U.E. test or epicutaneous patch test, to help him diagnose allergic contact dermatitis. The test’s sticky panel, which is applied to the patient’s upper back, contains tiny amounts of 35 allergens. Substances a person isn’t allergic to, won’t cause a skin reaction.

Gold, Chabra said, is the most common cause of eyelid dermatitis in women.

“Because the gold rings — and a lot of the facial products they use have sunscreen in them — have zinc and titanium. Titanium is a metal that upgrades little particles of gold. You’re putting this on your face every day, and eyelid skin is some of the thinnest skin in the body. That’s why you get eyelid dermatitis.”

A women visited her ophthalmologist multiple times to rid herself of an eyelid rash, before coming to Midlands Clinic. Chabra performed a patch test, which he said “lit up for gold.”

“Then we realized that the glasses have 14-carat gold,” he said. “She changed them and she was fine.”

Chabra also patch-tested a high school volleyball player suffering from a facial rash. It turns out that the teen is allergic to rubber accelerants used in the manufacturing process.

“To make rubber you take the sap and vulcanize it. Otherwise rubber is very gooey, and so you use all these accelerants in it,” Chabra explained. “She was allergic to all of those.”

Chabra contends that the teen is in a tough situation. He instructed her to wash her hands immediately after playing volleyball, and not to touch her face before she does.

“Allergic contact dermatitis is one of the more rewarding areas,” he said. “You can figure it out and fix it.”


To Help Patient Recovery Times, Local Surgeon Introduces New, Pre-Operative Drink

To Help Patient Recovery Times, Local Surgeon Introduces New, Pre-Operative Drink

Photo Courtesy of KCAU-TV.

Midlands Clinic surgeon, Dr. Lawrence Volz, has introduced a new pre-operative drink to his patients, and has seen some great results. This drink, Clearfast®, is the first U.S. patented and American Society of Anesthesiologist approved pre-operative beverage. 

According to Dr. Volz, “This beverage will satisfy pre-operative cravings, reduce anxiety and prepare the patient to heal after the surgical procedure is completed.”

Watch the video below, or visit the KCAU website for the full story.

Clearfast will become pre-surgery protocol at Midlands Clinic. For more on that, please click here.

What do you think about this new pre-operative drink? Let us know in the comments below. We would love to hear from you.


Clearfast to become Protocol at Midlands Clinic

Clearfast to become Protocol at Midlands Clinic

South Dakota clinic selects BevMD’s pre-operative beverage to introduce as an approved alternative to fasting for pre-surgical patient

May 22, 2014 San DiegoDr. Lawrence Volz, of Midlands Clinic in South Dakota, recently selected BevMD’s Clearfast® to become a part of physicians’ routine in preparing all pre-operative surgical patients. Clearfast® is the first U.S. patented and American Society of Anesthesiologist approved pre-operative beverage designed and patented by anesthesiologist M. Lou Marsh, M.D. This beverage is intended to become an alternative to traditional fasting for surgical patients at Midlands Clinic.

In August of 2013 Duke University Medical Center introduced Clearfast to its Enhanced Recovery After Surgery Program (ERAS) and now the procedure is catching on. “We are introducing this product to patients at Midlands Clinic to increase the Enhanced Recovery After Surgery (ERAS) of our patients,” said Dr. Volz. “This beverage will satisfy pre-operative cravings, reduce anxiety and prepare the patient to heal after the surgical procedure is completed.”

Improved surgical outcomes of patients in the ERAS program have been proven by fewer complications and with a decrease in readmissions post surgery. In addition significantly lower pain and fatigue scores are a benefit as well as patients were able to mobilize earlier than they were normally. Dr. Marsh of BevMD explains that “Clearfast is a cost-effective and practical solution addressing a key element of preoperative care in the ERAS protocol, that is, pre-operative oral carbohydrate loading while eliminating prolonged fasting.”

Bob Oosdyke, President of BevMD stated “Dr. Volz started using Clearfast while learning about ERAS and provided Clearfast to his patients for their benefit. He did his homework and saw the advantages. As a result of having implemented the ERAS program, his surgical costs have declined, readmissions have decreased and patients are clearly benefiting from Dr. Volz approach. He changed the surgical program for the sake of the patient and for that he is to be congratulated for all of his study and foresight.”

Introducing Clearfast as part of ERAS programs produces improvements in patient care and outcomes, shorter lengths of stay for patients and less pre-operative anxiety. Most all patients introduced to Clearfast were tolerating a full oral diet sooner than those who received conventional care, reducing the nausea and anxiety correlated with prolonged fasting. The Midlands Clinic serves healthcare patients in general surgery, endocrinology, dermatology and related specialized healthcare. Dr. Volz, the physician introducing Clearfast to the clinic, is most specified in general surgery, endoscopic procedures and trauma surgery.

About BevMD and Clearfast:

BevMD, a medical beverage company headquartered in San Diego, was created to provide simple, effective patented nutrition solutions for perioperative patients. BevMD’s first product line features Clearfast, a patented pre-op beverage that allows patients to remain nourished and hydrated prior to surgery. BevMD is dedicated to changing the way millions of patients prepare for surgery while supporting the pre-op fasting guidelines of the American Society of Anesthesiologists. For additional information on BevMD and its products, visit or call 1 (858) 649-1070.

About Dr. Volz:

Lawrence T. Volz, M.D. received a Bachelor of Arts-Chemistry from the University of San Diego in 1993, a Medical Degree from Creighton University School of Medicine in 1997, a General and Laparoscopic Surgery Residency from Baystate Medical Center in 2002 and was Board Certified in General Surgery, in 2003. He holds licenses in Iowa, Nebraska and South Dakota and has been practicing in Siouxland since 2006. He is affiliated with the following: Fellow-American College of Surgeons, Certified by American Board of Surgery, Member-Society of American Gastrointestinal and Endoscopic Surgeons, American Hernia Society.

For additional information on Dr. Volz, visit www.

About Midlands Clinic:

For over 13 years, Midlands Clinic has been providing comprehensive multi-specialty services such as General Surgery, Pediatric Surgery, Obesity Surgery, Dermatology, and Endocrinology . The clinics’ physicians, providers and staff are committed to providing high quality, cost-effective healthcare in a friendly and compassionate manner. Midlands Clinic provides a comforting atmosphere and a friendly, experienced staff ready to help its patients with dignity, respect and understanding every step of the way. For additional information on Midlands Clinic, visit www.

For additional information on BevMD and its products, visit or call 1 858-649-1070.


Ways to Avoid Holiday Weight Gain

Ways to Avoid Holiday Weight Gain

The holidays are upon us again, and for many of us, this is our most favorite time of the year. Is there anything that can stand in the way of our visions of sugarplums, white fluffy snow, or Jolly Old St. Nick? Sure…the fear of holiday weight gain!!! A 2011 Consumer Report Survey on what Americans dread most about the holiday season, 37% said the thought of gaining weight over the holiday season was what they dreaded the most! But how much weight do we actually gain over the holiday season? The answer to this question is not really known. The best answer we can find is anywhere from 1-10 pounds. What is most consistent about the findings of holiday weight gain, however, is that many Americans fail to lose what they gain over a holiday season. So as the years go on, our weight continues to creep up.

So can you have the best of both worlds? Can you truly enjoy the holiday season and prevent weight gain? Yes! This article includes a variety of tips to prevent holiday weight gain.

  • Plan, plan, plan.  It is the holidays after all!  More than likely, you are going to eat foods that you normally don’t, but you must have a plan in place.  It is important to plan to eat the healthy foods, but it is just as important to plan out the unhealthy foods as well.  This will help you keep the portions of your favorite holiday foods under control.
  • Change your holiday traditions.
    • Find more ways to add physical activity to your holidays.  Play games, the Wii, or take a walk with friends or family members.
    • Change up the menu.  Add healthier items to the menu this year.  Find lower-calorie sweet treats too.
  • Eat before you go.  Eat a small meal or hearty snack before attending your holiday gatherings.  Being satisfied, as opposed to hungry, will help you control your portion sizes and help you make healthier food choices.
  • If dining at a buffet or potluck, keep these rules in mind.  Walk through the buffet line with no plate in hand and make a game plan of what you are going to eat.  Strive to create a balanced meal.  Then, make 1 trip through the buffet with plate in hand, making sure that none of the food touches on your plate (to keep your portions sizes under control).
  • Beware of liquid calories.  Holiday beverages can be an easy way to pack in a lot of extra calories.  Opt for lower calorie versions of eggnog, flavored coffees, and your favorite holiday cocktail.
  • If all else fails, remember to eat higher-calorie foods in moderation.  You can do this by following the 3 Bite Rule:  the first bite tastes the best, the second bite confirms just how good the food really is, and the third bite is your last so savor it as much as possible.

Happy Holidays!


Quick, Easy, and Healthy Lunch Ideas

Quick, Easy, and Healthy Lunch Ideas

Remember the days when your mother packed you a nice, healthy lunch everyday to take to school?  In today’s world, it is not uncommon for us to be rushed to get out the door in the morning leaving little to no time to eat breakfast, let alone pack a healthy lunch.  This handout is going to give you ideas and strategies for creating quick, easy, and healthy lunches all week long.  

Before we get to the meal ideas themselves, let’s back up and talk about planning.  Planning is essential for creating healthy meals.  If you do not have healthy foods in your environment, it makes it really hard to make healthy meals.

  1. Think ahead and plan what you will be doing for lunch each day
  2. Make a list of healthy foods that you would like to eat for the week
  3. From that list, create a grocery list that includes these foods in the appropriate quantities
  4. Each day, think about what you will be having the next day
  5. Pack these foods the night before so that they are ready to go in the morning

* TIP:  If you are a person that doesn’t mind leftovers, plan to make extra at certain dinner meals so that you can take them to work with you the next day.

Remember when making your lunch to try and focus on balance and choose from the following food groups:


The USDA’s My Plate does a great job illustrating how your healthy plate should look at every meal.

  • Lean meats
  • Low-fat dairy products
  • Whole grains
  • Vegetables
  • Fruits


If you do eat out during the week, keep the following tips in mind:

  • Research the restaurant before you go
  • Pick restaurants that have a variety of veggies and fruits on the menu
  • Ask how the food is prepared and also to have the sauces on the side
  • Portion sizes in restaurants are generally double or triple the actual amount we should eat.  Ask for a take home box right when you get your meal so that you can put some of the meal away to save as leftovers.
  • If lunch is catered in to the workplace, still pack healthy sides like fruits, vegetables, and low fat dairy products to supplement the meal.
    • If you have a say in the type of foods that are catered in, request healthier options.
  • Baked potato bars, salad bars, build your own taco bars, sandwiches or wraps with fruit, leaner protein options like chicken breasts or pork loin with steamed veggies, etc.
  • Meal Ideas

    • Sandwich on whole wheat bread with lean deli meats such as turkey, ham, or roast beef; add 2% cheese, your favorite veggies, and low-fat condiments such as spicy mustard or light mayo.  Couple the sandwich with baked chips, low-fat yogurt, and any kind of fruit.
    • Wraps or pita pockets are something you can make with deli meats or even left over meats from dinner the night before.  Try grilled chicken or steak Greek-style by adding lettuce, tomatoes, onion, cucumber, low-fat feta cheese, and Greek vinaigrette.  You could also use the same meats and make them Mexican-style by adding lettuce, tomato, black olives, low-fat cheddar cheese, salsa, and low-fat sour cream.  (Feel free to add any other veggies in that you like and to keep your wraps or pitas from getting soggy, add the sauces to them right before you eat.)  Baked tortilla chips and salsa or fresh veggies with hummus/refried bean dip (see recipe below) pair nicely with either one of these ideas.
    • Salad with all sorts of your favorite veggies and lean protein such as chicken, salmon, steak, deli meats, shrimp, leftover taco meat, black beans, chickpeas, etc.  Add low fat cheeses and salad dressing to top it off.  Nuts are also high in protein and taste great in a salad, but can be very high in calories so make sure to use in moderation.
    • Pre-packaged frozen meals.  Check the Nutrition Facts Label to make sure the food is low in calories and moderate in sodium (< 600 mg).  To this meal add a salad or fruit and 1% cottage cheese or low-fat yogurt.
      • Some preferred brands include Smart Ones, Lean Cuisine, and Healthy Choice


Turkey and Vegetable Tostada
270 calories

What You Need
6 flour tortillas (6 inch)
1 pkg.  (1-1/4 oz.) Taco seasoning mix, divided
1 lb. ground turkey breast or 93% lean ground beef
4 tomatoes, chopped, divided
1 cup chopped zucchini
½ cup water
1 cup 2% shredded Colby & Monterey Jack cheeses
1-1/2 cups shredded lettuce
3 Tbsp. chopped fresh cilantro

Make It
Heat oven to 400°F.
Place tortillas in single layer on baking sheet; spray with cooking spray. Sprinkle with about 1 tsp. taco seasoning. Bake 6 min. or until crisp and lightly browned.
Meanwhile, cook turkey/beef in large nonstick skillet sprayed with cooking spray on medium-high heat 4 min. or until done, stirring frequently. Add 1 cup of tomatoes, zucchini, water and remaining taco seasoning; simmer 5 min., stirring occasionally.
Spoon turkey mixture onto tortillas; top with cheese, lettuce, remaining tomatoes and cilantro.

Caesar Pleaser
250 calories

What You Need
½ cup torn romaine lettuce
1 thin red onion slice, separated into rings
1Tbsp. shredded Parmesan cheese
1 Tbsp.  Light Creamy Caesar dressing
1 ciabatta sandwich roll, partially split
2 oz. Oven Roasted Chicken Breast, leftover steak or salmon, or deli meats like turkey, chicken, or roast beef
2 tomato slices

Make It
Toss lettuce with onions, cheese and dressing.
Fill roll with lettuce mixture, chicken and tomatoes.

Bean Dip
2 cans fat free refried beans
½ cup fat free sour cream
½ cup salsa
½ packet taco seasoning
1 can green chilis
Mix all of the ingredients together and bake at 350 for 30-45 minutes.


Dr. Paul Johnson achieves recertification

Dr. Paul Johnson achieves recertification

Dr. Paul Johnson, a general surgeon at Midlands Clinic P.C. in Dakota Dunes, has received recertification from the American Board of Surgery. His certification is now active until 2026.

The American Board of Surgery is an independent, nonprofit organization founded in 1937.

Johnson, who sees patients at Dakota Dunes, Oakland, Neb. and the Advanced Mercy Wound Care Center at Mercy Medical Center in Sioux City, has a strong professional interest in general, laparoscopic and trauma surgery and wound medicine.

See article on the Sioux City Journal website here: