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Midlands Clinic now offers Laparoscopic Sleeve Gastrectomy

Tired of feeling like you’ve tried every diet and failed? Do you worry about how your weight is impacting your health? Are you experiencing joint pain, diabetes, high blood pressure, high cholesterol, sleep apnea or other conditions? Is your weight affecting your family relationships – or the ability to have one? Do you feel discriminated against at work and in public?

If you answer yes to all of these questions, you may be a candidate for a new bariatric surgery being performed by Drs. William Rizk and Keith Vollstedt at Midlands Clinic in Dakota Dunes.

Starting mid-May, Midlands Clinic will be offering Laparoscopic Sleeve Gastrectomy, a procedure that limits the amount of food you can eat by reducing the size of your stomach.

Like other metabolic surgeries, it also helps to establish a lower, healthier body-fat set point by changing the signals between the stomach, brain and liver.

Here’s how it works: The surgeon creates a small stomach “sleeve” using a stapling device. This sleeve will typically hold 50 mL to 150 mL and is about the size of a banana. The rest of the stomach is removed.

Dr. William Rizk, general surgeon with Midlands Clinic, said 80 percent to 85 percent of the stomach is removed, dramatically reducing its size.

This procedure induces weight loss in part by restricting the amount of food (and therefore calories) that can be eaten, and therefore absorbed, without bypassing the intestines.

Laparascopic Sleeve Gastrectomy is the latest option that Midlands Clinic will be able to offer patients who come to them with co-morbid conditions, lack of mobility and a low quality of life.

In addition to the Laparoscopic Sleeve Gastrectomy, Midlands Clinic offers two other weight loss surgeries to fit with patients’ lifestyles: Laparoscopic Gastric Bypass and Laparoscopic Lap-Band.

Because all three procedures are laparoscopic, they only require five or six small incisions – all 1-2 centimeters – and are performed under general anesthesia. The surgeries are between 45 minutes to 1 1/2 hours long.

“There is no perfect surgery for weight loss or no magic bullet. Each surgery has a certain level of invasiveness, starting with Lap-Band surgery, which is the least invasive and offers the least amount of weight loss, to gastric bypass surgery, which is the most invasive with the most weight loss potential. All three surgeries work by diminishing the capacity of the stomach and restricting how much a patient can eat. They just do it in different ways,” Rizk said.

During the Lap-Band surgery, a silicone band is placed around the upper part of the stomach, and a small pouch is created. As a result, the stomach holds less food and the patient feels full faster and longer. The size of the restriction can be adjusted after surgery.

During gastric bypass surgery, six small incisions are made to hold laparoscopic instruments, then the stomach is separated through the use of staples to create a small pouch. The smaller stomach is attached to the middle of the small intestine, bypassing the section of the small intestine (duodenum) that absorbs the most calories. Patients eat less because the stomach is reduced from the size of a football to the size of a golf ball and they absorb fewer calories because food does not travel through the duodenum.

During the sleeve gastrectomy, the surgeon uses a spiral stapling device that divides the stomach and seals it off. The procedure causes hormonal changes to disrupt hunger.

“The Laparoscopic Sleeve Gastrectomy has been popular over the past five years. It has overtaken the Lap-Band surgery. It’s very effective with less nutritional complications than gastric bypass. It’s also relatively easy to perform. In bariatric literature, it’s more popular and studies to support its effectiveness are being done across the U.S,” he said.

The key to any surgery is to eat smaller meals, eat less between meals, and feel less hungry, he said.

“It’s important to change your lifestyle, drink more water between meals, and increase exercise. We’re available to counsel patients and teach them how to eat with the dramatic change. Portion sizes are a lot smaller. It can be done,” said Rizk.

Oftentimes, not only do patients lose a significant amount of weight, they also are able to reduce and/or eliminate medications while positively impacting their overall health with bariatric surgery.

“Behavior modification is very important,” said Megan Cleveland, registered dietitian at Midlands Clinic. “Weight loss surgery is a tool, not a quick fix or an easy way out. It’s a way to be successful.”

When you choose bariatric surgery at Midlands Clinic, you will receive all the support you need to positively take control of your health and your future.

“We’re here to help people. We know what they’re going through,” Cleveland said. “We’re here to listen to them and let them know the options that are available.”

Midlands Clinic offers:

  • A highly trained team of doctors, nurses, psychologist and a dietitian who specialize in weight loss surgery. This multidisciplinary team helps patients make lasting changes to their lifestyles, in conjunction with their weight loss surgery, to promote long-term success.
  • A facility geared toward the bariatric patient, with chairs and scales that accommodate the bariatric patient.
  • All staff have been trained in bariatric sensitivity – meaning, they understand your struggle, they don’t judge it.
  • Proven experience. Midlands Clinic has been performing weight loss surgery continuously since 1976. Since 2002, they have performed more than 1,000 laparoscopic weight loss surgeries, with complication rates well below the national average.
  • Real life, lasting results.
  • Excellent safety record.
  • Personal support – They will be with you for every stage of your weight loss journey, including all the years after your journey.

If you would like to explore your options or have questions about bariatric surgery, call Midlands Clinic at 605-217-5511.

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Osteoma cutis is the formation of bone in the dermis or subcutis. Depending on the context, these de novo ectopic bone lesions may be classified as primary or secondary osteoma cutis. Primary osteoma cutis is the idiopathic formation of bone. In contrast, secondary osteoma cutis, which is much more common, is bone formation as a potential complication of several acquired disorders, such as severe acne; connective tissue disease; or inherited disorders such as Albright’s hereditary osteodystrophy.

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Although the classic location of gouty tophi is the great toe (podagra), gouty tophi of the ear also is common and is worth including in the differential diagnosis in patients presenting with ear lesions. Other entities presenting as papules or nodules on the ear include chondrodermatitis nodularis helicis (CNH), actinic keratosis, basal cell carcinoma, squamous cell carcinoma, verruca vulgaris, amyloids, rheumatoid nodules, and elastotic nodules. If tophaceous gout is suspected, alcohol fixation of the biopsy specimen is preferable, as it enables visualization of characteristic needle-shaped urate crystals.

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Driving without sunscreen can cause cancer

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Do you ever think about wearing sunscreen while you are driving? A local Siouxland dermatologist says its time to because two out of three skin cancer cases are related to driving.

Skin cancer, the most common cancer diagnosis, is responsible for three and a half million cases each year.

A Siouxland dermatologist at the Midlands Clinic decided to dive into the numbers and found something that caught his eye.

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The sun is finally here. What about sunscreen?

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How does sunscreen prevent skin cancer?

By protecting the skin from sunlight, sunscreen prevents the development of skin cancer. Skin cancers will require surgeries to treat, and may even kill you.

Sunlight contains ultraviolet (UV) light, which can be divided into 3 sub-types – UV-C (100-290 nm), UV-B (290-320 nm), and UV-A (320-400). Almost all of the deadly UV-C, and most of UV-B light are blocked by the Earth’s ozone layer. However, some UV-B and most of the UV-A penetrate the atmosphere and reach us.

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New Faces at Midlands Clinic

Midlands Clinic, a multispecialty clinic in Dakota Dunes, has recently undergone an expansion and remodel to accommodate the addition of two physicians and a nurse practitioner to its staff.

“Midlands Clinic has been growing steadily every year, and to meet the demand of our expanding patient base, new providers have been added to the clinic,” said Clinic Administrator Stacy Harmelink, MBA. “Consequently, we had to add multiple exam and procedure rooms as well as expand our patient waiting area.”

The newest additions to the Midlands Clinic staff are Drs. Indy Chabra, dermatologist; Craig Nemechek, general surgeon; and Allie Nettleton, a nurse practitioner in endocrinology.

Dr. Indy Chabra, M.D., Ph.D., is an addition to the Dermatology department. He specializes in medical, surgical and cosmetic dermatology.

“It was not uncommon for a new patient to wait months for an appointment with Dr. Michelle Daffer, our current dermatologist. With the addition of Dr. Chabra, our patient demand can be handled in a more timely manner,” said Harmelink.

Chabra, a native of India who moved to Long Island, N.Y. with his family when he was 12, received his undergraduate degree at Stanford University in California. He completed his medical degree and Ph.D. in Molecular Microbiology and Genetics at the State University of New York. He performed his internship and residency in dermatology at the University of Pittsburgh Medical Center, the second largest training program in the United States.

Board eligible in dermatology, Chabra is also a member of the American Academy of Dermatology and a member of the American Society for Dermatologic Surgery.

“My goal is to make sure people in this community know they can get the best diagnosis and treatment of any skin, hair or nail problem – medical or cosmetic – here at Midlands Clinic. They don’t have to go to Omaha or Sioux Falls, or Mayo Clinic in Rochester. Between Michelle and I we are highly trained and up to date. We also use the latest technology,” Chabra said.
Chabra said patients who have had dermatological conditions for months or years and have been treating it on their own or going from doctor to doctor and not getting the right treatment don’t need to continue that way.

“We’re the specialists in the area, and patients should be aware of that. With three providers, including a physician’s assistant, we can easily accommodate new patients,” he said. “One of the challenges is patients not being able to see a dermatologist when they actually have the problem. Our goal is when someone has a problem, we will try to accommodate them. We want to diagnose and treat it while it’s happening.”

One such condition is actinic keratosis, which is a small, rough, raised area found on skin that has been in the sun for a long period of time.

Some actinic keratoses may develop into a type of skin cancer. He attributes actinic keratosis to our climate and the lack of sunlight during certain months of the year.

“During the winter time, we’re inside all of the time. In the summer time we get hit with sun. The climate changes dramatically. The average skin doesn’t get melanin and can quickly get sunburns.

“We’re experts here,” said Chabra. “Use us. We have a a lot of experience with that. Patients are very pleased with the results.”
Chabra said Midlands Clinic is also the go-to place for cosmetic procedures, such as chemical peels, neurotoxins, fillers, lasers and electrodessication.

“There are a lot of different modalities and there is ultrasound technology. None do everything. You should go somewhere you can get the right treatments for the right problems. We’re seeing that family doctors or aestheticians are associated with those types of procedures. Patients are associating us with medical dermatology. We’re not associated with cosmetic dermatology. It’s something I want to change.”

Midlands Clinic performs a lot of skin cancer surgery, and has recently added a new modality, photodynamic therapy, for patients who have many difficult to treat skin cancer lesions.

“We’re one of the only places in this area that offers this to patients,” he said. “It allows for treatment of multiple lesions in one setting. It has been used in Europe for years. It is covered by all insurances including Medicare.”

Harmelink said the addition of photodynamic therapy has increased patient volume because the therapy is faster and more convenient than other therapies available.

Dr. Craig Nemechek recently became board-certified in general surgery. His emphasis is in laparoscopic surgery.

Nemechek, a McCook, Neb. native, came to Midlands Clinic from Altoona, Iowa. He completed his general surgery residency at Iowa Methodist Medical Center in Des Moines in June. He earned his undergraduate degree in natural science from Midland Lutheran College in Fremont, Neb., in 2001 and his medical degree from the University of Nebraska Medical Center in Omaha in 2006.

He developed an interest in complex hernia repair during his residency at Iowa Methodist Medical Center, where he focused on performing open or laparoscopic hernia repair procedures.

Nemechek said he joined Midlands Clinic because it is a good fit.

“Dr. (William) Rizk and Dr. (Robert) Anderson came from the same training program. Midlands Clinic offers a unique opportunity in a unique place. I have great partners. It’s a unique job in a nice Siouxland town. I can take on larger, more complex cases and Midlands Clinic has the facilities to take care of them,” he said.

For the past year, Nemechek has been using his experience and expertise at Midlands Clinic to treat hernias. Another condition that is a prominent part of his practice is Gastroesophageal Acid Reflux surgery. People who have certain types of hernias can be more prone to acid reflux.

“Many people suffer from acid reflux,” said Nemechek. “The vast majority do well with medications. Some people don’t get relief. They have other symptoms not relieved by medications or don’t want to take medications. In those cases we recreate and correct the one way valve. Patients with acid reflux usually have leaking of gastric acid into the swallowing tube or esophagus. Surgery helps prevent leaking of acid into the esophagus.”

To obtain objective information regarding the nature and severity of the reflux, esophageal motility and complications of GERD, Nemechek peforms studies that include a 24 hour monitoring of the pH (acidity) in the esophagus. A small Bravo probe is placed into the esophagus with a scope at very specific points, and the number of acid exposures as well as the quantity of acid exposure is recorded.

If the patient is a good candidate for surgery, the procedure can be done laparoscopically.

“Most people who have had the surgery have a very high satisfaction score,” he said.

Allie Nettleton, B.S.N., NP-C, started at Midlands Clinic in August. She is assisting Dr. Tareq Khairalla with his caseload in the Endocrinology department. Nettleton graduated from Briar Cliff University’s nurse practitioner program in May and received her certification in July. She brings 17 years of nursing experience to Midlands Clinic.

“Dr. Khairalla has a very busy practice,” said Nettleton, a 1990 graduate of Woodbury Central High School in Moville. “Some patients waited 3-4 months to get into see him. I hope to lighten his load and allow patients to be seen quickly. We can diagnose, treat and manage endocrine diseases, such as diabetes and osteoporosis. We also help with thyroid management.”

Nettleton said she decided to become an advanced practical nurse because she sought new challenges.

“I had the desire to be an advanced practical nurse for the past 10 years. In 2009 I made the decision to pursue my goals in life. I feel fortunate to have been chosen for this position. I have a great mentor and teacher in Dr. Khairalla,” said Nettleton, who had worked at the Mercy Weight Loss Center clinic for six months in 2008.

The most common condition she and Dr. Khairalla have been seeing in the clinic is diabetes.

“I didn’t realize there was so much diabetes in Siouxland. There are also a lot of thyroid disorders including hypothyroidism and hyperthyroidism, and thyroid cancer, which is easily treatable. Osteoporosis, or bone disease, is affecting younger generations,” she said.

Midlands Clinic also diagnoses and treats adrenal and pituitary disorders.

“We are delighted to welcome these three new providers to our group,” said Harmelink. “The current physicians in our group are confident that these new providers bring skills and increased access to care in the communities we serve.

“These are well-trained providers and they will add to the quality of care Midlands Clinic is known for,” she added.
All three providers are accepting new patients.

Midlands Clinic is located at 705 Sioux Point Road, Suite 100, in Dakota Dunes. For more information or to make an appointment, please call (605) 217-5500.

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Dr. Keith Vollstedt Receives Recertification

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Dr. Keith VollstedtDr. Keith Vollstedt, a general surgeon at Midlands Clinic P.C. in Dakota Dunes, received his recertification from the American Board of Surgery.

Dr. Vollstedt has been practicing general surgery since 1992 and has a strong, professional interest in bariatric, general, thoracic, laparoscopic and trauma surgery.

He received his original certification in 1993. The Board, an independent, non-profit organization, was founded in 1937 to certify surgeons who have met a defined standard of education, training and knowledge.

Dr. Vollstedt is a fellow with the American College of Surgeons and the International College of Surgeons.

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All things in moderation.

That’s the motto Alison Kirkpatrick, 15, uses when she talks about her tanning regimen at SunSations Tanning, 1551 Indian Hills Drive.

“I’ll come in twice a week for 12 minutes to maintain my tan,” she explained.

The teenager has her parents looking over her shoulder with her tanning frequency, since Mark and Gayle Kirkpatrick own the salon.

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Ever since he was a young boy, Gary Carton aspired to be a doctor.

“I’ve known I wanted to be a doctor since I was seven or eight years old because they help people out and are someone everybody seemed to look up to,” said Carlton, general surgeon at Midlands Clinic, Dakota Dunes. “I knew I wanted to have that kind of occupation.”

Fifty-five years later Carlton is living that dream that began as a youth.

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