Our newest, FDA-approved weight loss surgery option, the gastric balloon, was featured on KCAU’s Your Health Matters segment this week.
To watch the video and read the story, click the link below:More
Our newest, FDA-approved weight loss surgery option, the gastric balloon, was featured on KCAU’s Your Health Matters segment this week.
To watch the video and read the story, click the link below:More
Article and photo courtesy of the Sioux City Journal
Obese patients wanting to go under the knife to lose weight now have another option: laparoscopic sleeve gastrectomy.
Since it made its debut in Siouxland in May, the procedure, which decreases feelings of hunger and the capacity to eat more by removing a portion of the stomach and re-shaping the remaining stomach into a sleeve, has grown in popularity, according to William Rizk, a bariatric surgeon at Midlands Clinic in Dakota Dunes.
By late August, Rizk and his colleague, Keith Vollstedt, had performed 10 laparoscopic sleeve gastrectomies between the two of them in Sioux City. The procedure joins laparoscopic gastric banding and laparoscopic gastric bypass.
“This is the en vogue surgery right now,” Rizk said just minutes before stepping into the operating room at Mercy Medical Center to perform the procedure on a woman.
“We really started doing it to satisfy patient demand. People come in absolutely seeking to have a sleeve. It’s very popular.”
BYPASS, SLEEVE OR BAND?
Laparoscopic gastric bypass surgery is the most common weight loss sugery. It is also the most invasive and effective, according to Rizk. Laparoscopic gastric banding on the other end of the spectrum is the least invasive and the least effective. Laparoscopic sleeve gastrectomy, he said, falls somewhere in the middle.
“Why someone would choose the sleeve gastrectomy is it’s less invasive as far as intestinal rerouting,” Rizk said. “There would be less malabsorption of certain vitamins while still having the advantage of significant weight loss.”
During the procedure, special laparoscopic stapling devices are used to reduce the human stomach from the size of a football to the size of a banana, according to Rizk.
“We put a sizing device that goes through the mouth, down the esophagus, down through the stomach and we staple along this sizing device to help us determine the diameter of this little banana,” he said.
About 80 to 85 percent of the stomach is then removed through one of five little incisions in the patient’s abdomen. A smaller stomach, Rizk said, will hold less food.
Ghrelin, a hormone produced by cells in the stomach, causes the feeling of hunger. After removing part of the stomach, Rizk said hunger dramatically decreases.
“As a patient eats a smaller amount of food, the stomach stretches slightly and sends a signal to the brain,” he explained. “The brain interprets that as being satisfied and the patients are no longer hungry.”
Although the stomach will stretch some after surgery, Rizk said it won’t stretch enough to allow patients to eat normally again. Eating frequent small meals, he said, is how most people gain weight back after having weight loss surgery.
“Grazing is the Achilles heel to all weight loss surgery, whether it’s a band, bypass or a sleeve,” he said. “If you eat a small amount for many hours a day, there’s potential that weight will be regained.”
Patients can expect to lose half a pound to a pound a day for the first four to six weeks following laparoscopic sleeve gastrectomy, according to Rizk. He said someone who weighs 450 pounds will lose more total pounds than someone who weighs 250.
“Most of these patients are morbidly obese, so to lose 100 to 150 pounds is very common,” he said. “If someone is going to go through surgical weight loss, it’s usually for a significant amount of weight. Our goal is to get them not to ideal weight, but to a healthy weight.”
Rizk cautions that weight loss surgery is a significant behavioral and psychological undertaking for patients and requires extensive counseling before and after surgery.
“Someone might see me today and have a gall bladder surgery tomorrow, it doesn’t work that way with weight loss surgery,” he said.
Rizk said occasionally patients will decide not to go through weight loss surgery after beginning counseling. Some, he said, will come back a year later when they feel more prepared to make lifestyle changes.
“If you’re going to undergo a surgery that is dramatically going to change the way you eat, you have to be ready to change your lifestyle,” he said.
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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.
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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:
If you would like to explore your options or have questions about bariatric surgery, call Midlands Clinic at 605-217-5511.More
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.More
Dr. William A. Rizk, a general surgeon at Midlands Clinic P.C. in Dakota Dunes, received his recertification from the American Board of Surgery. His recertification is active until 2020. He received his original certification in 2000.
Read the rest of this article featuring Dr. Rizk here.More