All posts in general surgery

Weight Loss Surgery – The Ins and Outs

Weight Loss Surgery – The Ins and Outs

Maybe you’ve heard of weight loss surgery before, and maybe you’ve thought it sounds like a pretty sweet deal for losing weight fast. This is not exactly the case. Weight loss surgery is a very comprehensive lifestyle change that takes time, effort, and discipline. Weight loss surgery, also known as bariatric surgery, is valuable for those who need it and are committed to being successful post-surgery. We will dive into weight loss surgery and the entire process in this blog below.


COVID-19 Response and Screening

COVID-19 Response and Screening

With COVID-19 officially being classified a pandemic, we as a healthcare facility need to act appropriately and carefully to protect our compromised patients, staff, and every person for that matter. Effective immediately, Midlands Clinic kindly asks that all patients experiencing flu like symptoms or who have traveled overseas or to infected areas in the last 14 days call our clinic at 605-217-5500 to receive instruction on how to move forward with any appointments.


Telehealth Virtual Visits

Right now, during the outbreak of COVID-19, we need your help to protect our ability to take care of you, your family and the patients who need us the most. We are continuing to explore ways to practice social distancing at our office and will continue to update you of these practices. One of those practices being implemented is telehealth visits.

Midlands Clinic now offers virtual visits!  If you have an upcoming appointment, our providers may be able to continue your care via a secure virtual visit. We will use a platform called is a secure site that allows you to have a video appointment with your provider through your desktop, tablet, or smartphone. It is extremely simple and easy to use for both clinicians and patients.

If you have an upcoming appointment, a representative from our office may reach out to you and offer a virtual or telehealth visit if they feel this is a good alternative for you.
If you need an appointment or would like to reschedule your appointment, you may call us at 605-217-5500, Opt. 8, to see if you would be a candidate for a virtual or telehealth visit.

For more information on accessing your virtual appointment, click the link below.
How to access your telehealth appointment


Midlands doctor recognized for surgery on tornado victim

Midlands doctor recognized for surgery on tornado victim

This October, Dr. Paul Johnson was recognized at a ceremony in Lincoln, Neb., for performing multiple surgeries on John Dunning, who survived a tornado in fall 2013 near Wayne, Neb.

Johnson, a general surgeon at Midlands Clinic and Mercy Medical Center – Sioux City, said of Dunning’s condition upon arrival, “I was amazed at the amount of injuries he had to the skin. It looked like he’d gotten sandblasted [from all the debris that assaulted his skin]. That was in addition to the large lacerations that he had and the fractures that he had.”

According to Johnson, Dunning required 38 procedures to treat his many injuries, including a tracheostomy and a feeding tube. Those procedures were completed slowly, over the period of several weeks, before Dunning was transferred to Madonna Rehabilitation Center, where he began a rigorous physical therapy regimen.

Madonna honored Dunning and three others with a GOAL award, and during the ceremony, the efforts of Johnson and other doctors were celebrated with a luncheon.


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.


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.


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.


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:


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.