“We look at weight loss surgery as just a tool it is not a quick fix or an easy way out,” said Megan Cleveland, Midlands Clinic. “So to really help the patients be successful with this tool, the educational program is really necessary along with the support group.”
The Educational program team includes registered dieticians, registered nurses, psychologists and bariatric surgeons.
“And so we really work together as a multidisciplinary team to help the patients not only physically but emotionally mentally prepare for the life style changes that they will have to make,” said Cleveland.
Doctors also recommend these patients join support groups to help them through these major life changes.
“If you are on a typical diet, you have the decision of either following your diet that day or not,” said Cleveland. “They don’t have that decision any longer because weight loss surgery is a permanent change to your body.”
Each group includes 10 to 30 patients and they talk about good eating habits and avoiding bad habits.
“So we really try to teach them not only alternatives of things they can do other than rewarding with food but also coping mechanisms to not use foods for comfort or to celebrate or to mourn” said Cleveland. “But to try to rely on some other things.”
Though the Midlands Clinic is one place to find a weight loss support group, you can also find other groups in the community and online.
It is no surprise that obesity can lead to a lot of complications.
Dr. Keith Vollstedt of Mercy Medical Group said, “That excess weight that we carry also contributes to pain on the joints, pain in the back, contributes to high blood pressure, acid reflux disease and getting that weight off can improve people’s overall physical condition. And hopefully reduce the use of medications or pills, and maybe some further surgeries down the road.”
This is why doctors recommend surgeries that can help with weight loss for patients who are 100 pounds overweight and have other health problems.
“Mercy and our group Midlands Clinic Office, offers a gastric by-pass, we offer a gastric sleeve resection, and we offer the adjustable gastric band.”
Each surgery has its benefits over the other and you and your doctor can decide which is best for you.
The surgeries usually require one to two nights in the hospital and up to 3 weeks of recovery at home.
Doctors also recommend time with a dietician before the surgery to create good eating habits.
But the key thing is, “When the person is ready to change their life, when they are ready to eat differently, when they are ready to give up foods, certain foods, when they are ready to start exercising, then we can have a successful operation and people are successful with the surgery.”
But remember these surgeries are not permanent, when patients fall back into old habits they will regain the weight.
Colonoscopies can be uncomfortable to talk about. But regular checkups could save you from the second leading cause of cancer.
Siouxland News Reporter Katie Link went to Midlands Clinic to learn more about this life saving procedure.
Dr. Michalak, Gastroenterologist at Midlands Clinic said, “So colorectal cancer is the 2nd leading cause of cancer in the united states it accounts for over eight percent of all cancer deaths in the United States.”
Dr. Michalak is a Gastroenterologist at Midlands Clinic he says that many people still aren’t getting screened.
“Usually this occurs after the age of 50… about 90% of all cancers are diagnosed after the age of 50 which is why we recommend colorectal cancer screenings to begin at the age of 50 for the average risk person,” said Dr. Michalak.
Many may find it uncomfortable to do the screening but it could save your life.
“Colonoscopy is done specifically to find polyps, specifically abnormal polyps that will form into colon cancer … if we find these polyps early we can remove them and decrease the risk of developing colon cancer,” said Dr. Michalak.
Knowing your family history is important since cases of colon cancer in your family can increase your risk.
“There are risk factors though…family members that have had abnormal polyps, family members with colorectal cancer… Those patients should be screened sooner. 10 years before the time that their family member was diagnosed,” said Dr. Michalak.
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.
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.
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.
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
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)
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 andif 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
Dark, tarry stools
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.
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.”
April 11, 2014 11:28 am • DOLLY A. BUTZ firstname.lastname@example.org
(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.”
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.