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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.”

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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 dbutz@siouxcityjournal.com
(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.”

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Endocrinologist encourages screening for osteoporosis

If you are of advancing age, you may be at risk of developing osteoporosis.

Osteoporosis is the thinning of bone tissue and loss of bone density over time. Bone thinning renders a person more susceptible to fractures, which may be multiple, silent or occurring because of low trauma.

Dr. Tareq Khairalla, an endocrinologist at Midlands Clinic in Dakota Dunes, said osteoporosis is a threat for more than 50 percent of the population over age 50.

Read the rest of this article featuring Dr. Khairalla here.

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20 questions with a surgeon Mike Wolpert

When it’s time for surgery, you probably don’t know what questions you should ask – or even much about the person wielding the scapel. Nick Hytrek caught up with Dr. Mike Wolpert, director of trauma at Mercy Medical Center and private practice general surgeon, and did some digging.

1. What made you want to be a eon?

My dad was a primary care physician in Onawa. My intent was to join my father in practice. At the time it was three years residency for general care physicians and with four years of residency you can be a surgeon. With all the automobile accidents on I-29, I figured that would be helpful. My father died three to four months before I graduated from my residency program, and my brother Paul had a general surgery practice in Sioux City so I decided to join him.

Read the other 19 questions with Dr. Wolpert here.

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Energy to burn – Thyroid problems could cost you

For some unknown reason one evening in 2002, Rick Wollman put his hand to his neck, discovering a swollen area just above his collar bone.

After seeing the bulging area in the mirror, he made a trip to the emergency room. A series of tests and X-rays showed a mass growing on his thyroid.

The funny thing, Wollman said, was that he felt fine.

Read the rest of this article featuring Dr. Khairalla here.

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