Patient Information

Procedure Instructions

Colonoscopy using Gatorate/Miralax
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THE FOLLOWING ITEMS NEED TO BE PURCHASED AT A PHARMACY:

  1. MiralaxTM—238 gram (1 bottle)
  2. Powerade ZeroTM or low calorie GatoradeTM (no red or blue color)—64 ounces
  3. DulcolaxTM 5mg ( Four tablets)

IMPORTANT WARNINGS:

  • Please inform our office in advance if you have congestive heart failure, kidney failure, chronic severe constipation, or have had an inadequate bowel preparation for a previous colonoscopy

STEP #1 WHAT TO DO WITH YOUR DAILY MEDICATIONS BEFORE YOUR COLONOSOCOPY:

  • If you take Coumadin, Warfarin, Plavix, aspirin, or aspirin containing products or any form of “blood thinners” please consult with your cardiologist or primary care physician as to whether you may temporarily discontinue these medications. This is extremely important, especially if you take any of these medications for treatment of heart disease or stroke.
  • If your primary care physician has instructed to continue any of these medications, please notify us and we will provide you with special instructions.

ONE WEEK (7 DAYS) PRIOR TO YOUR PROCEDURE:

  • Stop aspirin, aspirin-containing products, and iron supplements (such as Feosol).Acetaminophen (Tylenol) and Celebrex may be continued until the day of the procedure.
  • Stop Plavix (clopidogrel). Unless otherwise instructed  by your primary physician or cardiologist (see above)

3 DAYS PRIOR TO YOUR PROCEDURE:

  • Stop Coumadin (warfarin). Unless otherwise instructed (see above)
  • Avoid eating seeds or any foods containing seeds (such as grapes, berries, nuts, etc).
  • Limit high fiber foods (salad, fresh fruits and vegetables, whole wheat bread)
  • If you are diabetic, check with your primary care physician about taking your diabetes medication the morning of your colonoscopy. Call your prescribing physician if you have questions about what to do with other medications during the preparation period.

STEP #2:  THE IMPORTANCE OF YOUR BOWEL PREPARATION

  • To ensure that your doctor will be able to visualize all parts of your colon and detect any abnormalities including polyps please follow these instructions carefully.
  • If your bowel preparation is not adequate at the time of your colonoscopy, your doctor may ask that you repeat the procedure.
  • For 3 days prior to your procedure-
    • Avoid eating seeds or any foods containing seeds (such as grapes, berries, nuts, etc).
    • Limit high fiber foods (salad, fresh fruits and vegetables, whole wheat bread)

DAY PRIOR TO YOUR PROCEDURE: WHAT YOU CAN EAT?

  • Begin Clear liquid diet starting in the morning as soon as you wake up:  You may consume the following :  Water, Apple Juice, Pineapple Juice, White Grape Juice, and Grapefruit Juice ( NO PULP), 7 UP, Ginger Ale, Coffee or Tea with sugar and/or honey only (no milk or non-dairy creamer).  Jell-O of any color except for red, blue or purple (in limited amounts only).  Soups are permissible if clear broth only (no cream soups).
  • Do not consume any liquids that are red or blue
  • Do not drink alcohol

DAY PRIOR TO YOUR PROCEDURE: HOW TO TAKE YOUR LAXATIVES:

  • At 3pmTake 2 DulcolaxTM tablets.
  • At 5pm  – Mix the entire bottle of MiralaxTM into the 64 ounces of Gatorade/Powerade. Shake the solution until it is fully dissolved. Drink an 8-ounce glass every 30 minutes until you have consumed half (32 ounces). Place the remainder of the liquid in the refrigerator overnight.
  • At 7pmTake the last 2 DulcolaxTM tablets.
  • 6-8 Hours prior to your appointment – Drink the remainder of the MiralaxTM (an 8 oz. glass every 30 minutes until the solution is gone).  You must complete the remainder of the Miralax no later than 4 hours prior to your appointment time. 

Tips: The prep may not be palatable. If you experience nausea, bloating or vomiting, then you may increase the time interval between eight ounce glasses. In certain instances, you may not have bowel movements after completing immediately. Continue as instructed and you should start to pass bowel movements)

DAY OF YOUR PROCEDURE:

  • YOU MAY CONTINUE TAKING YOUR BOWEL PREP UP UNTIL 4 HOURS PRIOR TO YOUR PROCEDURE. DO NOT DRINK ANYTHING WITHIN 4 HOURS OF YOUR APPOINTMENT TIME.
  • You may take any necessary medications including blood pressure medications in the morning with just a sip of water.
  • You must have someone drive you home after the procedure because of the anesthesia you will receive for your procedure.   YOU WILL NEED A FRIEND OR FAMILY

MEMBER TO PICK YOU UP.  YOU ARE NOT ALLOWED TO TAKE TAXI OR BUS OR LIMOUSINE unless you are accompanied by a friend or family member – OTHERWISE, YOUR PROCEDURE WILL BE CANCELLED.

  • Please contact our office with any questions related to the procedure or bowel preparation. If you have an emergency and need to speak with the doctor on call after hours about the procedure, please call (310)858-2224.

Dosing Schedule for your Appointment will be given to you at the office!

Colonoscopy using MoviPrep
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If you have any questions after you read these instructions, please call us at 310-858-2224.

 

INSTRUCTIONS REGARDING MEDICATION USE PRIOR TO YOUR COLONOSCOPY

  1. Unless you have already done so, notify our office if you have a heart murmur of a history of heart valve surgery, heart failure, advanced kidney or liver disease, or diabetes (or insulin).
  2. If you are taking the following medication, you will require special instructions from the prescribing doctors: Coumadin, Plavix, Persantine or Ticlid, Iron, Insulin, and Mao Inhibitors, such as Nardil, Parnate, or Eldepril.
  3. If you take Anti-Hypertensive (blood pressure) medications you must take them the morning of the procedure.

 

Call our office at 310-858-2224, one-week prior to your appointment if you have not received special instructions concerning these medications.

 

THE CRITICAL IMPORTANCE OF DIET AND THE BOWEL PREPARATION

If the intestine is not adequately cleaned out, the procedure will not be successful and might need to be rescheduled. It is of critical importance to complete the ENTIRE preparation. In addition, the dietary guidelines below should be followed.  The less fiber, vegetable matter, nuts, seeds, and other foods that can potentially create stool bulk consumed – even within a few days of the procedure – the less likely that the preparation will be problematic.

 

The desired result comes when the evacuated rectal contents are crystal-clear, perhaps slightly-yellow-colored or brown, but clear as water. The salt in the solution is not absorbed so you need not worry about fluid retention, your heart, or high blood pressure.  You will know the preparation is successful if the passed liquid is clear yellow without particles and not cloudy.

 

WHERE TO GET THE SOLUTION

The cleansing solution can be obtained at any pharmacy with a prescription.  Most pharmacies stock it, but we suggest that you check by telephone first.  If there are any questions, please call my office at 310-858-2224.

 

DAY BEFORE COLONOSCOPY

Please follow these instructions carefully and completely.  You will know your bowel is clean when the liquid you pass becomes crystal clear and yellow.  If the bowel is not clean when you arrive to the procedures unit, your procedure will need to be rescheduled rather than giving you an incomplete examination.

 

  1. For at least the ENTIRE DAY (including breakfast) prior to the procedure, you should eat or drink only clear liquids for breakfast, lunch and dinner.  You should not have any solid foods, vegetables, nuts, milk, or milk products the entire day.  Clear liquids are to be light and see-though in color.  Clear liquids include: strained fruit juices without pulp (apple, white grape, white cranberry, lemonade, etc.).  Other liquids to include: Gatorade, carbonated and non-carbonated soft drinks.  You can also have coffee or tea (without milk or milk-products), plain Jell-O (without added fruits or toppings),

 

popsicles, soup with broth only.  Avoid dark liquids such as prune juice, grape juice, orange juice, etc.

  1. Stop all oral iron, bismuth, bulk agents (Metamucil, Konsyl, Peridiem, Etc.).  Stop aspirin or aspirin type medication (Naprosyn, Advil, Etc.) for one week prior to the exam.  Tylenol is allowable.  Please give our office a list of your prescription medications and they will guide you.
  2. Your body loses significant amounts of fluid during bowel preparation.  In order to prevent dehydration, it is important to supplement that fluid loss with clear liquids.  Make a conscious effort to drink as much as you can before and after the last 8 ounces.

 

DAY OF COLONOSCOPY

  1. STOP DRINKING CLEAR LIQUIDS OR TAKING ANYTHING BY MOUTH, EXCEPT FOR MEDICATIONS WITH ONLY SIPS OF WATER) FOR SIX (6) HOURS PRIOR TO THE SCHEDULED PROCEDURE TIME.
  2. Bring a list of all medications you take with you to the procedure unit.
  3. BRING SOMEONE WITH YOU TO DRIVE YOU HOME OR HAVE SOMEONE MEET YOU IN THE PROCEDURE UNIT TO ACCOMPANY YOU HOME.  YOUR PROCEDURE CANNOT BE DONE IF YOU HAVE NOT MADE THESE ARRANGEMENTS.  YOU CANNOT TRAVEL HOME BY CAB UNLESS ACCOMPANIED BY ANOTHER ADULT.
  4. You should not drive a car or operate machinery until the day after your procedure.
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PillCam Small Bowel Capsule Endoscopy
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To ensure the best results for your PillCam capsule endoscopy of the small bowel, follow your doctor’s instructions carefully and completely.

Day before the Capsule Endoscopy

  • Start the prescribed liquid diet after lunch.
  • Begin Clear liquid diet starting after lunch. You may consume the following : Water, Apple Juice, Pineapple Juice, White Grape Juice, and Grapefruit Juice (NO PULP), 7Up, Ginger Ale, Coffee or Tea with sugar and/or honey only (no milk or non-dairy creamers). Jell-O of any color except red, blue, or purple (in limited amounts only). Soups are permissible if clear broth only (no cream soups).
  • Do not consume any liquids that are red or blue
  • Do not eat or drink except for necessary medication with a sip of water 10 hours before the capsule endoscopy is scheduled to start.

Day of the Capsule Endoscopy

  • Starting 3-4 hours prior to the capsule study, mix 7 packets or capfuls of Miralax with 32 ounces of water and drink 8 ounces every 15 minutes.
  • Do not take any medication 2 hours before having the exam.
  • Wear an upper garment of thin natural fiber such as a t-shirt that is long enough to reach at least to hip level and will not ride up above the belt.
  • Arrive for your appointment at the scheduled time: ___________________

After Swallowing the PillCam SB Capsule

  • The capsule endoscopy procedure will last approximately 8-9 hours. Contact your doctor’s office immediately if you suffer from any abdominal pain, nausea, or vomiting during the procedure.
  • You may drink colorless liquids starting 4 hours after swallowing the PillCam SB Capsule.
  • Do not eat any solid food after swallowing the PillCam. After the examination is completed, you may return to your normal diet.
  • Be sure the sensor belt is tight at the waist. Do not attach it to anything.
  • Check the blue flashing Data Recorder light every 15 minutes to be sure it is blinking twice per second. If it stops blinking or changes color, note the time and contact your doctor.
  • Use the supplied Capsule Endoscopy Event Form to note the time of any event such as eating, drinking or a change in your activity. Return completed Event Form to your doctor at the time you return the equipment.
  • Avoid strong electromagnetic fields such as MRI devices or ham radios after swallowing the capsule until you pass it in a bowel movement.
Endoscopy
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No food for eight (8) hours prior to your scheduled appointment.

You may drink clear liquids up to two (4) hours prior to your scheduled appointment.

Clear liquids are black coffee (no milk or cream), plain tea (no milk or cream), soft drinks, sports drinks (i.e. Gatorade), strained fruit juices (no pulp), bouillon, broths/ popsicles, and Jell-O and water.

You can take medications with a sip of water.

What to do with your daily medications before your endoscopy:

If you take any “blood thinners” such as Coumadin, Warfarin, Prasugrel or Plavix you must consult with your cardiologist or primary care physician BEFORE discontinuing these medications as instructed below. This is extremely important, especially if you take any of these medications for treatment of heart disease or stroke. If your primary care physician has instructed to continue any of these medications, you must advise GABH on the day of your procedure.

7 days before your procedure:

  • Stop Plavix (clopidigrel) unless otherwise instructed (see above).

3 days before procedure:

  • Stop Coumadin (warfarin) unless otherwise instructed (see above).
  • Stop any iron supplements.

* Avoidance of “blood thinners” is designed to minimize the risk of serious bleeding if a polyp is removed

Call your prescribing physician if you have questions about what to do with other medications during the preparation period. Otherwise, take your daily medications with a sip of water the morning of your procedure.

Instructions

You have been provided with detailed instructions. Please read the directions carefully. Following these instructions will help us to accomplish a safe and effective examination.

Do not hesitate to contact this office if you have any questions at 310-858-2224.

Hydrogen Breath Test
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The guidelines listed below are to be followed for all hydrogen breath tests:

  • Patients will be NPO (nothing by mouth) for 12 hours prior to the test.
  • No smoking, including second hand smoke for 12 hours prior to the test.
  • No sleeping or vigorous exercise for at least one hour before or during the test.
  • Recent antibiotic therapy or colonoscopies will affect these breath tests à please advise medical staff is any of the above pertain to you as soon as possible
    • No antibiotics 14 days prior to the test (Amoxicilin, Erthromycin, Xifaxan, Neomycin, etc.)
    •  No acid suppressing medication and Probiotic up to one day before the test (Dexilant, Prevacid, etc.)
    • Wait 30 days after colonoscopy procedure.
  • Neither mints nor gum chewing after midnight.
  • Brush your teeth in the morning (mint flavored toothpaste/mouth wash is acceptable)
  • You may take scheduled medications at least two hours prior to the study (as long as they are not antibiotics, acid suppressing medications or probiotics) with small sips of water, however, it is preferable that medications be taken after the study has finished.

If any of the above conditions have been compromised, the test will be rescheduled.

Listed below are generic avoidance groups and are not limited to what is listed. If you are unsure if something may affect the test, do not consume the product and consult with medical staff.

24 hours prior to the test, please avoid the foods listed below. Nothing to eat or drink 12 hours prior to the test.

NO:

  • Grain products: pastas, whole grain products, cereal or brans
  • Fruits: fruit juices, applesauce, canned fruits, raw and dried fruits like raisins, etc.
  • Vegetables: vegetable juices, potatoes, alfalfa sprouts, beets, carrots, celery, etc.
  • Vegetables from cruciferous family: broccoli, cauliflower, brussel sprouts, cabbage, beans, lentils, corn, etc.
  • Nuts, seeds or beans: all nuts, seeds, beans and foods that may contain seeds
  • All dairy products (except eggs): milk, cheese, yogurt, butter, ice ceram, etc.

Suggestions for the patient’s last meal to consume 24 hours prior to the test:

YES:

  • Baked or broiled chicken or turkey seasoned with salt or pepper only
  • Baked or broiled fish seasoned with salt and pepper only
  • Plain steamed white rice – no oil or butter
  • Eggs
  • Clear chicken broth