Patient Forms
Prep Instructions
EGD Prep
Please call Express Check In 24-48 hours prior to the day of your procedure: (607) 274-4353
DEFINITION:
A small and flexible tube-like fiberoptic instrument is inserted through your mouth and into your stomach. Your doctor can then visually examine your esophagus, stomach, and opening to the small intestine.
PROCEDURE:
Before insertion of the scope, your throat may be sprayed with medication to numb your tongue and throat to prevent gagging. Intravenous medication will be administered to make you groggy. Mild discomfort may be experienced, but few people remember the procedure. The procedure itself will take approximately 5 to 20 minutes and you will remain in the Endoscopy Suite until you are more fully awake. Plan to be at the Hospital or Cayuga Endoscopy Center for 1-2 hours.
INSTRUCTIONS:
HAVE NO MEALS AFTER 8PM. NOTHING TO DRINK AFTER MIDNIGHT. SIPS OF WATER ARE ALLOWED UP TO 3 HOURS BEFORE THE PROCEDURE. (If you are also scheduled for a colonoscopy, on the same day as this procedure, and the colonoscopy calls for a morning laxative, you may take them as those liquids don’t interfere with a stomach exam.)
Take all prescription medication(s) up to 3 hours prior to the scheduled procedure starting time. Get specific instructions for any diabetic medications or Coumadin, Warfarin, Plavix, clopidogrel bisulfate (blood thinners) or if you have a mechanical heart valve.
Nothing by mouth 3 hours prior to the scheduled procedure starting time.
YOU MUST ARRANGE FOR A FAMILY MEMBER OR FRIEND to review the test results and discharge instructions with your physician and to DRIVE YOU HOME. If you do not have a driver, sedation will not be given.
AFTER THE PROCEDURE:
No driving, operating machinery, swimming, or climbing ladders for the rest of the day. You may eat as soon as your throat is no longer numb. Initially plan to eat lightly at home. Going to a restaurant is not recommended.
Should you have any questions or concerns after reviewing these instructions please contact our office at (607) 272-5011 and ask to speak with the scheduling coordinator.
PLEASE NOTE:
The above service may be considered as a surgical procedure by certain insurance companies. Please contact your insurance carrier for coverage information. Precertification may be required.
What is Upper GI Endoscopy?
Your doctor has recommended that you have a medical procedure called upper GI endoscopy to evaluate or treat your condition. This brochure will help you understand how upper GI endoscopy can benefit you and what you can expect before, during, and after this procedure.
What is Upper GI Endoscopy?
The term “endoscopy” refers to a special technique for looking inside a part of the body. “Upper GI” is the portion of the gastrointestinal tract, the digestive system, that includes the esophagus, the swallowing tube leading to the stomach, which is connected to the duodenum, the beginning of the small intestine. The esophagus carries food from the mouth for digestion in the stomach and duodenum. Upper GI endoscopy is a procedure performed by a gastroenterologist, a well-trained subspecialist who uses the endoscope to diagnose and, in some cases, treat problems of the upper digestive system.
The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end. By adjusting the various controls on the endoscope, the gastroenterologist can safely guide the instrument to carefully examine the inside lining of the upper digestive system. The high quality picture from the endoscope is shown on a TV monitor; it gives a clear, detailed view. In many cases, upper GI endoscopy is a more precise examination than X-ray studies.
Upper GI endoscopy can be helpful in the evaluation or diagnosis of various problems, including difficult or painful swallowing, pain in the stomach or abdomen, and bleeding, ulcers, and tumors.
How Do I Prepare for the Procedure?
Regardless of the reason upper GI endoscopy has been recommended for you, there are important steps you can take to prepare for and participate in the procedure. First, be sure to give your doctor a complete list of all the medicines you are taking and any allergies you have to drugs or other substances.
Your medical team will also want to know if you have heart, lung, or other medical conditions that may need special attention before, during, or after upper GI endoscopy. You will be given instructions in advance that will outline what you should and should not do in preparation for the upper GI endoscopy. Be sure to read and follow these instructions.
One very important step in preparing for upper GI endoscopy is that you should not eat or drink within eight to ten hours of your procedure. Food in the stomach will block the view through the endoscope, and it could cause vomiting.
Upper GI endoscopy can be done in either a hospital or outpatient office. You’ll be asked to sign a form that verifies that you consent to having the procedure and that you understand what is involved. If there is anything you don’t understand, ask for more information!
What Can You Expect During an Upper GI Endoscopy?
During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. Your doctor may give you a sedative medication; the drug will make you relaxed and drowsy, but you will remain awake enough to cooperate.
You may also have your throat sprayed or be asked to gargle with a local anesthetic to help keep you comfortable as the endoscope is passed. A supportive mouthpiece will be placed to help you keep your mouth open during the endoscopy. Once you are fully prepared, your doctor will gently maneuver the endoscope into position.
As the endoscope is slowly and carefully inserted, air is introduced through it to help your doctor see better. During the procedure, you should feel no pain and it will not interfere with your breathing. Your doctor will use the endoscope to look closely for any problems that may require evaluation, diagnosis, or treatment.
In some cases, it may be necessary to take a sample of tissue, called a biopsy, for later examination under the microscope. This, too, is a painless procedure. In other cases, this endoscope can be used to treat a problem such as active bleeding from an ulcer.
What are the Possible Complications From an Upper GI Endoscopy?
Years of experience have proved that upper GI endoscopy is a safe procedure. Typically, it takes only 15-20 minutes to perform.
Complications rarely occur. These include perforation – a puncture of the intestinal wall, which could require surgical repair, and bleeding, which could require transfusion. Again, these complications are unlikely. Be sure to discuss any specific concerns you may have with your doctor. When your endoscopy is completed you’ll be cared for in a recovery area until most of the effects of the medication have worn off.
Your doctor will inform you about the results of the procedure and provide any additional information you need to know.
What Can I Expect After My Upper GI Endoscopy?
You will be given instructions regarding how soon you c an eat and drink, plus other guidelines for resuming your normal activity.
Occasionally, minor problems may persist, such as mild sore throat, bloating, or cramping; these should disappear in 24 hours or less. By the time you’re ready to go home, you’ll feel stronger and more alert. Nevertheless, you should plan on resting for the remainder of the day. This means not driving, so you’ll need to have a family member or friend take you home.
In a few days, you will hear from your doctor with additional information such as results of the biopsy, or you may have questions you want to ask the doctor directly.
Liver Biopsy
The following instructions will prepare you for your procedure.
- No Aspirin or Ibuprofen type medications one week before your procedure.
- Nothing to eat or drink after midnight the night before your procedure.
- Report to the outpatient registration desk 15-20 minutes before your exam.
- The procedure will take place in the Radiology Department at Cayuga Medical Center.
- You should expect to be at the hospital for approximately 6 hours.
If you have any questions or need to reschedule this appointment please contact our
office at (607) 272-5011.
What is Liver Biopsy?
In a liver biopsy (BYE-op-see), the physician examines a small piece of tissue from
your liver for signs of damage or disease. A special needle is used to remove the tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An x ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged.
Preparation
Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take,
especially those that affect blood clotting, like blood thinners. One week before the
procedure, you will have to stop taking aspirin, ibuprofen, and anticoagulants.
You must not eat or drink anything for 8 hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the procedure. Your physician will tell you whether to take your regular medications during the fasting period and may give you other special instructions. The digestive system
Procedure
Liver biopsy is considered minor surgery and so it is done at the hospital. F or the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot.
You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for 5 to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes.
Two other methods of liver biopsy are also available. For a laparoscopic biopsy, the physician inserts a special tube called a laparoscope through an incision in the abdomen. The laparoscope sends images of the liver to a monitor. The physician watches the monitor and uses instruments in the laparoscope to remove tissue samples from one or more parts of the liver. Physicians use this type of biopsy when they need tissue samples from specific parts of the liver.
Transvenous biopsy involves inserting a tube called a catheter into a vein in the neck andguiding it to the liver. The physician puts a biopsy needle into the catheter and then into the liver. Physicians use this procedure when patients have blood clotting problems or fluid in the abdomen.
Recovery
After the biopsy, the physician will put a bandage over the incision and have you lie on your right side, pressed against a towel, for 1 to 2 hours. The nurse will monitor your vital signs and level of pain. You will need to arrange for someone to take
you home from the hospital since you will not be allowed to drive after having the sedative. You must go directly home and remain in bed (except to use the bathroom) for 8 to 12 hours, depending on your physician’s instructions. Also, avoid exertion for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site and possibly some pain in you r right shoulder. This pain is caused by irritation of the diaphragm muscle (the pain usually radiates to the shoulder) and should disappear within a few hours or days. Your physician may recommend that you take Tylenol for pain, but you must not take aspirin or ibuprofen for the first week after surgery. These medicines decrease blood clotting, which is crucial for healing. Like any surgery, liver biopsy does have some risks, such as puncture of the lung or gallbladder, infection, bleeding, and pain, but these complications are rare.
Colyte Prep
Colonoscopy examination requires a bowel prep prior to the procedure. It is very important to have a clean colon, without retained stool, to ensure the best examination results.By the end of your bowel prep your stool should be liquid, either clear or yellow in color. If your stool remains brown at the end of your prep there will be decreased visualization of your colon, and your exam may need to be rescheduled.
Because you will receive sedation, you will need someone with you to drive you home. If you do not have arrangements for someone else to drive you home we will be unable to administer sedation for this procedure. It is best if the driver is someone you are comfortable with having hear the preliminary procedure report, as you may not remember it clearly. Take your usual medications at your usual time that morning with a sip of water. Read and follow the instructions below to prepare for your examination. If you have questions call the Scheduling Coordinator at 272-5011.
*To pre-register please call (607) 274-4353 24-48 hours prior to the day of your
procedure.
INSTRUCTIONS FOR YOUR BOWEL PREPARATION WITH COLYTE, GOLYTELY, NULYTELY, HALFLYTELY PREPARATION
FOR THE PROCEDURE:
- Follow the preparation instructions given to you NOT THE ONES THAT COME WITH THE LAXATIVE (note: the more fluids you drink, the better the laxative works, and you will be less dehydrated.)
- Eliminate high fiber and whole grain foods, nuts and seeds in your diet during the three days leading up to your colonoscopy. In addition, discontinue iron, and bulking agents like Metamucil, Citrucel, Psyllium, and FiberCon during those three days leading up to your colonoscopy. If you are unsure about a certain food don’t eat it, err on the side of caution.
- If you are on Coumadin,Warfarin, Plavix, clopidogrel bisulfate (blood thinners), check with your physician regarding stopping medication prior to the procedure. Check with your physician before taking any over the counter medication that may contain aspirin.
- Diabetics on insulin may get individualized instruction.
- Other regular medications can be taken normally in the days leading to the procedure.
- Because the sedative medications remaining in your system after the procedure can slow your reaction times, it is our policy that you must have someone else drive you home after the procedure. If the person driving you does not remain at the hospital, they must be within 15 minutes distance and the nurse will notify them when you are almost ready to leave. Plan ahead to make arrangements for your transportation. You will be asked not to drive for 12 hours after the sedation. Most people feel tired after being sedated, so rest is recommended. You will be able to eat normally after the colonoscopy. You may resume regular activity the next day.
PLEASE NOTE:
Certain insurance companies may consider the above service as a surgical procedure. For Screening colonoscopies: in the event of a finding, such as the removal of polyps, the procedure would no longer be considered a screening exam and your insurance coverage could change to diagnostic colonoscopy benefits. Please check with y our insurance carrier. If you were seen in our office for symptoms prior to the colonoscopy; this would not be considered a screening colonoscopy examination (even if you were due for a screening at this time). Precertification may be required.
Page
COLONOSCOPY PREP INSTRUCTIONS:
- You will be given a prescription for COLYTE, GOLYTELY, NULYTELY, or HALFLYTELY to cleanse the bowel. Purchase it in advance. TWO DAYS
BEFORE THE PROCEDURE:
- In the evening, mix the prep following package instructions and keep it in the refrigerator, as it is more palatable when served cold.
THE DAY BEFORE THE EXAM:
- Drink only clear liquids for the entire day throughout the day; solid foods, milk or milk products are not allowed. Clear liquids include all of the following that are not colored red or purple: strained fruit juices without pulp (apple, white grape, lemonade), water, clear broth or bouillon (vegetable, chicken, beef), coffee or tea (without milk or nondairy creamer), Gatorade , carbonated and non-carbonated soft drinks, Kool-Aid (or other fruit flavored drinks), plain Jello (without added fruit or toppings), and ice Popsicles .
- 3:00pm Start the COLYTE/GOLYTELY. Drink 2/3 of the Colyte/Golytely “PREP”. Drink an 8 oz glass every 20 minutes until gone. If you become nauseated or bloated while drinking the PREP stop the PREP for 30 minutes and then resume. (Place remaining solution in the refrigerator overnight.)Tea or clear juices can be taken with it for taste.
- You may continue to drink clear liquids up to 2 hours before your procedure.
DAY OF THE PROCEDURE:
- 3 HOURS BEFORE YOU LEAVE FOR YOUR EXAM: Take the remaining 1/3 of the Colyte/Golytely “PREP”, just as you did the evening before. Continue to drink clear liquids up to 2 hours before your procedure.
- It is important to drink all of the prep to ensure a successful colonoscopy exam.
- After completing the prep wait 30 minutes, then take your morning blood pressure or cardiac medications; bring your other usual morning medications to take after the procedure.
AFTER THE PROCEDURE:
- Resume your regular diet unless otherwise instructed. Initially plan to eat lightly at home. Going to a restaurant is not recommended.
- Resume your regular medications unless instructed otherwise.
- No driving or operating machinery or making major decisions should be considered for the rest of that day.
- If you had polyps removed, plan no trips outside the country or to remote locations for 14 days as continuing care may be needed. On average one patient per year requires hospital attention following colonoscopy.
MoviPrep
Colonoscopy examination requires a bowel prep prior to the procedure. It is very important to have a clean colon, without retained stool, to ensure the best examination results.By the end of your bowel prep your stool should be liquid, either clear or yellow in color. If your stool remains brown at the end of your prep there will be decreased visualization of your colon, and your exam may need to be rescheduled.
Because you will receive sedation, you will need someone with you to drive you home. If you do not have arrangements for someone else to drive you home we will be unable to administer sedation for this procedure. It is best if the driver is someone you are comfortable with having hear the preliminary procedure report, as you may not remember it clearly. Read and follow the instructions below to prepare for your examination. If you have questions call our Scheduling Department at 272- 5011
*To pre-register please call (607) 274-4353 24-48 hours prior to the day of your procedure.
PREPARATION FOR THE PROCEDURE:
- Eliminate high fiber and whole grain foods, nuts and seeds in your diet during the three days leading up to your colonoscopy. In addition, discontinue iron, and bulking agents like Metamucil, Citrucel, Psyllium, and FiberCon during those three days leading up to your colonoscopy. If you are unsure about a certain food don’t eat it, err on the side of caution.
- If you are on Coumadin,Warfarin, Plavix, clopidogrel bisulfate (blood thinners), check with your physician regarding stopping medication prior to the procedure. Check with your physician before taking any over the counter medication that may contain aspirin.
- Diabetics on insulin will get individualized instruction.
- Other regular medications can be taken normally in the days leading to the procedure.
THE DAY BEFORE THE EXAM:
Drink only clear liquids for the entire day including breakfast, lunch, and dinner, Solid foods, milk or milk products are not allowed. Clear liquids include all of the following that are not colored red or purple: strained fruit juices without pulp (apple, white grape, white cranberry, lemonade, etc), water, clear broth or bouillon
(vegetable, chicken, beef), coffee or tea (without milk or nondairy creamer), Gatorade , carbonated and non-carbonated soft drinks, Kool-Aid (or other fruit flavored drinks), plain Jell-O (without added fruit or toppings), and ice Popsicles .
PLEASE NOTE:
- Certain insurance companies may consider the above service as a surgical procedure.
- For Screening colonoscopies: in the event of a finding, such as the removal of polyps, the procedure would no longer be considered a screening exam and your insurance coverage could change to diagnostic colonoscopy benefits. Please check with your insurance carrier. If you were seen in our office for symptoms prior to the colonoscopy; this would not be considered a screening colonoscopy examination (even if you were due for a screening at this time). Precertification may be required. Please contact your insurance carrier for coverage information.
COLONOSCOPY PREP INSTRUCTIONS:
The MoviPrep carton contains 4 pouches and a disposable container for mixing.
You must complete the entire prep to ensure the most effective cleansing.
3:00 PM: Prepare the MoviPrep:
- Empty 1 pouch A and 1 pouch B into the disposable container
- Add lukewarm drinking water to the top line of the container. Mix to dissolve. (can be made up ahead of time but should be used within 24 hours)
7:00 PM: First dose of MoviPrep:
- The MoviPrep container is divided by 4 marks. Every 15 minutes, drink the solution down to the next mark, until the full liter is consumed.
- Drink at least three (3) additional glasses of clear liquids in the next 2 hours. You are encouraged to drink additional clear liquids as desired.
9:00 PM: Prepare the morning dose of MoviPrep:
- Empty 1 pouch A and 1 pouch B into the disposable container
- Add lukewarm drinking water to the top line of the container. Mix to dissolve. (can be made up ahead of time but should be used within 24 hours)
DAY OF COLONOSCOPY:
3 HOURS BEFORE YOU LEAVE FOR YOUR EXAM: Take your second dose of MoviPrep just as you did the evening before. (Follow the instructions above) Continue to drink clear liquids up to 2 hours before your procedure.
- Take your morning blood pressure or cardiac medications and bring your other usual morning medications with you to be given after the procedure.
- Because the sedative medications remaining in your system after the procedure can slow your reaction times, it is our policy that you must have someone else drive you home after the procedure. Plan ahead to make arrangements for your transportation. You will be asked not to drive for 12 hours after the sedation. Most people feel tired after being sedated, so rest is recommended. You will be able to eat normally after the colonoscopy. You may resume regular activity the next day.
AFTER THE PROCEDURE:
- Resume your regular diet unless otherwise instructed. Initially plan to eat lightly at home. Going to a restaurant is not recommended.
- Resume your regular medications unless instructed otherwise.
- No driving, operating machinery or making major decisions for the rest of that day.
- If you had polyps removed, plan no trips outside the country or to remote locations for 14 days as continuing care may be needed. On average one patient per year requires hospital attention following colonoscopy.
Miralax/Gatorade
Colonoscopy examination requires a bowel prep prior to the procedure. It is very important to have a clean colon, without retained stool, to ensure the best examination results.By the end of your bowel prep your stool should be liquid, either clear or yellow in color. If your stool remains brown at the end of your prep there will be decreased visualization of your colon, and your exam may need to be rescheduled.
Because you will receive sedation, you will need someone with you to drive you home. If you do not have arrangements for someone else to drive you home we will be unable to administer sedation for this procedure. It is best if the driver is someone you are comfortable with having heard the preliminary
procedure report, as you may not remember it clearly. At times it will be necessary for a follow-up office visit to discuss results and long term changes to your treatment. If you have questions call our Scheduling Department at 272-5011.
*To pre-register please call (607) 274-4353 24-48 hours prior to the day of your procedure.
PREPARATION FOR THE PROCEDURE:
- Eliminate high fiber and whole grain foods, nuts and seeds in your diet during the three days leading up to your colonoscopy. In addition, discontinue iron, and bulking agents like Metamucil, Citrucel, Psyllium, and FiberCon during those three days leading up to your colonoscopy. If you are unsure about a certain food don’t eat it, err on the side of caution.
- If you are on Coumadin,Warfarin, Plavix, clopidogrel bisulfate (blood thinners), check with your physician regarding stopping medication prior to the procedure. Check with your physician before taking any over the counter medication that may contain aspirin.
- Diabetics on insulin will get individualized instruction.
- Other regular medications can be taken normally in the days leading to the procedure. Because the sedative medications remaining in your system after the procedure can slow your reaction times, it is our policy that you must have someone else drive you home after the procedure. Plan ahead to make arrangements for your transportation. You will be asked not to drive for 12 hours after the sedation. Most people feel tired after being sedated, so rest is recommended. You will be able to eat normally after the colonoscopy. You may resume regular activity the next day.
ITEMS NEEDED:
- TWO Dulcolax bisacodyl laxative tablets (not the stool softener or the suppository)
- One 238 gram bottle of Miralax or generic equivalent
- One 64 oz. bottle of Gatorade (no red or purple flavors). Please contact your insurance carrier for coverage information
COLONOSCOPY PREP INSTRUCTIONS
THE DAY BEFORE THE EXAM:
Drink only clear liquids for the entire day including breakfast, lunch, and dinner, Solid foods, milk or milk products are not allowed. Clear liquids include all of the following that are not colored red or purple: strained fruit juices without pulp (apple, white grape, white cranberry, lemonade, etc), water, clear broth or bouillon (vegetable, chicken, beef), coffee or tea (without milk or nondairy creamer), Gatorade , carbonated and non-carbonated soft drinks, Kool-Aid (or other fruit flavored drinks), plain Jello (without added fruit or toppings), and ice Popsicles .
- 3:00pm, take 2 Dulcolax laxative tablets.
- 5:00pm, mix the bottle of Miralax in 64 oz. of Gatorade using a separate container. Shake or stir the solution until the Miralax is dissolved.
- Drink 2/3 of the Miralax/Gatorade solution. Drink an 8 oz glass every 20 minutes until 2/3 is consumed . If you become nauseated or bloated while drinking the Miralax prep stop the prep for 30 minutes and then resume. (Place remaining solution in the refrigerator overnight.)
- You should continue to drink clear liquids (see definition above) until bedtime. You may feel fullness, cramping, or nausea after starting the laxatives. (Drinking a carbonated beverage may help you from becoming nauseated after drinking the laxative) Diarrhea usually begins in 1-2 hours and becomes clear of solid materials in 4-5 hours. You should continue to drink clear liquids up until 2 hours prior to your procedure at which time you should not consume any additional clear liquids.
DAY OF THE PROCEDURE:
- 3 HOURS BEFORE YOU LEAVE FOR YOUR EXAM: Take the remaining 1/3 of the Miralax/Gatorade solution just as you did the evening before. Continue to drink clear liquids up to 2 hours before your procedure.
- After completing the prep wait 30 minutes, then take your morning blood pressure or cardiac medications; bring your other usual morning medications to take after the procedure.
AFTER THE PROCEDURE:
- Resume your regular diet unless otherwise instructed. Initially plan to eat lightly at home. Going to a restaurant is not recommended.
- Resume your regular medications unless instructed otherwise.
- No driving or operating machinery or making major decisions for the rest of that day.
- If you had polyps removed, plan no trips outside the country or to remote locations for 14 days as continuing care may be needed. On average one patient per year requires hospital attention following colonoscopy.
PLEASE NOTE:
Certain insurance companies may consider the above service as a surgical procedure. For Screening colonoscopies: in the event of a finding, such as the removal of polyps, the procedure would no longer be considered a screening exam and your insurance coverage could change to diagnostic colonoscopy benefits. Please check with your insurance carrier. If you were seen in our office for symptoms prior to the colonoscopy; this would not be considered a screening colonoscopy examination (even if you were due for a screening at this time). Precertification may be required.
Flexible Sigmoidoscopy Preparation
SIGMOIDOSCOPY
PROCEDURE:
You will be positioned on your side on an examining table. The doctor will
then insert a small and flexible, tube-like instrument into your rectum so he can visually examine your intestine. Mild discomfort may be experienced, but the procedure lasts only a few minutes.
PURCHASE:
- 4 ducolax tablets
- 2 Fleet enemas
PREPARATION:
No meals after 6pm the evening before the procedure; take 4 ducolax tablets the evening before the procedure. Nothing by mouth after midnight on the night
before the exam.
Administer one Fleet’s enema two hours before the exam and another one, one
hour before the exam.
USE NO LAXATIVES!!!!!
Report to the outpatient registration desk 15 minutes early to register. If your procedure is scheduled to begin later in the morning, or after noon, you may consume clear liquids up to 3 hours prior to scheduled procedure starting time.
Take all prescription medication(s) up to 3 hours prior to scheduled procedure starting time.
Nothing by mouth for 3 hours prior to scheduled procedure-starting time.
PLEASE NOTE
Certain insurance companies may consider the above service as a surgical procedure. Please contact your insurance carrier for coverage information. Precertification may be required.
SUPREP Prep
– RX: You will be given a prescription for a solution to cleanse your bowel. The prescription is sent electronically to your pharmacy. Please purchase at your pharmacy in advance. If desired, you may request flavor packets from the pharmacist or you may use Crystal Lite as a flavor substitute (not red or purple).
– You may want to purchase baby wipes; they can help prevent your bottom from becoming sore.
ASK YOUR REGULAR DOCTOR ABOUT ADJUSTING OR STOPPING THESE MEDICATIONS:
* Blood thinners such as; Aggrenox, Eliquis, Pradaxa, Savaysa, Xarelto, Coumadin, Warfarin, Plavix, clopidogrel bisulfate (blood thinners), etc.
* Diabetics on insulin may get individualized instruction.
* Iron supplements (including vitamins with iron)
If you are not sure if any of your medications should be held please check with your physician.
THREE DAYS BEFORE YOUR PROCEDURE:
-STOP taking fiber supplements such as Metamucil, Citrucel, Fibercon or Psyllium.
-STOP eating high fiber foods. Foods to avoid; Whole grain breads, wild rice, quinoa, raw vegetables, tough meat or meat with skin, nuts, popcorn, seeds, Whole grain cereals, granola bars, whole wheat cracker or rolls, corn bread, pumpernickel bread, cucumbers, squash with seeds. Fresh fruits and vegetables should be peeled before eating. If you are unsure about a certain food don’t eat it, err on the side of caution.
Please follow package insert for mixing prep only; DO NOT follow package insert for instructions on how to take the prep. Follow our instructions only.
THE DAY BEFORE THE EXAM:
– Drink only clear liquids for the entire day throughout the day; solid foods, milk or milk products, or pulp are not allowed. Clear liquids include all of the following that are not colored red or purple: strained fruit juices without pulp (apple, white grape, white cranberry), water (plain, flavored, or carbonated), clear broth or bouillon (vegetable, chicken, beef), coffee or tea (without milk or nondairy creamer), sports drinks such as Gatorade, soft drinks(cola, ginger ale, sprite, etc.), plain Jello (without added fruit or toppings), and ice Popsicles .
DO NOT DRINK or eat: Dairy products, pudding, juice with pulp, cream soups or containing meat or vegetables, fruit pops. NO RED or PURPLE clear liquids.
TIP: Warm tea or broth will help prevent you from getting chilled. Drink plenty of clear liquids throughout the day to avoid feeling weak and fatigued. The more clear liquids you drink the better the prep will be.
Please follow package insert for mixing prep only; DO NOT follow package insert for instructions on how to take the prep. Follow our instructions only.
The SUPREP carton contains 2 6-ounce bottles of liquid and a disposable container for mixing.
You must complete the entire prep to ensure the most effective cleansing.
6:00 PM: First dose of SUPREP.
Pour (1) 6-ounce bottle of SUPREP liquid into the mixing container. Add cool drinking water to the 16-ounce line on the container and mix. Drink ALL the liquid in the container. (You may substitute another clear liquid for the water if you want.)
Refill the container with 16-ounces of clear liquid two more times and drink. You MUST drink these two more 16-ounce containers of clear liquids over the next hour to hour and a half.
DAY OF COLONOSCOPY:
3 HOURS BEFORE YOU LEAVE FOR YOUR EXAM: Take the remaining bottle of the SUPREP “PREP”, just as you did the evening before.
Stop drinking clear liquids 2 hours before your procedure.
-YES, you should drink ALL your prep solution, even if your results look clear. When you are passing nothing but yellow or clear fluid that is good, however, the best prep usually requires you to completely finish the solution…the goal is to allow the doctor to clearly see all of the colon.
– Medications: After completing the prep wait 30 minutes, then take your morning blood pressure and cardiac medications; bring your other usual morning medications to take after the procedure.
AFTER THE PROCEDURE:
1. Absolutely NO DRIVING!!
2. Resume your regular diet unless otherwise instructed. Initially plan to eat lightly at home. Going to a restaurant is not recommended.
3. Resume your regular medications unless instructed otherwise.
4. No driving or operating machinery, swimming, climbing ladders or any activity that requires you to be alert and coordinated.
5. If you had polyps removed, plan no trips outside the country or to remote locations for 20 days as continuing care may be needed.
IMPORTANT INFORMATION ABOUT HEALTH INSURANCE COVERAGE
Gastroenterology Associates of Ithaca, PC is a participating provider in many health plan networks.
Please contact your insurance carrier to verify our participation with your individual coverage plan.
You may request a written estimate of costs that will be submitted to your insurance on your behalf. Please be advised that these are just estimates and that the costs could increase due to unanticipated circumstances (i.e. a polyp is found and removed by varying techniques). Upon request you will be provided a list of other physicians and facilities that may be involved in your care. You must contact them directly to discuss their participation with your insurance plan.