Patient Forms
Prep Instructions
EGD Prep
What is Upper GI Endoscopy?
Liver Biopsy
- 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.
What is Liver Biopsy?
Colyte Prep
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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)
- 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)
- 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.
- 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
- 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.
- 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
- 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.
- 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.
- 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.
Flexible Sigmoidoscopy Preparation
- 4 ducolax tablets
- 2 Fleet enemas
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.