Digestive Health Center

Transcription

1 Digestive Health Center Digestive Health HOW TO PREPARE FOR YOUR COLONOSCOPY OR UPPER ENDOSCOPY FOR QUESTIONS OR TO SCHEDULE YOUR PROCEDURE CALL (217) PATIENT NAME PROCEDURE DOCTOR CLINIC NUMBER PROCEDURE DATE REPORT TIME

2 or Walkway Table of Contents PLEASE READ THE FOLLOWING SECTIONS Your digestive system 3 What to expect 4 Clear liquid diet 5 Starting your procedure 6 Colonoscopy 6 Upper-Endoscopy 9 Frequently Asked Questions 10 Diabetic instructions 11 On the day of your procedure, you must first check in at hospital registration. Registration is located in the main lobby N E E North Tower Map Legend E Elevator Patient drop off across from the Orchard Street E North Parking Garage. The Forum at Carle Once checked in, you will proceed Breezeway/ Concourse to Digestive Health, located on the first floor of the North Tower. Rogers Parkview E E Emergency Department Lobby/ Center Building Check-in Orchard Street Main Entrance Circle Drive North Parking Garage E North Clinic E University Avenue 2

3 Digestive Health Center THANK YOU FOR CHOOSING CARLE DIGESTIVE HEALTH CENTER. You have been scheduled for a Colonoscopy and/or Upper Endoscopy. This booklet will help you get ready for your procedure. If you have questions, review the Frequently Asked Questions at the end of this book or speak to a staff member at (217) MOUTH LIVER ESOPHAGUS COLONOSCOPY One out of every 16 Americans will get colon cancer. There is no single cause for colon cancer, but nearly all colon cancers begin as noncancerous polyps. A polyp is a small growth on the inside surface of your colon that can turn cancerous. Removing polyps early increases your chance of surviving or preventing colon cancer which is why screening colonoscopies are recommended for adults beginning at age 50. During a colonoscopy, the doctor uses a scope to inspect your colon and remove any polyps. The purpose of the colon prep is to clean out your colon. It is very important to have your colon as clean as possible so the doctor can get a clear look. GALL BLADDER STOMACH DUODENUM PANCREAS COLON SMALL INTESTINE RECTUM UPPER ENDOSCOPY Gastroesophageal Reflux Disease (GERD) is one of the main reasons we perform an upper endoscopy. During an upper endoscopy, the doctor uses a scope to inspect the upper portion of your gastro intestinal (GI) tract. Your upper GI tract is made up of your esophagus, stomach and duodenum (the first portion of the small bowel). 3

4 What to Expect You have been scheduled for a procedure requiring sedation. Please review these instructions carefully. Plan to be at Carle for two to four hours. This includes registration, prep, procedure and recovery time. Some procedures may require longer. Do not plan to drive, or return to work or school until the next day. THE FOLLOWING THREE ITEMS COULD SIGNIFICANTLY DELAY OR CAUSE YOUR PROCEDURE TO BE CANCELED: 1. DRIVER: Bring a driver with you. The medications used during the procedure will affect your memory and judgment. Your driver will need to accompany you to your procedure, stay with you in the department, and remain with you afterwards for a reasonable period of time. You cannot use a taxi or bus unless a responsible person comes with you. Your procedure will be canceled if you do not have a driver who stays in the department with you during your procedure. 2. JEWELRY: You must remove all jewelry, including wedding rings and body piercings before your procedure. It is strongly recommended that you leave jewelry at home. Consult a jeweler if you are unable to remove your jewelry. The presence of jewelry may cause injuries including burns, swelling and dislocations, skin tears or circulation problems. 3. PREGNANCY TESTING: All female patients of childbearing age will be asked to provide a urine sample upon arriving in the Digestive Health Center. Please notify the receptionist if you need to use the restroom before you have spoken with a nurse. PATIENT EDUCATION EMMI Video: You will receive a code to access an online video about your procedure. The program will provide you with general information about the procedure, prep and sedation. Please watch the video before coming for your procedure. If you do not have internet access at home, a computer is available in the Digestive Health Center. Call (217) if you have not received an access code to view the video at Your code: Moderate Sedation - What to expect: You will be given medication during your procedure to help relieve discomfort and anxiety. The medication may cause brief memory loss during the procedure and for a short time after. Certain medications may affect your ability to fully relax with the sedation. Your nurse will monitor you closely to provide you with the best sedation and comfort possible. Because of this sedation, you will receive specific restrictions upon discharge. THINGS TO BRING: Bring a current list of all medications and dosages, including supplements and over the counter. If you have sleep apnea, bring your CPAP or breathing mask with you. If you have a living will and/or durable power of attorney for health care, bring a copy to be filed in your electronic medical record (EMR). IF YOU ARE DIABETIC OR TAKE ANTICOAGULANTS (ASPIRIN, NSAIDS, OR BLOOD THINNERS): Special instructions will be provided for you to follow. LEGAL GUARDIAN: If you are the parent or legal guardian of the patient, you must stay in the Digestive Health Center before, during and after the procedure. The procedure will be canceled if no parent or legal guardian is available to sign the consent or talk with the doctor. 4

5 What is a Clear Liquid Diet? It is important to follow a clear liquid diet as indicated for your procedure. Solids, such as pulp and milk products can obstruct the view of your digestive system, and your procedure may be canceled or rescheduled. Your doctor needs the cleanest prep possible to accurately assess and view your digestive system. CLEAR LIQUIDS INCLUDE: water tea coffee (sugar is ok, no cream) fruit juices (strained, no pulp, not red) such as apple or white grape lemonade from powder mix (not fresh squeezed) soft drinks or carbonated beverages sports drinks such as Gatorade, All-Sport, Powerade (not red) fruit-flavored drinks such as Kool-Aid, Crystal Light (not red) fat free broth, bouillon, consommé plain or flavored gelatins such as Jell-O (no fruit or topping, not red) Popsicles (not red) Italian ice or sorbet (no fruit or cream, not red) Clear liquid nutritional supplements Honey and sugar Hard candy such as butterscotch or peppermint disc, lemon drops, lollipops YOU CAN HAVE A good rule of thumb, if you place the glass of clear liquid on a newspaper, you should be able to see the newsprint easily in the bottom of the glass. If in doubt, avoid it. YOU CANNOT HAVE Red-colored clear liquids, milk, cream, or dairy substitutes, alcohol products. 5

6 Starting Colonoscopy your procedure HOW THE COLONOSCOPY WORKS The colon is a hollow tube that helps to absorb water and pass stool and waste products from your body. Like other parts of your digestive system, it can be affected by many conditions and diseases. The purpose of colonoscopy is to look inside your colon for polyps, cancers, ulcers and other conditions. Colon cancer usually has no symptoms until advanced stages. It is very important to have your colon as clean as possible so the doctor can get a clear look. You will receive medication (a sedative) during the procedure to help you avoid discomfort. The endoscope is a thin flexible tube with a light and camera at the tip. If the doctor finds any polyps, he will remove them. A colonoscopy usually takes minutes. The scope bends as it passes through the colon. The headlight provides light so the doctor can see. HELPFUL HINTS IF you become nauseated or feel full, stop drinking for minutes. Then resume the Miralax prep using smaller amounts (4-6 ounces) every minutes. IF you would like to add the Miralax powder directly to the Gatorade bottle, you must first pour out and set aside one glass to make room for the powder. Mix as directed above. SOFT DRINKS You can add the glass of liquid back into the container later when there is room. 10 DAYS BEFORE YOUR PROCEDURE: If you take any of the anti-coagulants listed below, call your primary doctor or your Anticoagulation Management Service (AMS) to see if you can stop taking these medications or if you need special instructions. Once approved by your physician or AMS, stop these medications seven days before your procedure or as instructed. Aspirin Jantoven (Warfarin) Heparin Plavix Ticlodipine Coumadin (Warfarin) Dabigatran (Pradaxa) Lovenox Clopidogel other blood thinners If you take these or other NSAID s (non-steroidal anti-inflammatory drugs) like: Ibuprofen Motrin or Aleve Meloxicam Advil Celebrex Naprosyn call your primary doctor to see if you can stop taking them seven days before your procedure. It is okay to take acetaminophen or Tylenol if needed for pain relief. 5 DAYS BEFORE YOUR PROCEDURE: Stop taking iron pills and multi-vitamins that contain iron. Other names for iron are ferrous sulfate, ferrous gluconate or ferrous fumarate. Stop taking fiber medications such as Metamucil, Fibercon, Citrucel, Benefiber, Colon Care Capsules, or Psyllium. Stop eating nuts, popcorn and seeds or foods that contain them. Remove skins and seeds from fruits and vegetables before eating. Just use your best judgment. If in doubt, don t eat it. 6

7 Digestive Health DAY BEFORE PROCEDURE STEP 2: Begin the bowel prep (Dulcolax or Biscodyl tablets and Miralax ) as early in the day as your schedule allows, but no later than 6 p.m. You may be up late if you do not start early in the day. Mix the entire bottle of Miralax powder (either 238 or 255 grams) in 64 oz. of Gatorade or other clear liquid (DO NOT USE RED LIQUIDS). Mix until Miralax is completly dissolved. The prep is designed to clean out your colon. It will usually cause you to have loose bowel movements within two to six hours. STEP 3: Drink 8 ounces every minutes until 32 ounces, or half, of the prep is finished. This should take about one hour to drink. MEDICATIONS HELPFUL HINT: A ONE CUP MEASURING CUP EQUALS 8 OUNCES. You may take all of your regular medications. If you take diabetes medications, follow the instructions on page 11. If you take anticoagulants (aspirin or blood thinners) please follow the special instructions you were given. STEP 4: When you have finished drinking the first 32 ounces of prep, take the remaining two Dulcolax tablets. DIET No solid food Refrigerate the remaining 32 ounces of Miralax prep and plan to drink the rest in the morning. You will need to start drinking early to finish in time for your procedure, so plan accordingly. Follow a clear liquid diet the entire day STEP 1: Take two Dulcolax or Biscodyl tablets. Two hours later, start drinking the Miralax Prep (The generic of Miralax is Polyethylene Glycol). STEP 5: Continue to drink 8 ounces of clear liquid every hour until bedtime, even after you have finished the prep. Extra fluids will continue to clean out your colon and will keep you hydrated. IS MY PREP WORKING? The stool should eventually look like what you are drinking clear or light yellow, without many small particles. Dark and murky. Brown and murky. Dark orange and semi-clear. Light orange and mostly clear. Yellow and clear, like urine. NOT OK NOT OK NOT OK ALMOST THERE! YOU RE READY! 7

8 Digestive Colonoscopy Health (cont.) DAY OF PROCEDURE MEDICATIONS: You may take all of your regular medications. If you take diabetes medications, follow the instructions on page 11. If you take anticoagulants (aspirin or blood thinners) please follow the special instructions you were given. DIET: No solid food Follow a clear liquid diet the entire day. START BOWEL PREP: STEP 1: Start drinking second half of Miralax prep that was refrigerated from the night before at (write in time). Drink 8 ounces every minutes until the remaining 32 ounces are finished. It should take about an hour to drink. STEP 2: After you have finished the prep, continue drinking at least one cup of clear liquids every hour until two hours before you are to report to registration. This will help keep you hydrated. STEP 3: STOP drinking all liquids two hours before you are scheduled to report to registration. THINGS TO BRING: Bring a responsible adult to drive you home. Bring a current list of all your medications and dosages; include any over-the-counter supplements. If you have sleep apnea, bring your CPAP breathing mask. If you have a living will and/or a durable power of attorney for healthcare, bring a copy to be scanned into your electronic medical record (EMR). After the procedure, you will recover for about minutes. You may feel the need to pass gas during your recovery. You need to have a responsible adult to drive you home. They should stay with you until the total effects of the sedation wear off. Stop drinking clear liquids at REPORT TO HOSPITAL REGISTRATION: Registration is located in the main lobby across from the Orchard Street North Parking Garage. Digestive Health is located on the first floor of the North Tower. 8

9 Upper-Endoscopy An upper-endoscopy or EGD is a test that examines the upper portion of your GI tract: the esophagus, the stomach and the duodenum (first portion of the small bowel). Gastroesophageal reflux disease (GERD) is one of the main reasons this test is done. Abdominal pain, difficulty swallowing, intestinal bleeding, and GI cancers are additional reasons you may be scheduled for this procedure. A physician will use a scope to inspect the lining of your esophagus, stomach and duodenum to best diagnose and treat your symptoms. You will be given medication (a sedative) during the procedure to keep you comfortable. NOTE: as part of your preparation, please read and follow the instructions given on page 6 in the following sections: 10 days before your procedure: 5 days before your procedure: MEDICATIONS: If you take diabetes medications or anticoagulants (aspirin or blood thinners) you should have received special instructions from your primary care provider or anticoagulation management service (AMS). Please follow those instructions. You may take medications with water two hours before you are scheduled to arrive for your procedure. This includes your blood pressure pills. REPORT TO HOSPITAL: Registration is located in the main lobby across from the Orchard Street North Parking Garage. Digestive Health is located on the first floor of the North Tower. THINGS TO BRING: Bring a responsible adult who is able to drive you home. Bring a current list of all your medications and dosages; include any over-the-counter supplements. If you have sleep apnea, bring your CPAP breathing mask with you. If you have a living will and/or a durable power of attorney for healthcare, bring a copy to be filed in your electronic medical record (EMR). After the procedure you will recover for about minutes. You may feel a slight sore throat. You need a responsible adult to drive you home. They should stay with you until the total effects of the sedation wear off. FOOD: No solid food, starting at midnight before your procedure. You may have clear liquids until two hours before your report time. (see clear liquid diet list on page 5). You may brush your teeth or rinse, but do not swallow. STOP DRINKING CLEAR LIQUIDS AT. 9

10 Digestive Frequently Health Asked Questions WHAT IF I TAKE BLOOD PRESSURE MEDICINE? If you take blood pressure medicine, be sure to keep taking the medicine as you get ready for the procedure. The day of the procedure, take your blood pressure medicine with water at least 2 hours before the procedure. If you have questions about your medicine, please call your doctor before the day of the procedure. WHY CAN T I DRIVE MYSELF HOME AFTER MY PROCEDURE? You will be given medicine to make you sleepy during the procedure. This would make it unsafe for you to drive home. You must have someone drive you home after your procedure. You may use public transportation (taxi or bus), but only if you have someone who can escort you home. HOW LONG WILL THE PROCEDURE TAKE? Times are specific to which test you are having done. Expect to be at the Digestive Health Center for 3-4 hours, which includes your recovery time. WHAT ARE THE SIDE EFFECTS OF THE BOWEL PREP? The bowel prep is meant to give you diarrhea. This will start anywhere from 30 minutes to 3 hours after you start your bowel prep. Plan to be at home near a toilet. Some people feel bloating and mild abdominal discomfort. Do not be worried if you feel these symptoms. Some people have an upset stomach while taking the prep and may vomit. If this happens, take a break from drinking the prep for 30 minutes. Start again drinking your prep in 4 ounce doses every minutes until the solution is done. All liquids, including the prep, must be stopped 2 hours before the procedure. If vomiting does not stop, call the Digestive Health Center at (217) during regular business hours or Carle Patient Advisory after hours at (217) , for further orders. MY PREP HASN T STARTED WORKING YET. People react differently to the bowel prep. Some may have a bowel movement right away. Others may not have a bowel movement for a few hours. If you have not had a bowel movement in 3 hours, take the second part of your bowel prep and drink clear liquids. If you finish drinking all 64 ounces without a bowel movement, call the Digestive Health Center at (217) or Patient Advisory Services at (217) WHY DO I NEED A BOWEL PREP? Your colon must be clean to do the procedure. If it is dirty, your doctor may not be able to see everything, like polyps or cancer. A clean colon is like a clean windshield, easy to see through, but a dirty colon is like looking through a dirty windshield. If your colon is dirty, you may have to reschedule your procedure. WHAT TO EXPECT AFTER YOUR PROCEDURE Gas and/or cramps Smear of blood on toilet tissue Patients who have had an upper endoscopy may have a sore throat. You may feel sleepy for several hours. This feeling should go away by the next day WHAT ARE THE RISK FACTORS FOR COLON CANCER? You may be at a higher risk for colon cancer if: you are older than you have had polyps before someone in you family has a history of polyps or colon cancer You may also be more likely to get polyps if you: eat a lot of fatty food smoke drink alcohol are overweight do not exercise Please ask you doctor how you can reduce the risk of colon cancer. 10

11 Diabetic Digestive Instructions Health If you have diabetes or follow any special care for pre-diabetes, please follow these instructions. During your procedure, the Digestive Health care team will work to control your blood sugar. Before your procedure, follow these instructions. DIABETIC GENERAL INSTRUCTIONS Monitor your finger stick blood sugar level every four hours while awake or more often if you feel your blood sugar is low. Treat a low blood sugar according to your doctor s instructions. If less than 70 after two treatments, call your primary care doctor for further instructions. You will be given non-slip footies to wear for the procedure. If you prefer, you may bring slippers from home. Bring your diabetic medications with you to take after your procedure (insulin and diabetic pills). DIABETIC MEDICATIONS Day before procedure You may take your usual diabetic medications (pills and injections) the day before your procedure. Day of procedure Lantus Take your full dose NPH Take half of your usual dose Humalog/Novalog or Regular insulin DO NOT TAKE any before your procedure Diabetic pills DO NOT TAKE any before your procedure but bring them with you DIABETIC DIET DURING COLON PREP Follow colon prep instructions, you may mix your Miralax prep with Gatorade or clear liquids that contain sugar if your blood sugar is low or normal. You may choose a sugar-free clear liquid such as Crystal Light or sugar free tea if your blood sugar is high. You should replace lost meals with clear liquids that contain sugar (Example: Broth, Jell-O with sugar, clear fruit juice no pulp). Stay within your usual recommended carbohydrate allowance as instructed by your doctor or diabetic educator. To stay hydrated between meals, drink at least one cup of sugar-free clear liquids every hour. 11

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