COLONOSCOPY PREPARATION SHOPPING LIST Standard/Diabetic List 8.3 Oz. bottle of MiraLax (Polyethylene Glycol 3350) 5 Dulcolax tablets (Bisacodyl) 64 Oz. Gatorade (NO RED) Constipation List 8.3 Oz. bottle of MiraLax (Polyethylene Glycol 3350) 5 Dulcolax tablets (Bisacodyl) 64 Oz. Gatorade (NO RED) 17 g. Magnesium Citrate powder If you have any questions or concerns about the preparation, please contact Your Patient Advisor by calling 800-349-0285 or emailing support@yourpatientadvisor.com. Updated cg 3/18/16
The following instructions are your Doctor s specific directions. Please follow the directions carefully. 7 DAYS BEFORE THE PROCEDURE STOP using any iron and fiber supplements. If you are taking blood thinner medications, have a pacemaker or defibrillator, call our office and speak to a nurse. Continue your other medications. 3 DAYS BEFORE THE PROCEDURE STOP eating popcorn, seeds, raw fruits, raw vegetables, and nuts. Cooked fruits and vegetables may be eaten. If you have diabetes and are taking insulin, consult your diabetes physician for the correct dosage to take on the day of your exam. YOU MUST ARRANGE A DRIVER WHO WILL STAY WITH YOU AND DRIVE YOU HOME. Please inform your driver this will take about 2 hours. THE DAY BEFORE THE PROCEDURE NO SOLID FOODS. THE DAY BEFORE YOUR EXAM YOU MUST BE ON A CLEAR LIQUID DIET ALL DAY. NO ALCOHOL OR DAIRY PRODUCTS ALLOWED. A clear liquid diet is necessary for a colonoscopy. A complete cleansing of the entire bowel is essential for effective results, so that there will be no need for retesting. Your Clear Liquid diet options: Tea and Coffee Clear Juices Powdered Lemonade Water/ Vitamin Water Such as apple or white grape Carbonated Beverages NO DAIRY OR NON-DAIRY CREAMER NO PULP NO RED NO PULP NO RED NO DARK COLORED Sports Drinks Popsicles Jell-O Low Sodium Broths/ Coconut Water Honey/Sugar WITHOUT MILK OR ADDED FRUIT NO RED NO RED NO RED NO PULP, NOODLES OR PARTICLES
It is very important to drink plenty of water and other clear liquids throughout the day in order to avoid dehydration and to flush the bowel. THE DAY BEFORE YOUR PROCEDURE 1 3:00 PM the day before your procedure Mix the two packets of Gatorade powder with 64 oz. (1/2 gallon) of water and chill in the refrigerator. 2 3:00 PM the day before your procedure Take 2 Bisacodyl with a glass of water. 3 Between 5:00 PM and 8:00 PM the night before your procedure Mix together the ENTIRE BOTTLE of Polyethylene Glycol 3350 (8.3oz/238g) with 64 oz. of the chilled Gatorade. 4 5 Between 5:00 PM and 8:00 PM the night before your procedure Begin drinking HALF OF THE MIXTURE (32 oz.) Drink an 8 oz. glass of the solution every 15 minutes until gone. 10:00 PM the night before your procedure Take 2 Bisacodyl with a glass of water. *Please note you will only need 4 tablets total. (Please dispose of the extra tablet)
If you develop vomiting, slow down the rate at which you drink the solution. Please attempt to drink all of the laxative solution even if it takes you longer. If vomiting persists, stop the preparation and call our office or the physician on call for further instructions. Individual responses to laxatives vary. This preparation will cause multiple bowel movements, so stay close to a bathroom. THE MORNING OF THE PROCEDURE Remember no solid food, clear liquids only 6 the morning of your procedure Drink the OTHER HALF OF THE MIXTURE (32 oz.) Drink an 8 oz. glass of the solution every 15 minutes until gone. FINISH NO LATER THAN 3 HOURS PRIOR TO YOUR PROCEDURE THE DAY OF THE PROCEDURE 3 HOURS BEFORE YOUR PROCEDURE - NOTHING BY MOUTH - NOTHING TO EAT OR DRINK UNTIL AFTER YOUR PROCEDURE. - DO NOT USE chewing tobacco, gum, lozenges, candy or breath mints - If you regularly take medications in the morning, take it at least 3 hours before your colonoscopy, with a small amount of water. SOME SUGGESTIONS WHILE PREPPING AT HOME: You may experience chills. Dress warmly. (socks, robe, blanket) Walking around the house may help get the prep working. Drinking from a straw may be helpful. If you experience nausea or vomiting, stop drinking for 1 hour and then start again at a slower rate. Drink each glass in 10-20 minutes, resting 10 minutes between each glass. Be patient, the prep solution rarely fails. Most patients have a bowel movement within 30-60 minutes, but it may take up to two hours. ON THE DAY OF YOUR EXAM, PLEASE BRING: Medication list, include dosage Allergy list Medical problems and surgery list Insurance cards- You will be asked to present insurance cards at EVERY visit to our office. Photo ID- Photo identification is now required by Federal Regulation to prevent Identity Theft. You will be asked to present photo identification at EVERY visit to our office. Inhaler, if you use one These forms completed in black ink with you to your appointment: Financial Policy Patient Interview Form
PLEASE REMEMBER A DRIVER NEEDS TO CHECK-IN WITH YOU ON YOUR PROCEDURE DAY TO DRIVE YOU HOME AFTER YOUR PROCEDURE AND ASSIST YOU WITH FOLLOW-UP CARE. THIS TAKES APPROXIMATELY 2 HOURS. YOU WILL NOT BE ABLE TO DRIVE A CAR, OPERATE ANY MACHINERY OR GO TO WORK UNTIL THE FOLLOWING DAY. FAILURE TO BRING YOUR COMPLETED FORMS, PHOTO IDENTIFICATION, INSURANCE CARD(S), YOUR CO-PAYMENT, AND A DRIVER MAY RESULT IN YOUR APPOINTMENT BEING RESCHEDULED. If you have any questions or concerns about the preparation, please contact Your Patient Advisor by calling 800-349-0285 or emailing support@yourpatientadvisor.com.