TRI-CITIES DIGESTIVE HEALTH CENTER, P.S. 8819 W. Victoria Ave., Kennewick, WA 99336 (509) 460-5500
(www.checkmycolon.com)
PREPARATION FOR COLONOSCOPY – MIRALAX/GLYCOLAX
PLEASE READ THESE INSTRUCTIONS AT LEAST 7 DAYS PRIOR TO EXAM.
YOU WILL RECEIVE CONSCIOUS SEDATION DURING YOUR COLONOSCOPY. IT WILL NOT BE SAFE, OR LEGAL, FOR YOU TO DRIVE FOR THE REMAINDER OF THE DAY. It is REQUIRED that your driver check in with you when you come for your procedure, and stay in our office while you are here for your procedure. IF YOU DO NOT HAVE A DRIVER WITH YOU WHEN YOU COME FOR YOUR PROCEDURE, WE WILL CANCEL YOUR PROCEDURE. Plan on being here for 1 to 1½ hours.
Do not plan any out of town trips for one week after your colonoscopy. If the doctor finds polyps, he will remove them (polypectomy). It is important to remain close to home in the event of side effects or complications, such as bleeding.
Purchase from a drug store of your choice: Bisacodyl/Dulcolax tablets – 5mg each 238g bottle of MIRALAX/GLYCOLAX
Date______________________________ (SEVEN DAYS BEFORE COLONOSCOPY)
STOP NSAIDS (IBUPROFEN, ALEVE, etc…). YOU MAY CONTINUE TAKING ASPIRIN IF YOU ARE CURRENTLY ON IT FOR CARDIOVASCULAR PROTECTION. IF YOU ARE TAKING PLAVIX, COUMADIN, ELIQUIS, XARELTO, PRADAXA, OR OTHER BLOOD THINNERS, DISCUSS WITH THE DOCTOR WHETHER YOU SHOULD STOP IT. If you have questions about any medications that you are currently taking, please discuss them with the nurse.
Date_______________________________ (TWO DAYS BEFORE COLONOSCOPY)
1. Low-residue diet: no fruits, vegetables, nuts or fibrous grains. No fiber supplements (i.e.: Metamucil, Citrucel, Benefiber, etc…)
Date________________________________ (ONE DAY BEFORE COLONOSCOPY)
1. You may have two (2) plain scrambled eggs for breakfast (no onion or other vegetables added).
2. After breakfast, start on clear liquids only. Clear liquids include: Jell-O, soft drinks, broth, coffee, tea, fruit juice (pulp-free), Gatorade and popsicles, but NO dairy products. PLEASE DO NOT HAVE ANY RED LIQUID OR JELLO, as these may be mistaken for blood by your physician. Drink as much as you like.
3. At 12:00 noon take 4 (four) Bisacodyl (Dulcolax) tablets.
4. At 6:00 pm start taking the Miralax/glycolax. Mix one capful (17 grams) of the powder in 8 oz of clear liquid, and repeat every 10 minutes until 8 doses have been consumed. (Once you start to drink this laxative preparation, remain close to toilet facilities as it is expected that the laxative will work quickly)
Date________________________________ (EXAM DAY)
1. 4 hours prior to your arrival time, at ________________________, take 4 additional doses of Miralax/glycolax 10 minutes apart, as directed above.
2. After finishing the above prep, nothing else by mouth prior to the procedure. You may take necessary medications with a sip of water no later than 3 hours prior to your procedure.
3. Wear comfortable loose-fitting clothing to the exam.
APPOINTMENT DATE: ______________________________ ARRIVAL TIME*:_______________________
*Please note: Your appointment time indicates the time you need to be at the office for preparation. It does not indicate the time the procedure will start.
PLEASE GIVE OUR OFFICE 48 HOURS ADVANCE NOTICE IF YOU ARE UNABLE TO KEEP THIS APPOINTMENT TO ALLOW TIME FOR SOMEONE ELSE TO USE THIS ALLOTTED APPOINTMENT SLOT. THANK YOU. Rev. 08/14