Colonoscopy Preparation Handbook

Colonoscopy
Preparation
Handbook
Inside you will find:
• How to prepare for your colonoscopy
• Frequently asked questions
• Useful information regarding colonoscopy
BRENT K. EVETTS, MD, FASCRS
Trusted care. Experienced hands.
Table of Contents
About This Handbook ......................................................................
Scheduling ...........................................................................................
Colonoscopy Checklist ...................................................................
Why Should I have a Colonoscopy ..............................................
How does a Colonoscopy Work ....................................................
FAQs about your Medications .......................................................
What are Clear Liquids .....................................................................
How Do I Know if my Prep is Working .......................................
Preparation for a Colonoscopy
• Colonoscopy before 10:00 AM ..............................................
• Colonsocopy between 10:00 AM and 1:00 PM ................
• Colonoscopy after 1:00 PM .....................................................
What Liquids are OK? ........................................................................
What Liquids are NOT OK? ..............................................................
What Foods are OK? ..........................................................................
What Foods are NOT OK? ................................................................
Frequently Asked Questions ..........................................................
Driving Directions ..............................................................................
The Affordability Act and Colonoscopy .....................................
Other Services .....................................................................................
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About this Handbook
You are about to undergo a colonoscopy. This handbook will help you get ready. We know
it can be challenging to get ready for a colonoscopy. We also know that Colonoscopy can
find cancer and save lives by finding and removing polyps. You may have questions
about the test and the preparation. This handbook should answer your questions, if after
you have read this handbook there are still questions please do not hestitate to call me at
(503) 691-1743.
About Getting Ready
The MOST IMPORTANT thing you can do is to empty out your colon by following the diet
prescribed in this handbook and taking the “bowel prep” medications. We want to
help you get ready. If you come in with your colon properly cleaned out, then we will be
able to perform the test safely and thoroughly as well as avoid the risk and inconvenience
of asking you to come back and repeat the test.
Help Us Help You!
If you follow these instructions, then you’ll give us the best
chance of doing it right the first time and decrease the
chance of missing something important
Brent K Evetts MD
1
Scheduling
Colonoscopy Date: ______________________________
Colonoscopy Time: ______________________________
• Before 10:00 AM
See page 6 for bowel preparation instructions
• Between 10:00 AM and 1:00 PM
See Page 7 for bowel preparation instructions
• After 1:00 PM
See page 8 for bowel preparation instructions
Arrival Time: ____________________________________
• You need to arrive 1 hour prior to your colonoscopy time to allow time for
checking in and getting prepared for your procedure.
Location:
◊ Legacy Meridian Park Medical Center
See page 12 for directions
◊ Oregon Endoscopy Center
See page 12 for directions
Colonoscopy Checklist
Before you start
◊ Read this entire handbook carefully
◊ Make sure you have all the supplies you need
◊ If needed, talk to physicicans about your medications
Two days before your colonoscopy
◊ Review your preparation instructions
◊ Confirm your transporation
One day before your colonoscopy
◊ Follow the diet instructions
◊ Follow the bowel preparation instructions
Day of your colonoscopy
◊ Follow directions for diet and bowel preparation
◊ Report for your colonoscopy as instructed
◊ Eat or drink anything you want after your procedure
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Why Should I have a Colonoscopy?
Your colon, like other parts of your body can get cancer. There is no single cause for colon cancer, but
nearly all colon cancers begin as non-cancerous polyps. A polyp is a small growth on the surface of your
colon that can turn into cancer. Recent evidence shows that
removing polyps can reduce your chance of getting colon cancer
by over 52%. Removing polyps may prevent you from getting
colon cancer. If polyps have already become cancerous, catching
them early increase your chance of surviving or being cured of
colon cancer.
One out of every 16 Americans will get colon cancer.
Most people survive colon cancer if it is caught early, and
only 5% of people survive colon cancer if it is caught late.
You may be at higher risk for colon cancer if:
• You are older than 50 ( 45 for African
Americans)
• You have a family history of colon cancer or
polyps.
• You have had polyps before
• Someone in your family has had polyps
You may also be more likely to get colon polyps
if you:
• Eat a lot of fatty foods
• Smoke
• Drink Alcohol
• Do not exercise
• Are overweight
How Does a Colonoscopy Work?
The purpose of colonoscopy is to look inside your colon for polyps, cancers, ulcers and other conditions. It is
important to get a colonoscopy to test for colon cancer once you are 45-50 years od age or older since the
disease usually has no symptoms.
Just before the procedure starts there will be a safety timeout in which everyone, including you will confirm
you are who we think you are and the procedure we are doing. I will then begin giving you some medication
to make you sleepy. The medication wil help you avoid discomfort from the procedure. Most people do not
remember the procedure.
The procedure will start out with a rectal exam. The colon is then filled
with air to allow a clear look in the colon. The endoscope will then pass
through your anus and into the colon. The endoscope is a thin flexible
tube with a light and camera at the tip. Images are transfered to a TV
monitor. As we look through your colon we are looking for polyps,
cancer, or other abnormalities. If we find polyps we can usually remove
them at the time of your colonoscopy. If there are other abnormalities
found during your colonoscopy a biopsy will be performed.
3
FAQ About Your Medications
You may be asked to stop certain medications before your colonoscopy. If you are taking
any of the medications below, please talk to your doctor about how to safely change your
medication routine. Make sure to talk to the doctor who prescribed your medication before
stopping or starting any medication.
What if I take anti-inflammatory medication, like Motrin, Aleve, ibuprofen, Naprosyn?
In general it is OK to continue taking these medicines. If any questions check with your doctor
for more information.
What if I take aspirin, clopidogrel, or Plavix?
Some people need to stay on these medicines even if they are going to have colonoscopy.
Other people should stop taking these medicines before your colonoscopy. Most of the time
it is OK to continue aspirin. Please check with the doctor who prescribes these for you to find
out whether you should or should not continue these medicines prior to your colonoscopy.
If your doctor says that it is okay to stop, then plan on stopping these medicines one week
before your colonoscopy. You will continue these medicines after the test, unless directed by
your doctor.
What if I take a blood thinner like Coumadin or warfarin?
There are many new medications that are used for blood thinners including Coumadin
(warfarin). You will likely need to stop blood thinning medications prior to colonoscopy.
Occasionally patients will need “bridge therapy”. It is important to check with the doctor
who prescribes these for you as soon as possible to determine how to proceed. If your
doctor says that it is okay to stop, then plan on stopping these medicines 3 days before your
colonoscopy. You will continue these medicines after the test, unless directed by your doctor.
About this Handbook
What if I take fish oil?
STOP taking fish oil two days before your colonoscopy. You will continue these medicines
after the test, unless directed by your doctor.
What if I take diabetes medicine?
If you have diabetes, take half of your diabetes medicine while on the clear liquid diet. Then,
do not take your diabetes medicine on the morning of the test. You will continue these
medicines after the test, unless directed by your doctor.
What if I take blood pressure medicine?
If you take blood pressure medicine be sure to still use the medicine while preparing for the
test. On the day of your test, you should take your blood pressure medicine with water at least
2 hours before your test. You will continue these medicines after the test, unless directed by
your doctor.
If you have any questions regarding you medications please call!
(503) 691-1743
4
What are Clear Liquids
As you get ready for your colonoscopy, you must only drink clear liquids. A liquid is considered
“clear” if you can read something through it.
This is orange juice.
Orange juice is not clear
because you cannot read
the newspaper through
it. Do not drink this.
This is pineapple juice. It
is also not clear. Do not
drink this.
This is apple juice. Apple
juice is clear because
you can read newspaper
print through it. You can
drink this.
How Do I Know if my Prep is Working
How do I know when my bowel prep is complete ?
The stool coming out should look like the stuff you are eating and drinking - clear, without many
particles. You know you’re done when the stool coming out is yellow, light, liquid and clear - like
urine.
No soups with chunks of food
Dark and
murky.
NOT OK
Brown
and
murky,
NOT OK
Dark
orange and
semi-clear
NOT OK
5
Light orange
and mostly
clear.
ALMOST
THERE
Yellow and
clear, like
urine.
YOU’RE
READY!
Colonoscopy Before 10:00 AM
ONE DAY Before your Colonoscopy
I
M
P
O
R
T
A
N
T
What you Eat:
You must not eat any solid food the
day before your colonoscopy. You
may only eat a clear liquid diet. Go to
pages 9-10 for things you can eat or
drink
What You Drink:
You must only drink clear liquid for
breakrfast , lunch and dinner. Be
sure to drink at least 12 tall glasses
(about 10-12 ounces) of clear liquids
throughout the day in addition to
what you have to drink with your
bowel prep.
Your Calendar: One Day Before Your Colonoscopy
Time of Day
What you Eat
Morning
What you
Drink
Clear liquid
diet for
breakfast NO
solid food
Drink at
least 4 large
glasses of
clear liquids
Clear liquid
diet for lunch
NO solid food
Drink at
least 4 large
glasses of
clear liquids
Afternoon
4:00 - 6:00 PM
• Take 2 Dulcolax tablets
• Reserve the bathroom
• Consider using Aloe wipes
• Use Vaseline or A&D ointment to perianal skin
Taking Your Prep:
Make sure you have the following.
• Sports Drink (64 ounces)
5:00 - 7:00 PM
• Mix 1/2 bottle of Miralax (7 doses) with 1/2 of the
Sports drink (32 ounces)
• Drink 8 ounces every 20 minutes until gone
• Dulcolax Tablets (4 tablets)
For coupon visit.
www.dulcolaxusa.com/
Evening
Clear liquid
diet for
dinner NO
solid food
8:30 - 10:30 PM
Take 2 more Dulcolax tablets
Mix remaining 1/2 bottle of Miralax (7 doses)
with the other1/2 of the Sports drink (32 ounces)
• Drink 8 ounces every 20 minutes until gone
•
•
• Miralax (14 dose size)
For coupon visit.
www.miralax.com
Drink at
least 4 large
glasses of
clear liquids
STOPCLEAR
LIQUIDS 3
HOURS PRIOR TO
COLONOSCOPY
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I
M
P
O
R
T
A
N
T
Colonoscopy Between 10:00AM - 1:00 PM
I
M
P
O
R
T
A
N
T
What you Eat:
Eat a light breakfast the day before
your colonoscopy.You must not eat
any solid food after noon the day
before your colonoscopy. You may
only eat a clear liquid diet. Go to
pages 9-10 for things you can eat or
drink
What You Drink:
You must only drink clear liquid
for lunch, dinner and breakfast. Be
sure to drink at least 12 tall glasses
(about 10-12 ounces) of clear liquids
throughout the day in addition to
what you have to drink with your
bowel prep.
Taking Your Prep:
Make sure you have the following.
and follow directions.
• Sports Drink (64 ounces)
Your Calendar: One Day Before Your Colonoscopy
Time of Day
What you Eat
Afternoon
Clear liquid
diet for lunch
NO solid food
What you
Drink
Drink at
least 4 large
glasses of
clear liquids
4:00 - 6:00 PM
• Take 2 Dulcolax tablets
• Reserve the bathroom
• Consider using Aloe wipes
• Use Vaseline or A&D ointment to perianal skin
Evening
Clear liquid
diet for
dinner NO
solid food
Drink at
least 4 large
glasses of
clear liquids
6:30 - 8:30 PM
• Mix 1/2 bottle of Miralax (7 doses) with 1/2 of the
Sports drink (32 ounces)
• Drink 8 ounces every 20 minutes until gone
Your Calendar: Day of Your Colonoscopy
• Dulcolax Tablets (4 tablets)
For coupon visit.
www.dulcolaxusa.com/
5:00-7:30 AM
• Take 2 more Dulcolax tablets
• Mix remaining 1/2 bottle of Miralax (7 doses)
with the other1/2 of the Sports drink (32 ounces)
• Drink 8 ounces every 20 minutes until gone
Morning
Clear liquid
diet for
breakfast NO
solid food
• Miralax (14 dose size)
For coupon visit.
www.miralax.com
STOP CLEAR
LIQUIDS 3
HOURS PRIOR TO
COLONOSCOPY
7
Drink at
least 4 large
glasses of
clear liquids
I
MI
PM
OP
RO
TR
AT
NA
TN
T
Colonoscopy After 1:00 PM
I
M
P
O
R
T
A
N
T
What you Eat:
Eat a light dinner the day before
your colonoscopy.You must not eat
any solid food after 6:00 PM the day
before your colonoscopy. After 6: 00
PM, you may only eat a clear liquid
diet. Go to pages 9-10 for things you
can eat and drink
What You Drink:
You must only drink clear liquid
after 6:00 PM the night before your
colonoscopy. Be sure to drink at least
12 tall glasses (about 10-12 ounces)
of clear liquids throughout the day
in addition to what you have to drink
with your bowel prep.
Taking Your Prep:
Make sure you have the following.
and follow directions.
• Sports Drink (64 ounces)
Your Calendar: The Day Before Your Colonoscopy
Time of
Day
What You
Eat
What you
Drink
Evening
After 6 PM
Clear liquid diet
only NO
solid food
Drink at least
4 tall glasses
of clear liquids
Your Calendar: The day of Your Colonoscopy
5:00 - 6:30 AM
• Take 2 Dulcolax tablets
• Reserve the bathroom
• Consider using Aloe wipes
• Use Vaseline or A&D ointment to perianal skin
• Mix 1/2 bottle of Miralax (7 doses) with 1/2 of
the Sports Drink (32 ounces)
• Drink 8 ounces every 20 minutes until gone
Morning
• Dulcolax Tablets (4 tablets)
For coupon visit.
www.dulcolaxusa.com/
Clear liquid
diet for
breakfast
NO
solid food
Drink at least
4 tall glasses
of clear liquids
7:30 - 9:00 AM
• Take 2 more Dulcolax tablets
• Mix 1/2 bottle of Miralax (7 doses) with 1/2 of
the Sports drink (32 ounces)
• Drink 8 ounces every 20 minutes until gone
• Miralax (14 dose size)
For coupon visit.
www.miralax.com
STOP CLEAR
LIQUIDS 3
HOURS PRIOR TO
COLONOSCOPY
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I
M
P
O
R
T
A
N
T
What Liquids Are OK
OK
OK
Water/Mineral Water
OK
OK
Tea
Apple Juice
OK
“Black” Coffee
Soda
“Clear” Sports Drink
What Liquids Are NOT OK
NOT OK
No Milkshakes
NOT OK
No coffee with cream
NO
NOT
NOT
OK
NOT
OK
No Pineapple Juice
What about Alcohol?
NOT OK
No Orange Juice
NOT OK
Milk or Dairy drinks
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Although alcohol is a clear
liquid, it can make you dehydrated. You should NOT drink
alcohol while preparing for
your test.
What Foods Are OK
OK
OK
Honey
OK
Jello
CLEAR Broth
What about red food?
OK
You may have heard that red food is
not acceptable when preparing for a
colonoscopy. However, there are no
studies to show that red foods make
any difference to the success of your
procedure. When people follow all
the instructions, they ususally end
up with a clean prep, even if they eat
red food.
OK
Popsicles
Hard candy
What Foods Are NOT OK
NOT OK
No breads, grains, rice
NOT OK
No vegatables
NOT OK
No Soup with chunks of food
NOT OK
No Milk or Dairy drinks
10
NOT OK
No meats
NOT OK
No fruits
Frequently Asked Questions
Can I drive myself home after my colonoscopy?
• NO. You will receive medicine to make you sleepy and comfortable during your test. That means that you
cannot drive home, it is not safe for you or others on the road. You must arrange for someone to drive
you home after the test. You may also use public transportation (taxi or bus), but only if you have an
adult who can escort you home.
What are the effects of the “bowel prep”
• You will have lots of diarrhea from the bowel prep. This will usually start within 3 hours after you start
drinking your prep. So plan to be home and reserve the bathroom. Most people have some nausea,
bloating and occasional abdominal discomfort. This is normal do not be alarmed. If symptoms are severe
please call me.
My prep hasn’t started working yet . Is that OK?
• Different people respond differently to the bowel prep. If you have waited more than 3 hours without
a response, then make sure you are drinking enough fluid. Take 2 more Dulcolax tablets. Call me if the
medicine is still not working at all despite drinking enough fluid and taking the medicine as directed.
How long will the test take?
• A colonsocopy usually takes about 20-30 minutes.
What are the risks of colonoscopy?
• Perforation through the entire wall of the colon is reported in approximately 1/ 6000 screening
colonoscopies. The risk can increase for therapeutic procedures, such as biopsies or polyp removal
• Bleeding is reported in 0-4/1000 procedures.
• Cardiopulmonary. Irregular heart beat (1/1000), low heart rate (8/1000), low blood pressure (12/1000),
low oxygen levels (56/1000), heart attack and stroke (fewer than 1/1000).
Will the colonoscopy hurt?
• Not generally. Most individuals are given conscious sedation (twilight sedation) to make them very
comfortable during the examination.
What if Dr. Evetts finds something abnormal?
• If a polyp is found it can usually be removed at that time.
• If a polyp or mass is unsafe to remove it will be biopsied and marked for further treatment.
• Unusual appearing tissue will undergo a biopsy.
How long will I be at the facility?
• You will be there about 2 hours. You will arrive 1 hour before your scheduled time. This will allow the
staff to get you ready for your procedure. After your procedure you will be monitored and allowed to go
home after it is determined to be safe. This is usually about 30-45 minutes.
When will I get the results?
• I will give you a results information sheet after the test. If polyps were removed or biopsies were done
it usually take 5-7 days to get the results. I will then call you with the results. If I don’t call within 10 days
please contact the office at (503) 691-1743.
When will I be able to eat normally?
• As soon as you have recovered from the procedure you will be able to eat whatever you want.
When will my bowel movements return to normal?
• You should return to normal bowel movement pattern within 2-3 days
Anything else?
• YES. Given the importance of colon polyp detection and removal in the prevention of colon cancer;
please encourage family, friends and loved ones to get their colonoscopy.
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Driving Directions
Meridian Park Medical Center Endoscopy Unit
From the North - I-5 Southbound
• Take exit 289, turn left at the
stoplight.
• Cross the overpass and proceed
on Nyberg Road
• After the curve proceed on
SW 65th Ave and take the
second left onto the hosrpital
grounds
• The main entrance is to the left.
From the South - I-5 Northbound
• Take exit 289, turn right at
the stoplight and proceed on
Nyberg
• After the curve proceed on
SW 65th Ave and take the
second left onto the hospital
grounds
• The main entrance is to the left.
From I-205
• Merge onto I-5 North
• Take exit 289, turn right at
the stoplight and proceed on
Nyberg
• After the curve proceed on
SW 65th Ave and take the
second left onto the hospital
grounds
• The main entrance is to the left.
Gastroenterology Endoscopy Center
From the North 1-5 Southbound
• Take exit 289. turn right at the
top of the ramp on Nyberg
• Bear left onto SW TualatinSherwood Rd.
• Turn right on SW 90th
• Building is on the right
From the South I-5 Northbound
• Take exit 289. turn left at the
top of the ramp on Nyberg
• Bear left onto SW TualatinSherwood Rd.
• Turn right on SW 90th
• Building is on the right
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From I-205
• Merge onto I-5 North
• Take exit 289. turn left at the
top of the ramp on Nyberg
• Bear left onto SW TualatinSherwood Rd.
• Turn right on SW 90th
• Building is on the right
The Affordability Care Act & Colonoscopy
What change have been made in health care coverage related to colonoscopy?
• Under the Affordabilty Care Act, screening colonoscopies are now fully covered by Medicare and many
private insurers. Patients will still be repsonsible for co-insurance or some out of pocket cost if the
colonsocpy is a diagnostic rather than screening procedure. Patients may also still be responsible for cost
related to anesthesia.
What is the difference between a screening and diagnostic colonoscopy?
• A screening colonoscopy is a procedure done for a patient who has no symptoms of colon cancer.
• A diagnostic colonoscopy is performed on patient with a previous personal history of polyps or cancer,
or to investigate ocurring symptoms, such as blood in stools or change in bowel movements. A family
history of polyps or colon cancer may also indicate a diagnostic colonoscopy with some commercial
insurers.
Can a patient go in for screening colonoscopy but then have to pay for a diagnostic procedure?
• Yes. Even if the patient has no symptoms, the procedure will be classified as a diagnostic colonoscopy if
a polyp is found and removed. Furthermore other findings that would necessitate the need for a biopsy
may be classified as diagnostic as well.
• The good news is if that occurs the procedure may have prevented the patient from getting colon cancer
How much the patient typically have to pay for diagnostic colonoscopy?
• Medicare patients would be responsible for the standard 20%: co-insurance.
• For patients with private insurance, out-of-pocket cost will vary depending on the plan.
What kind of symptoms could cause a colonoscopy to be classified by an insurance plan as “diagnostic”?
• It will vary depending on the health care plan, but could include hemorrhoids, changes in bowel habits,
abdominal pain, or rectal bleeding. If a physician uses a diagnosis of family history, some commercial
payers may also processor claim as a diagnostic colonoscopy
Who should a patient call to determine how much of the colonoscopy will be covered?
• Patients should contact their insurance plan or benefits administrator directly.
• Our office can help you with the specific diagnosis code and procedure code.
Who will I receive a statement from?
• Your doctor who performs the procedure.
• The facility where you had your procedure done. This is separate from the doctors fee.
• If you have a polyp removed or a biopsy done you will receive a statement from the pathologist or lab.
This is also separate from the doctors fee.
• If you have anesthesia from another provider they will also send a statment.
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Other Services
Thank You, and I appreciate that you have chosen me and my staff to help you with your colonoscopy.
While we perfom well over 500 colonoscopies a year, there are several other services that may be of benefit
to you or others. If we do a good job for you please tell others; if we don’t please make sure you bring it to
my attention so that I can address your concerns.
Visit our website at
www.DrEvetts.com
Phone: (503) 691-1743
Advanced Laparoscopic Surgery
• DaVinci Robotic Surgery
• Inguinal hernia repair
• Ventral hernia repair
• Gallbladder
• Colon
• Gastroesophageal reflux repair
• Incisional hernia repair
Diseases of the Colon and Rectum
• Anal Fistula
• Anal Fissure
• Colon and Rectal Cancer
• Diverticulitis
• Rectal Prolapse
• Bowel dysfunction
• Fecal Incontinence
The
Hemorrhoid
Visit our website at
www.The HemorrhoidClinic.com
Phone: (503) 885-1734
Clinic
Strike out one of life’s most unpleasant problems
Trust us to help relieve one of life’s most
unpleasant and painful issues
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