Patient Info: Colonoscopy Instructions

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Using Pico-Salax

For your convenience, these Colonoscopy Instructions Using Pico-Salax are also available as a Adobe PDF file. To view and print the PDF file, you can download the free Adobe Reader if you don't already have it, or if you want to upgrade to the latest version.

Please see Appointments below for important reasons why you should not miss or cancel your appointment without due notice.

Instructions

For the colonoscopy to be thorough and safe, your bowel must be completely empty. Pico-Salax is a concentrated solution which works by taking water out of the body and putting it into the colon to flush it out, therefore you must drink enough fluids to avoid dehydration.

As with any strong laxative, you must take certain precautions. You should weigh yourself before and while taking the laxative and drink even more fluids if you lose 3 lbs. or more. Also please read the Precautions below.

Certain things must be done ahead of time.

Please purchase the following now as they may be hard to find:

• 1 box of Pico-Salax (it contains 2 sachets). Don't follow the instructions in the box!
• 4 bottles of Gatorade (not blue or red because you can see through the pale colours) or clear Powerade.
• Apple juice, ginger ale, white grape or white cranberry juice.
• Zinc ointment will help ease chaffed anal skin (optional).
• Gravol for nausea. (Optional) You may take one tablet a half hour before your Pico Salax.

Please read the Precautions below for information about aspirin, anticoagulants (blood thinners), diabetic medications and antibiotics.

Four Days Before Your Appointment

If time permits, stop all seeds and nuts in breads, fruit, tomatoes, cucumbers, grapes, watermelon, etc., as they could plug the scope.

The Day Before Your Appointment

Do not eat solid food. Drink three glasses of fluid just before 8 a.m.

At 8 a.m., stir the first sachet of Pico-Salax into a cool glass of water (5 oz.) and then drink 3 glasses (8 oz.) of the above fluids (especially Gatorade) at room temperature, each hour until the laxative stops working. It may take a few hours to start working. Then stay on clear fluids until your procedure is over. You may have tea (sugar only), alcoholic beverages, etc., but nothing you can't see through.

Before 5 p.m. take 2 glasses of fluid and then at 5 p.m., take the second sachet of Pico-Salax and drink 3 glasses of fluid per hour until the laxative stops working.

If you have a late morning or afternoon appointment, you may start on clear fluids after lunch the day before your appointment. Take the 1st Pico-Salax at 5 p.m. and the 2nd one at 8 a.m. (or at least 4 hours prior to your appointment.). This will allow you to work the day before and not be without food as long. Stay on clear fluids.

The Day of Your Appointment

Stay on clear fluids. Bring some Gatorade (or juice) with you. Check your weight on the scales.

Please note that if you are also having an upper endoscopy you should not drink for 3 hours before your procedure (ice chips are o.k.). However, drink extra before this.

Precautions

If you are on Coumadin (Warfarin), you must discontinue this medication 5 (five) days prior to the procedure. You should confirm with your doctor that it is safe to be off this medication.

Only if you are on Coumadin (Warfarin): you must have an INR test done before 12 noon on the day before your procedure and have the lab FAX the result directly to us at 416-597-2912 (Toronto) or 905-607-0013 (Oakville). Patients in the Ottawa region, please ask the lab to FAX the result to 613-216-1824.

If you have not received an INR requisition form, please contact us immediately so we can mail it to you. We must have your results before your procedure. To ensure that we have your result in time, do not book a Monday appointment or before 10:00 a.m. on other days, unless you are diabetic.

• If you are on Aspirin (including Bufferin, Novasen) discontinue the medication 10 days prior to your procedure. It may be restarted the next day if no biopsy was done. Otherwise, restart 3 days after the procedure (Note: No INR needed).
• If you take Plavix (clopidogrel), discontinue the medication 7 (seven) days before your procedure and restart the next day (or 3 days in case of biopsy). You should confirm with your doctor that it is safe to be off this medication.
• If you take iron supplementation, discontinue 5 days before the procedure.
• If you are on anti-inflammatory medications (Indocid, Motrin, Advil, etc.) these should be stopped the day prior to the procedure. Celebrex and Vioxx are alright to take.
• If you need to take medication for pain or headache, use plain Tylenol unless you are on chronic medication.

Other medications: Medications such as pills for blood pressure, thyroid, and cholesterol should be taken in the morning with sips of clear fluids.

Antibiotics should be taken if you have a history of endocarditis, artificial heart valves, or had a joint replacement in the last 6 months. Please obtain a prescription for the antibiotic from your family doctor and get it from your local pharmacy prior to the procedure.

Oral antibiotics should be taken 1 hour before the procedure. If the antibiotic is given intravenously, please bring the antibiotic to the clinic and advise us at the time of booking. In this case you need to arrive at the clinic 1-½ hours before your appointment time so that we can administer the antibiotic at the clinic prior to the procedure. (All other patients: please arrive 10-15 minutes before your scheduled appointment time.)

Diabetics: Please ensure that you are booked early in the day for your procedure.

• If you are on oral medication (pills) for control of your diabetes, only omit your morning dose on the day of the procedure.
• If you are on insulin, please discuss with your doctor about cutting the morning dose in half on the day of the procedure. You can take Ensure as a meal supplement.

Appointments

If you do not show for an appointment, the time is wasted and patients on our urgent waiting list will suffer. To avoid being billed $250 for a missed Colonoscopy appointment, which is not covered by OHIP, you must notify our clinic at least 3 business days before the date of the appointment.

Please use the form we have provided in our Appointments page to cancel an appointment.

Cancelling your appointment the day before your procedure does not give us a chance to prepare another patient. If you fail to show for your appointment, you cannot be rebooked until you have discussed the situation with our clinic. Rebooking a missed appointment requires the approval of our Clinic Administrator.

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