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 change or cancel your appointment without due notice. Also, please read the Precautions set out below.

Taking Pico-Salax

  • Fill a mug with 150 ml (5 ozs.) of water. Empty contents of a Pico-Salax sachet into the mug. Mixture may heat up — allow to cool before drinking. Stir for 2-3 minutes until completely dissolved.
  • You must drink between 1˝ to 2 litres of clear liquid over a period of 4 hours following each sachet. We recommend that you use yellow or orange Gatorade or clear Powerade. Diabetic patients can use the calorie-reduced product.
  • If you get nauseated easily, a Gravol 50 mg (1 tablet) may be taken ˝ hour before the Pico-Salax.
  • You should expect loose bowel movements, usually 1-8 hours after taking a sachet of Pico-Salax. Please ensure that you have access to a toilet at all times.
  • Please disregard the instructions on the Pico-Salax package.

Preparation

For your convenience, you can listen to the following preparation instructions on the phone by calling any of our clinics and selecting option #8.

Ahead Of Time

  • An information package will be sent to you when your appointment has been booked. Please read all the information as soon as you receive it, and again 5 days before your appointment.
  • Complete the questionnaire in the information package (3 pages) and bring it with you on the day of the appointment.
  • You may notify the doctor who has referred you about this appointment since most doctors would like to be informed about your care. Your doctor will receive a report from us, usually approximately two weeks after your appointment.
  • Purchase 1 box of Pico-Salax (it contains 2 sachets) and a bottle of Agarol (an over-the-counter laxative).
  • If you need a prescription for insurance purposes, you may use the prescription form on the last page of the information package we sent to you. Fill in your name and date and bring it to your appointment for our physician to sign, then send it to your insurance company for reimbursement.
  • For the colonoscopy to be thorough and safe, your bowel must be completely empty. Pico-Salax is a concentrated solution that 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.
  • You should weigh yourself before and while taking the laxative and drink extra clear fluids if you lose 3 lbs. or more.
  • Optional: Zinc ointment will help ease chaffed anal skin.
  • Optional: Gravol for nausea.
  • Obtain a supply of clear drinks: yellow or orange Gatorade or Powerade Plus, clear juices (such as apple, white grape, white cranberry), or ginger ale. Also, please bring Gatorade or Powerade for drinking at the clinic after the procedure.
  • If you will be sedated for the procedure, please see After the Procedure below for instructions on arranging for transportation after the procedure because you will not be allowed to drive for 24 hours.

Four (4) Days Before Your Appointment

Stop eating all seeds and nuts in breads, fruits, tomatoes, cucumbers, grapes, watermelon, etc., as they could plug the instrument during the procedure.

Two (2) Nights Before Your Appointment

Take 2 tablespoons of Agarol (a gentle laxative) two nights before the appointment to ensure that you are properly prepared. Double the dose if you tend to be constipated, if you had a poor preparation in a previous colonoscopy procedure, or if you weigh over 200 pounds.

Morning Appointments (before 11:00 a.m.)

The Day Before Your Appointment

  • You may have a light lunch, to be completed by noon.
  • After lunch and until the procedure is finished, you must remain on a diet of clear fluids at room temperature. No solid foods. You may take as much clear fluids as you can. We recommend yellow or orange Gatorade or clear Powerade. Do not take black coffee, soup or consommé, even if they look clear.
  • At 2:00 p.m., take the first sachet of Pico-Salax and drink 2-3 glasses of clear fluid per hour (Gatorade or Powerade) for a minimum of 4 hours. See Taking Pico-Salax above for details.
  • At 5:00 p.m., take the second sachet of Pico-Salax and drink 2-3 glasses of clear fluid per hour (Gatorade or Powerade) for a minimum of 4 hours.

The Day Of Your Appointment

  • Two (2) hours before your appointment time: stop taking any fluids. You may drink extra before, but only up to two (2) hours before the appointment time.
  • If you have colonoscopy and gastroscopy on the same day, stop taking any fluids three (3) hours before the appointment time. Ice chips are OK.

Things To Remember

  • Bring your Ontario Health Insurance card.
  • Bring something to drink after the procedure while you are in the recovery room. We recommend electrolyte-containing drinks, i.e. Gatorade or Powerade, to restore fluids.
  • Wear loose fitting clothing (no tight jeans or similar). Do not wear nail polish.
  • If you will be sedated for the procedure, please see After the Procedure below for instructions on arranging for transportation after the procedure because you will not be allowed to drive for 24 hours.

Afternoon Appointments (after 11:00 a.m.)

The Day Before Your Appointment

  • You may have a light (low fibre) breakfast and a light lunch, to be completed by 2:00 p.m.
  • After lunch and until the procedure is finished, you must remain on a diet of clear fluids at room temperature. No solid foods. You may take as much clear fluids as you can. We recommend yellow or orange Gatorade or clear Powerade. Do not take black coffee, soup or consommé, even if they look clear.
  • At 5:00 p.m., take the first sachet of Pico-Salax and drink 2-3 glasses of clear fluid at room temperature per hour (Gatorade or Powerade) for a minimum of 4 hours. See Taking Pico-Salax above for details.

The Day Of Your Appointment

  • Six (6) hours prior to your appointment time, take the second sachet of Pico-Salax and drink 2-3 glasses of fluid per hour for a minimum of 4 hours.
  • Two (2) hours before your appointment time: stop taking any fluids. You may drink extra before, but only up to two (2) hours before the appointment time.
  • If you have colonoscopy and gastroscopy on the same day, stop taking any fluids three (3) hours before the appointment time. Ice chips are OK.

Things To Remember

  • Bring your Ontario Health Insurance card.
  • Bring something to drink after the procedure while you are in the recovery room. We recommend electrolyte-containing drinks, i.e. Gatorade or Powerade, to restore fluids.
  • Wear loose fitting clothing (no tight jeans or similar). Do not wear nail polish.
  • If you will be sedated for the procedure, please see After the Procedure below for instructions on arranging for transportation after the procedure because you will not be allowed to drive for 24 hours.

After The Procedure

  • You will remain in the recovery room for close observation for approximately ˝ hour or longer.
  • A bloated feeling and flatulence can occur after the procedure if air was used to improve visibility. You can usually get rid of excess gas by sitting on the toilet with your head down.
  • You will be able to resume your normal diet after the procedure, unless you are instructed otherwise.

If you were sedated for the procedure:

  • You will not be allowed to drive until the following morning and must arrange to have someone else drive you home after the procedure. If you choose to go by taxi or public transit, you must be accompanied by someone.
  • For safety reasons, the person who drives or accompanies you must meet you inside the clinic after the procedure. You cannot leave the clinic on your own.
  • You may feel disorientated or forgetful for a short time after the procedure. This results from the sedation. You should not sign any legal or other important documents until the following day.

Commonly Asked Questions

How long can I expect to be at the clinic?

You can expect to be at the clinic for up to 1˝ hours.

What can I expect during the procedure?

The procedure is usually well tolerated. However, some patients may experience discomfort and can be given sedation.

A colonoscope is a long flexible tube, which is passed through the rectum into the colon. Colonoscopy is used to diagnose polyps, cancer, colitis and diverticular disease. You can watch the process on the TV monitor if you wish. The tip can be turned 180 degrees, so the scope can be advanced around the curves in the colon.

During the procedure, polyps can be removed with a snare and tissue samples can be taken from a lesion for further pathological examination.

Is sedation available?

Yes. The physician will advise you as to which type of sedation is recommended for your circumstances. Sedation is advised for new patients, especially in females with a history of constipation, hysterectomy, caesarean section, and endometriosis. Any questions you have can be directed to the doctor at that time.

Are there any complications?

Colonoscopy is safe and it’s associated with very low risk when performed by physicians who have been trained and are experienced in this procedure. Complications can occur, but they are rare. Local discomfort usually disappears at the end of the procedure.

Significant bleeding after removing polyps occurs in less than 1% of patients. Perforation of the colon occurs in less than 1 in 4,000 cases. If perforation occurs, surgery may be required. On rare occasions a temporary colostomy is necessary. Sometimes lesions can be missed, especially if the bowel preparation is not done properly. There is a rare type of colon cancer that grows outwards and doesn’t show on a colonoscopy.

Colonoscopy can be performed on female patients during menstruation. We recommend the use of tampons or tissue.

Facts about colon cancer:

  • Colon cancer is the second largest killer from cancer in both sexes.
  • Most colon cancers are preventable because they start in a polyp. Removing the polyps by routine colonoscopy prevents colon cancer. This is why colon cancer prevention is so effective.
  • Only colon cancer has a precursor (a polyp) that can be removed before the cancer starts. In other types of cancer, such as breast, prostate, lung, etc., the cancer is already there when a lesion is found.
  • We rarely see colon cancer in patients who follow our prevention program.

Precautions

Please carefully read and follow these instructions if you are on any of the medications listed below:

  • 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.
  • 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.), stop 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.

Only 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.

  • 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 905-607-0013 or 416-597-2912. 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 require the results by 8 a.m. on the day of the procedure.
  • If your doctor/cardiologist feels that it is unsafe for you to discontinue blood thinners (Coumadin) or if your INR results are not available to us due to any unforeseen event we can still go ahead with your test, but without doing polyp removals or biopsies because of the danger of bleeding.
  • If we find polyps in those circumstances we can reschedule your procedure for a later time with proper steps taken to ensure that chances of complications are minimized. Your physician can arrange for injections of Lovenox (Enoxaparine) that can act as a bridge therapy while you discontinue Coumadin.

Antibiotics: 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.

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.

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

Appointments

We make every effort to give you a firm date and time for your appointment. A procedure room and a surgeon, anesthetist, nurses and support staff is booked just for you. Therefore, please let us know as soon as possible if you have to change or cancel the appointment so we can give this time to another patient who may be urgently waiting for a procedure.

Appointments can be changed or cancelled only by calling our Contact Centre during working hours (8:00 a.m. to 4:00 p.m., Monday to Friday). One of our Clinic Representatives will approve the change or cancellation and provide you with a confirmation number. We cannot accept voice messages for changing or cancelling appointments.

  • To avoid a $250 Fee for a changing or cancelling a colonoscopy appointment, you must notify us at least three (3) business days before the day of your appointment. This fee is not covered by OHIP.
  • A Cancellation Protection Plan (CPP) is available as an option to protect you against charges in the event that you are unable to give us 3 days advance notice. This plan costs $37.50 per appointment, and it must be paid at the time of booking your appointment.
  • A Rescheduling Fee of $25.00 will be charged if you change your appointment (date, time or clinic location) more than one time. This fee must be paid at the time of rescheduling your appointment (Visa, Mastercard, American Express).

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