Patient Info: Colonoscopy Instructions

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Using Klean Prep

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Please see Appointments below for important reasons why you should not miss or cancel your appointment without due notice. Also, please read the Precautions set out below.

Instructions

For the colonoscopy to be thorough and safe, your bowel must be completely empty. Please follow these instructions carefully.

Ahead of Time

• Purchase 1 box of Klean-Prep and a minimum of 8 Dulcolax tablets at your drugstore.
• Clear drinks: Clear Gatorade and clear juices (Apple, white grape, white cranberry), or ginger ale.
• Zinc ointment will help ease chaffed anal skin (optional).
• Gravol for nausea (optional).

Four Days Before Your Appointment

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

The Day Before Your Appointment

Take only clear fluids. No solid foods. You may take as much clear fluids as you can (e.g. water, apple juice, white grape juice, ginger ale, clear soft drinks, clear Gatorade – but not blue and red) right up until the time of the test. Do not take black coffee, soup or consommé even if they look clear especially on the morning of the test.

How to Take Klean-Prep

If You Have a Morning Appointment

On the day before your test:

• At 6:00 pm take 4 Dulcolax tablets.
• Between 6:00 p.m. and 11:00 p.m., take 3 litres of Klean-Prep. If you find Klean-Prep difficult to take, try chilling it, drinking with a straw or sipping slowly and/or taking some Gravol. You may take 1 tablet half an hour before taking Klean-Prep.
• At 8:00 pm take the remainder of the Dulcolax tablets (eight tablets in total).

On the day of your test:

• 2-3 hours before your appointment time, take one (1) more litre of the Klean-Prep.

Note: If you have arranged for someone to pick you up after treatment, please ensure that the pickup is no later than 3:30 p.m.

If You Have an Afternoon Appointment

On the day before your test:

• At 6:00 p.m. take 4 Dulcolax tablets.

On the day of your test:

• At 6:00 a.m., take 4 Dulcolax tablets.
• Also at 6:00 a.m., start the Klean-Prep so that you finish all four (4) litres at least 3 hours before your procedure time. You may continue other clear fluids up to the time of the test.

The Procedure

The procedure is extremely well tolerated with little or no discomfort. However, some patients who are extremely sensitive suffer from Irritable Bowel Syndrome, have a loopy large bowel or severe diverticulosis may experience discomfort and will require sedation. The procedure usually takes 5-30 minutes. Major effects of the sedation wear off in about one hour.

Are There Any Complications?

Colonoscopy is safe and is 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.

Bleeding may occur from the site of biopsy or polyp removal. Perforation (a small hole in the lining of the bowel) may also occur rarely. These complications are usually mild but rarely may require blood transfusions or surgery.

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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