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Colonoscopy Information and Instructions

 

 

A Colonoscopy is a safe and effective way of examining the entire length of the colon with a colonoscope. It is recommended as a screening examination for everyone beginning at age 50, and possibly before age 50 if other risk factors are present. A colonoscopy allows the detection and removal of colon polyps, and therefore can effectively prevent colon cancer. Colonoscopy is considered the gold standard of colon examination.

 

Scheduling a Colonoscopy

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An office visit is required to schedule a colonoscopy. During this visit you will meet Dr. Pennington. She will obtain a detailed medical history and discuss the procedure with you. You will also have an opportunity to have any and all questions answered. You will be given a follow-up appointment after the procedure when she will discuss the findings of your colonoscopy and determine if and when you will need another colonoscopy.

 

It is very important to relay an accurate medical history, past surgical history, and complete list of medications, vitamins, and supplements to ensure an excellent and safe examination.

 

Margaret will schedule your procedure. We do colonoscopies on Tuesdays and Wednesdays at East Tennessee Ambulatory Surgery Center (ETASC) from 8 AM to 11:30 AM. You will have a pre-procedure appointment three to five days prior to your colonoscopy at ETASC with a nurse and/or anesthesiologist to review your medications and medical history. Blood work is not routinely ordered for a colonoscopy. You will also be informed at this time of any out-of-pocket cost that you would be responsible for prior to the procedure. You may pay at that time or on the morning of your procedure.

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We do colonoscopies at Franklin Woods Community Hospital and Johnson City Medical Center (JCMC) on Fridays between 8 AM and noon. You will have a pre-admission appointment either by phone or with a nurse or anesthesiologist based on your medical history. Your out-of-pocket facility cost will be collected by the facility prior to your procedure.

 

Preparing for Your Procedure

 

One-Two Weeks Prior:

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Make arrangements to have someone drive you home after the procedure. Our facilities will not allow discharge via net transit or a cab. You must have a responsible friend or family member drive you home.

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Obtain the bowel preparation in advance from your pharmacy. Sometimes they are out of stock and have to order your prep.

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The medication phenteramine must be stopped two weeks prior to any type of anesthesia.

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If you are on any anticoagulants, including aspirin, they must be stopped a week prior to your colonoscopy. Coumadin (warfarin) must be stopped four days prior to your procedure. We require clearance from your physician or cardiologist prior to stopping anticoagulants. You may be given a prescription for Lovenox to use during this time.

 

Anticoagulant Medications:

 

  • Coumadin (warfarin)

 

  • Plavix (clopidogrel)

 

  • Aggrenox (dipyridamole + aspirin)

 

  • Ticlid (ticlopidine)

 

  • Pletal (cilostazole)

 

  • Effient (prasugrel)

 

  • Brilinta (ticagrelor)

 

  • Pradaxa (dabigatran)

 

  • Xarelto (rivaroxaban)

 

  • Eliquis (apixaban)

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) can also cause bleeding during surgical procedures, like polyp removal, and must be stopped one week prior to your procedure.

 

List of Nonsteroidal Anti-inflammatory Drugs (NSAID's) that can increase bleeding:

 

  • Motrin/Advil (ibuprofen)

 

  • Orudis KT, Oruvail, Actron (ketoprofen)

 

  • Clinoril (sulindac)

 

  • Aleve, Naprosyn, EC-Naprosyn, Naprelan, Anaprox, Anaprox-DS, Vimovo (naproxen)

 

  • Lodine XL, Lodine (etodolac)

 

  • Nalfon (fenoprofen)

 

  • Arthrotec, Cataflam, Voltaren, Cambia, Voltaren-XR, Zipsor, Flector Patch, Voltaren Gel (diclofenac)

 

  • Ansaid (flurbiprofen)

 

  • Sprix, Toradol, Toradol IV/IM (ketorolac)

 

  • Feldene (piroxicam)

 

  • Indocin SR, Indocin (indomethacin)

 

  • Ponstel (mefenamic acid)

 

  • Mobic (meloxicam)

 

  • nabumetone (Relafen)

 

  • Daypro (oxaprozin)

 

  • Actron, Orudis KT, Orudis, Oruvail (ketoprofen)

 

  • Duexis (famotidine and Ibuprofen)

 

  • Meclofen (meclofenamate)

 

  • Tolectin (tolmetin)

 

  • Disalcid (salsalate)

 

  • Trilisate (choline magnesium trisalicylate)

 

  • Dolobid (diflunisal)

 

  • Celebrex (celecoxib)

 

 

 

Vitamins and Supplements present an interesting challenge to physicians and surgeons. There are literally over 40,000 supplements and supplement combinations of varying doses on the market. The following supplements are known to possibly increase bleeding risks: Bilberry, Cayenne (Red Pepper), Dong Quai (angelica), Echinacea, Evening Primrose Oil, Feverfew, Fish Oil, Flaxseed Oil, Garlic, Ginger, Ginkgo Biloba, Ginseng, Hawthorne, Kava Kava, Licorice Root, Ma Huang, Melatonin, Red Clover, St. John's Wort, Valerian, Vitamin E, Yohimbe. Dr. Pennington recommends that you discontinue all vitamins and supplements a week prior to your procedure.

 

Bowel Preparation Instructions

 

You will be given bowel preparation instructions. You will do the bowel prep the day before your procedure. It is very important to follow the instructions carefully so that your colon will be cleaned out and offer excellent visibility. A good preparation ensures a good examination to find colonic polyps and other disease processes. A poor bowel preparation can compromise the entire examination. Small pre-cancerous polyps can be missed completely under these conditions. Please advise your physician if you feel like the bowel preparation is not working. Sometimes, additional preparations can be given with clear liquids and the procedure can be rescheduled. It is normal to have some yellowish, green, mucus-like bowel movements after colonic cleansing but not solid stool material.

 

The day before your procedure you will prep:

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You may have a light breakfast. After this you are only premitted to have clear liquids during the day. Clear liquids are defined as:

 

  •  white grape juice or apple juice

 

  •  sports drinks, Gatorade, Powerade, etc. (not red, orange, or purple)

 

  •  water

 

  •  tea (no cream, milk or non-dairy creamers)

 

  •  soups (clear liquid or bouillon)

 

  •  popsicles (not orange, red or purple)

 

  •  hard candies (not red, caramels or chocolate)

 

  •  jello (not red, no fruit added)

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You may not have any red or purple-colored food or beverages because they can be mistaken for blood or polyps during the procedure. You may not have solid foods including nuts, fruits or seeds. No dairy products including ice cream, sherbet, pudding, yogurt, or milk. No alcohol.

 

Diabetic patients should hold short acting insulin the day of the bowel preparation. Check your sugar in the evening and hold evening medications if needed. Also check your sugar prior to the second part of the bowel prep (the 3 am dose). Drink apple juice if needed. Every effort will be made for your colonoscopy to be at 8 am. Please call if you have any questions.

 

There are various bowel preparations on the market. The goal is to thoroughly clean out the colon with little discomfort and complete safety. It is important to follow the instructions carefully. All bowel preparations work similarly. It is important to stay hydrated the day of the prep, but nothing by mouth after the 3 am dose. On arrival to the endoscopy center, an IV will be started and it is difficult to access small, dehydrated, veins. Be sure to drink the recommended water/clear liquid with your bowel prep so your IV will go in easily. The following preparations are frequently encountered and are summarized here for your reference and convenience:

 

SUPREP BOWEL PREP KIT

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The dose for colon cleansing requires administration of two bottles of SUPREP Bowel Prep Kit. Each bottle is administered as 16 ounces of diluted SUPREP solution with an additional one quart of water taken orally. The total volume of liquid required for colon cleansing (using two bottles) is three quarts (approximately 2.8 L) taken orally prior to the colonoscopy in the following way:

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At 6-7 pm the evening prior to colonoscopy: pour the contents of one bottle of SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16-ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16-ounce line with water over the next hour.

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At 3 am the morning of colonoscopy (8 to 12 hours after the evening dose): pour the contents of the second bottle of SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16-ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16-ounce line with water over the next hour. Complete all SUPREP Bowel Prep Kit and required water at least four hours prior to your scheduled colonoscopy time.

 

MOVIPREP 

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The MoviPrep dose for bowel preparation for adult patients is 2 L (approximately 64 oz) of MoviPrep solution (with 1 additional liter of clear fluids) taken orally prior to the colonoscopy in one of the following ways:

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Split-Dosing MoviPrep regimen: The evening before the colonoscopy, take the first liter of MoviPrep solution over one hour (one eight ounce glass every 15 minutes), and then drink 0.5 L (approximately 16 ounces) of clear liquid. Then, on the morning of the colonoscopy, take the second liter of MoviPrep solution over one hour, and then drink 0.5 L of clear liquid at least four hours prior to the start of the colonoscopy. This is the best method in terms of a clean, clear colon. This dosing is ideal for people who like to go to bed early and rise early.

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Evening-only (full dose) MoviPrep regimen: Around 7 PM in the evening before the colonoscopy, take the first liter of MoviPrep solution over one hour (one eight ounce glass every 15 minutes), and then about two to three hours later, take the second liter of MoviPrep solution over one hour. In addition, take 1 L (approximately 32 ounces) of additional clear liquid during the evening before the colonoscopy. Do not eat or drink anything four hours prior to your procedure. This method gives good results and is ideal for people who stay up late, or do not want to rise early for part two of the prep.

 

Helpful Tips:

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  • Plan on staying near the bathroom.

 

  • Reading in the bathroom is usually not recommended as it can aggravate hemorrhoidal symptoms, but this is the one time that it's ok to take your iPad, Kindle, books, or magazines with you.

 

  • After you mix your prep solution, chill it in the refrigerator for a few hours before drinking (drink within 24 hours of mixing).

 

  • Try drinking your prep solution with a straw. Bypassing the taste buds in the front of your mouth may make the taste more tolerable.

 

  • Stock up on hard candies (no red or purple) to enjoy between bowel prep doses.

 

  • Sip clear liquids between doses to stay hydrated.

 

  • Use baby wipes instead of toilet paper.

 

After Your Procedure:

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You will need a driver to take you home. Dr. Pennington will speak to your driver, with your permission, and briefly go over the immediate results. You will have an appointment to follow up with Dr. Pennington, even if your results are normal. If you choose not to keep this appointment please call us and we will forward results and recommendations to your primary care physician. You may feel some "gas" type pressure immediately after your colonoscopy. It is best to walk and try to pass gas during the immediate post procedure period.

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You may resume a healthy diet.

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You should probably not drive for 4-5 hours, and not return to work or engage in strenuous activity for the remainder of the afternoon.

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