Colonoscopy Preparation Handbook - The Hemorrhoid...

Colonoscopy Preparation Handbook

Inside you will find:• How to prepare for your colonoscopy• Frequently asked questions• Useful information regarding colonoscopy

BRENT K. EVETTS, MD, FASCRSTrusted care. Experienced hands.

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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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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

Table of Contents

About this Handbook

2

SchedulingColonoscopy Date: ______________________________

Colonoscopy Time: ______________________________

• Before10:00AM Seepage6forbowelpreparationinstructions

• Between10:00AMand1:00PM SeePage7forbowelpreparationinstructions

• After1:00PM Seepage8forbowelpreparationinstructions

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 ChecklistBefore 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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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.

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.

How Does a Colonoscopy Work?

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

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AboutthisHandbook

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. Pleasecheckwiththedoctorwhoprescribestheseforyoutofindoutwhetheryoushouldorshouldnotcontinuethesemedicinespriortoyourcolonoscopy. 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”. Itisimportanttocheckwiththedoctorwhoprescribestheseforyouassoonaspossibletodeterminehowtoproceed. 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.

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

FAQ About Your Medications

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No soups with chunks of food

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.

Dark and murky.

NOT OK

Brown and

murky,NOT OK

Dark orange and semi-clear NOT OK

Light orange and mostly

clear.ALMOST THERE

Yellow and clear, like

urine. YOU’REREADY!

How Do I Know if my Prep is Working

This is orange juice. Orange juice is not clear because you cannot read the newspaper through it. Donotdrinkthis.

This is pineapple juice. It is also not clear. Donotdrinkthis.

This is apple juice. Apple juice is clear because you can read newspaper print through it. Youcandrinkthis.

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.

What are Clear Liquids

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ONE DAY Before your Colonoscopy

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.

Taking Your Prep:Make sure you have the following.• Sports Drink (64 ounces)

4:00 - 6:00 PM• Take2Dulcolaxtablets• Reservethebathroom• ConsiderusingAloewipes• UseVaselineorA&Dointmenttoperianalskin

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

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

Your Calendar: One Day Before Your Colonoscopy

IMPORTANT

IMPORTANT

• Dulcolax Tablets (4 tablets) For coupon visit. www.dulcolaxusa.com/

• Miralax (14 dose size) For coupon visit. www.miralax.com

Morning

Evening

Afternoon

STOPCLEAR LIQUIDS 3

HOURS PRIOR TO COLONOSCOPY

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






dinner NO solid food

Time of Day What you EatWhat you

Drink

Colonoscopy Before 10:00 AM

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Colonoscopy Between 10:00AM - 1:00 PMWhat 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)

IMPORTANT

IMPORTANT



Your Calendar: Day of Your Colonoscopy

4:00 - 6:00 PM• Take2Dulcolaxtablets• Reservethebathroom• ConsiderusingAloewipes• UseVaselineorA&Dointmenttoperianalskin

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

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

IMPORTANT

Morning

Evening

Afternoon


breakfast NO solid food



Clear liquid diet for lunch NO solid food






dinner NO solid food

Time of DayWhat you

Drink

Your Calendar: One Day Before Your Colonoscopy

STOP CLEAR LIQUIDS 3


What you Eat

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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)

Drink at least 4 tall glasses

of clear liquids


breakfast NO

solid food

After 6 PMClear liquid diet

only NOsolid food

5:00 - 6:30 AM• Take2Dulcolaxtablets• Reservethebathroom• ConsiderusingAloewipes• UseVaselineorA&Dointmenttoperianalskin• 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

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

Time of Day

What You Eat

What you Drink

Your Calendar: The Day Before Your Colonoscopy

IMPORTANT

IMPORTANT



Morning

Evening

Your Calendar: The day of Your Colonoscopy

STOP CLEAR LIQUIDS 3


Drink at least 4 tall glasses

of clear liquids

Colonoscopy After 1:00 PM

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Water/Mineral Water Tea Apple Juice

“Black” Coffee Soda “Clear” Sports Drink

OK OK OK

OK OK

What Liquids Are OK

No Milkshakes No coffee with cream No Pineapple Juice

No Orange Juice Milk or Dairy drinks

What about Alcohol?Although alcohol is a clear liquid, it can make you dehy-drated. You should NOT drink alcohol while preparing for your test.

NOT OK NOT OK NOT OK

NOT OK NOT OK

NONOT OK

NOT OK

What Liquids Are NOT OK

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Honey Jello CLEAR Broth

Popsicles Hard candy

OK OK OK

OK OK

What about red food?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.

What Foods Are OK

No breads, grains, rice No meats

No vegatables No Milk or Dairy drinks

NOT OK NOT OK NOT OK

NOT OKNo fruits

No Soup with chunks of food

NOT OKNOT OK

What Foods Are NOT OK

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Frequently Asked QuestionsCan 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 daysAnything 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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Meridian Park Medical Center Endoscopy UnitFrom 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


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


Driving Directions

Gastroenterology Endoscopy CenterFrom the North 1-5 Southbound• Take exit 289. turn right at the

top of the ramp on Nyberg• Bear left onto SW Tualatin-

Sherwood Rd.• Turn right on SW 90th• Building is on the right

From the South I-5 Northbound• Take exit 289. turn left at the



From I-205• Merge onto I-5 North• Take exit 289. turn left at the



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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 atwww.DrEvetts.comPhone: (503) 691-1743

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