WHAT TO DO BEFORE YOUR COLONOSCOPY - Holly Clinic

1 WHAT TO DO BEFORE your COLONOSCOPY CONFIRMATION: Please confirm your appointment with us at least 5 days in advance. Because of the current demand for this examination, there will be a $ charge for any cancellation within 48 business hours. HEALTH CARD: Patients must present a valid Health Card at the time of the appointment as per the Ministry of Health. REFERRAL LETTER: All new patients must be referred to the Holly Street Endoscopy Clinic by a doctor. INFORMED CONSENT: Prior to COLONOSCOPY you will be asked to sign a consent form. Please do not hesitate to ask us any questions at that time. SEDATION: If you choose to have sedation, please note it is strongly recommended that you do NOT drive for 24 hours. We suggest that you bring a friend or relative with you to the Clinic who can escort you home and stay with you for the next 3-4 hours. PREPARING your BODY IN GENERAL: If you are taking prescribed medications, please continue on those medications BEFORE and after the COLONOSCOPY with the following exceptions: 1) Aspirin & Plavix should be stopped 4 days prior to the examination.

2 Otherwise, removal of polyps or biopsies may cause bleeding. Such medications include Entrophen, 217, Percodan, etc. 2) Coumadin (Warfarin) if you are on Coumadin, talk to your doctor about stopping 4 days prior to the exam and get an INR test done the afternoon BEFORE your examination. Ask your lab to fax us the results by 8:00 am the following day (416) 486-7888. Do not schedule a Monday appointment for the COLONOSCOPY . Book a late appointment so we can get your results BEFORE we start the exam. 3) If you are a diabetic on oral medication, please continue to take your mediation. Take one tin of diabetic Ensure or Glucerna at each mealtime during your preparation for the COLONOSCOPY and make an early morning appointment. If you are an insulin dependant diabetic, please consult with your family physician. 4) If you have damaged heart valves, an artificial heart valve or an artificial joint, you should be on antibiotics BEFORE the examination. We recommend that you obtain a prescription from your family physician for Amoxicillin 2gms, which is to be taken 1 hour BEFORE the procedure.

3 5) If you have a pacemaker, please remind us at the beginning of your examination your Appointment is at _____ on _____ Please be sure to arrive 15 minutes prior to your appointment time. COLONOSCOPY INSTRUCTIONS PLEASE AVOID SEEDS & NUTS 5 DAYS PRIOR TO your COLONOSCOPY poppyseeds, flaxseeds, raspberries, kiwi, corn, grapes, seeded breads etc. Please note this includes yogurts and jams that contain seeds. PREPARING your COLON The colon must be clean. This is the most challenging part of the exercise. This may limit your daily activities. It is suggested that you stay home during this time to have access to a washroom. PICO-SALAX PREPARATION 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. 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. You must drink Gatorade if you lose 3 lbs or more to avoid dizziness and fainting spells.

4 ITEMS YOU MUST PURCHASE AHEAD OF TIME 1 box of Pico-Salax (it contains 2 sachets) 6 Dulcolax tablets 4 bottles of Gatorade (lemon-lime or orange, NOT blue or red you can t see as much light through the darker colours) Apple juice, ginger ale, white grape or white cranberry juice Zinc ointment will help comfort chafed anal skin Gravol (you may take orally BEFORE you start the preparation to help avoid nausea & vomiting). THE RISKS This is an invasive procedure. Approximately one in 10,000 patients will experience a serious puncture of the colon requiring emergency surgery to repair the hole. Bleeding and/or abdominal pain may occur, especially after removal of polyps. If you go home, and the bleeding increases and pain becomes severe, Call the Clinic . If the Clinic is closed, please go to your local Emergency Department immediately. On rare occasions an allergic reaction to the sedative may occur. In general the procedure is 99%+ safe. COLONOSCOPY is not always 100% diagnostic, because of blind corners, poor preparations with residual fecal material or incomplete examinations.

5 We cannot guarantee perfect results, however this is the best test for the early detection and prevention of colon cancer. THE DAY BEFORE your APPOINTMENT Do not eat solid food. Do not eat: coloured Jello, puddings, milk, creamed or consomm soups, broths or coffee. Just BEFORE 8 AM, drink three glasses of fluid At Noon, take 3 Dulcolax tablets At 5 PM, follow these steps: o Stir the first sachet of Pico-Salax into a glass of cool water (5 oz) and drink it o Then drink 3 glasses (8 oz) of the fluids listed above (especially Gatorade) at room temperature each hour until the laxative stops working. It may take a few hours to start working. o 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 the next dose, take 2-3 glasses of fluid as above. At 8 PM, take the second sachet of Pico-Salax and follow the same routine as at 8 AM At 10 PM, take 3 Dulcolax tablets (optional) Be sure to drink lots of fluids.

6 THE DAY OF your APPOINTMENT Stay on clear fluids Bring some Gatorade (or juice) with you. Check your weight on the scales. IF YOU HAVE A LATE MORNING OR AFTERNOON APPOINTMENT You may have a light breakfast and start on clear fluids at noon the day BEFORE . Take the first Pico-Salax at 5 PM and second one at 7 AM the day of your appointment. Continue to drink lots of fluids. This will allow you to work the day BEFORE and not be without food as long. Stay on clear fluids. If you are concerned about travel time to the Centre, complete your Pico-Salax routine the day BEFORE your appointment. WHAT TO DO AFTER your COLONOSCOPY Afterwards you may eat what you want and you may resume normal activities. You should feel well. It is not uncommon to feel gas cramps for a short while following the COLONOSCOPY . But as long as your preparation for the procedure has been adequate, you can pass the gas with confidence its bouquet will not be offensive. If a polyp was removed, do not start your blood thinners or Aspirin for another 3 days.

7 Please contact the Holly Street Endoscopy Clinic if you have substantial rectal bleeding. A drop or two of blood on the toilet paper should not be surprising or worrisome. Also notify the Clinic if you have any severe abdominal pain or shoulder pain. Complications resulting from COLONOSCOPY are rare. Perforation and significant bleeding usually occur only when a polyp has been removed. Both are serious events and may require hospitalization. A mild transient colitis may occur. It will usually settle without further intervention. Should you develop anything untoward in terms of pain or bleeding, please notify the Clinic .