Microsoft word - colonoscopy with moviprep march 2012

UPPER CANADA LOWER BOWEL CLINIC INC
1366 Yonge Street, Suite 301
TEL : 416-926-0262
Toronto, Ontario M4T 3A7
FAX: 416-926-0936
Balmoral Medical Arts Facility – west side of Yonge Street, one block south of St. Clair/Yonge subway station COLONOSCOPY PREPARATION
PLEASE PLAN WELL AHEAD
*** A REFERRAL LETTER FROM YOUR DOCTOR is required if you are a New Patient
OR if you have not had a colonoscopy at the Clinic in the past year.

CANCELLATIONS – Because of the time needed to prepare for a colonoscopy we require a
minimum of five business days notice if you need to cancel or reschedule. All patients who give us less than
five business days notice that they will not keep their scheduled appointments will be charged a fee of $250.
CONFIRMATION – If you have not phoned us at least five business days before to confirm you will be
coming, your appointment will be cancelled and the time given to another patient.
HEALTH CARD – Patients must present a valid health card at the time of the appointment. Those failing
to do so will have to pay for the cost of the visit and then submit their claim to OHIP for reimbursement.
PREPARATION MATERIALS
If you pay the Block Fee, one sachet of PURG-ODAN and 4 sachets of MOVIPREP will be mailed to you.
If you do not pay the Block Fee, please purchase from your local Drug Store:
one 300 ml bottle of CitroMag or one packet of PURG-ODAN AND
• one box of MOVIPREP (this box contains 2 clear packages with 2 sachets (A and B) in each)

INFORMED CONSENT - Please do not hesitate to ask us any questions.
MEDICATIONS
If you are taking any medications, prescribed or over-the-counter, please read the following carefully because some medications must be discontinued prior to colonoscopy. IRON SUPPLEMENTS such as Ferrous Gluconate or Sulphate should be stopped 7 days prior to the exam.
PLATELET INHIBITORS - such as Plavix and Aspirin (ASA), and NSAIDs - such as Advil (Ibuprofen)
and Naproxen should be stopped 7 days prior to the examination. Otherwise removal of polyps or biopsies
may cause bleeding. Medications containing ASA include Anacin, Entrophen, 217, Fiorinal, Percodan etc.
• BLOOD THINNERS i.e. Anticoagulants, (e.g. Coumadin, Dicoumarol) should be discontinued five days
prior to the examination, under the guidance of your family doctor. ONLY IF YOU ARE TAKING
BLOOD THINNERS should a blood test to confirm normal coagulation be performed at a laboratory
the day before your appointment and the result faxed to (416) 926-0936. You should continue to take other prescribed medications as usual. PREPARING YOUR BODY IN GENERAL

1. If you are a diabetic on medication, please continue to take your medication and take one can of
Glucerna at each meal-time during your preparation for the colonoscopy. However nothing but clear fluids should be consumed on the day of your examination.
2. If you have damaged heart valves or an artificial heart valve please ask your Family Doctor if you should take
antibiotics before the examination. If so, Amoxicillin (2 gm one hour before the colonoscopy) is recommended,
for those who do not have an allergy to the Penicillins. If you are allergic to Penicillin, please consult your
Family Doctor. There is no definite policy in this regard concerning artificial joints - please consult your
orthopedic surgeon.

3. If you have a pacemaker, please remind us at the beginning of your examination.
4. Please stop eating all seeds one week prior to examination. Small seeds (sesame and poppy seeds, multi-
grain bread etc) can block the colonoscope, resulting in gaseous discomfort for the patient and economic anguish for the Clinic. PREPARING YOUR COLON
The colon must be very clean. This is the most challenging part of the exercise and during the two evenings before the examination you will not have much time for anything else. If you have problems ingesting large volumes of fluid you might want to purchase Gravol (50 mg tablets) to be taken 30 minutes before you start your preparation. The diarrhea promoted by the cleaning preparation will be definite and relentless but not uncomfortable. You will be reminded of gargoyles! However some people find the diarrhea irritating to the skin around the anus. You might want to keep the peri-anal area protected by Vaseline. You will be through your drinking by 8-9 pm. You will probably be through your diarrhea by midnight.
Even though they are not clear, nutritional supplements such as Boost, Ensure or Resource (Vanilla only)
may be taken the day before your appointment - but you must take nothing but clear fluids after you start
taking your first litre of MOVIPREP. Most patients do not need either Gravol or supplements.
TWO DAYS BEFORE YOUR APPOINTMENT

1. LUNCH: Should be light. Please avoid high fibre vegetables and, of course, seeds of any kind.
FROM NOW ON TAKE CLEAR FLUIDS ONLY – clear tea, clear soup, clear juices, jello
(but please avoid blood-like purple or red-coloured juices and jello).
2. 6 pm - 8 pm:
If using Citromag, disregard the directions on the bottle, drink the whole bottle (300ml) and
follow it with 5-6 glasses (250ml each) of clear fluid over the next two hours. OR If using Purg-Odan mix the contents of ONE SACHET ONLY in 150 ml of cold water. Keep stirring.
Let it cool before drinking. (Save the second sachet of Purg-Odan for next time - or give it to a friend!) Follow it with 5-6 glasses (250ml each) of any clear fluid over the next two hours. It helps the whole exercise if you keep active. Don’t just vegetate with your TV.
ON THE DAY BEFORE YOUR APPOINTMENT

1. On this day, continue to take clear fluids only - as much as you want.
But please - NO SOLIDS, NO DAIRY.
You can undertake normal activities until you start your laxative preparation at 5 pm. 2. At 5 pm: Dissolve one package of MOVIPREP (sachets A and B) in one litre of water and drink
this over the course of the next hour. MOVIPREP does not have to be cold and you do not have to
drink it any more quickly. Please be sure to drink one litre of clear fluids in the hour after you
finish the MOVIPREP.
3a. If your appointment is before 11 am next morning, at 8 pm dissolve the second package of
MOVIPREP (sachets A and B) in one litre of water and drink this over the course of the next hour.
Please be sure to drink one litre of clear fluids in the hour after you finish the MOVIPREP.
3b. If your appointment is after 11 am, please get up at 6 am or earlier on that day to prepare the second
package of MOVIPREP (sachets A and B) in one litre of water and drink this over the course of the
next hour. Please be sure to drink one litre of clear fluids in the hour after you finish the
MOVIPREP. Make sure that you finish drinking at least two hours before you leave home.
To be honest, MOVIPREP does involve a certain yuk-factor and if you are not turned on by this flavour, try holding your nose while drinking it, or rinsing your mouth out with any clear fluid after each glass, or adding Cointreau or white Crème de Menthe to it! 15ml of liqueur/litre of MOVIPREP is not to die for – but it’s not bad!! ON THE DAY OF YOUR APPOINTMENT
Rise for the occasion and put on loose, comfortable clothing. You are not going to have your picture taken even though you will be on television! If you have a meeting after your examination at which you do not want to appear rumpled, then bring a change of clothes with you.
1. Take your usual medications as detailed on page 1, and
please bring with you a list of all the medications you are taking.
2. Have a breakfast of clear fluids only – but NO coffee and NO nutritional supplements on this day.
3. Please arrange to have someone accompany you home from the Clinic.
Come to UCLBC with confidence that the procedure is not remotely as bad as everyone you have talked with claims it is. • The key to this procedure is relaxation - so relax.
Unpredictable delays may occur for a variety of reasons and you may be kept waiting. • Please realize that we don’t run late on purpose.
• The key is relaxation - so relax.
SEDATION

At the Clinic, you will be given the option of taking a light sedative by injection prior to the
examination and we recommend that you do so. It consists of Demerol or Fentanyl which reduces
discomfort and Versed which is like Valium and which makes you a bit drowsy. The Versed also
tends to relax the colon, which will be a bit surprised at things going in the opposite direction.
The sedation is light because you will be asked to change your position during the examination.
If you take sedation DO NOT DRIVE a motor vehicle, or operate heavy machinery, for 24 hours.
You will be able to travel by taxi or public transport but please have someone come to the Clinic to
accompany you home.
You should have something nourishing to eat and/or drink before you leave the building.

WHAT TO DO AFTER YOUR COLONOSCOPY
After you leave the Clinic you may eat what you want within the confines of any special diet which
you have been prescribed. Don’t be surprised if you don’t have a bowel motion for a few days. You
probably haven’t been this empty since you were born and it may take a few days to get re-filled.
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 you have had a polyp removed during the colonoscopy, please do not start your platelet inhibitors
and blood thinners for another three days.
Even if you have had a polyp removed, and unless you are advised otherwise, you may resume all
normal activities and you should expect to feel well.
Please contact your doctor if you have substantial rectal bleeding. A drop or two of blood on the toilet
paper should not be surprising or worrisome.
Also notify your doctor if you have any severe abdominal pain, bloating or shoulder-tip pain.
Complications resulting from the procedure are very uncommon and most settle down
without further intervention. Although perforation of the colon or excessive bleeding can
occur, these complications arise almost only when a polyp has been removed. Should you
develop anything untoward in terms of pain or bleeding please notify your doctor.

The biggest negatives are:
• small lesions can be missed (especially if cleaning has been less than ideal) • localization of lesions is not always precise.
The biggest positives are:
• colonoscopy is easier on you than colon cancer • your treatment will be more enlightened.

Source: http://www.uclbc.ca/wp-content/uploads/2013/03/Colonoscopy-with-Moviprep-March-2012.pdf