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colonoscopy preparation with halflytely

Procedure Date ________________
Arrival Time________
Your procedure is scheduled at New York Endoscopy Center located at Two Gannett Drive, on the First Floor in Suite 104. We are located in White Plains, NY however if you are using a navigation system you may need to enter West Harrison as the city. Please drive around the building and enter through rear entrance for convenience. Please call us if you have any questions at (914) 683-1619.
Colonoscopy is an examination of the colon (large bowel) with a flexible tube about the thickness of your pinky finger, which
transmits a live color image onto a television screen. There are many things a person would rather do than undergo a bowel
prep for a colonoscopy, but your efforts at cleansing your colon are essential for an accurate procedure. These instructions are
designed to maximize the ease, safety and success of your preparation. It is EXTREMELY important for you to drink large
amounts of clear liquids while doing this bowel cleansing prep!
No procedure can guarantee 100% diagnostic accuracy and all involve some risk. The decision to proceed is made after
weighing the potential risks and benefits. Serious complications are rare and include, but are not limited to, perforation,
bleeding, infection, aspiration, reaction to medicines, and the need for surgery or transfusion due to one of the above
complications. These occurrences are all rare.
Purchase at the Pharmacy
One (1) 238 gm (8.3oz) Bottle of Miralax
One (1) 64oz Bottle of Gatorade® or clear liquid (NOT RED)
Four (4) Dulcolax (Bisacodyl 5mg) laxative tabletsPlain or aloe Baby wipes (prevents a sore bottom) OPTIONAL Desitin or A&D Ointment (prevents a sore bottom) OPTIONALClear liquids (see list below) and drinking straws One Week Prior to the Procedure
• DO NOT take iron pills or medications that may cause bleeding. These medications may include: Plavix, Coumadin, Aspirin,. You MUST stop any anti-inflammatory type drugs including: Empirin, Ecotrin, Ibuprofen, Motrin, Advil, Naprosyn, Sulindac, Piroxicam,Feldene, Indomethacin, Indocin, Diclofenac, and Voltaren.
• STOP Vitamin E., Ginkgo and Ginseng.
• Tylenol and other brands which contain ACETAMINOPHEN are safe to use prior to this procedure.
• Stop fiber supplements 5 days before your procedure. • Stop Fruits, Nuts, Berries, Vegetables for 3 days.
*If you are taking Plavix, Aspirin or Coumadin because of a history of coronary stents, carotid stents, etc., proper dosing and timing before, during and after your procedure is essential. Be sure to discuss this with your physician.
One Day before the procedure:
• At 8 AM, take (4) Dulcolax (Bisacodyl) Tablets with an 8 oz glass of a clear liquid. • The day’s diet will consist of CLEAR LIQUIDS only. This includes: water, soda, clear broth (Fat free chicken or Beef), Gatorade, Kool-Aid, Jello, Popsicles, coffee or tea without milk/nondairy creamer, clear
fruit juices (apple, white grape, white cranberry) and hard candies. Do not ingest RED liquids or Red Jello.
You must drink at least TWO QUARTS of the above liquids throughout the day.
• At 5 PM, Mix the entire bottle of Miralax (238 grams) into the 64oz bottle of Gatorade or clear liquid (any color but NOT RED). Shake well, drink until the ENTIRE solution is completely gone within 2 hours.
• The preparation will cause you to have very loose stools, which is the intended result. You may drink all the clear liquids you desire until midnight. No further drinking is allowed until after the procedure is completed the following day. Do not take medicines within one hour of the preparation. Individual responses to laxatives vary greatly. This preparation often works within one hour but may take longer than four. Remain close to a toilet as multiple bowel movements may occur. Day of Procedure:
• If you take medication, you may have it the morning of the procedure with a small amount of water. This means NO MORE than a few SMALL sips of water. You may brush your teeth.
• Arrive at the Endoscopy Center ONE HOUR BEFORE your procedure is scheduled.
• Bring your completed Patient Information Sheet, driver’s license and insurance cards to the Center.
• You must be accompanied by a friend or relative to drive you home. You MAY NOT drive, go home in a taxi or by bus. If this instruction is not followed, your procedure will be cancelled.
_____ Hold morning dose of insulin the day of the procedure but bring your insulin to the facility.
_____ If you have an artificial heart valve, or have a previous history of endocarditis, or other specific indication, your doctor may prescribe pre-procedure antibiotics.
_____ Stop aspirin, anti-inflammatory medications such as ibuprofen (Advil, Aleve, Motrin) 3 days before the procedure. You MAY take Tylenol (acetaminophen).
_____ Bring a list of the medications (including the dosages) and any allergies to medications, or conditions that would make you sensitive to sedation such as sleep apnea syndrome to the Center with you. If you have sleep apnea, bring your CPAP machine.
Other_________________________________________________________________________________ How do I know if my prep is adequate?
The stool should be watery in consistency. It does not have to be clear in color like water since digestive
juices will continue to tint the stool yellow and small flecks of debris are not a problem as long as the stool
is not muddy or thick. If there is any question, you can self administer a tap water or fleet enema prior to
leaving home for the procedure.
What side effects may I expect?
Since the prep works by flooding the intestinal tract with fluid, abdominal bloating and cramping may
occur, as well as some nausea and vomiting. This is usually temporary, and as the diarrhea develops,
symptoms will gradually improve. Weakness can also occur, especially if you have not taken enough fluid
with the prep, and can be remedied by increasing fluid intake.
Will the prep interfere with my other medications?
Medications taken at least an hour before beginning the prep should be adequately absorbed, but thereafter,
they are likely to be washed away by the prep.
Remember, stay close to the bathroom facilities
It is also worthwhile to get a supply of aloe wet wipes and Desitin ointment to ward off a sore bottom.
Good Luck! This is the hardest part of the procedure, call (914) 683-1619 with any questions you may have.


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DATA PROCESSING SERVICES, INC. 19345 US HWY 19 NORTH, SUITE 206 CLEARWATER, FLORIDA 33764 TEL (727) 532-9481 FAX (727) 532-9723 E-MAIL: Website: OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1SETUP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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