ColonoscopyProcedure

You may contact your insurance company with any questions or concerns or if you’d like to better understand what your insurance will cover.

Glencoe Regional Health will contact your insurance company to see if a prior authorization is required. Many insurance companies require us to notify them of your date of procedure prior to it being completed. This can take up to 14 days to verify benefits and process these requests. If we experience delays with your insurance, we may need to reschedule your procedure. If your procedure is self-pay or has been denied, a financial representative will call and discuss your options.

A pre-operative appointment may need to be completed prior to your procedure. When you schedule your colonoscopy, our team will notify you if a pre-operative History and Physical is required. You will need to schedule your pre-op physical within 30 days of your procedure. For your safety, you must arrange for a responsible adult to take you home and remain with you for 12 hours after discharge. Purchase the following items from your drug store or pharmacy (no prescription is needed): • Four tablets of 5 mg Dulcolax® (bisacodyl) laxative pills (not suppositories, not stool softeners)

IMPORTANT: Please read this now, as there is information listed in this packet about steps you must take 7-10 days prior to your procedure. Failure to take these steps may result in your colonoscopy being rescheduled to a later date.If you have questions or need to reschedule your appointment, call Same Day Surgery at 320-864-7724.

• One, 8.3 oz (238 grams) bottle of MiraLAX® powder • 64 ounces of light colored or clear Gatorade® or other sports drink (no red or purple) Discontinue all herbal supplements including fish oil, until after your procedure. Notify your primary care provider if you: • Have insulin-controlled diabetes • Have heart valve disease or have had heart valve

replacement • Have had a total joint replacement within the past

six weeks • Are taking blood-thinning medications (see list below) to

see if and when your blood-thinning medication should be stopped before your procedure. Please call Same Day Surgery at 320-864-7724 as soon as possible if your primary care provider does not approve a temporary stop of your blood-thinning medications:

· Aspirin or baby aspirin · Coumadin® (warfarin) · Eliquis® (apixaban) · Lovenox® (enoxaparin) · Plavix® (clopidogrel) · Pletal® (cilostazol) · Pradaxa® (dabigatran etexilate) · Xarelto® (rivaroxaban)

ABOUT COLONOSCOPYA colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to see the inside of the colon. If needed, polyps or other abnormal tissue can be removed through the scope during a colonscopy. Before a colonoscopy, you will need to prepare by emptying out your colon. It’s important to clean out the colon as much as possible so the provider can see the inside clearly and get good pictures.

7-14 DAYS Before the Procedure:

DAY OF COLONOSCOPY If you can’t wait to use the restroom until after you arrive at the hospital, or are unable to provide us with a urine sample, we may take a blood sample instead. Do not, however, try to achieve a full bladder by drinking liquids the morning of surgery, or your procedure will need to be rescheduled. • Bring your photo ID and insurance cards. • Bring a list of all of the prescriptions and over-the-counter medications you are currently taking. If you do not have a list, bring in the containers. Be sure to inform the nurse of any allergies or medical restrictions. • Check in at the hospital entrance at your scheduled arrival time. Once you are checked in, the receptionist will provide directions to Same Day Surgery. If you are currently a hospitalized patient, our staff will transport you to Same Day Surgery. • Your driver and family members are encouraged to wait during the procedure and be available for consultation afterwards.

• Most morning medications can be taken as scheduled with small sips of water. Please check with your primary care provider. Follow your prescription as specified.• DO NOT eat anything for breakfast. You may drink clear liquids up to two hours before your arrival; see approved list.• DO NOT smoke, chew tobacco, or drink alcohol the morning of your colonoscopy. • DO NOT chew gum or consume cough drops, hard candies, or mints the morning of your colonoscopy. This could result in your colonoscopy being rescheduled. • DO NOT wear contacts, jewelry, or body piercings. Bring your eyeglasses, including their case. Wear comfortable clothing and leave all valuables, such as credit cards and jewelry, at home.• If you have an implanted pacemaker or cardioverter- defibrillator (AICD), bring your wallet card with you. • Bring your Health Directive, if it’s not already on file. • Females: If you have not yet gone through menopause, we will perform a urine pregnancy test before your procedure.

• DISCONTINUE ALL aspirin/baby aspirin, ibuprofen, Advil®, Aleve®, Motrin®, Mediprin®, or arthritis drugs, until your procedure, or your procedure may be. You may take Tylenol® (acetaminophen).

1. At noon, mix the entire bottle of MiraLAX powder into the 64 ounces of Gatorade. Shake until the powder is dissolved. TIP! Put it into the refrigerator. Many people find the solution tastes better chilled.2. At 1 p.m., swallow 4 Dulcolax tablets3. At 3 p.m., start drinking the Gatorade mixture until gone. TIP! Using a straw may help improve tolerance. If you become nauseated or vomit, stop drinking for 30-60 minutes. Then, resume drinking the Gatorade mixture until it is gone. 4. After finishing the Gatorade solution, continue to drink plenty

of approved fluids from the clear liquid diet list to avoid dehydration and lightheadedness.

5. Take evening medications as scheduled.6. DO NOT eat anything after midnight.

• Start a low fiber/low residue diet. See backside of this booklet for more information.

• STOP taking any iron supplements

• Do not eat any solid foods for the entire day, including breakfast.

• ONLY drink clear liquids, as indicated below: · Water · Gatorade (light colored; no red or purple) · Clear soda (7-Up, Sprite, or Ginger Ale) · Coffee or tea (non-dairy powder creamer and sugar allowed) · Clear fruit juices without pulp (apple or white grape) · Jell-O® (not red or purple), Popsicles® (not red or purple), hard candy (not red or purple) · Bouillon or broth • Do not drink alcohol.• Do not eat or drink anything that does not appear on the list above.

5 DAYS Before the Procedure:

1 DAY Before the Procedure:

What to expect:1. Plan to be near a bathroom. The prep usually begins working within an hour but may take a few hours for some people. You will

develop significant diarrhea after drinking the solution. This is normal as it means the medication is working to clear stool from your colon.

2. Most people feel mild bloating and mild abdominal cramps. This is normal. Drinking the prep medication more slowly and over a longer period of time can help alleviate these symptoms.3. A successful colon prep will cause you to have yellow or “tea-colored” liquid stools. You should be able to see through it. 4. If, at 2 hours prior to your arrival time, your bowel movements are not liquid (that is, if they are still solid or mostly brown), call Same Day Surgery at 320-864-7724 to reschedule your colonoscopy. Leave a voicemail if no one answers, and someone will call you back.

5. Your nurse or nurse anesthetist will use your IV line to give you medication to begin your sedation. Once adequate sedation is achieved, your provider will place a colonoscope into your rectum. The colonoscope is connected to a video monitor, where your provider can see the inside of your colon. Your provider will use air and water to move the colonoscope along the length of your colon and look for any abnormalities.6. You may feel mild cramping during the procedure. You can reduce this by taking several slow, deep breaths.

7. Do not plan on working, using power tools, driving, or using social media for 12 hours. You will be impaired for the day and may not make good or safe decisions. 8. You can return to your usual activities 12 hours after your procedure. 9. If you had a biopsy, it’s normal to have a small amount of bleeding from your rectum. There should be no more than a few drops of blood, and the bleeding should stop within 24 hours after your procedure. 10. After a colonoscopy, it’s normal for your bowel movements to be irregular or different from your normal habits. This may last up to a week after your procedure. 11. If biopsies were taken, the provider who performed your colonoscopy will notify you of the results within 10 days. If your test results indicate the need for further care or follow- up, we will notify you as soon as possible.

1. Before the procedure, you will get a hospital gown and nonskid socks to wear. The nursing team will start an intravenous (IV) line.

2. You will meet with your provider. They will explain the procedure to you and answer any questions you may have. 3. You will meet with your nurse or nurse anesthetist. They will review your medical history with you and talk about the type of anesthesia you will receive. 4. Once it’s time for the procedure, you will be brought into the procedure room on a cart. You will lie on your left side with your knees bent.

1. You will stay in a recovery room for approximately 30 minutes to 1 hour after the procedure. Your nurse will continue to monitor your heart, breathing, and blood pressure at this time.

2. Many people feel bloated and have stomach cramps after a colonoscopy. This is normal and goes away by passing gas. 3. Once you’re fully awake, your nurse will remove your IV. Your nurse will explain discharge instructions to both you and your driver.4. Your driver must meet you in Same Day Surgery to drive you home and remain with you for 12 hours following your procedure, for your safety.5. You may begin eating light foods after you are discharged. Work your way up to a normal diet. If your provider wants you to limit your diet for a time period, they will tell you. 6. Do not drink alcohol for 24 hours after your procedure.

What to Expect

After the Procedure

DAY OF COLONOSCOPY

• A perforation or tear in the bowel wall that could require surgery to repair. This occurs in one or two out of 1,000 colonoscopies on average. • Oversedation and/or allergic reaction.

• Bleeding at the site of biopsy or polyp removal. It is usually minor and stops on its own or can be controlled with the colonoscope. This occurs in one or two out of 100 colonoscopies on average. • Missed diagnosis.

Risk of the Procedure

Although complications are rare, they sometimes occur. They may include:

• Bleeding between bowel movements or heavy bleeding from your rectum.• Weakness, faintness, or nausea.

• A temperature of 101º F (38.3º C) or higher.• Severe stomach pain or bloating.• Bleeding from your rectum that lasts more than 24 hours.

Call Same Day Surgery at 320-864-7724 if you have:

If you have questions or need to change your appointment, please call Same Day Surgery at 320-864-7724

Questions and Appointment Changes:

NOTES

5 Days Before Colonoscopy | Low Fiber / Residue Diet for Colonoscopy PrepIf you have questions about the diet, call Same Day Surgery at 320-864-7724.

Food Group Foods Allowed

Milk and Dairy• Milk• Plain ice cream or plain yogurt (no nuts, seeds, fruit, or food pieces)• Cheese and cream

Beverages

• Coffee, tea, or hot chocolate• Apple juice or strained juice• Fruit drinks without pulp• Nutritional supplements without added fiber, such as Boost® or Ensure®

Breads, cereals, and starches

• Refined breads, rolls, bagels, English muffins, pita bread, biscuits, muffins, crackers, or pancakes• Refined cooked and cold cereals, such as cream of wheat or rice, CheeriosTM, Corn/Rice ChexTM, Cornflakes, or Rice KrispiesTM

• Potato without skin• White rice or refined pasta

Fruits• Canned or cooked fruit without skins or seeds (peaches, pears, apricots, or apples)• Applesauce• Ripe banana

Vegetables• Tender, well-cooked fresh, canned, and frozen vegetables without seeds (green beans) • Soup made with allowed vegetables, white rice, and/or refined pasta

Meat and meat substitutes

• Cooked and tender fish, poultry, beef, lamb, pork, ham, veal, and organ meats• Eggs or bacon• Tofu• Fish, seafood, or tuna• Smooth peanut butter and other smooth nut butters

Misc.

• Salt, sugar, or ground or flaked herbs and spices• Mustard, soy sauce, and vinegar• Jelly (but not jam or preserves)• Fats (butter, margarine, oils, dressing, gravy, and mayonnaise)• Desserts made with white flour, sugar, hard candies, marshmallows, and/or syrup

1805 Hennepin Avenue North | Glencoe, MN 55336

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Food Group Foods to Avoid

Milk and Dairy• Yogurt with fruit• Ice cream, pudding, or cheese with nuts, seeds, fruit, or food pieces• Any dairy products if you are lactose intolerant

Beverages• Any beverage containing pulp or seeds, such as orange or grapefruit juice• Prune juice• Nutritional supplements that contain fiber

Breads, cereals, and starches

• Whole grain breads, cereals, and crackers• Oatmeal or granola• Any bread, cereal, cracker, or pasta made with seeds, nuts, coconut, or raw or dried fruit• Brown rice or wild rice• Wheat germ or sprouted wheat• Bran, barley, or potato skins

Fruits

• Raw fruit (bananas are okay)• Canned pineapple, oranges, grapefruit sections, mixed fruit, or dried fruit• All berries, melons, or whole cranberry sauce• Avocado, coconut

Vegetables

• All raw vegetables, such as lettuce, onion, celery, cucumber, mushrooms, scallions, etc.• Vegetables with seeds• Tough, fibrous cooked vegetables, such as, Brussels sprouts, corn, eggplant, sauerkraut, cabbage, tomatoes, asparagus, broccoli, cauliflower, peas, spinach, zucchini, squash, etc.

Meat and meat substitutes

• Non-tender meats• Gristle, hot dogs, salami, or cold cuts• Meat substitutes made with whole grains, nuts, or seeds• Dried beans, peas, or lentils• Crunchy-style peanut butter and other crunchy nut butters

Misc.

• Pepper or seed spices• Seeds, nuts, or popcorn• Jams or preserves• Pickles or olives• Desserts made with whole grain flours, bran, seeds, nuts, coconut, dried fruit, and/or jam