Colonoscopy Prep Instructions UPDATED

Shahla Rah MD, FACG Email: [email protected] Phone: (949) 650-6700 Fax: (949) 650-6707 Website: DrShahlaRah.com ______

COLONOSCOPY (EZ2GO prep instructions)

WHAT IS THE PROCEDURE? You are scheduled for a procedure called a colonoscopy. During this procedure, after being sedated with Propofol or IV Versed & Fentanyl you will lie on your left side and a ﬂexible tube with a light and camera at the end of it will be inserted into your rectum and colon. This will allow the doctor to see the inside of your colon in order to look for any polyps or abnormal growths. Cancer of the colon is commonly found and preventable and this procedure helps ﬁnd cancer in its early stages. A biopsy (a small piece of tissue) may be taken from the colon, but you will not feel this. If you have colon polyps (small growths), they will be removed. You will be at the facility for a total of 2-3 hours; the procedure itself takes only 30 minutes.

HOW SHOULD I GET READY FOR THIS PROCEDURE? 1) Please fill the prescription for EZ2GO from the doctors office. It is an easy prep! 2) Since a biopsy or polyp removal may be performed, please STOP BLOOD THINNERS as listed below; stop arthritis medications (NSAIDs-Ibuprofen, Motrin, Advil, Naproxen, Celebrex, etc.), aspirin and aspirin-containing medication (unless directed by physician) five (5) days before the procedure; stop Coumadin or Plavix five (5) days before the procedure; stop Heparin, Lovenox or Fragmin for 24 hours before the procedure; stop herbs/vitamins that may have blood thinning qualities such as St. Johns Wort, Gingko Bilboa and Vitamin E. Please consult your physician if you have any questions about medications you are taking. 3) Diabetics- DO NOT take diabetic pills or insulin on the morning of your appointment. Bring your insulin and food; you may take them after the procedure is completed. 4) Be sure to tell the doctor and the nurse if you have a heart murmur or an artificial valve. 5) If you have major heart or lung problems please consult with your cardiologist or pulmonologist to obtain clearance prior to the procedure. 6) Do not eat any food with tough fiber or seeds ( cucumbers, pickles, watermelons, etc.) celery, beans or corn for at least five (3) days before the procedure.

WHAT ARE THE POSSIBLE RISKS ASSOCIATED WITH THIS PROCEDURE? The risks associated with this test are very low and include bleeding, infection, perforation (making a tear) and drug reactions since you will be sedated (made very sleepy) for the procedure. However, the chance of this occurring is less than 1 in 100.

READ THESE INSTRUCTIONS CAREFULLY! FAILURE TO COMPLY WITH ANY PORTION MAY RESULT IN RESCHEDULING OF YOUR EXAM. In order to make an accurate diagnosis, it is very important that our colon is absolutely clean. You must go on a clear liquid diet the day before the procedure and take the EZ2GO solution as directed.

1. THE DAY BEFORE THE EXAMINATION: a) Start on the clear liquid diet. You may have orange, apple, or other strained juice, Gatorade (not red), grape juice, tea, clear soup broth, coffee, soda pop, or jello without fruit. For breakfast you may have 2 scrambled eggs, or juices. For lunch you may have any plain protein chicken, fish or eggs, no veggies. NO FIBER. DO NOT USE red jello, grapefruit or cranberry juices. b) You may drink all the water you like. c) In order to decrease the irritation to your anal region, you may apply petroleum jelly to the area prior to drinking the solution. d) Take the tablets in packet @ 5pm with 8oz of any liquid stated above. e) Start the 10 doses of the EZ2GO prep approx. @ 5:30 pm. f) Continue intervals of 15 -20 minutes apart. g) Mix each dose with 8oz of any liquid stated above (1/2 capful = 1 dose) h) Initially, you may begin to feel bloated and even nauseated, but this will become more comfortable as you begin to have bowel movements. i) If you develop significant nausea or vomiting, stop drinking for about 30-45 minutes and then resume at a slower rate.

11. THE DAY OF THE EXAMINATION: a) Complete the remaining 4 doses 3 hours prior to your procedure in intervals o 15 minutes apart. Finish ALL of the preparation solution! b Please take your blood pressure, heart, asthma or anti-seizure medications as scheduled in the morning with 6oz. of water. You may use your asthma inhaler the morning of the procedure. NO OTHER MEDICATONS. c) You may continue to have ONLY clear liquids up to 2 hours before the procedure. CAN I GO HOME AFTER THE EXAMINATION? 1. You will be at the surgery center approximately 2-3 hours after the examination. 2. You may be sleepy from the medication after the examination, so someone will have to drive you home. YOU MAY NOT DRIVE YOURSELF HOME. NO BUSSES OR CABS ARE ALLOWED. Some surgery centers have a ride available to you from home and back. 3. Someone needs to care for you 3-4 hours after your procedure. You can resume your daily routine after that. 4. After the procedure, it is normal to feel gassy, bloated or to have mild stomach cramps. This may be relieved by walking around and/or expelling the gas. This should go away after several hours. You may use Gas X or Mylicon over the counter as needed. 1) PLEASE CALL THE OFFICE THE NEXT DAY TO SCHEDULE A FOLLOW UP APPOINTMENT TO GO OVER YOUR BIOPSY RESULTS WITH THE DOCTOR. A BIOPSY DOES NOT AUTOMATICALLY MEAN CANCER, SO PLEASE DO NOT BE CONCERNED. DOCTOR WILL GO OVER ALL OF YOUR RESULTS INCLUDING LABS, ULTRASOUND OR CT SCANS AT THAT TIME AND MAKE RECOMMENDATIONS BASED ON THOSE FINDINGS.

Please note: Bring insurance information and/or insurance card with you at the time of the procedure. Failure to do so could result in rescheduling the procedure. Please bring a list of medications with you to the procedure. If you cannot keep this appointment or have any questions, please call (949) 650-6700. Make sure to call within 48 hours of your procedure to cancel as there is a cancellation fee. And call the facility you are scheduled to meet to inform them of your cancellation as well. Thank you. Shahla Rah MD, FACG Email: [email protected] P: 949- 650-6700 F: 949-650-6707 Web: DrShahlaRah.com ______

UPPER G.I. ENDOSCOPY (EGD)

WHAT IS THE TEST? You are scheduled for a test called an Upper G.I. Endoscopy. During this test you will swallow a bendable tube that has a light and camera on the end of it. This will let the doctor see the inside of your esophagus or swallowing tube, the stomach and the ﬁrst part of your small bowel or intestine. Sometimes small samples of tissue are taken called biopsies, but you will not feel this.

HOW DO I GET READY FOR THIS TEST? 1) Do not take any aspirin or aspirin-containing products for 7 days before the test (including Alka-Seltzer). 2) Do not take any non0steroidal anti-inﬂammatory drugs for 3 days before the test (for example, Advil, Motrin, Ibuprofen). You may take Tylenol for pain. 3) You may be given a lab slip which MUST be done 1 to 5 days prior to your procedure if the physician feels that it is necessary. 4) You can eat dinner the night before the test, BUT DO NOT EAT ANYTHING AFTER MIDNIGHT. (Your stomach MUST be empty or the doctor will not be able to see anything). You may have ONLY sips of Water, up to 4 hors before the procedure. 5) DIABETICS On the morning of the test, DO NOT eat or take insulin. 6) If you are blood pressure medicine, take it (at 6:00 a.m.) with a small sip of water, the morning of the test, and bring it with you. 7) Be sure to tell the doctor and the nurse if you have a heart murmur or an artiﬁcial valve. 8) Please leave all jewelry at home.

WHAT ARE THE RISKS OF THE PROCEDURE? The risks associated with this test are very low and includes bleeding, infection, perforation (making a tear) and drug reactions since you will be sedated (made very sleepy_ for the procedure. However, the chance of this occurring is less than 1%.

WHAT WILL HAPPEN BEFORE THE TEST? 1) The back of your throat may be sprayed with some numbing medicine. 2) The nurse will put an IV in your arm and a medicine will be given through the IV to make you sleepy and relaxed. WHAT WILL HAPPEN AFTER THE TEST? 1) You may be sleepy after the test from the medicine. Then you will be sent to the recovery room. 2) You may be hoarse and experience a sore throat for a few days. You may also feel bloated or gassy for a few hours. 3) Please make arrangements for the ride home after the procedure. You may not drive yourself home, take a taxi or a bus after the procedure. 4) Someone will need to care for you 3-4 hours after the procedure is done and you may resume light activities. 5) PLEASE CALL THE OFFICE THE NEXT DAY TO SCHEDULE A FOLLOW UP APPOINTMENT TO GO OVER YOUR BIOPSY RESULTS WITH THE DOCTOR. A BIOPSY DOES NOT AUTOMATICALLY MEAN CANCER, SO PLEASE DO NOT BE CONCERNED. DOCTOR WILL GO OVER ALL OF YOUR RESULTS INCLUDING LABS, ULTRASOUND OR CT SCANS AT THAT TIME AND MAKE RECOMMENDATIONS BASED ON THOSE FINDINGS.

Phone: (949) 650-6700 Fax: (949) 650-6707

COLONOSCOPY (GO-LYTELY Prep)

WHAT IS THE PROCEDURE? You are scheduled for a procedure called a colonoscopy. During this procedure, after being sedated, you will lie on your left side and a flexible tube with a light and camera at the end of it will be inserted into your rectum and colon. This will allow the doctor to see the inside of your colon in order to look for any polyps or abnormal growths. Cancer of the colon is commonly found in this country and this procedure helps find cancer in its early stages. A biopsy (a small piece of tissue) may be taken from the colon, but you will not feel this. If you have colon polyps (small growths), they will be removed. You will be at the hospital for a total of 2-3 hours; the procedure itself takes only 30 minutes. The alternative to this procedure is a barium enema (x-ray) and/or sigmoidoscopy (a shorter flexible tube with a camera).

HOW SHOULD I GET READY FOR THIS PROCEDURE? 1. Please fill the prescription for Golytely & purchase 1 bottle of Fleets enema from the drug store. 2. Since a biopsy or polyp removal may be performed, please stop blood thinners as listed below: stop arthritis medications (NSAIDs-Ibuprofen, Motrin, Advil, Naproxen, Celebrex or Viox,etc.), aspirin & aspirin containing medication (unless directed by a physician) five (5) days before the procedure. Stop Coumadin or Plavix five (5) days before the procedure. Stop Heparin, Lovenox or Fragmin for 24 hours. Stop herbs/vitamins that may have blood thinning qualities such as St. John Wort, Gingko Biloba & Vitamin E. Please consult your physician if you have any questions about the medications you are taking. 3. Diabetics -- DO NOT take diabetic pills or insulin on the morning of your appointment. Bring your insulin and food; you may take them after the procedure is completed. 4. Be sure to tell the doctor and the nurse if you have a heart murmur or an artificial heart valve. 5. Do not eat nuts, corn or any food with seeds (sunflower seeds, strawberries, kiwis, cucumbers, pickles, watermelons, etc.) for at least 5 days before the procedure.

WHAT ARE THE POSSIBLE RISKS ASSOCIATED WITH THIS PROCEDURE?

The risks associated with this test are very low and includes bleeding, infection, perforation (making a tear) and drug reactions since you will be sedated (made very sleepy) for the procedure. However, the chance of this occuring is less than 1%.

READ THESE INSTRUCTIONS CAREFULLY! FAILURE TO COMPLY WITH ANY PORTION MAY RESULT IN RESCHEDULING OF YOUR EXAM. In order to make an accurate diagnosis, it is very important that your colon is absolutely clean.

(Over) COLONOSCOPY PREPARATION (Golytely Prep) PLEASE READ THESE INSTRUCTIONS CAREFULLY! In order to make an accurate diagnosis, it is very important that your colon is absolutely clean. You MUST go on a clear liquid diet the day before the procedure and take the Go-Lytely solution. 1. THE DAY BEFORE THE EXAMINATION: a) Start on the clear liquid diet. You may have orange, apple, or other strained juice, sports drink, grape juice, tea, clear soup broth, coffee, soda pop, or jello without fruit. DO NOT USE red jello, grapefruit or cranberry juices. You may also have milk, plain yogurt, cheese, eggs And ice cream without nuts. You may suck on hard candy if you wish. b) You make drink all the water you like. Drink at least one 8 oz. portion of clear liquid before retiring...... more if desired. c) At 6:00 P.M. TAKE FULL AMOUNT (4 LITERS) OF GO-LYTELY. YOU NEED TO FINISH THIS OVER A 2-3 HOUR PERIOD, but not more than 3 hours, or your colon will not be clean and the test may have to be re-scheduled. d) TAKE NOTHING BY MOUTH AFTER MIDNIGHT. e) In order to decrease the irritation to your anal region, you may apply petroleum jelly to the area prior to drinking the solution. 2. THE DAY OF THE EXAMINATION: a. You may continue to have clear liquids up to four (4) hours before the procedure. b. Please take your blood pressure, heart, asthma or anti-seizure medications as scheduled in the morning. You may use your asthma inhaler the morning of the procedure. c. Two hours before coming to your appointment, please take cleansing enemas (Fleets or tap water enemas) until completely clear or the procedure cannot be done. Please leave all jewelry at home.

CAN I GO HOME AFTER THE TEST? 1. You may be sleepy from the medicine after the test, so someone will have to drive you home. YOU MAY NOT DRIVE. NO BUSES or CABS ARE ALLOWED. 2. You will be at the hospital approximately l hour after the test. 3. After the procedure, it is normal to feel gassy, bloated or to have mild stomach cramps. This may be relieved by walking around and/or expelling the gas. This should go away after several hours.