Preperation for Colonoscopy

Preparation For Colonoscopy Using NuLytely or TriLyte

Three Days Before Colonoscopy

Omit fruits and vegetables with seeds or foods that are high in fiber from your diet. Examples include: cucumbers, tomatoes, corn, raspberries, whole grain breads and cereals, popcorn, and nuts.

Do not take Metamucil or similar fiber products. Do not take iron tablets, aspirin, or Plavix. NSAID medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) should not be taken for 24 hours prior to your procedure. If you are on coumadin, your doctor usually will direct you to hold the medication for 3 days.

Fill your prescription in advance just in case your drug store is out of stock and has to order your medication. Generic versions of NuLYTELY or TriLyte are fine.

One Day Before Colonoscopy

Drink clear liquids only all day. Examples include: water, black coffee, tea, soda, apple juice, beef broth, chicken or vegetable broth, grape juice, Gatorade, Jell-O or Popsicles. Please exclude liquids that are RED in color. Ensure or Boost (any flavor, no fiber) although not clear, is acceptable and can be purchased without a prescription at any drug store. Diabetics may drink Glucerna (no fiber). Drink PLENTY of fluids throughout the day to prevent dehydration. You will feel better and will make it easier for your nurse to find a vein for your I.V. in the morning!

At 5:00 p.m. begin drinking the NuLYTELY or TriLyte. Other than flavor packets that are included with NuLYTELY or TriLyte, do not add any flavoring or sweeteners to the prep. You should drink it at the rate of one 8-ounce glass every ten minutes. Drinking at this rate will give you the best cleaning results. If you wish, you may suck on a lemon or lime (don’t eat the pulp) between glasses. Sometimes drinking the liquid through a straw helps to keep the taste of the solution off your tongue. If you find the taste unpleasant, you might want to rinse your mouth out with water of mouthwash between glasses.

You must drink the entire gallon of NuLYTELY or TriLyte. Drinking any large volume of cold fluids may cause chills. To reduce this risk, pour several 8-ounce glasses at once and allow them to warm slightly before drinking them.

You may feel very full or bloated until your bowels begin to move. The first bowel movement usually occurs in about an hour, but this can vary. If you develop significant nausea or vomiting, take a break from taking more medications for about 30 minutes and then try again when you feel better. If you still cannot tolerate the liquid, call our office (630-xxx-xxxx) and have the doctor on-call paged. If you don’t hear from him within 30 minutes, have him paged again.

After you finish taking the prep, you may have clear liquids up to 4 hours prior to your examination. Remember that you’ll feel better with extra fluids. You will continue to have bowel movements for some time. Your final stools should be very watery, yellow in color, maybe a little cloudy but you should be able to see the bottom of the toilet. If your stools are not clear, you should give yourself 2 to 3 adult-sized Fleet enemas which can be purchased without a prescription at any drug store.

Please bring a list of current medications with you. Ladies! Please come with one fingernail on your right hand free of nail polish so we can monitor your oxygen level. Preparation For Colonoscopy Using Gatorade/MiraLAX

Three Days Before Colonoscopy

Omit fruits and vegetables with seeds or foods that are high in fiber from your diet. Examples include: cucumbers, tomatoes, corn, raspberries, whole grain breads and cereals, popcorn, and nuts.

Do not take Metamucil or similar fiber products. Do not take iron tablets, aspirin, or Plavix. NSAID medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) should not be taken for 24 hours prior to your procedure. If you are on coumadin, your doctor usually will direct you to hold the medication for 3 days.

Have your prescription for Polyethylene Glycol (generic MiraLAX) filled if your insurance covers it. Otherwise, purchase a 510 gm bottle of MiraLAX which is available over the counter. Also purchase 64 oz of Gatorade and refrigerate it. Any flavor is fine as long as it is not red in color.

One Day Before Colonoscopy

Drink clear liquids only all day. Examples include: water, black coffee, tea, soda, apple juice, beef broth, chicken or vegetable broth, grape juice, Gatorade, Jell-O or Popsicles. Please exclude liquids that are RED in color. Ensure or Boost (any flavor, no fiber) although not clear, is acceptable and can be purchased without a prescription at any drug store. Diabetics may drink Glucerna (no fiber). Drink PLENTY of fluids throughout the day to prevent dehydration. You will feel better and will make it easier for your nurse to find a vein for your I.V. in the morning!

At noon, mix 12 oz of any clear liquid with 3 capfuls (51grams) of the MiraLAX and drink. Take the 2 pills provided (placebo or bisacodyl laxative). Continue with lots of clear liquids until 2:00 PM, then fast for 3 hours.

At 5:00 PM, mix 64 oz of Gatorade with 15 capfuls (255 grams or 1 ¼ cups) of MiraLAX. Start drinking the liquid at the rate of one 8 oz glass every ten to twenty minutes. Drinking at this rate will give you the best cleaning results. If you find the taste unpleasant, you might want to rinse your mouth out with water or mouthwash between glasses. Sometimes drinking the liquid through a straw helps.

You must drink the entire 64oz! Drinking any large volume of cold fluids may cause chills. To reduce this risk, pour several 8 oz glasses at once and allow them to warm slightly before drinking.

You may feel very full or bloated until your bowels begin to move. The first bowel movement usually occurs in about an hour, but this can vary. If you develop significant nausea or vomiting, take a break from drinking for about 30 minutes and then try again when you feel better. If you still cannot tolerate the drink, call our office (630-xxx- xxxx) and have the doctor on-call paged. If you don’t hear from him within 30 minutes, have him paged again.

After you finish drinking the prep, you may have clear liquids up to 4 hours prior to your examination. Remember that you’ll feel better with extra fluids and your I.V. will be easier to start. You will continue to have bowel movements for some time. Your final stools should be very watery, yellow in color, maybe a little cloudy but you should be able to see the bottom of the toilet. If your stools are not clear, you should give yourself 2 to 3 adult sized Fleet enemas which can be purchased without a prescription at any drug store.

Please bring a list of current medications with you. Ladies! Please come with one fingernail on your right hand free of nail polish so we can monitor your oxygen level. Gatorade with or without Bisacodyl vs NuLYTELY for Colonoscopy Preparation

Patient Questionnaire

Patient Name: ______Patient Study ID #: ______

While cleaning yourself out for the colonoscopy, did any of the following problems occur:

Nausea: none mild moderate severe

Vomiting: none mild moderate severe

Abdominal Cramps/Pain: none mild moderate severe

Bloating: none mild moderate severe

Did any other problems occur during your preparation for your colonoscopy?

How much of your NuLYTELY (or TriLyte) or Gatorade were you able to drink? All or ______OR

How many ounces of liquid were left after you were done drinking? None or ______

Did you need to call the doctor for advice or help? Yes or No

Did you need to take any enemas in the morning of your colonoscopy? Yes or No How Many? _____

Did you need to change your medicine to clean out your colon because you could not drink it all? Yes or No

Did you wake up in the middle of the night to have a bowel movement? Yes or No

When was your last bowel movement? ______

If you needed to have another colonoscopy in the future, would you want to use the same liquid preparation? Yes or No

How difficult was it to drink the liquid? Easy Mildly Difficult Moderately Difficult Very Difficult

Overall, how difficult was the preparation? Easy Mildly Difficult Moderately Difficult Very Difficult

Have you ever had a colonoscopy before? Yes or No

If you have had a previous colonoscopy:

A. What did you use to clean yourself out last time? ______If you don’t remember the name, describe what it was. For example, “gallon of liquid”, “pills”, etc. B. How did your current preparation compare to the previous one? The prep I took yesterday was : Easier About The Same More Difficult compared to the previous one. Gatorade with or without Bisacodyl vs NuLYTELY for Colonoscopy Preparation

Doctor Questionnaire

Patient Name: ______Patient Study ID #: ______

Age: ______Sex: M or F Race: C AA H Other

Clinical Site: HH GS LaG GS-Office Scheduled Starting Time: ______

History of Creatine ≥1.30? Yes or No

History of Heart Failure? Yes or No

Indication: Screening h/o Polyps h/o Colon Cancer FH Colon Neoplasia Rectal Bleeding Long Standing IBD Anemia Other: ______

Findings: ______

Previous Colon Resection? Yes or No If Yes, Site of Resection: ______

Was the Cecum Reached? Yes or No If No, Extent of Colonoscopy: ______

Boston Bowel Preparation Scale (BBPS) 0=Unprepared colon segment with stool that cannot be cleared 1=Portion of mucosa in segment seen after cleaning, but other areas not seen due to retained material 2=Minor residual material after cleaning, but mucosa of segment generally well seen 3=Entire mucosa of segment well seen after washing

BBPS Right Colon: 0 1 2 3 BBPS TV Colon: 0 1 2 3 BBPS Left Colon: 0 1 2 3

Ottawa Preparation Scale (OPS) 4=Inadequate (Solid stool not cleared with washing and suctioning) 3=Poor (Necessary to wash and suction to obtain a reasonable view) 2=Fair (Necessary to suction liquid to adequately view segment) 1=Good (Minimal turbid fluid in segment) 0=Excellent (mucosal detail clearly visible)

OPS Right Colon: 4 3 2 1 0 OPS TV/Descending Colon: 4 3 2 1 0 OPS Sigmoid Colon/Rectum: 4 3 2 1 0 OPS Fluid Whole Colon: 2=lots of fluid 1=moderate fluid 0=little fluid

Did you consider the preparation adequate for a good quality colonoscopy? Yes or No