COLONOSCOPY PREPARATION
SPLIT DOSE BOWEL PREP


Split dose bowel preparation consists of splitting your colon cleanse over a period of time, as close to your procedure as possible. Split dosing has been shown to be superior to same day preparation in clinical studies and decreases the likelihood that the procedure will need to be canceled and rescheduled because of a poor cleansing. Note, this may require you to either awaken early in the morning or remain awake later in the evening, in order to complete the prep process. Although inconvenient, the correct timing of drinking the prep is critical to obtaining a good colon preparation

Date of Procedure: _________________

Procedure Time: ____________________

Arrival Time: _______________________

Location of Procedure

______ Cape Health Surgery Center 665 Del Prado Blvd. S. Cape Coral FL 33990, across the street from the Cape Coral Hospital ER (239) 424-6000. You must arrive 60 minutes prior to your procedure time for pre-op paperwork and assessment.

______ Cape Coral Hospital Outpatient 636 Del Prado Blvd. S. Cape Coral FL 33990, main entrance first left into outpatient services (239) 424-2000. You must arrive 90 minutes prior to your procedure time for pre-op paperwork and assessment.

Remember you must have someone to drive you home - this can not be a taxi or bus unless there is a known responsible adult to accompany you.

Diet

7 days before your colonoscopy

  • Stop eating seeds, whole grains, nuts, popcorn etc. for one week prior to your procedure.

1 day before your colonoscopy

  • Stop eating solid food, milk, and dairy products.
  • Consume clear liquids only. These include: water, plain tea and coffee, broth or bouillon, clear juices such as apple, white grape or white cranberry, fruit flavored drinks such as Crystal Light, Italian ices, Jell-O, sports drinks such as Gatorade, Powerade, or Propel, clear carbonated beverages, and popsicles.

Shopping List (all are over the counter):

  1. (2) 64 oz. bottles of Gatorade (any flavor or color/see alternatives below for diabetics)
  2. (2) 8.3 oz. bottles of Miralax powder (238 gram/14 dose)

The way in which you take the bowel preparation depends on the time your colonoscopy is scheduled, please follow the instructions below:

On _________________ (day prior to procedure) follow the instructions below. 

NO solid foods, clear liquids only.

In the morning, mix (1) 8.3 oz. bottle of Miralax with (1) 64 oz. bottle of Gatorade in one pitcher and other Miralax/Gatorade bottles in another. You may use other clear liquids (Crystal Light, Propel, etc.) if unable to tolerate Gatorade. Place in refrigerator to chill if desired, after powder dissolves.

Prep Instructions

Morning Colonoscopy (before 12pm)

  1. At 6pm, begin drinking the first half of the Miralax/Gatorade solution. You will need to drink an 8-ounce glass of the preparation every 15 minutes until the entire 64 oz. is gone. Nausea can be side effect of this preparation. If you become nauseated stop, wait 30 minutes, and then continue. You need to finish the solution within 2 hours.
  2. At 10pm, begin drinking the second half of the Miralax/Gatorade solution. You will need to drink an 8-ounce glass of the preparation every 15 minutes until the entire 64 oz. is gone.
  3. It is important for you to stay hydrated for the prep to work effectively, therefore ensure to consume ample amounts of water in addition to the prep.

Afternoon Colonoscopy (after 12pm)

  1. At 6pm, begin drinking the first half of the Miralax/Gatorade solution. You will need to drink an 8-ounce glass of the preparation every 15 minutes until the entire 64 oz. is gone. Nausea can be side effect of this preparation. If you become nauseated stop, wait 30 minutes, and then continue. You need to finish the solution within 2 hours.
  2. At 6am day of procedure, begin drinking the second half of the Miralax/Gatorade solution. You will need to drink an 8-ounce glass of the preparation every 15 minutes until the entire 64 oz. is gone. You will need to finish the solution within 2 hours.
  3. It is important for you to stay hydrated for the prep to work effectively, therefore ensure to consume ample amounts of water in addition to the prep.

On _________________ (day of procedure) you may continue to have CLEAR LIQUIDS ONLY until 4 HOURS PRIOR to your arrival time.

Please note if you drink any liquids within the 4-hour window your procedure will be delayed. This preparation is safe for those who have a history of congestive heart failure, kidney failure, or dehydration.

TAKE YOUR BLOOD PRESSURE AND HEART MEDICATIONS DAY BEFORE AND DAY OF PROCEDURE! Do not take oral diabetic agents, insulin, diuretics (Lasix, HCTZ), vitamins or supplements the morning of your procedure. Do not smoke on the day of your procedure.

Pre-Procedure Medication Instructions

Blood Thinners

If you take blood thinners you may be at an increased risk of bleeding if tissue is removed. You may continue aspirin unless instructed by your doctor. The risk of stopping your blood thinner must be individualized for each patient. If you had a stent placement within the past 12 months or have a history of TIA's, talk to your physician before stopping these medications. Please remind staff at the Endoscopy unit that you are taking blood thinners.

Stop taking: Coumadin Plavix  Xarelto  Pradaxa  Eliquis  Other ______________  on ______________ .

Please resume your medication after the procedure is completed or as directed by the doctor.

Diabetic Instructions (oral or insulin): Recommend Gatorade G2, Powerade Zero, or Crystal Light in place of regular Gatorade.

On you will need to only take one half (1/2) of your morning and evening dose. DO NOT take your diabetic medications the morning of the procedure. Once the procedure has been completed and you have eaten a meal you will need to take one half (1/2) of your morning dosage. Resume your normal dosage regime after this. Monitor your blood glucose level and if becomes low take glucose tablet.

The day before your procedure take _________________ in the AM.

The day before your procedure take _________________ in the PM.

What to Expect For Your Colonoscopy

Colonoscopy utilizes a long flexible tube camera to evaluate the large intestine. This test is commonly performed to investigate the cause of blood in the stool, diarrhea, abdominal pain, a change in bowel habits, or personal/family history of polyps/cancer.

An intravenous (IV) will be started in your arm and you will be sedated to make
you drowsy and relaxed. The examination is performed with you lying on your left side and the colonoscope will be gently guided through the colon. If any abnormalities are found such as polyps, biopsies (removal of small pieces of tissue) may be taken for examination. This is a very safe procedure and in many cases, eliminates the need for surgery.

Your stay at the facility will be approximately two hours long, depending on how long it takes to pass the scope around the colon. Please bring with you to the center glasses, hearing aids, dentures (no Fixodent or glue), insurance card and photo ID, medication list. Do not bring jewelry or any valuables. Do not use lotion, sprays, perfume/cologne. Wear warm loose-fitting clothing.

After The Procedure

You will be observed for about thirty minutes before going home. You will not be 
allowed to drive for 24 hours after the procedure since you will be drowsy several hours afterward. Following the procedure, your doctor will inform you of the preliminary results of the test. A follow-up visit may be scheduled so the final test results (biopsies) can be explained to you when you are fully awake. 

Risks

This is a very safe examination, but there is a small risk of complications, which occur in less than 1% of patients which could include bleeding, infection, or perforation of the bowel. 

We find 95% of polyps and usually, but not always, they can be completely removed during the procedure.

Reactions to medications may rarely occur such as allergic reactions or difficulty breathing. If you experience severe pain, bleeding, or any serious problems after the test, please contact our office immediately at (239) 772-ENDO (3636).

MAKE SURE YOU TAKE YOUR BLOOD PRESSURE AND HEART MEDICATIONS DAY BEFORE AND DAY OF PROCEDURE!

About Your Bill

We are pleased that you have chosen us to provide your medical care. It is our desire to provide you with 

the highest quality medical care possible. Therefore, we would like to make you aware of the following information.

IF YOU HAVE HEALTH INSURANCE we will file all claims on your behalf. We will request that payment from your insurance company, be sent directly to our office. It is your responsibility to know and understand the benefits provided by your insurance coverage for the procedures that are to be performed.

A statement will be mailed to you if there is an additional amount due from you after your insurance company has processed your claim. If your prepaid amount results in a credit balance, you will receive a timely refund from us.

IF YOU DO NOT HAVE HEALTH INSURANCE a deposit of 50% of the estimated charges will be collected from you. This amount is due no less than two days prior to your scheduled appointment. Please remit this payment to avoid any delays in your procedure. Payment of the balance is due 14 days after your procedure. If you need to make special arrangements for payment of your procedure, you must call our billing office at 239-772-3636, option 6.


You can expect to see insurance claims and/or bills from the following parties:

__________ Associates in Digestive Health, Billing Office (239) 772-3636, option 6. This bill is for the physician's fees for performing the procedure. 

__________ Cape Health Surgery Center, Billing Office (239) 772-3636, option 6. This bill is for the facility where your procedure was performed. It includes the operating room, nursing services, supplies and equipment used during your procedure.

_________ CRHAnesthesia of Cape Coral/IPS, Billing Office, (239) 205-7709. This bill is for the Certified Registered Nurse Anesthetist's (CRNA) services rendered during your procedure at the Cape Health Surgery Center. 

__________ Cape Coral Hospital, Billing Office, (239) 424-3743. This bill is for the facility where your procedure was performed. It includes the operating room, nursing services, supplies and equipment used during your procedure.

_________ Laboratory: You will receive a bill from a laboratory if biopsies or polyps are taken during your procedure. Various laboratories are used, depending upon your individual insurance coverage. A telephone number for billing inquiries will be included on any bill you receive from the laboratory. Some laboratory charges are split between two parties. A bill may be received from the laboratory for the physician's review of the specimen and a bill may be received from Associates in Digestive Health for the technical services which include preparation of the specimen on the slides. This is not a duplicate billing.


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