COLONOSCOPY: STANDARD BOWEL PREPARATION

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Patient Name____________________________________________

Date of Operation________________________________________

TIME TO REPORT TO FOURTH FLOOR GALTER PAVILLION *____________

You must call the G.I. Lab at 312-926-2950 to pre-register prior to test date.

For the purposes of safety, a thorough cleansing of the colon is required. Early preparation consists of modifying dietary intake starting 72 hours before the Colonoscopy procedure.
 
 

THREE DAYS PRIOR TO PROCEDURE: DATE:_______________________

Begin to remove hard-to-digest items from your diet. Examples of such food items are corn, spinach, or other items of roughage which you have noted pass through your system only partially digested. Switch your diet to breads, pastas and other refined food items.
 
 

TWO DAYS PRIOR TO PROCEDURE: DATE:__________________________

Further decrease dietary intake of any roughage and begin to eat a more liquid diet (juices, jello) and a diet with more refined foods such as cereals, breads, pastas and noodles.
 
 

ONE DAY PRIOR TO PROCEDURE: DATE:___________________________
 
 

Please contact Dr. Vazquez if you have a heart murmur, artificial heart valve, or heart implant. You may need to take antibiotics prior to the colonoscopy procedure.

The purge should take effect in 4-6 hours. If this does not occur, adminster a disposable enema, such as Fleets (R).

If the purge seems ineffective or incomplete call Dr. Vazquez's office.
 
 

CALL DR. VAZQUEZ IF:

1. You are unable to complete the preparation as instructed.

2. The preparation seems incomplete or ineffective.

3. If you have any other questions about the procedure or preparation.

Remember to take your regular prescription medications with some water. Such medications include hypertension medication, thyroid hormones and most other medications except those that affect blood coagulation such as Coumadin, Aspirin, or Ibuprofen. If you have questions regarding the taking of these medications around the time of your exam, ask Dr. Vazquez about these issues.
 
 

In general do not take aspirin or aspirin containing medications for 1 week prior to your procedure. Internal bleeding might occur if aspirin is in your system.
 
 

These items are allowed:

Water

Clear Broths:

Chicken broth, Beef broth

Apple juice or cider, Prune juice, Grape juice, Grapefruit juice (strained), Cranberry juice, Tang, Hawaiian Punch, Lemonade (strained), Kool Aid

Tea

Coffee

Clear Jello (without fruit)

Popsicles (without fruit/without cream)

Italian Ices

These items are not allowed:

Milk

Cream

Milkshakes

Orange juice

Tomato juice

Cream soups

Any soups other than clear broth

Oatmeal

Cream of Wheat
 
 

Please Note:

You are allowed unlimited amounts of clear liquids until 10:00 pm of the night prior to your surgery. You should drink as much fluid as possible until 10:00 pm to prevent dehydration from the laxatives prescribed.

Anything you can hold up to the light and see through is considered a clear liquid.

Please feel free to e-mail Dr. Vazquez with any medical questions,

or contact our office with any other questions.

Richard M. Vazquez, M.D., F.A.C.S.

201 East Huron Street

Suite 11-250

Chicago, Illinois 60611

(312) 649-6562