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.
Most Effective Preparation:
4pm: Eat a light meal or small clear liquid meal.
6pm: Drink a purgative as directed.
The names of acceptable preparation solutions:
a. Golytely [ ]
b. Nu-Lytely [ ]
c. Co-Lyte. [ ]
9 – 11pm: After the purge is complete, take one Dulcolax tablet by mouth (no prescription is needed for Dulcolax).
The purge should take effect in 4-6 hours. If this does not occur, administer a disposable enema, such a Fleets (R). If the purge seems ineffective or incomplete call Dr. Vazquez’s office.
The purge should take effect in 4-6 hours. If this does not occur, administer 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
YOU MAY NOT EAT OR DRINK AFTER MIDNIGHT
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.
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.
CLEAR LIQUID DIET
These items are allowed:
- Water Sodas Tea/ Coffee
- Clear Broths: Chicken broth, Beef broth Juices:
- Apple juice or cider, Prune juice, Grape juice, Grapefruit juice (strained), Cranberry juice, Tang, Hawaiian Punch, Lemonade (strained), Kool Aid
- Clear Jello (without fruit)
- Popsicles (without fruit/without cream)
- Italian Ices
- Salt, pepper, and sugar may be used
These items are not allowed:
- Milk Orange Juice Cream Soups
- Cream Tomato Juice Any soup other than clear broth
- Milkshakes Oatmeal
- Cream of Wheat
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.