COLONOSCOPY PREPARATION INSTRUCTIONS

--Please Read Carefully--

Please follow the instructions below to prepare for your procedure.

Do not take iron, aspirin, or other anti-inflammatory medications for SEVEN DAYS prior to your procedure. If you take anticoagulation medications such as Coumadin, please notify the gastroenterologist at least one week before your procedure. Please notify your gastroenterologist’s office if you take insulin.

PURCHASE at THE PHARMACY or MARKET:

• ONE 3 OUNCE BOTTLE OF LEMON GINGER FLAVORED FLEET’s PHOSPHOSODA
• FOUR DULCOLAX TABLETS
• 3 BOTTLES of LEMON LIME GATORADE or SPRITE
• ONE PACKAGE of YELLOW JELLO (NO OTHER COLORS PLEASE)
• VEGETABLE or CHICKEN or BEEF BOUILLON BROTH CUBES

1. STARTING THREE DAYS BEFORE THE PROCEDURE: LOW RESIDUE DIET. AVOID FRUITS, SALADS, CEREALS, BRAN, METAMUCIL, SEEDS and NUTS. (For example, if your procedure is booked on a Tuesday morning, begin on Saturday morning to eat as though you were getting over an upset stomach).

2. TWO NIGHTS BEFORE THE PROCEDURE: TAKE TWO DULCOLAX TABLETS.

(For example, if your procedure is booked for Tuesday morning, take two

Dulcolax tablets on Sunday night).

3. ONE FULL DAY BEFORE THE PROCEDURE: CLEAR LIQUID DIET (NO MILK or DAIRY PRODUCTS. USE JELLO, BROTH, GATORADE, SPRITE, BLACK COFFEE, PLAIN TEA, AND CLEAR JUICES.) (For example, if your procedure is booked for Tuesday morning, begin the clear liquid diet on Monday morning).

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4. BETWEEN 3 and 4 PM on THE DAY BEFORE THE PROCEDURE:

TAKE 1 and ½ OUNCES of PHOSPHOSODA MIXED INTO A LARGE

GLASS OF CHILLED GATORADE OR SPRITE. DRINK OVER A

20-MINUTE PERIOD. WITHIN the NEXT THREE HOURS, DRINK AT LEAST THREE EIGHT OUNCE PORTIONS OF EITHER SPRITE, WATER, OR GATORADE, and INCLUDE A LARGE BOWL of HOT BOUILLON or CONSOMME.

E. BETWEEN 6 and 7 PM, REPEAT ABOVE, i.e., TAKE 1 and ½ OUNCES

of PHOSPHOSODA FOLLOWED by AT LEAST 3 EIGHT-OUNCE SERVINGS of CLEAR LIQUIDS.

F. AT BEDTIME ON THE NIGHT BEFORE the PROCEDURE, TAKE TWO

DULCOLAX TABLETS. DO NOT DRINK FOR AT LEAST FOUR HOURS BEFORE THE PROCEDURE. IF YOU TAKE ANY MORNING MEDICATION, YOU MAY TAKE IT WITH A SMALL AMOUNT OF WATER.

A colonoscopy is performed with intravenous sedation. Therefore, you will be unable to operate a motor vehicle or leave the Center unescorted. Please arrange for an adult to escort you home post procedure approximately 1-1/2 hours from your scheduled time. If you need assistance obtaining transportation, please call MATCH UP, a volunteer program at 617-536-3557. It is advised that you not work or make any important decisions the day of your procedure.

IT IS THE PATIENT’S RESPONSIBILITY TO OBSTAIN A REFERRAL FOR THIS PROCEDURE, IF REQUIRED BY YOUR INSURANCE CARRIER.

If you have questions about how to obtain a referral, please call the customer/member service number on your insurance card or your Primary Care Physician’s office. For the colonoscopy procedure, you will need a referral number, the number of visits authorized, and the referral’s expiration date. IT IS MANDATORY THAT THIS INFORMATION IS OBTAINED PRIOR TO YOUR PROCEDURE. PLEASE NOTIFY YOUR GASTROENTEROLOGIST’s OFFICE AS SOON AS POSSIBLE WITH THAT REFERRAL. FAILURE TO DO SO WILL RESULT IN THE PATIENT BEING DIRECTLY BILLED AND ASKED TO SIGN A WAIVER.

These instructions are prepared by the office of Ram Chuttani, M.D.

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