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YOUR PROCEDURE: Colonoscopy

TAKES PLACE AT: Rose Surgical Center (Founders Building- 4700 Hale Parkway, Second Floor)

YOUR PREPARATION IS: SUPREP® or Prepopik®

1)  PURCHASE YOUR PREP in the next 3 days.

2)  THE DAY BEFORE YOUR EXAM- Wake up and begin consuming large quantities of clear liquids (ie: tea, juice, Gatorade, Jell-O, Coca-Cola, black coffee, soup broth, soda, water, etc). DO NOT CONSUME ANY SOLID FOOD TODAY (please, nothing red either, which can look like blood in your colon and no milk or juices with pulp).DO NOT EAT BREAKFAST, LUNCH, OR DINNER!!!! Avoid only drinking water.

3)  IF YOU ARE TAKING SUPREP® or Prepopik®- YOU WILL BE TAKING A DOSE OF THE PREPARATION MEDICINE AT 6PM THE NIGHT BEFORE YOUR EXAM AND AGAIN, 5 HOURS BEFORE YOUR EXAM. YOU MUST TAKE BOTH DOSES. You may refer to the instructions given separately. If there is any conflicting information between the instructions on the prep packaging and in this packet, please follow this packet.

4)  You may continue drinking clear liquids up to 4 hours before your procedure. Do not drink anything within 4 hours of your procedure or your procedure will be cancelled. It can be dangerous to have stuff in your stomach.

5)  Your goal should be to be passing clear watery bowel movements by the time of your procedure. For urgent questions regarding your prep, contact me directly on my cell phone at (303) 818-6823. PLEASE NOTE: You must remain well hydrated during your entire prep or you risk serious and potentially permanent kidney damage.

6)  PLEASE PLAN TO ARRIVE AT LEAST 60-90 MINUTES PRIOR TO YOUR EXAM. You will need a responsible adult to pick you up after the procedure (you may not leave in a taxi cab by yourself). You will not be allowed to drive yourself home or leave by yourself. You will be at the facility for a total of 2-2½ hours (from drop off to pick-up).

You may continue all your medications except for Blood thinners, Xarelto, Coumadin, Plavix full strength (325mg) Aspirin, or NSAIDS (Advil, ibuprofen, Aleve, Naprosyn).Most need to be stopped for 10 days. Please discuss with Dr. Burrows if you are on diabetes medicines. You may continue to take a low dose baby aspirin (81mg).

Payment and rescheduling/cancellations:

Rescheduling or Cancellations with less than 48 hours notice will incur a $200 fee (single procedure) and a $300 fee (double procedure) which is not covered by insurance. You are responsible for determining your financial obligation with your insurance provider (deductible, co-insurance). You must contact our office to cancel or reschedule your procedure (303)320-1111. Late arrivals are not tolerated. Please arrive earlier than an hour if you feel you may need more time to fill out paperwork.

Prior to your procedure:

Please log on to www.rosesurgicalcenter.com to review pre-procedure paperwork and to fill out your patient information (Passport). Click on “Online Pre-Registration” to register. If you do not have internet access, you will still be able to do all this at the surgical center on the day of your procedure.

Other Information: In addition to myself, there will also be at least one nurse present who will monitor your vital signs and assist me during the procedure. An EGD lasts about 10 minutes and a colonoscopy lasts about 25 minutes. After completion, you will be brought into recovery for 30-60 minutes of and then discharged home with your responsible adult. I will talk to you after your procedure; however, most people do not remember this conversation due to the sedating medicines. Due to the scheduling of procedures, there will only be a few minutes to discuss the case afterwards. You will have further opportunity to discuss this with me at a follow-up appointment or phone call if necessary. You should not drive or do anything requiring good coordination and judgment until the following day.

What is a Colonoscopy?

The term "colonoscopy" means looking inside the colon. It is a procedure performed by a gastroenterologist, a well-trained subspecialist.

The colon, or large bowel, is the last portion of your digestive or GI tract. It starts at the cecum, which attaches to the end of the small intestine, and it ends at the rectum and anus. The colon is a hollow tube, about five feet long, and its main function is to store unabsorbed food products prior to their elimination.

The main instrument that is used to look inside the colon is the colonoscope, which is a long, thin, flexible tube with a tiny video camera and a light on the end. The gastroenterologist can carefully guide the instrument in any direction to look at the inside of the colon. The high quality picture from the colonoscope is shown on a TV monitor, and gives a clear, detailed view.

This procedure also allows other instruments to be passed through the colonoscope. These may be used, for example, to painlessly remove a suspicious-looking growth or to take a biopsy-a small piece for further analysis. In this way, colonoscopy may help to avoid surgery or to better define what type of surgery may need to be done.

Why a colonoscopy?

Colonoscopy is recommended for evaluation of altered bowel habit, unexplained diarrhea, constipation or abdominal pain, occult or frank blood in stools, colon polyps or cancer or unexplained anemia.

Colonoscopy is also an important way to check for colon cancer and to treat colon polyps - abnormal growths on the inside lining of the intestine. Polyps vary in size and shape and, while most are not cancerous, some may turn into cancer. Colonoscopy is often used to remove polyps, a technique called a polypectomy.

How Do I Prepare for the Procedure?

There are important steps that you must take to prepare for the procedure. First, be prepared to give a complete list of all the medicines you are taking, as well as any allergies you have to drugs or other substances.

You will be given instructions in advance that will outline what you should and should not do in preparation for colonoscopy. Be sure to read and follow these instructions. One very critical step is to thoroughly clean out the colon, which, for many patients, can be the most trying part of the entire exam. It is essential that you complete this step carefully, because how well the bowel is emptied determines the success of the procedure.

Often, a liquid preparation designed to stimulate bowel movements is given by mouth, which may cause bloating. Additional approaches include special diets or the use of enemas. Whatever method or combination of methods that is recommended for you, be sure to follow instructions as directed. And remember, you should not consume anything within ~4 hours before your colonoscopy.

What Can You Expect During a Colonoscopy?

During the procedure, everything will be done to ensure your comfort. An intravenous, or IV, line will be inserted to give you medication to make you relaxed and drowsy. The drug will enable you to remain awake and cooperative, but it may prevent you from remembering much of the experience.

Once you are fully relaxed, your doctor will do a rectal exam with a gloved, lubricated finger; then the lubricated colonoscope will be gently inserted.

As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or no discomfort.

What are the Possible Complications from a Colonoscopy?

Although colonoscopy is a safe procedure, complications can sometimes occur. These include perforation - a puncture of the colon walls, which could require surgical repair.

When polyp removal or biopsy is performed, hemorrhage (heavy bleeding) may result and sometimes require blood transfusion or reinsertion of the colonoscope to control the bleeding. Be sure to discuss any specific concerns you may have about the procedure with your doctor.

The time needed for colonoscopy will vary, but on the average, the procedure takes about 30 minutes. Afterwards, you’ll be cared for in a recovery area until the effects of the medication have worn off. At this time, your doctor will inform you about the results of your colonoscopy and provide any additional information that you need to know. You’ll also be given instructions about how soon you can eat and drink.

What Can You Expect After Your Colonoscopy?

Occasionally, minor problems may persist, such as bloating, gas, or mild cramping. These symptoms should disappear in 24 hours or less. By the time you’re ready to go home, you’ll feel stronger and more alert. Nevertheless, rest for the remainder of the day. Have a family member or friend take you home.

How Colonoscopy Works

/ The colonocscope is inserted in your anus and gently guided to the cecum, the first part of your digestive tract. / / Upon reaching the cecum, your doctor can guide the colonoscope to view the entire area.
/ Upon finding something suspicious, your doctor can take a biopsy. / / ….or do a polypectomy.

Pre-Endoscopy Tips, Expectations and Responsibilities

-We do everything we can to make your procedure comfortable and safe including employing a highly skilled and caring staff, utilizing state-of-the art technology and using intravenous pain medicines (fentanyl) and sedatives (versed, similar to valium). However, despite all of our technology, these are still invasive procedures with risks. These risks include, bleeding, infection, perforation of the intestine, and reaction to the medications. Typically, the benefits of the procedure far outweigh the risks. You will have an opportunity to speak with Dr. Burrows prior to the procedure to discuss any further concerns you may have.

-Our goal with pain and sedation medications is to make you as comfortable as possible during the procedure, NOT to knock you out completely! However, most people do not remember the procedure at all or remember only small amounts as if in a dream state. On rare occasions during colonoscopies, people do experience significant abdominal cramping and pain. In the end, we must balance the amount of medicine you receive with your cardiovascular safety. For your safety, if you know that you are difficult to sedate, use supplemental oxygen, have been diagnosed with sleep apnea or have allergies to narcotics, please let Dr. Burrows know so that he can arrange an anesthesiologist to deliver the sedation medications at the procedure.

-The colonoscopy prep is typically the worst part of the colonoscopy. Some patients do experience nausea, vomiting, bloating and cramping, with some symptoms quite severe. If you are having difficulty with the prep, I suggest following these steps before calling your doctor.

1) Stop drinking the prep and take an hour break. Try taking a short walk (keep close to the bathroom though!). Resume drinking the prep but at a much slower pace.

2) If you are still having nausea, drink regular (good tasting) clear liquids until the nausea subsides. You can also try some ginger ale or ginger suckers. If you are having clear bowel movements, you may continue drinking only clears 4 hours before your procedure.

3) Drinking cold clear liquids can make you feel cold after a while. Be sure to have hot tea or hot soup broth as an alternative if you start to feel chilled.

-You may drink clear liquids up until 4 hours before your procedure. Do not get dehydrated! Clear liquids should not be red in color. Liquids that are not considered clear include milk, juices with pulp, etc. The nurse that calls you might tell you to “not drink after midnight”. Please disregard that and feel free to drink fluids up until 4 hours before your exam.

-You absolutely, positively, must have a responsible adult pick you up after the procedure. You will not be allowed to walk, bike or drive home after the procedure. The procedure will not be performed with sedation unless you have a ride home (we will, at your request, do an un-sedated procedure). Procedures cancelled due to lack of a ride, may incur a $200 fee (see cancellation policy below). Do not do anything that requires good coordination or judgment for the remainder of the day. This might even include using sharp utensils (knives) to prepare dinner that evening.

Results: Biopsy results will take a few business days to process. Dr. Burrows will call you when he has the results to discuss. Please only call us if you have not heard from us after 7 days to confirm that we have received your results.

Cancellation Policy: You must notify us of any cancellation, 48 hours prior to your procedure(s) unless other arrangements were made with Dr. Burrows. Any procedure cancelled with less than 48 hours notice will incur a $200 fee. Double procedures (EGD/Colon) will incur a $300 fee. You must call us directly at 303-320-1111 to cancel. Please do not assume the Surgical Center will contact us to cancel your appointment.

The price of a colonoscopy prep: We try to use the best colon prep medications on the market. They are hand selected to give you, the patient, the smallest volume and best tasting prep available. This sometimes means that the prep can be quite pricey (up to $90 dollars in some cases). We feel the added expense for the smallest volume prep and added comfort to our patients is well worth it. Some pharmacist may suggest a “cheaper” large volume prep like Golytely or Miralax. These typically still cost $20-$30 dollars but require consuming 128 ounces of prep medication compared to 10 ounces and lead to a very poor patient experience.

Patient Portal Use: We rely on and utilize a secure and efficient patient portal system. This system allows all our patients to review test results, communicate securely with our office, pay balances, get timely appointment reminders, change personal demographics, access educational sites and reschedule appointments, all from the comfort of your home and even outside of our normal business hours. It is one of the most advanced patient centered portals available in medicine and one that we are extremely proud of.