INSTRUCTIONS FOR AFTERNOON COLON MIRALAX PREP
YOU ARE SCHEDULED TO GO TO: ______________________________________ ON____________________AT: ________________A.M.________________ P.M. PROCEDURE WILL START AT APPROX: _____________ A.M. _____________P.M.
Inform your Doctor if you have had a heart valve replacement, blood thinning medication or insulin for control of diabetes. You MUST have someone drive you home from the procedure.
You will be given sedation for this procedure. DO NOT drive a car, drink alcohol, make any legal decisions or go to work for 12 hours after-wards. All follow up appointments will be scheduled for 1-3 months after the procedure. If the Doctor needs to reevaluate you sooner, the Nurse or Medical Assistant will inform the patient.
LIST OF CLEAR LIQUIDS
Apple Juice, White Grape Juice, Lemonade, Water, clear broth or bouillon, Coffee or Tea. Powerade, 7-UP, Gingerale, Sprite, Kool Aid, Plain Jell-O (no fruit or topping) and popsicles. Do not drink anything with the color “RED”, “GREEN” or milk products and powdered creamers.
PREPARATION INSTRUCTIONS
If you are taking Coumadin, Plavix, Persantine, Motrin, Ibuprofen, Aleve,
Aspirin, or Anti-inflammatory. If you’re not sure if your medications contain aspirin please call our office.
Tylenol is OK to take. Also, any vitamins with iron please discuss with your doctor or nursing staff. Please take all other medications through out the preparation, unless instructed by
Please stop the above listed medications on ___________________________. Please stop Coumadin on __________________________________________. Please stop Plavix on ______________________________________________.
What you need to obtain from the pharmacy:
TWO DAYS (2) BEFORE PROCEDURE / DATE: _____________________________. ⇒ Keep foods light and start drinking extra liquids ⇒ Take two (2) Dulcolax tablets before bed. ONE DAY BEFORE EXAM / DATE: ________________________________. ⇒ Drink only clear liquids this day. NO milk or dairy products, this includes non-dairy
creamer or dairy creamer, are allowed on this date. (See front page for list of clear liquids)
⇒ At 3:00pm take two (2) Dulcolax tablets. ⇒ At 5:00pm Mix the entire bottle of Miralax with 64oz of Gatorade or clear liquid
⇒ Divide the 64oz of Miralax in half. Place the remainder in the refrigerator. ⇒ Drink 8oz every 30 minutes until you have finished the entire 32oz of liquid. ⇒ Please drink plenty of fluids between the Miralax glasses. ⇒ At a.m. Drink the other 32oz of Miralax. Continue with clear liquid NOTHING BY MOUTH FOR 3 HOURS PRIOR TO YOUR PROCEDURE. DIABETIC INSTRUCTIONS
DAY PRIOR TO PROCEDURE: Check your blood sugar prior to taking any insulin.
If it is greater than or equal to 180mg/dl take ½ your normal dose. If it is less than 180mg/dl then HOLD insulin. If you take pills for diabetes, DO NOT take them the day prior or the morning of
Any questions please call: St. Pete Office 345-5500 Clearwater Office 447-3100 ATTENTION: PROCEDURE AND BIOPSY REPORTS ARE NOT AVAILABLE TO THE DOCTOR OR HIS STAFF FOR A MINIMUM OF 10 BUSINESS DAYS. PLEASE CONTACT YOUR INSURANCE COMPANY TO SEE IF AND WHAT YOUR OUTPATIENT SURGERY COPAYMENT WILL BE.
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