The dense
components of very high roughage foods such as
seeds and
some skins tend to layer out at the bottom of intestinal
segments
and thus may be more resistant to being flushed out
by
laxatives. In most cases the preparation fluids will flush out the
material anyway but an extra measure of assurance of obtaining an
optimal
preparation comes from avoiding these foods a few days.
We
recognize that it is likely that many will inadvertently eat
some of
these items and that’s okay. We would put a priority on
avoiding
the smallest densest seeds such those in tomatoes, kiwi fruit,
blackberries, and raspberries.
Iron
supplements in many people have a constipating effect,
making it
more difficult for the laxative to clean out the colon.
In
addition, retained iron frequently stains the walls of the colon
or the
fluid, limiting the clarity of views.
Even after
an excellent preparation for colonoscopy a certain
amount of fluid and
mucous is retained adhering to the walls
of the
colon. These will be tinted red or purple by natural and
artificial
dies in beets, fruit punches (Hawaiian Punch, e.g.), and
jello,
which can give an appearance similar to blood, which
increases
the difficulty in reaching clear conclusions during the
procedure.
Obtain the
clear liquids that appeal the most to you in the days
leading up
to the formal preparation day and have them well chilled
(as
appropriate). Most people find that they are much less hungry
than they
expected during the preparation day. Take the formal
laxative at
home as the time to its taking effect (“kicking in”) varies
greatly,
from 30 minutes to 4 hours. Extra fluids are encouraged.
Plan to do
light activities such as reading, watching videos, or simple
chores at
home.
I can’t
skip meals. The sugar and protein containing fluids (including
jello) can
sustain blood sugar very well for most people. Again in
many cases
patients who have had some trouble with “hypoglycemia”
in the past
find that their preparation for the procedure goes better
than
expected as the increased fluid intake that one hopes to
achieve
during colonoscopy preparation and a restful day (without
fluctuations in activity or meals) avoids the circumstances that usually
bring on
their symptoms. On very rare occasions where the above
advice
doesn’t work for a patient we’ve been able to in virtually
every case
design a customized eating plan at an office appointment
to get
through a successful colonoscopy preparation.
Beer and
white wine are indeed qualifying clear liquids and therefore
can be
taken during a colonoscopy prep in medically prudent amounts
(1-2
servings).
Advice about stopping and restarting oral
anti-coagulants
(warfarin/Coumidin)
is individualized and needs to come directly
from our
office. In most cases an office appointment will be
scheduled
to review the specifics of your medical history before
making the
final plan.
Patients on
these medications to treat a specific medical problem
will need
to have their history reviewed either by our scheduling
coordinator
or during an office appointment to get a specific plan
tailored to
their individual circumstance. After review sometimes
these
medications are continued.
If you
believe you have significant constipation or have been told
that your
preparation for prior colonoscopy wasn’t optimal, some
extra
preparation may be advisable. Please review your history with
our
scheduling coordinator, nurse, or with the provider at your
office
appointment.
In most
cases, yes, routine medications can be taken with a glass of
water up to
three hours prior to an endoscopic procedure. This will
often mean
waking up a little early and taking medications with clear
liquids
such as water, non-red juices/purple (no pulp), tea, black
coffee.
For those
with very early procedures an alternate plan is to bring
your
medication bottles to the endoscopy suite to be taken after the
procedure.
Yes, you
may continue to have water, soda ,non-red/purple juices,
tea, and
even black coffee up to 3 hours prior to the procedure.
You may
consume a small to moderate evening meal completing
it
prior to 9pm. The traditional NPO (nothing per os)
after midnight
works in
most cases but sometimes a large rich meal consumed at
10pm or
11pm at night will still be partially present in the morning
interfering
with the exam.
Once the
small to moderate solid meal has been digested, clear
liquids
such as water, non-red/purple juice, soda, tea, and black
coffee to
satisfy thirst are fine.
In general
the sedatives used do not have any effect the body’s
handling
(metabolism) of maintenance medications for most chronic medications. If you are taking sleeping , anti-anxiety, or psychiatric
medications your system may be some what more resistant to the
sedatives
which can usually be handled by raising the dose. The dose
of
maintenance medication and other categories (blood pressure,
diabetes,
gout, arthritis) need not be changed after an endoscopic
procedure has
been completed. Blood thinning medications such as
Warfarin, Coumadin,
clopidogrel bisulfate (Plavix), or aspirin are a
special
category and specific individualized advice is always needed
and is
usually covered in the post procedure discharge instructions.
