COLONOSCOPY PREPARATION INSTRUCTIONS CITRATE OF MAGNESIA **ALL CANCELLATIONS AND RESCHEDULE MUST OCCUR FIVE BUSINESS DAYS IN ADVANCE**

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1 COLONOSCOPY PREPARATION INSTRUCTIONS CITRATE OF MAGNESIA DATE OF COLONOSCOPY: Time: **ALL CANCELLATIONS AND RESCHEDULE MUST OCCUR FIVE BUSINESS DAYS IN ADVANCE** Why is the colonoscopy prep or bowel prep important? How well you do your colonoscopy prep will determine how well the doctor will see the lining of your colon and predict the time of your next colonoscopy (much sooner than current guidelines if the bowel prep is inadequate). Providing your doctor with accurate information about your health, medications and understanding the bowel prep instructions are your responsibility throughout the entire colonoscopy process. Please do not wait until the day prior to the procedure to read the instructions and do not hesitate to contact our office if you have any questions. What will you need to purchase? (These are found in the laxative section at the drugstore and you do not need a prescription.) 1) Two 10oz bottles of Citrate of Magnesia. You may use lemon or lime flavor. 2) Dulcolax 5mg tablets. 3) Follow tips and instructions given in the office. What to avoid prior to the colonoscopy prep? 1. DO NOT CONSUME ANY RED FRUIT JUICES OR JELLOS. 2. DO NOT USE FOR 7 DAYS PRIOR: Iron, Gingko, Flaxseed, Fish Oil, Hemorrhoid Ointment, Prescription Laxatives (such as Lactulose or Sorbitol). Do I take my medications the morning of the procedure? Hold all diuretics and diabetic medications until after the procedure (*see instructions for diabetics below). Be sure to take cardiac or blood pressure medications with a small sip of water 3-4 hours prior to your schedule time. (If you do not take diabetes medications, you may skip to the next page) *Instructions for diabetics: DIABETICS should alter diabetic medication during their preparation for colonoscopy and monitor sugar frequently. Type 1 diabetes: Please consult your doctor. Type 2 diabetes: Please follow medication instructions below: Half the dose of diabetes medications the day prior to the procedure while on the clear liquid diet. Do not take diabetes medications the day of the procedure; take them after you have the procedure and start eating. Monitor blood sugar frequently the day before the procedure and the morning prior to the procedure.

2 When will the colon preparation start? 3 DAYS BEFORE THE COLONOSCOPY: 1. Review the preparation instructions and plan your dietary needs for the next two days. 2. Confirm your ride. 2 DAYS BEFORE THE COLONOSCOPY: 1. Follow a Low Residue diet (See attached page for details). 2. Drink plenty of fluids to stay hydrated. The more clear liquid (water) you drink, the better hydrated you will be. Drinking plenty of fluids will help keep you hydrated for the IV insertion at the time of your procedure and help you tolerate the colonoscopy preparation better. 1 DAY BEFORE THE COLONOSCOPY: 1. Follow a CLEAR LIQUID DIET for breakfast, lunch, and dinner: Water, tea, coffee (without milk or cream), clear fruit juices, clear soups or bouillon, carbonated beverages, Jello, and Gatorade. No crackers, cream, eggs, or solid foods (See attached page for details). 2. Take one 5mg Dulcolax tablet by mouth in the morning. 3. STARTING AT 5:00 PM ON THE DAY BEFORE YOUR COLONOSCOPY, do not eat anything. Eating during this stage of your bowel prep creates fecal material that makes it difficult for your doctor to inspect the lining of your colon. a. Drink the first bottle of Citrate of Magnesia at 5:00 PM. Try to drink it within minutes. It tastes better chilled and you may flavor with a SUGAR FREE drink mix such as Crystal Light. b. Take second Dulcolax 5mg tablet by mouth after finishing the first bottle. 4. Continue to drink plenty of water the rest of the night. The more liquid you drink the better the laxative will work and will help keep you hydrated for the IV insertion at the time of your procedure. DAY OF THE COLONOSCOPY: 1. Drink the second bottle of Citrate of Magnesia 4 hours prior to your scheduled procedure time. Try to drink it within minutes. 2. Drink (3) three 8oz portions of clear liquid after finishing the second bottle of citrate of magnesia. The more liquid you drink the better the laxative will work and will help keep you hydrated for the IV insertion at the time of your procedure. 3. You must STOP DRINKING ALL FLUIDS 3 hours prior to your scheduled procedure time. Remain fasting until after the procedure. 4. DO NOT USE: Chewing gum, candy/mints, or smokeless tobacco 3 hours prior to your procedure. 5. Medications: Hold all diuretics and diabetic medications until after the procedure (*see instructions for diabetics on page 1). Be sure to take cardiac or blood pressure medications with a small sip of water 3-4 hours prior to your appointment. 6. Report to the office or outpatient center at the time instructed. 7. You will need someone to drive you home after the procedure.

3 TWO DAYS PRIOR TO PROCEDURE Low Residue Diet Options FOODS TO CHOOSE: Breads and Starches White bread, roll, biscuit White rice or noodles Plain crackers Potato rolls Skinless cooked potato Pretzels Puffed rice, Rice Krispies Meat Skinless chicken Skinless turkey Skinless seafood Fruit Applesauce Soft honeydew or cantaloupe Canned fruit without seeds or skin Ripe banana Vegetables Cooked or canned vegetables without seeds (Example: green beans, carrots, potatoes) Desserts Vanilla Wafers Sherbet Animal Crackers Other Eggs Chicken noodle soup without vegetables Margarine, mayonnaise, mustard All items included on the clear liquid diet FOODS TO AVOID: Breads and Starches Whole wheat breads, cereals, crackers, rolls Whole wheat pasta Brown or wild rice Breads or cereals with nuts, seeds, or fruit Buckwheat Cornbread Pumpernickel bread Meat Tough fibrous meats Fruit Other raw fruits Prunes or prune juice Raisins and dried fruit Berries Vegetables Raw or partially cooked vegetables Corn, Brussels sprouts, cabbage, broccoli, onions, cauliflower, beans, peas, winter squash, sauerkraut Desserts Those with nuts, seeds or fruit Other Nuts, seeds, popcorn

4 ONE DAY PRIOR TO PROCEDURE Clear Liquid Diet *Clear liquids are more than just water and lemon- lime soda. The variety of liquids that qualify as clear may surprise you; they usually include the following: Water (the original clear liquid) Chicken or beef bouillon/broth (low sodium) Flavored drink mix (lemonade, lime, orange flavors only) Frozen ice pops or Italian ice (no ice cream, sherbets, or fruit bars) Fruit juices as long as they are strained, without pulp (apple, white grape, white cranberry, orange, and lemonade, for example) Gelatin (lemonade, lime, or orange only: no fruit or toppings) Hard candies, as long as they are not red or purple Soft drinks (orange, ginger ale, cola, and lemon- lime soda, for example) Tea or coffee (no milk or non- dairy creamer) NOTE: Do not drink or eat anything colored red or purple and skip alcoholic beverages while you prep.

5 Outpatient Surgery Hints and Checklist 1. Follow the directions about eating and drinking; take your morning medications as directed by the doctor. 2. Wear loose fitting, comfortable clothing Sweats, button down front blouse/shirt, no corsets, girdles, or panty hose. Remove any nail polish. Leave valuables such as jewelry or money at home. 3. Bring the following: o Insurance Card o Driver s license or form of ID o Current list of medications and their dosages o Current list of allergies o List of any previous problems with anesthesia, surgery, blood transfusions or medical problems 4. You can expect to be at our office from 1-3 hours, depending on your procedure and recovery time. 5. Make arrangements for someone to drive you home after your procedure although you will be kept in a recovery area until all effects of the anesthesia have disappeared, someone must drive you home as a necessary safety precaution. Directions Our Harrisonburg facility is located at 30 Boyers Road, Harrisonburg, VA Route 1 1. Take I- 81 North 2. Take Harrisonburg exit 247- A and merge on to 33 East towards Elkton. 3. Continue straight on 33 East to Boyers Road (2 stop lights past the Golden Coral) 4. Our office is located on the corner of 33 East and Boyers Road on the right. 5. Turn right at stoplight for Boyers Road and then take immediate right into SVG parking lot. Route 2 1. Take I- 81 North 2. Take Weyers Cave exit 235. Turn right off the exit onto Weyers Cave Road. 3. Turn Left at 1 st stop light onto Keezletown Rd. (VA- 276) 4. Continue straight to US Turn left onto 33 West. 6. Turn left at 2 nd stop light for Boyers Road and then take immediate right into SVG parking lot.