Pezim Clinic

General information
Colonoscopy is a procedure in which the entire lining of the large intestine
(colon) is examined visually by means of a long flexible camera. If polyps
or other abnormalities are found in the bowel during the procedure, the
surgeon can often remove them through the instrument. Colonoscopy with
polypectomy is one of the most powerful tools we have available for cancer
prevention in modern medicine. The procedure takes from 15 to 45 minutes
depending upon degree of difficulty and what needs to be done. Intravenous
sedation is given to make the procedure better tolerated. While you will not
be put to sleep, you will be drowsy during the procedure and for a period
of time afterwards, so it is important that you arrange to be taken home by
a friend or partner and not drive for the remainder of the day. We strongly
suggest that a responsible adult be with you for the rest of the day and night.

Diet instructions

One week prior to the examination:
Avoid taking Metamucil or similar products, stop eating any foods that
contain nuts, fiber, poppy seeds, sesame seeds, kiwi, cucumber tomatoes or
any other type of small seeds.

The day before your procedure:
The day prior to the procedure you should have no solid food, only clear
fluids. A clear fluid item means that you can see through it when held up to a
light, i.e. water, clear tea, clear coffee (no milk or creamer), consommé soups,
Jell-O (avoid red Jell-O, and no toppings), pop, Gatorade, juices without pulp,
popsicles (no sherbets and no frozen fruit bars), etc. You may drink two cans
of a liquid meal replacement such as ‘Boost’ (available at the drugstore) on this
day if you are very hungry. Drink plenty of clear fluids, not just water. Avoid
milk. You may have hard clear candies.

Do not drink or eat anything with red or purple coloring: Red/purple food
coloring can leave a residue in the bowel that resembles blood. Keep this in
mind when purchasing Jell-O, Popsicles, hard candy, drinks, etc.

Preparing your colon for examination (bowel prep)
For your colonoscopy prep you may use one of the following preparations:

• Citromag prep
• Pico-Salax (Pergodan) prep
• Klean Prep (PEG, polyethelene glycol, Golytely)

Citromag prep

A few days before the procedure you must go to a drugstore and buy:

• Two (2) bottles of Citromag (300 mls each)
• One (1) small tube of Hydrocortisone cream 0.5%, you can apply this cream to the anal area if it gets sore during bowel preparation.
• You should consider buying some Gatorade and two bottles of “Boost.”

Make sure you buy the Citromag a few days before the procedure. It is
sometimes hard to find. You do not need a prescription for Citromag. The
cost is approximately $6.00 per bottle. Put the Citromag into the refrigerator
and chill. You will be using this product the day before your procedure.

The day before your procedure — At 8:00 A.M. drink the first bottle of
Citromag. It is easiest to drink a portion of the Citromag and then follow that
portion with some clear fruit juice. Repeat until the entire bottle of Citromag
is consumed. It is best to consume the entire bottle of Citromag within 90
minutes. This will cause you to begin having bowel movements. Continue on
a clear fluid diet and supplement with generous amounts of additional clear
juice, Gatorade or other clear fluids to prevent dehydration. Some patients
find that taking a Gravel tablet ½ hour prior to drinking the Citromag helps
prevent nausea. At 6 P.M. drink the second bottle of Citromag in the same
way as the first.

The morning of your procedure — You may drink clear fluids clear fluids
up to 4 hours prior to the procedure (avoid black coffee). Take all of your
normal medications with a sip of water in the morning unless instructed
otherwise. Most diabetics will have been instructed not to take their
diabetes pill on the morning of the procedure. It is better that your blood
sugar is a bit high than too low. Diabetic patients requiring insulin should
obtain specific instructions on how to manage their insulin from their
specialist. Once you are 4 hours from your procedure, you must remain
fasting. Nothing is to be taken by mouth, not even clear fluid.

Pico-Salax (Pergodan) prep
From a pharmacy pick up ONE package of Pico-Salax powder (the package
contains 2 packets).

The day prior to the procedure you should have no solid food, but you
must drink lots of clear fluids. One to two cups per hour of clear fluids is
recommended.

The day before your procedure — At 12:00 noon dissolve the contents of one packet into a mug with 150 ml (4 oz.) of cold water. Stir constantly for 2 – 3 minutes until all of the powder is dissolved. If it becomes hot, wait until it cools before you drink it.

At 6:00 pm the day before your procedure — Take the second packet the
same way that you took the first. Continue to drink clear fluids until you go
to bed (1-2 cups per hour). You may continue to drink clear fluids up until
4 hours prior to your procedure, at which point you must take nothing by
mouth until after the procedure.

Klean Prep (PEG, polyethylene glycol, Golytely)
Purchase Klean Prep from the drugstore

The day prior to the procedure you should have no solid food, but you must
drink lots of clear fluids.

The day before your procedure — At 12:00 noon, add the first packet of
Klean Prep to 750ml of cold water in the container provided, stir constantly
until it is all dissolved. Add 250 ml of any clear fluid. Drink one full glass
of the mixture every ten minutes until the entire litre is consumed. Drink
rapidly, do not sip slowly.

Take a break for one half hour then repeat the process for the second, third
and fourth packet of the Klean Prep.

You may continue to drink clear fluids up until 4 hours prior to your
procedure, at which point you should take nothing by mouth until after your
procedure.

Arriving at the Clinic
The Clinic is an allergy-free zone. DO NOT WEAR ANY PERFUME OR SCENTED
HAIR SPRAY OR LOTION/CREAM TO YOUR PROCEDURE. Do not apply body
cream on the day of your procedure.

You should arrive at the Clinic at 15 minutes before your scheduled
appointment. The Clinic is located in the Hycroft Building at the northwest
corner of Granville Street and 16th Avenue. There is pay parking below
the building (enter from alley off 16th Avenue). Do not wear jewelry (no
earrings, rings or bracelets), or contact lenses. Do not bring any valuables
with you to the Clinic. Please wear a tampon if you are menstruating.

Confirming or canceling your appointment
You must confirm your appointment 5 business days prior to your
appointment or your appointment will be given to another patient. If you
are unable to reach the Clinic by phone, please leave a message. In case

of sudden onset of illness, please call us to cancel as soon as you feel you
are not well enough to attend. If there is a reimbursement fee for your
procedure, it will have been discussed with you ahead of time. We accept
debit cards, cash, Visa, MasterCard and personal cheques.

© Pezim Clinic, Vancouver, British Columbia, Canada