You should arrive for your procedure(s) at:
Day:
Date: _______________
Time: _______________
Your Procedure has been scheduled with:
 Dr. Son Do
Advanced Gastroenterology, PLLC
 Dr. Samuel Sim
2415 NE 134th St., Suite 205
Vancouver, WA 98686
Your Procedure has been scheduled at:
Ph: (360) 576-5060
Fax: (360) 576-1133
Legacy Salmon Creek Hospital
Special Procedures/Surgery-2nd Floor
2211 NE 139th Street
Vancouver, WA 98686
HalfLytely
COLONOSCOPY PREPARATION
INSTRUCTIONS
APPOINTMENT DATE: ____________
___
Southwest Washington Medical Center
Same Day Surgery – Endoscopy
400 NE Mother Joseph Place
Vancouver, WA 98664
Medication Instructions for GI Procedures
Special Instructions for Coumadin/Diabetic Medications:
□
Coumadin/Plavix:
Your last dose should be taken on ________________.
At the time of your procedure, your doctor will tell you
when to restart the Coumadin/Plavix.
□
Diabetic Pills:
Do not take your diabetes pills the day of your
procedure. You can take ½ the dose of your diabetes
pills the day before the procedure.
□
Insulin:
On the day before your test: Take your regular dose in
the morning. That night, take ½ your regular dose.
On the day of your test: Do not take any insulin.
Make sure to take your blood sugar that morning
and report it to the nursing staff as they prepare
you for your procedure
Allowed Medications:
Medications you take for the following conditions should
be continued as usual on the day of the procedure. These
should be taken with a small amount of water, 4 hours
before your arrival time.
Heart Problems
High blood pressure
Fluid retention
Female hormones
Thyroid disorder
Depression or anxiety
Asthma/emphysema
Stomach ulcer or excess acid
Seizure disorder
NOT Allowed Medications:
Ibuprofen/Motrin
Advil/Aleve
Ticlid
Plavix
Celebrex
Aspirin
Preparation Instructions for Colonoscopy
with HalfLytely®
360-576-5060
Appt. Date ____/____/____ Check-in Time: ____:____ AM/PM
Mon Tues Wed Thur Fri Sat Sun
Mon Tues Wed Thur Fri Sat
Sun
*Stop all aspirin & anti-inflammatory
products.
*Purchase:
1-HalfLytely® Bowel Prep Kit
The pharmacy will require a prescription to
purchase the HalfLytely®.
Mon Tues Wed Thur Fri Sat Sun
Continue your low fiber diet
Mon Tues Wed Thur Fri Sat Sun
*A.M.: Start your low fiber diet. Page 4
section A is a list of the foods you can eat.
Mon Tues Wed
Thu
Fri Sat Sun
*A.M.: Start your clear liquid diet. Page 4
section B is a list of clear liquids you may have.
*12:00 P.M.: Take 2 bisacodyl tablets with
water. Do not chew or crush. Do not take the
tablets within l hour of taking an antacid.
Mon Tue Wed Thu Fri Sat Sun
_____:____ You CANNOT have anything
else to eat or drink until your procedure is
completed.
_____:_____ Check-in time
*6:00 P.M.: Mix the solution. Add water to top
of line on bottle, cap bottle & shake to dissolve
the powder. Mixture will be clear and colorless.
*Drink 1-8oz glass every 10 minutes (about 8
glasses). Drink each glass quickly. Drink all of
the solution. Do not add anything else, such as
flavorings, to the solution.
Important: Concern for your safety makes us insist you have someone to drive you home. If you have not arranged for a driver, the procedure
will be postponed. You will be ready to go home about 3 hours after your arrival. Your driver will need to come into the Endoscopy Center to pick
you up. Taxi or C-Van is not allowed unless you are escorted by a friend or family member. You will not be allowed to drive for 24 hours.
Section A: Permitted Low Fiber Diet
Suggestions:
Meats-Poultry, Beef, Fish, Pork
Dairy-NO CHEESE-including cottage cheese and cream cheese
Pasta-NO RED SAUCE
Rice-White Only
Eggs
Banana-NO other fruits allowed
White Bread
Condiments/Spices and beverages
~Any other LOW FIBER foods are permitted~
Do not have any of the following foods during this period: Popcorn, seeds,
nuts, multi-grain bread, salad, cheese, fruits, vegetables or high-fiber foods
Section B: Clear Liquid Diet
Please select clear liquids from the following list, omitting any RED or PURPLE items:
Water
Soft drinks (orange, ginger ale, cola, Sprite, 7-Up, etc.)
Sports drinks/Gatorade/Powerade
Kool-Aid
Strained fruit juices without pulp (apple, white grape, white cranberry, orange, lemonade,
etc.)
Tea or coffee (no milk or nondairy creamer)
Low-salt chicken or beef bouillon/broth
Hard candies
Jell-O (lemon, lime or orange; no fruit or toppings)
Popsicles, Italian ice ( no ice cream, sherbets, or fruit bars)
*DO NOT DRINK ANYTHING RED OR PURPLE IN COLOR
*DO NOT DRINK ANY ALCOHOLIC BEVERAGES
Colonoscopy Preparation “Frequently Asked Questions”
Is there any way I can make this taste any better?
You can try sucking on hard candy. You can rinse your mouth with water or a mouthwash. Do not eat or drink anything
while you are drinking the solution. Try drinking the solution with a straw.
Why avoid red & purple liquids?
The red & purple color can persist in the colon & potentially look like blood. However, cranberry juice is permitted since
it is a natural red color.
I feel like vomiting & don’t think I can drink anymore. What can I do?
It is important that you continue to drink the solution if at all possible. Without a clean bowel, the doctor will not be able
to see the inside of your colon to complete the examination. If you experience nausea, wait 15 minutes & resume drinking
slowly. If you do vomit, wait 45 minutes & begin drinking the solution again. Try sipping the solution with a straw.
I drank a lot of the solution & I have not gone to the bathroom yet. What should I do?
Keep drinking. Most people have a bowel movement after an hour. Some patients may take 2 hours or longer.
I am taking the prep & now have loose, watery stool. Do I still need the rest of the prep?
Yes, you may have solid stool higher in the colon that needs to be eliminated.
I already have diarrhea prior to taking the prep. Do I still have to take the prep?
Yes, you must take the prep as directed. Your colon is approximately 6 feet long. The entire colon must be emptied for
Dr.Do to see the colon clearly.
I see yellow color in the toilet bowl & a few flecks. What do I do?
If you have finished the entire solution or if your last bowel movements were clear enough that you were able to see the
bottom of the toilet, you should be fine.
My bottom is sore. What can I do?
When cleaning the area, avoid rubbing, gently pat with a wet washcloth or moist baby wipes. You may also apply
Vaseline.
Can I drink alcoholic beverages?
Do not drink any alcoholic beverages prior to your procedure since they can cause dehydration.
Can I chew gum or suck on candy?
Yes, but nothing with soft centers or red color.
Can I brush my teeth?
Please do.
Can I wear my dentures?
Yes, you may wear your dentures to the Endoscopy Suite. However, you may be asked to remove them depending on the
procedure you are having.
I have been instructed not to take aspirin products, anti-inflammatory medications or blood thinners for several
days prior to the procedure. What can I take for headaches & pain relief?
You may take Tylenol.
Can I have the colonoscopy done if I have my menstrual period?
Yes, the procedure can still be performed. We ask that you use a tampon if possible (not absolutely necessary).
Why do I have to stop taking aspirin, anti-inflammatory medications & blood thinners?
Some medications (prescription & over-the-counter) can reduce the body’s ability to form blood clots & taking these
before a colonoscopy procedure may increase your risk of bleeding if a polyp needs to be removed.