West chester g
WEST CHESTER G.I. ASSOCIATES
Procedure Date: _______/______/______
Bowel Preparation with Gatorade, Dulcolax & Miralax
□ DO NOT EAT OR DRINK ANYTHING 4 HOURS BEFORE YOUR SCHEDULED ARRIVAL TIME.
□ You must be accompanied by a friend or relative to drive and/or assist you home. We WILL NOT discharge you
cab, bus or other transportation service without
a responsible party with you. You may not drive for 12 hours following your
Materials You Will Need to Prepare For Your Procedure
□ Purchase at the Store:
8 oz. bottle (over the counter)
o Dulcolax Laxative
or Bisacodyl (generic) Laxative over the counter
64 oz. bottle No RED OR PURPLE
□ Clear Liquid Diet Instructions
(see attached Clear Liquid Diet Sheet)
Special Instructions Regarding Medications
□ Do Not
take Iron supplements
for one week prior
to the procedure date. Multivitamins are OK.
taking Coumadin/Plavix _____________ days prior
to your scheduled procedure date.
□ Diabetic patients
□ Do Not
take Lasix, HCTZ or Dyazide (water pill)
the day of the procedure
□ Heart/Blood Pressure/ Thyroid/Seizure/Nerve Medications can
be taken on the day of the procedure
with a sip of water.
□ Stop Effexor one day before
□ Asthmatic patients
should bring their INHALERS
with them on the day of the procedure
□ Other _________________________________________________________________
The Day Before Your Exam
□ DO NOT EAT ANY SOLID FOODS. YOU MAY ONLY HAVE CLEAR LIQUIDS UNTIL 4 HOURS BEFORE
YOUR SCHEDULED ARRIVAL TIME.
□ Take all of your normal prescription medications, unless advised otherwise.
□ You may go to work, but be home by 6 pm to begin your bowel prep.
□ Prepare the Gatorade® and Miralax
solution in the morning. Mix the entire 238g bottle of Miralax with the 64 oz bottle of
Gatorade® in a pitcher. Shake the solution until the Miralax is dissolved
, then place in refrigerator.
□ At 6 pm
– Take four (4) Ducolax Laxative
tablets with water.
□ At 6am (or earlier) on the morning of your procedure –
Begin drinking the Gatorade and Miralax
solution. Drink 8
ounces every 10-15 minutes - until the entire solution is consumed.
□ You must finish drinking this solution by 8 am.
□ WITH AN AFTERNOON PROCEDURE,
you may have CLEAR LIQUIDS
up to 4 hours prior to your Scheduled
Question about symptoms or medications call 484-356-1050 between 7:30 am- 3:30 pm (Nurse Line)
General or reschedule questions call 610-431-3122
If you reschedule, ask to see if you need new prep instructions.
______________________________________________________________________________________________________ Patient: Print Name Signature Date Gatora
PHYTOTHERAPY RESEARCH Phytother. Res. 18 , 687–695 (2004) Published online in Wiley InterScience (www.interscience.wiley.com). DOI : 10.1002/ptr.1575 REVIEW Zinopin® – the Rationale for its Use as a Food Supplement in Traveller’s Thrombosis and Motion Sickness J. H. Scurr1 and O. P. Gulati2* 1The Lister Hospital, Chelsea Bridge Road, London, UK 2Horphag Research, Avenue Louis-Cas
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