Suprep bowel prep reviews

Colonoscopy Prep Tips

Men and women age 50 and over will get a doctor’s order for a colonoscopy prep. Here are my top tips from my best colonoscopy experience.

  • 4 days before prep, switch to a low residue diet. A low residue diet essentially includes foods that you spend most of your life avoiding because they are not part of a healthy eating plan. Think white bread, white rice, pulp-free juice, eggs. Drink water like you are preparing for a drought. Drink, drink, drink.
  • 3-4 days before prep, pick up your prep kit from the pharmacy. READ THE INSTRUCTIONS. If your doctor did not prescribe an anti-nausea medication, call the office to request a prescription. My doctor included 2 Zofran tabs with my SuPrep kit – lifesaver.
  • 3 days before prep, go shopping. I bought a 6-pack of Smart Water (contains electrolytes), Jell-O (no red or purple allowed), Italian ices (again, no red or purple allowed), hard candy (I like lemon), sugar-free gum, Gatorade, Sprite, apple juice, chicken bouillon cubes, drinking straws, a lime, and don’t forget a tube of Preparation H cream and baby wet wipes.
  • 2 days before prep, despite what your pre-procedure instructions say, (unless you have medical conditions then you should do what your healthcare provider tells you) make an early switch to a liquid diet. Yes, you are going to get hungry but you will survive. Yes, you can have coffee but no milk or cream. Whatever you do, don’t fall prey to people who encourage you to have “one last meal”. Repeat this mantra to yourself: anything I put in my body has to come out of my body in 48 hours. Keep drinking.
  • Day before prep, clear liquid diet. Dehydration is the enemy. It causes headaches, low energy, cramps, nausea and a bunch of other unpleasant symptoms. Staying well-hydrated will reduce your post-procedure recovery time.
  • Prep day, clear liquid diet. My doctor prescribed SuPrep for my second colonoscopy plus 4 Dulcolax tablets. This regimen was a million times better than the prep I was given for my first colo 5 years ago.
  • After you have taken Dulcolax and before you drink your first bottle of SuPrep, send your loved ones to a movie, a game, a play date, whatever it takes to assure that you have privacy for the next several hours.
  • When it is time for you to drink your first bottle of SuPrep you may worry that the taste will be terrible, or that you won’t be able to finish the bottle. Tell yourself “I can do this”. Mix the 6 oz. bottle with water in the 16 oz. cup that is provided with your kit.
  • I had researched this topic for days and combined tips from several web-based advisors. Use a fun glass (martini glass, beer mug, wine goblet, etc.) drink through a straw (as fast as possible without choking worked best for me), take a breath, and suck on a slice of lime, repeat. If the lime isn’t working for you, have a piece of hard candy or gum to cancel out the after-taste. Once you have finished the first bottle of SuPrep, give yourself a high five.
  • Settle in for the evening. You need quick access to a potty. Really quick, the warning can be very short notice.
  • Beer, wine, and spirits are not included in the colo prep category of clear liquids. I know some of you wanted to ask.
  • When it’s time for your second bottle of SuPrep, you may want to try adding some crushed ice and a splash of ginger ale, Sprite, or club soda to your 16 oz. cup of fun. Don’t forget your drinking straw. For me, faster was better, meaning the quicker I could gulp down the 16 oz. the better. Sucking on lemon-flavored lemon candies helped me chug the 32 ounces of water required to reach the finish line.
  • I wrapped up the prep party around 11:00pm and fell asleep for about 2 hours. Mother Nature called on me one more time and then I slept well until my alarm rang at 5:00am. After a quick shower and a 20 minute commute to the Endoscopy Center (nothing to eat or drink), the next few hours were a breeze. I completed a few forms, paid my co-pay, spoke with my doctor and his team. I had the best nap ever and woke up in post-op with my husband by my side. The doctor gave me a clean bill of health and praised me for my outstanding prep and the pristine condition of my colon. See you in 10 years!

To make the prep a little easier, try some of these tips:

  • Chill those fluids: To make bad-tasting liquids more palatable, keep them chilled in the freezer. Try flavoring them with Kool-Aid or Crystal Light.
  • Use a straw: Drink liquids through a straw placed far back on your tongue.
  • Drink soda: Carbonation can fool you stomach into thinking it’s full.
  • Try various kinds of soup broth: Strain vegetables or noodles and drink different kinds of soup broth.
  • Fool your stomach: Hard candies, popsicles and Italian ice can make you feel like you’re eating solid foods even when you’re not.
  • Subscribe to Netflix: Catch up on all those TV shows you never got around to watching. You can watch entire seasons in just one day!
  • Go to the library: Schedule some holds on books you have been wanting to read or movies you’ve been waiting to see. Give yourself something to look forward to, and that will make the prep day go faster.

There is power in positive thinking. You can do this! Making your colonoscopy appointment is a commitment to yourself and your family that you want to stay healthy. According to Harvard School of Public Health, about 40 percent of all colorectal cancers could be prevented if everyone had regular colonoscopies. Make your appointment for a screening, and let’s eliminate colon cancer together!

This information will help you get ready for your colonoscopy while you’re under care at Memorial Sloan Kettering (MSK) using a SUPREP® Bowel Prep Kit. Your doctor will give you a prescription for the kit.

A colonoscopy is an exam of your colon (large intestine). Your doctor will use a colonoscope (flexible tube with a camera on the end) to see the inside of your colon on a video monitor. During your procedure, your doctor can:

  • Remove a small sample of tissue (biopsy) for testing
  • Remove a polyp (growth of tissue)
  • Take photos of the inside of your colon

Follow these instructions carefully. It’s very important that your colon is empty for your colonoscopy. If there’s stool inside your colon, your doctor may not be able to see polyps or other problems inside your colon and you may have to repeat the procedure. If you have any questions, contact your doctor’s office.

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1 Week Before Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop taking. We have included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. Examples are listed in the “Common anticoagulants (blood thinners)” table. There are others, so check with your doctor if you’re not sure.

Common anticoagulants (blood thinners)
  • apixaban (Eliquis®)
  • cilostazol (Pletal®)
  • clopidogrel (Plavix®)
  • dalteparin (Fragmin®)
  • enoxaparin (Lovenox®)
  • fondaparinux (Arixtra®)
  • heparin
  • rivaroxaban (Xarelto®)
  • tinzaparin (Innohep®)
  • warfarin (Coumadin®)

Medications for diabetes

If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the day before and the morning of your procedure. Tell your doctor you will be drinking a sugar-free clear liquid diet the day before your procedure.

If you take metformin (such as Glucophage® or Glumetza®) or a medication that contains metformin (such as Janumet®), don’t take it the day before or the day of your procedure.

Tell your doctor if you have an AICD

Tell your MSK doctor if you have an automatic implantable cardioverter-defibrillator (AICD). If you have this device, you will need to have your procedure done at Memorial Hospital (MSK’s main hospital).

Get a letter from your doctor, if needed

  • If you have an automatic implantable cardioverter-defibrillator (AICD), you need to get a clearance letter from your cardiologist (heart doctor) before your procedure.
  • If you’ve had chest pain, dizziness, trouble breathing that’s new or worse, or have fainted in the last 6 weeks, you need to get a clearance letter from your doctor before your procedure.

Your MSK doctor’s office must receive your clearance letter at least 1 day before your procedure.

Follow a low-fiber diet

Fiber is a plant material that can’t be completely digested by your body. It’s healthy to include fiber in your usual diet, but eating too much fiber before your colonoscopy makes it hard for your doctor to see clearly during your procedure.

The week before your procedure, follow a low-fiber diet to help clean out your colon. While following this diet, don’t take any fiber supplements (such as FiberCon®, Metamucil®, Citrucel®, and Benefiber®). Eat low-fiber foods, and avoid foods that are high in fiber. For a list of foods you should and should not eat, read the “Low-Fiber Diet” section at the end of this resource.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. Make sure to plan this before the day of your procedure.

If you don’t have someone to take you home, call one of the agencies below. They will send someone to go home with you. There’s usually a charge for this service, and you will need to provide transportation.

Agencies in New York Agencies in New Jersey
Partners in Care: 888-735-8913 Caring People: 877-227-4649
Caring People: 877-227-4649

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3 Days Before Your Procedure

An endoscopy nurse will call you between 8:00 am and 6:00 pm 3 days before your procedure. They will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which medications to take the morning of your procedure. Use the space below to write them down.

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1 Day Before Your Procedure

Starting the day before your procedure, do not eat anything. Follow a clear liquid diet.

Follow a clear liquid diet

A clear liquid diet includes only liquids you can see through. Examples are listed in the “Clear Liquid Diet” table. While you’re following this diet:

  • Don’t eat any solid foods.
  • Try to drink at least 1 (8-ounce) glass of clear liquid every hour you’re awake.
  • Drink plenty of liquids other than water, coffee, and tea.
  • Don’t drink anything red, purple, or orange.
  • If you have diabetes, only drink sugar-free clear liquids and check your blood sugar level often. If you have any questions, talk with your healthcare provider.
Clear Liquid Diet
Drink Do Not Drink
Soups
  • Clear broth, bouillon, or consommé
  • Any products with particles of dried food or seasoning
Sweets
  • Gelatin, such as Jell-O®
  • Flavored ices
  • Hard candies, such as Life Savers®
  • Anything red, purple, or orange
Drinks
  • Clear fruit juices, such as apple, white cranberry, or white grape
  • Soda, such as 7-Up®, Sprite®, ginger ale, or seltzer
  • Gatorade®
  • Black coffee
  • Tea
  • Water
  • Juices with pulp
  • Nectars
  • Milk or cream
  • Alcoholic beverages
  • Anything red, purple, or orange

Note the time of your procedure

A staff member will call you after 11:00 am the day before your procedure. The staff member will tell you what time to arrive for your procedure. If you’re scheduled for your procedure on a Monday, you will be called on the Friday before. If you don’t receive a call, call your doctor’s office.

If you need to cancel your procedure, call the doctor who scheduled it for you.

‌ ​Write your appointment information below.
Scheduled arrival time: ____________________
Date: ____________________

SUPREP bowel preparation

You will drink a large amount of cool liquid for your SUPREP bowel preparation. This may cause bloating or discomfort in your abdomen (belly), nausea, or a headache. These things aren’t cause for alarm. If you have pain in your abdomen or vomit, call your doctor.

Do your SUPREP bowel preparation in 2 parts.

At 5:00 pm the evening before your procedure, start drinking the first part of your SUPREP bowel preparation. Start at 5:00 pm no matter what time you’re scheduled to arrive for your procedure.

  1. Empty 1 (6-ounce) bottle of SUPREP liquid into the mixing container.
  2. Add cool drinking water up to the 16 ounce line on the container. Mix.
  3. Drink all of the liquid in the container.
  4. Drink 2 more 16-ounce containers of water (32 ounces total) over the next hour. You don’t need to drink the water all at once, but it’s important to finish all 32 ounces over the next hour.
  5. After you finish all 32 ounces of water, you can keep drinking other clear liquids until 4 hours before your scheduled arrival time.

You will repeat steps 1 to 5 for the second part of your SUPREP bowel preparation. The time you start drinking the second part of your SUPREP bowel preparation depends on your scheduled arrival time.

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The Day of Your Procedure

If your scheduled arrival time is 11:00 am or later, remember to start drinking the second part of your SUPREP bowel preparation 5 hours before your scheduled arrival time.

Starting 4 hours before your scheduled arrival time, do not eat or drink anything. This includes water, hard candy, and gum.

Things to remember

  • Take only the medications you were instructed to take the morning of your procedure. Take them with a few sips of water.
  • Don’t put on any lotion, cream, powder, makeup, perfume, or cologne.
  • Remove any jewelry, including body piercings.
  • Leave valuable items (such as credit cards and jewelry) at home.
  • If you wear contacts, wear your glasses instead.

What to bring

  • A list of the medications you take at home, including patches and creams.
  • If you have an implanted pacemaker or cardioverter-defibrillator (AICD), bring your wallet card with you if it isn’t already on file with the hospital.
  • Your rescue inhaler (such as albuterol for asthma), if you have one
  • A case for your glasses
  • Your Health Care Proxy form, if you have completed one

Where to go

Your procedure will take place at one of these locations:

  • Endoscopy Suite at Memorial Hospital (MSK’s main hospital)
    1275 York Avenue (between East 67th and East 68th Streets)
    New York, NY 10065
    Take the M elevator to the 2nd Floor. Enter the Endoscopy Suite through the glass doors.
  • MSK Monmouth
    480 Red Hill Road
    Middletown, NJ 07748

What to expect

Once you arrive, you will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.

After changing into a hospital gown, you will meet your nurse. They will place an intravenous (IV) catheter into one of your veins, usually in your hand or arm. The IV will be used to give you anesthesia (medication to make you sleep) during your procedure. You may also get fluids through the IV before your procedure.

You will talk with your doctor before your procedure. They will explain the procedure and answer your questions.

You will also meet with your anesthesiologist. They will review your medical history with you and talk with you about the kind of anesthesia (medication to make you sleep) you will receive.

When it’s time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through a thin tube that rests below your nose. You will lay on your left side with your knees bent. You will get anesthesia through your IV, which will make you fall asleep.

Once you’re asleep, your doctor will examine your rectum. Next, they will place a colonoscope into your rectum. Your doctor will use air and fluid to move the colonoscope along the length of your colon while looking for anything unusual on the video monitor.

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After Your Procedure

In the Post Anesthesia Recovery Unit (PACU)

You will wake up in the PACU. Your nurse will continue to monitor your heart, breathing, and blood pressure. You may feel bloated and have stomach cramps. This is normal and goes away by passing gas.

Once you’re fully awake, your nurse will remove your IV. If you have someone waiting with you, your nurse will explain your discharge instructions to both of you before you go home.

At home

  • You can eat all of your usual foods after your procedure, unless your doctor gives you other instructions.
  • Don’t drink alcoholic beverages for 24 hours after your procedure.
  • You can go back to doing your usual activities 24 hours after your procedure.

If you had a biopsy, it’s normal to have a small amount of bleeding from your rectum. There should be no more than a few drops of blood, and the bleeding should stop within 24 hours after your procedure.

After a colonoscopy, it’s normal for your bowel movements to be irregular or different from your usual habits. This may last for up to a week after your procedure.

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Call Your Doctor or Nurse if You Have:

  • A temperature of 101° F (38.3° C) or higher
  • Severe stomach pain or hardness
  • Bleeding from your rectum that lasts more than 24 hours
  • Bleeding between bowel movements
  • Weakness, faintness, or nausea
  • Heavy bleeding from your rectum

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Contact Information

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at 212-639-2210. After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000. Back to top Arrow (up) icon.

Low-Fiber Diet

See the next page for examples of foods to eat and foods to avoid while you’re following a low-fiber diet.

Low-fiber foods to eat High-fiber foods to avoid
Grains
  • White bread
  • Plain crackers, such as saltines
  • Cooked cereals, such as cream of wheat or grits
  • Cold cereals, such as corn flakes or puffed rice
  • White rice, noodles, and pasta
  • Seeds, nuts, and coconut
  • Popcorn
  • Whole-grain products, such as pasta, cereals, crackers, and breads
Fruits and Vegetables
  • Well-cooked canned vegetables without seeds, such as asparagus tips, beets, green beans, carrots, mushrooms, spinach, seedless squash, and pumpkin
  • Cooked potatoes without skin
  • Ripe bananas
  • Melon, such as cantaloupe and honeydew
  • Canned or cooked fruits without seeds or skin, such as applesauce or pears
  • Avocado
  • Most raw vegetables
  • Most raw or dried fruits, such as pineapple, raisins, and figs
  • Certain cooked vegetables, such as peas, broccoli, winter squash, Brussels sprouts, cabbage, corn (and corn bread), onions, cauliflower, and potatoes with skin
Meats and Proteins
  • Lean and tender meats, such as beef, lamb, chicken, fish, and pork
  • Eggs
  • Beans
  • Lentils
  • Tofu
Snacks
  • Plain cakes and cookies
  • Gelatin, puddings, custard, and sherbet
  • Ice cream and popsicles
  • Pretzels
  • Vanilla wafers
  • Peanut butter
  • Jam, marmalade, and preserves
  • Popcorn
Drinks
  • Coffee and tea
  • Carbonated drinks
  • Milk
  • Apple juice, no-pulp orange juice, and cranberry juice
  • Strained vegetable juices
  • Fruit juices with pulp or seeds
  • Prune juice
  • Nectars

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Suprep

SIDE EFFECTS

Clinical Studies Experience

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in clinical studies of another drug and may not reflect the rates observed in practice.

In a multicenter, controlled clinical trial comparing SUPREP Bowel Prep Kit with a bowel prep containing polyethylene glycol and electrolytes (PEG + E) that were administered in a split-dose (2-day) regimen, the most common adverse reactions after administration of SUPREP Bowel Prep Kit were overall discomfort, abdominal distention, abdominal pain, nausea, vomiting, and headache; see Table 1, below. Less common Adverse Reactions occurring were AV Block (1 case) and CK increase. In this study, patients receiving SUPREP Bowel Prep Kit were limited to a light breakfast followed by clear liquids; patients receiving the PEG + E bowel prep were allowed to have a normal breakfast and a light lunch, followed by clear liquids.

Table 1: Treatment-Emergent Adverse Reactions Observed in at Least 2% of Patients on the Split-Dose (2-Day) Regimen

Table 2 shows the percentages of patients who developed new abnormalities of important electrolytes and uric acid after completing the bowel preparation with either SUPREP Bowel Prep Kit or PEG+E administered as a split-dose (2-day) regimen.

Table 2: Patients with Normal Baseline Serum Chemistry with A Shift to an Abnormal Value While on the Split-Dose (2-Day) Regimen

There were also 408 patients who participated in a study in which either SUPREP Bowel Prep Kit or PEG+E were administered in an evening-only (1-day) regimen. Higher rates of overall discomfort, abdominal distention, and nausea were observed with the evening-only (1-day) regimen compared to the split-dose (2-day) regimen for both preparations. Patients treated with SUPREP Bowel Prep Kit had increased rates of vomiting with the evening-only (1-day) regimen. An evening-only (1-day) dosing regimen was associated with higher rates of abnormal values for some electrolytes when compared to the split-dose (2-day) regimen for both preparations. For SUPREP Bowel Prep Kit, the evening-only (1- day) regimen was associated with higher rates of total bilirubin (high), BUN (high), creatinine (high), osmolality (high), potassium (high) and uric acid (high) than the SUPREP Bowel Prep Kit split-dose (2- day) regimen. Administration of SUPREP Bowel Prep Kit in an evening-only (1-day) dosing regimen is not recommended.

Read the entire FDA prescribing information for Suprep (sodium sulfate, potassium sulfate, and magnesium sulfate)

Facebook

  • Last week, Dr. Stassen boldly went where few men have gone before. My colon.
  • All kidding aside, this is serious (if scatological) stuff. If you are 50 or older, or have a personal or family history of colon cancer, colon issues, or polyps, consume more fat, red meat or less fiber than you should, or smoke cigarettes, you NEED to have a colonoscopy. Ask my friend JH, who at 33 (an unusually early age) was diagnosed with colorectal cancer, a diagnosis that could not have been made without paying attention and seeking a colonoscopy, prompting quick and thus far successful treatment. All kidding aside, this was a simple, pain-free, embarrassment free procedure that took one weekday morning (excluding the prep the night before) and included delightful anesthesia that made the entire procedure itself a distant murky non-memory.
  • Do it. Just Do it. And try to chuckle a bit when you fart.

COLONIC CLEANSING AND SUBSEQUENT SPELUNKING

It sounded innocuous enough: “Bowel Prep Kit.”

Sort of like a model kit, something you might use in pursuit of a hobby. The chemical compounds sounded a bit more daunting: “sodium sulfate, potassium sulfate and magnesium sulfate, Oral Solution.” A bit ominous, but don’t I recall sulfates saving lives in the Civil War or some such?

12 concentrated ounces of gastrointestinal terror
.

The simple description in the spiffy looking booklet that accompanied the stuff said “Osmotic Laxative” but the “Mechanism of Action” made me wish I had paid more attention in Dr. McGinn’s Chem lecture: “Sulfate salts provide sulfate anions, which are poorly absorbed. The osmotic effect and the associated cations causes water to be retained within the gastrointestinal tract.”

Retained water. Doesn’t sound too bad actually, maybe a bit puffy but not unpleasant. Then I read something called Sec 12.2 – Pharmacodynamics: The osmotic effect of the unabsorbed ions, when ingested with a large volume of water, produces a copious watery diarrhea.” Oh Boy. Fasten your (toilet) seat belts, it’s going to be a bumpy night.

Thus began the preparation for my latest visit to the colonoscopy center, for a morning of periodic routine colonic spelunking in search of Jimmy Hoffa, lost wristwatches or a polyp or two. Unlike Katie Couric’s much-televised downing of a full gallon of nasty stuff called (ever-so-euphemistically) “Go-Lytely” or Dave Barry’s hysterical review of his own tasty concoction (see http://bit.ly/bNlEcJ ) my good Irish tummy doc said of this new revolutionary prep: “It’s only 2 pints, 12 hours apart, and skimpy American pints at that.”

Ahh. How simple he made it sound. Let me say this: this stuff is effective.

My procedure was scheduled for early Wednesday morning, and my instructions were to begin a LOW fiber diet the preceding Sunday, no whole grains, seeds, nuts, legumes, gristle or in general any of the stuff that we are usually supposed to try to eat more of. Easy adjustment. Light meals were the norm till Tuesday, when I began a liquid diet, consisting mainly of chicken broth punctuated by lots of water, club soda and white grape juice. Till 5pm.

The little bottle sat sneering at me on the kitchen counter, practically tapping it’s little round bottom impatiently as the zero hour approached. I was dreading the taste, the texture and most of all the effect. I was prepared as I could be, having filled the fridge with chicken broth, clear liquids and juices, and stocked the john with super soft Charmin Quilted TP, Cottonelle Moist Wipes, Aloe Vera Baby Wipes (do not flush these), the new Details mag with Mark Ruffalo on the cover, an FM radio, charged iPhone (sort of a 21st century LifeAlert), and that copy of Moby Dick I’ve been meaning to read.

Deceptively simple.

I opened the bottle and took a whiff, and surprisingly, it smelled like berries or grapes. I poured the viscous clear liquid into the bottom of the plastic serving cup it came with, topped it off with 16 ounces of cold water and stirred. At 5:15pm exactly, I gulped about half, braced for the worst and found it really didn’t taste bad at all, sort of like child’s cough syrup, but not quite as sweet nor as syrupy. I swallowed the rest, then immediately followed it with a pint of cold water. I filled my pint glass again, and settled down with my laptop, just a few steps from the bathroom.

At first, I thought, this isn’t going to work. Nothing happened. I caught up on some emails, updated our menu at the pub, watched some public television show on photographer/explorer Seneca Ray Stoddard and his writings on the Adirondacks and wondered if I’d have to reschedule my procedure due to blockage. Then I heard that sound that people always describe when they are caught in the path of a tornado: a train, distant at first, then rumbling closer and louder and more insistent till I realized the sound was coming from inside ME.

Safety tip: Once you “pull the pin” on this intestinal hand grenade, be sure there is no obstacle between you and the throne.

I give the stuff 4 stars for “Easy,” 3 stars for “Taste” but the full 5 stars, plus a blue ribbon and the gold statuette for “Effective.” At “Drink Hour” +60 minutes I was becoming reacquainted with food I am pretty sure I ate in grade school. Do not plan to entertain guests nor even leave the house for the next couple of hours.

Helpful tip from the Department of Enormous Understatement

Mercifully, I was “finished” and so empty I echoed by about 9:15 or so. I stayed up a bit just in case (you do NOT want to be drowsy if this stuff has not finished it’s work) but dropped off to sleep by 11, with reasonable comfort. I set my alarm for 4am (five hours before the procedure was scheduled–ugh) to complete the second part of this diabolical cocktail. Same drill–shuffle sleepily into the kitchen, mix the remaining bottle with a pint of cold water, drink, then follow with 2 more pints of good ol’ H2O. I thought I might have an hour to rest my eyes, but be advised that part two works REALLY fast. Like 15 minutes fast.

By about 5 I felt like I had been flossed. Even the simple pleasure of farting was gone, replaced by a sound like a car backfire in an empty train tunnel. I was empty. I’m pretty sure if you shined a flashlight down my throat you’d see light out the other end. Good friend and “responsible adult required” Marty arrived a couple of hours later to drive me to the Austin Endoscopy Center, and I felt fine and pretty relaxed if empty and hungry.

Once there, the AEC staff was just excellent, friendly and cheerful and happier than anyone should be when starting your day faced with a room full of asses. I answered some medical history questions, donned an obnoxiously revealing and impossible to close backless gown, had an IV started as I lay on the gurney and I was wheeled in to the surgical “studio” replete with huge screen TV and a camera far longer than I cared to think about. I asked if I could tip the guy who sterilizes these things, and got a chuckle from all concerned.

I wore a cardboard cut out of Orlando Bloom’s ass into the O.R. and passed out eye shields to the surgical team, lest they turn to stone when my butt was revealed. Then a masked man wielding something called Propofol, aka “Milk of Amnesia” entered and…I woke up after what seemed like about 30 seconds later feeling like Dorothy looking at the ranch hands, wondering if it had all happened. Actually, I was in and out (so to speak) in about an hour, though I have no recollection of it at all. This is a good thing.

Propofol is a wonder drug, it turns on and off like a switch, easy to get you under and easy to wake up from, it left me feeling refreshed and not at all groggy. I DID feel inflated like Violet Beauregard however, as a result of all the air they pump in to get a better look at the ol’ mine shaft. This is something nature took care of fairly quietly, fortunately. Dropped off at home after a nice lunch with Marty I napped on and off and smiled knowing I’m off the hook for another 5 years.

I had to chuckle when I was tossing out the box that the SUPREP arrived in though.

Ha. That’s all I did for about 5 hours.

Colonoscopy with Suprep

Preparation

There are many things a person would rather do than undergo a bowel prep for a colonoscopy, but your efforts at cleansing your colon are essential for an accurate procedure. These instructions are designed to maximize the ease, safety and success
of your preparation. Please read these instructions carefully at least one week prior to your exam. Obtain SUPREP Bowel Prep Kit from your pharmacist (Note: this requires a prescription).

Medication and Diet Instructions:

SEVEN DAYS BEFORE THE PROCEDURE:

1. Stop taking aspirin (and aspirin-containing products) and Plavix (clopidogel). Acetaminophen (Tylenol) can be continued or substituted as a pain-reliever for aspirin.

THREE DAYS BEFORE THE PROCEDURE:

  1. Stop taking Coumadin (warfarin). If you have an artificial heart valve, you need to talk to your primary care physician or cardiologist about using an alternative anticoagulant.
  2. Stop taking anti-inflammatory medicines such as Aleve, Motrin, Advil, Ibuprofen and Naproxyn.
  3. Avoid eating nuts, seeds, popcorn, grapes, green peas, beans and tomatoes. Fibers from these foods can clog the colonoscope.

ON THE DAY BEFORE THE PROCEDURE:

You may have a regular breakfast. After breakfast, you will need to go on a clear liquid diet. You can drink clear liquids up to 2 hours prior to the appointment. Avoid juices with pulp such as orange or grapefruit juice. No dairy products,
cream or soy. Coffee and tea are O.K. Examples of clear liquids include broth or bouillon, Jell-O, clear juices (white grape or apple), sports drinks such as Gatorade or PowerAde, sodas such as Sprite, 7-Up, or gingerale, lemonade, Popsicles,
coffee or tea and of course, water. Avoid red or purple colored liquids. You may use sugar, honey or lemon. It is important that you drink as much fluid as you can throughout the day. It is also worthwhile to get a supply of aloe wet
wipes and Desitin ointment to ward off a sore bottom.

The SUPREP Bowel Prep Kit contains two 6-ounce bottles of liquid bowel prep and one 16 ounce mixing container. You must complete the entire prep to ensure the most effective cleansing.

BEGINNING AT: 5 TO 8PM

Step 1:

Pour ONE (1) 6-ounce bottle of SUPREP liquid into the mixing container.

Step 2:

Add cool drinking water to the 16-ounce line on the container and mix.

Step 3:

Drink ALL the liquid in the container.

Step 4:

You MUST drink two (2) more 16-ounce containers of clear liquid of your choice over the next 1 hour

If your colonoscopy is at 11am or earlier:
Beginning at 5am on the day of the exam, repeat steps 1 through 4.
If your colonoscopy is after 11am:
Beginning at 6am on the day of the exam, repeat steps 1 through 4.

DAY OF THE PROCEDURE:

  • Do not eat or drink anything for at least 2 hours prior to your appointment.
  • You must be accompanied by a friend or relative to drive or assist you home. You will not be allowed to drive for 12 hours after the procedure.
  • You should take your regular medications with sips of water unless you are instructed otherwise.

Special Instructions:

  • If you are a diabetic taking insulin, hold the morning dose of insulin the day of the procedure
  • If you have an artificial heart valve, or have a previous history of endocarditis, or other specific indication, your doctor may prescribe pre-procedure antibiotics.
  • Be sure to remember any allergies to medications and to Latex, or conditions that would make you sensitive to sedation such as sleep apnea syndrome.

Commonly asked Questions:

HOW DO I KNOW IF MY PREP IS ADEQUATE?

The stool should be watery in consistency. It does not have to be clear in color like water since digestive juices will continue to tint the stool yellow and small flecks of debris are not a problem as long as the stool is not muddy or thick. If
there is any question, you can self administer a fleet enema prior to leaving home for the procedure..

WHAT SIDE EFFECTS MAY I EXPECT?

Since the prep works by flooding the intestinal tract with fluid, abdominal bloating and cramping may occur, as well as some nausea and vomiting. This is usually temporary, and as the diarrhea develops, symptoms will gradually improve. Weakness
can also occur, especially if you have not taken enough fluid with the prep, and can be remedied by increasing fluid intake (especially with the sports drinks such as Gatorade or PowerAde).

WILL THE PREP INTERFERE WITH MY OTHER MEDICATIONS?

Medications taken at least an hour before beginning the prep should be adequately absorbed, but thereafter, they are likely to be washed away by the prep.

What if I have other questions?

Call our office to address any other concerns not answered here.

Beverly Hills Colonoscopy Instructions

Colonoscopy Prep

Dr. Nowain utilizes the latest in low-volume prep to make your experience more comfortable. The low-volume bowel preparation cleans the bowels, allowing the doctor to better visualize the bowel during your colonoscopy – lowering the risk of missing polyps.

PLEASE NOTE: In an effort to improve the quality of colonoscopy, the American College of Gastroenterology guidelines for colonoscopy recommend that bowel preparations be given in split doses (one dose taken the evening before your procedure and one dose taken the morning of your procedure) and that this regimen be considered the standard of care. Suprep is to be taken in split doses.

When Suprep is taken as directed, and the entire preparation is completed, it provides a successful bowel cleanse approximately 98% of the time. It is imperative that you complete the entire preparation.

Be sure to tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

5 Days Prior to Your Colonoscopy

Have your prescription for Suprep filled at your pharmacy.

3 Days Prior to Your Colonoscopy

Begin avoiding nuts, seeds, whole wheat bread, beans, corn, raw vegetables, or fruits with seeds or skin as they may adversely influence the quality of your exam. Discontinue these foods until after your procedure.

1 Day (24 Hours) Prior to Your Colonoscopy

Clear fluids ONLY. DO NOT have any solid foods, milk, or milk products. Nothing colored RED, PURPLE, AND PINK. No fruits, vegetables, cookies, crackers, or frozen concentrated liquids. No alcoholic beverages.

Clear liquids that are safe to consume include:

  • Water
  • Chicken broth
  • Soft drinks (Sprite, orange soda, ginger ale)
  • Strained fruit juices (without pulp): apple, white grape, or white cranberry
  • Limeade or lemonade
  • Kool-Aid (NO RED, PURPLE OR PINK)
  • Gatorade
  • Coffee or tea (DO NOT use any dairy or non-dairy creamer)
  • Gelatin desserts without added fruit or topping (NO RED, PURPLE, OR PINK)
  • Clear hard candies (example: Jolly Ranchers)
  • Popsicles (No sherbet or fruit bars with pulp)

STAY HYDRATED! It is important to drink plenty of liquids to help flush out your intestinal tract.

Evening Before Your Procedure

Begin at about 7:00 – 8:00 pm (1st Dose):

  • Step 1: Pour ONE 6-ounce bottle of SUPREP liquid into the mixing container.
  • Step 2: Add cool drinking water to the 16-ounce line on the container and mix.
  • Step 3: Drink ALL the liquid in the container.
  • Step 4: You MUST drink two (2) more 16-ounce containers of water over the next 1 hour.

Day of Your Colonoscopy

Five hours before your procedure, repeat steps 1-4 from the previous night using the second bottle of Suprep.

You cannot drink anything in the four hours before your colonoscopy. It is very important that your stomach be empty for the anesthesia to be safely administered.

Before the colonoscopy, let Dr. Nowain know about:

  • Any health conditions
  • Allergies (medications, etc.)
  • Previous surgeries (especially in the abdominal region)
  • Medications you are currently taking

Please provide Dr. Nowain with a list of medications (over the counter and prescribed) – along with the dosages – you are currently taking, including:

  • Herbal supplements
  • Aspirin
  • Vitamins
  • Recreational drugs
  • Insulin or pills for diabetes
  • Arthritis medicine
  • Blood thinners or heart medicine
  • Vitamins that contain iron

Dr. Nowain may ask you to avoid blood thinning medication. However, Tylenol® is OK to take.

Your Colonoscopy Appointment

A colonoscopy takes about 30 minutes, but you should expect to be at the facility for about two to three hours. Upon arrival, you will go to a private area where a nurse will take your temperature, pulse, and blood pressure. They will also hook you up to some monitors and insert an IV. Next, you will meet your anesthesiologist and speak with Dr. Nowain before the procedure to go over any last questions you might have. The anesthesiologist will administer your sedation to ensure that you are comfortable and stable throughout the procedure. The anesthetic ensures that patients are safe and that they do not remember or feel anything during the procedure.

Once you are under anesthesia, a clean and lubricated scope is gently placed in your rectum. A tiny camera on the end sends video to a high definition TV screen so the doctor can see the inside of your colon. We prefer carbon dioxide to ambient air because patients experience significantly less bloating or discomfort after the procedure. The scope blows carbon dioxide into your colon, enlarging the space and making it easier to steer the scope to view the colon. The scope is moved all the way to where the colon meets the small intestine.

If Dr. Nowain sees anything (like a polyp or an area that looks abnormal) he’ll remove it and/or take a sample for pathology. Bleeding complications are rare (<1%), but should they occur special instruments and medications can be used to stop the bleeding. The scope is then slowly backed out of the colon for a second look, and finally, gently removed, concluding the procedure.

After Your Colonoscopy

Patients return home the day of the procedure. Because of the after-effects of anesthesia, you will need someone to drive you home. A responsible adult needs to come into the surgery center to sign you out. Taxi, Uber, or other ride services that will not come inside to sign them out will not be allowed. After the procedure, Dr. Nowain will talk with you about his findings and show you images of your colon should you wish to see them. If any biopsies, polyps, or samples were taken, you will set up a follow-up appointment one week after your procedure to go over your results.

We use carbon dioxide gas to distend the colon because this gets absorbed very quickly and patients rarely wake up feeling bloated or uncomfortable. Dr. Nowain always attempts to remove as much gas from your colon as possible, so that you do not come out of your procedure feeling excessively bloated. If you had IV sedation, you may feel a little groggy. You’ll need to rest for an hour or so until you’re fully awake, however, the anesthesia is very short acting and only the appropriate dose to ensure your comfort is used. In recovery, you’ll be watched closely and may be administered fluids through your IV.

You’ll want to take it easy for the remainder of the day after your colonoscopy. You may feel bloated, gassy, or have mild cramps, but most people do not. Be sure to drink plenty of water.

Make sure to contact the Center for GI Health if you experience:

  • A fever of 100° F or higher
  • Excessive pain, bleeding, or large blood clots when you go to the bathroom.
  • A swollen, firm, or tender belly

If you have any other questions about your colonoscopy, feel free to contact our Beverly Hills gastroenterologist at (310) 997-4044.

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