Download I need to learn about my upcoming colonoscopy

Date of Procedure: __________
Time: ________ Arrive: _______
Visit our website at www.mysummitgi.com for more information on your procedure and our medical practice
YOUR PROCEDURE: Colonoscopy
TAKES PLACE AT: Rose Surgical Center (Founders Building- 4700 Hale Parkway, Second Floor)
YOUR PREPARATION IS: SUPREP® or Prepopik®
1) PURCHASE YOUR PREP in the next 3 days.
2) THE DAY BEFORE YOUR EXAM- Wake up and begin consuming large quantities of clear liquids (ie: tea, juice,
Gatorade, Jell-O, Coca-Cola, black coffee, soup broth, soda, water, etc). DO NOT CONSUME ANY SOLID FOOD
TODAY (please, nothing red either, which can look like blood in your colon and no milk or juices with pulp).DO
NOT EAT BREAKFAST, LUNCH, OR DINNER!!!! Avoid only drinking water.
3) IF YOU ARE TAKING SUPREP® or Prepopik®- YOU WILL BE TAKING A DOSE OF THE PREPARATION
MEDICINE AT 6PM THE NIGHT BEFORE YOUR EXAM AND AGAIN, 5 HOURS BEFORE YOUR EXAM. YOU
MUST TAKE BOTH DOSES. You may refer to the instructions given separately. If there is any conflicting
information between the instructions on the prep packaging and in this packet, please follow this packet.
4) You may continue drinking clear liquids up to 4 hours before your procedure. Do not drink anything within 4
hours of your procedure or your procedure will be cancelled. It can be dangerous to have stuff in your stomach.
5) Your goal should be to be passing clear watery bowel movements by the time of your procedure. For urgent
questions regarding your prep, contact me directly on my cell phone at (303) 818-6823. PLEASE NOTE: You must
remain well hydrated during your entire prep or you risk serious and potentially permanent kidney damage.
6) PLEASE PLAN TO ARRIVE AT LEAST 60-90 MINUTES PRIOR TO YOUR EXAM. You will need a responsible
adult to pick you up after the procedure (you may not leave in a taxi cab by yourself). You will not be allowed to
drive yourself home or leave by yourself. You will be at the facility for a total of 2-2½ hours (from drop off to
pick-up).
You may continue all your medications except for Blood thinners, Xarelto, Coumadin, Plavix full strength (325mg)
Aspirin, or NSAIDS (Advil, ibuprofen, Aleve, Naprosyn).Most need to be stopped for 10 days. Please discuss with Dr.
Burrows if you are on diabetes medicines. You may continue to take a low dose baby aspirin (81mg).
Payment and rescheduling/cancellations:
Rescheduling or Cancellations with less than 48 hours notice will incur a $200 fee (single procedure) and a $300 fee
(double procedure) which is not covered by insurance. You are responsible for determining your financial obligation with
your insurance provider (deductible, co-insurance). You must contact our office to cancel or reschedule your procedure
(303)320-1111. Late arrivals are not tolerated. Please arrive earlier than an hour if you feel you may need more time to fill
out paperwork.
Prior to your procedure:
Please log on to www.rosesurgicalcenter.com to review pre-procedure paperwork and to fill out your patient
information (Passport). Click on “Online Pre-Registration” to register. If you do not have internet access, you will still be
able to do all this at the surgical center on the day of your procedure.
Other Information: In addition to myself, there will also be at least one nurse present who will monitor your vital signs
and assist me during the procedure. An EGD lasts about 10 minutes and a colonoscopy lasts about 25 minutes. After
completion, you will be brought into recovery for 30-60 minutes of and then discharged home with your responsible
adult. I will talk to you after your procedure; however, most people do not remember this conversation due to the
sedating medicines. Due to the scheduling of procedures, there will only be a few minutes to discuss the case
afterwards. You will have further opportunity to discuss this with me at a follow-up appointment or phone call if
necessary. You should not drive or do anything requiring good coordination and judgment until the following day.
What is a Colonoscopy?
The term "colonoscopy" means looking inside the colon. It is a procedure performed by a gastroenterologist, a welltrained subspecialist.
The colon, or large bowel, is the last portion of your digestive or GI tract. It starts at the cecum, which attaches to the
end of the small intestine, and it ends at the rectum and anus. The colon is a hollow tube, about five feet long, and its
main function is to store unabsorbed food products prior to their elimination.
The main instrument that is used to look inside the colon is the colonoscope, which is a long, thin, flexible tube with a
tiny video camera and a light on the end. The gastroenterologist can carefully guide the instrument in any direction to
look at the inside of the colon. The high quality picture from the colonoscope is shown on a TV monitor, and gives a
clear, detailed view.
This procedure also allows other instruments to be passed through the colonoscope. These may be used, for example,
to painlessly remove a suspicious-looking growth or to take a biopsy-a small piece for further analysis. In this way,
colonoscopy may help to avoid surgery or to better define what type of surgery may need to be done.
Why a colonoscopy?
Colonoscopy is recommended for evaluation of altered bowel habit, unexplained diarrhea, constipation or abdominal
pain, occult or frank blood in stools, colon polyps or cancer or unexplained anemia.
Colonoscopy is also an important way to check for colon cancer and to treat colon polyps - abnormal growths on the
inside lining of the intestine. Polyps vary in size and shape and, while most are not cancerous, some may turn into
cancer. Colonoscopy is often used to remove polyps, a technique called a polypectomy.
How Do I Prepare for the Procedure?
There are important steps that you must take to prepare for the procedure. First, be prepared to give a complete list
of all the medicines you are taking, as well as any allergies you have to drugs or other substances.
You will be given instructions in advance that will outline what you should and should not do in preparation for
colonoscopy. Be sure to read and follow these instructions. One very critical step is to thoroughly clean out the
colon, which, for many patients, can be the most trying part of the entire exam. It is essential that you complete this
step carefully, because how well the bowel is emptied determines the success of the procedure.
Often, a liquid preparation designed to stimulate bowel movements is given by mouth, which may cause bloating.
Additional approaches include special diets or the use of enemas. Whatever method or combination of methods that
is recommended for you, be sure to follow instructions as directed. And remember, you should not consume anything
within ~4 hours before your colonoscopy.
What Can You Expect During a Colonoscopy?
During the procedure, everything will be done to ensure your comfort. An intravenous, or IV, line will be inserted to
give you medication to make you relaxed and drowsy. The drug will enable you to remain awake and cooperative, but
it may prevent you from remembering much of the experience.
Once you are fully relaxed, your doctor will do a rectal exam with a gloved, lubricated finger; then the lubricated
colonoscope will be gently inserted.
As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is
introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or
no discomfort.
What are the Possible Complications from a Colonoscopy?
Although colonoscopy is a safe procedure, complications can sometimes occur. These include perforation - a puncture
of the colon walls, which could require surgical repair.
When polyp removal or biopsy is performed, hemorrhage (heavy bleeding) may result and sometimes require blood
transfusion or reinsertion of the colonoscope to control the bleeding. Be sure to discuss any specific concerns you may
have about the procedure with your doctor.
The time needed for colonoscopy will vary, but on the average, the procedure takes about 30 minutes. Afterwards,
you’ll be cared for in a recovery area until the effects of the medication have worn off. At this time, your doctor will
inform you about the results of your colonoscopy and provide any additional information that you need to know.
You’ll also be given instructions about how soon you can eat and drink.
What Can You Expect After Your Colonoscopy?
Occasionally, minor problems may persist, such as bloating, gas, or mild cramping. These symptoms should disappear
in 24 hours or less. By the time you’re ready to go home, you’ll feel stronger and more alert. Nevertheless, rest for the
remainder of the day. Have a family member or friend take you home.
How Colonoscopy Works
The colonocscope is
inserted in your anus and
gently guided to the
cecum, the first part of
your digestive tract.
Upon reaching the
cecum, your doctor can
guide the colonoscope
to view the entire area.
Upon finding something
suspicious, your doctor
can take a biopsy.
….or do a
polypectomy.
Pre-Endoscopy Tips, Expectations and Responsibilities
-We do everything we can to make your procedure comfortable and safe including employing
a highly skilled and caring staff, utilizing state-of-the art technology and using intravenous
pain medicines (fentanyl) and sedatives (versed, similar to valium). However, despite all of our
technology, these are still invasive procedures with risks. These risks include, bleeding,
infection, perforation of the intestine, and reaction to the medications. Typically, the benefits
of the procedure far outweigh the risks. You will have an opportunity to speak with Dr.
Burrows prior to the procedure to discuss any further concerns you may have.
-Our goal with pain and sedation medications is to make you as comfortable as possible during
the procedure, NOT to knock you out completely! However, most people do not remember
the procedure at all or remember only small amounts as if in a dream state. On rare occasions
during colonoscopies, people do experience significant abdominal cramping and pain. In the
end, we must balance the amount of medicine you receive with your cardiovascular safety. For
your safety, if you know that you are difficult to sedate, use supplemental oxygen, have been
diagnosed with sleep apnea or have allergies to narcotics, please let Dr. Burrows know so that
he can arrange an anesthesiologist to deliver the sedation medications at the procedure.
-The colonoscopy prep is typically the worst part of the colonoscopy. Some patients do
experience nausea, vomiting, bloating and cramping, with some symptoms quite severe. If you
are having difficulty with the prep, I suggest following these steps before calling your doctor.
1) Stop drinking the prep and take an hour break. Try taking a short walk (keep close to
the bathroom though!). Resume drinking the prep but at a much slower pace.
2) If you are still having nausea, drink regular (good tasting) clear liquids until the nausea
subsides. You can also try some ginger ale or ginger suckers. If you are having clear bowel
movements, you may continue drinking only clears 4 hours before your procedure.
3) Drinking cold clear liquids can make you feel cold after a while. Be sure to have hot tea
or hot soup broth as an alternative if you start to feel chilled.
-You may drink clear liquids up until 4 hours before your procedure. Do not get
dehydrated! Clear liquids should not be red in color. Liquids that are not considered clear
include milk, juices with pulp, etc. The nurse that calls you might tell you to “not drink after
midnight”. Please disregard that and feel free to drink fluids up until 4 hours before your exam.
-You absolutely, positively, must have a responsible adult pick you up after the procedure. You
will not be allowed to walk, bike or drive home after the procedure. The procedure will not be
performed with sedation unless you have a ride home (we will, at your request, do an unsedated procedure). Procedures cancelled due to lack of a ride, may incur a $200 fee (see
cancellation policy below). Do not do anything that requires good coordination or judgment
for the remainder of the day. This might even include using sharp utensils (knives) to prepare
dinner that evening.
Results: Biopsy results will take a few business days to process. Dr. Burrows will call you
when he has the results to discuss. Please only call us if you have not heard from us after 7
days to confirm that we have received your results.
Cancellation Policy: You must notify us of any cancellation, 48 hours prior to your
procedure(s) unless other arrangements were made with Dr. Burrows. Any procedure
cancelled with less than 48 hours notice will incur a $200 fee. Double procedures (EGD/Colon)
will incur a $300 fee. You must call us directly at 303-320-1111 to cancel. Please do not
assume the Surgical Center will contact us to cancel your appointment.
The price of a colonoscopy prep: We try to use the best colon prep medications on the
market. They are hand selected to give you, the patient, the smallest volume and best tasting
prep available. This sometimes means that the prep can be quite pricey (up to $90 dollars in
some cases). We feel the added expense for the smallest volume prep and added comfort to
our patients is well worth it. Some pharmacist may suggest a “cheaper” large volume prep like
Golytely or Miralax. These typically still cost $20-$30 dollars but require consuming 128 ounces
of prep medication compared to 10 ounces and lead to a very poor patient experience.
Patient Portal Use: We rely on and utilize a secure and efficient patient portal system. This
system allows all our patients to review test results, communicate securely with our office, pay
balances, get timely appointment reminders, change personal demographics, access
educational sites and reschedule appointments, all from the comfort of your home and even
outside of our normal business hours. It is one of the most advanced patient centered portals
available in medicine and one that we are extremely proud of.
The patient portal is easily accessed from our website: www.mysummitgi.com BUT, it does
require that you have access to your primary telephone number (the system will call you to
confirm that you are who you say you are!) and that you have your PIN number available
(generated by us during your first office visit or by calling us during normal business hours).
Once registered into the system, you will be able to change your PIN to something easy to
remember.
We would like to stress the importance of utilizing our patient portal system as it enables us to
keep costs down, speeds up the delivery of your important medical test results and creates a
convenient access point to interact with our office at any time of the day.
Please set up your access to the portal today and start experiencing more convenience and
efficiency for you.
Please remember to Log on to: www.rosesurgicalcenter.com to fill out your pre-procedure
paperwork. This will save you time on the day of your procedure.
Important Information about Your (the patient’s) Portion of Procedure Costs
There are several fees associated with any outpatient procedure:
1) The facility fee (the fee charged by the facility to do the procedure there). These
contracted fees vary with health plans but typically range from $2000-$3000.
2) The physician fee (the fee charged by Summit Gastroenterology/Dr. Aaron Burrows) is a
contracted fee with the health plan, and ranges from $200-$400.
3) There might also be additional charges for pathology specimens
processing/interpretation or an anesthesiologist (if required) and vary depending on the
procedure.
Please note, You may be responsible for a co-payment to the surgical center or to Dr.
Burrows for your procedure. Most insurance companies now require a co-payment for
outpatient services. In addition, if your plan has a deductible, your insurance company will not
cover the cost of the procedure until your designated deductible has been met.
Also, please be aware, some plans will not cover a screening colonoscopy if a polyp is found
during your procedure. Many plans consider the removal of a polyp medically necessary (and
no longer preventative) and therefore, co-pays, deductibles, etc, may apply, shifting the cost
to you. Please call the member services department of your insurance plan and check your
specific plan’s coverage before your procedure.
Both the surgical center and Dr. Burrows’ office will separately bill your health insurance
company for your procedure. Your insurance will then send us an explanation of benefits (EOB)
along with their payment. The EOB notifies us of any charges that are now your responsibility
and you are billed accordingly. Your prompt payment is greatly appreciated.
You are responsible for knowing your financial obligation with plenty of time to cancel or
reschedule the procedure (refer to cancellation policy above). If you cancel too late, you will
be charged the cancellation fee.
-If you have any questions regarding your procedure, the location, the prep, or anything else,
please contact us during normal office hours at 303-320-1111 or after-hours at 303-818-6823
(urgent issues only please). Please note: I am a part-owner of the Surgical Center at which you
will be having your procedure and I welcome feedback on your experience there!
VERSION 6/15/2015