Procedure Instructions

This test is done during pregnancy to screen for gestational diabetes. To perform this test the patient must:

• Fast for 12 hours. You may drink water during this time and after drinking the glucose solution but nothing else.
• An initial blood test will be drawn to determine the fasting glucose level.
• You will then drink a solution containing 75 grams of glucose.
• Blood will be drawn again one hour and two hours after drinking the glucose.

• If possible, wear clothing without any metal—sweatpants, t-shirts, sports bras, etc. You are welcome to bring clothes in to change into or you can use a patient gown.
• No perfume please.
• DO NOT take calcium supplements the day of the exam—a multivitamin with calcium in it is ok. Please bring your calcium pill bottle, Vitamin D pill bottle and your multivitamin pill bottle(s) with you to your appointment. If you take Tums, please bring these as well.
• This scan CAN NOT be done if you are pregnant or if you have had a barium or iodine exam (such as a nuclear medicine scan, barium enema or barium swallow) in the past 7 days.
• Bring your prior DXA scans with you if they were not done here at Valley Medical Care.

Please follow the indicated guidelines for the test that has been ordered for you.

• Pregnancy Ultrasound -Please drink a minimum of 32 oz. of water 1 hour prior to your appointment. You must have a full bladder for your procedure or we will have to cancel and reschedule.We do not permit videotaping or audio recording of the procedure. Pictures of your baby will be given to you at the end of the exam. All cell phones must be turned off.

  There is a limit of 2 people you can bring to your ultrasound appointment. Keep in mind the sonographer needs to be able to concentrate as they are performing a diagnostic medical exam. If you are bringing children under the age of 7 with you, please bring another adult to assist them while you are having the procedure. If your guest cause too much distraction, they will be asked to leave the exam room.

• Abdominal Ultrasound – Nothing by mouth after midnight prior to your exam. This includes gum, cigarettes and coffee.
• Pelvic Ultrasound – You will need a full bladder. Drink 32 oz of water 1 hour prior to your appointment and don’t empty your bladder. *If your bladder is not full, your appointment may be rescheduled.
• Abdominal Aorta Ultrasound – Nothing to eat or drink after midnight prior to your exam. No cigarettes or gum.

PREPOPIK BOWEL PREP

YOU NEED TO PICK UP THE FOLLOWING ITEMS:

• Prepopik prescription
• Dulcolax tablets (4)

2 DAYS BEFORE YOUR COLONOSCOPY (Sunday):

• At 2 pm: take 2 Dulcolax tablets

ON THE DAY BEFORE YOUR COLONOSCOPY (Monday):

• Begin a clear liquid diet. Remain on clear liquid diet until after your colonoscopy. Acceptable clear liquids: bouillon, broth, consommé, tea, coffee, kool-aid, sports drink, crystal light, juice without pulp, popsicle, jello (avoid red)
• At 2 PM: take 2 Dulcolax tablets
• At 7 PM: mix 1 packet Prepopik with 5 ounces cold water, stir until dissolved (2-3 minutes).
• Follow with at least 40 ounces of clear liquid, more clear liquid is better. Finish clear liquids within 90 minutes

ON THE DAY OF YOUR COLONOSCOPY:

• 4 hours prior to your scheduled arrival time at Short Stay, take second dose of Prepopik (mixed in 5 ounces of water).
• Follow with at least 24 ounces of clear liquid.
• You can drink clear liquids until you leave for the hospital.

OTHER CONSIDERATIONS:

• You might want to have diaper cream or vaseline available for skin protection.

IF YOU ARE NOT PASSING CLEAR WASTE (clear like urine, not water) BY THE END OF THE PREP SCHEDULE, PLEASE CALL SHORT STAY AT 6:30 AM (907) 796-8423

You are scheduled for a Colonoscopy at Bartlett Regional Hospital. Same Day Surgery will call you between 10am and 6pm the day before your scheduled procedure to let you know what time you need to arrive as well as review your Pre-Anesthesia patient evaluation form.

You will need to obtain ONE of the following items at your local pharmacy:

• Prepopik (need to mix with water) OR
• Clenpiq (pre-mixed in bottles)

THE DAY BEFORE YOUR EXAM:

• You will need to be on a CLEAR LIQUID diet starting from the time you wake up until you go to sleep. NO SOLID FOODS during the entire day. Acceptable clear liquids are listed below. You may take your morning medications today.
• Drink plenty of clear liquids (except red or purple) throughout the day for hydration.
• 2PM drink one 5 oz cup (Prepopik) or one bottle (Clenpiq).
• Drink at least 5 glasses of clear liquids over the next 6 hours.
• 8PM drink another 5 oz cup (Prepopik) or one bottle (Clenpiq).
• You may continue drinking clear liquids until 6 hours before your colonoscopy. Please do not consume any liquids or medications 6 hours prior to your procedure time.

* If you are NOT passing clear waste by the end of the prep schedule (above), please call Same Day Surgery at 6:30 AM at (907) 796-8423.

ACCEPTABLE CLEAR LIQUIDS:

• Soups: clear bouillon, broth, or consommé
• Beverages: plain tea, coffee (without cream, milk, or sugar), Kool-aid, carbonated beverages, sports drinks, crystal light
• Juices: any juice that does NOT have pulp or nectar
• Snacks: popsicles, jello

* DO NOT consume clear liquids that are red or purple in color. The dye in the beverage may give the physician false readings.

OTHER CONSIDERATIONS:

• You might want to have Vaseline, diaper cream, or a similar product available for skin protection.

You are scheduled for a Colonoscopy with Dr. Mather at Bartlett Regional Hospital. Short Stay will call you the evening before your scheduled procedure to let you know what time you need to arrive as well as review your Pre Anesthesia patient evaluation form.

You will need to pick up CLENPIQ at your local pharmacy.

THE DAY BEFORE YOUR EXAM:

• You will need to be on a CLEAR LIQUID diet starting from the time you wake up until you go to sleep. NO SOLID FOODS during the entire day. Acceptable clear liquids are listed below.
• You may take your regular medications
• Throughout the day drink 64oz of clear liquid (except red or purple).
• 2PM take first dose of CLENPIQ
• 8PM take second dose of CLENPIQ
• Stop drinking clear liquids and do not take any medications 4 hours before your colonoscopy.

* If you are NOT passing clear waste by the end of the prep schedule (above), please call Same Day Surgery at 6:30 AM at (907) 796-8423.

ACCEPTABLE CLEAR LIQUIDS:

• Soups: clear bouillon, broth, or consommé
• Beverages: plain tea, coffee (without cream, milk, or sugar), Kool-aid, carbonated beverages, sports drinks, crystal light
• Juices: any juice that does NOT have pulp or nectar
• Snacks: popsicles, jello

* DO NOT consume clear liquids that are red or purple in color. The dye in the beverage may give the physician false readings.

OTHER CONSIDERATIONS:

• You might want to have Vaseline, Ron’s diaper cream, or a similar product available for skin protection.
• If you suffer from constipation and discussed this with Dr. Mather you should pick up Four Dulcolax tablets at the pharmacy. You will do the prep as described above but you will take 2 Dulcolax tablets 1 hour after each dose of CLENPIQ.

WASH YOUR HANDS THOUROUGHLY BEFORE AND AFTER CARING FOR THE CIRCUMCISION SITE

• After the first two hours (or after the first void, whichever is first) apply Vaseline on the sterile gauze to the tip of the penis to prevent it from sticking to the diaper.
• Cleanse daily by squeezing warm water over the end of the penis to loosen any drainage with cotton balls, gauze, or a clean wash cloth.
• Keep the penis clean of stool for several days.
• Call us if there is any redness, swelling (beyond normal post-circumcision swelling) on the glans or shaft, or if there is any yellowish drainage (such as puss). Please let us know if there is significant bleeding or irritation from the procedure. Ask your doctor how much is too much.
• Be aware of what the penis looks like after the healing and inform us if there are any changes that concern you.

• Do not eat or smoke for at east two hours before the test begins. The preceding meal should be light, without butter, cream, coffee, tea or alcohol.
• Get a good night’s rest prior to the treadmill test.
• Footwear appropriate for walking or running is essential.
  Men should wear gym shorts, Bermuda shorts, or a pair of loose fitting light trousers or sweatpants.
• Women should wear a brassiere that provides adequate support, a short-sleeved, loose-fitting blouse that buttons in the front, and slacks, shorts or sweatpants. No one-piece garments or pantyhose may be worn during the testing.
• Continue to take any prescribed medications unless otherwise instructed by your physician.
• Do not apply lotion or powder to skin prior to procedure

• Do not eat or drink for 2 hours prior to the procedure. Have a light meal prior. No coffee, tea, cream, butter or alcohol.
• You must be off all beta blocker medications for 24 hours prior to your exam. (Check with your doctor about your medications to see if you need to stop them prior to the test.)
• Wear comfortable clothing and shoes that are suitable for exercise.

What is colposcopy?
Colposcopy is the examination of a woman’s cervix and genital tissues with a special microscope called a colposcope. Colposcopy is done after an abnormal Pap smear to examine for abnormal growths or to rule out cancer. The Pap smear is a good screening test for disease but results can be incorrect up to 30% of the time. Colposcopy can predict more accurately the extent of disease on the cervix.

How is the procedure performed?
Your doctor will explain the procedure to you. Your legs then will be placed in stirrups (just like when you have a Pap smear). After the speculum is placed in the vagina, vinegar is applied to the cervix. The vinegar can cause some brief, mild burning. Abnormal tissue turns white with the vinegar and can be seen with the colposcope. If the tissue appears abnormal, the doctor will perform a scraping and biopsies. The scraping excludes disease in the canal of the cervix and only takes about 15 seconds. If biopsies, or little pieces of tissue, are to be removed from the outside of the cervix, the doctor may spray some numbing medicine first. The biopsies take just a few seconds, and then some brown iron solution is applied to the cervix to stop any bleeding. If a biopsy or scraping is done, you will be instructed to have no sex or anything in the vagina for two weeks.

How should I prepare for colposcopy?
You can take ibuprofen (Advil, Motrin, Nuprin) four 200-mg tablets with food, about 1 hour before coming to the office. The ibuprofen reduces the uterine cramping that can occur with the procedure. If you are pregnant please speak with your provider about taking any medications before the procedure. You may be asked to complete some paperwork just before the procedure. The entire visit takes 30 to 40 minutes, and you should be able to drive home immediately following the procedure.

Will my cervix be treated at the time of the colposcopy?
Some doctors choose to treat the cervix based on the appearance of the cervix through the colposcope; however, this can result in the overtreatment of many women. A more appropriate and cost-effective approach is to treat women based on the biopsy results obtained at colposcopy. The small pieces of tissue removed during the colposcopy procedure are examined at the hospital by a specialist physician called a pathologist. It takes about a week to get the biopsy results, and your doctor’s office will contact you when the results are available. If you require additional treatment, such as removal of extensive diseased tissue of the cervix, that can be performed at a follow-up visit. Because some mild changes to the cervix can be monitored without a surgical procedure, your doctor will want to talk to you after the results are reviewed.

You may have some cramping or discomfort following the procedure. You can take ibuprofen, three 200 mg tablets three times a day with food. Most women return to work several hours later, or the day after the procedure.

A brownish iron solution (called Monsel’s paste) was applied to your cervix to control any bleeding during the procedure. You may want to place an absorbent pad in your underwear to prevent staining. Please do not place a tampon in the vagina. Brownish drainage usually continues for several days after the procedure.

Please do not have sex (intercourse) for 2 weeks following the procedure. Do not place anything in the vagina during this time. Women often develop bleeding or spotting if they resume intercourse too early.

Infection is very uncommon following colposcopy. Call your doctor’s office if you have any fever, foul-smelling discharge, or heavy bleeding in the first few days following the procedure.

It takes about 1 week to get the results of the biopsy specimens taken during colposcopy. Your doctor’s office will contact you once the results are available.

The need for further treatment is determined by the results of the biopsies. Low-grade changes can sometimes be monitored closely, but high-grade changes almost always require some type of surgical treatment. Your doctor will discuss these treatment options with you.

“LEEP” is an abbreviation for loop electrosurgical excision procedure. It is a way to test and treat abnormal cell growth on the surface tissue of the cervix. LEEP may be recommended after abnormal changes in the cervix are confirmed by Pap tests and colposcopy biopsies. (Colposcopy is a non-invasive procedure in which a device similar to a microscope is used to view the cervix.) LEEP allows your physician to remove the abnormal tissue and test it for cancer.

Abnormal cell growth on the surface of the cervix is called cervical dysplasia. Though cervical dysplasia is not cancer, over time it can worsen and lead to cancer.

How is LEEP performed?
LEEP begins much like a regular pelvic exam. Though you will remain awake throughout the procedure, you should feel only minor discomfort. First, you will be asked to lie back and rest your feet in stirrups at the end of the examination table. A speculum will be inserted into the vagina and opened so that the cervix can be seen. (Positioning for loop electrosurgical excision procedure).

A solution is applied to the cervix to make the abnormal cells visible. Your physician then places a colposcope near the opening of the vagina. The colposcope, which remains outside of the vagina, provides a magnified view of the cervix.

The cervix is then numbed with local anesthesia. An electrically charged loop made of thin wire is inserted through the speculum and up to the cervix.

As the loop is passed across the cervix, it cuts away a thin layer of surface tissue, removing the abnormal cells. This tissue will be later tested for cancer or abnormal cells. Finally, a medicated paste is applied to the area to prevent bleeding.

How long does the procedure take?
The procedure takes 10 to 20 minutes to perform. You will be able to go home as soon as the procedure has been completed.

Are there other treatments for cervical dysplasia?
Yes. There are a number of ways your physician can remove abnormal tissue from the cervix. These methods include:

• Cryosurgery: The surface tissue is destroyed by freezing.
• Cold knife conization–Removal of a cone-shaped wedge of tissue from the cervix.
• Laser treatment or cone excision–Heat from a high-intensity beam of light is used to destroy or cut away abnormal tissue.

The treatment that is best for you will depend on factors such as the amount and location of the abnormal tissue.

Is LEEP safe?
Yes. LEEP is very safe. Complications are rare and the procedure can be completed without use of general anesthesia. However, there are some risks, such as infection and bleeding. Discuss any concerns you may have with your physician.

Preparing for your procedure

The procedure should be scheduled at a time you are not having your menstrual period. A pregnancy test will be done just prior to your procedure.

You should take Ibuprofen (Motrin) 600 mg one hour prior to your procedure if you are not allergic to ibuprofen to help reduce discomfort of the procedure.

Recovering at home
Vaginal drainage or spotting is normal for 1 to 3 weeks following the procedure. The medication paste will produce a greenish-yellow discharge immediately after the procedure. A brownish-black vaginal discharge is also normal.

Pads may be used for discharge. You should avoid placing anything in the vagina for 4 weeks, including tampons.

Your menstrual cycle will not be disrupted by this procedure.

Avoid excessive activity for 48 hours after the procedure. Refrain from exercising for at least 1 week. You can begin exercising again in 1 to 2 weeks. Stop exercising if bleeding other than normal menstruation occurs. If excessive bleeding occurs after you resume normal activities, call your physician.

Abstain from sexual intercourse for 3 to 4 weeks.

Showers are allowed.

Relieving discomforts
During your recovery, you may experience vaginal bleeding and mild cramping. To relieve abdominal cramping, take a non-aspirin, over-the-counter pain reliever such as ibuprofen (Motrin®, Advil®) or acetaminophen (Tylenol®).

When to contact your physician
Contact your physician if you experience any of the following symptoms during your recovery:

• Heavy bleeding (more than a normal menstrual flow)
• Bleeding with clots
• Vaginal discharge that has a foul odor
• Fever over 100.4 degrees Fahrenheit
• Severe abdominal pain

Follow-up Appointment
You should schedule a follow-up appointment for 10 days after your procedure.

• SHAVE ALL HAIR FROM THE SCROTUM. You may do this the evening before or on the day of the vasectomy. You may lather the scrotum with soap and water and shave with a safety razor.
• After shaving the area, thoroughly wash the penis and scrotum, then shower or bathe to remove all loose hairs. Wash the area again just before coming in for your vasectomy.
• Bring a scrotal support (jock strap or suspensory).
• Wear comfortable trousers.
• If possible, bring someone who can drive you home.
• Refrain from eating or drinking for three hours before your vasectomy.

NOTE: NO ASPIRIN PRODUCTS FOR 10 DAYS BEFORE SURGERY (includes Ibuprofen, Aleve)

• You are not sterile yet.
• You should not ejaculate or have sex for one week because it might blow out the scars.
• You are not sterile until you have had 15 ejaculations AND HAVE TWO NEGATIVE SPERM COUNTS approximately three days apart.
• Watch for infection (pus or redness), bleeding (hematoma), and severe pain. Call your physician if any of these occur.
• Do no more activity than slow walking for two days, or complications may develop.
• Wear a jock strap or jockey shorts for a week to support your testicles.
• Place an ice bag on your scrotum for 20 minutes every couple of hours today to reduce pain and swelling.

Please follow these instructions carefully, and your risks for complications will be reduced. Feel free to call for any questions or concerns.

BEFORE your procedure:
• For 21 days: DO NOT TAKE any herbal drinks or herbal supplements
  You may take vitamins, fish or flaxseed oil, calcium.
  You may drink black, green, white, peppermint, plain fruited or plain flower teas.
• For 14 days: DO NOT TAKE any Glucosamine.
• For 7 days: DO NOT TAKE any Ibuprofen (Advil, Motrin), Aspirin, Baby Aspirin (81mg) Aleve (Naprosyn), Excedrin, Feldene or Indocin. If you forget and take some, please let us know, it is possible that your procedure may have to be rescheduled due to the anticoagulatory (increased bleeding) effects of these drugs.
  You may take Tylenol (Acetaminophen)

If you are taking any medications, check with your doctor to see if you should take them the day of the procedure.

Please DO NOT drink any alcohol before or after the procedure. The medications used during the procedure to relax you may interact negatively with alcohol.

Please arrange for a person to drive you home after the procedure.