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Patient Instructions

Instructions

Colonoscopy Preparation


Dr.Whelan utilizes  a ONE and a half DAY BOWEL PREPARATION for most of his patients. A clean colon allows the doctor to see the lining of your colon well. The colon must be completely clean for the procedure to be accurate and complete. Therefore, you must carefully read and perform the bowel preparation as outlined below. If you have any questions after reading the following material please call (212) 434-4860

MEDICATION

It is important that you continue to take your usual medications throughout this bowel preparation. If possible aspirin, motrin and other non-narcotic analgesics should be avoided for five days prior to the colonoscopy. If a doctor has prescribed the aspirin for you, please call and ask that physician if you can safely stop taking the medication before the colonoscopy. If you are taking any kind of blood thinners (Coumadin/Lovonox), IT IS IMPERATIVE THAT YOU CONTACT THE ABOVE NUMBER AND THE PRACTITIONER WHO PRESCRIBED the blood thinner for specific instructions. If you are a diabetic who takes insulin, you may want to adjust your insulin doses when you stop taking solid foods. If you have any questions regarding diabetic management, you should consult your internist or family practice physician.

TWO  DAYS BEFORE THE COLONSCOPY

You should STOP eating all solid food after lunch (1pm to 2pm).

1) At 2:00pm take two dulcolax ( bisacodyl 5mg)  pills. No prescription required.

2) Anytime from 4pm to 6pm drink 1 bottle of magnesium citrate.

Although you should NOT eat solid food, it is important to consume an adequate number of calories in the form of CLEAR LIQUIDS. Clear liquids include fruit juices, tea, coffee (without milk), water, soda, vitamin waters, gatorade, Jell-O, (not red or orange), broth or  popsicles. NO MILK or MILK PRODUCTS like ice cream. Please do NOT have anything that is RED or ORANGE.

 ONE DAY BEFORE THE COLONOSCOPY

 Continue drinking clear liquids ONLY.

1) At 10 am you should start the prescription bowel preparation. Mix according to directions. Drink 1/2 the bottle over the next 2 hours.  Take a break and then start drinking the second half around 2pm.  This will result in multiple bowel movements. Commit to the fact ahead of time that you will need to be in or near the bathroom for 4-6 hours.

It is very important that you continue to drink plenty of clear liquids in addition to the bowel prep, throughout the day. 

If you need to work the day before, we can adjust the time schedule a bit. Please call and speak with the Nurse Practitioner. 

Some helpful hints to get you through include:

  1. Refrigerating may help, but if you prefer it at room temperature that is okay too.
  2. If you get bloated during the process, stop for some time and then resume.
  3. If you find the last unpleasant, sucking on limes, lemons, or sour ball candies before and after every drink may help.
  4. Apply Vaseline to the rectal area as needed to prevent soreness.

THE DAY OF THE COLONOSCOPY

You can continue to drink clear liquids up to 5 hours before  the examination, DO NOT eat SOLID FOODS.

The procedure will be done at:

West Side GI, 619 West 54th Street

New York, NY 10019

You MUST BE escorted home on the day of the examination by a friend or relative over the age of 18 years. Conscious sedation is often given to make the exam more comfortable; consequently, it may take several hours to wear off. THE EXAM MAY BE CANCELLED IF YOU COME ALONE. YOU MUST ARRIVE AN HOUR BEFORE YOUR APPOINTMENT TIME.

 

 

 

Appointment Date:                                                                

 

Appointment Time:                                                                

*You must arrive one hour before your scheduled time.

2 Day Abdominal Surgery Preparation

Two Day Bowel Preparation

It is very important that the colon and rectum be clean before surgery.

We utilize a combination of Miralax  (polyethylene glycol powder ) and Duccolax  ( bisacodyl) 5mg pills. These are over the counter products.  You will need to purchase one 238 gm bottle of the Miralax and one small box of the Duccolax  which contains at least 4 tablets and one 10 ounce bottle of magnesium citrate. You will also need to purchase a 64 ounce bottle of gatorade, no red or purple. 

There will be two prescription antibiotics to take the day before surgery as well. 

You will also be given chlorhexidine soap to wash with before the surgery.

Please carefully read and perform the bowel preparation as outlined below. If you have any questions after reading the following materials please call (212)434-4860.

2 DAYS BEFORE SURGERY

Stop eating all solid foods. Clear liquids  include fluids that you can see through:  fruit juices, tea, coffee (without milk), water, All types of sodas, all jello except (RED) broth and popsicles… No Milk or Milk products like ice cream or cheese, no orange juice..

 It is important that you continue taking your prescription medicines during this time.  

If you take insulin on a daily basis please check with your regular practitioner about how to manage your diabetes while the bowel preparation is in progress.

At 4pm you should drink a bottle of Magnesium citrate. This is an over the counter laxative which is the first part of your bowel preparation.

THE DAY BEFORE SURGERY

Continue with only a clear liquid diet. No solid foods, no milk or milk product.

At 10 am take 2 duccolax (bisacodyl ) pills.

At 1 pm mix the entire bottle of Miralax or the generic equivalant, with 64 ounces of gatorade and  begin drinking the preparation.   Drink one 8 ounce glass every 15 minutes until finished.  

Be sure to drink additional clear liquids after you finish the prep.

At 4pm take 2 duccolax (bisacodyl) pills. 

The prep will result in several liquid bowel movements. Be sure to continue to drink clear liquids through out the day so you do not become dehydrated. 

You will have been prescribed two antibiotics which should be taken as follows: 

Neomycin sulfate 500mg: take 2 pills at 3pm, 7pm and 11pm

Metronidazole 500mg: take 2 pills at 3pm, 7 pm and 11pm. 

The evening before surgery you need to wash with the chlorhexidine.

MORNING OF SURGERY

Wash with chlorhexidine soap the morning of surgery.

You may continue to drink clear liquids up to 3 hours before the surgery. ( For example, if your surgery is scheduled for 10 am, you may drink clear liquids until 7 am)Please drink one 16-24 ounce  bottle of gatorade or powerade during this time. If you are a diabetic, use the sugar free solution. 

 

 

 

 

 

 

 

 

 

 

 

1 Day Preparation

You should STOP eating all solid foods the day before your surgery. You may have only clear liquids including fruit juices tea, coffee (without milk), water, soda, jello, broth, popsicles. No milk or milk products.


It is important that you continue taking your prescription medicines during this time. If you take insulin on a daily basis please check with your regular practitioner about how to manage your diabetes while the bowel preparation is in progress.

The bowel preparation is not a prescription. You will need to buy one 238 gram bottle of miralax. At the same time you should also one 64 ounce bottle of gatorade and one 16- 24 ounce bottle of gatorade or powerade.  

At 1pm mix the entire bottle of miralax with the 64 ounce bottle of gatorade. Drink one 8 ounce glass every 15 minutes until finished.  This will produce frequent watery bowel movements. 

Be sure to drink additional clear liquids during and after the prep to avoid dehydration. 

Two prescription antibiotics will have been ordered for you.   Please take them as follows: 

Neomycin sulfate 500mg:  take 2 pills at 3 pm, 2 pills at 7pm and 2 pills at 11pm.

Metronidazole 500mg: take 2 pills at 3pm, 2 pills at  7pm and 2 pills at 11pm. 

In the evening and in the morning before surgery use the Chlorhexidine soap to wash with. 

The day of surgery you should drink a 16-24 ounce bottle of gatorade or powerade 3-4 hours before your surgery.  If you are a diabetic, be sure to use the sugarless product. You may have clear liquids up to 3-4 hours before the surgery.  

 

Anorectal Preparation


It is very important that the bottom part of the rectum be clean before surgery. The rectum is normally filled with stool, which bacteria in it. This stool must be cleaned out so that the surgeon can visualize the lining of the rectum. Therefore, you must carefully read and perform the bowel preparation as outlined below. If you have any questions after reading the following materials please call (212) 434-4860

Abdominal Surgery Post Operative Instructions

Once the surgery is over, you play a large role in your own recovery. Complications from immobility after surgery can include pneumonia, blood clots, and prolonged ileus (intestinal immobility). You will be expected to take an active role in your care by doing the following:

Coughing and Deep Breathing Exercises

Pain from the incision along with lying in bed will prevent you from taking deep breaths and expanding your lungs completely. By coughing and deep breathing, you can help to prevent post operative pulmonary complications such as post operative pneumonia

You will be given a tool called an incentive spirometer which will help you do this. The spirometer has a mouth piece which you place in your mouth and then inhale as if you were sucking on a straw. This should be done in one long deep breath and it should be repeated 10 times every hour.

Coughing is important to rid your lungs of any fluid accumulation. The correct way to do it is to take a deep breath and cough on the exhale. Holding a pillow or your hands over your incision for support will help decrease the discomfort while coughing.

Ambulation

Walking after surgery is very important for your recovery. It helps prevent blood clots and also helps promote normal bowel function.  Walking will help to stimulate peristalsis and also help relieve gas pain. You can expect to get out of bed, at latest, the day after surgery. Depending on the type of surgery and time of day you are scheduled, you may be out of bed the same day.

Pain Medication 

You can expect to have some discomfort at the surgical site.  We will help you get through this by prescribing anti inflammatory medications as well as narcotic pain relievers.  We encourage very judicious use of the narcotics, as these can slow down the recovery of bowel function and prolong your general recovery. 

Diet

Anorectal Post Operative Instructions

Please read theses instructions very carefully. Follow the instructions as closely as possible. If you have any questions, please do not hesitate to call the office at (212) 434-4860.

Wound Care

Starting the morning after your surgery, you should begin taking “Sitz Baths”.  A sitz bath is simply soaking your bottom in warm water. You may use a regular bath tub or a commercial product that fits in the bowel of your toilet. Sitz baths increase the blood circulation in your anal area, which will help the healing process and make you feel more comfortable. This should be done at least three times a day and after each bowl movement.

 Each sitz bath should last about 15 minutes.

After the bath, carefully pat your bottom dry do not rub. It will also help to place a gauze pad over (not inside) your anus after these baths, or you may also use a sanitary napkin to protect your underwear and absorb discharge.   Using a hair dryer set on low to blow dry can also be effective in making you more comfortable.

Pain management

Toradol ( ketorolac) is a very potent nonsteroidal anti inflammatory.  You will take one pill (10 mg each) every 6 hours for the first 3 days.  You should take it on a regular basis as it will help prevent the pain. DO NOT take ibuprofen or aspirin or other NSAID with it, as it can cause bleeding or irritate your stomach. Likewise, if you have a history of a gastric ulcer please make sure you let us know. 

Percocet ( oxycodone) is a narcotic pain medication.  You may need this for pain together with the toradol, however it can be very constipating.  Try not to take it unless you really need it.   

Flagyl ( metronidazole) is an antibiotic that has been shown to have anti inflammatory properties  in hemorrhoidectomy patients.  You may have a prescription for this as well. 

Bowel Movements

It is very important that you do not get constipated after surgery. If you have a full rectum, you will have more pain.  

The following laxatives are to be taken on a DAILY basis and do not require a prescription:

Colace ( ducosate sodium) 100 mg capsules, take 2 pills (200 mg) twice a day. 

Mineral oil, 1 tables spoon nightly before bed. 

Fiber such as metamucil, citrucel or benefiber, take one tablespoon 2 or 3 times a day in a full 8 oz glass of water. 

If you do not have a bowel movement (bm) by the 3rd day after your surgery you should stop taking the narcotic and do the following:  

Take 2 tablespoons of milk of magnesia first thing in the morning. If you still do not have bm by the evening, repeat the dose. If you have not had a bm by the next day you need drink 1/2 a bottle  of magnesia and repeat the second 1/2 the following day.  

Please call the office at any time if you are having problems and speak to one of the providers.  If you develop any fever > 101, difficulty urinating or persistent bleeding, you must notify us immediately.

The first post op appointment is generally 7-10 days after surgery and should be scheduled with the nurse practitioner. 

Incision & Drainage of Abscess Instructions

 

 

 

 

 

Care after the incision and drainage

A pressure dressing has been applied to control any bleeding immediately after your procedure. This can be removed 8 hours after the procedure. However, if you need to have a bowel movement before that you may remove the dressing at that time.

After the dressing has been removed it is important to sit in a sitz bath with warm water for 5-10 minutes. This should be done at least three times a day and after each bowel movement for 7-10 days. You can either use your bathtub or a portable sitz bath which can be bought at any pharmacy.

After each bath gently pat the area dry and use a piece of gauze or sanitary pad to absorb moisture. A small amount of drainage is to be expected.

It is important to keep your bowel movement soft and easy to pass. You should take Colace 100mg 2 pills twice a day, and a soluble fiber such as Metamucil, or Citrucel one tablespoon twice a day.

Take pain medication as directed. Do not drive or operate machinery if taking a prescription pain medication.

Call our office for any of the following

Persistent rectal bleeding, Increased pain or difficulty urinating or a temperature over 100 F.

Dietary / Exercise Recommendations for Colon Cancer

Dietary and Exercise Recommendations Regarding Colon and Rectal Cancer


Researchers and physicians have long suspected a link between diet and lifestyle and the development of Colon and Rectal Cancer (CRC). For example, dietary fiber has been thought to be protective whereas red meat is thought to promote cancer development. Despite some suggestive evidence, it has proven very difficult to obtain the data needed to firmly verify these suspicions.* The World Cancer Research Fund/ American Institute for Cancer Research Continuous Update Project (WCRF/AICR CUP) continually tracks the published evidence regarding a number of different types of cancer. In recent years they have released a series of recommendations and guidelines for each cancer type based on the available data. When their experts believe there is sufficient evidence regarding a number of dietary items or lifestyle behaviors they release an updated report which incorporates these changes. This past spring the WCRF/AICR CUP updated their findings and guidelines for CRC. Their recommendations, which follow, are based on a review of 1,012 published studies.

Instructions to Follow Before Rectal and Colon Surgery

Colonoscopy Preparation


Dr.Whelan utilizes  a ONE and a half DAY BOWEL PREPARATION for most of his patients. A clean colon allows the doctor to see the lining of your colon well. The colon must be completely clean for the procedure to be accurate and complete. Therefore, you must carefully read and perform the bowel preparation as outlined below. If you have any questions after reading the following material please call (212) 434-4860

MEDICATION

It is important that you continue to take your usual medications throughout this bowel preparation. If possible aspirin, motrin and other non-narcotic analgesics should be avoided for five days prior to the colonoscopy. If a doctor has prescribed the aspirin for you, please call and ask that physician if you can safely stop taking the medication before the colonoscopy. If you are taking any kind of blood thinners (Coumadin/Lovonox), IT IS IMPERATIVE THAT YOU CONTACT THE ABOVE NUMBER AND THE PRACTITIONER WHO PRESCRIBED the blood thinner for specific instructions. If you are a diabetic who takes insulin, you may want to adjust your insulin doses when you stop taking solid foods. If you have any questions regarding diabetic management, you should consult your internist or family practice physician.

TWQ  DAYS BEFORE THE COLONSCOPY

You should STOP eating all solid food after lunch (1pm to 2pm).

1) At 2:00pm take two dulcolax ( bisacodyl 5mg)  pills. No prescription required.

2) Anytime from 4pm to 6pm drink 1 bottle of magnesium citrate.

Although you should NOT eat solid food, it is important to consume an adequate number of calories in the form of CLEAR LIQUIDS. Clear liquids include fruit juices, tea, coffee (without milk), water, soda, vitamin waters, gatorade, Jell-O, (not red or orange), broth or  popsicles. NO MILK or MILK PRODUCTS like ice cream. Please do NOT have anything that is RED or ORANGE.

 ONE DAY BEFORE THE COLONOSCOPY

 Continue drinking clear liquids ONLY.

1) At 10 am you should start the Nulytely preparation; you should have been given a prescription for this, which can be filled at any pharmacy. Mix according to directions. Drink 1/2 the bottle over the next 2 hours.  Take a break and then start drinking the second half around 2pm.  This will result in multiple bowel movements. Commit to the fact ahead of time that you will need to be in or near the bathroom for 4-6 hours.

It is very important that you continue to drink plenty of clear liquids in addition to the bowel prep, throughout the day. 

If you need to work the day before, we can adjust the time schedule a bit. Please call and speak with the Nurse Practitioner. 

Some helpful hints to get you through include:

  1. Refrigerating may help, but if you prefer it at room temperature that is okay too.
  2. If you get bloated during the process, stop for some time and then resume.
  3. If you find the last unpleasant, sucking on limes, lemons, or sour ball candies before and after every drink may help.
  4. Apply Vaseline to the rectal area as needed to prevent soreness.

THE DAY OF THE COLONOSCOPY

You can continue to drink clear liquids up to 5 hours before  the examination, DO NOT eat SOLID FOODS.

The procedure will be done at:

West Side GI, 619 West 54th Street

New York, NY 10019

You MUST BE escorted home on the day of the examination by a friend or relative over the age of 18 years. Conscious sedation is often given to make the exam more comfortable; consequently, it may take several hours to wear off. THE EXAM MAY BE CANCELLED IF YOU COME ALONE. YOU MUST ARRIVE AN HOUR BEFORE YOUR APPOINTMENT TIME.

 

 

 

Appointment Date:                                                                

 

Appointment Time:                                                                

*You must arrive one hour before your scheduled time.

2 Day Abdominal Surgery Preparation


It is very important that the colon and rectum be clean before surgery. Therefore, you must carefully read and perform the bowel preparation as outlined below. If you have any questions after reading the following materials please call (212) 434-4860.  

1 Day Preparation

You should STOP eating all solid foods. You may have only clear liquids including fruit juices tea, coffee (without milk), water, soda, jello, broth, popsicles….no milk or milk products like ice cream.


It is important that you continue taking your prescription medicines during this time. If you take insulin on a daily basis please check with your regular practitioner about how to manage your diabetes while the bowel preparation is in progress.

You will have a prescription for a bowel preparation which needs to be mixed with water. Follow the directions on the label for mixing. Start drinking the medication by noon to give yourself plenty of time. Do not drink it quickly. If you begin to feel full or nauseous, slow down between glasses.   

Anorectal Preparation


It is very important that the bottom part of the rectum be clean before surgery. The Rectum is normally filled with stool, which bacteria in it. This stool must be cleaned out so that the surgeon can visualize the lining of the rectum. Therefore, you must carefully read and perform the bowel preparation as outlined below. If you have any questions after reading the following materials please call (212) 434-4860

Day Before Surgery:

1. Stop eating all solid foods. You can drink clear liquids up until midnight the night before the operation. Clear liquids include fruit juices (no pulp), tea, coffee (without milk), water, soda, jello, broth and popsicles. No milk or milk products.

2. It is important that you continue taking your prescription medicines during this time. Blood thinners such as aspirin coumadin, plavix, lovenox and others should be stopped 5 days before surgery. (Consult with your doctor regarding this). If you take Insulin on a daily basis check with your regular family practitioner about how to manage your diabetes while the bowel preparation is in progress. You must let the prescribing doctor of these medicines know that you have to stop them.

3. At about 4p-6pm you should drink a full 8 oz. to 10 oz. bottle of magnesium citrate. This can be purchased in any pharmacy without a prescription. This should result in multiple bowel movements later that evening.

4. The hospital will call you the day before surgery to confirm time and location. 

Day of Surgery:

You should have nothing by mouth except for your prescription medications, which you should take at your regularly scheduled time with a small sip of water.

Abdominal Surgery Post Operative Instructions

Once the surgery is over, you play a large role in your own recovery. Complications from immobility after surgery can include pneumonia, blood clots, and prolonged ileus (intestinal immobility). You will be expected to take an active role in your care by doing the following:

  1. Coughing and Deep Breathing Exercises

Pain from the incision along with lying in bed will prevent you from taking deep breaths and expanding your lungs completely. By coughing and deep breathing, you can help to prevent post operative pulmonary complications such as post operative pneumonia

You will be given a tool called an incentive spirometer which will help you do this. The spirometer has a mouth piece which you place in your mouth and then inhale as if you were sucking on a straw. This should be done in one long deep breath and it should be repeated 10 times every hour.

Coughing is important to rid you lungs of any fluid accumulation. The correct way to do it is to take a deep breath and cough on the exhale. Holding a pillow or you hands over your incision for support will help decrease the discomfort while coughing.

Anorectal Post Operative Instructions

Please read theses instructions very carefully. Follow the instructions as closely as possible. If you have any questions, please do not hesitate to call the office at (212) 434-4860.

Wound Care

Starting the morning after your surgery, you should begin taking “Sitz Baths”. Sitz baths increase the blood circulation in your anal area, which will help the healing process and make you feel more comfortable. This should be done at least three times a day and after each bowl movement.

A plastic basin for these baths may have been given to you when you left the hospital. If not they can be purchased in any drug store or your regular bathtub the tub will suffice. Each sitz bath should last about 15 minutes.

After the bath, carefully pat your bottom dry do not rub. It will also help to place a gauze pad over (not inside) your anus after these baths, or you may also use a sanitary napkin to protect your underwear and absorb discharge.   

Incision & Drainage of Abscess Instructions

Care after the incision and drainage

  • A pressure dressing has been applied to control any bleeding immediately after your procedure. This can be removed 8 hours after the procedure. However, if you need to have a bowel movement before that you may remove the dressing at that time.
  • After the dressing has been removed it is important to sit in a sitz bath with warm water for 5-10 minutes. This should be done at least three times a day and after each bowel movement for 7-10 days. You can either use your bathtub or a portable sitz bath which can be bought at any pharmacy.
  • After each bath gently pat the area dry and use a piece of gauze or sanitary pad to absorb moisture. A small amount of drainage is to be expected.
  • It is important to keep your bowel movement soft and easy to pass. You should take Colace 100mg 2 pills twice a day, and a soluble fiber such as Metamucil, or Citrucel one tablespoon twice a day.
  • Take pain medication as directed. Do not drive or operate machinery if taking a prescription pain medication.

Call our office for any of the following

Persistent rectal bleeding, Increased pain or difficulty urinating or a temperature over 100 F.

Dietary / Exercise Recommendations for Colon Cancer

Dietary and Exercise Recommendations Regarding Colon and Rectal Cancer

Richard L. Whelan, MD, Chief Colorectal Surgery , Northwell Health Cancer Institute


Researchers and physicians have long suspected a link between diet and lifestyle and the development of Colon and Rectal Cancer (CRC). For example, dietary fiber has been thought to be protective whereas red meat is thought to promote cancer development. Despite some suggestive evidence, it has proven very difficult to obtain the data needed to firmly verify these suspicions.* The World Cancer Research Fund/ American Institute for Cancer Research Continuous Update Project (WCRF/AICR CUP) continually tracks the published evidence regarding a number of different types of cancer. In recent years they have released a series of recommendations and guidelines for each cancer type based on the available data. When their experts believe there is sufficient evidence regarding a number of dietary items or lifestyle behaviors they release an updated report which incorporates these changes. This past spring the WCRF/AICR CUP updated their findings and guidelines for CRC. Their recommendations, which follow, are based on a review of 1,012 published studies.

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