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Miralax, Galotorade and Dulcolax - Afternoon Procedure
You are scheduled for a colonoscopy, a procedure in which a doctor examines the lining intestine by looking through a flexible tube cal ed a colonoscope. If growths or other abnormalities are found during the procedure, the doctor may remove the abnormal tissue for closer examination or biopsy. To properly preparefor the colonoscopy, fol ow these instructions. A nurse from Altru’s Ambulatory Procedure Center wil cal you a few days prior to the procedure to review thepreparation process and answer any questions you have. Please remember to arrange for a responsible adult to accompany you home. If you do not have an adult escort, your procedure wil be cancel ed and rescheduled. Review the preparation
schedule below for the days preceding your colonoscopy. If you have any questions about this process, please cal (701) 780-6394.

one week prior
three days prior
two days prior
one day prior
procedure day
ü Purchase:
BEGIN LOW FIBER DIET
BEGIN CLEAR LIQUID DIET AS ü At 7:00 a.m., drink the rest of the
No red or purple liquids
SOON AS YOU GET UP IN THE
tablets (over the counter). These
ü No solid foods after midnight. creamer), Gatorade, Pedialyte,
tablets must contain 5mg of
Bisacodyl each.
gatorade if you want to drink it cold.
*No red or purple liquids.
ü If you take fiber supplements, oil
capsules or medications containing
ü You may drink clear liquids up
iron, discontinue those seven days
to ________hours before
procedure.
ü If you have diabetes, ask your regular
ü Remember you must have a
NOTE: Oral laxatives may cause mild cramping, bloating
driver accompany you home.
or nausea. Always stay near a toilet when using laxatives.
ü If you take a medication to thin your
blood and have not already discussed
bot le is empty. Take two (2)
ü You can not drive the
this with our of ice, please cal our of ice tablets of bisacodyl (Dulcolax)
remainder of the day after your
after Miralex is completed.
procedure.
ü Pregnant or think you might be?
Bowel cleaning products have not beenresearched/tested on pregnant women.
Please discuss risks and benefits of this procedure with your ordering doctor.
ü Remember you must have a driver
accompany you home after your
procedure.
Low Fiber/ Low Residue Diet
The diet limits fiber to 15 grams or less per day and omits nuts, seeds and whole grains. Fruits and vegetables are limited.
FOODS ALLOWED
Beverage - Al
Meat Or Substitute - Meat, fish, poultry, eggs, cheese, cottage cheese, creamy peanut butter.
Potato Or Substitute - Potatoes (white or sweet) are limited to a single 1/2 cup serving per day. White rices, refined pasta.
No whole grain.
Vegetable - Strained vegetable juices, Limit of 1 cup total per day of vegetables. Tomato paste and puree. No raw vegetables.
Fruit - Limit of 1 cup total per day of fruit. Note: Apple juice may contribute to loose stools. No raw fruit.
Bread - White, Vienna, Italian or French breads. Refined wheat bread (label often states - blended wheat bread), white or refined rol s
or crackers such as saltines, Ritz, biscuits, pancakes, waffles.
Cereal - Refined cooked and dry cereals (such as, but not limited to) cream of rice, cornflakes, puffed wheat, Rice Krispies (check
fiber content label on cereal, avoid cereals with more than 1.5 grams of fiber per serving).
Fat - Margarine, butter, salad oils, salad dressings, bacon and plain gravies.
Soups - Bouil on and broth.
Sweets - Pudding, custard, ice cream, popsicles, sherbet, fruit ice, gelatin, hard candy, honey, jel y, syrup, molasses, marshmal ows,
gum drops, licorice, chocolate, soft cream candies.

Source: http://www.altru.org/app/files/public/5833/pdf-6460-0074.pdf

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SISC CO-PAYMENT REFERENCE GUIDE Medco manages your prescription drug benefit at the request of SISC. Your plan gives you the option of getting your covered medications through the Medco Pharmacy ™ mail-order service or at a participating retail pharmacy. The chart below provides a summary of your prescription drug benefit co-payments. When you use a participating When you use the T

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