Miralax Prep

Per Inova policy, all patients have to complete a brief health history (One Medical Passport) on line or by phone prior to their procedure. If this is not done before arriving, your procedure will be delayed at the center, which inconveniences you and your ride, and generally makes the process run more inefficiently. Please go to www.onemedicalpassport.com to do this as soon as possible. If you are unable to do this, please call 703-922-0088 and someone may assist you from our pre-op office.

You have been scheduled for a colonoscopy procedure at the Inova Healthplex Franconia/Springfield (2nd floor, 6355 Walker Ln, Alexandria, VA 22310). 

Please arrive one hour before your scheduled procedure time. The procedure is a simple outpatient procedure which examines your colon (large intestine) using a colonoscope. The procedure will be performed by Dr. Charles McBride, M.D. Please ensure that you bring an ID, your insurance information, and have arranged for a ride home, as the precedure requires sedation. If needed, medical ride services are available to transport you.

If you need to cancel or reschedule, please call our office at 703-455-5556. If you believe this message is in error, or if you feel this is the wrong procedure, please notify us immediately.

Important information for patients undergoing procedures:

If you are 70 or older, diabetic, or have any heart condition, an EKG within approximately 1 year of your procedure is required at all Inova facilities. This prerequisite is mandated by Inova, not our practice, and allows Inova to meet standards required by the state of Virgina and Anesthesia guidelines. Please request your primary physician or cardiologist to fax your most recent EKG to 866-829-4773. If you do not have a primary doctor or cardiologist, we would be happy to order an EKG at a convenient center to meet this pre-procedure requirement. We encourage patients to obtain the EKG as early as possible to avoid cancellation of your procedure. If you have questions about this, don't hesitate to call our office at 703-455-5556.

PREPARATION FOR A COLONOSCOPY

If you are 70 years old or older, diabetic, or have a heart condition, see important information above regarding EKG and preparaton requirements.

Go to your local pharmacy and pick up the following items (which do not require any prescription - they are sold over-the-counter without a prescription)

· 4 Dulcolax laxative tablets containing 5mg of bisacodyl each (NOT Dulcolax stool softener)

· 1 – 8.3 oz. bottle of Miralax powder (238 grams)

· 64 oz. of Gatorade. G2, Gatorade Ice, Powerade or Powerade zero are acceptable. (AVOID RED COLORED DRINKS)

BRING PICTURE IDENTIFICATION TO YOUR APPOINTMENT.

You will receive IV sedation for this procedure, so it will be necessary to arrange for a responsible adult to transport you home. The Surgery Center will NOT release you to a transportation service such as Uber or a taxicab. You can anticipate being at the Surgery Center for approximately 3 hours.

RESTRICTIONS:

NSAIDS: Stop taking NSAIDS 7 days before your procedure, unless directed otherwise. Try to avoid aspirin, Advil, Motrin, Aleve, Arthritis medications, or any similar medications for 1 week prior to your procedure. Tylenol is permitted.

Coumadin/Plavix/Eliquis: Stop Coumadin/Plavix/Eliquis 3 days prior to your procedure unless otherwise directed.

Blood Pressure Medicine: Continue blood pressure medications, including the day of your procedure. You may take it with a small sip of water.

Diabetes Medicine: All Oral medications (i.e. pills) should be taken on the day before the procedure, but do not take on the day of your procedure.

Special instructions for GLP-1 agonists for diabetes such as Ozempic, Trulicity, Victoza, or Mounjaro ---No milk products are allowed the day before, and you must have a completely empty stomach the day of the procedure. You should not take any of these products within 1 week of your procedure!! These medications may delay stomach emptying, and increase the chance of vomiting and/or aspiration. If on these agents, you should not eat or drink on the day of your procedure.

Insulin is not included in this recommendation; you can follow the normal instructions below if your only injectable is Insulin.

Insulin: You will be given special instructions regarding insulin by Dr. McBride. Generally, 1/2 dose of insulin on day prior to procedure, and hold insulin on day of procedure until after the procedure. Check your blood sugar on the day prior periodically to ensure levels are not too high. We use 1/2 of the normal dose the day before as we are concerned that your blood sugar may be too low with the restricted diet for the colonoscopy.

3 DAYS BEFORE THE EXAM:

Do NOT eat beans, collard greens, corn, dried fruit, kale, nuts, popcorn, raisins, seeds, or spinach. You may eat canned fruits, or fruits without a peel. Please avoid fiber and iron supplements as well during this time.

DAY BEFORE THE EXAM:

This is the day you prepare for your procedure. Starting from when you wake up, drink only clear liquids all day. NO SOLID FOOD ALLOWED. Drink at least 8 glasses of water during the day to avoid dehydration.

Clear liquids that you may have include water, coffee, tea, carbonated beverages (i.e. Coke, Ginger Ale, 7-up, etc.), Jell-O gelatin without food particles, ices and popsicles, clear fruit juices, broth, bouillon, Gatorade, and Powerade as long as they are NOT RED in color. You may also have milk and vanilla milkshakes, and vanilla ice cream, but milkshakes and milk products are only allowed up until the time you start drinking your bowel prep. If you are taking any injectable GLP-1 agonists for diabetes such as Ozempic, Trulicity, or Victoza, no milk products are allowed. If you are insulin, you may take the milk products, but monitor your blood sugar accordingly. No yogurt is permitted.

At 12 noon, take 4 Ducolax tablets. Mix 64oz. of Gatorade with 8.3oz. Miralax and place in the refrigerator (DO NOT ADD ICE).

At 5:00 pm, drink one 8 oz. glass of the Miralax/Gatorade solution and continue drinking one 8oz. glass every 15 minutes thereafter until the mixture is gone. Set a timer every 15 minutes to keep the pace. 

You are welcome to start it earlier (2:00-4:00pm) if you are able to do so. The advantage of starting earlier is that you can drink it more slowly (which some patients tolerate better), and you will be more likely to be cleaned out before midnight, with less nighttime bathroom visits). Our experience has been if you start at 2:00 pm, you will be much more likely to be cleaned early, and have a more restful night!

It is very important you provide us with the cleanest colon you can. Please drink the entire prep.

MORNING COLONOSCOPY:

Do not eat or drink anything after midnight. You may take time sensitive medications with a small sip of water the morning of your procedure.

AFTERNOON COLONOSCOPY (Arrival time of 11AM or later):

If your procedure is scheduled in the afternoon, you may take 1/2 of the bowel prep the night before, and complete the remaining 1/2 on the morning of your procedure, to be completed at least 4 hours prior to your procedure. Alternatively, you can do the entire prep the night before if you prefer. If you are on any GLP-1 agonists for diabetes such as Ozempic, Trulicity, or Victoza, you must do the entire prep the day before, and must remain without food or drink after midnight the day of your procedure, except for pills with sips of water. The reason for this is that these medicines cause a delay in stomach empting, and increase the risk of vomiting and aspiration if you eat or drink the morning of a procedure.

Please stop clear liquids within three hours of your arrival time. Please do not drink any milk products on the day of your procedure. You may take time sensitive medications with a small sip of water the morning of your procedure.

***Due to the necessity of staffing requirements for an outpatient procedure, if you have to cancel for any unforeseen circumstance, it is mandatory that you give at least 3 day notice prior to your scheduled procedure time***. If a procedure is cancelled within 48 business hours of the procedure, there will be a $125.00 charge for the late cancellation.