Weekly News Capsule June 5, 2009 Acetaminophen Toxicity Acetaminophen is a pain reliever that is often used as a first-line medication for the treatment of mild to moderate pain and reduction of fever. If taken correctly, this medication is a safe and effective remedy for these ailments. However, as this medication is broken down in the body, a chemical that can injure the live
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14 Days Before Test Stop taking
• Aciphex® (rabeprazole) • Nexium® (esompeprazole) • Prevacid® (lansoprazole) • Dexilant® (dexlansoprazole) • Prilosec® (omeproazole) • Protonix® (pantoprazole) • Zegerid® (omeprazole/ sodium bicarbonate) 2 Days Before Test Stop Taking:
• Reglan® (metoclopramide) • Pepcid® (famotidine) • Tagament® (cimetidine) • Zantac® (ranitdine) • Axid® (nizatidine) • Carafate® (sucralfate) 24 hours Before Test Stop any Over-the-Counter antacids:
• Tums® • Rolaids® • Maalox® • Mylanta® It is OK to continue a baby Aspirin (81 mg) Stop Plavix 1 week before the procedure and restart 1 day after EGD, unless instructed
Stop NSAIDs or aspirin-like products (Motrin, Aleve, Advil, Naprosyn etc) 5 days prior to
procedure. You can use plain Tylenol for pain, if needed. If you are taking Coumadin (Warfarin), this should be stopped 5 days before procedure.
Some patients need to replace the Coumadin with blood-thinner injections for approximately one week. Please discuss the changes in Coumadin regimen with your family doctor or with Coumadin Clinic. If you are taking Pradaxa or Xarelto, this should be stopped 3 days before the procedure
and restarted 1 week after procedure, unless instructed otherwise by your doctor. If you are diabetic, please discuss with your doctor the change in your medications during
On the Day of Your Procedure:
1. You should not eat or drink anything, including water, for 8 hours prior to your procedure.
2. On the morning of your test, take only the medications for your heart or blood pressure with
a sip of water at least two hours before your procedure.
3. No chewing gum, hard candy or chewing tobacco at least 4 hours preprocedure.
You must have a friend of family member stay with you during the procedure and
drive you home afterwards.
You may not drive or work for 12 hours after the procedure. You have to come back to the endoscopy unit to return the recorder in 48 hours The test results will be available in 1-2 weeks. Bravo Ph Monitoring
The Bravo 48-hour pH test is being recommended as a tool in the diagnosis of GERD (GastroEsophageal Reflux Disease). During the Bravo pH procedure, a catheter containing a probe about the size of a Tylenol gel cap will be placed through the mouth in the esophagus (the tube leading from the mouth to the stomach). Using a small amount of suction, the probe will be attached to the inside of the esophagus. This procedure is simple, safe, and very well tolerated. As soon as the capsule is attached, it begins measuring the pH levels in your esophagus. The capsule transmits these measurements wirelessly to a small receiver you wear on your waistband or belt. As long as the capsule and receiver are within 3 feet of each other, the system will measure and record your pH levels. This means you can place the receiver nearby when bathing or sleeping without interrupting the test. The receiver is about the size of a standard pager, and has three symptom buttons. You will be instructed to press the appropriate button during the study when you experience heartburn, regurgitation, or chest pain. The Bravo Receiver is designed to prevent you from turning it off during the test period. You will also be asked to record periods of eating and sleeping in a diary throughout the test. You can go about your daily routine without any restrictions. Some people say they have a vague sensation that “something” is in their esophagus. Others say they feel the capsule when they eat or when food passes the capsule. Chewing food carefully and drinking liquids may minimize this sensation. After 48 h the receiver will automatically stop recording information. The receiver is then uploaded into the computer, and analysis by both the computer and physician allows a detailed report to be devised for diagnosis. Several days after the study, the probe naturally sloughs off the esophagus and passes through the digestive tract. Please note: The capsule contains a tiny magnet, and you should not undergo an MRI study within 30 days of using the Bravo system. Possible complications:
• The capsule could detach from the esophagus before the test is complete • The capsule may fail to detach from the esophagus within several days after placement, or there may be discomfort associated with the pH capsule, requiring endoscopic removal • Tears in the lining of the esophagus, causing bleeding or perforation and requiring possible medical intervention If you are unable to keep your appointment, please call our office at least 3 days in advance. If you miss a scheduled procedure without notifying our office 72 h in advance, you will be charged a NO SHOW fee of 75$.
IF YOU HAVE ANY QUESTIONS PLEASE CONTACT OUR OFFICE
“Cameron’s problem with women”: the reporting and the reality of gender-based trends in attitudes to the Conservatives 2010-11 Roger Mortimore, King’s College London/Ipsos MORI PAPER FOR THE POLITICAL STUDIES ASSOCIATION ANNUAL CONFERENCE, CARDIFF, MARCH 2013 In the autumn of 2011, there was significant discussion in the British press about the level of support among w