Monmouth Gastroenterology, LLC
142 Route 35 Eatontown, New Jersey 07724 (732) 389-5004
Nadeem Baig, M.D. Kenneth Belitsis, M.D. Thomas C. Fiest, D.O. Steven A. Gorcey, M.D. Laleh Merikhi, M.D. Rajiv Uppal, M.D
Patient Name: ___________________________________________________________________ Date:___________________Tentative Arrival Time: _____________ This time is subject to change. The facility will contact you the day before your procedure to give you an exact arrival time. Required Preparation for Your Colonoscopy-EXTRA -PM
Nulytely/Trilyte/Colyte--PM Prep and PM Half Prep
IF YOU HAVE DIABETES or TAKE BLOOD THINNERS (COUMADIN, PLAVIX, TICLID, ASPIRIN, ETC.,) AND DID NOT TELL THE DOCTOR, PLEASE INFORM OFFICE IMMEDIATELY. GENERALLY FOR 5 DAYS PRIOR TO THE PROCEDURE YOU SHOULD STOP MEDICATIONS OR VITAMINS CONTAINING IRON, VITAMIN E, FISH OIL, GARLIC TABLETS, GINKO BILOBA, GINSENG OR ASPIRIN LIKE PRODUCTS (ADVIL, MOTRIN, ALEVE, NUPRIN, ALKA-SELTZER, NAPROSYN,ETC). HOWEVER, YOU WILL BE SPECIFICALLY INSTRUCTED ABOUT WITHHOLDING ASPIRIN, PLAVIX AND COUMADIN ACCORDING TO YOUR MEDICAL SITUATION.
YOU MAY TAKE TYLENOL AS NEEDED FOR A HEADACHE OR PAIN. TWO DAYS PRIOR TO YOUR PROCEDURE.** **DO NOT EAT ANY FRUITS, NUTS, VEGETABLES, SALADS, SEEDS OR BERRIES**
Take 2 DULCOLAX tablets (purchased over the counter) with 8oz of water at bedtime.
DAY BEFORE PROCEDURE:
1. Have a liquid breakfast and lunch. Take 2 DULCOLAX tablets in the am with 8 oz of water. Clear
liquids include juice (apple or white grape), soft drinks, jell-o, broth, and tea (AVOID MILK AND SOUPS). 2. NOTHING RED OR ORANGE IN COLOR. 3. DO NOT HAVE DINNER. You may have small amounts of clear liquids 4. Take (2) DULCOLAX tablets at 6:30pm with 8oz water, followed by one glass of water at
5. MixTRILYTE/COLYTE/NULYTELY (shake well) prior to going to bed. DAY OF PROCEDURE: DO NOT EAT OR DRINK ANYTHING OTHER THAN THE PREPARATION AND MEDICATIONS APPROVED
BY YOUR DOCTOR WITH A SIP OF WATER. TAKE HEART MEDICATIONS OR BLOOD PRESSURE MEDICATIONS AT LEAST FOUR (4) HOURS PRIOR TO YOUR PROCEDURE.
1. Start NULYTELY/TRILYTE/COLYTE at 5:30am, drink 1/3 cup every 5 minutes and FINISH BY 9AM. 2. Take (2) DULCOLAX tablets when finished, followed by (2) 8oz glasses of water. 3. If you are not clear (CLEAR MEANS YELLOW-GREEN WATERISH MOVEMENT WITH NO SOLID
STOOL OR PIECES), take (2) extra DUCOLAX tablets with an additional glass of water BEFORE 9:00AM PREPARATION MUST BE COMPLETED 4 HOURS PRIOR TO YOUR PROCEDURE TIME*** Please report to the following location:
Advanced Endoscopy and Surgical Center: 142 Rte 35, Eatontown, NJ Monmouth Medical Center: 300 Second Avenue, Long Branch, NJ- outpatient registration
Jersey Shore University Medical Center: 1945 Rte 33, Neptune, NJ- outpatient registration * You must have a responsible adult to accompany you home. Driving yourself, taking a bus or walking is NOT PERMITTED. Updated 8-10-11
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