www.medigraphic.org.mx CONFERENCIAS MAGISTRALES Opioids for the treatment of non-cancer pain * Professor of Anesthesiology and Medicine. Vice-Chair for Clinical Affairs. Department of Anesthesiology,University at Buffalo. Chief, Pain Medicine and Professor of Oncology. Roswell Park Cancer Institute. INTRODUCTION gested by the WHO step ladder, portending that it may not be appropriate
Microsoft word - instructions for colonoscopy with halflytely web ver 04 16 10INSTRUCTIONS FOR COLONOSCOPY
Important – Please read this instruction sheet completely
You have received a prescription for HalfLytely. Have your prescription filled at a pharmacy. 1. On the morning prior to the examination, mix HalfLytely with lukewarm tap water to the top of the line on the bottle, shake to dissolve powder, and refrigerate. Add flavoring packet of your choice. 2. STAY ON CLEAR LIQUIDS THE DAY BEFORE THE PROCEDURE, such as Jello (no red jello), apple
juice, bouillon, tea, and coffee. DO NOT EAT SOLID FOODS. No milk products.
3. At 3:00 p.m., take the bisacodyl tablets enclosed with the kit. Do not chew or crush. Do not take bisacodyl
tablets within one hour of taking an antacid.
4. Begin drinking the HalfLytely refrigerated mixture before 6:00 p.m. Drink one 8 ounce glass every 10
minutes (about 8 glasses). Drink each glass quickly rather than drinking small amounts. Be sure to drink ALL
of the solution.
5. You are to have nothing to eat or drink (including gum and breath mints) after 12 midnight except
for medications with a sip of water (please read important notices below).
Please be sure that a member of your family or a friend accompanies you to and from the office to drive you home. This is necessary because of the sedation you will be given for the examination. You are not permitted to drive at any time following the procedure. You may resume driving the following day. You must have arrangements to have a friend or family member take you home after the examination. Taxis are not acceptable. Please take your heart and/or blood pressure medications with a sip of water 4 hours prior to the
procedure. Please read page 2 of this letter regarding discontinuation of blood thinners.
Do not take oral diabetes medication the morning of the examination. If you are diabetic taking insulin,
you are instructed to contact the prescribing physician for necessary insulin dosage adjustments.
IF YOU MUST CANCEL THE COLONOSCOPY, PLEASE INFORM US NO LATER
THAN 48 HOURS PRIOR TO THE PROCEDURE.
1. If you take anticoagulants or “blood thinners”, please speak with your cardiologist or family physician before
stopping these medications.
2. If you take aspirin or aspirin-containing medications for heart problems, circulation problems or are unsure,
please contact your cardiologist or family physician on whether or not these medications should be held.
If you DO NOT have heart or circulation problems, stop aspirin and all aspirin-containing medications FIVE
(5) days before your procedure.
Aspirin-containing medications: Ascripton Bufferin Enteric-coated aspirin Momentum 3. Stop ALL NON-ASPIRIN AND NON-STEROIDAL PAIN RELIEVERS THREE (3) DAYS before your procedure.
Non-aspirin containing medications: Advil 4. There are NO RESTRICTIONS on the following pain medications:
Acetaminophen (Tylenol) containing products (Tylenol, Darvocet, etc.), as well as:
If you have any questions, please call our office about your medications.
What is a colonoscopy? Colonoscopy is a procedure that enables your physician to examine the lining of the colon (large
bowel) for abnormalities by inserting a flexible tube that is about the thickness of your finger into the anus and advancing it
slowly into the rectum and colon.
What preparation is required? The colon must be completely clean for the procedure to be accurate and complete.
Your physician will give you detailed instructions regarding the dietary restrictions to be followed and the cleansing
routine to be used. Follow your doctor’s instructions carefully. If you do not, the procedure may have to be canceled and
What can be expected during a colonoscopy? Colonoscopy is usually well tolerated. There is often a feeling of
pressure, bloating or cramping at times during the procedure. Your doctor may give you medication through a vein to
help you relax and better tolerate any discomfort from the procedure. You will be lying on your side or on your back
while the colonoscope is advanced slowly through the large intestine. As the colonoscope is slowly withdrawn, the lining
is again carefully examined. The procedure usually takes 15-60 minutes. In some cases, passage of the colonoscope
through the entire colon to its junction with the small intestine cannot be achieved. The physician will decide if the
limited examination is sufficient or if other examinations are necessary.
What if the colonoscopy shows something abnormal? If your doctor thinks an area of the bowel needs to be evaluated
in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining).
This specimen is submitted to the pathology laboratory for analysis. If polyps are found, they are generally removed.
None of these additional procedures typically produce pain. Remember, biopsies are taken for many reasons and do not
necessarily mean that cancer is present.
What are polyps and why are they removed? Polyps are abnormal growths from the lining of the colon which vary in
size from a tiny dot to several inches. The majority of polyps are benign (noncancerous), but the doctor cannot always
tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent
for tissue analysis. Removal of colon polyps is an important means of preventing colorectal cancer. Tiny polyps may be
totally destroyed by fulguration (burning), but larger polyps are removed by a technique called snare polypectomy. The
doctor passes a wire loop (snare) through the colonoscope and severs the attachment of the polyp from the intestinal wall
by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk that removing a
polyp will cause bleeding or result in a burn to the wall of the colon which could require emergency surgery.
What happens after a colonoscopy? After a colonoscopy, your physician will explain the results to you. If you have
been given medications during the procedure, someone must accompany you home from the procedure because of the
sedation used during the examination. Even if you feel alert after the procedure, your judgment and reflexes may be
impaired by the sedation for the rest of the day making it unsafe for you to drive or operate any machinery. You may
have some cramping or bloating because of the air introduced into the colon during the examination. This should
disappear quickly with passage of flatus (gas). Generally, you should be able to eat after leaving the colonoscopy, but
your doctor may restrict your diet and activities, especially after polypectomy.
What are the possible complications of a colonoscopy? Colonoscopy and polypectomy are generally safe when
performed by physicians who have been specially trained and are experienced in these endoscopic procedures. One
possible complication is a perforation or tear through the bowel wall that could require surgery. Bleeding may occur from
the site of biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope.
Bleeding can occur several days after a polypectomy. Rarely, blood transfusions or surgery may be required. Other
potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation
of the vein where medications were injected may rarely cause a tender lump lasting for several weeks, but this will go
away eventually. Applying hot packs or hot moist towels may help relieve discomfort. Although complications after
colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your
physician who performed the colonoscopy if you notice any of the following symptoms: severe abdominal pain, fever
and chills or rectal bleeding of more than one-half cup.
How accurate is colonoscopy? Colonoscopy is an accurate method to detect colon cancer and polyps but is not perfect.
There may be up to a 10% miss rate for detecting polyps or other growths. It is also important to know that a
colonoscopy screening program can reduce, but not eliminate, the risk of developing cancer.
Exponential Growth and Decay Notes You are going to work for me for one month; there are 2 options from which you can choose to be paid. Which one would you choose? Option 1: $1,000 a day for 31 days or Option 2: $.01 on day 1, $.02 on day 2, $.04 on day 3, $.08 on day 4, etc.? Justify your response. Bacteria reproduce, or grow in number, by dividing. The total number of bacteria a