Cleaning out the colon before colorectal surgery is helpful and can reduce the risk of infection. The cleanout we recommend involves a combination of Miralax and oral antibiotics. Please prepare for your surgery as follows:
Patients taking anticoagulants and antiplatelet agents
Your surgeon will instruct you whether or not to stop these medications. Prior to your surgery, please confirm with your Internist or Cardiologist that they agree with the plan.
- For Coumadin (Warfarin): If the decision is made to stop Coumadin, this must be done 5 FULL days prior to the procedure and an INR should be performed on the day before the procedure. Some Cardiologists prefer to have patients hold their Coumadin prior to the procedure and take a medication, Lovenox (given as a shot twice daily), since it can be taken up to 12 hours before the procedure. This should be reviewed with your Cardiologist and your Colorectal Surgeon.
- For Aspirin, Plavix, and Pradaxa: If the decision is made to stop any one of these medications, it should be done 1 week prior to the procedure. No special blood testing is needed.
Patients with Diabetes
Patients with diabetes should speak with their Endocrinologist or Internist prior to the surgery regarding the dosing of their insulin or diabetic medications.
Resuming medications after your surgery
You will be given instructions as to when each of your usual medications should be resumed. If you do not clearly understand or recall these instructions, please call our office at (212) 342-1155.
THREE DAYS BEFORE YOUR SURGERY
FOLLOW A LOW FIBER DIET
- Avoid such foods as popcorn, nuts, fresh fruits, raw vegetables or products containing whole wheat or bran. Stop all fiber supplements (Fibercon, Metamucil, and Citrucel). Avoid products containing Olestra (a fat substitute found in some fat-free and low-fat foods) for one week.
- A few examples of foods you may eat are:
Dairy products, meats, poultry, fish, pasta, white rice, white bread, eggs, mashed potatoes, cooked carrots or squash.
PURCHASE THE FOLLOWING
- 238 gram bottle of Miralax
- 64 ounces of Gatorade (any color of liquid is fine)
- Dulcolax Laxative 5mg (2 pills)
- Neomycin 1 gram (3 doses)
- Metronidazole 500 mg (3 doses)
THE DAY BEFORE YOUR SURGERY
DO NOT EAT ANY SOLID FOODS – RESTRICT YOUR DIET TO CLEAR LIQUIDS ONLY
- A clear liquid is any liquid you can see through. Examples are:
- Water, chicken broth, apple juice, ginger-ale, Sprite, tea, black coffee (sugar allowed)
- Popsicles, Gatorade, Jell-O
- At 1:00 P.M., take Neomycin 1 gram and Metronidazole 500mg with a glass of clear liquid.
- At 2:00 P.M., take Neomycin 1 gram and Metronidazole 500mg with a glass of clear liquid.
- At 3:00 P.M., take 2 Dulcolax Laxative pills with a glass of clear liquid.
- At 6:00 P.M., mix(1)238 gram bottle of Miralax in 64 ounces of Gatorade (NO Red, Purple, or Orange liquids). Drink an 8 ounce glass every 15-20 minutes until finished.
- At 10:00 P.M., take Neomycin 1 gram and Metronidazole 500mg with a glass of clear liquid.
THE DAY OF YOUR SURGERY
- You may continue with CLEAR LIQUIDS until 6 hours prior to your surgery start time. After this time, you may have nothing by mouth (including gum, candy or water).
- Please take any heart or blood pressure medications with a sip of water when they are due and use your inhaler per usual (if applicable).
- Take your regular medications with a sip of water, except as advised previously.
- If you are insulin dependent, please let the surgery staff know upon check in.