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Frequently Asked Questions
   
Frequently Asked Questions

Below are answers to the most frequently asked questions that we receive from our patients. We thought we would share these with you since you may possibly have the same concerns. Of course, you are always welcome to contact us directly should you have additional questions.

The Office Visit Preparation for a Scope Test During Your Scope Test After Your Procedure Clinical Questions

Where is your office located?

Our main office is located in the Cherrington office complex in Moon Township, PA. The address is 725 Cherrington Parkway, Moon Township, PA 15108. You can obtain directions from our website at this link



Does it matter which doctor I see?

In general, no. All of our physicians ( Dr. Robert Fusco, Dr. Ernest Stanley, Dr. Richard Kim, Dr. Lester Stine, Dr. Frank Kim and Dr. Renee Flannagan) are university-trained experienced clinicians with Board certification in Internal Medicine and Gastroenterology and can handle all general digestive complaints. We also have a Nurse Practitioner in our office, Kathryn McParlane, CRNP. who is experienced in taking care of gastroinestinal disorders. Patients referred for special testing may be referred to a physician who has specific training in that area. For example, Dr. Richard Kim sees all patients referred for a test called Endoscopic Ultrasound (EUS). If your problem requires a specific physician, our appointment secretary will notify you.



What will happen on my first appointment?

During your first visit, you will be asked to register at our reception desk and to fill out a comprehensive health history questionnaire. This may take about 15 minutes, but is time well spent. This exercise forces you to recall details of your past medical history and puts things in perspective for the doctor. This would also be a good time for you to write down any questions you may have. The receptionist will also verify that we have correct demographic data such as your current address and contact information. She will also need to review your current insurance information - so be sure to bring your insurance cards with you. If you have HMO insurance that requires prior referral, she will also need to check that we received authorization for the visit.

You will then be taken to the nurses' station where your vitals signs will be recorded. Most patients will be asked to partially disrobe and put on an examination gown. The doctor or our nurse practitioner will then interview you and perform a focused physical examination. Depending on the problem, this may include listening to the lungs/heart, and examining the abdomen. When appropriate, a simple digital rectal examination is performed. (This requires no preparation and only takes a few seconds.) After you are dressed, the doctor will join you to discuss his assessment of the situation and what tests may be needed. You are welcome to bring along a family member or friend to join you for this discussion if you wish. Sometimes two sets of ears are better than one.



How can I best prepare for my first office visit?

If you are new to our practice or have not been seen for over a year, please come early to allow time to fill out necessary paperwork. Bring a written list of all of your current medications or put them in a paper bag and bring them along with you. Write down a list of all prior major illnesses, operations, hospitalization, and medical allergies. Be aware of what illnesses run in your family. Don't forget to bring your insurance cards with you. If you have HMO insurance, you will need to obtain the necessary referral from your family doctor, or primary care provider (PCP).

(To save time, you may wish to download our Patient Registration form from our website. Print it out and write down the information and bring it with you on the day of your appointment.)



Can you call for my referral?

Due to the high volume of patients we see each day and the complexity of the HMO referral process, we request that each patient be responsible for obtaining prior authorization for the doctor visit or any tests that are scheduled. Of course, our staff can help you if any problems occur.



How do I prepare for a gastroscopy exam - (stomach scope test)?

You need three things to prepare for a gastroscopy examination:

  • An appointment for the examination.
  • An empty stomach. You must be fasting for 6 hours prior. No food or drink.
  • A driver to take you home since you will not be able to drive until the following morning. We ask that your driver come with you and plan to stay the entire time you are here which averages about 1 1/2 hours. This is about 2 hours less than the average length of stay at the hospital outpatient surgery department.

For more information, check out this link on our website.



How do I prepare for a colonoscopy exam - (colon scope test)?

The standard preparation for colonoscopy begins the morning of the prior day. After having a light breakfast, the rest of the day should consist only of a clear liquid diet. No solid food or milk products. Just tea, Jell-O, clear broth, and water. Most patients will be asked to use the standard lavage solution (GoLytely, Colytely, Nulytely, PEG solution) which you drink the evening prior to your test. Don't make any plans for that evening. You will be at home in your bathroom most of the time. For more information, check out this link on our website:



Do you use the new pill for colonoscopy preparation?

Many patients have heard about a new pill called Osmoprep which may can be taken instead of the usual the gallon of laxative solution (GoLytely. ) This prep requires that you take 32 tablets - 20 the night before your test and 12 the morning of your test. Not all patients can swallow that many pills and individuals with heart or kidney problems or on diuretics may need baseline blood tests done to be sure the pill is safe.



Should I take my normal medications before a scope test?

Yes. In general, it is best that you take all of your normal medications before and after your scope test. The exceptions would be those patients on diabetic medications (insulin or pills) and those who take medications to prevent clotting such as Coumadin, Plavix, and Ticlid. If you are diabetic or on these "blood thinners," our doctor needs to review your medications and decide what should be done.



What happens if I start vomiting while taking the laxative preparation solution?

If you are taking your laxative solution and develop symptoms of nausea or vomiting, stop the preparation process for an hour or so. Then, if you feel better, try to pick up where you left off. If you can not complete the preparation, let our staff know. Your test may need to be rescheduled or an alternative preparation tried. During the day, call our office nurses' station. After office hours one of our doctors is always on call to help you. If you develop severe abdominal pain during your preparation, stop and call our office 412 262-1000. (The nurses station is option number 2.)



I am drinking the laxative preparation solution and my bowels have not moved?

Be patient. This laxative solution rarely fails. Most patients have a bowel movement within an hour or two of starting the solution. Sometimes, there may be a delay. If you have drunk at least half of the solution (8 glasses) and your bowels have not moved, just stop for a while. If nothing happens in an hour, try taking a small disposable 4-oz Fleets enema. They are available at your drugstore. (A hint: don't drive. Send someone else. Your bowels may "wake up" enroute.) Another hint that we tell patients in the office. Don't be constipated the day your take your laxative prep. This laxative solution works best if your "pipes are open" before you start the flushing process. Otherwise, you may have a delayed response. If you feel that you are constipated the day before the prep day, take whatever laxative works for you to open things up a bit. A good choice would be several ounces of Milk of Magnesia and several glasses of water.



Does it matter which brand or flavor of the laxative preparation solution I use?

No. There are several brands of the lavage solution - GoLytely, NuLytely, CoLyte, and generic PEG lavage solution. Which one you get depends on what your druggist has in stock, your insurance company, and your preference for flavor. They are all clear in color and come in a variety of flavors and unflavored. They all work the same. We don't have a preference.



The instructions on the bottle of laxative solution are different from what you gave me?

We provide most patients with printed instructions for their preparation. If you have those, follow them. If you didn't receive any written instructions, simply follow the instructions on the bottle.



I lost my instructions on how to prepare for my scope test.

We provide most patients with printed instructions for their preparation. If you have those, follow them. If you lost your instructions or didn't receive any written instructions, simply follow the instructions on the bottle. For more information about the proper preparation, check out this link on our website.



Can I put flavoring into the laxative preparation solution?

Yes. If you were given the unflavored solution and wish to add some flavoring, it is OK. Ignore the warning on the label about not adding any flavoring and add one packet of Crystal Light Lemonade or Iced Tea Mix. These two flavors do not interfere with the preparation or testing. Do not add any brightly colored flavoring, such as red, green, or blue as these may interfere with the examination.



Won't my rectum be sore after having so many bowel movements during my "cleanout?"

It might be. The very nature of the cleanout process means that you will have many liquid bowel movements over several hours. This might cause some soreness around the anal area. You can minimize this by using Charmin PLUS toilet paper (sometimes hard to find) followed by a baby wipe (Huggies, etc) after each bowel movement. Some patients report less problems if they apply 1% Hydrocortisone cream to the anal area after each bowel movement. You might consider purchasing these 3 items when you go to pick up your laxative solution.



Do I have to drink all 4 quarts of the laxative preparation solution?

It depends on the preparation prescribed. If Magnesium Citrate is taken before the PEG solution, you may only need to drink the first 2 quarts of the PEG solution if the output has become clear. If the PEG solution is taken alone, all 4 quarts must be consumed. Don't forget that you have 30 feet of digestive tract that we are trying to clean out from the top down. Even though it's hard to believe, it takes this whole gallon of laxative solution to really do a good job. If you want an accurate examination, it is important that your preparation for the test is complete. If your colon is not well cleaned out, the test may have to be aborted and rescheduled for another day.



Should I hold my aspirin prior to a colonoscopy?

Theoretically, aspirin and drugs like ibuprofen can inhibit blood clotting and make the risk of bleeding higher. You would think this would be important if you are going to have a biopsy taken or polyp removed. But in practice, this does not seem to be a problem. So, most doctors no longer routinely ask their patients to stop aspirin products before a scope test. It just doesn't seem to make much difference. But, if you are on daily aspirin or ibuprofen and wish to stop it before your exam, you must stop it at least a week before your test to get it out of your system. NOTE: If you are taking a daily aspirin to prevent a stroke or heart attack, don't stop it without your doctor's approval. Of course, if you have any bleeding tendencies, let your doctor know.



Why do I need to bring a driver for my scope test appointment and why does he/she have to stay the whole time I am there?

Scope examinations such as gastroscopy, colonoscopy, and endoscopic ultrasound require sedation to prevent pain and discomfort. These medications make the test quite simple for the patient, but do not wear off immediately. Because of this, you can not drive your car at least 12 hours or until the following morning. Therefore, it is necessary for you to come with a friend or family member who can safely drive you home after your test is over. We ask that your driver come with you and stay the entire time you are at our center. This makes them available for questions, and allows the doctor to meet with them in the recovery room after your test to explain the results.



How long will my scope test take?

If you are scheduled for a "scope test," plan to be in our center for about 2 hours. Procedures such as gastroscopy or colonoscopy require sedation to make them safe and painless. Even though the test itself takes about 30 minutes, you will need extra time for registration, preoperative check-in, the test itself, and postoperative recovery. Currently, our patients' average stay is about 1 1/2 hours.



Will my scope test be painful?

No. That is the nice part. With the modern anesthetic sedatives, your examination should be painless. In fact, after their exams most patients ask, "When is the test going to start?" Of course, the price you pay for a painless test is the fact that you will not be able to work or drive the rest of the day. That is why you need a driver to take you home.



Does a colonoscopy show if I have colon cancer?

Yes. In fact, colonoscopy is considered to be the most accurate way to determine the health of your colon. This includes checking for cancer, polyps, colitis, diverticulosis, and other less common lower digestive problems. The good news is that it is very rare for us to find colon cancer in an individual who is just coming in for a screening exam as a routine checkup. We often find polyps which are removed to PREVENT a colon cancer in the future.



What should I expect during my scope test?

After your pre-operative assessment, you will be taken by stretcher to the Endoscopy Room. Don't be surprised if it looks like an operating room. They look the same. The GI Technician will place you on equipment that monitors your heartbeat and blood pressure and gives you nasal oxygen. Don't be alarmed. This is routine for everybody. You will then be asked to roll onto your left side on the padded stretcher. The doctor will then administer the sedative into your intravenous line, and that's about all you can expect. The rest of the test is done while you are in a state called "conscious sedation." This is not like general anesthesia such as heart surgery. But a pleasant semiconscious state in which you should feel no pain and be unaware of the actual test itself.



I am afraid that I will say things that I shouldn't while sedated.

This is a normal and common fear. Most individuals are afraid of losing control, giving away their secrets, or saying something embarrassing while they are asleep. Don't worry. This is not truth serum. While in a state of conscious sedation, patients don't say much of anything. The medicine just doesn't work like that.



If the doctor finds a polyp during my test, will he remove it?

In most cases, yes. All of our doctors are trained in the latest endoscopic techniques. Most polyps can be removed at the time of colonoscopy. Rarely, a polyp is too big or too flat to remove and surgery is necessary. In fact, since Three Rivers Endoscopy Center opened in 1996, our doctors have removed tens of thousands of polyps. Each polyp removed is a potential colon cancer prevented.



How long will I be in the recovery room after my test?

The average time in our recovery room is about 30 minutes. Your family can be with you during this time. This allows them to hear what the doctor has to say about the results of your test.



How will I feel after my test?

After your test, you will probably have a dry mouth and feel drowsy, gassy, and hungry. The dry mouth and drowsiness are from the sedation. They will gradually wear off. The gassiness is from the air that is inflated into the digestive tract during the scope test. This helps your doctor see inside your stomach or colon. We try to remove most of the air after the procedure, but some of it just has to pass naturally. We often place a thin tube into the rectum after a colonoscopy to help the air escape. This is removed before you go home. Of course, since fasting is part of the preparation, you will feel hungry. Our recovery room nurse will offer you some juice and a breakfast bar just to treat the dry mouth and hunger pain.

Once you go home, you can pass the rest of the gas and have breakfast. Soon, you will be back to normal. Usually there is usually no real pain after a scope test nor sore throat after gastroscopy. The sedation given during your examination will likely prevent you from remembering exactly what the doctor had to say. However, you are given a full written report to take home and read once you are more alert. You are also welcome to schedule a follow-up office visit if you feel you have any unanswered questions about your exam.



Why can't I drive myself home after my test?

Obviously, if you are drowsy from the sedation, you will not be able to safely drive your car. We suggest that you do not drive for the remainder of the day. That is why you need a friend or family member to accompany you home.



Why can't I stop at a restaurant after my test?

All of our patients ask this question. They all want to go to Eat 'N Park on the way home. We suggest that you go straight home and have breakfast there. This is safer since the sedation affects your blood pressure and causes drowsiness for several hours. Also, you will probably be passing a large amount of gas from your rectum for a while. Don't subject your driver to all of this. We suggest that you go straight home, pass the gas, have a meal, and take a nap for several hours. After about four hours, you may go out as long as you feel well and do not drive.



How soon will I be able to eat after my test?

Immediately. As soon as you awaken in our recovery room, our nurse will offer you some juice and a breakfast bar to treat your dry mouth and hunger pain. Once you go home, you can have a normal breakfast or lunch. Eat whatever you feel like. Just go slow at first. Use some common sense. Don't try to make up for 3 missed meals all at once.



How soon can I drink alcohol after my test?

The medicines used for sedation should not be mixed with alcohol. We suggest you do not drink any alcoholic beverages (beer, wine, whiskey) until the day after your scope test.



How soon can I return to work after my test?

Most patients are able to return to work the following morning.



I am drug tested at work. Is this a problem?

The sedatives used for sedation will show up in blood tests for several days. If your job requires random drug testing and you need a written excuse for work, let the doctor know.



How long do I have to wait before I fly or travel after my test?

The risk of complications is very low for these procedures. In general, if you feel well, you may fly or travel the day after your scope test. However, if the doctor removes a large polyp or if your procedure was unusual in any way, he may request that you stay in the area for at least a week after the exam. This rarely occurs. Certainly, you should not travel to any part of the world where medical attention is not readily available right after any medical procedure. Should a rare complication occur, you may need prompt medical attention.



How long do I have to wait for the results of my test?

Unlike an x-ray, the results of a scope test are immediate. After you awaken from your sedation, the doctor will discuss the results of the test with you and your family. We also give you a written explanation of what was found and what treatment, if any, is anticipated. You will also have an opportunity to ask questions. Of course, any biopsies or samples taken for lab analysis will not be available that day. In that case, we will contact you as soon as we obtain the results. (Another reason that you need a companion to come with you is that the medications make you groggy and you may forget what the doctor tells you after the test. It is best to have another set of ears with you.)



Is Barrett's Esophagus the same as cancer?

No. Barrett's is not cancer. In simple terms, Barrett's is a reaction to longstanding esophagus damage caused by corrosive stomach acid backsplashing upward. After many years of heartburn, the cells in the lower esophagus begin to transform into a different type of cell which resembles the intestines below. In a small percentage of patients, the cells go on to form so-called low grade dysplasia, or early pre-cancerous changes. Some of these progress further to high grade dysplasia which is closer to cancer and, obviously, more serious.

It is true that the risk of esophageal cancer is higher if you have Barrett's - about 40 times normal. But you have to realize that the usual risk of esophageal cancer in the general population is extremely small - so you are multiplying 40 times a very small number... and the overall risk in those with Barrett's is only a few percent. Of course, if you are one of those, numbers make no difference. Follow-up is important especially for those with dysplasia.



Can I get ulcers from eating spicy food?

No. This is a common misconception. For may years, it was believed that peptic ulcers of the stomach and duodenum were caused by what you ate or how you felt. Scientific research over the past decade now has proven spicy foods, emotional stress, and even family history, turn out not to be major causes of ulcer disease. Most ulcers in the stomach or duodenum are caused by one of two things:

  • anti-inflammatory drugs like aspirin, ibuprofen, and other prescription drugs for arthritis or
  • a bacteria called Helicobacteria pylori, commonly called the "ulcer bacteria."

Ulcers in the esophagus are different. They are usually caused by the backsplash of powerful stomach acids up into the lower esophagus.

If you have ulcers and take aspirin-type drugs on a regular basis, switching to a different medication may allow the ulcers to heal and prevent future problems. More exciting is the discovery that the majority of ulcers are caused by the Helicobacter infection, H. pylori for short. Antibiotic treatment has a high success rate in eliminating the infection and curing ulcers for a lifetime.



What is the difference between diverticulosis and diverticulitis?

Diverticulosis is a condition, rather than a disease. The majority of adults have some degree of diverticulosis. It affects the large intestine, or colon. A normal colon is strong and relatively smooth. A colon affected by diverticulosis has weak spots in the walls. These defects allow the development of balloon-like sacs or outpouches - much like a bubble forming on a worn inner tube. These hollow pouches, called diverticulae, occur when the inner intestinal lining has pushed through weakened areas of the colon wall. A single pouch is called a diverticula. The presence of these pouches on the colon is called diverticulosis. When the pouches are inflamed or infected, it is called diverticulitis, a more serious ailment. Most individuals with diverticulosis never develop diverticulitis.



What is a hiatal hernia?

It simply means that your stomach organ is slipping upward into your chest. The diaphragm is a tough flat muscular membrane that separates your chest from your abdomen. Your stomach organ is normally all below the diaphragm in the abdomen. To connect with your stomach organ, your esophagus must come down the middle of your chest and pass through a hole in the diaphragm called the hiatus.

In simple terms, some people's hiatus weakens and opens up. This allows the esophagus to "pull the stomach up" into the chest cavity. Since part of the stomach herniates, or pushes through the opening, this condition has been termed a Hiatal Hernia. A hiatal hernia is a common finding in adults and may cause no symptoms at all. Sometimes it is associated with a weakness in the lower esophageal valve and can worsen symptoms of acid reflux, or GERD. Some slip up into the chest one day and back down into the abdomen another. This is called a sliding hiatal hernia. When they become large and permanently stuck above the diaphragm, they are called a fixed hiatal hernia.



Does red blood in my stool mean I have cancer?

Many patients ask this question. The answer is sometimes, but usually not. There are many non-cancerous reasons to have blood in the stool such as hemorrhoids, polyps, or fissures. However, any adult individual who sees blood in their bowel movements should consult their doctor for an examination. You can't tell what the cause is without having a look inside. If there is any concern, a full colonoscopy is usually advised. The point is that all bleeding in adults must be evaluated. In most cases, no serious problem is found.



What are the warning symptoms of colon cancer?

Unfortunately, when colon cancer develops, there are usually few , if any, early warning symptoms. In many cases, patients have had no symptoms at all - until it is too late. That is the problem. Colon cancer is really a silent disease. A colon polyp can be in your colon for many years, but there are no symptoms. Eventually, that polyp may turn into a small cancer, but there are still no symptoms. That cancer may grow larger and still cause no symptoms. Eventually, the cancer is so big that it either begins to bleed or block the passageway. Then there are symptoms of rectal bleeding, abdominal pain, weight loss, or change in bowel habits. By this time, the cancer may have broken through the back wall of the colon and spread to adjacent lymph nodes or on to your liver. This is why doctors recommend periodic checkups of all adults before they have any symptoms. It is much more fun to prevent colon cancer then to find one.



When should I call my doctor about diarrhea?

Everyone gets a little "stomach bug" from time to time and develops a bit of diarrhea. The cause is not usually known. Sometimes it's due to emotional stress, or a virus. Often the cause is unrecognized food poisoning. Some cases are a reaction to the use of antibiotics. Whatever the cause, most cases are mild and disappear in a few days. Don't try to stop diarrhea as soon as it develops. Diarrhea is the body's way of getting rid of whatever food, virus, or bug that is causing it. If the diarrhea is not severe and there is no fever, rectal bleeding, severe abdominal pain, simple measures are usually effecitve. This might include going to a BRATT diet for 48 hours and replacing lost fluids. The main inital concern is dehydration especially in young children and the elderly. Symptoms of dehydration include fatigue, weakness, dry mouth, dark urine, decreased urine flow. Authorities recommend drinking at least 8 to 10 glasses of fluid daily while the symptoms are active. Don't drink plain water, but instead use a solution such as Gatorade which also contains needed minerals such as sodium and potassium.

If the diarrhea does not respond to fluid and diet changes in a day or two, try one of the over-the-counter antidiarrheal medicines such as Kaopectate, Pepto-Bismol (will blacken bowel movements), or Imodium AD. Simply follow the label instructions.

Rarely diarrhea is a sign of a more serious infection or ailment. You should call your doctor for the following reasons:

  • diarrhea after recent antibiotic therapy
  • the diarrhea is severe
  • bloody diarrhea
  • fever over 101 degrees
  • severe or persistent abdominal pain
  • symptoms last longer than 72 hours
  • decreased urine production or dark urine



 

 

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