Frequently Asked Questions
Do you have a question? Chances are other patients have asked us the same questions. Here's a list of frequently asked questions (FAQs).
Center for Digestive Health & Nutrition (CDHN)
What is the Center for Digestive Health & Nutrition?
The Center for Digestive Health & Nutrition is a private medical practice of six experienced gastroenterologists, nurse practitioners, and staff, dedicated to the prevention and treatment of digestive disorders. Our physicians have been serving the needs of those in Western Pennsylvania and surrounding areas since 1977, having cared for tens of thousands of individuals with digestive problems. Our medical staff has over 200 years of collective experience in treating digestive disorders and are available to help those in need.
Where is CDHN located?
CDHN is conveniently located in a pleasant suburban setting north of Pittsburgh, PA. The address is 725 Cherrington Parkway, Moon Township, PA 15108. There is plenty of on-site free parking for our patients and their families. CDHN shares the first floor of this medical building with Three Rivers Endoscopy Center (TREC), a surgical center devoted to gastrointestinal procedures. Most of our outpatient endoscopy "scope" procedures are performed at TREC.
What conditions to you treat?
Our team utilizes cutting-edge technology to diagnose and/or treat all digestive conditions including colon cancer, colon polyps, heartburn, acid reflux, celiac disease, swallowing problems, digestive bleeding, stomach ulcers, chronic indigestion, liver disease, hepatitis, gallstones, diseases of the pancreas, irritable bowel, ulcerative colitis, Crohn’s disease, persistent nausea/vomiting, weight loss, gas and bloating, abdominal pain, chronic constipation and diarrhea.
We do not perform surgery. Our care is limited to diagnosis and medical treatment. However, we are all trained and experienced in both endoscopy examination of the stomach (gastroscopy) and colon (colonoscopy). We have also had great success with the O'Regan Hemorrhoidal Ligation procedure for treatment of internal hemorrhoids. Since 2005, we have also offered the amazing “camera in a pill” PillCam™ procedure to better visualize portions of the small intestine.
Do I need a referral to visit CDHN?
You may need a referral, depending on your insurance provider and insurance plan. Please contact your insurance provider for details.
How long will it take to get an appointment?
Unlike primary care providers, gastroenterology is a specialty practice and routine appointments may take several weeks. However, we keep a number of appointment slots open each day for more urgent care.
Do you treat children?
Our physicians treat patients who are age 16 and above. Children under age 16 should be seen by a pediatric gastroenterologist. Our endoscopy center, TREC, only accepts patients over 18 years of age. Younger patients who need an outpatient endoscopic procedure are scheduled at a local hospital surgery center.
Does CDHN handle Workers' Compensation claims?
No, CDHN does not handle Workman's Compensation claims.
Will my doctor receive updates on my care?
Coordination of care is a very important part of specialty consultation. Referring physicians often ask us to see patients about a specific digestive problem. Depending on the type of problem, we may initiate diagnostic studies or treatment. Most patients will continue under the care of their primary physician after a diagnosis and treatment plan has been established. At times, we may continue to follow your gastrointestinal problems ourselves. We encourage coordination of care with your personal physician who will always receive a prompt report of our findings and recommendations for treatment. With our new computerized Allscripts Professional Electronic Health Record (EHR) system and ProVation® MD computerized endoscopy record system, a report is usually sent to your doctor even before you leave our facility.
Which hospitals do your physicians attend?
Our physicians provide inpatient gastroenterology consultations and perform inpatient and outpatient procedures at Heritage Valley - Sewickley Campus and Ohio Valley General Hospital. However, the majority of our outpatient endoscopic procedures are performed at our endoscopy center, Three Rivers Endoscopy Center, which is conveniently located in the same facility as our outpatient medical practice.
Three Rivers Endoscopy Center
In 1996, Three Rivers Endoscopy Center was constructed in Moon Township to provide an efficient, convenient, and affordable option for patients needing endoscopic, or “scope,” procedures. Three Rivers Endoscopy Center was the first freestanding ambulatory surgery center in Western Pennsylvania solely dedicated to gastrointestinal endoscopy. Three Rivers Endoscopy Center is a member of the American Association of Ambulatory Surgery Centers and is fully certified by the Pennsylvania Department of Health and approved as a Medicare and Medicaid provider. We are proud to add that Three Rivers Endoscopy Center has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) since 1996. TREC was the first endoscopy center in Western Pennsylvania to achieve this accreditation.
Why do you perform procedures at Three Rivers Endoscopy Center (TREC) rather than the hospital?
Specializing in gastroenterology and endoscopy procedures, TREC was designed with efficiency, patient convenience, and ease in mind. All of our staff are specifically trained in GI procedures. Our highly skilled team of doctors and nurses are committed to providing the highest quality endoscopic services in a comfortable atmosphere. Three Rivers Endoscopy Center is committed to the care and concerns of each of our patients. Our facility, licensed by the state, offers patients a safe and professional environment. This physician-directed, patient-focused approach is intended to promote your long-term GI health, resulting in a high degree of patient satisfaction.
Benefits of an Ambulatory Endoscopy Center:
The benefits of having your procedure performed at an Ambulatory Endoscopy Center include:
• Endoscopy is performed by your own physician at our facility,
assuring you the same quality of care to which you are accustomed.
• Endoscopy is more economical due to the lessened overhead costs. The average charge is about 50% less than having the procedure at a hospital surgery center. In an era of increased copays and deductibles, this is especially important to our patients.
• Simplified admitting and discharge procedures provide added
convenience for the patient. Free onsite parking is available.
• The patient’s family can benefit from our center’s relaxing setting.
• Realizing that each case is unique, we provide close, personal
attention at all times.
What procedures do you perform?
- Flexible Sigmoidoscopy
- Removing colon polyps
- EGD (esophagastrodudonoscopy),
- Esophageal Dilation
- Endoscopic Retrograde Cholangiopancreatography (ERCP) at local hospital X-ray department
- Capsule Endoscopy or "Pill Cam"
- Percutaneous Endoscopic Gastrostomy (PEG Feeding tube) at local hospital surgery department
- Infusion Services for inflammatory bowel disease
- Breath Testing for H. pylori, the "ulcer bacteria"
Do I need a screening/consultation before scheduling a colonoscopy?
That depends. Every case is different. If you are a new patient, you will need to see the physician in the office prior to scheduling a colonoscopy. Our physician or nurse practitioner will do a history and physical to assure that you are healthy and have no medical problems that may make it unsafe for you to undergo the procedure. If you have no digestive symptoms and need a screening exam, we often just review your family doctor's last evaluation. In general, return patients who have been seen in the recent past do not need a preoperative office visit unless their health status has changed.
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. Even more importantly, colonoscopy can prevent colon cancer by detecting and removing precancerous polyps.
Should I bring a family member or friend to my procedure?
You will definitely need to bring someone with you to the Center. If you give permission, the doctor will discuss what they found during the procedure with your driver , since you may not remember what you are told due to the medications you received during the procedure. Additionally, you will not be allowed to drive or take a taxi home without a responsible adult with you. We request that the driver be over 18 years of age.
Questions about preparation
What is bowel prep and why do I need to do one?
The most important aspect of the colonoscopy is to be able to see the inside wall of your colon. What makes colonoscopy safe and accurate is an experienced doctor and supporting staff, state-of-the art instruments, great anesthesia AND A CLEAN COLON. If the colon is not well cleaned out, the test would not be safe nor accurate. It is extremely important to have a "clean" colon. The colon prep is a type of laxative that will cause the colon to empty of all debris so the physician may see all of the tissue within the colon. You must follow the instructions carefully and be sure to complete the entire preparation. For more information on Understanding Bowel Preparation, see the Understanding Bowel Preparation on our Patient Education Page.
Can I take pills for bowel prep?
Not any longer. There was a pill prep on the market a few years ago, but it was unsafe for many patients, especially those with high blood pressure, kidney disease, etc. Our physicians have decided not to use this prep any longer to assure it will not adversely affect anyone, especially if you have undiagnosed health problems.
Why can't I take all of the prep solution the night before my exam?
In the past, most colonoscopy prep were give the night before the examination. The colon was nice and clean when the patient went to bed, but overnight bile and mucous in the small intestine would enter the right side of the colon and cover the lining making the test less accurate. By cleaning out the colon the night before and the "polishing it" again 5 hours before the examination, the right side of the colon is almost always well prepared. The whole country swithced to this "split prep" a few years ago.
What if I start vomiting while drinking the solution?
If you develop symptoms of nausea or vomiting, stop the prep for a 30 minutes, then resume the process. Go slower and drink one 8 oz. glass every 30 minutes instead of 15 minutes. Cool down the prep in the refridgerator, or in an ice bath, before drinking it. If you were not able to complete the prep, please call us at (412) 262-1000 and speak to our nurse or doctor on night call.
What will happen if I eat or drink something right before (or a few hours before) my procedure?
Your procedure may be cancelled. It is dangerous to receive sedation if you have had something to eat or drink before your procedure. Our first concern is your health and safety. You will be given sedatives to help you relax during your procedure, and these medications affect your body’s ability to hold food and liquid in your stomach. If you eat or drink several hours before your procedure, there is a risk that food or liquid will travel up into your esophagus, where you could breathe it into your lungs. Your procedure will be re-scheduled if you do not follow the instructions provided by your doctor. You must be totally fasting for four (4) hours before your procedure, not even candy or gum.
How do I know when my bowl prep is complete?I do?
The stool output should look simlar to the liquids that you are drinking, clear, without any particles.
I finished my colonoscopy prep and I am not sure my preparation worked. What should I do?
It is normal to pass clear or yellow colored fluid from your rectum after the bowel preparation. But if you have completed your entire prep and are still passing formed stool, your procedure may need to be rescheduled. Contact us as soon as possible and request to speak with a nurse or our doctor on night call.
Do I have to drink all the solution to cleanse my colon?
Please follow all instructions and make every effort to drink all of the solution. The height and weight of a patient does not determine the amount of solution needed to purge your colon. Remember, we are trying to clean out your entire digestive tract. If your colon is not clean, the physician cannot do a thorough exam. You may have to reschedule your test for another day.
Can I drink wine or beer during the bowel prep?
No. The bowel prep may dehydrate you. It is important to drink plenty of water or clear liquids during your bowel prep to remain hydrated.
What about the medications I regularly take?
You need to tell your doctor about all medical conditions and any drugs, vitamins or nutritional supplements that you take regularly. If you are taking prescription blood thinners (Coumadin, Warfarin, Pradaxa, Plavix), please talk to your prescribing doctor. They may need to be temporarily held. Please continue all medications unless otherwise instructed by the doctor. If your take medications for high blood pressure, be sure to take them every day including the day of your colonoscopy prep and the morning of your procedure with a small sip of water.
Constipation and bowel preparation
One consistent factor that causes a poor preparation for colonoscopy is constipation. Starting the colon prep when you are constipated will just make you sick and probaby not result in a good preparation for the exam - which may have to be rescheduled. If you are constipated, you may need special prep instructions. This may require a "pre-prep" with a longer period of a clear liquid diet and additional laxatives to prepare for your colonoscopy. Please make sure your gastroenterologist knows that you are constipated before the procedure.
Should I continue to take my diabetic medications the day before my procedure?
Since you are on a liquid diet, you may need to adjust your diabetes medication the day before your procedure. Please refer to your instructions for details. In addition, please check your blood sugar regularly during your preparation. Remember, you may not be able to receive anesthesia for your procedure if your blood sugar is too high or too low.
I am diabetic and my blood sugar will go too low if I do not eat any solid foods, what should I do?
Please drink liquids with sugar the day before your procedure and do not stick to sugar-free drinks. You must consume 150-200 calories of carbs when you are on a liquid diet to maintain your blood sugar. Please do not eat any solid foods during your preparation or your procedure my need to be re-scheduled.
Can I have a colonoscopy if I am having a period?
Yes, menstural periods do not interfere with colonoscopy.
Before your colonoscopy
How soon can I have a procedure performed?
Most routine procedures are scheduled within 4 weeks of seeing the doctor. Of course, we also reserve some time for more urgent cases.
Why do I have to fill out paperwork and answer questions at the endoscopy center when I already answered them at the doctor’s office?
Three Rivers Endoscopy Center is owned by our physicians, and while the center is located next to our offices, it is a separate business. Medicare accredited facilities are required to have a separate chart for all patients. In addition, our staff wants to make sure we have your most up-to-date health information, including your current medications.
Why do I need to leave my jewelry at home?
We do not want you to lose or misplace it. You will have to change into a patient gown before the examination. You should wear loose, comfortable, casual clothing that is easily removed and folded. Avoid girdles, pantyhose, or tight-fitting garments. Please leave your jewelry, valuables, and high heels at home.
Questions about sedation
Is a colonoscopy painful?
No, a colonoscopy is not painful! During the examination, you will receive pain and sedation medications through an intravenous line. You will not be aware of the procedure and should not experience any pain.
Is the sedation safe?
Yes. Before the procedure, you will be evaluated by the Anesthesiologist. During the procedure, you will be continuously monitored by a Certified Registered Nurse Anesthetists (CRNA) using the latest monitoring equipment.
What medications do you use?
Our CRNA’s may use several medicines specifically selected for you based upon your health history. Medications commonly used are: Propofol (a sedative), Fentanyl (a narcotic used to control pain), and Versed (a medicine used to promote relaxation). This is called Monitored Anesthesia Care, or MAC. MAC anesthesia is perfectly suited to a short procedure like gastroscopy or colonoscopy. It is quick acting, very safe, and you feel no pain or embarrassment during the procedure. The anesthetic effect wears off quickly in the recovery room, and unlike many other anesthetic regimens, post-operative nausea and vomiting is quite rare.
I'm 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. While in a state of MAC anesthesia, it is very unusual for patients to speak.
Will this be the same type of anesthesia as when I had my gallbladder removed? Will I have a breathing tube?
Anesthesia required for gallbladder surgery is a general anesthetic. An anesthetic for a colonoscopy or upper endoscopy does not require general anesthesia or a breathing tube. You will be breathing on your own and at the same time be pain free during the procedure.
Is it common to “wake up in the middle” of the procedure or “watch the procedure on the screen”?
No. The sedation administered by the anesthesia care team usually takes effect in a few seconds. You are sedated before the procedure starts. You are usually waking up about three minutes after the procedure ends and safely in the recovery area. “Waking up in the middle” or “watching the screen” is not taking place with the medications being used at present.
Is it permissible to chew tobacco or “rub snuff” the morning of the procedure?
It is recommended that no chewing tobacco be ingested for at least 8 hours prior to your procedure. The liquid produced from your saliva with chewing tobacco often ends up in your stomach, producing acid. We think that it is important that your stomach be empty of these kinds of fluids prior to receiving anesthesia.
Can I chew gum the morning of the procedure?
As above, gum also generates saliva that is then ingested, producing acid in your stomach. We therefore strongly recommend that you abstain from all gum, mints, etc. for at least 8 hours prior to the procedure.
I have had nausea after other procedures that required anesthesia. Will I experience this also after my colonoscopy? Is it preventable?
Patients can experience nausea and/or vomiting after procedures for many reasons. Sometimes patients are prone to nausea and vomiting based on other pre-existing conditions. Some patients have a history of motion sickness, which can be correlated with post-operative nausea and vomiting. Please let the attending anesthesiologist know of your history if you suffer from this problem; we can add medication or alter medication to hopefully block that response. Because of the specific medications that we use for sedation, post-operative nausea and vomiting is rare after endoscopic procedures.
How will the anesthesiologist know how much anesthesia to give for my particular procedure?
There is no single or right amount of anesthesia for all patients. Every anesthetic must be tailored to the individual and to the procedure that the person is undergoing. The amount of anesthesia necessary can differ according to things like age, weight, gender, medicines being taken, or specific medical conditions. Heart rate and rhythm, blood pressure, breathing rate, and oxygen levels are monitored continuously during the procedure. Adjustments are made to anesthetic levels for each individual patient in order to keep the patient comfortable and safe.
Questions about procedures
What can I expect during the colon exam?
Sedation will be given before and during your procedure to help you relax and make you sleepy. You will lie on your left side as a flexible tube is slowly advanced into the rectum and colon. The procedure will cause you no discomfort. Please watch a video from American Society for Gastrointestinal Endoscopy for an overview of what you can expect during a colonoscopy procedure.
How long will my endoscopic procedure take?
If you are scheduled for an "endoscopic procedure," plan to be in our center for about two hours. Procedures such as gastroscopy or colonoscopy require sedation to make them safe and comfortable. 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 less than three hours.
What happens if the doctor finds a polyp?
The physician will remove the polyp and send it to the laboratory for an examination.
If the doctor finds a polyp during my procedure, will he remove it?
In most cases, yes. All of our doctors are trained in the latest endoscopic techniques. All but the largest polyps can be removed at the time of colonoscopy.
If the doctor takes a biopsy, does that mean I have cancer?
No. There are many reasons why your doctor may take a small sample or biopsy of your stomach or colon lining. Most have nothing to do with cancer.
Can my husband, wife, family member or friend come in with me during the procedure and watch?
No, this is not allowed at our endoscopy center. The physician will talk with your family or friend immediately following the procedure.
After your Procedure
Will the colonoscopy center keep me overnight?
No, you will not be kept overnight in the endoscopy center.
How will I feel after my procedure?
After your procedure, you will probably have a slightly 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 puffs of air that are put into the digestive tract during the endoscopic procedure. This helps your doctor see inside your stomach or colon. Most of the air is removed before the procedure ends, but some of it just has to pass naturally.
How soon will I be able to eat after my test?
As soon as you wake up, our nurse will offer you some juice. After you go home, you can have a light breakfast or lunch. Eat whatever you feel like. Just go slow at first and use some common sense.
Why can't I go to a restaurant after my procedure?
Because of the sedation, you must NOT go out to eat, but eat at home. You may stop at a take-out on the way home as long as you remain in the car.
Can I drink wine or beer after the procedure?
No. This is dangerous since you will have received narcotics and sedatives during your procedure. You must not mix alcohol and these medications.
Why do I need to bring a driver for my endoscopic appointment? Does he or she have to stay the whole time I am there?
Endoscopic examinations such as colonoscopy and gastroscopy require sedation. The sedation is to promote comfort to the patient, but will make the patient groggy for several hours, and slow reflexes for up to 12 hours. This is why you cannot drive your car or perform activities that require quick reflexes until the following morning. 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. If you arrive without an escort, your procedure will be rescheduled.
How soon can I return to work after my test?
Most patients are able to return to work the following morning.