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Your procedure is scheduled for:
PICO-SALAX®
A strong laxative must be taken before your procedure. Your doctor has recommended PICO-SALAX, which is available without a prescription at your local pharmacy.
THE DAY BEFORE YOUR PROCEDURE: Follow these instructions (not package insert).
Take the 1st Sachet of PICO-SALAX
Take the 2nd Sachet of PICO-SALAX
HOW TO TAKE PICO-SALAX:
1. Fill a mug with 150mL (5oz) cold water.
2. Empty contents of one sachet in the MUG
(rarely, mixture may heat up – allow to cool before drinking)
3. Stir for 2 to 3 minutes until completely dissolved
4. YOU MUST DRINK BETWEEN 1 ½ TO 2 LITERS OF WATER
OR CLEAR FLUIDS OVER 4 HOURS FOLLOWING EACH SACHET.
DRINK ONLY CLEAR FLUIDS - Water, clear power drinks, apple juice, white (not red) cranberry juice, white
(not purple) grape juice, ginger ale, broth, tea or coffee (sweetened to taste, no milk, cream or soy). Do not drink liquids that you can’t see through.
You can drink a small amount of water to satisfy your thirst up to 4 hours before the procedure.
Please advise your doctor if you are taking:1. Aspirin® (ASA), or medications containing ASA 2. Blood thinners such as Coumadin® (warfarin) 3. Iron pills or a multivitamin containing iron4. Ticlid® (ticlopidine), or Plavix® (clopidogrel) SPECIAL INSTRUCTIONS:
® PICO-SALAX is a registered trademark of Ferring B.V.
® Aspirin is a registered trademark of Bayer AG ® Coumadin is a registered trademark of Bristol-Myers Squibb® Ticlid and ® Plavix are registered trademarks of Sanofi-Aventis For more info www.pico-salax.ca
Understanding Your Colonoscopy Procedure
What is a colonoscopy? A colonoscopy is a procedure that allows a doctor to examine the lining of your colon (large intestine) for ulcers,inflammation, polyps (small growths, usually benign[non-cancerous]) or cancer. It is often used to investigatesymptoms such as abdominal pain, rectal bleeding, weight loss or changes in bowel habits. A long flexible tubewith a video camera is passed through the anus into the rectum and around the colon. The image of the lining ofyour colon is shown on a TV monitor in the same room so the doctor can look for: causes of bleeding, polyps,any abnormalities or inflammation (for IBD patients). If polyps are found, they are usually removed during thisprocedure. Very small tissue samples (biopsies) can be taken during the procedure if necessary.
PreparationIn order for your doctor to see the colon lining clearly, your colon must be completely empty. To prepare for theprocedure you will have to take a powerful laxative to clean the colon, as explained on the other side of this sheet. Before undergoing the procedure, tell your doctor or medical assistants if you have any medical conditionssuch as heart or lung disease, allergies, or if you have been told to take antibiotics before other procedures,or other medical condition that may need special attention. You must arrange for someone to take you to and from the appointment, as you will be drowsy following
the procedure. Do not drive or operate machinery for the remainder of the day, even if you feel ok, as you
are considered legally impaired.

What should you expect?You must register at the hospital/clinic before your test. You will change into a hospital gown. Then a nursewill ask you a few questions, give you a consent form to sign and take your blood pressure and pulse. An intravenous line may also be set up. Many patients are uneasy about the procedure, so medications canbe given through the intravenous to help you relax. You will not be asleep (like during surgery) but sorelaxed that you might not remember the procedure.
It may be necessary for the doctor to add air into your colon to help with the examination. This may causeabdominal pressure or cramping, which will pass after your exam is finished.
You will then be in the recovery area until the effects of the intravenous medication wear off.
What are the risks?A colonoscopy is a safe procedure and has very low risk when performed by physicians who have been specially trained. However, possible complications are: Perforation (a tear) in the colon wall after the colonoscopy - about 1 in 1,500, or following removal of a polyp - about 1 in 500. It may require surgery to repair or be managed with antibiotics and intravenous fluids.
Bleeding following a colonoscopy - about 1 in 2,000, following removal of a polyp - about 1 in 500.
Allergic reactions to the intravenous medications (including rash, fever or breathing problems).
A tender lump where the intravenous is placed in your arm may develop which may stay for up to several months but goes away. Apply heat packs or hot, moist towels to relieve the discomfort.
Heart problems, or a stroke can occur in a patient with underlying medical problems, but are very rare.
No test in medicine is perfect: rarely polyps and cancers are missed (2-6% missrate)1.
If you have any severe abdominal pain, fever or chills, or passage of red blood or black stools, or any other
unusual symptoms, you must call your physician or go to the Emergency Department of your nearest hospital
immediately.
1. B. Bressler, L. Rabeneck et al Gastroenterology, Volume 132, Issue 1, Pages 96-102

Source: http://pico-salax.com/French/pdf/english_form.pdf

Informed consent lhe

INFORMED CONSENT Naam m/v: ……………………………………Telefoon thuis: …………………………………. Straat: ………………………………………. Telefoon mobiel: ………………………………… Postcode + huisnr: …………………………… Geboortedatum: ……………………………….…. Woonplaats: ……………………………�

11.12.18.r10 programa interno

Tel/Fax (0351) 464 5938 WWW.HIPODROMOCORDOBA.COM.AR PROGRAMA NO OFICIAL Domingo 18 de Diciembre de 2011 Reunión Nº 10 PROGRAMA SUJETO A CAMBIOS. ACCESO EXCLUSIVO POR ENTRADA PRINCIPAL 1 º Carrera Apuestas a Ganador, Segundo, Exacta, Imperfecta y Trifecta CONCERTADA Premios: $150 P.C.C.- Insc. $150 R.O. $150 Der Prog $40 Procedencia Padre - Madre Cuidador

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