Dear Sir/Madam:

Greetings.

Thank you for choosing Jiahui Medical Endoscopy Center for colonoscopy examination. We sincerely wish to provide you with the best quality health care patient experience. To fully prepare for your colonoscopy/capsule endoscopy examination, please pay attention to the following instructions:

Before Colonoscopy

1. Diet recommendations

2 days before examination: Low residue diet

1 day before examination:
    Breakfast - Low residue diet
    Lunch - Low residue diet
    Dinner - Clear liquid diet

1 day before the examination, please avoid the following food:

• Grains: glutinous rice, black rice, cereals and others

• High fiber vegetables: celery, leeks, bamboo shoots and others 

• Fruits with seeds: watermelon, kiwi fruit, dragon fruit and others 

• Dark colored food: tomatoes, animal blood, animal liver, red dates, red hot chili peppers, black fungus, sesame and others

• Seaweed: kelp, seaweed and others

2. Bowel preparation

If your colonoscopy is in the morning,

• Start your bowel preparation on the day before your examination, 2 hours after dinner at 8pm

• Dilute 2 packets of prescribed powder in 2 L of warm water and mix well

• Finish the above prepared mixture in 2 hours:

  ○  In the 1^st hour, finish 1 L of prepared mixture

  ○  In the 2^nd hour, drink 250 mL of prepared mixture every 15 minutes

On the day of your examination:

• Start your bowel preparation at 6am

• Dilute 1 packet of prescribed powder in 1 L of warm water and 30 mL of Simeticone together, mix them well

  ○  Complete the above prepared mixture in one hour duration

If your colonoscopy is in the afternoon,

• Start your bowel preparation on the day of your examination 4-6 hours before the procedure without having breakfast

• Dilute 2 packets of prescribed powder in 2 L of warm water and 30 mL of Simeticone together, mix them well

• Finish the above prepared mixture in 2 hours:

  ○  In the 1^st hour, finish 1 L of prepared mixture

  ○  In the 2^nd hour, drink 250 mL of prepared mixture every 15 minutes

Minimum to moderate walking exercising required after completing 1^st liter of prepared mixture.

Please take note: In 1 to 2 hours after consumptions, your bowels will start to clear. You should notice your stools are turning clear in color, after several toilet trips. This means your bowel is well prepared for the examination. If you have constipation issues, please let your doctor know. He or she might add other medications to your bowel preparation.

3. Please stop eating and drinking 2-4 hours prior to the examination.

4. Please let your doctor know if you are taking any of the following blood-thinning medications: aspirin, clopidogrel (brand name Plavix, Talcom etc.), warfarin, etc. If necessary, your doctor might request you to stop taking these medications 5 to 7 days before the examination.

5. We do not recommend the examination be done if you are pregnant or having your period (menstruation).

6. Please tell your doctor or nurse if you have a cold or a blocked nose. 

7. On the day of examination, please also remember to bring all your medical records and relevant medical tests results and reports.

After Colonoscopy

1. If you have undergone a colonoscopy with no biopsy done – After 1 hour, you can resume your normal diet

If you have undergone a colonoscopy with biopsy done – After 2 hours, please start on low-residue semi-fluid diet. On the next day, you can resume your normal diet.

• Low-residue diet examples: porridge, bread, noodles, small wonton and steam egg custard, etc.

• Fluid diet examples: fruit juice without pulp, lotus root starch paste, clear broth, etc.

2. If you have undergone colonoscopy with treatments performed (such as removal of polyp and hemostasis): 

• Please have complete rest in bed on that day after the examination. Avoid any strenuous activity for the next three days

• For the first 2 days after the examination, please eat cool low-residue diet. Avoid soybean drinks, milk and carbonated soft drinks. On the third day, you can resume eating soft-textured food. Avoid eating spicy and oily food

3. You can resume your usual medications. Your doctor might ask you to discontinue aspirin and blood-thinning medications such as clopidogrel 3 to 5 days if needed.

4. After the examination, you may experience some abdominal bloating that will disappear after a few hours upon passing gas. Also, it is normal if you see a small amount of blood in your stools after the examination.

5. Please contact your doctor if you have the following symptoms: constant nausea and vomiting, abdominal discomfort, fever and others.

If you experience persistent abdominal pain or blood in stool, please contact your doctor and seek help immediately.

6. If you have undergone sedative colonoscopy: avoid strenuous activity and sudden position change to prevent vertigo when recovering from anesthesia. Avoid driving or operating heavy machinery on the day of examination. 

7. It will be ideal to have someone accompany you home after the examination if you are undergoing a sedative colonoscopy.

8. You will be able to get your pathological report 10 working days after the endoscopy procedure. Your doctor may also arrange a follow-up appointment to explain your examination results/report if required. 

What is an MRI scan?

What is a gastrointestinal endoscopic examination?

Gastrointestinal endoscopic examination is the most common and direct method used to look at your digestive tract. During the procedure, a flexible tube with a camera attached is passed through your digestive tract to capture pictures on a color TV monitor.

Endoscopic examination has been around for a long time and is a relatively fast and safe procedure. It is mainly used to detect inflammatory changes of the layers of the digestive tract, ulcers, cancer, and other diseases.

Gastrointestinal endoscopic examination is superior to ultrasound and computed tomography (CT) examination because besides being the most direct way to look at lesions and abnormal changes in the digestive tract, some tissue can be removed (biopsy) at the same time to confirm the nature of disease – whether it is inflammatory, benign growth, or malignant cancer. In addition, treatments can also be carried out using endoscopy.

What are the different types of gastrointestinal endoscopic examination?

Gastrointestinal endoscopic examination can be broadly divided into 3 types:

Other types of gastrointestinal endoscopic examination include endoscopic ultrasound, capsule endoscopy and enteroscopy (small intestines).

What are the treatments that can be done under gastrointestinal endoscopic examination?

The treatments that can be done include but are not limited to the following:

•   Removal of polyps from the stomach and intestines

•   Digestive tract bleeding control and treatment

•   Treatment for early cancer in gastrointestinal tract

•   Intestine dilation and placement of stents

•   Pancreas and bile duct treatment – removal or stones, cysts drainage, and placement of stents

Why do I need a gastrointestinal endoscopic examination?　

Digestive tract problems are very common and occur frequently among people nowadays because of work stress, unhealthy eating habits, and sedentary lifestyle. These cause undesirable effects such as stomach discomfort, stomach pain, acid reflux, gas, stomach distension, heartburn, diarrhea, constipation, and at times blood in the stools.

These symptoms may be caused by any of the following digestive tract problems: 

•   Chronic gastritis

•   Esophageal reflux

•   Gastrointestinal functional disorders

•   Ulcers in the stomach or intestines

•   Polyps in the stomach or intestines

•   Inflammatory bowel disease

•   Cancers of the digestive tract

Endoscopic examination provides the most accurate visual inspection of the digestive tract. It can detect cancer at an early stage, especially colon cancer and gastric cancer which are ranked 2^nd and 3^rd as the most common cancers respectively.

Early detection, early diagnosis, and early treatment can greatly improve your chances of recovering from cancer of the digestive tract. Thus, it is generally recommended that for people aged 40 years and above to have regular gastroscopy screening and those over the age of 50 to have regular colonoscopy screening. If you have digestive tract symptoms or a family history of digestive tract cancer, screening should be started at an earlier age.

Is gastrointestinal endoscopic examination painful？

Gastrointestinal endoscopic examination generally does not cause great discomfort. However, some may feel nauseous during a routine gastroscopy examination. Others may feel stomach distension or discomfort during routine colonoscopy. If you wish to avoid these unpleasant side effects, you can choose a sedative endoscopic examination.

Sedative endoscopic examination uses a combination of sedatives (medicines that help you to sleep or reduce your anxiety) and anesthesia drugs (medicines that prevent pain during procedure or surgery) on top of the routine gastroscopy or colonoscopy to achieve a state of light quiet sleep. The whole procedure takes about 30 to 60 minutes. It effectively reduces nausea, vomiting, pain, and other unpleasant side effects.

Reducing your anxiety and discomfort will help you to tolerate the examination and have a more satisfactory experience. After the procedure, your doctor and nurses will observe you closely till you are fully awake and well before discharging you.

Am I suitable for sedative endoscopy?

If you have any of the following conditions, please discuss with your doctor to determine whether you are a suitable candidate for sedative endoscopy:

•   Serious heart or lung diseases 

•   Sleep apnea or snoring 

•   Bleeding in the digestive tract

•   Declined liver function or severe anemia

•   Severe neurological disease (such as stroke, convulsions, frequent epilepsy relapse)

•   History of drug abuse or history of allergies to sedative drugs

What are the risks of doing sedative endoscopy?

The sedative medication that is used to help you to sleep during the procedure is called Propofol. This medication helps you to fall asleep quickly before the procedure and wake up quickly after the procedure. It acts fast and clears the body fast, thus it has relatively few side effects. A small number of patients may experience a short period of drowsiness, giddiness, nausea, vomiting or other unpleasant effects which the anesthesiologist can help you to manage.

Endoscopic examination, with or without sedation, is an invasive procedure and there are risks of injury, bleeding, and infection. However, the chances of these happening are rare. There is also a small possibility of it affecting the heart and lungs or drug allergies occurring, depending on the patient’s current health condition. Some complications caused by endoscopic examination such as bleeding, perforation, etc. are usually managed during the procedure itself. Talk with your doctor about your current health condition and obtain a good risk profile before your procedure.

Endoscopic examination generally does not produce unpleasant side effects, however a small number of patients may experience the following for a short period of time: 

•   Hoarseness or throat discomfort

•   Small amount of bleeding (due to biopsy or severe nausea and vomiting)

•   Stomach bloating or distension

Over time the above symptoms or discomfort will resolve by themselves. Avoid food and drinks that may irritate your gut. Drinking salt water or sucking lozenges can help to reduce throat discomfort. On the day after the procedure, consume cool and easily digestible food and avoid strenuous activity to reduce the chances of any gastrointestinal tract bleeding.

What is a Computed Tomography (CT) scan used for?

A CT scan can take images of body parts from many angles and combine them together to show clear-cut sections of your body. These images show much more than a typical X-ray image.

The following are common uses of CT scans of different parts of the body:

•  Head CT scan - detects stroke, tumors, bleeding, and fractures. Also used to assist stereotactic surgery and radio surgery for treatment of brain tumors

•  Lung CT scan - detects acute and chronic changes to lung structures and lung cancer screening

•  CT pulmonary angiogram (CTPA) - for diagnosis of pulmonary embolism

•  CT cardiac angiography - looks at the blood vessels that supply the heart

•  Abdomen and pelvic CT scans - diagnosis of abdominal and pelvic diseases. Also used to diagnosis and staging of abdominal cancers

•  CT colonography (also known as virtual colonoscopy or VC) - detects tumors in the lower gastrointestinal tract

•  Extremities - assesses complex fractures, especially those around the joints, before surgery

Besides the above, CT scans can also be used to guide biopsies and determine location for radiotherapy, etc.

What preparation do I need to do before a CT scan?

Usually, there is little preparation involved. You may need to remove metal objects from your body such as jewelry, hair clips, etc. It is best not to wear clothes with metal zips, studs, etc. You may also be asked to not eat or drink for a few hours before your scan.

What will happen during a CT scan?

You may be given a special iodine-based dye as a drink or injected through your veins. This dye is relatively harmless and helps to see things in the body more clearly. This special dye, also known as an oral contrast agent, may give you a warm, flushed feeling, and an odd taste in your mouth which will soon disappear. For some people, this dye may cause nausea, vomiting, or itchy rashes that can be relieved with medications. 

 You will be asked to lie on a movable bed that will pass through a ring-shaped scanner. Stay very still during scanning so that images remain sharp and clear. It is also normal to hear some buzzing, clicking, or humming noises during the scan. Our CT technicians will see you through the glass window in the room next to you. We will be able to hear you at all times and also speak to you over the speakers. The whole procedure takes about 30 minutes.

What are the risks of doing a CT scan?

A CT scan uses a low dose of radiation and is thus a relatively safe test. However, we recommend that pregnant women avoid having a CT scan if possible, as there is still a small risk of the unborn child developing abnormally.

On rare occasions, the special dye used can cause an allergic reaction or kidney failure. Let your doctor or radiologist know if you have any of the following:

•  Kidney disease or poor kidney function

•  Diabetes or taking a medication called metformin

 Your doctor and radiologist may request you to do a blood test to determine if you should continue the scan with a contrast agent.

Your doctor, radiologist, or nurse will advise you on how to take medications, when to contact us if you feel unwell, and how much fluid to drink to flush the dye out of your body. Do follow these instructions carefully, and ask them questions if you have any concerns.

Roughly 1 in 4 Chinese adults are now overweight or obese. Being overweight or obese may have negative effects on your health and increase the risk of getting obesity-related disease such as high cholesterol, diabetes, heart disease, sleep apnea and some types of cancer.

 

Why do you need to lose weight?

Diabetes

Losing 5% of your total body weight can improve blood sugar control. If you lose 10-20% weight, your blood sugar level may be restored to normal range.

Cardiovascular Diseases

Obesity can increase your risk of cardiovascular diseases. Every kilogram of weight loss can reduce blood cholesterol levels by 1% and blood pressure by 2 mmHg.

Joint Pain

Losing weight is also good for your joint health. If weight loss is successful, arthritis and joint pain can be significantly alleviated.

Sleep Apnea

Obese people are more likely to suffer from sleep apnea. Just 10% of weight loss is good enough to reduce snoring and improve your sleep quality.

 

So start your weight control journey today!

Knowing your health risk 

Body mass index (BMI) is a ratio of your weight to height, and it is commonly used as an indicator of body fat.

Waist circumference
Measuring waist circumference helps screen for possible health risks that come with overweight and obesity. If most of your fat is around your waist rather than at your hips, you're at a higher risk for heart disease and type 2 diabetes.

High risk Waist Circumference

•    Male ≥ 90cm

•    Female ≥ 80cm

The Law of Energy Balance

Health experts agree that the best and safest way to lose weight and promote health is to reduce calorie intake, eat a balanced diet and be more active

What is energy balance?

Food provides us calories (energy) for daily activities. The calories we consume should be balanced with the calories we burn through physical activity. When it is imbalance between the two, it can lead to weight gain or loss. Excessive calorie intake together with low physical activity level can lead to weight gain.

A Healthier Way to Lose Weight

In order to let you better understand what is a healthier, more sustainable way to lose weight, our dietitian made a healthy plate for you. 

Excessive calorie intake can increase your risk of getting obesity-related diseases, such as cardiovascular disease, high cholesterol, diabetes and some cancers. Limiting fat intake is one of the key ways to lose weight, and also can improve your own health. For the same amount of carbohydrates and proteins, fats contain more than twice as many calories. This means that adding fat can easily increase the calorie content of foods, even in small amount can lead to excessive calorie intake. Eating healthier foods in moderation will provide less calories and fat. Reading food labels can help you better understand the nutrient facts of food products. In addition, you also need to consider about the portion you consume. A healthier food can also provide excessive calories if consumed in excess. 

Tips on eating habits

•    Be aware of all the food and beverages you consume daily is the first step. Recording your food and beverage intake in the food diary can help you know your eating habits better

•    Don't skip meals. If you do so, you may become so hungry that eat much more at the next meal or snack before the next meal

•    Please eat slowly and chew well at your mealtime

•    Sit down to eat instead of eating on the run

•    Eat more fruits, vegetables and wholegrain products as they contain more fiber, which makes you feel fuller and longer

Knowing potential sources of extra calories

•    Extra calories can easily be ingested through

•    Extra portion

•    Large portion

•    Sugary drinks, desserts, high fat food

•    Overeating occasions, such as buffet, social gatherings, etc.

•    Alcoholic drinks

•    Eating for other reasons other than hunger, such as emotional eating

At the other end of the calorie balance, lack of physical activity may also contribute to weight gain.

Here are some tips to help you become more physically active.

•    Walking instead of driving or taking public transport

•    Climbing stairs instead of using elevators

•    Take a walk during your lunch break

Weight loss journey could be challenging and frustrating. Our experienced dietitians will tailor your weight loss plan based on your medical history, lifestyle and food preferences to help and support you throughout the journey. If you need help and support for your diet, Please contact 400-868-3000 for an appointment with our dietitians.

Cold and flus

•      Bring your child to the doctor at the first sign of infection

•      Get a flu shot once a year

•      Practice good hand hygiene habits

•      Avoid contact with infected people when possible

Cigarette smoke

•      Avoid places with smoke

•      Stay away from people who are smoking

Air pollution

•      Avoid exposure to vehicle exhaust

•      Avoid exercising outdoors or participating in outdoor activities when air pollution is high

Tree, grass or weed pollen

•      During certain season, stay indoors if your child is allergic to pollen

•      Use air conditioning when possible and keep windows closed

•      Avoid cutting grass, digging around plants, or participating in field activities

•      Once you return home, change clothes and shower to wash off any pollen

Weather

Hot weather

•      Don't leave inhalers under direct sunlight

•      Avoid exercising outdoors during the hottest part of the day (11am - 3pm) 

Thunderstorm and winter

•      Keep warm and dry

•      Cover mouth and nose with a scarf to help warm inspired air if the temperature is low

•      Bring your child to the doctor at first sign of a cold or flu, or if the asthma symptoms worsen

Food allergies

•      Talk to your doctor if you suspect your child has food allergies

•      Recognize the food your child is allergic to and the symptoms of a reaction

•      Know what to do when your child has a food reaction

•      Eat fresh, whole foods

•      Avoid unlabeled foods. Know the contents and food additives they contain

Physical activity

•      Although this is a trigger for certain people, it should not be avoided

•      5 minutes before exercising, take 1 to 2 puffs of rescue inhaler

•      Warm up adequately before each exercise session

•      Start slow and steadily increase activity gradually

•      Take all medications on schedule

•      Avoid exercising outdoors in extremely cold or hot weather

•      Cover your mouth and nose with a scarf to help warm inspired air if temperature is low

Stress and anxiety

•      Recognize your child’s stress triggers, such as taking exams, participating in competitions, performances, etc.

•      Allow your child to take some time out to do the things he or she likes

•      Stay healthy through balanced diet and moderate exercise

Bedroom and Living Room

•      Cover your pillows and mattresses with special zippered covers that keep dust mites away

•      Use washable blanket instead of a comforter

•      Use washable, vinyl or roll-type window covers

•      Use washable rugs instead of carpets

•      Vacuum floor and mattress weekly using a vacuum cleaner that has a ''HEPA filter'' (HEPA filter: High efficiency particulate air filter)

•      Every week, wash the following in hot water with detergent or dry them in an electric dryer:

•      If possible remove soft toys, clutter and fabric-covered furniture

Bathroom

•      Every 4 weeks, dilute 30 ml bleach in 1 liter of water, clean the sinks, tubs, surfaces with visible mold

•      Avoid using strongly scented aerosol air fresheners

Kitchen

•      Well-ventilate cooking areas

•      Kill cockroaches by using multiple baited traps or poison

•      Remove cockroach debris quickly

•      Remove garbage and food waste promptly

•      Wash dishes and cooking utensils immediately after use

•      Keep kitchen sink and drains dry. Mend leaking faucets or drains

Air quality

•      Air the room well if you have new furniture or carpet

•      If air pollution is bad, keep windows and doors closed

•      Reduce moisture in the air to less than 50%. Avoid using a humidifier

•      Keep your home smoke-free

Pets

If you can,

•      Keep all animals outside of the house 

•      After that, clean your home thoroughly

If you cannot remove your pets,

•      Use an air filter with a ''HEPA filter''

•      Reduce clutter in your home where allergens can build up (especially carpets, fabric-covers, etc.)

•      Vacuum floor with a vacuum cleaner that has a ''HEPA filter'' weekly

•      If you have a dog, bathe your dog 2 times a week

Upper respiratory infection (URI), also known as the common cold, is caused by a group of viruses. They can be passed between people by sneezing, coughing, and touching surfaces with the viruses on them. You can become infected if the lining of your eyes, nose or mouth comes in contact with the virus when you rub your nose or touch your face with contaminated hands. The usual symptoms are nasal congestion, runny nose and sneezing. 

The common cold weakens your immune system and at times leads to a new viral infection or bacterial infection. This can cause other serious problems such as sinusitis, infection of the middle ear, and pneumonia. Thus it is important that you take good care of yourself when you get the common cold to prevent these problems.

Do I need antibiotics?

Antibiotics are not useful for treating the common cold. If fact, taking antibiotics when not needed can negatively affect your health. The common cold gets better on its own with at-home care over time, even without any treatment. 

What medicines will my doctor give me? 

Depending on your symptoms, your doctor may give you medicines to relieve your runny nose, nasal congestion, cough, pain, or fever.

What can I do at home to feel better?

DOs

•      Get plenty of rest

•      Drink lots of fluids to keep the lining of your nose and throat moist

•      Add moisture to the air in your home. Use a cool-mist humidifier or vaporizer and be sure to clean it daily

DON'Ts

•      Avoid smoking or secondhand smoke

•      Avoid blowing your nose forcefully

When can I return to work? When can my child return to school?

You can resume your usual activities at least 24 hours after your fever totally subsides and when you feel better. Wear a mask if you still have a cough or runny nose, and practice good hygiene etiquette, like covering your mouth when sneezing or coughing to prevent the spread of infection.

How can I prevent getting a URI again?

Reduce your chances of getting a viral infection by exercising regularly and eating healthily.

Good hand washing habits, like washing your hands with soap and water before eating or after touching dirty surfaces, can prevent the spread of infection. 

Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Ensure that you thoroughly wash every part of your hands.

When should I see my doctor again?

Please contact your doctor if you have: 

•      Worsening symptoms after 3 to 5 days

•      A fever of 38.5°C or above lasting more than three days

•      Nasal congestion that does not improve over 14 days

•      Signs or symptoms of an ear infection - pain, ear discomfort, discharge from ear, difficulty hearing, fussiness (children), etc.

•      Severe body aches, joint pain

•      Rash

•      Nausea or vomiting

When do I need to go to the hospital or emergency department?

Call the ambulance or go to the nearest hospital right away if you have: 

•      Chest pain

•      Difficulty breathing

•      Shortness of breath

•      For children:

  ○  Increased irritability or decreased responsiveness

  ○  Poor oral fluid intake

When the middle section of the ear gets infected, it causes an ear infection just behind the eardrum, known as acute otitis media. This is a common problem in children. Middle ear infections often occur after a common cold, the flu, or nose and throat infection.  

When you or your child has a middle ear infection, swelling occurs and fluid forms just behind the eardrum. This may cause you pain, fever, drainage from your ear, and sometimes difficulty in hearing. Middle ear infections keeps usually clear up without long-term effects/problems. 

What medicines will my doctor give me? 

Depending on your age and severity of the infection, your doctor will decide if you need antibiotics. It is important that you complete the course of antibiotics as instructed.

Your doctor may also give you medications to relieve your pain and reduce your fever.

What can I do at home to feel better?

DOs

•      Keep your ears dry

DON'Ts

•      Do not use cotton swabs to scratch or poke your ears

•      Avoid blowing your nose forcefully

•      Avoid activities that will worsen your symptoms such as diving or swimming

When can I return to work? When can my child return to school?

You can resume your normal activities once the pain and fever have subsided. 

How do I prevent middle ear infection?

Reduce your exposure to the common cold or upper respiratory infections. Keep up-to-date with pneumococcal and influenza vaccinations. Stay in a smoke-free environment whenever possible. Your doctor may decide to give you a low dose of antibiotics if your middle ear infections keeps occurring 3 or more infections in 6 months.

When should I see my doctor again?

Please contact your doctor if you have: 

•      No improvement within 24 to 48 hours

•      Worsening of pain or fever

•      Increase in ear drainage

•      Increased difficulty in hearing. For children – lesser response to surrounding noise

•      For children – decreased activity or lack of appetite

We recommend children who are younger than 2 years old or at the age where they are learning to speak have a follow-up ear exam 2 to 3 months after being treated. This follow-up exam reduces the risk of your child delaying his/her speech development. If necessary, your doctor may refer you or your child to see an Ear, Nose and Throat (ENT) specialist.