Gastroenterology (619) 543-2347
http://health.ucsd.edu/specialties/gastro/
UPPER ENDOSCOPY (EGD) WITH BRAVO PH RECORDING WHILE OFF ACID REDUCTION (STOMACH) MEDICATIONS Patient Name: Check-in Time:
Date: March 24, 2014 Appointment Time:
Return Bravo receiver to Gastroenterology on:
If you arrive more than 15 minutes late to your appointment, you may have to reschedule. Check-in Information and Address of Procedure Site: UCSD Medical Center in Hillcrest: 200 West Arbor Drive, San Diego, CA 92103. Check in at the admissions/patient access reception desk in the main lobby. There is no free parking. Key Information to Review: You must arrange for a responsible adult to drive you home after the procedure, or accompany you if you are taking a taxi or public transportation. You cannot drive yourself because you will be given IV sedation, which will make you too sleepy for safe driving. If an adult cannot pick you up or ride with you home on the bus, your procedure may be canceled for the day. You may receive a courtesy call from Patient Access about your insurance benefits and inform you of any upfront payment that is due for your procedure. You may not drive or make any legally binding decisions until the day after your procedure if you receive intravenous (IV) sedation. Please arrive promptly at your check in time, which is listed at the top of this page. Arriving at your designated check in time will ensure we have time to prepare you for your procedure. Bring a picture ID, insurance card, and form of payment, if required, for check in. You will be ready to go home about 2 – 3 hours after your check in time. You will receive instructions regarding your follow-up care with pictures of your procedure when you go home the day of the procedure. One Week Before your Procedure 1. STOP taking iron pills. 2. If you take a blood thinner such as, Coumadin (warfarin), Plavix (clopidogrel), Aggrenox (dipyridimole/aspirin), Effient (prasugrel), Pradaxa (dibigatran), or take Lovenox injections please contact your prescribing doctor or Coumadin clinic immediately for instructions. 3. You may continue taking Aspirin or NSAIDS. 4. If you take medication for diabetes (pills or insulin), ask your prescribing doctor for any diet and medication changes needed for the day before and day of your procedure. 5. Stop taking acid reduction (stomach) medications (acid reducers like Nexium, Prilosec, Protonix, Prevacid, Aciphex, Omeprozole, Zegerid, sodium bicarbonate, Tums, Pepto Bismol, Milk of Magnesia, etc) until 48 hours after the procedure. Day of Procedure 1. Do NOT eat anything after midnight. 2. Take any important medications (for blood pressure, pain, post-transplant, seizure, heart rhythm) with a small sip of water.
3. Do NOT drink anything starting 2 hours before your check-in time, until after your procedure. 4. Bring your finished Esophageal Questionnaire, Medical History Form with you to check in. 5. We must make sure a responsible adult is driving you home after the procedure, or accompanying you if you are taking a taxi or public transportation either in person or by phone when you check in.
Cancellations: call 619-543-2347 and leave a cancellation message. Please include your name, medical record number (MRN) and message. For more information: Call the Clinic at 619-543-2347 and ask to speak to a nurse.
Emergency questions: After hours or weekends call (619) 543-6737 and ask for the G.I. Fellow on-call for emergency questions.
Bravo pH Diary - OFF Instructions The purpose of pH monitoring is to measure the frequency and duration of gastroesophageal reflux during a normal day. It is important that you eat, drink, work, and exercise as you normally would. Using the Symptom Buttons Symptom Button
Symptom Heartburn Regurgitation Chest Pain
Record symptoms (Heartburn, Regurgitation, Chest Pain) by pressing the specific symptom button as displayed above. To confirm that the button has been pressed, a green indicator light remains lit for 3 seconds and a beep is heard if this feature is turned on. Using the Diary Record events (i.e. meals, snacks, drinks, lying down and sleep) in the patient diary using the time on the Receiver’s display. (i.e. 12:30 – 12:55…Meal, 21:00 – 07:00…Sleep) Record the name of your medication and the exact times when you take your medication Remember to record the date and times from the receiver. For example: Start Time
End Time
13:05
13:45
13:45
13:46
14:18 21:39
Heartburn
Regurg.
Chest Pain
Meal
Sleep/Rest
Medications
X
Comments
Lunch X
Spironolactone 50 MG
X 7:07
X
Receiver Out of Range!! If the Receiver is too far from the BRAVO Capsule, a beep will be heard for 30 seconds and the display will flash C1 or C2. Move the Receiver to your breastbone until the beep stops and the C1 or C2 is no longer visible. If you have any problems or questions during your study, call (619) 543-2347, or after hours call (619) 543-6737 and ask for the G.I. fellow on-call for emergency questions. At the completion of your pH study, return the Bravo pH Receiver and your diary to the Gastroenterology front desk. Bravo____of____/Download Date______/X if need to edit study___/X if need to edit demographics ____
Page 3 of 6
Bravo pH Diary - OFF Day 1 ___ / ___ 20__ Start Time
End Time
Heartburn
Regurg.
Chest Pain
Cough
Belch
Hiccups
Page 4 of 6
Meal
Sleep/Rest
Medications
Comments
Bravo pH Diary - OFF Day 2 ___ / ___ 20__ Start Time
End Time
Heartburn
Regurg.
Chest Pain
Cough
Belch
Hiccups
Page 5 of 6
Meal
Sleep/Rest
Medications
Comments
Bravo pH Diary - OFF Day 3 ___ / ___ 20__ Start Time
End Time
Heartburn
Regurg.
Chest Pain
Cough
Belch
Hiccups
Page 6 of 6
Meal
Sleep/Rest
Medications
Comments
