The steps that make procedure day go smoothly.

General Surgery Preparation

Most outpatient general surgery procedures share a common set of pre-op steps. Follow these unless your surgeon has given you different instructions specific to your procedure.

Before procedure day

• Discuss all current medications with your surgeon — including over-the-counter, supplements, and blood thinners. Some need to be stopped several days in advance.
• Arrange a driver to take you home and stay with you for 24 hours after the procedure.
• Plan to shower or bathe the night before. Do not apply deodorants, perfumes, lotions, or hair products on procedure day.
• Set aside the documents you'll bring: medical records, insurance card, photo ID, Social Security number, and emergency contact information.

Procedure day

• Be on time for your appointment.
• Do not eat or drink for the time your surgeon specified — typically nothing after midnight, but follow the exact instructions you were given.
• Wear loose, comfortable clothing. No makeup, contact lenses, or nail polish.
• Leave jewelry and valuables at home.

What to pack

An overnight-style bag with personal care items: socks, slippers, pajamas, undergarments, toothbrush, and any prescription medications you take regularly (with their original bottles).

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Colonoscopy Preparation (Miralax)

This guide will help you prepare for your colonoscopy at Sulphur Surgical Clinic using polyethylene glycol (MiraLAX), bisacodyl (Dulcolax), and simethicone. A clean colon is essential — if stool remains, your surgeon may not be able to see polyps or other problems clearly, and the procedure may need to be repeated.

Read these instructions all the way through when you receive them, then keep this page open the day before your procedure to follow the timeline. Questions at any point — call (337) 527-6363.

↓ Download / print prep instructions Colonoscopy Prep Instructions – Miralax · PDF

Quick reference — prep day timeline

1 week before your procedure

Arrange a ride home. You must have a responsible care partner drive you home — someone who can get you there safely and report any concerns to your team. Plan this before procedure day.

Talk to your doctor about your medications. Some need to be stopped before your procedure. Common examples:

• Fish oil — stop 1 week before
• Metformin (including Glucophage, Janumet, or any product containing metformin) — do not take the day before or the day of
• Ozempic, Wegovy, Mounjaro, or any semaglutide / tirzepatide — hold for 1 full week before your procedure
• Iron supplements — stop 5 days before (covered below)
• Insulin or other diabetes medications — your prescribing doctor will adjust your dose; tell them you'll be on a sugar-free clear-liquid diet the day before

If you take a blood thinner — see the full list and instructions

Ask the doctor who prescribes your blood thinner when to stop it before your procedure. Do not stop a blood thinner without asking the prescribing physician. Common blood thinners include:

• Eliquis (apixaban)
• Pletal (cilostazol)
• Plavix (clopidogrel)
• Fragmin (dalteparin)
• Lovenox (enoxaparin)
• Arixtra (fondaparinux)
• Heparin
• Xarelto (rivaroxaban)
• Innohep (tinzaparin)
• Coumadin (warfarin)
• Aspirin

Buy your supplies

• 4 (5 mg) tablets of Dulcolax (bisacodyl) — usually sold as a box of 10
• 1 (238 gram) bottle of Miralax (polyethylene glycol)
• Simethicone — 80 mg tablets, soft-gels, or chewables (at least 4 tablets / 320 mg total). Brand names include Gas-X, Mylicon, and Phazyme. Generic store-brand is equally effective.
• 64 ounces of clear liquid that is not red, purple, or orange to mix with the Miralax. Keep at room temperature. A sports drink like Gatorade or Powerade is a good choice — it replaces electrolytes you'll lose during the prep. If you have diabetes, use a sugar-free sports drink.

Why simethicone? It breaks up the gas bubbles and foam that collect in your colon during the prep. Removing those bubbles gives your surgeon a clearer view of the colon lining and helps catch small polyps that bubbles can hide. It's safe, inexpensive, and available over the counter.

5 days before your procedure

Stop iron supplements. Iron causes color changes in stool that make the colon lining harder to see.

3 days before your procedure

Start a low-fiber diet. During this period, do not eat:

• Raw (fresh) fruits and vegetables
• Whole kernel corn, including canned
• Whole grains (oatmeal, brown rice, quinoa, wheat bread)
• Seeds (sesame, poppy) or nuts

2 days before your procedure

Most patients — if you're not usually constipated, don't take opioid medications, and haven't had a prior colonoscopy with poor prep — just continue the low-fiber diet (no raw fruits/vegetables, whole kernel corn, grains, seeds, or nuts). Skip to "The day before" below.

If you are usually constipated, take narcotic medications, or have had a colonoscopy with a poor prep in the past:

• Take 1 capful (17 g) of Miralax mixed with 8 oz of liquid at breakfast, lunch, and dinner
• Follow a full liquid diet: yogurt (no fruit pieces), fruit juices without pulp, soda, strained broth or cream soups, nutritional supplements like Ensure or Boost, ice cream and fruit ices (no fruit pieces)

The day before your procedure

Morning: Mix all 238 g of Miralax with 64 oz of room-temperature clear liquid until the powder dissolves. Once dissolved, you can refrigerate it — most people find it tastes better cold. Do not mix earlier than this morning.

Follow a clear liquid diet all day. Drink at least one 8 oz glass of liquid every hour while you're awake. If you have diabetes, drink only sugar-free clear liquids and check your blood sugar often.

Start your bowel preparation

Day of your procedure

• Nothing by mouth within 4 hours of your scheduled arrival time
• Take only the medications your surgeon has approved, with a small sip of water
• Wear comfortable, loose-fitting clothing
• Leave jewelry and valuables at home
• Bring photo ID, insurance card, and a list of your medications
• Make sure your ride home is available

Devin Seale, MD, FACS • Stephen Castleberry, MD, FACS • Matthew Ayo, MD, FACS
Board-certified general surgeons serving Southwest Louisiana for over 50 years

Post-Procedure Vein Care

Recovery instructions after Endovenous Laser Treatment (EVLT) and Varithena foam treatment. Most patients are walking and back to light activity the same day. Following these instructions carefully helps the treatment work as well as possible and keeps your recovery smooth.

↓ Download / print recovery instructions Post-Procedure Instructions – EVLT & Varithena · PDF

What's normal in the first weeks

• Bruising along the treated vein for 1–2 months — it can look dramatic before it fades.
• Tenderness or a firm, rope-like feeling along the closed vein. This means the vein is sealing as intended.
• Mild aching or tightness in the leg for the first 3–7 days, especially in the evening.
• Small areas of skin discoloration that fade gradually.
• A small amount of pinkish-tan drainage or spotting from the catheter access site for the first day.

The first 24 hours

• Walk for 10–15 minutes every 1–2 hours while awake. Walking is the single most important thing you can do today — it helps the closed vein stay closed and lowers your risk of a blood clot.
• Keep your compression stocking on (see below).
• Drink plenty of water.
• Avoid sitting or lying still for long stretches. No long drives, naps, or movie marathons today.
• You may shower in 24 hours. No baths, hot tubs, swimming pools, or soaking the leg for 7 days.
• Eat your normal diet. Light foods are fine if you feel queasy from the procedure.

Compression stockings

After EVLT (Endovenous Laser Treatment): Wear your compression stocking continuously for the first 24 hours (you can take it off briefly to shower after the first 24 hours). After that, wear it during all waking hours for 1 to 2 weeks. You may take it off at bedtime.

After Varithena: Wear your compression stocking during all waking hours for 2 weeks. You may take it off to sleep and to shower.

If your stocking feels too tight, rolls down, or causes numbness in the toes, call our office — it may need to be refitted.

Activity

• Walk frequently — short walks throughout the day are better than one long walk.
• No heavy lifting (over 25 lb) and no strenuous exercise for 1 week. This includes running, cycling, weightlifting, yard work, and similar activity.
• No air travel or long road trips for 2 to 4 weeks. If travel is unavoidable, call us before you go so we can advise you.
• Most patients return to a desk job in 1–2 days. If your job involves heavy lifting or prolonged standing, talk with us about timing.
• Avoid hot tubs, saunas, and very hot baths for 2 weeks. Heat can dilate the veins and interfere with closure.

Medications

• Take your prescribed anti-inflammatory (NSAID) — ibuprofen or naproxen — for 2 weeks exactly as your physician prescribed. This is not just for pain; it is part of your treatment. It helps the closed vein heal and reduces inflammation along the vein. Take it with food.
• You may also take acetaminophen (Tylenol) as directed on the label if you need additional comfort. Most patients need very little.
• If you take a blood thinner (aspirin, Eliquis, Xarelto, Plavix, warfarin, or another), continue taking it on your normal schedule. We intentionally do not stop blood thinners for these procedures.
• Continue all of your other usual medications — blood pressure, heart, diabetes, thyroid, etc. — exactly as you normally take them.
• A cool pack wrapped in a thin towel may be applied over the stocking for 15 minutes at a time during the first 48 hours.

Site care

There are no incisions — only small catheter and injection sites that close on their own. Light bruising along the treated area is expected and will fade.

Do not apply lotions, creams, or ointments to the treated leg unless we have told you to.

Follow-up ultrasound

Your follow-up venous ultrasound is scheduled approximately 1 to 2 weeks after your procedure. This is required to confirm the vein has closed and to screen for any blood clots.

Please do not skip this visit, even if you feel completely back to normal. Insurance coverage for any additional treatment may depend on it. To reschedule, call (337) 425-9300 as soon as possible.

Devin Seale, MD • Stephen Castleberry, MD • Matthew Ayo, MD

Important Disclaimer

These guidelines are general information and do not constitute medical advice or replace instructions from your surgeon. They are not a comprehensive list. Your surgeon will provide specific instructions tailored to your procedure and your individual medical situation.

If you have any question at all about your preparation — what to stop, what to take, what to eat, when to arrive — call the office. We would much rather hear from you twice than have you arrive unprepared.