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PATIENT INSTRUCTIONS FOR AMBULATORY pH MONITORING
(print this page out to keep it handy)
FIVE (5) DAYS PRIOR TO THE TEST:
STOP Proton Pump Inhibitor medications: Prilosec, Prevacid, Aciphex, Protonix or Nexxium.
ONE (1) DAY, 24 HOURS, PRIOR TO TESTING:
STOP all H2 antagonist medications and prokinetic drugs. These drugs include Zantac, Tagamet, Tagamet HB, Pepcid, Pepcid AC, Axid, Reglan, Propulsid.
Antacids such as Riopan, Mylanta, Maalox, Tums, Rolaids and Carafate may be taken 6 hours prior to testing.
Other medications other than the above may be continued.
If you do not comply with the above directions and stop the appropriate medications as indicated, the test will have to be rescheduled.
DAY OF pH TESTING:
1. NO food or drink 6 hours prior to test.
2. Showers, tub bathing, hair washing is recommended prior to your appointment as these activities will not be permitted for 24 hours while the pH catheter is in place.
3. Wear appropriate clothing on the day of the test, i.e., shirts or blouses that open and fasten in the front. NO PULLOVER shirts, sweatshirts or jackets please.
4. Please arrive on time for your scheduled appointment.
5. Allow at least 45 minutes to one (1) hour for your appointment. This will allow for pH catheter placement along with instructions and any other discussions necessary.
6. You will need to return to the office 24 hours after the catheter is placed for removal. This visit will take approximately 15 minutes or less.
PLEASE CONTACT OUR OFFICE IF YOU SHOULD HAVE ANY QUESTIONS OR ARE UNCLEAR ABOUT ANY OF THE ABOVE INTRUCTIONS.
Appointment Date: _______________
Appointment Time: ________________
STOP YOUR MEDICATION(S) ON THE FOLOWING DATE:
_______________________
Please Note:
You are being scheduled for a 24 hour pH monitoring test. We ask that all patients call the office at least 24 hours in advance to cancel the scheduled procedure if you are unable to make the appointment. Due to supply costs, it will be necessary to charge you for the procedure tray in the event that 24 hours notice is not given.
If you have any questions regarding this policy, please let us know.
Thank you in advance for your understanding.
Please note: We do not answer questions regarding individual medical problems on this website. We advise you to contact your physician for your specific health related concerns.
©2007 Syracuse Gastroenterological Associates, P.C.
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