 Informed consent was obtained prior to the procedure with special attention to benefits, risks, alternatives.  Risks explained as bleeding, infection, bowel perforation, aspiration pneumonia, or reaction to the medications.  Vital signs were monitored by blood pressure, heart rate, and oxygen saturation.  Supplemental O2 given.  Specifics discussed.  Preprocedure physical exam performed.  Stable vital signs.  Lungs clear.  Cardiac exam showed regular rhythm.  Abdomen soft.  Her past history, her past workup, her past visitation with me for Inflammatory Bowel Disease, well responsive to sulfasalazine reviewed.  She currently has a flare and is not responding, therefore, likely may require steroid taper.  At the same token, her symptoms are mild.  She has rectal bleeding, essentially only some rusty stools.  There is not significant diarrhea, just some lower stools.  No significant pain.  Therefore, it is possible that we are just dealing with a hemorrhoidal bleed, therefore, colonoscopy now needed.  Past history reviewed.  Specifics of workup, need for followup, and similar discussed.  All questions answered.