3.  Elevated CEA.  The patient will need colonoscopy on an outpatient basis.  He has refused this today.  We would like to encourage him to do so.  Of note, the patient when he came in was on bloodless protocol, but with urging did accept the transfusion.  Similarly, I am hoping that with proper counseling, the patient will consent to further examination with colonoscopy given his guaiac-positive status, elevated CEA and risk factors.