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Category:

Chemotherapy

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Question:  #31 6/14/2009		Q:	I finished a 12 week course of Taxol and Herceptin. The guidelines passed down in the last couple of months are suggesting continuing Herceptin for the duration of a year every 3 weeks. My cancer was .6cm, poorly differentiated cells, nothing in nodes or margins, EP Receptors+ Her2Nu + and K1 67 = 37(high) I have a history of heart trouble on both sides of my family and am relulctant to continue with herceptin. Any recommendations from you?
		A:	Hi Simbeau, This is Ben Park one of the medical breast oncologists here at Hopkins. Lillie referred your question to me. Your question is a good one as there is no set answer. Current recommendations are to receive Herceptin for 1 year total, but no one knows whether this should also apply for such a small focus of disease such as yours. And given your history of heart troubles, this is a really important consideration. THere are emerging data looking at shorter durations of therapy, but nothing conclusive yet. I would suggest you talk to your doctors about this and ask whether they feel the risk/benefit ratio favors you taking Herceptin for a whole year or a more truncated course. Ultimately, it will be up to you to make as informed choice as possible, since we don't have hard set guidelines for your stage of disease. Best, Ben
Question:  #32 6/14/2009		Q:	I am 32 years old, and was diagnosed with IDC in April-2 months after my mother was diagnosed with stage 4 invasive lobular carcinoma. I am stage 1b: .8 cm tumor, 2 sentinel nodes removed were negative, ER/PR+ and Her2Neu negative, grade 2 (7/9 on BR scale), lymphatic vascular invasion present, intermediate Oncotype score of 20. Is chemo generally recommended for such a situation? If so, what would the regimen be? thanks so much for providing this wonderful resource.
		A:	due to your age along and despite having favorable prognostic factors, chemo is usually recommended. i hope both you and your mom are having genetic testing done. your situation shouts out for genetics evaluation. if positive, then consider bilateral mastectomy and bilateral oopherectomy too. sorry your mom's cancer is metastatic stage... L
Question:  #33 6/14/2009		Q:	dearest illie is a dose of tykerb of 3x250 with no considerable renal or liver dysfunction adequate ,and what is the influence of taking tykerb with or without food? thank you
		A:	Hi! Your question is not easy to answer since Tykerb is so new. The "usual" dose is about 1250mg/day, but there is much variability depending on your disease and things like your liver and kidney function as you mention. Tykerb is supposed to be taken on an empty stomach to increase absorption which is why it is recommended to take it greater than 1 hour before or after eating.
Question:  #34 6/14/2009		Q:	My 48 year old sister was diagnosed with IDC, stage 1, no lymph involvement, oncotype 26. She decided to have a double mastectomy. She will be taking Tamoxifen. She begins chemo next week. She is having trouble deciding between the two options presented by her oncologist. Option 1 is TC - once every three weeks and it''s over in 3 months. The second option is CMF - weekly for six months. The CMF option seems to have fewer/milder side effects, in general. She decided to get a second opinion. The second opinion stated that she should go for the TC. He negated some of the information provided by the first oncologist (told her 50% of people lose their hair on CMF which isn''t what we were told and is not what I''ve read on many of the cancer boards) and told her that she would have a much higher chance of leukemia on the CMF regime. She doesn''t care about hair loss, but I''m trying to track down the CMF/leukemia . She''s making her decision on this supposed leukemia . Is there any truth to this? Thanks for any additional information you can provide....
		A:	With any chemotherapy there are chances of both longterm and short term side effects. Leukemias are indeed a possible consequence of this, usually from the cytoxan, but that is also part of the TC regimen and at the doses used for breast cancer extremely rare for both regimens. Adriamycin is much more of a concern for causing secondary leukemias as well as heart toxicity which is why the TC regimen was developed. CMF is being looked at again in premenopausal women where it tends to work better, and this may be because it is much more likely to induce premature menopause than other regimens, ie one could almost think of it as secondary "hormonal therapy". However, across the board, the AC regimen proved in the 1990's to be slightly better than CMF, and now TC is as least as good as AC if not better. Also, CMF can cause hair loss, but usually not complete hair loss. The hair does have a high likelihood of thinning and becoming fragile however, so not all women would say that CMF is completely harmless to the hair.
Question:  #35 6/1/2009		Q:	Hi Lillie, i just had a follow up question on the study that showed weekly taxol to be superior to every three weeks. I thought that the dose dense every 2 week protocol was sort of the standard now (that is how I am getting it). Are there any studies comparing this regimen to the weekly? My oncologist said that the every three week administration is now considered old, and that the weekly protocol they might give to her positive patients. Just curious about this.
		A:	Dose dense AC +T hasn't been compared directly to every three 3 week AC followed by weekly T, so no one really knows. Some docs are mixing the two up based upon the trials and extrapolating the data such that dose dense AC is given followed by weekly T, but you should talk to your doctors about what is best for you. Best regards,
Question:  #36 5/31/2009		Q:	Hello Lillie...thank you so much for taking your time to answer the questions on this web site. Your kindness has given me MANY nights of peace. It always seems that the fear and ''what if''s'' hit at night. My question: I am 6 weeks out from AC/T chemo, 8 rounds in 16 weeks.46 yr old. Is it normal to still be tired and joint/muscle pain. My mind wants to resume normal life but my body seems to be saying different. I stiffen up easy and tire easy. How long does it take for the body to get over chemo? I start radiation on Monday for 33 treatments. Thank you again and God Bless.
		A:	You have been through much physically and emotionally dealing with chemo and the stress of a cancer diagnosis. It will take time for the body and mind to heal. Fatigue is one of the biggest complaints of treatment. Also, radiation can add to fatigue. Listen to your body for now and know that this should improve when all treatments are over. Glad you are ready to get back to life. You will be finding a new normal for awhile. ds
Question:  #37 6/1/2009		Q:	It''s me again, still waiting for oncotype results I am stage 1, grade 1, 5/9 BR scale, no node involvement, no lymphatic involvement, ER/PR highly positive I am praying that I have a low/inter score, I believe chemo to be toxic, as is radiation, but since I had a lumpectomy w/ a 1.5 cm tumor I know I must to the rads I will end up on a pill for 5 years I know, so the chemo seems like overkill, they are killing me waiting for the results since they ordered the test on 5/19 I am into alternative meds, and have researched calcium d glucarate, take vitamins, juice w/ wheatgrass etc I am a teacher and they want me to not take any vitamins during rads, but I must take care of my immune system also, one doc wants 33 rads, one says 36 is cool 28 + boosts , also they dont want me to shave my armpits what''s up with that Sorry for the tangent writing! Thanks
		A:	Hang in there. The features of your tumor suggest that there is a good chance you won't need chemo. Best regards.
Question:  #38 6/1/2009		Q:	my sister has 4th stage breats cancer and she is taking taxol she went for scans and everything is stable the cancer is not moving but she has developed a lot of iron in her liver dose that mean the cancer has spread to her liver?
		A:	No it does not, but that should be evaluated as well. Increased iron in the liver can be from other diseases unrelated to breast cancer and can lead to liver problems.
Question:  #39 5/24/2009		Q:	I am waiting for my oncotype test results, however, I doubt I will have chemo. I am stage 1, grade 1, 5 on the BR scale, no node involvement, no lymphatic involvement and ER/PR high % positive. I have set my rad treatment up, and am wondering if I am being too positive?? Will have 36 rads and definately some pill for at least 5 years
		A:	i would certainly be feeling positive and very optimistic with such a pathology report.
Question:  #40 5/24/2009		Q:	I have ILC, 3cm and IDC same tumor 0.25. ER/PR+,HER2-,grade 1, stage 2, BRAC1&2 neg, Oncotype 12,ki-67 15%, 1 sentinal node negative. Removed with clear margins. I was all set to take TCX4 after speaking to two oncs. They both said due to my onctoype test of 12 that I can reasonably do only tamox. I decided to be sure and do TCX4. I was blindsided when i went to Sloan for my final opinion to validate what i was doing only to be recommended AC+T X8 or CMF for 6 mos. I do not understand why TC is not their 2nd choice over cmf which is clearly better. they do not administer TC. I am concerned on heart and bone marrow for AC+T. What is your opinion of TCx4 + tamoxifan + double mastectomy following. Also i had a hysterectomy in 2002, no concerns, still have ovaries. Mom had breast cancer stg.0 and died of pancreatic cancer 2nd primary, material grandmother cancer at 60 and 80 died in late 90''s and paternal uncle with prostate cancer in mid 50''s
		A:	Hi there, This is Ben Park,one of the medical oncologist here at Hopkins and I was forwarded your email by Lillie. Sloan Kettering is starting to "resurrect" CMF for premenopausal women for a number of reasons, but I understand your confusion. I can't honestly give a 2nd opinion via the internet given what little information I have, but I would be more than happy to discuss this with you and your oncologist and/or provide a formal 2nd opinion here at Hopkins. Please email me at bpark2@jhmi.edu and we can discuss further. Best, Ben
Question:  #41 5/24/2009		Q:	Hi Lillie, hope you can stand another question on this-here goes. I know that er pr pos may not be as sensitive to chemo and I am wondering why that is. Is it because these types of breast ca are not always as aggressive as hormone neg? If so, does it correlate to the grade? In other words, if one is er/pr positive, but a grade 2 or 3, would chemo potentially be more effective than for the er pr pos but grade 1? Thanks again.
		A:	good question. not sure that the data has been analyzed in that way to be able to tell us though. it is true however that chemo seems to be most effective with grade 3, which is logical since they are rapidly proliferating cells and chemo is designed to destroy this type of cell. this is a key reason by grade 1 doesn't usually receive a great deal of benefit in some cases when chemo is given. it also is true that grade 2 and ER/PR positive tumors are very favorable prognostic factors. so when we see such a situation as this, and if node negative, the opportunity for doing oncotypeDX may lend more information as to the need for chemo or not. if the score is low then great. if the score is high, then we want to usually recommend chemo anyway and make sure the pt is being very compliant with taking the hormonal therapy as prescribed. L
Question:  #42 5/23/2009		Q:	Was totally healthy prior to my diagnose of 1.2 cm IDC, no node involvement, Triple neg in late Feb. Prior to my first A/C 4/30 all blood work was excellent. One week after first round, developed neutropenia and fever - cellulitis in cancer breast which is still healing from large batwing procedure (re-excision 4/8). Spent 4 days in hospital on iv vancomycin and Serapeem. Additional 10 days on iv infustions prior to work each a.m. of Cubicin (Daptomycin) and oral Cipro for 10 days. Second chemo was put off total of 2 weeks and will have it this coming Thursday. Am petrified of same thing happening. BS and Infect. Disease docs have cleared me. What are my chances of this occuring again? Thanks, Lillie, for your time and knowledge.
		A:	i'd be a bit concerned that it will happen again. at least the neutropenia part. hopefully not the cellulitis. they may opt to keep you on antibiotics for a longer period perhaps. hang in. put big "x"s through each day you have behind you on the calendar that bring you closer to being done chemo!!!!! L
Question:  #43 5/11/2009		Q:	My breast cancer involves 1 lymph node and is estrogen receptor positive, HER2 negative. I have completed 4 rounds of adriamycin and cytoxan. Is it worthwhile to complete the next 4 rounds of taxol in light of the 2007 study in the NE Journal of Medicine which indicated taxol had no effect on positive estrogen receptor tumors? Thanks for your help.
		A:	Sorry, but not sure which study you are talking about. If you mean the study by Sparano et al in 2008, that study did show a benefit for getting weekly taxol for 12 weeks after 4 cycles of AC in HER2 negative women with either ER positive or ER negative disease. So I would continue with a regimen of taxol, but I would ask your doctor about weekly taxol instead of taxol every 3 weeks for 4 cycles.
Question:  #44 5/11/2009		Q:	Dear Lillie, My wife is on her third line of chemotherapy being docetaxel (taxotare) and carboplatin and has just had her 16th cycle with results still keeping tumour stable. Is there a maximum number of cycles or is it you keep going until either through side effects you stop or if you have a refractory response?
		A:	There is no absolute maximal number at this point, and would rely upon side effects or resistance as you pointed out. That said, one must always be cautious about weighing the side effects with the benefit, and how your wife feels while taking the chemo should factor heavily into continuing the chemotherapy. Best wishes.
Question:  #45 5/10/2009		Q:	I had a mastectomy in april. The tumor was 3.4cm and 1/20 lymph node was positive. The margins were clear. I am ER positive/favorable and HER2 negative. I am recommended to do chemo followed by hormone therapy, but I am afraid of the chemo and think maybe just the hormone would be as good. Any ideas would help me. I can answer more if you wish.
		A:	this was a big tumor and it spread to a node. so it makes sense to do both treatments. ask about whether your doctor wants to do oncotypeDX to get more information about the tumor and its likelihood of recurrence in the future.
Question:  #46 5/11/2009		Q:	I just finished 4 rounds of AC (stage II er pr ++). I had very few negative side effects, and in fact felt quite well throughout. Will be starting taxol in about one week. Have a couple of questions. 1-why is it necessary to premedicate for taxol with benadryl and steroids? Makes me nervous, also very nervous about possible neuropathies! 2-I know there''s some controversy about taxol with the er pr + breast cancers, that it may not be as effective, etc.But I have also read recently that some studies indicate that over the long term it may show alot of benefit that hasn''t necessarily been shown yet (in er/pr+ women). I guess I''m trying to look at all the pluses here. What are your thoughts on this? I am just so nervous about taxol now, and can''t help but wonder if it is necessary to take.
		A:	Taxol is dissolved in a solvent that many people have an allergic reaction to, so it is necessary to premedicate. Although many do get neuropathies, in most patients this goes away or is greatly reduced after stopping the drug. There are suggestions that ER/PR + breast cancers in general are not as chemosensitive, but as a group, the AC+T regimen is a very good one. The latest study suggests that weekly Taxol is better than every 3 weeks, which was from a study Hopkins was a part of, so be sure to ask your oncologist about this.
Question:  #47 4/20/2009		Q:	Hello Lillie, you answered some questions for me recently-thank you so much. Am 49 yrs old, had 2.1 cm, highly er/pr pos (3+) her neg breast ca, double mast Feb 09. sent node pos on IHC only (2.5mm). ax dis:10/10 nodes neg. Having TAC chemo now. Am aware that er/pr neg/aggressive cancers tend to respond well to chemo, but er/pr pos possibly not as much. Is this true? Thinking I should have had oncotype dx done. Do er/pr pos cancers tend, in general to come test lower on recurrence score, or not necessarily? Thanks again for your great help.
		A:	Hi. This is Ben Park MDPhD and Lillie referred your question to me. In general, Oncotype is ONLY for ER positive HER2 negative breast cancers and is useful for determining whether chemo should be considered or not. Now that you are on chemo, it wouldn't make sense to get the test as the decision has been made. It is generally true that ER positive cancers are not as sensitive as ER negative, but they are also less aggressive and of course amenable to hormone therapy. That said, given your age, size of tumor and one positive lymph node, I would agree with chemo and TAC is a reasonable choice. Hope that helped.
Question:  #48 4/19/2009		Q:	I am a health care worker and taking care of clinic''s patients ( urgent care and regular clinic )and I am going to have chemothearpy for breast caner. Should I continue to work during chemotherapy or should I stay home to prevent getting infection from patients during chemotherapy.
		A:	Being immunosuppressed from chemotherapy is a concern. Talk to your oncology nurse or doctor about risks to you if you are working around others who have infections or potential communicable diseases. ds
Question:  #49 4/11/2009		Q:	is there a chemo for her 2 neg sister is her 2 neg across the board has taken 19 different chemo. ductal caranoma grade 3 with blood clots right arm and lungs.recently got blood clots
		A:	there is not a specific drug designed for women with HER2neu negative tumors. sounds like she has been having a very tough time. glad she has you for support.
Question:  #50 4/4/2009		Q:	Just had 2nd treatment of TAC, and my hand/veins where I have had the infusions are unhappy, red tracks, swelling and cording on 2nd site. Looked at, says it''s ok, warm compresses. When does it make sense to use a port? Any suggestions on how to get 4 more treatments in this arm?
		A:	sounds like it IS port time. ask about doing this.
Question:  #51 4/5/2009		Q:	My sister has had 1 treatment of Gemzar and Avastin two weeks ago. Now she is very stiff all over. It is very hard for her to walk. Could this be a side effect of the chemo?
		A:	yes, it could be side effects from treatment. make sure she makes her oncologist aware of it so that he can prescribe something to reduce these symptoms. thanks for being there for your sister too.
Question:  #52 4/5/2009		Q:	Hi my mom just finished the 6cycle of chemotheraphy last Feb.17, 2009 - Taxotere, Invasive Ductal Carcinoma StageII, left breast, E/R P/R triple Negative, Mastectomy (MRM) last Sept2008. A week after she finished her last session of chemotheraphy, a lymphnode appeared in her left neck & the oncologist advised us she need another 4sessions of chemotheraphy. Other chemo drugs will be used, and chances of recurrence 60-70% after chemo. Do you think we should follow our oncologist?? Are there other ways of treating my mom? Would you suggest radio theraphy, perhaps? The doctor wants the whole system to be treated and not just the part where tumor originated/recurred. But definitely might affect other normal cells. Please help us, I want to hear your opinion. We are in the state of confusions & emotional distress. Also,I am after the long term side effect. My mom is precious to me,, PLease help, need to hear your expertise. THanks.
		A:	having a lymph node pop up in her neck containing breast cancer cells is a worrisome sign of metastatic disease. i would expect that a bone scan and cat scan have now been done to further assess this. the drugs he will or has recommended for systemic treatment will be different from the drugs she has received so far because the drugs taken up to now didn't kill all the cancer cells-- thus this node in her neck now declaring itself. nodes in the neck are usually not radiated. too many other vital organs/vessels in the neck area to make it safe. systemic treatment , chemo, is usually done. unfortunate it she isn't a candidate for hormonal therapy. you might want to get the book, 100 questions and answers about metastatic breast cancer. useful reading for you and your mom. take care.
Question:  #53 3/29/2009		Q:	I was recently diagnoised with lobular invasive breast cancer- right breast. Left breast cancer free. My breast were very dense. I had a lumpectomy on the right breast, clear margins were not received, therefore decided to take off both breast. Tumor was ER+, PR- & HEr2-. Nodes Negative.Oncotype DX scored came back at 32.(High) Oncologist suggested chemo. I begin chemo this Thursday. My oncologist has also called an explained that my Internal Mammery Lymph marker is reading slightly elevated and has called for a PET Scan. What does this mean. I
		A:	it means that on some type of xray they have done, they saw a hot node near the breast bone and are suspecting it might be a node, not one in the armpit but toward the center of the chest. they might decide to biopsy it. If positive, then more chemo than originally planned will happen along with hormonal therapy which i assume is already in your future post chemo. take care.
Question:  #54 3/1/2009		Q:	Hello Lillie, Can you please tell me what are the worse and most common side effects of Gemzar and avastin thearpy? Just wondering what to expect Thanks so much
		A:	Everyone reacts a bit differently, but with Gemzar, nausea and vomiting can occur, as well as decreased blood counts, hair loss, diarrhea and so forth. It is chemotherapy and shares many common chemotherapy side effects. Avastin is a monoclonal antibody that attacks blood vessels. It's side effect profile is therefore different and can include clot formation and bleeding. All of these side effects are carefully monitored and some can be prevented and/or lessened with medications. Best of luck.
Question:  #55 2/28/2009		Q:	Lillie, Please help! I was diagnosed 5 yrs. ago with DCIS in right breast. Had 2 lumpectomies & radiation and took tamoxifen for 5 years. Just diagnosed 12/30/08 with IDC in left breast, .9cm, clean margins, no lymph invasion, ER+/PR+, Her2 Neu neg. It took several weeks to schedule a Sentinel Lymph node biopsy, which was negative, several more weeks to do BRCA test which came back negative for BRCA1 but "Variant of Uncertain Clinical Findings for BRCA2. Then I had to wait for Oncotype reults--a score of 21 with a 13% recurrence rate. Nothing has happened except for tests! Decided that I wanted bilateral masectomies with reconstruction (Lat flap) and I think I should do chemo. Onc suggested CMF. My breast surgeon and plastic surgeon can''t schedule a date for surgery together until early April. Then my onc said he would start cmf 2-3 weeks later. Is this too late to be starting chemo? What if I complications from surgery and chemo has to be delayed? When is the latest I can start chemo and make sure it is as effective as possible?
		A:	oh my.. sorry you are revisiting this again. smart to have pursued the genetic testing though. doing bilateral mast is logical as well. waiting nearly 4 months for surgery is a bit long... I'm not sure if surgery is booked for beginning or end of april. hopefully beginning so you have 4 weeks to go. good to know sentinel node already tested and negative. you might want to consider a different plan to avoid risk of further delay. get bil mast, skin sparing method, done now and put in tissue expanders as space holders. do chemo, then do final reconstruction afterward. am surprised you are okay with bilateral lat dorsi flaps. this will effect your physical activity /abilities later. assume you don't golf at all? consider instead diep flap or s-gap as a better option. if you want to come to us call 443-287-2778. LS
Question:  #56 2/21/2009		Q:	Do you know if the latest protocol for stage 1 2.1cm, no node involvement, pre menopause (41) ER + PR - HER 2 is negative.....I am told by one onco that I should do AC Taxol, the other says that I need just AC x 4 q 3weeks....very confusing. Second onco says no adriamycin if I am HER - Also when is it appropriate to start after mastectomy.....again, first onco says no later than 5 weeks but I haven''t healed yet. Second onco says HEAL first, cancer is gone already, chemo is housekeeping. What is JH protocol for this? Thanks as always.
		A:	As you are experiencing there is no one specific protocol in use. there are a variety. so getting second opinions is wise. Remember too that this free service isn't a substitute for a formal consultation. such recommendations cannot be merely made by email. You wrote stage 1 but listed the tumor to be 2.1cms. if that is the invasive measurement then it was a stage II. you need to be completely healed before embarking on any chemo because it will slow healing due to reducing blood counts. request that your case be presented by the oncologist to their weekly tumor board discussion. this will enable you to get input from multiple oncologists at once and its usually free. LS
Question:  #57 2/16/2009		Q:	My 40 yo sister-in-law was recently diagnosed with IDC stage IIIa with tumor size 1.4 cm and 4 of 8 nodes pos, ER+(97), PR+(14), Ki-67 25, & HER2/nue neg. She has had a simple mastectomy w/ axillary node dissection (complicated by severed long thoracic nerve) and a prophylactic mastectomy with reconstuction bilat. (incl. tissue expander placement). Her only other medical problem is immunotactoid glomerulopathy (ITG) which is stable with a CrCl of 65 and proteinuria of about 1 gram. Her planned treatment is AC q2w x 4 followed by T q2w x 4 then radiotherapy and Tamoxifen. Is this approach state of the art or is there a better approach or is there an equally good approch that has less potential deletarious side effects? Can liposomal doxorubicin be used in this country? Should it be used?
		A:	Generally speaking that is a pretty state of the art regimen. Every 2 weeks is a more aggressive "dose dense" regimen than the standard every 3 week dose, which is thought to be more effective, but is more toxic and requires growth factor support. As far as dosing due to the kidney disease, this is something you want to discuss carefully with your doctors, but they should be familiar and aware of this. Liposomal doxorubicin, while less toxic, has not yet been extensively studied in this setting and therefore cannot be recommended for this particular setting.
Question:  #58 2/16/2009		Q:	is a SGOT ELEVATION OF 63 ,SGPT OF 46 WHILE ON GEMZAR AND TYKERB AN INDICATION FOR REDUCING THE TYKERB DOSE THANK YOU
		A:	depends on what protocol the medical oncologist may be following. so ask him to share with you what are the lab values that would result in holding a dose as well as what lab values that would signal the need to reduce the dose.
Question:  #59 2/14/2009		Q:	im 36 and just had a lumpectomy with 0 lymph nodes infected i havent yet started chemo my cancer was told very agressive no one in my family has had it im the first. my question is what are the chances of it spreading through my body with 0 lymph nodes infected? im afraid of it gone to my liver bones or lungs.
		A:	good news nodes were negative. tumor diameter of invasive component along with hormone receptors and her2neu as well as Ki67 weigh in here regarding how well you can anticipate doing. we will hope for a small tumor, low to moderate grade, hormone receptor positive, her2neu negative and a low Ki67 score.
Question:  #60 2/14/2009		Q:	I just saw Dr. Heyer in Reston, VA, wondered if you could recommend another oncologist for second opinion for my piece of mind. Stage 2 Grade 2 no lymph node involvment dx of IDC 70% and DCIS 30% ER + PR - HER 2 1.6. (You answered my chemo question today) Incidentally I saw in an earlier post that they can measure just the portion of the tumor that is IDC...this might bring me to a Stage 1 (mine is 2.1) which would help me mentally. I have had only a few lows but this chemo path is making me think too much. Thanks in advance.
		A:	I don't know the oncologists in your area. you are welcome to see one of ours though for a second opinion. consider coming to see Dr. Park. so, sounds like this may be a stage 1!!