May 1, 2012 11:14PM Bon_ wrote:
This is an awesome thread....I learn so much on this board thanks to ya'll.
Do you ever feel like you're having to educate your medical team? ;)
Posted on: Apr 29, 2012 03:25PM, edited Apr 30, 2012 07:01PM by CoolBreeze
On another forum, somebody posted this abstract, and I want to share it with you all - with comments. Since I am being treated as a true oligometastatic patient, this topic interests me. I think it is becoming more and more accepted as a real possibility, that a very small subset of women with mets can live long lives.
It is incredibly hopeful, especially that three people with mets lived out their full, natural lifespan, almost 70% with single organ mets made it 10 years, and 50% made it to 20 years. Too many doctors are still unaware of this possibility and may not treat patients appropriately. I am very pleased that my onc recognized the possibility and I got aggressive treatment. Of course, we are still waiting to find out if it is working or not.
Only a few years ago oncologists were telling their patients that the average Stage IV patient survived an AVERAGE of two years no matter what their treatment and many were nihilisitic in their attitude. Oligometastatic disease has such a better prognosis, would this not imply it is important to be aggressive in trying to find and equally aggressive in trying to treat the first metastases if they are rare.
The rationale behind not testing periodically after completion of treatment and waiting for a fracture to occur , seizure or change in vision to occur etc has been that most patients don't, it is expensive to check, and there is not much benefit in finding the metastases earlier rather than later. That is obviously not so for oligometastatic disease.
Is oligometastatic disease a characteristic of the type of breast cancer or the fact it was found early?
Breast Cancer. 2012 Apr 25. [Epub ahead of print]
Possible clinical cure of metastatic breast cancer: lessons from our 30-year experience with oligometastatic breast cancer patients and literature review.
Kobayashi T, Ichiba T, Sakuyama T, Arakawa Y, Nagasaki E, Aiba K, Nogi H, Kawase K, Takeyama H, Toriumi Y, Uchida K, Kobayashi M, Kanehira C, Suzuki M, Ando N, Natori K, Kuraishi Y.
Department of Clinical Oncology and Hematology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan, email@example.com.
Metastatic breast cancer (MBC) is generally incurable. However, 10-20-year relapse-free survival of MBC is approximately 2%, implying that at least a small subset of MBC patients achieve prolonged survival. We therefore analyzed long-term outcome in a particular subset, i.e., oligometastatic breast cancer (OMBC).
Data of OMBC subjects (N = 75) treated in our institution from April 1980 to March 2010 were retrospectively analyzed. OMBC was identified as: one or 2 organs involved with metastatic lesions (excluding the primary lesion resectable by surgery), fewer than 5 lesions per metastasized organ, and lesion diameter less than 5 cm. Patients were generally treated with systemic chemotherapy first, and those who achieved complete response (CR) or partial response (PR) were further treated, if applicable, with local therapy (surgical or radiation therapy) to maintain CR or to induce no evidence of clinical disease (NED), with additional systemic therapy.
Median follow-up duration was 103 (6-329) months. Single or 2 organs were involved in, respectively, 44 (59%) and 31 (41%) cases with metastatic lesions, 48% of which were visceral. In cases where effects of systemic therapy, possibly in combination with other treatments, were evaluated (N = 68), CR or PR was achieved in 33 (48.5%) or 32 (47.1%), respectively, with overall response rate (ORR: CR + PR) of 95.6% (N = 65). In cases receiving multidisciplinary treatment (N = 75), CR or NED (CR/NED), or PR was induced in 48 (64.0%) or 23 (30.7%) cases, respectively, with ORR (CR/NED + PR) of 94.7% (N = 71). CR rates (60.5%) with systemic therapy and CR/NED rates (79.5%) with multidisciplinary treatment were significantly better in subjects with a single involved organ than in those with two involved organs (P = 0.047 and 0.002, systemic only or multidisciplinary treatments, respectively). Medians estimated by Kaplan-Meier method were: overall survival (OS) of 185.0 months and relapse-free interval (RFI) of 48.0 months. Estimated outcomes were: OS rates (OSR) of 59.2% at 10 years and 34.1% at 20 years, and relapse-free rates (RFR) of 27.4% at 10 years and 20 years. No disease progression was observed after 101.0 months as RFR. Cases with single organ involvement (N = 44) showed significantly better outcomes (OSR of 73% at 10 years and 52% at 20 years, RFR of 42% at 10 years and 20 years). Those who received local therapies (N = 35) also showed better prognosis: OSR of 82% at 10 years and 53% at 20 years, RFR of 38% at 10 years and 20 years. Three cases (4%) survived for their lifetime without relapse after achieving CR or NED, our definition of clinical cure. Multivariate analysis revealed factors favoring better prognosis as: none for OS, and single organ involvement with metastasis, administration of local treatment, and shorter disease-free interval (DFI) (P = 0.030, 0.039, and 0.042, respectively) for RFR. Outcomes in OMBC in literature were OSR of 35-73% at 10 years and 26-52% at 20 years, and RFR of 27-42% at 10 years and 26-42% at 20 years.
The present analyses clearly indicate that OMBC is a distinct subgroup with long-term prognosis superior to MBC, with reasonable provability for clinical cure. Further prospective studies to better characterize OMBC are warranted to improve prognosis in MBC.
Posts 31 - 60 (109 total)
May 1, 2012 11:14PM Bon_ wrote:
This is an awesome thread....I learn so much on this board thanks to ya'll.
Do you ever feel like you're having to educate your medical team? ;)
May 1, 2012 11:21PM CoolBreeze wrote:
I don't think I know everything. I like to learn. Can you post an abstract where it says breast cancer in the liver spreads like dandelion seeds? Curious to see that, as I haven't before. Thanks.
May 1, 2012 11:41PM , edited May 1, 2012 11:46PM by jenrio
I always admired your post and the things you do to better your chances. I only jutted in because you or somebody mentioned Kathy Rich and maybe she is oligometastatic. When I read her book, I was looking for it, and she didn't fit the common definition. BUT, I agree that as systemic medicine does better job, the word oligometastatic will be expanded to include a lot of women like her who achieved NED or stable.
Liver metastectomy resection and liver transplant for cancer patients was originally developed for colorectal cancer and only more recently become available to breast cancer patients (the former). Even so, the mortality rate is higher the bigger mass of resection. Check out for some of the papers on how rare oligometastatic breast cancer is.
I felt that your words are not exactly nice: bad written, bad information, agenda, commercial. I admit I'm not the most linguistically gifted, nor am I familiar with how BCO's system works. But my only agenda is the cure of metastatic breast cancer patients. I care about it for myself and for a lot of people who shared their experience generously with me, including yourself. Go ahead and delete my post from this thread, but I'll get the abstract for you another time because i need to do something else right now
May 1, 2012 11:53PM , edited May 1, 2012 11:58PM by CoolBreeze
I'm sorry. If I hurt your feelings. I'm on my iPad now and it's really hard to post and edit on this thing. It just seemed to me you were asking people to read your blog in the last bunch of threads I read from you and it started to sound like advertising.
But, I was meaning to give you a helpful hint to put it in your signature. Right now, it isn't, and that way you don't have to mention it, it will be in every thread you post. now it's only in the last few you posted it in. So, that is good advice for you if you want people to read it.
I guess it upsets me when people post incorrect information about liver mets. I've done a lot or research on it, and while mets not the visceral organs is not good, it's not true that it spreads like dandelion seeds when it's in the liver, and that is not a nice thing to say either, so I guess we are even. We all want hope, not the worst case scenario. I posted this abstract so that women to whom it might apply can feel hopeful and you were bringing it down. And, I just checked and I don't find a thing that describes the process in the liver that you are stating. Anyway, I hope we can get back to the hopeful tone of this thread as that's why I started it.
May 1, 2012 11:57PM , edited May 2, 2012 12:04AM by Jejik
May 2, 2012 12:14AM steelrose wrote:
I don't know about the "dandelion seed" theory, but in my case I had a single, large liver tumor (6 cm), which my oncologist said was unusual. Don't know what that means exactly? Unusual in that it didn't "seed" the rest of the liver I guess. It seems to be a common thing for me though, these single, large tumors. I had the same thing on my spine. Our grades, patterns of growth, response to treatment, ER status, all should be examined when considering the oligometastatic state, I would think. Very interesting thread! Thanks, Ann...
May 2, 2012 12:22AM texasrose361 wrote:
I have a quick question- does this oligometastatic cancer term apply to those that have had more that 5 lesions or whatever that have been successfully treated with chemo and all that???
I had more that 5 on the start, but now no... just graspin at straws here!
May 2, 2012 08:51AM susan_02143 wrote:
In some ways, I find this idea of 2% of our population being "curable" exciting, but it also has a tinge of false hope. I also don't really understand the concept since you are describing people who continue to have treatments so how does this really change one's daily life?
Kathy Rich was never cured of breast cancer, since someone used her as an example. She was in constant treatment, and the disease killed her. How could her disease be classified as oligometastatic? It just took longer than normal. There are a number of women who hang in the chat room who have been NED for years, but they too continue to receive treatments.
My cancer is extremely lazy and a bit stupid. It doesn't seem to mutate quickly and was easily knocked back with minimal treatment. I fit the lesion count implied by these articles. But so did my Aunt [all the same characteristics actually.] But, the mets, over the 10 years following their discovery, slowly but surely overtook her body. I fully expect this to happen to me, just in slow motion.
So for now, I think I won't worry about whether or not my cancer is somehow different than everyone elses. It doesn't change the number of doctor visits, my treatment plan, or how I live day to day. Maybe, just maybe, I will be one of the lucky ones. But maybe I am just one of the 98%.
May 2, 2012 09:05AM , edited May 2, 2012 09:18AM by jenrio
I accept your apology. I still insist that i have spread no misinformation, and my blog has more helpful information. If I'm running a commercial, so be it. If anyone found misinformation, i'll be happy to correct it.
Here's the seminal paper on oligometastatic BC:
Quote: " These long-term survivors are usually young, have excellent performance status, and have limited metastatic disease. Although this fraction represents a numerically small group of patients (between 1% and 3%), this finding challenges the commonly held belief that metastatic breast cancer is universally fatal."
Here's the paper that specifically on liver mets:
The pattern of disease within the liver was most commonly nonconfluent multiple metastases, with single metastasis the next most frequent pattern and diffuse involvement of the liver parenchyma seen least frequently (Table 1).
Remember, some of these data are old (ignore survival stats, they are OLD). With newer systemic treatment, with better treatment of other organs, even multiple/diffuse liver involvement can have a chance to become NED/Stable/Oligometastatic state, hence option of local treatment may become available. That would be wonderful.
What would be even more wonderful, is some innovation that give 100% of MBC patients guaranteed normal life span. Because often i gave out information in some hidden places like this with completely different topics. So I'll need to write another blog posts and repost for other people. You accused me of pushing stem cells. Here are the ways stem cells research will impact cancer patients:
1. Heart stem cells help low LVEF-heart to regain muscle. Implication to cancer patients? If this research pans out, then patients who had already had lifetime doxocirubin or reaction to Herceptin can have more doxuribin/Herceptin if it's needed.
2, Liver stem cell to reduce mortality after hepatic resection
3. Liver stem cells to grow whole organ
Innovation is going to save lives, I don't understand why I get attacked for pushing for it, or running commercials for it. There are lots of things patients can do to accelerate the process, like participating in clinical trials, go to major NCI cancer centers, donating tissue and blood samples, ask questions to make sure the research data will be shared, push for better quality clinical trials to be designed. My blog makes more elaborate cases for these patients participation. Please don't be put off by the lousy English. I am not an english major or a marketer:
May 2, 2012 12:22PM Lauriesh wrote:
I think the most interesting aspect of this discussion is how this could change treatment and attitudes that oncs have about treating stage 4 patients.
When I went to Mayo for a second opinion, the first thing that the onc said was "all we can offer you is palliative treatment". He basically told me that I had little hope of surviving more than a few years.
When I went to the Univ. of Minn, they took a much more aggressive approach, They told me "we are not going to take away your hope". Their approach has given me 14 months of a "normal life". I believe that if I would have went with Mayo, I wouldn't be in this position.
I guess I am not worried about whether I am in the 2% who can be cured. I hope dr's will realize that some women can live a long time. I want my dr's to treat me agressively.That it is worth to do rfa or resection or other procedures, and not take the attitude of the dr at Mayo, when I asked about rfa and he said " why do it, it is only going to come back somewhere else"
I want stage 4 women to be offered these procedures, and not have to fight for them.
May 2, 2012 03:24PM reader123 wrote:
Thank you so much for sharing this - I had no idea what Oligometastatic meant - but I guess I fit in this catagory. I will be following up with my onc. I have already been printing the occasional article for her - but will definitely share this one.
May 3, 2012 01:08AM Iwillwinthisbattle wrote:
Lauriesh-I had a similar experience at Mayo. Then I went to CTCA which offered me a much more aggressive treatment plan. I am currently NED and pray that I stay that way for a long, long time.
I fall into the category that you ladies are talking about. 2 very small lesions in my back and two small lesions on my liver -- both gone (as well as breast tumor) after 6 rounds of C/A. Oligo? Who knows? But I'd sure like to be based on this info!!!
May 3, 2012 02:28AM Anko66 wrote:
I mentioned this article to my oncologists yesterday here in Japan. They weren't aware of this specific study and they couldn't say either way if my case was oligo or not (I have two very small liver mets which have responded well so far to chemo). They just kept saying that I won't be having surgery. So I guess that means that they won't be treating me agressively but I kind of knew that and if I wanted surgery anyway I would go back to the UK. I don't know, maybe something got lost in translation. Is just feeling oligometastatic enough? Don't we all wish we were in that 2% bracket?!
May 3, 2012 07:57PM CoolBreeze wrote:Jenrio, I wasn't asking for links about oligo as that is what I provided.
What I wanted was for you to back up these statements that you made:
Breast cancer has the nasty habit of dispersing itself like dandalions across liver. S
ome people who has big liver or total liver involvement will face high mortality risks if you cut more than 2/3 of liver. And cancer patients are not eligible for liver transplant anyway.
You haven't done that so far. In fact, in the abstract you posted, dispersing itself across the liver was the third least likely scenerio.
"The pattern of disease within the liver was most commonly nonconfluent multiple metastases, with single metastasis the next most frequent pattern and diffuse involvement of the liver parenchyma seen least frequently"
The mortality rate of liver resection is 2%. That mortality is not attributed to size of liver removed, but state of health of the patient. Those who died had COPD or acites, and lesser comorbidities were alcohol use.
Like I said, having had a liver resection I have done my share of research ont his subject. I may not know it perfectly but I do know when somebody doesn't understand what they are posting.
Anyway, I'm with Laurie. I think they write a lot of us off too quickly. They rarely do aggressive treatment with us, and in fact, leave our original tumors there. For most, that may not make a difference but for some, it might. Lowering the tumor burden is a trending topic and one that is interesting. Not many people are studying oligometastatic research, and one of the first articles you encounter when you search for it is "does it exist". I've met doctors who asked me what I was thinking when I subjected myself to a resection and why did the doctor bother?
Well, who wouldn't take a crapshoot to get a few more years out of life? What kind of question is that anyway?
May 3, 2012 08:39PM jenrio wrote:
We can agree to disagree and ultimately I think patients' choice should be respected and supported.
I respect you and everybody here immensely and really appreciate your brave experiment. Peace out.
May 3, 2012 11:31PM Naniam wrote:
I had not heard the term Oligometastatic before but it also doesn't apply to me. I also had one liver lesion at mets diagnosis. I am not sure I buy into the seeding like dandelion; I've never heard or read that. Nothing like that was ever discussed with me.
May 4, 2012 12:23AM irish22 wrote:
I'm glad I found this thread as it has a lot of interesting information. I heard about oligio last year shortly after I was diagnosed. I asked my onc and he said no such thing. I've been pretty push with more aggressive treatment. Call it denile but I refuse to believe at 27 with 3 bone mets all about 1cm or under that I am going to be dead in five years.
Last time I saw my hemotologist I pulled up his doctors note to check what the new dosing on my meds was going to be and he refered to me as oligiometastatic which thrilled me. I wanted to print it out and run to my doctor like "See! See! I'm not crazy!" The two radiation oncologists I saw also told me I was oligiometastatic. Infact I was all set to do a radiation protocol where they give high doses to the two remaining mets on my spine to put me NED, it's the same regime in the curative bone mets trial at MDA. Then my oncologist talked me out of it and sent me to see a radiation oncologist at his hospital who in turn told me I should most definatley do the plan the original rad onc has and he would if he were me.
I read recently that with systemic treatment keeping MBC patients in general alive longer that there may be a need to reconsider targeted therapy however underfunding and a lack of doctors interested in research on mets patients is what keeps any changes from occuring in the standard care protocols. I pushed really hard to have my surgery for these very reasons. The last time a true trial was done on how removal of the initial tumor in stage IV patients affected outcome was I believe in the 70s. I mean with all the new meds and treatment options since then there is no reason this trial hasn't been repeated.
May 4, 2012 08:53AM , edited May 4, 2012 10:30AM by jhammel
In my wife's case, circumstances worked out that we didn't have to do any pushing of our doctors to have the surgeries done.
Her single spine tumor was in a very accessible spot right on the back. All they had to do was cut off just the back section of her lowest vertabrae, well behind the spinal column. We asked if they wanted to do a biopsy first and they said not to even bother since 1) it was very likely cancer based on the imaging, and 2) the surgery would be relatively simple and the biopsy would be nearly as risky.
Once they got the spine tumor out, they found it was mostly dead, and the pathology couldn't be determined with any certainty. That meant that her lung tumor still couldn't be identified as lung or breast cancer. A previous bronchoscopy failed to be conclusive since the lung tumor was very deep. So, she had to have the surgery anyhow to determine the source of the tumor, in addition to removing it.
Had there been more certainty about the source of her tumors before the surgeries, or if the spine tumor had been less accessible, I don't know if her doctors would have favored the aggressive treatment she ended up getting. She recovered well and quickly from her surgeries and two years later has no ill effects from either. In hindsight, the lung surgeon and oncologist were both very happy with her course of treatment, given how well her recovery went.
I understand the thinking of some doctors. Perhaps those people with limited and slow growing metastases are destined for better outcomes on average, even without aggressive treatment. I don't think the data can prove that wrong or right at this point. But psychologically for a patient, the idea of being quickly brought to NED is very enticing. If aggressive local treatment can do that, and if there is even a possibility that it might help extend the length of time one can remain NED or alive, then the doctors arguing against it will have a tough sell to their patients. It's possible that my wife's treatment may end up having no impact on the length of her life, and it's also possible she might have gone to NED if she had been given systemic treatment alone, but I know that having those tumors out of there and being NED for 2 years has made life more peaceful than it would have been if we were watching tumors. The psychological benefits alone have made the surgeries worth it for us. Though that's easy for me to say since the insurance company paid for them and since she had no serious or long-lasting ill effects.
May 4, 2012 09:30AM kayfh wrote:
I agree with jhammel.
When I was initially dx I was told I could go with a lumpectomy or a mastectomy, to reduce the tumour load. I was told that there was likely lymph node involvement so the mast was probably the best option. After sx, lymph node involvement had been confirmed so I had a staging CT. That's where the liver mets were found, then confirmed with biopsy. I was given very aggressive chemo, at least that is what I think. The liver lesions necrotised. I have been NED. Ever since. When I brought up the concept of oligometastic breast cancer with my onc she laughed. Basically it appears that while she is not going to spend anytime disabusing me of the notion, she thinks I am wack.
I happen to think that she is incorrect, has not done enough new reading or attending at breast cancer conferences, or is very thick because the information is out there. So I refuse to accept the grim prognosis given me and look at the new information (actually not all that new, researchers have been talking about this since the early 2000's) very, very encouraging.
May 4, 2012 06:26PM CoolBreeze wrote:
I think one of the treatment hallmarks of oligomets is that it is treated locally at the site of cancer spread after systemic treatment.
I don't think a systemic chemo alone is a treatment for oligometastatic disease. It is having a liver resection (as I have) or radiotherapy or anything to remove the tumors in the area of spread is the treatment that most doctors don't think is worthy but is just beginning to find favor and acceptance. That is what we should be asking about, and if necessary, pushing for.
They do tend to want to give us palliative rads (for bone) and chemo only - and in many cases, that's the appropriate treatment. But, for some people with limited mets, surgeries might help too. As the abstract I posted above shows, at least in that small sample, surgery or local treatments did do better over standard treatment.
That is, of course, a retrospective study and not a controlled one - but it's hopeful.
Too many doctors just blow it off. As I've said before, some have said the same to me. Not my oncologist though.
May 5, 2012 06:44AM Heidihill wrote:
Just got back from vacation and love reading this! Thanks, coolbreeze. I had aggressive treatment, including local treatments so according to this article my prognosis is great: OSR of 82% at 10 years and 53% at 20 years. My only reservation is that this is a Japanese study and maybe my diet and environment are not sufficiently Japanese to merit such optimism. OTH, post-Fukushima, this may not apply to Japanese women today either. :-(
Aug 8, 2012 05:14AM Lemonsoda wrote:
I have a problem with labelling people oligiometastatic, terminal or anything else, if it's going to exclude people who "don't fall into the category". As we all repeatedly see, people with limited metastases sometimes don't respond as well to treatment as well as those with more widespread metastases. I accept that getting aggressive local treatment can be a challenge, whether it is surgery, RFA, SIRT or whatever, but whatever the extent of your disease, the important thing is to find an onc who is prepared to try things. Reducing your tumor burden is vital to remission, and this is what we all want. I don't think any of us would ever dare say we were cured!
Re the recent thread about positive stories, Her2+ may potentially be seen as a curable disease according to Laurie's post. Fantastically hopeful! If you get chemo, local treatment and Her2 targeted treatment, it's a combination of all these things which may lead to a durable remission. But please don't keep on about oligiometastatic MBC. It excludes too many people. Let's talk about getting the full range of treatments to everybody.
Aug 8, 2012 05:47AM Lauriesh wrote:
I don't agree that discussing the concept is bad because not everyone falls under that term. If we follow that logic, then those who are Ned should not post asking others who are Ned what treatments they stayed on, or if they took chemo breaks, etc.
Or, if someone is going to have Rfa and wants to talk to others who have had it, I don't think it is inappropriate to talk about that even though there are women who have liver mets who don't/ can't have it.
Ogliometastatic is not some made up term, it is a legitimate area of research, and I think if people want to discuss it and it's implications in their life, they should be free to do so.
Aug 8, 2012 09:18AM lilylady wrote:
marie12-so glad for your good news and I am glad that you found cancer in 2012 so much imoroved from 1999. I have been lucky to have an onc who is young and aggressive and forward thinking. Last summer I was termed oligo-and thrilled about it but it never worked out for me because while I had mets confined to 1 organ they were too small and spread out to make a surgical option possible and they were too close to the pumonary artery to make the other options reasonable also.
The whole oligo thing is like a lightning rod to many people. I started several threads alst summer when my doctor first brought it up to me just to see how many others had been told the same thing. Hey if you don't want to believe in it that's fine but don't tell me I can't talk about it wish for i,t pray for it ect.
It didn't work out for me but I hope to see it brought up as working for anyone!! NED or Oligo-the gold standards.
Aug 8, 2012 11:27AM Jejik wrote:
I don't understand the logic behind not talking about ogliometastatic because it doesn't apply to everyone...if there is a way for even just a small percentage of women to achieve a long life with this disease why would you want to deny them information about it? I really don't understand why this is controversial. Should we not talk about herceptin and how it is helping people because most bc patients aren't her2+?
I think if something about the idea of encouraging women with a small amount of metastatic rumors to go with the most aggressive treatment possible to better their chances is offensive to you, better you just
avoid threads with "ogliometastatic" in the title...
Aug 8, 2012 12:15PM exbrnxgrl wrote:
Thanks jejik, Laurie and lilylady,
Not only do I want to talk about oligomets but I think that as researchers explore it it may benefit many people. It is wonderful that we are beginning to understand MBC is not one disease in which everyone progresses the same way. Why should we not encourage tx and hope for women who fall into this category, even if we all don't? Not all doctors think such a thing exists but clearly there is enough evidence to suggest it does. Both my regular mo and my second opinion mo think oligomets exist and treat me as a chronic, but manageable patient. Why take that away from me just because it doesn't include all stage IV? To do so is to lump all bc patients under one big umbrella and attempt to treat all of us the same. If that's not the case, and we know it isn't, why shouldn't oligomets be treated differently? Caryn
Aug 8, 2012 03:16PM tlangston07 wrote:
Thank you so much for all of this info..My onc has not mentioned Oligomets(that I know of) to me but I will mention it to him. He is really pushing for Liver resection..I had 3 small lesions and chemo knocked out 2 with shrinkage to the other..Right now I am doing rads from mx and when done will have more scans to see if I still qualify..not for sure what I am going to do but I have PM'd a couple of ladies and talked to them about it..I would love to hear opinions and all of this gives me hope where at first I was hopeless..Terry