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Jan 4, Interactive CHAT log.

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KatieB[5]: Are we ready to start?

DrWest[3]: OK

KatieB[6]: cindy0519- Do you have a question?

cindy0519[4]: can you maybe speak to lc running in families...does genetics play a part

DrWest[4]: we don't know much about that at all, and I would say it's a pretty minimal component. There aren't really any familial syndromes with lung cancer.

cindy0519[4]: today would have been dads 67th bd - seems my family can't get past year 66

DrWest[4]: smoking is a bigger issue, and we've realized that women seem to be more susceptible to getting lung cancer with minimal or no smking history, esp Asain women, but why? We're jsut sarting to ask these questions.

cindy0519[4]: suppose that is good to know - not a smoker myself - but lived with two for many year

cindy0519[4]: thanks dr west

DrWest[4]: I mentioned on my post at OncTalk yesterday a study comparing smokers and non-smokers, women vs. men, in terms of prior enviromental exposures and genetic differences in the tumors. The detailed questionnaire as part of that study will look carefully at passive smoking risk (from others)

KatieB[6]: daggiesmom- Do you have a question?

daggiesmom[4]: Yes, as far as small cell, what is the rate of recurrence?

DrWest[4]: the recurrence rate for limited small cell is about 75-80% unfortunately, and for extensive disease it's almost all cases. I wish I had better results to report

KatieB[6]: Eileen4- Do you have a question?

Eileen4[4]: Yes.... Hi Dr. West Is it common for lc to met to kidneys?

DrWest[4]: Eileen, it's decidedly uncommon but not too rare to go to the kidneys. it's very common to have lc spread to the adrenal glands on top of the kidneys. they're very rich in blood supply and "fertile soil" for the LC mets

toosuper52[4]: My Mother is 79 and was diagnosed with Stage IV inoperable non small cell in August. She has bone mets also. Dr gave Taxol and carboplatin but she can never get past 2nd treatment without severe problems, ie., heart attack, dehydration. The tumor shrunk to 4 cm x 4 cm, despite her shortened cycles. She now takes Tarceva every other day. Is there any possibility the tumor will continue to shrink?

DrWest[4]: toosuper, yes, there's absolutely a real chance the tumor will shrink with tarceva. it may also be possible to have her receive a less intensive single-drug regimen. Many are reasonable choices

toosuper52[4]: Thanks. I was worried that Tarceva was much less potent

DrWest[4]: Tarceva's different, but definitely not a consolation prize

KatieB[6]: Judy-OK: Do you have a question?

Judy-OK[4]: NSCLC .... when or would you suggest a brain MRI?? Only if there are symptoms or as a precaution???

DrWest[4]: If it's potentially early stage and curable, I usually would get an MRI before embarking on an aggressive and side-effect ridden treatment, only to find a short time later that there are brain mets. for advanced disease, I used to have a "don't ask, don't tell" policy if there were no symptoms, but now if the patient is a candidate for Avastin, we generally don't give it with brain mets, so I always look

KatieB[6]: Karen335- Do you have a question?

karen335[4]: what are good meds for nausea prescription and OTCkaren335[4]: Prescription and OTC

karen335[4]: Kytril

DrWest[4]: I generally offer compazine, phenergan, zofran, as outpatient meds at home. Ativan is also helpful. It's not clear people vomit less, but it bothers them less if they do, and they're on ativan. No joke. decadron is also good. Before the chemo, as an IV, I generally give aloxi or emend, and decadron. I don't know about OTC, because I give everyone prescriptions. Compazine and decadron are cheap. Kytril and Anzamet are essentially just like zofran, expensive but very good.

karen335[4]: Thank you

KatieB[6]: What is the best way to bring up getting a second opinion without “offending” your current doctor?

Cindy RN[4]: I guess I am to late to chat with the resident DR

KatieB[6]: No. cindy, there's plenty of time

DrWest[4]: yeah, Katie, I give so many second opinions that I understand it's just part of the process, and I don't feel any doc should take it personally. I also encourage my patients to get one if they are at all interested. Patients can be reassured by knowing that the second opinion doc agrees with what the patient's regular doc is doing, and sometimes they can provide new ideas. I am a specialist in lung cancer, so it shouldn't be a knock on a general oncologist who isn't a lung cancer subspecialist to have a patient see me. And I am happy to get info from other smart docs about tough cases.

Cindy RN[4]: Hey Katie-nice to see you here

KatieB[6]: Lisa Smith: Do you have a question?

Lisa Smith[4]: Ever had any experience with severe left arm pain. Mom has recurrent local NSCLC on tarceva. they've run tests, but cant get a grip on it. Has had arm pain for about a year, but just recently it is severe? Hoping for some insight. It is not pancoast

DrWest[4]: Cancer is high stakes. If people would feel better to know they're getting the best treatment, they should be left with as little doubt as possible.

DrWest[4]: I think an MRI of the shoulder area, where the nerves to the arm run through, might possibly be helpful.

KatieB[6]: Maryanne: Do you have a question?

Cindy RN[4]: I have a question for the Dr---I have had worsening arthritis since last yr. I had cisplatin, camptosar in 2001 and in 2003 I had carboplatin and VP-16. Could these have caused this?? Bone scan is norm

DrWest[4]: I wouldn't think they're related. the platinums can definitely cause neuropathy, but not typcially arthritis. Probably not directly related, I would think.

KatieB[6]: Maureen: Do you have a question?

maureen[4]: Dr. West I just completed my regiments of treatments lobectomy, positive margin...33 radiation treatments 4 chemo taxol carbo and then adjuvant chemo cisplatin/navalbine. Last week I had my first PET/CT no clinical evidence of cancer. I do have pneumnitis and began a regiment of steroids and antibiotics. I met with my oncologist today and he states we will do a CT in two months and follow me for the pneuminits. Is there any other course of treatment you know of to help reduce the chances of the cancer returning?

Cindy RN[4]: Just wondered. I have some neuropathy but nothing I can't live with Thanks-

DrWest[4]: sorry for the delay. got a phone call. maureen, to answer your question, no time is really the key. Beyond that, I'd say the risk of anything further may exceed any benefit.

DrWest[4]: I mean, "No, time is really the key".

KatieB[6]: Myrnalu: Do you have a question?

myrnalu[4]: pass

KatieB[6]: recce101: Do you have a question?

recce101[4]: pass

KatieB[6]: Sheri: Do you have a question?

Sheri[4]: Hi Dr. West, I realize your specialization is in non-small cell, but have you ever experienced a male limited small cell survivor achieve a second remission after a relapse that occurred a year and a half later? The relapse appeared in the right Supraclavicular node and possibly in the original right lung tumor site. First chemo Carbo/VP 6 cycles with radiation, the second chemo Camptosar/Cisplatin, 4 cycles. CT scan shows Supraclavicular node resolved, but there may be a 1.5 mm progression at the original site. We understand this could be subject to individual radiologists’ interpretations. We are in watch and wait mode now. My Dad’s Onc, from the beginning told him he would have a 0% chance of survivorship if he relapsed.

DrWest[4]: I must presume that I am the model of clarity.


Cindy RN[4]: Sheri-I was diag in 2001 with ext. sclc and relapsed in 2003. I am still here so there are some of us around

DrWest[4]: Sheri, I actually have a remarkably similar case. I agree with your dad's onc, since he knows the rules. But I have a guy who received carbo/irinotecan on a trial, after a local recurrence, after initial treatment with cisplatin/VP16 with RT. He's now more than 18 months out from that with no evidence of progression. There are occasional exceptions...

KatieB[6]: Tanner: Do you have a question?

Tanner[4]: My wife has mets to the brain and had 12 days of low dose whole brain radiation last month. She is now experiencing some short term memory loss. I thought that this could be because she is also under a tremendous amount of stress. Should we be worried and what should we do?

DrWest[4]: I tell my patient with recurrent SCLC but who looks and feels great now approaching 4 years out that I can't explain it, but it's terrific.

Sheri[4]: Thank you and Cindy, you're a hero to many more people than you know!!

Cindy RN[4]:)

DrWest[4]: Memory loss can be a short term, often transient effect, but sometimes is longer lasting after brain mets. I assume she's on decadron. sometimes increasing the dose can help, as it reduces inflammation in the brain from the mets and RT. But I agree with the general treatment...

KatieB[6]: toosuper52: Do you have a question?

toosuper52[4]: My Mom's original tumor was 7cm x 6.2 cm with mets to illiac and neck. Radiation eliminated neck. Now lung tumor, middle lobe, is 4cm x 4cm after Taxol and carbolplatins. I asked about surgery since tumor shrunk but Dr. said no. Why? Is she too old?

toosuper52[4]: Oh, she's 79

DrWest[4]: In general, if disease was as distant as neck, it's really considered metastatic, and we'd presume that it's a near certainty that there are still micrmetastatic tumor cells in the bloodstream. So surgery would be a helluva lot to go through, for the high likelihood of something popping up elsewhere before she recovered from the surgery. And I would be very worried about doing too much harm at 79. I'd be reluctant to "push the envelope" with an approach like that in someone much younger. At 79, it'd be kind of sadistic.

DrWest[4]: well, maybe not sadistic, but "ill-advised", I'd say...

toosuper52[4]: ok - thanks

KatieB[6]: wendyr: Do you have a question?

wendyr[4]: my husband is on tarceva for one week. when does the rash appear

DrWest[4]: usually within the first 2-3 weeks. Not likely to get worse after that.

KatieB[6]: wondermom: Do you have a question?

wondermom[4]: Pass

wendyr[4]: he is in a trial of tarceva and avastin/placebo any comments

DrWest[4]: Our center is involved in that trial. I think it's a valuable one, and everyone is getting at least the treatment that has the proven value in 2nd line

KatieB[6]: Botley: Do you have a question?

Botley[4]: Perhaps in a minute.....

KatieB[6]: CIndyRN: Do you have a question?

Cindy RN[4]: already had it answered-thanks-also Dr West thanks for being here-gotta go

KatieB[6]: Aurora06: Do you have a question?

Aurora06[4]: have you looked at familial vulnerabiliy AS MUCH AS smoking as far as risk factors?

wendyr[4]: is it true that no rash then tarciva not working

DrWest[4]: no, we haven't really focused on that much. We haven't done much on genetics in lung cancer up until the last few years. We're starting to look much more carefully. I can tell you that the strong signals just don't seem to be there for familial syndromes in lung like we sometimes see with breast cancer and BRCA1 gene or some colon cancer syndromes in families

Aurora06[4]: Look and you might find

Aurora06[4]: other factors beside smoking

KatieB[6]: Skye: Do you have a question?

skye[4]: pass

KatieB[6]: daggiesmom: Do you have a question?

DrWest[4]: as for rash and tarceva, I have some patients who have done quite well on tarceva with minimal or no rash. As big populations go, the trend is that better results are seen in those with rashes, but in individual patients, plenty of exceptions are seen, either with big rash and no benefit or the other way.

daggiesmom[4]: Dr. West, is bleeding a common problem, specifically at the site of the original tumor? My turmor was successfully eliminated, but left a hole in my lung where bacteria collected and bleeding became a problem three separate times. Finally, aumentum was used to patch the hole and the bleeding stopped. Is this a common problem with lung cancer. I've rarely heard about it. It is the hope the aumentum will bond in my lung, but I still live in fear I could start bleeding again.

DrWest[4]: other than smoking, radon occasionally, some other environmental toxins (benzene, etc.), a thought that maybe a key issue in Asian women getting lung cancer is exposure to cooking oils at high heat, like wok cooking.

DrWest[4]: Daggiesmom, no that's not common, but happens. I don't deal with that issue much, but my lung surgeon colleagues do, and they sometimes use that omentum to patch the area. It also has lots of blood vessels and I think my aid in the healing process after surgery.

KatieB[6]: debishere: Do you have a question?

debishere[4]: Have you ever heard of a nutritional supplement called Goji Juice and if so...... what is your opinion of it? Also I am trying to loose 60 pounds after surgery, chemo and radiation! Its the hardest thing I have ever done! What about low carbs???????

Botley[4]: Is there a reason why a Pet Scan would be lit up just about entirely?

wendyr[4]: Noni, Mangosteen, Green Tea???

Aurora06[4]: People who don't smoke are almost mis-lead into thinking they can't get lc because they don't smoke

DrWest[4]: I am not really familiar with that. I would try to be gradual about it. I think any general diet approach, including low carbs, is reasonable. I like steak, myself, so that would be my diet of choice.

KatieB[6]: lets give Dr. West a chance to answer. We are going in order of our names on the list ot the right.

debishere[4]: okay thanks!

DrWest[4]: PET scan lighting up entirely: no, I couldn't explain that. Would consider repeating at another center.

KatieB[6]: elliome: Do you have a question?

debishere[4]: didn't follow the prep?????

elliome[4]: Just lurking.. I am the wife of a 56 man diagnosed in May with Advanced stage NSC Lung Cancer. Things are getting rough and I thought I would learn things here.

KatieB[6]: welcome! I hope you'll browse the message boards.

KatieB[6]: exxesanduhuhs: Do you have a question?

DrWest[4]: The supplements are not my strength. I know several patients doing Mangosteen, and I've talked with some of my naturopath colleagues about it, who think the BUZZ/hype about it exceeds the evidence. Someone is doing a good job marketing.

exxesanduhohs[4]: Dr. West, my mother is currently on many different medications, but one is Dilantin which her doctor prescribed to help reduce the headaches she's had from her brain tumors, but all they do is increase them. Is there any other type of medication she could take to help with her headaches? [she has NSC and has had radiation therapy along with chemotherapy which is still continuing]. Sorry if that was phrasing sounded confusing...Honestly I am fourteen but am actually much older in maturity [many events] but I am very concerned about my mother. Also, her father died from the same type of lung cancer, does this dampen any survival rate she might have?

DrWest[4]: exxes, I'd say that decadron, a steroid, would potentially be a valuable addition (and stronger pain medicines are also a thought). Decadron is a steroid that can reduce inflammation and pressure in the brain.

DrWest[4]: as for your second question, I don't think her dad's history would affect things much either way, but I'm sure sorry for everything she, you, and your whole family have had to go through.

KatieB[6]: Karen335: Do you have a question?

karen335[4]: Can the removal of a brain tumor and necrosis (same surgery) cause Automonic Nerve damage .How can this be treated? Brain met from LC

exxesanduhohs[4]: I believe she is also on Decadron, and that hasn't really helped.

DrWest[4]: might consider upping it. Worth asking her rad onc and/or med onc again.

exxesanduhohs[4]: But thank you I've been sitting back here for half an hour just watching other people ask questions I've thought of so it's helpful.

DrWest[4]: Karen, I don't think that's common, but I suppose it could happen. I don't know of any way to treat it. A neurologist or neurosurgeon might have a better answer.

karen335[4]: Thank you

KatieB[6]: Maryanne: Do you have a question?

KatieB[6]: Maureen: Do you have a question?

maureen[4]: what is the criteria for tarceva to be used.?????

DrWest[4]: for tarceva use, it's approved second line, and the survival benefit is seen not in small subgroups but in the general population. More in next line

KatieB[6]: Myrnalu: Do you have a question?

myrnalu[4]: pass

maureen[4]: do you have to be a certain stage?

DrWest[4]: some particular groups, especially never-smokers, and often asian patients, are particularly likely to get a major response that can last a long, long time, perhaps over a year. But others may still get a survival benefit, often without much or any tumor shrinkage, just keeping the cancer from progressing for months.

DrWest[4]: tarceva is approved for advanced stage disease and isn't well tested in earlier stages yet.

KatieB[6]: peacelover: Do you have a question?

peacelover[4]: Do you believe in the mind/body/spirit connection? Do you offer in your practice alternative or complimentary therapies that support the mind and spirit while meds heal the body? Do you see growth in this side of your practice?

DrWest[4]: Peacelover, I do somewhat. My institution works closely with naturopaths for patients who want that, but there are other centers in town that have these offerings and programs more integrated. I'm more grounded in chemo and targeted therapies, but that doesn't mean I totally dismiss Qi.

DrWest[4]: I'd have to say though, that there's so much to struggle to keep up on, it's not where I'm developing a new expertise.

peacelover[4]: Thank You, I believe my mom has survived 8 years with 3B(mets to brain and liver)with visualization and I am pretty passionate about that....your answer is appreciated!

KatieB[6]: recce101: Do you have a question?

recce101[4]: Please discuss the reason(s) for dividing treatments into 1st line, 2nd line, etc.

DrWest[4]: I know there's still plenty we don't know and am happy to learn anything we can from someone who has done as well as your mom. Part of the issue is that I don't want to "blame" people who lose a hard fight against an aggressive cancer with the implication that they didn't have the spirit.

von[4]: von How do you stop the feeling of when the next shoe may drop i have 1 lung cancer over 5yrs. 2 throat cancers 1&3 yrs.

peacelover[4]: her oncologist dropped her chart last week cause she was still there...and i do understand that, it is a large chasm to cross sometimes....I would love to discuss offline sometime

DrWest[4]: The reason for dividing into first line vs. second vs. later is that cancers get more resistant after they have seen more chemo or other treatments, and patients have often been hit hard by those treatments. So to make a comparison of one treatment to another, we need to compare similar populations, not some with much more responsive cancers against others with less responsive ones.

DrWest[4]: Von, I'm sorry I don't have a good answer. I'm a control freak and hate not knowing what to expect,.

wendyr[4]: My husband is being treated at MD Anderson in Orlando and they say no anti oxydants but some other cancer centers support the use of anti oxidants. What is your opinion as I am confused by the 2 trains of thought

DrWest[4]: the evidence I know of is that anti-oxidants can interfere with several types of standard chemo, and advise against high doses of Vit A, C, E, or other anti-oxidants during chemo.

KatieB[6]: Roger C.: Do you have a question?

KatieB[6]: Sheri: Do you have a question?

Sheri[4]: Do Mets met?

DrWest[4]: Don't know where new metastatic cells come from. Could be circulating and land anywhere, or could go from one met into bloodstream to another place. We're still learning biology of metastases,

KatieB[6]: toosuper52: Do you have a question?

toosuper52[4]: You said earlier that Tarceva could definitely reduce my Mom's tumor. Just a few questions ago, you said "others may still get a survival benefit, often without much or any tumor shrinkage. So, I'm curious as to which is the correct response. Will her tumor shrink while taking only Tarceva every other day or are we just prolonging life with less side effects than conventional chemo, i.e., Taxol and carboplatins

von[4]: Good nite all Von

KatieB[6]: von: visit the website for support.

KatieB[7]: goodnight.

von[5]: ok

DrWest[5]: the rate of significant tumor shrinkage with tarceva 2nd line is 9%. the rate of significant tumor shrinkage with chemo is also about 9% in second-line. First-line chemo has a tumor shrinkage (response rate) of more like 20%, and we don't really know how well tarceva does first-line, but it's only likely to be higher than 9%. Anyway, there are some who have signifcant shrinage, but more than that small % have a survival benefit with minimal or no shrinkage and just slowing before progression.

toosuper52[5]: You must be a very dedicated Dr. Thanks for answering our questions tonight and alleviating many concerns.

KatieB[7]: wendyr: Do you have a question?

wendyr[5]: pass

KatieB[7]: wondermom: Do you have a question?

wondermom[5]: Why would Tarceva eventually stop working? You said in a previous post that it can last for up to a year. Is there anything in the works to make it last longer?

DrWest[5]: one year isn't a firm limit. A few have gone 2 or more years and still counting. But cancers became cancers because they mutate, and it's like evolution on a cellular level. So eventually a new cancer cell mutates and now has a resistant gene to tarceva, and it survives and divides and spreads. It may be 4, 6 , or 12 months, or longer, but in almost all cases, even after a great response, the cancer starts to grow again.

Roger C[5]: I have stage IIIA nslc, have had carbo/taxol and 37 rads. Shrunk 80 to 90 %. Last scan everything stable. If I have a relapse, what treatment would you recommend?

DrWest[5]: the agents that have an established benefit for previously treated patients are taxotere, alimta, and tarceva. If you smoked little or none, I'd favor tarceva if it comes back. If more of a smoking history, I'd pick one of the standard chemos. No data to really say which one, but I would say alimta is often better tolerated.

Roger C[5]: Thanks

toosuper52[5]: Can you believe that Tarceva costs about $3000 for a one month supply?

DrWest[5]: toosuper, I'm afraid that we're going to start thinking $3000/month is looking like a bargain with some of what we're starting to see come out in oncology.

toosuper52[5]: Geez!

KatieB[7]: Aurora06: Do you have a question?

Aurora06[5]: Does pneumonia in childhood increase risk-possible scarring in lungs from pneumonia

DrWest[5]: re: pneumonia, it's a controversial point, with perhaps a little evidence for it, but very little. I would say it either is an extremely minor point or has no relevance for 99% of lung cancers.

KatieB[7]: Skye: Do you have a question?

KatieB[7]: Aliboo: Do you have a question?

Aliboo[5]: My Boy friend is in such great pain what can help he is getting sick from all the pain med and cannot keep food down and has lost a lot of weight

DrWest[5]: for weight, megace can stimulate appetite. decadron is also sometimes used for both appetite and energy, and sometimes helps with pain. But with narcotics, they can be really helpful, but often need anti-nausea meds and stool softeners, etc. to go with them.

DrWest[5]: all of the narcotics can cause nausea, but a fentanyl patch is probably among the least likely to induce much nausea, may be worth a try if he hasn't tried that.

Aliboo[5]: Thanks we have all of those but it's just ketting really bad I feel that htey just don't have the combonation right or something

DrWest[5]: For a case like that, it may be worth finding a true pain specialist, often an anesthesiologist, specially trained, and not in every town, but may be worth a consult with someone with that particular specialty.

Aliboo[5]: Thank You very Much Dr. west

KatieB[7]: Debishere: Do you have a question?

KatieB[7]: Karen335: Do you have a question?

karen335[5]: how long has cancer existed? Why no cures?

DrWest[5]: cancer has been around since people have lived long enough to get them. There are some cures, and we do much better than we did just a few years and certainly decades ago. But cancers mutate all the time, so they adjust as we develop new ways to fight them.

KatieB[7]: Do sugary foods feed cancer?

DrWest[5]: no evidence that sugar feeds cancer, which I fear is a common myth. I strongly advise my patients to eat as balanced a diet as they can. Many patients find that cancer treatments change the taste of foods, so maintaining weight is often a challenge. I don't like to restrict patients to much, since losing too much weight is definitely bad for patients with cancer.

karen335[5]: why does the FDA take so long to approve the meds?

DrWest[5]: FDA: trying to protect us and keep from approving something like Vioxx that later causes early cardiac deaths, or DES that caused lots of birth defects. They try to balance between dragging their feet and being reckless.

karen335[5]: thank you, Dr West. Your time is appreciated

KatieB[7]: We've got about 10 minutes left folks

KatieB[7]: Maryanne: Do you have a question?

toosuper52[5]: Can Avastin be used for NSCLC that has previously been treated with Taxol/Carbos and then Tarceva? Any benefit to that

DrWest[5]: toosuper, the combination of avastin with either tarceva or single-agent chemo like alimta or taxotere has been studied, but in smaller trials. Appears safe and promising, but not a large enough study to be definitive. You can find details about the trial at my website, www.onctalk.com

toosuper52[5]: ok, thanks

KatieB[7]: Muriel: Do you have a question?

Muriel[5]: No

wondermom[5]: Should children of lung cancer patients be screened early for the disease?

Aurora06[5]: Are you frustrated by the minimal advancement in early detection and lack of funding compared to other types of cancer?

DrWest[5]: for that trial, look for info in the subject archives under anti-angiogenic agents, a post about "where to go from here with avastin", or something like that.

DrWest[5]: aurora, that's a loaded question. I think the detection questions are hard because they take forever to answer and technology changes while we wait. And yes, it is very bothersome that funding for cancer research per cancer death is 9 times greater for breast than lung cancer. But I don't want a fight between lung and breast cancer advocates. Better we learn from their success and mobilize ourselves.

Aurora06[5]: thank you

KatieB[7]: Myrnalu: Do you have a question?

myrnalu[5]: pass

KatieB[7]: Nushka: Do you have a question?

Nushka[5]: not at this time

KatieB[7]: OK folks, this will wrap up tonight’s Interactive Chat with Dr. West!

A BIG hand to Dr. West for taking the time to answer all of our questions!

You are very much appreciated. Your dedication and compassion are a breath of fresh air and hope to all of us

toosuper52[5]: clap clap clap

toosuper52[5]: thanks

Nushka[5]: clap,clap, clap...etc

Muriel[5]: Thank you

Aurora06[5]: cyber claps

wendyr[5]: thank you

DrWest[5]: happy to do this every month or two. I'm glad to help.

Aliboo[5]: Thank You

Nushka[5]: Thank you so much Dr. West

KatieB[7]: Thank you so much!! And I will be posting the logged chat on LCSC in the next day or so!!

Nushka[5]: Katie, are you going to post this chat?

Nushka[5]: oops

KatieB[7]: Members feel free to stick around and chat the floor is yours

Aurora06[5]: Thanks Katie

recce101[5]: Many thanks -- I'll post my remaining question on the onctalk website.

KatieB[7]: Yes, everyone remember to visit http://www.onctalk.com to read Dr. West’s articles/blogs and to ask your LC questions

KatieB[7]: Good Night Everyone!!

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