<qa>  What type of treatment will the investigators compare to?The investigator will compare usual care MED, which will be offered to all patients, to two types of laser treatment PDL and CO2, which the investigators hypothesize to be beneficial. The timing and sequence of therapy will be randomized, but all patients will receive some form of laser treatment. If the investigators simply stopped at the end of Aim 1, the investigators would complete a traditional randomized control trial RCT, with some patients potentially receiving laser treatment. However, the investigators are interested in determining whether the sequence of laser treatments is beneficial; therefore, the investigators will be employing a sequential multiple assignment randomized trial SMART design. Because of the nature of the study and SMART design, the investigators will offer all patients some form of laser therapy. 