2/13/26: Neuropathy in Left Pinky Toe

This past Sunday, the "feels like my sock is wet, but it's not" type neuropathy has randomly returned, but this time it's in my left pinky toe. 

As a reminder, this previously happened in the last 2 toes on my right foot, and all my medical providers figured it was related to body positioning as I recovered from surgery. Eventually I stumbled upon leg stretches that helped, and the "wet sock" neuropathy went away, but a "subdued sensation" feeling remains to this day, very similar to the neuropathy I have in the first 3 fingers of both hands, which I've had since chemo.

This time, I haven't had any recent surgery to be recovering from, so we can't blame it on that. 

The only thing I can think of that might be noteworthy is that recently I had a full week that was very stressful and tiring - both physically and mentally. Without getting into the details, suffice to say it was go-go-go with one thing after another. Once I finally had a chance to catch my breath, I was bewildered at how continually tired I was for the whole following week; I was sleeping a lot but kept feeling like I hadn't slept enough.

It wasn't until last weekend that I seemed to have crossed a hurdle and my energy level felt back to baseline, only it coincided with the start of that "wet sock" feeling. Maybe all that sleeping pinched a nerve somewhere?!

Anyway, by Monday I remembered that leg stretches seemed to help the last time I had this weird toe neuropathy, so I've started doing them again. I think they're helping because the "wet sock" feeling is mostly gone, but the "subdued sensation" feeling is still there. Very depressing to think I may end up with yet another site of persistent, potentially chronic neuropathy.

1/23/23: New Stretches Helping with Neuropathy in Right Toes

To address the neuropathy (numbness and tingling) in the last two toes on my right foot (which recently started feeling like my sock is wet, but it's not), my oncologist had suggested stretching. 

My OB/GYN and GYN surgeon both seemed to think it's possible that the neuropathy could be related to having had poor body positioning while recovering from BSO surgery. To me, this potential connection to lying down made me think that any "pinched nerve" must be in the area of my hips or back. 

So, I'd been doing full-body stretches, the kind I used to do in dance class growing up. Mostly, these stretches were variations of sitting on the ground with my legs either extended together straight in front of me, or spread out to either side, and elongating my back while bending at my waist and reaching for my toes. Generally speaking, I think stretching can only help, but they didn't seem to help this particular issue.

The other day, out of the blue, it suddenly occured to me to stretch my legs specifically. I started doing the types of stretches I used to do when I was on the track & field and field hockey teams in high school, ones that isolated the calves, quadriceps, and hamstring muscles. To my surprise, these helped! The wet sock feeling is gone, and the neuropathy feels very much reduced in my pinky toe. 

At first I felt a little sheepish that it took so long to make this discovery. But when I thought about it, why should I have known? I'm not a physical therapist! None of my doctors gave me any specific recommendations or directions, so it's not like they knew either. 

Anyway, this is an encouraging development. I'll keep up the stretches and hope for continued improvement, or at least for things to not get worse. 

1/13/23: OB/GYN Appointment

Today's appointment was an annual check-up, but I figured I'd include it in this blog because it's my first time seeing my regular OB/GYN after getting my ovaries out.

First, she reviewed my medical history since the last appointment. She saw the oophorectomy surgery in my medical records, but had not seen the Tamoxifen and hepatology-related stuff, so I caught her up and explained how that led to removing my ovaries. Without knowing that background, I think she at first assumed that my oophorectomy was elective, since we had previously discussed that option.

(It's interesting to me how my different medical providers all seem to gather different information from my records, even though they're all in the same hospital network.) 

After going over everything from last year, she asked if I had any questions. I asked her if she thought the neuropathy in the last 2 toes on my right foot could be a symptom of menopause? At this point, I would describe the sensation most like this: it feels like my sock got wet around those toes, but when I check my sock, it's dry. But it also still feels like the sense of touch is subdued in those toes, similar to how my chemo-induced neuropathy feels in my fingers, as I described to my medical oncologist recently. Anyway, my OB/GYN didn't think it sounded like menopause. She said it's possible it could have resulted from how my body was positioned during recovery from surgery (similar to what my GYN surgeon said), in which case, she said it could still improve, though she did not elaborate on how or why.

(Meanwhile, I Googled the "wet sock" feeling, and was surprised - and somewhat relieved - to find some references. If my toes still feel weird by the time my next PCP appointment rolls around, I might ask about whether or not I should see a neurologist, or maybe even a podiatrist, since the links I found were posted by foot specialists.)  

Anyway, the doctor did a brief breast exam and also looked at my oophorectomy scars, then did the internal exam. She said everything looks fine, I don't need any other follow-up besides my annual check-up. Yay! At this point, she asked me again if I have any more questions; notably, she didn't make any signs of leaving until after I said no. 

I think that's actually what I appreciated most about this appointment, how the doctor asked me multiple times if I had any questions, and how she didn't appear rushed when asking. It really made me feel like she wanted to help me if she could, rather than me feeling like I am monopolizing the doctor's time or being a "difficult" patient by asking questions.

11/10/22: Medical Oncologist Appointment

My oncology appointments are getting more spread out, which is a good thing; fewer problems means fewer appointments. My last appointment was exactly 5 months ago, and my next appointment will be in about 7 months. After that, my oncologist said I can move to yearly appointments, ideally timed in coordination with my yearly breast NP appointments so that I alternate between the Breast Center and oncology every 6 months. My oncology appointments will continue to be scheduled with either my oncologist or oncology NP. I am acutely aware of how I used to feel when going 3 months in between appointments felt "too long", and it's interesting how I'm clearly in a new place now, able to welcome the longer time in between appointments.

But I'm getting ahead of myself.

I arrived 15 minutes early, guessing that I would need time for a blood draw, which I did.

Checking in at the registration desk, I felt a weird sense of sadness when I looked around and recognized nobody. I had gotten so used to seeing familiar faces that seeing no familiar faces at all made me feel kind of lonely. What's more, as I was getting my blood drawn, my old port nurse was in the room, too, but did not recognize me. Granted, I was masked, and back when I used to see her, I always wore a hat to hide my hair loss. Still, I did not say anything to her, for fear that she would still not recognize me even if I reminded her.

Speaking of masks, I'm very glad that medical facilities in my area still require masks, which I know is not the case across the country. Still, I will never understand why, 2 1/2 years into this COVID-19 pandemic, medical facilities continue to provide only surgical masks to staff and patients, knowing that they do not provide sufficient protection against airborne viruses. I was impressed that many, if not most, of the patients I saw were wearing high-quality N95 / KN95 / KF94 masks, though there was one guy who did not wear a mask at all. I think he was the escort for a patient who was wearing a mask, and I don't understand why he was not asked to wear a mask, or denied entry for not wearing a mask.

Anyway, during my blood draw, the phlebotomist had a difficult time filling the tubes. By now I well know the drill of having to drink extra water starting the night before a blood draw, but I just plumb forgot! I felt pretty sheepish about making the phlebotomist's job harder. 

As usual, I got my vitals taken, and was relieved that my blood pressure was fine, since it's given me a little trouble in the past.

I was glad to see my oncologist. I know she's not a friend, but she was a familiar face and has always been supportive. 

I asked if I would be getting an EKG today, and she seemed surprised at the question. I have learned to not hold it against my doctors when they don't know my whole medical file; I figure, they have so many patients, and only a few minutes to review each file before an appointment, so it's okay if they don't remember everything, as long as they think things through after I bring something up. In this case, I reminded her that the cardiologist who did my pre-surgery clearance said I should get an EKG every 6-12 months while on hormone therapy. Once she confirmed that note in my medical file, she went ahead and arranged for an EKG to be done at the end of the appointment.  

We then discussed my concerns. First, I said I'm still feeling the same very mild neuropathy in the first three fingers of both hands, presumably a remnant of chemo. At this point, I mostly ignore it, but it's there.

Then, I told her about various menopause-related side effects, presumably from taking anastrozole and having had my ovaries out. Stiffness in my fingers, hot flashes, and vaginal dryness are not new, and my doctor reminded me that if my side effects start to interfere with my daily living, I don't have to suffer, there are options, including trying another aromatase inhibitor called letrozole. 

I did tell her about a new concern, which is that my thumbs sometimes hurt now. They are stiff like the other fingers, but additionally, whenever I try to grasp or squeeze something (like a bottle), the thumbs hurt and feel weak. Sometimes it's mild and is just an inconvenience, but other times it's more severe, like I end up using both hands to hold a bottle to make sure I don't drop it. My doctor said arthralgia (pain in joints and muscles) is common with anastrozole, but there's always a chance it could be arthritis. Again, it came down to how bothersome the symptom is: if it's very problematic, I could get imaging to rule out or diagnosis arthritis, and/or get physical therapy to help manage the pain, and/or try letrozole and see if side effects improve. Otherwise, I can just monitor it and live with it. At this point, it's not so bad, so I figure I'll just put up with it.

Lastly, I mentioned the mild numbness and tingling in my right foot and leg that has been happening on and off since July. Sometimes it's just in the last 2 toes of my right foot, and it feels similar to the neuropathy in my first 3 fingers. Other times the numbness and tingling extend up my leg to some degree. Because the sensations are always concentrated in the same area, essentially in a line down the outside of my leg, my doctor thinks it's nerve-related, especially since I had a lot of similar nerve-related problems in the past. She suggested I add regular stretching to my daily routine, and see if that helps. 

After all the talking, I changed into a gown (top only) for a physical exam. Everything was fine!  

The doctor then stepped out and a medical assistant came in to do my EKG. She put one lead on each of my calves, one on each of my forearms, and 6 on my torso. She printed out the EKG on the spot and left it on the computer table for my doctor. I took a look and jotted down my QT/QTc numbers: 442/438 ms. Normal QT is 350-450 ms, and normal QTc is 360-460 ms, so it looks like I'm back in the normal range! 

When my oncologist returned to wrap up the appointment, she gave me the business card of the new social worker in the Cancer Center, in case I ever want to talk with her. Apparently, the amazing social worker who helped me through chemo retired.

Back home, I checked my lab results, and my LFTs and estradiol are both within the expected range! Yay! Maybe things are really finally settling down. 

7/12/22: (3.5 Weeks Post-BSO) GYN Surgeon Appointment

Today was my scheduled post-surgery follow-up with the GYN surgeon.

Thankfully, all the bruises have been noticeably improving, so that was one less thing I was worried about going into this appointment. 

The right incision is healing almost perfectly, there is just a very small bump underneath. I think it's scar tissue. The doctor was unconcerned and said she thinks it'll go away on its own.

The bigger lump of scar tissue under the left incision is still there. The doctor said to Google "C-section massage" and apply the same techniques. The incision area isn't swollen anymore, but it's still puckered - the doctor used the word dimpled - and she said it can take up to 4 months for everything to settle down. (I appreciate having my expectations set appropriately.) She said she thinks it will eventually look normal, but it's possible the incision will create like a "shelf" (or "pooch"), which is exactly what has happened with my C-section scar. Unlike the blog entry I just linked, I don't mind it, I hardly ever think of it, and it doesn't bother me. So, on the one hand, I'm used to my C-section scar, and it's fine if the left incision heals similarly; on the other hand, the right incision already looks basically normal, so it'll be a shame if the left incision doesn't heal the same way.  

Finally, the doctor said there was nothing concerning in my pathology report, and it's okay to sleep on my belly now.

After she assured me everything surgery-related was fine, I told her about an unusual symptom I've been having, which is that my right leg started to feel numb last Friday. It's a very mild numbness, like the neuropathy in my first three fingers on both hands (which is a lingering side effect from chemo). I feel it most in the 4th and pinky toes on my right foot, but sometimes my whole right foot feels a little numb and tingly, sometimes it's in my right calf, sometimes through the knee, and sometimes all the way up my leg to my right hip. 

The doctor said any surgery-related numbness would have occurred immediately after surgery, so this one popping up 3 weeks later means it's not because of the surgery directly. I remembered that I had some bizarre, unexplained numbness in my hands after breast surgery and chemo, and at one point I thought that maybe sleeping on my back all the time was pinching my nerves, because sleeping on my side seemed to help. This time, though, I have been sleeping on my side a lot. The doctor said it's possible that might be the problem; sleeping on my left side might be stretching the nerves of my right leg. She suggested placing a pillow between my legs when sleeping on my side, or changing my sleep position. She didn't seem worried, and I guess I'll just follow up with my PCP or oncologist if it persists.

Meanwhile, I also remembered that my physical therapist used to talk a lot about "getting the lymph flowing". At the time she recommended the Instagram account of a physical therapist who specializes in oncology. I like this account a lot and still follow it, so I looked up some lower body exercises for the lymphatic system. I figure it can't hurt to do them.

6/10/21: Lupron + Medical Oncologist Appointment

I expected to have blood drawn today to check the estradiol number, but there wasn't an order for it when I checked in. As it turned out, my oncologist decided during my appointment that we should check the estradiol again, so I got my blood drawn after seeing the doctor, before getting my Lupron shot. The results should show up on the online patient portal later. 

During my appointment, I told my oncologist about one new concern. About a month ago, I noticed that a spot on the right side of my torso felt bruised, but when I looked, there was no bruise. Poking around, I could feel a round bump that felt tender when touched. Was it a bone? An organ? Was it something to worry about? I laid down on the examing table, and the doctor spent a good amount of time feeling around. She said she definitely could feel the bump, but she wasn't sure what it is! 

On one hand, it's disconcerting when the doctor doesn't know something. On the other hand, I do appreciate her honesty. She said it might be a "floating rib" - one of the lower couple ribs that don't connect to anything in front - and then she Googled it right there in the office. She suggested we keep an eye on it, and if it gets worse or continues to be worrisome, maybe she'd order a CAT scan. But in the meantime, I should try not to poke around at it, which might be aggravating it unnecessarily.

I told her that I am aware that maybe my worrying has a psychological component. I've been hypervigilant about my body for a couple years now, first in finding the breast cancer myself, then in trying to keep tabs on the many side effects of treatment. After all this time, it's like I'm looking for things to feel wrong. Plus, the typical aging process and Lupron-induced menopause are confounding factors, reminding me that I shouldn't even expect my body now to feel like it did pre-cancer. Anyway, my oncologist said all that sounded perfectly normal, and I appreciated that she didn't make me feel like a hypochondriac.

Anyway, I also reported that I've been getting hot flashes again. I hadn't been getting them for a while, but they're back, and I wonder if the hot weather is a trigger. Interestingly, I think eating sugar is a trigger; at least, I seem to get hot flashes any time I eat the fudge I got for Mother's Day. 

For the record, the first three fingers on both hands still feel very, very mildly numb and tingly. I never notice it anymore unless I tap my thumb and fingers together, so it's just something I've accepted as permanent. My joints still feel stiff sometimes, especially in the mornings, but it doesn't interfere with my daily activities, so it's also not something I worry about anymore.

She said since there aren't any treatment-related issues, we can stretch my next appointment out to 6 months instead of 3. I remember when 3 months between appointments made me feel a little nervous, but now I think I'm okay with it. I'm ready to put more distance between me and cancer treatment. 

Finally, I got my Lupron shot. The nurse was one I've had before, but the shot felt like it was in the wrong place! The location was much higher than where it's usually given, closer to my hip than actually in my butt. I didn't say anything, but as soon as I got home, I Googled, "What if a shot is given in the wrong place?" I found this Quora entry, with one answer that includes a helpful image showing the safest place in the butt for a shot. Apparently, the place I got the shot today looks to be more squarely in the safe area, all the other shots were probably on the low side!

3/18/21: Lupron + Medical Oncology NP Appointment

I wore a KF94 mask again today, and they didn't bother giving me a new surgical mask.

I was originally scheduled to see my oncologist, but at some point the online patient portal showed that the appointment was switched to the NP. I don't know why, and I don't really mind. I like my NP a lot now.

I had expected to get my blood drawn today, and I'm curious to know what my estradiol number is. But my NP said my oncologist decided to put it off for another month, so that my body will have had 3 months to adjust to Tamoxifen before we look at my hormone numbers again.

First we went over all my side effects. 

I seem to have a runny nose all the time now. Sometimes I wonder if I might be developing seasonal allergies, but it's also listed as a side effect of Tamoxifen, so who knows. I keep meaning to try some seasonal allergy medication, just to see if it helps, but then I never quite feel like the runny nose is that bad, I feel like I can put up with it. Interestingly, my NP asked if my nose hairs have all grown back! It's true that I lost all my nose hairs during chemo, and whatever hair that is growing back now, including on my legs and underarms, has grown back much thinner. So, maybe part of the problem is that I just don't have enough nose hairs anymore. 

My hair is growing in thin, presumably because of the Tamoxifen. If I don't shower for a couple days, and my hair gets a little matted, my part becomes pronounced in the back. Not quite as bad as in this photo, but similar, and definitely evident. The friendly medical assistant I saw today was very positive and encouraging about my hair growing back, but I told her I still just don't feel like myself, and I'm impatient for my hair to grow longer. 

The first three fingers of both hands continue to be very mildly numb and tingly. This persistent neuropathy doesn't interfere with my activities of daily living at all, but I can feel the numbness and tingliness when I tap my thumb and fingers together. 

I still feel some stiffness in my fingers, particularly in the morning when waking up, but it's not nearly as severe as it was before. My legs are much improved, too, and they no longer feel stiff like they did when I was on exemestane. I first noticed the difference in the kitchen; in the time it took to cook dinner, my legs used to stiffen up so that sitting down to eat felt like a huge relief. Thankfully, that's no longer the case. Going up and down the stairs feels easier now, too.

After talking through all that, the NP did a physical examination, which went fine. I'll see my oncologist again in another 3 months.

Upstairs in the infusion room, the nurse who gave me my Lupron shot was new. She said she's a traveling nurse from Florida! I don't know how hospital staffing works, but she said she's filling in for one of the regular nurses for the next 3 months.

Incidentally, today my left arm only feels sore at the vaccine injection site if I touch it. I suspect all soreness will be gone tomorrow.

2/19/21: Lupron + Other Updates

I think today was the first time I felt like my monthly Lupron appointment was a burden. I guess I had gotten so used to weekly appointments for chemo, and then Herceptin infusions every 3 weeks, that when I got down to only Lupron appointments every 4 weeks, it felt luxuriously infrequent by comparison. Normally I don't mind going in, but it's school vacation week, and a snowy day; I would have preferred to sleep in, and not drive in the snow.

There's been a lot of chatter about upgrading your masks for COVID-19 protection. I recently bought some KF94 masks, and I wore one for today's appointment. In the past, I would wear a surgical mask. The Cancer Center provides surgical masks for people to use instead of cloth masks, but if you already have a surgical mask, they just like to confirm that it's a new one. I was a little confused today when the person checking me in handed me a surgical mask along with my screening sticker and identification tags, without asking if my mask was new or not. Maybe she thought it was made of cloth? Or maybe they have a new procedure to hand out new masks to everyone. I decided not to swap out my mask since a KF94 is supposed to be better than a surgical mask, but I think if it happens again, I will wear their surgical mask on top of my KF94. That way they can be assured that I am wearing a new mask, no matter what other mask I may be wearing. 

(As an aside, I wonder if they want to be sure that everyone is wearing an actual medical grade surgical mask. All the surgical masks we have been able to purchase since the pandemic started look like surgical masks, but none are labeled with ASTM standards. By contrast, the surgical masks I bought from CVS for myself during chemo, before the pandemic, were clearly labeled as meeting ASTM Level 3 standards.) 

Anyway, the shot went smoothly, and I was glad to have the nurse who I think gives the best shots. 

Here are some other updates:

I have been diligently applying the scar cream to my port scar every night. It's part of my routine now, I put it on after brushing my teeth. It doesn't seem like it's doing anything, though; I think the scar looks the same, but it's hard to tell on a day-to-day basis. 

I think I'm doing fine on Tamoxifen. I have side effects, but they don't disrupt my activities of daily living, so I figure they are manageable. I expected the joint stiffness in my fingers to go away once I stopped exemestane, but this page lists joint stiffness as a "less common" side effect of Tamoxifen. I wonder if already having joint stiffness made it more likely for it to stick around when I switched to Tamoxifen... Very sadly for me, my hair is growing back thinner than it was before chemo; hair thinning is listed as one of the "more common" side effects. Also, my vision is poorer, but it's been a little blurry ever since chemo, so it's hard to know what to blame. Getting my eyes checked is on my list of things to do after the pandemic.

Meanwhile, the first three fingers on both my hands continue to feel very mildly numb and tingly. Most of the time I don't even notice it anymore, but if I tap my fingers together, I can feel it. 

11/25/20: I Have a Lot of Joint Stiffness, and Other Side Effects

Joint stiffness is a common side effect of exemestane. The longer I don't move a joint, the worse the stiffness. Every morning when I wake up, this is as far as I can go in making a fist:

It's a little painful pushing through the stiffness. I have to slowly, gradually open and close my fingers until I can make a fully closed fist. 

If I don't use my hands for a while, or stay seated or standing in the same position for a while, the joints stiffen. Just the amount of time it takes to cook dinner makes sitting down afterwards feel like a huge relief on my legs. It's all manageable, but it's a nuisance, and makes me feel decrepit.

The tips of my thumb, index, and middle fingers on both hands are still very slightly numb and tingly all the time. It's just another nuisance now. It doesn't affect my ability to do any daily activities, but I do think I'm a lot clumsier than I used to be, like I always have butterfingers. 

My hands are still puffy, and my feet feel bigger, too. At least, my shoes and socks feel tighter. I don't know if it's fluid retention or actual weight gain, but if it persists, once this pandemic is over, I'm going to see about re-sizing my rings, which I haven't been able to wear since January. 

9/24/20: Last Maintenance Herceptin! + Medical Oncologist Appointment

Today was my last infusion!!!!!

I am talking excitedly about it, but I'm not really sure how it feels yet. Maybe a little anticlimactic? Maybe a little scary? Or disorienting? It's a little weird to have a certain routine for a year, and then stop it suddenly. Of course, all the time not spent at the hospital is mine again, so that's good. 

Some hospitals do this thing where you ring a bell on your last day of treatment. It's a pretty big deal to a lot of people, and bell-ringing photos and videos regularly pop up in the Facebook support groups I'm in. But my Cancer Center doesn't have a bell, and I'm okay with that. I don't like being the center of attention, and I think I would feel self-conscious. But part of me does wonder if ringing the bell would provide a kind of closure, to help in the moving forward process. 

Anyway, I made chocolate lava cupcakes to celebrate. And Ken will be making paella for dinner. Yay!

Okay, back to my appointments today. The port nurse was behind schedule so the medical assistant took my vitals while I waited to get my port accessed. (For the last time!) 

My medical oncologist appointment went well, I think because I didn't have any open-ended concerns. 

I reported that my thumb and first 2 fingers on both hands are still numb and tingly, but now only very mildly so. Occasionally, for brief moments, my left hand even feels normal! Ever since my last appointment with my physical therapist, I've been doing only the prescribed stretches, and I haven't had any flare-ups of pain or discomfort. 

Thanks to the exemestane, the stiffness in my fingers has increased significantly so that I need to pump my fingers regularly throughout the day, to keep the rigidity at bay. It's a crazy feeling every morning, waking up to fingers that won't bend, and having to slowly work my fingers until the mobility returns. 

My left hand still looks puffy to me. Shoes that used to feel loose now feel snug, and my old watch is tight on my wrist. Even my face looks a little puffy to me, so either I've gained weight all around, or I'm retaining fluid. Either way, I think I can blame the Lupron.

Also because of the Lupron, I still get hot flashes, but not nearly as frequently as before. I used to get them at least several to many times a day, but now it's more like 0-2 times a day. I don't know if the side effect is wearing off, or if the cooler weather and colder household temperature are a factor. 

As suggested by my PCP, I asked about getting a colonoscopy before age 50. Contrary to what I found online, she said I don't have an increased risk of colon cancer due to breast cancer. Interestingly, however, several organizations, including the American Cancer Society, have recently changed their recommendations to say that even people with an average risk of colon cancer should get screened at age 45. Apparently there are many types of screening besides colonoscopy, but a colonoscopy is the most thorough option. I'm 44 now, and I'll be 45 by the next time I see my PCP, so I guess I'll go ahead and ask for some type of screening and see what my PCP suggests.

My oncologist was very nice and excitedly congratulated me on finishing Herceptin. No hugs because of COVID-19 but I think if we weren't in pandemic it would have been a hugging moment.

Up in the infusion room, I saw the "new" nurse that my regular nurse had trained. I had to wait a long time for the Herceptin to be delivered from the pharmacy, but that's not a complaint, I didn't mind just sitting and reading my book. 

When everything was finished, I wanted to say it felt great, but I didn't really feel much at the time. The nurse de-accessed my port, and then confirmed my upcoming appointments, including next week's Lupron shot. I guess that's part of why I don't really have a sense of completion; I'll be back again next week, and every 4 weeks after that, until menopause or until I opt for an oophorectomy, whichever comes first. 

9/9/20: The Hospital Called Me

My port removal is scheduled for October 1!

At first it was scheduled for September 25. I asked if it's possible to know which doctor I would be seeing, and the scheduler said no, there are multiple doctors on duty. She asked if I had a request to see a particular doctor, and I explained how I actually have a request to NOT see a particular doctor. She said this doctor is scheduled to work that day, but she could put in a note for me to see someone else. That seemed like it had the potential to get awkward, so I asked if I could be scheduled on a day that this doctor isn't even working. 

Now I just have to hope that the procedure goes well, and the final incision heals cleanly. I have some anxiety over the possibility of having another poor outcome, and I keep trying to tell myself that beyond asking for a new doctor, there's nothing more I can do about it. It's out of my hands. 

I know I should try to focus on the good news, which is that my infusions will soon be ending! But part of me is not sure how to feel about that. Yes, it's something to celebrate for sure. It will be nice to not have an appointment every 3 weeks! But it also feels kind of weird. After more than a year of active treatment, I'll have to settle back into some sort of normal life.

I think a lot about this meme, which I posted before at the start of my treatment. It seems like there should be a sense of empowerment and completion, but what I'm feeling is more like disorientation, and helplessness.  

Practically speaking, I am looking forward to being off Herceptin because I'm hoping it will lead to an improvement in the numbness and tingling in my fingers and toes. Or if not, at least I'll be able to eliminate one possible cause for those symptoms. 

Maybe I don't feel that sense of completion because even though I can check off surgery, chemotherapy, and targeted therapy, the hormone therapy part of my treatment is still on-going. 

Well, maybe I just shouldn't think about it too much. I don't need to be spending time analyzing myself when there's plenty of other things for me to think about, e.g, the kids starting school, the pandemic, the upcoming election!

8/23/20: (1 Year Post-DMX) Cancerversary

Another date that marks another milestone. A year ago today, a skilled surgeon cut the cancer out of me. Once the pathology report came back clear, he declared me tumor-free. Later on, an oncology nurse used the term NED, no evidence of disease. (They were careful not to use the phrase "cancer-free" because it's impossible to know whether or not any rogue cancer cells are still lurking somewhere in my body.)

I'm not really sure how I feel. I don't think I feel particularly celebratory.

Cancer has hijacked my life for more than a year now, and I still feel like I'm in the middle of it. Surgery and chemo don't feel like they are "behind me". Some parts of my chest and underarms still feel numb from surgery. I know the numbness can actually be permanent, so I'm not expecting it to go away, but I guess I'm hoping I'll wake up one day and feel used to it. Like maybe it could feel familiar instead of weird.

Chemo doesn't feel "over and done with" either because I'm still wondering if the neuropathy in my fingers (and occasionally in my toes) could be a lingering side-effect. Plus I'm dying for my hair to grow back. I still wear a hat any time I leave the house. Yes, I'm grateful that my hair is growing back thick and black, but I hate the way it looks. It stands up more than it falls downward, and it looks like a helmet! Ugh! I really had no idea I was so vain. 

Side effects from hormone therapy seem to be getting worse. Thanks to the Lupron, hot flashes are common and annoying. Exemestane continues to cause joint stiffness. It's mostly in my fingers, but I can feel it in my legs, too. Any time I go up and down stairs, it's like it takes effort to bend my ankles. In the time it takes to cook dinner, my legs feel so stiff that sitting down to eat is a huge relief. And any time I stand up after sitting down, my knees crack. 

I have 2 infusions left for Herceptin. Still waiting for my port removal to be scheduled. Maybe once I'm past those two things, I'll feel more like I'm moving forward. 

I think I do feel frustrated. I miss feeling comfortable in my own body, and not being hyper-focused on ailments. I guess I feel kind of resigned, and wistful for my old self. 

Still, I'm optimistic that I'll one day feel "normal" again. This pandemic sure doesn't help, since nothing feels "normal" to anybody. Maybe when life out there settles into a "new normal", it'll be easier for me to do the same.

7/30/20: Physical Therapy Appointment #21

My physical therapist spent almost a full hour with me today. 

She did a whole bunch of tests on my wrists, arms, and neck to try to learn more about the numbness and tingling in my fingers. Nothing in my neck seemed to cause any trouble, and she conceded that maybe the MRI isn't needed just yet. 

She was pretty confident that the problem is my median nerve, leading to some kind of carpal tunnel syndrome. 

I guess the big question is what is causing the carpal tunnel syndrome. At first, she still seemed to think there might be a musculoskeletal explanation, partly because the symptoms are symmetric. Also, I get intermittent tingling in my toes. It could be related to Herceptin, or Taxol. One possibility that seemed to make the most sense to me is the old idea of swelling; maybe the hormone therapy is causing fluid retention, which is squeezing some nerves in both my hands and feet. My hands and feet do look a bit puffy, but when the physical therapist actually measured my arms, they were not swollen compared to my previous measurements. 

She apologized for not being able to pinpoint the root problem. I appreciated her efforts, and completely understand the difficulty. I have so many medications and treatments, it's impossible to definitively link one thing to another! 

Anyway, she advised me to do a median nerve glide and two upper body stretches. I didn't schedule another physical therapy appointment; I figure I'll see how these exercises go, and I can always call if things get worse.

7/24/20: Maintenance Herceptin #11 + Medical Oncology NP Appointment

After the port nurse accessed my port, and before I went upstairs for my infusion, I met with a medical oncology NP. My oncology appointments now alternate between the doctor and the NP, and this was my first time meeting the NP. She was great, like everyone else I've met at the Cancer Center.

We went through the whole history of the numbness and tingling in my hands. The symptoms have been at baseline since the beginning of June, and since they're not disrupting my daily activities anymore, there's no sense of urgency to get an MRI. The NP decided to wait, and to have me see the physical therapist in person first. If the physical therapist still thinks I need an MRI, maybe they'll order it then. I don't have a strong feeling one way or the other about it at this point. 

As instructed by my PCP, I asked if I should get a colonoscopy before age 50. The NP seemed surprised by the question, and said no, they do not usually recommend early colonoscopy for breast cancer patients. 

I also asked her opinion about getting my ovaries out. Based on the genetic counselor's advice, I should feel fine about not getting them out. I guess I'm just curious to know if anyone has any thoughts or information that I haven't considered. Anyway, she said she understands how complicated the question is, but she isn't very knowledgable about this particular issue, and would defer to the medical oncologist.

After the NP appointment, I went upstairs for my Herceptin treatment. When the infusion was finished, and the infusion nurse took off the dressing on the port to de-access it, I asked her to take a closer look at my port incision; lately I've noticed two little dots, and a tiny black shadow between them, on the incision scar. I think it's a tiny stitch! Not the dissolvable kind, either; it looks like the regular kind that was used for my re-stitch. The infusion nurse agreed, and said maybe it's working its way out. She put some antibiotic ointment on it, and a bandaid. I guess we'll see if it comes out. I figure, they can always take it out when I get my port out. I just don't want it to get infected or anything in the meantime.  

Today's appointment took about 3 hours total. Back at home, I checked my blood work online, and my vitamin D levels are back to normal! I'm taking a daily supplement of 2000 IU, and it's good to know for sure that it's working. 

7/10/20: Lupron

Driving to and from today's appointment, I was discouraged to see the low rate of mask wearing in front of stores, on the sidewalks, and in the parks. (My state has an order to wear masks in indoor and outdoor public spaces where social distancing is not possible.) Compared to a couple months ago, there were more people out and about, and fewer people wearing masks. Everyone thinks we're okay because our numbers are flat, but with people not taking precautions, I'm nervous about a resurgence.

For some reason, the Cancer Center was extra busy today. The parking lot was unusually full, and there was a line to check in.

My nurse today was one I've had before, but not often. She called me in from the waiting area, instead of the medical assistant, and took my vitals. Maybe having me see only one person was an effort to minimize patient interactions among the staff.

I was pleasantly surprised that even though she's not my usual infusion nurse, she seemed up-to-date on my hand symptoms. She knew about my physical therapist appointment yesterday, and confirmed that I should expect an MRI to be sheduled soon.

She also mentioned that she is a breast cancer survivor, too, and that she has the exact same symptoms - numbness and tingling in the tips of her thumb, pointer, and middle fingers!! She attributed her symptoms to Taxol, which she finished about 2 years ago. She said her symptoms have gotten better over time, but they're still there. I asked her if she ever had Herceptin (she didn't), but I didn't ask if she had surgery or hormone therapy. She didn't at all imply that my problem might be the same, but it's always reassuring to hear that I'm not alone with these symptoms.

The whole visit was a very efficient 15 minutes.

7/9/20: Physical Therapy Virtual Appointment #20

My physical therapist called on Monday about scheduling a virtual appointment, but she called my cell phone, which I don't always keep at arm's length, so I missed the call.

I called the Cancer Center on Wednesday, and the scheduler said the physical therapist is doing both virtual and in-person visits. But she's not seeing patients on Fridays, the day I usually go in for treatments. I'm still wary when it comes to the coronavirus, plus I figured, I don't have any urgent concerns, so I decided to schedule a virtual visit.

The virtual appointment was today, and we spoke on the phone for 30 minutes. I told her about my current baseline: I wear wrist braces to sleep every night, and my thumb, pointer, and middle fingers are mildly numb and tingly all the time, but don't disrupt my daily activities. I also described the painful flare-ups that led me to take a break from basically everything.

She asked me a bunch of questions along the lines of: Am I getting headaches? Do I have any pain in my shoulders? Do my arms feel tired? Do I have symptoms in my legs or feet?

After all that, she was very confident in saying that she would like me to get an MRI. She said that symptoms that are side effects of medication usually do not change with a person's activities, so the fact that lying down on my back seems to be a trigger for making numbness and tingling worse is an indication of a non-medication-related problem. (My medical oncologist said the same when she first proposed the MRI.) She also thought that the symmetry of my symptoms, and the existence of some numbness and tingling in my toes, suggested something going on in my neck. If we had had an in-person visit, she would have performed some physical tests on my neck, and even then, she still would have wanted an MRI so that we could have all the pieces of the puzzle. Ideally, an MRI will either confirm or rule out a neck problem.

As for why I might be experiencing neck problems, she explained how my double mastectomy resulted in major changes to my chest wall that ultimately affected my chest, shoulder, and neck muscles, which are all interconnected.

I told her how I had been leaning towards not getting an MRI until after my Herceptin treatment ends, in case Herceptin is causing some of the symptoms, but she said not to wait. If the problem is not Herceptin, the sooner it's treated the better; if the problem is nerve-related, letting it go unaddressed now might make it harder to treat later.

She said she would email my medical team about scheduling me for an MRI. Then I can schedule an in-person appointment with her after we have the MRI results.

As always, I really appreciated my physical therapist's insights. Getting her professional opinion felt very reassuring.

6/12/20: Maintenance Herceptin #9 + Lupron

I arrived at 9:15. There was a new pexiglass barrier on the reception desk between me and the person checking me in. She handed me a surgical mask and didn't ask me for my name. Through all the crazy uncertainty of the last few months, my visits to the Cancer Center have been a surprisingly grounding routine.

While waiting for the port nurse, the social worker happened by. She greeted me by name, and I felt bad that I couldn't come up with her name right away. There's actually a thing called "chemo brain", a chemotherapy-related cognitive impairment. I think I have it. I've had trouble coming up with the right word since even before being diagnosed with cancer, so I can't blame chemo for all my mental fogginess.

But there are two things in particular I've noticed over the last several months. First, I am taking a lot longer than usual to read books. I find myself frequently re-reading sentences, so much so that it sometimes feels like I read every sentence twice in order to process it.

Second, I can't follow complex, fast-paced TV shows anymore. We recently watched the series Star Trek: Picard, and I had trouble keeping up, even my kids (in middle school) rolled their eyes at my questions. Then, inspired by Picard, I went back and re-watched episodes of Star Trek: The Next Generation. I specifically remember watching an episode maybe just a couple years ago, and being impatient with how slowly the story unfolded, how every detail was explicitly spelled out, as if the audience couldn't be trusted to make inferences. Watching the show now, I am practically relieved at how clearly events and dialog explain what is going on; the exact thing that used to bother me is now something that helps make the show enjoyable for me.

Anyway, the social worker was on her way to somewhere else, so we only exchanged pleasantries. I think it would have been nice to chat with her for a while, but I guess I don't feel "in need" of talking to her, so it's okay.

For the first time during this pandemic, the port nurse accessed my port (which used to be routine), instead of having the infusion nurse do it (presumably to minimize exposure risks). Even with the orange "Allergy" tab hanging off the "Screened" sticker on the front of my shirt, I had to remind her to use the Betadine instead of chlorhexidine. I think I've gotten more comfortable with speaking up for myself, and less indignant at this kind of oversight. I don't know if it's because I have general confidence in the port nurse, or if it's because I feel a sense of familiarity with her, or if I've just become more understanding that medical providers are human, too, and can make mistakes.

With my port accessed, I didn't have long to wait before being called into the infusion room. Apparently, the forehead thermometer was broken and sent off for repair, so the medical assistant was back to using an oral thermometer.

My infusion nurse came in pretty much as soon as I got settled into my bay. I told her all about the flare-up with my numb and tingly hands, and how doing nothing has gotten them back to baseline.

While getting me started on the Herceptin, she briefly wondered if maybe I should take a break from the hormone therapy, thinking it might be the cause of my hand troubles. I immediately felt uneasy about that option. Stopping my hormone therapy might give the cancer just the chance it needs to start growing again... Also, I pointed out that the first time my hands felt numb and tingly was before I even started exemestane. So maybe the exemestane has exacerbated the issue, but it definitely wasn't the initial cause. Still, that didn't rule out Lupron as the culprit.

I told her how I had found some web sites that link carpal tunnel syndrome with Herceptin. Like my medical oncologist, she didn't seem familiar with the connection, but didn't discount it either. I told her how I've been thinking that maybe if I can just get through my year of Herceptin treatment, then I'll also be almost a year out from chemo (so any residual effects from Taxol should be gone, too), and maybe the problem will just go away! At least I'll have fewer variables by then; after Herceptin is over, I'll only be getting hormone therapy with Lupron and exemestane.

My infusion nurse said the problem with my hands was clearly interfering with my life, and she suggested it might be time to see an orthopedic hand specialist. Maybe they can actually diagnose carpal tunnel syndrome, or rule it out. Again, I felt a little reluctance. That's yet another specialist, another referral, more appointments, maybe more imaging. I don't want to get bogged down chasing this symptom if there's a possibility it might just go away on its own in the fall? But I guess I don't want to risk the symptoms getting worse, either... Anyway, she said she'd touch base with my doctor about making a referral. I think I will be extra vigilant about not over-using my hands and arms, and I'll consider the specialist if my symptoms take a turn for the worse again.

I asked my nurse if she knew when my physical therapist would be accepting patients again. My medical oncologist had said that commonly one of the earliest treatments for something like a pinched nerve is physical therapy, so maybe it would help if I could see my physical therapist again, before turning to a hand specialist? But she didn't know when my physical therapist would be available.

Once my Herceptin was finished, I didn't have any wait at all to get my Lupron shot. I washed my hands and was out of the building by 10:45. Only ninety minutes total! I think that may be a record.

6/4/20: Doing Nothing Helped

The weirdest part of having these symptoms in my hands is not having any visual indication of what's going on. Someone looking at me would think I'm fine. I feel like, if someone asked me, "How are you?" and I answered with a brief description of the pain and discomfort in my hands, they might think, "Uh... O-kaay... Well, your hands look totally normal, so..." I think it's given me some understanding of how people with hidden disabilities, or chronic pain, might feel.

So after a day of pretty much doing nothing, I was able to wear a wrist brace on both hands to sleep last night, and this morning I woke up feeling a LOT better! My left hand felt like it was back to the old baseline, at least temporarily. But even the slightest use - like trying to type with my left hand - made the numbness and tingling increase. I'm going to keep minimizing the use of my hands and limit my exercise to walking, with the hopes of seeing more improvement, though it sure makes me feel useless.

Of course, doing nothing is not a realistic way of managing this pain. I'm hoping the doing nothing will help me get back to the old baseline, and then gradually I can increase my activity without adversely affecting my hands.

6/3/20: Left Hand was a 7 on Pain Scale

The pain is intermittent, not constant.

My left hand is orders of magnitude worse than before. I am typing this with my right hand only. Typing with my left hand is impossible because either my hand hurts and can't be used, or it's fine at the moment but typing makes it worse.

After my last oncology appointment two weeks ago, I started wearing my wrist braces to sleep every night, plus I started doing yoga about every other day. Just a light start, first only 3 series one sun salutations, then gradually adding in 2-3 series two sun salutations. I followed the yoga with leg stretches. I noticed an immediate benefit in my legs; they didn't feel as stiff. But in retrospect, I think poses like the downward dog put the wrong kind of pressure on my wrists, even though my wrists did not hurt while doing yoga.

About a week later, my left hand started acting up. After getting up in the morning, instead of settling into the usual "baseline" (very mild tingling in just the first 3 fingers of both hands), I continued to feel increased numbness and tingling in my left hand throughout the day. Extreme temperatures (a hot plate from the microwave or a cold glass of water) made symptoms worse. Sometimes my fingers themselves felt cold, and I wondered if there was a problem with my blood circulation. In retrospect, at this point, I think I should have taken it easy and babied my left arm. Instead, I kept up with yoga and nerve glides and stretching and walking and housework and gardening as usual.

A few days ago, I woke up with my left hand in pain. It was super numb and tingly, and the pain came from a sensation that something like a rubber band was squeezing my hand so that my fingers felt like their circulation was being cut off, like they were under pressure and would explode. This is the level 7 pain (on a scale of 1 to 10) referred to in this post's title. I freaked out and walked around my bedroom. Any attempt at stretching or nerve glides made it worse. I even took a Lasix (and potassium pill) just to feel like I was doing something. Gradually, after about 30 minutes, my left hand felt better.

For the record, I don't think the Lasix helped. My left hand continued to look noticeably swollen, puffier than my right hand. I didn't even pee a lot, implying there wasn't a lot of excess fluid to get rid of.

At this point, I was worried, but not too worried because the last time my hands freaked me out in the morning, it eventually passed. But what finally got me super worried was that last night, I felt the level 7 pain in my left hand before going to bed, not in the morning when waking up. Putting on the wrist brace made it worse. Walking around helped a little, but what helped the most was squeezing my left hand into a tight fist, with the thumb on the inside. The problem was, once I tried to release the fist, I couldn't open my fingers all the way! It hurt a LOT. Ken noticed a very prominent "line" popping up on the inside of my left wrist, like something was stretched taut, and trying to open my fingers was stretching that line more than it could go. I took two ibuprofen to help dull the pain to fall asleep, no wrist brace on my left hand.

I had made up my mind to call the doctor today because the pain was getting unbearable. In the morning, Ken told me he Googled "carpal tunnel syndrome" and suggested complete rest. I took 2 more ibuprofen and walked around my bedroom for an hour. It's better now. I don't feel like I need to call anymore; I'll see how today goes. I'm going to take it easy for a while. No yoga or housework or gardening. Maybe I'll continue with leg stretches, but only minimal arm stretches, if any. I'll keep walking. Typing only with right hand, but I should limit that, too. Thank God my right hand is still functional. If both hands were acting up with level 7 pain, I honestly don't know what I would do.

5/20/20: Maintenance Herceptin #8 + Medical Oncologist Appointment

Yesterday, the Cancer Center called to pre-screen me for today's appointment. Over the last few months, the number of COVID-19 screening questions has grown, and the questions have evolved. At first, they asked only if I'd travelled to China in the last 2 weeks, then they asked if I'd travelled internationally, and now they ask if I've left the state. They used to ask if I'd had a fever or respiratory symptoms, and now they also ask about other possible symptoms, like if I've lost my sense of taste or smell. And in terms of exposure, not only do they want to know if I've been in contact with anyone who has been diagnosed with or tested for COVID-19, they also want to know if I've been in contact with anyone who just shows symptoms of COVID-19.

I had an 8:45 appointment to get my port accessed and blood drawn, but around 9:00, the port nurse came out and said she had to check with my doctor because she didn't see any lab orders for me. Meanwhile, a medical assistant took my vitals.

It turned out that my oncologist did not require any blood work today, which threw me off a little because I was hoping to see if my vitamin D levels have improved. (The last time I checked, they were slightly better, but still below normal range.)

In the exam room, the medical assistant let me know that the doctor was running late. I had a book to read, so I didn't mind the wait.

The doctor came in around 9:45. We started out talking about how I've been feeling emotionally, and it occurred to me to say, "I bet you hear this kind of stuff from your patients all day long, just the same type of complaints from different people." She told a story of something that happened to another patient, along the same lines of what I had been saying, and it really helped in that "you are not alone" type of way. She said some supportive things, and it really felt strengthening.

I asked if my vitamin D deficiency was something I should be worried about. My vitamin D number is in the mid-20s, but normal range is 30-60. She said if my number was in the teens, then that would be concerning, and she might temporarily prescribe a weekly uber-dose of vitamin D to get the number back in the normal range. But with a number in the 20s, my 2000 IU supplement should be enough, plus we're coming up on summer, and the added sun exposure should help, too. She said she'd check my levels next time.

I also asked about my most recent echocardiogram. I checked my results online, and the primary number of interest, the ejection fraction, wasn't listed exactly. My first report had an ejection fraction of 63%, and the second report said 61%. This third report said only >=55%, with a note saying it was "visually estimated". The ejection fraction is affected by Herceptin, and some people have to discontinue treatment if the number gets too low. My doctor didn't know why this report didn't have an exact number, and she said she'd look into it. She pointed out that the range might not be informative enough; if my ejection fraction was actually as low as 55%, even though that's in the acceptable range, the precipitous drop would be concerning.

Then, I gave a full report on what's going on with my hands. She said the fact that symptoms get worse when I'm lying down makes her think it could be a pinched nerve in my spine. Apparently, sometimes one of the first things to try for a pinched nerve is physical therapy, so it's too bad I'm not able to see my physical therapist because of the coronavirus. She asked if doing yoga was within the realm of possibility. I said I used to do it a long time ago, so it's possible... She suggested doing yoga 3 or 4 times a week between now and my next appointment, and if there's no improvement, she might want to order an MRI.

There are medications that can be used to address numbness and tingling, but I said I am not too keen on taking medication for a side effect of another medication. I'd rather try to manage the symptoms in other ways.

I asked if she thought my symptoms might be related to Herceptin. She didn't seem familiar with a link between Herceptin and carpal tunnel syndrome, but she also said she "never says never", because the range of reactions to medication is so broad; it's not impossible. She said there's a stronger connection between Taxol and neuropathy, and it's possible for neuropathy to start even after finishing Taxol. In fact, she said that she usually advises patients to allow a full year for the effects of Taxol to subside. Either way, if I can just push through until next fall, maybe things will get better after I'm done with Herceptin, and with chemo farther behind me.

I also described the stiffness I've been feeling in my legs. Recently I've noticed that in the time it takes me to cook dinner, my legs feel so tight that when I sit down, it's a huge relief. But then, if I sit for even just a few minutes, standing up takes effort, and I feel a lot of discomfort in my legs for the first few seconds, until I'm able to walk it off. My doctor seemed confident that these symptoms are a side effect of the exemestane. I remember I first reported this symptom before I even started exemestane, and at the time she said it could be the Lupron. If it's hormone-related, maybe it's both. It's definitely gotten worse, so maybe the exemestane exacerbated it. In any case, she recommended doing leg stretches, which could also be accomplished with the yoga. Also, if the stiffness gets to be too much, I could try taking ibuprofen to relieve it.

Up in the infusion room, around 10:15, I got settled in a bay, and was immediately annoyed with myself because, despite having written down all my questions, I forgot to mention one of the symptoms that I thought was important. I felt like maybe it wasn't worth mentioning now, but my infusion nurse said if it was important to me, then I should say it. I appreciated that reassurance so much. I told her about the couple incidents when I woke up feeling like my fingers were being squeezed to the point of my circulation being cut off. She said she'd put it in her notes so my doctor would be aware of it. Also, she suggested wearing the wrist braces every night.

We discussed upcoming appointments, and she said my next oncology appointment would probably be with my doctor's NP, and after that, my appointments would alternate between the doctor and the NP. She must have sensed I was caught off guard by this news, because she then listed a series of positive things, like she was trying to allay my concerns. She said she thinks I will really like this NP, that it will be easier to get appointments (I won't have to move my infusion appointments from Fridays to Wednesdays, like I did today, in order to accomodate the doctor's schedule), that it's always good to have another point person for communications with the Cancer Center, and I can always request to see my doctor, if I want. I am actually pretty comfortable with the idea of seeing an NP, but I was feeling like I was just getting comfortable with my new oncologist, and now I'll have to get used to yet another provider. It felt like another "baby bird" moment. It's all fine. Just another step in the process.

I started the Herceptin just after 11:00. The infusion took the usual 30 minutes, then the infusion nurse de-accessed my port, I washed my hands in the restroom, and I was out by 11:45. So, 3 hours total, not including driving time.