Hi! Through the Fall I kept feeling the pain in my neck and again spoke to my primary care doc. Questions: The terror at night is gone, I'm feeling calm and back to myself. Furthermore, last night, I was awoken at 3 am by pain in my neck. Side effects of thyroid surgery are common and include neck pain, a sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism that usually resolves within a few weeks. Has anyone struggled with breathing issues post TT? Your health care provider may advise using sunscreen to help keep the scar from being noticeable. After hours emergency: A/Professor Miller's mobile - emergency only please. A few days later I realized that I had not heard things like birdsong in 3+ years. The first time I did it at 75mCi and the second time at 200mCi (lung nodules don't seem to uptake which is annoying, so we tried to hit them with a bunch). She was right, the yogurt was a snap to get down while the apple juice was really painful. I did. As his caregiver I am feeling so helpless. It's a mild annoyance to have to take it every morning, but I feel exactly how I did pre-surgery, and was able to go back to college and get through my hardest semester ever with no feelings of fatigue or anything. They just put me on a table and put a flat board 2" above my nose and it slowly moved down my body. He also said he was worried about my balance issue. Increase in pain at the incision that is not relieved by pain medication. 2 Mar 2011 1 year from being told I have cancer. It took 26 minutes. A literature review shows a variable postoperative onset of Horners syndrome between 2 days and 1 week. So, I turned to look at my partner and to make sure he was OK. I've read posts on this board from people who say they've met with doctors who were evasive about answering certain questions. On April 19th I started on the low iodine diet and stopped taking Cytomel in preparation for Radioactive Iodine treatment. I was also finally getting the follow-ups setup so they could deal with my loss of hearing (Stapendectomy) so I managed to get an appointment with the ENT Clinic. You should not lift any heavy objects for about 2 weeks after your operation to avoid any strain on your neck. There's just so many nerves and glands and other structures in your neck that you don't want to mess with, don't make the mistake of blindly putting your future in some random doctor's hands. On the 3rd of May 2010 I went up to Madigan for a scan of my body for radiation followed by my first uptake dose of radiation (RI-131 UPTAKE) 8.1 uCi of I-131 t1/2= 8 days. Numb feeling on the front side of my neck between my chin and incision. 18 October. At right about that time he came in with a transfer team and a shot of midazolam. Please help me understand! I was told I would be having surgery in mid-October and it was not able to be scheduled until November 23. 3 Sep had an appointment with my primary care doctor for setting up appointment for my right knee and more ear drops for the infection. I can't imagine home hard that would be in the neck. While doing the setup for the Stapendectomy preparation Dr H. noticed I had a lump in my throat and sent me in for further testing. Have a wonderful holiday season and thank you again so much to this board for existing. A 27-year-old woman with no significant medical history presented to our institution for management of her thyroid cancer. On the 30th I had Fasting Labs for the blood work the nutritionist wanted. The only linger symptom I have from my surgery is that my parathyroids shut down, which was a bummer cause I have to take calcitriol 1-2x/day, but no symptoms unless I majorly forget a few in a row. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Numbness or tingling of fingers, toes, or around the mouth. Bethesda, MD 20894, Web Policies After getting checked into the radiation isolation room #625, they brought me my dose of radiation 175 mCi of I-131 t1/2= 8 days. I did not want to be anywhere around my kids or clients. Today it seems very logical to have asked for something like that, but at the time I was just in the frame of mind to wait. Vascular dilation on the other side of the face may or may not be present (Figure 1). So, I was really getting insistent that he go home. 2012 w/ different Endocrinologist, found 6 very large lymph nodes in neck. The best reason I can come up with is that water and juice rush down the throat hitting the sore spot quickly. Straining on the toilet not only can rip the surgical site, it can cause you to stroke out. The nurse said, how was that. Neck stretching exercises done immediately after a total thyroidectomy reduce short-term neck pain and disability symptoms. At home I had only pain pills (as needed) and Motrin (every eight hours) no more IV pain medication. Horners syndrome as described in this case report is a very rare complication after thyroidectomy with fewer than 35 cases reported in the literature, and most cases occur after surgery for malignant thyroid glands associated with lymph node dissection or with surgery for large goiters with retrosternal extension. I hate the word goiter. He also informed me that because my mother had a pheochromocytoma, I was at particular risk for MENS syndrome and medullary thyroid cancer and so were my children. Reading other posts I feel a little discouraged that this feeling of fatigue is so common . In the weeks after your thyroid surgery, you may have neck pain, soreness of your vocal chords or a weak . It's hard to raise my head and I couldn't look up at the ceiling. RAI was the next thing that worried me, but once again, I found that it was overly emphasized online. When I first started this journey I read that thyroid cancer is a good cancer to have and I told my family this to ease their fears (and mine). A later CT scan also showed some suspicious pulmonary nodules in the lungs. Two things which haven't gone away, and bugging me greatly are: It is estimated that 70% of patients with Horners syndrome after thyroidectomy will have permanent damage or incomplete recovery while the remaining 30% will completely recover between 5 to 15 months after surgery. That seems crazy low, is there any benefit at < 0.1 vs < 1.0? What is the standard for removing them? NEVER do this! Post-Operative Instructions for Parathyroid Surgery. Everything is looking good cancer wise they will tell me more in December when I meet with my endocrinologist. Answers often cure fears. If they kept me overnight, the plan had always been for him to go home for the night. Your thyroid is a butterfly-shaped gland located in the front of your neck. Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force; Ryu CH, Lee SJ, Cho JG, Choi IJ, Choi YS, Hong YT, Jung SY, Kim JW, Lee DY, Lee DK, Lee G, Lee SJ, Lee YC, Lee YS, Nam IC, Park KN, Park YM, Sung ES, Son HY, Seo IH, Lee BJ, Lim JY. The pain is in the natural curve of my neck, about 2-3 inches above the incision. Complementary and alternative therapies for back pain II. Twenty-eight patients who had undergone thyroidectomy and 28 healthy . Nothing too bad though, and apparently I had the biggest dose you can give without being hospitalized, so most people will be getting less. 3) Met with Surgeon and he said, the mass on right was big enough that it needs to come out weather cancer or not . so according to the ultrasound write up surrounding lyphnodes were normal but no film existed. They placed an IV line and took some blood samples. Most people start to feel recovered in 10 to 14 days. Be careful. And mostly, please, pass it forward after you have your surgery. Overall the pain wasn't terrible. My only regret at that point is that I didn't ask for ativan or xanax or something to calm my nerves it could have been given IV. I'm considered low risk for recurrence. With that in mind, here are 5 things that I think you should know if you've had your thyroid removed based on THIS experience. I woke up and ate some more pretty soft food (didn't want to push it) and stayed up until about 10pm. I have had unexplained "symptoms" including but not limited to: chronic sinus infections, severe neck pain with left arm numbness and tingling, severe "random" aches, pains and stiffness, chronic "IBS," chronic flu like symptoms; chills and nausea, constant lethargy and sleepiness, chronic diarrhea, rapid irregular heart beat and my weight went from 128 to 116 in the last two months. My time in the ICU was unpleasant, but only because I wasn't able to get any sleep the night before my surgery and the night I was there. I just started going back to work this week. My wife went home to take care of our kids and my mom came in for a couple hours. Hi, I used regular tylenol only immediately following surgery and upon returning home. Tomorrow I have my 1 week post op appointments with both the surgeon and the endocronologist. He also said he would slowly decrease our visits since I am not having the depression issues and I am in a stable mental condition. Also, for me that was nice because they normally come out on day 2 to 4 after surgery and that would have meant another 100 mile round trip to get the JP drain removed. He said I was drenched on my back, and at that point I'd had all I could take of that plastic and paper gown and it came off me and onto the table. Would really love some advice on how to proceed about improving my breathing. Complications are much less common and can include neck bleeding, permanent hypoparathyroidism that requires ongoing calcium replacement, and damage to . Everyone was extremely professional, everyone was very nice. I felt bad the first two days but that was it. At the end of the first week, the NPDS scores (mean [SD] = 8.82 [12.23] vs. 30.28 [12.09]), neck sensitivity scores (median [IR] = 0 [.75] vs. 2.00 [4.0]) and pain levels with neck movements (median [IR] = 0 [2.0] vs. 3.5 [5.75]) of the stretching exercise group were significantly lower than those of the control group. I really haven't had pain since mid-lsat week. 2 days for thyrogen shots then one day for RAI. 5) Does the TSH suppression level really effect the possibility of spread? I have never had the kind of fear that I experienced leading up to the weeks preceding my TT. Soooo I got in to see a new guy in my Drs practice and he referred me to an ENT the next week. My thyroid was removed due to papillary cancer in April 2008. Takamura Y, Miyauchi A, Tomoda C, Uruno T, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Amino N, Kuma K. World J Surg. Dr H. thinks everything is looking good and she retires on the 19th of Aug. However, the location on the neck minimizes the likelihood of keloids. Had a visit to ENT clinic at Madigan and then I did my pre-op for left ear surgery. On Sept 7th did follow up scan and 1 definite lymphnode lit up in an obscure location, so then was ordered for AG, AGant, and full neck ultrasound (WISH THEY HAD DONE ALL THAT EARLIER). The week of the 20th to 25th I had my first run-through of TAP class, there is so much information they give you there I am so glad I can go again prior to retiring. Once your thyroid is removed you are now . Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force, et al. People with a history of keloids (excess scar tissue) may experience more scarring after thyroid surgery. So, that worked out OK. I woke up with full back and neck in spasm do to previous athletic neck and back injuries. My partner, expecting me to be in surgery by 4pm, had left around 3:30pm to go to a nearby hotel and take a nap. The mass was softball size and the cancerous tumor was 4.8 cm follicular cancer with hurthle cell varient, since August 2012 I have had a partial thyroidectomy, TT 2 weeks later, RAI 157 mc October 17th, modified neck dissection Nov. 27th and now it's the waiting from blood test to body scans and getting the meds adjusted just right, a lot of side effects with Levothyroxin. 2019 Dec;98(51):e18309. I had a lot of other questions, but those two were, at the very least, on the top of my list. At 18 days post surgery the throat pain flares up only if I over use my voice. If skin is not sufficiently retracted after 6 months, anterior neck lift or lower face/neck lift should be a consideration. I can turn my head side to side and rotate them with some discomfort, but I feel the discomfort fading gradually. I got into bed and took a 3 hour nap, which was pretty glorious. I am not sure if TMJ or other dental problem vs the salivary glands. 2011 Jan;34(1):62-71. doi: 10.1016/j.jmpt.2010.11.005. Also put me on the We fit balance game and I completed it on the 3rd try. I was also immediately able to have near full use of my voice, which told me that my larangeal nerves were ok - big relief. Complications associated are still common and 80% of patients complain of posterior neck pain. However, expecting something and being prepared for it are not the same thing. ThyCa: Thyroid Cancer Survivors' Association, Inc. But, on leaving the hospital I was told to come to the doctor's office in a week for my replacement prescription. By Friday morning I got up at 7:15 a.m. and stood in line in 32 degree weather for some Goose Island Bourbon County, went to lunch and ate a cheeseburger. She did not develop other complications of thyroidectomy, such as bleeding, wound infection, vocal cord palsy or hypoparathyroidism. Waiting on that was probably the worst part, as I felt like I had been released from a jail sentence (I've never been in jail but I assume it's like this) but not being unlocked from the cage. The moment was really intense, as I didn't have a clue what to expect over the next several hours. Your neck is likely to be swollen and may feel hard and numb right after the surgery. Voice affectations after thyroidectomy thyroidectomy surgery side effects 1 Week Post-Op Total Thyroidectomy Had total thyroidectomy Major problems after total Thyroidectomy, very scared =(chest tightness, headache, fatigue - post thyroid surgery Problems swallowing after thyroidectomy. Trust me they are, but I worked it out. I kind of learned quickly to tilt my chin toward my chest as I swallowed to lessen the pain and actually got the four HIV and a couple of other pills down. My surgeon has me taking 500mg calcium with vit.D along with Tums for my parathyroids (they were left intact during the surgery, but my doctor put me on the calcium as a precaution). The middle cervical ganglion and the sympathetic trunk lie posterior to the thyroid gland close to the inferior thyroid artery within the thyroid bed (Figure 2). It's typically worse the day after surgery and quickly begins to get better. Tuesday morning I saw my surgeon who removed a huge bandage from my neck. On the 16th of September I star my physical therapy, I have defiantly noticed that during and for the next few hours after physical therapy my knees hurt a lot more as expected for the next 4 or so days the pain is greatly reduced and I can walk better. I put them on the table so the doctor could see them and very soon after saying hello, I said, these are my questions. Some people experience short-term side effects after thyroidectomy, including the following: Neck pain: You may experience pain on swallowing or breathing for several days following surgery. They redid the area around my neck for about 10 more minutes (this is slightly unnerving). I feel very lucky. Follow-up of the patients with the scales applied in the experimental group were also performed to the control group at the same intervals. As of august I am no longer seeing mental health, they think Im normal, and I am feeling a lot better. I had a total thyroidectomy last week. The diet is annoying, but even with being ridiculously strict (pretty much only ate fruits, veggies and egg whites), its only for a short time and at least is a good diet. The effects of the stretching exercises on the participants' neck pain and disability, neck sensitivity, pain with neck movements as well as on wound healing, were evaluated at the end of the first week and at 1 month following surgery. I also gained 30lbs last summer. The effects of the stretching exercises on the participants' neck pain and disability, neck sensitivity, pain with neck movements as well as on wound healing, were evaluated at the end of the first week and at 1 month following surgery. I got a copy of RAI film and right starburst is bigger than left . maybe this is why. Could this be from the RAI even 3 weeks after? and transmitted securely. Emerging from my first anesthesia experience was quite honestly like waking up from a bad alcohol blackout where you have no idea what was going on for the last few minutes, hours, days?, weeks? Exercise therapy for office workers with nonspecific neck pain: a systematic review. Before 2007 Mar;39(2):126-32. doi: 10.2340/16501977-0015. Cleanse the incision area the day after surgery. The biopsy of the left thyroid nodule was rated as Bethesda category IV (follicular neoplasm), and the lymph node was consistent with metastatic papillary thyroid cancer. My blood pressure which normally is very normal (120 to 125 / 80 to 90) was spiking at that point at 160 over 105 and I know it was just anxiety and ativan would have helped. I called the office to verify that was correct and was told it was. Can it grow that fast from elevated TSH levels? I am usually not one to write on here because It is my husband who had thyroid cancer in 2013 & most recently a neck dissection on his right side they removed 31 lymph nodes & thankfully only 1 was cancer. First, let me say, I don't like iced water. An observational case-control study was carried out. Injury: Trauma and other injuries can damage muscles, ligaments, disks, vertebral joints and nerve roots in your spinal cord and lead to neck pain. I was downing water like crazy as well, which helped but also was a double edged sword of making me need to use the restroom quite frequently, which was a chore with all the monitor wires attached. If you are taken care of only half as well as was I, then you will be in excellent hands at the hospital. The hospital said I could return to work after 2 days of isolation but my doc said 7 days ( I work with kids and have 2 kids). Just to briefly give my details again. The usefulness of rehabilitation (i.e., a stretching exercise) for reducing these symptoms after surgery has never been studie Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. Find other members in this community to connect with. government site. Learned its horizontal vertigo or thats what Co. (my torturerphysical theraphist) said. 5 May 2011 1 year out from treatment (for radiation) On Mar 09 2010 I had a thyroidectomy completion surgery. Unauthorized use of these marks is strictly prohibited. Ask for prayers. Older posts I saw explain that because the facial nerve were cut and will take few weeks to months to heal. He said he wanted to get my RAI done - he likes to do it within 3 months of surgery and thought it had been enough time since ct. Swallowing discomfort. That was where the majority of my swelling was, this corresponds to about where the top of the thyroid was. I've read some of the older posts concerning this issue but the posts are discontinued. That was attributed the nodules and the cancer. I know lots of people have little kids- my dose was small and I am still a danger to people at 8 days out. Family has been very patient with my mood swings, thank God! I'm not sure if this is related with the numb feeling I'm having. For those that are getting ready to have this surgery I would never say "don't be scared," I would just say let the fear come like you are going skydiving and know that it will be over soon and things will start getting much better. An 84-year-old woman presented with chronic neck pain one year after thyroidectomy. Which on one hand I'm annoyed, but on other hand - if its cancerous GET IT OUT. He said he would test the tissue during surgery for cancer. I also would like to provide a write-up of my experiences with the surgery, as others that did so were extremely helpful for me. Well low and behold, I am still very radioactive after 8 days to anyone closer than 4'. was it there all along? I was sweating pretty badly and was given anti-nausea medication (it really wasn't that bad to be honest). You should wait at least 6 months after surgery to see how much would neck skin retract. My mind doesn't wander as much as it did a week ago, and I have a really great appreciation for everyone that cared for me, checked in on me, and helped me in any way through this. Overnight was pretty miserable. Which is what I had expected because that is what I was told. In the morning they brought me what I asked for for breakfast (Cherios, yogurt, and apple juice). You can relieve the discomfort using non-steroidal pain medication like ibuprofen. Don't get a ct scan ask for an ultrasound first. Reprinted with permission. The first few sips of water are described below, but then the pain quickly got better over the next week. I am hoping against hope that I can build my endurance with regular exercise. On March 2nd I was told I had several small foci of papillary carcinoma in the tissue of the right thyroid that was removed and that the entire mass was being sent to another hospital for further research but it looks benign the doctors recommended removing the other side, we decided that was the best plan. On the 4th of May 2010 I was back at Madigan for a radiation count on my thyroid followed by my second uptake dose of radiation (RI-123 UPTAKE) 2.8 mCi I-123 t1/2= 13.2 hours Clipboard, Search History, and several other advanced features are temporarily unavailable. Anyway - I am still alone in hotel away from Family after RAI. Difficulty swallowing. Im a pinch over 2 years post thyroidectomy for what turned out to be a couple small areas of PTC. Regarding the pain levels and my voice. 5) Biopsy report came back showing 2cm+ Papillary - w/ follicular variant, and Lymphocascular invasion, but completely contained in Thyroid. I know this is long but if you are new to this, maybe hearing my story will be helpful. Two weeks ago I wrote a post about my extreme anxiety preparing for a total thyroidectomy and central neck dissection. Although, I have a lot of support from my family and friends, I am struggling with inexplicable sadness. He got out the floor roll to start working on my leg muscle as well man that hurts. Also, people with darker skin tones may seem to have more noticeable scars due to the contrasting color of pigmentation in scar tissue and skin color. Simply put, for me, the only option was the traditional open neck procedure; but, I felt better knowing I'd exhausted that possibility. It has become shrill and high-pitched. That was a Tuesday. I also feel sad that my recovery has stagnated and I don't see any improvement in my voice or breathing. The surgical pathology reported a 5 cm papillary thyroid cancer in the left lobe of the thyroid with lymphovascular invasion, microscopic positive surgical margins, with five of 59 positive lymph nodes (two left level IIA nodes, one Delphian node and two level VI nodes). 7 weeks after TT and like 2 weeks after RAI. I have been constantly monitoring my weight and diet, and have been able to keep it in check till now. Her symptoms were a hypoesthesia around the right neck scar, and a continuous and spiking pain with allodynia in the right neck and arm. Early in August my kneed started acting up (been giving me pain for 7 years but I was told they couldnt do anything about it. I received a lot of encouraging feedback from many people on this site and would like to thank them all again. How long it takes to recover will depend on your situation and the type of surgery you had. Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication (occurring in less than 0.1% of cases that requires My LMT said I can thank the virus. Do they usually do a full neck ultrasound before TT? Thyroid function labs were all within normal range. September 17th took S. to Madigan for her weight loss surgery; J. came with me to help me through the waiting. That is where my memory starts to come back. Thyroid cancer support group and discussion community. Suffice to say, I was very disoriented for about the next 10 minutes. If I can be as much of an emotional and psychological mess as I was and get through it I promise you will be just fine. I had to make a decision. Then a bunch of insurance crap happened (my entire surgery may not be covered because the ENT was not on my list of docs I could see - this is bs but a completely different story) and I had to start driving an hour away to see an endocrinologist. No chemo or typical radiation but I had pretty major surgery, will need to take meds the rest of my life and LID and RAI was/is no picnic. As a complete aside, that bair paws gown they'd put me under was starting to heat up like turkey in a browning bag. I am from USA but in the Philippines, and I went full Vegan after all of this. Post thyroidectomy neck pain after endoscopic thyroidectomy. My wife was with me. Just seems like order of operations has been a complete mess. The visit included an ultra sound and 6 needles biopsy of the mass. Unable to load your collection due to an error, Unable to load your delegates due to an error. But, you could tell pre-op was used to people popping in for a brief stay and then being whisked off to surgery. The two most common early complications of thyroid surgery are hypocalcemia (20-30%) and recurrent laryngeal nerve injury (5-11%). My body scan was interesting. Answer: Skin laxity after thyroid surgery. A nurse came in shortly after that and I started an IV with a saline drip. God, family, friends and prayer are what got me through these last 7 months with thyroid cancer. Since then I have had minor vertigo and a small section of my tongue tastes like metal when eating (supposedly this is do to the taste sensor in the ear?). Abstract Introduction: Thyroid surgery is a popular and effective treatment for many thyroid diseases, including thyroid cancer. Our plan had been for him to get a hotel room to use as a day room while I was in surgery and to use it if they released me way late in the evening. Through the night I got up to use the bathroom. Nerve pain or neuropathic pain comes with skin sensitivity, tingling, numbness, and stabbing pain. I know my body and disagree. I couldn't even have water easily without aspiration/choking. An MRI of my neck (ordered by orthopedic due to neck pain) showed not only several herniated bulging discs- but a mass on my right thyroid gland. My salvitory glands swelled up a bit and were sore the first day, my sense of taste just minorly changed and was a little fatigued/headachy for a couple days. 2022 Sep;46(9):2212-2222. doi: 10.1007/s00268-022-06610-0. 8600 Rockville Pike So, here is a more detailed experience of what just the thyroidectomy was like. They brought him back to see me in pre-op again. Is RAI 90MCI enough to take out 2 lymphnodes? Mostly because this disease caused a huge disruption in my life. 14 Months After Thyroidectomy. So I was told at that time . Will do an RAI in 4 weeks. After surgery, you may have a scar at the base of your neck. I had to cave in and take one of my remaining pain meds. I told them I had good insurance and that I'd take care of the bill after surgery (which is the arrangement I had with every other service provider for my thyroid cancer). 2 weeks ago I was sent to yet another doctor, an endocronologist. Are you sure you want to block this member? It's a scary place I don't really want to go back to. Over the course of 2 years or more I've been from Doctor to Doctor including my family doc, allergist, gastronologist and orthopedic specialist. You will experience some discomfort at the incision site as well as a raw or sore throat from the breathing tube that . Is the lack of hormone 6 days post op the reason for feeling like HELL??? Hi Sweetpea2936! However in addition to no LID, no one ever discussed things like AG, AGant, what TSH is, etc . A month later I had a TT and my tonsils out due to a chronic sore throat. My Dr (Endo) said he did not want me in his office for another 7 days and the hospital nurse said that was crazy and she used a Geiger counter on me to see how "hot" I was. Yeah! I was told I had a goiter and it could be cancer so I needed to get to my primary dr asap. A postoperative neck ultrasound conducted in the clinic did not show any suspicious nodes, masses, hematoma or collection that could potentially compress the sympathetic trunk. Health care providers perform thyroidectomy to treat thyroid disorders. I have discovered that this is not a good cancer to have and it has not been easy. That's not what happened. I still feel some prickling pain inside my neck and when i tried to lift my neck slightly from flat on my back the pain is still quite significant, I don't know if that means i'm still healing or whether i'll keep having the same issue. I have felt 100% on my medicine (and I've been all over the TSH scale). Now, I know the surgeon has rethought his position and is now recommending going hypo with T3 as an intermediate therapy. These symptoms may persist for long . As my health slowly improves I am starting out my workout regimen again and slowly building my strength back. I had a Total Thyroidectomy around 9 weeks ago for FVPTC, then they ran me hypothyroid for 6 weeks and pushed TSH over 100, then did my RAI 3 weeks ago. This community is sponsored by ThyCa: Thyroid Cancer Survivors' Association, an Inspire trusted partner. My first endocrinologist was awful to deal with so I switched to seeing my current endocrinologist, who is ok but a hour and a half drive and she recently reduced her clinic hours to just on friday which doesnt work with my work schedule.
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