@tmickelson Like at @zacharycat suggested, sometimes it just come with the diagnosis. I was diagnosed in 8/22. My PNET and liver spread blocked some veins, so I was wondering if you had any of that going on. I too have adjusted to realistic expectations with my energy. I begin the day with the most energy and it decreases with each passing hour. I try to schedule some time for rest mid day. I also run out of energy in the early evening, if not sooner. I do go for hikes with my dog every morning, so my energy level has greatly increased over time one step at a time. Other than fatigue, how are you feeling? How are you holding up mentally and emotionally?