…a good prognosis but a difficult diagnosis for JHLundin part3

  1. 20171106 BlogPost JHLundin …a good prognosis but a difficult diagnosis for JHLundin part3… Visit to MDAnderson Cancer Center in Houston last week: diagnosis: Squamous cell carcinoma of oropharynx. November 6, 2017.
    1. Visit with Dr Gross who is focused on precisely the cancer that I have, about surgical and immunotherapy options for the best outcome (both with eradicating my cancer and with limiting the side effects from the treatments)
    2. CT scan to see precisely where the cancer is
    3. Visit with Dr Rosenthal head of the Head and Neck Radiation Oncology about radiation options post surgery
    4. Visit with Dr Chambers on the impact on my teeth to reduce the risks associated with radiation and surgery
    5. Visit with Dr Mott oncologist on the issues surrounding immunotherapy and the clinical trial that is currently in place that is targeted at exactly the cancer and cause that is my cancer.
    6. Signed the documents for the trial
      1. Two immunotherapy treatments that are one month apart Day 1 and Day 30, with an of the impact for the trial data collection and for assessment of the surgery and radiation treatments to follow
      2. surgery on Day 60
      3. Further treatments TBD (radiation//chemo)
    7. Had biopsy of tonsil taken before departure
    8. Return next week for first treatment
    9. This is precisely why I made the additional trip to Houston

…a good prognosis but a difficult diagnosis for JHLundin part2

  1. 20171025 to Charleston and return October 25, 2017
    1. Why is it that the path from A to B is never a straight line?
      1. The suggested therapy at MUSC is a traditional combination of surgery and radiation
        1. It will almost assuredly kill the cancer
        2. It will also have the traditional temporary and permanent side effects of a seven-week course of radiation therapy…
      2. At the suggestion of one cancer survivor, I started investigating MDAnderson, arguably the best cancer treatment facility in the country/world
        1. Dr Neil Gross at MDAnderson returned my call this morning and we discussed where I was… based on an article he had published a little more than a year ago about some of the surgical techniques he had been pioneering (TORS) to mitigate the side effects of traditional treatment (chemo, surgery, radiation) and improve outcomes. During the conversation, he put two more options on the treatment table (they are just ‘possibilities’ at this point):
          1. Immunotherapy: a technique to kinda supercharge the body’s own immune system to more aggressively attacking the cancer… but the process of boosting the immune system and targeting cancer cells is not nearly as toxic as the traditional chemotherapy that chemically attacks the cancer cells…   
          2. Proton therapy which uses a particle beam that is able to target and provide the optimal effect at a specified distance/depth which differs from traditional radiation which does damage both entering the body and leaving the body in addition to doing the targeted damage to the tumor itself.
          3. Both do less collateral damage and change the outcomes (i.e. radiation damages the salivary glands which produce the saliva that among many functions lubricates the food we eat and helps clean our teeth… Proton therapy would not damage the salivary glands)
          4. And both have clinical trials to find and treat patients within trial parameters
        2. This afternoon, I discussed this with Dr Neskey at MUSC.
          1. He knows of Dr Gross and uses his TORS surgery technique…
          2. He thought that I should check into the MDAnderson techniques… soooo, I don’t consider it a ‘second opinion’…
          3. I look at it as checking into a more advanced, but not nearly as proven a set of techniques that could possibly save a few of my teeth and lots of salivary glands… and a lot more… and a lot less.
          4. I put the process at MUSC on hold until I complete this research
        3. I now have an appointment for October 30- November 1 at MDAnderson in Houston, TX for up to a week of meeting and tests to explore these therapies… at this point, I am thinking that I will drive to Houston and find a convenient place to stay until I can learn enough to make an informed decision…
        4. Thanks Dave for remaining flexible in this last minute pursuit of a better solution… Health and happiness to you all,  J

…a good prognosis but a difficult diagnosis for JHLundin part1

  1. JHLundin prognosis October 12, 2017 (this is being posted on November 6, 2017, after my exploratory visit to MDAnderson last week).
    1. Recently found out that I will need to prepare and undergo two surgeries and seven weeks of radiation treatment to contain/control/cure tonsil cancer. This means treatments at MUSC every day, Monday through Friday plus the time to prepare and recover. That is a big block of time in a busy life! [update: I have since gone to MDAnderson and have a new treatment plan discussed in part3 of these blogs]
    2. The good news is:
      1. It is a P-16 positive cancer which improves the likelihood of a cure (if you are curious, you will have to do the research…)
      2. MUSC’s head & throat cancer facility is ranked #11 in the nation for ENT and #42 for cancer
      3. All the major specialists (surgeon, radiologist, oncologist) are talking about an 80% chance of cure (and in my reasoning, there is no 90-100% certainty, so this is as good as it gets)
      4. MUSC has a Hope Lodge where I can most probably reside while I am undergoing daily treatments in Charleston
    3. On the downside, there are no ‘good’ options, only ‘less bad’ options… and they have prepared me for all the bad stuff that can happen… and the process is not pretty. With radiation, there are functions that are permanently damaged and that never return… so the issues are
      1. Swallow and voice damage
      2. Muscle and bone damage
      3. Tooth abscess risk
      4. Fatigue, loss of saliva, taste, hearing… and much more
    4. Soooo, it sounds like this is about a two month+ process (prep for treatment, seven weeks of treatment, and the assurance that once treatment stops, there are still effects from the treatment for weeks). I will know more as I proceed in the process. I will be complying with the MUSC Tumor Board’s recommendations that will happen Monday (October 16th)… and will last from this week until about late December.
    5. And that means that I have to set some things down to open my schedule to be in Charleston pretty much all week every week and deal with the fatigue and other effects that such an insult to my system will cause:

A traveling nightmare: a review of Delta Airlines, Hotels.com, and Comfort Inns

Comments/reviews on Delta Airlines, Hotels.com, and Comfort Inns

…Update 8/2/2012: After sending feedback via the best web feedback link to each of the offending parties about two weeks ago, I have only one response from *any* of them… the standard form response… I will include it in the comments.

The purpose of this post is to document the failures of Delta, of Hotels.com and of Comfort Inns in sufficient detail that an executive in these companies can begin to address the systemic flaws in their customer handling… I don’t waste my time with this type of detail without the hope that someone at these companies is sophisticated enough to have Google Alerts collect all the comments about their company and actually do something with them (because there is no obvious way to provide feedback to the company about these issues)

My trip from Savannah to San Jose July 13-14, 2012 was quite the disaster. I spent approximately 30 hours in or around aircraft and airports. I will first state that while I was *on* aircraft, Delta did a great job… it was just while I was not *on* the aircraft that the wheels came off… on many dimensions…

  1. was scheduled for United flight  to San Jose, CA through Houston (with 3 hour layover in Houston)
    • aircraft was late getting into Savannah from Houston due to thunderstorms
  2. rescheduled to Delta through Atlanta (with approximately two hour layover)
    • ground hold on Savannah taxiway for approximately two+ hours
    • reduced speed transit to Atlanta because of congestion
    • flight from Atlanta to San Jose was boarding when I checked as I was waiting to get off the Savannah flight
    • Missed my San Jose connection by minutes
    • Upset because Delta released aircraft to take off without waiting for the passengers that had been delayed by ATL’s two hour ground hold. If you send your departures before your transfers arrive, then you will strand *all* the transferring passengers. In these days of very high fill rates, there is no slack to “catch up” if you get behind. In my opinion, if you send outbound aircraft before inbound aircraft have landed and passengers have had a chance to get to their connections, this is *not* a weather issue, this is a company call to strand their passengers. Doing a quick calculation of the 92 million passengers that went through ATL in 2011, that means: 14,000 passengers per hour, 10,000 of which are Delta’s, 5,000 of which are changing planes.  Soooo, a two hour ground hold stacks up 10,000 Delta customers that will miss their connection. I was one of those 10,000

      Just one of the hundreds of gates where passengers spent the night
      Atlanta’s Hotel Delta
    • Upset because I waited hours in line to get rebooked onto a flight for the next morning (I have pictures)
    • Upset because Delta (agent and supervisor) were unwilling to do *anything* to help me during this inconvenience. The agent was unable to give me a seat assignment for my morning flight (which suggests that the flight was already oversold). Would not pay for a room because delay was a “weather related” issue (with which I disagree). Would not provide any assistance or documents to help with finding a room on my own. How about a little handout entitled: “what to do when you are stranded overnight in Hartsfield?” That would have been really helpful… A list of twenty+ hotels with shuttle service to and from the airport with phone numbers? A discount code arranged by Delta to reduce the $$ impact for these 10,000 stranded passengers.  Maybe even free wifi internet access so I could make arrangements without having to battle for phones at the hotel courtesy counter which was stacked 4-5 deep. Agent only provided a toiletries kit after I suggested that Delta “I didn’t even have a toothbrush”
  3. At the Airport Hotel courtesy counter
    • It was quickly apparent that there were hundreds of people that were in the same predicament as I…
    • The ones that were waiting were talking about hotels not having any vacancy
    • I started calling the listed phone numbers on my cellphone to find that the two that I called did not have any vacancy
    • I called hotels.com and booked a prepaid reservation at the Comfort Inn and Suites Atlanta Airport North. I was charged for the room, given a confirmation number, sent an confirmation email, and the hotel’s phone number to make arrangements for the shuttle  . I called the hotel, the phone rang for 40-50 rings before someone answered. They stated that the shuttle was in transit and to wait in the designated pickup spot (shuttle gates 25-29) which I did for about an hour and a half.
  4. Trip to the Comfort Inn and Suites
    • When the shuttle arrived, it was apparent that there were about 30 people waiting, many had been waiting much longer than I had…
    • The driver announced that he was going to the *other* Comfort Inn and that there were no rooms available at the Airport North Comfort Inn. I had my paid Hotels.com reservation as did the man next to me… we assumed that we were OK and requested to be taken to the North Airport location.
    • Driver dropped us off at the NorthAirport location and all the passengers queued up at the check in counter (an noticed the *booming* music coming from the entertainment… and hoped that any rooms available would not be close to the lobby).
    • The man that I sat next to was in front of me in line. He was told that they did not have his reservation, that his confirmation number was “invalid” and that the hotel was full. I received exactly the same message, and was refused. The checkin person had no alternate instructions or directions to any other hotel in the area that might have space.
    • I asked for some sort of documentation that I had been refused, and the agent said ‘no.’
    • I called Hotels.com and spoke to an agent who stated that she would call the hotel to confirm that I had been refused. In her three attempts to call the Comfort Inn, no one answered the Comfort Inn telephone.
    • The Hotels.com agent said she would follow up on the refusal (she referred to it as a cancellation)… but offered no rebooking or alternative lodging.
    • It was now approaching 1am, I reboarded the shuttle and asked to be taken to the airport.
    • On the way to the airport the shuttle drive picked up an airline crew at a nearby Motel 6 (?) that had also been having problems with reservations and we all returned to the airport.
    • Hotels.com and Comfort Inns, this is FAILURE. None of these seasoned travelers will risk doing business with you again… and some will suggest in a public forum that you did not support your customer even as the process failed.
  5. At Hartsfield airport (now about 1am),
    • I asked the agent (the nicest Delta person all day) if there were any flights available any earlier than the 8:25am flight to Salt Lake City/San Jose. I was told there was not.
    • Rather than struggle to find a room and repeat the hotel process just for a shower and two or three hours sleep, I decided to find a power plug in the airport and work/read until the gate agent showed up for my morning flight
    • I was very surprised to see how many people were sleeping at the gates… my best guess (199 gates time 15-20/gate) is about 3,000 stranded passengers *in* the airport (I have pictures). You probably have a much more accurate count (most people had your tiny red blankets… how many did you hand out on the evening of July 13?)
    • I was able to get a seat on the 8:25a flight when the gate opened, but the gentleman that I spoke with at the gate had spent the previous three days attempting to get to another city… Does anybody at Delta listen to these stories of your disasters? Does anybody care?
    • I will bet your executives don’t know that the McDonalds in terminal E opens at 5:00am… A chit for a McDonald’s breakfast would have been nice…
    • Delta: 3,000 stranded passengers in the airport and 7,000 somewhere scattered around Atlanta is FAILURE on a huge scale. None of these people have a good impression of Delta, and you will spend hundreds of thousands winning new customers to replace the ones you have just p****d away.
  6. Balance of the trip
    • The legs from Atlanta to Salt Lake City and then to San Jose went flawlessly
    • My bag (I still am irritated by your silly $25 bag fee… it encourages people to carry-on more stuff which slows boarding…) which went through Houston on my original United flights, arrived in San Jose about two hours before I did… so, next time I will stick with United…
  7. Post trip Hotels.com
    • After arriving home, I checked my bank debit card and found that there was still a hold for the refused reservation amount of the Comfort Inn and Hotels.com.
    • On Monday July 16th, I called Hotels.com and restated that I had been refused at the Comfort Inn. Nothing had been done since I called immediately after I was refused. She then called the Comfort Inn Atlanta Airport North and confirmed that I had indeed been refused at the Comfort Inn, and stated that the charges would be reversed and would be reflected on my account in 3-7 days and sent a very un-official looking email with the bare minimum of facts. I was still not confident that I would indeed be refunded the money for my refused reservation.
    • On July 19, my account was credited with the amount charged earlier…
  8. My Expectations
    • Delta and Hartfield:
    • You have a sophisticated revenue maximization system for ticket prices and dates/times… so you can squeeze more revenue out of every seat sold. Please factor in stranding your passengers overnight! For the courtesy of: Providing instructions on what to do if you are stranded: pre-arranging a list of hotels that will give favorable attention to stranded Delta passengers: sending an apology letter to all of us passengers that you threw out into the street: buy us breakfast.
    • generate a model for when to restart flights after a ground hold that does not strand 10,000 of you own customers at an airport for flights that have no slack (open seats)… I will bet you $10 that my seat from Atlanta to San Jose was empty when my flight left without me… and that my seats the next day displaced other, much higher revenue paying passengers… you lost me as a future customer and the revenue of others with the stupidity of pushing out flights before connecting flights had arrived…
    • give your poor agents some leeway to accommodate stranded passengers… I actually felt sorry for the agent doling out the bad news… She could not do anything… You hire and train smart people and then handcuff them with bad policies… a bad way to run an airline.
    • Have a feedback system for passengers that encourages passengers to record both good and bad. Every Delta employee that I had any discussion with was excellent, but the policies that they were strapped with were short sited and uninformed.
    • Hotels.com
    • Become the champion of your customer (that would be ME if you are unsure)…
    • Reward customer service that actually completes the issue. I should not have to call twice after my prepaid reservation is refused.
    • Keep me informed of the status of my refund… it is *MY* money, not yours
    • Let me know that you have penalized Comfort Inns for this violation of their contracts and their insult of *your* customer.
    • I now have little confidence that any future Hotels.com reservation will be honored… What can you do to recapture my confidence?
    • Comfort Inns and Suites
    • What can I say? At a minimum, if someone shows up with what is a reservation that you cannot honor, then find them another place to stay…
    • I have never been treated so poorly. I was treated like I had presented the Comfort Inn clerk with a bad counterfeit $100 bill.
    • There are far too many quality choices in the hospitality space for me to ever consider trying your brand again (in the previous week we spent two nights at different Hampton Inns).
    • You will need to offer me free lodging to get me to even consider Comfort Inns again…
    • Develop some way of feeding back issues and suggestions that your customers can find and complete… otherwise they have a tendency to go public
  9. You are building a reputation… and only *you* can determine if it is a good one or a bad one.

Information Technology Risk in the Time of Cloud Computing

The press makes hay when technology products or services have problems… currently big businesses that are smeared all over the headlines are Sony’s PlayStation compromise and temporary closure, and Amazon’s (AWS) services outage. All businesses large and small need to assess “technology risk” of any application/service whether they are developing,  hosting and managing their own applications or whether they are procuring their applications by licensing software or renting services in a public cloud. There are five categories of IT risk that should be assessed in the decision about applications/services:

  1. Can our organization select application/service solutions that will meet our needs and fit into the enterprise plans both today and into the future?
  2. Can we implement that solution?
  3. Can we keep that solution running?
  4. Can we fix it when it breaks?
  5. What is the downside if the systems is compromised?

I am surprised at how many organizations take this lightly. There are penalties and losses whenever your organization fails to prepare for any of the categories of IT risk. One of my favorite examples is the popular DVD service NetFlix. All too frequently their servers go offline for days, during which time the company virtually stops. The IT risk of keeping it running (3) or fixing it when it breaks (4) has not been fully addressed. With smaller businesses, the ability to develop applications like NetFlix is not an option. They must select applications/services from among many alternatives, but they still must assess the IT risk like big companies.

Most smaller businesses do not have the luxury of big IT departments or have IT experts on staff. Most smaller businesses have little idea what their demands are… and are quickly willing to select some unproven solution based solely on the least cost model. The chances for an effective solution with a low IT risk is just about 0%.

Every business should have both a IT plan and an IT risk assessment. These are not big documents. They are, in fact, just a roadmap and a feasibility assessment of the events that could possibly happen along the way. I work with lots of businesses on IT issues. I can tell within five minutes if they have a plan (and not having any IT plan strongly suggests that they have no clue about IT risk)…

So where do you start? Ask your selves the questions:

  • How can we work to fulfill our objectives by using information technology?
  • What is the plan to make it work?
  • What can possibly go wrong?
  • What do we do then?
If you don’t have any idea how to proceed, then it would be appropriate to find someone to step you through the process…  J