Good? Better? News

Received an update from Dr. Sonn yesterday. Test results from the PET scan. Good news: the tumors that appeared in the bone scan did not also appear consistent with the PET scan. As stated by the Dr - "good news, but that does not rule out the possibility that the tumors are cancerous."  At this same time, however, "there are some unusual spots in the lymph notes in the pelvic area". Woa. Heavy shit that I don't know how to calibrate. What is the level of risk they assign to ribs versus lymph nodes?. I have no freakin' idea.  Another classic example where a medical explanation delivered over email is almost totally useless without calibration and explanation. I can do nothing other than to wait to talk to someone.

Today was the day when the "tumor board" met at Stanford, and where I expected to hear some form of update as to what my course forward is. As of 9:00pm, no update. This can only lead to speculation. If I applied this "tumor board" meeting to any other walk of society, I can only presume the following: 1) the clear cut cases, whether positive or negative, can be communicated back to patients first. They deserve a fast response. Everything in the middle requires further thought and qualification before responding to a patient. I get it. I will wait until tomorrow.

No Data

Test results from Thursday: none.

From what I can gather from discussion with Dr. Sonn, it is just another data point to validate whatever they have already concluded. Another test that is not perfect, just another data point.

At this point, in advance of the Stanford "tumor board" meeting on Tuesday, this thing is that this is what they suspect - a spreading to my bones. It is yet another great irony of life. I feel great. I am looking at a beautiful sunset on a perfect night, having cooked a great meal (in my opinion) for my family. It is becoming more difficult to reconcile what I am hearing from the doctors with the need to make sure that my family knows where I am mentally and, most importantly, what I hope they can use to stay focused in their lives.

What I've concluded at this juncture is that the phrase "it is what it is" is banned. Its a horrible expression. I am reminded of this all too frequently. The much better phrase is that we will attempt to deal with the reality that we are faced with on a daily basis. I am struck with this constantly. In February, I learned that I had a high PSA score and needed an MRI to see if they could understand why. After a brief emergence from COVID lock-down, I learned with a biopsy in June that I had cancer. In a recommended follow-up in July, I learned that the cancer may have spread to my ribs. My expectations of what I have to deal with and a possible road to recovery changes at each step in the process. In February, I had no idea that this is where I would be 6 months later. It gives me a much different perspective on time. I've known about the root of this thing for a while. I waited too long to deal with it, and now everyone is suffering the consequences. It totally sucks, and I want my kids to be clear to not repeat my mistake.

I cannot fault my wife for the pain she is going through with this situation. There is no one to blame. I am responsible. And I look for a way to resolve this in order to prepare for whatever step lies ahead. I appreciate, love, and need the support of everyone in my circle to attack whatever the next reality is.

The final test

PET/CT scan today. The same location and (apparent) machinery as the full body scan. However, a different dye that did not require a full hour to do its thing. This one .. just 4 minutes, versus 90 minutes for the previous. If nothing else, it tells me they are to a point of injecting me with something that is significantly more powerful to figure out what is going on. When you are dealing with the nuclear medicine department of one of the most advanced medical institutes on this planet, that tells you something.

The purpose of the scan was to get a closer look at what is going on with the bones. The purpose (as far as I can tell) is to get a more detailed look at the "hot spots" on my ribs. (Hot spots, from what I can determine, is where they believe cancer may have spread from the prostrate based upon some unusual pattern that emerged in the previous body scan).

The part of this process that I cannot put aside are the words from the previous discussion with Dr. Sonn: "nobody wants to be in this spot, given that this has most likely "spread beyond the prostate". The "most likely" phrase is what weighs heaviest on me. He is a man of science, working in one of the top medical institutions in the world. He would not say this without thought. It makes me pray for the best, but be prepared for what is most likely to happen.

Another Day, Another Medical Perspective

I am fortunate to still live in an area where I can benefit from one of the top medical research institutes in the world - my alma mater, Stanford.

I've interacted with 2 doctors in particular across my journey - Dr. Sonn and Dr. Gill.

Dr. Gill performed my initial "roto rooter" procedure to clear a path within my enlarged prostate to get the plumbing working again. Dr. Sonn performed the biopsy when I returned later, but Dr. Gill conveyed the results after that process, as well as after the bone scan.

I asked to talk to Dr. Sonn to hear a different voice; to see if the diagnoses lined up, or if there were differences in the way that they read the data. In sum, their perspectives were very similar, perhaps reflecting the fact that they are both cancer experts from the same hospital. Perhaps.

Asking Dr. Sonn the first question of radiation versus surgery - Dr. Sonn appeared more tuned into my history, and because of it, was probably stronger in recommending surgery... if he were in my shoes.

However, the question of the bone scan make that question of secondary importance. I asked why a clear course of treatment was not suggested based upon what they saw, he indicated that it was not a clear case and advised an additional test be done. OK, I'll buy that.

He also provided some feedback on the hormone treatment that made that route a little clearer for me - it is a last resort option. It is not a path to eliminate the cancer, simply to slow or stop its spread. That is hard to process. That sounds terminal to me. That sounds like I need to confront some pretty bad outcomes - which sucks for everyone, but also makes people angry in the process. This is something I will have until August 3rd to think about. And pray about. And worry about how to discuss this with my family.

The New Normal

I write this post as I begin a new chapter in my life. I write it for 2 primary reasons, 1) to convey to my family what I am going through, and 2) to hopefully provide a sounding board for those that are going through similar events in their lives.

The primary topic: cancer.

I find that my current situation is difficult to talk about. I have the diagnosis, I don't know yet the method of treatment, and I don't know yet what a road to recovery would look like. What I do know right now is that it is difficult to talk about.

For those that know something medically is going on, it is still difficult to talk about. I've not been here before, so I don't know what to say about what this means. I see the reports from the hospital and talk to the doctors, but I have no way to calibrate my situation to others. I have a million questions. What I know is that I see the expressions on the faces of loved ones who want to say something positive and supportive, but they don't know what that is. I don't either. I can only feel their love and support and comfort for the relationships I already have with them. I am blessed by this and don't need more than that. I hope to comfort them in the uncertainty of this situation as much as I want to better understand what may happen next.

For those that don't know anything about my health, it is even more uncomfortable. I am dealing with a ton of shit that probably consumes the majority of my mental energy at any given moment. Someone can simply ask me "hey, how's it going?" or "how was your week-end?" It is easy enough to give a superficial answer back "I am doing fabulous". Or "fantastic". Or "brilliant". Or whatever false front I can put in front of me to mask a bunch of heavy duty churning that is going on. I might as well have a mask. I have even resorted to putting a Pinocchio stick figure into my camera when I am on a Zoom call.  At this point, I just don't have enough information to know what I can and should convey. I do know that - when I get to the point where I am impacting others - those people will know what I am dealing with and I'll have a back-up plan to not leave them scrambling.

So, as of today, July 20, 2020, all I know is that the doctors have data back from my scan to suspect that the prostate cancer that was previously diagnosed may have traveled to my ribs. The experts from Stanford apparently meet to discuss specific cases 3 times a month, so I'll apparently learn more after they meet and recommend a course of action. Those courses could be to 1) either proceed with on the course of either radiation or surgery if they believe the risk of spread is low, or 2) to go through hormone treatment (potentially along with other stuff) if they want to deal with the spread. What I know is that the hormonal treatment is intended to block or suppress the production of testosterone, which is the enemy here. This apparently impacts a whole bunch of stuff that separates males from those that are androngenous, (e.g. facial hair, sexual interest, as well as some memory impact). This scares the shit out of me, and I know less about what this entails, which scares me even more. It scare me, and it scare me for my family.

As of this day, my first reaction is to document what I am going through and to share stuff that would otherwise be the stuff that remains "unsaid". I want to share this experience. I want to stay strong and positive about how I can battle through it. And I want to make sure that others who might be dealing with similar things can echo their feelings against mine.

Strategic Alliances - Need, Fit, Reach, Maturity

To continue from the previous post, 'strategic' alliances are relative. What is needed is a model to prioritize the existing and potential value to be derived from an investment in alliances. I've used the following approach in multiple environments with success - Need, Fit, Reach, and Maturity.

One important note - these items can be assessed via a simple scoring approach, or weighted based upon agreed upon executive management priorities. Also important to note that the weighting should consider the perspective of the partner as well, not just that of the firm.

1. Need: assess the scope and scale of the needs that can be addressed by growth of the alliance. Highest scores address each of the following:
- Company Need: Addresses a clear and immediate product or technological need as expressed by existing customers, or required to pursue new opportunities
- Product Need: Fills a product or technological hole, or extends basic product or architectural capabilities to improve alignment to identified market or customer opportunity
- Partner Need: Fills an existing hole in each other’s partner portfolio that is currently unsatisfied by other partnerships

2. Fit: Extent to which partner capabilities are complementary to the firm's capabilities. Highest scores address all of the following:
- Strategic Fit: in pursuit in common goals or aligned against common enemies
- Architectural Fit: consistent architectural base/philosophy
- Feature Fit: product integration does not make joint bids uncompetitive; road maps are not on collision course
- Market Fit: both companies can compete more effectively vs. common enemies
- Solution Fit: integrated products provide logical base relevant to vertical or functional solution strategy
- Customer Fit: percentage of existing customers using partner technology, and/or strong overlapping funnel

3. Reach: Assessment of the value of assets that extend internal capabilities. Highest scores address all of the following:
- Technology Reach: access to incremental pools of technical resources or expertise
- Market Reach: market presence, brand name awareness, market coverage/footprint, company size
- Customer Reach: access to, and knowledge of, buyers and influencers beyond those generally accessible via standard sales processes

4. Maturity: Assessment of the ability and effort required to execute on joint initiatives. Highest scores address all of the following:
- Organizational maturity: have FileNet & Partner had previous success with this type of relationship?
- Alliance Maturity: Presence of multiple, well established executive level relationships
- Product Maturity: State of current product integration, and investment required in order achieve partner’s desired level of platform support
- Solution Maturity: depth/breadth of partner awareness, and level of expertise around key joint initiatives
- Customer Maturity: quantity/quality of field engagement, existence of common customers and reference accounts

Once the assessment of each existing and potential alliance has been complete, prioritization of investment can be completed using a portfolio model that will be described in subsequent posts.

Inorganic growth

What? Counter-green movement? Non bio-degradable?

Offering consulting services focused on inorganic growth essentially entails exploring and using any available resource to address a market - other than those you already own and pay to address the market. If today's model entails use of an expensive direct sales force, inorganic means channels, alliances, self-serve, referral-based and everything else. If you can measure the difference between your Total Available Market (TAM) and Served Available Market (SAM), this is essentially SAM expansion. Managing resources you control is an understood task - building mindshare and incenting those you don't to act in your behalf is more difficult.

TA2 can help you to identify and qualify the inorganic. New geographies. Alternative channels. Alliances that create unique combined value propositions. SAM expansion.