Dan Kohn has died
67 comments
I wish if these posts got enough karma they would automatically turn the site with a black bar instead of abirtrary decisions by the admins...
Nobody should die from colon cancer.
Get a colonoscopy starting soon and then every 5 years.
Get a DNA poop test every year in between.
Get a colonoscopy starting soon and then every 5 years.
Get a DNA poop test every year in between.
No. Iatrogenic harms are real and screening has never been shown to save lives. You will have many more people getting punctured colons and unnecessary treatment, causing physical and psychological harm if you try to get everyone screened.
https://www.bmj.com/content/352/bmj.h6080
It's tempting to think that early detection is the simple solution. It's not, and the experts understand this when they make recommendations.
https://www.bmj.com/content/352/bmj.h6080
It's tempting to think that early detection is the simple solution. It's not, and the experts understand this when they make recommendations.
> Get a colonoscopy starting soon and then every 5 years.
New guidance is to start at 45.
http://nccrt.org/wp-content/uploads/2018ACSCRCGuidelineOverv... (warning: PDF)
New guidance is to start at 45.
http://nccrt.org/wp-content/uploads/2018ACSCRCGuidelineOverv... (warning: PDF)
For what reason should it be limited to 45?
If risk is probability * harm, the lower probability of getting colon cancer under 45 should be offset by the greater harm of getting it young.
If risk is probability * harm, the lower probability of getting colon cancer under 45 should be offset by the greater harm of getting it young.
A colonoscopy requires sedation (typically, in the US; this practice is not universal) and also has a non-trivial chance of complications like bleeding, from perforation of sensitive tissue. Also if the doctor finds polyps they will remove them (usually by hot wire constriction), which means you now have minor surgery to recover from. So it’s not like a “check-up” where they just look up your nose with a light pen.
Anecdotal, but polyp removal for me and some of the people I know didn’t result in any additional post-surgery recovery time.
It was simply: go home, and don’t drive or operate any machinery today, just like any other procedure with light sedation.
That’s it.
It was simply: go home, and don’t drive or operate any machinery today, just like any other procedure with light sedation.
That’s it.
I also hear patients can request the level of sedation. It's ultimately up to the doctor though. https://www.templehealth.org/about/blog/what-are-my-options-...
My 2nd colonoscopy, I requested we skip the normal sedation.
During the procedure, there were a few instances of painful bloating, like perhaps the worst gas you've ever felt, as the doctor uses air pressure to expand the intestines for a clearer view and navigation around corners. But the pain receded in seconds each time, and the whole inspection takes maybe 10 minutes.
It was really interesting to see what the doctor saw, fully alert, and be able to leave immediately afterward without a ride.
For those who are curious, not squeamish, and don't mind a little transitory discomfort during a professional procedure, consider less or no sedation.
During the procedure, there were a few instances of painful bloating, like perhaps the worst gas you've ever felt, as the doctor uses air pressure to expand the intestines for a clearer view and navigation around corners. But the pain receded in seconds each time, and the whole inspection takes maybe 10 minutes.
It was really interesting to see what the doctor saw, fully alert, and be able to leave immediately afterward without a ride.
For those who are curious, not squeamish, and don't mind a little transitory discomfort during a professional procedure, consider less or no sedation.
Great. It seems like you and your doctor both respected each other. As it should be.
I ask for very light sedation. I still remember what was happening, but didn't feel any discomfort.
I asked for local anesthesia for a major knee surgery. (They normally do full anesthesia for that because an epidural injection is considered a bit riskier.)
That was a lot of fun! The doctor was delighted to have such an interested and captive audience, and ran over time because he spent too much time explaining everything while doing the procedure.
"Now I will cut loose this useless tendon from your thigh and reuse it as a replacement ACL."
I asked for local anesthesia for a major knee surgery. (They normally do full anesthesia for that because an epidural injection is considered a bit riskier.)
That was a lot of fun! The doctor was delighted to have such an interested and captive audience, and ran over time because he spent too much time explaining everything while doing the procedure.
"Now I will cut loose this useless tendon from your thigh and reuse it as a replacement ACL."
I had a polyp removed during mine, and there was absolutely no physical indication for me that anything had happened. The only way I knew any cutting or burning had been done is because I was told and shown a picture.
Yes, I've also had it done and it was the same experience. (In fact, waking up after propofol was perhaps the most pleasant two minutes I've had in the last ten years.) Just like the procedure itself, the vast majority of times it's fine. But when it's not, you are looking at life-threatening complications: bleeding, tearing, infection, etc. This is why the recommendation for such screenings is so conservative.
Yes, and there is also some risk of process errors introducing infections, and of course the same resources ($, professional time) might better create more health/longevity if directed elsewhere.
Cost/benefit. The procedure is not free, and there are harms associated with the procedure that are unlikely, but push it into negative ROI. In particular pay attention to the risks of the procedure; it’s not common (neither is colon cancer in young people) but people do die of complications from the colonoscopy.
I actually saw some discussion a few years ago saying that the procedure is a net harm in all age groups if there are no symptoms/genetic predisposition, trying to dig up a ref and could only find https://www.cancerdefeated.com/the-tragic-risks-of-a-colonos... so I might be misremembering that detail.
I actually saw some discussion a few years ago saying that the procedure is a net harm in all age groups if there are no symptoms/genetic predisposition, trying to dig up a ref and could only find https://www.cancerdefeated.com/the-tragic-risks-of-a-colonos... so I might be misremembering that detail.
Health resources are finite and colon cancer is extremely rare among young people who do not have family histories of cancer or some existing bowel problems. Norway starts colorectal testing at 55 for people without specific indicators.
Does a check cost more for young people than old? "finite resource" seems to be an issue of public health funding; private health scales to fit the market (by producing more doctors, say) - hence it's not a zero sum if people start spending more on healthcare overall.
Basic colorectal cancer screenings cost around $100, but like all health care there is considerable variance in what people pay. You are implying that we should test all people for all possible problems which is simply not practical and probably not even possible. Testing is instead based on health condition and history.
The specific details of why this money would be a waste that could be better spent elsewhere are in the report which is a good read: http://sciencenordic.com/should-colon-cancer-screening-start...
The specific details of why this money would be a waste that could be better spent elsewhere are in the report which is a good read: http://sciencenordic.com/should-colon-cancer-screening-start...
Cost of a colonoscopy is roughly $3000 in the US, and many insurance providers won't cover the costs of this procedure prior to 50 if not recommended by a doctor. Your doctor will need a reason to prescribe before 50.
Colonoscopy is an entire "line of business". And my insurance provider, CareFirst, balks at Cologuard as an alternative, even though it is less than 1/3 the cost of a standard colonoscopy.
Colonoscopy is an entire "line of business". And my insurance provider, CareFirst, balks at Cologuard as an alternative, even though it is less than 1/3 the cost of a standard colonoscopy.
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> If risk is probability * harm, the lower probability of getting colon cancer under 45 should be offset by the greater harm of getting it young.
Only if you assume harm goes up at exactly the same rate as probability goes down, which sounds like an application of the law of averages.
Only if you assume harm goes up at exactly the same rate as probability goes down, which sounds like an application of the law of averages.
You'd get a check so long as risk is over a threshold, without regard to how far above it is. If harm is "dead at 30" vs "dead at 45", that's an extra 15 years lost, so harm should go up linearly.
Probability dictates the rationing of finite resources
Better start at 35. Rare, but happens.
Do you still get it at early 30s if your family has no history of colon cancer? Are there any complications? I don't want to be sedated because I heard/read there's bad side effects.
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TotalBiscuit from beyond the grave reminds you all that if you have blood on your stools you really ought go get checked, yes it will be sort of degrading and suck, but it is not the end of the world and you will be happier and calmer afterwards
Had to look up what you meant by "TotalBiscuit". Apparently he was somebody who died of cancer, was diagnosed at 30 but had a history of cancer in his family.
See: https://en.wikipedia.org/wiki/TotalBiscuit
See: https://en.wikipedia.org/wiki/TotalBiscuit
People who use Twitch will likely at least know him as the face of the LUL emoji
fuck I didnt realize TotalBiscuit died. I kept wondering why I hadn’t heard that fantastic voice in a while. double RIP
That may be true, but I find the preparation totally uncomfortable which deters me from a potentially necessary preventative procedure.
> Get a colonoscopy starting soon and then every 5 years.
That's nice to say, but a colonoscopy costs $3,000 in the US. If you have good insurance, get one.
That's nice to say, but a colonoscopy costs $3,000 in the US. If you have good insurance, get one.
Any insurance will cover it, good or bad.
And if you can't afford insurance you can get free insurance.
And if you can't afford insurance you can get free insurance.
Even in other countries where it's covered they often wont start screening for it until later in life when you are considered at higher risk (but you can get it much younger).
Dan's disease progression was remarkably quick too. He wrote a blog post about his Stage IV diagnosis in early August:
https://www.dankohn.com/health/2020/8/29/diagnosis
And if you quick the 'Previous' link on the bottom you can see how it went from stents to ablation to an emergent hospital admission in the course of two months. Just so tragic for his wife and young sons.
https://www.dankohn.com/health/2020/8/29/diagnosis
And if you quick the 'Previous' link on the bottom you can see how it went from stents to ablation to an emergent hospital admission in the course of two months. Just so tragic for his wife and young sons.
https://www.dankohn.com/health Though it hadn't been updated.
There was a FoRK post on the 26th. http://xent.com/pipermail/fork/Week-of-Mon-20201026/066478.h...
Suppose a programmer saw blood in their stool. Is there a fairly high likelihood that it's due to hemorrhoids rather than cancer?
Obviously, they should get checked anyway. But I was curious if there is usually a benign explanation for the blood.
Obviously, they should get checked anyway. But I was curious if there is usually a benign explanation for the blood.
The first time I met Dan, we were talking about this and that and mentioned that I'd seen something on HN. He was very proud of his score[0] here :)
[0] https://news.ycombinator.com/user?id=dankohn1
[0] https://news.ycombinator.com/user?id=dankohn1
https://news.ycombinator.com/user?id=dankohn1
someone changed my submission which included that link
someone changed my submission which included that link
Both were registered on the same day, but he posted with dankohn1. It's the same as his twitter acct. Shows a bit of his high level of tech savviness, which he used for good.
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This is so sad. Dan always found time to talk to you, whether it was at the local NYC meetup or one of the monster Kubecons. No matter how small your company, he tried to get everyone to be active in the community.
I have a quick Dan story. I saw him after a Kubecon keynote and I joked that he should have sent me the slides for review, because the numbers for diversity grants he showed on stage were great, but the total was wrong. Later that day, I saw him again at the evening party. I think it was in Austin, the crazy one where it snowed. He told me, still embarrassed, that he had checked and the numbers were wrong. Then, he handed me a couple of extra tickets for drinks. I think I'll pour one for him now.
I have a quick Dan story. I saw him after a Kubecon keynote and I joked that he should have sent me the slides for review, because the numbers for diversity grants he showed on stage were great, but the total was wrong. Later that day, I saw him again at the evening party. I think it was in Austin, the crazy one where it snowed. He told me, still embarrassed, that he had checked and the numbers were wrong. Then, he handed me a couple of extra tickets for drinks. I think I'll pour one for him now.
> I think it was in Austin, the crazy one where it snowed.
One my favorite memories of Dan is him going from venue to venue during this crazy "snowstorm" in Austin (it was less than an inch) trying to make sure that everyone got more drink tickets. And he would joke "If I don't come back from the next place send a pack of sled dogs after me" or something.
Out of all his duties he took giving extra drink tickets to attendees very seriously, that was his thing.
One my favorite memories of Dan is him going from venue to venue during this crazy "snowstorm" in Austin (it was less than an inch) trying to make sure that everyone got more drink tickets. And he would joke "If I don't come back from the next place send a pack of sled dogs after me" or something.
Out of all his duties he took giving extra drink tickets to attendees very seriously, that was his thing.
> this crazy "snowstorm" in Austin (it was less than an inch)
Coming from MN and NY, that was nothing, but I had only packed t-shirts. The first I was aware of any snow was when walking out of the conference and seeing a BMW covered with an inch of it (from elsewhere? there was nothing on other cars).
Like the other poster said, Dan was an influence in people's careers/lives and definitely on mine, even if I met him only a few times per year. I changed jobs and no longer have the original emails, but somehow he put me in touch with folks at CoreOS about a blog post, which led to a lot of networking that I probably would have never made otherwise, including a relay race in LA(!)...
This week has already started badly. :-(
Coming from MN and NY, that was nothing, but I had only packed t-shirts. The first I was aware of any snow was when walking out of the conference and seeing a BMW covered with an inch of it (from elsewhere? there was nothing on other cars).
Like the other poster said, Dan was an influence in people's careers/lives and definitely on mine, even if I met him only a few times per year. I changed jobs and no longer have the original emails, but somehow he put me in touch with folks at CoreOS about a blog post, which led to a lot of networking that I probably would have never made otherwise, including a relay race in LA(!)...
This week has already started badly. :-(
> Coming from MN and NY, that was nothing, but I had only packed t-shirts.
Being from Newcastle, England, it sounds like you were dressed perfectly adequately for the occasion!
Being from Newcastle, England, it sounds like you were dressed perfectly adequately for the occasion!
Spent 12 years in Toon and I'll definitely second that! Geordies are crazy:-)
I love people like this. Thank you for sharing the story. May his memory be our blessing
After reading the comments here and on Twitter, it seems like many people had the same experience of Dan taking a personal interest in their work, career and projects.
It was impressive how he could have such a connection with so many people and remember details. The first time I met him was at the OSSummit in LA 2017 where he was presenting the CNCF Landscape in a small side-room. I asked him how to get a project listed and he helped me get openfaas on there and approved the pull request. After that he always seemed to have time for me and helped me in my career.
This is such a shocking and great loss for our community, he was too young.
It was impressive how he could have such a connection with so many people and remember details. The first time I met him was at the OSSummit in LA 2017 where he was presenting the CNCF Landscape in a small side-room. I asked him how to get a project listed and he helped me get openfaas on there and approved the pull request. After that he always seemed to have time for me and helped me in my career.
This is such a shocking and great loss for our community, he was too young.
That was a great Kubecon. I remember a couple of the sponsor swag items were beanie hats, which ended up being a big help, but was (hopefully) completely unplanned.
I am one of the people from small companies that Dan spent so much time talking to, even though I'm sure there were a billion people from Google/Microsoft/Amazon that would have paid handsomely for his time. We've truly lost someone special.
I am one of the people from small companies that Dan spent so much time talking to, even though I'm sure there were a billion people from Google/Microsoft/Amazon that would have paid handsomely for his time. We've truly lost someone special.
So sad that Dan is no longer with us, he is gone much too soon. My sincere condolences. Dan was an extra ordinary human. He was patient, friendly, warm, smart, and moved an entire community forward, sometimes almost by himself.
His too early departure is a loss not just to those who knew him, but to all those in the industry on the path towards Asimov’s planetary computer.
Very sad. I met Dan through my previous company where we worked on Kubernetes. He was always willing to find time to chat and seemed to truly want the best out of the cncf.
I used to jokingly call him Dan Korleone at his conferences.
The first time I met him was at the NYC WeWork. We had a great conversation for a few hours, shook hands, and I proceeded straight to the airport hell bent on traveling. Contract was in my inbox when I landed. Just like that.
I've been to 50 countries since. Still have to beat his record of 100+, he had an unusual life - before and outside tech - and a genuine soft spot for people who take the unbeaten path.
This sucks. I should have reached out during this pandemic. Write those awkward messages to old friends folks you never know how long they'll be around.
The first time I met him was at the NYC WeWork. We had a great conversation for a few hours, shook hands, and I proceeded straight to the airport hell bent on traveling. Contract was in my inbox when I landed. Just like that.
I've been to 50 countries since. Still have to beat his record of 100+, he had an unusual life - before and outside tech - and a genuine soft spot for people who take the unbeaten path.
This sucks. I should have reached out during this pandemic. Write those awkward messages to old friends folks you never know how long they'll be around.
I only met Dan once but he was kind, enthusiastic, and helpful about a project of mine at a time when I badly needed that encouragement. I'm learning how that he had a similar impact on hundreds of other developers. RIP.
I had a chance to work with Dan on a small project at CNCF about this time last year. We hit a wall with how everything was setup, COVID hit and we shelved everything in late January as events started getting cancelled. He was very down to earth and wonderful to work with.
This is so sad. Cuck fancer.
The world is poorer without Dan Kohn. He has improved the world in so many different ways. He was always kind and thoughtful to others.
Dan was a curious, brilliant, gentle giant. He will be missed.
In 2001, he wanted the VC firm he was a young partner at to invest in my way-early & mispositioned P2P startup, Bitzi. His partners gave good feedback, but passed, probably for the right reasons. Dan wrote a personal check, no paperwork, that helped keep the servers on for another year or so.
During the 2001-2003 dotcom winter, I put Dan in touch with the founders of both Friendster & Tribe, which he also angel-invested in. Still no financial return, as far as I know – and maybe some investor acrimony in those early social-networking rivalries? But he expressed his deep appreciation to me for those adventures for other reasons.
There's still a Fitbit on my wrist, after hearing his early raves about them a decade ago.
He really loved lower Manhattan, & it was a vicarious thrill to observe Dan raising his children there. (As someone whose parents fled 1970s Manhattan with young me, there's still a deep limbic "You can do that?!" wonder when people pull that off.)
Thanks, Dan. My heart goes out to his family.
In 2001, he wanted the VC firm he was a young partner at to invest in my way-early & mispositioned P2P startup, Bitzi. His partners gave good feedback, but passed, probably for the right reasons. Dan wrote a personal check, no paperwork, that helped keep the servers on for another year or so.
During the 2001-2003 dotcom winter, I put Dan in touch with the founders of both Friendster & Tribe, which he also angel-invested in. Still no financial return, as far as I know – and maybe some investor acrimony in those early social-networking rivalries? But he expressed his deep appreciation to me for those adventures for other reasons.
There's still a Fitbit on my wrist, after hearing his early raves about them a decade ago.
He really loved lower Manhattan, & it was a vicarious thrill to observe Dan raising his children there. (As someone whose parents fled 1970s Manhattan with young me, there's still a deep limbic "You can do that?!" wonder when people pull that off.)
Thanks, Dan. My heart goes out to his family.
I met Dan at Kubernetes Day Bangalore. He was so gentle and kind, I thanked him for hosting diversity scholarships. Great loss to the open-source community. RIP.
really sad about this.
when we [grafana labs] was first starting, dan was someone that i talked to a fair bit. he was always so welcoming and willing to help us in any way he could. a few years ago he was super excited about the growth of kubecon, and his excitement was infectious.
we have offices in lower manhattan, so we'd meet up fairly impromptu pretty often. he always wanted to meet at le pain quotidien; i think he had a special affinity for that place ;-)
i can't believe this news... i'll miss dan.
when we [grafana labs] was first starting, dan was someone that i talked to a fair bit. he was always so welcoming and willing to help us in any way he could. a few years ago he was super excited about the growth of kubecon, and his excitement was infectious.
we have offices in lower manhattan, so we'd meet up fairly impromptu pretty often. he always wanted to meet at le pain quotidien; i think he had a special affinity for that place ;-)
i can't believe this news... i'll miss dan.
[0] https://news.ycombinator.com/user?id=dankohn1
[1] https://twitter.com/DrOceanJulie/status/1322957062444326919