Tuesday, September 26, 2006

Musings on the nocebo response

Allergy [al-er-jee] noun: an abnormal reaction of the body to a previously encountered allergen introduced by inhalation, ingestion, injection, or skin contact, often manifested by itchy eyes, runny nose, wheezing, skin rash, or diarrhea (dictionary.com)

"I'm not sure I can take that. I'm allergic to pretty much everything." Statements like this are fairly commonplace in my pharmacy. They usually come from middle-aged or elderly women dropping off a prescription for something they've never taken before. True allergies, however, are not so commonplace. It is estimated that around 5% of all drug treatments will result in a true allergic reaction. Penicillin allergy, for example, perhaps the most prevalent and well-known of medication allergies, affects about 10% of patients. Codeine is another commonly cited allergy amongst patients (albeit frequently for dishonest purposes, but that's another post). But these are commonly used drugs...wouldn't you expect people to report allergies to these agents since there's a greater chance of them having been presicribed them sometime in their lifetimes?

For comparison, around 15% of all treatments will result in an adverse effect, i.e. a side effect. The problem is the layperson's definition of allergy. It is used in a colloquial sense as a blanket definition to cover any sort of undesired reaction to a drug. Aspirin hurt your stomach? I'm allergic to it. Benadryl dry your mouth out? I'm allergic to it. Lortab make you nauseated? I'm allergic to it (ok, so I've never heard that one before, but you get my drift).

Let's look at this mathematically: given that the probability of true allergy to any given medication is 5%, what is the probability of a patient being allergic to (let's be conservative at first) three different medications?

5/100 * 5/100 * 5/100 = 0.000125, or 1/8000, or about 1 person in the city of Corbin
5/100 * 5/100 * 5/100 * 5/100 = 1/160,000, or about 0.8 people in Laurel, Knox, and Whitley Counties combined
How about five?
5/100 ^ 5 = 1/3,200,000, or about 1.2 people in the entire state of Kentucky
Given the 2006 US population of 299,360,879, how many medications must the most allergic person in the country avoid?
(It's between six and seven. I'm sure your eyes are glazing over at all the numbers already).
The next time that lady with the laundry list of 7 or 8 drugs that she's "allergic" to walks into the pharmacy, I'll be sure to stand a safe distance away so that I'm not struck by lightning. Or ask her to buy me a lottery ticket.

Saturday, September 09, 2006

9/9/06 Today's Ride -- Tour de London

Route: 41.17 miles.

Weather: 77 degrees, mostly sunny, light wind.

Performance: average speed 18.1 mph, time 2:16:34. Average HR 162 bpm.

Motionbased.com link: http://trail.motionbased.com/trail/episode/view.mb?episodePk.pkValue=1339861

Comment: So it's time at last to put my intervals, sprints, and general all-purpose miles to the test. Want to see how it turned out?

Preparation: I ate a pre-race meal the night before of spaghetti with meat sauce and garlic bread. Good ol' banana puddin' was the last piece of my carb load. I slept ok, but probably didn't get in more than 8 hours thanks to waking up about 6:00 and not being able to completely fall back asleep. Breakfast was a couple of servings of oatmeal with chocolate milk. Wal-Mart was out of individual muffins or I would have tried one of those.

At the site: Traffic in downtown London was detoured around Main Street to allow for the race start and finish. It was nice to see that they had put up one of those big Tour de France-style inflatable arches. I got there about 10:00, right about the time the pros were heading out. There was no one at the (unmarked) registration area when I finally found it, so I did a bit of self-service and found my number (208) and release form myself. Then it was time to warm up and kill time until our group, the "citizens", was set to leave at 10:50. I watched as the motorcycle lead and support vehicle for each group headed out every 10 minutes, with riders behind -- category 3, women, masters, category 4 & 5. Then it was our turn. We lined up around the start to listen to the official's speech about staying to the right of the yellow line, giving right-of-way to any returning groups we might pass along the way thanks to the course's figure-8 layout, and the rolling start over the railroad tracks. He also told us about the hay bales that had been placed at the bottom of all the dangerous descents and in front of trees. Had been being the operative phrase. Someone had stolen them twice. As all of this was going on, I was sort of zoning out, as I had heard bits and pieces of all of this already before the other groups left, until suddenly came a radio message that caught us all by surprise: "the pros are on Main Street!" Calls for "let's go" gave way to "let's get out of the way." We moved to the sides of the road as, sure enough, a group of about 15 riders came flying up behind us. Ok...they're on their second lap through...we knew they would pass us somewhere on the course, but here? Now? They've been through once in...50 minutes? They're averaging 40 mph? Now I wasn't there, so I don't know, but there must have been a shortcut somewhere...

The race: So we were off. The first several miles were uneventful other than the fact that I realized that I should have reversed the positions of my water bottles, considering that my bottle of Perpetuem was harder to reach and replace than my seldom-used water bottle. As expected, I was able to overtake several riders on the ascent of the Dezarn Road hill. As I was chugging away, I looked back just as I heard a quick swoosh coming up from behind. A group of about 4 riders, with no hyberbole involved, just blew past me. Like they were on flat ground. I hope they were pros.

In spite of this humbling experience, I looked down to see that I was averaging 20 miles an hour so far. I never ride that fast for that long. So naturally my thought turned to my left knee and the tendinitis I had been feeling on most of my previous rides. No problems so far. I had prophylactically taken a couple of Motrin before I started.

So at 25 miles I'm still feeling fine. I can feel a little tightening in my knee but no pain. I sip my Perpetuem every 15 or so minutes and knock back a pack of gel. As I predicted, I'm slowly losing ground on flats and descents but gaining it on ascents. Unfortunately for me this course is about 79% flats and descents. I can't see the lead motorcycle anymore...as a matter of fact, I can't see anyone. I know there are some people behind me, but considering the fact that a couple of them had mountain bike handlebars and weren't, how can I say it, in the physical mold of a road cyclist, they're probably a non-factor by this point. I am presently dueling it out with about 3 guys within striking distance ahead. I check my average speed. I'm still doing a good 18 mph, which is good for me, so I'm satisfied. I know my ability. All I can do is keep it up and things will play out as they may.

At 30 miles it's time for Oakley Hill. I'm sure most riders were dreading it like a root canal but I looked forward to it as my final chance to make a big gain. Halfway up I take a satisfying trophy...passing a couple of club riders. Club riders with shaved legs. Those guys must be Cat 4 or 5. Meaning they had a 10-minute head start on me. No more pros zooming up, so my pride is intact as I summit.

Around 37 miles I finally catch up with a guy I've seen only in the distance the whole race. We talk for a bit with some self-deprecating musings about who could possibly still be behind us. I can tell he's just about spent, both by the way he's riding and his sighing countdown of miles to go. We reach the base of a small hill and he gives me a flagging "see you later" as he falls behind.

I still feel pretty good...this gives me optimism. My strategy is paying off. I pass another handful of tiring riders heading up the gradual incline on Sam Black Road. The good thing is that I still have enough energy to continue to accelerate and keep them behind me.

So I'm on 80, heading toward Main Street and the finish. Volunteers lining the roads tell me this in case I didn't already know, along with words of encouragement. Just like the Tour de France, only much fewer of them. And no guy dressed up like the devil running alongside.

As I make the right turn onto Main Street the police are moving barricades to re-open traffic. Not the best timing, but there aren't many cars yet and the ones around are moving carefully. So I cross under the big arch and the race ends.

I'm still not sure how I did. I have my own time, but I don't look for the official results to be available until Monday. The criterium is tomorrow, but it's not for me. Not my style!

To sum it up: Regardless of how I placed, I had a blast in my first race. The organization and execution was great...it felt nice (and a little unusual) to be catered to so much by having Main Street closed down for us and support vehicles to, if only for a few hours, make the cars defer to the bikes for once. The volunteers at all the major intersections to hold up traffic and direct our turns were invaluable.

I really think having "home-field advantage" helped me. I was familiar enough with the course to know where to save my legs and where to gun it. I rode harder and faster for longer than I have ever gone before. That's why I say that my placing is immaterial. This is a sport where easily quantifiable outcomes (time, in particular) delineate performance. And my time in this race was simply as good as my current physical conditioning can produce.

That brings me to the bigger picture...of course I wanted to win. I tried to win. This race has taught me that I can't just come into my first race and win it. I now have perspective on my rides that I didn't have before. I'm a recreational rider. I value distance, scenery, variety, and fun over speed and training. I know that to win this race next year would require me to ride as hard as I did today two or three times a week or more. Working a full-time job with 12-hour days just doesn't give me the time to dedicate to that. So I think I'll try to be the best recreational rider I can be. I'm happy with that.

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