Friday, January 29, 2010

Just a spoonful of immunoglobulin

Dog Attack Update

After a failed attempt to locate the dog that bit me last week (to verify its vaccination status or have it quarantined), I began considering the rabies post-exposure prophylaxis shots.  You may have heard horror stories about these shots from the olden days when people used to have something like 10 shots injected into their abdomen.  It's a good thing the method has changed, or I might not have considered getting them.

I had gone to the emergency room the day after the attack, but the ER doc had little information to quell my rabies concerns.  As with most things in life, I was better off doing my own research.  With the help of my rabies mentor, Julie, I found out just how horrible the disease is.  Though my chances of contracting rabies from my dog encounter were very, very low, the consequences of being that one-in-a-million case, were quite grave--certain death.  By the time you start showing symptoms after contracting the virus, you are already dead.  Moreover, the virus can hang out in your body for up to a year (though 30-90 days is the average) before you start to show these symptoms.

On Friday, I decided to contact my regular doctor to get his opinion.  He advised me that the shots were unnecessary because the risk of infection was so low.  He did say, if it was going to keep me up at night with worry, that it wasn't too late to start the series of shots, but I would have to go in to the ER to get the first round.  After asking my Facebook peeps on Saturday morning what they would do, I finally decided I would get the shots.  My rationale was this: there are very few opportunities in life to reduce your risk of death from an infectious disease, or anything else for that matter, to zero by receiving a few shots after you’ve been potentially exposed.

The Long Run

I still had a little matter of a 94-mile week of running to wrap up before venturing in to the ER.  I could tell that the stress of the week was weighing on me, when Saturday, at 3 p.m., I tucked my tired self into bed for a nap while The Genius went off for his 22-mile run.  I arose about 30 minutes later and started gearing up for a run.  I was undecided whether I would go 8 miles (scheduled for Sunday) or 22 (scheduled for Saturday), but I decided I would go out prepared for 22 just in case I felt spry enough to tackle my long workout.  

I started my run at around 4:00 and felt decent during the first 4 miles.  I decided I would just go for 22 and see how my body responded.  My workout was 22 miles total with the following speedwork (all programmed into my Garmin):
  • 10 x 1 mile with 90-second jog rests in between each repeat;
  • within each mile, alternate pace every ¼ mile between 10k effort and goal marathon pace (GMP)

I started this about 5 miles into my run.  I hadn’t done a workout like this before and found it to be difficult to execute well.  If it wasn't so long, this would be an ideal track workout with regular, reliable pace feedback and consistent topography to develop a rhythm.  Doing this on the Bike Trail was challenging with only the chirps from my electronic wrist coach to alert me that I was off pace.  And, I was off pace a lot.  I would inevitably start each repeat with a little Garmin chirp indicating I was going too fast, back off the pace, hear a chirp that I was going too slow, speed up, and then end up being too fast on average as I heard the beeps announcing the beginning of the next ¼-mile repeat.  While I didn’t care much about how slowly I ran the 10k-effort bouts, I knew that it was important in this workout to hit GMP.
By the 7th mile repeat (~13 miles into the run), I was starting to get tired and was concerned about holding GMP at the end of the repeat.  As I ran along, I listed my options in my head:
  • end the speed work after 7 repeats;
  • run the entire mile repeat at GMP; or
  • stop mid-repeat (after a ½ mile), jog for a few seconds and complete the 2nd ½ mile at the prescribed paces. 

I remembered this interview with Kara Goucher where she talked about how her coaches adjust her workouts on the fly when she is having a tough time.  One approach was to just shorten the length of the repeat until she could hit the pace.  So, if she was supposed to be doing mile repeats at tempo pace, but wasn’t hitting that pace, they would make her next repeat 1200m.  If she still couldn’t hold it, then they dropped it to 800m, and so on.  At some point, they would just call the workout and try again the next day.

I didn’t really have the option to try again another day since I was already so far along in the workout.  So, I decided to take a very short jog break after the first ½ mile and resume the same paces in the second ½ of the remaining repeats.  This worked great, and I was able to hold my paces without frying my body.  I still had another 5-6 miles to run home after completing the speedwork, after all, and it was dark and rainy by this point.

When I got home from the run, I downloaded my data and realized that I had overshot on all of my paces, which partially explains why I felt so tired.  I averaged 5:52 for the 10k effort (faster than that, actually, before I started taking the breaks) and 6:08 for GMP.  My overall pace for the 22 miles was 6:46. 

Let the treatment begin!

With my long run out of the way, I was now free to get my rabies shots--on Saturday night at 8:30 p.m. at my HMO’s 24-hour Emergency Room.  While I admit this wasn’t the smartest timing, I didn’t have much choice.  There’s a 72-hour post-exposure window for treatment to ensure the highest effectiveness.  I was staring at hour 96 and needed to get it done.  The Genius accompanied me, and we watched some of Sacramento’s finest being treated for blood clots in their urine, bloody wounds sustained from drunken behavior, gashed heads from falling out of the kitchen cabinet, to name a few.  I felt pretty certain that I was the only person being treated for rabies.

In fact, I may have been the only person treated for rabies post-exposure in this ER in a long, long time.  This was verified when my nurse came in with multiple boxes of the vaccine delivered from the pharmacy and asked, “Am I supposed to give you all of this at once?!”  She continued, “I have never given anyone this much vaccine for anything.  It just seems like an awful lot for someone your size.”  At this point, my eyes were darting around the room looking for a quick exit.  Maybe I had made a bad choice coming here.  I told her that I could look it up on my iPhone, because I was pretty sure there was an app. for that.  I then suggested that it might be best to ask the doctor or read the instructions that came with the package.  Wow.

Dr. Hottie (not his real name) came in and reassured me that I was indeed supposed to get the 7 cc’s of material in the hypodermic needles.  After my initial terror, I warmed up to my nurse when she proved adept at shot delivery.  There were 5 total—4 immunoglobulin shots to boost my immune system plus the first rabies shot.  I got one shot in each deltoid and 3 across the top of my butt.  The needles were super long, but she recognized that she didn’t have a whole lot of fat to poke through to get the needle in contact with my muscle for intramuscular delivery.  She was gentle with me and I actually was hardly sore at all the next day as a result.  Bless her.  She was disappointed when I told her that, while 5 shots at once was a record for her to administer, I had once received 11 in one day (including typhoid, yellow fever, tetanus, flu, etc.) when I lost my military shot record and had to get all of my vaccinations to remain "deployable".

I am happy to report that, aside from a little dizziness following my second and third rabies shots, I have been unaffected by the vaccinations.  I have completed all of my workouts and am nearing the end of a 101-mile week of running.

Thanks to everyone for your advice and concern.  This has been a huge learning experience, and I hope I’ve opened a few eyes to the seriousness of this disease.  Julie suggested that we organize a race for the rabid, but it appears that Michael Scott of Dunder-Mifflin has already done that.  You can get your t-shirt here.  There's also a Facebook page that you can join: Dunder Mifflin Fun Run Race for the Cure for Rabies.


  1. Wow, what a week. Great run, woman, talk about crazy paces, you got 'em! Lol on the iPhone app, that was a good line. Glad you got the shots because otherwise, you'd have spent the next 30-90 days or even the year, wondering if every cough or sniffle signaled imminent death. Glad we'll have you blogging for a little while longer. :)

  2. Thanks, Flo. You're sweet! Now that I'm more than halfway through the series of shots, I'm feeling better about my decision too. Today's shot barely phased me. Two more to go!

  3. I guess I was lucky. I got the shots from my regular Doc, who'd just given the series to his daughter after a bat landed on her and bit her. But in my case he shot the immunoglobulin directly into the bite wounds, which was a special treat.

    To distract me, he gave me the whole history of rabies and vaccination. Did you know that, among his other accomplishments, Louis Pasteur developed the vaccine?

    I hope you continue to not be bothered with side effects. But, just an FYI, the later shots may make you feel worse than the earlier ones do, so don't be freaked out by that if it happens.

    Yours in rabid sisterhood...

  4. Now I know where to go for a rabies mentor if I'm ever attacked by wild Koalas. I'll try to avoid it though as I'm not a fan of long needles in the butt. Like the T-shirt for the race for the cure for a disease that's already been cured!

    Nice going with the 22 mile (incl speedwork) session. Kara's the man when it comes to session adjustments ;)

  5. I love the photos. That episode was hilarious, especially Andy's nipple chafing. Scary that such a bizarre topic as rabies was actually relevant... I'm glad to hear that you took the safe route. Seems smart.

    Your long run is very impressive. The average pace is obviously intense, but what struck me more was how difficult it must be mentally to keep doing intervals over such a long distance. I survive my long runs by drifting off and not thinking about them. But, with such a set routine, you don't have that option.

  6. JT, You were lucky, if you can call that luck. I was pretty tired over the weekend after getting my third rabies shot Friday. I wasn't really able to tell whether that was from the shot or the 100-mile week. Good thing this current week is a recovery week for me!

    Ewen, Yes. Beware the rabid koala. I hear they have a mean streak a mile wide.

    RJR, This long run is pretty typical of what I get. I haven't seen a flat out easy long run in ages. I remember enjoying them:)

  7. Wow "J" I just finished reading about the do bite incident! I've never thought about getting rabbies like that but I'm going to find out what the situation is here. More than likely it is worse than in the states.

    Anyway, one bitten twice shy as they say.


    You know as I was reading I couldn't get the image of Aticus Finch,(spelling) from "To kill a Mocking Bird", lining up a rabid dog with his rifle,out of my mind ;)

  8. Scott, I learned a lot about rabies during this ordeal and concluded you don't want to mess with it. You might be comforted to know that rabies in Japan is even rarer than in the US according to what I read on the web. The most recent cases were from people being bitten somewhere else and returning to Japan to die. (