All posts by karin.ljubicc@gmail.com

Napredne metode zdravljenja hemofilije

Sicer mi področje ni ravno blizu, a ker se je bilo v zadnjem meecu potrebno nekoliko poglobiti v teorijo genskega zdravljenja, tukaj nekaj o naprednih metodah zdravljenja hemofilije, o katerih pred leti v študentskih knjigah ni bilo ne duha ne sluha.  Hemofilija je recesivno dedna bolezen, ki nastopi zaradi pomanjkanja specifičnega faktorja strjevanja krvi, pri kateri nastanejo same od sebe ali po neznatni poškodbi krvavitve v koži, mišicah, sklepih, dlesnih, jeziku, telesnih votlinah in krvavitve iz sečil. Ločimo dve po vzroku različni obliki hemofilije, ki se dedujeta recesivno preko kromosoma X, in sicer hemofilijo A, ki nastane zaradi pomanjkljive aktivnosti faktorja VIII (antihemofilnega globulina), in hemofilijo B, ki je posledica pomanjkljive aktivnosti faktorja IX (Christmasovega faktorja).

Source: nature.com

Pomemben napredek v zdravljenju hemofilije predstavlja genska terapija. Glavni namen genske terapije je popravek oziroma zamenjava problematične genske sekvence z namenom, da se prepreči manifestacija patološkega fenotipa. Fokus večine današnjih genskih terapija je dodajanje neokvarjenega gena brez odstranitve oz. deaktivacije okvarjenega gena. Hemofilija A in B sta med najbolj raziskanimi boleznimi za genetsko zdravljenje. Gre za in vivo prenos gena v jetra preko AAV (adeno-associated viral) vektorjev. AAV vektorji so transgenski produkti, pridobljeni s pomočjo parvovirusov. AAV vektor ima tropizem za številna tarčna tkiva, med njimi tudi jetra in skeletne mišice. Edina prava omejitev omenjenih vektorjev je, da ne morejo “nositi” sekvenc, ki so daljše od 5 kilobaznih parov. AAV ima kratko, enojnovijačno, krožno DNK molekulo, ki kodira kapsido in drug strukturne proteine virusa, hkrati pa kodira tudi proteine, ki spodbudijo integracijo virusa v specifično okvarjeno mesto na kromosomu 19. Doslej so aplikacijo AAV v človeški prganizem poskušali intravenozno (cilj jetra) in intramuskularno (skeletne mišice). Metode dostave so bile torej ali z intramuskularno injekcijo ali preko portalne ali periferne vene. Ker imamo na voljo več serotipov AAV vektorjev, lahko vplivamo na tropizem injiciranih vektorjev. Tako lahko pojasnimo dejstvo, da je aplikacija serotipa AAV8 preko periferne vene povsem učinkovita zaradi močnega hepatotropizma navedenega serotipa. Ko AAV vektorji enkrat dosežejo svoj cilj, katerega prepoznajo po serotipsko specifičnih membranskih receptorjih, z endocitotskimi vezikli vstopijo v notranjost celice. Kapsida se odstrani in nukleinska kislina vstopi v celično jedro. Nukleinska kislina nato perzistira v jedru. Pri visokih dozirnih koncentracija pride do integracije v gostiteljev genom. Doslej je bilo objavljeno eno poročilo o razvoju hepatocelularnega karcinoma pri miškah, katerim so injicirali AAV. Zdravljenje z AAV vektorji je že bilo opravljeno tudi na ljudeh, in sicer za hemofilijo B v obliki intravenoznih in intramuskularnih injekcij. Koncentracije faktorja FIX v plazmi prično naraščati po 2-6 tednih, in sicer dosežejo vrednosti 2-10%. To se na prvi pogled zdi relativno malo, vendar je z vidika hemofilije že minimalen porast v aktivnosti koagulacijskega faktorja znatnega pomena. Še vedno poteka sledenje pacientov, ki so bili zdravljeni z gensko terapijo, zato zaenkrat še ni mogoče napovedati, kako dolgo povprečno traja učinek enkratne apliakcije. Po doslej znanih podatkih je pri 1/3 pacientov 3,2 leta po enojni aplikaciji vektorja v periferno veno nivo faktorja FIX še vedno med 1-5%.

Na kratko, biotehnologija je prihodnost!  🙂

ING Night Marathon Luxembourg, 27.5. 2017

Night marathon Luxembourg became almost a tradition for us since we have been there already in 2015…and want to participate also in 2018.  It is a really lovely marathon with approximately 10.000 participants all over the world.. We flew to Luxembourg City two days before the event. First, there was an all-night drive from Maribor to Vienna with no remarkable sleep at all. During the second flight from Zurich the tiredness took its toll and I can’t even recall the take-off and landing. After setting in a nice, budget hostel near the airport the only reasonable thing was to get some good afternoon sleep. We were all a bit lazy since we only made a short trip to the capital center in the evening … and even that was dedicated to Burger King. I skipped the fast-food dinner, the most basic mistake I could have made as I realized after during the marathon. The following morning we had some breakfast with a lot of carbohydrates. It was time to get to the registration point to pick up our numbers and some other important stuff.  Pasta party in the evening was delicious, they served pasta with local ingredients and some drinks. Enough food for one day.

And there it was…the marathon morning. Actually a bit different this time since the start was at 7 PM. So we were counting down the hours and spent all day long relaxing in pyjamas,  saving all the energy for the 42,2. I was starting to feel the adrenaline which gets me every time the start approaches and it is a special felling,I was happy to be there. Though something just did not feel right and it is hard to describe what exactly. Well the start was approaching and we were almost late. There was a 15 minute bus ride to the start but unfortunately we had a bus driver who obviously did not like runners and marathons. He decided to adapt the bus route by adding 90 minutes. So we were driving around Luxembourg (which would be nice in other circumstances) and  picking up Saturday walkers at every local stop. The driver decided to drop us at main station which was 6 km away from the start. So there were not many chances to get to the start on time…we had to run fast. I have never been so warmed up before the marathon. We crossed some red lights and when the police stopped us the smartest thing was to ask them for a ride. Of course they declines but meanwhile there was a bus passing and we made another sprint to catch it. Luckily, we got on the bus headed to the start.

ING Night Marathon Luxembourg-start.
(Source: luxbynight.com)

The start was crowded with runners and the time was approaching.  Iztok and I separated for some final preparations before the start but luckily met again a few seconds before in the start box. The moment when the gun goes off and there is 42 km of running into the late evening is something worth training for.  The sun was still high and the water was out of reach.  The first 10 km were the hardest… I felt mentally tired, though the legs were soft and eager to run. I must say I have never felt so low in any endurance competition till this marathon and I could easily stop and lay down somewhere in the grass by the way. But quitting is never an option. I was trying to think positively,  indulging into all the beautiful things by the way, cheering crowds and the smell and colors of a magnificent spring evening in the city of Luxembourg. I admit I had a crisis until I have reached the 15th kilometer. After that everything became easier and I was starting to feel strong and full of energy.  I focused on the finish line and the time just went by. The course was leading us through the small streets of Luxembourg, people by the way were cheering and enjoying the evening.  There was a smell of grilled food all around. Children by the way were pouring us with water and giving us “high-fives”. Truly, a lovely marathon. Really enjoyed it.

The spirit of marathon.
(Source: marathons.ahotu.com)

The sun went down and deep into the dark I started to realize that the finish line is approaching. Going into the last kilometer was emotional and full of adrenaline. Not even one finish line should not be taken for granted and therefore I really appreciate all the finishes in the past. Finish line was magnificent again and afterwards I took a few minutes to lay down on bare ground…still gathering all the impressions. This is the “runner’s high” and you eventually become addicted to it…

Hematofagocitna limfohistiocitoza (HLH)

Čeprav je v vsakdanjem delu bolje razmišljati pragmatično in se osredotočiti na najverjetnejše diagnoze (ker se pri pri pretiranem poglabljanju lahko spregleda tiste očitne “zastavice”), je včasih dobro slišati tudi o redkejših diagnozah.

Ena takšnih je hematofagocitna limfohistiocitoza, ki mi je v zadnjem mesecu zelo ostala v spominu, ker sta na enem izmed oddelkov v kratkem razmaku ležala kar dva pacienta s to diagnozo (toliko o redkosti).  Gre za nekontrolirano hipervnetno stanje, ki ga pri predisponiranih posameznikih lahko spodbudi okužba (EBV), malignom (tipično limfom) ali avtoimuna bolezen. Eden izmed teh dejavnikov spodbudi pozitivno povratno zanko intenzivnega sproščanja citokinov zaradi okvare aktivnosti citotoksićnih limfocitov T in naravnih celic ubijalk.

Na sindrom je potrebno posumiti pri perzistentnem vročinskem stanju, ki ga lahko spremlja bicitopenija, splenomegalija, povišane zaloge feritina kot marker perzistentnega vnetja in nekaj drugih kriterijev, ki so ali niso prisotni. Ime “hematofagocitna” izhaja iz procesa, ko aktivirani makrofagi “jedo” druge krvne celice, čigar posledica je citopenija. Sicer pa hematofagocitoza v razmazu ni patognomonična za sindrom. Na drugi strani pa je hiperferitinemija ena izmed karakterističnih pokazateljev, da bi ob ustrezni klinični sliki in pridruženi citopeniji lahko šlo za HLH.

Poleg zdravljenja vzroka je za umiritev citokinske nevihte potrebna imunosupresorna in imunomodulatorna terapija, še prej pa seveda posvet z revmatologom in hematologom, katera sta pravzaprav vodji zdravljenja te pogosto spregledane diagnoze.

Pomembno sporočilo je torej, da ob vročinskem stanju s citopenijo in hiperferitinemijo, predvsem pri kritičnih pacietnih v enoti intenzivne terapije, pomisliti tudi na HLH. Za nas, ki pa smo šele na začetku poti s pridobivanjem izkušenj, pa mogoče koristno  znanje za kdaj pozneje. Tukaj pa še link do brezplačnega zelo kratkega prispevka, ki pove vse o tej temi: Link.

Laguna Porec Half Marathon, 26.3. 2017

Last weekend we took part in another half marathon distance after a long, cold winter. It felt so good to wear shorts again and do the running by the sea.

We have decided to arrive two days before the run on Friday night. It was almost midnight and at the time of our arrival a nice hotelier apologized since there was no dinner left. Of course. Never mind, we were full of the world`s best cake from Iztok`s grandma. The next day we were woken up by a small, grey-yellow colored bird knocking on our window. By being so nice to wake us up, a birdy deserved a breakfast, some bread leftovers from the previous night, and soon there was a flock of few small birds and two big gulls on the front yard.

A view from Grožnjan

We decided to visit a small town of Grožnjan on Saturday. In a small local Kaufland we found a small piece of my “best-ever” cheese, a goat cheese from the Pag island. Two bites and it was gone. By the way, this cheese has received numerous awards (MIH Dairy Kolan) and it is my all time favorite. Grožnjan is actually a small settlement and it is known as the city of artists. Many houses have been reorganized into painting studios. When returning to Poreč, we registered for the run, got our numbers and went back to pick up some dinner. There was pizza, pasta, potatoes and lots of salad. I also tried some white shark meat and squids and it was more than enough.

Too cold for swimming

On the race morning we were again woken by the same bird knocking on the window. No alarm clock needed. It was time to get up, dress up and eat some breakfast. The start area was already crowded with runners, more than 800 from different parts of the world, the most distant ones came from Kenya. We did some warming up and then it was time to get started with 21 km distance in front of us. The first few kilometers of fast running felt so good, there were three 7 km laps routed by the shore. I could feel the salty sea breeze on my skin and I have decided to speed up in the second lap. I must say I was surprised with how good I felt since there was not as much time invested into training this winter as it was in previous year. The finish line was getting closer and closer, the distance just flew by. I have almost forgotten how good this feels like. Amazing day once again.

Start and finish line

We have decided to do it once again next year. It is a well organised event in a lovely setting.  The next in line is 42 km of ING Night Marathon Luxembourg. Can`t wait.

Intelligent sport training

The advent of artificial intelligence has also entered in the field of sport training. Every time we undergo a training session our sport watches collect and save different parameters, which require further analysis in order to improve our next performance. And not to mention all the parameters we are unaware of. Of course, human cognitive functions are of limited value in dealing with large data sets. Our brain might intuitively  plan the following training based only on how we felt during the past training and not regarding the actual performance facts which can only be detected with the tools of computational intelligence. There are hidden correlations to be  found.  Our past work has proven to be more than useful in this area and here you can find our articles regarding this hot topic: Planning the sports training session with the bat algorithm and Computational intelligence in sports: Challenges and opportunities within a new research domain.  The advent of a new concept in the form of artificial sport trainer in collaboration with a human trainer is still in the developing phase. Hence we could see it fully in practice in the following years.

Labelling of varieties covered by patent protection

One of practical implications of storing data into plants is an insertion of short DNA labels into protected plant varieties. It is a new approach for managing intellectual property rights in the seed industry. By using our online application tool it will become easy to distinguish protected from non-protected varieties. The original scientific article was published in Transgenic Research by Springer and is available at:

Article

WINFOCUS: Vse o uporabi UZ na enem mestu

Pretekli teden je v Ljubljani potekal 12. svetovno znani kongres posvečen ultrazvoku in širjenju njegove uporabnosti. Edinstvena priložnost, saj gre sicer za kongres, ki je vsako leto organiziran drugje v svetu, medtem ko so posamezni segmenti kongresa organizirani posamično tudi v Sloveniji. A kot rečeno, tokrat celoten WINFOCUS v Ljubljani. Udeležila sem se dvodnevnega programa uporabe ultrazvoka v vsakdanjih urgencah in resnično lahko rečem, da po skupno 12 urah predavanj in 8 urah praktičnega dela z ultrazvokom zapustiš prizorišče samozavestnejši za trenutke, ko ti na vrata urgentne ambulante potrka pacient z dispnejo in bolečino v prsnem košu. Da ne omenjam vsakdanjega kruha urgentnih ambulant – globoke venske tromboze in pljučne embolije. In v infektologiji pogosti vzrok dispneje – pljučnica s pridruženim plevralnim izlivom – vse to in še več je sposoben prepoznati soliden UZ in seveda ultrazvočist za njim. Ni zastonj namera, da bi vsak zdravnik poleg stetoskopa v žepu nosil še dlančni UZ aparat, tudi kot aplikacija s sondo na našem mobilnem telefonu.

Echocardiogram
                                                Echocardiogram

Osnovni pristop h kritično bolnemu je naš algoritmični ABCDE. In prav pri vsaki črki protokola nam pomaga ultrazvočni aparat.

Pri pregledu A(irway) si lahko z linearno sondo pomagamo pri vstavitvi endotrahealnega tubusa. Predvsem nas seveda zanima ali smo vstopili v trahejo ali v požiralnik. Druga redkejša indikacija je uporaba za lociranje tiroidnega in krikoidnega hrustanca oziroma krikotiroidne membrane, kadar je zgornja dihalna pot neprehodna. Konikotomije oziroma krikotiroidotomije nihče nerad izvaja na slepo, z UZ pa nam je prihranjena dilema pri lociranju mesta, kjer bomo pičili.

Pri pregledu B(reathing) nas zanima več stvari. Sicer je boljša uporaba linearne sonde in manjše globine, a z abdominalno sondo dobimo širše vidno polje. Zanima nas “lung sliding, lung pulse in B linije (več kot dve na en medrebrni prostor). Če je kateri izmed treh naštetih pojmov viden oziroma najden na UZ pljuč, lahko s 100% verjetnostjo ovržemo pnevmotorax tega pljučnega krila. Dodatno nam najdba “lung point”,kjer je plevra tipično prekinjena, seveda na kazuje pnevmotorax. Na drugi strani pa najden kateri izmed teh znakov ne pomeni, da je krivec pnevmotorax, saj gre lahko tudi za KOPB ali drugo dogajanje v pljučih. B linije so znak spremenjene lomljivosti svetlobe in nam nakazujejo intersticijski sindrom oziroma edem (pljučni edem katerekoli etiologije, pljučnica,…). Na bazi pljuč, kjer je diaframga v stiku z jetri desno ali vranico levo, smo pozorni na t.i. znak zavese oz “curtain sign”. Preprosto rečeno, smo pozorni ali se med mirnim dihanjem diafragma lepo pomika glede na vretenca in ali preko diafragme ne zaznamo hipoehogene tekočinske kolekcije. Sistematičen in koristen UZ prikaz pljuč je na voljo na tej povezavi: https://www.youtube.com/watch?v=uv6zI4QHYss

Pri pregledu C(irculation) je UZ izjemnega pomena. Pregledamo lahko vse tri pomembne komponente, torej vene, srce in arterije. Za oceno šokiranega bolnika po poškodbi ali mlade ženske, v šokovnem stanju, s sumom na rupturirano ektopično nosečnost, je FAST UZ pregled trebuha nepogrešljivega pomena. Pregledamo 3 (vključno s perikardialnim prostorom 4) področja v telesu, kamor bi se lahko izgubljala tekočina. In sicer desno hepatorenalno področje vključno z desnim plevralnim prostorom, levi splenorenalni žepek z levim hepatorenalnim prostorom, substernalni pogled na perikardialni ovojček in preko mehurja pogled v rektovesikalni žepek pri moškem oziroma rektovaginalni žepek pri ženski. Prosta tekočina v teh predelih nam nakaže, da je vzrok šoka lahko hipovolemija. Nazoren prikaz pa v tem videu: https://www.youtube.com/watch?v=6qWNmMvAfdQ

Dodatno lahko pregledamo tudi aorto, če sumimo na rupturo anevrizme ter za oceno volemije še polnjenost spodnje vene cave. Pregled srca sestoji iz treh pogledov, najbolje je seveda uporabljati kardiološko sondo, čeprav se da tudi z abdominalno sondo kar precej videti. Pogledamo substernalno, parasternalno in apikalno. Najboljši je parasternalni pregled. Ocenjujemo 3 E-je, in sicer “equality, ejection, effusion”. Pod prvo točko nas zanima ali je desni prekat manjši od levega, ali je septum raven. Kakršnekoli anomalije normalnih razmerij bi nam lahko nakazovale povečane polnilne tlake v desnem srcu, ki bi nastopili recimo ob pljučni emboliji, pljučni hipertenziji, ipd. Drugi pojem nam nakazuje ustreznost sistolne funkcije in kaže na možno hipotonijo srca recimo ob infarktu. Tretji pojem pa se navezuje na perikardilani izliv oziroma na morebiten hipoehogeni pas tekočine v perikardu. Prikaz pa tukaj: https://www.youtube.com/watch?v=H_3V9xlDMA0

Na koncu pregledamo še vene, katere pa sem že opisovala v enem izmed prejšnjih postov. Dvotočkovni pregled ob sumu na GVT je po raziskavah dovolj za izključitev potencialno nevarne GVT, katere ne moremo poslati domov z napotnico za UZ čez dva dneva. Prva točka pregelda je predel v. femoris communis z vtočiščem v. saphene magne. Druga točka pa je pregled poplitealne vene z v. sapheno parvo. V obeh naštetih točkah iščemo znake tromboze in skušamo stisniti vene z ultrazvočno sondo. Izvedemo lahko tudi augmentacijo, pozorni pa smo lahko tudi na respiratorni alterans z dihanjem. Vsekakor izjemnega pomena, ko se odločamo ali je oteklina na račun limfedema, površinskega tromboflebitisa ali resnično GVT.

WINFOCUS zelo priporočam v udeležbo. Ko je pred tabo resnična situacija z adrenalinom na vrhuncu in pacientom v akutni stiski, je vsako čakanje na dodatne slikovne preiskave (RTG pc. CT, ipd.) lahko preveč zamudno in je tista neškodljiva naprava v kotu sobe lahko diagnostičnega pomena.

Challenge Šamorin, Slovakia, 21.8. 2016

On 21. of August we took part in an inagural Challenge Samorin, Slovakia. It was a 1,9 km swim, 90 km bike and a half-marathon run… Swimming took part in the Donau river, which had pleasant 19 degrees. Though it was only an up and down route with no obvious turns to the left or right, it was a particulary special swim because of the current. Anyway, on the bike it started raining like a shower.  I was kind of a “deja vu”…like Iceland… again cold and wet bike ride.

Swim start (source: Challenge Šamorin)
Swim start (source: Challenge Šamorin)

Well, once we managed to get to the running part it was all OK. It was a really lovely run on the banks of the Donau river, the rain stopped and we started enjoying the countdown to the finish line. Through the rice I have been feeling rather tired and sleepy, a long season behind has started to take its toll. But still, we had a really nice time in Slovakia and the race was just a relaxation during the weekend.

Now, that is it for this season. 1 Ironman and 4 half-Ironman distances this year. I am really satisfied with the 2016 season. 🙂 Now it is time for autumn and winter… and indulging into activities other than triathlon.

Challenge Iceland, 23. 7. 2016

On Saturday, 23.7. 2016, we were a part of an amazing, inaugural Challenge Iceland, half Iron distance triathlon. The name says it all and all three of us agree that this was the most fascinating, adventurous triathlon we have ever done. An unforgettable experience in the land of the Vikings.

Swim start (source; Challenge Iceland)
Swim start (source; Challenge Iceland)

The swim start took place on Saturday morning in a 10.000 years old glacier lake situated 40 km from Reykjavik. It was a rainy morning with outside temperatures approximately 12°C. The water in the lake was said to have 15°C but in fact this was only true for the shallow part on the entry into the lake… as you went further, the water became colder and colder. We dressed up our swim suits in a nearby tent because the rain was pouring from the sky. The tent was already crowded with athletes and it seemed like we all knew that going into that lake will take some craziness. The scenery behind the lake was a picturesque mountain and hills covered with snowy patches and we also noticed a waterfall which was probably providing all this cold water into our lake. It was time to get in. We did not think much; we got wet as fast as possible and once you swam a few metres the water temperature seemed bearable. We were laughing and shaking, waiting for the start signal.

Swim start (source: Challenge Iceland)
Swim start (source: Challenge Iceland)

Swimming started and the first few hundred meters were actually OK, like swimming in a »normal« lake. The water was crystally clear and the first problem we have encountered was its unequal depth. Therefore, we had to walk for a few meters in the middle of the lake until we could swim again. The time went by, I could feel my finger tips freezing and after swimming for 40 minutes the coordination of limbs was awfully bad…I got the feeling that I came into the coldest part of the lake. It took another 5 minutes to swim to the exit on the shore and a few minutes to get out into the transition zone. The conditions really prolonged our swimming times.

Bike ride (source: Challenge Iceland)
Bike ride (source: Challenge Iceland)

Iztok and Dušan were already starting the bike ride, when I entered the transition zone and dressed up my bike gear in a whole-body-shaking condition. As a doctor, I would of course totally disencourage anyone to perform swimming in a cold, glacier lake… I was thinking of our kidneys, our heart pumps and all the organs who had to perform their functions despite our morning glacier bathing. But on the other hand, we will never walk this road again and I knew we were well prepared and fit enough to do this without consequences. The cold water took its toll, some of the athletes had to finish their race during or after the swim…medical professionals had much work to do; from mild hypothermia to cramps. Luckily, nothing serious.

Bike ride-Dušan (source: Challenge Iceland)
Bike ride-Dušan (source: Challenge Iceland)

I took my bike and ran to the bike start area. I almost dropped it as I was getting on it. In the second attempt I managed to start biking, rain was still pouring from the sky. »Nice and easy« said someone from the surrounding crowd… and we took his advice, we did the 90 km bike ride considering all the safety precautions; careful use of brakes, slow turning. I was afraid to speed up since the road was slippery and I do not have a lot of experience with racing in the rain. All the events so far were in tropical conditions in comparison to this event. I was happy with the scenery I was able to see during the bike course. Astonishing. The road was actually traffic-free and as you were riding in the middle of the road with cliffs and shore on one side, mighty hills on another side it felt like living on another planet. The hills seemed like being there forever, long before the human invasion of this planet and they were the silent witness of our bike ride on that vintage day. From Vikings to Challenge Iceland, those hills can manage all as long as you leave nothing but footprints and take nothing but memories.

Bike ride (source: Challenge Iceland)
Bike ride (source: Challenge Iceland)

The bike course was going up and down with app. 1000 m of ascent. This warmed my fingertips, the rain stopped pouring and after 90 km it was time to do the 21 km run-a half marathon. The run took its place around the lake, two 10,5 km laps. I was so hungry when getting off the bike, I could not wait for that chocolate bar in the transition zone. I must have underestimated the conditions on the bike and took only one small bar with me on the bike… obviously not enough. I changed my clothes and started running. The run was sitauted in a lovely scenery beside the lake, there were some aid stations with chocolate and bananas. The sun was already shinning and it was time to get to the finish line. Passing the line I stopped and took a few deep breaths.

Bike ride (source: Challenge Iceland)
Bike ride (source: Challenge Iceland)

There was a hot, spicy pumpkin soup in the finish area. We ate several cups of it, and a lot of fruit, it was delicious! And all the volunteers with cool, big Icelandic hearts were there to help us through the day. We did well in competition and our highest rankings in our age groups brought us entry slots for the Challenge World Championship 2017 in Šamorin. For all the rest, I will let the pictures do the talking…

Moraviaman,18.6. 2016

It was a sunny Thursday afernoon when we packed our things and hit the road to Czech Republic, more accurately to Otrokovice town. Moraviaman triathlon is a part of Czech national triathlon championship but it is also open for foreign athletes. We arrived in the late evening and of course all the restaurants were closed. So we took a look into the nearest restaurant with lights on (later we foud out that it was actually a Texas country style bar) which served us heated deep-frozen pizzas and, of course, Staropramen beer. It looked like we were the most complex guests in the last few years since they had to brush the dust from the menu. Well, we were satisfied anyway.

The following day was dedicated to “carbo-loading”…it is that sweet part of the preparations when you have to do “all you can eat” thing. Boiled potatoes, lots of bread, pizza (from the night before), pasta (in the days before) and some muffins. I must say that the last year I was actually tired of eating so much, but this year I ate smarter: less, but with more complex carbohydrates. I was really satisfied with how I felt: strong and full of OH. In another words, ready to make a lot of ATP molecules on the Ironman day.

Dušan and I went to do the registration on Friday. Iztok was our indispensable companion since he had to skip this Ironman because of some unpredictable health issues. Luckily, he shall be ready for Challenge Iceland since it was not easy for him to skip this emotional, amazing racing day.

Transition zone
Transition zone

Saturday. The swim start was at 7 AM, so we set our clocks at 5 AM. It was a sunny, promising morning. The sun was already up and we had to prepare our things and check in the bikes. I had prepared all the accessories on the desk the night before: swimming googles, swim suit, clothes, helmet, cycling shoes, running shoes, … For breakfast we had some croissants with no filling: this always works for the first  hours.

Swim start in the morning
Swim start in the morning

And there it was…a swim start in the nearby lake. Dušan was already dressed up in his swimming suit, I had to dress up too. My thoughts were already in the evening, I had that weird dumpling in my stomach, I was trying to look calm but inside I was really tense …it was that exciting fear of the unknown, that feeling you get when you are coping with a challenge far greater that yourself. I was trying to visualize the finish line, the adrenaline that will flush me in the last kilometres of running and that deep pride inside.

As they say, the swim start in the Ironman can not be felt, it can only be lived. When the gun goes off, it is a war. A 3,8 km swim started violently, people were trying to swim over each other. I managed to make my way through the crowds. There were approximately 400 athletes and it was hard to swim for the first few minutes. The water was dark but it somehow did not bother me too much… I fell into my swimming speed and the time was flying by. We had to do three laps and in between I could see the dark clouds gathering above the lake… After approximately 1h 20 min I was getting out of the lake, the sun was shinning again and I was encouraged for the next distance: 180 km cycling.

Cycling hours - Dušan
Cycling hours – Dušan

I changed my clothes in the transition zone, that took me approximately 3 minutes. I put a banana in my pocket, took my bike and ran to the start of a long, challenging bike ride. We had to do 4 laps, each lap 45 km long. The first part of a lap was somehow boring, heading up the main road, but the second part was abundant with green scenery, with ascents and descents… altogether 800m of ascent. The winds were not helpful and so I can say that the bike course was challenging. I was cycling in a steady pace and I let my mind wander off… in the future, in the past, in imaginary worlds and then back to reality. One moment I felt so happy and fulfilled… indescribable thing. I was doing good until a weird cramp in my gastrocnemicus muscle spoiled that mental harmony… I poured some cold water on it from the bottle on the bike. It was ok then and I ignored the pain since I knew that some salt from the iso drink in the transition zone after the bike ride will save this problem. I was such a relief to get off the bike after more than six hours…

Getting off the bike
Getting off the bike

I was really relieved when the run started. 42,2 km, a marathon under the hot sun. We really tried to wash off all the salt that was left on the skin. During the run I reset my watch because I was somehow interested in the distance… and it is mentally encouraging to count down the kilometres. The runnig course was really beautiful, but not flat. There were many ups and downs and in that steep parts my running pace was slower. I tried to drink as much as I could… iso every 20 minutes. After three hours of running the tiredness was coming to the surface. The sun was already going down, loosing its power and when I took my last 10 km lap it was all so full of nostalgie, running in the middle of the wheat fields swaying in the evening breeze. I could easily cry of happiness and relief because the finish line was in the reach.

A marathon
A marathon

And there was the finish line in the evening after 13h and 12 min….  A gift for all evenings in the last months spent in preparations for this day.  I took a glass of champaign in the finisher arena. It was again an amazing day, like in the last year”s Ironman. There are many priceless moments in life, those are one of them… We achieved two third places and this was a memorable award for all of us.