Zeltweg ITU Winter Triathlon World Championships, 14.2.2016

A winter triathlon event in Austria on Sunday which consisted of running, mountain biking and cross-country skiing. The start was at the forecourt of the Zeltweg hall. The run course was flat and lead through the whole area of the sports center. Well, still there were many curves and short climbs on different substrates like snow and rocky sand.

After the transition area, the bike course went along the main road…but not on the road. It was a dirty, wet and muddy course for about 500 metres. Then the trail lead through a hall and then into a blocking terrain where there were many ascents and descents. Luckily, the path back to the transition area was flat.

The cross-country route ran in clokwise direction, it was flat and not so fast because of the artificial snow. There were two to three snow hills to break the rhythm on the cross-country ski route.

And a few graphic pictures…

Vascular Ultrasound in Phlebology

Duplex ultrasonography is probably the most frequently used investigation to evaluate the venous system for the management of chronic venous disease (CVD) of the lower limbs. Last week, I took part in practical classes organised by Slovenian Phlebological Society in Ljubljana to gain extra knowledge on this topic and to practice ultrasound investigation of the lower limb. To me and for my work general ultrasound investigation of the lower limb is not the key point, but excluding deep venous thrombosis (DVT) in emergency cases absolutelly is. Therefore, I payed special attention to DVT exclusion in practical courses and I would like to share some of this practical information here. But as with any procedure, practice makes perfect.

Source: WebMD
Source: WebMD

A few words on Chronic Venous Disease. Basically, two very useful articles proposed here (part 1: basic principles, part 2: anatomy) on anatomy an ultrasound guidance are recommended to be read. They are “open access”.

http://www.ejves.com/article/S1078-5884(05)00540-X/abstract

http://www.ejves.com/article/S1078-5884(05)00539-3/abstract

Well, Chronic Venous DIsease has four stages. In first stage patients report of pain in their legs, swollen legs which get worse in the evening. In this stage we should recommend lifestyle changes, weight reduction, more physicall activity (especially walking to activate our muscle pump in the legs). We also recommend flavonoids in pills (e.g. Detralex, …). They are natural substances with proven effect on venous disease. The second stage are varricose veins, in this stage we recommend elastic socks. In higher stages when ulcerations occur it is time to think of operation.

Deep venous trombosis (DVT) which is potentionally life threatening can be excluded with a few simple measures. We are all familiar with Wells score, we carry this med calc on our smartphones and check out the calculation whenever necessary. Then we decide whether to take the D-dimer dice or not. Negative D-dimer is a major predictor for no DVT. For ultrasound investigation, the minimal requirement is to check out the femoral vein along its way, the common femoral vein, the saphenofemoral junction (SFJ) and the saphenopopliteal junction (SPJ). We check for compressiblitity, respiratory responsiveness and reflux. I recommend one of many videos on DVT with ultrasound guidance on Youtube. Of course, as I said, practice makes perfect and in order to be better at it, it is good to take an ultraosund of veins on evry patient that comes in the ED with a suspicion of DVT.