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.

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.

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.