Ocean Lava Race Celje-Logarska Valley, Slovenia

On 28. 5. 2016 we were racing the only half iron distance (1,9-90-21) triathlon in Slovenia. This year it was included into the Ocean Lava Series but it has already existed since 2013.

Swim start
Swim start

The weather this year and general conditions were excellent.  The swim start was in Šmartinsko lake near Celje. The water was surprisingly not cold, but this lake is known for its large inhabitants (catfish 2 metres long etc.). Therefore we had an additional motivation to swim fast and near the group of other swimmers. It is not a lovely feeling to stay behind knowing that you might be a tempting stranger for those creatures below.  Luckily, I did not see a thing.

A beautiful forest run (Iztok and co-runner)
A beautiful forest run (Iztok and co-runner)

Bike course was 90 km long, with the last 30 km ascent to the valley. Winds were upfront, so all this together made it a quite difficult ride to T2 location. But it went fast since the nature was so astonishing you could easily forget the conditions you were in.

Mountain scenery
Mountain scenery (Dušan on the go)

The run was actually one of the most beautiful ones. There were two 10, 5 km laps and the course was going up and down in the forest. The last part, and the most memorable part, was headed to the meadow and then turning onto the soft grass with the mountain scenery in the back. Since the sun was really strong, we all got sunburned (in up-to-the knee-fashion).  Anyway, it was a nice saturday and a really beautiful triathlon in the nature.

Award ceremony (2nd place)
Award ceremony (2nd place)

Austrian 1/2 Iron Triathlon Mureck

It was a 1,9k/90k/21k half Iron distance triathlon in Mureck, Austria on 7.5. 2016. In the morning it looked like it was going to be a beautiful day, not like a week before when we had snow in the last days of April. Therefore we had a reason to expect that the water in the Rocksee lake is about to be cold. The start for the women was at 9.15 AM  and at 10 AM for the men and the sun had just began to warmen the atmosphere. When I first put my soles into the lake, I was positively surprised… it was not so cold afterall. The water had 18°C but I was ok with it for that 40 min swim.

Rocksee, 7.5. 2016
Rocksee, 7.5. 2016

There was one slight problem in transition 1, getting out of the water and on the bike, because I had some problems with taking off my swim suit. It just did not want to go off! And it took me more than three minutes to get out out T1 zone with my bike. I was already on the bike for 15 minutes when Iztok and Dušan started their race in the second wave-men start.

Rocksee, 7.5. 2016
Rocksee, 7.5. 2016

There were two 45km bike laps and it took me 2h and 53 min for both laps, taking into account the two hilly passages in the middle of the lap. The bike course was windy most of the time and it took a lot of effort to cycle against it. Transition 2, from bike to the run, was much faster, taking a little bit more than one minute.

Rocksee, 7.5.2016
Rocksee, 7.5.2016

The run was very beautiful, two laps around the lake and into the forest. On the run the sun was already hot and many of us took some seconds to drink cola in between running. It really felt good. Rushing against the 21st kilometer of running I was already seeing the finish line and passed it after 5h 16 minutes and 51 seconds. And that is my recors for this distance. Not to mention, I achieved the firts place and a voucher for shopping in Giga Sport. It was worth sweating for. 🙂 After the race, there was an award ceremony and we took the chance to meet and make a photo with Marino Wanhoenacker,  a Belgian triathlete who broke the world record for the full Ironman triathlon at Klagenfurt in Austria, finishing after 7 hours, 45 minutes and 58 seconds.

Rocksee, 7.5. 2016
Rocksee, 7.5. 2016

At the end of the day, we went for a tasty dinner and this was the best possible ending of that perfect day.  Anyway, the trainings contiune, there is 5 weeks until the full Ironman distance.

Ehinokokoza

Zgodba iz vsakdanjika. Nekaj, kar se pri nas diagnosticira vsakih nekaj let.

Moški v srednjih let sprejet zaradi enostranske pljučnice in pnevmotoraksa. Vse skupaj se je začelo z epizodo kašlja, ob katerem je za kratek čas izgubil zavest. Na CT-ju prsnega koša pa presenečenje… slika, identična spodnji.

Vir: www.radiopedia.org
Vir: www.radiopedia.org

Torej, na prvi pogled izgleda kot klobčič parazitov v levem pljučnem krilu…in tako je tudi v resnici. Kasneje je bilo z analizo dreniranega materiala iz ciste ugotovljeno, da gre za ehinokoka. Bolezen, katero povzroča, pa se imenuje hidatidoza ali ehinokokoza. Pogosto se bolezen začne popolnoma brez simptomov in traja leta in leta.  Najpogostejša je alveolarna oblika bolezni, kakor zgornja, ki se najprej začne v jetrih (in v resnici je bila na ct-ju vidna tudi zgostitev v jetrih) in se nato širi v možgane ter pljuča. Ko bolezen prizadene pljuča, pride do zgoraj opisanih simptomov.

In kje v naravi se lahko okužimo s trdovratnimi jajčeci tega parazita? Najpogosteje so s paraziti okuženi psi, lisice, volkovi. Jajčeca se nato v naravo izločajo z njihovim blatom, človek pa se okuži preko tesnega stika z okuženo živaljo ali njenim blatom. Psi, lisice, volkovi pa parazita dobijo s prehranjevanjem s surovimi organi recimo ovc ali glodalcev.  Seveda se lahko tudi mi okužimo s tem, ko jemo recimo premalo pečeno ovčetino ali drugo meso.

Zdravilo, ki se uporablja za zdravljenje je albendazol – širokospektralni antihelmintik. Včasih ga je potrebno jemati tudi več let. Seveda pa je ob formirani cisti indicirana kirurška odstranitev le-te.

It all starts with a plan

And it is good to have one, I agree. In a sport field we have a few self-challeging goals for this season. If you set up a goal, it is of course easier to commit to it, not looking right or left but going straightforward to the finish line. The best part of this journey is the journey itself. And all the time you have invested enriches your album of experience, your personality. Therefore, never regret the time invested in reaching your goals… the fact is that the time will pass anyway. And it is not about the results, it is about getting to the finish line feeling satisfied with your race against yourself. It is an art to combine your full-time working responsibilities and training and therefore I really respect the older athletes, being successful in their career, having two or three happy kids (who can not wait to pass the finish line with their parents) and a family and doing the Ironman. And not to mention that those were the one of the most positive, inspiring people we have ever met.

Vir: www.pinterest.com
Vir: www.pinterest.com

In April we are running an Ultramarathon in Istria, in May the first half-iron distance triathlon this year. Then comes June and an a fulfilling full Iron distance triathlon in Czech Republic. I know all the excitement will be as rich as the first time last year… leaving the comfort zone and looking forward to it. Then in August again one half-Iron distance in Slovakia. For autumn we do not have a plan yet, but working/professional responsibilities always come first so sport will  have to step aside in autumn in order to commit fully to other projects.

Now, I have it written!

I will probably often return to this post when searcing for motivation, inspiration for another afternoon training sesson (the problem is that before the Iron day the long endurance bike rides all become the same). But the passion for life felt on a racing day will pay off all the efforts and I will forever know I did not miss an opportunity to feel it and that I gave great memmories, created with my loved-one, a chance to happen. And that is the spirit of the Ironman triathlon.

Zgodnja obravnava menopavzalnih težav

Iz letošnje Menopavzne šole v Ljubljani sem želela izluščiti predvsem napotke, ki bi mi bili kot družinskemu zdravniku v pomoč pri obravnavi pacientk z menopavzalnimi simptomi, seveda temelječ na znanstveno potrjenih dejstvih. Veliko je bilo govora tudi o hormonskem nadomestnem zdravljenju, katerega pa prepuščamo ginekologom. Izven hormonskega nadomestnega zdravljenja namreč obstaja kar nekaj pristopov, s katerimi se je vredno seznaniti. Poleg tega se mi je tudi razjasnil pogled na t.i. bioidentične hormone, ki so predvsem v Ameriki zelo “opevani”, a je resnica povsem drugačna. Priznam, da je tudi mene mikal študij (na daljavo) tovrstnega zdravljenja v Belgiji, a se mi zdi pametno glede na dosedanje znanstvene izsledke s tem še malo počakati.

Kot vemo, je menopavza zadnja menstruacija v življenju ženske. Določamo jo retrogradno, pri  nas se pojavlja okoli 50.  leta starosti, v stari grščini pa klimax predstavlja zadnjo najvišjo prečno letev ali zaključek stopnišča. Sicer so longitudinalne študije pokazale, da se postopno izčrpavanje in upad plodnosti pojavi že vsaj 10 let pred foliklov v jajčniku pade pod 25.000.

V zgodnji pomenopavzi prevladujejo spremenjeni fiziološki procesi prilagajanja na spremenjeno hormonsko ravnotežje v telesu in na pomanjkanje estrogenov. Pomenopavzno obdobje je povezano z naravnim izgubljanjem mišične mase (sarkopenija) in mineralne kostne gostote (osteoporoza). Upad mišične funkcije je predvsem v stilu izgube hitrih mišičnih vlaken, zato verjetno po petdesetem letu ženske ne bomo prekosile svojega hitrostnega rekorda na 42,2 km pri 25ih.  Kostna gostota se začne spreminjati zaradi povečane razgradnje kosti in njene zmanjšane izgradnje.

Lajšanje klimakteričnih težav je sicer v domeni ginekologov, ki lahko ženskam predpisujejo različne oblike hormonskega nadomestnega zdravljenja, A vendar nekatere ženske tega zdravljenja ne smejo uporabljati, ga odklanjajo ali pa jih zanima naraven način zdravljenja, fitoterapija. Učinkovitost slednjega potrjuje veliko število kliničnih dokazov in kot samozdravljenje jih lahko svetujemo v ambulanti. Poznamo dve veliki skupini naravnih snovi, ki se na tržišču pojavljajo kot snovi za lajšanje klimakteričnih težav.

a) Fitoestrogeni (v prehrani ali koncentrirano v obliki prehranskih dopolnil)

b) Zdravilo naravnega izvora: grozdnata svetilka (Cimicifuga racemosa)

Fitoestrogen je vsaka snov rastlinskega izvora, ki je strukturno in/ali funkcionalno podobna estrogenu in njegovim aktivnim metabolitom. Po domače: lajša menopavzalne težave, saj deluje kot estrogen. Poznamo več kot 20 različnih fitoestrogenov, ki se nahajajo v več kot 300 rastlinah. Fitoestrogene razdelimo v dve veliki skupini: lignani in izoflavoni. Med pomembnejšimi viri izoflavonov sta soja in črna detelja, lignane pa najdemo v lanu, žitaricah, sadju in zelenjavi. Na primer: Azijke le redko poročajo o menopavzalnih teđavah in kot možno razlago za to lahko jemljemo dejstvo, da je njihova prehrana bogata s sojo, kajti njihov dnevni vnos sojinih izoflavonov znaša do 100 mg dnevno. Pri nas v Evropi pa so vnosi do 2 mg maksimalno. Svetujemo lahko torej večjo vključenost omenjenih hranil v prehrano, a lažje je zadosten vnos zagotoviti z rastlinskimi pripravki, ki se na tržišču pojavljajo kot prehranska dopolnila  (npr. Menosoy in drugi).

Vir: www.nutragreenbio.com
Vir: www.nutragreenbio.com

Drugo naravno zdravilo za lajšanje klimakteričnih težav je ekstrakt korenike rastline grozdnate svetilke. Gre za severno ameriško in kanadsko rastlino, poznano kot kanadsko zdravilo. Naravno registrirano zdravilo iz grozdnate svetilke je Remifemin. Izsledki predkliničnih in kliničnih raziskav pa so potrdili, da lahko pacientke to naravno zdravilo varno uporabljajo in naj bi bila celo primerljiva s hormonskim nadomestnim zdravljenjem. Bolj kot estrogenska aktivnost naj bi bil učinek grozdnate svetilke vezan na spremembe na ravni nevrotransmiterjev v osrednjem živčnem sistemu. Raziskava Liskeja in sod. je potrdila odsotnost estrogenskega učinka rastline, ugotovili pa spremembe v prenosu preko dopaminergičnih in serotoninskih receptorjev.

Tudi pri nas bi lahko torej ženskam z blagimi klimakteričnimi simptomi najprej priporočali spremembo življenjskega stila in sočasno uporabo naravnega zdravila grozdnate svetilke ali prehranskih dopolnil s sojinimi izoflavoni, predpisovanje hormonske nadomestne terapije pa naj ostane standard za zdravljenje zmernih in hudih klimakteričnih težav.

Treviso Marathon, 6.3.2016

On March 6th, Sunday, we took part in Treviso Marathon; 42,2 km run. Well, for the beginning I made three classical pre-marathon mistakes: new shoes worn only for a 5km run a few days before, too much clothes, no chocolate bars in the pocket (the first crackers were available on 21st km). Therefore, I enjoyed running the first 32km, but the last 10 km were a bit painful (or very painful) and I had to slow down the pace.

Treviso Marathon Finisher Medals
Treviso Marathon Finisher Medals

There is an interesting phenomenon, which I always observe in long distance running.  It is the group effect. Though I have I feeling  that I am running at a training pace, when I look at my Garmin, I am surprisingly 1 minute faster as it seems to my “internal pace detector”. I tried to explain it with relativity. I could say that I seem faster because some other runners I pass are a bit slower. But this theory falls since Garmin gives an exact pace per kilometer.  Well, the other theory is, of course, the group. It is very simple.  When you decide to follow a fast group, you somehow become faster too. Up to 40 % faster.

But as I mentioned in the introduction, this was not the case here. 🙂 At least not for the last 12 km…

Konoplja v medicini II

Tokrat pa nekaj več o medicinskih učinkih konoplje oziroma možnostih njene uporabe v medicini. Iz 11. stoletja izvirajo prvi znani zapisi o uporabi konoplje kot zdravila. Takrat jo je arabski učenjak al-Majusi uporabil za preprečevanje epileptičnih napadov. Poznejše in tudi sodobne klinične študije potrjujejo učinkovitost THC-ja kot antiepileptičnega zdravila. Kot vemo ima THC psihoaktivne učinke, zato večjo potencialno vrednost pri preprečevanju epileptičnih napadov pripisujejo drugima dvema fitokanabinoidoma: kanabidolu (CBD) in tetrahidrokanabivarin (THCV).

Na področju zdravljenja nevrodegenerativnih bolezni je bilo ugotovljeno, da THC kompetitivno zavira acetilholienesterazo, CBD pa zmanjša tvorbo reaktivnih kisikovih spojin, katere izvirajo iz beta amiloida – tako in vivo kot in vitro. Oboje je seveda pomembno s stališča Paarkinsonove kot tudi Alzheimerjeve bolezni. Na področju zdravljenja multiple skleroze, ki je kronična, progresivna bolezen z demienilizacijskimi poškodbami, so klinično preizkušali THC, CBD in dronabinol in dokazali manj spastičnosti in oksidativnega stresa. To je pripeljajo tudi do pridobitve dovoljenja za promet za prvo zdravilo, ki vsebuje kanabinoide rastlinskega izvora: Sativex. Tudi v Sloveniji bi ga lahko predpisali pacientom z multiplo sklerozo, kateri bi nato hodili v lekarno po svoje doze konoplje, a je proces menda tako zapleten (utemeljena indikacija, naročilo lekarne za uvoz točno določene količine zdravila, papirologija), poleg tega pa tudi zdravniki premalo (nič) ne vemo o njenem predpisovanju, da to preprosto ni stalna praksa.

Source: www.everydayhealth.com
Source: www.everydayhealth.com

Kanabinoidi so posebej pomembni tudi na področju zdravljenja kronične bolečine. Kanabinoidi namreč preko receptorjev CB1  preprečujejo sproščanje vnetnih mediatorjev iz mastocitov, preko receptorjev CB2 pa posredno stimulirajo opioidne reeptorje, prav tako pa povečujejo tudi analgetični učinek NSAR (nesteroidni antirevmatiki). Lahko rečemo, da imajo kanabinoidi protibolečinski učinek v perifernem živčevju, hrbtenjači in možganih in bi lahko postali ustrezna alternativa danes široko uporabljanim (še posebej v ZDA) in odvisniškim opioidom. Kar četrtina kliničnih študij, ki trenutno poteka, preučuje vpliv kanabinoidov pri bolečini.

Kanabinoidi tudi stimulirajo apetit in povzročijo povečan vnos hrane, kar je še posebej pomembno pri rakavih in kahektičnih bolikih.Na področju zdravljenja raka so  ugotovili protitumorsko aktivnost na in-vitro in živalskih modelih, žal pa primanjkuje tovrstnih kliničnih študij na ljudeh. Na Zdravniški zbornici naj bi kmalu potekalo izobraževanje o medicinski konoplji in možnostih njenega predpisovanja, vsekakor pa bo potrebno v eni izmed naslednjih objav spregovoriti tudi o toksikologiji in nekaterih nevarnostih konoplje.

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…