Tuesday, 27 August 2019

Muscle fibers, I ran the 42 km Reykjavik Marathon without specific training

Why did I run the 42 km Reykjavík Marathon on 24th of August 2019 ?



by Ovidiu C. Banea, MD
Clinical Neurophysiology and Sports Medicine specialist


The simple answer to the question from the title would be: I ran the marathon because my colleague, Eysteinn Ívarsson told me on Friday 23rd of August 2019 at 4:00 pm that he cannot come on Saturday to help me with a sleep video-polysomnography because he has to run the marathon and he will be tired in the evening. And yes, this was enough to rise my curiosity and look to internet and find information just before the weekend of marathon started. It was 6:45 pm when I was looking for a parking place at Laugardalsholl Sport Center. 10 minutes were enough to register myself and to get my registration package to my first 42 km marathon.

Disclaimer: 
Please note that this report is just a simple story and you should consult a doctor before you run a marathon. Twelve runners died at the end of their 42 km only at London Marathon since this started in 1981 (here) and 50 died worldwide after the first Marathon runner, a soldier named Philippides  died in Athens after the run of 42 km to announce the Battle of Marathon victory. Before this, he had other runs of 240 km to Sparta and back and he fought in the morning with the Persians, this being probably  the reason of the exhaustion which lead  to his dead after the 42 km run. Now, ultramarathons of 50, 100 km or other distances are organized in mountain terrain, desert or ice environment.

If you are one of the pupils who remained between the lasts when your sport teacher asked you to run 3 kilometers surrounding your school it might be that you are like me or I am like you and that in some of our muscles the predominant fibers are the slow twitch muscle fibers or Type 1 (ST).  
ST muscle fibers are more efficient at using oxygen to generate more ATP fuel for continuous, extended muscle contractions over a long time, firing more slowly than fast twitch fibers and can go for a long time before they fatigue. Slow twitch fibers are great at helping athletes run marathons and bicycle for hours (here). 

Why did I run the #ReykjavikMarathon 2019 ?

In my childhood I did swimming for few years, then equitation, and I have been training weekly with 5-8 km running through forest near my city of Sibiu while I was Mountain Rescue Team member. 
I climbed mountains like Retezat, Rodna, Caliman, Ceahlau, Bugegi, Fagaras in Romania, Certascan Peak in Pyrenees Mountains or Uhuru Peak (5895 m) in Kilimanjaro, Tanzania. I am traveling to Romania each year in Danube delta and almost every year I walk from Letea village to Periprava village and back around 24-28 km depending on how many sent dunes I cross or if the floods period worsens the pass through the wild forest. The last "walk" of 5 km in Danube delta was on June 2019. On the 2nd of August 2019 with two colleagues from Nordic Romania NGO Iceland and 5 Icelanders I helped Icelandic authorities from 1:30 am to 6:30 am to keep alive 9 pilot whales after they stranded at Garður, near Keflavik airport, wearing cubes of water. This was my last physical effort before the race of 42 km. So, am I considering myself physically trained to run a marathon? Not to run, no. Then why did I run a Marathon? Psychologically I had my challenges in the past. I did not run, I just walked, I went to the Marathon to walk, so I used the run-walk strategy and my target was 6 hours. Every trained marathon man or woman is doing the race in 4 hours. I finished my race after 6 hours and 36 minutes.

What did I do to succeed?

In the evening, before the race I went to an Icelandic geothermal pool in Reykjavik where there is a powerful hydro-massage pot. There I used the moving water to train my peripheral lower limbs proprioception, the GTOs from both ankles and both knees for more than 5 minutes each but also I let the water to press on the hamstrings, quadriceps and triceps surae muscles for a while, thinking that my muscles spindles are also in need "to move" and trigger the gamma motor co-activation the second day. I went then to the cold pot where I usually go for 2-3 minutes. Before I left, I measured my weight, it was 87 Kg.  At ten a´clock I was buying at Hagkaup two raw eco energy bars, 450-600g of Icelandic code which I ate with 3 eggs at home. I also drank 1 liter carrot juice when I left the store (I was thirsty after the pool) before the fish meal and half liter isotonic when I went to sleep.
In the morning, 70 minutes before the race I drank 2 bottles of 250 ml isotonic Aquarius and ate 1 Icelandic 500g blueberries Skyr (yogurt), 4 biscuits and 2 apples. During the race I have been drinking 4 x 500 ml isotonic water by filling my bottle at drinking stations. Sometimes, I had 2 glasses of water. In total, during the day before and during the race I consumed 4,5 - 5 liters liquids (During the race 2,5 L). There is a risk if one drinks to much to suffer of hyponatremia which causes collapse and other side effects which may be irreversible and fatal.

The race: I started the running-walking at 8:40 am and I was feeling the anaerobic-aerobic change after 8-10 minutes, 10 km being achieved at 1:24 minutes after the start. The right shoe was pressing over the anterior tarsal region, so I had to release the cordon. The 21 km were passed at exactly 3 hours. I didn´t look to the watch I was just following and enjoying the race analyzing other runners. My first attack of soreness started bilaterally at quadriceps then also at gastrocnemians. I was thinking that there is no possible that the pain is due to muscle elongation or fibrilar rupture because the bilaterality, so I stopped to stretch 2 times. I did not feel tired at all. When the second pain attack occurred I was at 26 km from start. At that moment I started to walk lateral and sometimes backwards. It was the time when I ate the two energy bars and when I reduced the intensity of walk. After 20 minutes of slow walk I was able to run again. Every 5 km I was eating 1 or two Phoenix dactylifera, commonly known as date or date palm (döðlur, in Icelandic). After 30 km the physical senses and soreness stabilized there was no more need to stretch. I was arriving to the city together with Japanese and Taiwan people but also with few older ladies from USA. When I was crossing near "Penninn Eymundsson Skólavörðustíg" people clapped their hands and encouraged us. We were seeing the 40 km sign. From this moment there was question of records-breaking. I left the group and I have been running again. After one kilometer I was seeing Harpa, I was running-walking like in the morning. My video and Marathon Photos VIDEO with me.

I arrived at the finish line at 3:20 pm 40 minutes before the organizers quit the stands and closed the race.

I was having diffused pain in my legs. I sat for 20-30 minutes, then I went to my car and directly to the Icelandic pool where I moved slowly the legs. I went again to the cold pot, this time only for 1 minute and I had the water only over the legs. I was 87 Kg. I did not use any pain-killer or ibuprofen until Sunday morning when I used the first of two. The medication might mask other signs of serious injuries or chest pain. Today after 48 hours from the race I can walk much better than exactly after the marathon. The soreness or muscle contraction I feel it at both gluteal regions. 


Reykjavik,
27th of August 2019

Monday, 8 April 2019

FIRST HEILA VISTFRÆÐI JOURNAL CLUB MEETING

Possible evidence of human ability to detect Earth's magnetic field found HERE.
First Journal Club Meeting at Reykjavik, Iceland

We talk about the 6th human sense, MAGNETO-RECEPTION IN HUMANS






Thursday, 24 January 2019

D wave IONM in Iceland. Third case: Meningocele


IONM for medular herniation at T5 level Use of D-wave 

HERE

Ovidiu C. Banea, Halldór Skúlasson, Ingvar H. Ólafsson, Aron D. Jónasson and Eysteinn Ívarsson

52 y.o. with meningocele.

Modalities:

MEP with direct cortical stimulation (560 V to the left and 890 V to the right) with train of five from C1-C2 and C3-C4 to:
- Right EDC, APB, TA, AH
- Left APB, TA, AH
SSEP were performed from lower tibialis nerve and recorded to FpZ-Cz´ and from median nerves to Fpz-C3´ and Fpz-C4´. Both were controlled at popliteal fossa level (TN) and spinal C7 (TN and MN).
D wave was obtained rotral and caudal to the defect with D-wave electrodes after stimulation at 1Hz continuously (199V)
TOF was used from rioght median nerve to right APB.  was 100-99% during the entire surgery.
EEG was analized from C4´-Fpz and Fpz-C3´channels.

Results:
At the beginning of the surgery MEP was obtained in the upper limbs and left lower limb muscles. Right AH muscle was very difficult to elicit with 890 V, while TA in the right side was not obtained. At the end of the surgery the MEP were similar with those obtained at the beginning.

SSEP showed normal latencies during all the procedure. At the middle of the surgery, SSEP from right TN decreased 10-20% in amplitude. Rapidly we confirmed the decreased TA when asked the anaesthesiologist. After 5 minutes the SSEP recovered baseline values.

D-Wave was unchanged during all the spine manipulations and the defect corrective procedures.

Conclusion:
The IONM was successful and all modalities showed normal evolution. We do not expect sensory or motor new neurological deficits.

Technical data:
-Surgery duration 4,5 hours.
-Material: 11 subdermal needle paired electrodes, 4 monopolar subdermal needle electrodes, 2 D-wave electrodes, 8 Cork-screw electrodes, 1 ground electrode.

Neurophysiology Plus Iceland © 2019



Meningocele at T5 level.


 After surgery.
 SSEP upper and lower limbs

 MEP in lower limbs

 D wave: left rostral and right caudal
D wave: upper trace rostral, lower trace caudal. Latency 5-6 ms and amplitude 8uV.
The reference electrode was placed between two electrodes. (phase reversed peak).
It would be useful to reference both electrodes to a proximal sub-dermal well inserted electrode.

Monday, 13 August 2018

VAFO project Iceland, QEEG, P50, P300 recordings

On 11th of August 2018 VAFO project started officially with the first healthy subject data acquirement in the Icelandic Center for Neurophysiology, Department of Biomedical Engineering, Reykjavik University.


Valerio Gargiulo, Fabio Barollo, Eysteinn Ívarsson and Martin Freiler


Dr Sigurjón Stefánsson gave us important insights on methodology of P50 and P300. 
Continuous averaging is still a desired EEG system option to avoid artifacts during recordings.

Thursday, 9 August 2018

VAFO project Iceland: P50, P300, QEEG objective measurements for schizophrenia patients

by Neurophysiology Plus Iceland

Reykjavik, 9th of August 2018

A team of young researchers leaded by biomedical engineer Dr Paolo Gargiulo, from Reykjavík University, Department of Biomedical Engineering performed successfully the first data acquiring for a healthy subject recording P300, P50 and dense array 256-channel EEG.

P300 was first used in Iceland by Sigurjón B. Stefánsson and Anna L. Möller since the nineties.
Scientific data was published in 1995 and 2001 and 2005.
In July 2017 P300 returned to Iceland in Clinical Neurophysiology Unit of Landspitali (here).
P50 was acquired first time in patient with tinnitus on 20th of February 2018 in a paired-stimulus
or conditioning-testing paradigm, (S1, conditioning click; S2, testing click; 500 ms inter-click interval; 10,000 ms inter-pair interval). This was a trial of 30 paired stimulus with sensory gating with stimulus in the left and observed from Cz-A2 (right cortex) and with absent wave and response from the left Cz-A1 channel when stimulus was applied for the right ear.

Today the team formed by:

Viktor Díar Jónasson, Clinical Psychology master student at the Department of Psychology, Reykjavik University
Fabio Barrolo, PhD student at Reykjavik University Iceland / Aston University, Birmingham, UK, Biomedical Engineering
Valerio Gargiulo, Research assistant at the Icelandic Center for Neurophysiology, legal advisor and EEG technologist at Department of Biomedical Engineering, Reykjavík University
Eysteinn Ívarsson, Psychologist and technologist at Clinical Neurophysiology Unit, National University Hospital of Iceland
Ovidiu Banea, PhD student at Reykjavík University, Department of Biomedical Engineering and Clinical Neurophysiologist MD at National University Hospital of Iceland

performed both P300 and P50 acquisition with dense array 256 channel EEG system at the Icelandic Center for Neurophysiology, Department of Biomedical Engineering, Reykjavík University

Video on YouTube


artifact removal process, 256 channels EEG raw data

256 brain P50 map and selection of the 4 representatives lines

Valerio Gargiulo, Viktor Díar Jónasson, Eysteinn Ívarsson

Fabio Barollo



P 50 experimental


P300 experimental

256 channel dense array EEG, set-up



Friday, 18 May 2018

Yanny and Laurel explanation

Two days ago a BBC news announce that the computer generated word "Laurel" produced an internet debate if this is heard as "laurel" or "yanny".


The sound specialists run to explain how the humans are losing the higher frequencies listening ability with the age and this why we might listen the world with lower frequencies as is would be "laurel".
I was listening the playback and for two days since the Head of Neurology Department and one colleague told me the story and the new internet debate news, I always had listen the "yanny" word.
30 minutes ago I started to listen "laurel" word.
Yes, I know the word was created by computer and is an artificial voice the human cannot reproduce. The sounds are fake and the frequency differences are very difficult to assess by a computer voice generator. I remember the applications when you press a word text and suddenly you could listen it. This happened more than 6-7 years ago. There was no tonality, no stops or pause between words, no comma. You had to do everything.
But what happened to me? Why did I hear "laurel".
I did something before changes occurred. And I said to me, yes.
The gabaergic neurons from my cortex are weaker (the inhibitory mechanisms of my cortex were diminished by the substance intake)  and the sub-cortical areas and temporal lobe auditory cortex or let us say the auditory biological neural network is now a little bit more "awake"  and can hear the lower frequency. Or the higher frequencies are perceived with more glutamatergic (excitatory neurons) mechanisms? Is this known?
Ono et al 2017 found that responses to pure tones of both inhibitory and excitatory classes of neurons were similar in their thresholds, response latencies, rate-level functions, and frequency tuning, but GABAergic neurons may have higher spontaneous firing rates.
The auditory phantom perception biological neural network (BNN) 
involved in the subjective tinnitus perception

Conclusion:
The debate is easy: We are in front of unknown auditory perception mechanisms of a fake *artificial* sound. It seems that all is in our brain and that the gabaergic inhibitory mechanisms are involved. As much as you approach the freedom of the deeper brain structures (by forming gaps in the cortex "analytical" system) you will listen differently the word.

by Neurophysiology Plus Iceland, 18.05.2018


Monday, 26 February 2018

Cerebellopontine angle (CPA) mass IONM

by Neurophysiology Plus Iceland © 2018


IONM in 31 year-old male patient with 43/41mm right cerebello-pontine angle (CPA)  tumor
(e-Bulletin report)

We performed the following modalities:
Transcranial MEP, Corticogeniculate MEP (CoMEP), SSEP from both tibialis nerve, EEG, mapping cranial nerves (accesorius, hypoglossus, glosopharingeal, facialis ), BAEP, TOF, Blink Reflex.
Results: All modalities could be performed with exception of blink reflex which was not elicited.
Incidents: At the end of the surgery we observed decrement of right facialis (Orbicular oris muscle), CoMEP decrement of more than 80% which did not recover throughout the rest of the surgery. Surgeons explained that "there was a bleeding around the nerve". They started cooling,  irrigate and "treat" the lesion.  Mapping showed also partial decrement, but recovered after 20 minutes when stimulation was performed proximally.
Our protocol for corticobulbar MEP was double train: 1st train formed by 5 stimuli with 50 ms duration (ISI 2ms), 2nd train (single pulse 50 ms)  ITI (inter-train interval) 40 ms.
LIMIT: The assessment was possible for the right Orbicularis oris muscle and slightly for the right Orbicularis oculi muscle. No responses were obtained from the left muscles (we didn´t increase the stimulus intensity to look for the better Threshold-level ) and we consider the absence of other muscle MEP ipsilaterally (e.g. mentalis) as a serious limit of interpretation.



Right Orbicularis oris Corticogeniculate MEP decrement



Mapping with 0,3 mA baseline

Mapping with 0,86 mA (after the decrement was seen in CoMEP)

Conclusions:
Ø  All modalities with exception of  CoMEP showed similar findings at the end as at the beginning of the surgery. R1 (Trigeminofacial reflex) was not possible to elicit during this surgery.
Ø  Mapping was useful to drive the surgery moments before debulking and after the surgical removal of the tumor.  We expect partial facial nerve dysfunction (temporary deficit) in the right side.
Ø  24h after surgery, the patient showed 60% function of facial nerve preserved, Grade III (of VI) on House-Brackmann. Other VIII, IX and XII monitored cranial nerves didn´t show deficit 24 h after the surgery.
Ø  CoMEP as a measure of corticogeniculate motor tracts with different and variable assessment protocols should be considered as mandatory when trigeminofacial reflex (R1) cannot be monitored and the interpretation of the amplitude loss should be verified with anesthesist, neurosurgeons and with T-L technique (Calancie B, 2017).

Reference:
Intraoperative Neuromonitoring of CPA mass by Alba León Jorba & Ovidiu C. Banea (Oct 2014 IMGB)