On January 21, 2013, a group of 14 Combat Wounded and Injured military veterans and their support staff embarked on a courageous and inspirational expedition to summit the highest mountain on the African Continent, Mount Kilimanjaro. Their objective: to find medical solutions to further improve the science impacting the advancement of their prosthetics, Post Traumatic Stress (PTSD) and Traumatic Brain Injury (TBI) treatments. U.S. mountaineering guides who accompanied the Team included the founder of the Alaska Mountaineering School (AMS), Colby Coombs, and AMS senior guide Tim Hewette, both of whom are uniquely familiar with the members of the team, experienced and prepared to deal with the challenging conditions encountered by the veterans. Tanzanian mountaineering guides included Dawson, Thomas Meela, Danford, Hubert, Waziri and Roman. The expedition was the team’s second Explorers Club Expedition. Explorers Club Flag #93 was carried by the Kilimanjaro team. Flag 93 was first carried in 1939.
The J.E. Hanger College of Orthotics and Prosthetics, St. Petersburg College in St. Petersburg, Florida, partnered with the Combat Wounded Veteran Challenge to provide clinical support for amputee climbers during their expedition. In addition to the clinical support Certified Prosthetist and Program Director Arlene Gillis provided, the school allowed O&P student Ted Graves to accompany the Combat Wounded Veterans to document his own case study. His case study followed each amputee’s reaction to the environmental stresses of Mount Kilimanjaro, specifically, residual limb fluctuation in traumatic amputees during periods of increased activity at high altitudes. The main objective of the prosthetic case study was to note ways to improve and expand prospects for amputee service members who wish to return to active duty, specifically focusing on controlling and adapting volume changes inside the prosthetic socket during extended periods of high activity.
In the case study, three Combat Wounded amputee participants were measured for volume changes twice a day. During each data collection, a measurement of total body volume was taken along with segmented measurements of the residual limb. For data collection, bioimpedance spectroscopy was used. This method was utilized due to its proven accuracy when compared to other known volume measuring devices. It proved to be the best and most rugged tool for accurate measurements during the ascent of Mt. Kilimanjaro. Bioimpedance spectroscopy uses low current electrical pulses that flow through the body tissues at different frequencies. The device analyzes and converts these frequencies into usable data. The fact that this device can read the different frequencies is of high value in this study because it was required to analyze the difference between the amounts of volume that is inside the cells during that moment compared to that outside the cells. This data will aid in providing us with some answers as to what exactly is going on in the limb during activity.
We hypothesized that the changes and differences of the fluid inside the cells, also known as intracellular fluid, and the fluid outside of the cells, extracellular fluid, will be patterned according to the participant’s activity level.
Bioelectrical impedance analysis (BIA) measures the impedance or opposition to the flow of an electric current through the body fluids contained mainly in the lean and fat tissue. In practice, a small constant current is passed between electrodes spanning the body and the voltage drop between electrodes provides a measure of impedance. Using the Bioimpedance Analyzer (BIA) for a total body measurement consists of placing a total of four electrodes on the wrist and ankle and logging the data point in the BIA. The segmented body measurement consists of placing the four electrodes on the residual limb followed by the same process to log the data point in the BIA. The objective will be to correlate short-term physiologic changes with extracellular fluids volumetric changes and long-term physiologic changes with intracellular fluid’s volumetric changes. Bioimpedance measurements will be taken at key intervals throughout the day while logging environmental conditions to include, but not limited to: participant’s daily hydration, time of day, humidity, altitude, ambient temperature, and activity level.
Each data collection will consist of a total body composition measurement and a segmented body composition measurement of their residual limb. These two measurements allow us to log the total fluid in the participant’s body and track how much of that fluid is retained in their residual limb. The aim of this case study is to better understand how extreme environmental conditions affect socket fit, suspension, and its resulting adverse effects on the residual limb.
Traumatic Brain Injury
The first ever concentrated study at altitude concerning the effects of elevation, decreased atmospheric pressure and O2 Saturation on Traumatic Brain Injury was conducted and authored by Combat Wounded veteran SFC Michael Rodriguez during this expedition. SFC Rodriguez is an active duty United States Army Special Forces Green Beret with a history of multiple Traumatic Brain Injuries (TBIs) sustained from blast and blunt force. SFC Rodriguez still exhibits strong residual neurological symptoms from these events. SFC Rodriguez’s desired end-state is to document and find more effective ways to differentiate between altitude sickness diagnosis and progression versus residual TBI symptoms, ultimately learning how to prepare for and cope with these symptoms. His hope is that the data he collected will increase the survivability of service members operating in high altitude environments by delineating possible duty limitations for those with a history of TBI or even provide a safe means for an individual with neurological injuries or deficiencies to take on the challenges that increases in elevation can offer.
Post Traumatic Stress
Mr. Tom Barnhill, PTSD counselor, conducted in-field psychological research assessing veterans with PTSD demonstrating that a positively aimed team-based adventure activity, which challenges veterans both mentally and physically, best supports quality of life and a lasting reduction in PTSD symptoms.
Tom assembled a unique survey placing together validated scales, isolating some clinical dimensions of combat stress but also focusing on functioning in life. This allowed Tom to capture those without PTSD and to focus on quality of life gains while also noting clinical dimensions such as avoidance behaviors and depression. “It’s all relevant data for PTSD research”, he indicates, “specifically as well as for those without a formal diagnosis but with wounds from combat whether they be PTSD, amputations or TBI”. The results of Tom’s Case Study are forthcoming in six months after further post-event interviews.
MCPO (Ret) Will Wilson; BKA (USN)
SSG (Ret) Peter Quintanilla; BKA (USA) 75th Ranger Regiment
SGT Dan Swank; BKA (USA) 10th Mountain Division
SSG Vic “Yeti” Thibeault; (Ret) BEA (USA) 10th Mountain Division
SSG Billy Costello; AKA (USA) 3rd Special Forces Group – Airborne
Arlene Gillis; CP, LPO, M. Ed, Program Director, Orthotic & Prosthetic Program, College of Health Sciences, St. Petersburg College (TBD).
SFC Michael Rodriguez; TBI/PTSD (USA) 7th Special Forces Group – Airborne
Mr. Tom Barnhill; Expedition PTSD Research Analyst, Coordinator and TBI Evaluator.
LT (Ret) Justin Legg; Cardio/Pulmonary (USN) SEAL
Dr. David W. Zaas; Medical Director, Lung Transplant Program, Duke University.
Mr. Colby Coombs; Alaska Mountaineering School, U.S. Mountaineering Guide.
Mr. Tim Hewette; Alaska Mountaineering School, U.S. Mountaineering Guide.
CAPT (Ret) Dave Olson; (USN) Aviator
Maj (Ret) Brett Hutchins; (USAF)
Expedition brief to be conducted on site by AMS staff, indigenous guides and porters, equipment staging and final preparation.
After completing the necessary registration formalities, the team transfers by road to Nale Moru (1,950m) to begin our climb on this unspoiled wilderness route. The first day is only a half-day walk on a small path that winds through farmland and pine plantations. It is a consistent but gentle climb through attractive forest that shelters a variety of wildlife. We reach our first overnight stop by late afternoon at the edge of the moorland zone (2,600m). Approx. 3-4 hours walking.
The morning walk is a steady ascent up to ‘Second Cave’ (3,450m) with superb views of the Eastern ice fields on the rim of Kibo, the youngest and highest of the three volcanoes that form the entire mountain. After lunch, we leave the main trail and strike out across the moorland on a smaller path towards the jagged peaks of Mawenzi, the second of Kilimanjaro’s volcanoes. Our campsite, which we reach in late afternoon, is in a sheltered valley near Kikelewa Caves (3,600m). Approx.. 6-7 hours walking.
A steep climb up grassy slopes is rewarded by superb panoramas of the Kenyan plains to the north. We leave vegetation behind close to Mawenzi Tarn (4,330m), spectacularly situated in a cirque beneath the towering cliffs of Mawenzi. The afternoon will be free to rest or to explore the surrounding area as an aid to acclimatization. Approx. 3-4 hours walking.
Depart from camp to cross the lunar desert of the ‘Saddle’ between Mawenzi and Kibo to reach Kibo campsite (4,700m) at the bottom of the Kibo Crater wall by early afternoon. The remainder of the day is spent resting in preparation for the final ascent before a very early night! Approx. 5-6 hours walking.
We will start the final, and by far the steepest and most demanding, part of the climb by torchlight at around midnight. The team will proceed slowly in darkness and cold on a switchback trail through loose volcanic scree to reach the Crater rim at Gillman’s Point (5,685 m). We will rest there for a short time to enjoy the spectacular sunrise over Mawenzi. Those who are still feeling strong can make the three hour round trip along the snow-covered rim to the true summit of Uhuru Peak (5,895m), passing close to the spectacular glaciers and ice cliffs that still occupy most of the summit area. The descent to Kibo Hut (4,700m) is surprisingly fast and, after some refreshments and rest, the team will continue descending to reach our final campsite at Horombo (3,720m). This is an extremely long and hard day, with between 11 and 15 hours walking at high altitude.
A sustained descent with wide views across the moorland takes us into the lovely forest around Mandara (2,700m), the first stopping place on the Marangu route. The trail continues through semi-tropical vegetation to the National Park gate at Marangu (1,830m). We leave the local staff to return to our hotel in Marangu by mid-afternoon for a well-earned rest and a much needed shower. Approx. 5-6 hours walking.
The times and days listed above are relative to able body climbers with few physical limitations. When you factor in the compromised physical condition and prosthetic element into the equation, you will add several hours in some instances to the estimated climbing and decent times shown. Kilimanjaro is a formidable challenge that favors the strong. This exactly the element of the challenge that favors our wounded and injured veterans! Although many will attempt this climb with only one hand or one leg, others with newly tested lungs and still others bearing the sometimes crippling emotional scars of war they climb as a team with a bond few can truly understand. These men are American heroes and represent the very best this nation has to offer, we invite you to follow our progress via social media and encourage you to support this research in any way possible.