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'If you went to the top of Kilimanjaronow, most would find it very hard - around nine out of 10 for discomfort' In September 15 former Wales captains and coach Warren Gatland will attempt to reach the summit of Kilimanjaro to raise money for lung cancer research. Health Editor Madeleine Brindley, who will be part of the Brains SA Captains Climb, examines the impact the high-altitude trek will have on the team.

Byline: Madeleine Brindley

AT ALMOST 6km up, the air is considerably thinner than at sea level and the body struggles to get the oxygen it needs.

People walking - or climbing - at this altitude have as much as a 50-50 chance of developing acute mountain sickness, which in turn can develop into a potentially life-threatening condition.

But even if they don't develop a high-altitude illness, most will experience some symptoms - a headache, dizziness or shortness of breath - as a result of the lower oxygen levels.

The Brains SA Captains Climb team, made up of 15 former Wales rugby captains and current coach Warren Gatland, will experience the effects of altitude first hand when they attempt to climb Kilimanjaro in September.

They will be helped in their preparation by expert Professor Damian Bailey, who conducts cutting-edge research on the UK's only acclimatisation chamber, which is based at the University of Glamorgan, in Treforest.

"If you were to go up to 6,000m now, most people would find it very, very difficult - it would be a nine out of 10 in terms of discomfort," Prof Bailey said.

"But with acclimatisation over four or five days it falls to five or six out of 10. The acclimatisation process helps you to breath in and out more efficiently and increases the red blood cell count.

"Essentially you will be able to suck more oxygen from an oxygen-depleted environment.

"The brain is very clever - the less oxygen it sees, the more it sucks out. It defends the amount of oxygen that powers the brain, which is, after all, the most oxygen-dependent organ in the body.

"Acclimatisation is about turbo-charging the body from the cellular level to organ systems, making it more efficient and effective in dealing with less oxygen.

"If you were exposed to the altitude of the summit of Everest (8,848m) without acclimatisation, within two to three minutes you would lose consciousness. But in 1978 Reinhold Messner and Peter Habeler climbed the mountain without supplementary oxygen."

At 5,893m, Kilimanjaro is the highest mountain in Africa and one of the tallest, free-standing volcanoes in the world.

The route to the summit is by a series of well defined paths and, unlike some of the world's other highest peaks, the climb is technically easy - it is essentially a week-long trek.

But this does not mean it will be akin to a walk in the park - the combination of altitude, low temperatures and occasional high winds make it a difficult and dangerous trek.

All the guides to Kilimanjaro emphasise that acclimatisation is essential and even then most people will suffer some degree of altitude sickness.

Around 10 climbers die from acute mountain sickness every year together with an unknown number of local porters - Kilimanjaro's summit is well above the altitude at which high altitude pulmonary oedema (HAPE), or high altitude cerebral oedema (HACE) can occur.

"Physical fitness is not protective," Prof Bailey said. "Fitness is important to get up the mountain but will not predict whether you get sick or not."

At just before 5,000m altitude there is around 12% oxygen in the air, compared to 21% at sea level. While the oxygen concentration in the air does not fall the higher you go, barometric pressure falls impacting on the amount of oxygen available to breathe.

"If you are acutely exposed to hypoxia it's almost like the first stages of being drunk," said Prof Bailey, who is a professor of physiology and biochemistry.

"You haven't got a sense of awareness around yourself; you feel slightly disorientated and a bit woozy. Your lips become purple and your nail beds won't flush red when you press on them.

"There's not enough oxygen in your circulation; your heart rate increases and you become breathless because you are breathing in and out more rapidly.

"Some people also get flushed because when there is less oxygen coming in the blood vessels will open up.

"After around six hours in 12% oxygen you have a 50-50 chance of getting sick and suffering a constellation of symptoms known as acute mountain sickness (AMS), which is almost indistinguishable from migraine - it includes headache, nausea, dizziness and extreme lethargy.

"The theory is that AMS is a sub-clinical form of HACE - a build up of fluid in the brain - and HAPE, which is a build up of fluid in the lungs. AMS can be a pre-cursor to high-altitude illness and typically precedes HACE or HAPE. The golden rule is to ascend 350m every day for two days and then rest on the third. But you'll be breaking that rule on Kilimanjaro, which is why it is so dangerous in terms of AMS.

"All the altitude illnesses occur because of a lack of oxygen so it makes sense that the faster you go, the higher you go and the quicker you go there will be less oxygen.

"AMS is a warning sign that there are more insidious or severe events occurring in the body.

"It's not a given that AMS will progress to HAPE or HACE but it does give you an indication of how poorly people are and if left untreated and if it doesn't settle down it can become more serious - if someone wakes up with severe AMS and it gets worse in the evening, I'd be looking to treat them and get them off the mountain."

Both HACE and HAPE are deadly and claim the lives of countless people every year. But they are also treatable with a combination of drugs and oxygen therapy, coupled with a rapid descent.

"If you can get them off the mountain, to a hospital and they are treated they will recover without any apparent neurological effects," Prof Bailey said.

"We've done studies with the aim of inducing HAPE to study the evolution of pulmonary oedema. We have then treated them aggressively once they have developed HAPE and, within 12 hours, they are like Olympic athletes and raring to go again.

"I have had HAPE - my blood oxygen levels dropped to around 38% - and it is not a pleasant experience because you know that without proper treatment you will die."

While the risk of developing HACE and HAPE is a very real one and not to be under estimated by the members of the Brains SA Captains Climb team as they ascend Kilimanjaro, it is not a given that any of the team will fall so severely ill.

But even with acclimatisation - both in the University of Glamorgan chamber before the trek and during the steady ascent of the mountain - most members of the team will suffer some form of mountain sickness as a result of Kilimanjaro's altitude.

Prof Bailey added: "Every single one will have some symptoms of AMS - everyone will feel slightly lethargic, dizzy, have a headache and won't sleep well the night before. The degree to which people suffer the symptoms will be different.

"The key is to be aware of the symptoms and that they shouldn't be getting any worse.

"There will always be some symptoms lurking in the background but it could be the harbinger of more malignant types of high-altitude illness if you continue to ascend with ever-worsening symptoms."

Rugby stars take on mountain to tackle cancer Fifteen former Wales captains and coach Warren Gatland will attempt to reach the roof of Africa to raise money for lung cancer research.

The Brains SA Captains Climb will see the stars make an assault on the summit of Kilimanjaro in September.

Media Wales health editor Madeleine Brindley will also be taking part in the high-altitude trek.

They aim to raise pounds 1m for Velindre Cancer Centre's Stepping Stones appeal, which will fund research into lung cancer and raise awareness of the disease.

The climb is the brainchild of photographer Huw Evans, whose wife Sue was diagnosed with lung cancer in 2008.

Dr Jason Lester, a consultant oncologist at Velindre Hospital, said: "With this sort of money we can make a real difference - the aim has to be a cure, to try to find a solution to this disease.

"Whether a smoker or a non-smoker, it is an horrendous disease and unfortunately most people don't do very well with it.

"Although we may never get to a cure for those people with advanced disease, hopefully we will have treatment that will keep them alive for longer and longer.

"We want to be able to turn what is a life-threatening and often fatal disease into a chronic illness, like diabetes."

To sponsor the captains visit To sponsor Madeleine visit and you can keep up to date with news about the climb and training at THE TEAM NAME: Gareth Thomas AGE: 35 CAPS: 100 (1995-2007) NAME: Colin Charvis AGE: 37 CAPS: 94 (1996-2007) This will be a great challenge but there's also a cause behind it. It's taken on a bigger influence for me because '' a family member is fighting cancer. Cancer is something that affects everyone and it's important we can raise the profile.

NAME: Mark Taylor AGE: 37 CAPS: 52 (1994-2006) ''Having lost someone to cancer many years ago, it is great to be a part of such a charity, raising money for Velindre. Climbing Kilimanjaro will be a wonderful experience and I'm so delighted that many other captains of Wales have put their names forward.

NAME: Rob Howley AGE: 39 CAPS: 59 (1996-2002) NAME: Jonathan Humphreys AGE: 41 CAPS: 35 (1995-2003) NAME: Scott Quinnell AGE: 37 CAPS: 52 (1993-2002) NAME: Scott Gibbs AGE: 39 CAPS: 53 (1991-2001) '' I've climbed Kilimanjaro once before, and it is one of the toughest things I have ever done, but when Huw asked me to climb it again, I had absolutely no hesitation in saying yes.

'' This is a cause that affects everyone because cancer affects everyone. This is something that is very worthwhile and a challenge all the boys will take very seriously.

NAME: Mike Hall AGE: 44 CAPS: 42 (1988-1995) THE TEAM NAME: Ieuan Evans AGE: 46 CAPS: 72 (1987-1998) NAME: Rob Jones AGE: 44 CAPS: 54 (1986-1995) NAME: Bob Norster AGE: 52 CAPS: 34 (1982-1989) '' Cancer is a disease that touches all our lives. When Huw asked me to take part in the Captains Climb I was delighted to accept the invitation.

NAME: Paul Thorburn AGE: 47 CAPS: 65 (1985-1991) NAME: Bleddyn Bowen AGE: 48 CAPS: 24 (1983-1989) '' I'm really excited about Kilimanjaro. We are all able-bodied people and we have to make the most of what we have to help other people.

NAME: Garin Jenkins AGE: 43 CAPS: 58 (1991-2002) NAME: Eddie Butler AGE: 52 CAPS: 16 (1980-1984) NAME: Andy Moore AGE: 36 CAPS: 26 (1995-2002) '' Huw Evans said do you fancy doing Kilimanjaro and I said not a problem - I didn't even know where Kilimanjaro was. The kids have looked on the web and they are now calling it killing-me-dad-oh."

NAME: Warren Gatland AGE: 46 JOB: Wales coach 2007 to present
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Date:Apr 5, 2010
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