the explorers journal - The Explorers Club

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E x t r e m e m e d i c i n e your health and safety in the field He alth in the final Frontier zero gravity and other challenges by Michael J. Manyak, M.D., FACS Long before the first manned space flight, humanity dreamed about civilian space travel. As this sci-fi fantasy nears reality, major concerns about safety persist. Explorers Club Fellow Richard Williams, M.D., NASA’s Chief Health and Medical Officer, addresses some major issues of space travel health. Williams has extensive experience in health care for U.S. astronauts and development of public policy regarding space health and travel, and discovered a syndrome related to balance problems during high G-force flight. MJM: What are the unique medical problems associated with space travel RW: Microgravity, space radiation, and isolation and confinement all can produce changes in physiology and behavioral health. Adaptive physiological changes after exposure to the space environment can increase the risk of pathologic conditions on Earth. Some examples 54 are transient adaptations of neurologic and balance systems (resolved within days of return), bone-mineral density loss in microgravity, muscle strength loss in microgravity, possible immune compromise, and cataract development years earlier than expected. Other problems related—and possibly unique—to space travel may emerge as knowledge and evidence grows. MJM: Aside from normal exclusions for remote travel (i.e., cardiopulmonary instability, unstable diabetes, etc.), are there other medical conditions that may not impede terrestrial travel that would preclude space travel RW: Our experience so far shows that travelers can experience the space environment for short durations (minutes to days) with medical conditions acceptable for travel to remote and extreme terrestrial environments. But like in extreme Andromeda galaxy, 2.5 million lightyears away. Image courtesy CalTech Palomar observatory.
Earth environments, the longer the duration of stay, the higher the risk of an underlying medical disorder causing untoward consequences. MJM: Isolation and stress could certainly create psychological problems, especially in someone with an underlying predisposition or susceptibility. How do you screen for psychological stability for long-duration space flight RW: NASA employs a team of psychiatrists and psychologists to provide behavioral health screening, through interview and testing, prior to selection as an astronaut. NASA behavioral health personnel support astronauts, and the flight surgeons taking care of them, throughout their careers. This behavioral health support intensifies before, during, and after missions—especially long-duration missions—with scheduled opportunities for crew members to interact with behavioral health specialists. MJM: Ionizing radiation is more intense in outer space. How much of a problem will this be and what measures are being entertained to protect travelers RW: Space radiation is different from most terrestrial sources of ionizing radiation. Space radiation consists of particles (protons, electrons, neutrons, and the nuclei of elements) traveling at light- and near-light-speed. These particles cause damage at the cellular level as they pass through tissues. The biological effects of this unique radiation are not well known, and research is being pursued to delineate the short- and long-term risks better. Spacecraft themselves afford some protection from space radiation, and spacecraft like the International Space Station (ISS) contain areas where the crew members can take shelter in the event of a space radiation event (such as a solar particle event). Research for effective shielding materials and techniques is a priority. MJM: What are the long-term effects of microgravity and how will those be addressed or minimized RW: The known long-term effects of microgravity relate mainly to loss of bone-mineral density, cardiovascular deconditioning, and loss of muscle strength. These are minimized by aggressive aerobic and resistive exercise regimens on orbit, and aggressive rehabilitation upon return. Evidence concerning long-duration space flight is still in its early stages, though, and other conditions and microgravity related health liabilities might surface. MJM: How do nutritional requirements for space travel differ from terrestrial requirements RW: Nutrition remains one of the great challenges of human spaceflight. Many astronauts find that foods taste more bland in space. Some crewmembers experience weight loss. A great deal of effort is spent on providing a diet that is as interesting and varied as possible, while still fulfilling nutritional requirements. MJM: What medical issues occur with high-G forces encountered on launch and reentry RW: Space Shuttle crew members are exposed to a maximum G force three times that of gravity. Despite microgravity deconditioning, crew members tolerate reentry well. Long-duration crew members return lying recumbent to minimize the untoward effects of G forces. The longer the duration in space, the more difficult G forces are to tolerate. MJM: What technologies will be utilized to monitor astronaut health RW: On the ISS, we can remotely monitor vital signs and ECG, perform video telemedicine activities, perform ultrasonography, and accomplish limited laboratory work. We are developing advanced ultrasonic, colorimetric, chromatographic, video, and other technologies to monitor astronaut health in real time. MJM: If an adverse medical event occurs, will there be instant communication back to earth to inform and receive instruction on medical management RW: Communication delays in low Earth orbit (LEO) are minimal, though periodic short communications blackouts can occur. Real time telemedicine is our primary medical practice and routinely performed. With exploration beyond LEO, communications delays ranging from seconds to 20 minutes will challenge us. Development of near-autonomous health care systems to support long-duration flight beyond LEO is a major goal. the explorers journal
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