In Space No One Can Hear You Scream... So Don't You Get Sick There

  Don't you ever feel compelled to look up and just wonder what other worlds could space travel lead you to if you left our planet behind? Ever since ancient times man has been intrigued by the mystery of outer space. The discoveries of the last few decades have made it possible to travel hundreds of thousands of kilometers away from Earth, you know, even with computers dumber than your smartphone. So where does the complexity of space-travel lie?

Astronaut Alan B. Shepard Jr., the first American to fly in space, prepares for his Mercury Redstone 3 launch on May 5, 1961. (Photo credit: NASA)

   Since humans are just visitors in space, we must find a way to adapt to the environment of emptiness. Prolonged exposure to zero-G has a few negative side effects on the skeletal, muscular and circulatory system. Astronauts lose 1-5% of their bone mineral density every month, causing drastic osteoporosis on long-term space flights. In addition, living in microgravity for a few weeks causes 20% muscle mass loss, so as a means of prevention, space travelers must exercise regularly. Moreover, due to loss of gravity-induced hydrostatic pressure, 1,5-2 l of fluid moves from the lower to the upper part of the body, further reducing muscle mass in the legs. Another problem is decompression sickness, which may occur during space walks and can easily lead to joint pain, numbness or even death. Due to the rapid decrease in pressure during these walks, nitrogen in the bloodstream leaves the solution and forms bubbles. What's more, explosive decompression can cause ruptures or an ebullism (boiling of body fluids). Theoritically, the release of toxins like ammonia, freons, hydrazine and nitrogen tertoxide could result in serious damage. Furthermore, fast travel through different time zones leads to desyncronosys or jet lag, and consequently to insomnia. Radiative, neurovestibular and psychosocial stressors should also be put into perspective. 

1. Normal (left) and osteoporotic (right) bone. (Our skeleton isn't that inert, osteoblasts and osteoclasts change its structure dynamically.) 2. Cross sections of rat muscle show the effect of space-travel on muscles. (Top: Earth, bottom: Space; photo credit: NASA) 3. DSC results in nitrogen bubble between joint surfaces. 

 Routines and prevention. Those are NASA's tactics against emergencies. Astronauts are trained in various environments, roleplaying several situations and then reviewing their actions. One week before takeoff they are secluded and undergo several medical examinations. Plus, they have a protocol for most medical situations from a cough or pregnancy tests, to suicide crisis. Flight surgeons are the ones responsible for the crew's physical and mental health and their safety, they even take care of their families, so spacemen can be at ease and don't have to worry about family issues. They train with the crew, teach them medicine and help them if any problem occurs. Among the staff taken on longer flights there are members even more trained in the field of medicine.  

Flight Surgeon (FS) takes part in lunar simulation on Devon Island in the Arctic Ocean.

Cosmonaut undergoes a dental examination by medical officer Joseph Kerwin. No examination chair needed, the astronaut simply rotated his body to facilitate the procedure. (Photo credit: NASA)

 For the future of effective space missions the health of the crew must be maintained for longer periods. To achieve this, surgery in space should be improved, tools need to be lighter and more effective and new techniques must be developed. On one hand, any liquid in microgravity could easily contaminate the environment, and since drops fly around freely, it can even reach uncovered eyes or the mucousal membrane. This is also true for the sterile equipment used during surgeries. Additionally, zero gravity causes organs to move rather freely in the body, making them harder to locate. On the other hand, new surgery techniques are developed continuously, equipment is improved, benefitting rural areas and modern medicine.

One technique developed by Virtual Incision (VI), the company based in Lincoln, Nebraska, includes a fist-sized robot that may be able to perform abdominal laparoscopic surgery on astronauts. A camera on top of the robot provides information to a control station regulated by a surgeon using joysticks, guiding the two arms of the machine equipped with various tools to grab things, suture and cauterize wounds. 

Aqueous Immersion Surgical System (AISS) developed by the University of Kentucky and Carnegie Mellon (Pennsylvania) is a unique method for keeping blood from entering the airspace. “AISS is a transparent box that creates a watertight seal when it is placed over a wound and pumped full of sterile saline solution.” said George Pantalos, bioengeneering professor from Louisville. This astro-surgical tool holds the solution under pressure, so blood stays in the circulatory system. By changing the level of pressure it could be also used to recycle the patients' blood or to siphon it up. Tamás Haidegger, a bioengineer from Budapest, Hungary claims the AISS is going to be an essential device for future space missions. Since the only option now in case of serious emergency is to transport the patient back to Earth -an expensive and dangerous procedure- scientists are focusing on devices like the ones previously mentioned. With these new methods it won't be necessary for a doctor to be aboard the spacecraft, invasive procedures could be performed by teleoperated robots as well. 

"Beep bloop beep beep beep blooop!" -R2D2

 There are lots of innovations thanks to the rapid progression of space medicine (like CAT and MRI scanning, pacemakers and defibrillators). These new inventions in this field  help build a more fruitful future for medicine.  Just like we hope medisensor from Star Wars won't be fiction for that long and we can determine a patient's medical condition with just one smart device and a quick checkup, we also need to believe that the solution to the problems of today's medicine lies within our reach and not in a galaxy far, far away.

If you're further interested in this topic, check out these exciting articles on the website of the Space Medicine Association or the Space Safety Magazine.

What do you think the next difficulty is to be solved concerning human health during spaceflights?

Let me know in the comments!