Orthopedic Shoulder and Elbow Surgeon. Engineer. Edmonds, Washington
I want to say congratulations to NASA and SpaceX for the first successful crew launch in the United States since the retirement of the space shuttle program. It's an exciting day for all lovers of space and space travel.
NASA astronaut Scott Kelly has spent 520 days in space, so he knows a thing or two about social distancing. Let’s hear what tips he has for us in the era of COVID-19.
I have added a new resource for new studies and news concerning orthopedic space medicine on my Space Medicine page today. I hope it will be a nice resource for all of those interested in human space travel. Enjoy!
Today more than ever, the prospect of not only traveling, but colonizing, another planet seems less like fantasy and more like reality. While many of the barriers that still exist are technological or logistical, like how to fuel such a voyage or communicate back to Earth, perhaps the most important barrier is how to treat health conditions that are bound to arise in space, especially if they require operative interventions. While there are multiple environmental hazards in space, perhaps the most apparent is the gravity, or rather lack-there-of.
An Example: The effect produced by microgravity exemplifies the potential for a single (albeit significant) environmental change to cause major multi-systemic consequences on the human body. On Earth, gravity pulls fluids to the lower extremities. In space, absence of gravity causes fluids to redistribute evenly throughout the body. The heart receives an increased volume of fluid returning to it, and compensates by increasing stroke volume. In microgravity conditions, increases in stroke volume are usually accompanied by increases in heart rate to boost total cardiac output. Via the parasympathetic effect, this will actually cause a drop in heart rate, which can be problematic in such an environment.
In situations of internal bleeding when simple tourniquets or other topical treatment are inappropriate, more drastic surgery may be necessary. Relative to Earth, surgery in space may carry greater risks. For example, the intestines are essentially free floating within the abdomen, tethered only to the posterior abdominal wall. Consequent to microgravity, bowel may therefore freely float out of an abdominal incision, creating a risk of contamination or damage. In cases of bleeding in space, blood does not collect or pool in the same way it des on Earth, but instead forms miniature droplets on surfaces.
If these droplets are disrupted, blood may float off the surface, potentially creating a biohazard. As surgery is a fine-motor task, vestibular may make performing even simple surgical tasks incredibly difficult and time-consuming. Inclusion of a surgical robot may address onboard surgical needs. Surgical robots have become widely used in certain surgical subspecialties. They use arm-like actuators that actually have a greater range of motion and are not susceptible to fatigue compared to the human hand. Commonly they are situated a short distance from the patient, with the operating surgeon controlling it in real time using controllers. The distance between the surgeon and robot can potentially be expanded, and robotic surgery has been conducted underwater and even across the Atlantic Ocean. Though this would effectively permit a surgeon on Earth to perform surgery in space, as distance between the surgeon and robot increases, the time taken for radio signals to travel in between operator and robot also increase.
For example, Mars is several million miles from earth. Radio signals can take more than 20 minutes to travel from Earth to Mars. Obviously, if a patient were critically ill or actively bleeding, this time delay creates a greater risk to the patient and could lead to catastrophic results. Due to this, it seems like a medically trained crew member is essential personnel with the current state of technology. However recently, fully autonomous robotic surgery in an animal was demonstrated for the first time. If this technology is developed into a feasible solution for human surgery, an autonomous surgical robot could address the issue of needing an onboard surgeon and also allow independence from Earth-based surgical solutions.
When considering the necessities for space exploration, it’s often forgotten that the health and medical requirements in such an environment are much different than what can be expected on firm ground. With the majority of astronauts being physicists and engineers, it’s important to consider how to maintain health in a zero-gravity environment and what to do should something go wrong as there are no physicians or hospitals that can assist with such issues.
Past space exploration missions have proven that there is a unique subset of conditions that can develop in even the healthiest of astronauts after a relatively short period of time. Without appropriate exercise, they lose bone and muscle mass, their hearts become deconditioned, and their blood vessels stiffen. A subset of astronauts develop a swelling of the optic nerve and possibly an increase in pressure on the brain. Even dormant viruses become activated, alongside changes to the immune system. There is a sense of urgency to solve these problems if we are to send humans to Mars and return them safely in the next decade or two.
However, these kinds of issues being identified and studied have led to many medical and healthcare innovations on earth that serve a much greater population than just those who are slipping the bounds of our planet. Discoveries in space robotics and new materials propelled the field of prosthetics, improving the quality of life for many. Millions of cancer patients depend on the digital imaging techniques developed by the space program to enhance MRI and computerized tomography (CT) scans so that we can detect tumors early, or better yet, that there are not any to find at all. Though many do not realize it, humans have been living and working in space continuously for the past two decades. The conditions of spaceflight have accelerated our ability to study progressive degenerative diseases as well.
With this being considered, it becomes more clear that these kinds of space missions have goals that go beyond just attempting to find what is out there. These conditions allow for the rapid development of new technologies to ensure that not only astronauts, but all humans can receive the highest quality of care possible.
Space demands the best in healthcare innovations, focusing on prevention and early intervention using smart, creative solutions. This is somewhat a shift in the existing paradigm of reactive treatment to conditions that arise in humans. On a mission to Mars, blood tests must be done in a matter of minutes, by the patient, on a single drop of blood. A trained and adaptive computer algorithm will track health status based on a variety of physiological parameters and alert astronauts when important deviations from normal become evident. These astronauts must rely on such computer resources because the sheer distance from Earth will prohibit the majority of communication. Due to this, the astronauts must act as their own healthcare providers and rely on the assessment of these automated machines and computers to assist in the maintenance of their health.
Space exploration has already produced hundreds of innovations that have saved the lives of countless humans. Simply put, to land women and men on Mars and return them healthy, we must reinvent healthcare. While this is an extremely daunting task, the positive consequences of this work will impact all of humanity.
It appears that future astronauts charting a journey to the Red Planet will have to have an affinity for red wine, or at least something which is made with the skin of grapes
While most of the recent stories and research about Mars is based on what to do when humans arrive on the planet, there is still much to be considered about the journey there which can take the better part of one year. One particular concern is the loss of muscle mass from the lack of use in the zero-gravity environment, but there is now research to suggest that red wine, or rather a compound found in red wine, can aid in the retention of muscle mass for astronauts traveling to the Red Planet.
The research, which was published in Frontiers in Physiology, focuses on resveratrol, a compound that is found in the skin of some berries and is rich in red wine. Based on this research, scientists now believe that the use of this compound in astronaut diets may allow for greater muscle mass retention and thus better physical outcomes from the journey.
To better understand the muscle strain, you first have to understand the difference in gravitational pull between being on Earth, being in a space craft for an extended period of time, and being on Mars. On earth, the gravitational pull is about 60% more than on Mars with open space being even more than that. Due to this, the muscles will not be as strained and will atrophy as a result. This is problematic for the overall health of the space traveler.
For the test, the team used two dozen male rats split into four groups. 12 of the rats experienced standard “loading,” which is what we all experience every day on Earth, while the other half were fitted with harnesses and rigged to a suspension system that subjected them to roughly 40%t loading, matching Mars’ gravitational pull
The two groups were further split in half, with half of each group receiving resveratrol supplements in addition to their water, and the others receiving no additional supplements. Strength tests were administered throughout the test period, which lasted two weeks.
As anticipated, the group which was subjected to the reduced loading without supplementation showed significant muscle atrophy. However, the 40% gravity rats that received the resveratrol supplement showed dramatically improved grip strength as well as less loss of muscle mass, while not affecting the rats’ overall body weight.
The researchers believe this is due to how the compound affects the body’s sensitivity to insulin. “Resveratrol treatment promotes muscle growth in diabetic or unloaded animals, by increasing insulin sensitivity and glucose uptake in the muscle fibers,” Dr. Marie Morteux, lead author of the study, said in a statement. “This is relevant for astronauts, who are known to develop reduced insulin sensitivity during spaceflight.”
Study Link - https://www.frontiersin.org/articles/10.3389/fphys.2019.00899/full
This was the question posed by scientist at Henry Ford Hospital. As many of you know, I am fascinated by the effect spaceflight has on the human body and in particular, the musculoskeletal system. The researchers found that after just 30 days in space, cartilage in rats began to degrade, imitating the process of osteoarthritis. They theorized that the unloading of the joints due to microgravity led to the cartilage breakdown. The biggest concern is that cartilage does not repair well, even on Earth, which is why many patients with osteoarthritis end up with hip, knee, and shoulder replacements. This could lead to long term issues for astronauts traveling to the Moon, Mars, or beyond. More research is needed, but this is a very interesting study and shows that we will need to continue to research the effects that spaceflight has on the human body.
For years, patients have been asking why surgeons can't just glue bones together. Well, a company named LaunchPad Medical is seeking to do just that with their product, Tetranite. They are developing a bone adhesive to "glue" fractures together. They are currently in the testing phase of their product.
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