Prime Time Replay:
Dr. Joe Ortega
on NASA's medical preparations for the Mars mission
MsgId: *breakthrough(6)
Date: Wed Apr 2 21:02:52 PST 1997
From: moderator At: 206.80.182.200
Welcome to Breakthrough Medicine. Tonight my guest is Dr. Joe Ortega of NASA, along with Dr. Pat McGinnis, NASA flight surgeon, who was the flight surgeon for NASA 3/MIR 22 mission, which was completed mid-January. Dr. Ortega, let's begin tonight by discussing one of the more exciting missions coming up--the Mission to Mars. How does a flight surgeon help plan a mission to Mars?
MsgId: *breakthrough(8)
Date: Wed Apr 2 21:06:59 PST 1997
From: Joe_Ortega At: 139.169.148.202
First we have to have a starting point from which to plan. This means some sort of initial starting conditions or assumptions. In NASA parlance this is called a "reference misison." The reference mission will be of certain length, have certain mission objectives, and have specific resources available to use. Then we use the principles of Aerospace Medicine to address the risk to crew health and human performance. We then lay out some requirements for the mission planners to include in their analysis, for example we need a medical kit that weighs 30 pounds, we need a defibrillator which uses this much power, etc.There are many different reference mission scenarios. What really changes a lot are the logistical concerns -- how long are you staying, what are you doing on the surface, what is the transit time, etc. As you might guess, the amount of food, oxygen, water, etc. all vary with the differing scenarios. All the things you take with you mean more weight or mass which at the present time costs you a lot in space travel. Our medical requirements don't change a whole lot from one mission to the next. You still have people away from the earth for extended periods of time.
MsgId: *breakthrough(10)
Date: Wed Apr 2 21:09:08 PST 1997
From: moderator At: 206.80.182.200
What are the unique requirements when heading for Mars?
MsgId: *breakthrough(11)
Date: Wed Apr 2 21:10:25 PST 1997
From: Joe_Ortega At: 139.169.148.202
There are 3 main areas of concern for us on long duration planetary type missions. A-number one issue -- radiation. We just don't know nor can we predict with any kind of certainty what the tissue dose of radiation will be out there in interplanetary space. It all depends on the amount of shielding, solar flares, galactic cosmic radiation, etc. Tough to predict.Problem number 2 is bone mineral loss. Without weight bearing on the skeletal system, the bones lose calcium. With less calcium bones become weaker and could be subject to fracture more easily. When an astronaut comes back to gravity he may not be able to stand up with these weakened bones.
Problem number 3 is psychological. As you can imagine, the length of a mission to Mars is anywhere from 1.5 to 3 years! The remote nature of these missions make it intensely difficult to keep motivated. Other problems include crew interactions, social heirarchy, small living quarters, remote nature, lack of entertainment etc. The list is long. How do we protect our crews from going "crazy!?"
MsgId: *breakthrough(15)
Date: Wed Apr 2 21:15:46 PST 1997
From: moderator At: 206.80.182.200
Dr. McGinnis, have the recent long duration come up with a new ways to keep astronauts from 'going crazy' after months in space?
MsgId: *breakthrough(16)
Date: Wed Apr 2 21:17:41 PST 1997
From: Pat_McGinnis At: 139.169.148.202
John Blaha said that for his flight one of the issues for him was the cultural and language barrier. This happened in spite of the fact that he lived and trained in Russia for about 18 months! He was still one American with 2 Russians as his crewmates. In retrospect, it made him very sensitive to the importance of cultural understanding and training for future long duration crews. He never truly understood this before this particular experience.
MsgId: *breakthrough(17)
Date: Wed Apr 2 21:18:42 PST 1997
From: moderator At: 206.80.182.200
Will training be changed in the future to reflect what he found?
MsgId: *breakthrough(18)
Date: Wed Apr 2 21:20:37 PST 1997
From: Pat_McGinnis At: 139.169.148.202
For the current Mir missions, John was able to go back to Star City to share this information with the American astronauts currently training for future Mir missions. His recommendations are being considered by the ISS (International Space Station) planning folks for revising station operations plans.
MsgId: *breakthrough(19)
Date: Wed Apr 2 21:22:15 PST 1997
From: moderator At: 206.80.182.200
Did the Russians have any suggestions that you found helpful?
MsgId: *breakthrough(20)
Date: Wed Apr 2 21:24:45 PST 1997
From: Pat_McGinnis At: 139.169.148.202
It was a learning curve for the Russians as well. They have a lot of experience in station operations -- 11 years they have kept the Mir station in continual operation. Their previous experience with international crewmembers was usually limited to one or 2 weeks. They do have regular communication with the ground, news from home, and family video conferences to help with the isolation. Holidays are important also. They celebrate all relevant holidays, as well. The American crewmembers have also extensively utilized Ham radio and email to stay in touch.
MsgId: *breakthrough(21)
Date: Wed Apr 2 21:27:19 PST 1997
From: moderator At: 206.80.182.200
Getting back to Mars, what if a medical emergency does come up. How prepared are the crew for something like a heart attack or a burn?
MsgId: *breakthrough(22)
Date: Wed Apr 2 21:28:51 PST 1997
From: Joe_Ortega At: 139.169.148.202
The first line of defense against medical problems in space is a lack of medical problems on the ground, that is, healthy astronauts. The principles of prevention of disease must be fully utilized. Hopefully we will select astronauts for these missions with no discoverable medical problems to start with. Then we should educate them on healthy lifestyles and provide them with proper food, water and exercise for the entire mission.Should any medical problems arise we will hopefully be prepared to treat them effectively. We would have a medical kit with diagnostic equipment and many types of medications and treatments available for the most likely diseases or injuries. We also would train them in the use of medical equipment and medications. In the case of a heart attack, hopefully we screened out any one with heart disease. But should a problem arise, they will have to treat medically. Bottomline, on the way to Mars, they will be on their own. We can assist them with some forms of telemedicine but that will be of limited help to them the farther out they get.
MsgId: *breakthrough(24)
Date: Wed Apr 2 21:34:45 PST 1997
From: moderator At: 206.80.182.200
Did the training with the Russians help formulate any of the current policy for long duration training?
MsgId: *breakthrough(25)
Date: Wed Apr 2 21:37:41 PST 1997
From: Joe_Ortega At: 139.169.148.202
The Russian space medicine specialist and the crew are more sensitized to the importance of psychological health and well being. With each mission we get more open to these concepts that they are so familiar with. Astronauts as a group tend to shy away from medical things and particularly away from psychological things. They are becoming more attuned with these needs, as well. We have started to add some of these items to the long duration planning process that is being developed for ISS.
MsgId: *breakthrough(26)
Date: Wed Apr 2 21:39:03 PST 1997
From: moderator At: 206.80.182.200
Where there any surprises coming out of John Blaha's mission?
MsgId: *breakthrough(27)
Date: Wed Apr 2 21:41:37 PST 1997
From: Joe_Ortega At: 139.169.148.202
John had had 4 previous space flights, a veteran to say the least. After each of the previous short duration missions he was ready to walk over to the pad to launch again. During NASA 3, he adhered to the Russian exercise countermeasure protocol and throughout the flight felt stong and healthy. Even as late as the deorbit phase of the shuttle trip home, he anticipated no problems. When the shuttle stopped, John was really surprised by how strong gravity really was. He said it was like a huge magnet!
MsgId: *breakthrough(28)
Date: Wed Apr 2 21:43:15 PST 1997
From: moderator At: 206.80.182.200
So you've landed on Mars, but you're too weak to get out of the vehicle, let alone meet a Martian. How's the crew going to prepare?
MsgId: *breakthrough(29)
Date: Wed Apr 2 21:47:12 PST 1997
From: Joe_Ortega At: 139.169.148.202
Well, that's where we surgeons make our money, eh? We'd like to prevent that for a Mars mission so we plan on trying to validate some preventive exercises and other countermeasures during the station era to get ready for the long transit times to Mars. If we can find a regimen that will maintain muscle & bone strength, then that will be key. Other options include adding variable gravity facility (short arm centrifuge) to expose crews to gravity enroute. Of course on obvious answer to mitigate all the deleterious effects of long duration space flight would be an innovative engine design that would provide constant acceleration to the midway point and deceleration to Mars (shortening the trip & producing artificial gravity).
MsgId: *breakthrough(30)
Date: Wed Apr 2 21:50:28 PST 1997
From: moderator At: 206.80.182.200
Is it likely that you'll have artificial gravity before the Mars mission, or will the crew be dependent on rehab before landing?
MsgId: *breakthrough(31)
Date: Wed Apr 2 21:52:54 PST 1997
From: Joe_Ortega At: 139.169.148.202
That depends on how much national will we have to get there. Martian gravity is only about .38 times the force of gravity. So you won't have to be quite as strong as here. The crew would be doing exercises all along the way there. Further rehabilitation would be similar to that used after long duration missions, that is resistive and aerobic exercise and vestibular readaptation exercises.
MsgId: *breakthrough(32)
Date: Wed Apr 2 21:55:54 PST 1997
From: moderator At: 206.80.182.200
How do the medications you send along hold up without gravity? Do they work the same during these long flights?
MsgId: *breakthrough(33)
Date: Wed Apr 2 21:58:30 PST 1997
From: Joe_Ortega At: 139.169.148.202
Many folks are very concerned about that very possiblity. There are several proposals out there to study that effect. As an operational flight surgeon, the drug efficacies we have experienced do NOT indicate significant difference in drug efficacy in space. I have collected some preliminary data that suggest that drug use in space is similar to that on earth. There may very well be differences in drug absorption (GI effects of microgravity) and distribution, but they don't appear to be clinically significant or impede clinical efficacy.
MsgId: *breakthrough(34)
Date: Wed Apr 2 22:03:09 PST 1997
From: moderator At: 206.80.182.200
Dr. Ortega and Dr. McGinnis, thank you for joining me on Breakthrough Medicine. Good luck with the Mission to Mars. To our viewers, please join me next week when I interview Elaine Glass, R.N., a palliative care nurse who will discuss important issues in end-of-life care, and alternatives to Dr. Kevorkian-type solution to chronic pain in terminally ill patients.
MsgId: *breakthrough(36)
Date: Wed Apr 2 22:14:35 PST 1997
From: Joe_Ortega At: 139.169.148.202
Thank you for having us, Madeleine. Good night. One final word: There is a document -- a vision if you will -- for how and why America should proceed with space exploration. It is called America at the Threshold, America's Space Exploration Initiative. Lt Gen (ret) Thomas Stafford (of Gemini 6&9, Apollo 10 & Apollo-Soyuz) headed the Synthesis Group commissioned by then President Bush to chart a course for the future.This 1991 report is still applicable today and is a common sense roadmap for safely beginning the journey to our neighboring planets. Go to your library, request it and read it. Then write all your representatives and senators - we must forge the national (and planetary!) will to further man's evolution and journey into our solar system and beyond, to the rest of the cosmos.
Another document that is an excellent guide to Mars palnning is the American Institue of Aeronautics and Astronautics symposium notes called "Mars Exploration Strategies: A reference program & comparison of alternative architectures." (AIAA 93-4212) Another one is the project report from the 1991 session of the International Space University, entitled "International Mars Mission."
Thanks again, and let's head for Mars and the stars!
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