ISS Update: Flight Surgeon Keeps Astronauts Healthy

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>>Amiko Kauderer: Hi. Welcome to Mission
Control Houston. Joining us now here in the International Space
Station Flight Control Room, the doc is in. Today we have NASA flight
surgeon Steve Gilmore. Welcome, Steven. Thank you for coming.>>Dr. Steve Gilmore:
Thank you having me. It’s a pleasure to be here ->>Amiko Kauderer: Great. Well, so we always hear
about a lot of things that the astronauts are
doing medical experiments and all these kind of things. Taking their own blood
and this kind of stuff. We’re going to get into
some of that, but, first, I want to talk a
little about you ->>Dr. Steve Gilmore: OK ->>Amiko Kauderer: So, first, tell me how did you
make your way here?>>Dr. Steve Gilmore: I had the
opportunity when I was training and in medical school to do a
rotation down at Cape Kennedy, or Kennedy Space Center,
and had the opportunity to see a few launches and couple
landings, and thought it looked like a really interesting field
to get into and just pursued that interest through
getting here. So I finished medical
school and did a residency in emergency medicine,
and then I went and did some specialized
training down at the University of Texas in Galveston, and
ultimately got hired here.>>Amiko Kauderer: Very,
very cool, and we’re very, very happy to have you here. We know you do an awful lot
to support the crew aboard, and I know they appreciate
it as well as we do. Real quick, I want to
just, for you to just kind of explain what your role
is as a flight surgeon and when you get assigned
a crew, kind of take us through that, what life is like once you’re
assigned a crew member.>>Dr. Steve Gilmore: OK. Well, essentially, there’s
three phases of a mission, and so we typically get
paired up with crews in the pre-flight phase,
and the primary activities that we’re doing there in the pre-flight phase
is we will be involved in the medical exams
that the crews do. They have exams that are similar to what a commercial
pilot would have, and they have some
additional specialized testing, and so we help walk them
through those processes, and if there’s any issues to
work out, we’ll work those out. And then our other
primary responsibility in that time frame is to take
that information that we get and take them to
our medical boards, which certify crew members as
medically cleared for flight. And then the other
activities that we’re doing in the pre-flight time
frame are, we’re involved with the crew in terms of
their selection of the type of experiments and stuff that
they are participating in, and we have a, not just me, but
there’s a large group of folks in my division, and we put
together a schedule to make sure that they can complete
all the science and research activities
that they’re doing. And then as we get close
to flight, we typically for the launches from
Kazakhstan, we’ll travel over to Star City and then
to Kazakhstan with the crew, and go into quarantine
with them, and go through the launch
process, and get them all to the point where they’re
all suited up and ready to go. And then after the
launch, we come back and support the mission
here in the control center ->>Amiko Kauderer: OK ->>Dr. Steve Gilmore:
And support meetings and have frequent conference
with the crew and work out any issues that
come up there ->>Amiko Kauderer: OK. So let’s go back to
Kazakhstan when you go in there before they launch. What is, say, let’s say you say
you go and stay in quarantine, what is that week leading
up to launch like for you, and what kinds of tests and
things that you are doing with the crew members?>>Dr. Steve Gilmore:
That’s a great question. So there’s, one of the
primary things that we’re there for in Kazakhstan is
there’s a quarantine process, and the rationale
behind that is you want to start limiting access to the
crew so that they don’t pick up any type of illness that might impact their
ability to launch into space. And so we participate in that. We help screen persons that
are going to be meeting with the crew, and, typically,
that’s not a, you know, we make folks aware of
the importance of that, and that’s not typically a
terribly involved process. The other things that we’re
doing in that time frame is, you know, crew are
typically taking advantage of their last week or so on
the ground and want to get out and enjoy the fresh air
and some of the sights that you can see in Baikonur. And so ->>Amiko Kauderer:
Like the tree ->>Dr. Steve Gilmore: Yeah ->>Amiko Kauderer:
Their little stick.>>Dr. Steve Gilmore: Yeah. And so we’ll do things like some of the crews really
like running. I can recall running
two or three times a day with various crews in the
week or so before launch. And then the other important
thing we’re doing is we have a, we sort of organize some of
the crew’s personal affects so that they have everything
that they need when they go out to get suited
up and are ready and prepared for the launch. Those are the primary things ->>Amiko Kauderer: So you
mentioned the running, and so I’m curious now. Is there ever any kind of
active, are there any sort of activities that you
try to limit the crew to or keep them saying, no, we
can’t, you know, restrict them from certain activities? I mean, obviously, I guess
sky jumping is not an optimal, something that they
could do, but ->>Dr. Steve Gilmore: Yeah. Thankfully, that, I
think those rules come from the crew office
themselves ->>Amiko Kauderer: Oh, OK ->>Dr. Steve Gilmore: So we
don’t really get involved. I think they have some policies. They don’t want them doing ->>Amiko Kauderer: Sure ->>Dr. Steve Gilmore:
Something like downhill skiing or something to close to flight
where they would have a risk of injuring themselves,
but as far as when we’re down in Baikonur, they
have access to a gym with some weights and stuff
like that, and then jogging. So the risks there
are pretty minimal.>>Amiko Kauderer: Right. And which, of course, as we
know, fitness is essential to our health as well, and
I’m sure you have some sort of involvement, I guess not
with the physical fitness itself but overseeing their
health, you know, overall ->>Dr. Steve Gilmore: Right.>>Amiko Kauderer: As
you said, even during. So during their flight, how
is it that you’re maintaining that because I understand that these guys have their
periodic health check, and I don’t know. Who was your last crew member?>>Dr. Steve Gilmore: The
last crew I had the privilege of working with was
Scott Kelly ->>Amiko Kauderer: OK ->>Dr. Steve Gilmore: So that
was two years ago or so ->>Amiko Kauderer:
Expedition 2060. And so real quick,
when he was in space. So we have these
periodic health exams. Are they just like what we
kind of refer to as just going to the doctor for
a regular checkup ->>Dr. Steve Gilmore: Right.>>Amiko Kauderer: So is it
the similar types of exam. I mean, the same kind of
things that we’re looking at, or how is that data transferred
to you so that you can review and see how the crew
is actually doing?>>Dr. Steve Gilmore: So in terms of the periodic
health tests itself, that happens every, you
know, month or two on board, and it’s a fairly basic thing. We have the crew take
a set of vital signs. They’ll collect their
weight, and then, you know, if they have anything going on,
they’ll talk to us about it, but most crews don’t really
have significant problems while they’re in flight. So we do that just
on a periodic basis, and then before big activities. Like, I know they just had a
space walk, and we would have a, you know, a medical
conference with the crew, and we’d also do an assessment
of their fitness level, their aerobic capacity so we can
be sure that when they’re going out on the space walk that
they’ll have the energy that they need to perform
all the tasks that are ->>Amiko Kauderer: Right ->>Dr. Steve Gilmore:
Expected of them ->>Amiko Kauderer: So
in addition to the exams that you have, you also, I’m aware that you have the
private medical conferences ->>Dr. Steve Gilmore: Yeah ->>Amiko Kauderer: And
so I guess that’s just to talk one on one. I know Akapa had one yesterday ->>Dr. Steve Gilmore: Yeah ->>Amiko Kauderer: And so I
guess that’s just one on one to say, hey, how are you doing? Are there any issues
or that sort of thing. I mean, ->>Dr. Steve Gilmore: Yeah. So we, basically the
medical conferences, they occur about every day
for the first five days or so when crew get on board, and then
after that, they occur weekly, and we’re just touching
base with the crew on a personal level to see if
they have any medical things that have come up, but more
typically we’re talking about is there exercise
program working for them. What is the work pace up there? Do we need to kind
of throttle back and let them get a little rest? Those type of issues ->>Amiko Kauderer: OK ->>Dr. Steve Gilmore: So ->>Amiko Kauderer: And so you
mentioned collecting weight as one of the thing, parts
of that exam, and so I know that people are going to
want to know about this. When you’re in microgravity,
how do you collect your weight? I mean, do you get to
always say, yeah, I weigh 0.>>Dr. Steve Gilmore:
That’s a good question. I knew the physics of
it once upon a time, but basically the crew
are sitting on a device or positioned on a device that
vibrates, and you can figure out their mass and, thus,
their weight from that. And the reason that
we’re interested in that is just from
a high level. If you keep your body weight
or mass about or close to what it was when you
left, it’s a good predictor of how you’re going
to do post-flight, and we typically see that people that maintain their body weight
close to what it was when they, before they launch do
very well when they get ->>Amiko Kauderer: And
that’s good insight from a medical standpoint
because I think, I know that we want to be
sure we can also fit back into our seats when we
get back home as well. So that’s all very good. So now I have another question,
and this is going to be on the, some of the things that they do. So they check their own blood. I guess they learn here. Are you involved in that
process at all, or, I mean, I understand the astronauts
actually get trained for, to perform those kinds of
things as well as the scans. So are you involved in
that process at all or ->>Dr. Steve Gilmore: Yeah. It’s a great question. We’re sort of secondarily
involved here. We’ve got a great
team of trainers here, and so we’ve got some nurses
here that help us train the crew about how to draw some
blood from themselves. And so they’ll, and also on
other people, but they take them through a couple class
process where they practice on mannequins and learn the
techniques that you need to be successful
with drawing blood. So, and something, it’s a task
that or skill that crew can pick up pretty quickly, and most
of them do really well at it.>>Amiko Kauderer: Sure. So, essentially, I
mean, not only are they up there doing science and
maintenance and, you know, all these other things,
but they’re also somewhat of a medical officer up there
as well, and so this brings me to a question that
we have on Twitter. Actually I have a couple
questions on Twitter. So we ->>Dr. Steve Gilmore: OK ->>Amiko Kauderer: Had polled
Twitter and the public, and they do have
questions as well ->>Dr. Steve Gilmore: OK ->>Amiko Kauderer: So the first
one is actually talking about, and you can probably here
a little bit in my voice, fall has come into the United
States, and with it allergies. This comes from Look at More 7. Do you get a break from the
allergies when you’re on ISS?>>Dr. Steve Gilmore: Well, the
short answer to that is yes. They, you’re not exposed,
you know, the air up there, we do a lot of testing
on, and it’s very clean from the point of
view of allergens. They have had in recent, some of the recent missions they’ve
noticed some accumulation of dust and other
particles like that. So some crew will experience
some similar type symptoms to allergies, but from the point
of view of is it the pollen in the air and that kind
of stuff that you get on the ground, you really don’t
see that when they’re on board.>>Amiko Kauderer: Sure. So this brings me to
the next question then ->>Dr. Steve Gilmore: OK.>>Amiko Kauderer:
It’s not allergies. The next question we have on
Twitter comes from Josh Stern. What happens is an
astronaut gets sick in space?>>Dr. Steve Gilmore:
So there’s a couple ways to answer that question. The first thing that
folks should know is that in the pre-flight
time period for these three-man crews, we
select two of the individuals on a three-man crew, and we
take them through a process of medical skills
training so that we know that everyone has a
defined set of capabilities, and this would be things like taking vital signs,
maybe giving a shot. Talking about giving medications
and other activities like that. Then in conjunction with that,
we’ve over time have built a set of procedures or a checklist
that the crew get trained on, and so they have some, they
have a stock set of procedures up there if I’m, you know,
having some nausea or, you know, it’s related to the
medical type symptoms that you might expect
them to see up there. So they have some instructions
for how to use the equipment and the skills that we’ve
trained them on on the ground. And then, so then the third part
of that is if something were to come up, probably what we
would expect to happen is based on the severity of it or
their concern about it that most things, you know,
common things happen commonly. And so they have up there
something akin to, like, your medicine cabinet at home. It’s got some vitamins,
you know, pain relievers, things like that, and so
they can take care of a lot of the things that come
up without talking to us. But if something were to come
up that was more concerning to them, then we’d probably
have a medical conference, one that wasn’t scheduled versus
the ones that we already talked about that happen on a weekly
basis, and we just figure out from them what
their concerns were. What was going on? Maybe provide more direction
and instruction and point them to one of the particular
procedures about how to take care of it ->>Amiko Kauderer: Sure. So I think that the real
answer is define sick. It depends on what
level of sick you are ->>Dr. Steve Gilmore: Right ->>Amiko Kauderer: Now what
if they are terribly sick? What would happen ->>Dr. Steve Gilmore: Well,
you know, one of the things, the biggest thing that we do
in that regard is it falls into the ounce of prevention’s
worth a pound of cure, and so we spend a lot of time,
as you’re probably familiar in talking with crew and stuff,
there’s a lot of time spent in terms of scrutinizing
the crew medically, and that actually
prohibits a number of people that apply from getting in. Because basically what
we want to try to do and spend our most effort
on is identifying things that could potentially
cause problems because what we don’t want to
have happen is have events occur that results in having to
bring crew members home early. And so for that reason,
there’s a number of things that if a person has in the medical history
it may prevent them from becoming an astronaut. And so that’s really where
most of the emphasis is placed. We do have some ability
to take care of more severe medical
conditions, and we do spend some time,
as I talked about earlier, with the crew officers. Teaching them how to do
interventions for those types of situations, but
really where most of our effort is placed
is in the prevention.>>Amiko Kauderer: OK. So we’re talking about
taking care of the crew as they’re on the station. Meanwhile, they do
participate in some of these medical experiments,
one of which today looks at if the integrated
cardiovascular. So it looks at the
heart muscle atrophy.>>Dr. Steve Gilmore: Yeah.>>Amiko Kauderer: And so we
know space does some things to our bodies, and I guess this
is actually a part of trying to understand that as well. If you will explain, because I
think this morning Akapa took part of some ultrasound
scans with Aki ->>Dr. Steve Gilmore: Right ->>Amiko Kauderer: You know,
some assistance from Aki. So can you talk to me a
little bit about that?>>Dr. Steve Gilmore: Yeah. So I’ve had some crew members
participate in that experiment in the past, and it’s
a very interesting and thorough experiment. And basically what we’re trying
to get a better understanding of is in the past, we’ve
done experiments like this where you take snapshots
of information, and what they’re doing is
they’ve put a whole complement of tests together to
really get an understanding of what is happening to
the cardiovascular system as a result of being in space. And so pre-flight, they do
some very sophisticated imaging tests, some MRI’s so that they
can measure accurately volumes and function of the heart. And then in-flight,
we have access to a fairly sophisticated
ultrasound. And so what they’re doing
with those tests is to look at the heart in someone that’s
been in space for awhile, and try to understand has the
size of the heart changed. Has the volumes inside the
chambers of the heart changed? Can we measure any
differences as a result of being in this environment where your
cardiovascular system doesn’t have to work as hard as
it normally does just on a day-to-day basis
here on the ground? And then when they get back,
they go through the similar set of imaging and function tests. So it’s a very thorough
and good investigation.>>Amiko Kauderer: And I know
one of the other things, well, I guess, sorry, you can, maybe
you can talk to me a little about what are the most
common things or the things that you try to prevent
or maybe a problem. I think I understand
kidney stones is something that you definitely want to prevent before a crew
member goes up in space. There’s the issue with
the vision, the eye, and I know they do eye
exams pretty periodically. So can you talk to me
a little about that?>>Dr. Steve Gilmore: Sure. I guess I sort of separate
that into a couple of things. First, there’s, just
in terms of the process of when the crews
first go into space, one of the reasons we have a
medical conference for everyday for the first several
days is in our experience, crews experience some
problems, not problems, but there’s an adaptation phase,
and we, what we typically expect out of that is some crews
will have some nausea, some occasional vomiting
as they’re getting used to this new motion environment. And so we meet with them
on a regular basis just to see how those types of
things are progressing, and for the vast majority of
the crew, it’s not something that significantly impacts
their ability to perform work and do those types of things. As you mention, you talked a
little bit about, we’ve noticed, as we’ve gotten better
medical equipment on board, we’ve been tracking a few,
or this process in some crew where we notice that they
have a little bit of change in how well they can
see, and what I mean by that is they might have
a change in a line or two. I’m sure your viewers have
been to the eye doctors, many of them, and they might not
read quite as well if you looked out at the eye chart that that
may change by a line or two, and we’ve noticed
this in the past, but now that we have better
equipment up there, we’re trying to take and get a case, or
get a series of individuals where we have really high
quality images of the back of their eye and as well as
other ways to test the vision to see if we can
understand the process by which this is happening and ->>Amiko Kauderer: Sorry,
and that’s really interesting that while we’ve been in space
for all this time, there’s still so many things that
we don’t know ->>Dr. Steve Gilmore: Right ->>Amiko Kauderer: How the
effects of space on our bodies and especially when we’re
talking about our future and go further, you know,
it’s really important for us to understand these things ->>Dr. Steve Gilmore: Right.>>Amiko Kauderer: So we talked about you
being the doctor pre-flight and just before they launch
and traveling with them, and I guess, you know,
staying pretty close with them throughout their,
you know, until they launch. Staying very much in contact with them while they’re
in space. So treating them while they’re
in space, and let’s talk about landing because Akapa
is going to be landing soon with [inaudible] in, gosh,
almost a week on the 16th. And so explain to me, do you
go back when they land, and, you know, what happens at that
time, and I guess you want to check out the crew
member when they ->>Dr. Steve Gilmore: Right ->>Amiko Kauderer:
As soon as they.>>Dr. Steve Gilmore: So
there’s a couple of things that. There’s, obviously,
an integrated team that goes over to support that. The crew surgeons
that are working with Dr. Akapa are doing
a couple of things. Now, they’re doing a
little refresher and review. We take a medical kit out
with us to the landing sites, and they’re just kind of
reviewing the contents of that at this point in time. The crew on board will do a
little bit of fitness testing, again, another fitness test
just to, so we understand where their fitness
level is, and can assure that they’re prepared
to re-enter. And so our docs will
sort of take off from here over the weekend. So they usually go over about
a week before the landing, and they have a meeting in
Moscow that they support where there’s folks
from the program office and the crew office, and
we talk about the plans and the contingency
plans and how we’re going to support the operations. So we do that every time
that there’s a landing. And then after that
meeting we’ll deploy, we’ll go to Star City and
deploy down to Kazakhstan with our colleagues from GCTC, and we have a good
working relationship with the medical group over
there, and they have a lot. They have a bit more training on
the specifics of their vehicle. Their docs are very involved
in terms of extracting the crew from the vehicle, and
once the crew are gotten out of the vehicle, we’re
there doing medical checks and supporting the crew with
whatever they might need. And after they do a brief ->>Amiko Kauderer:
Right, because actually when they’re landing, they’re
landing in a, you know, desert, like, you know ->>Dr. Steve Gilmore: Right ->>Amiko Kauderer: [Inaudible] and so I think don’t they erect
some sort of medic tent to kind of give them some privacy
and get out of their suits, and I guess that’s where some
of the testing takes place ->>Dr. Steve Gilmore:
That’s right, that’s right. I may have skipped a
step, but, typically, the way the operation works
is once we get to Kazakhstan on the landing day, we all get
in helicopters that are provided by our Russian colleagues, and
we fly out to a very remote part of Kazakhstan, typically,
and the capsule will land, and they’ll get the crew out. And then we’ll go through
about an hour or so of time in the tent with them, just
getting them ready to get back in the helicopters and
go back to the airport where ultimately
they’ll return home to the States or
back to Moscow ->>Amiko Kauderer: And then
you somewhat oversee their, once they get back here, you
still oversee some of their, I guess, their wellness
for when they get back ->>Dr. Steve Gilmore:
That’s correct. So on the airplane flight back,
we call it the R plus 0 flight. So the crew, about four hours
after landing, the crew will get on a NASA plane in Kazakhstan,
and we’ll fly all the way back to Houston, and it’s typically
a roughly 20-hour flight, and on the course of
that flight, typically, the crew will be resting. We have a couple stops
where we’ll get out and just walk around,
stretch our legs ->>Amiko Kauderer: Where they
can take their first shower and ->>Dr. Steve Gilmore: They
can take their first shower in months, and I’m always
surprised that, I mean, the station is a very
clean and sanitary place, but many of the crew
have commented, you know, you just don’t miss it as
much as you think you might, which I find a little
bit hard to believe ->>Amiko Kauderer: Yeah, yeah ->>Dr. Steve Gilmore:
Obviously, they don’t. But on that plane flight,
we’ll be participating and helping them collect some
preliminary medical tests and research tests. And then once they
get back to Houston, the first two weeks is pretty
busy, but we have, in total, in terms of, for my perspective, we have roughly a 45-day what
we call a reconditioning period, and there’s a great team
that we are lucky to work with call the Acers, and
these are basically trainers with a lot of experience with
the working with the astronauts when they return from space. And so the goal there is to
get them get their strength and all their functioning back
to their pre-flight baseline, and that, you know, 45 days
with folks working hard, typically we get folks
to where they were when they, before they launched. So it’s a great program ->>Amiko Kauderer:
Well, I understand a lot of them come back healthier
and leaner and meaner than, you know, when they launched. So, obviously, you guys
are doing a great job. Dr. Gilmore, thank you so
much for coming out today.>>Dr. Steve Gilmore: Thank you. It’s my pleasure. I appreciate you having me ->>Amiko Kauderer: Thank you. This is Mission Control Houston.


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