Wok
2007-02-11 21:01:04 UTC
MEDICAL EMERGENCIES IN SPACE
Tamarack R. Czarnik, MD
Resident, Aerospace Medicine - Wright State University
http://chapters.marssociety.org/usa/oh/aero5.htm
OVERVIEW
Mechanical failures in spaceflight are so routine as to be
considered unavoidable; whether you hear about it or not, nearly
every spaceflight will have failures of one or more components.
Usually these failures are not critical, and can be fixed
in-flight without disrupting mission objectives. Occasionally,
several failures occurring simultaneously will threaten to abort
the mission (as on STS-93, with two engine computer crashes,
loss of hydrogen fuel and low orbit), or one mission-critical or
sensitive component will fail, cutting short the flight (as on
Challenger's O-ring or Apollo 13's #2 oxygen tank).
So it is with the human body in spaceflight; while minor
'failures' (e.g. skin infections, respiratory symptoms, etc) are
commonplace, they can usually be easily treated in-flight with
minimal mission disruption. But infrequently, several 'minor'
problems will combine to complicate a mission, or one major
exposure or illness in-flight will abort or shorten the flight.
This paper will first examine the incidence of and
accommodations to 'minor' medical breakdowns in-flight, then
briefly describe the mission-threatening occurrences thus far.
'MINOR' AILMENTS
SPACE MOTION SICKNESS
By far the most common of ailments on entering space is Space
Motion Sickness, or SMS. As discussed in a previous paper
('Countermeasures to Long-Duration Spaceflight', Part One), this
poorly-understood syndrome of sweating, dizziness, nausea and
vomiting affects 2/3rds to 3/4s of all astronauts and can be
disabling. EVAs (extra-vehicular activities, or 'spacewalks')
are not scheduled for the first 3 days of a Shuttle mission for
just this reason. But since astronaut doctor Bagian gave the
first intramuscular injection of Phenergan in-flight for a
severe and disabling case back in 1990 (1), there has been
slowly growing acceptance of this well-tolerated (though
invasive) treatment.
HEADACHE AND BACK PAIN
Second only to medications (like Phenergan) for SMS is
consumption of analgesics, predominantly for headache and back
pain. Headache in space seems to be a function of fluid
accumulation in the head and sinuses; try standing on your head
for a few hours and see what happens. While Mercury crews
carried nothing for pain, Gemini missions carried Aspirin and
injectable Demerol, and Apollo added Tylenol and Darvon.
Back pain, on the other hand, seems to result from the body's
'antigravity' (slow twitch) muscles having nothing better to do.
Because there is no gravity to hold yourself erect against,
astronaut's naturally assume a curled, fetal position when
relaxed. Since the back is designed with a lumbar curve to help
counteract gravity, muscles in the lower back begin to ache. I
have not yet found data to suggest wearing the Russian 'Penguin
suit' (with strategically placed bungee-like resistive cords)
lessens this syndrome.
INFECTIONS
Minor infections of the skin, eyes and respiratory tract were
reported 13 times in Apollo (including stomatitis, pharyngitis,
recurrent inguinal and axillary infections) (2), and 8 times in
Skylab (3), despite carrying Tetracycline, Ampicillin and
Neosporin antibiotics (4).
Viral upper respiratory infections occurred 3 times on Apollo
(not counting nasal stuffiness and rhinitis of undetermined
origins), but a 'cold' in space isn't just a nuisance; just ask
Wally Schirra. Developing a cold on Apollo 7, it quickly spread
to shipmates Donn Eisele and Walter Cunningham. But in
microgravity, the nose won't drain, so the sinuses become more
packed and with fluid and uncomfortable, aggravating the natural
headward movement of fluid and congestion. Sinus pressure and
pain caused some strained relations with Mission Control,
worsened by the astronauts' decision not to wear helmets on
re-entry ( to allow pressure on the ear drums to equalize as
cabin pressure changed on descent). None of the three ever flew
in space again.
Skylab also had one occurent of a urinary tract infection
in-flight (3), but nothing to compare with Fred Haise's UTI on
Apollo 13 (of which, more later).
Why are infections common in spaceflight? Without gravity,
particles larger than a micron in size (which normally settle to
the floor) remain in the cabin atmosphere, irritating eyes and
lungs. Some potentially harmful bacteria grow faster and yield
higher numbers in spaceflight (5,6). Lymphocytes, a kind of
white blood cell that fight infection, show decreased activation
in space (7). Immunoglobulins ('antibodies') are decreased after
long-duration spaceflight (8), and cell-mediated immunity
appears to be decreased as well (9). Cosmonauts routinely take
Lactobacillus (a normal and harmless intestinal bacteria)
supplements to offset the observed shift to (potentially
harmful) Enterobacteria and Clostridia. There is even evidence
that some antibiotics work less well in microgravity, presumable
because of gravity-sensitive mechanisms of action (10).
'RASHES'
Skin infections usually require a break in the skin to set in,
and these too are frequent in space. Since humans cannot live in
zero pressure, spacesuits are 'inflated' in space, like
balloons. This makes joints hard to move, especially the fingers
(which are moved most frequently), and working in space gloves
can rub fingers raw and cause subungual hematomas (blood under
the fingernails). These contributed to two skin infections on
Skylab and five subungual hematomas on Apollo; no comprehensive
data are yet available for the ongoing Shuttle program.
Astronauts frequently wear biosensors, giving us data on their
condition. But skin irritation from these biosensors is common,
being reported 11 times during the Apollo program (2). As Apollo
also had no toilet facilities, astronauts got excoriations from
constantly wearing urine collection devices.
SERIOUS AILMENTS
As noted in 'Adaptations to Long-Duration Spaceflight', many
ominous predictions of the consequences of spaceflight have been
proposed. Increased urinary calcium, decreased urinary pH,
decreased urine volume and decreased urinary citrate, which all
occur in spaceflight (11), increase the risk of kidney stones.
Bones thinned from long months in microgravity are expected to
be more susceptible to fracture, either during the mission or on
return to Earth. Orthostatic intolerance and loss of aerobic
capacity could inhibit astronauts' ability to quickly escape
from an emergency landing (12).
However, as also noted in 'Adaptations', many of the earlier
fears did not pan out. Astronauts did not choke on their own
saliva, the lungs did not fill with fluid, and hallucinations
have not been a problem. So how real are these concerns? With
literally dozens of cosmonauts having spent more than 6 months
continuously in space, and 4 (Polyakov, Avdeyev, Manarov and V.
Titov) for longer than 12 months, what serious medical ailments
have been noted in spaceflight?
CARDIAC DYSRHYTHMIAS
Numerous irregularities of heart rhythm have been noted, both in
the American and Soviet/Russian space programs. During Skylab,
one crewmember had a 5-beat run of ventricular tachycardia (a
rhythm that can progress easily into ventricular fibrillation
and death) during a lower-body negative pressure protocol, while
another had episodes of "wandering supraventricular pacemaker"
(13). During reentry, one Shuttle crewmember showed up to 16
PVCs per minute, and another had sustained ventricular bigeminy
during EVA (all rhythms which can lead to death). One Soviet
cosmonaut had to be returned to Earth prematurely for abnormal
heart rhythms; Alexander Laveikin, having spent 6 months on Mir
with Yuri Romanenko (who went on to spend 430 consecutive days
on Mir), had to cut short his mission and return due to
dysrhythmias (14) (although there is also a suggestion that
interpersonal issues played a role - see under "Psychological
Problems). Finally, Vasily Tsibliyev was bumped from an
'internal EVA' in 1997 due to developing an arrhythmia (15).
It is not known if spaceflight (or any of its attendant
circumstances) is inherently arrhythmogenic, but incidence of
arrhythmia has been elevated over preflight incidences.
DECOMPRESSION
Because humans cannot long survive at low pressures, spacesuits,
shuttles and stations must be pressurized. On several occasions,
a breach of pressurization has endangered astronauts' lives.
Vladimir Lyakhov & Aleksandr Aleksandrov, aboard Soyuz T-9 in
1983, prepared to evacuate after hearing a loud crack;
investigation revealed a 3.8 mm impact crater on a window. They
escaped decompression that time, but others were not so lucky.
On STS-37, the palm restraint in one of the astronaut's gloves
came loose and migrated until it punched a hole in the pressure
bladder between his thumb and forefinger. The astronaut bled out
into space, but the skin of the astronaut's hand partially
sealed the opening. His coagulating blood sealed the opening
enough that the bar was retained inside the hole. (16)
On 25 June 97 resupply ship Progress struck the Mir space
station, causing a 20-30 centimeter hole in the Spektr module
and decompressing the station rapidly enough to make Michael
Foale's ears pop. During a subsequent IVA ('internal' EVA),
Pavel Vinogradov's left glove leaks, leaving him with 15 minutes
air; it takes more than half this time to repressurize the node
to safety.
On Soyuz 11's return from Salyut-1 in 1971, a pressure
equalization valve was jerked loose at the jettison of the Soyuz
Orbital Module, depressurizing the cabin. Viktor Patsayev tried
to close the pressure equalization valve, but only got it half
closed before he died. As the cosmonauts were not wearing
pressure suits, Dobrovolskiy, Volkov, and Patsayev were found
dead in their cabin (17).
TOXIC EXPOSURE
Following the 1997 fire aboard Mir, Jerry Linenger and 2
cosmonauts don gas masks to avoid smoke inhalation, benzene and
carbon monoxide. Linenger prepares to intubate victims, but they
emerge safely (18). Later, ethylene glycol (a frequent problem
from 1995-97) leaking from the Kvant-1 coolant loop hits
cosmonaut Tsibliyev head-on, causing eye irritation, lethargy
and nausea (19). Carbon monoxide buildups cause Shannon Lucid to
complain of difficulty thinking (20).
But Mir is by no means the only spacecraft plagued by toxic
exposures. In 1977, during reentry of the Apollo capsule from
the Apollo-Soyuz Test Project, inadvertent firing of the
reaction control system during descent exposed the 3 American
astronauts to toxic gases (mostly nitrogen tetroxide). After a
very hard landing, the crew was able to escape the gas by
donning oxygen masks, but not before Vance Brand lost
consciousness. All crewmembers developed a chemical pneumonitis,
and all required intensive therapy and hospitalization (21). And
as recently as 1999, astronauts aboard STS-96 to the nascent
International Space Station complained of headaches, burning and
itching eyes, flushed faces and nausea, suspected to be due to
carbon dioxide buildup (22).
INFECTIONS
After Apollo 13's oxygen tank exploded, the Command Module lost
all power and the three astronauts had to use the attached Lunar
Module as a lifeboat. In addition to enduring freezing
temperatures and dehydration (water was rationed to six ounces
per person per day), all three had to wear their condom-style
urinary catheters constantly. Fred Haise became feverish and
lethargic; medical examination after their successful recovery
indicated a Pseudomonas aeruginosa urinary tract infection
brought on by dehydration. Had their 87-hour ordeal gone on much
longer, all three would likely have had the infection. (23)
In September 1985, Vladimir Vasyutin rode a Soyuz-14 to Salyut-7
with fellow cosmonauts G Grechko and A Volkov for another
record-breaking stay in space. In late October, however,
Vasyutin had lost his appetite and was obviously sick, staying
in bed all day. Mission Control told him to wait for his
condition to change and continue working. But by November his
condition had not improved, and on November 21 the crew returned
to Earth. The Soviets released to the press that he had a fever
of 104o F (40o C) and inflammation for three weeks; the press
initially reported that he had appendicitis, then a prostate
infection. (24)
But there is some indication that Vasyutin's problem may have
been psychological, rather than inflammatory. The crew did not
return immediately, unhurriedly mothballing the station.
Vasyutin himself said he thought the problem was in his frame of
mind, and his condition improved a bit when they were told to
come home. On landing, Vasyutin rejected a stretcher; he was the
first out of the capsule, and reported "I'm feeling all right,
the way I should after a landing. I am very happy to see people.
It has been just the three of us for so long, it is nice to see
so many people." (25)
PSYCHOLOGICAL PROBLEMS
While NASA seems only now to be discovering psychological
concerns in spaceflight, the Russians have been dealing with it
for years. Nonetheless, numerous problems have arisen.
Information is scant, as both NASA and the RSA are loathe to
discuss them (both for patient confidentiality and for image
control).
John Blaha, aboard Mir for 4 months in 1996-7, began
experiencing fits of anger, insomnia and withdrawal, exacerbated
by an overdemanding workload. "He was hurting," Linenger
recalls. "He was, in essence, depressed." (26) Blaha confirms
the depression; with a reduced workload and improved support, he
completes his mission.
Salyut-5's visit by the Soyuz-21 cosmonauts Volynov and
Zholobov, slated to beat the 63-day record, was cut short after
seven weeks, and no official reason was given. Based on medical
records (released a year later) indicating a marked decline in
the copilot's health, Soviet news items on the problems of
psychological isolation and sensory deprivation, and the
statement of the crew's general health as "satisfactory" rather
than the far more usual "excellent", author James Oberg
conjectures that psychological problems cut short the mission
(though there is some suggestion that an "acrid odor" from the
cabin air-regeneration system may have been the culprit). (27)
Burrough, in Dragonfly, quotes 'NASA sources who have spoken at
length with Russian psychologists' as stating Soyuz-21 (Volynov
and Zholobov) as terminated early due to "interpersonal issues",
Soyuz T-14 (Vasyutin) due to "mood and performance issues", and
Soyuz TM-2 in 1987 (Laveikin) due to "interpersonal issues and
cardiac irregularity". (28)
Stress from the fire aboard Mir led Jerry Linenger himself to
become more withdrawn and isolated; eventually he even refused
to participate in voice communications. Burrough observes,
"Linenger's voice is high-pitched and shrill; he sounds as if he
is on the verge of some kind of breakdown." (29)
When psychological problems are discussed the "24-hour mutiny"
aboard Skylab-4 is frequently brought up; for one 24-hour
period, astronauts Carr, Gibson and Pogue 'refused' to do any
work, choosing instead to relax, look out the window, and rest.
This is given as evidence that long-duration spaceflight
engenders conspiracy and revolt, and in fact, the rebellion
against NASA Ground Control overtasking led to none of the crew
ever flying again (30). An alternate explanation for the
'sedition' is that all Sundays were scheduled to be 'down time';
the astronauts worked through most of their 'vacation Sundays'
to keep up, but claimed one Sunday as their own for rest and
relaxation. Be that as it may, it is unlikely to be a
coincidence that none of the three ever flew again.
Psychological Special Case - 'The Call of the Abyss'
In the days of sailing ships, physically sound young men would
occasionally throw themselves from the boat and drown, overcome
by fascination with the sea. This "Call of the Waters", as it
was named, may have a latter-day equivalent in spaceflight. Just
as some are compelled to stand on the edge of precipices or
stare off bridges into the void below, some astronauts are
fascinated by the free-falling view of space afforded by
spacewalking. Valeri Ryumin's diary from his 1979 stay aboard
Salyut-6 described his August 15 spacewalk: "You're out of your
mind, I was telling myself - hanging on to a ship in space, and
to your life, and getting ready to admire a sunset." (31)
In fact, right from the start some spacewalkers have been
reluctant to return to the safety of the ship. America's first
spacewalker, Ed White, had to be ordered back into the capsule
by Mission Control. When McDivitt had to tell him it was time to
come back inside, White sighed, "It's the saddest moment of my
life." (32)
But this compulsion to stare into the void almost turned deadly
for rookie cosmonaut Yuri Romanenko. During his 1977 stay
on-board Salyut-6 with Georgi Grechko, a 20 December spacewalk
was scheduled; Grechko would spacewalk, and Romanenko was to
stay inside the airlock, monitoring medical readings. But
Romanenko's curiosity got the better of him; he stuck his head
out of the hatch, then drifted further and further out. When he
started thrashing wildly, Grechko realized his friend's safety
line wasn't attached, and Romanenko was drifting off into space!
By leaning over as Romanenko drifted by, Grechko was able to
grab hold of the safety line and pull him back in. Had Romanenko
been further out, he would have drifted off and eventually
suffocated. (33)
Future spacewalkers would do well to heed Nietzsche's advice:
"When you look long into an abyss, the abyss also looks into
you."
Space is a dangerous place to get sick (mentally or physically),
and help is currently a long way off: evacuation time is
estimated to be 24 hours from Low Earth Orbit (LEO), 3 days from
the Moon, and as long as 2 years from a Mars colony. But what if
definitive treatment could be provided on-site, whether it be in
LEO, on the Moon, on Mars, or beyond? This possibility is the
subject of the final 'Aerospace Medicine 101' paper, "Surgery in
Space".
REFERENCES
1. Davis JR, RT Jennings and BG Beck. 'Comparison of
Treatment Strategies for Space Motion Sickness'. Acta
Astronautica 1993 Aug; 29(8):587-91.
2. Berry CA. Biomedical Results of Apollo. Washington :
Scientific and Technical Information
3. Office 1975. NASA SP-368. Pg. 68.
4. Dietlein, L.F. 'Skylab: a beginning', pp. 408-18. In:
Biomedical Results from Skylab (NASA SP-377). Edited by
Johnston, R.S., and Dietlein, L.F. Washington, D.C., U.S.
Government Printing Office, 1977.
5. Berry, pp. 55-6.
6. Bryan LE. Bacterial Resistance and Susceptibility to
Chemotherapeutic Agents. New York: Cambridge University Press,
1982.
7. Menigmann HD, M Lange. 'Growth and Differentiation of
Bacillus subtilis under Microgravity'. Naturwissenschaften.
1986; 73: 415-7.
8. Cogoli A. 'Effect of Spaceflight on Lymphocyte
Proliferation'. In: Sahm PR, R Jansen, eds. Scientific Goals of
German Spacelab Mission D1. In: Wissenschaftliche Ziele der
Deutschen 1985; 155-7.
9. Yegerov AD. 'Results of Medical Research during the
175-day Flight of the Third Main Crew on the Salyut-6/Soyuz
Orbital Complex'. NASA TM-76450, 1981.
10. Taylor GR, RP Janney. 'In Vivo Testing Confirms a Blunting
of the Human Cell-Mediated Immune Mechanism during Spaceflight'.
Journal of Leukocyte Biology 1992; 51:129-32.
11. Tixador R, G Gasset, B Eche et. al. 'Behavior of Bacteria
and Antibiotics Under Space Conditions'. Aviation, Space and
Environmental Medicine June 1994; 65:551-6.
12. Huntoon CL, NM Cintron, PA Whitson. 'Endocrine and
Biochemical Functions', pp 342-3. In: Space Physiology and
Medicine, 3rd ed. Edited by Nicogossian AE, CL Huntoon and SL
Pool. Malvern, PA. Lea & Febiger. 1993.
13. Charles JB, Bungo MW and Fortner GW. 'Cardiopulmonary
Function', pg. 286. In: Space Physiology and Medicine. Edited by
Nicogossian AE, CL Huntoon and SL Pool. Malvern, PA. Lea &
Febiger.
13) Ibid, pg. 302.
14) Wade M. 'Laveykin' entry, Encyclopedia Astronautica CD-ROM,
1998.
15) Burrough B. Dragonfly, pg. 448. HarperCollins Publishers;
New York, NY. 1998.
16) Landis, G. Personal communication, 1999.
17) Oberg J. Red Star in Orbit, pg. 104. Random House Inc.; New
York, NY. 1981.
18) Burrough, pg. 135.
19) Ibid, pg. 355.
20) 1997 letter from NASA Inspector Roberta Gross to
Representative F. James Sensenbrenner,
Appendix C.
21) Nicogossian AE, Pool SL, Uri JJ. "Historical Perspectives',
pg. 12. In: Space Physiology and
Medicine, 3rd ed. Edited by Nicogossian AE, CL Huntoon and SL
Pool. Malvern, PA. Lea &
Febiger. 1993.
22) Borenstein S. 'NASA Has Health Problems', published in
Detroit Free Press, 24 July 99.
23) Berry, pp 94-5.
24) Newkirk D. Almanac of Soviet Manned Space Flight. Newly
printed; ISBN 0872018482.
Chapter 5 available on-line, currently at
www.mcs.net/~rusaerog/aosmsf/ch5.html .
25) Burrough, pp 111-4.
26) Oberg, pp. 145-6.
27) Burrough, pg. 185.
28) Ibid, pg. 178.
29) Ibid, pp. 185-6.
30) Oberg, pg. 217.
31) Wade, 'White' entry, Encyclopedia Astronautica CD-ROM, 1998.
32) Oberg, pp. 165-6.
Tamarack R. Czarnik, MD
Resident, Aerospace Medicine - Wright State University
http://chapters.marssociety.org/usa/oh/aero5.htm
OVERVIEW
Mechanical failures in spaceflight are so routine as to be
considered unavoidable; whether you hear about it or not, nearly
every spaceflight will have failures of one or more components.
Usually these failures are not critical, and can be fixed
in-flight without disrupting mission objectives. Occasionally,
several failures occurring simultaneously will threaten to abort
the mission (as on STS-93, with two engine computer crashes,
loss of hydrogen fuel and low orbit), or one mission-critical or
sensitive component will fail, cutting short the flight (as on
Challenger's O-ring or Apollo 13's #2 oxygen tank).
So it is with the human body in spaceflight; while minor
'failures' (e.g. skin infections, respiratory symptoms, etc) are
commonplace, they can usually be easily treated in-flight with
minimal mission disruption. But infrequently, several 'minor'
problems will combine to complicate a mission, or one major
exposure or illness in-flight will abort or shorten the flight.
This paper will first examine the incidence of and
accommodations to 'minor' medical breakdowns in-flight, then
briefly describe the mission-threatening occurrences thus far.
'MINOR' AILMENTS
SPACE MOTION SICKNESS
By far the most common of ailments on entering space is Space
Motion Sickness, or SMS. As discussed in a previous paper
('Countermeasures to Long-Duration Spaceflight', Part One), this
poorly-understood syndrome of sweating, dizziness, nausea and
vomiting affects 2/3rds to 3/4s of all astronauts and can be
disabling. EVAs (extra-vehicular activities, or 'spacewalks')
are not scheduled for the first 3 days of a Shuttle mission for
just this reason. But since astronaut doctor Bagian gave the
first intramuscular injection of Phenergan in-flight for a
severe and disabling case back in 1990 (1), there has been
slowly growing acceptance of this well-tolerated (though
invasive) treatment.
HEADACHE AND BACK PAIN
Second only to medications (like Phenergan) for SMS is
consumption of analgesics, predominantly for headache and back
pain. Headache in space seems to be a function of fluid
accumulation in the head and sinuses; try standing on your head
for a few hours and see what happens. While Mercury crews
carried nothing for pain, Gemini missions carried Aspirin and
injectable Demerol, and Apollo added Tylenol and Darvon.
Back pain, on the other hand, seems to result from the body's
'antigravity' (slow twitch) muscles having nothing better to do.
Because there is no gravity to hold yourself erect against,
astronaut's naturally assume a curled, fetal position when
relaxed. Since the back is designed with a lumbar curve to help
counteract gravity, muscles in the lower back begin to ache. I
have not yet found data to suggest wearing the Russian 'Penguin
suit' (with strategically placed bungee-like resistive cords)
lessens this syndrome.
INFECTIONS
Minor infections of the skin, eyes and respiratory tract were
reported 13 times in Apollo (including stomatitis, pharyngitis,
recurrent inguinal and axillary infections) (2), and 8 times in
Skylab (3), despite carrying Tetracycline, Ampicillin and
Neosporin antibiotics (4).
Viral upper respiratory infections occurred 3 times on Apollo
(not counting nasal stuffiness and rhinitis of undetermined
origins), but a 'cold' in space isn't just a nuisance; just ask
Wally Schirra. Developing a cold on Apollo 7, it quickly spread
to shipmates Donn Eisele and Walter Cunningham. But in
microgravity, the nose won't drain, so the sinuses become more
packed and with fluid and uncomfortable, aggravating the natural
headward movement of fluid and congestion. Sinus pressure and
pain caused some strained relations with Mission Control,
worsened by the astronauts' decision not to wear helmets on
re-entry ( to allow pressure on the ear drums to equalize as
cabin pressure changed on descent). None of the three ever flew
in space again.
Skylab also had one occurent of a urinary tract infection
in-flight (3), but nothing to compare with Fred Haise's UTI on
Apollo 13 (of which, more later).
Why are infections common in spaceflight? Without gravity,
particles larger than a micron in size (which normally settle to
the floor) remain in the cabin atmosphere, irritating eyes and
lungs. Some potentially harmful bacteria grow faster and yield
higher numbers in spaceflight (5,6). Lymphocytes, a kind of
white blood cell that fight infection, show decreased activation
in space (7). Immunoglobulins ('antibodies') are decreased after
long-duration spaceflight (8), and cell-mediated immunity
appears to be decreased as well (9). Cosmonauts routinely take
Lactobacillus (a normal and harmless intestinal bacteria)
supplements to offset the observed shift to (potentially
harmful) Enterobacteria and Clostridia. There is even evidence
that some antibiotics work less well in microgravity, presumable
because of gravity-sensitive mechanisms of action (10).
'RASHES'
Skin infections usually require a break in the skin to set in,
and these too are frequent in space. Since humans cannot live in
zero pressure, spacesuits are 'inflated' in space, like
balloons. This makes joints hard to move, especially the fingers
(which are moved most frequently), and working in space gloves
can rub fingers raw and cause subungual hematomas (blood under
the fingernails). These contributed to two skin infections on
Skylab and five subungual hematomas on Apollo; no comprehensive
data are yet available for the ongoing Shuttle program.
Astronauts frequently wear biosensors, giving us data on their
condition. But skin irritation from these biosensors is common,
being reported 11 times during the Apollo program (2). As Apollo
also had no toilet facilities, astronauts got excoriations from
constantly wearing urine collection devices.
SERIOUS AILMENTS
As noted in 'Adaptations to Long-Duration Spaceflight', many
ominous predictions of the consequences of spaceflight have been
proposed. Increased urinary calcium, decreased urinary pH,
decreased urine volume and decreased urinary citrate, which all
occur in spaceflight (11), increase the risk of kidney stones.
Bones thinned from long months in microgravity are expected to
be more susceptible to fracture, either during the mission or on
return to Earth. Orthostatic intolerance and loss of aerobic
capacity could inhibit astronauts' ability to quickly escape
from an emergency landing (12).
However, as also noted in 'Adaptations', many of the earlier
fears did not pan out. Astronauts did not choke on their own
saliva, the lungs did not fill with fluid, and hallucinations
have not been a problem. So how real are these concerns? With
literally dozens of cosmonauts having spent more than 6 months
continuously in space, and 4 (Polyakov, Avdeyev, Manarov and V.
Titov) for longer than 12 months, what serious medical ailments
have been noted in spaceflight?
CARDIAC DYSRHYTHMIAS
Numerous irregularities of heart rhythm have been noted, both in
the American and Soviet/Russian space programs. During Skylab,
one crewmember had a 5-beat run of ventricular tachycardia (a
rhythm that can progress easily into ventricular fibrillation
and death) during a lower-body negative pressure protocol, while
another had episodes of "wandering supraventricular pacemaker"
(13). During reentry, one Shuttle crewmember showed up to 16
PVCs per minute, and another had sustained ventricular bigeminy
during EVA (all rhythms which can lead to death). One Soviet
cosmonaut had to be returned to Earth prematurely for abnormal
heart rhythms; Alexander Laveikin, having spent 6 months on Mir
with Yuri Romanenko (who went on to spend 430 consecutive days
on Mir), had to cut short his mission and return due to
dysrhythmias (14) (although there is also a suggestion that
interpersonal issues played a role - see under "Psychological
Problems). Finally, Vasily Tsibliyev was bumped from an
'internal EVA' in 1997 due to developing an arrhythmia (15).
It is not known if spaceflight (or any of its attendant
circumstances) is inherently arrhythmogenic, but incidence of
arrhythmia has been elevated over preflight incidences.
DECOMPRESSION
Because humans cannot long survive at low pressures, spacesuits,
shuttles and stations must be pressurized. On several occasions,
a breach of pressurization has endangered astronauts' lives.
Vladimir Lyakhov & Aleksandr Aleksandrov, aboard Soyuz T-9 in
1983, prepared to evacuate after hearing a loud crack;
investigation revealed a 3.8 mm impact crater on a window. They
escaped decompression that time, but others were not so lucky.
On STS-37, the palm restraint in one of the astronaut's gloves
came loose and migrated until it punched a hole in the pressure
bladder between his thumb and forefinger. The astronaut bled out
into space, but the skin of the astronaut's hand partially
sealed the opening. His coagulating blood sealed the opening
enough that the bar was retained inside the hole. (16)
On 25 June 97 resupply ship Progress struck the Mir space
station, causing a 20-30 centimeter hole in the Spektr module
and decompressing the station rapidly enough to make Michael
Foale's ears pop. During a subsequent IVA ('internal' EVA),
Pavel Vinogradov's left glove leaks, leaving him with 15 minutes
air; it takes more than half this time to repressurize the node
to safety.
On Soyuz 11's return from Salyut-1 in 1971, a pressure
equalization valve was jerked loose at the jettison of the Soyuz
Orbital Module, depressurizing the cabin. Viktor Patsayev tried
to close the pressure equalization valve, but only got it half
closed before he died. As the cosmonauts were not wearing
pressure suits, Dobrovolskiy, Volkov, and Patsayev were found
dead in their cabin (17).
TOXIC EXPOSURE
Following the 1997 fire aboard Mir, Jerry Linenger and 2
cosmonauts don gas masks to avoid smoke inhalation, benzene and
carbon monoxide. Linenger prepares to intubate victims, but they
emerge safely (18). Later, ethylene glycol (a frequent problem
from 1995-97) leaking from the Kvant-1 coolant loop hits
cosmonaut Tsibliyev head-on, causing eye irritation, lethargy
and nausea (19). Carbon monoxide buildups cause Shannon Lucid to
complain of difficulty thinking (20).
But Mir is by no means the only spacecraft plagued by toxic
exposures. In 1977, during reentry of the Apollo capsule from
the Apollo-Soyuz Test Project, inadvertent firing of the
reaction control system during descent exposed the 3 American
astronauts to toxic gases (mostly nitrogen tetroxide). After a
very hard landing, the crew was able to escape the gas by
donning oxygen masks, but not before Vance Brand lost
consciousness. All crewmembers developed a chemical pneumonitis,
and all required intensive therapy and hospitalization (21). And
as recently as 1999, astronauts aboard STS-96 to the nascent
International Space Station complained of headaches, burning and
itching eyes, flushed faces and nausea, suspected to be due to
carbon dioxide buildup (22).
INFECTIONS
After Apollo 13's oxygen tank exploded, the Command Module lost
all power and the three astronauts had to use the attached Lunar
Module as a lifeboat. In addition to enduring freezing
temperatures and dehydration (water was rationed to six ounces
per person per day), all three had to wear their condom-style
urinary catheters constantly. Fred Haise became feverish and
lethargic; medical examination after their successful recovery
indicated a Pseudomonas aeruginosa urinary tract infection
brought on by dehydration. Had their 87-hour ordeal gone on much
longer, all three would likely have had the infection. (23)
In September 1985, Vladimir Vasyutin rode a Soyuz-14 to Salyut-7
with fellow cosmonauts G Grechko and A Volkov for another
record-breaking stay in space. In late October, however,
Vasyutin had lost his appetite and was obviously sick, staying
in bed all day. Mission Control told him to wait for his
condition to change and continue working. But by November his
condition had not improved, and on November 21 the crew returned
to Earth. The Soviets released to the press that he had a fever
of 104o F (40o C) and inflammation for three weeks; the press
initially reported that he had appendicitis, then a prostate
infection. (24)
But there is some indication that Vasyutin's problem may have
been psychological, rather than inflammatory. The crew did not
return immediately, unhurriedly mothballing the station.
Vasyutin himself said he thought the problem was in his frame of
mind, and his condition improved a bit when they were told to
come home. On landing, Vasyutin rejected a stretcher; he was the
first out of the capsule, and reported "I'm feeling all right,
the way I should after a landing. I am very happy to see people.
It has been just the three of us for so long, it is nice to see
so many people." (25)
PSYCHOLOGICAL PROBLEMS
While NASA seems only now to be discovering psychological
concerns in spaceflight, the Russians have been dealing with it
for years. Nonetheless, numerous problems have arisen.
Information is scant, as both NASA and the RSA are loathe to
discuss them (both for patient confidentiality and for image
control).
John Blaha, aboard Mir for 4 months in 1996-7, began
experiencing fits of anger, insomnia and withdrawal, exacerbated
by an overdemanding workload. "He was hurting," Linenger
recalls. "He was, in essence, depressed." (26) Blaha confirms
the depression; with a reduced workload and improved support, he
completes his mission.
Salyut-5's visit by the Soyuz-21 cosmonauts Volynov and
Zholobov, slated to beat the 63-day record, was cut short after
seven weeks, and no official reason was given. Based on medical
records (released a year later) indicating a marked decline in
the copilot's health, Soviet news items on the problems of
psychological isolation and sensory deprivation, and the
statement of the crew's general health as "satisfactory" rather
than the far more usual "excellent", author James Oberg
conjectures that psychological problems cut short the mission
(though there is some suggestion that an "acrid odor" from the
cabin air-regeneration system may have been the culprit). (27)
Burrough, in Dragonfly, quotes 'NASA sources who have spoken at
length with Russian psychologists' as stating Soyuz-21 (Volynov
and Zholobov) as terminated early due to "interpersonal issues",
Soyuz T-14 (Vasyutin) due to "mood and performance issues", and
Soyuz TM-2 in 1987 (Laveikin) due to "interpersonal issues and
cardiac irregularity". (28)
Stress from the fire aboard Mir led Jerry Linenger himself to
become more withdrawn and isolated; eventually he even refused
to participate in voice communications. Burrough observes,
"Linenger's voice is high-pitched and shrill; he sounds as if he
is on the verge of some kind of breakdown." (29)
When psychological problems are discussed the "24-hour mutiny"
aboard Skylab-4 is frequently brought up; for one 24-hour
period, astronauts Carr, Gibson and Pogue 'refused' to do any
work, choosing instead to relax, look out the window, and rest.
This is given as evidence that long-duration spaceflight
engenders conspiracy and revolt, and in fact, the rebellion
against NASA Ground Control overtasking led to none of the crew
ever flying again (30). An alternate explanation for the
'sedition' is that all Sundays were scheduled to be 'down time';
the astronauts worked through most of their 'vacation Sundays'
to keep up, but claimed one Sunday as their own for rest and
relaxation. Be that as it may, it is unlikely to be a
coincidence that none of the three ever flew again.
Psychological Special Case - 'The Call of the Abyss'
In the days of sailing ships, physically sound young men would
occasionally throw themselves from the boat and drown, overcome
by fascination with the sea. This "Call of the Waters", as it
was named, may have a latter-day equivalent in spaceflight. Just
as some are compelled to stand on the edge of precipices or
stare off bridges into the void below, some astronauts are
fascinated by the free-falling view of space afforded by
spacewalking. Valeri Ryumin's diary from his 1979 stay aboard
Salyut-6 described his August 15 spacewalk: "You're out of your
mind, I was telling myself - hanging on to a ship in space, and
to your life, and getting ready to admire a sunset." (31)
In fact, right from the start some spacewalkers have been
reluctant to return to the safety of the ship. America's first
spacewalker, Ed White, had to be ordered back into the capsule
by Mission Control. When McDivitt had to tell him it was time to
come back inside, White sighed, "It's the saddest moment of my
life." (32)
But this compulsion to stare into the void almost turned deadly
for rookie cosmonaut Yuri Romanenko. During his 1977 stay
on-board Salyut-6 with Georgi Grechko, a 20 December spacewalk
was scheduled; Grechko would spacewalk, and Romanenko was to
stay inside the airlock, monitoring medical readings. But
Romanenko's curiosity got the better of him; he stuck his head
out of the hatch, then drifted further and further out. When he
started thrashing wildly, Grechko realized his friend's safety
line wasn't attached, and Romanenko was drifting off into space!
By leaning over as Romanenko drifted by, Grechko was able to
grab hold of the safety line and pull him back in. Had Romanenko
been further out, he would have drifted off and eventually
suffocated. (33)
Future spacewalkers would do well to heed Nietzsche's advice:
"When you look long into an abyss, the abyss also looks into
you."
Space is a dangerous place to get sick (mentally or physically),
and help is currently a long way off: evacuation time is
estimated to be 24 hours from Low Earth Orbit (LEO), 3 days from
the Moon, and as long as 2 years from a Mars colony. But what if
definitive treatment could be provided on-site, whether it be in
LEO, on the Moon, on Mars, or beyond? This possibility is the
subject of the final 'Aerospace Medicine 101' paper, "Surgery in
Space".
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2. Berry CA. Biomedical Results of Apollo. Washington :
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3. Office 1975. NASA SP-368. Pg. 68.
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5. Berry, pp. 55-6.
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13) Ibid, pg. 302.
14) Wade M. 'Laveykin' entry, Encyclopedia Astronautica CD-ROM,
1998.
15) Burrough B. Dragonfly, pg. 448. HarperCollins Publishers;
New York, NY. 1998.
16) Landis, G. Personal communication, 1999.
17) Oberg J. Red Star in Orbit, pg. 104. Random House Inc.; New
York, NY. 1981.
18) Burrough, pg. 135.
19) Ibid, pg. 355.
20) 1997 letter from NASA Inspector Roberta Gross to
Representative F. James Sensenbrenner,
Appendix C.
21) Nicogossian AE, Pool SL, Uri JJ. "Historical Perspectives',
pg. 12. In: Space Physiology and
Medicine, 3rd ed. Edited by Nicogossian AE, CL Huntoon and SL
Pool. Malvern, PA. Lea &
Febiger. 1993.
22) Borenstein S. 'NASA Has Health Problems', published in
Detroit Free Press, 24 July 99.
23) Berry, pp 94-5.
24) Newkirk D. Almanac of Soviet Manned Space Flight. Newly
printed; ISBN 0872018482.
Chapter 5 available on-line, currently at
www.mcs.net/~rusaerog/aosmsf/ch5.html .
25) Burrough, pp 111-4.
26) Oberg, pp. 145-6.
27) Burrough, pg. 185.
28) Ibid, pg. 178.
29) Ibid, pp. 185-6.
30) Oberg, pg. 217.
31) Wade, 'White' entry, Encyclopedia Astronautica CD-ROM, 1998.
32) Oberg, pp. 165-6.