An osteopathic physician helps ensure astronauts stay healthy in space

Every September, the sun rises in Antarctica and doesn’t set again until March. The Earth’s fifth-largest continent is 98 percent covered in ice, with an average temperature range of -49 to 26 degrees Fahrenheit. The unforgiving conditions mean there are no trees or shrubs, with plant life mainly limited to mosses, fungi, grasses and lichens.

The austere conditions of Antarctica, which has earned it the nickname White Mars, make it a good place to study the effects of isolation and life in a remote environment with parallels to outer space. NASA Flight Surgeon Richard Scheuring, DO, will head to Antarctica in early October for six weeks to support the National Science Foundation (NSF) and its research teams who will be working there. Dr. Scheuring will be providing medical support for the McMurdo and South Pole stations operations teams and NSF expeditions on the ice.

In this edited Q-and-A, Dr. Scheuring shares the latest developments in space medicine and his upcoming mission where he’ll support astronauts on the International Space Station (ISS).

What are the latest space flight developments?

The quickly developing commercial space effort is really bringing us back to shuttle-style bedrock operations. NASA is going to be launching crews from Kennedy Space Center in Florida to the International Space Station on commercial spacecraft by SpaceX and Boeing.

Recent talk of a lunar mission is really exciting. The last time we were on the moon’s surface was 1972.

What’s it like taking care of astronauts in space these days?

At NASA, we really focus on preventive care, which means screening for diseases in advance, as well as screening for capabilities and aptitudes.

When astronauts are on space missions, every week the crew surgeons do a 15-minute private medical video conference with each crew member onboard the ISS. We ask how they’re eating, sleeping, exercising, pooping and peeing. We discuss their workload, general wellbeing, and any issues that might have come up during the week. We’re available to crew members 24/7. They call our cells whenever they need something, which could be while we’re at home watching movies.

Space medicine is often similar to telemedicine, with more communication issues. Depending on satellite availability, crew members aren’t always able to connect to us. Capabilities for diagnosis and treatment can be limited, depending on communications with the ground and whether a physician is up there. The ISS doesn’t always have a physician on site, though currently NASA Astronaut Serena Aunon-Chancellor, MD, is on board. Next year, NASA Astronaut Andrew Morgan, MD, will launch in July for a proposed 180- to 200-day mission.

You’re supporting a 2019 mission to ISS. What will that entail?

I’ll head to Star City, Russia, for the launch next summer for a week with my crew member for his qualification simulations, then travel to Kazakhstan for about a month with the crew for quarantine and final launch preparations. The space mission is about 180-220 days, and I’ll be on call for that whole period. Ten days before the mission ends, I’ll head back to Russia with my deputy crew surgeon to support landing operations.

The human body adapts very well to microgravity, with the most notable changes occurring in the musculoskeletal system. Without exercise countermeasures, the cardiovascular system deconditions aerobically. Bone and muscle loss is most pronounced in the lumbar spine and lower extremities.

The astronauts undergo intensive pre-flight physical conditioning in preparation for their mission with NASA’s athletic trainers, then maintain that strength and conditioning program in space until they come back home. From the moment they return to Houston, about 24 hours from landing in Kazakhstan, they begin an intensive reconditioning program with the trainers.

Over three to four weeks, they work with an athletic trainer to get back into the condition they were in pre-flight. Everyone is sore, especially in their weight-bearing joints, when they get back because they are re-adapting to a stronger gravitational pull.

What are the common health complaints of astronauts?

You grow two to six centimeters in space due to spinal off-loading in microgravity and predictably shrink a little when you come back. Gravity recompresses your spine. Low back pain is very common for this reason. Astronauts’ sleep is often affected because their normal circadian rhythm cues are interrupted due to the loss of normal day-night visual cues.
Those on the ISS experience 90-minute day-and-night cycles. Melatonin can help. Once their sleep gets back on track, they tend to do OK.

Because small amounts of dust and debris float, we also see foreign bodies getting into eyes and minor upper respiratory issues.

Exercise in space is very important for injury and illness prevention. On the ISS, astronauts can use a treadmill, bike or do resistance exercises. Typically they are doing over two hours of exercise a day to counteract space-associated changes, so we’ll see minor aches and pains related to that. Crews are doing better physically than they ever have before in space due to the robust exercise capability of the ISS.

Do astronauts work with mental health specialists as well?

We have a fantastic team of behavioral health specialists. They usually get assigned two years out before a mission. A big piece of it is screening applicants in advance for psychological distress. Then the focus is on improving performance through managing workload schedules, maximizing sleep quality, and ensuring that the crew’s families are supported on the ground.

Dr. Scheuring, an osteopathic physician, is a NASA flight surgeon who serves as an integration lead for medical operations in NASA’s Constellation program that will return humans to the moon and eventually take them to Mars.