How Health Is Different in Space

I remember one of my test pilot friends

was really feeling sick, but did not want to go

to the doctor cause he didn't want to be grounded.

He finally couldn't take it.

He collapsed on the way to the doctor's office.

This is not a good idea, kids.

If you're sick, go see the doctor.

I'm Mike Massimino and this is how health

is different in space.

I was an astronaut for 18 years.

I flew in space two times,

two missions on the space shuttle.

Health is really important for astronauts.

There are a whole list of things that can

have you become disqualified from going to space.

Typically, you want to try to be as healthy as you can

and you want to have a healthy heart,

you want to be as fit as you possibly can,

you wanna eat right and take care of yourself,

and if you don't and you fall out of the standards

that you're supposed to be within, it could mean

you're not going to get a chance to fly in space.

You don't have to be an Olympic athlete,

but they want to make sure that you're healthy enough to do

the job, which means they don't want to be worried about

a medical situation when you're in space.

If you have a propensity toward kidney stones, for example,

that was a disqualifying thing.

They don't want you having a kidney stone develop

while you're in space.

The medical situation on Earth is bad enough,

but it space, it's really bad.

So, they want to make sure that people they're putting into

space are not going to have a problem once they're in space.

Exercise is important for all of us.

Before I became an astronaut,

I generally did sports for recreation,

riding my bike for fun or maybe going for a run,

things like that.

Once I became an astronaut,

it became a little more structured.

I felt like, I was getting ready for somewhat of

an athletic event because spacewalking did require exertion

and you needed it to move around almost constantly

and you had to manipulate this suit that you were wearing.

So, the better shape you could be in,

the better off you were gonna perform.

I was in the best physical shape of my life

before each one of my space flights

and that was, I was older.

I was 39 on my first flight and then,

46 on my second flight,

but I was in better shape than I ever was

as a high school athlete or any other time in my life.

Exercise in space is a little bit different.

Because you're in zero gravity, you're floating.

So, it's as if you're on bed rest, but even worse than that

as far as physical conditioning goes.

You're laying around, you're not exerting yourself,

you're just floating around and even doing things

like just walking or even sitting on Earth,

you're fighting against gravity.

In space, you're floating the whole time.

So, it's no load on your bones or on your muscles

and if you don't exercise in space

for a prolonged period of time,

you can lose bone mass and you can lose muscle mass

and your heart, which is a muscle, it'll shrink

and that's not a good thing.

So, the way we prevent these bad things

from happening is by exercising.

Weights aren't going to work very well in space.

You can take an object that weighs 600 pounds

and pick it up with one finger

cause everything's floating, it's weightless.

So, you want to be pulling against something

for a resistive exercise workout,

like a spring or something that has some resistance to it

cause that works just fine in space

but actual weights won't.

There is a two-hour exercise period set up,

six days a week for astronauts who are on the space station

and it's a combination of cardio,

which is riding an exercise bike or a treadmill.

The CEVIS, the bike,

Cycle Ergometer Vibration Isolation System.

The Vibration Isolation part of it is pretty important

because when you're working out,

you're gonna cause vibration

and the advantage that you have on a space station

for science is that you're in zero gravity

and if you start shaking and vibrating,

that compromises the microgravity environment,

you're going to disturb the experiments that are using the

micro gravity to zero gravity environment for the science,

but start shaking it up a little bit

and you're going to hear about it.

So, these engineers who have developed these machines,

probably don't get as much credit as they deserve

because they are not only keeping astronauts healthy,

but they're isolating the vibrations

associated with doing that sort of work out

to those machines and not spreading it around

to compromise the integrity of

the zero gravity experiments on board,

but that's the way you can get cardio exercise in space.

For resistive exercise, Advanced Resistive Exercise Device,

ARED, which is a pretty high-tech piece of equipment

that works on pulleys and springs

and you can do a variety of exercises with that.

You can even do squats.

You can do leg presses.

You can do curls.

You can do bench press and so, combining that with

the cardio devices, you get a pretty good workout.

We also had TheraBands, these elastic bands that

we would use, they'd give you some resistance

and we have astronauts coming back in sometimes

better shape than they were when they left.

The way we prevent sickness in space is by putting you,

the astronaut, into a quarantine ahead of time,

so you're not bringing germs to space.

The spacecraft should be perfectly clean.

There should not be bacteria in the spacecraft.

So, what we do is, we enter a quarantine period

about a week before the flight,

and you're in, what we call it is health stabilization.

The only people that are allowed to be around you

have to be screened and approved by the flight surgeon.

There was an age limit that changed

for kids to be around you.

My first flight, my children were too young to be near me.

My second fight, they were both teenagers,

so they were able to come visit me.

Food poisoning is probably not going to be happening

cause that's all controlled on what goes on board.

Your water is clean water.

I think we could treat it as well with iodine, if needed.

Iodine leaves a certain taste,

so there was another filtration system we had

to remove the iodine out of the water.

So, they really wanted to make sure your water was clean.

So, you're in a pretty much a germ-free environment.

On Earth, when you're not feeling well,

you can go to the doctor.

Sometimes, you might take care of it yourself

in some ways, some medicine or aspirin

or whatever you have available to you,

but eventually, if you're feeling sick,

you can go to the doctor and get checked.

When you apply to be an astronaut,

if you get far enough along in the selection process,

that you're a finalist and typically there's

about 100, 120 finalists for each astronaut class

and then, they'll pick however many they need,

your selection interview is not just an interview

but it's also a lot of medical exams

and you get checked out pretty much from top to bottom.

It's a really extensive medical exam that you go through

that takes a few days and they'll check you out

and make sure that you're healthy.

I still go for an annual physical every year

as part of like a long-range health data

collection that NASA does,

but in space, your medical care is a little bit different.

We had a full set of medicine in our medical kit

for just about every kind of ailment imaginable

and we had to make sure we didn't have

any allergic reactions to those medicines.

So, we got a drug testing kit.

We were supposed to take one of these,

they would tell you how many you're supposed to take

and every day pretty much, we tested something different,

whether it's an antibiotic or sleep medicine

or painkiller or whatever it was.

We always had someone who was our main

medical officer on the flight.

Sometimes that was a doctor.

I never flew with an MD.

I did fly with a veterinarian and he became a medical doctor

but someone needs to work on that person as well.

So, they have another person

who is kind of like the assistant.

So, you always have at least two or sometimes,

three people who were trained to be medical officers.

We get CPR training, we get basic first aid,

so we can help each other that way

but some of us get the more extensive

medical officer training, which is kind of like

the equivalent to being an EMT.

You also are in close contact with the flight surgeon.

So, flight surgeons are medical doctors

who have this special certification that allows them

to deal with aviation space medical issues.

All flight surgeons are also aware of things

that can happen in zero gravity

and the ill effects of zero gravity, human bone loss

and muscle loss and other issues that might arise

because of the space suit, causing of injuries

and so on, for the job we have.

So, if you have a problem in space,

there is a first aid kit, there's a medical kit

that you can do basic things with.

You can do things like suture up a cut if needed.

Surgery is a bit of a problem.

I think at first in the space station program,

they thought that they would be able to do surgeries.

It really is not practical to be able

to do any major invasive operation.

If someone needed something like that,

they would de-orbit them and bring them home.

It's easier to do that, take care of that on Earth.

That's not going to be the case

when we go further away from the planet.

We're going to be have to,

you can't fly people back from Mars that easily.

You're gonna have to be able to deal with things

en route or once you get to that new place.

So, right now, the luxury of being close to the ground

helps with lot of major medical IMS.

We've never had anything that we've had do that for,

we've never had to de-orbit for a medical issue.

If you need help from the ground and on the space station

or on the space shuttle, we were able to call the ground

and see if there was help.

Motion sickness happens to most people, it happened to me.

My first day in space, I didn't feel very well.

It's a conflict between our vestibular system

and our eyesight.

That conflict can lead to a little bit of stomach awareness.

You're moving around the cabin, let's say with your eyes

but your inner ear is telling you you're perfectly still

and it does not feel good.

I was not used to it, my first day in space, of course

and I ended up throwing up at the end of the day

and the next day, I was fine

and on my second flight, I was fine.

Your brain doesn't know what's going on at first

and it reacts a certain way, but then it learns

and you don't have a problem.

So, it's an adaptation as opposed to a real sickness.

How do you throw up if you get sick in space?

Ooh, the Sun's starting to come up.

So, here's an astronaut barf bag, right here.

Puking works just like it does on Earth,

in that, stuff will come out of your mouth, right,

from your stomach, like a projectile.

Now, the difference is that, if you do that on Earth,

it's probably going to land somewhere.

In space, it's going to come out and float around,

which is not a good situation, it'll get everybody sick.

So, we want to use our vomit bag

and we have really good vomit bags,

emises bags is what they call them.

I guess emises is a fancy word for vomit.

You would vomit into those and they're really well made.

They're cloth on the outside, plastic on the inside.

[mumbles into hand]

poof, so everything will go inside of this bag

and then, once you're done, you can seal it off,

roll it up, compact it and then, get another one ready.

I was very concerned about this on my first flight.

I had two on me all the time that first day

and after the first day, I was fine, I didn't need one.

But you want them handy when you first get to space.

I think in everyday life, we realize

the importance of mental health

and trying to keep ourselves mentally healthy

and NASA is the same way.

So, there was always help available if you needed to speak

to someone about whatever issue you might be having

and they were very open to that.

It was just like anything else,

if you were sick, you went to go see the doctor

and if you weren't feeling well and felt like

you needed to speak to a mental health professional,

that was available for you as well

and you were expected to go see one

if you weren't feeling well.

So, if you just remember those two exercises

and keep your breathing paced,

you should be okay in this test.

So, they were very open to that and it was very important

and I appreciated that, I think most of us did.

In space, I think what NASA has realized over the years,

in particular for long duration flights

or even short flights, there could be

some extra mental stressors put on the astronauts.

It could be stressful.

You're worried about your physical well-being.

So, there's stress associated with that.

Also, performance of your job.

You want to do a good job and you might

feel the pressure that way too.

Also you're away from home,

you might not get as much sleep as you like.

It's a new environment.

There may be family issues happening.

All these things might be happening

that could also affect your performance.

We have a whole program associated with,

what we call psychological support

and psychological support is there to help astronauts

feel good and that all involves contact with home.

So, we have email, we have capability of calling our family

and friends from space through an Internet Protocol phone,

the possibility to Skype with your family is there as well.

Keeping in contact with Earth

is really important for psychological support.

It's not just being nice, but it's also to, for performance,

a happy crew member is a productive crew member.

What I've seen come though sometimes is that,

an event happens on Earth.

We had a crew on board space station

when we had the Columbia accident

and we need to get the word up to those guys

that we had this accident and the crew was lost

and the accident was a time where

mental health was really stressed.

In fact, it was required that all of us

go check in with the psychiatrist.

When a traumatic event like that happens,

like a loss of life, bad news happened on Earth

for directly affecting the personal life

of the crew member in space, that's when you sometimes

need some psychological support, right.

So, I think that comes in different forms,

sometimes it's a crew member, a good friend,

a member of the clergy, a spouse, a brother,

whoever, they try to get that person on the phone.

So, then your flight is over and you return to Earth.

So, once you come back and you land,

the biggest difference that you'll notice

is gravity has kicked back in.

Those changes to your body that occurred

because you went to zero gravity

and some of those are physical changes,

they revert back to the way it was

when gravity is encountered again.

So, some of the physical changes for example,

is in space, our spine grows a bit

because our spine is held into place by gravity

to some extent and in zero gravity, the spine elongates.

So, my space walking suit was actually sized

an inch and a half higher in the waist

to accommodate spinal growth than what I wore into space

or I would wear when I practiced

in the pool for my spacewalks.

You had a little bit of discomfort in the back

when that happens in space, you feel it, little back pain,

but then it goes away.

When you come back to Earth,

your spine is settling again immediately.

So, you have to be really careful,

no abrupt movements with your head.

We've had some astronauts hurt their backs,

particularly in their neck by doing something quick motion

or something like this, before things have settled,

can hurt themselves.

You're not supposed to pick up anything.

Your kids are usually the biggest hazard

cause you want to hold them and pick them up.

If they're a baby, that's not a problem.

If they're a teenager, they're too big to do that.

But you're somewhere in between,

you want to be careful with that.

So, lifting things as soon as you get back are an issue

because you want your spine to

kind of settle where it's supposed to

and the other thing that is a physical change

is the fluid in your body in space,

when you're in zero gravity tends

to pull in your upper extremities.

What that could mean, is when you get back to Earth

and gravity sets and the fluid redistributes,

you could get lightheaded, your blood pressure

could go down, you could pass out.

So, one of the things we do to help prevent against that

before we enter, we go through fluid loading,

where before you enter, we have lots of drink bags

and is a prescription you get based on your body weight

of what you're supposed to drink.

It could be salt tablets with water

or a chicken consomme or there was this thing

we called Astro-Ade, which was kind of like,

not really Gatorade, but we had a drink a lot

to try to get those bodily fluids there,

so that when you got back to one gravity,

you didn't have this bigger orthostatic problem

when you tried to stand up.

Bigger issue may be, or the thing that's more prominent

is the, what's going on in your head

because now gravity is there again

and that vestibular system that was silent

for all those days or however long you were in space

is now excited again, and it's getting input like crazy

and the brain is saying, what the heck is this,

what's going on here.

You want to move slowly.

I felt like I needed to walk with my legs wide apart

cause I felt like I was going to

fall over to keep my balance.

I didn't want to turn my head very much

to excite my vestibular system as much

and after a couple days, you're fine,

but you're instructed not to drive a car

or fly an airplane or lift anything heavy

or do anything like that until you're approved

for those activities by the flight surgeon.

[Space Crew Member] Final farewells and handshakes

all the way around before they make their way through that

hatch way behind peek into the Soyuz TMA-19M spacecraft.

One of our biggest concerns for astronaut health

in space is radiation exposure.

We have to be careful about that here on Earth as well.

When we're out in the Sun, we want to wear sunscreen.

Protects us from the harmful effects of the Sun.

In space, we don't have an atmosphere or a magnetic field

which also protects us from radiation here on Earth.

If you're above that, you're going to be exposed

and that we're very concerned with.

So, we try to do whatever we can to shield the astronauts

from radiation and we do that in the spacecraft,

for example, by using certain materials and shielding

that will protect them from radiation.

NASA does monitor that.

We have a device called a dosimeter,

which is more or less, looks like a piece of plastic

that can measure the amount of radiation you have taken

and is placed in your launch suit,

and then, you hand that in at the end of the mission

and they read it to see how much radiation

you've been exposed to.

As we go further and further away,

we get further from Earth.

Radiation exposure could be the most important issue

that needs to be solved or prevented against if we're

going to be traveling further and further into space.

Something we don't always think about.

Radiation exposures can be very harmful

and it's a real challenge for space travel.

One thing to remember is you want to enter

your space flight in as best shape as possible.

It's hard to make up for a lack of exercise

while you're in space, but it is much easier

to be able to maintain where you are

and maybe get a little better if you enter the flight,

if you launch in pretty good physical condition.

For now, the best way to stay healthy

in a zero gravity environment is to exercise.

[gentle music]