Medicinal herbs for respiratory tract infections are safe

>> so now we'llget to dr. dervay. dr. joe dervay has been a flightsurgeon at nasa for the past 20 years and currently servesas the lead of the medical operations group. he graduated from cornelluniversity and syracuse upstate medical university. entering the us navy andcompleting training as a naval flight surgeon, he served aboardtheir aircraft carrier uss john f. kennedy.

that one's been decommissioned, right? >> dr. joe dervay: yes indeed. >> dr. dervay has completedresidences in emergency medicine and aerospace medicine,fellowship training in space medicine, research and clinicalwork undersea medicine, received a master's in public health anda masters of medical science with a focus on nitrogenbubble nucleation. prior to jsc included workingthree years at nasa headquarters and since being at jsc beginningwith sts-77 he has served as

crew or deputy crew surgeonfor numerous shuttle and iss missions. he serves as co-chair of themulti-medical operations panel mmop and is chair of themmop eva working group. dr. dervay holds the rank ofcaptain in the us navy with over 30 years of active duty andreserve service with numerous navy and marine corpsunits worldwide. thank you for your service. >> dr. joe dervay: thank you.

>> and so we now introduce dr. dervay. >> dr. joe dervay:thank you [applause]. well good afternoon and janicei'd like to thank you and your team for the invite to comehere and speak to this group. we're going to have a little funthis afternoon and i also want to welcome the clerks that arein town for the month that are going to be working withus primarily in the medical operations arena. so today we're going to have achance to talk with you a little

bit about spaceflightmedical operations. some of you in this room areexperts in given areas and i'm just going to kind of give youthe broad-brush perspective from the flight surgeon's vantagepoint to give you a sense of how we deal with our crewmemberspre-flight, during flight, and post-flight. and dr. blake chamberlain, oneof my flights surgeon colleagues is in the audience so blakeplease pipe in if there's anything else you want toadd to the conversation.

so for those folks that arevisiting from out of town what's the first word said fromthe surface of the moon for all you jeopardy folks out there? [ inaudible comment ] houston exactly, houstontranquility base, the eagle has landed. so we're very proud of our spacecity here and hopefully during your time here you'll have anopportunity to see houston and kemah and our entire area.

the space center is grand placeobviously, our big apollo rocket is now covered down here in thecorner, but hopefully you'll have an opportunity to see avariety of things, i know aliska [assumed spelling] is going tohave some great tours, as well as some of the academics thatare going to take place for you here. if you brought your own car becareful going down route 146 officer starskywith the radar gun has caught some of our clerks in thepast, so be a little careful as

you go zipping bythis area here. so some of the objectives isto give you a perspective and a scope of the nasa medicaloperations, highlight some of the unique medical,physiological and behavioral aspects of spaceflight that wedeal with, and review some of the challenges for remote care. our primary responsibility isto ensure the health, safety and well-being of the astronaut coreduring all phases of the flight. so it's a very broadresponsibility and we'll tease

some of those areas out. our docs come from a variety ofbackgrounds, we have about 20 physicians or so, almosteverybody is clinically trained, as well as aerospace trained. we have a number of folks thatcome from the military as well and so for many of us ourmedical care began -- our learning of how to take careof folks in high-performance operations. and the as mentioned earlier,i spent two and a half years on

the john f. kennedy and we had a -- it's acity unto itself 5,000 sailors and marines on board. we had about 85 aircraft and itwas a very impressive operation. obviously, we've retired theshuttle, how many folks have been to a shuttle launch? so it really issad to see it go. obviously, a beautiful vehicleand so for those that have been done there i think you'll attestto the fact that every launch

was unique, the acoustics, thelighting parameters were all different and it still amazesme to think that you can take something that's 18 stories andby the time it's clearing the launch pad it's going over ahundred miles an hour, so it's very impressive. some of the physiologicalissues, you've had some experts already come and chat with you,but i'm giving you a look how we break down a couple of ourkey physiological areas. one of them is our spacemotion sickness, cardiovascular

neurovestibular, musculoskeletaland behavioral psychosocial and we'll kind of talk through afew of these different ones. so there are some differenceswhen we take a pretty normal human being and put them upin an environment of space. as i'm standing here right nowthere's obviously blood going down to my legs, there's variousmuscles and also the vessels are pushing the blood more cephalad. as soon as you hit the spacearena what happens, you get that cephalad fluid shift.

and we're also seeing changeswith all these different components here, many of whichyou'll have some specific lectures on and i know you'vereceived some bone lectures already. so as i mentioned, the fluidin space comes up cephalad, the receptors your aortic receptors,your carotid receptors sense that extra fluid load andwhat typically happens? you want to unloadsome of that fluid. so the astronauts actually thefirst few days they diurese,

they urinate a lot morethe first few days. and there's overall about a 12to 15% redistribution, we lose some plasma volume, there's adecrease in red cell mass as we try to adjust forthat relative anemia. so when you see the crewmembers'faces initially they're rounder, more cherubic type looking andthey also will maybe have more of a nasal congestion type ofsound that will abate over a period of time. so that cardiovascularrebalancing which the body is

brilliant at doing is anissue for us when we bring our crewmembers home. so we have to adjust variousissues when they're coming back, we use various fluid treatmentprotocols, things like we call astro raid or various salttablets and water solutions the period of time before they comehome to try to rebuild up that 12 to 15% plasma volume. on orbit exercise has been verybeneficial to our cardiovascular system.

we've also looked atvarious medications. we had a study in midodrinefor example, which is used for autonomic dysfunctionfor folks on the ground. that study went for a littlewhile and terminated because of some issues regarding thingsin the literature with a qt duration. but medications may have somerole as well down the road. from a neurosensory perspectiveit's pretty amazing to think what happens.

the computer in the brain isgetting all these different inputs because you think abouthow long does it take to get into space from the pad, anybodyknow, about how many minutes? about eight and a half minutes. so eight and a half minutesyou're on orbit and particularly taken for example the shuttle,eight and a half minutes they're getting out of their seatspretty promptly, they're often getting their cameras out totake various pictures of the external tank, setting uplaptops, getting out of their

gear and it can often bea very provocative time. so all those different inputsthe window's over here you see the sun coming in at a differentangle, the earth's down there, your crewmember might be upsidedown and you're trying to get your bearings and the computerin your brain is getting all these various inputs, as well asyour elbows in your joints the proprioceptive aspects. i know where my body knows wheremy elbow is right now, but all of a sudden in that environmenteverything is very different.

so we have this sensoryoverload that causes some of our crewmembers to get ill. it affects about 70%of our crewmembers. interestingly though in thegemini, apollo or mercury, gemini and apollo program veryfew astronauts got sick at all. why is that, well they were inessence strapped in their seat? the mercury and geminicrewmembers were in essence in their seats they never got outfor the most part unless they were going an evathrough the gemini hatch.

and so the body was able toadapt to those inputs versus what we experiencein the shuttle. so about 70% of ourcrewmembers get ill. the range of symptoms could beanything from just a little bit of stomach awareness to frankvomiting that is there's really no projem they don't reallyfeel nauseous all of a sudden boom they're setting up alaptop and they get ill. so that's why sometimes you'llsee the photographs of the folks with a little vomit bag stickingin their pocket because we

encourage them to be verycautious with their head movements, keeping their head ona stick, trying to keep the 1g orientation. for example, in the shuttle whenthey were going up the ladder not to go diving down to the middeck from the upper deck, but use the ladder as theynormally would until they could equilibrate. we also use various medications. for example, meclizineoral meclizine, phenergan

intramuscular to help withthese various symptoms. a few of the astronauts actuallyhave a voracious appetite, so while some of their crewmembersare getting ill and not feeling too well a few of them are veryhungry when they get up there. how does that translate, wellwhen they pick their menu items out if you know you're someonewho feels pretty good the first day and you watch your friendpick their menu you might go, you know, you really might wantto go with the shrimp cocktail the first day or so because i'mgoing to end up

eating it for you. so some value there. so the neurosensory responsesthat eventually equilibrates and the crewmembers will say oncethey break through that wall those first couple of dayseverything is fine and so, therefore, the sense of up anddown is really what you choose to define it. we have all this workspace now. the lighting is still set upto be on top and some of the footholds here they give you --still have that

sense of up and down. but the crewmembers once theyequilibrate they do very, very well. musculoskeletal system, i'lljust cover this lightly, i think dr. sibonga was here recentlyand gave you some perspective on it. but the bone and muscles areconstantly remodeling due to physical loads and so we'retracking this, we're learning a tremendous amount fromour colleagues

in the bone community. and looking at how the differentspongy bone and compact bone how they react with the balancebetween the osteoclast and osteoblasts are and this alldovetails into what we do for exercise. exercise is a key component ofour ability to maintain muscular strength and as wellas our bony health. a couple shots here of jerrylinenger back on the mir space station with the russians on atreadmill and bob curbeam here

is in the shuttle mid deck withan ergometer, a little cycler ergometer. so currently our crewmembersexercise on orbit about two hours a day, it might seem likea lot of time to you, but for them it's something they lookforward to, they're doing a balance of aerobic exercise,resistive exercise, and some of them are in better shape thanwhen they left because their schedule is often very, verybusy before they left so for them to have a chance to focus.

and they're often coming backand we're almost able to retire the risk of some of these bonelosses because we're really seeing some excellent muscularstrength when they come back. dr. shannon lucid here she is onthe mir and you'll notice she's on the treadmill, soparticularly for our new folks coming in you'll notice thatshe has a harness on because obviously due to simple physicsequal and opposite reactions as soon as you hit that treadmillshe's going the other direction. but the mir was pretty it'slike being in the back of your

garage, there was stuffeverywhere and our inventory systems now are much moredesigned to help keep a cleaner environment and make surewe know where things are. but she's working out andhaving a good old time. and now on the iss with thetreadmill dr. thirsk, a canadian physician and you'll seehim there with his bungies. now deitra i think you said thatit should work on the next slide if i double-click it. >> just double click.

>> okay, let's see how we get. we have a little video clip justof him running on that, which you may have seen with theexercise class, i'm not sure why this is not takingon the wav file. and you get a little bit of afeel for the advanced resistive exercise device, yougot a sense that. so this device again, if youwant to take a quick peek at this see if we canget that going. the exercise device theengineering behind it allows us

to get loads up to 600 pounds. now think about that for amoment, the device doesn't weigh anything in space it has inertiaof course, but the engineering is such that we're able to getup to 600 pounds for some of the squats, other workthat's necessary. so there we go. i might have you just do theother one and we'll go backwards for a second afterthis one is done. but you can see that the motionof it this gentleman is working

-- one of our russian colleaguesis working pretty hard here. but notice there has to be asystem here vibration isolation system because you cannot impartthe loads into the vehicle for a couple reasons. you guys and ladies have been tothe gym you see people throwing weights down and justall that movement. so we don't want to impart theloads to a couple of different areas. one of them is where the modulescome together at the joints and

secondarily and probably mostimportant is to the big solar arrays. you don't want to get thosesolar arrays wafting in the breeze from all these energiesthat are imparted there. so we're were seeing some greatwork with this gentleman and love the results. if we can go back to thetreadmill for just one second, two slides back. and here is the astronaut rongaran, you got it up i think it

just needs to, there we go. you'll see him running and thecrewmembers will often watch a movie, listen to some music. how long does it take to goaround the earth once, anybody know? ninety minutes, so you canbasically -- we've had multiple folks in essence that was theirgoal to run around the world. we've also had folks thathave -- captain sonny williams actually did the bostonmarathon, while some of her

friends were on the groundrunning the marathon she was on orbit performing that. but the bungees themselves andthe harnesses they impact some abrasions and some other issues -- thank you, i think we're in good shape. so we often have to dealwith some of those issues. so let's just talk about thebehavioral psychosocial, this is a big arena for us. the two limiting factors inmany respects to go to mars for

example are radiation andbehavioral psychosocial. you know, how do you pick six ofyour best colleagues to spend a couple years with you, how doyou pick those people, how do we do that? there's so many factors involved with the personalities and habits. and as we're doing aninternational space station with 16 countries we've learneda tremendous amount. some cultures, some people whenthey get very mad

they get very quiet. there's other people that getvery demonstrative when they're upset about little things. and so the personalities arevery important for us to learn about. we have nols national outdoorleadership school where some of our crewmembers will go and some of our physicians dr. chamberlain and i have bothgotten to do that with some of our flight directors.

we actually go out in the fieldeither on it could be a kayaking expedition or some kind of trekand the crew is put in various scenarios where they have tolearn how to work together, they learn a lot about theirstrengths and weaknesses and various leadership styles thatthey have very, very helpful. and as well as issues nothere with our family contact. the crewmembers now havewhat they call an ip internet protocol phone where they havethe opportunity to call their family up and talkto their families.

we also have private familyconferences once a week where they can actually have a videolinkup so they are able to see their families. so those elements are all veryimportant as we try to maximize their health and performance. anybody know whothis gentleman is? this is a shot from i believearound 1994 of the mir space station that's dr. polyakov,he spent 438 days in space. now think about that.

we're going to close the doors,we're going to get you a little bathroom, a little galley, someexercise equipment, some good science, but you're going tostay here for 438 days, it's a long time. we have about four folks thathave had over a year-long space expeditions and obviously we'revery proud of captain scott kelly going up here launchingvery recently, so his year his clock is starting towind down backgrounds. but i've met this gentleman,a very interesting fellow.

when you first met him you kindof were looking for that deer in the headlights look, i meanthat's a long time, but he's very engaging and wonderful. but it is a long time and we'regoing to obviously have to have a lot more experience inthis arena, as well as some ground-based studies to help usreally understand some of the cycles of behavioral aspectsbefore we send folks far away. another shot of dr. lucid hereshe's got a big smile on her face, she's doing somehydroponics activity.

growing some wheat, at leasti hope it's wheat on space station, but these activitiesare very, very good and very helpful. fresh fruit is another one whenthe little delivery truck came up or a visiting vehicle cameup with some fresh carrots and grapes big smiles on our folks. so these things they mayseem small, but they're very important to the behavioralsupport of our crewmembers. some different medical eventsthat we've had in the program as

i had mentioned earlier withmercury and gemini where we didn't have any space motionsickness, we really didn't get anything until really aroundapollo 8 when the crewmembers started to move within theconfines of the capsule. we had some space motionsickness during eva apollo 9, as you recall just went around theearth it was to test the lunar lander in earth orbit. and we had a delay in one ofthe evas because of some motion sickness.

dcs stands for decompressionsickness and for those of you -- any divers here youunderstand what the bends are. we never really haddecompression sickness during an eva that's been reported,but mike collins in his books reported some knee pain thatexisted when the capsule went from 14 pounds per square inchto 5 pounds per square inch 100% percent oxygen, he had some kneediscomfort that arose and that may have been attributed tosome kind of dcs for that knee. urinary tract infection duringapollo 13, you're all very

familiar with the apollo13 movie and how cold that environment got as they had topower things down and a urinary tract infection existedfor the crewmembers. there was some cardiacdysrhythmias that took place on the lunar surface that werenoted during one of the crewmembers. the fidelity and the abilityfor us to look and evaluate cardiovascular issues with ouraeromedical boards is at a much higher capability now, so wespent a lot of time really

looking at our crewmembers-- for all the international crewmembers in that capacity. and then the apollo test projectas you recall when the americans and russians shook hands and thetwo vehicles docked in orbit and when the apollo capsule cameback there was a little bit of a leak through one of the vents ofnitrogen tetroxide and it caused some chemical pneumonitis andthe crewmembers ended up just spending a couple of days inthe hospital in hawaii as they recovered and did quite well.

so these thingshave all happened. and in the russian programissues that helped that result -- not resulting in missiontermination or early return, but as we looked at a couple ofthese different areas these arose before our spacestation was built. so what are the two worstthings you can think about in a confined closed environment,fire and decompression of the vehicle and thosehappened in various ways. some small fires with someoxygen generating candles.

for example, on the mir we hada decompression when a visiting vehicle came up and impactedit and caused some the pressurization. kidney stones, we believe therussians had one that they were able to treat on orbit withouthaving to return the crew member with various medicationsand hydration. and there was a psychologicalstress reaction that took place that may be related tocarbon dioxide buildup or the crewmembers notgetting along well.

a lot of this information wenever even were able to get from the russians for years until westarted to work with them much more closely and had goodworking relationships with them. so obviously the hazards ofspaceflight includes some of the issues we've already coveredin terms of the physiological aspects, but just radiation,debris and various other aspects and we're going to touch ona few of these in terms of circadian anddecompression sickness. from the radiation perspectiveour workers are considered --

our astronauts areconsidered radiation workers. and the principle is the alaraprincipal as low as reasonably achievable and so we try toprevent the radiation dose for their lifetime experience toresult in greater than 3% risk of developing cancer. so obviously, we have solarparticle events, cosmic galactic radiation coming in and oncewe leave the van allen belts because currently we're withinthat and our astronauts get a slightly higherdose of radiation.

but it's when we start goinginto deep space that that's going to be a big deal. so how do you develop thevehicle to protect them, i mean you can't fly led vehiclesthat weighs a lot. do you use water as aninsulator, water is known to be insulated for some radiation. we do we have a shield aroundthe vehicle of a certain thickness of water. what about some pharmaceuticals,what medications can we fly on

board that are going to helpthe dna repair medications? what about ladies ofchildbearing age, should we be going and harvesting some oftheir eggs so if they eventually finish their spaceflight andthey said it's time for me to be a mom or to be a mom again,approaching all those different issues. looking at the genetics arecertain crewmembers predisposed because of their genetic makeupthat may have more implication due to the radiationthey may be exposed to.

so some wonderful topicsfor us to dive into. anybody rememberwhat this is here? >> the vomit comet the kc-135, an aircraft that weused to have we fly a dc-9, but it flies over the gulf of mexicoabout 26,000 feet in parabolic flight and you get about twosecond or i'm sorry about 20, 30 seconds of microgravity and thendownhill you're kind of slammed down into the cabinunder a 2g load. but this is the vomit comet,weightless wonder and you can

see some shots here of someprocedures that we have to do. for example, here is somethingwith some blood draw and iv. this guy's not having agood day here obviously. and there's some airwaywork being done here. so a lot of this is to test howdo you do these procedures and also to develop checklists. everything has to have achecklist and a procedure because for those of you thathave drawn just a simple thing

-- have drawn blood, have donesome suturing, every time you touch something basically put itdown, but now you got to imagine this floating environment wherethe alcohol pad you let it go it's going to corkscrew thatlittle edge of the alcohol pad could easily hit you in the eyeand cause a corneal abrasion. the end of your sutureis going to wrap up. all those things have tobe taken into account. so a lot of work is done todevelop the procedures that the crewmembers will utilize.

acls procedureshad to be utilized. how do you do cpr? we talked earlier about runningon the treadmill as soon as you hit you're going theopposite direction. well, the same thing when you'rein this aircraft and you do a compression for your cpr onthe mannequin, which way do you think you're going,the other way exactly. so we looked at various devicesthat you can put compressors on, various belts that youcan be close in proximity.

one of the best ways wasactually this piston method where you actually had your feetup on top and you were able to get that that vertical push andkind of regulate how much force you put on. so very interesting trying tofind the simple solutions to problems. we've also flown -- this is someshots where we've actually flown this is a pig that we flew andwe were doing various procedures here on if we can do adiagnostic peritoneal lavage,

which really isn't done so muchnow because we have ultrasound capability. but it was to look for bloodin the abdominal cavity. putting in chest tubes. we actually also fed the camerasthrough the urethra and up into the ureters to see if we cango in and kind of snag a kidney stone if it existed here. so there's some great work thatthat was done over a period of time.

very challenging because you gotto imagine you're doing these parabolas and you're onlygetting about 30 seconds and then you're pushed down and thenyou're also trying to keep all the anesthesia and everythingelse going with the pigs up there. and then once in a while youhave a little bit of fun and you get to spin around here. you can't do this your firstfew parabolas because if you do you're going to be prettyworthless, but i wish everybody

would have a chance toexperience it, it is an e ticket amusement park fun no doubt. this is to remind me about thesettling of dust and foreign body and injuries to the eyes. this is steve smith, one of ourastronauts, who's showing how he had to get somethingout of the eye. the russian colleagues wouldsqueeze some water and you kind of float in, put his eye inthere and kind of blink up and then take a toweland then dab it out.

and that was how they gotsomething out because as we're sitting and standing here dust,debris, anything falls to the ground. but obviously when you'refloating all those little particulate matters which wehope gets pulled out through our filtration system still exists. and we've had occasion wherefolks have opened a panel behind a -- near a locker and had asmall little piece of metal that was there that got shaken duringthe launch that corkscrewed out

and get in somebody's eye. we've had foreign bodiesthat we've had to remove. now that could have a big impactif it happens a day or so before your spacewalk, of course. so those ocular issuesare important for us. we have a device and this is oneof our colleagues here, chuck lloyd, who's in the kc flightwith flying basically a little simple set of speedo goggles. we're trying to figure out howdo you go about if you get a

toxicological element in youreye, how do you rinse your eye out? do you just keep squirtingthe water with a towel? and so a few folks came up witha rather elegant way to do this and basically it was a $6.96set of goggles with some water hooked up which on the shuttlefor example was from the galley and the waste collection systemwould be through the waste management system. and so basically it was a veryelegant way to bring water in as

opposed to goggles keeping thewater out we do the opposite. we put the goggles on, runthe water through and that way you're able to goahead and utilize it. and we've used it in space,we've used it at least on a couple of occasions. i could think of two spacewalkswhere the visor on the inside of the visor you put a thin layerof the anti-fog, it's almost like dishwasher detergentto keep it from fogging up. and some it's a drink bag -- thewater from the drink bag leak

got in there and it caused thesethings to run off and it got in the crewmember's eyes. so when you're in a spacesuityou can't rub your eyes sand so it was very uncomfortabletoward the end of their evas. and they came into the shuttleand put these goggles on and were able toirrigate their eyes. so 650 or whatever it is forthe goggles probably cost us a hundred grand just to do thepaperwork and the certification. but it is nice to see thatsometimes there's an elegant

solution to a problem thatcould be right in front you when you're sitting there watchingyour kiddies in the pool. so anybody know who this andwhere this shot was taken? this is a shot from skylab andthis is dr. joe kerwin, navy captain doc, first us physicianin space and he's taking care of pete conrad. and this is how he had hisoffice set up, pretty ingenious way for him to go aheadand do some medical care. so this leads him to a littlebit -- some specifics about the

support of our medical cadre. and we have what we call privatemedical conferences that take place with our crewmembersin essence, once a week. for the shuttle, for the shortduration missions we used to do it every day. and everything that's said onthe loop, the communication loop is on open air to groundfor open consumption. medical stuff is private, so wehave a private conference where we have an opportunity todiscuss with the crewmember how

they're doing, a whole varietyof aspects on their sleep, their physical condition. remember they're exercising, butthere's no showers on iss, so you got to imagine that. six months or a year without ashower, so they're using various sponge baths, baby wipes,etcetera so we're monitoring their skin condition. we're talking to them abouttheir sleep, their rest, any other physical problems thatthey're having, the medications

that we have up there forthem for a variety of reasons. so we work very closely with ourcrewmembers and make sure that we try to maximize their healthin every way that we can. we have various kits, i'mhighlighting this because i just like the way it's -- this isfrom the shuttle orbital kit and it's just going to giveyou the same perspective. we have medical kits for theinternational space station, but you can see things are brokenout by various subsystems. we've got a trauma sub pack,ear, nose and throat, an iv

administration subpack, drug sub pack. how much it cost to send1 pound of gear uphill? if i was going to take 1 poundof something and send it uphill, it costs about $10,000 or more. so think about that, so you'rein charge of designing a medical kid. how are you going to do that? well you start looking atantarctica, you start looking at the submarine community, priorspace experience, aircraft

carriers and you try to findout what do you really need. plus we have a pretty good senseof the hundred or so different medical conditions that we'veidentified that really think could have an impact for us. try to maximize whatstuff we bring on orbit. so everything is laid out inkind of a kit formation and in this case the packs we don'thave a lot of room so everything has to be carefully packed. we have -- everything is alsolabeled so when we open that

procedure book that we talkedabout before everything has a procedure, we tell a crewmemberto go and get some dexamethasone in slot number 28 and everythingis queued up so that they can go through and rather efficientlytake care of the medical work that they have to. we also have a medical checklistup there, so if you name the system whether it's foreign bodyin the eye, if it's diarrhea, whatever it is we also have allthose medical procedures listed out as well for them.

we also support with -- we usedto fly a defibrillator, we had a defibrillator for some of thespace shuttle missions where we did some science and that's nowmoved over to an aed and we also have a respiratory support packthat we utilize should there be any issues with maintaining anairway either through various serious problem with adecompression hit, a type 2 neurological hit or sometoxicological exposure. cmrs, crew medical restraintsystem, we have to have a device that we can actually put acrewmember on, strap them on and

take care of them, and it also has to be electricallyisolated so if we're delivering some type of a shock we don'twant that delivered to the entire vehicle. so this is designed and we runvarious simulations and on orbit training with the crewmembersutilizing some of the emergency procedures. what happens when you get thingsin your eye, some foreign bodies in your eye?

we have the emergency eye washthat we talked about, we also have a contamination cleanupkit because there's been various leaks that sometimes you'll beworking on replacing a battery for the spacesuit, the emubattery and there's compounds that come out and crewmembersgo what is this white material. and so we have a hazmat databasewe can figure out what that is and do they need to put gogglesor gloves on, what's the best manner for them toprotect themselves. so the international spacestation, how long has this been

up on orbit, anybodyhave an idea? this is a shot from 1998,november 1998 when the ftb, the russian ftb functional cargoblock and the node 1 unity were put together for the first time. and subsequently, the spacestation was put together over time until we getto where we are now. so just to think this is prettyamazing to think that we've had permanent human presence,continuous presence i should say since november of 2000.

think about that for a second. i think most of the publicdoesn't realize that it's been that long. who's in space right now, wellyou know captain kelly is in space, but a lot ofpeople don't know. sometimes that's good that meanswe are up there, we are doing the work, we aredoing the science. and the flipside of it issometimes we're not lighting the fire for some of our youngpeople to really pay attention

to some of the unique thingsthat are going on and look at some of the great workthat's being done. so the space station as youknow, it's about the size of a football field and for ourclerks here if you haven't had a chance to see this at night youcan go on wherever you live type in international iss sighting and usually just after sunset or just before sunrise as the sunangles hitting it you'll see it coming across your area. and it is pretty remarkable,it says you'll see it for five

minutes and then it comes southsouthwest and north northeast and it tells you how manydegrees off the horizon and it's pretty accurate. so you go outside and you lookand it's the brightest object moving it's hauling andit really is remarkable. and for us that work closelywith the crewmembers to realize that there's human heartbeatson board is pretty incredible. in particular, if a spacewalkis going on and then you scoot outside and you look at that andyou think that these folks are

hanging off the side of thisvehicle it's really impressive. so it's over 800,000 pounds ofpieces and equipment and gear were hauled up there over theconstruction phase, that's pretty incredible. this is to me is one of the mostangelic photos of the entire space program, it's captainbruce mccandless in the man maneuvering unit. i just think it's phenomenal,which i want to lead into the section about spacewalks.

so when we look at the spacesuitin this case he's on the man maneuvering unit we don'tutilize this anymore, we use it during a shuttle fora couple missions. but our crewmembers now are alltethered so they can't float away from the space stationwhen they're doing their various work. but it really just makes me stopto realize that this is a space vehicle unto itself. it's got cooling and heating,it's got -- they wear a diaper

so there's some abilityto collect fluids. we have a drink bag in there,we have multiple layers of protection from the environment,from the hot, cold, and also from the micrometeorite. we have a communication systemin, we have cameras, lights, it really is a remarkable --co2 scrubbing, things of that nature, oxygen delivery. this shot is from the hubble,so this is about 310 nautical miles, you can definitely see alittle bit more

curvature of the earth. so we call it spacewalking,but really it's very upper body intensive, very shoulder, armintensive and our crewmembers unless you're on a planetarysurface is when you're walking you can see the varioushandholds here as the crewmembers are going on andalso the various tethers so they can't get out ofreach of the vehicle. and the crewmembers also tellyou when they first open that hatch it's pretty breathtaking.

they know they're not going tofall, intellectually you know you're not going to fall, butwhen you open it up and you're looking down 220 miles it'squite energizing for them. so during the mission controlaspect of it we are -- the circuit control we're monitoringvarious -- we're monitoring the co2, the 02, thebio-environmental such as like the metabolic rate. we know when they're underwaterdoing their training what their normal metabolic load shouldbe to do a given task.

so we're monitoring this andkeeping in touch with the eva officer and the flight directorbecause if they're doing something and you say man, theirmetabolic rate doesn't look right, why is that, are theyworking too hard on a given task, is this going to impacttheir ability to continue to work for a few more hours. and so we carefully follow thatand in conjunction with any medications that they may be on. for example, say if someonewas on a decongestant or

pseudoephedrine for example, itmight impact their heart rate a little bit. so we know that so when we lookat their metabolic rate and their heart rate webalance all that out. so we have a pretty goodunderstanding of the physiology. folks been out to the sunnycarter training facility? even for our folks that workhere sometimes we see jsc colleagues that have neverhad a chance to go out there. please go out and take a peek atthat, it's a tremendous national

asset and it's theworld's largest pool. it's 100 feet by 200 feet by40 feet, 6.2 million gallons. so how much is 6.2 milliongallons, imagine going out to you corner where you live andtaking the fire hydrant and opening it up full-bore january1st and letting it run 24 hours a day, 31 days lateryou can turn it off. that's about how much water,it's an incredible amount there. and obviously, we have variouscranes that we can take pieces in, we don't have the spaceshuttle component in

like we used to. but various aspects of theinternational space station where our crewmemberscan go and work. dr. scott parazynski you see himgetting ready to go, he's got various tools set up on hisworkstation there and he's going to be lowered intothe water here. you can see some weightsthat are put here to make him neutrally buoyant once he's inthe water and being lowered in. these are all our control rooms,we have some

medical monitors out there. and we have one of ourphysicians that works there is a hyperbaric trained doc. we have a hyperbaric chamber outthere should there be any issues with the astronauts orthe folks that are diving. can't swim in the spacesuit sothese divers basically have to move them from one workstationto the next workstation. there's also cameras down theremonitoring, filming, so folks can see.

and the crewmembers when they'reunderwater there is a certain inertial drive, the water hasa certain resistance to it and also when they're upside downthey still have that sense of blood rushing to their head. so we don't keep them upsidedown for an extended period of time. but the crewmembers will tellyou it's the next best thing to being in space and they operateabout 10 hours of training for every one hour that they'regoing to be doing a spacewalk.

just take a little mentalsnapshot of this picture and this is on the edge of thesill of the payload bay of the shuttle and compare that to whatit looks like in space and the blackness of space. and the crewmembers willsay this is really excellent fidelity training. and here's another picture of acrew member on the -- an arm, a foot restraint being movedunderwater and then take a look at this image in space.

so that the training, thefidelity is really quite wonderful. the spacesuit beatsyou up though. you're in there and you'rekind of like the michelin man, michelin lady in there the suitis there to protect you, but you got to work against theresistance of it sometimes. in of our crewmembers we have afew injuries that come up from time to time and for example,in this one we have some issues within the fingernails.

the nails get banged up andthere's some demyelination. so the design of thegloves are very important. you think about when you putyour hand up what's the longest finger, it's the middle finger. but when you close your handergonomically what's the longest finger now, it'syour ring finger. and so it's a little differentthan just wearing a pair of gloves that keep your hand warmbecause you're having to do work against the resistance.

so what we're learning is that the design obviously is very important. so some of our crewmembershave these issues not everyone, sometimes it may be due to themoisture component, it could be due to the fact that the lengthof the fingers compared to the depth of the webs. so we try to manage this. we looked at things likephenols, retin-a, various creams.

we also for some crewmemberswe actually put bandages and dermabond on there to give thema little protection and there's other crewmembers that don'thave any issues at all. but it's important because ifyou've ever had a fingernail start to come off it couldbe a real painful thing. and if you had a few more evasto do that would not be a real pleasant experience. here's a shot of the firstmetacarpal getting banged up over here, mcp joint gettingbanged up because of the nature

of the glove and themetal ring there. here we have somewhat of alittle bit of a suit pressure on the shoulder, we've had someshoulder injuries that take place in the training facility. so we're very carefulto monitor that. but these things are allimportant to highlight because for those divers decompressionsickness can often result in a joint pain or a discomfortin a shoulder or a knee. so we want our astronauts whenthey're in the tank to really

understand what they're feelingso if that happens on orbit they go this is very similar towhat i feel in the pool or i'm getting this kind of knee orjoint pain that i've never had before and maybe a clue thatwe're having some decompression issues. and you can see some folksputting some moleskin on their anterior shins forsome discomfort. and here you see that thebladder inside the suit was causing some hot red spots andwe've had that happen on orbit

where a piece of the fold ofbladder felt like somebody said like a knife was being driveninto the top of their foot. and they're out there doing aspacewalk and the suit was being pressurized and they wereout there it was very, very uncomfortable. so we really try to work closelywith our suit folks to make sure we get a good fit and look atall these different aspects that can impact them. anybody know wherethis picture is from?

this is the shot from russia,this is the russian hydro lab, the equivalent of our neutralbuoyance lab and this is the strela arm and you can see therethe crewmember is in an orlan spacesuit outfit. this is a hydro lab andit's round as opposed to our rectangular one. and here's an air force colonelmike fink ready to get into the orlan suit and you can see himin this thermal garment and there's various little plastictubes here which carry the heat

and cooling through a liquidto maintain a comfortable environment for him. and this suit is basicallyunlike our us suit which has a lower torso harness, upper,the gloves, the helmet. this is sort of basically aone-size fit all you kind of slide in, grab a handle hereand close the door on it. and basically you do have somegloves that are more custom fit. this is a good suit for bigbulkier tasks, our us suit is much better for some of the finethings that we've done like for

example with the hubblerepair, things of that nature. our suit is 4.3 pounds persquare inch like being at 30,000 feet and the russian suit is5.8 pounds per square inch. so it isn't as muchof a custom fit. we've had some smallerdiminutive ladies in this suit who actually have to pull theirarms up and almost kind of scratch themselves a little bitwhereas you could never do that in our suit because it'sa different type of fit. and whereas we have the bigcranes that come in and pull our

equipment out of the bottom,here's a picture of the hydro lab the floor is like a sieve. so the floor kind of comes up,the water drains out, a guy pulls up in his little golf carttype of device and pulls the equipment off andchanges it out. so an elegant way to handle aproblem in a different manner. at the neutral buoyancy labwe also have a hyperbaric capability there should we everhave to do any treatments in there.

we really don't use it forresearch per se, but it is out there to treat any of the diversor crewmembers that get injured or hurt. we also have an altitudechamber out there. altitude chamber is utilizedfor us to go ahead and do our physiological testing. so when folks are flying in thet-38 or another aircraft we can go up and take them up to 25,000feet or so and get them off the mat so that they understand whatthe symptoms of hypoxia are and

that's very important. to understand what it feels liketo be a little hypoxic and also important we train themseparately on what their carbon dioxide symptoms are. and those are two differentthings and why that's important is if they're doing inside theirspacesuit and the sensor goes out of the spacesuit and thecarbon dioxide is building up we want them to know whatdoes it actually feel like. and there are often differenttype of physiological systems or

sensations. our prebreathe programs, i'mjust going to highlight this a little bit to give you a sense. when we put folks in thosespacesuits there is a risk of decompression sickness. decompression sickness arisesbecause of nitrogen that's mobilized that comes out insolution and causes impacts either in the capillaries, itcan put pressure on nerves, it can get into your brain,spinal cord,

and so we try to mitigate that. well one of the simplest ways todo that is to breathe oxygen for four hours before youget in your spacesuit. so now think about that we'llput you an oxygen mask and you're going to sithere for four hours. that's kind of you're using alot of resources and astronaut's time is very valuable, theteam's time on the ground as well. so we look for variouslystrategies to how we mobilize

that nitrogen and get it outof your system a little bit quicker. well, you can't take peopleup into the vomit comet and do those kind of research. so we do various things inchambers, hyperbaric chambers and in order to do that we havevarious ways that we try to use some elegant solution, thingswe've learned from the air force and other researchers to tryto get this nitrogen mobilized. so it's along the theory of thatif you go out and you run, you

do some exercise and then you goright to the gym and you start to lift some weights yourcardiovascular system cardiac output i is still going,you're still mobilizing blood. and in our case we want tomobilize that liter of nitrogen or so to start gettingit out of your system. so we come up with littleelegant ways to simulate microgravity. well, in this particular casewe put people in chambers and we used to have them do varioustasks like they would utilize

their eva tools, butthey're walking around. well that's not really a goodrepresentation because now you're loading yourjoints, your hips. and so what we did is we came upwith this solution here, we put people in the semi recumbentposition, we had various tasks they had to do to simulatethings they would do in the suit, we had bungee cords kindof giving them a little sense a resistance of the suit. we had a no kidding bathroomscale here, we knew exactly how

many found pounds of force itas if you were locking your feet into the foot restraintbefore you were moved. so we would put all thistogether, we would choreograph it, we had the astronauts getin they go yeah, it's pretty fidelity forsomething like this. and then we would put folks inthe altitude chamber after we would utilize this to testour various protocols. and we also did a lot ofmonitoring with the heart. when you put somebody in thechamber and you want to listen

if they're developing bubbles,you listen to the right outflow tract with a doppler and youhear this chirping sound [making chirping sound]. and if you hear those littlebubble sounds that means you're starting to generatethis nitrogen gas. we want, of course, minimizethat and we also are trying to make sure that we don't seethrough any hole in the heart, patent foramen ovale or anyother intrapulmonary shunts. we don't want to see bubblesgoing from the right side to the

left side of the heart. so this is one of our techniquesas we study eva bubbles. i'm going to talk to you justthe sense -- i just to focus on a couple key things to talkto you about our pre-breathe protocol. so if you're watching nasa tvand a spacewalk is ready to begin and they say they're doingtheir pre-breathe protocols. so what does that actually mean,what are they actually doing? well there's a program that wedon't utilize right now, but

this was the key program thatallowed us to help build the space station initially andit was the cevis, the cycle exercise vibrationisolation system protocol. so what does this actually mean? well, what would happen on theday of eva you would get up in the morning, you and yourcolleagues would dawn a mask and you start breathing oxygen. and where these little greenareas are we'd put you on a cycle ergometer, an exercisebike in the space station and

you'd start to pedal for about10 minutes and you'd ramp up to about 75% of your vo2 max. the purpose of which was tokind start of mobilizing that nitrogen, get it moving, getit going and this was all predicated on a lot of thingsthat we had done with the air force. when that was done you stayed onyour mask and then we would take the airlock where you were goingto put your equipment on, take that to 10.2 pounds per squareinch, 10,000 feet and then you'd

put your spacesuit on. and one of your colleagues wouldhelp two of you put your gear on. once you're all buttoned in wetake you back up to 14.7, we open the hatch and thecrewmember who's not going on a spacewalk that day will go backinto the cabin and then you'd sit and you'd breathe oxygen foranother hour before you'd go out the doors. so instead of four hoursyou're breathing an hour.

and this we utilized as 21 timesand this was really the crux of how we initiallybuilt space station and it was very, very valuable. so after a while we realizedthat there were 21 single point failures that can happen withthis and nasa always likes to minimize thingsthat can go wrong. so 21 point failures everythingfrom the way the ergometer worked to the settings to theshoes that you had to the mask, all that stuff added up.

so we went to something a littlebit different and what we came up with this is what we call --we utilized that were campout. because what the campoutprotocol was that eliminated that bicycle and it basically,this little yellow line here represents eight hours and 40minutes sleeping overnight in an airlock with your eva partnerat 10,000 feet to off gas that nitrogen. so imagine you finish up yourwork day, you grab some urine collection bags and some otherthings, some food, some tools,

some last-minute study you goand close the hatch, do a little study, get your sleep. and the next morning you get upand we put you on a hose, you go out and get some food, use thelavatory, come back in, button up on your suitand then you have a 50 minute final prebreathe. so we used this 73 times and itwas beautiful because it really was the crux of so many of ourspacewalks and we've never had a reported decompression hit.

now does that mean it didn'thappen, well by and large we try to educate our astronauts thatif you've got a problem you need to be pretty forthcomingbecause nobody wants to be bad protoplasm, nobody wants to saywell you know i think i had some dcs. but what's happening is yoursetting yourself or your buddy to have a problem down the road. so we think we've been prettyforthcoming, i think the crewmembers have as well, idon't think they've been hiding

a lot of things. we know the suit beats you upand there's certain aches and pains you get from that, but wereally don't think we've had -- we think we've got somereal safe protocols. the protocol we use now isit stands for in-suit light exercise. what we were trying to do is ourholy grail was to get down to like a 90 minutein-suit pre-breathe. and what we came up with is thatone where we don't have to do

the exercise on the bike and wedon't have to sleep for eight hours and 40 minutes overnight. so the in-suit light exerciseprogram basically utilizes the simple principles of movementand exercise and increased cardiac output and gettingrid of those nitrogen bubbles. so the protocol we use now we'veused it 16 times to date, the crews love this. because basically they get up inthe morning, they prepare, they have their breakfast, they geton a mask for a while and then

we go down to 10.2, the airlockis decompressed at 10,000 feet and then they'reputting on their suits. and after that's all done theybutton back up, their colleague gets out. now they're in their suit for50 minutes and when they're in there they're doingthis light exercise. and this is things that we'velearned over the years, we put all this together. and the light exercise it'sbasically a series of leg

movements that are pretty light,we affectionately call it the hokey pokey because thecrewmembers are kind of doing this and we train them on theground to understand what that metabolic rate is. and for those that likethe numbers it's about 6.2 milligrams perkilogram per minute. that's like walking a mile in70 minutes, that's not that intense. four times around the trackin 70 minutes it's not a lot.

but it's an effective way toget that nitrogen immobilized. so the crewmembers are ableto go out the door, so it's a shortened protocol where you useless assets and it's been very effective and easy forthe crew to perform. everything the crewmembers doare often in these checklists. now we could have a bad day anddr. chamberlain and i and others we practice our simulations withour biomedical engineers and the whole control team duringsome of our simulations. so we have to ready forthat day when you can have a

decompression hit whenthe crewmember says, i am experiencing pain in my shoulderand hip like i've never -- this doesn't feel like the normalsuit rubbing up against me, this is different, i can't grab mytool anymore or i've got some paralysis or weakness on oneside and it may be because of a like i said we've never hadthat, but we got to be ready for it. so we have a series ofprocedures which incorporate various switch throws, changeouts for carbon dioxide

scrubbing, etcetera, as well asother medical procedures as we utilize -- basically we'regoing to utilize the suit as a treatment vessel. we don't have a hyperbaricchamber on iss and some flight directors will tell you can flythe entire brooks air force base chamber we don't want it if it'sgoing to hurt somebody and not be utilized very well. and so we look at is there anyportable chambers, things of that nature and we haven'treally found anything that's

compelling to fly yet. so we use the suit asa treatment vessel. so if you were in your spacesuitand you had a decompression hit we would bring you back intothe vehicle so you'd be at 14.7, which is normal atmosphereplus 4.3 in the spacesuit. so you would stay in that for acouple hours until your symptoms abated. so theoretically, for those thatdied if you got hit we would take you in a chamber like at alocal hospital down to 60 feet

of seawater and that'sthe pressure load. so, theoretically in our suitwe can get almost 112 feet, 113 feet of seawater by justsimple boyle's law of physics. so we hope that that would workand that's what we simulate. this shot is to remind me ofgoing around the earth in 90 minutes, 16 sunsetsand sunrises every day. and so sleep is important andyour circadian rhythm is going to change for a little bit. you can see the crewmembers thisgentleman is floating in this

capacity, very relaxing to sleepin that environment like that. here's some other shots offolks sleeping in the shuttle. we have individualcrew sleep stations. now even just look at some ofthe interesting things, this gentleman always liked tohave the sensation of his head against the pillow, so hewould have his head like that. we have this other gentlemanwho liked the sensation of being jammed under some covers, so youcan see him in kind of tighter. some folks wearearplugs and ear marks.

so they really do sleep quitewell, they're slated for about eight and a half hours sleepon the space station, they typically don't speak as muchmaybe six and a half to seven. but the environment is prettyquiet and pretty comfortable and so sleep is very,very important. this is just to show somehow weutilize our circadian shift this was during sts-108, but similarprinciples when we go over to star city in russia andlaunch through there. so in this particular case, yousee these lightbulbs to show

that we use some bright lightas we were shifting them. we had conference rooms in thecrew quarters of up to 10,000 watts of light, light is a verypowerful stimulant to help make some sleep adjustment. so we would go ahead andutilize various techniques. so when you look at thephysiology of it obviously, darkness is going to be workingto help stimulate melatonin for sleep and light ofcourse, changes that. and we're not going to go intoa lot of depth on this, but the

key thing i just want to showyou is that when you look for peak melanopsin which helpssuppress melatonin, the peak is about 480 nanometers of light. but what does that mean andinitially some of us we were a little uncertain of this. is this a little bit of voodooor does this actually work? so the idea of the blue lightand i don't endorse phillips products just to let you know,but this just to show, this is a little device for example thatemanates light at about that

frequency. and why we're utilizing itemslike this is that in the middle of the night in the missioncontrol center if you're the person getting up at 2:30 in themorning and you got to go work some mission control shifts. what happens at 4:35 inthe morning, you're in your circadian you're feelinglike dog meat it is not good. the first night usually you dopretty good you got it out of you, yougot a little coffee,

but the second andthird they're often the worst. so we will often look at thelighting in here and we actually in some of our workstations havethose little lights that are available. and for those folks that travela lot go overseas, we will often allow them to go ahead andutilize that so when you get to a different area and you get upand you want to try to adjust your biorhythms utilizingsome light is very effective. and to the point where when youlook at the space station, i

mean there's various areas wherewe have lights and a ton of gear, but we're also lookingat the lighting in the space station is going to be changedand eventually it's going to be changing in your home as well. so when you get up in themorning you're going to have a higher frequency of that 480nanometer type of light, it's not going to really look blueper se, but it'll be different. and as your day goes by yourlighting scheme is going to be more normal.

and then at home at night youcan set your lighting such that you start to get a little bitmore of a reddish wavelength not red like those that have everbeen on a ship and we try to adjust your vision at night, butjust a higher percentage of that light to help you kindof download a little bit. because what's the worstthing that happens, what does everybody do with theircomputer there or their little blackberry, they're all playingon their phones and that's the worst thing beforeyou go to bed.

you're sitting there lookingat this your phone and it's the exact opposite of whatyou should be doing. so we're doing some neat thingson orbit eventually to change the lighting. i'm going to talk just a littlebit here to give you an idea of one issue that's high onour list and things that you might've heard or read about issome visual changes that we've noticed for some of ourlong-duration crewmembers. and it is a change in theirvision oftentimes that's a

little bit of a hyper-shift,it's hyperopic such that their near vision, have little moreproblem with their near vision. but what really noticed we sawsome crewmembers coming home and they weren't complainingof any symptoms at all. but when you examined the backof the eye you started to see some swelling back at theoptic disc and cup area. and you look at that and yougo that's a little odd, are you having any symptoms,no i'm doing fine. you know, they might be at thatgiven age where they're starting

to have some presbyopic changes which take place with age normally. but we started notice somedifferent things, anything from some cotton wool spots to somefolds in the back of retina to some flattening of the globehere and it led us to start looking at things. what's going here, what isphysiologically happening. we know we've got these fluidshifts coming up is that impacting it?

are we changing the intracranialpressure, is there something going on within the brain spinalcord system that dovetails into the optic nerve,is that an issue? so we started to look at thingswe were doing tonometery, eye pressures, we starteddoing ultrasound on orbit. we now have a device calledoct ocular coherence tomography where we can actually measurethe thickness of the retinal layer. we're trying to get all thisdata and put it together and

figure out what's going on. we're seeing it in some crewmembers, not all crewmembers. we're seeing it sometimes injust one eye not another eye. does this have something to dowith the salt load that you eat in your diet? is it intracranial pressure? it is something with theresistive exercise and all that -- what we generatethe forces there.

so this is one of our bigenigmas right now that we're trying to continue to get dataat and maybe it'll help us with some on earth issues as we tryto translate all the sciences we learn to issues on the ground. but this is a very, veryinteresting phenomena that we're trying to chip awayat and get smarter on. and now our russian colleaguesand our internationals are working with us as well. we have ultrasound, we doultrasound for various organ

systems and it's atremendous tool for us. and here you see don pettit he'sdoing some ocular ultrasound as well for us, doing some ofour science and clinical work. so coming home, as we'rewrapping up here today we obviously don't fly the shuttlehome, but a nice shot from kennedy. but we're going back now to someof the physiological issues. remember we talked earlier wesaid we lose about 12 to 15% of our plasma volume, well when wewant to get some of that back

when the crewmembers come home. so here is just a simple examplethat right around landing for the shuttle a few hours beforewe started to do a fluid load. as i mentioned, this kind ofsalty solution kind of a chicken consomme type of thing toincrease that salt load, retain some fluid. so of that 12% loss we've gotmaybe -- we're back about 5% of that loss, so that when we hitthe ground and we got out of the vehicle we were ableto do better on that.

and so that was interestingphysiological work that we did. even after only 10 days ofspaceflight this is 10 days before flight and thisis at return plus zero. so if you're flying a vehicleand you're tracking a moving target you're just watchingsomething, your head, your eye and the target. your eyes move in a certaincapacity here and you can see the eye movements. but look at this, look at thisjust look at the variation this

is only after 10 days inspaceflight how the systems adapt. so this could have been an issuefor us somebody's trying to land the shuttle and as you know, theshuttle is a glider you only got once chance to do it so you wantto maintain that visual system. so we actually used tohave a laptop on orbit where the crewmembers would practice someof their visual landings and try to overcome some of thesepursuit tracking issues. so some veryinteresting physiology.

so when the crew landed, here'sa shot at edwards air force base with the shuttle we had allkinds of devices that come up to safe the vehicle and makesure it was in a good safe capability. we see a little vehicle overhere like you've seen at the airport in dulles for example,the people mover and this is where we had our entiremedical suite in there where we have various little emergencymedicine suits, we had some recliners, we kept it very cool.

we also were able to do somevarious sciences here and we used to make that right up tothe shuttle and we'd begin some of our sciences pretty quickly. so now you fast-forward hereto what we're doing, here we're launching out of baikonur inkazakhstan with a crew of three and it still takes about eightand a half minutes to get in space. it's based on thesimple physics there. and where we are we'redealing with areas in russia.

so this is the longitude isabout 12 time zone differences and you're basically almostnorth of kabul, afghanistan if you will and it's on theother side of the earth. and that's where we're coming inand our vehicle was coming home under the chute and justbefore they land there's some retro rockets that help slow itand they use the term here the steps of kazakhstan. and you know here's part of thewelcome wagon and here you see the vehicle landing on its sideand the helicopters and this is

how we get there, dr.chamberlain and i and others that rotate over there. this is how you get therebasically through the russian system. and here you see the crewmembersbeing extracted from the side and we try to minimize theirmovements because things can be very provocative. you've been in space for sixmonths and now you're trying to do a lot of this and those headmovements can be

very, very provocative. and here you see another wayif the capsule lands vertical, there's a stanchion they putin here you get your elementary park amusement ride down here. but this is the slide so thecrewmembers are extracted and we try to keep their heads stilland then bring them right down here. and you can see they're a littlebit pale and they got that pensive look likedon't move too quick.

and there is a range how folksdo, some folks have a lot of difficulty and otherfolks adjust pretty well. and then they're hauled off insome chairs as we bring them over to some medical facilitiesand it's a tent that's put up and in there you can see thesnow in this particular case. and in there we have some ofthose cubicles that we can start to desuit the crewmember, wecan start intravenous because they're usuallydown on some fluid. we can start to consider givingthem fluids, we can start doing

some basic sciences there, andwe don't stay there very long. we get back into these vehicles,move the crewmembers over to the helicopters and subsequentlyload up on the helicopters and then fly back a couple hoursto an airport for example in karaganda and at that airportwe'll have the nasa 992 aircrafts. so this is pretty amazing tothink from the time they land we can have them back at ellingtonfield typically in about 24 hours to see their family,that's pretty impressive,

it really is. and in there we have our crewsurgeon, as well as another physician, so wehave it laid out. we have a variety of medicalequipment and capabilities and so we're able to put them downand let them rest, give them the appropriate medications aswe need to, additional fluids either by mouthor iv, and acclimate. we have two stops on the wayhome, one's in prestwick, scotland and one'stypically in bangor, maine.

crew health coming back,rehabilitation is very, very important and we have a 45 dayintensive program where the astronauts are working almostevery day for a couple hours with our trainers and it isremarkable to see the changes and how quicklythey're coming back. all that work we're doingfor their aerobics and their musculoskeletal work is payinghuge dividends because we're seeing them come back. we want to mitigate risk, wedon't want people getting hurt

because they're not ingood physiological status. so they're coming back well. and even every day almosthour by hour you see their neurovestibularaspects come back. some of the crewmembers willtell you that they do make a few mistakes at home. for example, if they havesomething in their hand now they're at home they got acoffee cup and the phone rings or something they just let goof the coffee cup to go get the

phone well everything crashesbecause they're used to just letting things go for example. the shower, they haven't hada shower for a long time. some crewmembers will tell youthat it's the most heavenly feeling on earth tohave that first shower. other folks will say thepercussion of the water pellets on their back was a littleuncomfortable, it felt weird. sitting, so you've been sittinghere for a good hour you haven't been sitting on your toochie inspace for six months even though

you get on an ergometer you'remore kind of standing on an ergometer when you're pedaling. so when we put them back here wetake them to the lab and we try to test their vo2 max, sometimesthey peter out not because their legs are tired it's becausethe seat is really comfortable. and we try to buy really nicesoft gel lined seats, but there are certain things thatare very interesting. on the exam besides theneurological things that dr. chamberlain and i deal withis the skin for example, you

almost kind of moltto some degree. so right now if i was to go andexamine all of your elbows and your feet and your heels ladies,you know what i'm talking about right whatever those specialemollients are for your feet. their feet come back they'relike little baby's feet because after about a month or two theyalmost kind of shed that thick layer of skin. so when you look at their elbowsthey're little shiny, pink, soft skin.

the same thing with their feetthey're just like these little pristine little feet becausethey haven't had that impact forces, they're not wearingthose same shoes, they're not scuffing up against them. so there are some veryinteresting physiological differences that we see. and i only have a few moreslides here as we close out. i want to talk to you a littlebit about the personal aspect of some of things we do.

i'm sharing this slide thisis sts-134, next to the last shuttle mission. and this was the crew they werebringing up the alpha magnetic spectrometers. so for the science folksout there alpha magnetic spectrometer is reallyto study dark matter. and professor ting, dr. tinga nobel prize winner was very involved with the design andimplementation of this and this crew brought it up.

and a great group, an italianastronaut, they have an air force, a navy guy and captainmark kelly and you probably know who captain mark kelly is. well captain kelly's wife wasgabrielle giffords and she's a u.s. congresswoman and january8th, 2011 she was shot. and i'm telling you this storybecause part of what we do is all this great science, but wereally have -- these people are our family. and i was the crew surgeon forthis mission and the day this

happened was a saturday and iwas -- i had done some coaching some lacrosse and we werewatching game film at a pizza place with our team and i see inthe corner of the place i see a picture of gabby giffords on thetv and what's she doing up there and i look and then i see thishorrible banner that she had been shot. i picked up my cell and calledmark i go mark, where are you and he goes i'm in my car. i go do you know what justhappened, he goes yes i found

out i'm on the wayto the airport. he had a friend who had aprivate plane that was going to take he and hisfamily out there. and a few hours later i foundmyself in tucson arizona and i walked into the emergencydepartment almost in disbelief that this justactually happened. as i'm walking in i asked mikewho's running the trauma program at tucson, arizona. they go well it's dr. peterrhee, i go peter rhee i says is

he a navy guy, koreanbackground, former navy guy, retired and theygo yeah that's him. dr. rhee and i were inafghanistan or in iraq at the same time in 2005 serving withthe navy and the marine corps. so my comfort level went from0 to 99 in a heartbeat because he'd been there, donethat, he'd seen it. and the care that she got wasphenomenal and eventually we were able to transport herback to houston, texas for her rehabilitation.

and she's a remarkable lady,it's a remarkable family. but there's a lot of tremendousdecisions that have to take place on how do you fly a guylike this he wanted to go back and fly in april, the shootingwas in january and in april was when the firstlaunch attempt was. so how do you as anorganization, how do you come together and say okay, can wefly this individual while his wife is stillgoing through this. he's had a lot of training.

the folks that he's worked withthese guys really wanted him to fly if they could. he knew the mission well,but what's going on. so this was a very interestingaspect for us to get our medical team together, our behavioralfolks, our psychiatrists, our representatives from theastronaut corps and to figure out how we make a determinationis he safe to fly. he's flying a $3 billionspacecraft with another couple billion dollar alpha magneticspectrometer, you're paying for

it as taxpayers are we doingthe right thing putting him in. and mark is a remarkable guy andwe went through a very detailed evolution where we had a plan,we looked, we monitored him, we put him back into somesimulations, into some flying environments in a t-38 and otherthings and he had all these checks and balances to the pointwhere we got an opportunity to say, you're good to go, youcan go fly this mission. it very motivating for him, verymotivating for his wife and for the crewmembers.

first launch attempt was inapril and that day the mission was scrubbed as we were puttingthe crewmembers in the vehicle there was an auxiliary powerunit heater line sensor failure, so the crew never evengot in the vehicle. so we brought themback to the quarantine facility. and as we're bringing them backin the quarantine facility the phones are going off airforce one was landing. air force one was landingbecause the president and his family were showing up, they hadnever seen a shuttle flight and

they were going togo see this flight. and gabby giffords actually cameover there as well during part of her rehab she got flown thereand so she was going to have a chance to witnessher husband launch. very, very motivatingacross the board. but the president of the unitedstates wants to go and see the crewmembers. well, if anybody works here theyknow about something called hsp, health stabilization program.

it really doesn't matter who youare you're not getting to see the crew in quarantine untilthere's a screening process involved. now why is that, it's becausenot only do we want to keep these folks healthy before theygo uphill think about who's on orbit. there's six individuals on orbitwhose immunological system is dialed down a little bit, weknow that immunological system isn't as responsiveto various problems.

so we have this program we'veonly had one mission in the history of the space shuttledelayed because of illness, it's sts-136, the commander got ill. a couple days later after anupper respiratory infection we were able to fly. so we screen folks. so if you were a trainer and youwere going to come in and give the crew some last-minutetraining at the kennedy space center you would go through aseries of evaluations the doc

would make sure you'rehealthy, etcetera. so now the president wants togo meet with the crew and i'm handed this baton and i go -- icalled the white house physician and i said, you know with alldue respect it doesn't matter who you are, we have to gothrough a certain process. if you can tell me that thepresent is absolutely healthy, he has had his flu shot, he isnon-communicable, afebrile, you tell me he's good to go we willclear it otherwise, it's not going to happen.

so he says okay, i'll callyou back in 15 minutes. he calls me back he goes okay, italked to the president we want you to do hisphysical, i go what. next thing i know i am broughtinto this room after the secret service does their handy-dandypat-down and everything and this is a shot from the kennedy spacecenter where the president, his wife and his two daughters andhis mother-in-law are there and i'm brought into this room andthe president comes up he goes okay doc, what's the story?

and i go well sir, i'm thinkingthe whole time i'm going why do they want me to do this ifanybody else if the white house physician says the presidentis good to go he is good to go. then i said well maybe this isplausible deniability because if something goes wrong it'sthe nasa guy's fault right. so i am explaining to him nowthat we have this -- just as i shared with you, we have thishealth stabilization program and we have certain wickets to check and i explained this to him very carefully.

and then there this was this bigpregnant pause and i was kind of unsure what he was going to say,then he goes doc you do what you need to do we don't want to bethe ones to get the crewmembers sick. roger that sir,thank you very much. so we proceeded to do a -- makesure that everything was in place, did a limited physicalexamination and eventually cleared him and then had todo the same with his wife. so they were able to spendsome time with the crew.

so it was a very interestingevolution that you just never expect. i mean i don't think later thatday when i called my kids up i go you're not going to believethis, you know, my whole mission that day was to keep my crewhealthy and get them ready for launch the last thing iever expect was to meet the president, let alone examinehim, i mean it just doesn't happen right becausethat's the white house. so anyway, you've got to beready and for the future docs of

the world here the other bottomline is you've got do your medical work with him like youwould do with every other single patient, don't cut cornersbecause sometimes you can't be intimidated by who somebody isyou've got to proceed and do everything like you normallywould because if you don't do that that's when you're goingto make an error, that's when you're going to make a mistake. so lock that in your mind. so if you're taking care of --at the military base if you're

taking care of a general or asenator you've got to everything the same on everybody becauseotherwise you can make those errors. but anyway, it was a great honorto meet them and they had some quality time withthe crewmembers. the last couple of slides,anybody know who these folks are? this is the original seven, themercury astronauts getting ready for some of theirfield training.

and this particular gentlemanover here is now in his 90s john glenn and he flew on the sts-95and senator glenn he was like 77 years of age when he flew,pretty remarkable if you think about it. and i think we learned somethings about the fact that if you take care of yourselfphysiologically you never know what's going to happen to you,what's going to end up on your plate. he was, of course, volunteeringhimself to learn some things

about geriatrics and otherphysiological aspects that might be of value added. but he went up and he did someremarkable things up there for us and it was a big motivatori think for folks back at home they're sitting on their couchrealizing if i take good care of myself i might not fly in space,but i can have some pretty good years ahead of me. so where are we going from here,well a lot to be determined. the space station is in essencebuilt, we're going to be doing a

lot more science here. hopefully, our commercialprograms will be able to get us up there. we've got the orion program ontap, we've got the space launch system hopefully to get us intodeeper space opportunities. how that's going to translate ifwe're going to have a chance to go back to the moon and here's ashot of what was conceptualized as the altair lander and perhapssome folks advocate going back to the moon.

whatever planetary body we go towe have a lot of issues to deal with in terms of whether it's1/6 gravity, 1/3 gravity, what about the various compounds andhow is the dust going to be an issue. and you're not going to be doingan eva once or twice, you may be doing an eva almost everyday or couple of days. so there's a lot of interestingmedicine and physiology that awaits us. if we go to the moon how do youuse the lunar regal then, how do

you use this as a protectiveenvironment from radiation? we had an encounter between twoof the different landing on the moon where the crew could havebeen in grave danger for acute radiation if they were onthe surface at that time. so we've got to have warningsystems and we've got to be real smart on how we protectour crewmembers. so some good work ahead of us. and deitra, i just wantedto click this for a second. this is a couple of short littlevideos, but this came up from a

summit we had. we brought back the apolloastronauts, particularly the ones that landed on the moon. and we were talking to themabout various things for example, we were talking aboutthe design of a habitat, to live on on a surface and about how tomake it quiet and [inaudible]. and one thing that they saidthat was very interesting they go don't make it too quiet. and we go what do you meanby that, there was something

innately comfortable about thehum and the sounds of fans and motors, it means the vehicleis working in essence. so it was an interesting littletidbit yeah, make it quiet but not too quiet. we also talked to them about thespacesuits as we're looking at the next-generation spacesuits. how do you design that? when we see people fall on thesurface of the moon we're going to look at that here, we wereasking what kind of loads, what

did that feel like when you fellor you moved, how much torque on the elbow, on the back becausewe want to look where do we put the center of gravity withthe plss we call it, the life-support system. and it was very interesting forthem and i just want to show you a couple of theseif we they pop up. as we're queueing this up, butbasically when you see them they didn't actually walkthey kind of loped. remember that kangaroo walkat 16 gravity they said that was

the most efficient manner forthem not a simple gait, but kind of a loping gait and it wasphysiologically good for them. but when they fell we werewatching some of this and we go oh my god, that's got to betough and they go it was like falling on a bed of pillowsin essence, it wasn't a lot of torque on our joints. so i think we learned a lot fromthose kind of discussions and hopefully we'll utilizethat for future events. i think we may just no joy okay.

and they were basically andyou could online and see them they're about 20-second clipsand it just shows the crewmember working on picking up some rocksand he stumbles and falls and the legs come flying out andhe hits the ground and when you first see it you go whoathat cannot be good. but in essence it wasn'tthat bad of a load. we'll just press that's okay, ohthere it is, there it is, hey we got it. i don't know what you did but.

that's okay just queue me up andwe'll just proceed that's good. and again, 2 30-second clips ifyou ever want to have a chance to look at it. so in closing, you know,december 17th, 1903, 66 years later we're on the surface ofthe moon, pretty incredible. so what we're going to seein the next few years given a budgetary balance and giving ussome zest it'll be very, very fascinating to see where we go. this gentleman is obviously --passed away the other year, but

neil armstrong and when youthink about -- when you're thinking about 1492,what do you know? columbus sailed theocean brew, the brew. thinking about beer here. he sailed the ocean blue. so the fact is that that'swhat marked that epic of time. and when you think about what'sgoing to happen here a thousand years from now when peoplelook back at our epic they will realize that this is the firsttime humanity stepped off our

planet and went to do adifferent celestial body. so for those of us that arein the arena of taking care of these, you know, we look at itas our mission statement of we take care of the men and womenwho go into space, willing to go into space and do science andwork and explore on behalf of all mankind. so i think we all collectivelyhere that work here try to support in whatever way wecan this this noble venture. and with that i will close andthank you for your attention,

hopefully we shared some goodinsights on how we from the medical operations side viewour role, some of the challenges that we have, and we would bemore than happy to take any questions. [ applause ] yes mam. >> how do you account for eye changes on orbit? you know, if they are experiencing any change in vision.

do you have spare, various contacts or glasses or somethign like that on orbit, or has that not really been... >> good question.so how do you handle, the question ishow do you handle any ocular changes thatwe're having on orbit? well, obviously it's of concernto us because it is a single point failure, you onlygot one set of eyes going. we do have a couple things onething we have is we have some glasses and crewmemberssometimes will notice some

differences over time becauseremember their focal distance is typically within theconfines of a node. every once in a while they do golook outside and have a chance to change their focal distance. but we do have some glasses thatwe fly that are almost what we call variable, there's anopportunity with a little bar to change the curvature of it. this kind of had its originsback on some of the things that the navy and the army and othersoverseas would do,

various parts. i'll give you an example, someof the healthcare that was done in parts of africa where thesefolks never had access to glasses and they had theseglasses you put on and you inject silicone through astopcock and it changed the curvature. and all of a sudden somebody ina fairly rural environment can go oh my goodness, ican see and i can focus. and you close that off andthey had an immediate

pair of glasses. so that principle of justchanging the curvature of the lens is something thattransformed into a little bit fancier version wherewe can utilize that. so we do fly somedifferent glasses up there. we are now looking at thechallenge of what medications can we fly that if thesesymptoms get worse, we haven't had any real problems, but whathappens if they get worse and it's really noticeable.

are there medicines for example,for any of you that have gone to high-altitude environmentsdiamox, acetazolamide we use that for glaucomaand eye pressures. but does that have a role,could that help us out. so we're looking at avariety of medicines. but there is no magic -- onemagic cure i know, we got to figure out why does this happen. if any of you out there knowof a non-invasive intracranial measurement we love that.

we're looking at thetechnologies around the globe on that. how do we measure without havingto put a bolt through the skull, how can we measurethat pressure? is it an intracranial pressureissue or not, that's something we really need to tease out. any the other questions? >> has anyone received stitches >> has anyone received stitches?

we have had some injuries forexample, somebody may be moving too quickly through a givenmodule and banged their head up on a hatch. we've had some injuries wherefolks we actually use a compound called dermabond, it's likea superglue that's safe for biological tissues, so we'veactually closed those up. and i think we have had a coupleof scenarios where we've had a few stitches put in, in a minorway but not what we thought it would be.

a lot of ocular issues, we'vehad foreign bodies in the eye and procedurally that's one ofthe things we've had to deal with. >> what kind of protocols have you considered if someone does end up with a flu or cold? >> protocols for the flu or cold, very similar to what you do on the ground in terms of keeping somebody well hydrated we have various decongestants, we fly medications like claritin non-sedating antihistamines,

pseudoephedrines, afrin nasal spray. we also have antibiotics that wecan use if we think it's turning into a bacterial infection. we also have some nasal inhalersof people getting any bronchial spasms that sometimes folkswill get a cold and they end up having a little bit of aresidual cough or a little bronchospasm, we have someinhalers that we can use for that. >> do you assume more than one person would have the problem

under those circumstances? >> the question isn't how do weassume more than one person is how you get the virustransmitted up there. obviously if they're up therefor a stable period of time there should be no entranceinto any new virus. so when our upcoming crews up,we do spend time on the order of three weeks or so in quarantineor a couple of weeks in quarantine with the crew inbaikonur and we monitor them very carefully.

we really limit who's comingin, so we've been very blessed. we have not hadany big problems. we've had one or two issues inthe shuttle days where we think that there was some latetransmission to the crewmember, perhaps there's some trainersor family, but we've been very fortunate it hasn't impactedus in any substantial way. all right, well great thanks forquestions and thanks for your attention. [applause]

>> i just want to inform you of upcoming classes we have coming up. on the 14th of april we have the human reseach program overview with-