Treating a medical emergency ... in space

ABC Listen Podcasts radio There was a chook who was left something like ten million pounds in a will. She was called Jiju, but she was rich, so maybe kosh like Jiju. Anyway, does that mean I can leave my cat or my daddo to my dog. What the duck is presenting nature's most wanted. of animals and the law. You know, peeks being tried for murder. Getting speeding tickets. What the duck on ABC Listen or wherever you get your podcast.

So Priya, have you ever had this ambition to be a cruise doctor, you know, sort of out there on the high seas and you're the doctor on this luxury cruise? Spoiler alert, I'm not into cruises because gastro outbreaks scare me. So I've never had this stroke. But some people like you know, that like Survivor or things like that. You know, they they like to be the doctor in the middle of nowhere and I'm gonna save you. I mean that's never never been a fantasy of yours. No. I quite like being around

Yes, and and help if I need it. No, I've d I don't have that desire. Why? Do you? No, God, it terrifies the hell out of me. Absolutely terrifies me. And how much more would it be if you're stuck on a spaceship in the middle of bloody nowhere? And that's what we're going to be talking about today on the Health Report. I'm Priya Alexander on Wearing Jury Land. I'm Norman Swan on Getigo.

Also on the show, a lot of people go and get shoulder imaging done, an ultrasound or an MRI, and it shows up findings. The question is does it correlate with pain and is it what's to blame for your symptoms? One of my favorite topics, whether imaging makes any difference. And also on today's show, we're going to be looking at the trajectories of mental health amongst adolescents and what happens to them. A big study at the Black Dog Institute of

In the news though, it would not be a health report without a story around G or P ones. We should have a little like what's that rash. We should have a little bell or something, a little sound. You know, we've got a bell for Mediterranean diet in What's That Rash. We should have some sound for GLP ones, maybe a burp or something like that, but we'll come back to that later. We should discuss that offline and come to a unanimous decision, don't you think?

Well send in your suggestions on what you think the noise should be. In the Lance at Psychiatry, a study that has looked at people who have a diagnosis of diabetes, and it's tried to answer the question if people go on a GLP 1 or use a GLP1 at any point for their diabetes management. Does it worsen their mental health? So these are people with diagnoses like depression, anxiety, and diabetes.

And just a bit of context here. With weight loss, there have been reports and there are labeling along these lines, which is there have been reports of people who uh psychological state deteriorating, in other words, increased risk of depression or even self harm thoughts when you're on these Ozempic like drugs to lose weight. So this is looking at people with diabetes and what happens to their Quite a large study, over ninety five thousand people, the majority were female.

And what they really looked at, their primary outcome, what they were trying to measure, was was there worsening of mental illness? So they looked at things like did people have sick leave for more than fourteen days due to mental health issues? Were they admitted to a hospital due to a psychiatric reason? They looked at really that was their primary outcome.

Interestingly, they found that in the people who are on semaglutide, which people would know as Ozimpic or Wagovi, I know we don't like to use brand names, but that's what people know them as. It did actually show a protection in depression and anxiety. There was there was less serious mental health deterioration, which is really quite interesting. Yeah. And most of the others showed s the same or no deterioration at all.

Yes, so lyric glutide had some reduced risk of worsening depression, but some of the others didn't. I wonder Norman though Because there's a lot of discussion now about do these GLP one medications have some other neuropsychiatric impact? That's the question here. But it appears to be that some may and some may not potentially when you look at a study like this, because it wasn't a class effect. It wasn't all GLP ones.

Yeah, when you talk about class effect, does this cut across all these drugs'cause they have the same sort of effect? But it turns out that, you know, there are subtle differences and and as you say, they have effects throughout the body, not just on the brain. We should mention that this was um a study that used the National Swedish Electronic Health Register. So God for the Scandinavians.

Yes, but they've also said they really do need the authors have admitted that a randomized controlled trial is really required to look further. At this issue and the benefits potentially of GLP1s in patients with diabetes. Remember, this is diabetes, not weight loss space, and the mental health implications. Yep. We're not contradicting the concern that some people who are taking these drugs for weight loss may find themselves in psychological distress.

Yes. Very different entities, diabetes versus weight loss.

Big news. Talcum powder, the Lancet and a Retraction. This is quite huge. Well it's it's We need a bell for me, don't we? Well it's a paper that was actually in nineteen seventy seven. I wasn't alive. Were you? Ha ha ha. I was already 100 years old. Antibiotics had come in. There was all sorts of things that happened in nineteen seventy seven. We should place some nineteen seventy seven Yes, we should.

But ninety seventy you know, in the seventies when we started to notice a connection between the use of talcum powder, which was very common in our parents' generation, not in my generation, not in your generation, our parents' generation, they they said slathered on t talcom powder after they had a bath or a shower. And the c concern is that there was an association with ovarian cancer, for example, in women, and lung damage as well.

And there was a paper on this in the Lancet and a commentary piece which said, really, there's nothing to worry about in normal domestic use. Nineteen seventy seven, so back in the day, that's when that happened. Okay. Yeah. and then All these years later, they've discovered that the people who wrote that commentary were actually being paid by Johnson and Johnson who made the talcum powder.

And the commentary had been sent to Johnson and Johnson and edited before the Lancet actually published it. And of course the Lancet wasn't aware of it at the time. They've been made aware in December of last year. And they've retracted it. They have retracted it. Now can I say because this has obviously been a big

area of litigation and Johnson and Johnson. We've seen these headlines. I think most people are familiar with it. But one of the people who has exposed this discrepancy, Rosner, actually said We have testified on behalf of women suffering from ovarian cancer linked to exposure to talcum powder polluted by asbestos.

They go on to say, um, in these cases we are occasionally confronted by the defense with the unsigned commentary that appeared in the Lancet in 1977, which claimed that asbestos in Tauc was not dangerous.

We have been surprised by this piece as the Lancet must have known that asbestos was a pollutant of talc and therefore must have been a suspect in nineteen seventy seven. These public health historians, wow So even though it's seventy nineteen seventy seven, as you say, it's still important today.

And important that it's retracted and corrections are made always. Onto the appendix. This is a passion topic of yours. There's a study that's been published in Jarma Surgery. And we should say that Norman does appear to be quite passionate about the appendix. But the question this study has asked. The question they've asked is, Well, let me just go back. Oh, we're going back. Good. Because I do suspect we may disagree here, but let's see.

There's been anybody who saw my four corners last year on early onset cancers, one of the one of the cancers we didn't talk about, which is going up, is cancers of the appendix. They are going up. So from from a low base, you know, they're quite rare cancers, but they are rising as well as colon cancer and so on in younger people. The question is why? One of the hypotheses that the that to explain why they might be going up

is that this has been timed with a change in medical practice where you come in with an inflamed appendix and you get treated with antibiotics so they don't have to remove the appendix. And the question is Is leaving an inflamed appendix in your abdomen bad for you and it might turn malignant, or there's a malignancy there to begin with, which is causing the inflammation?

When I heard about that at the time I thought, Oh, well if I ever get appendicitis, I'm gonna hold a gun to the surgeon's head to take my appendix out rather than leave it in. However, um this study was designed to see whether or not that's a real risk. And what they did was they studied. a large sample of appendices that had been removed to see if there were malignancies in the appendix. Well they've really looked at whether or not you have the potential to miss tumors in the appendix.

And I think a uh it's a it's a small number. It's about one point six. There were early tumors. They weren't all carcinomas, which is a much more aggressive form of tumor. Some of them were called were neuroendocrine tumors. Won't go into that there, but it's a different kind of tumor. Not a nice one to get, but not as nasty necessarily as a carcinoma.

And one point six percent. What they also found was that you could actually identify the people who had the high risk appendices. They tended to be older. with a longer track record of symptoms rather than a shorter episode. You know, m a lot of people come turn up with appendicitis, it's two or three days.

you know, the pain started in the middle of their bellies, moved to the right hand side of their abdomen, very typical story. Whereas people who turned up that had hidden surprise malignancies They tended to be older and a much longer history. So they reckon that if you actually look at those risk factors, you could eliminate the risk of a missed malignancy, which is good

You could pick up potentially the people who might have a tumour. I think though, you know how you said you would say, I really want my appendix out. Mm-hmm. This Norman is and this is why I'm often quite grey. I'm sure compared to you listeners often think You're never going to be able to do that. great. No, well I'm I think sitting in the consulting room and seeing patients like yesterday, I just know how gray things are. And I think that people often

Want the option. If you've got appendicitis, someone should be saying to you, you've got this option of medical management antibiotics, or you can go and have surgery. Both options, Norman, have pros and cons. And one of the cons of the antibiotic management might be from this study. You can't we can't look at your appendix under the microscope. We may miss a tumour. It's very rare, but it could happen.

That's part of the C saw people need to do, the pros and the cons and the risks and the benefits. But I don't know, this is where I differ. I'm like I don't think I'd want the surgery if I could avoid it. Yeah. Well you see I I'm a hundred and fifty years old, so I I you know I'd probably Do you have an appendix? I still have tonsils and I still have an appendix.

Um but coming back to your point, at least this study gives you something to tell people that uh here's the risk, you make up your own mind. That's right. You weigh up your own pros and cons and make an informed decision.

Always on the Health Report, which you're listening to on ABC Radio National. So Priya, one of the things about mental health issues is that they generally start in adolescence. And the question is, How does that track? And what are the influences on adolescent mental health and what happens to young kids as their lives proceed and what are the risk factors? Which is exactly

Well they've been studying at the Black Dog Institute at the University of New South Wales and on the line is Professor Eliza Werner Seidler. Hi Eliza. Hi Norman. Hi Priya. Thank you for having me. So Elisa, this is the future proofing study, which was launched back in twenty nineteen. You've surveyed adolescents from year eight and now to year eleven and and asked them pertinent questions about their home life, their school life.

their mental health, their sleep. What are some of the key things that have come out of it? If you were to give us a snapshot on adolescent wellbeing in Australia, what's the takeaway? So I guess the first thing is that the rates of psychological distress, depression and anxiety symptoms are quite high by the time young people are already in year age.

On the one hand, most young people are doing okay, but there is a concerning subgroup of young people who are already showing symptoms at that time. And before you go on, you're not showing this is not a trend study, this is a cross section. So it's a it's a moment in time rather than saying ten years ago it was X and now it's Y.

Correct. So so what we've done is we we looked at students in the eight, but then we tracked the same students longitudinally throughout their high school journey. So we're looking at the same young people because we're interested in their trajectories. which are the groups of young people who get worse and what are some of the factors associated with that worsening trajectory.

And I guess what we found is there are a few key things that predicted a worse trajectory over the high school years in the same student. Uh the first one was uh being female or gender diverse, so gender is a really important factor in predicting mental health over time for young people. The other thing that we found is relational factors are really important.

So we found that bullying and like young young people who are bullied or those who don't have good social and peer connections often fed worse. Than their peers who didn't have those difficulties. And of course, there's always going to be a role of the family environment and exposure to adverse events early in life, which seem to predict.

a worse trajectory. But I also want to say the data that we found from this study, like it's not all doom and gloom. So there are two main findings that we found around what I like to think of as modifiable factors that can protect against mental health. And that's actually enhancing young people's social connection. So young people who feel connected to one another, like they belong at school, they do much better over time. And also young people who get good enough good quality sleep.

they do much better over time. And I think that's really important because sleep seems to be like a pillar of health. that isn't covered in schools or taught in schools or, you know, indeed across the general population in the same way things like nutrition and physical activity are. And I think there's a real opportunity to do some good work.

So let's dissect some of this. Um there have been longitudinal studies of large numbers of adolescents over the years, which have shown that kind of confirm what you found, which is that your connectedness to school. is a critical predictor of a a a healthy trajectory in adolescence. Predicts all sorts of things such as early sexual experiences, substance use and so on.

But you seem to imply with what you were saying, but maybe I misunderstood you, is that it's a secondary phenomenon, not a primary phenomenon. So in other words, those longitudinal studies suggest this is core. The school's got to connect with your child and the child's gotta connect with the school. Is it a different story from your research?

No, I I think I think what I'm saying is the same thing that uh young people who connect with their school environment and with their peers, they're at a much lower risk of developing mental health symptoms over time. Because what you've actually said in the report though is that it's really about it's call connectedness, but more specifically it's a sense of belonging.

for the child and a quality of relationships with their peers. So it's actually so those are the key things that really put kids on a positive trajectory. If a child is suffering from psychological distress, depression and anxiety for example, or they've got ADHD or or or or they're on the spectrum. they are already hobbled a bit in terms of their ability to form healthy relationships. So my question is what comes first?

Well I mean that's that's a really important question. I think we have uh uh what's the most likely scenario is a bi-directional relationship. There are studies trying to pick this apart, and it's certainly something we're going to be looking at in our in our data set. But I guess we've started looking at um connection and belonging first cross sectionally, but then looking at connection and belonging, predicting mental health over time rather than the other way around.

So in other words, is it therapeutic if the school really works hard to make that connection?

Well, that's what is implied by our data and that's that's absolutely the programme of work that we're pursuing. We're looking at developing uh programmes that schools can used to enhance how students feel and look at how they can feel better integrated and connected within the school environment, including Uh, kids who are neurodiverse, including kids who are perhaps from a minoritized group and who have typically been overlooked because we want to understand if

those students, if they are better connected and and have a greater sense of belonging at school, whether that will protect their mental health over time. I noted this thing about adverse childhood events that if a child experienced them in the eight, it could increase the risk of some negative outcomes for mental health. Can you just talk us through what what constitutes those events and how do they have a negative impact?

Yeah, sure. So um the sorts of questions that we're asking young people, and it's actually throughout their life up until the point at which they are being asked. So they ask questions around, do you live at home with a parent or family member who experiences alcoholism, drug abuse, mental health problems? Have your parents separated or divorced?

These are the sorts of questions that they are answering and what we find is that those who report a greater number of adverse childhood experiences up to the point of being in year eight, that predicts a worse outcome over time.

So it doesn't mean that the presence of these of these events alone mean that somebody will definitely experience a worsening of their mental health, but it is a risk factor. So it is contributing to that level of risk and it is associated with a worsening trajectory over time. Of course some people listening to this will say, Well, it's all about screens. Is it is it all about screens, Elisa?

Look I look again, that's a really important question. We don't yet have the answer to it. There's some really good work that's going on at the moment evaluating the social media ban that was introduced towards the end of last year. Uh I think the sc screens are probably a part of the picture.

What's the conclusion then, Elisa? Like where to from here with all of this information? Is it more education about the benefits of sleep? Is it working on connectedness for children within schools or adolescents? What what's the takeaways? What do we do with this report? And the tips for parents listening. Yes. Yeah. So like I am encouraged by these findings because they they offer a clear path for better prevention programs. The first thing we've learned is that

in order to reduce the risk for the development and worsening or onset of some of these disorders, you want to get in earlier. So I so the first thing I think, you know, prevention science as a field. can do better at not waiting until we get to adolescence to start delivering prevention programmes and education campaigns and so on.

So first thing is to get in earlier. The second thing is is to really explore uh social connection and sleep and look at interventions because if we can deliver interventions through randomized control trials. and see benefits compared to a control group, that will be really strong evidence to suggest that these are the factors that we really need to be targeting and actually embedding in our school systems and in our communities.

Profisa Werner Seidler from the Black Dog Institute at the University of New South. Well, you're with the health report on ABC Radio National. Say it's the shoulder and it's all yours, Priya. Well, not quite all yours, but we'll see how you go. Oh we'll see how I go. Wow that's a vote of confidence. Well you said you're grey. I'm I'm gonna I'm gonna push this grayness here.

Well, it is always a bit gray in medicine. I think as you sit in the consulting room, that's the thing I leave with every day. The shoulder shoulder complaints, brutator cuff injuries are really quite common. Just for my benefit.'Cause you know, I During the nineteenth century. What is the rotator cut? Oh the rotated now that is I feel like orthopods and physios are going to really tune in now. It is a group

Of structures that constitute the rotator cuff and it's things like your supraspinatus tendon. There's others and they are Things on the top of your shoulder. Yes, and they're very important for your shoulder stability and movement. What do you think? And it can get stuffed up.

It can get stuffed up. That's a good w that's, you know, that's as basic as it gets. It can. Lots of people are sent for MRIs, shoulder ultrasounds. Imaging is quite common of the shoulder, and there's a study that's just come out of Finland that has looked at MRIs of the shoulder and how helpful it really is. These are people who come in with shoulder pain.

No, this study has looked at people who are general population. It has looked at um not people with shoulder complaints and this is addressed in the interview. But it's really saying if we do MRIs on all healthy shoulders, what do we find? Does it change clinical practice? And it's a very interesting space. Perhaps in Australia we have a bit of a problem.

I spoke to the lead author of the study, Dr. Thomas E. Bunig, who is a shoulder and elbow surgeon at Helsinki University Hospital and a researcher at the Finnish Centre for Evidence-Based Orthopedia. What we want to do with the imaging is usually that we we we take the image and and quite often we see some abnormality on on the MRI scan.

And then when we have an abnormality on the scan and a patient with pain, of course it's quite logical that those two are linked together and we start treating them. However, we know from other joints like spine and knee that that those structural abnormalities can also be found in people without any pain. So we just wanted to see if that is also the case regarding the shoulder. And what did you find?

So what we found was that in in people over forty, uh virtually everyone, ninety nine percent had some kind of abnormality on their on their MRI scans. And also when we looked uh on shoulders with pain and shoulders without pain, there was basically no difference. So we had ninety eight percent of abnormalities in symptomatic shoulders and ninety six percent of abnormalities in asymptomatic shoulders.

So regardless of whether you had pain or not, the scam was detecting that there was something going on in the shoulder. Yeah. So what does that tell us then, Thomas? What's the takeaway here? Is it that the pain doesn't necessarily reflect what's happening on a scan? Is it that scans are being overdone and don't necessarily change clinical practice? What's the takeaway? Yeah, yeah, exactly. That that that's one of the takeaways. And and and what we also found in our study was that

those changes, they might be not so severe and not as common in 40 year olds. But then as uh age increases, uh even more severe changes like like full thickness rotato cuff tears. became very very uh frequent And eighty percent of those were in people without without pain. So so it seems that most of those chang changes that we see on on imaging are actually age related, normal changes, like uh

grey hair or some wrinkles that you might find and that that are normal in in sixty or seventy year olds, but not normal in twenty year olds. And it seems that's a little bit the case also regarding these imaging findings.

What's the risk then? Someone goes and has a scan. I I think some people would argue that they want all the knowledge to make a decision. Some might say, Well, there's no radiation within M R I. I want to get it done. What's the harm then? Is it that you detect things which are not potentially causing your pain and it causes fear? Or is it that you undergo interventions that aren't necessarily indicated? What are the harms to having a scan done when you might not need it?

Those two points you made are exactly in my opinion the most important ones. So so we we have findings that are incidental and not not the true cause of pain and they might cause treatments that are unnecessary and on the other side those imaging findings. can cause anxiety, th they can do harm. It it depends a lot what terms we use, but if we would use terms like tear or or implying that something is broken, of course, that makes a healthy normal person suddenly a patient or a sick person.

when we could use other terms like age related normal change or or fraying or something like this. And and actually there are it's interesting what you said. Our research collaborators from Melbourne did some studies, for example, regarding back when it seems quite logical when you

that you want to get all the knowledge you have and and it and and you you might think that imaging doesn't harm you. The more you get, the more information, the more imaging the more sure you can be that there is nothing going on and that people might be more relaxed, not so anxious. after they had their image done. But but there's one study on on back pain where hundred persons were imaged and h uh a hundred persons were not imaged and actually those that got the scan were more anxious

it it took them longer time to to heal or to to get better. So it seems that there are That imaging is not not just something that you do and and and and it doesn't have any harm. And so who should be getting an MRI or a you know, any imaging of the shoulder if it's not everybody, it's perhaps being overutilized and potentially causing harm. When is it indicated?

Are uh situations of course where where imaging definitely plays a role, especially if you wanna rule out uh severe causes. Um or of of patient symptoms, like after a a significant uh injury or trauma, through fractures, uh traumatic tears. And and then also if we wanna make sure that there's no uh cancer going on or or infection and and things like this. But usually there are quite clear clinical signs guiding us in in and and telling us when when imaging might be relevant and when when not.

Is it safe to say, Thomas, that if someone has shoulder pain, they go to get examined by a physiotherapist or a doctor? The doctor examines them and says, look, this is most likely a rotator cuff injury. Is it really the takeaway here that you don't then necessarily need imaging to confirm that? Because if you image everybody, as we say, in the waiting room or out on the street, most people over 40 are going to have something detected.

Is that the kind of takeaway that this is a clinical diagnosis and not everybody needs a scan? Exactly. Yeah, that's exactly the takeaway. A majority of people don't need a scan. The the clinical examination, especially if we have experienced clinicians. is enough to rule out all those severe causes that would need imaging and in case we don't find any signs. like this then then definitely we can do so without without imaging.

doctor Thomas E. Boonig, who is a shoulder and elbow surgeon at Helsinki University Hospital. And he's also at the Finnish Centre for Evidence Based Orthopedics, which you know, could be a contradiction in terms. The orthopods are going to write in. Luckily, my brother-in-law is one, so I feel like I can make these jokes. But it is an interesting name. I actually had the same thought.

How how how how honest of you. But I mean we should just nail this on MRIs. I mean th there's the the famous sorry we we covered it many years ago in the health report, which is doing exactly the same study on people with um on people older people, I think it was people over fifty five, l doing MRIs on their knees, irrespective of whether they had knee pain or not.

And what they found was that when you're over fifty five, knees tend to look like disaster zones with torn meniscae and so on, and it had no relationship to their level of knee pain or whether they had knee pain at all. And you know, and what they've shown is that if you do an MRI of the spine when you've got spinal pain back pain or a MRI of the knee, you find stuff you weren't meant to know.

Yes, Norman. It's called incidental omas. My mentor, Dr. Andy Morgan, he talked to me about this notion of incidental omers. You don't want someone to scan your body. without a really clear indicator. Because you find things that don't matter, don't change clinical practice that can generate fear and anxiety and exacerbate pain. Well sometimes it does change clinical practice but in the wrong way. So you you end up Over intervention.

being referred and s the the surgeon or whoever you're referred to feels they've got to do something and you end up on this medical round. In fact I made a four corners on this a few years ago. Which is a source of waste in the system. And, you know, if you've got you know, talking about evidence based orthopedics, if you've got osteoarthritis of the knee, you get a s you either get no x ray at all or you just get an standing x ray of the knee.

Yeah, especially if you're having operative intervention they will image you beforehand. And that is totally warranted. But not a random thing. Not a random willy nilly thing. No, I agree. But I think the takeaway here is Do you need the scan? You can always push back and say, Do I really need this? Do I need to spend the penny pennies? Is it going to change anything? If only it wear pennies. Hm. It's not anymore, is it? You've probably used pennies, am I right? Yeah, well.

A lot of pennies, let me tell you to do an MRI scan of you.

On ABC Radio National, you're with the Health Report. Now the crew of Artemis two mission have spent ten days in space going around the far side of the moon, farthest they've ever traveled from Earth. NASA says it's planning more ambitious missions in the future to establish a base in the moon itself and one day even go to go to Mars.

What happens if something goes wrong medically on one of these missions? How do they handle that? God, that's a scary thought. And what does being in space long term do to a human body? Our producer, James Bullen, has looked at those very questions. Yeah. It's an environment on the bottom. as a human spaceflight, so small teams operating in isolation and confinement, dependent on technology for survival, chronic low-grade stress, changes in circadian rhythm, changes in immune response.

um, you know, group uh and team dynamics a and the impact of that on um, you know, operations. This is Dr. John Cherry. He's the Deputy Chief Medical Officer at the Australian Antarctic Division. So I've had a couple of opportunities to work in Antarctica on the ground, uh both for summer seasons and a winter season where you're physically isolated for up to nine months of the year where uh you know if something goes wrong you can't get in or out.

It's by n its very definition is an extreme environment. So I mentioned the the winter isolation, nine months of physical isolation over winter. Uh in order to support that we have a pretty unique medical model uh internationally, which is a a generalist uh medical model where we have a a generalist doctor at each station who's provides generalist medical, surgical, anesthetic and dental care of their expeditionary team.

But they also, you know, uh collect the blood and and and run the blood tests with the point of care testing devices that we have. Uh they uh are trained on how to take uh x rays uh and uh medical imaging. Uh, they manage the inventory, they uh you know, uh manage patients for extended periods of time in isolation. The isolation, those difficult conditions also make Antarctica a great model to study as an analogue to long-term space exploration.

The studies that have been run out of the Australian Antarctic program test things like cognition, fatigue, metabolic health, and medical measurement in tough conditions. We've run numerous studies over many years, but some of the most notable ones recently. Uh we've uh run NASA's largest ever uh ultrasound study, uh looking at a new portable ultrasound device with uh protocols that have been written to assess if novice sonographers, so people who've never picked up an ultrasound

uh before, uh if they can pick it up and generate clinically useful images. And this has implications for, you know, I'll work down south, but implications for human space flight. We've looked at metabolic health studies using uh three D uh lidar camera technology uh to create three D scans of people to assess their metabolic health changes.

over an extended deployment down south and that also has a applicability to human space flight as well because we know there are metabolic changes in astronauts as there are in Antarctic expeditioners. And if we can better understand those and and how they occur and when they occur, we can create countermeasures to make sure we're optimising people's health during those extended expeditions.

But what That's when something goes wrong in space. Yesterday, January seventh, a single crew member on board the station experienced a medical situation. And is now stable. eleven ahead of their planned departure. That's NASA Administrator Jared Isaacman announcing the crew of the International Space Station were being pulled back in January this year. The pilot, Mike Fink, had experienced some kind of medical episode.

Some of the details of what happened have been kept confidential by NASA, but what we do know is the uh astronaut had difficulty talking for a number of minutes. I think they were eating a meal at a time. Um and out of an abundance of caution after doing some testing, including some ultrasound testing, um they uh elected to return the astronaut to Earth where they've undergone further testing here on Earth. Crews do have some capacity in space for treating a medical emergency.

If an emergency does happen, they can treat with the advice of telemedicine doctors. That actually happened a few years ago when a blood clot was discovered in the neck of an ISS astronaut. So what happened was the astronaut uh who was involved, who has chosen to remain anonymous, was involved in another study. So they they were doing a scientific study. And part of that study meant using the ultrasound to have a look at the blood vessels in the neck, uh specifically the jugular vein.

Dr. Kirsty Lindsey is an aerospace physiologist and physiotherapist at Northumbria University in the United Kingdom. While they were undertaking that scientific protocol, they found a blood clot within the the jugular vein. Um And they radioed down to earth and said, found something a bit unusual. Could you have a look at it? Uh and the flight doctor went, Ooh, that's not so good.

Um NASA then contacted some specialists in um thrombolytics, so blood clots, um, and it was determined that the blood thinning drugs that they had on the station were suitable and that the astronaut should take that drug. the blood clots started to resolve with the medication, so the astronauts stayed on the space station. NASA even sent a resupply of the medication up into space.

And so they were on uh blood thinning medication for the rest of their flight. So it was managed for about ninety days before they landed. For long term missions, like a months long journey to Mars, there are other challenges to health posed by a spaceflight, separate to any kind of emergency. So the space environment is very challenging. First of all, because they're in free fall, so because they and their spacecraft are falling around the earth at the same speed.

they're not affected by the pull of gravity in the same way. So there's no gravity pulling uh their blood down, making their body stand upright and and kinda it takes away the effort of having to move the body. So things like muscle strength and bone mineral density reduces in space. We call it a space-flight adaptation. So you become more adapted to being in space. Um for muscle, it can be quite a significant drop unless we have countermeasures.

So we have exercise countermeasures. So essentially the astronauts have to go to the gym every day. Being in microgravity is a really bizarre feeling. Uh it's fun. It's uh I've done it, it's great. But Doing things like sleeping and eating, you feel just a bit squiffy, you're a bit off. And that means astronauts often have two to three hours less sleep a night. And then they have all the problems that come with not having enough sleep.

Uh also there's sixteen sunsets and sixteen sunrises. So we don't have a nice circadian rhythm to say, oh it's getting dark now I need to go to sleep or it's getting light now I need to wake up. So their circadian rhythm is also knocked off. It sounds pretty tough, but despite the challenges, becoming an astronaut remains a dream for many. Dr. John Cherry says it could perhaps be more than ever, thanks to the Artemis missions.

A student, you know, in a school in Australia, you know, does does human spaceflight interest you? I'm sure you're gonna get a positive answer for that. And and at a time where we have the opportunity to inspire the next generation in uh in STEM subjects. I I think that's really exciting. That special report was from James Bullen, our dear producer. If you'd like to listen to more about Artemis 2 and follow the mission, you can listen to the series.

Artemis Explained, brought to you by Jacinta Bowler and Belinda Smith, who are science reporters. It's an amazing pod that my kids are really enjoying, and so are mine. And it's part of the science fiction podcast. On ABC Radio National, you're listening to the Health Report.

We have had Graham write in. Graham says, Dear Norman and Priya, a recent episode indicated that a saline spray could help alleviate childhood snoring. So this was in relation to a story we did last week, children sleep apnea that saline could help some kids. Graham asks, would saline spray also help with adult snoring? We don't know the answer to that question, but adult snoring tends to be a different pathology. It's a different entity.

It is. But do you know, can I just because this is a passion area of my Norman, obstructive sleep apnea in adults. It can have flow on consequences. It can impact your blood pressure, heart disease risk. So if you are a snorer and you're sleepy in the day, I would go and chat to a health professional like your GP. Yep. Don't rely on some salt water up your shores. It's not gonna do you any harm to try it, but in most situations it ain't because it's a different anatomical problem.

Sue's also written in, Norman and Priya, on your recent discussion about sleep disturbances in children. Oh, this got people thinking, Norman, they like that story. I'm about to turn eighty. Happy birthday, Sue. When I was a child, it seems that tonsil and adenoid removal was the go to for any child who was vaguely off colour. I had mine done in early primary school and my mother told me later that I wasn't particularly ill.

but it was just what they did in those days. Ever since I have been plagued with sore throats and allergies, so please leave the tonsils and adenoids alone unless really necessary. Love your shows. So Thanks, Sue. Everyone has a different experience, I guess. Yeah. But thanks for sharing yours. And Jim's written in. Hi guys, great programme. Really enjoy the updates on health matters. On that note, watch the latest

Uh c can I just put out a a warning here. If you are having your breakfast or eating something, put it down while we go on with this story. What's the latest in nail fungus infection cures? Over the years I've tried many off the shelf ones, even a twice daily wipe wipe of tea tree oil, and at best it seems to have stopped spreading, but it looks like it could come back easily.

I know there's a tablet, but apparently it's not great on the kidneys. Is laser a real option? Even the nails that have fallen off due to excessive trail walking have grown back with the fungus. My food hygiene is pretty solid, and I'm at a lot. Jim, we feel for you. We do feel for you. But you know, we can't give individual advice here about what to do with your nail fungus.

What we'll do is we'll look around for the latest research and if we find it we'll put it on an interview and see how you go. But there is there is a there is a tablet for it. Series. There are options. I would go and chat to your GP or podiatrist. There are many options. And it's not the kidneys that are at risk with that tablet. It's the liver but we monitor it. But Jim, thank you. It's very it is a very annoying problem. So we uh we understand that.

And now you can go back to eating your breakfast or your lunch or your dinner or mid morning or Maybe you're listening to us. Uh we do love your letters. Our address is healthreport at abc.net.au And don't forget our sister podcast, What's That Rash, where this week we're talking about handedness. Left handed, right handed. Is it worth training yourself to do the opposite hand and thereby exercise your brain? I don't know if I have the time for that, but I'll find some

I'll see you next week, as always. Yeah. Which w which hand do you put at the top of a broom when you're pushing your broom? I never thought of you as a princess, but no. No, I'm just I'm not a broomer. Well on what's that rationale? Yeah. More about how you actually define happiness. And one of the things is See you then. You've been listening to an ABC podcast. Discover more great ABC podcasts, live radio, and exclusives on the ABC Listen.