HOUSTON — The American Academy of Physician Associates paid tribute to Houston, a.k.a. Space City, by inviting two astronauts — physician associate (PA) Hayley Arceneaux and physician, engineer, and NASA astronaut Serena Auñón-Chancellor, MD — to discuss the ins and outs of space medicine during its first 2024 conference Main Stage event. The two compared notes about their experiences in space — and highlighted why more PAs are needed for a future in space.
Arceneaux, who made history as the youngest American, first pediatric cancer survivor, and first PA to travel to space in 2021 with SpaceX's Crew Dragon Resilience, started the conversation by asking Auñón-Chancellor, who spent 197 days on the International Space Station in 2018, about space adaptation syndrome — a diagnosis curiously absent from UpToDate®, an evidence-based point-of-care clinical resource for better patient care.
"This is something that almost every flyer gets," Auñón-Chancellor said. "You just don't feel good. You have some nausea. Some folks vomit. You get a headache. It tends to resolve in about 5-7 days. But you don't get 5-7 days off once you get up there. You have to get to work."
The two went on to discuss the changes that occur in the body's physiology during prolonged space flight — including substantial bone loss. That, Auñón-Chancellor said, is something that will have to be considered when planning extended missions to Mars in the future.
In addition, "a paper using Monte Carlo simulation estimated a 30% bone loss even with routine exercise. People worry about what would happen if the astronaut fractured a hip on Mars' surface. But I'm thinking, 'What horrible osteoporosis are they going to have when they return?'" she said.
Auñón-Chancellor added that she also worries about the potential health effects of space radiation and the behavioral health consequences of being away from family and friends for so long. Arceneaux then said that an additional challenge for these long missions is the limited resources available to astronaut crews due to weight and space restrictions on board.
"Limited resources not only in terms of the resources you can bring on board, but also, as the medical officer, you have to play all the roles," Arceneaux said. "You are the nurse. You are the specialist, especially in instances when there is a loss in communications, which is very common."
Despite the challenges and the many unknowns, the two said they see a bright future for space medicine and encouraged the PAs in the audience to learn more about it. Auñón-Chancellor said the field is advancing much more quickly than she could have ever imagined.
"It used to be just the NASA astronaut corps that flew. Fairly healthy people, though you'd probably be surprised at some of the diagnoses that we waive for space flight," she said. "But now we are launching Captain Kirk! We're launching people with everything [disabilities] because we can. And we should."
But that requires a higher level of healthcare and a clear understanding of the physiological and psychological changes involved with space flight. Auñón-Chancellor said she expects to see more space medicine opportunities "pop up" at universities, as well as in private practice and in the military.
"I'll tell you that it's not just for the MDs," she said. "There's been a tremendous amount of interest across multiple specialties, including PAs because these populations of space flyers are just going to increase.
I'm inclined to call UpToDate® and tell them that they need some space medicine on the platform so people can become educated about it. Because it's a fascinating world where the body's entire physiology changes."
Kayt Sukel is a healthcare and science writer based outside Houston.