When we think of telemedicine sessions, most of us probably picture consultations that take no longer than a typical appointment; once a treatment plan is agreed upon, only brief follow-up telemedicine visits remain. But what if the patient isn’t on earth? As reported by Forbes, in the longest telemedicine consultation on record, a U.S. astronaut has been successfully treated for a potentially fatal condition while living on the International Space Station (ISS). Although telehealth for astronauts is not a new concept, having been around since the late 1960s, recent advancements in technology and medicine are enabling physicians to help patients in amazing ways.
Several months ago, the astronaut, who remains anonymous, was undergoing a routine neck ultrasound for a research study designed to examine bodily fluid function during space travel. Although the study was not intended to screen for blood clots, a large clot was discovered in the internal jugular vein, the large vein that returns blood from the head and neck down to the heart. The revelation came as a surprise since the astronaut was not experiencing any symptoms.
Once researchers confirmed the clot as a deep vein thrombosis (DVT), NASA consulted Dr. Stephan Moll, an earthbound Professor of Medicine and Hematologist-Oncologist at the University of North Carolina with specialized expertise in thrombosis (blood clots). The danger presented by the DVT was the risk of the clot loosening and traveling to the lungs, where it could lodge and create a pulmonary embolism, an emergency medical situation that could prove fatal—similar to the risk from DVTs that could develop during travel or after surgery. Thus, after assessing the situation using telehealth for astronauts, Dr. Moll had to make a tough call: Blood thinners are the typical treatment, but the ISS only carried a 40-day supply; the astronaut was scheduled to remain in space for another four months.
Ultimately, Dr. Moll opted to treat the clot with the onboard blood thinner. A similar medication was shipped to the ISS to continue therapy after the 40-day supply ran out. However, considering the high risk of trauma to the body upon re-entry to earth, therapy was stopped four days before re-entry.
In the end, everything went smoothly, and the astronaut did not need further treatment for the clot upon return to earth.
The particulars of this preeminent case study – telehealth for astronauts – are unprecedented; at this point, little is known about the risk of DVTs in space or why the astronaut developed a clot in the neck as opposed to the legs, where DVTs typically form on earth. And since the astronaut was asymptomatic, was this a random event caught by chance, or do researchers need to screen more aggressively for other medical conditions that could present in space with a different pattern than on earth? Dr. Moll expects further research from NASA into these and related matters—not just for space stations, but for other forms of travel as well.
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