Medical Training Simulations

Hello, everyone!

You are listening to the Red Shift - your connection to your piece of the sky. I'm your host, Emma Miller!

So let's jump right into this - this week is going to be a little bit of a different kind of show. I'll get a little bit more into it in a little bit but with the Martian dust storm that's still over top of our base, it's a little bit harder for our astronauts to get information to us, so it's a little bit harder for them to get us a letter, but I wanted to make sure that this week was something super, super special and fun for us all, so we're going to do something super exciting!

But we'll get to that in a little bit. First, we're going to do the things that are the same. So, first, let's go over our ISA announcements.

ISA Announcements

It's a light week this week for our ISA announcements, but do keep an eye out on the ISA Twitter for more astronaut bios. It's also a great place to just see ISA news, so make sure that you are following that ISA Twitter.

Like I said, the storm has prevented us from getting any letters from our astronauts this week. Hopefully the astronauts are doing well, but we will have to just wait and see. I do also want to say hi to Stephanie. Hello, Stephanie! I hope you're doing well! It's great to see you, Jon-Jon, and MaDAlen, and Spoons, hello, hello!

So, before we get into this ‘something different’ of the week, I think it's important that we talk about our weather forecast. Like I said, this week is a little bit different because of the weather. So let's hop right into it.

Weather report

ISA weather models confirm that the anticipated dust storm from the previous week's model is now on top of the Martian base and could last for some time. Current conditions have the temperature ranging from highs around -22 degrees Celsius to lows at -92 degrees Celsius. The wind speeds are variable between 15 and 25 meters per second, or 55 to 90 kilometers per hour. Atmospheric pressure will be 645 Pascals, and the current atmospheric opacity is 1.55, which means that it's very, very difficult to see. The ISA is continuing to actively and closely monitor the storm as it passes over top of Mars.

For anyone at home wondering what this actually means for our astronauts, though, let me tell you. For the astronauts that are currently at the base, this storm will feel like a long, sustained period of night. With the dust spanning from high in the Martian atmosphere to being near the ground itself, there is limited opportunity for any light or heat to reach the base. During these days, the astronauts will be relying on the reactor for main power, but solar-powered vehicles or antennas will have to get by on what they have in their batteries.

An interesting thing to note is that while the temperature on Mars during a dust storm is fairly cold, the dust actually acts as a layer of insulation to a degree. Instead of a huge differentiation between nighttime lows and daily highs, it tends to stay a little bit more constant throughout the day. While it is still extremely cold, obviously, there isn't that much of a change!

The most important concern for the astronauts now, honestly, is to ensure that the technology coming into contact with the constant barrage of Martian dust does stay operational. The astronauts will also need to ensure that the air and water filters are properly working to ensure that none of the perchlorate-rich dust of the Red Planet manages to get into the supply of either life-sustaining substance.

***

So, with our weather report out of the way, and with the dust storm ongoing, I really wanted to do something special for all of you Shifters, so I actually reached out to our sponsor this week.

If you remember, the last couple of weeks our sponsor has been one of the ISA training sites for our new astronauts. This week is ISA Ladakh, which is very exciting, and I'll be able to read their message for you in just a moment here, but I reached out to them to ask if there was any kind of exclusive training simulation that I could share with all of you to, kind of, put your minds to the test!

So that's what we're going to be able to do together after our message from the sponsor! I hope you all are incredibly excited. I know I am! I get to act as your guide through this sponsor-led experience. It's going to be similar to, like, a tabletop role playing game, if you will, but we'll get to that in just a minute after we have our word from our sponsors.

Commercial break

Do you wish to put your medical knowledge to the test while establishing an entirely new form of practice on a new planet? Do you have a desire to bring a dead planet back to life through the cultivation of plants?

If you answered yes to either of these questions, come share your knowledge with others while training in ISA Ladakh, ISA’s primary training facility for Doctors and Botanists.

Located in Ladakh, India, and in affiliation with Central Sindhu University, ISA Ladakh is a perfect place to put your medical or botanical knowledge to the test. With its location 3500 meters above sea level, Ladakh offers a perfect cold desert atmosphere to experiment and study in near-Martian conditions. This offers the trainees a rare opportunity to apply their skills in conditions that will come as close as possible to replicating the conditions on the Red Planet. 

ISA Ladakh is also known throughout the region for their local contributions, including regular donations of grown plants and vegetables to the community.

If you want to make a difference in the lives of future Martians, paving the way for a safe and healthy new planet, ISA Ladakh is the training site for you!

Medical simulations

Well, now is the time! With our sponsor here, we are going to put our medical thinking hats on and we are going to put our instincts and knowledge to the test.

The way that these simulations are going to work - we have two for you today - the way that they will work for you all is, we are going to be given some information, some background information, about two astronauts, learn some of the symptoms that they're exhibiting while they are in space and on Mars, and then we're going to have to diagnose them. It is of course important for us to be able to diagnose our astronauts based on the information that we are given and we're going to do all of this together. I hope you all are very excited! I know I am!

I got to play through this with one of the trainers from ISA Ladakh, which was incredibly cool as an opportunity that the ISA provided for me, so I'm excited to be able to do this for you all! Like I said, you can think of me in this simulation like a Dungeon Master in a tabletop role playing game, if you will. I will also act as your search engine. So I will lead you through the experiment, if you have questions, I will do my best to answer based on the information that the ISA has provided me, and we will hopefully get to the bottom of both of the situations that our astronauts, our hypothetical astronauts, are experiencing. Are you all excited? I'm watching #ISA-comms. I'm waiting to see.

Are you all ready? Going to need your help with this for sure? I like the gif usage in the chat right now. They're– very good gif usage, super excited. Stephanie's ready. Let's do this!

Oh, speaking of Stephanie, I should actually probably mention this now. Stephanie and I worked together to think of a great way that we can reward all of our Shifters while they are doing this experiment together. I like the little coy smile. “Oh, that,” yes - oh, that.

So, for all of our Shifters who are able to help us complete this experiment - the simulation - today, extra XP will be gifted to you on Discord. We all love ranking up, right? So extra XP will be gifted to you to help you rank up a little bit faster. So it'll be about 1000 XP. Stephanie can correct me if I'm wrong, but it's about 1000 XP, which is quite a bit of chatting otherwise, so, hooray, we love XP! So let's make sure that we diagnose our astronauts correctly so that they are healthy and ready to get back to their lives. Are you all ready? I'm excited! I think we start our first simulation now. Let's do this. Okay.

This is the background information that they provided us for the very first experiment, or simulation:

“After a day of work around the base, all of the Astronauts gather for a period of relaxation and recreation. One astronaut, a young male engineer, is particularly excited about recreation time on this particular evening. He is uncharacteristically enthusiastic, nearly euphoric. He sits down at the table and deals cards. When he picks up his own hand of cards, he grins and exclaims that he already knows that he will win. 

He places down a card with pride - but the astronauts around the table notice something is wrong. Where the astronaut stated the card was a seven of hearts, it is in fact the seven of diamonds. Same color, same number, but a different shape. The astronaut laughs it off and plays another card - but a mistake of the same kind happens again. They rub their eyes. 

After it is clear they cannot play the game, because something is going on with their vision, they say, dejectedly, that they will just turn in early for the night. As they stand, however, they wobble severely on their feet and are unable to walk in a straight line.

You usher them quickly to the medical bay, realizing that something is wrong.”

So at this point you've noticed a couple of different symptoms. You've got euphoric emotions, you've got fuzzy vision - or, a lack of proper vision - and also dizziness. At first glance, it appears that this could be the effect of drugs or alcohol. These symptoms could also potentially be linked to dehydration. Would you like to test for either of these things first?

Lack of oxygen is also a good thought. You are in a controlled area, however, in the space that you're in right now, so a lack of oxygen currently wouldn't necessarily be presenting. “Two tests?” - you can run as many tests as you want within the parameters of the simulation. So you would either do a urinalysis test that would test for drugs and dehydration, or you could do a breathalyzer to test for the BAC level, Blood Alcohol Content level. The other astronauts are all fine, this is the only astronaut that is presenting in this kind of symptom– or, with these kind of symptoms. Do you want to do a breathalyzer test? Alright, let's do a breathalyzer test, there, alright, let’s test.

So, you do a breathalyzer test. The astronaut actually struggles really hard to get enough air into the breathalyzer while you test them. It actually takes you multiple tries before you can get a good reading, which does come back as negative. As you're waiting for the results of the breathalyzer, the astronaut actually begins to cough.

So, they don't have a BAC level that would indicate that they are intoxicated, but they have started to cough and they are having trouble breathing. So, different test? Do we want to do a urinalysis test for dehydration, just to test and see if that's dehydration and also potential drugs?

Alright, so run a urinalysis test and it does come back negative for any drugs in the system or lack of hydration.

So, we're at a bit of a crossroads here, right? We have a new symptom. We have this new symptom of coughing, which is, of course, incredibly concerning, especially when we're in space. There's little that could cause an astronaut that is otherwise healthy to start coughing. So we have to think about what could be a potential cause of this.

So we can kind of look into two things here right now - we can either look into the health history of the astronaut and see if it's perhaps something that might be flaring up from, you know, something previous. We could also look into the daily activity of the astronaut, which, actually, it looks like Chris is kind of already thinking about, “exposure from daily activities,” could be Martian sand in lungs, that's true. Daily activities, alright, so let's look into the daily activities of the astronaut.

So, you look into the daily activity of the astronaut and discover that this astronaut, in particular, has spent a long span of time over the last 24 hours out in a rover and in their space suit collecting soil samples from the planet. Knowing this, it would appear that it is likely that what the astronaut is experiencing has something to do with the balance of oxygen, carbon dioxide, and nitrogen levels in the atmosphere of the rover or of their spacesuit.

Both carbon dioxide toxicity and oxygen toxicity can present in a loss of vision, dizziness, and coughing, and both occur when there are higher amounts then the normal amount of either in the given environment. “Were far away from the base?” they were far away from the base, yes. “Air contamination,” that's what it's sounding like! The only thing that's important to know about, or one of the other important thing to know about this, though, is that when carbon dioxide toxicity occurs, carbon dioxide toxicity gives you that feeling of choking for air when you're choking for breath, whereas oxygen toxicity doesn't necessarily do that. But that feeling that you get when you are gasping for air comes from a buildup of carbon dioxide.

So, the next question for us is - what do we want to take a look at first? Do you want to look at their suit? Do we want to look at their rover to see if all of the monitors are working properly, the monitor for nitrogen…? We want to look at the rover. Buddy was fast with that!

Sounds like the rover might be the way to go. Alright, let's take a look at the rover. Alright,we're going to look at the Rover first, I think. Let's see, because if it's not in the rover, it's probably a problem with the spacesuit, so let's check the rover first.

So you do check the various gauges for CO2, nitrogen and oxygen. The CO2 and nitrogen monitors are working fine. But! You discover that the oxygen monitor has malfunctioned and has not been properly registering the correct amount of oxygen, which means that levels well above normal oxygen would have been present for a sustained period of time while the astronaut was out in the rover working, putting them in increasing danger throughout their trip. Fortunately, you've caught it! You’ve caught the problem, and caught it quickly enough to prevent any further exposure. The astronaut will have to make sure that they are getting the correct levels of oxygen moving forward, so you have to make sure that they are being watched while they are in the Hab, and of course you, as the doctor, will have to monitor them closely while they recover to ensure there's no truly harmful lasting effects outside of the initial lung damage that they will have incurred.

But your diligence and your fast movement here did make sure that they didn't sustain any additional lung damage or any additional oxygen toxicity, and you have successfully completed your first simulation! I'm so proud of you all! You all did a great job, congrats!

How did that feel? You guys ready for a little bit of a harder one? [Emma laughs] “Fire this man!!” “Who has rover ownership?,” that's a great question, Jon-Jon. We'll have to find out, we'll have to find out. Luckily, we'll have fixed the rover ownership though– or, the rover, so whoever is the owner won't have to worry about it.

Are you all ready for the next simulation? I'm excited. I'm really proud of you all! I hope you all know, I'm a very proud Shifter right now. “These simulations are fire.” Good! Well, hopefully not fire. If there was fire, there would be a lot of problems, Though, luckily, there were no matches in the oxygen rich environments of the rover. That would have been a bad time.

Alright, let's do it.! Our next simulation. “FIRE FIRE FIRE,” it would be very bad, Vellum. That would be a rough time.

So, this one is… I chose this next simulation because I felt like it was pertinent to what our astronauts are dealing with at the moment, actually, so… Let's see how we do!

“A few days have elapsed since a Martian dust storm passed over the base. Fortunately, it appears that any damage that the storm might have caused was not critical. After a few days of cleaning dust off of all the technology outside of the Hab, like the solar panels, it appears that life on Mars is back to normal. 

You, the doctor, begin to notice that there has been some lethargy around the crew in the base. After the large storm, however, it seems fairly natural to expect that the crew is tired. The extra work needed to maintain the base after the storm would tire anyone out - even rigorously trained astronauts. Additionally, you begin to note concerns about the temperature in the Hab and the subsequent requests for additional heat. 

A few days later, one of your astronauts, a female botanist in her mid forties, comes to the medical wing of the hab clutching their neck. As you pull their hand away, you notice a large golf-ball shaped swelling in their neck. Something is clearly more wrong than any of you had realized.”

So at this stage, you have noted three symptoms exhibited by the astronauts. The first is the extreme lethargy that they are feeling, the second is the lack of standard temperature regulation and general feeling of cold, and the third, and potentially most pressing is the swelling in the neck. Which do you want to investigate first?

So you have three options here - you can look into their lethargy, you can look into the cold, and you can look into the swelling in the neck. These gifs are phenomenal! Swelling in the neck? Okay. We'll do the cold next. So let's start with the neck first.

So the swelling in the neck could be a reaction to an allergen for the astronaut that is manifesting as a swelling in the lymph node. Due to the regulation of food, it is unlikely that this would have been caused by an allergic reaction to something the astronaut ate, but it could have been an allergic reaction based on exposure to something else on the Hub. Potentially.

Obviously, the swelling could also be a tumor. Both space travel and life on Mars will expose astronauts to higher than normal levels of radiation, and cancer is always going to be a concern.

Finally, the swelling could also be caused by a reaction in the thyroid gland causing a goiter to develop. Whether the thyroid is over- or underperforming, the imbalance of the thyroid can lead to swelling in the neck.

So those are the, kind of, three thoughts about the neck swelling. Yeah, so there's a couple of different diagnosis - diagnoses? That's the word! - that it could be. So, do we want to look into the cold next? I think that was what was suggested by Galdwin… Alright, let's look into the cold.

So, at surface level, Mars is inherently a very cold planet. It's not out of the realm of possibility for astronauts to feel cold while they are outside of their regulated and pressurized space suits. Tying exhaustion and lethargy to the temperature feelings - the more tired you are, the colder people tend to feel. So with the exhaustion in the crew, it is possible that the spike in temperature complaints simply stem from exhaustion. Issues, however, with the thyroid condition can also cause a lack of ability to regulate temperature, however. While an overactive thyroid, so hyperthyroidism, can cause someone to feel excessively hot, an underactive thyroid or hypothyroidism can cause someone to feel inescapably cold.

“Hypothyroid,” potentially... Do we want to look into our exhaustion level and see if there's anything that's connecting these three things? Look into the lethargy? Let's look into lethargy first.

So, again, potential causes of lethargy could be surface-level. If the astronauts have not been sleeping well, simply a lack of sleep can cause fatigue. Due to the storm, it is not impossible that the lack of energy can come from the, you know, long days of regular and rigorous work. The astronauts may also not be eating or drinking enough. Dehydration, especially, can lead to lethargy and exhaustion. However, under the surface, the body's thyroid condition can also cause lethargy. Hyperthyroidism, where the body's thyroid is overworking, can lead to an initial burst of energy followed by a lack thereof. Hypothyroidism, where the body's thyroid is underperforming, immediately brings out an intense sense of exhaustion and fatigue. And Stephanie does make a good point here! So remember, the entire crew is all presenting with this exhaustion and the feeling of cold. This particular astronaut does have this additional symptom of a swelling on their neck, but otherwise they're all exhibiting the same symptoms. “Multiple signs of thyroid under performance,” do we feel confident that it's something that's related to the thyroid underperformance?

I know for me, it kind of seems like that's probably a solid place to go from. Because after we establish that, we'll have to figure out what's going on beyond that.

Alright, so let's assume that we've diagnosed that this is an issue with the astronaut thyroid condition. It appears that the astronaut is currently experiencing hypothyroidism where the thyroid is functioning abnormally by producing less than the amount of hormones needed for regular function. So now the question is, what has caused it? It seems like you all are getting into that line of thinking, as well.

There are three things that really stand out in terms of what could cause hypothyroidism - an autoimmune disorder, an iodine deficiency, and perchlorate poisoning. So what would you like to investigate first out of these three? An autoimmune disorder, iodine deficiency or perchlorate poisoning?

Iodine? Okay, so a lack of iodine in the diet can cause or can lead to a potential for an iodine deficiency. Iodine deficiencies present itself with thyroid issues, including visible swellings in the neck, an inability to get warm and stay warm as the body is not able to adequately maintain heat, and persistent fatigue. Do you want to test them for iodine deficiency?

Yes, please? Alright, let's test them. So you do some tests on the diet of this crew member and on the crew member themselves. With the limited variation in the food present on Mars, it's possible that there could be room for a lack of iodine. However, upon checking the log of food and through their tests, you can establish that this particular astronaut has a balanced nutritional meal plan and they are not presenting with a lack of iodine in their diet. So it's not coming from a lack of iodine in the diet of the astronauts on the ship.

So the other two that we could look into are an autoimmune disorder or perchlorate poisoning. “Do they have an autoimmune disease?” Let's take a look.

So, an autoimmune disorder such as Hashimoto's disease could cause hypothyroidism. The disease typically develops, however, in people with other autoimmune disorders, which the ISA would have found before sending the astronauts into space. Symptoms– or, disorders like rheumatoid arthritis or celiac disease. And it would have to be present in every one of the astronauts in order for this to be a shared experience. The likelihood of the autoimmune disorder being the cause of this thyroid concern is something you can rule out, which leaves perchlorate poisoning. Would you like to look into perchlorate poisoning? Let's do a perchlorate test.

So perchlorate poisoning on Mars is not impossible by any means. Perchlorates, which are both toxic and corrosive chemicals, can be found in the soil covering Mars at a level that is certainly toxic to humans… if consumed. Typically, these would be filtered out using a biofiltration system in which bacteria would process the perchlorates and release salt and oxygen in its place. The result of perchlorate poisoning can cause significant health problems, but will often manifest initially in hypothyroidism.

Upon testing the astronaut, you discover higher than expected levels of perchlorates in their body, which means that you have found the culprit! But despite the fact that this particular astronaut has the additional symptom of swelling in their neck, many, if not all of the other crew have been involved with this feeling of lethargy and cold, leading you to believe that this is a shared experience of perchlorate poisoning. The next question is - where are the perchlorates coming in?

In order to experience perchlorate poisoning, the perchlorates must be ingested, either through the food or water supply. So would you like to look at first? Water supply? Alright, we'll take a look at water.

So, you head to the water filtration system and begin to test the water. You are stunned to discover high levels of perchlorates in the water. As you investigate, you discover that the storm damaged a part of the system that came after the biofilter, allowing the perchlorate-rich dust to seep into the water supply without being filtered out during the storm that had passed. It was able to go undetected because it was initially a very small level, but the sustained drinking of the water led to a larger and larger exposure to the perchlorates. They entered after the bioreactor, or the biofilter, meaning that they couldn't be taken out of the water.

Luckily, you found this because that also means that the plants that you were growing in your Martian greenhouse, or that your botanist is growing in the Martian greenhouse, were being watered with water that had perchlorates involved, and every bit of water that anyone in the hab were drinking or ingesting all had perchlorates in it. So, using a new biofilter, you were able to refilter the water that was in your tanks and able to get it back to a safe drinking and ingesting level. With the properly clean and filtered water and some extra iodine in the diets of all of the astronauts in the base, you are able to get the perchlorate poisoning past the astronauts, and soon they are back to their happy and healthy selves!

Which means that you have not only saved the one astronaut from oxygen toxicity, but you've also saved all of the astronauts in the base from perchlorate poisoning, which is incredibly, incredibly impressive! I am so very proud of you! I hope you all give yourself a big pat on the back. A very, very big pat on the back. “We are the champions, my friends,” very, very true!

And that means that all of you involved today are going to get the extra XP that Stephanie promised, as well as a very special new member group which I didn't mention earlier. But you all get the Shifter member group on Discord, which is very exciting!

We're very excited that we get to have this official way to recognize you all as Shifters and make you a special little community here on the Discord. So thank you all so much for involving yourself today. This is so fun! I loved being able to run this for you all. I hope you all enjoyed, and hopefully maybe you learn something too about space and about different concerns that can literally plague our astronauts as they're on the Mars base. Very exciting!

I just noticed that I do have a question from [Emma laughs] Ais_Galdwin. I do want to just quickly answer that question. If anyone has any final thoughts before we wrap up for today, feel free to send them either in #ISA-comms using the /ask command or just sending them here and I'll do my best to answer them, but Ais_Galdwin asked, “Hello Emma, how are you?” I'm doing very well, thank you for asking. “I'd like to learn a little bit more about the– I'd like to learn more about the little stake you bought in the Mars colony, what it looks like, and do you plan to go there one day to cover the future of the colony as an official reporter for the ISA?” That's a very, very good question!

I don't know if I'll ever personally have the chance to actually go, but how cool would that be if I got to be the first official reporter for the ISA? Imagine if the Red Shift could actually be brought to you live from the Red Planet. That would be incredible.

My stake otherwise looks very much like your stake in the Mars project, so… it's otherwise very similar. But being the official reporter would be really, really cool. So, thank you, that's a great question.

“I have the role that The Martian doesn't,” oh, no! Competitions have begun!

Well, thank you so much, everyone, for hanging out. As always, I appreciate all of you being involved! I can't wait to bring you more Red Shift next week and hopefully you all have a fantastic, fantastic week. I will see you all really soon.

Have a great day, everyone! Thank you all for playing with me!

Bye, everyone!