First Orthopaedic Surgeon in Space!

Orthopaedist blasts into space

By Jennie McKee

http://www.aaos.org/news/aaosnow/oct09/youraaos3.asp

Robert L. Satcher Jr., MD, PhD, will travel to the International Space Station
Four decades after watching the grainy television images of Neil Armstrong and Buzz Aldrin landing on the moon, Robert L. Satcher Jr., MD, PhD, will go where no orthopaedic surgeon has gone before: outer space. In November, he will fulfill his life-long dream of space travel as one of six crew members on a mission to the International Space Station.
Members of the crew take a break from training to pose for a portrait. From left: Leland D. Melvin, mission specialist; Col. Charles O. Hobaugh, commander; Capt. Michael J. Foreman (Ret), mission specialist; Robert L. Satcher Jr., MD, mission specialist; Capt. Barry E. Wilmore, pilot; and Lt. Col. Randolph J. Bresnick, mission specialist. Courtesy of NASA
“Exploration—the concept of venturing out into the unknown and discovering something—excites me,” says Dr. Satcher. “Seeing the astronauts walk on the moon stirred my imagination and made me think that space exploration would be something great to do.”
Although he has always maintained a strong interest in space travel, Dr. Satcher was also drawn to medicine—specifically, orthopaedic oncology. His career as an orthopaedic surgeon and researcher has helped prepare him for what will surely be the experience of a lifetime.
The path to the starsDr. Satcher, who earned a PhD in chemical engineering from the Massachusetts Institute of Technology and a medical degree from Harvard University School of Medicine, went on to become an assistant professor of orthopaedic surgery at Northwestern University Feinberg School of Medicine in Chicago. He treated child and adult bone cancer at Northwestern Memorial and Children’s Memorial Hospitals and held a research position at Northwestern’s Robert H. Lurie Comprehensive Cancer Center and Institute for Bioengineering and Nanoscience in Advanced Medicine.
“My career was very rewarding because operating on the musculoskeletal system requires the use of many tools and engineering concepts in reconstructions,” he says.
Although he was focused on his orthopaedic career, Dr. Satcher still maintained a strong interest in space exploration, as evidenced by his research into how physical stresses affect bone.
“We know that when a person goes into outer space, gravity is removed; however, other forces continue to act on the skeleton,” he says. “Those forces are imparted primarily by the attached muscles that pull or push the bones. When people are in space, they typically lose bone mass from some of the weightbearing areas, such as the legs and spine. Presumably, the bone loss is the result of not putting weight on the legs and spine because there’s no gravity.
“What are the main components of mechanical stress that mediate these changes? Are stresses being transmitted through fluid flowing over the cells or over the substrate—or both? These important questions remain unanswered,” he says.
In 2000, Dr. Satcher applied to the National Aeronautics and Space Administration (NASA) astronaut training program. He believed his chances of being accepted were slim.
“I thought whatever consideration I got would at least make for good stories,” he says, with a chuckle.
A year later, NASA called Dr. Satcher to arrange an initial interview. He soon completed medical and psychological testing and underwent a background check by the Federal Bureau of Investigation. Three years later, the phone rang—and an official from NASA was on the line. He offered Dr. Satcher a spot in the next astronaut candidate class—the first in four years.
“It was a wonderful and surprising phone call,” remembers Dr. Satcher. “Although I was excited about starting my training at NASA, I was also sad to leave my colleagues at Northwestern University.”
In the next few days, Dr. Satcher spent a lot of time talking with his family about how all their lives would change.
“Many people have asked how my wife and family feel about what I do,” he says. “They have been overwhelmingly supportive, despite the risks and inconveniences.”
Dr. Satcher uses virtual reality hardware in the Space Vehicle Mock-up Facility at NASA’s Johnson Space Center to rehearse some of his duties on the upcoming mission to the International Space Station. Courtesy of NASA
Training for spaceDr. Satcher and his family soon moved to Houston, Texas, to be near the Lyndon B. Johnson Space Center, where he began rigorous training. He also took a position as clinical assistant professor of orthopaedic oncology at MD Anderson Cancer Center.
Dr. Satcher quickly found that the skills he possessed as an orthopaedic surgeon translated well to being an astronaut.
“I drew on my ability to maintain focus despite anything going on around me and to multitask under difficult circumstances,” he says. “Having reasonably good manual dexterity and a good understanding of engineering concepts was also helpful.”
He enjoyed nearly all of the training exercises—especially being a copilot in a T-38 supersonic jet.
“Flying in a T-38 is like being in the fastest, scariest, most dynamic ride imaginable,” he says. “The jets are very acrobatic. It’s fun to see what everything looks like from high altitudes.”
Perhaps more demanding have been training exercises that last seven to eight hours, during which Dr. Satcher wears a 300-lb space suit modified to be worn under water. He still participates in this training on an ongoing basis.
“We get in the pool at the Neutral Buoyancy Laboratory to practice space walking as well as repairing or replacing components of a full-size model of the International Space Station and space shuttle,” he says.
Dr. Satcher, who has performed this training nearly 40 times, says it’s physically and mentally exhausting.
“The tasks are very technical and detailed,” he says. “You’re doing fine manipulation in a bulky suit under a simulated zero-gravity environment.”
The missionAfter Dr. Satcher and the other crew members blast off on November 12 (launch date is subject to change), they will travel for 3 days to reach the International Space Station.
“The commander and the pilot will fly the ship,” he says.
“As a mission specialist, I will monitor the navigational and ship data and will relay that information to the commander and pilot. I will also be responsible for performing numerous tasks required for the daily operations of the shuttle.”
Dr. Satcher explains that even activities such as eating and sleeping will require careful coordination because the crew members will be in a confined space.
“When we reach our destination, we will transfer supplies and store them on the space station,” he explains.
During the 11-day mission, Dr. Satcher will go on two space walks. During the first, he will perform maintenance tasks on the International Space Station’s robotic arms. In his second space walk, the primary task will be to install a high-pressure oxygen tank that will supply breathable air to the space station.
Dr. Satcher will also operate the space shuttle’s robotic arms.
“Operating the robotic arms is similar to performing arthroscopic surgery in many ways,” he notes.
He will also serve as a proxy scientist for principle investigators whose experiments were selected by NASA, which uses a peer-review process similar to those employed by the National Institutes of Health and the Orthopaedic Research and Education Foundation.
“One of the studies will focus on how the height of a person’s spine changes in a zero-gravity environment,” he says. “We’re going to perform measurements to see if disk height changes when you go into outer space.”
Dr. Satcher says that many of his orthopaedic colleagues have expressed great interest in his upcoming space flight.
“A number of them will be attending the launch,” he says.
“I think we’re an untapped talent source, because so many of the skills an astronaut needs are the same skills surgeons need. I think more orthopaedic surgeons should become interested in being astronauts—in certain ways, it’s something we’re already trained to do.”
Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org
AAOS NowOctober 2009 Issue

Orthopaedic astronaut studies bone’s response to stress


http://www.aaos.org/news/bulletin/jul07/research1.asp

An OREF/Zimmer Career Development Award enabled Robert L. Satcher, MD, PhD, to begin studies on ways to replace destroyed bone
Too much stress can fracture bones, as any long-distance runner or orthopaedic surgeon knows. Too little stress and bone fails to develop properly. Traumatic stress and cellular stress from diseases such as cancer can also lead to bone loss.
Robert L. Satcher, MD, PhD, is among the researchers studying ways to replace lost bone. A recipient of a 2002 Career Development Award sponsored by the Orthopaedic Research and Education Foundation (OREF) and Zimmer, Dr. Satcher is also a mission specialist astronaut candidate.
Dr. Satcher’s interest in how bone responds as a whole to the various stresses thrust upon it and, conversely, how it responds to the absence of those stresses goes back to his postdoctoral work at Northwestern University’s Feinberg School of Medicine.
Dr. Satcher gets a close-up look at one of the agency’s T-38 jet trainer aircraft.
The stresses bones faceTo gain a better understanding of how various forces affect bones, Dr. Satcher—then an assistant professor of orthopaedic surgery at the Feinberg School of Medicine, a researcher at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and an orthopaedic surgeon at Northwestern Memorial Hospital—investigated bone at the cellular level.
Bone is made up partly of living tissue and partly of an inorganic and organic matrix. Proteins make up the organic portion, while calcium and phosphates constitute the inorganic part. It is the living portion, however, that reacts to stress placed upon it.
“It’s been known for a long time that if you subject bone to physical stress, such as loading it, the bone will become larger in size,” Dr. Satcher said. “What that means is that the bone cells—the smallest living units that make up the bone—are helping to build up that bone to make it stronger in response to that physical stress.”
Using bone cells harvested from rats, Dr. Satcher and a team of researchers were able to study how bone reacts to different physical forces using several methods. In one study, Dr. Satcher observed flowing fluid across the bone cells to see how they were affected. The side of the cell exposed to the flowing fluid represented how a physical force would affect the bone.
Dr. Satcher was also able to grow cells on a deformable membrane. “When you deform the membrane that the cell is growing on, it subjects that cell to the same deformation,” he explained, “which is equivalent to a physical stress that would cause deformation in the bone.”
This enabled Dr. Satcher to test the cells’ response to controlled loading. “We can specify how much straining the cells experience, or the deformation they experience because we artificially input the load,” he said. “This lets us observe the patterns of response.”
These initial studies led Dr. Satcher to his more recent investigation of designing materials that promote bone growth and that could be used to reconstitute areas of bone lost due to trauma, surgery, or cancer.
“We took what I had learned from working on the more fundamental process of how physical stresses affect bone and applied it to practical applications,” he explained.
Robert L. (Bobby) Satcher, Jr., MD, PhD, mission specialist astronaut candidate, floats freely aboard a KC-135 aircraft as part of his early training.
Research beyond EarthDr. Satcher may someday have the opportunity to study this process in a completely different setting. He was selected as a NASA astronaut candidate in 2004.
He has nearly completed the 2-year basic training course that combined both didactic and experiential lessons. For example, classroom training covered the specifics of the space shuttle and international space station, while training in a large pool simulated the weightlessness of space.
“We also had a trip that involved leadership training, where we were put in scenarios of hostile environments and had to work together as a team to solve the problem under stressful situations,” Dr. Satcher said.
Once he has completed a technical assignment to support ongoing activities at NASA, Dr. Satcher will be eligible for assignment to either a space shuttle mission or a research project on the international space station. In either case, at least part of Dr. Satcher’s role will be that of researcher.
“Some NASA experiments have specifically studied how bone cells respond to a low gravity environment, but I won’t necessarily be conducting orthopaedic research,” Dr. Satcher said. “NASA has a review process similar to the National Institutes of Health or OREF. They accept research proposals and select the experiments that will be flown on the space shuttle and on the space station. Most likely I’ll be a proxy scientist for the principle investigator, doing some experiments that were selected by the peer-review process.”
Dr. Satcher, a mission specialist candidate in NASA’s 2004 astronaut class, poses with a T-38 jet trainer aircraft at Ellington Field.
Discovering the future of orthopaedicsDr. Satcher stresses, however, that it is important to support orthopaedic research. “Orthopaedics as a whole has been expanding throughout the years, and the capabilities of the surgeries have become better as technology has improved,” Dr. Satcher said. “As we age, most of us will need orthopaedic care, even if it’s not operative. Our joints are going to start to bother us, or our back is going to give us problems. If orthopaedics is going to continue to improve, it will be through research that is carried out intelligently and effectively. Supporting research is essential to the continuing improvement and evolution of orthopaedics.”
Each year Zimmer supports six $50,000 awards through OREF. According to Ray Elliott, Zimmer’s board chair, “When we realized that young, practicing clinicians did not have the resources that were available to residents or veteran clinicians, we decided to help these young researchers by providing funding through OREF for a new grant program. Since then, we’ve granted to OREF more than a quarter of a million dollars each year to help these younger surgeons pursue additional research, education, travel, or any legitimate endeavor to help them advance orthopaedic science or care.”
For more information on the Zimmer/OREF Career Development Awards or ways you can support research through OREF, visit the OREF Web site, www.oref.org