When it comes to coping with some of our most frigid outdoor temperatures, we all get cold feet (and hands) at times. Cold extremities result from sharply reduced peripheral blood flow which is a physiological response aimed at preserving core body temperature and warding off hypothermia. In normal people, the restricted blood flow is restored intermittently, to prevent tissue damage. However, there are some people who respond by clamping off blood flow in a pathologically extreme way. These people suffer from a vasospastic condition called Raynaud’s phenomenon. It affects about 11% of women and 8% of men in America.
Sufferers of Raynaud’s have recurrent episodes of blanching of fingers, toes, and, occasionally, nose, earlobes, and nipples. The blanching can be dramatic, often giving the affected extremity a temporary corpse-like appearance and becomes cold, numb, and, often, painful. If the spasm of the arterial blood supply persists long enough the oxygen supply becomes depleted and the skin color turns blue. When the blood supply returns, the skin turns red and may be accompanied by swelling, pain, or tingling. The attack may last for less than a minute or continue for several hours. These attacks are an exaggeration of the normal response to cold exposure which is a blotchy red and white pattern.
Usually, the attacks are harmless. However, there are a few people who get tissue or blood vessel damage as a result of prolonged blood flow interruption. In these unusual cases, ulceration or gangrene can result.
These episodes can even be triggered by seemingly minor exposures to cold. Some people can have bouts triggered by holding a cold drink on a warm day or walking into an air-conditioned supermarket. Emotional stress is a trigger for others.
The cause of Raynaud’s phenomenon is not known. It can occur in otherwise healthy people, unrelated to serious illness, in which case it is termed Primary Raynaud’s and appears to run in families. This is especially true when it occurs in young women. When Raynaud’s occurs in conjunction with certain more serious diseases it is termed secondary Raynaud’s and is more likely to lead to tissue damage. When it appears in men or the elderly, it is more likely to be Secondary Raynaud’s related to medical conditions such as autoimmune disorders, blood disorders, toxin exposure or from arterial damage caused by vibration injury from prolonged machinery use or by prior frostbite.
Relief Of Raynaud’s Attack:
Place hands in warm (not hot) water.
- Whirl arms around in a windmill fashion.
- Move to a warm place.
- Place hands in armpits.
- Wiggle or gently massage fingers and toes.
Even Better… Prevent Attacks:
Do not smoke and do not breathe second-hand smoke.
- Avoid caffeine or chocolate.
- Do not take decongestants, stimulants, or weight loss drugs. They constrict blood vessels.
- Dress warmly in layers, carefully adjusting the number of layers as your temperature varies to avoid excessive sweating and chilling.
- Wear a hat.
- Wear gloves or mittens as much as possible. A thin pair of gloves under mittens allows hand protection when the outer layer is removed for tasks requiring dexterity.
- Carry hand warmers in mittens to prevent episodes. Be careful: direct contact of cold, pale skin of a Raynaud’s afflicted extremity with hot objects can result in burns.
- Get regular exercise
- Control stress.
- Avoid vibrating hand tools.
- Do not wear anything that constricts blood vessels in your hands or feet such as wristbands, rings, or too-tight footwear.
When To See A Doctor:
If you have severe or worsening Raynaud’s or develop an ulcer or infection of one of your affected extremities.
- If you appear to have an underlying disease such as arthritis or lupus.
- If you are on medications such as beta-blockers and birth control pills which can worsen Raynaud’s.
- If the measures in this article don’t give adequate relief.
Treatment:
Murray method: This was developed by Dr. Murray Hamlet while a researcher at the Army’s Research Institute of Environmental Medicine. It is a rather laborious procedure which involves retraining blood vessels to dilate instead of constrict when exposed to cold. It consists of immersing the hands or feet in warm water for 5 minutes while in a warm room and then moving to a cold area while lightly clothed and again placing the hands or feet in warm water for 5 more minutes. This is done 3-6 times a day every other day until 50 rounds are endured. Preliminary studies find this technique to be effective and long-lasting.
- Niacin, also known as vitamin B-3 causes blood vessels to dilate and can improve Raynaud’s symptoms.
- Severe symptoms may require prescription medication to dilate blood vessels. Most commonly used are calcium channel blockers, often used by people with high blood pressure. There is also evidence that a new class of drugs which includes Viagra is also effective at treating Raynaud’s.
- Surgical or chemical destruction of certain nerves that trigger blood vessel constriction.
- Consider referral to a therapist who can teach you biofeedback.
This article was originally printed in the Catamount Trail Newsletter and was authored by Dr. George Terwilliger, an ER physician who lives in Brattleboro and is a lifelong Vermont resident. He is an avid backcountry skier and has skied many sections of the Catamount Trail.
