Friday, January 04, 2008
Cold weather can cause more than just frost bite for some
We are moving into the coldest time of the year in New England. Although snow lovers might welcome the usual arctic blast, it can cause problems for those suffering from Raynaud phenomenon, which is a condition in which some of the body's blood vessels (commonly in the fingers and toes) constrict in an exaggerated way in response to cold or emotional stress.
Normally, blood vessels supplying the skin constrict or narrow in response to cold temperatures, decreasing blood flow to the skin, which helps to minimize heat loss. In people with Raynaud, the vessels constrict in an exaggerated way in response to cold and stress, causing the skin to change to a white color. The skin may then become purplish-blue, caused by low oxygen levels in the blood. When the vessel recovers, it dilates, allowing blood flow to resume; the skin may become red. Approximately 3-5 percent of people are affected by this condition.
According to uptodate.org and raynauds.org:
There are two kinds of Raynaud – primary and secondary. Patients with primary Raynaud – most common in women, younger age groups and people with family history of the disease -- don’t have a related disease causing it. The underlying relation to cold is uncertain. Fortunately, most patients with primary RP are not significantly disabled by the condition and respond well to treatment. Some patients with secondary Raynaud have an illness, such as scleroderma or SLE, that injures or alters the blood vessels and impacts how they react to cold and stress. Secondary RP can be more difficult to manage because the underlying condition can physically damage the blood vessel.
A Raynaud attack can be triggered by exposure to cold temperature or even by a shift in temperature from warm to cool. As a result, even mildly cold exposures, like air-conditioning or by the cold of the refrigerated food section in a grocery store, can cause a RP attack. Emotional stress and being startled can cause an attack as well.
Most often, an attack affects the blood vessels in the fingers. The fingers or toes become suddenly cold as the blood vessels constrict. The skin color changes markedly, and may become pale (called a "white attack") or a purple or blue color (called a "blue attack"). Usually, the symptoms begin in a single finger and then spread to other fingers in both hands. The index, middle, and ring fingers are most commonly involved, while the thumb is often not affected. Symptoms subside as the provoking factor (cold or stress) is removed. After leaving the cold area and warming up, the discoloration resolves after 15 to 20 minutes and, as normal blood flow resumes, the skin "blushes" or becomes pink. Patients with severe secondary Raynaud can sometimes experience a serious decrease in blood flow that does not resolve even after the provoking factor is removed. Pain and ulceration of the skin (tips of the fingers and toes) can result.
Raynaud is diagnosed based on the patient's description of typical symptoms following cold exposure. Through the history, a healthcare provider can usually distinguish Raynaud from more common complaints of cold hands or feet. Often, the clinician will witness the symptoms during the physical examination. Laboratory tests may be performed to determine whether any conditions that contribute to Raynaud are present. In addition, the small blood vessels (capillaries) around the nail beds may be examined.
Raynaud patients usually benefit from:
Avoid sudden cold exposure by dressing warmly, wearing layered clothing, and using mittens or gloves.
To end an attack —placing the hands under warm water or area, or rotating the arms in a whirling windmill pattern.
Avoid smoking — the nicotine and other chemicals in cigarettes cause the blood vessels to constrict.
Avoid medications - include decongestants, diet pills, some migraine remedies (ergotamine), and herbs containing ephedra.
Reduce stress and use relaxation techniques to reduce anxiety.
While the tips mentioned above are generally enough for patients with primary Raynaud (medication might be needed for cold exposure), patients with secondary Raynaud may require more aggressive treatment. Medications are usually needed to reduce the frequency of attacks and prevent ulceration of the skin of fingers and toes.
Hospitalization can result if blood flow to a finger or toe is seriously restricted. Treatment then requires additional medications to dilate the blood vessels and to prevent blood clots. Medication or surgery may be used to block the nerves that trigger vasoconstriction in the affected area.
To avoid hospitalization or the worst case scenario, amputation, it is important that if you experience these symptoms you are examined by a healthcare provider. If this is something that you have been putting off or avoiding, put it at the top of your list for the New Year.
Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org
Normally, blood vessels supplying the skin constrict or narrow in response to cold temperatures, decreasing blood flow to the skin, which helps to minimize heat loss. In people with Raynaud, the vessels constrict in an exaggerated way in response to cold and stress, causing the skin to change to a white color. The skin may then become purplish-blue, caused by low oxygen levels in the blood. When the vessel recovers, it dilates, allowing blood flow to resume; the skin may become red. Approximately 3-5 percent of people are affected by this condition.
According to uptodate.org and raynauds.org:
There are two kinds of Raynaud – primary and secondary. Patients with primary Raynaud – most common in women, younger age groups and people with family history of the disease -- don’t have a related disease causing it. The underlying relation to cold is uncertain. Fortunately, most patients with primary RP are not significantly disabled by the condition and respond well to treatment. Some patients with secondary Raynaud have an illness, such as scleroderma or SLE, that injures or alters the blood vessels and impacts how they react to cold and stress. Secondary RP can be more difficult to manage because the underlying condition can physically damage the blood vessel.
A Raynaud attack can be triggered by exposure to cold temperature or even by a shift in temperature from warm to cool. As a result, even mildly cold exposures, like air-conditioning or by the cold of the refrigerated food section in a grocery store, can cause a RP attack. Emotional stress and being startled can cause an attack as well.
Most often, an attack affects the blood vessels in the fingers. The fingers or toes become suddenly cold as the blood vessels constrict. The skin color changes markedly, and may become pale (called a "white attack") or a purple or blue color (called a "blue attack"). Usually, the symptoms begin in a single finger and then spread to other fingers in both hands. The index, middle, and ring fingers are most commonly involved, while the thumb is often not affected. Symptoms subside as the provoking factor (cold or stress) is removed. After leaving the cold area and warming up, the discoloration resolves after 15 to 20 minutes and, as normal blood flow resumes, the skin "blushes" or becomes pink. Patients with severe secondary Raynaud can sometimes experience a serious decrease in blood flow that does not resolve even after the provoking factor is removed. Pain and ulceration of the skin (tips of the fingers and toes) can result.
Raynaud is diagnosed based on the patient's description of typical symptoms following cold exposure. Through the history, a healthcare provider can usually distinguish Raynaud from more common complaints of cold hands or feet. Often, the clinician will witness the symptoms during the physical examination. Laboratory tests may be performed to determine whether any conditions that contribute to Raynaud are present. In addition, the small blood vessels (capillaries) around the nail beds may be examined.
Raynaud patients usually benefit from:
Avoid sudden cold exposure by dressing warmly, wearing layered clothing, and using mittens or gloves.
To end an attack —placing the hands under warm water or area, or rotating the arms in a whirling windmill pattern.
Avoid smoking — the nicotine and other chemicals in cigarettes cause the blood vessels to constrict.
Avoid medications - include decongestants, diet pills, some migraine remedies (ergotamine), and herbs containing ephedra.
Reduce stress and use relaxation techniques to reduce anxiety.
While the tips mentioned above are generally enough for patients with primary Raynaud (medication might be needed for cold exposure), patients with secondary Raynaud may require more aggressive treatment. Medications are usually needed to reduce the frequency of attacks and prevent ulceration of the skin of fingers and toes.
Hospitalization can result if blood flow to a finger or toe is seriously restricted. Treatment then requires additional medications to dilate the blood vessels and to prevent blood clots. Medication or surgery may be used to block the nerves that trigger vasoconstriction in the affected area.
To avoid hospitalization or the worst case scenario, amputation, it is important that if you experience these symptoms you are examined by a healthcare provider. If this is something that you have been putting off or avoiding, put it at the top of your list for the New Year.
Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org
# posted by ----------------- @ 11:43 AM 
