Healthy Living

It’s been a cold winter, and despite some brief warm ups recently we can be assured that it is not over yet.

While there has been a high number of slips, falls and snowblower injuries, there has also been a much quieter result of the cold — Raynaud’s Phenomenon.

Approximately 3% to 5% of the population suffers from Raynaud’s 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 and emotional stress.

This restricts blood flow to the affected areas and causes the skin to change to a white color, then to blue when there are low levels of oxygen, and then back to pink.

Raynaud’s usually occurs on its own and is most common among women, younger age groups and people with family members who also have it. It is sometimes related to an autoimmune illness like lupus or scleroderma, and in these cases can cause a serious decrease in blood flow.

Most often, Raynaud’s affects the blood vessels in the fingers. In a typical attack the fingers become suddenly cold, color changes markedly and become blue or purple. Usually the attack begins in a single finger and then spreads to fingers of both hands.

Symptoms of Raynaud’s generally subside when the cause is removed. The discoloration resolves after 15-20 minutes.

Diagnosis is based on the patient’s description of the attack following cold exposure, and in some cases, particularly when Raynaud’s is related to another disease, consultation with a rheumatologist is needed.

To limit the chances of Raynaud’s, avoid sudden cold exposure and dress in layers. You can help end an attack by placing your hands in your armpit or rotating your arms in a whirling windmill pattern. Avoid smoking and medications such as decongestants, diet pills and some migraine drugs.

Sometimes treatment involves medication, including those that contain calcium channel blockers. Several other medications have been studied including topical nitroglycerine, trental and sildenafil.

In extreme circumstances, hospitalization and surgery may be required.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Varma or any of the Healthy Living columnists at healthyliving@wwbh.org

Last week in this column, as part of American Heart Month, we discussed what to do if you experience heart attack symptoms.

This week is an opportunity to talk about steps to take so you never end up in that situation.

And “steps” is a key word. One of the most important things you can do is exercise.

Exercising daily, even if you don’t start until midlife, can help improve survival rates into your 70s.

There is a strong and positive association between physical activity and living a longer, healthier life.

Moderate physical activity, including brisk walking, reduces risks of chronic disease, reduces the loss of cognitive function, physical function and improves mental health.

It is encouraging that studies show even starting moderate exercise in midlife can improve your life over the long-term.

As life expectancy continues to rise — in 1900 the average life expectancy was 47.3, in 2005 in was 80.4 for women and 75.2 for men — it is important to take steps to improve your health.

By 2030, 1 in 5 people will be 65 or older, and the healthier people are the better off they will be -- and the better off society will be as a whole.

Whether it is full-fledged gym or workouts in your home or outdoors, the key is to establish a consistent exercise routine.

They say an apple a day keeps the doctor away. Exercising daily might just help keep the cardiologist away.

John Foley, MD, is a cardiologist on The William W. Backus Hospital Medical Staff, a member of Cardiology Associates of Norwich and on the faculty at Yale University School of Medicine. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Foley or any of the Healthy Living columnists at healthyliving@wwbh.org

February is American Heart Month, a time to bring attention to just how prevalent heart disease is and provide education that could help reverse the grim statistics.

Every year more than 600,000 people die of heart disease – it is the leading cause of death for both men and women. In fact, a little known fact is that half of the deaths from heart disease are women.

Paying attention to your symptoms when you are having a heart attack and seeking immediate treatment can lead to improved survival and better outcomes.

A recent study examines why some people come into the hospital when they are having a heart attack and why others delay seeking treatment. Overall, among men and women, non-whites, those of lower socioeconomic status, and those who have had prior angina, diabetes or hypertension delay in seeking care.

According to the study, women often delay longer than men. They may not realize they are having a heart attack because of atypical symptoms, or they may not want to trouble anyone. Women present older and are more likely to have chronic heart failure, diabetes or other chronic medical issues, which can further complicate treatment.

Women may have nausea, back, neck and jaw pain rather than the traditional arm and chest pain or in addition to those symptoms. They also may experience shortness of breath or break out in a cold sweat.

Women are more worried about breast cancer, but statistics show they are more likely to have heart disease.

According to the American Heart Association, coronary heart disease is the single leading cause of death for American women. Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer.

John Foley, MD, is a cardiologist on The William W. Backus Hospital Medical Staff, a member of Cardiology Associates of Norwich and on the faculty at Yale University School of Medicine. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Foley or any of the Healthy Living columnists at healthyliving@wwbh.org

Over the past several weeks, the world has been witnessing a remarkable example of modern trauma care, neurosurgical treatment and rehabilitation.

On Jan. 8, Arizona congresswoman Gabrielle Giffords was the victim of an assassination attempt. The assailant shot her in the head at close range. This was followed by a succession of medical interventions that continue to unfold.

The gunshot entered the skull and went through the left side of the brain before exiting. The trajectory of the bullet avoided many of the major blood vessels that are more vulnerable when the projectile moves from side-to-side.

Rapid emergency response to the scene allowed for control of blood loss and maintenance of respiratory function. Amazingly, Ms. Giffords was reported to have been in the operating room only 38 minutes after being shot. This short transition time from site of injury to OR is because she was brought to a trauma center where protocols have been designed and rehearsed that allow for rapid care and make the necessary neurosurgical resources immediately available.

Many of the protocols used today have been developed in response to battlefield injuries from various explosive devices.

The two biggest challenges in a penetrating head injury are bleeding and swelling. In response to any trauma, tissue swells. An example would be a sprained ankle. The accumulation of fluid at the site of injury causes the surrounding skin to expand. When swelling occurs in an enclosed space like the skull, pressure builds and forces the brain downward toward an opening in the base. This “herniation” often results in death.

In addition to the use of diuretics, the most immediate way to relieve a potentially life-threatening increase in intracranial pressure is by removing the skull over the area of injury. This allows the brain to expand freely. After the swelling is controlled, the skull can be replaced at a later time.

Despite the remarkable emergent treatment received by Ms. Giffords, the rapid introduction of rehabilitation in the first week after injury and transfer to a rehabilitation facility within three weeks of injury is astonishing.

Recent studies have shown that the early establishment of physical, occupational and speech therapy programs for neurologic injuries is imperative for successful recovery. The brain possesses an incredible ability to redirect nerve fibers and networks. This process, known as neuroplasticity, can help resume function previously performed by nerve cells that were destroyed.

The early institution of rehabilitation is an important first step down a long road to recovery after brain injury. The world will be closely watching as Congresswoman Giffords makes this journey.

To learn more about this topic visit www.backushospital.org/multimedia. Anthony G. Alessi, MD, is Medical Director of The William W. Backus Hospital Stroke Center and in private practice at NeuroDiagnostics, LLC, in Norwich. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Alessi at aalessi@wwbh.org