During this recent cold snap I got to sneak out to Ober Gatlinburg with some of my family – tame skiing for my wife and me, and a little more edgy snowboarding for the kids. The wind chill was pretty impressive and the toes and fingers were getting chilled. My youngest daughter peeled off her boots and socks to reveal some red, numbed toes. It reminded me of a conversation earlier in the week with a boy with Raynaud’s phenomenon.
Raynaud’s shows up in the cold or under stress. The fingers and/or toes, usually in a somewhat symmetrical pattern, show at least two of the colors of the flag. First they become almost white with cold or stress, then dusky blue, and finally flushed red. These color changes can be associated with pain or numbness. The border between the normal part of the hand and the area affected by Raynaud’s is usually a fairly sharp line. Less commonly, Raynaud’s can result in some tissue death and ulcers of the toes or fingers.
What’s going on with Raynaud’s phenomenon? The small arteries of the toes and fingers are going into spasm in response to cold or stress, cutting off circulation to the downstream areas.
Sometimes there is no other disease or problem connected with Raynaud’s; this is called Primary Raynaud’s, or Raynaud’s Disease. But in over half of the cases, some other particular disease or problem is present, or will show up, sometimes as long as 20 years later. Some of these connected problems include rheumatoid arthritis, scleroderma, leukemia, lymphoma, exposure to vibration (such as a jackhammer), hepatitis C, and a long list of other maladies. If you’re playing the odds, young women with Raynaud’s usually will have no connected problem, while older men who develop it usually have something else going on with it. The cause of Primary Raynaud’s is still unknown.
What if while out skiing, sledding, working in the cold or even with lesser cold or stress exposure, you notice these kinds of color changes in your hands or feet? If you can, take a photo with a digital phone or other device so that you can show it to your doctor, since it will probably not be visible when you come in for your appointment. Your doctor will ask questions about possible triggers and probably get some blood work to screen for some of the most common associated diseases.
Can it be treated? Keeping the hands and feet warm is a common sense mainstay of treatment. I’ve had a few patients even move farther south to avoid the problem. Short of that, using good gloves, not putting your hands around a cold drink, and avoiding other inciting activities can help. Nicotine is a definite bad guy if you have Raynaud’s, so this needs to be cut out. Certain other meds, such as beta blockers, can also make the symptoms worse. Your doctor may be able to substitute a more circulation friendly alternative. On the other hand, calcium channel blockers, such as nifedipine, can often reduce the symptoms of Raynaud’s phenomenon.
So if your hands and feet are cold, it’s obvious you need to warm them up. But if your fingers or toes are turning the colors of the flag with sharp lines between normal and abnormal coloring, it’s time to talk to your doctor about what else may be going on. In the meantime, bundle up, it’s freezing out there!
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835