DR. HOOK- Freeze out: Raynaud's syndrome a chilling reality

Pretty Woman's Julia Roberts said something like, "You can freeze water on her butt." I've encountered a handful of cold-hearted people to whom this expression applies. One secretary I know is so devoid of expression or joy that it looks like she moisturizes her face with Botox. 

But some people are literally cold. I hate it when someone with freezing hands says, "Hey, feel how cold my hands are," while touching my bare neck. Brrr!

 "Stay cool" is something a person with Raynaud's Phenomenon (RP) normally does not want to do. Someone who has RP becomes Mr. Freeze like on Batman... well, that's an exaggeration. But with RP, there's an exaggerated response to cold (or emotional stress) so that the arteries clamp down, cutting off blood supply to the fingers. It can also occur on the toes, and less commonly on the face, nose, ears, knees, and even the nipples, like that expression, "Cold as a witch's..."

In RP, the skin changes to the colors of the American flag. White occurs first because of the lack of blood flow. Blue follows due to lack of oxygen. Red– within about 15 to 20 minutes, the fingers fill up with blood again. An RP attack can range from uncomfortable to "pins and needles" to downright painful. Skin ulcers can develop from the lack of blood flow, and a person can even lose some tissue (such as a finger) over time. 

Emotional stress and nervousness can precipitate an RP attack, but one usually occurs suddenly as one goes from a warm to a cold environment. 

Say you want some ice cream. I scream, you scream, we all scream for ice cream. But touching the cold container can make you scream with pain due to RP. Three to five percent of the population has RP. For most RP there is no underlying cause; symptoms start between the ages of 15 and 30. 

However, if RP is due to an underlying cause, it's called Raynaud Syndrome (RS). The simplest cause of RS is a trauma such as using crutches incorrectly or working with vibration, such as a jack hammer. Rheumatological causes are no fun because they tend to be serious, such as lupus, scleroderma, and rheumatoid arthritis.

People with migraines and vascular problems like clogged arteries can have Raynaud's. Stimulants such as caffeine and cocaine can also clamp the arteries down.

What's a person with RP to do? A rheumatologist should evaluate a sufferer to see if RP or RS is the diagnosis. An examination of the fingernails as well as some blood tests can provide good information. 

Remember the blood pressure cuffs that go around the upper arm during an exam? Well, cute little finger BP cuffs exist as well, and they can be used to diagnose RP. (I love little things, like little bottles of ketchup, little shoes, Little John.)

Treatment consists of staying warm. Michael Jackson always wears gloves, and so should a person with RP if there might be exposure to cold things or a cold environment. There are those hand warmers which are pretty cool... er, warm. The Molly Shannon trick on Saturday Night Live of putting cold fingers in the armpits can help warm things up. Biofeedback might be of some benefit. For  RS, treating the underlying problem is in store.

Choosing between being Mr. Heat Miser vs. Mr. Snow Miser à la The Year Without a Santa Claus would be tough for me. I'm always cold in the winter and hot in the summer. Probably I would be Mr. Heat Miser because I could bring some sunshine to those who are cold and prickly.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.



Dear Dr. Hook,

I have a client who suffered bilateral crush injuries to the middle three fingers of his left hand and the 4th and 5th fingers of his right hand and developed cold intolerance. He had testing which shows Raynaud's syndrome even in fingers which were not crushed. He had no cold intolerance before the injuries. Does it make sense that the crush injuries caused cold intolerance/Raynaud's even in fingers that were not themselves crushed? Thank you.

dear dr. hook,
I have a question,my hands are very painful,they ,same time are red same time are dark I have problem to close them end hold even a broom. my doctor say thet I have the(RAYNAUD'S SYNDROME).I will like to have your opinion or suggestion what to do if there is a cure or how to alliviet the pain.
theng you.