FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

THE COLD FACTS ABOUT RAYNAUD'S SYNDROME

Question: My hands and feet are constantly cold, even when the rest of me is warm. Occasionally my hands and feet take on a bluish appearance and they often hurt. I was diagnosed with Raynaud's syndrome, but I haven't been able to find out much about my condition. Even my doctor doesn't seem to know much about it. Other than always wearing gloves and heating my shoes and socks with the hair dryer, is there anything I can do?

Answer: Raynaud's syndrome, which is also called Raynaud's disease, is a problem caused by inadequate circulation. It most commonly involves the hands and feet, just as you are experiencing. In this illness the small arteries that nourish these parts don't supply adequate amounts of blood, particularly when you are in a cold environment.

Raynaud's syndrome may be an exaggeration of a normal body reaction to cold temperatures. For a normal individual, cold exposure produces a reduced blood flow into the cold extremities -- the hands and feet -- that thereby shifts blood toward the heart and lungs to conserve heat and allow us to live in colder environments. In Raynaud's disease this normal reduction in blood flow to the hands and feet is carried out to an extreme degree. The hands, feet or both can become quite cold when the weather is only cool. On cold days the circulation in these areas may be so severely reduced that they become very pale or blue and then become painful later when you go to a warmer environment that allows your extremities to warm up.

Raynaud's is sometimes a consequence of illness that produces a narrowing of the small arteries nourishing the hand and feet. Scleroderma, systemic lupus erythematosus and rheumatoid arthritis are three common examples of these diseases. Raynaud's can also occur from chronic exposure to cold, direct injury to an artery, or from the frequent use of equipment that vibrates or jars the hands. It may even occur as a consequence of nicotine use.

Raynaud's syndrome is often more of a nuisance than it is a serious disability, as I hope it is for you. Most individuals suffering with the illness are comfortable if they just keep their hands and feet warm. This is true even though the condition does tend to get progressively worse as the years pass.

The most effective treatment is the avoidance of cold weather. That is easier for those who live in Florida, but not so easy for you and me who are here in Ohio. Consequently, this means you should be the first person in your neighborhood to get out warm boots and mittens. And I stress "mittens" because when wearing them, each finger warms its neighbor. Therefore, they are much warmer than gloves. It is also important to avoid the use of tobacco and cough, cold, and sinus remedies that contain decongestants since these can worsen the circulation problems of this illness.

Medicines in the "beta blocker" family are used for many heart conditions and for high blood pressure. These drugs make Raynaud's much worse, and therefore, should be avoided. Medicines in the "calcium channel blocker" family, particularly nifedipine, can provide some relief of the symptoms. Other products can help circulation or can cause problems, too. Therefore, you really need to talk to your doctor or pharmacist about each one you take.

I recommend that you talk with your doctor again about your Raynaud's syndrome. He or she may want you to see a specialist who deals with vascular problems to help clarify the specific cause of your Raynaud's symptoms. He or she will also check to insure that any medicines you need won't make your condition worse. And, if your symptoms are sufficiently severe, you may need to take a medicine, perhaps nifedipine, to help your condition.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.