FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

MONTANA AND RAYNAUD'S SYNDROME NOT A GOOD COMBINATION

Question: I am a 12 year-old girl living in Montana and I have Raynaud’s syndrome. I wear gloves or mittens, but still my hands turn blue or purple and get cold. If I wear gloves and go outside for a brief period of time my hands are fine. But when I wear gloves and go outside for 10 or more minutes, my hands never warm up for about 30 minutes or more depending on how long I stay outside. I can’t escape coldness living in Montana. Also every weekday I have two 15-minute recesses and two 30- minute recesses. Then, that’s when my hands really turn blue and purple and cold. I have gone to my doctor about it and he had hardly any info on this. What do you suggest?

Answer: You are very informed about Raynaud’s Syndrome for a young lady of 12. Let me see if I can add to your understanding of this problem.

Raynaud’s syndrome, also called Raynaud’s phenomenon, affects about 5 percent of the U.S. population and usually is seen in women. It starts between puberty and age 30 and tends to run in families. Normally when we are exposed to cold temperatures, the blood vessels in the arms and legs constrict to decrease blood flow to the skin and decrease loss of body heat. In Raynaud’s, there is an exaggerated response to cold temperatures. The blood vessels “over constrict,” and decrease the blood flow to the fingers, toes and ears more than needed. This pronounced decrease of blood to the extremities causes the fingers, toes and ears to become painful, cold and white, blue or purple. This can lead to gangrene in severe cases.
Raynaud’s syndrome can be a primary disease or can be due to another problem. Frequently Raynaud’s is associated with connective tissue diseases like Scleroderma or systemic lupus erythematosus.

Raynaud’s can also be seen in occlusive vascular diseases, or it can be due to certain medications -- like pseodoephedrine -- or some rare blood disorders.

Many common substances make Raynaud’s worse in people affected with the problem. Tobacco should be avoided at all costs. Caffeine, medications like pseodoephedrine that constrict blood vessels, some hormones, and some beta blockers can make Raynaud’s symptoms worse.

The diagnosis is usually made on a basis of the symptomatic presentation. It is important that underlying causes are eliminated. While there is no single medical treatment for Raynaud’s, some people are helped by using medications such as calcium channel blockers or nitroglycerin.

But here is what you can do for yourself. Wear mittens instead of gloves. There are battery warmed mittens, and socks available at some sporting goods stores. Avoid cold places, which is not easy in Montana in the winter.

Some people have had luck with retraining their blood vessels to not overreact to the cold. While in a warm room, place your hands in a bowl of warm water for 5 minutes. Then move to a cold room and place your hands in warm water for ten minutes. Repeat this three or four times a day until your blood vessels “learn to open up” in the cold. This could also be done on your feet. Try to avoid prolonged exposure to the cold, dress properly and promptly re-warm your extremities.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.