Beyond cold feet: painfully cold fingers and toes may signal Raynaud's disease

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Painful cold hands and fingers are the sign of a problem. It's best to seek medical advice if cold hands interfere with your daily life activities.

Vegetarian Times , by Joanne McAllister Smart

I first heard of Raynaud's disease while rock climbing on a cool spring day. The heat of the sun had yet to caress the cliff, and I could scarcely feel my fingers as I made my way up a 60-foot crack. It's not easy climbing when your fingers are numb - they feel big and clumsy, but I was on a top rope, meaning that even if I slipped, the rope above me would keep me from faring. After finishing the route and being lowered off the cliff, I complained about my cold fingers. As I worked to warm them, my climbing partner suggested I might have Raynaud's disease. She described it as a fairly common condition that causes hypersensitivity to cold.


Though I hated to disappoint my friend - she's one of those people who likes to find an underlying disorder for every minor health complaint - I assured her that it was just that die rock was really cold. In no time my fingers felt normal, and I was ready to climb again - though I was glad the rock had warmed up.

That my friend thought I might have Raynaud's was actually not too far-fetched. According to the Mayo clinic, one in 20 Americans has the disease, named for the French physician who described it more than a century ago, with women four times to five times as likely to develop it. Leonard Bielory, M.D., director of the Allergy and Immunology division at the University of Medicine and Dentistry of New Jersey estimates that S percent of the population has it. Other estimates run from 2 percent to as high as 10 percent.

Change in circulation in the hands or feet is a normal physiological response, a reflex mechanism that causes the blood vessels to narrow when exposed to the cold. Almost everyone can recall a time when their fingers, nose or toes were painfully cold, but for people with Raynaud's, even minimal exposure can cause the small arteries that supply the fingers and the toes to contract suddenly, cutting off blood flow. During an attack, which can last for minutes or hours, the affected fingers and toes tingle, bum or go numb. (In rare cases, sustained restriction of the arteries causes ulceration.) Aside from unusually cold extremities, Raynaud's is defined by color: Fingers and toes turn white due to a lack of blood, then blue as the blood sluggishly returns. As they warm and normal blood flow is re-established, they turn red.

When such symptoms are the result of a known underlying disorder, such as atherosclerosis, rheumatoid arthritis or lupus, or are caused by long-term use of vibrating tools like jackhammers and chain saws, the disease is known as secondary Raynaud's phenomenon. Primary Raynaud's phenomenon - what my climbing buddy thought I had - has no known cause. "It's not a disease," says Frederick Wigley, M.D., associate professor of medicine at Johns Hopkins University and co-director of the Raynaud's center there. "People with primary Raynaud's phenomenon are perfectly fine."

Though Wigley is technically right, people who suffer from severe cases of Raynaud's view it as more than a nuisance. "I get frustrated," says Barbara Lax, a fund-raiser who works in New York City. "I'm fearful of going outside because I know it will cause me pain." Lax, 42, says her Raynaud's began while she was in her mid-20s. At times during the winter, her feet would become so painful she could barely put on shoes. When she goes outside in the winter, Lax bundles up from head to her often painful toes.

Bunding up when it's cold is perhaps the most obvious advice for preventing an attack. But though winter may be almost a distant memory, for people who suffer from Raynaud's disease, the discomfort of numb fingers may be only as far away as an aggressively air-conditioned office. Bielory has pointed out that although Raynaud's is more prevalent in winter, "it can occur any time in a variety of cold environments, such as the frozen foods section of a supermarket." And according to Wigley, it's not necessarily constant cold temperatures that cause attacks; it's often die shifting of temperatures. "A lot of my patients have the worst time at the changing of the seasons," he says.

Stress also can bring on an attack because it creates the same reaction in the body as does the cold (think of the term "cold feet"). Under stress, blood is pulled from the hands and feet to the brain and internal organs to help one think and act more quickly.

If you have primary Raynaud's - and it's important to undergo a medical exam to make sure your symptoms are not a sign a more serious disorder - there is a lot you can do to help prevent attacks. Keep warm and dry in cold weather. Before going out in the cold, have a warm meal or drink to raise your core body temperature. (Avoid caffeine, however, as it constricts blood vessels.) Run your car in cold weather to warm it up. In all seasons, keep mittens near the freezer to use when handling frozen foods, and use insulated glasses for cold drinks. Drink plenty of fluids - dehydration can aggravate the condition by reducing blood volume - but pass on the booze. Alcohol increases blood flow to the skin, making you feel warm at first, but then cold as the heat is soon lost to air. Avoid smoking as it further restricts blood flow.

Once an attack has started, your first move should be to get warm. You can also try swinging your arms around to increase blood flow to your fingers. Rosemary Gladstar, herbalist and author of Herbal Healing for Women (Simon and Schuster, 1993), suggests a tincture (herbs soaked in alcohol) of ginkgo and ginger to help increase circulation quickly. (You can make your own tincture - combine one ounce of powdered herb with one, 80 - or 100-proof alcohol in a glass jar, cap tightly and store in a dark place for two weeks; shake well, strain out the herbs, and place a few drops under your tongue with an eyedropper - or buy a commercially prepared one at a natural food store.) She also suggests rubbing St. John's wort oil mixed with a warming oil like ginger or sage on affected fingers and toes. St. john's wort, according to Gladstar, helps soothe damaged nerve endings.

Proven long-lasting treatment is less readily available. According to The Doctor's Book of Home Remedies (Rodale Press, 1990), you can condition yourself to overcome chills and train your hands to heat up in the cold, with an adaptation of a technique developed by U.S. Army researchers in Alaska. In a room that's a comfortable temperature, submerge your hands in a container of warm water for three to five minutes. Then go into a freezing room (outside in wintertime unless you have access to a walk-in freezer) and again dip your hands in warm water for 10 minutes. The cold environment would normally make your blood vessels constrict, but the warm water makes them open. Repeatedly training vessels to open despite the cold around them may enable you to counter the restriction reflex even without the warm water.

For patients with severe cases of Raynaud's, drugs such as short-acting Nifedipine may be prescribed to help reduce the intensity of the attacks by relaxing the walls of the blood vessels. But these drugs, used to treat high blood pressure, can have side effects including headache, dizziness, rapid heartbeat and water weight gain.

Dr. Wigley suggests that to treat Raynaud's, it's important for the patient to understand what triggers an attack. Whether the condition is stress-related or related to the cold (in most cases, it's a combination of both), the treatment that looks the most promising is biofeedback, which teaches a person how to control a physiological function.

The principle behind biofeedback is that every physiological change is accompanied by the appropriate change in mental or emotional states (conscious or unconscious); the theory also involves the notion that any function that can be monitored with results made available continually to subjects can be voluntarily controlled by subjects. According to Wellness Medicine (American Health Press, 1987) "voluntary warming of the extremities using feedback with a thermal machine has been very successful. Following training, elevated temperature can often be maintained despite cold temperatures."

In biofeedback, subjects are attached to a recording device that electronically monitors a physiological function and presents a visual or auditory signal to the subject. On observing this information, the subject is able to vary the internal neurological elements controlling the monitored function by assuming a relaxed, quiet internal mental state. Though the electronic monitoring is done by trained staff, patients usually do relaxation exercises on their own between sessions.


Barbara Lax had some success with biofeedback when she tried it through the International Center for the Disabled in New York City about 10 years ago. "They [staff members at the center] taught me how to find imagery that would represent peacefulness, warmth, calm." Lax imagined a hot bubble bath. "That was my image; I got to the point where I could feel myself slide into the tub." Lax believes her biofeedback experience helped reduce the severity of her attacks but says that over time the effects of her sessions wore off. "It's something you need to practice all the time," she says. Though Lax is currently taking the drug Cardisem, a calcium channel blocker used to treat angina, to help combat her Raynaud's, she is thinking about trying biofeedback again.


Biofeedback studies concerning Raynaud's - though promising - have not been conclusive, says Wigley. Currently both he and Bielory are involved in separate ongoing clinical trials funded by the National Heart, Lung and Blood Institute of the National Institutes of Health testing biofeedback treatment for Raynaud's sufferers. The trial is also looking at the effectiveness of long-acting Nifedipine in separate tests. Though neither Wigley nor Bielory could comment much on their double-blind studies, Wigley says the trials are to compare the results of biofeedback to the results of taking the drug.

Other non-traditional ways to help alleviate Raynaud's attacks may also emerge. Chiropractors (health practitioners who use hands-on manipulation to bring the patient's spinal cord into alignment, thus helping alleviate other symptoms the patient may have) and osteopaths (medical doctors who focus on the impact of the musculoskeletal structure on all of the body's systems) claim success in treating the condition by working on the neck and upper spine to improve nerve and circulation supply. Lax's osteopath, George Kessler, D.O., has used manipulation to help his patients with Raynaud's. One patient, whose Raynaud's seemed exacerbated by a back injury, saw great improvement after undergoing cranialsacral balancing, a manipulation technique involving the spine that normalizes the flow of the cerebrospinal fluid. "Even I was amazed" at the patient's improvement, says Kessler, who practices in New York City. Kessler says that more traditional manipulation of the neck, as well as body massage, "relaxes symptoms, but never really resolves the disease.

Iron-rich foods also may help relax symptoms, according to the U.S. Department of Agriculture's Human Nutrition Research Center in Grand Forks, N.D. Researchers measured the effects of dietary iron on six healthy women when they entered a cold chamber. When the women took only one-third of the recommended amount of iron for 80 days, they lost 29 percent more body heat than when they were on an iron-rich diet. You can find iron in leafy greens like spinach, lentils and other dried beans; orange juice and other foods high in vitamin C help the body absorb iron.

To boost the circulatory and nervous systems, herbalist Gladstar recommends regularly drinking tea made from hawthorn berries. For overall relaxation, she recommends soothing herbs like chamomile and valerian. Aside from all these suggestions, Wigley maintains that the real trick to living with Raynaud's is "recognizing what the challenges are."

Barbara Lax understands that advice. "I learned how to know my body," she says. She's even taken up ice-skating. "But," she adds, "I skate indoors."