Sunday, 14 July 2013

Icy Fingers and Toes: A Guide to Raynaud's

My feet and hands are pure white and ice cold, like blocks of ice. I could probably create Arctic ice shelves with my extremities (hey, at least that would counteract the effects of global warming!). I have a strange cold burning sensation in my hands and feet, ears and nose. The colder my extremities get, the more painful they become, which aggravates the joint pain. Usually, I will wear several pairs of socks, no matter what the weather is like. What is this odd thing?  






It is called Raynaud's Syndrome.

Raynaud's  is defined as '...a condition in which cold temperatures or strong emotions cause blood vessel spasms that block blood flow to the fingers, toes, ears, and nose.'1 

During Raynaud's episodes, the blood vessels of the affected area(s) constrict, which decreases the circulation of your blood and therefore, the supply of blood to the affected area. The extremities are most affected, because the body is constantly concentrating on keeping our internal organs warm; so hands, feet, nose, ears etc, take a back seat.  The reduced blood supply causes discolouration of the skin of the affected area and that horrible cold iciness of our hands and feet (depending on what part of the body is affected). 


Primary Raynaud's is a condition that occurs on its own i.e. it is a primary condition, not caused by secondary to any other cause, which often 'begins in people younger than age 30'.2

Secondary Raynaud's can occur in connective tissue disorders such as lupus, scleroderma, Sjogren's, hypothyroidism, the occupational disorder vibration white finger, arthritis and other various illnesses. 

Symptoms


During an episode of Raynaud's, it usually starts with my fingers or toes changing colour, from pale white with an icy or numb sensation, then blue; purple; and red, with a burning sensation. When it affects my ears and nose, it feels like my head has been dunked in a cauldron of boiling hot oil. The icy and burny sensations can be very painful at times, and it makes handling things like ice and hot cups torturous. These episodes occur randomly, without warning and may last anything from a few minutes to a few hours. 

How is Raynaud's treated? 


The most essential course of action is to treat whatever is causing the Raynaud's (if it's a secondary condition). There are various medications that a doctor can prescribe to help with Rayanaud's.

Medications (which act on the blood vessels by relaxing them) include: 

Calcium channel blockers, which are medicines that widen the blood vessels to improve circulation of the blood. A commonly prescribed calcium channel blocker is nifedipine

Angiotensin converting enzyme inhibitors (ACEs), which are medications which also widen the blood vessels for improved circulation. Examples include captopril, lisinopril, enalapril and quinapril. 

Angiotensin II receptor antagonists are drugs that block a chemical made in your blood called angiotensin II. This chemical narrows the blood vessels, so drugs like valsartan and iberartan, stop this chemical from doing so, thus allowing for improved circulation.   

Selective serotonin reuptake inhibitors (SSRIs) are anti-depressant medicines that also widens the blood vessels and examples include sertraline (Zoloft/Lustral) and fluoxetine (Prozac). 

In extreme cases, intravenous infusions of prostacyclin are prescribed. This drug also widens the blood vessels.    

Lifestyle changes can also help alleviate the symptoms of Raynaud's. Here are some changes you can make: 
  • Cut down on caffeine (which is easier said than done for me!) 
  • Reduce your stress levels, as can aggravate Raynaud's (this too is easier said than done, as life with a chronic illness is stressful)! 
  • Quit smoking. Cigarettes cause blood vessels to constrict, which reduces the circulation in your extremities and aggravates the Raynaud's. I quit smoking three years ago and I haven't looked back. It was difficult, so please ensure you get all the help you need. Ask your healthcare provider for advice. 
  • Ensure that you keep warm and especially wrap up warm if you're going out in cold weather. The Mayo Clinic in the US advice is to  "Wear a hat, scarf, socks and boots, and mittens or gloves under mittens when you go outside. Put them on before you go outside. A hat is important because you lose a great deal of body heat through your head. Wear a coat with fairly snug cuffs to go around your mittens or gloves, to prevent cold air from reaching your hands. Wear earmuffs and a face mask if the tip of your nose and your earlobes are sensitive to cold. Run your car heater for a few minutes before driving in cold weather.
  • If you are able to exercise, regular exercise can help improve your blood circulation. Please consult your healthcare provider before embarking on any sort of exercise.  
  • Wear woolly, or thermal, or chunky socks. One of the best things I have ever bought in my life so far are microwaveable slippers. You can find these on websites like eBay or Amazon. You can also find other useful objects, such as hand warmers, thermal gloves, wrist warmers, ear warmers (knitted is best) and thermal underwear. 
  • The Mayo Clinic in the US recommend: "Wear socks. When taking food out of the refrigerator or freezer, wear gloves, mittens or oven mitts. Some people find it helpful to wear mittens and socks to bed during winter. Because air conditioning can trigger attacks, setting your air conditioner to a warmer temperature may help prevent attacks. You may also find it helpful to use insulated drinking glasses."
  • Taking Evening Primrose oil is said to help increase prostacyclin (a chemical made in the body that widens blood vessels). Before taking this supplement, speak to your doctor first as it may not be the right thing for you. 


Do you have Raynaud's? 


Below is a link to a Raynaud's screening quiz: 


Please remember to discuss any worrying symptoms with your doctor; if you suspect that you may have Raynaud's, mention this to your doctor so they can investigate and treat the condition. 


For further information and advice, the following links are helpful: 


Raynaud's information 

General Raynaud's information

UK-Based information leaftlet on Raynaud's


Raynaud's information: PDF

A wiki article:  Secondary Raynauds

Information on Raynaud's can be found here 

New York Times article on Raynaud's can be found here 

Raynaud's support in the States: www.raynauds.org 

Raynaud's support in the UK: www.raynauds.org.uk


I hope you have found this article useful. Thank you for reading! :) 

Sources: 

1. http://www.nlm.nih.gov/medlineplus/ency/article/000412.htm
2. See above.
3. http://www.bupa.co.uk/individuals/health-information/directory/r/raynauds-phenomenon#textBlock252178
4. http://altmedicine.about.com/od/healthconditionsdisease/a/raynauds_disease.htm

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