Raynaud’s Big Chill

The disorder nips at fingers and toes—even in warm weather.

Illustration by Dàv BordeleauAllison B. Weer was in her final semester as a painting major at the University of Delaware when she fell and broke three fingers on her right hand. Once she got her cast off and completed her degree in 1991, she thought nothing more about it— until one cool day, nearly three years later, when she felt chilled to the bone and noticed her fingertips were white.

Her doctor told her she had Raynaud’s phenomenon, a lifelong condition associated with blood circulation and characterized by fingers and toes that turn “frostbite white.”

There are two types of Raynaud’s. Weer has the less common form, caused by an underlying problem. Regardless of the type, experts call it a hyperactive or exaggerated response to cold temperatures or emotional stress.

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Cold and stress normally narrow small blood vessels in the skin. This is nature’s way of redirecting blood flow away from the extremities and toward the internal organs. It conserves heat and—in situations that induce a fight-or-flight reaction—prevents excessive blood loss in case of injury.

But, rather than slowing the flow to extremities, the arteries in Raynaud’s sufferers undergo a vasospasm, temporarily disrupting blood flow. It’s most noticeable in the hands—and so pronounced that it looks as though the fingers were dipped in a whitening solution. It can also affect the nose, lips, knees and ears.

For Weer, the disorder is mostly an inconvenience, though the “frostbite look” still takes her by surprise. “I never know when it’s going to hit—suddenly, I feel cold, and I have white fingertips,” she says. “It’s freaky.”

In a typical episode, the tips of the fingers and toes turn bone-white, then a bruise-like blue, then fiery red. The last phase, considered part of normal recovery, is generally the only uncomfortable stage and one of the reasons people turn to medications to manage symptoms, which range from an itchy, pinpricked sensation to outright numbness.

You’re more likely to have primary Raynaud’s if you experience these kind of attacks before the age of 40, and have no other symptoms and normal blood work. You are also more likely to learn to monitor your triggers—an easy thing to do in summer, right?

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Actually, an episode of Raynaud’s is more likely to occur during the warmer months, judging from comments on support blogs. Summer opens up another set of triggers, like picking up a cold soda, reaching into the freezer, or sitting in an air-conditioned theater.

In certain occupations, Raynaud’s is taken in stride. Those who work with pneumatic drills, for instance, call it “vibration-induced white finger.” For concert pianists and violists, it can derail a career for good. Data-entry clerks often have to look for other forms of work.

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Raynaud’s may affect as many as 15 percent of people under the age of 40, according to the National Institutes of Health. In the general population, it drops to 3-5 percent. More women than men are affected, especially in the case of late-onset Raynaud’s. Again, researchers have singled out age 40 as the starting point, since it can be an early warning sign for autoimmune diseases common in women.

Indeed, it’s only been recently that scientists have made the connection between estrogen and a vascular reaction to cold temperature. One recent study followed thousands of nurses recruited by Harvard Medical School. It showed that the prevalence of Raynaud’s was higher in women who’d undergone estrogen-based hormonal replacement therapy.

Raynaud’s remains a condition most of us have never heard about. That’s partly because episodes typically last only a few minutes, and those with mild cases may not even be aware that they have it.

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But if a flare up lasts long enough, it can kill tissue, causing an ulcer or even gangrene. And the 5-10 percent who have secondary Raynaud’s must worry about more serious underlying causes and/or medical conditions.

A rheumatologist at Bryn Mawr Hospital, Dr. Kendra K. Zuckerman sees most Raynaud’s patients when they experience joint, bone and muscle issues. “Most people just live with it, never bring it to the attention of doctors, and never need any treatment for it,” says Zuckerman, who has a simple way of determining whether or not patients have Raynaud’s. “I’ll ask if they ever notice that their fingers turn color in the cold. If they say ‘yes,’ we’ll go into more depth about the color changes and what brings it on.”

Research into its causes has come a long way since French physician Maurice Raynaud first described the condition in 1862. At the time, the disorder was attributed to the sensitivity of the “fair sex.”

Today, studies have shown that the problem lies not in the stress-regulatory system but at the site where whitening syptoms occur. One important discovery happened only a few years ago in a Johns Hopkins University research lab, turning the focus away from how the brain works with skin receptors to the receptors themselves. Found in the smooth muscle of blood vessels, Alpha-2 receptors have proven to be sensitive to cold.

Researchers now suspect that the skin, with its tiny nerve fibers that sense temperature, is the key to unlocking the mystery of Raynaud’s, a minor nuisance that can sometimes turn deadly.

To learn more, visit raynauds.org.

See page 3 for Triggers of Raynaud’s and Questions to Ask Your Doctor …

Raynaud’s Triggers

• Fractures, surgery or untreated frostbite.
• Autoimmune disorders like scleroderma, lupus and rheumatoid arthritis.
• Diseases of the arteries.
• Repetitive trauma to the hands or fingers.

• Walking barefoot or not wearing gloves when working outdoors.
• Work situations that might lead to long-term nerve damage, such as carpal tunnel syndrome.
• High blood pressure medications that constrict blood vessels.
• Birth control pills that contain estrogen.
• Cold remedies that contain pseudoephedrine (Sudafed).
• Smoke (even secondhand smoke), which causes the construction of blood vessels in one’s extremities.
• Coffee, which is thought to mimic adrenaline in the bloodstream.
• Migraine medications containing ergotamine.
• Stressful situations, especially those that might evoke strong emotions like anger.

Raynaud’s: What to Ask Your Doctor

1. Except for cold hands and feet, I feel fine. Should I be concerned? It depends on whether or not you know what type of Raynaud’s you have. Most suffer from primary Raynaud’s, which is easily controlled by avoiding certain triggers. Older patients typically get the secondary version, which is often more severe (if unrelated to an injury or surgery).

2. How can I reduce the number and severity of my attacks? Experts say that none of the current drugs are as potent a treatment as simply staying warm. Attacks are also known to lessen over time as you age.

3. What are my treatment options?
They vary widely, from the more costly (BOTOX injections) to the unconventional (Viagra and Prozac). Most doctors prescribe drugs used to treat high blood pressure.

4. Do natural treatments and solutions made of herbs and plant steroids work?
Doctors never rule out exercise and eating healthy, but they still believe the best treatments work on a cellular level—specifically those that widen or dilate the blood vessels.

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