Rx For Readers: Cold hands, warm heart

Chronically cold extremities may go hand-in-glove with serious health concerns

By JUDY SIEGEL-ITZKOVICH
Person holding a snowball (illustrative) (photo credit: INGIMAGE)
Person holding a snowball (illustrative)
(photo credit: INGIMAGE)
I am a 42-year-old woman who immigrated three years ago from a warm state in the US. I find that in the winter, my hands are cold and I always have to wear gloves outdoors, even when other people seem not to have to. I never smoked. My doctor said I might have Raynaud’s disease. That got me nervous.
What is Raynaud’s? Is it serious? How is it diagnosed? What can be done about it?
Y.N., Jerusalem
Dr. Karen Djemal, a veteran family physician and director of the Terem Family Clinic in Jerusalem, replies:
Cold hands and feet occur are a normal response to exposure to cold temperatures.
Blood vessels constrict in response to the cold and this decreases blood flow to the skin. This is a healthy physiological response that minimizes heat loss and preserves a normal core temperature even in a cold environment.
Conversely, in warm temperatures, these same blood vessels dilate, allowing heat to leave the body. These specialized blood vessels are controlled by the sympathetic nervous system, the same nervous system that reacts when we are nervous or upset emotionally.
This explains why both cold and emotional stress can trigger vasoconstriction of these blood vessels, causing cold fingers and toes.
Raynaud’s phenomenon is a condition in which some of the body’s blood vessels (most commonly those in the fingers and toes) constrict in an exaggerated way in response to cold or emotional stress. This phenomenon is represented by three successive skin color changes. First, severe vasoconstriction reduces blood flow to the skin of the affected areas, causing the skin surface to feel cold to touch and to have a white color. The pale white color is due to virtually no blood flow to the skin. The skin then typically becomes a purplish-blue color as a reduced flow of blood through the skin returns. When the vessel fully recovers, it dilates, allowing blood flow to resume; the skin may blush, becoming very pink or red.
Usually, the underlying cause of Raynaud’s is unknown, but we do know that it can be a family trait, and it occurs more in women than men. The symptoms are usually mild and manageable. It is called a “phenomenon” and not a disease to emphasize the fact that this is an exaggerated but normal response to cold.
An attack can be triggered by exposure to cold temperature or even by a shift in temperature from warm to cool. Even mildly cold exposures, such as those caused by air conditioning or the cold of the refrigerated food section in a grocery store, can cause an attack.
Usually the color changes and accompanying “pins and needles” start in one finger and can then spread to other fingers in both hands. The thumb is not involved. The symptoms resolve when normal blood flow resumes after leaving the cold area and rewarming; the discoloration resolves after 15 to 20 minutes, as normal blood flow resumes.
There are no tests to diagnose Raynaud’s phenomenon. The diagnosis is clinical based on the history and the absence of signs of disease.
To prevent attacks it is important to avoid sudden exposure to cold and damp. Similarly, dressing warmly, wearing layered clothing, thermal underwear, hat and gloves can be very helpful.
Cigarette smoking aggravates Raynaud’s seriously, as well as certain medications like decongestants and Ritalin.
In more severe cases, medications can be prescribed that help increase blood flow to the extremities.
More severe Raynaud’s can sometimes be a manifestation of an underlying illness.
This “secondary” Raynaud’s can occur as part autoimmune conditions such as scleroderma or systemic lupus erythematosus. The symptoms are usually more severe and the attacks can be really painful. In secondary Raynaud’s, medication is often needed to reduce the frequency of attacks and prevent injury to the skin on the fingers and toes.
My 82-year-old mother, a widow who lives with us, was recently diagnosed with Alzheimer’s disease. She is forgetful but still has a pretty normal life.
I suppose it is inevitable that she will eventually need to live in an institution, but in the meantime I was wondering whether there are any special rules for providing nutrition, especially in the winter, to elderly people who begin to show signs of dementia.
A.D., Ramat Hasharon
Naama Ben Moshe and Maya Levi, clinical dietitians at the Amal Besharon geriatric facility in Ra’anana, comment:
Unlike most of the population that tries to lose weight during the winter, the elderly should keep a stable weight; a little bit of overweight could protect them from disease and from a reduction in the quality of life. This is true especially for those with dementia.
It is important that they get enough to drink, as the feeling of thirst is usually reduced in the elderly. Cold weather and heating dries out the body and can cause dehydration. Although it depends on a person’s weight, most people of this age should drink 10 glasses of water (or herbal tea) a day.
The current weather also requires eating hot food that warms the body.
So instead of a fresh salad, one is advised to eat a rich vegetable soup, including pulses such as beans, barley or chickpeas; instead of bread, try serving hot cereal such as oatmeal. Such a diet increases the feeling of satiety and introduces fibers and protein that can prevent a decline in muscle. Complex carbohydrates such as sweet potatoes, burgul, quinoa, whole-grain rice, barley and the like can improve mood.
While vitamin C supplements are not needed, one can increase the intake of this antioxidant by serving broccoli, oranges or other citrus fruits, red peppers, tomatoes and strawberries.
The elderly person with dementia should also be helped to have an active life by walking or otherwise exercising.
Doing housework or gardening can also be helpful.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538- 9527, or email it to jsiegel@jpost.com, giving your initials, age and place of residence.