Q: For the last few years I have been dreading the beginning of winter more and more. My fingers used to get cold before, but now they turn white with very little exposure. It takes 10 to 30 minutes for them to return to normal when I reheat them.
My 70-year-old mother was told she has poor circulation in her hands due to her aging arteries, but she has nothing like this. What do you think is my problem, and what can I do with it?
-- G.D., Easton, Conn.
A: In cold weather everyone will feel cold fingers or toes sometime. The further from the heart, the less the flow of warming blood, especially for older people and those with peripheral artery disease.
But based on your symptoms and my guess about your age, it sounds like you have Raynaud's. This is a condition in which the nerves connected to small arteries of the fingers, and sometimes the toes, cause those arteries to go into spasm. This constricts the arteries and cuts off blood flow.
Raynaud's is primarily a disorder of young women. In men it is often the result of occupational trauma, such as the repeated use of vibrating hand tools.
When this condition is related to another disorder it is called Raynaud's phenomenon. This is the most common form. When no other underlying disease is found it's called Raynaud's disease.
There are many potential causes of Raynaud's phenomenon including: scleroderma, rheumatoid arthritis, atherosclerosis, decreased thyroid activity, injury, and reaction to certain drugs. In a recent research study, the most common causes of Raynaud's phenomenon were the use of beta-blocker drugs (primarily used for blood pressure control and heart conditions), carpal tunnel syndrome, and rheumatoid arthritis.
Episodes of Raynaud's come on quickly and are usually triggered by stress or exposure to cold. Rewarming the affected hands or feet usually restores normal color and sensation within a few minutes. But a burning sensation is often felt as they return to normal.
However, over time, the skin of the fingers and toes may change permanently. More severe cases can include chronic severe pain and even tissue destruction.
Raynaud's phenomenon is treated first by treating the underlying disorder. Do you have any other health condition that might affect the arteries of the hands or the nerves that supply them?
Nifedipine has shown positive results in treating the symptoms of Raynaud's. Drugs that dilate the blood vessels (vasodilators) have been tried, but studies show they are of limited benefit. Surgery on the nerves controlling the affected blood vessels (sympathectomy) is reserved for very severe cases.
Research reported a few years ago suggests that applying nitric oxide to the affected fingertips can help return the circulation to normal. But this is difficult to do and is not available.
You should do what you can to keep your extremities warm. Some people with severe Raynaud's wear battery-powered heated socks and gloves. Some even decide to move to warmer climates. In any event, protect your hands from cold and injury at all times.
Even the slightest change in temperature can affect your fingers. So put on gloves long before you think you hands might get cold, even if other people poke fun at you.
Drugs that restrict blood vessels, including tobacco, should be avoided. If you have a problem with stress -- understandably, you may be anxious about the condition of your fingers -- you may want to talk to your family doctor or a psychological therapist.