from the New York Times
The adage “Cold hands, warm heart” might describe me accurately if it also included “cold feet.” Every autumn, even before the leaves begin to fall from their airy perch, I begin an annual search for better ways to keep my hands and feet from freezing during the coming winter.
My investment in mittens and boots could stock a store and includes what is touted as the warmest of warm, but so far no product has been sufficiently protective. The popular advice, “Move to a warmer climate,” doesn’t mesh with my life’s interests, and so the search continues.
I may or may not have a version of Raynaud’s phenomenon, but I can surely empathize with those who do. First described in 1862 by a French medical student named Maurice Raynaud, it is characterized by highly localized cold-induced spasms of small blood vessels that disrupt blood flow to the extremities, most often the fingers and toes and sometimes also the tips of the ears and nose.
Viewed in the best possible light, it is a patriotic disorder: Affected areas typically turn white when vessels collapse and cut off blood flow, then blue for lack of oxygen-rich blood, then red as blood flow is gradually restored when the areas rewarm.
While it is normal for blood to shift toward the body’s core to restrict heat loss when a person is exposed to cold, this reaction is exaggerated in the extremities of people with Raynaud’s phenomenon, also often called Raynaud’s syndrome or disease. Small vessels that supply blood to the skin of the fingers, toes, ears and nose overreact to cold, developing spasms that greatly reduce or completely shut down blood flow to these areas.
The weather need not be cold to trigger an attack of Raynaud’s. Moving into an air-conditioned room to escape summer’s heat will do it as well.
The same reaction can occur when a person with Raynaud’s is under stress and the body undergoes the kind of fight-or-flight response that protects animals in danger by shunting blood to tissues needed to aid survival.
In a recent review of the disorder in The New England Journal of Medicine, two professors at Johns Hopkins University School of Medicine, Dr. Fredrick M. Wigley and Nicholas A. Flavahan reported that Raynaud’s affects between 3 percent and 5 percent of the general population. It occurs in two forms: primary, which is most common and has no known underlying cause; and secondary, in which it is associated with another disorder, usually a connective tissue or autoimmune disease like scleroderma, rheumatoid arthritis or Sjogren’s syndrome. People who work with certain chemicals, like vinyl chloride, or vibrating tools like a jackhammer are also susceptible to secondary Raynaud’s.
Primary Raynaud’s typically begins relatively early in life, between the ages of 15 and 30, and up to half of these individuals have a first-degree relative — parent, sibling or child — who also has the disorder. Women are more often affected than men.