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Symptoms include numb fingers and toes, particularly for younger women

By Dr. Cynthia Paulis

Red, white and blue may be patriotic colors, but when they occur on your fingers it may be a sign of something known as Raynaud's disease. The condition is characterized by a vasospasm and in some cases can be associated with autoimmune diseases such as lupus or scleroderma.

In Raynaud's, areas of your body such as your fingers, toes, the tip of your nose, ears and, on rare occasions, tongue will feel numb and cool in response to cold temperatures and stress. Smaller arteries that supply blood to the skin narrow and go into spasm, causing the numbness. The symptoms experienced depend on the severity, frequency and duration of the vasospasm; the first thing a patient notices is that the area, usually the fingers, turns white due to inadequate blood flow. As oxygen is depleted in the tissues they turn blue, and when the spasm stops and blood returns, the skin turns bright red and can be tingling or painful. The attack can last from less than a minute to several hours.

Dr. Robert Dickerson, a rheumatologist in Manhattan, said Raynaud's often affects women between the ages of 17 and 25.

"The problem with trying to diagnose the disease is that they look very normal," he said. "The first line of treatment is to give the patient an understanding of the event, because that reassures them and [helps them] understand the triggers that will cause this problem."

The two most common triggers are cold temperatures and stress. In both cases the body's normal response is to preserve core temperature-in people with the disease, this response is exaggerated.

Dickerson also stressed that other triggers that can cause the event are "smoking, caffeine, estrogen-based birth control pills, occupations where vibrations are constant, such as working with a jackhammer" and perhaps vinyl.

"I once had a patient many years ago who was a disc jockey. She was working with vinyl records and developed symptoms of Raynaud's disease," said Dickerson.

Certain over-the-counter medications that contain pseudoephedrine can also act as triggers. Beta blockers used to treat high blood pressure and heart disease such as Lopressor, Toprol, Corgard, Inderal and Innopran XL have also been know to trigger Raynaud's disease.

The problem with Raynaud's is that if attacks increase in frequency, poor oxygen supply to the tissues can cause the tips of the fingers to ulcerate and become infected. With a continued lack of oxygen, gangrene can occur-although this is very rare, it does happen.

When an attack occurs, Dickerson advises, "Warm your hands by putting them in warm water. If that's not available, gently massage your hands or, if it's your feet, wiggle your toes. Make wide circles like a windmill with your arms or place your hands under your armpits to warm them up."

Prevention is the best way to minimize the attacks. In cold weather wear gloves, a hat, a scarf and boots. Dickerson advises, "Wear socks and gloves to bed. If you are drinking a cold drink, use a napkin or insulator around the glass to keep your hands warm."

If you are taking food out of the refrigerator or freezer, wear gloves or oven mitts to keep the cold from your hands. Air conditioning may trigger the attack, so set the temperature higher to prevent attacks.

Dickerson reassures patients that "80 percent of people will do well with prevention and avoidance of the triggers that cause the attacks." The most common drugs used for treatment are calcium channel blockers such as Adalat, Procardia, Norvasc and Plendil. They work by relaxing and opening up the small vessels in your hands and feet, thereby decreasing the frequency and severity of the attacks. They also can be used to heal ulcers on the fingers and toes.

Another class of medication used is alpha blockers, which counteract the effects of the hormone norepinephrine, which constricts the blood vessels. Minipress and Cardura are commonly used alpha blockers.

Niacin, also known as vitamin B3, has been used to treat the problem and biofeedback has been used to cope with stressful situations.

One of the more unusual treatments is Viagra, which is a potent vasodilator.

Raynaud's disease can't be cured, but its symptoms can be minimized by eliminating the triggers that cause it-cold, stress ( easier said than done), smoking and caffeine. So, the next time you feel inclined to go for the 60-ounce cup of coffee, think about switching to green tea instead and maybe booking a nice trip to Hawaii in December.

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