Andrew Siegel MD 3/4/2023
FYI, Raynaud’s is pronounced “ray-nose.”
Although I enjoy writing about medical issues that I confront and treat daily, I am even more passionate when writing about medical issues that I have personally encountered and that have impacted my own health. “Living it” is another dimension entirely as compared with “vicarious experience.” Raynaud’s disease, inherited from my mother, is one such medical issue that I have a personal stake in. I have been dealing with this gradually worsening annoyance, nuisance, and a source of frustration for years, but it is a manageable problem that is not disabling. There are many other far worse medical conditions.
Raynaud’s is a constriction of the arterial flow to my fingers. It often happens after lunch, triggered by holding a glass of an iced drink or a cold bottle of water. My fingers blanch white and feel icy cold. It typically will happen in both hands, even though provoked by contact with cold in only one hand. It may progress to a generalized body chill. Any given episode may persist from several minutes to hours. It is seasonal, always worse in the winter and barely present in the summer. It’s no wonder that as I have aged, I find myself preferring heading down south in the winter and seeking warmth rather than traveling out west to ski!
To seek relief, I find myself positioning my hands on warmer areas of my body (underarms, etc.), rotating the front and back of the palms. Sometimes my wife will “lend me her neck” to grasp for a few moments to get some relief. I have discovered that one sure-fire way of eradicating an acute episode is through exercise. Consistently, after 15 minutes or so on the treadmill, my hands warm up and the episode is over. Another solution is sitting by the fireplace, or alternatively, heating up a microwavable bean bag and grasping it with both hands. Sometimes furiously rubbing my hands against the legs of my jeans creates enough friction to do the trick. When a Raynaud’s “attack” happens during lunch while at work, I head to the turbo-powered hand dryer in the bathroom and literally bathe myself in the profusion of hot air. One of the best features of my car is a heated steering wheel — the ultimate of luxuries — that provides magical relief! A nice hot cup of tea cradled in my hands has also proven to be helpful; the British with their tea sipping habit to keep them cozy in the winter really have something there!
I try to prevent the often lunchtime onset of the problem by drinking beverages with a mug that has a handle that doesn’t get cold despite the icy contents. During winter, I never head outside without gloves to keep my hands warm.
Raynaud’s disease was first described in 1862 by a French physician, Auguste Gabriel Maurice Raynaud. It is a multifactorial vasospastic (spasm of blood vessels) disorder characterized by a temporary, recurrent, and reversible constriction of peripheral blood vessels, most commonly in the fingers. It is an exaggerated reflex response to cold exposure induced by the sympathetic nervous system in which the cutaneous arterioles (small arteries that provide blood flow to the skin) constrict, the purpose of which is to redirect circulation to prevent heat loss. One’s fingers blanch white, become ice cold, and sometimes feel either numb or a pins and needles sensation occurs.
The characteristic color changes in the fingers are due to constriction of blood vessels and are classically described as a triphasic discoloration, beginning with pallor (white) due to the ischemia (decreased blood flow), followed by cyanosis (blue) due to deoxygenation, and ending with erythema (red) due to reperfusion (restored blood flow). Red, white, and blue –how American!
Not everybody with Raynaud’s experiences the classic white, red, and blue. I only experience the white component. In addition to the fingers, Raynaud’s may also affect the toes, nose, earlobes, and nipples.
Raynaud’s affects 3-5% or so of the population. Contributing factors are gender (estrogen seems to play a role), genetics, tobacco use, certain medications (sympathomimetics and gemcitabine are two examples), and exposure to vibration (e.g., those who work with jackhammers), activities that involve overuse of the fingers (e.g., typing, piano playing, etc.), and stress (by activation of the sympathetic nervous system). 70% of those with Raynaud’s are female.
Raynaud’s is classified into primary and secondary. Primary Raynaud’s is the more common of the two and is a benign condition that is episodic, generally symmetrical, and is what I have.
Secondary Raynaud’s, aka Raynaud’s Phenomenon, is due to an underlying medical issue, most commonly an autoimmune connective tissue disease including lupus, scleroderma, Sjogren’s, rheumatoid arthritis, mixed connective tissue disease, or dermatomyositis. Secondary Raynaud’s is asymmetrical, painful, and may have serious consequences — digital ulcerations, ischemia, necrosis, gangrene, and infections. A rheumatology consultation is in order for anyone with Raynaud’s to rule out an underlying autoimmune connective tissue disorder. Fortunately, my evaluation was negative.
The solution to primary Raynaud’s is avoiding cold and keeping one’s environment warm — turning up the heat, using hand warmers, increasing physical activity, trying to minimize stress, and cessation of smoking. Several different classes of medications that increase blood flow have proven effective for Raynaud’s, including calcium channel blockers (e.g., nifedipine), alpha blockers, angiotensin-converting enzyme inhibitors (e.g., losartan), nitric oxide, prostaglandin analogs, and phosphodiesterase inhibitors (e.g., Viagra, Cialis, Levitra). That’s right, the erectile dysfunction drugs are also good for Raynaud’s and for pulmonary hypertension for that matter!
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, one of the largest urology practices in the United States. He is the co-founder of PelvicRx and Private Gym. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
Tags: Andrew Siegel MD, connective tissue diseases, digital vasospasm, Raynaud's disease
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