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Raynauds Syndrome, Cold Hands and Feet in Winter Training by John Post, MD

And I love to live so pleasantly,

Live this life of luxury,
Lazing on a summer afternoon.
In the summer time,….
                                                    The Kinks
Ah summertime, for many of us it’s only a memory.  The arrival of winter has brought with it a host of training challenges. The cold, shorter days, more competition for pool access, the kids back in school, did I mention the cold? And how we meet these challenges tells us a lot about our seriousness in the sport.  (In last weeks post, Arthritis part 3, I talked about the committment and life changes made by Farrokh Bulsara who transformed himself into Freddie Mercury . ” I guess the question is…are you willing to make the types of sacrifices Freddie made to achieve your goals?”)

The past few weeks have seen below freezing temperatures for those wishing to stay outside for the morning run/bike ride, particularly the long ride on the week end.  A simple solution would be to put your bike on a training stand and “ride” indoors watching CDs of last years TdF to see if Bradley wins again.   Also, I’m sure that a number of readers own Computrainers that can reproduce a variety of race courses.  I enjoy outdoor biking and if the road surface is safe, no snow or ice, I’ll probably ride regardless of the temperature as will many of you.

But some have significant complaints about very cold fingers and toes despite several trials with gloves, mittens, chemical hand warmers or battery powered shoe inserts.  They report a variety of color changes in their digits when exposed to the cold. These occur secondary to spasms of the local finger arteries as seen below.
   First, the fingers turns white and get a bit of a numb feel because of the lack of blood flow.  This loss of blood can make the fingers turn a purple blue color, almost black on some occasions.  When the spasms resolve the digits turn red for a short period and then slowly back to their normal color.  This is known as Raynaud’s Disease or Raynaud’s Phenomenon when it occurs without other disease processes.   Frequently, when it’s a part of other diseases, it’s called secondary RP.  A large study from Massachusettes found that 5% of men and 8% of women suffer from RP.

The actual cause of RP is unknown.  What is known is that the blood vessels narrow because of spasming of tiny muscles in the walls of the arteries, eventually followed by sudden relaxation of these muscles opening the vessel back up.  The symptoms can be quite variable.  Some will complain of only a small amount of skin discoloration/numbness/tingling if they have mild disease.  Others get these same symptoms in their ears and nose. An unlucky few will have such prolonged spasm that the tips of the fingers actually develop ulcers, get infected, and then become subject to amputations.  Fortunately it’s a very small population.  RP can be exacerbated by certain drugs like beta-blockers or in occupations that have a great deal of vibration. Those who have secondary RP can also have a skin and joint disease called scleroderma or have it associated with with an arthritis-like disease such as Lupus or rheumatoid arthritis.

So, what’s recommended for those who have this?  If possible, try to avoid the stresses that bring on the symptoms.  Try to keep your hands and feet warm, regardless of the outside conditions.  Companies like Assos carefully divide their catalogs by riding temperatures and recomend specific clothing, including gloves/mittens and foot wear for each temperature range.  If you smoke, this can exacerbate RP and it would be recommended that you try to quit. Diabetics need to take the best care of their disease possible.  They say that caffeine can bring this on.

If the symptoms occur, warming the affected area is recommended.  Put your hands in your pockets, pants or arm pits.  If it’s only a finger or two, put them in your mouth!  Some will even put their hands in warm water to more quickly reverse the symptoms.

A very small number of folks will need drug therapy or even surgery to keep the symptoms at bay.
So, if you can do your best to keep warm, those winter rides can be just as enjoyable as the summertime. Well, almost, till you get to the end at the local coffee shop.