Phenomenon: An Overview
Guest: Dr. Edwin Smith – Rheumatology &
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Edwin Smith, who is
Professor of Medicine in the division of Rheumatology here, at MUSC. Dr. Smith, you have lots of different
interests and one of them is Raynaud’s phenomenon. Can you describe what that is?
Edwin Smith: Raynaud’s phenomenon is
color changes that people notice in their extremities, particularly the end
part of their fingers or toes turning blue or very pale, usually when they get
into a cold environment or there’s a change in temperature that they’re exposed
to. All that it really takes to have a
diagnosis of Raynaud’s is a color change in the cold.
Linda Austin: What causes this?
Edwin Smith: It is caused by blood
vessels. When the fingertips go white,
there is no blood in those fingertips.
The blood vessels have constricted, closed off, so there’s no blood flow
to the fingertips. The blue happens when
the blood out there doesn’t have any oxygen in it. So, there is blood in those fingers, but
there’s no oxygen in that blood because the blood flow is so slow.
Linda Austin: Is it uncomfortable?
Edwin Smith: It can be very
painful. It can cause numbness. It can cause pain. It can cause inability to function.
Linda Austin: Now, we discussed, in
another podcast, that this can be a warning sign for scleroderma, but that it’s
not necessarily associated with scleroderma, correct?
Edwin Smith: Most everybody who has
scleroderma has Raynaud’s phenomenon.
However, the vast majority of people who have Raynaud’s do not have
scleroderma, because, as we talked about previously, in that podcast,
scleroderma is very unusual. It’s, maybe
1 in 1000. Whereas, we know, here, in South Carolina, that
five percent of the population has Raynaud’s phenomenon. Almost all of those people are completely
healthy. They do not have a connective
Linda Austin: How do you go about
treating this phenomenon?
Edwin Smith: The main treatment for
Raynaud’s phenomenon is to keep warm, to keep your body from losing heat. That means, not just in the extremities, not
just gloves and warm socks, but also scarves and sweaters and hats, because we
lose a lot of the heat from our body through our head. So, having a ski-type cap, if it’s cold, can
be very helpful, keeping the temperature up in the house. And, if you’re going to a really cold
environment, the use can be of electric gloves, electric socks or boots. There are also medicines that can be used to
open up blood vessels, calcium channel blockers. People might be familiar with Procardia
(nifedipine) or Norvasc. We know those
things can be helpful too.
Linda Austin: So, even though you feel
it in your fingers and toes, it’s not just that the fingers and toes get cold. The rest of your body gets cold. In other words, could you be wearing gloves
and socks, and so forth, and, if your head gets cold, you might still have the
Edwin Smith: That is true, because our
body’s response to getting cold is to decrease blood flow to the extremity
parts, to our fingers and toes, to try to keep the blood flowing to our vital
organs. So, that’s a normal thing, but
people with Raynaud’s have that to an exaggerated extent than others. So, yes, any time you’re getting cold, it
doesn’t mean you have to put your hand into the freezer to have Raynaud’s
phenomenon. A lot of my patients will
say that one of the most inciting causes of this is to walk from outside into a
grocery store or go to the frozen foods section of a grocery store, where it’s
Linda Austin: Who gets Raynaud’s?
Edwin Smith: It is more common among
women than men, almost always, at least, people who are teenagers or older, but
it can occur at any age.
Linda Austin: And, once you get it, do
you have it for life? Does it ever
spontaneously go away?
Edwin Smith: It can spontaneously go
away. The most common thing I’ve seen
make it go away spontaneously is weight gain or pregnancy. I’ve seen it happen in women who become
pregnant, they don’t have Raynaud’s phenomenon but, once the baby’s born, the
Rayaud’s phenomenon comes back. I don’t
know if that’s just because of the weight gain or there’s something about the
blood vessels in pregnancy.
Linda Austin: It sound is if, generally,
this is not serious, but it can be a true annoyance and a very uncomfortable
Edwin Smith: It can be an
annoyance. And, we know that the most
common times of day this happens to people are the commuting times, getting in
the car in the cold to go to work and when you’re coming back, getting out and
going into the car to get back home in the evening. There are peaks of Raynaud’s phenomenon at
Linda Austin: You mentioned that
scleroderma can sometimes be heralded by Raynaud’s. Is there anything that a person can do to
make them less susceptible to getting scleroderma if they have Raynaud’s?
Edwin Smith: No. There’s nothing we know about.
Linda Austin: Nothing? Dr. Smith, thanks so much for talking with us
Edwin Smith: You’re welcome, Dr. Austin.
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