Q: I have been diagnosed with Raynaud’s disease. My hands and feet are always cold and often red, white, or blue in the classic progression. Sometimes the discomfort is fairly severe. I enjoy hiking, snowshoeing so becoming a homebody is not an option for me.
I also have a low white blood count, have tested positive for the Jo-1 antibody. However, my EMG was negative so myositis was ruled out. All other tests have been negative. The only symptoms I have are fatigue which when present, is fairly severe but it is not always present and mild muscle discomfort in my upper arms; and it feels as if I am getting the flu but the flu never occurs. Any information you can give would be appreciated.
A: Raynaud’s disease is a condition in which specific areas of the body – typically the fingers, toes, ears and nose – feel numb and cold because of limited circulation to those areas. Signs and symptoms include tingling or stinging pain and color changes to the area. The skin commonly turns a gray/white initially, after which it turns blue. As circulation improves, the area may tingle, swell, throb, and turn red. Not everyone will experience the three color change, nor will the order be the same for all individuals diagnosed with Raynaud’s. Attacks may be brief, lasting less than a minute, or they may last for several hours.
It isn’t clearly known why some individuals are more prone to the condition than are others but living in colder areas of the country and stress are definitely known to have a bearing. There may be an inherited component that comes into play, as well. We can all understand that when the body, particularly the hands and feet, are exposed to cold temperatures, those extremities lose heat. The body’s entire system slows and blood is shunted to the core to preserve heat. Small arteries narrow even more and those with Raynaud’s have greater than normal symptoms. Most individuals do not go out of doors without gloves or mittens but even running cold water from a faucet or removing a cube of ice from a freezer tray can trigger a reaction.
There are two types of Raynaud’s, primary and secondary. The primary form has no connection to an underlying medical vasovagal condition. The latter type is less common and does have an underlying problem such as carpal tunnel syndrome, rheumatoid arthritis, scleroderma, lupus and others. Further, there are specific medications, including some for chemotherapy, beta blockers for hypertension and others that have been linked with Raynaud’s.
Treatment begins with wearing warm gloves, mittens and heavy socks when out of doors and dressing in layers. One suggestion is for you to visit a sporting goods store and purchasing hot packs that are worn by some individuals that indulge in outdoor activities in cold weather. The packs are activated and simply slip into a mitten to provide several hours of heat. If it is necessary to progress beyond this, vasodilators or calcium channel blockers might be prescribed by your physician.
A low white blood count (which may be normal for some individuals) can be caused by an autoimmune disorder, viral infection, cancer or other diseases that harm bone marrow, specific drugs that destroy white blood cells, radiation, vitamin deficiencies, and more. You might wish to speak with the physician who ordered your lab work to determine the cause for your low count. I might also suggest he or she delve deeper into an autoimmune (rheumatologic) cause. Your normal EMG implies you don’t have myositis, however one study found that 11% of patients with myositis had a normal reading.
Myositis refers to muscle inflammation that may be caused by infection, injury, or an autoimmune disorder such as polymyositis or dermatomyositis that cause muscle weakness, with the latter also causing a skin rash. Difficulties breathing, frequent falls and fatigue are common. Treatment of such disorders might include high doses of corticosteroids, physical therapy, the application of heat, and ample rest.
Be sure to eat well, include fresh fruits and vegetables in your daily diet, exercise as much as allowed by your physician, and take time out of your daily routine to rest to combat the fatigue. Good luck.
