DEAR DOCTOR K:

During the colder months, I'm prone to "attacks" in which my fingers and toes get very cold and then go blue and numb. Although they do eventually return to normal, it's a recurring problem. Could I have Raynaud's disease?

DEAR READER:

Raynaud's is certainly one cause of cold fingers and toes. You mention that your symptoms come and go. This, coupled with the fact that your fingers and toes lose color, leads me to believe you may have Raynaud's. In addition to causing your digits to feel cold or even painful, Raynaud's causes the top part of the fingers and toes to get very white or blue-purple.

The most common trigger for Raynaud's is cold air. So for most sufferers, it's more of a problem in winter. But Raynaud's can strike even in summer. If you move from outdoors to a very well-air-conditioned building, the change in temperature can set it off. Emotional stress or being startled can also trigger an attack of Raynaud's. Most attacks of Raynaud's end if you get out of the cold air and also take certain steps that I discuss below.

In anyone, cold causes the tiny blood vessels (arterioles) in and under the skin to clamp down. In Raynaud's, they clamp down very hard, more than they need to. As a result, the fingers and toes don't get enough blood or oxygen. This causes the symptoms.

Your doctor definitely should be able to diagnose or rule out the condition -- particularly if you see your doctor during an attack.

The most important thing to do to protect against Raynaud's is to avoid situations that trigger an attack. Avoid cold air. If you have to get out in cold weather, bundle up. Keep your whole body warm (not just your hands and feet). Buy a hat that protects the forehead (wind on the forehead can trigger Raynaud's). Protect your hands when handling items from refrigerators and freezers at home or at the grocery store. Wear warm clothing when you're in air-conditioning, if air-conditioning brings on attacks.

There are other triggers to consider. Avoid cigarette smoke -- chemicals in cigarettes can irritate your blood vessels and cause them to clamp down. Too much caffeine can make some people with Raynaud's get attacks more easily. And if you think stress triggers your Raynaud's, try deep breathing or meditation.

What's the best way to end an attack? Get out of the cold air, and soak your hands or feet in warm (not hot) water. If you can't get out of cold air quickly, put your hands in a warm place -- your armpits. Then rotate your arms like a windmill. (Every time I demonstrate this to a patient, they look at me funny.) Yes, I know you may look like you're trying to fly. But you're also increasing the flow of warm blood to your armpits.

It sounds as if you have Raynaud's. As it turns out, I have it, too. It can really be aggravating. And if you really want to know, yes, sometimes on a very cold day I do put my hands in my armpits and look like I'm trying to fly. I don't care what people may think: My hands feel better.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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