When cold weather hurts

Cold winter weather can be especially hazardous for people who work outside or even for those who just like to spend lots of time outside. Cold-exposure injuries, including frostbite, have increased over the past 20 years. But sometimes the cold can cause other ailments, too.

A 40-year-old chef was still wearing woolen gloves when she sat down in my office last winter. She said her symptoms—hand pain and numbness—worsened when she was outdoors or reached into the freezer. When her fingers got cold, they turned shades of red, white, and blue. Several fingertips were ashen and one had a small ulcer. She had a severe case of Raynaud's phenomenon, caused by spasm of the arteries of the digits or a nerve sensitivity to cold, which affects 3 to 5 percent of people.

Attacks usually last from a few minutes to several hours. Aside from avoiding the cold and not smoking, treatment is generally not warranted. In more serious cases, calcium-channel blockers such as nifedipine (Procardia and generic) may prevent and reduce episodes. In advanced cases, ulcers can develop on the fingers and may necessitate amputation.

Frostbite is another concern. While it affects feet or hands in 90 percent of cases, it can also involve the face and ears. At first, most people experience a cold numbness, and the body part feels icy to the touch. Go to the emergency room immediately if you are affected, to be warmed (a whirlpool is ideal) and to take steps to avoid infection and gangrene. Two to three days later, the blood supply re-establishes, causing a throbbing pain that can last weeks or months.

Other cold-weather ailments include hypothermia—when the body's temperature plummets below 95º F (35º C)—and cold-induced asthma and heart attacks. People with hypothermia first feel cold, shiver, and seem socially withdrawn. As the condition worsens, victims can become confused and sleepy and slur their speech. In the most severe stage, the heart can slow down dangerously.

The risk of hypothermia is highest when people are not prepared for it—when they're at a sporting event on a cold, rainy day, for example, or swimming in a cold lake on a hot spring day.

Exercise-induced cold stress, which can be caused by working outdoors in the winter, can raise blood pressure. Activities involving the upper body seem to be most dangerous, particularly for people with coronary artery disease, who may be susceptible to angina and heart attacks. That is why people with coronary disease shouldn't shovel snow.

My patient was lucky. She responded well to medication and her skin ulcer healed. She has asked her sous-chef to handle the freezer and is thinking of moving to Florida.