Counseling Raynaud’s Phenomenon
Raynaud's phenomenon (RP) is characterized by episodic constriction of the small arteries. The phenomenon is an exaggerated response to cold or other triggers, and eventually results in reduced blood flow to certain areas of the body. The disorder most commonly affects the fingers and toes, the ears, and the tip of the nose, but may affect other areas as well. When Raynaud's phenomenon (RP) occurs as an isolated symptom, it is known as primary RP, or Raynaud's phenomenon, and tends to be harmless. In contrast, when RP occurs as a symptom of an underlying illness (for example, systemic lupus erythematosus), it is known as secondary RP, and is often more severe and more difficult to treat. While there is no cure for RP, symptoms can be controlled, and complications can be prevented. The severity of RP varies widely from patient to patient.
Episodes are often triggered by cold or stress. When exposed to cold, the body's normal response is to constrict blood vessels (a process known as vasoconstriction) in the extremities, thereby shunting blood towards deeper vessels. This response slows heat loss, and maintains the body's core temperature.
In patients with RP, vasoconstriction is inappropriately exaggerated, and causes the same small arteries to close spasmodically. This is known as vasospasm, and drastically reduces blood flow to tissues supplied by these arteries. The affected tissues may then become starved for oxygen and other nutrients.
While secondary RP is seen in many other diseases, not everyone with those diseases develops RP. Some of the diseases in which secondary RP can occur include the following:

  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Systemic sclerosis
  • Sjögren's syndrome
  • Dermatomyositis and polymyositis
  • Systemic vasculitides
  • Carpal tunnel syndrome and other nerve entrapment syndromes
  • Atherosclerosis
  • Thromboangiitis obliterans (Buerger's disease)
  • Polycythemia

Certain drugs and toxins have been linked to RP. Some of the more commonly implicated agents include:

  • Beta-blockers
  • Ergot alkaloids
  • Certain cancer chemotherapy agents (particularly bleomycin)
  • Vinyl chloride
  • Pseudoephedrine
  • Phenylpropanolamine (now discontinued by the Food and Drug Administration)
  • Cocaine
  • Caffeine
  • Nicotine

As a result of reduced blood flow, the skin may turn from normal-colored to white to blue to red. Sensory symptoms may be absent, or where present, may range from mild numbness and tingling to severe pain. In the most severe cases, skin ulcerations, infections, and permanent tissue loss may occur. In the early stages of RP, the affected areas will become pale and cold as circulation diminishes. If the blood flow does not return, the affected areas turn blue and become increasingly painful as the tissue becomes oxygen-poor. Acute attacks can last from seconds to hours. As the arteries relax and blood flow is reestablished, throbbing pain and redness may occur. Individual patients may experience some or all of these changes.
With severe or repeated attacks, skin ulcerations may develop. If left untreated, the ulcers may become infected and may lead to permanent tissue damage and loss.
Take steps to prevent attacks by keeping yourself warm. When indoors, maintain a warm temperature, and avoid drafts, direct exposure to fans, or currents of air-conditioning.
Wear oven mitts when taking food out of the refrigerator or freezer. Wear appropriately insulated clothing at all times; mittens or fur-lined gloves in cold weather can be used with portable hand warmers inserted within. Drinking something warm can help before venturing into cold weather.
Avoid medicines and other substances (notably caffeine and nicotine) known to precipitate attacks, and make sure to drink enough fluids.
Avoid injuring areas affected by RP, as the reduced blood flow may prevent scrapes and cuts from healing efficiently.
When you have an episode or flare-up of Raynaud's phenomenon, the most important thing is to stay calm and gently re-warm your fingers or toes as soon as possible. Movement, such as wriggling your fingers or toes, swinging your arms, or walking briskly, increases blood circulation. Placing your hands under your armpits often helps.
As soon as possible, run warm (not hot) water over the affected area. You can also drink something hot, but avoid caffeinated drinks. Hot cider or broths are especially good during a flare-up. Try to keep up a daily routine of gentle exercises to keep your blood circulating.
Your doctor is the best source of information on the drug treatment choices available to you. Surgical interventions are normally reserved for the most severe cases of RP. The success of procedures is highly dependent on the experience of the surgeon. Sympathectomies are procedures in which the goal of surgery is to disrupt the nerves that cause the vessels to contract. One such procedure, which is performed in the nervous system near the spinal cord (proximal sympathectomies), is more effective with primary RP than with secondary RP. Sympathectomies performed closer to the affected arteries in the hands and feet (digital sympathectomies) are more effective than proximal procedures in secondary RP.
Long-term studies show that no more than 10% of patients diagnosed with primary RP develop an underlying illness that leads to secondary RP. If this happens, however, it may not occur until many years after the initial symptom of RP. Therefore, a Neurologist or a rheumatologist should continue to monitor patients diagnosed with RP in order to minimize complications.
Cutting Edge Laser Therapy is an excellent way to cause local increase in circulation. The benefits of laser therapy are relatively new in the medical industry. Despite this, doctors are quick to adopt the technology as they see a marked improvement in their patient’s quality of life and most notably in the reduction of pain and swelling and the increase in patient mobility. Cutting Edge Laser Therapy works by opening up blood vessels, increasing circulation to deep tissue, stimulating the metabolism of tissue for healing and allowing tissue to rebuild itself.
Benefits of Cutting Edge Laser Therapy

  • Anti-Inflammatory Effect
  • Analgesic Effect
  • Accelerated Tissue Repair and Cell Growth
  • Improved Vascular Activity
  • Increases Metabolic Activity
  • Stimulation of Trigger Points and Acupuncture Points
  • Reduced Fibrous Tissue Formation
  • Improved Nerve Function
  • Immuno-regulation
  • Faster Wound Healing

Patient was informed that Cutting Edge Laser Treatment is not covered by medical insurance. The charge for the treatment is $10 per treatment given 3-5 times weekly for one month. Treatment can be extended for more than one if needed. Patient was informed that the clinical outcome of this treatment regimen is uncertain, but it is completely safe, will not harm the patient, and is a conservative method of managing the problem.

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