Raynaud’s phenomenon is true winter woe for sufferers

Dr. Keith Roach

Question: My daughter, in her middle 50s, is plagued with Raynaud’s. The winter here in Illinois is hard on her. She wears heavy gloves, but still her hands are very cold. It affffffffffffects her feet, too. — P.S.M.

Answer: Raynaud’s phenomenon is an exaggeration of the body’s normal response to cold. The blood vessels in the hands (and often feet) constrict in the cold or sometimes under emotional stress), turning them very pale. The tissues become blue from poor tissue oxygen levels. When the skin is rewarmed, it may turn bright red. Raynaud’s phenomenon can happen by itself primary) or can be secondary to other conditions, especially lupus and other rheumatic diseases. Most experts will do a search for secondary causes in someone with Raynaud’s.

Treatment of Raynaud’s starts with keeping the person warm. Warmth all over is important, in order to avoid the body shutting down blood flflow to the extremities. That means a hat in addition to multiple layers of clothing.

Active warming of the hands, such as chemical hand warmers, can make a big difffffffffffference. Thick woolen socks can’t be beat for warmth.

If medication is necessary, calcium channel blockers such as amlodipine are useful. Rarely, other drugs are needed, such as sildenafifil (Viagra — a useful drug for several conditions, not just erectile dysfunction), nitroglycerine and flfluoxetine (Prozac).

Q: My primary doctor referred me to a nephrologist because my lab report showed a GFR of 38 (normal should be greater than 56). An ultrasound showed “senescent kidneys.” My diagnosis was “third stage of renal failure,” but no diet or medications were suggested.

I am 90 years young. Should I seek advice elsewhere? — M.E.S.

A: This is a question I see with increasing frequency, as laboratories have started giving estimated GFR (glomerular fifiltration rate, a test of kid- ney function). There are a few very important points to make:

■ Kidney function routinely goes down with age. About half of adults over the age of 70 will have GFR levels below 56, giving them the diagnosis of “renal failure.”

■ There is no effffective medication treatment to prevent age-related decline in kidney function. However, a plantbased diet has been shown to slow progression of kidney disease in a large population of (not necessarily older) adults, and may slow down age-related changes as well, and it certainly has additional benefifits.

■ Knowing that kidney function is reduced, whether due to normal aging or due to kidney disease, is important so that medication can be dosed properly.

At age 90, a GFR of 38 is just slightly lower than what I would expect. I can’t tell whether this is normal aging or kidney disease, but I suspect that it is normal aging, especially given the fifindings on the ultrasound.