Dear Dr. Roach: 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 affects her feet, too.
P.S.M.
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 flow to the
extremities.
That means a hat in addition to multiple layers of clothing. You don’t even need to be outside to get exposed to the cold — my patients have told me that walking into the frozen-food aisle in a market can set off Raynaud’s.
Active warming of the hands, such as chemical hand warmers, can make a big difference. 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 sildenafil (Viagra — a useful drug for several conditions, not just erectile dysfunction), nitroglycerine and fluoxetine (Prozac).
There’s much more advice available through the National Institutes of Health website at http://tinyurl.com/h9cc8hc.
Dear Dr. Roach: 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 and full of senescent organs, I think. Should I seek advice elsewhere?
M.E.S.
This is a question I see with increasing frequency, as laboratories have started giving estimated GFR (glomerular filtration rate, a test of kidney 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 effective medication treatment to prevent age-related decline in kidney function. However, a plant-based diet has been shown to slow progression of kidney disease in a large population of (not necessarily older) adults, and might slow down age-related changes as well, and it certainly has additional benefits.
• 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 findings on the ultrasound. Many older people are alarmed by the scary-sounding diagnosis of “renal failure,” but I don’t think you need to change anything. Your doctor hopefully will have already double-checked the doses of any medication you might be taking. Eating more plants and less meat is healthy for most people, especially those with kidney issues.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
