What a winter this has been! As I write from my home here in the Northeast, I am painfully aware of how much snow there is still to shovel and ice to chop. And more is coming! A colleague of mine recently told me she was standing on a train platform outdoors in sub-freezing weather for over an hour and developed a burning and itching in her toes. She asked what I thought it was. Holy fallin’ snowflakes, Batman! Sounds like a possible cold weather-related injury to me.
Cold temperatures make blood vessels constrict (get smaller) and, therefore, do not allow as much blood to flow through them. Damage to the skin and tissues below occurs from lack of oxygen-containing blood. The body, clever as it is, always wants to be sure that blood is getting to the most important parts – the brain, the heart and the lungs. In order to do that, it has to take the blood from somewhere else. While these weather-related injuries can affect any part of the body, the extremities – the places farthest away from the heart like hands, feet, nose and ears – are favorite spots from which to borrow blood.
Cold weather-related injuries can occur even when the temperature is not below freezing. The damage from cold depends on whether clothing or skin are wet, if there are high winds (this cools you off even faster), and length of time you are exposed. The two most common cold weather-related injuries are chilblains and frostbite. Chilblains is a superficial form of cold injury, so the deeper blood vessels and tissues don’t get frozen. The skin may look mottled (blotchy) or reddish/purplish. It may be painful, itchy or burning, and, in some cases, blisters may even form. Although these skin changes may last for a few days to weeks, it does not cause permanent damage other than being more sensitive in future cold weather.
Frostbite, on the other hand, is a deeper form of damage that affects the underlying tissues and blood vessels. At first, people usually complain about a “pins and needles” sensation and then numbness, although some people experience pain at the start of frostbite. The skin gets hard and looks pale. If the frostbite is not very advanced, when warming begins, the skin turns very red and can be very painful. Blisters may form. In worse cases of frostbite, the skin turns black (gangrenous), indicating that there is no blood flow to those parts; that part is essentially dead. If not treated correctly, this can lead to amputation (removal of the dead part).
Anyone who is exposed for a period of time, especially if they are not appropriately dressed for the weather, can have one of these injuries. A person who smokes or takes medicines that cause the blood vessels to constrict (vasoconstrictors) is more likely to get chilblains or frostbite. Many cold medicines contain vasoconstrictor drugs and some non-prescription drugs (like cocaine and nicotine) also cause this constriction of the blood vessels. Certain diseases like peripheral vascular disease or diabetes can make a person more likely to suffer from a cold weather-related injury. Persons of color – African Americans or people whose ancestry is from a warmer climate – may also be more likely to get frostbite.
Although every movie you’ve ever viewed with a scene where the person is stranded in the cold shows that person drinking alcohol, which is one of the worst things you can do. Alcohol makes you feel warm because it opens up the blood vessels, causing more heat to escape from the body, which just makes the situation worse. Also, if a person has been drinking before going out in the cold or while they’re out there, they may not realize that they are losing sensation and can end up getting severely ill. Medicines like beta blockers (ones ending in “lol” – like metoprolol, atenolol, carvedilol, for example), often used for high blood pressure, make the blood vessels dilate (get bigger), causing loss of body heat in the same way as alcohol.
So, what should you do if you think you might be suffering from a cold weather-related injury? If you think you have chilblains, get in from the cold so it doesn’t become frostbite. If you have chilblains or frostbite, rapidly re-warming the affected area(s) is the best thing you can do. An old home remedy tells us to rub the area with snow – this is a REALLY BAD idea! While some home remedies are great, this is not one of them. It will only make the situation worse. In fact, vigorously rubbing the area can cause more harm than good. Putting your hands in your armpits or sitting on them is a good way to warm them. Soaking the affected part(s) in warm water is also an excellent way to bring back the circulation without the risk of burning yourself. Direct heat, like warming over a fire, can cause burns because you may not realize you are getting burned if the area is numb. Lastly, be sure to remove any jewelry or clothing that can cut off circulation.
Here is one more very important tip: do not thaw a frozen area if you are at risk of freezing again – it is better to leave the area frozen until you can get medical help. Thawing and re-freezing causes severe damage and should be avoided. If you see that your skin is hard and pale or you have developed blisters, seek medical help as soon as possible. It will be necessary to make sure that your body temperature is not too low and to prevent infections as a result of having blisters. Preventing gangrene from setting in can save your life and limbs!
The best way to prevent these types of injuries is to dress in layers. Dressing in layers not only makes it possible to remove wet clothing if necessary, but it also keeps you warmer. Keep extra dry clothing in your truck. Dress appropriately – even if you are only going out for a short run. If you lose control of your truck and end up in a ditch or snow bank, that short run could turn out to be much longer than you expected. Make sure you have a winter weather kit in your truck and keep your cell phone charged at all times. This way, if you do get stuck, at least you can call for help. Or, even better, when possible, just drive somewhere warm and sunny!