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suffering from Raynaud Syndrome

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I've been told that my daughter, aged 15, maybe suffering from Raynaud Syndrome. I am looking for second opinion. Her symptoms are;

1) attacks where her toes start to itch or burn and change color. Often they start off being red and then change to purple. Sometimes her toes are cold to the touch and sometimes they are very warm.

2) Her feet are often sweaty.

3) Her feet and legs are a patchy red and purple after taking a shower. These showers are not overly hot. It takes about 30 minutes for the color to return to normal

4) Just recently she was sent to a Doctor because of her heart rate. Her resting heart rate is often between 90 and 120. Testing didn't show anything.

5) No allergies, thyroid function was normal, no signs of auto-immune problems, no gluten allergy.

6) She's often suffering from fatigue

7) Symptoms appear mostly in the winter time. Temperatures generally run between 25 and 45. During the summer her toes can turn tomato red but this doesn't happen very often.

She's about 5'4" and weighs about 108lbs. She does exercise regularly and we do watch her diet fairly closely. Her sugar intake is reasonably limited and we rarely drink soda's. We have been supplementing her diet with 50mg Niacin.

My questions are; should we see a second opinion or is it likely that Raynaud is the correct diagnosis? We are concerned about long term effects of this condition. What are the long term effects and is there anything we could be doing to ease or prevent these attacks form occurring.

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Category: Family Physician-GP
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Expert:  Dr. John Monheit replied 4 Days ago

Thank you for consulting with Doctor spring. I understand that you are worried that your daughter has been diagnosed with Raynaud's phenomenon and that you want to be sure of the diagnosis. First of all, I want to thank you for giving such an in depth history about your daughter's problem.

Raynaud's phenomenon is characterized by episodes of deprivation of blood supply to the fingers and the toes on exposure to cold and subsequent rewarming. In some people emotional stress may also cause an attack. The affected finger or toe on exposure to cold will go through a characteristic three changes in colour:

The finger or toe turns white due to narrowing of the artery to the digit.

Then, the finger will turn blue due to stagnation of deoxygenated blood in the digit. This is called cyanosis.

3. Lastly, on rewarming, due to restoration of blood supply to the finger, the digit turns red. Usually this is the phase that is painful.

This triphasic change in colour is typical of Raynaud's but, some patients may have only a white and blue phase or sometimes the blue phase alone. In some patients, there may be profuse perspiration in the fingers and toes in between attacks which you have described in your daughter.

Raynauds phenomenon may be the associated with some conditions. This is Secondary Raynaud's. Some diseases are:

1. Scleroderma, Lupus, Rheumatoid arthritis.

2. Diseases causing narrowing of the arteries in the fingers.

3. Neurologic disorders

4. Some blood cancers

5. Electric shock, cold injury, vibration injury, typing.

6. Certain drugs: Ergot based migraine medication, Beta blockers and some anti-cancer drugs

From the history you mentioned the most likely diagnosis is Raynaud's phenomenon but the question that remains is whether your daughter is a patient of Primary Raynaud's or secondary Raynaud's. The red fingers and toes that you mentioned when your daughter is exposed to a hot bath and summers are because of the increased response of the entire body to temperature. Most patients with Primary Raynaud’s experience only mild and infrequent attacks. I'd advise your daughter to dress warmly especially in the winters. This includes no only keeping the hands warm with mittens and gloves but also the rest of the body and to avoid exposure to cold unnecessarily. Drug treatment is reserved only for severe cases. Since your daughter has been worked up for most of the causes of secondary Raynaud's, I think you can relax and consult you doctor if any other health issues arise. I hope this information was of use to you.

Dr. John Monheit
Category: Family Physician-GP
Residecny: North Colorado Family Medicine
Medical School: The Chicago Medical Center
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