Heel Pain....

So for the past few weeks I've been having heel pain and ankle aches (more in my left foot than my right). While I am doing more physical things with my limbs than when I was in my flare (walking, standing, etc), in the beginning I just thought it was my 'tired' legs getting use to be 'alive' again! But when it got worse after a foot massage, and two weeks later still didn't go away (even after buying new sneakers!), I had to have it checked out.

So we've ruled out all the usual suspects including plantar fasciitis, neuropathy, and any kind of serious injury to the foot. The next logical thought is that my RA is coming back, but that's not it because nothing else was bothering me.....until this morning.

So today I get up and realize my palms ached (again, more in the left than the right)....yup, you heard me, my PALMS. Still not sure what is wrong I go and touch a hot pan from the oven today and DON'T REALIZE ITS HOT for way to many seconds! So now I know, my Raynaud's is back.....

Actually it never went away. That's the joy of having a chronic illness like Lupus. Even though I've healed my Lupus all those "extra's" you get from it leave a little reminder behind. When you have a chronic illness like Lupus you get a lot more than you bargained for, you acquire other diseases like Sjogrens, RA, Reiter's, and ankylosing spondylitis, just to name a few. OH yea, and Raynaud's! How could I forget?!

So what is it? The clinical definition of Raynaud's phenomenon (RP) is that it is a condition resulting in a particular series of discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events. Skin discoloration occurs because an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues. Initially, the digit(s) involved turn white because of the diminished blood supply, then they turn blue because of prolonged lack of oxygen. Finally, the blood vessels reopen, causing a local "flushing" phenomenon, which turns the digit(s) red. This three-phase color sequence (white to blue to red), most often upon exposure to cold temperature, is characteristic of RP.

Ok, so I say it is a "clinical" definition because anyone with this syndrome will tell you that whether you live in a hot climate or a cold climate it doesn't really matter! I live in South Florida and its 85 degrees out side today and I still have this, so truly there is no association with hot or cold conditions. I had to laugh when I initially was diagnosed and read the "recommended treatments". Number one was "move to a warmer climate"!

However, when it is colder outside than normal (i.e. a cold front) AND I'm in a flare, it does present itself more quickly (i.e. my toes and fingers are at the blue stage before I realize anything is happening) and at that time I plunge my little digits into a warm (not hot!) water. We don't want to shock it, just coax it back to where it belongs. But my digits are fine and not turning any colors, however one big symptom I remember was not having "feeling" in the hands or feet (oh, and it can affect your entire hand or foot, not just your fingers....its your fingers that show you the outwardly symptoms in order for you to pay attention and take action).

Anyway, Raynaud's most frequently affects women, especially in their thirties, fourties and fifties and symptoms depend on the severity, frequency, and duration of the blood vessel spasm. Most patients with mild disease only notice skin discoloration upon cold exposure. They may also experience mild tingling and numbness of the involved digit(s) that will disappear once the color returns to normal. When the blood-vessel spasms become more sustained, the sensory nerves become irritated by the lack of oxygen and can cause pain in the involved digit(s). Rarely, poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Ulcerated digits can become infected. With continued lack of oxygen, gangrene of the digits can occur so it is important to take precautions (discussed later in this post). Less common areas of the body that can be affected by RP include the nose, ears, and tongue. While these areas rarely develop ulcers, they can be associated with a sensation of numbness and pain.

RP is the initial symptom of 70% of patients with scleroderma, a skin and joint disease. Other rheumatic diseases frequently associated with RP include systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome. Lucky me, in a flare I get all three!!!

So why my heels? According to my doctor, PRESSURE. I forget I have been off my feet, sitting with my feet up or lying down for several months at a time (a flare) and then not getting back enough strength during my remissions to do anything strenuous to my body. Now that I am feeling so much better I am exercising more and trying just to do more in my daily life and my body isn't quite ready for me to be there!

When the body gives you a sign, pay attention. It needs time to catch up....

So how do I take care of this? For me and my feet it is wearing socks (preferably the ones with toes in them for better circulation), leg warmers (remember those?!) at night so I can sleep and better fitting shoes (anything that I could slide my feet into was what I wore during my flares and I just got use to them. Seems they don't provide enough support for my new found physical independence). I'm also famous for stubbing my toes/breaking toe nails, getting hang nails, you name it.....I just have to take better care of my extremities from now (especially since I plan to move to Colorado!).

So management of Raynaud's phenomenon involves protecting the fingers and the toes from cold, trauma, and infection. Medications that can aggravate blood vessel spasm should be avoided by patients with RP. In patients with persistent symptoms, medications that dilate the blood vessels can be administered.

Those with RP should guard their hands and feet from direct trauma and wounds. Any wounds or infections should be treated early to prevent more serious infections. This can be as simple as a hang nail or as serious as a burn, as simple as a stubbed toe or as serious as dropping something on it. Avoiding emotional stresses and tools that vibrate (ever heard of a laptop computer?!) the hand reduces the frequency of attacks.

Direct and indirect (passive) smoking should be avoided by patients with RP. The chemicals in tobacco smoke can cause blood-vessel constriction and lead to atherosclerosis (hardening of the arteries), which can further impair oxygen supply to the extremities.

Care of the nails must be done carefully to avoid injuring sensitive toes and fingertips. Ulcers on the tips of the digits should be monitored closely by the doctor as these can become infected quite easily. Gently applied finger splints are used to protect ulcerated areas. Ointments that open the blood vessels (nitroglycerin ointment) are sometimes used on the sides of severely affected digits to allow increased blood supply and healing.

Medications that can aggravate symptoms of RP by leading to increased blood-vessel spasm include over-the-counter cold and weight-control preparations, such as pseudoephedrine (Actifed, Chlor-Trimeton, Cotylenol, and Sudafed). Beta blockers, medicines used for high blood pressure and heart disease, can also worsen RP. These include atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), and propranolol.

Remember, ignorance is not bliss. Severe RP can lead to gangrene and the loss of digits. In rare cases of severe disease, nerve surgery called "sympathectomy" is sometimes used to prevent blood-vessel spasm; the nerves that stimulate the constriction of the vessels (sympathetic nerves) are surgically interrupted. Usually, this is performed during an operation that is localized to the sides of the base of the fingers at the hand. Through small incisions the tiny nerves around the blood vessels are stripped away.

Researchers have reported finding a substantial genetic (inherited) contribution both to the symptoms of RP and to the associated blood-vessel changes of patients with Raynaud's phenomenon. Also, it has been reported that those who do not take care of their Raynauds (or other autoimmune dissorder that could be associated with it) and the disease progresses they can develop carpal tunnel syndrome.

Remember:

• Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold.
• Raynaud's phenomenon occurs because of spasm of blood vessels.
• The cause of Raynaud's phenomenon is unknown, although abnormal nerve control of blood-vessel diameter and nerve sensitivity to cold are suspected of being involved.
• Symptoms of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood-vessel spasm.
• There is no blood test for diagnosing Raynaud's phenomenon.
• Treatment of Raynaud's phenomenon involves protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.

Raynaud's phenomenon has been seen with a number of conditions, including rheumatic diseases (scleroderma, rheumatoid arthritis, systemic lupus erythematosus), hormone imbalance (hypothyroidism and carcinoid), trauma (frostbite, vibrating tools), medications (propranolol [Inderal], estrogens without additional progesterone, nicotine, bleomycin [Bleoxane] used in cancer treatment, and ergotamine used for headaches), and even rarely with cancers.

Footnote: If you have Raynaud's and live in a cold climate, I would love to hear how you handle your symptoms. I am blessed that my symptoms appear to be "mild", but painful just the same, and would like to take some precautions before moving...