Maximal Living
By UAB’s Mark A. Stafford, M.D., F.A.C.P.
Dedicated to helping you improve your quality of life.
In this column, I hope to share with you three things:
1. Learning how our bodies talk to us (they’re always speaking-sometimes whispering, sometimes screaming!) in health and disease.
2. Ways to maximize our quality of life by attending to the whole person-physical, mental, emotional and spiritual.
3. Answers to questions you want to ask your doctor but are afraid, ashamed or just forget to ask.
Have you ever wondered when your hands and feet were uncomfortably cold if you have poor circulation? Would you like to know how to check your own circulation? Today, I want to share with you some common causes of cold hands or feet and some simple ways you can check to reassure yourself the circulation is intact.
“Poor circulation” generally describes a condition where blood flowing to a hand or foot is inadequate to meet the metabolic needs. Cold hands and feet may mean there is decreased blood flow but there are several other causes for cold hands and feet, perhaps the most common is anxiety. We most often experience anxiety when we are afraid of something in our future. Since anxiety stems from fear, our bodies secrete hormones to prepare us for the potential threat, be it real or imagined. This “stress response” is often referred to as “fight or flight” since our bodies and minds have been conditioned to confront fear (like a saber-tooth tiger fixing to spring on us) by either running away or staying to fight. The adrenaline pumping into our bodies causes our hearts to beat harder (sometimes we feel our heart in our throat it beats so hard) and faster. Adrenaline also causes the blood flow to our skin to decrease in anticipation of possible wounds that might bleed. We also sweat to cool ourselves down. This complex group of physical reactions occurs automatically through our nervous systems outside of our conscious awareness. This combination of decreased blood flow to our hands and sweating has lead to the old saying, “ Cool hands, warm heart.”
Cool temperature can also cause the skin in our hands, feet and tips of our noses to constrict to prevent undesirable heat loss caused by blood flowing at 98.6 degrees. The diminished blood flow causes our hemoglobin molecules to use all their oxygen, leaving unsaturated hemoglobin, darker blue in color, behind. The decreased oxygen causes our fingertips and nails to look blue, a condition known as cyanosis. These changes reverse rapidly with rewarming and do not represent a serious decrease in circulation.
One of the most common causes of our feet feeling cold, aside from cold weather and anxiety, is altered sensation due to damaged nerves in the legs. Our legs develop symptoms earlier than our hands when we have circulatory and nerve problems because the blood vessels and nerves in the legs being farther away from the heart and spinal cord, respectively, are more susceptible to injury. Damaged nerves may discharge electrically causing a variety of unusual sensations in the affected extremity. The feet or legs may “feel” cold, even in the presence of adequate blood flow. They may also feel like they are burning, cramping, aching, numb and/or tingling. Nerve damage (peripheral neuropathy) can be caused from a long list of conditions. Diabetes may be evidenced by such nerve damage before the more common symptoms of excessive thirst, urination and weight loss occur. B12 and other vitamin deficiencies and chronic alcohol abuse are among the most common causes. Your doctor, by conducting a thorough history and physical exam, may uncover a reversible cause for the neuropathy.
Actual “poor circulation” as a cause of cold hands and feet is uncommon but not rare. Affected individuals commonly have had prior heart disease, such as heart attack or bypass surgery, or have risk factors for hardening of the arteries (atherosclerosis) such as high blood pressure, cigarette smoking, family history of premature vascular disease, diabetes or high cholesterol. Cold feet due to poor circulation often accompany a cramping pain in the calves or buttocks when walking, symptoms that are subsequently relieved with rest. The foot may feel colder and more painful when elevated and improve with dropping the foot below the level of the heart to increase circulation by hanging the foot off the bed. Poor circulation in the legs may cause hair to be thin or absent below the knee and can cause nails to thicken. Men often also have erectile difficulties.
While there are many ways your doctor can check for poor circulation, you can check yourself by noting how quickly your toes regain their pink color after you compress them to the point of being white. Normal circulation recovers pinkness within one or two seconds. On the top of your foot, about two inches in front of your ankle and slightly to the outside of the midline, if you press lightly with your finger pads you should be able to feel one of the foot pulses. You may be able to feel the other foot pulse by placing your finger pads a finger’s width immediately behind the inside of your anklebone. If you can feel your pulse or your toes regain pinkness within seconds of blanching, your circulation is likely fine. Be sure to check with your doctor for any problems or questions with your self-exam.
So, as cold weather continues, you can know if your cold feet represent a significant circulatory problem or if other causes need to be evaluated. You may just have a “warm heart.”
Enjoy good health.
Dr. Mark