Raynaud Phenomenon

What is Raynaud phenomenon?

Raynaud phenomenon is a condition that affects your blood vessels (the tubes that your blood flows through). It causes your blood vessels to narrow, which decreases blood flow. This is called a Raynaud episode or "attack." The attacks usually affect your fingers and toes, causing them to become cold and numb. They may also change color, usually to white or blue. These attacks happen in response to cold temperatures or stress.

Raynaud phenomenon may also be called Raynaud disease or Raynaud syndrome.

What are the types of Raynaud phenomenon?

There are two types of Raynaud phenomenon:

• Primary Raynaud phenomenon is the more common type. Its cause is unknown.
• Secondary Raynaud phenomenon is usually caused by another disease or problem, such as lupus or scleroderma. Other causes may be exposure to cold or certain chemicals. The type can be more serious than the primary type.

What causes Raynaud phenomenon?

Researchers don't know exactly why some people develop Raynaud phenomenon. But they do understand how the attacks happen. When you are exposed to cold, your body tries to slow the loss of heat and maintain its temperature. To do this, the blood vessels in the top layer of your skin constrict (narrow). This moves blood from those vessels near the surface to vessels deeper in the body. But when you have Raynaud phenomenon, the blood vessels in your hands and feet react to cold or stress by narrowing quickly. They also stay narrowed for a long time.

Who is more likely to develop Raynaud phenomenon?

Anyone can develop Raynaud phenomenon, but some people are more likely to develop it:

• Primary Raynaud phenomenon has been linked to:
  • Your sex. Women get it more often than men.
  • Your age. It usually develops in people younger than age 30. It often starts in the teenage years.
  • A family history of Raynaud phenomenon. You are more likely to develop Raynaud phenomenon if you have a family member who has it.
• Secondary Raynaud phenomenon has been linked to:
  • Certain diseases. These include lupus, scleroderma, rheumatoid arthritis (RA), carpal tunnel syndrome, and connective tissue disorders.
  • Certain medicines. Medicines that treat high blood pressure, migraines, and attention deficit hyperactivity disorder (ADHD) may cause similar symptoms to Raynaud phenomenon or make your symptoms worse.
  • Work-related exposures, such as repeated use of vibrating machinery (such as a jackhammer), or exposure to cold or certain chemicals.

What are the symptoms of Raynaud phenomenon?

Raynaud attacks most often happen when you get cold, for example when you grab something cold from the freezer or go into an air-conditioned building on a warm day. Attacks usually affect your fingers and toes. But sometimes they can affect other parts of your body, such as your ears, nose, lips, or nipples.

An attack causes the skin to become cold and numb. Your skin may also turn white or blue due to a lack of oxygen. As the blood flow returns, your skin may tingle, throb, or turn red. An attack may last a few minutes or a few hours. If you have darker skin, you may not be able to easily see the skin color changes.

For many people, especially those with the primary type, the symptoms are mild. People with the secondary type often have more severe symptoms. They may develop skin ulcers (open sores caused by poor blood flow) or skin infections.

How is Raynaud phenomenon diagnosed?

There is no specific test to diagnose Raynaud phenomenon. To find out if you have it, your health care provider:

• Will take your medical history and ask about your symptoms.
• Will do a physical exam.
• May order blood and other lab tests to check for other conditions which could be causing your symptoms and/or to help decide which type of Raynaud phenomenon you have.

What are the treatments for Raynaud phenomenon?

Most people with Raynaud phenomenon can keep their symptoms under control by avoiding getting cold. But if this is not enough, medicines and, in some cases, surgical procedures can help.

Secondary Raynaud phenomenon is more likely to be serious and to need more treatments. It's also important to treat the condition or problem that is causing your Raynaud phenomenon.

You may need to see a specialist such as a rheumatologist, a doctor who treats diseases of the joints, muscles, and bones.

Can Raynaud phenomenon be prevented?

Raynaud phenomenon cannot be prevented, but you can help prevent attacks and manage your symptoms by:

• Placing your hands or feet in a warm place when you have an attack. This could mean putting them under warm (not hot) water or under a heating pad.
• Keeping your body, especially your hands and feet, warm in cold weather.
• Avoiding triggers, such as certain medicines and stress.
• Quitting smoking (or not starting smoking).
• Managing stress.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Rural Health Concerns

Around 15% of people in the United States live in rural areas. There are many different reasons why you might choose to live in a rural community. You may want a lower cost of living and a slower pace of life. You may enjoy having access to big, open spaces for recreation. Rural areas are less crowded and can offer more privacy. You may choose a rural area so that you can live near your family and friends.

But there are also challenges to living in a rural area, including when it comes to taking care of your health. Compared to urban areas, rural communities tend to have:

• Higher poverty rates.
• A higher percentage of older adults, who are more likely to have chronic health problems.
• More residents without health insurance.
• Less access to health care. For example, clinics and hospitals may be far away.
• Higher rates of certain substance use, such as cigarette smoking and opioid and methamphetamine misuse.
• Higher rates of chronic health problems such as high blood pressure and obesity.
• More exposure to environmental hazards, such as chemicals used for farming.

There are solutions to deal with these problems. A few examples include:

• Clinics offering telehealth to provide care for people who live far away from specialists or can't easily get to their providers' offices.
• Local public health agencies working with their communities to promote healthy living. They can provide wellness and exercise classes and start a farmer's market.
• Local governments adding bike lanes and trails to encourage people to bike and walk.
• Rural schools can offer counseling and mental health services for their students.

Stillbirth

What is a stillbirth?

If you lose a fetus at or after the 20th week of pregnancy, it's called a stillbirth. A stillbirth can occur before or during delivery and may be considered as:

• Early. The loss of a fetus between 20 and 27 weeks of pregnancy.
• Late. The loss of a fetus between 28 and 36 weeks of pregnancy.
• Term. The loss of a fetus at 37 or more weeks of pregnancy.

What are the risk factors for stillbirth?

Stillbirth can happen in any pregnancy. Some factors may increase the chance that one can occur. Risk factors can include if you:

• Are age 35 years or older
• Are of low socioeconomic status
• Smoke during pregnancy
• Have certain medical conditions, such as diabetes or high blood pressure
• Are a non-Hispanic Black woman
• Previously had a stillbirth
• Are pregnant with more than one baby (twins or triplets)

What are the possible causes of stillbirth?

In many cases, the cause remains unknown. Some causes may be preventable, but most are not.

Causes for a stillbirth may include:

Problems with the placenta, the organ that carries oxygen and nutrients to the fetus

Genetic problems with the fetus

Fetal infections

Other physical problems in the fetus

Problems with the umbilical cord during labor and delivery

How is a stillbirth diagnosed?

Before delivery, the only way to diagnose a stillbirth is to check if the fetus's heart is beating. Your health care provider may use an ultrasound to look for the fetal heartbeat.

During your pregnancy, your provider may recommend keeping track of fetal movements. However, if you don't notice movement, it doesn't always mean a stillbirth occurred. Sometimes, especially if it's your first pregnancy, it might be difficult to notice movement. If you're pregnant and something seems unusual or is worrying you, talk to your provider.

After labor and delivery, your provider will check the baby for signs of life. These can include breathing, heartbeat, voluntary movements, and pulsations in the umbilical cord. If one or more signs of life are not present, then life-saving measures are taken. If these measures are unsuccessful, a stillbirth may be diagnosed.

How do health care providers manage a stillbirth?

Care after a stillbirth depends on when it occurs. If it happens before delivery, your provider may induce (start) labor or use surgery to deliver the fetus (cesarean delivery). If it happens during labor and delivery, the placenta will still need to be removed or delivered.

No matter when it occurs, losing a pregnancy can be difficult. Counseling may help you cope with your grief. Later, if you decide to try to get pregnant again, work closely with your provider to understand any risks. Many women who have a stillbirth go on to have healthy babies.

NIH: National Institute of Child Health and Human Development

Teen Health

As a teenager, you go through many changes. Your body is on its way to becoming its adult size. You may notice that you can't fit into your old shoes or that your jeans are now 3 inches too short. Along with these changes, you are probably becoming more independent and making more of your own choices. Some of the biggest choices you face are about your health.

Healthy habits, including eating a healthy diet and being physically active, can help you feel good, look good, and do your best in school, work, or sports. They might also prevent diseases such as diabetes, high blood pressure, heart disease, osteoporosis, stroke, and some cancers when you are older.

Teenage Pregnancy

Most teenage girls don't plan to get pregnant, but many do. Teen pregnancies carry extra health risks to both the mother and the baby. Often, teens don't get prenatal care soon enough, which can lead to problems later on. They have a higher risk for pregnancy-related high blood pressure and its complications. Risks for the baby include premature birth and a low birth weight.

If you're a pregnant teen, you can help yourself and your baby by:

• Getting regular prenatal care
• Taking your prenatal vitamins for your health and to prevent some birth defects
• Avoiding smoking, alcohol, and drugs
• Using a condom, if you are having sex, to prevent sexually transmitted infections (STIs) that could hurt your baby. If you or your partner is allergic to latex, you can use polyurethane condoms.