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. This 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.

Steatotic Liver Disease

What is steatotic liver disease?

Your liver is the largest organ inside your body. It helps you digest food, store energy, and remove harmful substances (toxins). Steatotic liver disease, formerly called fatty liver disease, happens when too much fat builds up in your liver. It's typical to have some fat in your liver cells, but too much can be a problem.

There are two main types of steatotic liver disease:

• Metabolic dysfunction-associated steatotic liver disease (MASLD)
• Alcohol-associated liver disease (ALD)

What is metabolic dysfunction-associated steatotic liver disease (MASLD)?

MASLD is a type of steatotic liver disease that is not caused by heavy alcohol use. It used to be called nonalcoholic fatty liver disease. There are two main forms:

• Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver damage. This form usually does not get bad enough to cause liver damage or complications.
• Metabolic dysfunction-associated steatohepatitis, or MASH (previously called nonalcoholic steatohepatitis or NASH), is when MASLD gets worse. In addition to fat in your liver, MASH may cause inflammation and liver damage. This can lead to fibrosis, or scarring, of the liver. This scarring sometimes leads to cirrhosis or liver cancer.

What is alcohol-associated liver disease (ALD)?

ALD is caused by heavy alcohol use. It used to be called alcoholic fatty liver disease, or alcoholic steatohepatitis.

Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can create harmful substances. These substances can damage liver cells, cause inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. ALD is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

Who is more likely to develop steatotic liver disease?

The cause of MASLD is unknown, but it is more common in people who:

• Have type 2 diabetes and prediabetes
• Have obesity
• Are middle aged or older (although children can also get it)
• Have high cholesterol or triglycerides
• Have high blood pressure
• Take certain medicines, such as corticosteroids and some cancer medicines
• Have certain metabolic disorders, including metabolic syndrome
• Have rapid weight loss
• Have certain infections, such as hepatitis C
• Have been exposed to certain harmful substances

MASLD is the most common chronic (long-term) liver disease due to increasing rates of obesity, type 2 diabetes, and high cholesterol.

ALD only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for people who drink heavily and are women, have obesity, or have certain gene changes (known as variants or mutations).

What are the symptoms of steatotic liver disease?

Both MASLD and ALD usually have few or no symptoms. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen (belly).

How is steatotic liver disease diagnosed?

Because there are often no symptoms, it's not easy to find steatotic liver disease. Your health care provider may suspect you have it if you have abnormal results on liver tests. To make a diagnosis, your provider may use:

• Your medical history. This may include asking about your alcohol use and any medicines you take.
• A physical exam. This may include checking your height and weight. Your provider may also check your body for signs of liver disease such as an enlarged liver or jaundice, a condition that causes your skin and whites of your eyes to turn yellow.
• Blood tests. These may include liver function tests and blood count tests.
• Imaging tests. These tests may be used to check for fat in the liver and for fibrosis.
• A biopsy. In some cases, a biopsy may be done to confirm the diagnosis and check for liver damage.

What are the treatments for steatotic liver disease?

The first step in treating MASLD is usually weight loss. Losing weight can reduce fat in the liver, inflammation, and fibrosis. If your provider thinks that a certain medicine is the cause of your MASLD, they may tell you to stop or switch medicines. But don't stop taking any medicines unless your provider tells you to.

More studies are needed to see whether certain medicines are safe and effective to treat MASLD. Currently, no medicines are approved for treatment.

The most important part of treating ALD is to stop drinking alcohol. If you need help, you may benefit from counseling, a recovery program, or medicines that reduce cravings or make you feel sick if you drink alcohol.

Both ALD and one type of MASLD can lead to cirrhosis. Health problems caused by cirrhosis may be treated with medicines, surgery, and other medical procedures. If cirrhosis leads to liver failure, you may need a liver transplant.

What are some lifestyle changes that can help with steatotic liver disease?

If you have any type of steatotic liver disease, there are some lifestyle changes that can help:

• Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains.
• Talk with your provider about vaccinations. If you have chronic liver disease you are more likely to get infections. Your provider may recommend vaccinations for hepatitis A and B, the flu and pneumococcal disease.
• Get regular exercise, which can help you lose weight and reduce fat in the liver.

Check with your provider before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some supplements or herbal remedies can damage the liver.

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.