Dr. Kevin Most: Cold Exposure and Flu
Happy New Year !! We want everyone to have a safe and healthy 2018. What a way to start the year, we have very dangerous temperatures and influenza out breaks across the United States. The combo is not the way to start the year but the impact of the cold weather may help minimize the spread of influenza. It is so cold out that many are staying in place and avoiding socializing or shopping, two areas where influenza is spread. So the cold weather we are complaining about may actually be good for our health.
There has been lots of talk that this years vaccine is not as effective as we had hoped. While that is true for the current strain circulating it is not a reason to not get a flu shot. The flu shot will give you some protection and we also know we will have more than one strain hit us this year. So if you have not yet gotten a flu shot now is a good time as your chances of being exposed to influenza are only going to increase over the next month.
The temperatures for the past few days and next few days are beyond uncomfortable they are also very dangerous, so lets take just a few minutes to remind us what to do from a prevention view as well as how to treat skin that has been affected.
The most important thing is to minimize your time outside. Do not go out unless you have to. With windchills in the minus 25-30 range it only takes 10-20 minutes of exposure to cause frostbite on exposed skin.
Let’s first discuss prevention for those who need to be outside. The walk from a parking garage or the train may not seem like a big deal but for the next few days it is. First, put fashion aside. Those of you who walk from the train to the office, the walk is not your usual walk. For shoes do not wear gym shoes, I know many of you wear gym shoes from the train and change into dress shoes at the office, well tomorrow wear boots. They may be clunky and not fashionable but they are safe. Gym shoes are now built to breathe and allow heat to escape as they are built for use in warm weather. This is the opposite of what you want, toes are one area that has a high incidence of frost bite as it is the furthest point from the heart. Boots will keep your feet warm and more importantly dry.
Don’t work about how your hair will look ! Wear a hat that covers your ears. Ears are designed to hear and thus are exposed to air from both sides, they also have poor blood supply and will be frostbitten in a short time if left exposed. A short time with these temperatures may be 5-10 minutes. A hat not only covers the ear but also holds it close to the scalp which has great blood supply for warmth. Use a scarf to cover your face, the tip of the exposed nose can also be frostbitten quickly. The thought that we lose most of our heat from our head is not true, it was based on a study done in the 50’s on soldiers in frigid temperatures. The flaw was the head was the only part of the body left uncovered so of course it lost more heat. This old wives tail has allowed all of our parents to tell us to put a hat on or we will catch cold.
If you need to be out for an extended period of time or work outside, understanding layering is important. A few tips, first, the layer closest to your skin should not be a cotton based material. It should be a polyester material and tight to your skin. Cotton retains water and will actually make you skin colder, so wear a polyester layer. This layer will wick moisture away from skin. The next layer should be a good wool sweater. Wool helps retain heat and keeping the bodies heat close is important. Next layer should be a wind resistant layer, this will block any heat from leaving as well as blocking any incoming cold. Your outside layer should be a good winter coat, again, function over fashion. That great looking leather coat is not what you want now, you want a bulky down coat. Wearing a thin leather coat is not a good idea.
I know we always discuss gloves versus mittens and with weather like this, mittens win hands down. The concept with mittens is that the fingers can stay together and keep each other warm. How many times have you worn gloves and it is cold and you pull the glove almost off so that you can make a fist with your fingers due to cold. There are some great mittens out there, I am a big fan of “Hand Out” mittens. This is a US company and their design has a zipper on the back which allows you to keep the mitten on and free up a finger or two if you need to answer the phone or start a car. Again, fingers, ears, toes and tip of the nose is the area we are most concerned about.
A big concern is also the individual who goes out for a “quick cigarette” we have all seen these individuals standing outside in cold weather, often without even a coat on. The temperatures and wind chills we will be seeing should make you think twice about that. Frostbite can occur in the amount of time it takes to smoke that cigarette. In fact smoking actually makes you more prone to frostbite, as does alcohol
Now, why do we get frostbite? The body is going to do everything it can to keep the vital organs warm, so when it gets really cold the body sends less blood to the extremities and increases the blood flow to your brain, kidneys and lungs. It will work to keep the vital organs safe and keep you alive.
Now for anyone who is unable to dress properly or is caught in a bad situation, what do you look for. Frost nip is the early sign of cold exposure, your skin may look white and start to tingle, itch or burn a little. This is a sign to get inside. Skin with frostbite will look greyish, feels hard or waxy and is very cold. What is occurring is the water in our cells is frozen and damage is occurring.
Treatment of frostbite is very important as our goal is to not cause more damage and minimize the damage that has already occurred. First the most important and most common thing not to do. Do not rub your hand together to warm hands that may be frostbitten. It is usually the first thing we do when we come in from the cold, reflex is to rub your hands and cause friction and heat. This can cause major damage with frost bitten hands as the tissue is frozen and the rubbing of the hands causes damage to cells and nerves. Instead run the hands over lukewarm water or place your feet in lukewarm water. If possible have someone set the temperature of the water for you. The reasoning for this is you will have no feeling in your hands and we do not want you to place frozen fingers in water that is too hot. If no one is with you, test the temperature with your elbow, it should be warm but not hot. Doing this allows the fingers to rewarm slowly and minimizes the damage to the fingers. Do not use direct heat like ovens or fireplaces as these may cause burning tender skin. The sensation and color should return after a few minutes, if it does not, you should seek medical attention as long as you can get there safely and dressed properly. If there is a chance that your affected skin will be exposed again to cold, stay in place, as a second frostbite can be devastating to skin.
Taking some advil soon will also help as the inflammation will cause this process to be painful. Long term effects of frostbite include sensitive skin especially to cold in the future. Permanent loss of sensation in the area affected. Short term concerns are the possibility of infection and death of some areas of the skin.
Stay warm, dress smart and know what to look for and how to treat frostbite safely.