Dr. Kevin Most: Preparing For the Bitter Cold
What a crazy year for weather, snow before Halloween and 63 degrees on Christmas. I think Mother Nature got those switched up as no kid wants a White Halloween and skates and sleds are not that much fun when the temp is in the 60’s. One thing we can always agree on we will get some really cold weather in Chicago and this year is no different, with the exception that it snuck up on us. Last week we had temps flirting with 40 degrees, now we are looking at wind chills approaching 20 below zero, before going back to near 40 a few days later. Although it seems like a quick blast of cold air, we all remember the polar vortex from last year. This will not be our last exposure to cold air in Chicago.
When we have wind chills in the 20 below range it only takes 15-20 minutes in some individuals to have frostbite on exposed skin.
I thought we would take a few minutes and review cold weather and how we need to not only be prepared for the cold but also what to do to treat cold weather injuries.
My first recommendation is Function over Fashion, what I mean here is wear appropriate clothes regardless of how they look. Clunky warm boots and hats over your ears may not be fashionable, but thin leather shoes and exposed ears increase your chance of cold related injuries dramatically. Snow Sneakers are probably the best foot wear for these days when we see single digit temperatures, they are superior to the gym shoes many wear from the train to the office. Gym shoes are made to breathe and are not waterproof, so the gym shoes allow heat to escape and water to get in, the exact opposite of what we want when we see these cold temps. Boots or snow sneakers will keep feet warm and dry.
Individuals who know they will be outside for a long period of time need to be prepared and dressed appropriately. If you are outside and moving around a lot, the primary layer of polyester is key as activity can cause sweating and having a wet layer as your primary layer may increase your chance of temperature related problems. Individual that will be standing in a specific area should consider adding a layer of insulation, even something as simple as a carpet piece, cardboard box or newspaper will protect your feet from a comfort as well as temperature view versus standing on ground that is below zero.
Dress in layers, we have all heard this numerous times in the past. Layers allow us to keep trapped warm air around us and act as insulation. One interesting point that many may not know or understand is the concept of the base layer being a polyester material tight to your skin versus the traditional cotton shirt. Cotton actually retains water so it will actually make your skin colder. Polyester on the other hand wicks moisture away from the skin. The next layer should be a wool product, this layer will retain heat. The outer layer should be wind resistant , this will hold heat in as well as protect cold air from coming thru. Forget about the fashionable leather jacket and go with the bulky down jacket when concerned about cold exposure.
So what about the old wives tail that you lose most of your heat from your head. Well it is interesting, this statement came from a study done on soldiers in the 1950’s who were in frigid temperatures. The statement was completely true for the study, the problem was that for the study that was the only part of the body left exposed or uncovered so of course it was going to lose more heat. The comment from our Mothers, “Put a hat on or you will catch a cold” This is a great threat but has no science behind it, viruses do not come thru our hair or skull, we get colds because we are exposed to a virus that gets into our respiratory system, often by us touching our face and moving the virus to our nose and mouth. If our Mothers were right on that one, we would all get Hats in place of Flu shots each winter.
That being said, let’s not discount the importance of a hat and scarf. Two areas that are prone to the highest chance of frostbite are the ears and tip of our nose. The reasons are poor blood flow and minimal fat to protect these areas. The hat may not protect you from a cold but it will certainly decrease your chance of frostbite.
Those of you who are loyal listeners will know that I am a big fan of mittens over gloves. The importance of keeping your hands warm cannot be underestimated and wearing mittens allows for each finger to help warm the other. Gloves unfortunately isolate the fingers and increase our chance of frostbite. I am a big fan of a company called “Hands Out” this is a well made mitten that is waterproof, well insulated and has a simple zipper that still allows for access to your cell phone, keys etc for a quick short time without needing to take the mitten off. Mittens allow you to make a fist and keep your fingers warm.
What exactly is Frostbite? Believe it or not the human body is composed of water more than anything else. Skin contains and is made up of 64% water. The cells in skin have water in them and as long as it is water the hand, skin and nerves work well. However when the water in those cells is allowed to freeze damage is done to the cells which can cause major damage to nerves, function as well as loss of the finger in some cases.
Although frostbite is a risk for all of us, there are groups of patients that this is more concerning for developing. As we age our circulation is not as robust and our nerves in our hands and feet are not at the level they were in younger years. Couple that with a loss in fat in our skin and we set up seniors at a much higher risk for frostbite. So having seniors dress appropriately for the weather is very important. Another good idea is shoes with traction to minimize the risk of a fall in icy conditions.
Smokers and diabetics are also at higher risk for frostbite regardless of their age as we know that their vascular and neuro sensation systems are compromised. The senior who smokes and has diabetes is obviously at very high risk. Individuals that drink excess alcohol are also at risk as their sensation and judgement are often impaired.
Now for anyone who is unable to dress properly or is caught in a bad situation, what do you look for and what should you do and what not to do. The first condition is Frost Nip, we all have had this condition. The symptoms and signs are the skin may get a little white and you feel tingling, itching or burning. This is a sign to get inside to a warm area and the condition resolves with simply getting into a warm environment/ Skin with Frostbite will see their skin get greyish and the skin will feel hard or waxy and is cold, when this is occurring the water in our skin cells is actually freezing. This is causing damage.
The treatment for Frostbite is very important, the condition causes enough problems and we don’t want our treatment to do more harm. Below is a list of simple things to be aware of.
1.) Our initial response to cold hands is to rub our hands together to warm them up, this is one of the worst things you can do as that friction causes damage to the frozen cells
2.) Slow warming by placing your hands under warm running water is great, however you must have someone who is not impacted to test the temperature of the water as the individual with frostbite will not be able to feel the temperature of the water so that can do more harm with hot water
3.) Do not use direct heat like a stove or oven to warm the hands, again the loss of sensation may end up with the patient burning their skin
4.) If you do not have a warm area to get to, placing your hands under your arms or in your groin can be helpful as these areas have high blood flow thru a narrow area.
5.) Having the patient take advil is also a good idea as these areas will become quite inflamed and taking an antiinflamatory will be helpful.
6.) If a patient has frostbite, be very careful moving them to another site, you should be sure they will be protected from another exposure. Frostbite on top of frostbite can be devastating to and individual, so holding them in a warm environment is important until you can safely move them with good protection.
7.) If the individual has wet clothing or wet shoes, these should be removed gently and warming should again be with warm water for feet and dry clothes
Individuals who go out for that “quick cigarette” need to be aware and dress appropriately for this activity. These are individuals that are already at risk for frostbite even at short time frames as cigarettes cause spasm in our blood vessels so we already see a decrease in blood flow to the fingers, couple that with the concern that smokers rarely wear gloves and the concern for frostbite increases.
Hypothermia is a much more concerning condition, simply put this is a condition where the body is losing body temperature faster than it can maintain temperature. These are medical emergencies and the patient needs to be warmed quickly
Stay warm, dress smart, know what to look for and know how to treat in a safe environment.
We have dodged the snow storms so far this winter with some missing to the north and some to the south, but we all know we are going to get hit with a couple good storms. The health related illnesses with snow should be a point of awareness as we have injuries and unfortunately deaths each year from shoveling snow.
First the act of shoveling snow is bad for a few reasons. We use terrible body mechanics when we shovel with a large weight held out in front of our body as we bend and throw. This action done hundreds of times can give us shoulder pain, back pain, shortness of breath and chest pain. The bad thing is that the same symptoms of muscle soreness from shoveling, mimic those of a heart attack. We see many heart attacks as the burden of energy needed to shovel can be as bad or worse than a stress test. 15 minutes of shoveling snow is considered moderate physical activity.
Patients should talk to their doctor about shoveling snow and come up with a plan, of no shoveling or limited shoveling. If they feel pain or SOB you should stop immediately and go inside. If symptoms persist or begin again with shoveling you should see a doctor immediately. If chest pressure or Shortness of breath continues you should seek medical attention immediately. Best thing you can do is pay the young kid next door to shovel for you.
People may laugh but here is a fun fact for you. A driveway 16 ft. wide by 30 feet long, fairly common size. One foot of wet snow. When cleared you would have moved 4 tons of snow. You wonder why it can cause a heart attack.