Health Matters: Stopping frostbite before it starts

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January is Vermont's coldest month. Here in Brattleboro, January's average temperature is 22 degrees Fahrenheit. It is not as cold as northern parts of the state, like Newport, where the mean temperature hovers at 13.8 degrees, but chilly enough to be concerned about frostbite and other cold-related injuries.

Frostbite is very similar to a burn in that it is a condition caused by damage to tissue. When skin is exposed to extremely cold conditions, ice crystals form around the cells and blood vessels narrow, leaving the tissue to die without oxygen.

Temperature isn't the only contributor. Wind chill factor and moisture also play a part. Nordic and alpine skiers, snowboarders, hunters, snowshoers, or kids just playing in the snow are at risk for frostbite from a frigid gust if their clothes are wet, even if the air temperature hovers around or is just above freezing.

Both alcohol and tobacco can make you more susceptible to frostbite. These drugs have a negative impact on your circulatory system, reducing the amount of blood flowing to areas of your body, especially extremities like your hands and feet. You should also pay attention to how your clothing and boots fit, as tightness or cramping of body parts can also contribute to loss of circulation.

The longer a person ignores a frostbite injury, the more serious it will become. The mildest form, called frostnip, typically occurs on parts of the body that aren't covered by winter clothes, like the nose, ears, cheeks, or hands. Patches of discolored skin will appear and the area will be itchy before becoming numb. The sooner you get into a warm indoor area and out of any wet clothing the better.

Exposure over an extended period of time can lead to second degree frostbite, which is characterized by blisters forming on the affected area a day or so after the skin freezes. The blisters will look black and hardened, but they will go away in a few weeks if treated properly. You may, however, lose all feeling in the affected area permanently.

Third degree frostbite, also known as deep frostbite, turns the affected skin hard and waxy and also causes blisters that are more purplish in color because of the amount of blood built up inside them. This level of frostbite can cause such severe tissue damage that some cases have required amputation of fingers or toes to prevent gangrene from spreading.

The average person will not experience deep frostbite unless they are outside in extreme circumstances and conditions. Warm clothing is protection enough in most instances, especially wool socks, heavy boots, and heavy gloves or mittens. A hat is also critical as more heat escapes from the head than from any other part of the body.

Itching, tingling, or discolored skin patches are signs to get indoors where it's warm and dry. You can run the affected area under warm water, but not too hot or the extreme temperature change will damage the tissue. Also, do not stand too close to heat sources like radiators or wood stoves in an attempt to thaw out. You can drink warm, non-alcoholic, non-caffeinated beverages to balance out your internal temperature, and elevating hands or feet can help reduce swelling. One of the best treatments is another person's body heat. Have someone hold the frostbitten area between their hands for several minutes. But have them do it gently; do not massage or squeeze.

Call your medical provider or visit the hospital if numbness continues or blisters start to form. It is difficult to tell how severe a case of frostbite actually is during the early stages, but the sooner your doctor can start doing tests and monitoring the affected area the better your chances are for a full recovery. A lot of us live in Vermont because we enjoy cold weather outdoor activities. Make sure you and your loved ones use good judgment when the weather gets severe so you can stay healthy and active.

Amanda Hepler, MD is a board-certified family practice physician at Brattleboro Family Medicine, a department of Brattleboro Memorial Hospital. For more information, call 802-251-8455 or visit bmhvt.org.

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