Two possible causes of cold toes
DEAR DR. ROACH: I am 79 years old. I have lupus, and currently my main focus is the lungs (COPD, asthma), which is under control. However, no one seems to be able to tell me what to do to prevent my toes from feeling like they have been soaking in ice. Even when I'm sleeping, they are so painful. I wear warm socks day and night. I have asked the nephrologist, rheumatologist and pulmonologist, and no one seems to have an answer. -- M.M.R.
ANSWER: Although many people, especially older people, may have cold-feeling toes, your medical condition and age present two particular possibilities.
The first is peripheral artery disease. All of the body's arteries -- from the aorta, the main arterial blood vessel, down through to the toes -- can be blocked by cholesterol and calcium plaques. This condition is called atherosclerosis. It is the same condition that causes heart attacks and strokes when the blockages are in the arteries supplying the heart and brain, respectively. Symptoms of peripheral artery disease also include pain or cramping in the leg with exercise. Diagnosis is important, because treatment not only improves symptoms, but it can also help prevent a heart attack or stroke. Testing is straightforward, with a Doppler ultrasound of the blood vessels of the legs. I'd recommend this test to a person with your symptoms and history.
The second is Raynaud's phenomenon. Most people know that Raynaud's can cause color change and a painful coldness of the hands when exposed to even very mild cold air, but the toes and feet may be affected as well. Occasionally, the feet alone are affected. The color change won't be noticeable if you are wearing your warm socks and shoes.
Lupus is a common condition associated with Raynaud's, but many people don't know that inflammatory rheumatological diseases like lupus or rheumatoid arthritis increase the risk of atherosclerosis as well. Doctors must have an awareness of the increased risk and stand ready to test for and treat heart disease in people with lupus.
DEAR DR. ROACH: My wife was recently diagnosed with Huntington's disease. She is 67 and has had noticeable symptoms for about a year. Can you recommend any prescriptions to help overcome this disease? -- R.H.
ANSWER: I'm very sorry, but there are no treatments to cure or even slow down the progression of Huntington's disease, a degenerative neurological disorder that triggers abnormal movements, psychiatric problems and dementia. It is caused by an inheritable abnormality in the huntingtin gene, and thus runs in families, so a family history is critical in considering the diagnosis.
Although there are no treatments to slow or stop the disease, there are treatments for the symptoms. The abnormal movements -- called chorea, from the Greek word for "dancing" -- can be treated with medications such as tetrabenazine. The psychiatric problems, especially depression and abnormal thinking, may also be treated. Unfortunately, there are no clearly effective treatments for the dementia associated with Huntington's disease. The progression of each of these symptoms is variable, and may worsen over years or decades.
The diagnosis of Huntington's disease brings incredible challenges to the patient and caregivers, and having an experienced team to help is critical. Genetic counseling is important, especially if your wife has siblings or children. You can read much more about this condition at the Huntington's Disease Society of America at https://hdsa.org/.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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