Topics Covered In This Episode:
- The “Screaming Barfies” – yes, it’s a real thing.
- Raynaud’s Phenomenon
- Non-temperature related causes of Raynaud’s Phenomenon
- Primary and Secondary Raynaud’s Phenomenon
- Increased risks for women
- Treating and preventing the effects of Raynaud’s Phenomenon and other cold-related injuries
Corrine Malcolm has been a CTS Coach for more than 5 years and holds a B.S. in Health and Human Performance. She’s a professional ultrarunner, a top ten Western States finisher, and a former U.S. Biathlon National Team member.
Have questions you want Corrine to cover in a podcast? Email her at firstname.lastname@example.org.
- Winter Running Tips for Training in the Cold
- Can Training in Extreme Cold Permanently Hurt Your Lungs?
- Layering for Ultrarunning Training in Cold Weather
This Week’s Episode Was Fueled By The Feed
Please note that this is an automated transcription and may contain errors. Please refer to the episode audio for clarification.
Corrine Malcolm (00:00):
I’m Coach Corrine Malcolm. And I’m back. One more time to take us through another scientific deep dive. You know, my bio 1 0 1, going back to school, something a little bit exciting for everyone. So today we’re gonna dig into something I personally struggle with. I’m known to have very cold hands and very cold feet. And as we approach the winter months here in the Northern hemisphere, things about cold hands and cold feet start to come to top of mind when it comes to getting out on the bike or getting out for a long run, or a Nordic ski, whatever you might be doing as we approach November and December specifically, you know, thinking more about cold hands and cold feet, this includes things like Raynaud’s phenomenon, other cold injuries, and my personal favorite, the Screaming Barfies, All things I’ll get into a little bit here today.
I’m gonna focus a lot of my time on Raynaud’s because a lot of people have what is known as Raynaud’s phenomenon or something that’s kind of adjacent to Raynaud’s. We can learn a lot from both, from both of those things. Specifically kind of some of the, the science we understand now about how Raynaud’s happens and how it occurs. So what is Raynaud’s in general? So, Raynaud’s in general is a condition named for Maurice Raynaud who first described this vascular issue back in 1862. So it’s been around in people’s minds in the medical text for quite some time, but it did take several decades, something like 70 more years to really understand the issue, understand the ideology of the issue, kind of the medical underpinnings understand that was an issue with circulation specifically. And, you know, what, what could we do to fix it?
How could, why would it happen, et cetera. So it was described more clearly as an individual issue in which there was a problem with circulation. And it generally happened when there was an exposure to moderate cold, but sometimes it seemed to happen seemingly without reason. I e at warmer temps. And I personally remember running in high school with a gal who had to wear mittens at not insanely cold fall meets because she had Raynaud’s, because she had this, this constriction issue in her hands. So people that are experiencing a renos episode, you’ll oftentimes see their, their fingers become bloodless and numb, and they often take on like a whiteish yellow hue. When I have something similar to Raynaud’s post exercise, when it’s damp and cold, not necessarily super cold, but it has to be damp. I call them my dead hands, they don’t work very well, and that’s because blood flow isn’t occurring at that site due to vasoconstriction, which we’ll kind of dive into a little bit more here in a second. It, this isn’t super uncommon, in fact particularly in women, it’s pretty common where one in five women are likely to have experiences with Raynaud’s. Over the decades, again, kind of the underpinnings and the criteria for diagnosis became more clear and they were able to
Corrine Malcolm (02:59):
Describe it visually by as either biphasic or triassic changes in your skin color. Oftentimes this is white to blue and sometimes this is oftentimes white to blue and then to deep red. And this is of the fingers and it generally does not affect the thumb. And you’ll see, you know, a clear delineation kind of across where the fingers are gonna meet the rest of your palm. It’s very, it’s very striking, I would say people and people who have true Raynaud’s. That white pale color is due to the initial vasospasm or vasoconstriction, which again is a narrowing of the blood vessels, and specifically in this case, the narrowing of the blood vessels that are entering your fingers. The blue and dark coloring is a lack of oxygen to that tissue, the things that make us nice and pink. And for individuals who experience triassic color changes, or again, that shift to that, ultimately that red color is generally when blood flow is returning to the digits.
And it can be accompanied by pain and tingling, and that can sound all rather grim, right? We’re talking about a lack of blood flow to an area. We’re talking about a lack of oxygen to an area. But broadly speaking, vasoconstriction is actually completely normal, particularly when it comes to how our body’s thermoregulate. You have, you experience vasoconstriction and vasodilation most days, particularly if you’re exercising. And then there are certain medications that also create vasodilation or vasoconstriction. So when you get cold and your core body temperature begins to drop your extremities and other peripheral tissues. So again, it’s gonna be your hands, your feet, your nose, your ears the vessels there will vasoconstrict. And what this does is it keeps your blood closer to your core. It keeps that, that source of warmth, your warm blood closer to your core, protecting your core body temperature or allowing to keep your bo core body temperature closer to normal.
Obviously, if you’re exposed to that over the long term your core body temperature will continue to drop. You can’t vasoconstrict it away completely. And then when you get warm, for example, in the summer months, or if you’re like me and you’re riding a bike trainer that’s behind me you get really, really warm. Your vessels vaso dilate or expand, and this is to send blood to the skin surface. And it’s literally pushing heat from your body to your skin surface to push it out into the environment around you. So basically dissipating heat off of your system. We’ve talked that about that a little bit when it comes to cooling strategies, right? That’s one of the reasons why we sweat and why we send blood to our core or blood from our core to our skin just to help with that thermal regulation.
Vasoconstriction, though that takes place in rayons is abnormal, and it’s abnormal in the sense that it can happen at considerably warmer temperatures. And sometimes it’s triggered by things that are not temperature related. I e stress, you can be sitting in a classroom, maybe you’re giving an oral report or you’re presenting to your team for the day, et cetera. Stress can also trigger like this vaso construction, this Raynaud’s phenomenon. And so medically it’s thought of as a overreaction or a hypersensitivity, not that dissimilar from allergies. Allergies are an overreaction to something that normally shouldn’t cause your body to, to have a response. There are two main types of Raynaud’s phenomenon. There’s primary and secondary Raynaud’s phenomenon. And primary, primary Raynaud’s phenomenon is more common and it’s actually completely benign which is great. We love that, We love that it’s not, there isn’t some underlying medical condition that we have to be worried about.
It’s just something that happens. A secondary Raynaud’s phenomenon is generally related to an underlying condition and sometimes that underlying condition can be more serious. And if you’re sitting here listening to me thinking, I, I mean I think I have Raynaud’s, I experienced this thing, Oh my goodness, like do I have an underlying condition? Don’t worry. 80 to 90% of individuals who experience Raynaud’s phenomenon have primary Raynaud’s . And again, that’s completely benign, but this is a good place to say, I am not a physician while married to one, I am not a physician. And if you have concerns about Raynaud’s or anything else, that is something that you should bring up with your primary care provider and they’ll help you kind of understand what might be going on there. So some of the things that might be related to secondary Raynaud’s phenomenon, and again, a lot of these things are pretty mild.
Things like having a previous cold injury, so it could, that can be frost nip to frostbite. Maybe you’re on estrogen replacement therapy. So both that frostbite, frost nip and or estrogen replacement therapy alters blood flow. So that can lead to secondary Raynaud’s. Additionally, if you are on an anti migraine medication that causes vasoconstriction, so that can lead to that, that can be a potential for Raynaud’s. Additionally, if you are on things like beta blockers, another thing that could potentially cause secondary Raynaud’s because it alters heart rate and blood pressure. So there are lots of things that it’s like we know, we know what the secondary cause is of Raynaud’s and it’s likely not a big deal. Some things that are more concerning, and these would be like maybe if you’ve got a family history of it cuz there is a hereditary, a hereditary component to Raynaud’s.
This might be why it’s worth bringing it up with your provider is that it can be a result of hypothyroidism and it can also be a result of connective tissue disorders. And so that’s why we’d be worried about it kind of having joint issues, et cetera associated with it. So once again, 80 90 80 to 90% of individuals who experience Rayons phenomenon have primary Raynaud’s phenomenon and it’s completely benign. So not too much panic there, but interestingly, women are nine times more likely to struggle, struggle with Raynaud’s than men. And that kind of goes back to that hereditary component they believe. And when, when they look at ray odds being reported in populations as little as 1% of men report experiencing Raynaud’s phenomenon, whereas as much as 20% of women, again, that’s that one in five number experience Raynaud’s phenomenon.
So, you know, I think that’s, I think that’s really, really interesting. And we don’t completely understand why that’s happening. If you find yourself struggling with Raynaud’s phenomenon, you likely already know that it’s really critical to try to stay warm even in less cold environments. My friends who struggle with this personally, you know, they’re the runners that are always gonna have mittens in the running vest as well as hand warmers. And then you can also try topical vasodilators. That could be something to talk to your physician about. There are some other medications, some oral medications that will help as vasodilators. But there are also topical vasodilators things that are gonna help open open blood flow and return blood flow to your, to your extremities, particularly your hands. But if you’re like me and I don’t have traditional Raynaud’s i e doesn’t happen at random, it happens in very specific situations.
You know, it’s me returning to my car post run, maybe it was damp out, I’ve gotta get dry clothes on right away. I’m driving home and I have to alternate between having the heat blowing at my hands on the steering wheel versus the windshield because it’ll fog up. But I do, it’s this kind of over-correction of thermo regulation where I have this extreme vasoconstriction post exercise and, and you see it in my, my fingers turning white so it’s not rain odds. But one of the reasons that you might fall in duck camp like this where you do have colder extremities is that it’s possible that you pre previously experienced a non freezing cold injury. So not quite frostbite. And these reactions are your body, you know, generally trying to protect yourself, right? As I mentioned above, when your skin cools down, you naturally experience cold induced vasoconstriction.
Commonly we see it again in the hands, feet, nose, chin, ear lobes, cheeks and lips. And this is protective because it keeps warm blood near your core. And this happens in cycles lasting five to 10 minutes. And this allows you to conserve heat while also trying to not cause permanent damage to your extremities. I e that’s why it cycles back and forth because you can’t have blood loss to extremity for forever. That’s where we see this kinda extreme frostbite scenarios. But if that cooling happens really, really rapidly, ice crystals actually form in the fluid outside of your cells and that damages those cell membranes and causes injuries that are, you see more commonly in mountaineers and can range in severity. And that’s gonna lead more towards that frost bite category. So if you’re in, if you’re in my boat, not frost bite, but you’ve had a lot of kind of non freezing cold injuries you know, if you have that persistently you have it repeated over and over again. I group as a figure skater
Corrine Malcolm (11:52):
And then I was a Nordic skier, so my hands and feet were cold all the time. That repeated type of injury to your extremities can persist and lead to sensory disturbances in your hands and feet, which include numbness and tingling and chronic pain. And I think also that kind of leads to that hypersensitivity, you’re more likely to have another cold cold related injury down the road. You might also just be less tolerant of the cold. And that’s a real thing. It’s not that you just don’t like it, you can actually physically be less tolerant to the cold. And sometimes again, this happens due to cold, previous cold related injuries. But there are many other reasons why someone might have lower cold tolerance and that can include having really low body fat. Chronically high stress or high anxiety actually is one hypothalamus disorders, cuz once again, that helps with the e e equilibrium.
That thermo regulation is done at the hypothalamus. And also anemia, which has to do with red blood cell volume and circulation issues. So lots of reasons why you might be less tolerant of the cold and it’s not just, you know, being brushed off jokingly as that cold hands, cold heart phrase that I know I’ve definitely heard thrown around due to my kind of chronically cold hands. Before I let you go, before I give you my last tips and tricks and advice for today, I wanna talk a little bit about the screaming barfies. And it’s not just because the name is really funny and it is, it’s actual, it’s actual name, at least that’s what it’s called by it was coined that by the North American ice climbing community. But more broadly and in more international circles, it’s known as the Hot aches, which I also really enjoyed that name.
And if you’re lucky, you’re sitting here, you know, you’re sitting here or maybe you’re running or you’re in your car and you’re listening to this and you have no idea what I’m talking about, you’ve never experienced the screaming barfies. And I want you to count your lucky stars because those those names are very descriptive and I would say very, very accurate. Although comically enough, I was reading a emergency, a wilderness in an emergency medicine journal that talked about the screaming barfies. And they thought it was hilarious that that is what they were called because they hadn’t actually heard reports of anyone actually vomiting due to it. And I was like, well, if you’ve experienced it, you, you know what it’s called, the screaming barfies, it might not actually produce vomit, but it’s pretty, pretty horrendous and I got a big kick outta that.
But essentially the symptoms are generally localized in the hands or the feet. It’s really common in the hands, but speaking from experience, you can definitely get it in your feet as well. And it generally happens when you’ve been spending time outside in cold weather normally towards the beginning of an outdoor activity. Generally there’s a period of cooling or inactivity. That’s why ice climbers experiencing experience it, right, because you’re generally belaying order the person climbing. And one is much more active than the other. And then they have their hands above their heart when they’re striking with ice axes. So they unfortunately experience it quite frequently. So it’s very common to happen early in activity, generally right after a period of cooling or, or inactivity. And for me, this happens almost every time I go cross country skiing or back country skiing.
It is generally after I’m, you know, I’m outside of the car, I’m getting my gear ready, but it’s cold out had that moment of inactivity we get going again, bam, it happens, it begins, I can’t talk, I can’t think, I can’t, I can’t speak because if I do, it’s gonna be, I’m gonna swear. But essentially most people experience pain and throbbing and then tingling or kind of a burning sensation as that blood flow returns to those, to those digits or to your toes. And this is oftentimes accompanied by here’s the baring part, nausea, dizziness, transient loss of vision, and irrit irritability. And I chuckled when I heard irritability, cause I said, of of course you’re trying to avoid, like simultaneously avoid crying, yelling, vomiting, and again, if you’re me swearing at everyone around you. So irritability not the least, not the least symptom there at all.
Despite it being incredibly common in ice climbers, it’s reported to 81 to 96% of ice climbers surveyed have experienced it. It, and about 60% of them experience it every single outing. So very, very common in specific sports. And despite all of that, it’s not well understood, but akin to any of that kind of, we have broad advice about avoiding what avoiding having a Raynaud’s phenomenon episode about avoiding generally cold digits and or kind of cold induced injuries and now kind of avoiding screaming barfies. A lot of the advice boils down to kind of well duh conclusions. And by that, by well duh conclusions, I mean things where it’s like, yes, the practicality, right? They’re practical things. There’s no, there’s no shortcuts, no cheats. It’s very, very straightforward. It’s super practical advice and obviously a lot of it has to involve around staying warm.
And so a lot of that evolves around actually dressing appropriately for the weather conditions. My grandmother will tell you there’s no such thing as bad weather only bad clothing choices. And while I don’t always nail it, I think that that is a very, very true. And so this means maximizing loose clothing maximizing heat, insulating layers while avoiding constriction of body parts. You’re gonna try to utilize wicking materials like wool as opposed to cotton. The Park City Search and Rescue has a saying involving, involving individuals who pass away during the winter. It has to do with cotton. So really wool is gonna be one of your best bets. It’s gonna move that moisture away from your body and keep that sweat from cooling you down. The thing we want in the summer, we don’t want in the winter we wanna keep kind of optimally, optimally warm. You can do things like opt firm mittens over gloves because it allows you to create more of a
Corrine Malcolm (17:48):
Heat pocket by keeping those digits close together. You can utilize hand warmers and actually if you, if you struggle with cold feet, you can apply that hand warmer to the, to either the top or the bottom of your outside of your sock. You don’t want it directly on your skin cuz you, it can cause burning for sure. So that’d be my advice there. And additionally you know, you really wanna, actually, one other thing before my last, my last point is people who are wearing watches, right? That’s cold metal against your skin. It’s not so much the compression from it that’s causing a restriction or a vaso constriction, but it’s cold and it’s against your skin and then your skin is also exposed to the elements a bit more. So consider putting it outside a base layer. I know that’s not gonna help with your optical heart rate to wear a chest strap, but that, that is something I would advise keeping that watch off your, off your skin, off your wrist during your run and then taking, taking your watch off immediately post-run so that you don’t have that cold material against your skin so that you can get warm, kind of a warm pocket of air there with a jacket.
And then finally, it’s really important to maintain adequate hydration and nutrition. Because maintaining normal fluid and electro electrolyte balance is actually really, really important for thermo regulation. It’s really, really hard to thermoregulate when you’re dehydrated and you have low bo like low body water volume. So again, super practical things. I hope you enjoyed this. I hope you never experienced the screaming bar’s, but if you did, maybe you got a kick out of this. Stay warm.