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Another Buerger's versus Raynaud's Question

Posted by Kathryn B. on 3/07/03 at 18:03 (112180)

I have not had the plethysmography yet, but I certainly respond to cold with blueness and pain in my feet. I got back the results on my doppler-ultrasound and blood pressure tests (wrist, ankle, big toes) which was normal. My docs don't advise an ateriogram because of just the general risks of that proceedure. But they said that one can still have small vessel Buerger's and a normal doppler. How likely is this? If I really just have Raynaud's, I'd hate to think that I will have to go around wondering if it is really Buerger's and more dangerous. Is an ateriogram really the only way to know for sure, and is it really all that risky?

Your webpage is just wonderful. I can't believe how quickly you respond to so many questions!!! Thank you!!!

Re: Another Buerger's versus Raynaud's Question

Ed Davis, DPM on 3/07/03 at 18:22 (112182)

Kathryn:
The purpose of an arteriogram is to look for specific areas of blockage once doppler studies have shown a decrease in blood flow. If no decrease in flow is seen on Doppler, an arteriogram is not usually indicated.

Blueness and pain in the feet in response to cold is a vasospastic phenomenon, that is, the blood vessels go into spasm in response to cold. That is usually seen in Raynaud's disease or Raynaud's phenomenon as opposed to Buerger's disease. Treatment involves avoidance of cold and/or use of drugs (calcium channel blockers) which relieve spasm of the arteries in the feet.
Ed

Re: Another Buerger's versus Raynaud's Question

Kathryn B. on 3/07/03 at 20:29 (112206)

Thank you, Dr. Davis!! I have similar responses when warm but when under too much family stress. And I have read that Raynaud's can react that way, too. Nothing ever seemed like ischemic type pain, though. I think my docs just feel the fact this started in summer (though when I was very stressed) and my smoking means Buerger's is more likely. It is encouraging that you think not. Though, I now know the smoking needs to go for reducing Raynaud's as well. I was advised not to take calcium channel blockers because I have low blood pressure. I have read of other possibilities. Is there one that you think would be a second best in effectiveness and not lower blood pressure? Thanks again so much!!!

Re: Another Buerger's versus Raynaud's Question

Ed Davis, DPM on 3/08/03 at 11:06 (112244)

Kathryn:

Calcium channel blockers can lower blood pressure so if yours is too low to begin with, that can be a problem.

One option is to try a topical, in very small amounts. That is nitroglycerin paste or cream. If a toe gets cold and blue, applying a ring of the paste around the base of the toe will cause vasodilation and restore warmth and color. If you have to use it on multiple toes, you may absorb too much and get a headache. Many docs are not familiar with this and may not support this treatment or may be concerned that patients may have difficulty controlling the dose. The key is to apply the paste very sparingly.
Ed

Re: Another Buerger's versus Raynaud's Question

Kathryn B. on 3/08/03 at 12:46 (112260)

Thank you!!! All of my toes end up cold and blue, so I am not sure they will try that, but I will mention it. Appreciate all of your advice!

Re: Another Buerger's versus Raynaud's Question

Dr Z on 3/08/03 at 13:07 (112264)

The nitropaste is an excellent treatment rid the pain and increas local blood flow. Headaches are a problem for some

Re: Another Buerger's versus Raynaud's Question

Kathryn B. on 3/08/03 at 13:10 (112265)

Thank you, too, Dr. Z!! Maybe that will be a way to go. My pain level is better, but I am really not to where I can do any physical activities like dancing, and I miss them. I can walk for my job, but that is about it.

Re: Another Buerger's versus Raynaud's Question

Dr. David S. Wander on 3/08/03 at 16:40 (112287)

Kathryn,

Sorry if I missed some information in earlier postings, but when you had your vascular tests performed, did they do a 'cold challenge' to see if the test results differed when you were exposed to cold?

Re: Another Buerger's versus Raynaud's Question

Kathryn B. on 3/08/03 at 19:32 (112297)

Hello again. No, they did not do this test. My feet are definitely affected by cold though, as well as emotion. In the summer when they first hurt, I noticed that my toes looked whiter, and that there was a reddish band across all of my toes over the first joints. This gets redder when I take a warm bath. (Also, my feet overall get slightly red up to where my socks would stop after such a bath). But, everyone was thinking I had something like neuromas. Then, when it turned colder here, my feet started hurting much more, and that is when the bluish changes started. When Raynaud's was first suspected was when I saw a rheumatologist one day and an orthopedic foot specialist the next. It had snowed that day and was very cold, plus both doctors left me in cold offices with no socks for a good while. That definitely brought out the bluish color. But then, when I am calmer, cold weather doesn't hurt as much or cause so much bluishness. It was the rheumatologist who also mentioned Buerger's or possibly RSD. In terms of that possibility, all I know is that, even though my feet are painful, they are not so extremely painful like RSD is usually described. During an ordinary day at work, if I check my feet, they will change from bluish one hour to completely normal looking the next even though I have been sitting in the same place doing nothing different. All very strange seeming to me. I have all my docs here pretty baffled, as well. But, I have read about that test, and I would imagine my feet would react like in Raynaud's. I can ask my docs about it. Thank you!