on the last slide.
The symptoms, of course: There's quite a lot
of discomfort, particularly in the fingertips.
There may also be claudication when walking.
Patients are very sensitive to cold; that
increases the pain in the hands and the fingertips.
There are diminished or absent peripheral
pulses. The extremities may be blue because
of lack of blood flow, and there's often thin,
very shiny skin with reduced hair growth and
then ulcerations and gangrene as we've talked
The therapy: Number one, patients have to
stop smoking. There are a number of medications
that dilate the blood vessels. This improves
blood flow to the little distal areas of the
fingers. Sometimes, a sympathectomy—actually
interrupting the sympathetic autonomic nerves
that go out to the peripheral areas—can
actually decrease the amount of spasm in the
blood vessels. Spasm can also decrease the
blood flow. But the problem with a sympathectomy
is you can't reverse it. It's not reversible,
whereas with the drugs, you can always reverse
it. And unfortunately, in many instances,
amputation is necessary for the gangrene that
develops in the fingertips.
Let's talk about Raynaud's phenomenon, because