Raynaud's features an aggressive response to cold extremities
DEAR DR. ROACH: Sixty years ago, I was diagnosed with Raynaud's syndrome by my doctor. I started taking nifedipine during winter months, but not during the summer. After moving to Colorado, I took the medication year-round because the weather here was often cool in the mountains even in summer. Then I was told to take two tablets a day rather than just one. I had been wearing support hose for three years due to leg swelling. One day I reviewed the medication paper that comes with the prescription and saw that nifedipine could be causing leg swelling. So, I discontinued taking the prescription last summer, but I am really struggling with symptoms in my hands and feet. Is there any other medication available to improve my circulation? Even wearing socks and gloves all day is not helping this winter. -- M.W.
ANSWER: Raynaud's phenomenon is an overexuberant body response to cold, causing color changes in the extremities, such as fingers, toes, and earlobes. Severe cases can cause tissue damage, even leading to gangrene. In addition to avoiding cold places wherever possible and wearing protective clothing, medication treatment can be very effective. Nifedipine, a calcium channel blocker approved for use in the United States in 1981, is one effective treatment, but the swelling of the legs can sometimes make it intolerable.
There are several other options, some of which may be surprising. Sildenafil (Viagra) has been a very effective option for some people. Nitroglycerine cream is reasonable for people who have limited exposure, but isn't a good choice for someone with symptoms year-round. Fluoxetine (Prozac) is helpful for some, as is the blood pressure medicine losartan (Cozaar). In general, I wouldn't recommend stopping a medicine without talking to your doctor about an alternative plan.
DEAR DR. ROACH: I keep hearing, inconsistently, that N95 masks should be used only once or twice and then discarded. I've been wearing the same one, uncleaned, since COVID-19 began. Doesn't smell bad, is a little dirty, but seems like the filtering qualities "look" unchanged. What is your opinion and recommendation? Second, are those light-blue flimsy masks that come in the 100 pack any good at all? So much space around sides of the face. -- T.A.
ANSWER: Many of my colleagues are reusing their N95 respirators due to limited supply. Current guidance from the Centers for Disease Control and Prevention states that the N95 masks may be used for an extended period as long as they continue to have a tight fit and have not become contaminated. We use a surgical mask (the "light-blue flimsy" ones) on top of the N95 to extend its lifespan. N95 masks should be discarded after high-risk procedures, such as performing an intubation on a patient with severe COVID-19.
Surgical masks do provide some protection: They protect you to some extent, but they protect others around you, and that probably has more public health benefit. The current thinking is that people are most infectious in the day or two before they develop symptoms. Wearing your mask, even if you have no symptoms, protects the people around you, if you should have an asymptomatic case of COVID-19 or you haven't developed symptoms yet.
I recommend a well-fitting, multilayered cloth mask, since they provide better protection than surgical masks. We should save N95 masks for the front-line hospital workers who most need them. Cloth masks should be washed regularly.