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Erythromelalgia
Erythromelalgia is a fairly rare disorder
manifested by vasodilatation of the blood vessels in the feet. Normally
blood flow through the feet and hands is regulated by nerves and
muscles in the walls of the blood vessels that either tighten and
shrink the vessel's diameter so as to restrict flow or to open the
blood vessels diameter to allow for more flow. This is all controlled
automatically by the body and is necessary to preserve or give up body
heat so that we maintain a constant body temperature. For
instance, when we are subjected to cold temperatures the blood vessels
will constrict and shunt blood back to the heart and body cavity. This
is an example of how our body responds to cold and is a survival
mechanism to keep us alive if we where exposed to prolonged or severely
cold temperatures. The heat of the blood is not allowed to escape in
the fingers and toes into the air or water around us and is sent back
to the heart to keep the core body temperature warm so your heart will
continue to beat. Certainly you have heard "Cold hands, warm heart".
When we are hot just the opposite happens and the blood vessels enlarge
or dilate allowing for more blood to go to the fingers and toes thereby
'giving up heat' to the surrounding air. The 'cooler blood then goes
back to the heart where it helps lower core temperature. The
vasoconstriction (tightening of the blood vessels) and the
vasodilatation (opening of the blood vessels) is always changing and
adjusting to maintain blood pressure, control body heat, regulate heart
rate, among other functions you don't even think about. Part of the
controls for this are partially understood and maintained by the
primitive part of our nervous system called the autonomic nervous
system. It is this part of our nervous system that is responsible for
out heart to beat and for us to breath regularly without having to
think about it. When these controls fail to
operate normally we see the pathologic disease patterns of
erythromelalgia or Raynauds disease or phenomenon.Raynauds disease
or phenomenon is a vasoconstriction of the blood vessels in the feet
and hands. We notice it when our fingers and toes get icy cold and turn
blue or even white. This can be a very painful condition depending on
how long we are subjected to the cold and the vasoconstriction since
the tissues of the hands or feet are deprived of blood and therefore
oxygen. In many individuals it may be very mild and not be a problem.
All of us experience vasoconstriction to some degree when we are in
cold weather. In the disease state however the vasoconstriction does
not entirely reverse when subjected to warmer temperatures and a
chronic painful situation ensues. Erythromelalgia
on the other hand is just the opposite. The blood vessels are open or
dilated and the oxygen and heat of the blood is discharged into the
tissues making them turn red and feel hot all the time. Likewise this
can be a very painful condition. It is a more rare disorder and less
understood than Raynauds. Diagnosis Before
treatment, the diagnosis should be confirmed. This can be accomplished
by a variety of different medical specialties. Internal medicine or an
internist is a good place to start to make sure there are no disease
factors or other medications causing the Raynauds or erythromelalgia.
In many instances the internist will treat the disorder so he may help
you monitor medications that have undeliverable side effects or react
with other medications. Treatment These
disease states can be treated with varying degrees of success using
drugs that induce vasodilatation or vasoconstriction. Unfortunately,
the side effects of vasodilators or vasoconstrictors are often times
worse than the disease. Obviously, avoiding temperatures or situations
that can trigger the responses are also useful. For instance, people
with vasoconstrictive problems should wear socks and well insulated
shoes to maintain heat. Patients with vasodilatation problems may be
more comfortable in sandals, going barefoot, or certainly using a light
shoe that can 'breath' to allow heat to escape. In severe conditions
pain medications can be a useful adjunct. Hypnosis and biofeedback may
have some degree of success in certain individuals if administered by
appropriately trained individuals.
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