Summary of Chapter 14
You simply have to put one foot in front of the other and keep going. Put blinders on and plow right ahead.– George Lucas
Most likely, you’ve heard the expression having “cold feet.” Usually it’s in relation to getting married or other major decisions or events like having a baby or starting a new job. It means that you have a case of the nervous jitters, and a literal case of cold feet is also linked to your nerves.
Your feet get cold because your warm blood isn’t circulating properly through the veins and arteries into your legs and out to your toes. Normally, the skin temperature down there should range between 75ºF and 90ºF. If it drops below 65ºF, you’ve got a problem with your vascular or circulatory system. Your arteries, the smaller-sized blood vessels called “arterioles,” and your veins aren’t letting enough blood through.
Your nervous system plays a significant part in determining how much blood gets through. If you are upset about something or under a great deal of stress, nerves can constrict the smaller arterioles in your feet and lessen their ability to carry blood, giving you cold feet. At the other emotional extreme is the person whose nervous system sends excess blood through his or her body when the pressure is on. This is called vasodilation of the blood vessels and it can make you hot all over (hence the expression “hot under the collar”).
This disorder arises from the inability of your smaller arteries to dilate and send blood where it is supposed to go. The attacks are episodic and seem to be brought on by cold temperatures, as in the case of Raynaud’s Disease. But Raynaud’s Syndrome is linked to various underlying systemic diseases such as collagen diseases, lead or nicotine toxicity, or neurovascular trauma.The key to treatment is to avoid the cold. In severe cases a physician may suggest a sympathectomy, a surgical procedure in which some sympathetic nerves to the foot or hand are cut. However, this should only be a last resort.Also known as “thromboangiitis obliterans,” this rare disease shows up in adult men who have yet to celebrate their 40th birthdays. What happens is that the small arteries and arterioles in the legs and feet constrict and refuse to let the proper amount of blood pass through. When this happens the skin in your extremities doesn’t get the nutrients and oxygen it needs to be healthy and thrive. Symptoms include pain when you use your arms or legs, pale skin on your fingers and toes when it’s cold and painful, open sores on these areas. Most people who are diagnosed with this disease smoke cigarettes or use tobacco. The difference between Buerger’s and Raynaud’s is that with Buerger’s Disease tissue can be destroyed and become ulcerated, even gangrenous as the disease runs its course. At that point, amputations may be required.
In this chapter of My Feet Are Killing Me Dr. Levine warmly explains:
- What causes cold feet?
- How is smoking linked to cold feet?
- Raynaud’s Disease
- Raynaud’s Syndrome
- Buerger’s Disease
- Coarctation of the aorta
- Real Patient Recap: Aeryn makes a wise choice between keeping her toes, or losing the smoking habit that caused her cold feet.