Baby, it's cold outside ...

Happy new year! I hope you had a fun, safe holiday season and wish you the healthiest, happiest year yet for 2012! I am ready to learn new things and share them.

With the new year comes even colder weather as we are now deep into winter. And that means more risk for extreme cold pathologies, such as frostbite. I'm mentioning this because something like frostbite should NOT be massaged, even though you may feel the instinct to do so.

"About Frostbite
Occurring when the skin and other tissues are exposed to very cold temperatures, frostbite can cause permanent tissue damage. Usually affecting the hands, feet, nose, cheeks and ears, frostbite can happen within minutes of exposure to extreme cold, or even in above-freezing temperatures if there is a strong wind chill or if the person is at high altitude or wet.

When exposed to cold, the body strives to preserve heat. By constricting the blood vessels near the skin's surface, blood is forced into the body's core to keep the vital organs warm. This is exactly the mechanism that prevents the extremities (such as hands and feet) from receiving enough blood, which causes them to become cold and makes them vulnerable to frostbite. The following sequence of events can lead to frostbite:

• Initially, the blood vessels alternate between narrowing and widening to keep the extremities as warm as possible.
• Under extremely cold conditions the vessels stop widening.
• When the skin's temperature drops low enough, ice crystals form around and within the cells, freezing tissue and possibly rupturing cells.
• The lack of circulation that occurs when the body directs blood flow away from the extremities can cause damage to the cells.

Frostbite Stages
There are four degrees of frostbite severity, each with their own symptoms:

1. First Degree - Known as frostnip, this affects only the skin's surface. Initial symptoms are itching and pain, and some numbness may exist. These symptoms are usually not permanent.

2. Second Degree - This level involves freezing of the skin, but not deep tissue. The affected area usually will develop blisters one to two days after cold exposure.

3. Third Degree - Possibly causing a temporary loss of use of the affected area, this level is deep enough to involve tissue, muscle and tendons. The skin turns hard and waxy and purplish, and blood-filled blisters may be present.

4. Fourth Degree - Freezing tissue, muscle and tendon, this is the most severe stage of frostbite. The affected area suffers permanent loss of function and is at risk for possible amputation due to infection.

In general, the indications of frostbite are:

• Itching, pain or prickling progressing to numbness
• Pale, hard, cold skin with a waxy appearance
• Flushing from blood rushing to the area after being re-warmed
• Burning sensation and swelling from collected fluid that can last for weeks

Medical help should be sought right away to prevent permanent tissue damage, as the extent of the injury may not be apparent until the area is re-warmed. If medical care is not available immediately, a mildly frostbitten area can be warmed in warm water (101 - 104° F), or by repeatedly applying warm cloths to the area for 30 minutes. Never use hot water, fire, a heating pad, or other dry heat because these methods may burn the skin before the feeling returns. Because the affected area may swell, remove any jewelry before re-warming. You can also give the person with frostbite something warm to drink (no alcohol or caffeine). If the toes are the frostbite culprit, help the person ambulate without them putting pressure on their feet. If there is any danger of refreezing, wait to thaw the area out until warm shelter is guaranteed. Thawing and refreezing can cause even more serious damage to tissue.

Warming should be done without applying movement to the tissue. That means no rubbing, massaging or shaking. Excessive movement will cause the ice crystals to injure sensitive body tissue."

Source: What Massage Therapists Should Know About Frostbite

As always, the best game plan is prevention. Remember your hat, scarf and gloves before going outside. Even if you don't think you'll need them, pack them in your bag, or stuff them in your pockets. It may be 50 this Saturday, but only in the middle of the day. Winter temperatures can drop dramatically in short periods. And if you suspect frostbite, please follow the instructions above.

Stay safe out there!