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The Doctors Book of Home Remedies II: Frostbite

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Frostbite

Whoever decided that Jack Frost merely nips on noses must have lived in Florida. Spend enough time outdoors in major frosty weather and you may find that little nip turning into a big bite--frostbite.

Frostbite is what can happen when bitterly cold weather meets a body that's trying to stay warm. Attempting to warm the inner organs, your body cuts back on the circulation to your hands and feet. And if they receive less than their share of warm blood, these parts can freeze.

Severe frostbite may cause permanent damage, but there's no reason why it needs to go that far. From Eskimos to mountaineers, those who venture into the chilliest realms on earth have found ways to prevent lasting damage to toes, noses and fingertips.

How do you know that you're getting frostbite? Watch the skin, says Carol Frey, M.D., chief of the Foot and Ankle Service and associate clinical professor of orthopedic surgery at the University of Southern California School of Medicine in Los Angeles. There is no standard amount of time within which frostbite can occur, but the ice crystals that form on the skin's surface are the first sign. Here's what you need to do.

When to See the Doctor

When a frostbitten area begins to thaw, you'll feel pain. While some kinds of frostbite are more severe than others, be sure to see the doctor if the pain continues for more than a few hours. And see the doctor as soon as possible if you see dark blue or black areas under the skin or if blistering occurs.

There are four degrees of frostbite, says Carol Frey, M.D., chief of the Foot and Ankle Service and associate clinical professor of orthopedic surgery at the University of Southern California School of Medicine in Los Angeles. Ice crystals on your skin are a sign of first-degree frostbite. When symptoms increase beyond this--for example, if your skin begins to feel warm even though it is not defrosting, or if the skin turns red, pale or white--you should seek a doctor's attention: You have a higher, more dangerous degree of frostbite.

Don't rub. "The old adage about rubbing frostbitten areas with snow is false, though it's been perpetuated for years," explains W. Steven Pray, Ph.D., R.Ph., professor at the Southwestern Oklahoma State University School of Pharmacy in Weatherford. "The snow's coldness does not help raise the temperature of the affected area. In fact, any kind of rubbing, with hands or otherwise, only traumatizes it."

Stay put and stay warm. Once you find a warm place and can begin to thaw your frostbite, stay there. If you must leave and there is any chance that your frostbitten area will refreeze, avoid thawing it. According to Dr. Frey, refreezing will cause tissue damage far worse than the original damage from frostbite. Treat your skin gently before and after it has thawed. Avoid hitting or applying pressure to the injured area. If your toes have just been warmed, try to avoid walking (or skiing or skating) for as long as possible.

Thaw in the tub, not by the campfire. Dr. Frey recommends a water bath about 10°F warmer than body temperature for thawing frostbite. A warm water bath in the range of 102° to 111° is ideal. But avoid the intense, dry heat of a campfire, stove or heater, because you might burn frostbitten areas. (Frostbitten nerve endings don't send a signal to tell you when exposed skin is in danger of becoming burned.)

Avoid contact with metal. Everything from steel-tipped shoes to metal machine controls have caused otherwise prepared people to become frostbitten, according to Thomas Sinks, Ph.D., an epidemiologist with the Centers for Disease Control and Prevention in Atlanta. Take extra precautions when handling snow shovels and tools in cold weather: Wear gloves or mittens.

Warm up your central heater. When you get cold, "the blood has a tendency to leave the surface areas, such as the hands or feet, and go to more central areas," says Dr. Frey. "But by putting on a heavy jacket and keeping your core body temperature higher, sometimes you can decrease the incidence of frostbite." And as an extra precaution when driving during winter, always carry extra blankets and clothing in your car, just in case the car breaks down, suggests Dr. Sinks.

How to Prevent Frostbite

Staying inside is the only real prevention for frostbite. However, when you must venture into the cold, take these precautions.

Try to walk where the wind is blocked. The wind chill factor is just as important as the temperature, so limit the amount of time you stay in the wind.

Stay dry. Wearing water-repellent clothes and changing clothes when they become wet will help keep your body warm.

Generate your own body heat. If you have no other way to protect your skin, try curling up in a ball or placing your hands underneath your armpits.

"Syn" a little. For outdoor winter clothes, choose synthetic fabrics that act as water barriers, and change your clothes immediately if they become wet.

Wear mittens. Because mittens enclose all the fingers in a single, well-sealed "air pocket," they protect better than gloves. The most effective mittens have inside liners that can be taken out and dried separately from the mittens.

Keep your skin dry. To avoid frostbite, make sure you don't get water, gas or other liquids on your skin in subfreezing weather, warns Thomas Sinks, Ph.D., an epidemiologist with the Centers for Disease Control and Prevention in Atlanta. Gasoline is especially risky, since it evaporates quickly, chilling the skin (a handy thing to remember if you use a self-service gas pump).

Don't drink alcohol. Although it may make you feel warmer, alcohol actually prevents the constriction of blood vessels, increasing heat loss. A swig of brandy won't warm your toes and fingertips. In fact, alcohol reduces shivering, which is the body's way of helping you stay warm, according to Murray Hamlet, D.V.M., director of the Plans and Operations Division at the U.S. Army Research Institute of Environmental Medicine in Natick, Massachusetts.

Cover your ears. "Overchilled and windburned ears are best treated by protection as soon as possible," says William Epstein, M.D., professor of dermatology at the University of California, San Francisco, School of Medicine. "In fact, just covering your ear with your hand may be all you need."

Drink plenty of water. Hydration increases the blood's volume, which helps prevent frostbite. Drinking fluids such as herbal teas, hot cider or broth is a good idea. But you should avoid caffeinated beverages, which constrict blood vessels. Drink before leaving shelter, and take a Thermos with you while you are outdoors.

Don't light up. "When you light a cigarette, the blood flow in your hand shuts off," says Dr. Hamlet. Restricted blood flow is a major factor in frostbite, as the body loses its ability to warm itself.

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