Q: When my fingers are cold, they turn dark blue. After awhile some of them turn white and are painful. What can I do? — Maureen A: It sounds like you have symptoms of Raynaud's syndrome.

Raynaud's is a condition that causes some areas of your body — such as your fingers, toes, tip of your nose and your ears — to feel numb and cool in response to cold temperatures or stress. In Raynaud's, arteries that supply blood to your skin narrow, limiting blood circulation to affected areas. Women are more likely to have Raynaud's syndrome. It's also more common in people who live in colder climates.

There is a characteristic sequence of color changes in response to cold or stress. Fingers turn white first, then blue and end up red, when they warm up or stress is relieved. You describe a slightly different order, which also happens. There is also a sensation of pain and prickly-like feeling when warming up, just as you described.

Raynaud's syndrome is not just cold feet or hands and is not related to frostbite. Doctors don't completely understand the cause of Raynaud's attacks, but blood vessels in the hands and feet appear to overreact to cold temperatures or stress. Normally, with exposure to cold and/or stress, our body fights to keep the vital organs warm.

It does this by limiting blood flow to "less important" parts of the body like fingers and toes. Small blood vessels delivering blood to these parts contract. In Raynaud's this contraction is too

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long and becomes a spasm. Eventually, blood vessels relax and the flow is restored. Over time, these same small arteries may also thicken slightly, further limiting blood flow.

Raynaud's is classified as primary or secondary. In the primary form, there is no underlying disease or associated medical problem that could provoke vasospasm. It's the most common form of the disorder. I suspect that you have the primary Raynaud's.

The secondary form is also known as Raynaud's phenomenon. This form is caused by an underlying problem. Although secondary Raynaud's is less common than the primary form, it tends to be a more serious disorder. Signs and symptoms of secondary Raynaud's usually first appear at around 40. Causes of secondary Raynaud's could be different diseases, such as rheumatoid arthritis and more rare ones, like scleroderma, Lupus, and Sjogren's syndrome. In these diseases the body's self-defense system attacks itself, hence the name autoimmune disorders.

Diseases of the arteries, carpal tunnel syndrome, repetitive trauma, smoking, injuries and chemical exposure can also play a role. Certain medications, including beta-blockers, which are used to treat high blood pressure; migraine medications that contain ergotamine; medications containing estrogen; certain chemotherapy agents; and drugs that cause blood vessels to narrow, such as some over-the-counter cold medications, have been linked to Raynaud's.

To distinguish between primary and secondary Raynaud's, your doctor may order multiple lab tests and even request help from a specialist. There is no one blood test or X-ray to diagnose this disorder. As far as the treatment, mild forms are helped with self-care and prevention, such as avoiding cold temperatures, warming hands/toes under warm water, wearing gloves, hats, earmuffs and so on.

Asking your doctor to review all of your medications, avoiding over-the counter cold remedies and stopping smoking helps as well. Some advocate moving to a warmer climate, although it is not guaranteed that this will help. In more severe cases, special medications to open up your blood vessels and promote circulation may be needed. Since all medications do have side effects and their effectiveness vary, this needs to be done under close supervision of your physician and only if absolutely necessary.

Overall, the prognosis for Raynaud's is very good. If you have not done it yet, discuss your concerns with your doctor and try preventative strategy. I am optimistic that you will be able to get these unpleasant symptoms under control.

Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.