Help! Managing Raynaud’s (or very very cold hands and feet) at high altitudes

Julia, I can very much relate. Here is how I have dealt with it.

Paid attention to my triggers: for me, 50-65 deg is the danger zone, because I think it isn't cold, but after eating and being sedentary my hands are changing colors. sedentary after eating is the biggest trigger for me. Cold water of course too.

I acknowledged it as a condition that affected me in ways beyond the physical, and realized the main effects were mental and emotional.

I learned I was scared of the cold, and chose to address that like any other barrier fear (height, falling, etc).

I stopped climbing with others. This may not apply to everyone, but was the biggest thing for me. If someone else is there and I get cold hands, I instantly switch to death march, "I don't want to be here" mentality. By only climbing solo (roped mostly), I am always choosing to be where I am. And when I feel like shit, I turn around with no second thoughts or partner to complain (although that almost never happens due to cold any more). Also, climbing alone means no inactive belay time. When I go ice climbing, I only bring thin gloves, and I just keep moving all day.

the biggest physical way I have dealt with it is by becoming fit. When my condition was at its worst, I was bouldering hard and had low (5-6%) body fat, as well as being extremely aerobically deficient. My interests have shifted to more endurance focussed climbing, and now I have decent fitness to move uphill all day. And when I'm moving uphill, my hands aren't cold. I have no clue what your training background is like, but if you haven't, read a book like Training for the New Alpinism, and see if perhaps training your aerobic base could help. Previously, I'd go in spurts of energy, shifting between breathing hard then getting tired and being wet with sweat. This was really bad for my hands. 

Other thing I do is really think through and plan any potential triggers that I have to deal with. For instance, if I HAVE to deal with filtering cold water, or getting out of my sleeping bag. It is much easier to be in complete control by myself, and is another reason I climb alone.

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J C wrote:

Julia, I can very much relate. Here is how I have dealt with it.

Paid attention to my triggers: for me, 50-65 deg is the danger zone, because I think it isn't cold, but after eating and being sedentary my hands are changing colors. sedentary after eating is the biggest trigger for me. Cold water of course too.

I acknowledged it as a condition that affected me in ways beyond the physical, and realized the main effects were mental and emotional.

I learned I was scared of the cold, and chose to address that like any other barrier fear (height, falling, etc).

I stopped climbing with others. This may not apply to everyone, but was the biggest thing for me. If someone else is there and I get cold hands, I instantly switch to death march, "I don't want to be here" mentality. By only climbing solo (roped mostly), I am always choosing to be where I am. And when I feel like shit, I turn around with no second thoughts or partner to complain (although that almost never happens due to cold any more). Also, climbing alone means no inactive belay time. When I go ice climbing, I only bring thin gloves, and I just keep moving all day.

the biggest physical way I have dealt with it is by becoming fit. When my condition was at its worst, I was bouldering hard and had low (5-6%) body fat, as well as being extremely aerobically deficient. My interests have shifted to more endurance focussed climbing, and now I have decent fitness to move uphill all day. And when I'm moving uphill, my hands aren't cold. I have no clue what your training background is like, but if you haven't, read a book like Training for the New Alpinism, and see if perhaps training your aerobic base could help. Previously, I'd go in spurts of energy, shifting between breathing hard then getting tired and being wet with sweat. This was really bad for my hands. 

Other thing I do is really think through and plan any potential triggers that I have to deal with. For instance, if I HAVE to deal with filtering cold water, or getting out of my sleeping bag. It is much easier to be in complete control by myself, and is another reason I climb alone.

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Hey, thanks so much! It’s really comforting to know other people with the same issue and interests exist 

I’m definitely not at a point where I feel comfortable climbing alone / definitely prefer to be with someone  90% of time, but what I’m pulling out of what you said is to be more assertive — make all my climbing partners very cognizant of this limitation and do what I must to manage it

I’m not “unfit” but definitely have a long ways to reach where I’d love to be. I’ve read Training for the Uphill Athlete and have employed some things from there, and actually just ordered New Alpinism as well. No matter what, getting better in this realm will help me in a lot of other ways too haha

Thanks again!

Alec Baker wrote:

Not reynaulds in my hands, but I've had nerve damage in my feet that presents in a similar fashion. Same as anyone else has said, the sensation of not feeling your hands or feet in very cold environments is weird and unsettling, but if your entire body is cooking you don't have to worry as much about your extremities getting too cold. I'd rather manage sweaty layers than potentially frozen digits. I've moved away from heavy insulated down products and towards lighter fleece and a shell layer for insulation since it doesn't wet-out as easily and you can dump heat quickly by opening the shell for a few minutes.

I also have sweaty hands, and multiple pairs of cheap fleece gloves for insulation and one lightly or non-insulated overmitt seem to work best there. They get wet, but stay warm and dry out quickly. Fancy goretex waterproofing or goretex wind stopper just take longer to dry out.

Thanks! This is also in line with what @David Pneuman was saying too — I think I’m finally learning that sweaty core is the lesser of two evils :D multiple pairs of fleece gloves is one I honestly haven’t tried and it’s been suggested here earlier as well so I’m happy to carry that weight

I have a mild case, so this advice may not help much. But one thing that's worked for me that I haven't seen mentioned yet is activity. When I start to feel the cold/numbness setting in (often after a sedentary period without enough layers, or in wet conditions), I try to actively pump blood throughout my body. I'll do air squats, burpees, jumping jacks, etc. with the addition of arm "pumps" and arm swinging to pool blood in the hands, clapping, rubbing hands vigorously between my thighs clenched together, and placing my hands directly on warm body areas underneath my layers. It can be hard to motivate yourself to do this when you're cold, but it usually works quite well. Bonus, it'll generally warm you up for the climb!

Sweaty core is not OK. Wear several layers of various breathable polyester fabrics and slow down or shed layers if starting to get sweaty, IE... If you are exerting more than your layers can evaporate off. If you slow down or stop, add a less breathable shell layer to keep warm and remove again once moving. You don't ever want to have any form of liquid sweat in the winter. Only water vapor that evaporates off you quickly. All your skin should feel dry, not ever wet. If wet, the clothing layers are not breathing or you are overexerting for the amount of clothing you have on.

A common misbelief is that polyester fabrics and insulations will keep you warm even when wet and they will to an extent if kept well wrung out. If saturated with water or sweat, though, you will lose heat very quickly. 

My normal combination is, skin out, Capaline lightest base layer bottoms and zippered top to regulate heat and evaporation, mid-weight fleece bottoms sweatpant type, midweight zippered fleece top to regulate heat and evaporation, Scholler Softshell pants and Scholler Soft Shell Jacket to be breathable, but wind-resistant. If very cold I add a Windstopper Fleece jacket below the softshell to stop any heat loss at all from wind. That combination has worked with various layer combinations down to -20 with winds at 40+ MPH+. Gloves are thin polyester liners inside windstopper fleece glove outers with down mittens for stopping when very cold. Hat is a windblocking fleece stocking hat and neoprene full head baclava backup. Glacier Glasses with Goggles backup.

I agree with you that in a normal case, not getting sweaty at all is what you want! My whole issue is that my body temp regulation is dysfunctional — as I sit in my ~70F apartment responding to this, my toes are white and fingernails purple, but my core is perfectly fine and warm. Keeping my core feeling “normal” is just not enough to push blood out to my hands and feet, so I have to overcompensate in some way. I’m not saying it’s a great solution, but it certainly has been the lesser of two evils in my experience! I obviously don’t let myself drip with sweat, but the danger that not being able to use my hands poses so far outweighs being a little bit damp :) I just make sure to add other layers fast if I stop, or not stop at all :D

Julia Sakalus wrote:

I agree with you that in a normal case, not getting sweaty at all is what you want! My whole issue is that my body temp regulation is dysfunctional — as I sit in my ~70F apartment responding to this, my toes are white and fingernails purple, but my core is perfectly fine and warm. Keeping my core feeling “normal” is just not enough to push blood out to my hands and feet, so I have to overcompensate in some way. I’m not saying it’s a great solution, but it certainly has been the lesser of two evils in my experience! I obviously don’t let myself drip with sweat, but the danger that not being able to use my hands poses so far outweighs being a little bit damp :) I just make sure to add other layers fast if I stop, or not stop at all :D

Julia, you are correct. Sweat is easily the lesser of two evils as you are still fully functional and can perform as necessary to stay safe (climb, bail, hike, escape, etc.).  Frozen fingers and toes no longer allow performance and render you stuck. There is a wide spectrum of sweatiness amongst people and for those of us who are quick to sweat, there is not really a choice to not sweat if we are engaging in these activities. If I go for a 10min/mile jog in -5F I am wearing just a baselayer and windshirt and my core is wet. I can't slow down to a crawl and actually complete any mission/climb, so if I'm going to climb, I understand I am taking on the risk of being wet and need to then manage that risk with either extra layers to change, weather to allow drying, or bivy gear for worst case. So anyways, you have great advice throughout this thread and you can ignore the naysayers who don't have to deal with our problems. Core warmth via layers and/or activity and extra dry gloves/socks is generally the trick.

This got me thinking of another tactic I've been using lately, which is to put a light wind shirt (I use a Patagonia houdini) between my sweaty layers and my insulation. This is an old Mark Twight idea that basically accepts sweat as inevitable, and therefore attempts to simply prevent the sweat from totally wetting out the insulating layers on top of it. I tend to use it ski touring, where I'm moving in an R1 and a houdini, but as soon as I stop (or slow down, or transition to downhill skiing) I add puffies, etc. Seems to have worked reasonably well this winter.

I see, Julia, that you have an abnormal condition regarding circulation,

I am no doctor, but I can surmise you have an issue with the capillary action in your extremities returning your blood to your heart given your account of blue fingers, IE... an excess of oxygen depleted blood cells.

The pressure of the heart pushes blood out fast, but the return is slow. They work in conjunction to create the overall circulation rate. If there is a problem returing blood to the heart, there will be no warm blood to give back to the extremities.

When you say you have blue fingers sitting in 70 Deg. it indicates those extremities have an obstacle to returning blood to the heart.

Are there times of the day that are better than others ?

At those times are your extremities perhaps more swollen than when your fingers are not blue ? Or what else may be different then ?

I would suggest investigating the condition more toward solving the circulation issue rather than some type of band-aid gear type solution. FWIW.

David Pneuman wrote:

I see, Julia, that you have an abnormal condition regarding circulation,

I am no doctor, but...

...I would suggest investigating the condition more toward solving the circulation issue rather than some type of band-aid gear type solution. FWIW.

Some easily accessible information about Raynaud's:

https://www.mayoclinic.org/diseases-conditions/raynauds-disease/diagnosis-treatment/drc-20363572

Treatment is to determine underlying autoimmune etiology, but the phenomenon is typically idiopathic. Lacking a different primary cause, interventions are nerve surgery (invasive much?), certain drugs (some of which have already been mentioned in this thread), or lifestyle changes such as "band-aid gear type solution[s]." Hence the reason for this thread--to share insights among those with practical experience, since that is often not one's primary care provider.

Has anyone here been diligent enough to try the Hamlet conditioning method? Nothing to do with Shakespeare or homicidal stepfathers, it's named after a US army doctor who developed this back in the 1980s. The idea is to re-train the blood vessels in your fingers to dilate rather than constrict in response to cold. From https://www.raynauds.org/2019/09/26/classical-conditioning-raynauds-therapy/:

The Hamlet method is simple.  A person sits in a warm room with warm hands. They then move to a cold place (32⁰F) for ten minutes, wearing only light clothing. Their hands are kept warmed to about 110⁰F [originally by immersion in buckets of warm water; heated gloves can also be used]. They then come back to a warm location, and keeping their hands warm, they let their bodies return to a comfortable temperature.  

In Dr. Hamlet’s experiment, this was repeated three to six times a day, with a day off between session days. The experiment called for 50 ten-minute sessions.

I've never been organized enough to try this as described, although I've tried to work this idea into wintertime trail runs and uphill ski days by using heavy gloves and hard-warmers, but otherwise starting out somewhat under-dressed.

More references:

• https://www.nytimes.com/1988/01/19/science/simple-method-found-to-warm-cold-hands.html?smid=url-share. May be behind a paywall, PM me if you'd like a copy.
• Jobe et al, "Induced vasodilation as treatment for Raynaud's disease", https://pubmed.ncbi.nlm.nih.gov/7137735/

Martin le Roux wrote:

Has anyone here been diligent enough to try the Hamlet conditioning method? Nothing to do with Shakespeare or homicidal stepfathers, it's named after a US army doctor who developed this back in the 1980s. The idea is to re-train the blood vessels in your fingers to dilate rather than constrict in response to cold. From https://www.raynauds.org/2019/09/26/classical-conditioning-raynauds-therapy/:

I've never been organized enough to try this as described, although I've tried to work this idea into wintertime trail runs and uphill ski days by using heavy gloves and hard-warmers, but otherwise starting out somewhat under-dressed.

More references:

• https://www.nytimes.com/1988/01/19/science/simple-method-found-to-warm-cold-hands.html?smid=url-share. May be behind a paywall, PM me if you'd like a copy.
• Jobe et al, "Induced vasodilation as treatment for Raynaud's disease", https://pubmed.ncbi.nlm.nih.gov/7137735/

I played with it a bit, but never dedicated the time to do the full protocol. I've done similarly to what you've described, with a 25min walk one-way to office work in the winter with mitts and not much on my torso. On field days (instructing/guiding), I find I tend to improve throughout the season, acclimating with continuous exposure to cold temps more generally. But early season sucks for field work as I typcially can't move at a pace that I stay warm, so I tend to get sweaty, bring many gloves and layers, and use tadalafil for really cold days.

https://pubmed.ncbi.nlm.nih.gov/20837499/

Conclusion: Tadalafil as add-on therapy improves symptoms of RP, heals and prevents new DUs and improves QoL in patients with resistant secondary RP.