Winter is upon us, and many of you are making plans for winter vacations. Skiing, snow boarding, snowmobiling, ice fishing, and ice skating are all terrific ways to enjoy the season. However, they all share the potential dangers from frostbite. Frostbite is not a simple issue of getting a little cold and numb from overexposure to the elements. True cases of frostbite can result in the loss of an affected extremity, finger or ear. The sad thing is that frostbite is often a preventable condition. Make this holiday season a safe one by following the recommendations below:

1. STAY DRY. Wet clothing dissipates heat from the body 25 times faster than dry conditions.
2. MINIMIZE WIND EXPOSURE. Wind proof clothing can help if you?re outdoors, as wind speeds increase heat loss from the body 5 times faster than normal.
3. WEAR LOOSE CLOTHING. Constrictive clothing increases the likelihood of frostbite as does immobilization and dependency of the extremities.
4. TRAVEL WITH BLANKETS. How many times do you hear of people trapped in their cars due to an unexpected snowstorm? Plan ahead for safe travel.
5. STAY SMART IN THE MOUNTAINS. Higher elevations increase the risk of frostbite due to tissue anoxia and decreased mental orientation from diminished oxygen flow to the brain. Know when you?ve had enough of the slopes.
6. WEAR A HAT AND GLOVES. Smaller areas of the body such as ears and fingers are much more at risk of developing frostbite.
7. MINIMIZE ALCOHOL INTAKE WHILE PARTICIPATING IN OUTDOOR ACTIVITIES. Alcohol in the bloodstream can increase your risk for developing frostbite.
8. LISTEN TO YOUR BODY. Sensations of intermittent stinging, burning, throbbing and aching are all early signs of frostbite. Symptoms of numbness or heaviness are associated with more advanced frostbite. Pay attention and get indoors. Seek medical attention immediately if you fall into the latter category.
9. SUPPORT YOUR LOCAL HOMELESS SHELTER. The homeless are at a far greater risk of developing frostbite as they have no satisfactory way to protect themselves. Offer old jackets, hats, gloves and blankets to your local shelter for distribution. This makes a great church, temple or school community project and will make a big difference for many this winter.
10. DON'T LEAVE PETS OUTDOORS You have a cat or dog who lives outside most of the time, but when the thermometer is registering single digits (or worse), please bring in your pets. Their fur simply cannot protect them from such extreme temperatures and they can develop frostbite, too. If they need to spend a bit of time outdoors, make sure they have plenty of straw or hay available to insulate them against the cold.

Now that you know some of the things you need to do to stay safe, let me tell you a little about frostbite from a medical standpoint. Frostbite is a localized cold injury. No tissue is safe. The severity of frostbite is associated with how deep the freeze is. This can involve the various layers of the skin as well as the fat, muscle, blood vessels, lymphatics, nerves and even the bones. Just like receiving a burn, frostbite is categorized based upon the extent of the tissue injury.

Chart information is based upon work by L. Delano Britt, M.D., MPH, FACS, William H. Dascombe, M.D., and Aurelio Rodriguez, M.D., FACS.

What happens when you experience frostbite? If you?re caught outside, DO NOT try to thaw the area. Repeated freeze-thaw cycles actually damage the tissues further. Seek help at a hospital. Most frostbite patients, particularly those with second degree tissue damage or higher are hospitalized.

Once the patient is in an area where they are no longer at risk of frostbite, the affected area is rapidly thawed in a circulating water bath for about 15-30 minutes. Fluid is removed from clear blisters but the "tented skin" is left in place to act as a bandage. Topical treatment is initiated to try to reduce the . There has been some evidence that aloe vera in a 70% concentration reduces the amounts of prostaglandins in the tissue which in turn limits inflammation and improves blood flow by reducing blood vessel constriction.

Hemorrhagic blisters are left in place and the aloe vera is applied every 6 hours.

Frostbitten areas are splinted and elevated.

A tetanus vaccination is given.

Pain management and antibiotics are started.

FROSTBITTEN AREAS SHOULD NOT BE AMPUTATED IMMEDIATELY! It is amazing how forgiving the body can be. It may take up to 2 months to determine whether an area is beyond help. This is important to realize so that you can be informed about your care.

So enjoy winter, stay active and keep warm! Don't let the weather get the best of you.

Thank you for taking the time to read my newsletter. I hope you have found it informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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