Winter’s cold can bring with it more than just some discomfort and the urge to snuggle up before a warm fire. It also can bring erious health concerns, especially for those who want to or have to be outdoors.
So says Dr. Christopher Moore, a clinical pediatrician at UCHealth Pediatric Care Clinic – Greeley. He also rotates as a pediatric hospitalist at UCHealth Medical Center of the Rockies.
Moore understands cold.
“I grew up in Maine and winters tended to be colder than they are here, or maybe that’s just me getting older and telling tales,” he said. “I can tell you that it regularly got cold enough to ice skate outside for much of the winter.”
For some folks winter weather just means their arthritis hurts a little more, but there are real health risks to watch out for. Like frostbite.
“Definitely frostbite is the main worry with extremely cold weather,” he said. “Exposed skin on the face will always be vulnerable. Fingers and toes, because of their end circulation distance from the body’s core … are particularly susceptible to frostbite and tissue death, even when adequately covered.”
Anyone who needs or wants to stay outside for prolonged periods of time in extremely cold conditions should have someone periodically inspect their face, “or check a mirror to look for white or paler areas of skin that warn of decreased circulation and freezing. Digits that are numb, have reduced mobility, and are waxy or that feel hard when palpated are likely frostbitten.”
Treatment consists of immediate rewarming “provided that the injured areas can be kept warm, because refreezing can exacerbate the damage, as can walking with frozen toes. Heat provided through warm, body-temperature water is more effective and safer that dry heat.
Also, “the arm pits are a very convenient source of heat. Folk wisdom of not rubbing frozen extremities to warm them is in fact true, because the friction can cause further tissue injury,” he added.
To avoid frostbite, he suggested that you “make sure that you stay hydrated to assure adequate circulation.
“While a St. Bernard with a cask of brandy hanging from its collar is a staple of comics and movies, alcohol is a risk factor for frostbite and hypothermia. Ethanol causes heat loss through vasodilation and dehydration trough diuresis. Think: a flushed face and trips to the bathroom.”
Proper clothing is the key element to avoiding frostbite, he said. “Gloves and footwear should provide enough insulation for both the cold and wind, but not so constraining that they reduce circulation.”
People who need to be outdoors for long periods of time also need to be concerned about hypothermia, he said.
“Hypothermia, or dangerous lowering of the core temperature, is a serious condition,” Moore said. Hypothermia can occur at even moderately low temperatures, facilitated by wind and wet clothing, he added.
“Hypothermia is the one true life-threatening condition associated with cold weather,” he said. “It is insidious, occurring at even moderate temperatures and causing clouded and confused thinking that keeps you from seeking or even accepting care. Don’t assume that altitude is causing your buddy to behave stupidly, especially if they are shivering or at all wet.”
Hydration, and more importantly, energy intake is crucial to avoiding hypothermia, he added.
“Remembering what I said about vasodilation with alcohol. It should be apparent that booze is the last thing you want to give to your pal. It is probably a bad idea to make drinking alcohol part of your cold weather outdoor activity, even if you are not shivering,” he said.
Again clothing is crucial to staying safe.
“Assuming that it is cold enough to not be raining, the value of the outer layer is to provide wind protection and shed snow before it melts, “ Moore said. “If you are exerting yourself, the number of layers you are wearing underneath should not be so many or so thick that you are sweating profusely.”
A good rule of thumb, he said, “is that you should put on enough extra layers to be warm when resting, and take off enough layers that you are a little chilled as you start moving.
“Even with modern artificial fabrics, any water leaving your body is taking heat – a great deal of heat – with it. There are many new fabrics on the market that retain their insulating ability when wet. I personally rely on wool and polypropylene. Whatever you choose, avoid cotton clothing. It is less than worthless once wet. A proper wool hat will reduce heat loss, and I always pack one when hiking at altitude, regardless of the season.”
To treat hypothermia, he suggested removing all wet clothing, then “get your friend out of the elements if possible and begin rewarming. Warm air does not contain much heat, but warm water, warm packs applied especially to the groin and axillae (armpits) and neck will be most effective means of rewarming.”
If the situation is dire, “another undressed non hypothermic body and a sleeping bag is a very convenient and effective heat source.”
If there is a serious change in the mental status of the patient, “remember that this is a life-threatening condition and summoning emergency medical services is warranted.”
Another winter weather danger in Colorado is sunburn. Really?
Yes, sunburn.
“I learned the hard way that sunburn is much more of an issue here at altitude than it was growing up at sea level. The thinner atmosphere, in addition to the reflection of sunlight from large areas of snow-covered terrain above tree line, can result in brutal sunburns, especially when the colder weather has you forgetting to put on sunscreen (and it is very unpleasant to put on cold sunscreen when you finally remember to do so later in the day).”
Sunburn in the winter is best addressed with sunscreen, SPF 15 or higher, applied liberally to exposed skin, Moore said.
“There is a lot less of (exposed skin) in cold weather, so no excuse for skimping! Lip balm with UV protection is essential as well. Wear polarized sunglasses to avoid snow blindness – burning of the surface on the corneas that can result in several days of blurred vision, light sensitivity and severe pain.
“Lastly remember that you are being exposed to sunlight from above, as well as below, from light reflected off snow and ice.”
Hikers and skiers need to be especially aware of this.
“If you plan on spending time above tree line, exerting yourself and breathing with your mouth open (which tends to happen at altitude), use a bandana over your mouth and lower face and smear sunscreen on the underside of your nose and in your nostrils.
“Trust me, sunburn to the roof of the mouth and the nostrils, though not life threatening, is very unpleasant. At the very least it interferes with enjoying a beer at the end of the trip.”
Treatment of sunburn is done by applying aloe or similar creams and debridement of blisters. More important, he added, is avoiding sunburn to avoid the risk of skin cancer.
If you’re not a skier or outdoorsman, but a home owner who clears the walkways after a storm, there are other risks to consider.
“Shoveling snow is hard work, even in Colorado, where the white stuff tends to be a good deal fluffier and lighter than the wet sludge we had to deal with back in New England,” he said. “Back and other orthopedic injuries are always a risk when shoveling, (which is) swinging a weight at the end of a lever.
“In cold weather, any exertion could be exacerbated by the body’s vasoconstriction, a natural response to the cold. The resulting rise in blood pressure, for an unconditioned person with a heart that is otherwise hanging in the balance. could result in an ER visit, hospitalization, or worse.”
None of this means you have to stay housebound when it’s cold outside.
“Dress right, in layers, drink lots of water, save the toddy for when you are finished for the day and safely inside a warm shelter, and have fun outside,” he advised.