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Winter Worries, It ain't just the cold
by Buck Tilton

DANGER: NAEGLERIA INFESTATION. DIP AND DIE. 

The metal sign was embedded in the snow just before the forest trail opened into a string of hot, watery pearls. After our ski in to these natural warm springs, with wine chilled by the icy breezes drifting around us, the warning could have been a massive frustration. Once the single-celled amoeba, Naegleria Fowleri, sets up housekeeping in a human brain, death usually occurs in three to six days. Cause of demise: Primary Amoebic Meningoencephalitis. PAM is nobody to fool around with, but knowledge allowed us the soak we wanted.
Naegleria breeds year-round due to the constant temperature of the water, but cold weather makes the warm water more inviting to humans. As the mercury drops, Naegleria and several other opportunities to become sick, damaged, or dead, arise. Most of the problems are preventable, and all are treatable.
In the case of amoeba vs. human, Naegleria Fowleri gets into the
central nervous system through the mucus membranes of the nose. It will wash through your mouth and eyes harmlessly, but one snort and headaches and fever start a day or so later. Nausea, vomiting, loss of sense of smell, irrational behavior, coma, and death form the typical schedule of
events. Although saves are possible, this parasitic amoeba is very difficult to treat once established in the brain. Moral: Keep your hot head above water.

Hard exercise on a cold day, the kind of workout that requires aggressive panting, might lead to a second winter worry: "frozen lung." Temps must be low, usually below zero Fahrenheit. No tissue actually freezes, but severe bronchial irritation results from sucking down very
cold air faster that the human airway can warm it up. The irritation produces spasms in the muscles of the airway and a burning pain, with the possibility of coughing up blood. Increased mucus production frequently creates wheezing sounds when the sufferer breathes. A severe case might last one to two weeks. Treatment is rest, warm and humidified air to breathe, and plenty of water to drink. Prevention is less painful: wear a hooded parka and a face mask, or breathe through a fluffy scarf.

A third worrisome phenomenon, which can appear with temperatures as high 60 degrees F, is chilblains. They aren't mentioned much in the United States, but approximately one in every ten residents of England have experienced these red, itchy skin lesions. When skin is kept cool
and moist for a long time, rewarming causes a rush of blood to the heat-dilated vessels near the surface of a human body. The swollen vessels can't take the load. Fluid and metabolic waste products leak out of the vessels and into the surrounding tissue. Those tissues swell and
itch, and hurt. Pus may fill the lesions in a severe case. Treatment includes keeping the damaged skin warm and dry, and applying a protective ointment. Prevention is simple: Keep your skin warm and dry from the start.

If the wet and cold are isolated in boots, another non-freezing problem, immersion foot, might develop. Also called "trench foot," prolonged exposure to the wet and cold leads to lack of circulation in the feet. Owners of these feet complain of numbness, tingling pain, and itching. The feet look white or mottled in disgusting shades of blue, gray, and burgundy. On rewarming the pain does much more than tingle, and swelling and redness occur. Severe cases crack the skin and
bacterial invasion is imminent. Avoid aggressive rewarming. Skin-to-skin is best. All cases need to be kept warm and dry. Walking may become difficult. Painkillers often help. William Forgey, MD, "Father of Wilderness Medicine", suggests an ounce of hard liquor every waking hour to promote circulation to the damaged feet until a doctor can be found.

Failure to wear sunglasses that keep all the ultraviolet light out, may lead to a fifth problem, snowblindness (sunburned eyes). There is seldom any sensation on the surface of the eye until the damage of too-much-sun is done. It can occur in as little as one hour. Usually six to twelve hours pass before the eye feels painful and dry and gritty. It hurts very much to move or open the eye--so don't do it. Rinse the eye with cold water, and patch it closed. The problem should resolve in 24-to-48 hours with no permanent damage. If it doesn't, or if the pain is unbearable, see a physician.

The winter sun is closer to the earth than the summer sun, but, because it's lower in the sky, the radiation is less intense. This healthier aspect of winter exposure is counterbalanced by the fact that snow and ice are very efficient reflectors of sunlight, bouncing 80-to-85% back on the outdoor enthusiast. Reflected light helps create snowblindness and another problem, "sun poisoning", an allergic reaction to ultraviolet light, primarily UVA. Allergies are specific to certain susceptible people, and this one looks like poison ivy, or, sometimes, eczema. Intense itching usually starts 24 - 48 hours after exposure. Treatment for most allergies is limited to time, anti-itch measures (topical hydrocortizone and anti-histamines), and eliminating contact with the allergy-producing agent. Severe reactions often benefit from prescription drugs that a doctor must suggest. Prevention is offered by clothing and sunscreens that block UVA and UVB radiation. Of particular efficacy are sunscreens that contain titanium dioxide.

As the icy tendrils of winter swirled around his house in 1862, Maurice Raynaud took pen in frigid hand to first scratch out the description that would bear his name. Raynaud's syndrome results from intermittent spasms in the peripheral vessels of fingers or toes, and occasionally ears and nose. Color changes accompany this painful response to cold - usually white, often red or blue. Nobody knows what causes Raynaud's syndrome, but thousands suffer with the slightest drop in temperature.
Many treatments have been tried including avoidance of cold (which ruins winter fun), tranquilizers, vasodilating drugs, hormones, and, in extreme cases, a sympathectomy (cutting the sympathetic nerves so the blood vessels can't constrict).
For the past decade researchers at the US Army Research Institute of Environmental Medicine, Natick, MA 01760, have been experimenting with techniques to countercondition these syndrome-impaired nervous systems. Test subjects were required to keep their distressed parts in hot water for 15 - 20 minutes while the rest of their bodies stayed cold. Then, with hands or feet still in hot water, they were moved to a warm ambient environment for 15 - 20 minutes. A couple of times a day and eventually, depending on the severity of the case, the brain is conditioned to keep the peripheral vasculature open, without the hot water, despite the changing air temperature. Sometimes it doesn't work, but the Institute says 90% of their patients improve and conditioning may last for years before it has to be repeated.

As a final word, the human body is more susceptible to problems of cold weather than warm. But the human brain is capable to making up the difference. Use yours.


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