I need a consult and advice

Salty1 · Dec 4, 2004

If this is Raynaud's it is most unusual since it involves only one finger. While I have only seen two or three Raynaud's cases they all involved all the fingers. I would think that your spouse should see a vascular surgeon asap and if an appointment is not immediately available I would go to an ER where they have vascular people on call. Keep us posted.

Salty

Nurse Ratched, RN · Dec 4, 2004

Definitely recommend a vascular person. Keep us posted - that's uber bizarre. Wishing your hubby well! (And smack him and tell him to quit smoking .)

(Just as a side note, you don't suppose there's any chance it's a weird onychomycosis?)

Bonnie Nurse · Dec 4, 2004

Your husband is not by any chance on coumadin, is he? Reason I ask is that a woman presented with same at the hospital the other day and it turned out to be coumadin necrosis. But I have to say that the color was black by the time we saw her. From what I understand, though, coumadin necrosis is not your garden variety common thing.

My husband's right index finger has begun to turn blue at the tip. He is also right-handed and smokes about 1/2 ppd. hx HTN.
Anyway, for about 6 weeks it has been like this, and now it is getting worse. The fingernail looks as if it is lifting away from the nailbed, the tip is whiter with cap refill between 3-4 seconds. There is a brown line under the free edge of the nail that looks sort of like splinter hemorrheg, but isn't.
Frankly, it seems to me that he has thronw microemboli to the very distal tip of the finger, and I am concerned that if it gets worse he may lose it.
He showed it to the doc about 6 weeks ago, and told the doc I thought it was Raynaud's, but naturally since I said so, the doc didn't think so
Now he saw the doc again yesterday, and he now thinks it's raynauds and is doing lab work, it is a weird one, I forget the name of the lab, to determine if it is raynaud's.
Meanwhile, I have him on ASA 325/day and have him wearing a glove and keeping it as warm as possible.
My question is, what kind of specialist does one see for a problem with circulation of the hand? Vascular surgeon? Hand specialist/ortho? Cardiology? I am not entirely satisfied that my doctor was appropriately impressed with the degree of circulatory impairment. My husband is 47, and needs that finger as he still has many years of work ahead of him. Why couldn't it be his freaking left pinky?
Also, have you ever heard of it affecting the fingers a person uses to hold their cig more than the other fingers? Just seems logical to me, that the nicotine may be locally absorbed in small amounts over time, and make the syndrome worse. I know he needs to quit smoking, but that just is not possible right now as he is going through a very difficult transition in his life, which I will not go into to maintain his privacy, but it is just not the time to quit smoking, and that is from a staunch former smoker, anti-smoking advocate, so you need to understand that.
What do you think the next step should be? What kind of specialist?
The NIH affiliated web site... http://www.niams.nih.gov/hi/topics/raynaud/ar125fs.htm is the M/S skin assoc, should we maybe see a rheumatologist?
Thanks!!!

group_theory · Dec 4, 2004

Your husband needs to see a primary care doctor that is willing to lead a team to investigate this issue. This includes rheumatologist, hematologist, cardiologists, etc.

It can be Raynaud's associated with connective tissue disorders (e.g. SLE, scleraderma, etc). It could also be CREST. It could also be clotting disorder, endocarditis, atherosclerosis, etc.

Another possibility (esp when I read about the hx of smoking) is Buerger's Disease.

The classic patient with Buerger's is a relatively young male age (20-50) with a history of smoking (however lately there have been an increase in females and people >50 getting this).

"The initial symptoms of Buerger's Disease often include claudication (pain induced by insufficient blood flow during exercise) in the feet and/or hands, or pain in these areas at rest. The pain typically begins in the extremities but may radiate to other (more central) parts of the body. Other signs and symptoms of this disease may include numbness and/or tingling in the limbs and Raynaud's phenomenon. Skin ulcerations and gangrene of the digits are common in Buerger's disease. Pain may be very intense in the affected regions"

http://vasculitis.med.jhu.edu/typesof/buergers.html

However, this disease is pretty rare so don't assume that this is what he has. Remember, when you hear hoofbeats, think horses, not zebras (unless you are in South Africa where zebras outnumber horses)

Just make sure your doctor understand your concerns and take that into account when he/she investigate this.

Group_theory

*disclaimer - please do not substitute the web or anonymous advice for medical advice from your physician*

Jay-Jay, RN · Dec 4, 2004

Sorry to hear about this Hoolahan. I have an uncle who lost a leg to smoking. He first had vascular surgery on the leg. While he was in rehab, to encourage him to quit smoking, the physio pointed to a couple of amputees who were relearning how to walk. "That could be you in a couple of years," she said. "Vascular surgery as a poor success rate in smokers."

He's in his 80's now BTW, and I think he had the surgery (amputation) about 10 years ago. Hope you find that last bit a little reassuring! (and I know I'm preaching to choir here...if only the congregation would listen!! :) )

DDRN4me · Dec 4, 2004

Hmmmm..I have Raynaud's myself and it doesnt only affect one finger, usually..it also usually turns red, then white...my nailbeds are blue most of the time..and it also affects my toes.........but no other circulatory issues...I definitely think vascular is the way to go. better safe than sorry!! Best of luck

P_RN, ADN, RN · Dec 5, 2004

My first thought was either a bone felon (infection of the pulp) or a herpes whitlow.

http://www.merck.com/mrkshared/mmanual/sections.jsp

Was the test for Reynaud's ds you mentioned a Homocystine level?

akcarmean, LPN · Dec 5, 2004

Good luck and keep us posted

purplemania, BSN, RN · Dec 5, 2004

I know it goes without saying, but whatever the problem is, he would be better off not smoking. I hope you discover the root cause and he has a successful recovery.