Hypothermia Early Warning Sign?

[rfolster]

On a recent paddle, I tested some new layering options, and did not get it right. Without getting bogged down by the details, I will instead provide an observation. I noticed that, during the paddle before lunch, my hands and feet got cold and I could not warm them up. I was wearing wool socks under by drysuit booties with decent neoprene boots over top. My hands were in 2mm fleece-lined neoprene gloves that are remarkably waterproof - no water gets inside if I spend a minute getting all the wrist layering and strapping done properly. However, on that morning, no amount of finger flexing or toe-tapping would get the extremities warm.

At lunch, I put on my storm cag to help me warm up, and I decided to keep it on for the paddle back. The "ah-ha" moment came to me when I noticed that no chill came to my hands or feet, even though I could feel the cold on the outside of the neoprene trying to sneak in. Does that make sense? Anyway, my question is this: Can cold hands and feet be an early warning sign that one is at risk of becoming hypothermic? My assumption is that the hands and feet are the first place that the body will restrict blood flow to preserve heat, and that no amount of warming exercises or techniques will help without warming the body.

When we discuss hypothermia in the Cold Water Workshops, we always discuss warning signs that are usually not recognized by the hypothermic individual since reduction in cognition is one of the symptoms. However, if this is an actual early warning signal, it could be extremely helpful since it is easily recognizable while we still have our wits about us. Now, actually doing something about it is an entirely different story.

Thoughts?

[Phil Allen]

Hi Rob-

After lunch, food calories and the cag would have kept you warmer overall. It's likely you were cold, and the blood flow was being shunted away from your extremities, an early indicator you could be on the way to hypothermia. That said, cold hands and feet could just be a symptom of restricted blood flow from clothing (tight gaskets and tight overstocks) with an absolutely fine core temp. Only you know what's right for you, so use what you know.

An aside, did you mention to your paddling partners your issues with being cold? Often, they're the best judge of our condition when we're on the hypothermia slide.

best

Phil

[Jed]

Often cold hands and feet are the first signs of mild-hypothermia for the otherwise healthy and properly dressed, IMO. There are lots of mechanisms that can lead to cold extremities for paddlers: inadequate thermal protection (heat loss), mechanical restriction of the blood vessels (restricted blood-flow), Raynaud's Syndrome (restricted blood flow due to stress or cold) and/or lack of fuel (lowered metabolism) to name some of the possibilities.

Since you warmed up quickly once the cag was on, it sounds like the problem was heat loss from something other than the hands and feet, likely the head or neck. The old adage about putting on a hat if you have cold feet is a great example of this effect. As soon as the body detects a compromise in it's ability to maintain core temp, the hands and feet are the first things on the hit list. When things get to this point, working the hands and feet won’t do much, there just isn’t enough musculature in the hands and feet to create much heat. The only way to warm them is to reestablish blood-flow to the extremity, typically by raising the core-temp and reducing any restrictions.

I can't think of an example when someone has been hypothermic (even mildly) and their hands and feet weren't very cold. I'm not sure it's possible for a healthy person to be hypothermic and still have relatively warm hands and feet. For me the distinction is between feeling the cold and being cold. With the “feeling the cold” happening via the otherwise warm skin and the “being cold” permeating through the skin to deeper tissues.

cheers,

Jed

[jason]

When I paddle with gloves I have cold hands. The fix for that IMO is pogies. The gloves tend to squeeze the blood out of my hands. (Not sure that they make gloves that are big enough).

[Nancy Hill]

I realize that I am not answering your question, but, I have found some relief by using chemical toe-warmers stuck to the top of my socks under my drysuit booties. That made a world of difference for my feet. I just bought neoprene mittens to try instead of gloves and intend to wear a thin glove liner underneath. Hopefully, that will take care of cold hands, but I haven't gotten out to try it, yet.

-Nancy

[EEL]

Although it might not seem rational at first, you can often become chilled shortly after starting up again after stopping to eat lunch in cold conditions. The body needs to divert blood to the stomach to digest food and this in turn leads to the extremities getting short changed just when they need it. Worse it can start to short change core areas. Often this is not noticed because folks will dress heavier after lunch for various reasons, but it is very apparent if you eat a big lunch. Which is another reason why it is better to just constantly nibble during the day when you are traveling in cold conditions and not stop for a long, big lunch. Not sure this is a big deal when kayaking in mild temps of thirties and twenties or so, but when you are doing a day long hike in temps around zero it can be noticeable. In those temps once you get truly cold as in deep cold, it is very hard to get warm. Rewarming extremities is a piece of cake comparatively.

Ed Lawson

[JohnHuth]

I generally don't see cold hands as a symptom of hypothermia. This is a general reaction of vasoconstriction in response to cold that preserves your core temperature. It can be painful, but not necessarily hypothermia. Hypothermia is when your core temperature starts to drop - so the 'umbles' are the first sign, then shivering.

Recently I found out that paradoxical undressing (end-stage hypothermic victims shed their clothes) is the result of the glucose burning that creates vasoconstriction exhausts the supply of glucose - the blood vessels relax and blood floods back into the limbs, giving a sensation of warmth.

Often times, after a meal, the diverted blood flow to the gastrointestinal system can divert blood from the limbs. A bunch of friends and I had this happen while bushwhacking in New Hampshire. Just after lunch, we noticed that our hands suddenly got cold. At no point did I think we got even close to hypothermic, however.

[rfolster]

Ed & John both have an interesting point of being cold AFTER lunch due to blood supply being diverted to meal digestion. I think this correlates to the old adage of not swimming for some length of time after eating, which I think as been dispelled as an old wives tale. To my case, I ate a rather hearty meal that consisted of a full can of beef stew and a couple of slices of banana bread with some hot tea. However, after lunch, my hands and feet were toasty warm.

John, just to clarify, I am not suggesting that cold hands and feet are a symptom of hypothermia, and I am not even saying that it is a definite that hypothermia will occur if your hand and feet are cold. I am merely making an observation that uncontrollably cold hands and feet (that can not be warmed using flexing techniques) might be an early warning sign that you are at a higher risk of becoming hypothermic if you don't make some adjustments.

Although the first signs of hypothermia are fumbling, stumbling, and mumbling, it is the last one that is key in that the victim is experiencing a loss of mental functions. This means that they are usually incapable of recognizing the signs, and therefore is unaware of the situation they are in. The point of this post is to suggesting that, if you end up with cold hands and feet that you just can't warm up, you can recognize it as a potential sign for impending hypothermia, and address the problem before your core temperature drops to a point where you loose the cognitive ability to deal with it.

[Suz]

I have always found that if I can't get my hands/feet warmed up, then my temperature is dropping. Last night when snowplowing, I was a wee bit over dressed and found my hands were much toastier than usual when snowplowing. I think if you are warm to almost sweating, your hands and feet just can't be cold. Only way for that to happen is exertion or overdressing.

[Phil Allen]

Actually Rob, I'd say that the first signs of potential hypothermia are the grumps. Just like some people get hangry when their blood sugar drops, many get cranky when their core starts getting cold.

best

Phil

[cfolster]

Since I have a terrible memory, I tooled around the internet and checked on symptoms of hypothermia, and cold or numb hands and feet are a symptom. Here's just one excerpt:

Dr. Robert Pozos, a leading hypothermia

researcher and former director of the Hypothermia

and Water Safety Laboratory at the

University of Minnesota—Duluth, School of

Medicine, recommends keeping a lookout for the

following symptoms:

 Continual shivering

 Poor coordination

 Slowing of pace—hanging back

 Increasingly numb hands and feet

(this leads to stumbling, clumsiness,

and loss of dexterity)

 Dazed and confused behavior (victim

may be careless and forgetful)

 Slurred and slow speech (victim may

be slow to respond to questions)

 Hallucinations

 Dilated pupils (open)

 Decreased attention span

 Changes in personality often to the

exact opposite of victim’s usual

personality.

Dr. Pozos advises that if any of these symptoms

appear, begin rewarming procedures

immediately. If the victim recovers from these

early symptoms in time, their chances of beating

hypothermia are quite good. The longer you

delay, the poorer his or her chances become.

[Pintail]

The original post asked whether cold hands and feet could be a taken as an early sign of impending threat of hypothermia, unless I am mistaken, and on those grounds I believe the answer to that question must be an unequivocal "affirmative"!

The cold hands and feet <might> also be a sign of overly-tight gaskets in the drysuit...(it was, for me, with my very first one, before I trimmed the gaskets)

Who is this "Jed"-character who posted above? I don't think he knows anything about sea kayaking -- only about music? ;^)

[EEL]

I believe Sir Christopher has the correct view. As in it does not indicate a person is at any stage of hypothermia, but rather an early sign of the threat of hypothermia. After all, hands and feet often get chilled for a variety of reasons including it is just hard to keep extremities warm given the path the blood must take to get to the fingers and toes if nothing else. You can suffer frostbite and never exhibit any symptoms of hypothermia. People often have cold hands and feet even have minor shivering episodes while working/playing in the cold, but those are not symptoms of hypothermia as such. Are they indications that a person might become hypothermic? As Pintail says, "Yes." Do they need to be treated for hypothermia? No. Should some minor adjustments be made to to warm things up? Yes.

I also think it is important to recognize that people are at risk of having a catastrophic accident due to mild hypothermia well before the more obvious and frequently discussed symptoms show up.

For those interested, the following is a good reference work for those who play outdoors:

http://www.mountaineersbooks.org/Hypothermia-Frostbite-and-Other-Cold-Injuries-P324.aspx

Ed Lawson

Edited February 20, 2014 by EEL

[JohnHuth]

Just to clarify - using the label of hypothermic to a person to me implies that you should try to treat it. Certainly one symptom is cold hands, but there are plenty of cases where a person has cold hands and is in no danger of hypothermia, as long as the cold hands is the result of something well established - like taking gloves off temporarily during lunch. Once you start paddling, the hands warm up again.

I'd look for more symptoms.

I recently had been told about the causes of paradoxical undressing - people who are in advanced stages of hypothermia discard their clothes. Evidently the act of vasoconstriction (the things that makes your hands cold) takes active burning of glucose for the blood vessels to constrict. When all the glucose runs out, the vessels can no longer constrict, and they open up - leaving blood flooding back to the limbs, which creates a sensation of sudden warmth.

[rfolster]

Yes, John, if someone is hypothermic, you should try to treat it if you can. However, just because someone isn't actually hypothermic doesn't mean that preventative measures can't be taken to prevent someone from becoming hypothermic. What we are trying to convey here is that there is an opportunity to avoid the whole mess in the first place.

I thought that it would be apparent that this discussion was not about getting cold hands due to some simple reason such as removing gloves at lunch or having a gaping hole in a glove seam. While there are plenty of reasons why someone's hands or feet might separately become cold, the point of this posting was from an observation that I made and has been since confirmed. Both my hands and feet became very cold simultaneously (although not instantaneously), and I was not able to warm them up again while paddling. It was a warning sign that, if I didn't deal with what was an unknown drop in core temperature in the near future, I was going to become hypothermic. Without realizing why at the time, I decided to let others know that I was having trouble keeping warm, even though our lunch stop would be soon enough for me to address my chill. It occurred to me later that it was a good idea just in case my sensibilities went downhill before our arrival.

This is the whole meaning behind the cold hands AND feet being a warning sign. If you are out on a paddle with cold hand and cold feet, and your next "scheduled" stop is not for another couple of hours, you should know to speak up to the group that you need to stop and make an adjustment. More often than not, you will get someone else that will be glad for the stop to make adjustments of their own.

We often spend a lot of time discussing the symptoms of hypothermia, but by the time they become noticeable, the chances of successfully treating them in the field has already diminished. If you don't recognize someone is hypothermic until they become lethargic in the middle of a 3-mile crossing, then what are the chances of getting them towed to land in time to treat the hypothermia in the field? At some point, hypothermia can only be treated in a hospital using specialized equipment to warm the blood directly. More than likely, you will be calling for an ambulance when you get to shore, or worse, a helicopter for an off-shore or on-water rescue.

Also to be clear, if someone gets to the point of shedding their clothing like John is talking about, the chance of survival is almost none. I think it was posted on another thread some time back hat one wilderness rescuer was quoted as saying that wen they are on a search and find abandoned clothing, it is no longer a rescue operation, but the search for a body.

[Phil Allen]

Rob-

Don't beat up on John. As many have said, your cold hands and feet could have been due to core temp, or your choice of restrictive clothing and foot wear (the neoprene socks). I'm glad you figured it out for you on that day. We are all different in our tolerances to hot and cold.

best

Phil