Does your dog freeze in extreme cold? Let's talk about Frostbite!

We all love the cold, right? But sometimes, if this cold gets a little harsh, it's not good for our bodies. Especially if you live in a cold area like Nuwara Eliya, or if you are going to a foreign country during a snowy season, what I'm going to say will be very important to you. Today we're going to talk about the damage that extreme cold can do to our skin. We call this `Frostbite`. Just like water turns to ice, our skin can freeze in extreme cold.

What is `Frostbite`? Let's understand it simply.

Simply put, `Frostbite` is damage to our skin and the tissues underneath it caused by exposure to temperatures below 0 degrees Celsius (32 degrees Fahrenheit). Imagine, when you are in a very cold environment, some parts of your body start to freeze like ice cubes. This is `Frostbite`. This condition is more likely to occur:

• In snowy winters.
• In windy weather conditions. (Wind makes the body feel colder.)
• In areas much higher than sea level.
• If there is no suitable shelter to protect yourself from the cold.

Remember, frostbite can occur even when you are wearing cold-weather clothing. Sometimes, the cold can penetrate through clothing and cause damage. Frostbite can sometimes cause permanent, irreversible tissue death. This is called necrosis in medical terms. So the best way to avoid it is to limit your time in cold places and to warm up frequently.

If you think you have frostbite, get out of the cold and into a warm place as soon as possible. Then, seek medical attention immediately or go to the nearest hospital emergency room. Doing so can greatly reduce tissue damage.

Who is most affected by `Frostbite`?

Anyone exposed to extreme cold can develop frostbite. However, some people are at higher risk, especially:

• For young children under 18 years of age and for those over 65 years of age.
• For those who live and work in areas with cold climates. (For example, for those who live in provinces like Nuwara Eliya in our country, or for those who work in cold countries.)
• For those without proper housing facilities.
• For those with certain underlying medical conditions. For example:
• Peripheral vascular disease
• `Malnutrition`
• Raynaud's syndrome
• Hypothyroidism (underactive thyroid gland)
• `Arthritis` (Arthritis/Joint Inflammation )
• ` Diabetes ` (Diabetes )
• For those who use tobacco products. ( Smoking can affect blood circulation.)

Fewer cases of frostbite are being reported than in the past. This is because people can now easily find cold-resistant clothing and there is increased awareness of the dangers of frostbite and how to protect themselves from it.

What are the chances of `Frostbite`?

We can see the symptoms of `Frostbite` under three main stages. The way it feels also changes according to these stages: 1. Feeling of coldness, tingling and pain `(Frostnip)`: This is the first stage. It is like when we hold an ice cube in our hands, after a while our fingers become red, tingle and feel a little pain. 2. Feeling like needles are being pricked (Surface `Frostbite` - `Superficial frostbite`): At this point, the water under the skin begins to freeze. 3. Numbness and loss of feeling (Deep `Frostbite` - `Deep frostbite`): This is the most dangerous stage.

The most important thing is to seek medical attention immediately if you notice symptoms in the second or third episode. This is the only way to avoid long-term damage.

How does frostbite feel? What does it look like?

The symptoms of frostbite vary depending on the location and severity of the damage to the skin.

1. `Frostnip` (early stage)

This is the warning time for `Frostbite`. At this time:

• Your skin may turn red, maybe even purple. Or your skin may become paler than normal.
• The skin may feel cold and tingly with a slight pain.
• The damage to the skin at this point is usually temporary.

What to do? As soon as you notice these symptoms , go indoors or somewhere warm. Then, warm the affected skin with lukewarm (never hot!) water . Then, you may develop small red blisters called ``Chilblains'' on your skin. Even if you have these minor symptoms, see a doctor, because sometimes there may be damage that is not visible.

2. Superficial frostbite

This is the second instance of `Frostbite`. This definitely requires medical attention.

• At this point, your skin may feel warm, but what's really happening is that the water inside your skin is turning into ice cubes. (Our skin is over 60% water!)
• A "pins and needles" sensation may occur.
• The skin may feel inflamed and swollen.
• After the skin is rewarmed, painful, patchy, or bruise-like purple or blue spots may appear on the skin.
• The skin may start to peel off, as if it were sunburned.
• After a day or two , water-filled blisters may form.

3. Deep frostbite

This is the third and most serious case of `Frostbite`.

• At this time, even the deep tissue beneath the skin (subcutaneous tissue) freezes.
• You feel completely numb and unable to feel anything .
• Frostbite may make it difficult to move the affected area, or it may be impossible to move it normally.
• You need to seek medical attention immediately!
• Large blisters may appear on the skin a day or two after exposure to cold.
• The skin turns black as skin cells slough off and die.
• Sometimes a black, hard shell called a ``carapace'' forms on the skin, which may fall off on its own. If it doesn't, a doctor will surgically remove it.

The main reason frostbite is so dangerous is that it can cause numbness in the skin, which can leave you unaware of anything wrong. So, if you have even the slightest suspicion that you have frostnip or frostbite, see a doctor immediately.

Is it possible to not know if you have frostbite?

Yes, you can. Many people who get frostbite don't even realize they have it. This is because frostbite numbs your nerves and can cause deep damage to your skin. You may not even notice any symptoms until you come back from the cold. That's why it's important to limit your time outside in extremely cold weather.

Where does frostbite most commonly occur?

Frostbite can actually occur anywhere on the skin. However, it is most common on the extremities . These are the areas that are most exposed to the cold, even when well covered with clothing:

• Hands and fingers
• Legs and toes
• Face and nose
• Ears

How do I know if my child has frostbite?

This is a bit of a tricky question. Small babies don't fight like big ones because they don't have as much energy stored in their bodies. Older children usually don't even realize they've got frostbite while playing outside.

• Check your baby or toddler for any signs of frostbite, even if they've been out in the cold for just 10 minutes . If you notice any areas of their skin that are paler than normal, redder, whiter, or grayer, call a doctor right away.
• If your children are a little older, if they have been outside in extreme cold for more than half an hour, even if they are wearing cold weather clothing, Ask them to come inside and change out of their wet clothes. Put on dry clothes, wrap them in a blanket, and warm them up. Giving them a warm bath can also help warm them up. Never use hot water, only lukewarm water!

How does `Frostbite` develop?

Frostbite is mainly caused by extremely cold temperatures . Sometimes, even temperatures slightly above freezing can cause frostbite if exposed for a long period of time . These things can cause frostbite:

• Exposure to freezing temperatures.
• Holding a frozen object, such as an ice pack, or metal, against the skin.
• Not wearing enough clothing to protect the skin from the cold.

Remember that frostbite can occur even if you are wearing protective clothing such as a hat, shoes, or gloves. Frostbite occurs when the water in your skin freezes and turns into ice crystals (our skin is made up of more than 60% water). This damages skin cells and tissues, cutting off blood flow to those areas. In severe cases of frostbite , muscles, nerves, and joints can also be damaged.

How long does it take for frostbite to develop?

Frostbite can occur in 30 minutes or less when the wind chill is -26 degrees Celsius (-15 degrees Fahrenheit) or lower. If you live or work in a cold climate, limit your time outdoors to prevent skin damage.

How cold does it have to be to get frostbite?

For frostbite to occur, the temperature must be below 0 degrees Celsius (32 degrees Fahrenheit). Remember, if there is wind, it can feel much colder than the actual temperature. This increases the risk of frostbite.

How to recognize `Frostbite`?

A doctor will determine if you have frostbite by physically examining you and possibly doing imaging tests such as an X-ray. During the examination, the doctor will look for changes in your skin color, spots, or blisters. They will also ask questions about how long you were exposed to the cold and what the temperature was like at the time. Depending on the severity of your symptoms, an X-ray may also be taken to see if there is damage to the tissues under your skin.

How do you know if frostbite has caused permanent skin damage?

Your doctor will tell you whether the damage to your skin is permanent. If there are clear watery blisters on your skin, this may indicate temporary damage. However, if there are blood-filled blisters, this may be a sign of permanent damage. If your skin turns black, or darker than your normal skin color, this may indicate severe tissue damage.If this happens, the damaged skin may need to be surgically removed to prevent secondary infections or gangrene.

How is frostbite treated?

Treatment for frostbite varies depending on the stage of the injury. If you have symptoms of frostnip (early stage): If possible, immediately go indoors or to a warm place to get out of the cold. Then, follow these steps to warm the affected skin:

• Remove any items you were wearing for the cold, such as socks and shoes. Also remove any jewelry, such as rings and watches, if they are near the area of ​​injury.
• If your clothes are wet, put on dry clothes.
• Place the affected skin in a bowl of lukewarm (not hot!) water . This is a process that gradually warms the skin, and can take at least 30 minutes.
• Place something like a blanket over the damaged skin. But don't wrap it tightly. Doing so can cut off blood circulation and stop blood from flowing to the damaged tissue.
• To avoid burns, do not apply heat directly to the skin with things like heaters.

If you have symptoms of superficial frostbite or deep frostbite (second and third degree), seek medical attention immediately. Time is of the essence with frostbite. You may feel severe pain as the skin thaws. A doctor will do the following to treat frostbite:

• Soaking in lukewarm water or placing warm, damp cloths on your skin will raise your body temperature for about 30 minutes.
• Cover the frostbite with sterile bandages. To prevent the fingers from rubbing together, wrap them separately.
• Blood flow to the injured body part is checked. If you have third-degree frostbite, you may also be given an IV (a tube that gives saline solution into a vein in your arm) to improve circulation.
• Antibiotics and painkillers such as `(Ibuprofen (Advil®, Motrin®))` are given.
• Frostbite causes tissue dehydration, so give your body water to rehydrate.
• Oxygen therapy is provided. In severe cases of frostbite, you may be given pure oxygen in a pressurized chamber. This treatment is called hyperbaric oxygen therapy. This increases the oxygen levels in some people's blood, speeding up recovery.

Does frostbite require surgery?

In severe cases of frostbite, your doctor may need to perform surgery to remove the dead skin and tissue after you have healed. It may take days, or even months, to decide whether surgery is necessary. If the tissue is dead, or gangrene has developed, surgeons may need to amputate parts of the body, such as fingers or toes.

Can frostbite be treated at home?

If you have frostnip or frostbite, you should definitely seek medical attention. However, if you are in a difficult area or cannot get to a hospital quickly, you can take these steps at home to help prevent further damage to your skin and tissues. Your first priority should be to stay warm. Find shelter and try to keep your body warm and prevent yourself from freezing again. Doing so can cause more serious damage to your skin. Here are some things you can do to stay warm:

• Take off all wet clothes and put on dry clothes.
• Keep the injured area slightly elevated.
• Warm the skin with lukewarm water, between 37 and 39 degrees Celsius (98.6 and 102.2 degrees Fahrenheit) . It may be difficult to know the exact temperature of the water because your skin is numb. Use a thermometer if possible. You can stop warming the skin when it feels soft again, or after at least 30 minutes.
• Cover the frostbite area with a clean cloth. If you have frostbite on your fingers, wrap each finger separately. Keep them apart to prevent pressure from rubbing together. To help blood flow, don't wrap your fingers tightly.
• Try to keep the area as still as possible until the skin thaws. Do not walk on frostbitten toes or legs.
• Do not rub frostbite. Rubbing skin that is stiff or numb can cause further damage to the tissue.

You may feel some pain during the skin thawing process. This is normal. You can take over-the-counter painkillers as directed by your doctor.

How to protect yourself from `Frostbite`?

Here are some tips to avoid frostbite:

• Avoid going outside: When it's cold, stay indoors as much as possible.
• Limit your travel: If you must go out, go out for a short period of time, like 10 to 15 minutes, every few hours, and then come back inside.
• Dress warmly before going out: Dress appropriately when going to cold places. Wear several layers of clothing. Wear warm socks, a thick hat, mittens, and a heavy scarf that covers your face, ears, and mouth.
• Wear wind and water resistant clothing: Wear clothing designed to protect you from the weather and keep your head and neck warm.
• Do not interfere with blood circulation:Make sure your shoes and clothes are not too tight. If they are, your blood circulation may be poor. Move regularly to maintain good blood circulation.

When traveling in cold weather, always keep your phone with you. It will be your lifesaver in case of an accident or if you get stuck on the road and need medical help. Finally, keep a car emergency kit in your car. Then, if the weather turns bad, you will be prepared with first aid, food, gloves, shoes and blankets. How does this affect us in Sri Lanka? Actually, severe `Frostbite` cases are very rare due to the climate of our country. However, in high altitude areas like Nuwara Eliya and Haggala, especially during winter, the temperature drops significantly. At such times, if you do not wear proper protective clothing, there is a small chance of `Frostnip` cases. In addition, it is very important for those who travel to cold countries or go to work to be aware of this.

What to expect if you get frostbite?

If you think you have frostbite, go indoors and call a doctor or go to the emergency room immediately. The time it takes for your frostbite to heal after treatment depends on how severe the frostbite was and how long it has been there. A very mild frostnip can heal in a few days to a few weeks. A second-degree frostbite can take up to six months to heal. The skin may crust over and change color as it heals. A third-degree and more severe frostbite can cause permanent skin damage. Surgery may be needed to repair this type of skin damage. Your doctor can give you the best time frame for how long it will take for your skin to heal, depending on the severity of your symptoms.

What are the complications of frostbite?

Frostbite can cause complications. After the initial frostbite (frostnip) has passed, long-term side effects can occur, such as:

• Nerve damage (Neuropathy)
• Excessive sweating
• Increased sensitivity to cold
• Frostbite arthritis (stiffness in hands and feet)
• Skin discoloration
• Nail damage or nail loss
• Scarring

Also, once you get frostbite, you are more likely to get it again. Frostbite can cause serious complications:

• `(Gangrene)` (tissue rot)
• Secondary infection
• Amputation
• Damage to tendons, muscles, and bones

When should you see a doctor?

If you think you have frostbite, don't delay in seeking help. Call a doctor or go to the emergency room immediately. Acting quickly and getting out of the freezing temperatures can help prevent serious complications.

What questions should I ask my doctor?

• What chance do I have of `Frostbite`?
• Will frostbite cause me long-term damage?
• How can I take care of my skin until it heals?
• Will I need surgery to treat frostbite?

What is the difference between `Frostbite` and `Chilblains`?

`Chilblains (Pernio)` are swollen, inflamed patches of skin that develop after exposure to cold air. This condition is not the same as `Frostbite`. `Frostbite` is damage to the skin caused by exposure to freezing temperatures. The main difference between the two conditions is the temperature. `Frostbite` is caused by freezing temperatures below 0 degrees Celsius (32 degrees Fahrenheit) , and requires immediate medical attention. `Chilblains` are caused by cool or cold temperatures above 1 degree Celsius (33 degrees Fahrenheit) , and usually heal on their own.

What is the difference between `Frostbite` and `Hypothermia`?

Frostbite is damage to skin cells and tissues caused by freezing part of your body. Just like ice forming on your car's windshield, frostbite causes your skin to harden and change color. Hypothermia is when your body temperature drops below 35 degrees Celsius (95 degrees Fahrenheit). Our normal body temperature is around 37 degrees Celsius (98.6 degrees Fahrenheit). Hypothermia is a more serious condition that affects the whole body. Frostbite only affects specific parts of the body. You can have both hypothermia and frostbite at the same time. Both are medical emergencies.

Finally, things to remember (Take-Home Message)

When cold weather arrives, make sure everyone stays safe at home, or at least wrap up warm. This will not only keep you comfortable, but it will also help protect you and your loved ones from frostbite and the serious health risks associated with it.

If you have been exposed to cold for more than half an hour in extremely cold conditions and think you have frostbite, seek medical advice immediately. Remember, taking quick action can prevent major damage. Take care of your skin!