The Big Chill: Listen to experts to avoid frostbite

When's the last time you thought about getting frostbite? After last season's "snowmageddon" and October's surprise nor'easter, part of living in the Northeast is preparing for anything Mother Nature might have in store.

"While frostbite is pretty uncommon, you have to be careful, particularly if you have diabetes or other issues that could affect blood flow," says Dr. Kilbourn Gordon, a physician at Fairfield Urgent Care Center. Frostbite is frozen skin, which can range from first-degree -- known as frostnip, which only affects the skin's surface -- to second-, third- and fourth-degree. Severe third- and fourth-degree frostbite freezes the muscles and tendons deep under the skin, requiring amputation in worst-case scenarios.

"Fortunately, you don't see a lot of severe frostbite," Gordon says. "But you have to be cautious about how you layer and protect yourself, and your family. Be cognizant of young, pre-verbal children who may look bundled up, but may not be as warm as they look."

Exposure time can vary, but roughly "a few hours" is enough to cause a case of first- to second-degree frostbite, says Dr. William Begg, EMS medical director at Danbury Hospital. The top patients Begg sees, however, aren't the elderly, the very young or the folks with diabetes or circulatory problems, such as neuropathy.

They're young adults. The reason? Alcohol, Begg says. "You know, you think about homeless populations, or people with mental health needs. But you don't always think about people who have taken drugs or been drinking."

Alcohol itself, Begg says, actually cools down the body. While it might feel nice and hot going down, that burning shot of whiskey causes the body to open up blood vessels, and dilated blood vessels lose heat faster.

Begg also stresses the importance of wearing appropriate clothing when you go skiing or hiking this winter. "There's a lot of great insulated, warm clothing out there that people aren't always thinking about," he says. "You have to make sure you're protecting more than just your core. Don't forget to cover your ears and nose as well as your hands, which people tend to already think about."

And the thin cartilage at the tip of your ear is just as vulnerable. Adds Gordon, "Use common sense."

There's an important difference between mild frostnip that can be treated with gradual rewarming, and more serious frostbite. "You know when you're getting cold, and you should be especially aware if you have a condition like neuropathy," Gordon says. "Go inside right away, but don't turn on the hot faucet. You'll hurt your skin more." Indeed, a sudden burst of hot water -- like slipping into a steamy shower-- can tear delicate skin and aggravate the condition.

Be patient and use lots of warm blankets instead, Begg advises.

Five Signs To Watch For

Be aware of telltale signs of frostbite that may not seem as obvious:

• Red skin. "Everyone thinks about the skin turning white, but edema, which can signify frostbite, occurs when the skin turns red and looks wet," Gordon says. If your skin looks like this, head to the hospital.

• Blistered skin. "Be especially concerned if the blister starts to break," Begg says. Go to the nearest urgent care center.

• Your shivering has stopped. While burning and discomfort is common, start to be concerned if you stop shivering after prolonged time outside -- usually a few hours, Begg says. "Go right inside, and if you don't start to feel better, or have a lack of sensation, you should go to the emergency department."

• You feel disoriented or mildly confused. "That neurological component is always something to be concerned about," Begg says. Go inside. If your condition doesn't improve, head to the emergency room.

• `Block of Wood' sensation. This is when your skin feels like a block of wood -- numbness and tingling giving way to stiffness. This isn't necessarily a sign that your condition has improved. If in doubt, Begg says, head to the emergency room.

Five Common Misconceptions About Frostbite

• You have to be outside a long time. Although it commonly takes a few hours for frostbite to occur, there are situations when it can happen sooner, particularly if it's windy, Begg says. "The bottom line is, if it's really cold out, be prepared, and take in that wind chill factor."

• You can warm up with alcohol. Substitute a hot, non-alcoholic cider or hot chocolate for that glass of wine or beer. Alcohol opens up the blood vessels, and dilated blood vessels lose heat faster.

• You can go right back outside after heating up. While this is a big no-no for severe frostbite, it's also not best practice to dash right back outside if you've just been significantly cold, Begg says.

• You can feel better with a hot shower. Warm up gradually with some fluffy blankets before diving under the faucet. Use tepid, not hot, water to slowly rewarm tender skin.

• You can rub your hands together to heat up. If you think you've got mild frostbite, rubbing your fingers together or applying direct heat will not mitigate the condition, Begg says. "It takes time to get the heat to come back naturally."

¨