You may think that outdoor adventurers are the only people who need to worry about hypothermia and frostbite. But that’s not true.

Here are common myths about these cold-weather dangers and the facts you need to stay safe… 

MYTH #1: Everyone has the same risk for hypothermia and frostbite when temperatures drop. The truth: Anyone can develop these conditions (see below), but older adults are at greater risk. Their bodies lose heat faster, thanks to thinner skin. Older adults also may have a diminished awareness of drops in body temperature and weakened natural responses to the cold caused by chronic medical conditions and/or the use of certain medications.

People with diabetes, for instance, have a heightened risk for hypothermia. Here’s why: If a person’s blood sugar drops too low, perhaps due to too much medication, his/her body may try to adapt by conserving energy. One way to do this is to reduce shivering—the body’s most effective way of staying warm. Without shivering, the body doesn’t generate as much heat, and a person cools more rapidly.

People with diabetes-related peripheral neuropathy also are at increased risk for frostbite because numbness in their limbs may make them less aware of the sensations of cold and pain. For example, if snow has made its way into a boot while walking, it might not be detected, setting the stage for frostbite.

Other conditions that can make it harder to stay warm include hypothyroidism, severe arthritis, heart disease, stroke, Parkinson’s disease, peripheral arterial disease and Raynaud’s disease (a condition that causes numbness and pain in the hands and feet, in particular, when exposed to cold temperatures and/or stress). Smokers are particularly vulnerable to hypothermia and frostbite—smoking impairs the function of blood vessels, slowing circulation and increasing risk for tissue injury.

Medications that can affect the body’s thermoregulatory mechanisms include blood pressure drugs (such as beta-blockers)…antidepressants…certain antinausea medications…and some over-the-counter (OTC) cold remedies.

MYTH #2: Hypothermia happens only when the temperature is freezing or below. The truth: Symptoms can begin as soon as your core body temperature dips below 98.6°F, usually at around 95°F. That can happen when the temperature is above freezing outside if a person is improperly clothed, wet and/or is being simultaneously exposed to wind.

For example, a person who is jogging outdoors in windy, 45°F weather, wearing shorts and a T-shirt and sweating, could become hypothermic if heat loss exceeds heat production and conservation. Camping, hunting and fishing enthusiasts also should avoid cool-but-not-freezing temperatures for extended periods if they are wet or not properly dressed to avoid both hypothermia and cold-induced tissue injuries.

Important: Hypothermia also can occur indoors. Even with functioning heating units, indoor temperatures in the 60°F to 65°F range can lead to hypothermia if a person’s core body temperature drops to 95°F or lower—perhaps due to improper clothing or falling down on a cold floor and not being able to get up.

What to do: Keep your thermostat set to at least 68°F. Have blankets handy, put on socks and slippers, wear long underwear beneath your clothes and ask your doctor if any of your medications, prescription or OTC, might increase your hypothermia risk. Also, be sure to stay well hydrated.

Older adults who live alone should make every effort to ensure that they stay safe during blizzards and other bouts of especially cold weather and isolation. This includes having someone check in regularly, storing extra clothing and blankets, and knowing how to obtain assistance.

MYTH #3: If your skin is cold and numb, you’ve got frostbite. The truth: A condition called frostnip resembles frostbite but is less severe. The extremities may appear pale or red and feel numb, tingly or burning. A key distinguishing feature between frostbite and nip is that the skin still feels pliable with frostnip.

Because only the most superficial layers of skin are injured by the cold, there are generally no permanent injuries with frostnip. If you seek a warm environment as soon as possible, you should be fine. However, if the freeze deepens, it can become a frostbite injury.

MYTH #4: Alcohol is a quick fix. The truth: Sipping alcohol may make you feel cozy, but alcohol actually dilates the blood vessels in your skin, causing you to lose heat faster. Booze also impairs judgment, so drinking in cold weather can cause a person to not notice hypothermia or frostbite symptoms.

Alcohol is dehydrating as well, and dehydration is a risk factor (and a feature) of hypothermia and frostbite. Avoid caffeinated beverages, which also are dehydrating.

What helps: If you suspect someone is hypothermic, offer warm liquids, such as hot chocolate or warm milk, if the person is coherent and alert—capable of purposeful swallowing without choking.

MYTH #5: Rubbing your cold skin helps. The truth: With frostbite, rubbing can lead to additional tissue damage, due to internal trauma caused by ice crystals in the skin. You should ignore any advice to rub snow on cold skin—it will never help!

What to do: Use body heat to warm cold, frostnipped or frostbitten limbs, although this may not be very effective for frostbite. Never thaw frostbite if it cannot be kept thawed, because refreezing causes much worse damage. Warm your fingers in your armpits…beneath your breasts (for women)…or on a friend’s warm belly.

Refrain from placing anything hot, such as a heating pad, on a frostnipped or frostbitten area. Numbed skin may prevent you from sensing heat, leading to burns. Immersion in warm water will help—100°F is ideal and never above 108°F. It’s best if you’re with someone who can confirm that the temperature isn’t too hot.

Remember: Shivering is your friend. Your teeth also may chatter if your jaw muscles are shivering. Thankfully, this natural body response will protect some people from developing frostbite or, even worse, hypothermia—all that quaking may be uncomfortable enough to drive them inside, out of the cold.

If you suspect hypothermia, the key is to seek shelter, replacing any wet garments with dry ones—even if it means briefly exposing the skin—and warming up with blankets, a hat and gloves or very carefully near a fireplace or heating vent, if available. If someone has suffered frostbite, medical attention should be sought to determine what further care might be necessary.

When the Body Gets Too Cold

The most significant cold-weather dangers are…

• Hypothermia—a medical emergency marked by abnormally low body temperature due to cold temperatures. In freezing water, for example, it can occur in less than 15 minutes…while it may take an hour or two in water that is 50°F to 60°F. The body begins losing heat faster than it can produce it, impairing the function of the heart, brain, lungs and other vital organs. Symptoms begin with shivering and fatigue, quickly progressing to confusion, clumsiness, slurred speech, muscle rigidity and eventually death.

• Frostbite—occurs when unprotected skin is exposed to temperatures below 32°F for an extended period of time. The tissue (usually hands, feet and/or nose) can literally freeze, possibly resulting in permanent damage, such as infection, gangrene and, in severe cases, amputation.

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