Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Symptoms of RP depend on the
severity, frequency, and duration of the blood vessel spasm. Most patients with
mild disease only notice skin discoloration upon cold exposure. They may also
experience mild tingling and numbness of the involved digit(s) that will
disappear once the color returns to normal. When the blood-vessel spasms become
more sustained, the sensory nerves become irritated by the lack of oxygen and
can cause pain in the involved digit(s). Rarely, poor oxygen supply to the
tissue can cause the tips of the digits to ulcerate. Ulcerated digits can
become infected. With continued lack of oxygen, gangrene of the digits
can occur.
Less common areas of the body that can be affected by RP
include the nose, ears, and tongue. While these areas rarely develop ulcers,
they can be associated with a sensation of numbness and pain.
Patients with secondary RP can also have symptoms related to
their underlying diseases. RP is the initial symptom of 70% of patients with
scleroderma, a skin and joint disease. Other rheumatic diseases frequently
associated with RP include systemic lupus erythematosus, rheumatoid arthritis,
and Sjogren's syndrome.
How is Raynaud's phenomenon diagnosed?
In patients with the characteristic sequence of skin-color changes of the digits upon cold exposure,
diagnosing RP is not difficult. Sometimes, certain patterns in the
tiny blood vessels (capillaries) adjacent to the fingernails of patients with RP
can be seen using a magnifying viewing instrument. Abnormal nail-fold capillary patterns can suggest
the possibility of an associated rheumatic condition. There is, however, no
single blood test to help the doctor to confirm the diagnosis. The doctor
can order certain blood tests (for example, sedimentation rate,
rheumatoid factor, antinuclear antibody, thyroid hormone levels, and protein
levels) to exclude associated rheumatic diseases and thyroid disorders. The doctor can also
perform certain maneuvers with the patient's extremities to exclude pinched
blood vessels that can produce symptoms that mimic RP, such as in thoracic outlet syndrome.
Typically, patients with Raynaud's phenomenon that is a
manifestation of a rheumatic disease have elevated blood sedimentation rates and
antinuclear antibodies. Furthermore, capillary nail-fold abnormalities can
frequently be found as described above.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Gangrene may result when blood flow to a tissue is lost or not adequate to keep the tissue alive. There are two types of gangrene: wet and dry. All cases of wet gangrene are infected by bacteria. Most cases of dry gangrene are not infected. If wet gangrene goes untreated, the patient may die of sepsis and die within hours or days. Dry gangrene usually doesn't cause the patient to die. Symptoms of dry gangrene include numbness, discoloration, and mummification of the affected tissue. Wet gangrene symptoms include swelling, pain, pus, bad smell, and black appearance of the affected tissue. Treatment depends upon the type of gangrene and how much tissue is compromised by the gangrene.
Thoracic Outlet Syndrome is a condition where symptoms are produced from compression of nerves or blood vessels because the passageway through the neck and armpit is inadequate. Symptoms of thoracic outlet syndrome include neck, shoulder and arm pain, and numbness or impaired circulation to the extremities.
There are two categories to cold weather-related injuries. 1) no freezing of body tissue (trench foot and chilblains), and 2) freezing of body tissues (frostbite). Chilblains in general, will not need medical attention (unless there is infection). Trench foot and frostbite, however, require medical attention. Symptoms of frostbite include pain, burning, numbness, and eventually a complete loss of sensation in the affected body part. The young, elderly, and patients with certain medical conditions (diabetes, hypothyroidism, circulatory problems, and psychiatric illnesses), are more susceptible to cold weather-related injuries. People who abuse alcohol and illicit drug user are also at risk for cold weather-related injuries.
Secondhand smoke can cause illness and disease in nonsmokers. Some of these conditions include lung cancer, heart disease, respiratory illnesses such as asthma, SIDS, bronchitis, and pneumonia. Learn how you can protect yourself and your family from secondhand smoke exposure in the home environment and workplace.
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