Thanks Shirley for your excellent comments on vasospasm of the nipples. My
observations are similar except I would say that
        1)I would still say that this is a raynauds phenomenon, and most
raynauds phenomenon are not secondary to connective tissue disease. So by
calling it raynauds, that doesn't imply that it is due to an underlying
disease.
        2)I have been finding it necessary to use larger doses of
nifedipine, and I use the long acting form, which causes less dizziness and
headaches. I also find that if I stop it, the symptoms come back. So maybe
there are a few subtypes of vasospasm disease.
        3)I too find that the vasospasm first presents with another
problem, such as cracks or thrush. When the other problems clear, the
vasospasm reduces, and then some don't feel a need for nifedipine.
        4)Perhaps this is our chance to pool patient populations, to get
more patients that would provide for a good study!! I really don't know how
to go about this but if others are interested in a collaborative study, I
would be willing to give it some energy.
        5)Another note about nifedipine--in the US there have been several
case reports of sudden death in patients on calcium channel blockers,
although nifedipine hasn't been implicated. I have made it a policy to do
an ECG on my patients first to be sure there is no hidden abnormality
before administrating it. Unfortunately, I did have a young patient die of
a sudden death on diltiazem that she was for headaches, about 6 years ago.
                                -Anne Eglash MD