context: Most people know that smoking can lead to problems like heart disease and lung cancer. But sometimes it also causes very rare illnesses, like Buerger's disease. When you have Buerger's disease, the blood vessels in your arms and legs get blocked. This blocks the blood flow and leads to blood clots that affect the hands and feet. It can't be cured, but if you quit all tobacco use, you may prevent the symptoms from getting worse. If you don't quit, you might end up with severe tissue damage. You could even lose your fingers, toes, or parts of your limbs. Doctors aren't sure exactly what causes this condition, but almost everyone who gets it has used tobacco products. This includes cigarettes, cigars, chewing tobacco, and snuff. While the link between tobacco and Buerger's disease isn't totally clear, your genes might play a role. Some people may just be more likely to get it. Some experts think that certain chemicals in tobacco might irritate your blood vessels, and that's what makes them swell. Others think it may be an autoimmune response. This means tobacco triggers your immune system to attack your blood vessels like they're bad germs. Usually, the first sign of Buerger's disease is pain in your hands or feet that spreads to your arms and legs. It can be intense, and you can get it whether you're active or at rest. You also might notice the pain is worse when you're cold or under stress. You may also notice changes in your hands and feet. They may: Feel cold, numb, or tingly Look pale, red, or blue in color Your fingers and toes might: Get painful, open sores Turn pale when you're cold ( Raynaud's phenomenon) You could also get swelling along a vein just under the skin. This is usually caused by a blood clot, so see your doctor right away if it happens. Eventually, Buerger's disease can slow -- and sometimes completely stop -- the blood flow to your fingers and toes. This can cause gangrene, which means the skin and tissue in your toes and fingers starts to die. They turn blue or black, and you lose feeling in them. If you get gangrene, your doctor usually has to cut off the affected area. You could lose your fingers, toes, and maybe parts of your arms and legs, as well. There's no one test that can tell you if you have it. First, your doctor will talk to you about tobacco use and your symptoms. Next, he may do tests to check your blood flow and look for other diseases that cause similar symptoms. For example, peripheral artery disease also causes pain in your legs, but it's caused from plaque in your arteries, not inflammation. Other tests your doctor may do are: The Allen test. This is a basic blood flow test that can be done in your doctor's office. First, you squeeze your hand into a hard fist, which pushes blood out of your hand. Your doctor then presses on the arteries of your wrist to slow the flow of blood back into your hand. At this point, your hand will lose its normal color. When you open your hand, your doctor releases the pressure over the artery on one side of the wrist. Then he releases the artery on the other side. If takes a while for your hand to go back to its normal color, it may be a sign of Buerger's disease. Angiogram. This is a type of X-ray that checks for blockages in the blood vessels in your arms and legs. For this test, your doctor first places a thin tube, called a catheter, into an artery. Then, he pumps dye into the artery and quickly takes X-ray images. You can also get an angiogram with a computed tomography ( CT) or MRI scan. Blood tests. These help our doctor to see if other diseases might be causing your symptoms. He may order tests to check for conditions like diabetes, lupus, and those that cause blood clots. Pain medications can help relieve pain in affected areas. But quitting tobacco use is the only way to limit the effects of Buerger's disease. Just a few cigarettes a day can make it worse. If you're having a hard time quitting, your doctor can help find the right program for you.