My fingers and toes are freezing all year round, even in the summer. Despite wearing layers, I am still cold even when my colleagues are sweating. Why is this?
Jyothi Eregowda, by email.
Although you say you don’t know anyone who feels the cold like you do, your experience is not uncommon.
It is perfectly normal for the body to respond to a cold environment by reducing blood flow to the extremities – this maintains the body’s core temperature but leaves the fingers and toes feeling cold.
However, there is a condition called Raynaud’s, in which blood flow to the fingers and toes temporarily stops due to spasms in the arteries that supply them, usually in response to cold temperatures.
Raynaud’s can lead to dramatic and very different episodes in response to the cold.
People with certain autoimmune diseases — rheumatoid arthritis, scleroderma, and dermatomyositis — are more likely to develop Raynaud’s, but it can affect anyone.
Please be reassured, your cold hands and toes will not affect your overall health, writes Dr. Martin Scurr (file image)
However, I believe that the feeling of cold fingers and toes you describe is a hereditary trait and completely normal – simply put, we all experience the cold differently.
And there is research to support this. A study of 894 pairs of twins, all healthy young adults, published in the journal Twin Research and Human Genetics in 2014, concluded that having a cold finger/cold toe is usually a hereditary trait.
Some experts call this condition primary vascular dysregulation (PVD). It usually becomes noticeable at puberty, is more common in females, and decreases with age. It is suggested that hormones (especially estrogen) are involved in some way in what is essentially a circulatory problem (i.e., a blood flow regulation problem).
Incidentally, the study also found a series of characteristics in those who had cold hands and feet: a reduced feeling of thirst, a tendency to low blood pressure and a higher incidence of migraines, for example, compared to those who did not have PVD . The exact connection to these other conditions is unexplained.
Whether any of these apply to you is something to consider, but rest assured, your cold hands and toes have no impact on your overall health.
My 90-year-old mother has been taking a low-dose antibiotic (125 mg cefalexin) daily for nearly two years to prevent persistent urinary tract infections (UTIs) caused by a permanent catheter. The treatment has worked, she is infection free, but I am concerned about the long term side effects.
Name and address provided.
It can be challenging to weigh the potential risks of long-term antibiotic treatment against the need to prevent repeated urinary tract infections.
If a permanent catheter is in place – after, as you say in your longer letter, surgery in your mother’s case, for example, or due to urinary incontinence – urinary tract infections are an almost unavoidable complication.
Bacteria usually colonize the tube that drains urine from the bladder, and they can travel to the kidneys, cause infection, and even lead to sepsis (a potentially fatal blood infection that can spread throughout the body).
These are not trivial infections, making them a potential danger to which our minds should be directed. Catheter use – especially permanent or indwelling catheters – is the leading cause of urinary tract infections. But studies comparing preventive long-term daily use of low-dose antibiotics with treating infections when they arrive have shown that there is no difference between the two approaches in preventing complications such as sepsis.
As a result, the National Institute for Health and Care Excellence (NICE) recommendation is that routine prevention in the form of a low-dose antibiotic, like the one your mom gets, is no longer recommended. This also takes into account the risk of antibiotic resistance.
Instead, it is advisable to seek medical advice if symptoms of a urinary tract infection (for example, bladder pain or fever) develop.
Nevertheless, given that your mother has been feeling well for the past two years, with no urinary tract infections, on the small prophylactic dose of cefalexin, there is, in my opinion, no reason for your mother to discontinue it at this time.
In your longer letter, you say she has persistent abdominal pain, which you believe may be caused by the antibiotics. I doubt it though – the more likely side effect of long-term antibiotic use is diarrhea.
You suggest giving her a daily probiotic, a form of beneficial bacteria, to ensure that the antibiotic doesn’t cause unnecessary disruption to the microbiome, the community of microbes in the gut that is associated with so many elements of health.
I think this is sensible, and I would suggest adding a prebiotic as well – fiber found in many foods such as oats, grains, leafy greens and fruits that feed friendly bacteria in the gut.
You may already be incorporating these foods into your mom’s diet, but if you don’t, it’s definitely worth doing.
Write to Dr. Scurr
Write to dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email: drmartin@dailymail.co.uk — add contact details.
Dr. Scurr cannot respond to personal correspondence. Answers should be taken in a general context. In case of health problems, consult your own doctor.