Why are my fingers and toes cold all the time? Ask the GP DR MARTIN SCURR 

My fingers and toes are freezing all year round, even in summer. Despite layering up, I still feel cold — even when my colleagues are sweating. Why is this?

Jyothi Eregowda, by email.

Although you say you know no one who feels the cold like you do, your experience is not uncommon.

It is completely normal for the body to react to a cold environment by reducing the blood flow to the extremities — this preserves core body temperature, but leaves the fingers and toes feeling cold.

There is, however, a condition called Raynaud’s, where blood flow to the fingers and toes temporarily stops due to spasms in the arteries supplying them, usually in response to cold temperatures.

Raynaud’s can lead to dramatic and very different episodes in reaction 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.

However, my view is that the feeling of cold fingers and toes that you describe is an inherited trait and completely normal — put simply, we all experience the cold differently.

And there is research to back this up. 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 the cold finger/cold toe state is usually an inherited trait.

Some experts refer to this condition as primary vascular dysregulation (PVD). It typically becomes noticeable in puberty, is more common in women and decreases with age. There is a suggestion that hormones (particularly oestrogen) are somehow involved in what is essentially a circulatory problem (i.e. a problem with blood flow regulation).

Incidentally, the study also noted a range of characteristics among those who experienced cold hands and feet: a reduced feeling of thirst, a tendency to have low blood pressure and a higher incidence of migraine, for instance, compared to those who did not have PVD. The exact link with these other conditions is unexplained.

Whether any of these factors apply to you is something for you to think about, but please be reassured, your cold hands and toes have no implications for your overall health.

My 90-year-old mum has been on a low-dose antibiotic (125mg cefalexin) daily for almost 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 supplied.

Balancing the potential risks of long-term antibiotic treatment with the need to prevent repeated UTIs can be a challenge.

When a permanent catheter is in place — following, as you say in your longer letter, surgery in your mother’s case or due to urinary incontinence, for example — UTIs are an almost inevitable complication.

Bacteria commonly colonise the tube that drains urine from the bladder, and these may travel to the kidneys, causing an infection, and can even result in sepsis (a potentially deadly blood infection that can travel around the body).

These are not trivial infections, making them a potential hazard that must focus our thinking. Catheter use — particularly permanent or indwelling catheters — is the number one cause of UTIs. But studies comparing a preventative long-term daily low-dose antibiotic use with treating infections when they arrive have found there is no difference between the two approaches in terms of preventing complications such as sepsis.

As a result, the recommendation from the National Institute for Health and Care Excellence (NICE) is that routine prevention in the form of a low-dose antibiotic like your mother is receiving is no longer recommended. This also takes into account the risk of antibiotic resistance.

Instead, the recommendation is to seek medical advice if symptoms of a urinary infection (bladder pain or a high temperature, for instance) develop.

Despite this, given that your mother has felt well over the past two years, with no UTIs, on the small prophylactic dose of cefalexin, in my view there is no case for your mother stopping it at the moment.

In your longer letter you say she has a perpetual stomach ache, which you are concerned may be caused by the antibiotics. However, I doubt it — the more likely side-effect with long-term antibiotic use is diarrhoea.

You suggest giving her a daily probiotic, a form of beneficial bacteria, to ensure that the antibiotic doesn’t cause undue disruption to the microbiome, the community of microbes in the gut that is linked to so many elements of health.

I think this is sensible, and I’d suggest also adding a prebiotic — fibre found in many types of foods such as oats, grains, leafy vegetables and fruits that feed friendly bacteria in the gut.

You may already incorporate these foods into your mother’s diet, but if you don’t, it is definitely worth doing so.

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 — include contact details. 

Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.