I’ve increasingly felt very cold, particularly in the evenings – and it makes me miserable. Friends my age (I’m 82) do not feel cold like I do. I try to keep active but is there anything else I can try?
John Boyd, Kilmarnock.
Dr Martin Scurr replies: I’m sorry to hear this, as being perpetually cold can be very debilitating. In your longer letter, you ask if this might be related to the fact that, as we age, we lose a layer of insulating fat.
While this may be so, it should not have a big enough impact to leave you feeling cold in normal domestic circumstances. And as you say, others your age aren’t troubled in the same way.
That’s why I wonder if there’s an underlying medical cause.
Feeling cold when you should not is a symptom of an underactive thyroid gland, a condition known as hypothyroidism.
The gland produces thyroxine, a hormone that regulates metabolism. If thyroxine production falls, your metabolism slows and the body is less able to generate heat and keep you warm.
Most commonly, this occurs as the body’s own antibodies start to attack the gland. In the early stages, feeling the cold more than normal may be the only symptom. Other signs – e.g. fatigue, weight gain, dry skin, depression – may follow.
Being perpetually cold can be very debilitating, writes Dr Martin Scurr (picture posed by model)
Some patients I’ve treated for it have had no other symptoms apart from a very low heart rate, which illustrates how variable symptoms can be.
I recommend asking your GP for a blood test to check your thyroid. If you do have hypothyroidism, they can prescribe a daily thyroxine tablet.
If the test is negative for hypothyroidism, then I’d suggest doing your utmost to walk twice daily – a mile if you can, and as rapidly as you can confidently manage. Using your muscles, as you will be aware, generates body warmth.
My wife has been on the blood thinner warfarin for years, using a machine at home to check she is taking the right dose. But our GP has stopped supplying the test strips needed and she has to go to the surgery each week for testing instead. Now her readings are all over the place and she suffers dreadful nosebleeds and is covered in bruises. What can we do?
Roger Matthews, Devon.
Dr Martin Scurr replies: Let me first reassure you that there may be a remedy. I assume that your wife is on warfarin for atrial fibrillation, an abnormal heartbeat that raises the risk of a stroke, as blood can pool in the heart and form a clot.
The dose of warfarin varies depending on several factors, even what foods are eaten, hence the need for regular blood testing to assess the international normalised ratio – a measure of the ‘clotability’ of blood.
Carrying out these tests – often weekly, fortnightly or monthly (depending upon the stability of the treatment) – is a significant burden and the introduction of home-testing devices allowed patients such as your wife to get the correct dose, without the need for hospital or surgery trips. However, you mention in your longer letter that your wife was diagnosed with dementia 18 months ago. And this, together with a lack of testing strips, means that her clotting readings have not been well maintained.
I’d suggest you accompany her to a consultation with the GP and request that she is transferred to one of the newer drugs, known as direct oral anticoagulants (DOACs), such as rivaroxaban, apixaban or edoxaban.
Unlike warfarin, these don’t require any form of testing to check the dose levels, and while they work differently from warfarin, they have similar anticoagulant effects.
As long as your wife doesn’t have impaired kidney function (a contraindication), these tablets would be a suitable and safer option for her.
