Q: My husband is 84 years old and has always been in good health. He has taken vitamins for over 50 years and quit smoking 60 years ago. He has recently developed tingling in his legs which feel cold, however, his legs are warm to the touch. We thought this might be a circulatory problem and consulted a heart specialist. He had blood tests, sonograms of his heart, aorta and carotid arteries. The only thing found was that he had high blood pressure. He has been on medication for that for about six weeks. He also takes a baby aspirin and ½ of a Crestor. The blockage in his carotid artery is 40% and the doctor does not plan on doing any surgery until it is at least 60%.
All of this has not addressed his original symptoms, nor has there been any change in these symptoms. He says his legs should feel sweaty to the touch but they are always warm and dry. Please help.
A: Paresthesias (the sensation of pins and needles, numbness and tingling) of the extremities commonly occurs because a temporary restriction of the blood supply to the specific area. The situation is generally remedied by straightening the leg, repositioning the arm that may be pressing against a table or counter, or otherwise removing pressure placed on the extremity. The sensation may be transient or chronic. Because you indicate your situation has continued for over a year, you appear to have a chronic form that indicates a problem with either poor circulation or with the functioning of neurons.
Older individuals with paresthesias may suffer from circulatory difficulties such as peripheral vascular disease (PVD), a diminished supply of blood flow and a lack of oxygen distribution to muscles. The resulting narrowing that occurs is an indication that nerve cells cannot send appropriate signals to the brain, causing tingling and numbness. Other possible causes, to name a few, are a vitamin B12 deficiency, malnutrition (which is rather uncommon), hypothyroidism, mercury poisoning, and diabetes. Tissue inflammation may also cause similar symptoms for such disorders as rheumatoid arthritis, psoriatic arthritis and carpal tunnel syndrome. If there is any direct nerve damage from an injury or infection (including Lyme disease), a neurological disorder might be considered.
A B12 deficiency may result from the body’s inability to store it for extended periods of time. Those paresthesias associated with a B12 deficiency may, indeed, indicate ongoing nerve damage. On the upside and were this to be the case with your husband, treatment is probably in the form of injections for several weeks, followed by oral supplements.
Thyroid disease must also be considered in the big picture. Thyroid symptoms may present in a variety of ways, including aches, pains and weakness in muscles and joints. Becoming easily chilled from cold weather is a significant sign of hypothyroidism, yet when the thyroid is overacting and producing too much thyroid hormone (hyperthyroidism), an individual might become less tolerant of heat, sweat profusely, and feel excessively warm to the touch.
I cannot address your specific concern of his legs that feel cold but are warm to the touch, until he undergoes such testing as lab work to rule out thyroiditis, a vitamin deficiency or other conditions, and peripheral vascular studies. If a simple Doppler ultrasound fails to detect a problem, a neurologist might follow up with a nerve conduction study to determine if peripheral neuropathy is to blame. There is no real reason to run up the bill by getting a complete battery of testing performed, but he should undergo those tests that might help confirm the underlying cause for his symptoms. Once this has been determined, he should be able to receive the necessary treatment to get him back on track.
