When cold hands point to an underlying health condition

Dear doctor,

Why are my hands always cold?

Dear reader,

It is normal for your hands to be cold when you are in a cold environment, and the hands may get cold before the rest of the body does, and they warm up once the rest of the body warms up. The hands may also become cold as a response to stress.

However, if your hands are cold even when you are in a warm environment, or if you also experience numbness, tingling, pain, change in skin colour or tightening of the skin around the fingers, this may be due to an underlying health condition.

It could be due to anaemia, low blood pressure, hypothyroidism, vitamin B12 deficiency, diabetes, some autoimmune diseases like lupus, scleroderma, and some medications. It may also be due to Raynaud’s phenomenon — where the blood vessels narrow excessively as a response to cold or stress, making the hands very cold, and sometimes there may be skin colour changes, numbness or pain.

Smoking may also cause damage to the blood vessels, leading to cold hands. Severe restriction of blood flow can lead to development of sores or wounds that do not heal, and tissue damage and death (gangrene) if there is no blood flow.

You can warm up the hands by rubbing them together, by running warm (not hot) water over them or by wearing gloves. A healthy balanced diet will prevent vitamin B12 and iron deficiencies that can cause anaemia. It is also advisable to be evaluated and treated for any underlying health conditions.

Dear Doctor,

For the past two years, I wake up every morning with swollen upper lips. This problem worries me. Kindly help me understand the cause and possible treatment.

PM

Dear PM,

The swollen upper lip may be because of allergic reaction to certain foods, spices, medications, or the sting/bite of an insect. If it is an allergic reaction, then it is likely to be something you are exposed to every day/evening such as a food component or spice that you use daily, or exposure to an insect that is found within your beddings.

Another possible cause of the swollen upper lip is injury to the lips, for instance from unintentional chewing or biting of the lip during sleep. Also, if you sleep in a position that puts pressure on the lips, this can lead to development of a temporary swelling.

There are other possible but very rare causes of upper lip swelling: granulomatous cheilitis, which is an inflammatory condition where bumps/swellings form within the upper lip; or Melkersson-Rosenthal syndrome, a rare neurological condition that causes facial swelling, lip swelling and muscle paralysis.

Since the swelling has been persistent for two years, it is advisable for you to be reviewed by a doctor, preferably when the swelling is present for evaluation and relevant tests. The treatment will be dependent on the diagnosis.

Dear doctor,

Last week, my sister, who is currently five months pregnant, developed symptoms of a stroke on one side of her face. She woke up one morning drooling from the left side, and that side of her face looked paralysed. Her mouth and eye muscles on the left side were weak. At the hospital, she was told that what she had was triggered by a viral infection, and it was not a stroke. She seems to be getting better. If this was not a stroke, what is it? Is there a way of preventing it from happening again? Will it affect the baby?

Mark

Dear Mark,

This is likely to be idiopathic facial paralysis, otherwise know as Bell’s palsy. This is temporary weakness or loss of muscle control (paralysis) on one side of the face that happens due to problems with the facial nerve, the seventh cranial nerve. The facial nerve has nerve fibres from the brain to the facial muscles, and there are two facial nerves; one on each side of the face. With Bell’s palsy, the facial nerve does not work well as a result of injury, irritation and/or inflammation of the nerve.

Bell’s palsy usually develops fast, within 48 to 72 hours. Symptoms may include weakness and/or paralysis on one side of the face; drooling from that side; drooping mouth on the affected side; drooping eye brow and eye lid; difficulty closing the eyelid on the affected side, which can lead to eye dryness; facial pain; pain at the jaw or behind the ear; headache; excessive tearing; sensitivity to loud sound; altered taste; and problems with making facial expressions or with eating and drinking. Rarely, Bell’s palsy will affect both sides of the face.

The exact cause of Bell’s palsy is unknown, but there are possible triggers, including viral infection; reduced immunity from any cause; facial nerve infection; exposure to toxins; or conditions that cause damage of the myelin sheath, which is the protective layer that covers the nerve. Anyone can develop Bell’s palsy, though there is greater risk of developing it during pregnancy, or if you have diabetes or hypertension, or if you are obese, or when you have an upper respiratory tract infection.

There is no specific test to diagnose Bell’s palsy. A physical examination will determine if there is paralysis of the facial nerve. Tests may be done to diagnose any underlying illnesses and to rule out other possible causes of the paralysis such as blood tests, scans and electromyography.

Bell’s palsy usually resolves on its own after a few weeks. Most of the time recovery is complete, but occasionally, some symptoms may not fully resolve. Rarely, Bell’s palsy will recur. Steroid medication may be given soon after onset of symptoms so as to manage the inflammation. Pain medications can be used to control pain, and anti-viral medication may be prescribed where a viral infection is the trigger. To protect the eye when the eyelid is not able to close, lubricating eye drops and glasses may be used during the day; and eye ointment and eye patches may be used during the night. Other possible treatments include facial massage and physical therapy. Surgery may be done to manage the complications of Bell’s palsy, if they occur.

The Bell’s palsy itself would not affect a pregnancy, but if there is an underlying condition or infection, then this can affect the pregnancy. Because of this, it is vital that screening for any underlying condition is done, and anything that is found is adequately managed.

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