Extremely cold all over

I am a 44 year old male. I have been getting goosebumps even in hot showers. I began by getting cold hands, then my feet. It has now (in 6 months) spread to my whole body. My hands and feet are numb. I feel like I have "brain freeze" at times. Even if I go out in 80 degree weather, I am still cold. At first we thought Raynaud's, but it is spreading so fast and all over. I was also put on Procardia and it did not work. I have been taking b12 vitamins, omega 3 fish oil, one-a-day vitamins. Nothing seems to be helping. Lately, my ears are so cold it feels like frostbite and when I breath in, it feels like the air is cold (even though it is almost 80 outside). I searched the internet and cannot find anything to help. I do not drink or smoke. I am at a very healthy weight and I am physically active. I do not have any more stress in my life than I would normally have. Any ideas?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

You may have a neuropathy, but more information is needed. There are two types of sensory neuropathies in the body – large and small fibers. With small fiber neuropathies, symptoms include burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, and autoimmune problems.

The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved there will be weakness. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called an oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy usually from an early age associated with other clinical features such as high-arched feet), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis or monoclonal proteinemia. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles) are involved, leading to sensory symptoms as well as weakness.

The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerves conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required.

Treatment for neuropathic pain (pain coming from nerves) includes neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well).

This is just a few possibilities for your symptoms. I recommend that you be seen by a neurologist. He/she may order laboratory tests as indicated above and may order an EMG/NCS.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[mar22pop]

What does the doctor say? I will be interested to know what the problem is. so  please post when you find out.

[rschwager]

I went to a Rheumatologist. She did not think it was Raynauds. She was unsure what to think (I appreciated her honesty). She felt it was possibly neurological. They took about 10 vials of blood to run a series of tests. She put me on a dose of Gabapentin, hoping that it would help the nerves. I am starting slowly and building up. She says give it 2 weeks. I am waiting on the blood test results. Thanks for your interest.

[rschwager]

Thank you. I was told it could be neuropathy by the doctor. The results from the blood test have not been returned and I have felt no difference on the Gabapetin (keep in mind that I have only been on it for 3 days and my dose will gradually increase). It is weird because at night, I will put on the blankets and will even sweat, but still feel cold. I do not have diabetes and had blood tests done at the end of 2011 to test for it. It does not improve after eating. I have not gotten any weaker. I went out for a training bike ride today and my numbers, as far as speed and heart rate, were very good. Blood pressure was actually 120 over 80. It could be vitamin related, although I take a one-a-day for men, Omega-3 fish oil, B-12 vitamins, and even Magnesium recently in hopes it would get better.

I am on Prozac and Vyvanse (for ADD and anxiety). But I was on them prior to ever experiencing these symptoms. I was on Effexor XR for a number of years and was weaned off of it last summer. My doctor was good about slowly easing the dosage down. Even so, there were some withdraw symptoms. Which was why he went to the Prozac.

Thanks again for your reply. It gave me much more insightful info. I will update when I hear anything. If you have any questions or other insights, please feel free to post.

[rschwager]

I also had a sinus infection that went on for weeks on end. It took 3 antibiotics to knock it out. I read that infections could bring about neuropathy. The infection has been gone for 4 months now, but the symptoms started around the time of the infection.

[rschwager]

I have seen a neurologist and all of the nerve tests.look fine. Still no relief from the cold. He tried Cymmbalta but it seemed to make things worse. I am getting lots of pain too. I am running out of ideas.