DEAR DR. DONOHUE: I’ve been cold for two years. Right now my house thermometer says 71. I am wearing a short-sleeve shirt, a hooded sweatshirt and a heavy fleece sweatshirt, and I still feel a little cold. When it says 86, I still need a shirt and sweatshirt. I am female, 76, in excellent health except for ulcerative colitis, which is under control. Any suggestions? I’m tired of being bundled up all the time. – B.M.

ANSWER: In May, I tried to answer this question for another reader. I asked for help, and Dr. G.E. from Florida suggests the following:

“Feeling cold all the time is one of the problems not addressed in medical school. Quite often, it’s due to physical inactivity. Activity produces heat. Movement generates heat. Since this sensation is usually one of older people and since older people are often inactive, muscle deterioration takes place. My theory is that muscle wasting is responsible for many elderly feeling chilled all the time.”

Muscles do generate heat. Aging and lack of exercise shrivel muscle tissue. It’s called sarcopenia. The doctor has a good theory. B.M., however, is active. She says she walks six days a week for 40 to 55 minutes. Resistance exercise – lifting weights – is necessary for muscle building, even at 90. It might heat you up, B.M.

Body metabolism – the thousands of chemical reactions that take place in assimilating food, changing it into products necessary for rebuilding worn-out body structures and converting it into substances like hormones and nerve transmitters – creates heat too. Metabolism slows with age. Exercise perks that up. Proper nutrition is also needed for high level of metabolism. People living on a diet of mainly tea and toast are not getting the nutrients necessary to carry out body metabolism and are, therefore, not generating body heat. Diet must be considered.

Of course, ailments like a sluggish thyroid gland and anemia have to be considered for people with this complaint.

I thank Dr. G.E. for his thoughtful comments and welcome those of others.

DEAR DR. DONOHUE: A year ago my doctor said I had narrow heart valves. I am now 80 and work part time. It’s therapy for me. Now, a year later, she wants to do an EKG after the heart doctor gave me the echo thing. Is there an operation or other options? – A.P.

ANSWER: The “echo thing” was an echocardiogram, a sound-wave picture of the heart and its valves. It’s one of the best tests to determine the need for treatment of narrowed heart valves. The heart doctor didn’t give you any medicines, didn’t restrict your activity and didn’t suggest surgery. I take that to mean the narrowing is minor. You’re an active woman and have no symptoms – another indication the valve narrowing isn’t critical. Yes, there are operations for narrowed heart valves, and there are medicines if you have symptoms. Apparently you need neither.

DEAR DR. DONOHUE: I know that Xanax and Ativan are in the same category of medication. My son, who is 36, suffers from severe anxiety. He takes either Xanax or Ativan for his anxiety. His prescription is for 0.25 mg of Xanax. He takes two pills in the morning and two more at 4 p.m. He has a prescription for Ativan 2 mg, which he takes when he runs out of Xanax and his prescription isn’t refilled on time. He takes one 2 mg Ativan in the morning and one 2 mg at 4 p.m. I’m not a rocket scientist, but it seems to me that 0.5 mg is not the same as 2 mg. Please enlighten me. – J.P.

ANSWER: Xanax (alprazolam) and Ativan (lorazepam) are both benzodiazepines, a drug family used to quiet the turmoil of anxiety. Although they are of the same family, they have a slightly different chemical structure, and their doses are not the same.

The upper daily doses of Xanax is 4 mg; that of Ativan, 6 mg. (Doctors can safely prescribe higher doses for individual patients.) Your son isn’t taking the maximum dose of either. He’s not going to get in trouble with this amount. The amounts he takes are roughly equivalent. The equivalency of the drug dose can be better measured in the result obtained when taking the two drugs. If the result is the same, the doses are equivalent.

DEAR DR. DONOHUE: I am confused as to whether there is any difference between fibromyalgia and reflex sympathetic dystrophy. How are they diagnosed? Are they treatable or curable? – R.H.

ANSWER: The two have nothing in common.

Fibromyalgia is a condition with widespread body achiness, disturbed sleep and great fatigue. Its distinguishing feature is tender points – specific body sites where the pressure of an examining finger produces pain far out of proportion to the pressure applied. There are no visible signs of illness.

Reflex sympathetic dystrophy, now called complex regional pain syndrome, is pain confined to a body area where there was a previous injury. The injury might be a sprain, a bone break, a heart attack or something so minor it never registered on a person’s consciousness. The injured site continues to hurt long after it should have healed. A number of changes occur in the overlying skin and surrounding tissues. At first there is swelling and warmth in that area. Then the skin and tissues shrivel and become cold. These changes are obvious to an observer.

Both conditions are treatable, but both take lots of time to overcome; sometimes symptoms remain but at diminished intensity.

The booklet on fibromyalgia deals with that condition and its treatment. Readers can obtain a copy by writing: Dr. Donohue – No. 305, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com