My hands, feet and nose get very cold – my hands can turn white from the cold even in the summer! I have Hashimoto’s thyroiditis and for years I thought that was why I had a cold. But my kidney function tests also show a decline.
I quit smoking in 2005 and have been addicted to nicotine gum and lozenges ever since – could that be to blame?
name and address given.
Many people use nicotine therapy, and while that’s a good thing (since it helps you quit smoking), we shouldn’t ignore potential complications.
But first, let’s start with your Hashimoto’s thyroiditis, which is the most common cause of an underactive thyroid. It occurs when the body’s antibodies attack the gland.
My hands, feet and nose get very cold – my hands can turn white from the cold even in the summer! (Picture from a picture agency)
I quit smoking in 2005 and have been addicted to nicotine gum and lozenges ever since – could that be to blame? (Picture from a picture agency)
One symptom is feeling colder than usual because the thyroid produces hormones that control our metabolism that maintains body temperature.
This makes you more sensitive to cold, but you’re wondering if there are other factors at play in your case.
And nicotine therapy may well contribute to this by narrowing the blood vessels in your fingers, toes and nose. But could the nicotine gum and lozenges also affect your kidney function?
In your longer letter you say that two years ago your eGFR, a measurement of kidney function based on a blood test and other factors such as age and height, was 60 – ie normal; it is now 55, which is outside the normal range.
While nicotine has been shown to accelerate the onset of kidney disease in cigarette smokers, there are no studies of long-term use of nicotine replacement therapy.
However, studies of vape users show that exposure to nicotine increases levels of creatinine, a chemical that healthy kidneys should filter out of the blood.
So it could be that the nicotine is simply raising your creatinine levels (and lowering your eGFR) and not directly damaging your kidneys.
The only way to find out if nicotine is the culprit is to stop using it. I would suggest reducing by microscopic degrees each week so that in six to 12 months you are no longer dependent – and by then your eGFR could be back in the normal range.
In the meantime, tell your GP about your nicotine use and, as a precaution, request a referral to a kidney specialist for additional testing.
I have had recurring urinary tract infections since my first Covid vaccination. When I finish a course of antibiotics, the infection returns within a few days. Why can’t I get rid of them? i am 81
Terry Payne, via email.
I think your Covid shot is a red herring here – I’m afraid urinary tract infections are not uncommon in older men.
They often occur as a result of residual urine – the urine that remains in the bladder after it has been emptied.
The amount left behind increases with age: in a 30-year-old man it may be less than a teaspoon, but in an 80-year-old man it may be half a teacup or more.
That’s because the prostate, a walnut-sized gland that surrounds the urethra (the tube that drains urine from the bladder), gets larger as we age. This distorts the shape of the bladder, leaving more urine in it when it empties. Insects can multiply in this residual urine and cause an infection of the urinary tract.
I have had recurring urinary tract infections since my first Covid vaccination (stock image)
I think your Covid shot is a red herring here – I’m afraid urinary tract infections are not uncommon in older men (stock image)
The next time you develop an infection, it’s paramount that your GP sends a fresh urine sample to a lab to determine which antibiotics are best for treatment.
Options include nitrofurantoin, an antibiotic dating back to the 1950s that has come back into fashion due to the emergence of resistance to more commonly chosen antibiotics like cefalexin.
Once the correct treatment is identified, it is also important that a sufficiently long course of treatment is prescribed to ensure that the infection is properly cleared. This will help reduce the risk of recurrence.
However, recurrent infections are common, and many specialists opt for what is known as low-dose prophylaxis — when a small dose of an antibiotic is given every day for three to six months to try to prevent recurrent infections.
Sometimes patients are prescribed methenamine, an antiseptic. However, this will not clear an established infection and should therefore only be given to prevent the development of a new infection once the original infection has cleared.
The way forward is obvious – a thorough investigation is needed to find out exactly what pathogen is causing this infection and the right antibiotic to treat it.
- Write to Dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or by email: drmartin@dailymail.co.uk – provide your contact details. dr Scurr cannot conduct personal correspondence. The answers should be viewed in a general context. If you have health concerns, consult your GP.
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