Does nicotine gum make you sensitive to cold? DR MARTIN SCURR answers your health questions

My hands, feet and nose get very cold – even in the summer my hands can turn white from the cold! I have Hashimoto’s thyroiditis and thought I had a cold for years. But my kidney function tests also show a decline.

I quit smoking in 2005 and have been addicted to nicotine gum and pills ever since – could this be to blame?

given name and address.

Many people use nicotine therapy, and while this is a good thing (because it helps you quit smoking), we shouldn’t ignore potential complications.

But first, let’s start with your Hashimoto’s thyroiditis, the most common cause of an underactive thyroid. This occurs because the body’s antibodies attack the gland.

I quit smoking in 2005 and have been addicted to nicotine gum and pills ever since – could this be to blame? (Photo from a photo agency)

One symptom is feeling colder than usual because the thyroid produces hormones that regulate our metabolism which maintains body temperature.

This leads to increased sensitivity to cold, but you wonder if other factors are involved in your case.

And it may well be that nicotine therapy contributes to this by causing constriction of the blood vessels in your fingers, toes and nose. But can nicotine gum and lozenges also affect your kidney function?

In your longer letter you say that two years ago your eGFR, a measure of kidney function based on a blood test and other factors such as age and height, was 60 – normal; it is now 55, which is out of the normal range.

Although nicotine has been shown to accelerate the onset of kidney disease in cigarette smokers, there are no studies on 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 are said to filter from the blood.

So it could be that the nicotine just raises your creatinine levels (and lowers your eGFR) and doesn’t directly damage your kidneys.

The only way to find out if nicotine is the culprit is to stop using it. I would suggest tapering off by microscopic degrees each week until you are no longer dependent in six to 12 months – by which time your eGFR may be back in the normal range.

In the meantime, tell your GP about your nicotine use and, as a precaution, ask for a referral to a kidney specialist for further testing.

I have had recurring urinary tract infections since my first Covid vaccination. If I stop a course of antibiotics, the infection comes back within a few days. Why can’t I lose her? i am 81

Terry Payne, by 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 emptying.

With age, the remaining amount increases: in a man of 30 it may be less than a teaspoon, in a man of 80 it may be half a teaspoon or more.

This is because the prostate, a walnut-sized gland that surrounds the urethra (the tube that drains urine from the bladder), enlarges with age. This distorts the shape of the bladder and leaves more urine in it when it empties. Insects can thrive in this leftover urine and cause a urinary tract infection.

I have had recurring urinary tract infections since my first Covid vaccination (stock photo)

I think your Covid shot is a red herring here – I’m afraid urinary tract infections are not uncommon in older men (stock photo)

It is extremely important that the next time you become infected, your GP sends a fresh urine sample to a laboratory to determine which antibiotics are best for treatment.

Options include nitrofurantoin, an antibiotic dating back to the 1950s that has regained popularity due to the emergence of resistance to more commonly chosen antibiotics such as cephalexin.

Once the correct treatment is established, it is also important that a course of treatment is prescribed that is long enough to ensure that the infection is properly cleared. This helps 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 prevent recurrent infections.

Sometimes patients are prescribed methenamine, an antiseptic. However, it will not eliminate an existing infection and should therefore only be given to prevent the development of a new infection after the original infection has cleared.

The way forward is obvious: thorough research is needed to find out exactly which pathogen is causing this infection and the right antibiotics to treat it.

• Write to Dr. Scurr to Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk — add contact details. DR Scurr cannot respond to personal correspondence. Answers should be taken in a general context. If you have health problems, contact your GP.