ArcaMax

DEAR DR. ROACH: I have a good friend who is almost 77 years old. He was a heavy smoker until about 14 years ago. He decided to quit smoking and used nicotine gum to help with this process. It's my understanding that nicotine gum should only be used for a fairly short period of time to help a person quit smoking.

However, he is still using it multiple times a day and freely admits that he is "addicted" to it. What kind of negative health impact can this have on him? -- J.K.

ANSWER: I often hear people note that treatments like nicotine replacement, methadone, or similar drugs for opiod use disorder is "trading one addiction for another." However, this is not a helpful way of looking at it because smoking has very serious consequences on a person's health, while nicotine replacement has relatively minor adverse effects.

The most common adverse effects of nicotine-replacement therapy included heart palpitations, nausea, vomiting, other gastrointestinal complaints, and insomnia. Nicotine gum in particular can cause mouth and throat soreness, mouth ulcers, and cough or hiccups. Compared to the many health concerns of smoking (heart disease, many cancers, lung disease), nicotine replacement is dramatically safer.

The goal of treatment when it comes to nicotine use disorder is to reduce health risks. While being free of smoking without using nicotine replacement is better, I would congratulate your friend on quitting and sticking to it after so many years.

DEAR DR. ROACH: Sadly, my brother (73) has failing kidneys, and his doctor says he will need to go on dialysis soon. He also said Farxiga will not help his kidney problems, but why wouldn't it? Being his brother, would I be a suitable kidney donor for him? -- B.F.

ANSWER: There are many causes of chronic kidney failure, but once the kidneys reach a certain point, dialysis or transplantation becomes inevitable to provide a longer and better quality of life.

Dapagliflozin (Farxiga) is one of the SGLT-2 inhibitors, which work by preventing the kidney from being able to reabsorb sugar. It is especially useful for kidney disease associated with diabetes, but it is also useful in people with the kind of kidney diseases that has high amounts of protein in the urine. So, it may be that dapagliflozin was prescribed too late to help, or he may have one of the kinds of kidney failure that isn't associated with protein in the urine.

Since you are his brother, there is a good chance you may be an acceptable kidney donor. Kidney transplantation would give your brother the best quality and length of life of all the treatments we have for end-stage kidney disease. Having a living-related donor bypasses the long waiting list for a cadaver kidney.

However, there is not a guarantee that you two are compatible. In addition, he needs to be in otherwise good health. Furthermore, some centers have an age limit on donation, and you need to be in good physical condition. You should speak with your brother's kidney specialist about a referral to a transplant program. They will counsel you on your risks in becoming a donor.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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