Why does everything have a metallic smell all the time?

Q I’m 84 and constantly experience have a metallic smell. It’s been going on for at least a year. When I told my doctor, and also mentioned I couldn’t taste very much either, he told me to see my dentist. She reassured me the few teeth I have left are OK. Is there anything I can do, or do I have to accept that this is another age-related thing?

A The senses of taste and smell are strongly linked and, unfortunately, as you get older they do deteriorate, in the same way that eyesight and hearing do.

However, before you assume your age is to blame it is worth checking for an underlying cause.

Gum and tooth disorders are a common cause of a persistent strange smell, along with infections in the sinuses, inflammation in the nose and nasal polyps.

Eating certain foods, such as garlic and onions, can also cause issues.

A dry mouth can also be to blame and, in older people, this can be triggered by medications such as antibiotics, diuretics (water tablets), drugs used to treat an irritable bladder and also anti-depressants such as amitriptyline, used to treat chronic pain.

Nitrate medications, used for some types of heart disease, can also cause a weird smell and, less commonly, underlying health conditions such as poor renal function or diabetes can be to blame, although this usually causes a sweet, rather than a metallic smell.

People with depression also sometimes report changes to their sense of smell so it would be worth having a chat with your GP again now that your dentist has given you the all clear.

If the problem is really bothering you, a trial of a steroid nasal spray may be helpful. You do usually need to use this for a couple of months for it to make a noticeable difference.

Q I’ve had some vaginal itching recently so I had a swab test done. This showed that I had thrush, which accounts for the itching, but also group B strep. The nurse said this was “normal flora” and nothing to worry about. Does it need treating too?

A Group B streptococcus – also called strep or GBS – is a common bacterium that occurs in both men and women. It is found in between 20 and 40 per cent of UK adults, most commonly in the rectum (lower bowel) and the vagina in women – hence the term “normal flora” which is the medical term for the mix of bacteria that is normally found in the vagina. It is not sexually transmitted and carrying GBS is normally harmless.

It does not cause any symptoms and most people are unaware that they have it. It does not require treatment and trying to treat it with antibiotics can affect the balance of other bacteria in the vagina and make you more at risk of getting further infections, especially thrush.

GBS in the vagina can be a problem though if it occurs in a pregnant woman, as very occasionally the infection can spread to the baby during birth and cause a serious infection such as sepsis, meningitis or pneumonia.

Testing for GBS is carried out routinely in the UK, but if you do have a test taken during pregnancy which shows GBS you should be offered antibiotics in labour to reduce this small risk to the baby.

You have not stated your age, but if you are planning to start a family soon then please speak to your GP about more specific tests for GBS that can be done when you are pregnant. You can get more information from the Group B strep charity. Phone 0330 1200796. gbss.org.uk

Q I’m 72 and was diagnosed with atrial fibrillation about a year ago. My doctor has been reassuring but will it affect my life expectancy?

A Normally, the four chambers of the heart work in a regular, ordered way, with first the upper atria contracting, emptying the blood they contain into the lower ventricles, which then contract, pushing blood out into the vessels going to the body and the lungs.

In atrial fibrillation, or AF, the atria quiver and only partially empty, while the ventricles, which control the pulse rate, contract in an erratic way, leading to a variable fast rate that is sometimes slow, but more commonly is very fast. This may not cause any symptoms but it can cause palpitations and shortness of breath, especially on exercise, and dizziness.

The main risk of AF is pooling of blood inside the heart which can lead to formation of clots. If one of these travels to the brain it can cause a stroke. The chance of having a stroke is about four times higher in people with AF compared to others and this is why all people with AF are routinely given anticoagulant drugs to prevent the formation of clots.

The other risk of AF is that the heart muscle gradually becomes weaker, a condition known as heart failure.

There aren’t any life expectancy statistics for people with AF as the effect it can have on how long you live can vary enormously according to whether or not you have other health conditions.

In about one in 10 cases there is no apparent cause and the heart is otherwise fine, but in the others problems such as high blood pressure, coronary heart disease or damaged heart valves are present.

Drug treatment for these can make a big difference to your life expectancy. Lifestyle changes are also very important, such as losing excess weight, eating a healthy, low-fat diet, taking regular exercise and not smoking. So do what you can and make sure you have any regular checks advised by your surgery.