A brief resume of how we reached this point

In January 1986 due to the lack of work in Norfolk my husband Bob started working in London as a Freelance Computer Programmer.

In 1988 we bought our first home, which was a huge mistake, as it left us in Negative Equity for many years.  Also within a year of buying the house the mortgage rate went sky high.

In November 2005, after nearly 20 years of working away, Bob decided to give up working in London, for several reasons, he was very close to the London Bombings of 7^th July 2005 which upset him, he was tired and worn out with the rat race in London, and he also missed being involved daily with our family life.

After giving up working in London, Bob had difficulty getting a job, and for 9 months was unemployed but too proud to claim benefits, however, he never expected to be unemployed for as long as he was, and during this time all our reserves dwindled and debts started creeping up, leading to another mistake, which was getting a consolidation loan using the house as collateral.

Bob got a few casual jobs, which barely kept the wolf from the door, and was not enough to clear our debts. Until in September 2009 Bob settled to a long term job in Customer Service at a local garage, working for minimum wage.

Because of our general decline in income and rising costs we were now in serious debt and to prevent the house being repossessed in 2010 we sold our property for a lot less than we had hoped, the sale of the property just covered what was left of the mortgage.

Which left us having no choice but to move into the flat above the family business.

In 2012 after several years of struggle the family business closed which also left me now out of work, it also left us homeless.  I got  2 jobs as a cleaner at minimum wage.

We then moved into a Static Caravan, however, our living costs proved to be a lot higher than we were led to believe, and Bob’s health was now suffering with the living conditions.

Our current main problems are:-

·         Old Debts

·         Living costs are Higher than our income

·         Very few benefits apply to our situation

·         Health + prescription costs

·         Inadequate Housing

Help Sought

·         CAB cannot help, unless we want to declare bankruptcy, but they advised against it

·         Shelter only deal with specific housing needs

·         Council, are not prepared to discuss or negotiate just threaten with court

The consensus of opinion is that we fall into a black hole, we work, have no dependants and are under 65 – hence no help or advice is available.

Narcolepsy

Recently Steven has been complaining of being extremely tired, not able to concentrate and focus, he is worried about losing his job

Narcolepsy Isn’t Like the Movies: 16 Secret Signs of Daytime Sleepiness

We all know the punch line of the narcolepsy joke – person falls asleep while standing or in the middle of the conversation. My daytime sleepiness doesn’t look like this. On the surface, it doesn’t look like much of anything.

Internally – my sleepiness aches. My limbs become heavy and pressure pushes on my skull. Over 15 minutes or so, I lose my ability to process thoughts and communicate (described best here). Sometimes I do eventually fall asleep. Other times, I snap out of it randomly and return to myself.
Externally - my sleepiness is fairly undetectable. At it’s worst – friends have reported that I seemed “subdued,” “quiet,” “annoyed” or “dazed.” While I’m experiencing utter cacophony internally – I look “subdued.”
Daytime sleepiness manifests in other ways that we may not associate with sleepiness.
Narcolepsy’s sleepiness can appear as poor mood regulation such as irritability, mood instability and a less positive mood. It can also appear as behavioral issues like internalizing or externalizing (aggressiveness, hyperactivity and impulsivity). Likewise, daytime sleepiness can show as neurocognitive deficits – problems with attention, organization, self-monitoring, planning, memory and verbal creativity. Over time, daytime sleepiness can manifest as poor academic functioning, social impairments and family dysfunction.

16 secret signs of daytime sleepiness:

1. Irritability
2. Mood instability
3. Less positive mood
4. Internalization
5. Aggressiveness
6. Hyperactivity
7. Impulsivity
8. Attention deficits 
9. Organization issues
10. Self-monitoring deficits 
11. Planning issues
12. Memory problems
13. Verbal creativity deficits 
14. Poor academic functioning
15. Social impairments
16. Family dysfunction

I recently attended a presentation by Dr. Judith Owens highlighting these manifestations of daytime sleepiness in children. Although perhaps exaggerated in children, I believe these signs apply to narcolepsy at any age.
These not-so-obvious signs of sleepiness are helpful for diagnosis. They can also help people living with narcolepsy recognize daytime sleepiness in their everyday lives, because once diagnosed, treatment and lifestyle changes may improve sleepiness but are unlikely to erase it.
For me, irritability, aggressiveness and fidgeting are huge signs. Blaming narcolepsy doesn’t make this behavior “okay” or excusable, but acknowledgement is the first step toward change. Discussing with loved ones will allow us to work together to put moodiness to bed. Literally.
Of course, moodiness isn’t always sleepiness in disguise. Hunger manifests as moodiness often. And sometimes moodiness is plain ol’ moodiness!
In closing, sleepiness is more than nodding off in one’s soup bowl. Sleepiness is as invisible as insulin levels in diabetics, but without objective tools to measure sleepiness yet, we must do our best to subjectively recognize it. In a sense, sleepiness is like a soul – floating around undetected, only seen when it takes shape in a body (like in our mood, behavior or performance).

Eat a Rainbow

Mixed Neurodevelopmental disorder

Sophie, Jen, Andy and Bob attended an appointment with a Doctor Rashmi Adiga a child psychologist for what we hoped would be the start of a general reassessment, however unfortunately it was most unsatisfactory.

Dr Adiga had quite obviously not done her homework, she asked inappropriate questions in front of Sophie regarding her biological parentage, as Sophie’s biological Father is not allowed contact with her. At this stage of her life, Sophie has not been informed of him, because of her lack of understanding.

A teachers assistant was called in, we had no knowledge of who this teachers assistant is, she never introduced herself and has never attended an Annual Review.  Her input was unhelpful and misleading, according to her Sophie is perfect at school and all the problems are caused by her brother. At the moment Sophie is fixated with her brother, her brother is not blameless, but he is not solely responsible.

The report by Dr Melanie Bruce and Dr Bakka was ignored and not taken onboard.

Dr Adiga said none of the symptoms described were consistent with ADHD, and we had to make a suggestion about the possibility of Autism, she then said she would send out a questionnaire.

Dr Bakka specifically asked for support with bedwetting and this was never bought up.

The meeting was unsatisfactory and offhand and Dr Adiga couldn’t get rid of us fast enough.

Dr Adiga did suggest it could be Mixed Neurodevelopmental disorder 

A neurodevelopmental disorder,^[1] or disorder of neural development, is an impairment of the growth and development of the brain or central nervous system. A narrower use of the term refers to a disorder of brain function that affects emotion, learning ability and memory and that unfolds as the individual grows. The term is sometimes erroneously used as an exclusive synonym for autism and autism spectrum disorders.
Disorders considered neurodevelopmental in origin, or that have neurodevelopmental consequences when they occur in infancy and childhood include:

• Autism and autism spectrum disorders such as Asperger syndrome
• Fetal alcohol spectrum disorder
• Traumatic brain injury, (including congenital injuries such as those that cause cerebral palsy^[2])
• Communication, speech and language disorders
• Genetic disorders, such as fragile-X syndrome
• Down syndrome.^[3]

Neurodevelopmental disorders are associated with widely varying degrees of mental, emotional, physical, and economic burden to individuals, families and society in general.

There are many causes of neurodevelopmental disorder, which can range from deprivation, genetic and metabolic diseases, immune disorders, infectious diseases, nutritional factors, physical trauma, and toxic and environmental factors.
Some neurodevelopmental disorders—such as autism and other pervasive developmental disorders—are considered multifactorial syndromes (with many causes but more specific neurodevelopmental manifestation).^[4] However other multifactorial syndromes such as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) are presently thought to have a more specific primary causation as well as a specific neurodevelopmental manifestation.

Bob not well

Bob ran out of his medication and he couldn't order any till he had saw the doctor on trying to make an appointment he couldn't get in for a week, as a result, he spent 24 hrs violently throwing up with his acid reflux, he couldn't eat and drink, or move, he couldn't drink so was getting dehydrated which was causing him to develop an asthma attack.

So this morning, i went to see the pharmacist in boots, and asked his advice, the pharmacist sold me some tablets for Acid Reflux and told him to take 2, he then advised me to make an emergency appointment at the doctors, which i did.

He got into to see the doctors, who gave him his tablets and told him to double the dose, and prescribed some anti-nausea tablets, and gradually he started to improve.

This all meant taking a day off work sick.

The Gym

I had an appointment at the Gym today with Jonathan, however, because i went as a GP referral, but they needed someone with extra training for that who wasn't on today, so i have to go back on Thursday to see Tracy.

But Jonathan gave me a tour and i tried some of the equipment out.

13 Steps to Reach Weight Loss Goals in 2013

January: Clean out your kitchen of leftover holiday foods and temptation. Stock with healthy staples such as frozen or fresh fruits and veggies, whole grains, nut and nut butters, dried beans, seeds, condiments like olive oil, low-fat milk and yogurt, eggs, and so on.

February: You don’t need an expensive gym membership to get your workout on! During the cold winter months, make time for activity at home with an exercise DVD, or bundle up and schedule walks around your neighborhood with a buddy to keep you honest.

March: This is about the time people’s New Year’s Resolutions seem so far away and fall to the wayside. Keep a food log or a plain old pen and paper to stay accountable for what you’re eating and recognize where you need to make improvements.

April: Take the whole grains challenge and make three servings of grains every day whole – including brown rice, whole wheat pasta, quinoa, and even air-popped popcorn. These foods help fill you up on fewer calories than refined grains and are not only beneficial for weight loss but can reduce your risk for heart disease and diabetes.

May:  It’s officially farmer’s market season! Make an effort to visit yours and incorporate a serving of a new fruit or vegetable every week. Choose produce from every color in the rainbow to get a variety of nutrients such as antioxidants and fiber.

June: Swap in lower sodium foods. Instead of deli meats or sausage at your barbecue, choose fresh grilled chicken, fish, or roast turkey to save on saturated fat and help reduce bloating for swimsuit season.

July: Stay hydrated with about 8-10 cups of water per day to keep your energy high and metabolism strong during sweltering summer months. Ditch sugary drinks like lemonade or soda and, instead add fresh fruit flavor to water using an infusion pitcher if the taste of plain water is unappealing.

August: Lazy, summer months, no more. Take advantage of more free time to be active with your family. Once per week, go on an outing such as going to a local park for a healthy picnic and nature walk or engaging in a family friendly sport like swimming or biking.

September: Just because you’re not in school doesn’t mean you can't learn new skills. Try a new exercise or cooking class to keep it interesting and keep you motivated for healthy habits.

October: Don’t save up all your “treats” for Halloween! It’s healthy and balanced to include all the foods you love in moderation into your diet. Otherwise, you’re more likely to overeat when you’re faced with them, like you may have overindulged in the past on October 31^st.

November: Be savvy on the go and remember that "snack" isn’t a bad word. Always keep a nutritious snack on you, like nuts or an energy bar, as you gear up for the holiday season while shopping or traveling.  Going more than 4-5 hours between meals can set you up to overeat or give into not so healthy options when you’re at the mall, airport, or rest stop.

December: Drink alcohol in moderation – 1 drink per day for women, 2 for men. As the holiday party season gets into the swing, you’ll have plenty of opportunities to drink and add empty calories to your day. Brush up on best practices, lowest in calorie choices, and strategies to limit your alcohol intake so it doesn’t sabotage your healthy eating.

All Year Round: Reassess and revise as needed! You may try to make an improvement in your lifestyle but going to the gym for an hour every day isn’t realistic for you or you really dislike the new foods you’ve swapped in. This doesn’t mean you’re a failure and should give up hope. Take smaller steps and instead, figure out when you can fit in time for activity and what nutritious foods you do enjoy that you can include.

Health and Wellbeing

Saw this on Twitter interesting................

Improving the health and wellbeing of people in the borough is important to us.

Do Something Different

Do you want to make changes in your life? We are offering the opportunity for members of the public to sign up for the highly successful Do Something Different programme. The programme is designed to help and encourage you to make small changes in your life which make a big difference in your overall health and wellbeing. It will help you:

• become more active and stick to it
• be a healthier weight
• get out of a rut that depresses you
• have a better relationship
• be happier in yourself and with life

Making changes is not easy for anyone. Change is a difficult and much misunderstood process but it can be a lot easier than you think! By making small changes in your daily life and changing some habits, bit by bit, you can take charge of your destiny and become a happier and healthier person.

Do Something Different programmes are different, exciting and a lot of fun! Just a series of simple steps that will gradually transform your life, health and well-being and bring about lasting behavioural change.

All our programmes are designed to be:

• Fun
• Personally developing for each Do-er
• Do-able in only 7-weeks
• Great value for money

The Do Something Different programme is tailored to your specific needs of becoming a healthier and happier person. It is designed to help you to take small steps in a new direction by giving you a small daily ‘Do’ to complete.

Available Courses

Each course costs £35 per person and each participant must be aged 16 or over.

Healthy Weight/Happy Life
To register for the programme, please e-mail contact@west-norfolk.gov.uk or telephone 01553 616200.

http://www.west-norfolk.gov.uk/default.aspx?page=26686

http://www.kingslynnonline.com/2012/12/take-control-of-your-life-in-the-new-year-do-something-different#.UORzz1IuSL0.twitter 

Dietician

This morning i went to see the dietician Rebecca Hayes at Heacham Surgery, I really felt that there was nothing she could do and was clutching at straws.

She suggested
cutting down to
1 hot chocolate
1 weetabix

She said protein filled you up more than carbohydrates

She suggested eating more

Chicken
Vegetables and Salad
Drinking Fruit Teas

She said my calorie count was within the right range

She discussed exercise and suggested i try swimming. She also had doubts how useful the gym would be because of the pain.

I felt there was nothing new to be learned here, it seems i am not making any drastic blunders and she said nothing i didn't already know.

My next appointment is in a month.

At long last an improvement

Recently my pain has improved and i feel much better, the recent changes i have made are:-

Vitamin D

Apple Cider Vinegar

taken every morning in conjunction with my other supplements which are below:-

Soluable Vitamin C

Multivitamins

Glucomsomine Sulphate

Cod Liver Oil

My prescribed medication

Naproxen 500mg

I was supposed to take this 2 twice a day, but i am taking 2 once a day, as i feel that is sufficient.

And Copper Insoles.

The question is is it one of the above or a combination of above.................

The Doctor also prescribed me 

Co Codamol (30mg/500mg)

To take as and when needed but since i have been taking the above, i have not needed to take them.

Steven heard from Papworth

Steven had a call from Papworth today from a member of Dr West's team.

He asked questions about how he was feeling, when did he have his operation, and other information.

He expressed concern that the valve could be too small, and is going to track down all Stevens record from Great Ormond Street and Queen Elizabeth, and will keep monitoring which is good.

Why lack of sleep may trigger arthritis - but treating insomnia may improve the condition

Published in the Daily Mail

Anyone who suffers from it knows that joint pain can have a significant effect on your life, restricting mobility and making it harder to complete even everyday tasks.
But it’s not just during the day that it can cause problems — sleep can be affected, too.
Persistent, aching pain in the back, hip, arms and legs can lead to disrupted, restless sleep.

Until recently restless nights were viewed as a secondary and almost inevitable problem for people with arthritis

Experts say insomnia is common among the ten million arthritis sufferers in Britain, with some estimates suggesting that nearly two in three experience trouble sleeping.
However, until recently restless nights were viewed as a secondary and almost inevitable problem for people with arthritis.
But now scientists are realising that this problem is a two-way street: not only does joint pain cause sleep loss, but sleep deprivation makes joint pain worse, and can even accelerate joint damage.
There is growing concern that sleep disturbance exacerbates osteoarthritis (wear-and-tear arthritis) and rheumatoid arthritis (where the immune system attacks the joints), and experts believe that treating insomnia could lead to an improvement in the condition.
‘There’s a correlation between lack of sleep and pain and it’s a vicious circle.
'Pain induces lack of sleep and lack of sleep induces pain,’ says Professor Alan Silman, medical director of Arthritis Research UK.
Osteoarthritis develops when cartilage that protects the surface of bones becomes damaged and starts to break down.
The exact causes remain unknown, but genes, weight and age are all thought to be involved.
Much of the pain and swelling is caused by inflammatory molecules in the body travelling to the joint.
For reasons that are not fully understood, disrupted sleep leads to increased numbers of these inflammatory markers, which further aggravates sore joints.
One of these markers is called interleukin-1 (IL-1), which is made by white blood cells.
One expert thinks IL-1 is the ‘primary trigger’ of osteoarthritis.
Professor Peter Wehling, an orthopaedic surgeon whose Dusseldorf clinic has become a pilgrimage site for sports stars seeking to prolong their careers, says even a limited amount of sleep disruption can cause the immune system to ‘go into overdrive’.
It then begins to ‘flood the body with white blood cells in a vain attempt to address exhaustion-related distress’, as he puts it in his book The End Of Pain.

Osteoarthritis develops when cartilage that protects the surface of bones becomes damaged and starts to break down

Many of the IL-1 producing white blood cells lodge in the joints and cause ‘discomfort and gradual erosion of cartilage’, he says.
Professor Wehling warns that even one bad night’s sleep can set this in motion.
Professor Silman from Arthritis UK agrees that inflammatory compounds play a role in arthritis. ‘Sleep disturbance can change the body’s natural cycle of hormones as well as possibly adversely affecting the underlying levels of inflammation,’ he says.
He agrees that IL-1 is ‘an important player’ in the development of inflammatory arthritis, but says other cytokines — inflammation-causing chemicals — may also be involved.
He adds that some of the symptoms of osteoarthritis, especially in its early stages, may be a direct consequence of inflammation.
And while loss of sleep may release damaging inflammatory chemicals, it also means the joints miss out on the healing benefits of sleep.
Sleep is the longest time during which the body has low levels of inflammation and opportunity to heal.
Around 15 to 25 per cent of it should be deep sleep — this equates to around 1½ to two hours every night.
During this time, energy levels are restored and the immune system strengthened.
But it can take up to 45 minutes of sleeping to enter deep sleep — and these deep phases seem to occur only in the first half of the night, for reasons not understood.
This means that if someone is tossing and turning they may have very little deep sleep.
This not only increases the number of inflammatory markers in the body, but it can also disrupt the workings of hormones vital for joint healing, says Professor Wehling.
Perhaps most notably it lowers production of human growth hormone, sometimes called the ‘master hormone’ because it is vital to many processes in the body including tissue repair, weight management and continuing replacement of bone and collagen.
Though human growth hormone is produced in small surges during the day, by far the biggest burst comes 60 to 90 minutes after falling asleep as we enter deep sleep.
Inflammation suppresses human growth hormone — and so deep sleep causes levels to surge.
But without much deep sleep we may not produce enough growth hormone, speeding the decline of tissue and bone, causing it to become worn in joint areas.
Furthermore, weariness makes people more sensitive to pain, and can lead to them becoming even more immobile.
Professor Kevin Morgan, director of the Sleep Research Centre at Loughborough University, explains: ‘Moving involuntarily in the night can wake you up with a lightning shaft of pain and a cracking sensation.
'This sleep disruption makes pain worse the next day, and makes a person less inclined to want to move around.
‘However, movement and activity makes joints hurt less.’
Arthritis Research UK is funding a study by King’s College London’s Institute of Psychiatry, which aims to identify and treat the issues preventing patients with rheumatoid arthritis from being physically active and sleeping well.
Around 200 people with the disease are taking part in the research, which it is hoped will lead to new techniques to tackle inactivity, sleep disruption  and pain.
A similar study by the University of Washington in Seattle involving 375 patients with osteoarthritis is also being held and is due to report next year.
It is examining whether targeting pain and sleep problems is more beneficial than a regimen focusing on pain alone.
The researchers have hypothesised that the dual approach will have greater long-term benefits for sleep and pain, increase physical activity and lead to a reduction in healthcare costs.
Jo Cumming, head of helplines at Arthritis Care, says the charity speaks to 12,000 people a year, and 63 per cent say they don’t get a good night’s sleep.
‘It is a huge burden to bear. When GPs are considering medication or joint replacements one of the things they ask patients is whether the pain stops them sleeping,’ she says.
But Professor Morgan argues that previously GPs have considered insomnia as an unfortunate consequence of another health problem, rather than an important health problem in itself.
This has led to patients not always receiving the best treatment.
‘You have to put in a lot of work convincing clinicians that sleep problems are not just collateral damage from the main disease,’ he says.
So what can help those with joint pain achieve a good night’s sleep?
Tips include cutting out afternoon naps, using lamps rather than ceiling lights in the evening, avoiding caffeine after 3pm and not drinking alcohol after 9pm.
Professor Wehling also recommends ‘keeping a consistent bedtime and rising within an hour of sunrise’.
Avoiding midnight snacks can also help.
An estimated 50 per cent of our body weight is carried by the menisci, small pads of cartilage in the knee, so piling on the pounds adds substantially to an already considerable strain.
Excess body fat can also heighten arthritis directly because our fat cells expand and produce more cytokines, which fuel inflammation.
However, a lack of sleep can lead to weight gain, which is known to make joint pain worse.
Levels of melatonin, the key hormone in regulating our daily body cycle or circadian rhythm, are also disturbed by sleep loss, and this in turn upsets the balance of two other hormones.
The first is ghrelin, known as the ‘hunger hormone’.
Elevated levels of ghrelin at night can prompt people to raid the kitchen, craving carbohydrates in particular. It also causes extra insulin production, making the body store more fat.
The second is leptin, which usually helps regulate appetite, but may be disrupted by loss of sleep.
Studies in mice also suggest that leptin may itself have inflammatory effects.
Arthritis Care Helpline free on 0808 800 4050 or email Helplines@arthritiscare.org.uk.

Miracle Drug

When i went to the Doctors the Co-codomol he prescribed was

Solpadol 30mg/500mg capsules (Codein Phosphate and Paracetamol)

I have taken this when my pain became unbearable, and the difference was extreme, the relief was incredible.

Solpadol

Main use	Active ingredient	Manufacturer
Severe pain	Paracetamol 500mg, codeine phosphate 30mg (co-codamol)	Sanofi-Aventis

How does it work?

Solpadol caplets, capsules and effervescent tablets all contain two active ingredients, paracetamol and codeine phosphate. This combination of medicines is often referred to as co-codamol. (NB. Co-codamol is also available without a brand name, ie as the generic medicine.)
Paracetamol is a simple painkilling medicine used to relieve mild to moderate pain. Despite its widespread use for over 100 years, we still don't fully understand how paracetamol works to relieve pain. However, it is now thought that it works by reducing the production of prostaglandins in the brain and spinal cord.
The body produces prostaglandins in response to injury and certain diseases. One of the effects of prostaglandins is to sensitise nerve endings, causing pain (presumably to prevent us from causing further harm to the area). As paracetamol reduces the production of these nerve sensitising prostaglandins it is thought it may increase our pain threshold, so that although the cause of the pain remains, we can feel it less.
Codeine is a stronger painkiller known as an opioid. Opioid painkillers work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors.
Codeine mimicks the action of natural endorphins by combining with the opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain. Therefore, even though the cause of the pain may remain, less pain is actually felt.
Solpadol caplets, capsules and effervescent tablets contain 30mg of codeine, which in combination with the paracetamol, is effective at relieving severe pain.

What is it used for?

• Severe pain.

Warning!

• This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.
• Do not take this medicine with any other products that contain paracetamol. Many over-the-counter painkillers and cold and flu remedies contain paracetamol. It is important to check the ingredients of any medicines you buy without a prescription before taking them in combination with this medicine. Seek further advice from your pharmacist.
• An overdose of paracetamol is dangerous and capable of causing serious damage to the liver and kidneys. You should never exceed the dose stated in the information leaflet supplied with this medicine. Immediate medical advice should be sought in the event of an overdose with this medicine, even if you feel well, because of the risk of delayed, serious liver damage.
• Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistant heavy drinkers and in people with alcoholic liver disease.
• If this medicine is taken regularly for long periods of time, the body can become tolerant to it and it may become less effective at relieving pain. With prolonged use, the body may also become dependent on the codeine. As a result, withdrawal symptoms such as restlessness and irritability may occur if the medicine is then stopped suddenly. If you find you need to use this medicine all the time you should consult your doctor for advice.
• Consult your doctor if your symptoms persist despite taking this medicine.
• Taking a painkiller for headaches too often or for too long can actually make the headaches worse.

Use with caution in

• Elderly people
• Weak or debilitated people
• Decreased kidney function
• Decreased liver function
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Epilepsy
• Underactive thyroid gland (hypothyroidism)
• Low blood pressure (hypotension)
• Narrowing of the urethra, causing difficulty passing urine
• Enlarged prostate gland (prostatic hypertrophy)
• People at risk of bowel obstruction, eg due to constipation
• Inflammatory bowel disease such as ulcerative colitis or Crohn's disease
• Biliary tract disorders, eg recent surgery on the biliary tract
• Underproduction of natural steroid hormones by the adrenal glands (Addison's disease)
• Myasthenia gravis.
• Solpadol effervescent tablets contain sodium. They should be avoided in people with kidney problems and those on a low sodium diet.

Not to be used in

• Children under 12 years of age
• Slow, shallow breathing (respiratory depression)
• People having an asthma attack
• Alcohol intoxication (acute alcoholism)
• People with a head injury or raised pressure inside the skull (raised intracranial pressure)
• Paralysis or inactivity in the intestines that prevents material moving through the gut (paralytic ileus).
• Solpadol effervescent tablets contain sorbitol and are not suitable for people with rare hereditary problems of fructose intolerance.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Label warnings

• Do not take more than 2 at any one time. Do not take more than 8 in 24 hours.
• Do not take this medication with any other products containing paracetamol.
• This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

• Constipation.
• Nausea and vomiting.
• Dizziness.
• Lightheadedness.
• Drowsiness.
• Shortness of breath.
• Confusion.
• Mood changes.
• Difficulty in passing urine (urinary retention).
• Skin rash.
• Dry mouth.
• Slowed heart rate.
• Contraction of the pupils.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
You should not take other medicines that contain paracetamol in combination with this medicine, as this can easily result in exceeding the maximum recommended daily dose of paracetamol. Many cold and flu remedies and over-the-counter painkillers contain paracetamol, so be sure to check the ingredients of any other medicines before taking them with this one.
This medicine should not be taken at the same time as, or within 14 days of taking a monoamine oxidase inhibitor (MAOI), for example the antidepressants phenelzine, tranylcypromine or isocarboxacid.
There may be an increased risk of drowsiness and sedation if this medicine is taken with any of the following (which can also cause drowsiness):

• alcohol
• antipsychotics, eg haloperidol
• barbiturates, eg phenobarbital, amobarbital
• benzodiazepines, eg diazepam, temazepam
• other opioid painkillers, eg morphine, dihydrocodeine
• sedating antihistamines, eg chlorphenamine, hydroxyzine
• sleeping tablets, eg zopiclone
• tricyclic antidepressants, eg amitriptyline.

Cholestyramine reduces the absorption of paracetamol from the gut. It should not be taken within an hour of taking paracetamol or the effect of the paracetamol will be reduced.
Metoclopramide and domperidone may increase the absorption of paracetamol from the gut.
Long-term or regular use of paracetamol may increase the anti-blood-clotting effect of warfarin and other anticoagulant medicines, leading to an increased risk of bleeding. This effect does not occur with occasional pain-killing doses. If you are taking an anticoagulant medicine and you are also taking co-codamol regularly, your blood clotting time (INR) should be regularly monitored.