Sandy Williams

Sandy Williams

Q:  I have chronic lower back pain which often radiates to my abdomen.  A few days ago I tried Acumed pain patches. They're bioelectromagnetic patches
that contain high purity zinc and cooper in a magnetic field.  They are classed as acupuncture 'on the go'. The pack comes with the map of the body and the pressure points used in acupuncture, telling me where to place the patch/es.  I placed 2 on my lower back and 1 on my stomach. After a few hours I got many side effects, strange sensations from pins and needles in my feet and hands, to muscle aches, twitches, spasms and an all round odd body feeling.

I thought perhaps I had too many on so took off the 2 back ones in the night. It helped a tad but I still had these strange side effects, especially shoulder muscles aches, aches in my fingers and psalms of my hands and occasionally my neck.  I didn't like this feeling and got to yesterday, 4 days with the one on my
stomach left on before taking it off (it suggests leaving them on for 5-7 days for full effect).

I took the patch off last night thinking all would be gone. However today I'm still getting pins and needles, muscle aches in hands, feet, shoulders and neck. It is upsetting me.  I know these patches aren't acupuncture exactly but act exactly in the same manner. Therefore my question is that does these type of symptoms/feelings
happen sometimes after acupuncture? Do they calm down?

Any response and information/advice would be greatly appreciated.

A:This sounds highly unusual. We do see a number of relatively infrequent side-effects from treatment, but the vast majority of these resolve within the next 48 hours after the treatment. The only ones which carry on beyond that are where there has been actual physical damage, even rarer but possible. These instances can involve a punctured lung, of which there have been a very small number in the last twenty years, and nerve damage from needles or occasionally nerve impingement after a small internal bruise, which can take a while to recover.

That said, the range of symptoms which you have experienced and for the duration you have experienced them are very unusual. We have not come across a collection like this, although one or two have been reported as transient adverse events. Our only surmise is that you could be energetically very sensitive, and this treatment is altogether too powerful. We do come across the occasional patient for whom anything more than two or three needles causes a greater disturbance than the good outcomes which eventually emerge, and we treat such people very conservatively.

It is not at all unlikely that the treatment, if it has had an effect (and magnets can be very strong), could still be doing so. We hope that by the time you get this response the symptoms have started to abate. This would be our expectation. If they haven't, then we would advise that you see your GP as soon as possible. It is highly probable that the effects have been caused by the treatment, but we always advise patients in whom strange symptoms appear to visit their GPs because it may simply be a
coincidence, and it would be unwise to keep changing the mix of treatments to deal with a problem that might require conventional treatment as a solution. We
say this not because we want to deny the possibility, but because our primary concern is to identify what is going on and deal with it more than trying to establish what actually caused it. We have seen a number of cases where the patient has spent all their time trying to prove the treatment did it while not dealing with the problem.

Wednesday, 29 July 2015 00:00

Can acupuncture help after a stroke

Q:  My husband has had a stroke and he also has weakness on the left side.  He also had a heart attack this May and had a pacemaker fitted. He has difficulty walking.  Can acupuncture help him. If so how many treatments would he need to see any improvement.

A:  We are very sorry to hear about your husband's problems.  Either problem would be bad enough in itself but the two together are a major  burden.  With such a complex background it is very difficult to say sight unseen whether acupuncture would be of great benefit to your husband. Certainly there is some hope if the difficulty in walking arises from the stroke. In China it is not uncommon for people who have had a stroke to be given acupuncture daily or twice daily as soon as they are admitted to
hospital, the idea being that the energies of the body have been disrupted, and the quicker the flow is reinstated the better. In this country this is not yet a popular option, so we tend to see people a little later down the line, often after conventional treatment has reached a point where there has been no further progress. In the circumstances progress tends to be a little slower, but over time there can be some very positive changes. This is very difficult to show by research, because there is often a process of natural recovery alongside the acupuncture treatment, and deciding what has been the cause of improvement can be difficult.

The confounding factor is the heart attack. This can also be a major contributory factor to difficulties in walking, and without being able to assess the impact of the two events on the energy of the body by direct observation it is really hard to be able to offer good advice. We often advise people to see a BAcC member local to them for a chat about whether acupuncture treatment would be a good option, and in most cases they are happy to do this without charge in order to give a balanced view of whether treatment would be worthwhile.

The imponderable would be how many sessions it might take to see improvement. This is really impossible to say. We have all had the experience of fit young people taking months to get better, and seemingly impossible cases changing overnight, so we are never happy to venture guesses. What we do say, though, is that a practitioner should review progress after the first four or five sessions, and then maintain a constant review if it seems worth continuing. We always advise members to establish with a patient a good set of measurable outcomes - distances walked, times on fee, etc - to provide some objective as possible measure of progress. Otherwise a lot will come down
to how someone feels on the day, which is never a reliable option.

 

A:  We are in the very fortunate position of having an independent accrediting body, the British Acupuncture Accreditation Board, which we helped to establish over twenty years ago and which we fund heavily now. The Board ensures not only that courses deliver the standards which the BAcC regards as the minimum requirement for safe independent practice, but also that the learning environment meets appropriate standard of staffing, equipment and support. Details of the Board can be found here http://www.baab.co.uk and details of the the accredited courses here http://www.baab.co.uk/accredited-courses.html. The website offers a great deal of information about training and acupuncture as a career.

All of the courses accredited by the Board offer similar standards of high quality training. Each has a distinct and unique flavour, not entirely surprising when you look at the extraordinary breadth of the tradition, and we usually advise potential students to visit as many open days as possible to get a sense of which courses appeal more to them. The adage of 'nearest best' does not always generate the best results in the training on offer.

There remains a healthy debate inside the profession about what counts as a suitable training. The BAcC and BAAB standards accord with those published by the World Health Organisation which specify 3600 hours of training, which is a degree or degree-equivalent level. Training in China, however, can run to between five and seven years, although a great deal of this will be conventional medical training. At the other end of the scale there are courses which offer to turn out trained practitioners in two years or less, but we do not believe that this can offer the level of supervised practice which we think is essential to give someone the confidence to set up by themselves.

Our experience is that most of our members continue to study for as long as they practise. The materials available, as well as the huge number of postgraduate courses, are a sound basis for life-long learning.

Q:  I have got multiple sclerosis and a bad intention tremor in my left hand. I was just wondering if you thought acupuncture would help ease my tremor please?

A:  We have to be honest and say that if the intention tremor is a manifestation of the MS and involves irreversible changes in the cerebellum, then from a Western medical perspective there would be little prospect of being able to improve the condition. However, we look at things from an entirely different perspective, and our general approach to problems like this is summed up in an answer we gave some time ago to a question about benign essential tremor as follows:

There are occasions when acupuncture can achieve surprising results, and if you undertake an internet search you will find a case report written up by one the American medical acupuncture practitioners

http://www.medicalacupuncture.org/aama_marf/journal/vol1_1/tremor.html  which outlines a very successful intervention. There is also a paper

http://www.ncbi.nlm.nih.gov/pubmed/20214065 which suggests that acupuncture alongside conventional treatment may be more effective in reducing symptoms. We have to say, however, that these are far from the norm, and benign essential tremor can prove very resistant to treatment.

The point which we also have to emphasise, however, is that Chinese medicine works on the basis of an entirely different conceptual structure from conventional medicine, premised as it is on the understanding of the body as a flow of energy, called 'qi', and what happens when that flow is disrupted or disturbed. This means that symptoms as
they are described by a patient and signs observed by the practitioner are filtered and made sense of within this 'grid', and that can mean on occasion finding an explanation which would not be a part of western medicine thinking at all. Were this to be the case, there may be treatment options which a Chinese medicine practitioner would employ to address the problem as it was defined within this system, and with 2000 years of development and refinement there are going to be occasions where a solution is found which western medicine cannot match. This is still in the realms of 'unlikely', but it would be nonetheless be possible. There is a category in Chinese diagnostics called 'internal wind', for example, which can manfest as shaking and tremors in the limbs, and a fairly direct treatment used to address it.

We could not make this kind of determination remotely, however, and you would need to see a BAcC member local to you and your mother to seek advice on whether there were elements of her condition which lent confidence to a practitioner that there was something they could do. Most members are willing to give up some time without charge to advise prospective patients on the suitability of treatment, and we would recommend this as your best option to get a clearer picture for your mother.

We think that the same point applies here, and mirrors to some extent what we do when we treat people who have recently had strokes. There is undoubtedly damage to brain tissue from the stroke but from a Chinese medicine perspective it is the disruption of the flow of qi in the limbs which generates the spasticity and paralysis as a manifestation of the same energetic problem which has affected the brain. It is not at all uncommon in China for people to have a course of acupuncture treatment starting within hours of the stroke itself to encourage a rapid return to normal flow of qi in the affected limbs.

Our view is that it would certainly do no harm to have a few sessions of treatment, and it may lessen the severity of the symptoms. As we said in the earlier reply, though, this might still be something of a long shot. The most recent review of evidence, however, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086829/

is not altogether negative, concluding that people 'should not assume that acupuncture is not effective in this population but rather that the literature is insufficient to make claims either for or against its use', which in medical research terms is a tacit admission that there may well be something good going on.

Our advice in these kinds of case is always the same. Each individual is unique, and it is, as the great Canadian physician William Osler once said,' more important to find out about the patient who has the disease than the disease the patient has.' It would be useful to have a chat face to face with a local BAcC member to get a clearer assessment. If you did decide to go ahead, we would always advise caution, though, in how many sessions you had. It can be quite easy to get locked into a treatment pattern that carries on for some time with no discernible improvements, so we like to see reviews put in place after every four sessions and try to find clearly measurable outcomes to assess whether there has been any progress.

Q: I'm contacting you on my wife's behalf. She has suffered from extreme indigestion/heartburn for a long time. She has had endoscopies and ultrasound tests that have all come back clear. She has one last PH test. We really need to look for alternative therapy.  Can acupuncture help?

A:  There is surprisingly little research on the use of acupuncture for the treatment of acid reflux even though it is a very common presenting condition in our clinics. There are one or two studies like this  http://www.ncbi.nlm.nih.gov/pubmed/20697939   http://www.ncbi.nlm.nih.gov/pubmed/17875198 

and occasional articles like this one http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080874/

which suggest other possibilities for the appearance of heartburn symptoms, but not the solid body of evidence one might expect based on the usually quite effective treatment of this problem.

Obviously there are physical problems such as hiatus hernia where there has been a physical change in structure of the oesophageal tract which can cause heartburn. If this is the case, then it will seriously limit the possibilities for treatment in any system of medicine. If investigations show that this is not the case, however, then there may be some value in using acupuncture treatment.

From a Chinese medicine perspective the classic presentation of reflux or heartburn is described as Stomach Fire or Rebellious Stomach Qi where the energy of the Stomach does not follow its normal pattern of causing food to descend but lets it stay in the Stomach or reverse its flow to create the classic symptoms with which people suffer. Knowing the immediate precipitating cause, however, does not mean that one goes straight to this for treatment. The flow of energy in the body, called 'qi' in Chinese, is a complex interweaving of channels connecting Organs whose functions are also inter-related. The art and skill of the practitioner lies in determining what
the primary underlying imbalances are, in the belief that treating here will cause the symptom to go and stay gone rather than be treated simply as a symptom.

This is one of the primary differences between Chinese and conventional medicine. From the Chinese medicine perspective the symptom is an alarm bell telling the practitioner that the system is out of balance. Thus twenty patients with the same symptom could have twenty different underlying causes and therefore twenty different treatments, in contrast to the standard western procedures which have two or three main strategies for a problem. In Chinese medicine the balance of the system is unique in every patient, and this means that each treatment plan is also unique.

It follows that this does limit what we can say about individual cases and why we invariably advise people to visit a local BAcC member for an informal assessment of what is going on and whether treatment would be of benefit. Most practitioners can get an idea in a very short time of what is going on and as a consequence give a good informed view of what might be possible. This would invariably take into account other changes in the way that everything functions which are perhaps not significant enough to concern anyone but from our perspective enrich the picture which we have. Reflux and heatburn are often accompanied by changes in bowel habit, and secondary information can refine the diagnosis a great deal. A practitioner can take all sorts of other factors into account, including mental and emotional ones, to
offer you a much more precise assessment of what may be possible.

Q:  If you go to the practitioner search function on the BAcC home page you will see under the postcode search an option to search by other criteria. If you click on this link you will find a location search, and by entering 'Spain' in the 'country' box you will see a list of ten names of our members in Spain.

These are spread out across the country so it is probable that only one or two are within reach. However, there are often informal networks of practitioners within a country, especially expatriates, and the nearest to where you are likely to be may well know the names of other practitioners who are not necessarily BAcC Overseas members who are working in Spain.

We tried to cut and paste the results but the way the site is constructed means that we could not get all ten names and their relevant addresses on the same screen all at once!

Q:  Has there been any success in the treatment of ME/CFS? Principally dizziness and fatigue but many other symptoms.

A:  ME/CFS is finally being accepted by conventional medical practice as a legitimate problem, not as a fashionable label for feeling a little below par. We have always felt that this is on a par with the relationship between headaches and migraines. The latter are not simply a slightly difficult version of the former, but a real debilitation condition
which is indescribable unless you've actually experienced it. In the same way the fatigue and mental fog associated with ME/CFS is not just a flu which goes on, and we have seen many patients whose lives have been radically changed for good.

Our factsheet  http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-fatigue-syndrome.html

takes a rather apocalyptic line with its gloomy predictions of a 5% recovery rate. Our experience is that this is taking a very specific view of recovery, and a great many more people manage to get back to a high level of previous functioning as long as they manage the condition well.

It is always necessary to be careful, though, with ascribing every symptom to ME. Because the condition affects the whole system there will often be secondary problems which are not simply a direct consequence of the condition but a consequence of the effect of the condition on the overall energetic balance of the person. This might mean, for example, that the dizziness could be treated effectively by helping to reduce the effects of the ME on the pre-existing balance of the body. We are all more or less out of
balance from birth, not pathologically but because the variations in individual balance from the centre are what make us the individuals we are. The ancient Chinese doctors used this understanding of the person to help them to treat in advance of the changes of the season to protect patients against climates which could push their constitutions out of kilter enough to generate symptoms. This preventative approach was central to Chinese medicine.

This is a rather long-winded way of saying that each symptom has to be seen in the context of the whole. We find that many patients with a disease label see every problem through that lens, and so it is ' the Parkinsons' or 'the MS' or 'the ME', when in fact some of the problems are entirely contingent. The best advice that we can give is to visit a BAcC member local to you for advice on the specific manifestations of the problems you have. They will be able to see first hand what is going on, and be more than
happy to give you some time without charge to assess whether they believe they can help.

What we can say is that it may be a long process. Our experience is that it can take months to get on top of the problem, and that there are often setbacks. The  management programme for ME run in the NHS actually places severe restrictions on what people are allowed to do even when they begin to feel better because  experience has taught them that positive changes are often fragile, and the sufferer's first reaction when they feel better, to go out and enjoy themselves, can often undermine their progress. The key thing, if you decide to have acupuncture treatment after talking to a practitioner, is to review progress on a regular basis. The fact that change may take a long time can sometimes mean that treatment can go on and on when there is no real change, and a wise practitioner will try to find some means of objectively assessing whether there actually is progress.

We find that many conditions like this are like an interlinked spiral of problems, and that if we can change one aspect of the presentation it often helps a sufferer to believe that things can change, which in turn fuels progress in other areas.

A:  As you can imagine, this is a topic which pops up relatively frequently, and a typical answer we have given in the past is:

Weight loss was the subject of some critical scrutiny a decade ago, and the conclusion drawn at the time was that acupuncture did not have any significant effect on
weight loss. However, trying to test whether acupuncture can help someone to reduce their weight is likely to be a difficult matter; there are dozens of reasons in Chinese medicine why someone's weight may be increasing. Trying to group together a sufficiently large number of patients whose western problem
and eastern diagnosis are the same is extremely difficult.

In one or two cases there is a very direct correlation between someone's weight and their underlying imbalances from a Chinese medicine perspective. Correcting these may have an immediate impact on, say, the amount of fluid someone is carrying, and that could create a 3-5kg loss very quickly.

However, all of the best dietary programmes say that after the initial and often quite dramatic week or two most good weight loss programmes at best will see someone
lose only a pound or two every month, and in fact, there is discouragement from trying to do more in order for the body's system to keep pace with the change.
Acupuncture may well have been used successfully alongside some fairly strict dietary rules, and from a patient's perspective it would be very difficult to say whether the acupuncture treatment added value to what someone was doing already.

The bottom line is that there are are no 'magic' points which reduce someone's weight without effort, and the effect of acupuncture may be no more than to give
someone the support and commitment to keep trying with diet and exercise programmes. However, if someone remains motivated as a consequence of acupuncture
treatment that itself would be a very positive outcome.

There is nothing that we would add to this advice other than to beware of anyone making promises they cannot keep about what acupuncture treatment can deliver. Some of the less reputable high street shops still appear to be making claims of a fairly speculative nature without any evidence which supports what they claim.

This is probably the best advice that we can give. Our clinical experience is that their are often subtle emotional and spiritual issues underpinning the loss of control which people have of their weight, and some of these are amenable to acupuncture treatment. We have answered many questions on anxiety and depression, and we find quite often that a response to depression is to comfort eat. Helping with the depression may well reduce the desire to use food in this way.

One has to be realistic, however. Some of the psychological issues are not best suited by long term acupuncture treatment and really do need to be addressed directly by
someone skilled in this area. There are also many occasions when the 'habit energy' to eat is so well entrenched that a direct intervention like hypnotherapy or cognitive behavioural therapy is appropriate because it goes straight to the point. We also have to tell some patients, sensitively we hope, that oaks breed oaks and willows breed willows. If a family are all size 18, then the chances are that trying to be a size 8 is not going to be likely.

The best advice we can give is that visiting a BAcC member local to you will be able to provide you with advice based on a brief face to face assessment. This is very
likely to offer you the best range of options for you. All of our members are concerned to ensure that a patient gets the help they need, which is not always what they have to offer. We often refer to other colleagues if we feel something would work better. Each patient is unique, and finding what works for each individual case is the best guarantee of success.

Wednesday, 29 July 2015 00:00

Pain killers after acupuncture

Q:  I had acupuncture this morning which has  left me with a headache like pressure basically like I had before.  Can I take pain killers?

A:  The answer about pain killers is, of course - do! Although we are often seen as very anti-western medicine, this is not the case. The only concern that we have about painkillers is that from our perspective more often than not the symptom which someone has is not the same as the problem, but more likely to be a kind of alarm bell alerting the person to the fact that whole system is out of balance. Taking painkillers for a long time is rather like switching off a fire alarm because it is too noisy. As a short term fix, therefore, they are fine, but as a long term solution less so.

It is possible that your headache is not simply a result of treatment but also a sign that the pattern as a whole is shifting. It is not unknown with headaches and migraines for a patient to have a very rapid and unpleasant return of the symptom which is worse than usual. This is often seen in Chinese medicine as a sign that the body is expelling a pattern which is causing the problem.

However, it is also possible that the headache is a transient adverse effect of the treatment. Some people, very few it has to be said, get a number of short term symptoms which soon pass. If they happen after every treatment session the responsible practitioner will be reducing the power of the treatments - fewer needles, less action on the needle - to ensure that the adverse effects are lessened. A very small number of people just have very strong reactions to treatment, and for this unlucky few it's a straightforward judgement call about whether the longer term gains outweigh the short term discomfort.

It is always worth talking to your practitioner about this as your first port of call. There may be something of great value in the report you make which will inform your treatment. It may also be that the after-care advice wasn't quite as clear as it could have been. Alcohol, strong exercise and spicy foods can all cause a treatment to have
secondary effects because the system's balance has been affected at the time of treatment and can be disturbed more easily.

 

Wednesday, 29 July 2015 00:00

Pain after acupuncture for knee pain

Q:  Yesterday, for the first time , my physio suggested acupuncture to ease my knee pain. He inserted 7 needles in various positions on my leg and one on the bottom of my foot behind the big toe. All went well with no pain until he inserted one in my mid calf on the outside of my leg which was very painful. Once  the pain eased as a side effect
 I could not pull my foot towards me without incurring serious pain.  Every time he moved this needle it produced pain and he had to stop. I asked him why was I feeling this pain and surprisingly he had no answer! The session lasted 10 minutes. Can you give me your thoughts?

A:There are several reasons why this might occur. The most obvious one is that the needle was inserted very close to a larger nerve, and that the needle was retracted slightly after your first sharp pain, either deliberately by the practitioner or more subtly by the body trying to move your leg away from the source of pain. If you moved the leg and flexed the muscles, or if the practitioner tried to manipulate the needle even slightly, there is every likelihood that you or he unwittingly pushed the tip of the needle
against the same nerve. The only sensible option when this happens from the outset is to remove the needle and try again. In medical acupuncture the points are not so critical because the majority of practitioners are using what are called trigger points, knot-like structures in the muscle, which are not quite so precisely defined as traditional acupuncture points. The explanation can be as simple and prosaic as that - needles are, after all, sharp metal objects!

There are a number of sensations which can be associated with traditional acupuncture treatment, ranging from a dull aching sensation called 'deqi' by the Chinese to a much brighter sharp sensation. These can occur during treatment, but they tend not to re-occur once they have happened, i.e. the dull aching feeling is continuous, and the sharper sensation tends not to have any further impact after the initial line of travel.

On balance we think it is most likely the needle getting a little too close to a physical structure. The important issue is whether the sensation continues after the treatment has finished. If it has it could mean that a small subcutaneous bruise has formed which might impinge a nerve slightly for a few days.

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