Sandy Williams

Sandy Williams

Thursday, 28 January 2016 11:33

My Healthy Life

Alison Savory, British Acupuncture council member and lecturer,  reveals how she boosts her health and wellbeing

Q:  Recently I had a broken t7 in my spine.  This has left me with bad pains around my ribs which I am told is nerve damage and could last longer than 12 months, Would acupuncture help and can I get this on nhs or if not can you recoimmend anyone  in my area, kt152fd Addlestone surrey? 

  

A:  A great deal depends on the way in which the nerve damage has occurred and whether there is any residual impingement which will keep generating pain. If the damage has caused long term inflammation which in turn presses on nerves and creates a cycle of further pain and inflammation, then the acupuncture treatment may well help to break this cycle and allow the area to settle down. This is essentially what conventional medicine does with the prescription of painkillers and anti-inflammatories.

Acupuncture treatment first found greater prominence in the West after Nixon's visit to China and the extraordinary scenes of people having surgery without anaesthesia while under acupuncture treatment. This led to a focus on researching on the painkilling effects of acupuncture, and there is considerable research on this which shows convincingly that it works. The question is really not whether it does or not, but how long the pain can be controlled and to what extent. If acupuncture is like a short term medication which wears off then unless someone has really deep pockets and the trade-off is that they get a reasonable amount of pain free time, it's not really a viable option.

Chinese medicine, though, is all about restoring balance in the system in the simple belief that a system in balance will heal itself better and quicker. On that basis we would have to say that traditional acupuncture is geared to helping the person as a whole to recover, and our clinical experience of treating people after injuries or operations is that they do appear to heal more quickly than their counterparts  If you google 'ncbi acupuncture post-operative recovery' you will see a number of studies which seem to show that there are some very good reasons to think that treatment may be of benefit.

Since each case is unique and different, however, your best bet is to seek a brief face to face assessment with a BAcC member close to where you are. Most are happy to give up a little time without charge, and can advise you far better by actually seeing what is going on. Using the postcode function on our home page www.acupuncture.org.uk will identify several practitioners near where you live. We can't recommend individual practitioners, but we can assure you that all our members are trained to degree level and work to high standards of safety and conduct.

As far as getting acupuncture treatment on the NHS is concerned perhaps your only hope would be your local Pain Management Clinic where acupuncture is quite often a part of the offer they make. Otherwise there is very little prospect of getting treatment free at point of delivery; NHS funds are very tight at the moment and even where there is a proven evidence base and a NICE recommendation there are very few of our members who have managed to find funding.

Q:  I have morton neuromas on both my feet affecting the toe next door to the little toe in both cases. I have had steroid injections in the past but want to look into alternative treatments and thought acupuncture the best place to start. Can you advise me if it is affective please?

A:  We have to be honest and say that there is not a great deal of evidence for the effective treatment of Morton's neuroma with acupuncture. We published an answer through this same section three years ago to a question from a patient who was convinced, and with some justification, that treatment with one of our colleagues has been wholly responsible for a complete improvement in his condition.

We have to say, though, that our clinical experience runs counter to this, which is why the very upbeat tone of webpages like that of this American practitioner

http://acuroots.com/mortons-neuroma-treatment-plan-with-acupuncture-and-tui-na/

(informative as it is) raises a wry smile. If only... Having said that, what he describes in the formation of the tissues which cause the condition is something with which we deal elsewhere on the body, and in theory there is no reason why treatment should not be able to reduce some of the discomfort. However, we would be very surprised if this could be done without the aid of orthotics which reduce some of the pressure on the affected areas while any treatment beds in.

Each case is unique and different, however, and the only real solution is to seek face to face advice from a BAcC member who can look at exactly how the problem manifests in you, and more importantly, can see the overall context in which it is occurring. One of the great strengths of Chinese medicine is that it looks at the whole system, not simply at a symptom which is regarded as merely a warning sign. Thousands of people with identical foot structures to you will walk thousands of miles without getting neuromas, and there may be systemic problems which have predisposed this to happen.

The other recommendation we would make, and we are sure that you have done this already, is to find a good chiropodist or podiatrist who can work alongside any other treatments you try to help to maintain improvements. Working in partnership with other health professionals for problems like yours can often be extremely powerful.


Tuesday, 26 January 2016 17:02

Acupuncture and painful arthritis

Q:  I am currently in a significant amount of pain in my back, shoulders and neck due to arthritis. I was going to book an appointment for a session of acupuncture today but don't think I would be able to bear it at the moment. Is it best to wait for the flare up to subside slightly before trying acupuncture or be brave and do it whilst in this amount of discomfort?

A: This is quite a difficult question to answer. We would probably say that if you think you couldn't bear the treatment at the moment, the best course of action is to wait until you feel that you can. There is a very strong feeling in many patients that letting the practitioner see things at their worse is a good thing, and they struggle into clinics when they are feeling very unwell. This expert tends to take the view that if getting to treatment becomes an ordeal on top of the pains which are already bad, it is not a sensible thing to do.

There is, of course, the counter-argument that the treatment may well be of immediate benefit in reducing the pain. Our experience, however, is that with long term conditions like this such changes are short-lived, and it is far better to wait until the pain has become more manageable so that the whole experience is a pleasant and upward moving one.

There is no doubt that from our experience when the pain of arthritis is very severe any kind of intervention can become immensely painful in itself. Oddly enough, the one thing which always seems to be helpful in these sorts of situations is reflexology. It has been a common experience in those patients with severe arthritis, especially those of mature years, that they report that as a short term palliative this treatment works very well. For the long term, however, Chinese medicine has an increasingly impressive track record of helping people with arthritic pains, and a growing body of research to underpin it.

 

Q:  Unbearable pains of body, muscles,nerves.bones,sprain,numbness,twisted feeling from head to toe due to acupuncture treatment over  30 days @twice a week,half hour each for diabetes,bph-prostate enlrgd. A tv doctor in Bangalore advised me to continue acupuncture treatment inspite of severe  kinds of pain.

A:  We have to be careful how we express this, but the first thing to do is to seek conventional medical advice about what is happening to you. These would be most unusual adverse effects of acupuncture treatment, the majority of which are transient and rarely have any impact after the first 48 hours. For something to continue for this long and to such effect would be unusual, so it needs investigating soon. We say this because we have come across a number of cases over the last few years where some really extreme symptoms have started at around the same time as a patient has started having acupuncture treatment, and it is a natural and obvious assumption to make that one has caused the other. Rather than spend time arguing about whether there is a causal connection or not, it is vital to get the problems analysed in case there is treatment which would help or even be necessary.

If, however, it is a result of the acupuncture treatment there are only a few reasons which we can think of where something like this can happen. Physical damage I think we can rule out; you do not appear to have had a single treatment after which everything went wrong. The possibilities are that the treatment is done too vigorously for you, the frequency of treatment is too much for your system, or more rarely, you are one of a small percentage of patients for whom acupuncture is not a good treatment.

In the last case we do find on occasion that there are patients who react too strongly to acupuncture treatment, and it stirs up far too much in the way of reactions. In these cases all that we can do is advise other forms of treatment which are less disturbing to the system. Gentler manipulative therapies like cranial osteopathy or regimens like homeopathic treatment may the best option.

If the treatment is too frequent this can sometimes cause problems. Since the system is a self-enclosed whole, anything which stirs things up could cause all sorts of apparently unrelated problems elsewhere. One of our old teachers used to use the analogy of cleaning a muddy pond. When you do this the water becomes cloudy and you really can't see how well things are until the residual mud has settled. If you keep stirring things up the water will be perpetually cloudy. Reducing the frequency of treatment may help matters settle down.

If the treatment is too vigorous this is simply a matter of discussing with the practitioner whether he or she could use fewer needles, less vigorous needle action, or less powerful acupuncture points. Treatment always has to take into account the patient's overall health, and just as you wouldn't give a sports massage to a 90 year old, there are treatments which may be too powerful for a person to deal with. 

This really comes down to communication with the practitioner. If he or she can say with confidence that what you are suffering now is on a pathway to better health, then you could choose to continue. If your own doubts are growing, then simply take a break from treatment and see if the symptoms relent, in which case you have your answer. In any event, we still think that getting a conventional medical perspective is important. These symptoms may be indicative of another as yet undiagnosed problem, and we would be remiss if we did not direct you to your GP for advice and direction. 

Tuesday, 26 January 2016 16:47

Wrist pain after acupuncture treatment

Q:  I have had 10 treatments from an acupuncturist who treats your 'element'. It has had mixed results and her decision on which element I am has changed. Although I pay for an hour my treatment typically now takes 10 minutes and consists of one needle being put into and out of my wrist very quickly and then inserted into the back of my wrist the same way using the same needle. When removing the needle she uses a piece of cotton wool to press against the needle as it is taken out. 6weeks ago I had a treatment and left with great pain in my right wrist where the last needle point was. It didn't go away and got worse so that if I moved my hand in a certain way I experienced a tearing sensation inside my wrist. I felt there was a piece of needle left inside my wrist. I went to my next appointment two weeks later and asked if there was a possibility of a piece of needle being left inside me. I was pretty much dismissed and told there was nothing wrong. (There clearly is as i am frequently in agony). A month passed and I have made an appointment to see my gp. I have waited several weeks for the appointment and still have another 4 days to go but my wrist is still really bad. I don't know whether to go to casualty and if so whether an X-ray would show up a tine fragment of needle or if I would need an ultrasound? I am now very scared and worried as the point the needle went in is in line with major arteries and nerves. Can you advise best course of action and if you think anyone will take me seriously? There is no inflammation and my wrist looks entirely normal from the outside.

 

A: This sounds very distressing for you, but we can say straight away with some confidence that it is highly unlikely that you have a piece of broken needle embedded under the skin of your wrist. Although all practitioners are trained in what to do if a needle breaks, in modern times this is virtually unheard of. The most recent report of a possible break to the BAcC was over fifteen years ago. The main cause of needle breakage, rare as it was even then, was when needles were autoclaved to sterilise them for re-use. Modern needles are used once only and then disposed of, so the constant heating and cooling which made the steel brittle does not happen.

The most likely cause of your discomfort is that there has been some bruising beneath the skin surface which has caused a hard clot to form and which impinges a nerve when you move in certain ways. We have seen this before, and it can take several weeks for something like this to clear. There is a small possibility of damage to a tendon, which might also account for the symptom, but the needling would have to be rather more vigorous than sounds was the case for this to happen. If the practitioner is using the style of practice which we believe they are, then very fine needles are the order of the day, and damage from the needle itself would be unlikely.

We think that going to your GP is a very wise move. He or she may have a precautionary X-ray or ultrasound done - just because needle breakage is rare doesn't mean that it can't happen - but there will be a number of investigations they can undertake on the spot in terms of range of movement and pain on movement which should alert them to the probable cause.

As far as the style of practice is concerned, this sounds like the Five Element system which is one of the two more common  styles in use in the UK. The diagnostic certainties of this are open to re-assessment and change, and for all sorts of complex reasons a person might be initially treated on one element and then find that another element presents itself as the core of the problem. This is the not the difference between right and wrong so much as between good and better. All treatment will have a beneficial effect because in a closed system of energy any attempts to improve the flow will have impact everywhere. Treating the heart of an imbalance, though, will get better results and can lead to much more profound change. It is heartening to hear that the practitioner is making adjustments; it is often said that immediate certainty is not always a sign of good diagnosis. People are very complex.

In terms of technique, the schools which teach this system tend to use mainly 'in and out' needle insertions which can take up a very small amount of a treatment session. We occasionally hear rumblings of discontent from patients who think that this doesn't seem quite right, and we have to explain to them that the time spent up to that point is all a part of the diagnostic process. All of this preceding work -  investigation, pulses and conversation - refines the diagnosis so that when the points are chosen their effect can be all the greater.

Having said all of this it is a concern to us that the practitioner appears to you to have made light of what you have experienced. We try our hardest to ensure that practitioners pay particular attention to what their patients experience and to respect what they have to say. While we would probably not consider something like this actionable under our professional codes it is certainly something which the practitioner would benefit from knowing so that they can look at how they have addressed the issue. Unfortunately the only person who can really address this is the patient, who is not always inclined to get involved in setting a practitioner right and more likely to want to walk away from the situation. If you do raise it with her, however, we hope that your concerns are properly addressed.

Just to re-iterate what we said above, we think that it is highly unlikely that a needle tip has broken off in the wrist, but we are happy to know that you have a GP appointment within the next few days to make the necessary investigations. We hope that you understand that we have taken your account very seriously, and we are a little disappointed that you do not feel as though you have been listened to. For us acupuncture is a daily way of life, and we are used to what happens. For most patients it is still a largely unknown area, and for this reason we have to remember to acknowledge that in what is already an unusual situation anything untoward which happens is likely to cause great anxiety.

We hope that it is as we a transient adverse event which resolves soon without the need for any medical intervention. 

A:  As this expert knows only too well from personal experience, persistent hiccups/hiccoughs can be a very distressing experience, not the increasingly funny experience which many observers seem to find it. 

There is a little bit of evidence for the use of acupuncture, mostly in the form of what are called case studies about single instances where treatment has helped, or sometimes where treatment has been offered to a specific target group where hiccups often present and where there is a need to deal with them quickly, as in post myocardial infarctions. Below are a few examples of these kinds of studies

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035062/

http://www.ncbi.nlm.nih.gov/pubmed/15813167

http://www.ncbi.nlm.nih.gov/pubmed/11908864

 Most practitioners during their training learn a number of what we call 'first aid points' which are known to have an effect on specific conditions. There are certainly two or three which are commonly used to stop hiccups, and one additional one which appears to be effective for treating children with persistent hiccups. Overall, though, there isn't a great weight of evidence, and we would be a little remiss to suggest that acupuncture definitely provided a solution.

However, that said, we are practising a system of medicine where hiccups, a symptom like any other, is not always seen as the problem itself but is usually a manifestation of other imbalances and blockages in the system. As you may have read, Chinese medicine is premised on the understanding of the body as a system of energy in flow, and the skill of the practitioner lies in making sense of symptoms within the general background context against which they appear. This is why the same symptom can often be treated in a dozen different ways in a dozen different patients depending on what internal causes are allowing it to develop.

The short answer to your question is that you may have to visit a BAcC member local to you for them to be able to see what is going on and try to make sense in Chinese medicine terms of what is happening. This is the only way that you will get a clear idea of how treatable the problem is.  What we can say, though, is that with conditions like this we tend to take the view that if they are going to respond they will do so quite quickly, and as such we would caution a prospective patient about getting engaged in a long run of treatment with no obvious improvement. We would suggest three or perhaps four treatments would be the maximum we ourselves would offer before reviewing the case in depth and deciding whether there is any point in carrying on.

This all sounds rather negative, especially when many of us have stuck a needle in with almost immediate effect like a party trick. However, everything works for someone, but something doesn't necessarily work for everyone, so we would advise caution. 

Q: I have had complicated hand surgery which has left my hand very tender and easily hurt. I would be very reluctant to have needles in my hand because I think this would be very painful. Is it still possible for me to have effective acupuncture avoiding the hand? My most obvious problem is catarrh and chest problems. 

A:  Many people are worried about acupuncture needles without really having come across them. The majority of needles in use are about 0.18mm to 0.25mm in diameter, which is finer than the average sewing needle, but the crucial factor is that they are solid. Most people have experiences of hyopdermics which, being hollow, are a great deal more uncomfortable when they break the skin. Solid needles cause less discomfort, and this is further reduced when they are inserted by the use of a guide tube which is positioned on the skin and the needle gently tapped in. The 'distraction' caused by the pressure of the tube makes the needle insertion less palpable.

However, there are prospective patients like yourself who have good reason to be fearful of needles, however small the impact might be, and there are a number of ways of getting around this. Most points on the body are bilateral and although traditional use says that the left side is for tonifying energy and the right side for reducing energy, in practice they are interchangeable, and it is the needle action and direction which determines what effect is achieved. There is, then, nothing that a practitioner may want to do that will be ruled out by having no access to the left hand.

Indeed, even if both your hands were sensitive, there are ways around the problem by using points elsewhere on the body which have a direct connection with the channels and organs you are trying to influence. This is very much the case with post-mastectomy patients where we cannot needle the arms and hands below where lymph nodes have been stripped out in the armpit. Where someone's constitution would normally require the use of needles on the arm, we have to use our knowledge and skill to generate the same effects by the use of leg and body points.

The bottom line is that there is nothing which would impair the quality and effect of treatment by protecting your hand. You may even find, though, when you have needles inserted elsewhere that you might be able to tolerate needles in the left hand. It may also be worth discussing with a practitioner what might be done to render the area more benign. We occasionally treat amputees who have a continuing neuropathy from the severed nerves, and we are quite often able to turn the volume down.

As far as chest problems and catarrh are concerned, there are many clearly defined patterns recognised in Chinese medicine for the treatment of problems like this, and it may well offer a solution. However, the strength of Chinese medicine lies in the fact that it treats each patient as a unique combination of energy, with the same symptom often being treated differently from person to person, so the only sensible advice we can offer is to visit a BAcC member local to you to discuss whether they might be able to help.

Q:  Should I continue to have acupuncture from NHS physiotherapist for chronic plantar fasciitis? I had my first and only session so far last Tuesday. This was extremely painful, and has actually made my condition a lot more painful than it was before. Is this normal and will it improve if I have further sessions? 

A:  As a general principle, there are a number of conditions where someone's discomfort or pain levels may well increase after a treatment session. This is most common with back and neck problems, and is similar to what people report after osteopathy and chiropractic sessions. The structural work in their case and functional work in ours often causes a re-arrangement of structure which can cause additional pains. However, nearly all of these subside within 48 hours, leaving the area improved or improving. This is less so in cases like plantar fasciitis where the problem is more of an inflammatory nature but can still happen.

One of the perceived anomalies of traditional acupuncture is that needles are often placed away from the site of a pain but nonetheless have an action at a distance. This is very much to do with the underlying theoretical basis of our work and the concept of energy, or qi, as we call it. Pain arises from blockage or changes in the flow which we hope to correct with our needles.  Sometimes we avoid the area of pain because our experience is that sticking a needle in it just adds to the inflammation. However, the western medical acupuncture which most physios use in their practice is often based on underlying principles which aim to disperse inflammation and muscle knotting by direct treatment, often with slightly thicker needles and slightly more vigorous needle action than most of us would employ (although interestingly Chinese practitioners often use a much more vigorous technique than European practitioners.) The overall effect should be the same, however; a possible increase in discomfort for a couple of days followed by improvements. If, however, the amount of additional pain is more than someone can take, physios tend not to have the same options for treating at a distance as we might.

We have been asked about plantar fasciitis many times on our ask the expert website function and the most recent answer we gave was:

Plantar fasciitis can be a very unpleasant and debilitating problem, as you no doubt know. There is some evidence for the use of acupuncture treatment, as this paper shows,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094706

and if you google 'acupuncture' and 'plantar fasciitis' you will find a number of other papers which suggest that there may be benefits from treatment. However, the combined weight of the various studies is not enough to be able to give an unqualified recommendation.

That said, the strength of Chinese medicine is that it operates from an entirely different paradigm or theoretical basis, and has different ways of making sense of the symptoms which a patient is experiencing. This can sometimes offer treatment options which would not necessarily translate into a western understanding of physiology, although there is usually an overlap. The system of medicine rests on a theory of energy, called 'qi', whose flow and balance determine how well the various systems of the body function. Many problems like plantar fasciitis point to local blockages and disturbances, often due to over-use or poor gait, which once they have become established remain a problem even after someone's habits have changed. Symptoms such as this can also point to more systemic problems, and the skill of the practitioner lies in making a clear diagnosis of the whole system before starting to correct aspects of it.

In this case, since the presentations of plantar fasciitis can be very different, we would advise you to visit a BAcC member local to you for a brief face to face assessment of the problem before committing to treatment. We are fairly sure that you will have seen a chiropodist as well as your GP, but if you have not, we would highly recommend that you do. There are a number of treatment options which can work alongside acupuncture treatment to great effect, and with these sorts of problems it is often a combined approach which pays the greatest dividends.

This isn't touting for business for our members, by the way! I'm sure the physio will be able to help you, but if the treatment is proving painful in the first instance the best thing to do is to give feedback about the discomfort and ask if the treatment can be modified in order to achieve the same progress but without the same discomfort. Fewer needles or less vigorous treatment should remedy the problem.

 

Q:  My daughter (aged 20) has been diagnosed with cyclical vomiting syndrome. She has had 8 episodes in 2 years and has been admitted to hospital 3 times for stays of over 1 week each time to try to stop  the vomiting and rehydrate her. The doctors cannot find any cause for this and we are just experimenting with different medications when an episode begins. I had acupuncture during my pregnancy for severe morning sickness and wondered if it might help my daughter. Can you offer any advice? 

A:  As a rather broad generalisation the use of acupuncture for stopping nausea and vomiting is well documented and researched. Our newly updated fact sheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html

provides a wealth of evidence of the various manifestations of nausea and vomiting and its treatment. As you can see from the detail the research evidence on the treatment of morning sickness is not as positive as the post operative nausea treatment, but our clinical experience is that more often than not we can reduce the severity of the episodes even if they persist. The only caution, as your daughter knows all too well, is that someone can become severely dehydrated very quickly, and we always advise colleagues not to let the patient's current conventional treatment schedules lapse while they follow someone's urge to find an alternative solution.

Of course, the major concern that we have is that the research protocols often run completely counter to the way we actually work in treating people rather than named conditions. The formula treatment often applied, while it may work well with a number of patients, will be nowhere near as good as treatment which sets this symptom in its overall context. This can often generate better results, but can also reveal underlying issues which might make a rapid fix of the problem unlikely. An honest practitioner will let you know this rather than let you pin your faith on studies which may not apply, and we trust out colleagues to work in this way.

The best advice, advice which we tend to give routinely, is for your daughter to visit a BAcC member local to her for a brief chat and informal face to face assessment of what may be possible. Most members are happy to give up some time without charge for a prospective patient to discuss what is happening, and this also gives the patient a chance to meet the practitioner and see where they work. In my personal experience, this is a very sensible and reassuring way to work, and patients appreciate the fact that they are not being railroaded into treatment about which they are uncertain.

I hope that acupuncture treatment is able to help your daughter with what I know to be a very debilitating problem.

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