Sandy Williams

Sandy Williams

Q  I have no upward movement in my big toe joint following an operation to remove a lump in the base of my foot. Can acupuncture help with muscles and nerves? 

A: A great deal depends on the extent of the damage caused by the operation.

 We do not intend any criticism of your surgeon or podiatrist, but any operations to remove lumps or growths carry a small but real risk of interfering with both the nerves which supply the foot 'downstream' and also the muscles which sometimes have to be cut slightly, or may even have become fused to the lump and become collateral damage when the lump was taken out. It would only be fair to say that if the damage is permanent then acupuncture treatment will not make a difference.

 However, traditional Chinese acupuncture operates on an entirely different theoretical basis from western or conventional medicine. The basic premise is that the body, mind and emotions are all one interconnected flow of energy, which the Chinese call 'qi' and which does not translate well into English. Health, vitality and proper function all depend on a good flow, rhythm and balance of energy. When someone has an operation involving cutting through tissue there is always likely to be some break in the flow. In severe cases, especially when someone has a great deal of keloid scar tissue, the blockage this creates can cause significant trouble. In more confined areas it can result in symptoms such as you describe, loss of sensation or loss of movement.

 

Of course, if everything in life were that simple it would be an easy thing to fix; just pop into an acupuncturist's clinic, have a few needles and all should be well. In reality, some cases respond well and others don't respond at all. There are all sorts of factors which influence this, not least of which the overall balance of energies in the person in whom the problem occurs. This will mean that some people will heal faster anyway, and others will struggles. A skilled practitioner would take this into account when making an assessment.

 In any event, where the outcome is rather uncertain it is vital to set a limit to the number of treatments which someone has before drawing a conclusion about whether it is working. Having a measurable outcome makes life much easier because progress will be visible, not just based on how someone feels on the day. We tend to suggest that four or five sessions at most are a good chance to tell whether treatment will work. If there has been no change at this point it may be good to look at other options.

 The best advice, which we invariably give, is that someone visits a local BAcC member for an informal assessment of what may be possible. Actually seeing a problem is a far better basis for offering advice, and most members are happy to spare a short time without charge to see if it is something they think they could help with.

Q:  Can acupuncture for lower back pain cause imbalance and dizziness . The next day I spent in bed because when I moved I felt I might fall over and and everything was moving especially when I bent down or moved quickly.

A: We are sorry to hear of your problems.

 The first thing we have to be clear about is that acupuncture, whether performed as traditional acupuncture or one of the versions of medical/symptomatic acupuncture, treats the person as much as the condition. To that extent even a symptom elsewhere in the body may have been triggered by treatment aimed at something entirely different. The same applies even if the person thinks they are 'only treating a bad back', and we have registered our concerns over the years about people using formula treatment having unexpected effects on the patient.

 That said, the reaction which you have had is a great deal more severe than we would normally see. We warn patients that they may feel a little odd for 24 to 48 hours, but the 'normal' reactions of this type are relatively minor - a slight headache, additional tiredness for a while, and occasionally a slight return of an earlier symptom as the body reverses the process of disease. To have to spend a day in bed feeling dizzy after a treatment would be highly unusual; we gather statistics on what we call adverse events, and this is not one we come across before. That does not mean that it hasn't happened, only that it hasn't been reported to us. However, we find that patients are usually very keen to tell us when something has happened.

 We think the most likely reason is that you have had the misfortune to have a viral infection which has by chance coincided with your treatment. With over 4 million treatments a year in the UK there are going to be a few cases where something happens after a treatment which has nothing to do with it, and this may well be one. It does sound rather unpleasant, however, and if it has persisted into a second or third day we think you might do well to consult your GP. There are other possibilities, none of which you should worry about but which treatment may be able to help. There are a number of problems associated with the inner ear, for example, which can generate these symptoms, and your GP may well be able to help you deal with this.

 We shall definitely keep a record of what you have reported, though. The fact that we have had very few reports like this in the past does not mean that there isn't a theoretical risk that it could happen, and if we find over time a cluster of cases we would always update our information to the public to make them aware of the potential risk.

 In any event, we do hope that the problem has already resolved, and that it hasn't put you off having further treatment for your back. As you may be aware from our literature back pain is a problem which really does seem to respond well to acupuncture treatment to the extent that it forms one of the recommended treatments in the NICE guidelines for NHS patients.

Q:  I would like to know what I have to do to become a registered NHS Acupuncturist.  I am a qualified acupuncturist. I studied with the CNM college.

We are not sure that there is such a thing as a registered NHS acupuncturist. Our members have sought for years to achieve some form of recognition, either by way of statutory regulation or by way of recommendation from statutory bodies, and the best that we have managed to achieve at a national level is the use by NHS Choices of the BAcC's register as the 'go to' place to find a traditional acupuncturist. This was very much premised on the fact that the BAcC has been accredited by the Professional Standards Authority under its Assured Voluntary Register scheme.

 Other than that we have many individual members who have managed over the years who have managed to gain contracts for services with specific NHS departments or consultants in their area, but the recession has seen a significant fall in the number of these. Where NICE guidelines have made room for the use of acupuncture, as in the currently hotly challenged NICE Guideline for Back Pain, what little take up there has been has been through work being offered to practitioners like physiotherapists who are already employed within the system.

 And more than that, we are afraid, we cannot say. 

A:  We have produced a factsheet on hypertension

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

which we have to confess we found a little lukewarm. However, we were delighted to find that there have been a number of new studies published since the factsheet was written, two of which 

 https://www.ncbi.nlm.nih.gov/pubmed/20232615

https://www.ncbi.nlm.nih.gov/pubmed/23724695

make much more encouraging noises. However, the most recent systematic review

https://www.ncbi.nlm.nih.gov/pubmed/26207806

concludes that acupuncture treatment is probably more useful as an adjunct to the use of conventional medication, and that, surprise surprise, more research needs to be done with larger studies. Easier said than done in the West where very little research is funded by mainstream bodies. However, one day....

 From a Chinese medicine perspective there are a number of clearly defined patterns which generate hypertension and where there are well-established protocols for lowering blood pressure, usually described from the external signs - the ancient Chinese did not have sphygmomanometers. When we come across new patients with these kinds of symptoms patterns we are usually confident of being able to offer some help. However, we always work as closely as we can with their doctors, whether directly or indirectly, to ensure that any reduction in medication is managed carefully. We have seen enthusiastic patients stop taking their meds in their desire to use a more natural method of B control and watched their BPs go through the roof. This is not what we want to see; the risk is too great.

 As far as snoring is concerned, there is very little research about snoring per se. There is quite a bit about obstructive sleep apnea, and we suspect that if your GP is aware of your BP problems and the snoring that investigations have been done to assess whether the snoring is part of the sleep apnea and contributing in part to the higher BP. Otherwise we have to be honest and say that when we take on patients with a problem like snoring, we tend to do so with the caveat that we will use our skills to balance things as well as we can from a Chinese medicine perspective and see what effect this has. However, we tend to set a tight limit on how many sessions we will do as an experiment, and we always look for a decent measurable outcome so that it is clear whether the treatment is working or not. This can be a problem; the sufferer is usually blissfully ignorant of the effect they are having.


Q:  I've had three weekly sessions of acupuncture having had a miscarriage 5 weeks ago. After the first I felt strong benefits. After the second I experienced unpleasant stomach cramps and diarrhoea and after the third although it was a gentler session, diarrhoea and vomiting 12 hours after. Just for a couple of hours and then I was fine again. obviously I am concerned as to whether I should continue as my body is clearly reacting quite dramatically. She is unable to advise me as she hasn't had any other patients react in this way in ten years! I'm happy to continue if this is seen in TCM as a positive thing but concerned that I may be causing harm to my body.

A: It is always a problem when someone throws a large reaction to treatment on more than one occasion. We do tend to advise patients of the range of possible reactions, what we usually called transient adverse events, and that if these do happen they will last for no more than 24-48 hours. We also tend to say that they are more common when someone has a first session, and we are often quite reassured by a strong reaction that the treatment has cleared something, and that the reaction has been a good one.

 However, if the same thing happens twice or three times, then we start to look at a number of factors. First is the case history. Is there sufficient evidence of prolonged energetic disturbance over a long period of time to warrant the kind of disturbance which is happening? We have come across cases where the 'clearing' of past blockages has taken a number of sessions, but when you look at the case history it was not a surprise. Then we might ask whether the treatment itself was too much for the person to take. There are a number of individuals for whom acupuncture treatment will always be a problem. This 'expert; had a patient for whom any more than three needles with minimal manipulation sent her spiralling out of control for a week or more. It took a long while to establish what the safe limits were.

 However, it looks as though your practitioner has taken this into account by making the treatment more gentle, and vomiting and diarrhoea is a very extreme reaction, even as a positive one. The first thing that we would do is to advise you to see your GP just to rule out that there isn't some sort of background infection which having treatment brings to the surface. It is highly unlikely, but there may be a contingent bug in your system which is causing problems because of the added influence of the treatment, for whatever reason, and you need to eliminate this.

 What we can say with some certainty is that you are highly unlikely to suffer any damage to your body with symptoms such as you report, other than perhaps a pulled muscle or two from heaving and slight soreness from the diarrhoea.  There is almost no evidence that acupuncture can cause harm other than by the physical nature of the needling itself puncturing organs or causing bruising. Reactions such as yours are probably a sign that the body is dealing with a pathogen of the kind which we describe, and this should mean that the reactions will diminish and cease soon. 

 Without knowing a great deal more about your case history there isn't much more that we can say, but we are impressed by the candour of your practitioner and believe that you are in safe hands. We strongly suspect that she will be as puzzled as you and will be talking to experienced colleagues to see what suggestions they may have.

 In any event we hope that these reactions cease and that the treatment can really benefit you without first having caused this rather extreme ripple on the pond.

A:  We would perhaps need a little more information before we could give a more definitive view.

 We imagine that by 'fear in certain situations' you might mean a specific phobic response, like to heights, dogs or even some people! A great deal would depend on whether the fear was consistent with some of the patterns in the body's energy, and therefore a rather more extreme reaction of a kind which was commonly experienced, or whether it was caused by a specific primary event. If it was the latter we suspect that other forms of treatment like hypnotherapy or even cognitive behavioural therapy might be a more precisely targeted response.

 That said, the word 'appropriate' appears in a great many explications of ancient texts, and arises from a basic premise that a person in balance will experience all emotions in reasonable proportion to the circumstances which cause them, Everyone grieves when they lose a loved one, but to grieve for twenty years or to not grieve at all would be unusual reactions. Of course, no-one is in perfect balance, and there are many imbalances which predispose people to have rather unpredictable emotional responses in certain situations or occasionally a stuck response, 'angry at everyone and everything.' In such cases, there may well be remedies within Chinese medicine which can point to ways of balancing the system up and reducing the impact of some of the emotional responses.

 In short, if the fear which you experience in some cases is an extreme case of a pattern which tinges all of your experience then acupuncture treatment could well help. The best thing to do, though, since we do not really have enough to go on here, is to contact a BAcC member local to you for advice. Most are very happy to give up a little time without charge to discuss whether treatment would be of benefit, and they will also almost certainly know of reputable therapists in other fields if they think that something like hypnotherapy would be a better bet.

Thursday, 24 November 2016 11:24

Acupuncture instead of general anaesthesia?

Q:  I require the extraction of an old crown as I have reacted to both local and general anaesthesia.  I was hoping to find an acupuncturist who would be able to attend theatres with me in order to provide pain relief and bypass the need for any anaesthetics . I am an ex nurse and have had acupuncture before including a large filling with acupuncture . Sadly my acupuncturist no longer practices due to age and I am desperate to find someone 

A:  We suspect that you might find this rather difficult to achieve.

 Acupuncture anaesthesia (AA) had a brief period of popularity in the 1970s and 1980s after Nixon's visit to China and remarkable footage of people having operations under AA. What you didn't see, however, were the large banks of conventional equipment lined up in case the AA ceased to work, and over the following decades the use of AA has declined, even in China itself. It is regarded as too unreliable to be certain of having the appropriate effect. The fact that your previous practitioner has retired probably means that he or she learned to use this skill many years ago when it was first in vogue.

 However, we have come across the occasional member who has, often with extreme reluctance, used points on people who are unable to have conventional anaesthesia for procedures like rhinoplasty. The one colleague we remember well actually learned the technique from a book for one such operation. There was less blood, the woman healed quicker, and the consultant was all for making it a regular feature of his work, but our colleague found it too stressful!

 We don't have a list of practitioners who might offer this, so the best option is to use our postcode practitioner search function and ask someone local to you whether they are aware of a colleague who does this, or is willing to do this. Local knowledge is often more precise than ours, and it may well be that a local network knows of someone, perhaps not even a BAcC member, who uses AA in this way.

 The other option is to see if there are any British Medical Acupuncture Society members in the area who do this, or even, if you can find a contact number (we have been unable to find one for the last five years), British Dental Acupuncture Association members, who are happy to do this. Many of the BMAS members routinely use electro-acupuncture which is probably the easiest way to provide the constant stimulation of the points which AA can require.

 We hope this helps. In cases like yours it can be the difference between operation and no operation, but we can understand why our members were not always willing to expose themselves to the risk of someone having treatment where the AA effect wears off.

Thursday, 24 November 2016 11:21

Burning and aching in my knee after acupuncture

Q: I was in a snowmobile accient about 12 years ago. I started having  acupuncture in my knee which has had a screw in it for about 5 months ago. I have it once a month and a couple days later I have the worst burning and aching in that knee. is that normal?

A: We always hesitate to use the word 'normal' in cases like this. It is always possible that acupuncture can trigger a reaction, but the vast majority of these are short term, what we call transient adverse events. When they do occur we try to work out whether there is some aspect of the treatment which we can adjust to prevent their re-occurrence, or simply to understand why they occurred in the first place. This helps us to build up a comprehensive picture of the kinds of adverse events about which we might choose to warn prospective patients.

 The fact that this happens every time is a little unusual, and we would perhaps need to know whether the treatment was manual acupuncture or electroacupuncture. Some practitioners do use EA quite regularly for musculo-skeletal problems, and if this is the case then some for of interaction with the metal in the knee is possible, although still highly unlikely.

 Usually when heat is released from the body in this kind of way we tend to see it as a good thing, and it is just possible that the trauma to the knee has caused internal disruption which is clearing slowly as the needles are applied every time. Our practice is based on an understanding of the body as a system of energy, called 'qi', and if the knee has been extremely badly injured (being pinned suggests it was) then the energetic trauma may have been very considerable. If this is the case then it is possible that inserting needles is allowing this to be released on a regular basis, but if this is so we would expect the effect to reduce with time.

 We think the best thing to do in this case is to discuss the matter with your practitioner. We are intrigued by why this is happening and we would strongly suspect that he or she is too. Acupuncturists are by nature very curious about how things like this arise; our whole tradition is about making sense of disparate or unusual groups of symptoms. If your practitioner is aware of what is happening then we think it very likely that they will be actively trying to understand it and working out how best to refine the treatment to make sure that it gets addressed and doe not recur.

 Of course, the other factor we have to bear in mind is that the damage to your knee has sensitised the area to the metals of the needles. Some contain nickel in the steel, and others are silicon coated for ease of insertion. If the area has been disturbed by the accident it may have become hyper-sensitive to one of these substances. Again, your practitioner would be able to explore this as a possibility and see if the treatment can be adjusted accordingly.

 

Q:  Can acupuncture be used with someone who has muscular dystrophy, not to help with the condition, but with a pinched muscle in the shoulder. 

A:  There is no reason of which we are aware that someone with muscular dystrophy should not have acupuncture treatment.

 We are always extremely careful as a professional body to set down clear guidelines to our members about when it would be unwise or even contra-indicated to use acupuncture. We do this both from a western medical perspective and also from a Chinese medicine perspective (there are, for example, good reasons to avoid some points in pregnancy, and other points which can cause a rapid drop in blood pressure which might affect some patients). We have never come across anything which suggested that acupuncture treatment would be a problem for someone with muscular dystrophy.

 As an aside we did come across this article, of which you may already be aware, which suggests that acupuncture may be a useful adjunct in treatment packages to help with the common symptoms of DMD.

 http://musculardystrophynews.com/2015/08/10/traditional-chinese-medicine-used-help-dmd-patients-study/

The Chinese undertake hundreds of thousands of trials every year on almost every health problem you can imagine, and as interesting results emerge the studies then tend to be translated and circulated more widely. 

 Even where the treatment is used for a specific purpose, like a pinched muscle, proper traditional acupuncture treats the person, not simply the condition, and we have sometimes found that with chronic degenerative problems the rate of deterioration appears to slow down. This is impossible to verify experimentally because conditions like this are so variable anyway, but we have seen several patients whose problems seem to plateau for longer when they are having regular treatment. However, we would never encourage people to have treatment on this basis, and in this case we would suspect that treatment for a pinched nerve may well be beneficial in itself, however the rest of the system reacts.

 
Thursday, 24 November 2016 11:10

Can acupuncture help with Sjoegrens syndrome

Q: Can acupuncture help with Sjoegrens syndrome, immune disease affecting connective tissue, salivary glands, symptoms include dry mouth, reynauds tingling/burning hands and feet.

A: As you are probably fully aware Sjogrens can occur as either a primary or secondary condition whose origin is not entirely clear. Treatment is usually supportive and symptomatic rather than curative, and the wide array of potential symptoms which arise from the change in moisture producing cells means that research studies are not as common as would normally be the case.

 This is certainly the case with acupuncture trials and Sjogrens. We wouldn't want to quote specific studies because they tend to be small and methodologically 'under-powered' but if you use an open access database like NCBI by typing in 'ncbi acupuncture Sjogrens' you will find at least half a dozen studies which report significant changes from treatment, whether it be with acupuncture, auricular acupuncture, electroacupuncture or Chinese herbal medicine. What most conclude, however, is that the sample size is too small to make any firm recommendations other than that larger studies should be organised.

 Of course, from a Chinese medicine perspective the somewhat disparate nature of potential symptoms plays to one of its greatest strengths, the ability to make sense of what appear to be unconnected symptoms within a framework based on an entirely different conceptual structure. Chinese medicine is based on theories of energy, called 'qi', whose rhythm, flow and balance determine the overall health of the individual. Within this overarching picture are Organs which have specific functions within the flow. Organs are different from the western concept of an organ, being seen as functional units whose effects can be seen in several areas of the body. This can often mean that symptoms which would be treated separately in western medicine are treated as a part of one functional disturbance.

 This means that when a practitioner looks at each presentation within the Sjogrens pattern he or she will be analysing them across the range of functional disturbances which might show common roots, and this can often mean an individual treatment for the person as a unique presentation rather than a standard formula treatment.

 It is also fair to say that in many cases of connective tissue disorder the various symptoms are all assumed to be fruit of the same tree when in reality some of them may from a Chinese medicine perspective be consequences of weaknesses in the system caused by the Sjogrens. Some may well be amenable to constitutional treatment.

 The bottom line, therefore, is that acupuncture treatment may be able to offer some benefits, and will certainly do no harm. In order to say more, though, we would have to see your symptoms in their overall context, which online is not an option. The best advice that we can give is that you visit a BAcC member local to you and seek a brief face to face consultation to assess what might be going on. Most members are willing to give up some time without charge to give a better view of what may be possible, and this gives you a chance to meet them and see where they work.

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