Sandy Williams

Sandy Williams

.Q:  Is it possible to have acupuncture for the help of getting my taste and smell back?

A:  This question comes up from time to time, and one of the answers we gave was:

Most of what people regard as 'taste' is in fact 'smell', and if someone has lost their sense of smell entirely the range of tastes which they can experience is very limited. There is a frequently cited case study from nearly a decade ago



http://aim.bmj.com/content/21/4/153.full.pdf+html
 
which reports the successful treatment of one case, but in all honesty there are very few others, and no substantial evidence suggesting that this has been replicated by other practitioners. Most members have had patients for whom the loss of the sense of small. anosmia, has been a secondary complaint, but we have heard very few reports of great success.
 
It may be worth you while to visit a BAcC member local to you to ask their advice face to face. If you were to decide to have acupuncture treatment, or indeed any treatment from a complementary medicine practitioner, we would advise you to be very clear about outcomes and reviews of progress. Our experience is that people can rapidly run up considerable costs chasing solutions when there is nothing substantive to suggest the treatment is having any effect, and the responsible practitioner will always draw a clear line in the sand if they are not achieving changes which the patient can experience and which underpin continued treatment. 

 
Essentially we would not want to give you an unrealistic expectation about the outcome. We have not heard many reports of this condition being treated successfully, and there are very few case reports on the web which report success.

We have edited out some bits of the answer because the questioner had also problems with excessive mucus production, and we could not say without a face to face examination whether there may be some aspect of this which was the principal reason why the sense of smell had gone. It may well be that if you visit a BAcC member for advice they can see something in the energetic presentation and balance which similarly encourages them to believe that there may be a solution. There may also be something in the way in which your sense of smell and taste went which encourages then.

The bottom line, though, is that if you are fortunate enough to find that it works, you may be the exception rather than the rule.

Q: I had acupuncture today, the lady used re-usable needles instead of disposable ones. She assured me they were sterilised using the appropriate machine. Is this ok?  Shouldn't all acupuncture needles be disposable?

A:  The BAcC's Code of Safe Practice could not be more explicit on this:

You must only use single-use pre-sterilised disposable solid needles which, if in multipacks of five, ten or more needles, must not be used or stored for use after the session in which the seal on the package is broken. Any needle with damaged packaging seal must not be used.

The only exceptions which we ever allowed were when the transition to guide tube needles was introduced in the late 1990s and some of the longer needles were not available at that stage. We allowed members who purchased these to use them only after they had been sterilised before use and then only used a single time as if they were single-use needles. In modern times all sizes are available as single use needles and there is no excuse for re-using needles.

The ban on the use of re-useable needles was introduced for safety reasons. It transpired that prions, the proteins involved in the transmission of Variant CJD, the 'mad cow' disease human equivalent, were not killed by autoclaving, and there was always a theoretical risk that someone could unwittingly spread the disease by needle re-use. Subsequent investigation revealed that it required more than simply exposure to the prion to create the condition in another subject, but by this stage the change to single use needles had become firmly established and patients and practitioners alike were reassured by the safety that this provided. The growing market also meant that needle prices dropped and quality improved, where the earlier disposables had been shockingly poor. Nowadays a needle can cost as little as 2p, and there really is no justifiable reason not to use single use needles.

If the practitioner is a BAcC member, you would be well advised to report them to the Professional Conduct Officer or Safe Practice Officer immediately. The chances that you have been put at risk are minimal, but that does not change the fact that this is a breach of one of the more strict rules under which we operate. If the practitioner is not a BAcC member, you should take the matter up with their professional body, or should that not be something you want to do, then you could contact the local authority Environmental Health Department. The law relating to skin piercing does embrace the possibility of re-using needles, but this is because the new byelaws were extended to covering all skin piercing and many tattooists and body piercers do use re-useable equipment. Had it been an acupuncture-only law, we would have insisted on single use disposable equipment being the legal norm. If someone is re-using needles, then their autoclaving equipment has to be maintained in an exemplary fashion to guarantee that it delivers what it is supposed to.

Aside from anything else, inserting a needle can do considerable damage to the point, as this recently published paper shows

http://aim.bmj.com/content/20/1/11.full.pdf

and creating small fish-hook ends which go in easily but tear tissue on the way out is not a great option for patients. Needle breakage is almost unknown in modern times, but where this used to happen in the old days, it was usually related to the over-use of needles with autoclaving which made the steel become more brittle. Single use needles have all but eradicated this problem.

   

Wednesday, 22 April 2015 00:00

Could acupuncture help osteoarthritis?

Q:  Could acupuncture prevent further deterioration of joints affected by osteoarthritis, specifically joints between base of thumb and wrist, where an osteophyte is forming. Might the area even restore itself with treatment?

A:  We are always a little cautious about appearing to offer over-positive outcomes in giving advice here. The frequently used line in modern sales advertising, that 'once it's gone it's gone', seems to us appropriate when talking about actual physical change in the body. We have come across cases where there appears to have been some reversal in the growth of osteophytes, but when this has happened there have often been two or three treatments in use at the same time, making it rather difficult to assess whether one of them worked or whether there was some kind of synergistic response to using all three. We take the safer view that once osteophytes have become established the best that one can hope for is that the rate of growth slows down or stops altogether, the 'getting worse slower' option.

There is considerable evidence accumulating that acupuncture can be effective in treating osteoarthritis, as our factsheet

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

shows. The majority of this evidence, which is not yet quite enough to give a blanket assertion of efficacy, is centred on treatment of the larger joints (hips, knees, etc) but the general principles employed are the same.

One aspect of your condition which you have not mentioned in the question is any specific form of work or leisure activity which may have contributed to the condition. It may be that this 'just happened' but we very often find that there is a background of injury, perhaps even twenty or more years ago, against which backdrop the current condition developed and which an otherwise innocuous activity has exacerbated. This writer broke his scaphoid bone in the wrist as a 15-year old without realising it until his whole wrist seized up as a 29-year writing his PhD longhand (those were the days!) and the radiologist found the fracture lines. Without the constant pen in hand day after day this may never have developed.Once it had been identified, however, it did mean a more careful management of repetitive activity of this kind, and there may be some practical management which a practitioner may have to consider.

In Chinese medicine each patient is unique and different. Twenty different people may have the same problem, but each will have a different overall setting against which the problem developed and which condition the response in such a way that there would be twenty different treatment approaches. The best advice we can give you for the best assessment of what acupuncture treatment may be able to offer you is to contact a BAcC member local to you and see if they can offer you a few moments without charge to take a look at what is going on and offer a slightly more precise assessment of what might be possible.

Q: I am a practising podiatrist . I have my own practice and have been qualified for 15 years. My question is what is the  most appropriate way to train and qualify to be an acupuncturist?

A:  From our perspective as the leading body for traditional acupuncture in the UK, we believe that training at one of the courses accredited by the British Acupuncture Accreditation Board (BAAB) is the best route into the profession. A full list of the courses which have already been accredited or are in the process of seeking accreditation can be found here:

http://www.baab.co.uk/accredited-courses.html

These are mainly three-year degree equivalent courses, and successful completion leads to automatic eligibility for entry to the BAcC, subject to suitable health and criminal record checks. There are a number of courses which are not BAAB-accredited, one or two of which appear to aim for an equivalent standard, but we believe that the insistence on a full 3600 hour programme involving a great deal of clinical time is the best preparation for full time independent practice.

Roughly one third of the course is dedicated to western medicine, and it may well be that your current training and experience will render you suitable for an exemption from some of the training, which may have both financial implications in choosing which course may be more suitable for you.

This, of course, is the training to become a traditional acupuncturist. The other option is to train in western medical acupuncture. While this is suitable for working within the scope of practice of an existing doctor or physiotherapist, as most medical acupuncturists are, it does not offer the same breadth of application, being limited usually by the regulators to work within scope and for which there is an adequate evidence base. For reasons too technical for a brief response, the evidence bar is set at the randomised double blind control trial, which is not really appropriate for testing a multivariate discipline like traditional acupuncture, and as a consequence the limits of scope are quite severe.

We believe that your best option is to visit one of the regular open days which the colleges hold several times a year, or to initiate contact with the ones most likely to be of interest to you. All are more than happy to discuss their training with prospective students. You might also be able to talk to BAcC members local to you about what being an acupuncturist is like. We cannot guarantee that they will be able to spare you time, but some may. The other option is to have a course of treatment to see from a user's perspective whether it is the sort of thing you want to be doing. The underlying premise of traditional Chinese medicine, that the true aim is keeping people well rather than getting them better after they have become ill, means that you do not have to be unwell to have treatment and may benefit in unexpected ways from  being balanced in accordance with the 2500 year old principles of the Chinese medicine system. This will give you plenty of chance to talk to your practitioner about their practice

Q: I had acupuncture done to my left hip and I'm in a lot of pain is that normal and  what can I do to ease the pain?

A:  We would need to know a great deal more about the exact nature of the pain, and crucially why you first sought treatment, before we could offer precise comments. It would also be helpful to know how long after treatment the problem started.

There are a number of possibilities. On occasion when patients present with structural problems or problems which arise from a structural fault, such as low back pain or sciatica, then there can be a chance that in the process of the body re-discovering its proper shape there can be a number of aches and pains to do with the muscles and tendons having to adjust. In common with osteopaths and chiropractors, we often advise people that the next 24-48 hours might be a little more uncomfortable, after which they should see improvements.

If the initial problems was in the hip itself, then there are a number of points which are used in the area which can be inserted quite deeply and with perfect safety. It is always a possibility that there has been some bruising fairly deeply under the skin, and this may well cause some local nerve impingement which, because the bruising is deep, would show no surface signs.

in both of these cases we would expect the discomfort to pass relatively quickly, although we have come across cases of deep bruising where the effects have lasted longer. 

The best course of action is to raise the matter with your practitioner. He or she will know exactly what they have done and been trying to achieve, and can probably set your mind at rest. There is no obvious reason to start seeking medical advice at this point unless the pain is very severe or there is an accompanying loss of free movement. If it does carry on for longer than either you or the practitioner think reasonable, then a visit to the GP would be a sensible option.

As far as short term measures are concerned, proprietary pain killers are probably the first line of attack. In most cases these will buy time while the underlying problem rights itself. If the pain is too strong to be touched by proprietary over the counter drugs, then the visit to the GP for advice and stronger treatment may be brought forward.

Your practitioner may, of course, uncover energetic reasons why you have pain and be able to address these with needles, although understandably someone who believes a pain has been caused by treatment may be unwilling to have further treatment to deal with it.

Of course, the one possibility that we haven't mentioned is that the pains are unconnected with the treatment. We always have to say this cautiously because some people take it as an attempt to say 'not my fault' but we do come across a small number of cases each year where problems arise after treatment which were not caused by it, they simply were a case of the timing suggesting a causal relationship which wasn't there. We are always concerned when this happens because the focus tends to turn to whether or not the problem was caused by treatment when the problem itself is left untended. If there is a problem, howsoever caused, the main priority is to get it sorted. Arguments about causality and responsibility can usually wait a while.

Q:  Can you give me the names of practitioners in central London who practice estim acupuncture. I had it in North America and it was very successful

A:  We are afraid that this is not possible. E-stim or estim acupuncture is a sub-group within the field of electro-acupuncture (EA). While this is sometimes predicated on a use of traditional acupuncture, there is a greater amount of practice which does not use the diagnostic systems of traditional Chinese medicine, and we would not therefore claim to have the expertise to be able to set standards in this field. We are not even aware of any generic standards; the majority of practitioners within the BAcC who use EA are charged with ensuring that the equipment is properly classified with CE-marking, has been properly maintained, and is being used in accordance with the manufacturer or supplier's instructions. As a consequence we cannot maintain a separate 'register within a register'. 

We think that your best bet may be to ask BAcC practitioners working near you for a recommendation. It is highly probable that they will be more aware of colleagues near them who do use EA and E-stim in particular, and may be able to direct you to them. Other than that it's google, we're afraid to say, and the hope that someone who does use the equipment with which you are familiar is advertising themselves as such.

Wednesday, 22 April 2015 00:00

Can acupuncture help with type 2 diabetes?

We were asked this question again very recently, and our answer was:

There have been a number of studies and reviews of the effects of acupuncture on specific aspects of Type 2 Diabetes, two examples of which are:

 
http://www.ncbi.nlm.nih.gov/pubmed/18257350
 
http://www.ncbi.nlm.nih.gov/pubmed/20590731

 

However, as in many cases, there are not enough trials and not a consistent enough standard of methodological rigour to be able to draw any firm conclusions on which we could base positive recommendations.
 
One factor which our members do take into account when treating people with diabetes in any form is that acupuncture treatment may have the effect of kick-starting any residual function in the insulin-producing cells. For Type 2 this is less critical but for a Type 1 diabetic with a carefully balanced regime the addition of unplanned insulin in the system could tip them into an unexpected hypoglycaemic state.
 
Diabetes is not new, and was recognised in most ancient cultures, sometimes being diagnosed, as in ancient Greece, by the sweet taste of the excess sugar in the urine. Traditional Chinese medicine also recognised some of the groups of symptoms as distinct 'wasting-thirsting' syndromes, as our factsheet describes

 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/type-2-diabetes.html
  
but as the factsheet also says, acupuncture is generally used alongside conventional treatment and is not offered as an alternative to it.
 
Although it is becoming a more common condition, partly because of the increasing age of the population and partly because of the increasing levels of obesity and dietary weakness as well as being a hereditary condition, it remains a serious problem, and can lead, if not properly managed, to some very serious complications in later life. For this reason our members are always very keen to ensure that their treatment is a part of an overall management plan for the condition.
 
Each presentation is different, however, and you would be best advised to have a short conversation with a practitioner about whether they think acupuncture would benefit your particular presentation. Clearly we believe that regular acupuncture treatment is a valuable way of maintaining good health, but we have to take into account that many patients have specific outcomes, and try not to commit people to open-ended treatment if what they need or want may be more limited in scope.

 

We should perhaps add a more positive statement about the advantages of using acupuncture to help with the factors which predispose people to Type 2 Diabetes, like diet and exercise. Although we cannot make any specific claims about acupuncture having been shown to assist in weight loss or make someone fitter, there is no doubt that the dietary advice which is a part of the Chinese medicine tradition can be very valuable. It is often surprising how many people are eating the types of food which their system, understood in Chinese medicine terms, are least able to cope with and which make their problems worse. Even something as simple as a slight variation of diet based on an understanding of which foods help or hinder the system can have a surprising effect.

Each person is unique and different, however, and the best advice we can give is for you to visit a BAcC member local to you for advice which

This still sums up our stance very well.

Q:  When you are having acupuncture in your back and neck should you be moved and if you are moved can this cause more problems especially if you are jolted ?

This is a matter of professional judgement for the practitioner. Best practice is not to have to move the patient at all once needles have been inserted, and to avoid any contact which moves the patient or risks the patient pushing the needle(s) in further if, for instance, he or she loses their balance in moving from a prone position to resting on the side. Apart from the obvious risks about contact with other surfaces, there are a number of compelling anatomical reasons to avoid muscular effort by the patient when needles are in place. This could force an inserted needle into a nerve or blood vessel or could in an extreme case on the thorax cause a lung puncture. The deeper the needles are inserted, the greater the risk.

That said, the majority of practitioners in the UK use very shallow needle insertions compared to some of those favoured in the Far East, with needles being as little as 3mm to 5mm under the skin, and often at oblique angles rather than perpendicularly. It may well be that a practitioner has used professional judgement in this instance because, the most likely scenario, he or she wants to needle points which can only be reached after the body has been turned slightly. This can happen if one wants to use needles on the front and back at the same time.

We suspect that your question is driven by an actual occurrence. If so, the first point to make is that the risk of any damage is very slight, and if you had experienced  any damage the chances are that it would have been immediately palpable, especially in the needle had gone into a nerve or blood vessel. The best thing to do is to ask your practitioner about what they did. If they are sound and competent they will be able to provide you with a good explanation for why they did what they did.

If you are not satisfied with the explanation that they give, or are are unwilling to take up the matter with them, it is always open to you to make a complaint to the professional body to which they belong. Complaints do not have to be seen as combative. If there are concerns about someone's standards of practice, these can be addressed in the public interest. We do not encourage anonymous complaints because there is a risk of malicious intent, but if someone does not want to make a formal complaint but merely alert a professional body to a problem, most have powers to investigate further and require members to amend their practice.

Of course, it goes without saying that all UK practitioners are properly insured, and if you have suffered damage or detriment from your treatment you can seek redress from the practitioner's indemnity insurance. Here again, a good practitioner will direct you to the appropriate person without demur; insurance is in place precisely to cover accidents and extends to malpractice and negligence.

Thursday, 16 April 2015 00:00

Can acupuncture help with a wrist ganglion?

A:  We were asked about a ganglion on the thumb some time ago, and the response we gave then is equally as valid for the treatment of a wrist ganglion. We wrote:

Long gone are the days when the treatment for a ganglion was to lay the hand flat on the table and drop the family bible onto it. Current conventional medical treatment is to aspirate the rather thick, clear jelly-like content from the cyst at a GP surgery or occasionally to have a minor operation in the hospital day surgery unit. These latter are less frequent because they are regarded as relatively low priority, and also can be quite complicated if the cyst is entwined with nerves and blood vessels, as is often the case in the wrist area.  We are assuming that you have seen your GP and had the options explained to you. If you haven't this is always a worthwhile thing to do. GPs are very adept at making judgements about what may appear to be simpler conditions which in reality aren't, and having your GP take a look is a wise move.

 
From a Chinese medicine perspective any accumulation and thickening of fluids in the body points either to a local obstruction in the flow of energy, called 'qi' in Chinese medicine, or to a systemic problem which manifests in a number of problems across the body and mind as a whole. A skilled practitioner can quickly make this determination, and treat accordingly. The greater majority of cases we come across are local problems, often caused by muscular tensions which constrict the flow of fluids and blood. Treatment can help to reduce the tension and encourage flow, but can also help to disperse the thickened fluids. From a Chinese medicine point of view these are 'stuck' qi, and needling moves the qi and reduces the lump.
 
You won't, of course, find any clinical evidence for this; it is one of the least likely problems to be researched at great expense. Our experience, however, is that acupuncture may be helpful, but we always taken into account the other factors which may have contributed to the cysts' occurrence. There may be postural reasons - work stations, frequent use of the joint in a skilled operation - which mean that the cyst will return. There may also be wider tensions and stresses in the system which again may result from lifestyle. Addressing a small problem like a cyst may not work if it is part of a wider pattern of disharmony.
 
The best advice we can give you is to seek the face to face opinion of a BAcC member local to you. Our own feeling is that if you did decide to have treatment, the results would manifest relatively quickly or not at all, and you should not get tied into a long sequence of treatment. If it does work, the question then remains about how sustainable the improvement is. If treatment is only successful for a short time, then it may be worth discussing with your practitioner whether some forms of massage may be a more effective way of addressing the problem, either Chinese massage such as tui na or orthodox massage.  
 

We think that this probably remains the best advice we can offer. What we can say is that if a ganglion is going to respond to treatment it tends to do so quite quickly; this is not a cause for taking on an extended course of treatment. The one caveat is that 'easy go, easy come' occasionally applies; the ganglion can sometimes become visibly smaller during the course of a session and carry on shrinking, only to regain its original size again later. If this happens twice in a row, we would be cautious about treating over and over again, unless of course the problem was causing such an impact on someone's life that the cost of maintenance treatment over an extended period was more than offset by the gains, however temporary.

Q:  I have had chronic pain in the testicle and area of repair following a mesh repair of an inguinal hernia 4 years ago.  9 weeks ago I had the mesh removed and a neurectomy of the illioinguinal nerve, which was supposed to sort the problem out but has not. Would acupuncture help and if so is there any particular type that would be best. Can you recommend anyone in the Leigh on Sea area who would be appropriate.

A: A great deal depends on what may be causing the pain. We are assuming that the neurectomy was selected after a very thorough neurological examination; it is not common practice to start cutting nerves unless there is a very good and clearly diagnosed reason. On the assumption that this nerve corresponded to the area in which you were and still are experiencing pain, then there may be a small chance that acupuncture treatment may be of benefit.

Acupuncture treatment does have a general pain-relieving effect which has been the object of a great deal of study over the years, as our factsheet on chronic pain shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

The chemical markers for pain relief, the neurotransmitters, are easily measured to provide an objective marker of whether something is happening. The main question with treating at this kind of generic level is how much relief the treatment may give and how sustainable the relief is. In many cases this comes down, unfortunately, to a financial question: is the treatment affordable and worthwhile when the cost is set against the relief.

However, the understanding of the body as a system of energy in flow which underpins traditional Chinese medicine does afford other possibilities for consideration. Like any enclosed and self-contained system, if there is damage then where the flow is impaired pain will arise, either from a deficiency or excess of energy in the area, or through the stagnation in the flow. Using needles this flow can be reinstated, and the pain reduced or removed. Sometimes the very fact of surgical incision can create a blockage, as can the formation of scar tissue. This can sometimes have effects some distance away from the scar tissue itself. Treatment is often a mixture of local treatment and treatment some distance away, although we can reassure you immediately by saying that there are no acupuncture points on the testicle or scrotum! There are, however, points on the lower leg a which refer directly to this area, and these may come into play.

The best advice that we can give is to visit a BAcC member local to you for an informal assessment of what may be possible. Although we can be quite confident about the treatment of conditions which we often see it is far more difficult to offer opinions on unique presentations like yours. However, a skilled practitioner may well be able to make a few diagnostic soundings which can tell them how likely it will be to help your problem.   

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