Sandy Williams

Sandy Williams

Q:  My son, John aged 31 years, has just been diagnosed with a very large ganglioglioma tumor 9,5cm x 6cm x 4,5cm on the right hemisphere. He has been living with this tumor since a child. So far  he is only suffering headaches, no convulsions. We understand that he will need neuro surgery which may take a couple of months to organise. Our question is what can we reasonably expect from acupuncture whilst waiting for the operation?

A: As you might expect there is no research save a few case studies which we can find about the treatment of ganglioglioma itself with acupuncture, so there is nothing we can usefully add about the treatment of the problem. Surgical resection, especially in the young adult otherwise in good health, shows a reasonably high rate of success, with recurrence levels being quite low unless the tumour has been difficult to remove fully because of its location.

 We are aware that there are ways of looking at problems like this from a Chinese medicine perspective which might give someone expectations that acupuncture treatment will offer a 'cure'. The ancient Chinese did not have the benefit of MRI and X-ray images, and from their perspective any accumulation of fluids or tissue in the body represented a functional disturbance whose origins could be traced to particular Organs of the Body (capitalised because this means something specific and different in Chinese medicine). If this were the case then there would be other signs and symptoms to guide the practitioner, and some hope of dealing with this as a systemic functional disturbance.

 However, it is very dangerous to translate between 'oranges and apples' medical systems because there will be unintended implications that working in one will deal with a problem in the other. What we can say, however, based on our own experience is that acupuncture treatment can have a demonstrable effect in reducing someone's anxiety levels, and anecdotally appears to aid recovery after surgery. The early systems of acupuncture were largely asymptomatic but aimed primarily at establishing balance and harmony in the body's energetic flow and functions in the simple belief that a system in balance was best placed to address any health issues it had. 

 On that basis we would certainly be happy to recommend that your son has treatment in preparation for what might be some very difficult times ahead, but not with any expectation that it would reduce or delay the need for surgery. The fact that he has been carrying this for over twenty years suggests that it is not rapidly growing, and that surgery will be successful. We certainly hope so for his and your sake.  

Q:  I had acupuncture for the first time  and felt very energised after it. By the afternoon I was experiencing lower back pain - which I normally do not have. 2 days later and the lower back pain is still there. Could this have anything to do with toxins being released in the session and if so can I expect relief from the pain anytime soon?

A:  We have to say that we have not encountered any instances where someone has reported lower back pain as a direct consequence of acupuncture treatment, and we have searched the databases to check.

 That is not to say that it didn't come out of the session itself. Our colleagues in the physiotherapy profession who also use acupuncture do say that there are occasions when a rigid back is actually guarding and holding in place a problematic disk, so releasing the muscles by relaxing everything can actually cause problems to appear. However, in this instance there is almost always some case history of back problems before which would support this as a causal pattern.

 You don't mention whether or not you have had back pains before, but there are also occasions when a symptom which has cleared earlier in life can reappear for one last time. This is more common with problems like migraine, where someone can end up with a one-off 'special' but we have heard of the same happening with back pains. This will almost definitely be a transient reaction if this is the case. The same would apply if there were a general release of toxins, but in that case we would expect a slightly more extensive range of odd symptoms.

 

Of course, there can sometimes we simple mechanical reasons. We have heard of people who found that the couch on which they were treated was lumpy or unbalanced, and the back pain literally arose from the treatment because of this.

 Finally we have to say that the appearance of the back pain may be coincidental. This does sound horribly like 'it wasn't me' but with over 4 million treatments a year there are bound to be some cases where the problem appears after but not because of the treatment.

 In nearly all cases, though, the pain will be transient and probably have gone by the time you read this. If if hasn't then it is worth talking through in detail with your practitioner what they did and how this might have been implicated in what happened. If it does carry on, though, it may well also be worth talking to your GP in case it is a sign of an underlying problem which needs to be followed up, or worth seeing an osteopath trained to make precise judgements about someone's physical structure. There are a number of internal problems which can manifest as back pain, and your GP is the best placed person to see if there is anything going on. 


Monday, 30 January 2017 16:07

Microsystems acupuncture courses

Q: I am pretty confused because I would like to study Microsystems Acupuncture to use it in my relaxation therapy sessions.  I've found different short courses open to anyone. I wonder if they are reliable courses and if I will be able to perform ear, hand and face acupuncture safely.   My concern is can I do it  without breaking the laws about the practice. I see a full acupuncturist degree lasts 3 years so I am pretty perplexed by the difference. 

A:  Let's begin with the basics. Since there is no statutory regulation of acupuncture in the UK the only laws relating to the practice of acupuncture are to do with the registration or licensing of premises in which the practice takes place. There are different laws in place depending on where you are based, but they are mainly concerned with the health and safety aspects of practice - clean and suitable premises, proper techniques for the safe use and disposal of acupuncture needles and other clinical waste and maintenance of the premises themselves. An increasing number of authorities are beginning to check someone's training credentials, and this may have an impact on those with very little training, but the majority of bona fide UK courses will pass muster.

 We obviously are committed to the idea of a degree level training as the minimum standard for a traditional acupuncturist in independent practice. However, many of the microsystems in common use, like ear acupuncture, are relatively modern. Auricular acupuncture, for example, was mainly a development by a Frenchman called Paul Nogier in the 1950s, and other systems, while based loosely on classical principles, are often modern innovations, scalp acupuncture being one such.

 When all the acupuncture groups met to discuss the possibility of statutory regulation the microsystems groups worked out pretty quickly that they would be unlikely to meet the standard for statutory regulation, likely to have been agreed at degree equivalent, and formed a working group to seek recognition through the Complementary and Natural Healthcare Council. This they achieved. The CNHC website itself is rather unhelpful, mainly identifying individual practitioners rather than the organisations which generated them and which provided their training. However, you can still find a listing on what had been the site of the Microsystems Acupuncture Regulatory Working Group here http://www.macrwg.org/html/group_members.html, and the names and addresses look pretty current.

 Some of these groups are mainly 5-point detox organisations, and probably not what you have in mind. The others offer different forms of microsystems acupuncture based on holistic principles, and while it is not our place to comment on them individually, the majority are credible bodies which offer specific training within precise limits of competence. As long as someone works within their scope of practice the work they do can be very effective. We would obviously prefer it if everyone learned to practise traditional acupuncture at degree level, but there are likely to be all sorts of constraints which make that impossible for some.

 Of the different varieties of microsystem work the one which does give us the greatest concern is facial or cosmetic acupuncture. We have reservations about the extent to which people are taught how to use needles safely in an area where mistakes could prove very costly for their insurers, and some of the courses we have seen have been very rudimentary. We are also working hard to establish safety standards for regulated healthcare professionals whose short training courses has led to a number of serious accidents, so we would advise that you check this aspect of the training very carefully. We would not wish to see you expose yourself to risk because you don't know what you don't know, if that doesn't sound too cryptic. Acupuncture seems to deceptively simple at times - find point, stick needle in - that people forget what is going on inside the body they are puncturing, even people who should know better. 


Monday, 30 January 2017 16:04

Can acupuncture help with pain in my toes?

Q:  My toes draw and go crooked and the pain is awful.  It's every day, all day and I wondered  if acupuncture would help?

A: We think that the first thing you should do, if you haven't already done it, is to speak to your doctor about this. There are one or two simple causes of foot cramps like dehydration and mineral deficiencies which may need to be checked (most patients are aware that they don't drink enough water but few realise how little they actually take in), and one or two slightly more serious neurological disorders which can generate these symptoms. We think it is highly unlikely that this is the case, but it would be our duty of care as practitioners if you came along with these symptoms to make sure that you had been thoroughly checked in conventional medicine first.

 As far as acupuncture treatment is concerned there are both local and systemic reasons why this might be happening. Tight cramping pains are often caused by blockage or stagnation of energy, or 'qi' as the Chinese called it, and this can be either a local or systemic problem. If it is a local problem it can sometimes be traced back to a particular event or series of events, especially since i Chinese medicine terms once the body has been 'invaded' by cold it sometimes needs to be removed rather than just being left to dissipate.

 The other possibilities are what we would call systemic, involving the under-performance of parts of the system which supply energy to the extremities. If this is the  case they are very likely to be generating other symptoms in the body that someone may not even recognise as symptoms, like bloating after eating or becoming slightly less good at concentrating. A skilled practitioner looks at the way the system is performing for even the smallest of problems in the extremities because the small symptom can be the tip of a much larger iceberg.

 The best advice we can give, and which we invariably do, is to visit a BAcC member local to you and seek a brief face to face assessment. Most members are happy to give up a little time without charge, and this gives you a chance to meet them and see where they work before committing to treatment. Seeing the wider context within which you have this problem is invaluable in giving an informed view of whether acupuncture can or may help. 

Q:  I have been recommended to have acupuncture for possible migraine. I have polymyalgia rheumatica and take steroids. Is it ok to have acupuncture ?

A:  There is no reason of which we are aware that suggests that acupuncture treatment was at all contra-indicated for someone taking steroids for PMR. In fact, a great many patients using steroids as a long term treatment for PMR seek treatment to see if over time they can reduce their steroid use. Clearly our members are very cautious in these situations and always advise the patient only to reduce a dose of medication with the knowledge and prior agreement of their doctor. As you are no doubt very well aware, a sudden reduction in a steroid dose can have serious consequences.

 As far as the treatment of migraine itself is concerned, you may well have looked at the details on our website, but if you haven't there is a fact sheet

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

 which provides some of best current research information about the treatment. In clinical practice migraine remains one of the more frequent reasons why patients seek acupuncture treatment. 

 As long as you are very clear about your situation when your practitioner goes through the initial interview there will not be a problem. Our members are all highly trained and take a full medical history to ensure that any and every factor in someone's health is taken into account.

Q:  After treatment 2 years ago with high dose oral steroids I experienced a raft of adverse effects, including fatty deposits on my left lower leg and foot that caused extensive nerve damage and paralysis [juxta-articular adiposis dolorosa].  Clinicians tell me that there is no way of removing the fatty lumps; however, I wonder if acupuncture could stimulate the body's own mechanisms. Any information you can offer would be most appreciated.


A:  This is one of the sorts of question where we tread with great caution. Acupuncture treatment is often a treatment of last resort and we are always concerned about raising expectations where the chances of improvement are slim. However, there have been for nearly every condition we have seen cases where there has been a remarkable turnaround, and although this is often described as 'spontaneous remission or cure', often much to our colleagues annoyance, the reality is that this is the exception rather than the rule, even if it were demonstrably caused by the treatment.

 There is, as you might have expected, no research of which we are aware or could find which suggest that acupuncture treatment might help. The condition is rare, and research studies would need a much larger cohort of people to work with to have any meaningful outcome. We have not even been able to find a case study.

 However, problems such as this have been around for thousands of years, whatever the cause, and Chinese medicine would have been used to address the manifestation, just as it would for any other condition which we now recognise under a western name. Traditional acupuncture, based as it is on a flow of energy called 'qi', would have and still does look at problems like this as blockages in the flow of qi or accumulations of energy caused by stagnation. The practitioner would be keen to establish whether it was a local problem or a local manifestation of a systemic problem, and then use the needles to try to move the qi and disperse the problem.

 All sounds rather easy when put like this, but the reality is that the growth of new tissue in the body as a consequence of conventional treatment has proved very difficult to address, and if you were to present at our clinic the best that we would ever say is that it may be worth a few treatments to see if there was any noticeable change, and if so to discuss how much and how sustainable. The problem is always to determine a scale by which change can be measured. If there are clear signs that it impairs movement or causes local pain then there are scales which one can use to determine what effect the treatment has. If it's simply a matter of trying to measure the size of a fatty lump, that would be much more difficult.

 The best advice which we can give is to visit a local BAcC member to see what they make of the presentation in the context of your overall health picture. There may be something in the systemic presentation which suggests that treatment may have an impact, but in any event it would enable much more detailed advice than we can give at a distance. Most members are happy to give up a little time without charge to help prospective patients make informed decisions about their health and healthcare options.

 In summary, we think it might be a long shot to try acupuncture treatment for this problem, but we would never say 'don't' because our work is not simply about trying to get rid of specific conditions but about trying to balance the energies of the body to enable it to function as best it can. The ancient Chinese used to believe that this would enable to body to heal itself, and we have certainly seen cases where change happened against out expectations.

 

Monday, 30 January 2017 15:33

Acupuncture and needles

Q: What does it mean if the needles move a lot in your body during acupuncture?  Also what does it mean if the point at which the needles have been inserted go very red?

A:  The most common reasons for the movement of needles once they have been inserted are either that they have been placed very close to blood vessels and are moving in time with the pulse rate, which can look in equal measures entertaining and alarming, or the person has shifted their position ever so slightly since the needle was inserted and there is a certain amount of muscular tension which is making needles move as the muscles contract and relax. Neither is a problem unless the patient is slightly alarmed by the needle movement, in which case it can be adjusted, usually without having to re-insert it, or if this doesn't work, removed and replaced.

 Redness at the point where the needle has been inserted can have a number of causes. At a very prosaic level there are many people whose skin reacts to any for of skin piercing in this way. In other people there can be mild allergies to the metals in the needle, nickel being a very common cause of skin irritation, and occasionally to the silicone coating which the needles sometimes have to make insertion smoother. In the energetic terms which we recognise redness often implies heat, and needles can sometimes be said to release heat from the body. This is most dramatically the case in one particular tradition used a great deal in the UK which places several needles in the back and uses these as a test for disturbed energy which is released by the same treatment in the form of erythema or redness around the place where the needle has been inserted. 

 The cause can sometimes be a combination of all of these factors, but in very few cases is there anything to worry about. The redness usually subsides within a few hours or less, and is only an issue if it remains for more than 24 hours. This may point to an allergic response, and if this is the case this is worth a discussion with your practitioner to see if there needles might be responsible.

 For any reactions like these it is important to let the practitioner know what has happened so that they can make a record and adjust their treatment accordingly.

 

Q:  I have a friend who is training to be a doctor in Brazil and will specialize in acupuncture after her degree. If she was to come to the UK to work and live, would she need any extra qualifications or would she be able to work straight away if a work visa was granted?

A:  There is no statutory regulation of acupuncture in the UK, so theoretically anyone can set up in practice. This is sometimes described as a common law right.

 However, in practice there is some relevant legislation in the various skin piercing laws enacted by local authorities. These give the local authority a right to inspect practices, and although the original legislation made no comment on training, an increasing number of the newer bylaws give authorities the power to refuse to license or register those whom they do not consider suitable. The legislation varies depending on where someone chooses to work. The majority of the UK authorities are governed by Local  Government Miscellaneous Provisions Act 1982 as amended by the Local Government Act 2003. This allows for a one-off registration from which only dentists and doctors are exempt. In Greater London the London Local Authorities Act 1991 applied under which everyone must obtain a licence unless they are registered with a statutory body (dentist, doctor, osteopath, physio, etc etc)) or belong to a professional body which has been granted exemption for its members. In Scotland new skin piercing regulations were introduced in 2006 which require annual licensing of everyone who is not a registrant with a statutory body.

 As far as your friend is concerned, if she joins a relevant professional body she may well be exempt from licensing in London but would probably have to be licensed or registered elsewhere. The chances are that with a medical qualification there would be no reason to question her bona fides. If she chose to register with the GMC she would be exempt from all licensing and registration requirements, but we understand that this registration brings with it a great many requirements and costs which would probably exceed the financial and practical benefits of licensing or registration as a non-medical practitioner.

 The legal requirements are largely to do with the health and safety standards of the clinic and of the actual hygienic practice of acupuncture, and anyone trained to a reasonable standard would be able to meet the conditions, all of which are clearly laid out in the legislation. Membership of a professional body may be more difficult, because the majority practise traditional rather than medical acupuncture, and the main medical acupuncture body (BMAS) may require someone to be GMC registered. However, each case is taken on its individual merits, and if you don't ask, you don't get!

 We wish her well - we understand that acupuncture is taken very seriously in Brazil, as we learned once when we ribbed a medical colleague for attending a world acupuncture conference in Brazil. He roundly told us off with a detailed account of the fact that the gathering was so intense and well-attended that none of them even saw the beaches at all.


Q: I suffered pneumothorax secondary to accupuncture by a well trained medical doctor. The needle entered my plural space collapsing my right lung. Could this be due to a history of bronchitis? Is there documentation on PTSA? 

Q: We are always reluctant to make too definite a comment in cases such as this where there may be a possibility of either conduct proceedings or insurance claims in which we may be formally asked for a view. Without knowing a great deal more about the details of the case we can only offer a general view.

 This is that we advise members who are treating people using points around the thorax to be especially careful with the old, frail and those with a history of bronchial disease in any form, as well as with those who are seriously underweight in eating disorders. In all of these categories of patient there is a risk that the pleural cavity is a great deal nearer the skin surface than usual, and although most indications for the use of points on the thorax are for shallow insertion of the needle at an oblique angle, there are a number of points which we would consider high risk even then.

 That said, we would always, should a case arise, want to examine very closely the circumstances which led to the pneumothorax. There have been very few reported cases in the traditional acupuncture world in the last twenty years, and in one of two of this handful there was a suggestion that there may have been a spontaneous pneumothorax. This can happen, and with over 4 million treatments a year coincidences can happen.

 However, it is usually unmistakable when the cause and effect are pretty much close together, and the only issues to settle then are whether there are questions of competence or negligence to address, and then whether there is an insurance claim which can be made for the injury. As we said above, there are occasions when we are asked for a professional view as expert witnesses, so we tend to avoid specific comment about culpability, especially without knowing a great deal more than a brief outline.

 If you do come back to us with a clarification about what you intended by PTSA in your question we shall naturally respond as soon as we can.

Q:  I recently had acupuncture for severe pain in left leg and lower back from putting lower back out. The 2nd session was so uncomfortable and painful I haven't been back. Needles placed on left side of body and told to stay on back and keep still -that in itself caused problems and I could not lie on my back without a lot of pain, Needle put in between eyebrows to relax/sleep while I was left alone in room for 20 minutes, which was impossible with the pain I had in my leg and back lying that way. 2nd session was the same only this time a needle was put in top of my head as well. Felt like I was being stabbed with a knife and remained really painful for at least an hour after I left session. I had to ask her to check it was all out of my head as it still felt so painful. She checked and said it was fine. The next day my scalp started to itch really badly and I couldn't stop scratching it. Had to go to doctor to get it checked and she prescribed elocon lotion. I am still experiencing itching a month later on scalp and sometimes back of neck. Could the acupuncture have triggered this. I did not have an itchy head before the acupuncture session and as the head needle was so painful I wondered if it could have been the cause. Some days are not so bad but other days the itching drives me crazy and it's hard to not scratch when that happens which I'm sure would make it worse. I haven't had acupuncture before this and didn't realise the needles and session could be so painful, also seemed to do nothing to help the back pain. If anything, I came out worse than I went in after having to lie on my back so very reluctant to do it again.

A:  Obviously we are going to be quite cautious in what we say, because without knowing a great deal more about the way that the treatment was conducted it would be difficult for us to say with any certainty that the needles actually caused the problems you have. The itching on the scalp immediately after the use of the needle does seem suggestive of a causal pattern, though. People do sometimes have reactions to the needles, especially if they contain nickel or are coated with silicone, as some needles are to make them smoother to insert. A very small proportion of people suffer allergic responses, and it may be that you are one of them. The fact that your doctor prescribed a steroid suggests that there is generalised inflammation.

 If there had been signs of an infection the medication would probably have been different. There are again one or two very rare occasions when needles can cause infection by moving bacteria from the skin surface to slightly lower levels of the dermal layers. This is called autogenic infection, i.e. the needles are sterile and inserted correctly, but the infectious agent is moved from where it is contained and safe to where it can run unchecked. Very unusual but possible, but the itching reaction would not be the most common response.

 The fact that the needle in the head was painful is unlikely in itself to have been the cause of the subsequent problems. The reasons why a needle can be painful are sometimes to do with the energetic reaction of the point (some points generate a dull aching sensation called 'deqi' by the Chinese), and sometimes to do with the needle aggravating a local nerve on being inserted. In neither case would this normally generate an itching sensation.

 As far as needles for the back are concerned, it is probably not very good practice to ask people to sit or lie in positions where the position itself is going to aggravate the problem. This is probably not the best way to endear yourself to a patient, and suggests that the communication was not that well organised. We try to ensure that patients are comfortable and certainly make sure that we change what we are doing if they start to feel really uncomfortable - treatment need not be an endurance test.

 We are not sure what else we could offer by way of advice. We suspect that it is highly unlikely that you will go back to the practitioner for further treatment, and may well have been put off acupuncture altogether. If this is so, then perhaps something like cranial osteopathy may well be the answer. If you do want to give acupuncture treatment another go you will almost certainly find a number of our members close to where you live. We are sure that you will be able to explain your problem to them, including the problems you have had with the treatment so far, and be sure that they will taken this into account.

 As far as the itching is concerned you are doing exactly what we would advise anyway, getting treatment from your GP. If the problem persists and causes you longer term problems you may well be able to make a claim against the practitioner's insurance by setting out what has happened to you and asking them to forward your letter to their professional insurers who will then contact you directly. Again, we suspect that you might simply want to draw a line and walk away, but if you have suffered detriment or been treated beneath the standard which you think you were entitled to, nearly all UK practitioners belong to professional associations which can offer support and advice about options open to you.

 We are sorry once again that your experience of acupuncture treatment has not been a good one, and hope that you do find an effective way of addressing your back problems.

 

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