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Q: In the last year I have been diagnosed with an inherited condition called spino cerebellum atrophy 6 (SCA6). One of the symptoms is nystagmus which sometimes means reading is difficult. Could acupuncture or acupressure help with either condition? If so, is there a practitioner in West London who might specialise in such conditions?

A:  We are always a little wary about answering questions about hereditary conditions, especially ones like yours where the condition is genetic and where there are few recorded instances of reversal of the symptoms, although several accounts of supportive treatments which reduce the rate of deterioration.

 The reason that we are cautious is that from a Chinese medicine perspective, where there was and is no concept of genes but often a very strong sense of patterns of energy being passed down from generation to generation, there are occasions when a hereditary pattern like migraine or asthma can be addressed successfully when the energetic 'glitch' is treated. However, our practical experience is that where the conditions are genetic and inherited, rather than energetic dispositions to certain problems, there is less chance of success. You can find a number of Chinese studies of the treatment of cerebellar ataxia which make very encouraging noises, but these are mainly stroke or accident related occurrences which have a more obvious and potentially treatable cause.

 Having said all that, there is no doubt that many of the symptoms of conditions like SCA6 can be successfully mapped onto the diagnostic categories of Chinese medicine, and it may be possible to help reduce the severity of some of the effects of the condition. A great deal depends on the causal pathway. There are occasions when the symptom is not a directly caused problem but the consequence of an earlier part of the 'chain' being disrupted. If this is so, then treatment may be worth considering, even if only for the fact that the general well-being associated with the use of traditional acupuncture may make someone's attitude and response to their condition improve.

 We think the best thing to do, given that we are not in a position to assess the Chinese medicine diagnostic patterns or the symptom presentation that you have, is for you to visit a BAcC member local to you for a brief informal assessment of what may be possible. Most of us are happy to give up a small amount of time without charge to assess whether treatment would be worthwhile, and this gives the patient a chance to meet the practitioner and see where they work before committing to treatment. There are no specialists in this particular field, or indeed in very few fields with the exception of paediatrics and obstetrics. Chinese medicine is by its very nature generalist, and all of our members are equally well qualified to treat the greater majority of patients who come to their clinics. 

 The one thing we would say, though, is to try to set measurable outcomes if you do decide to have treatment and to ensure that progress is reviewed regularly. It is quite easy to run up a large number of treatments without realising one has done so, and if there has been no real progress this can be a cause of some frustration. Better, in our view, to keep a careful eye on progress, or lack of it, and make decisions about carrying on on a clear basis.

A:  There are many ways of assessing whether a treatment has achieved anything. Many patients have a 'headline' condition for which they have sought treatment, and if this is the sole determinant of success, then we would have to say 'it depends what this condition is.' Some conditions do move slowly towards being cleared and there is a sense of progression - a backache not lasting as long as usual or needing as many painkillers, a migraine that is less frequent. In some cases, however, a problem can remain much the same until the change reaches a tipping point after which progress is discernible and quite often rapid. Knowing which is the more likely reaction is guesswork, and although nothing may have shifted yet there is often diagnostic information which points towards a likely change.

This is where secondary information plays its part. Quite often people have what we might regard as second-string conditions, ones which would not have seen them seeking treatment but are nonetheless a nuisance. It is quite common for someone to report that a problem like acid reflux or poor sleep has resolved, and this can often be an indicator that the main problems are likely to shift.

Many patients also report a more general and diffuse sense of 'feeling better in myself' which, vague as it sounds, is often a really goo indicator that there are some significant changes in progress.

The bottom line, though, is that there comes a point where we all have to admit that the treatment is changing things enough or at all, or the changes are short-lived, and the challenge then is to use the evidence of what has happened and reactions to treatment to determine what may be the next best option to pursue. Your practitioner should be only too happy to sit down and review progress with you, and tell you what they have found in your energies and what they think the prognosis is. If they are convinced based on what they have seen that the treatment will work, it is important to set a limit at which you review the decision to continue.

It may also be important to review the markers for progress which you have adopted. These sometimes need to be really clear to record exactly what may be happening. People occasionally make a little more progress than they think, and clear outcome measures are essentaial to establish this.

A: There isn't actually a great deal of evidence for the treatment of COPD as our factsheet

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1587-copd.html

 shows. If you click on this link and then click on the 'evidence' button you will see that there hasn't been a great deal of research, and it only cites a trial from 2004 conducted by George Lewith and a systematic review from a few years ago. There has been another systematic review published more recently

http://www.ncbi.nlm.nih.gov/pubmed/25478799

 and evidence that another is about to be done, so there is clearly a great deal of interest. This is probably because COPD rates as one of the more frequently occurring and debilitating problems, and anything which can help is worth investigating. Acupuncture treatment has shown encouraging signs of helping existing treatments to be more effective, so larger studies may well follow.

 Of course, this is the problem as seen from a conventional medical perspective, and one of the factors which makes the research so difficult to organise is that there are many possible causes, some of which are more tractable to treatment than others. If, for example, someone has smoked for fifty years or has emphysema then the potential for improvement is severely limited. If the obstruction is more transient, like excessive phlegm or poor lung function, then there may be more that can be done. The great strength of Chinese medicine is that it looks at the symptoms which someone has in the context of their overall health, and also has a number of different ways of viewing the same symptom pattern. This means that the treatment is very much geared to the individual, and not simply a protocol based on the symptoms alone.

 A great deal depends on the reasons for the development of your COPD, so it would be unwise to start making too many promises about what may be possible. Your best bet would be to visit a local BAcC member for a brief face to face consultation to get advice on what may be possible. Most members are happy to see someone without commitment for a few minutes to assess whether acupuncture is the best treatment for them.

 We think, though, that the advice is likely to be very realistic. Once someone has been diagnosed with COPD it is for the most part a matter of getting worse slower rather than getting better, so outcomes have to be realistic from the off.

 

Q:  I have bad sciatica had 3 visits to a chiropractor and started to feel a bit better  yesterday.  I was given acupuncture in the bottom of my spine.  The needles caused me a lot of pain when inserted and since then I am in so much pain feeling  like raw nerves -  is this normal ?

A:  We would hesitate to use the word 'normal' in circumstances like this but it can happen.

 There are two possibilities. First is that the treatment has caused an exacerbation of the original problem. This can happen with treatments for back, neck and sciatica types of pain, and if this is the case then the feeling will subside within 48 hours, or by the time you read this reply. Many health professionals like us, osteopaths and chiropractors do warn people that this can happen, and take it as a good sign that the treatment has 'engaged'. 

 The reaction is not usually that severe, however, normally the existing problem plus a bit more, so we suspect that the problem may well have been caused by the treatment. Chiropractors are not within the mainstream of acupuncture practice within the UK, and many learn small amounts of acupuncture for treating specific problems within their scope of practice. This can mean that there use of needles is slightly more hard-hitting than, say, a traditional acupuncturist who is trying to move energy. Trying to get a neuro-physiological effect can sometimes mean using thicker needles and deeper insertions, and with that the risk of a bruise or a slight nerve impingement increases considerably. This does not usually mean permanent damage; even when people do suffer treatment injuries very few indeed cause more than a short lived problem. It does mean, though, that there can be a very different kind of post treatment pain, often sharp and severe.

 The best thing to do is to discuss the problem with the person who gave you the treatment to see if they can provide any illumination about where they were needling, how deeply and with how much manipulation, to get a sense of what damage might have been caused and how quickly it will resolve. If it carries on for a week then it would be advisable to arrange a GP appointment for the doctor to have a look at what is going on, and possibly prescribe some pain relief.

 The chances are that the reaction is the former. We certainly hope so, and this will mean that it has resolved by the time you read this. If it hasn't, then it would warrant further investigation

Q:  I have colitis, hayfever and dust allergies, psoriasis and recently some new pain and swelling in my thumb and toes. I am aware that auto immune diseases can cluster in this way in individuals and now with the new symptoms am wondering if acupuncture could help me and if there is an NHS practitioner in my area of Gloucestershire? 

A:  You are right to think that the approach inherent in traditional Chinese medicine may offer possibilities for the treatment of some of the problems which you have. We don't want to quote great numbers of studies at you because you have clearly done your research, but if you want further details then you need look no further than our website where you will find under the 'research' tab a further button for fact sheets which cover many of the problems which you mention. Indeed, if you use the 'site search' facility on the home page you will find dozens of answers which we have given over the years about many of the problems which you have.

 The great strength of Chinese medicine is that the practitioner is trying to make sense of all aspects of a person's health and well-being by using a theoretical framework which draws on 2500 years of understanding of the whole body, mind and spirit as an energy system. This means that interconnections are very naturally a part of this understanding, whereas conventional medicine tends to address each aspect separately and in isolation. This is often not quite so pronounced as some of our colleagues argue; we know of many GPs who are proud of their genuine holistic approach to health. The system itself, however, does not lend itself to this kind of approach.

 We think, however, that you may find it very difficult to identify any traditional acupuncture provision in your area. What acupuncture treatment there is can most often be provided by doctors and physios within their normal scope of practice, and usually only on conditions for which there is a substantial and persuasive evidence base in western terms. This does not extend to many of the problems you have.

 On the assumption that you want to find treatment free at the point of delivery, it might well be worth asking a BAcC member local to you (whom you can find using the postcode search facility on our home page) if they are aware of anything local to you in NHS provision. We know of one member who was heavily involved in NHS work but we think it may have been in another field of medicine. If this doesn't turn anyone up you may well be pointed to someone who is prepared to treat you at highly reduced fees. Many of our members are as concerned with helping people than making a mint, and are usually prepared to help people find what they need.

 There is also a growing number of multibed clinics trying to provide acupuncture at reduced rates for work in group settings. A list of these can be found at this website http://www.acmac.net/, and this may offer possibilities.

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