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A: There is no absolute contraindication to acupuncture after a mastectomy. The advice we give to members in the Guide to Safe Practice, an internal document which contextualises the provisions of the Code of Safe Practice, is:
Most patients who have had lymph nodes removed (eg from the axilla after a radical mastectomy) are cautioned against being needled in the limb below the site of lymph node removal due to the increased risk of infection.
It is advisable to mark your treatment notes clearly and visibly to ensure that you do not overlook this in practice.
There have been some discussions about whether the entire quadrant of the body relating to the affected limb should be avoided. Most patients are, however, just advised by their consultants only to avoid having the affected limb needled.
We recommend that in each individual case you follow the individual guidelines the patient has been given by their consultant.
We would leave it to someone's professional judgement about when it would be appropriate to needle proximate to the scar tissue itself, but members are trained to err on the side of caution. Indeed, the nature of traditional acupuncture, where points can be used to act on areas of the body far removed from the needle site means that there are always ways of treating an affected area without going near it.
This is particularly apposite when the mastectomy has been accompanied by the stripping of lymph nodes in the axilla, after which many women experience some lymphoedema. Amplifying the advice we give in the Guide in a response to another enquirer, we said
As far as needling a lymphoedematous arm is concerned, our current recommendation to members is that this is not to be done. Although there is little or no evidence to support the almost universal prohibition of acupuncture by consultants, we have to acknowledge that there is an increased risk of cellulitis and other infection from needling a limb below where lymph nodes have been removed. However, there are many ways of using the interconnections within the system as a whole to treat successfully at a distance within the body, and a qualified practitioner will have many ways at their disposal to effect change and improvement.
Indeed, one of our members, Beverley de Valois, has published several landmark papers in this area
and has shown that treating constitutionally without needling an affected limb can be very beneficial.
We have heard of instances where the prohibition of acupuncture after mastectomy has been total, and we can only re-iterate what we said in this response, there is no evidence that acupuncture has elsewhere on the body has any adverse effects on a post-mastectomy patient.
Q: I have had 4 strokes and I have diabetes, high blood pressure and high cholesterol. I have been falling a lot lately, tripping over my own feet. This happens a lot more when I am tired. My neurologist says that my falling is multi-factorial - the diabetes he feels has caused some neuropathy in my feet and the strokes have messed up my center for balance in my brain. I am at my wits end trying to avoid falling. Do you think that acupuncture could help my condition(s)?
A: There is certainly no likelihood of any hard from trying acupuncture treatment; it remains one of the safest medical interventions, with very few adverse effects, most of which are transient.
We have been asked about diabetic neuropathy on a number of occasions. Our factsheet on neuropathic pain tends to address neuralgias more than neuropathy itself, and our answer to our last enquirer, slightly more specific than your question, was:
Q: My husband has diabetic lumbosacral radiculoplexus neuropathy. Please advise if he should find an acupuncturist specializing in this condition. .We live in west wales and would be grateful if you could recommend a practitioner.
A:The first thing we have to say is that you are unlikely to find an acupuncturist who specialises in treating this condition, but that is in the nature of Chinese medicine which is inherently generalist. In fact, in ancient China the specialist was regarded with disdain because they were restricted to treating a small number of conditions, whereas the generalist could treat all. Chinese medicine treats the person, not the condition from which they suffer. It would not be unusual for twenty patients with the same presenting conventional named condition, say migraine, to be treated in twenty entirely different ways.
Symptoms, what the patient experiences, are the same whatever system of medicine one practises, however, and it is the sense which a practitioner can make of them which determines whether treatment is possible. The normal symptoms of this form of diabetic neuropathy - pain, weakness in the limbs, muscle wasting and so on - would be seen by a Chinese medicine practitioner in the context of the Chinese medicine system which is premised on an understanding of the body as a flow of energy, called 'qi'. How qi flows. The balance and rhythms of this flow determine whether someone is healthy or not, and unsurprisingly where the flow is blocked or out of balance, pain and loss of function will result.
This is a rather long-winded introduction to saying that the Chinese medicine practitioner will be less interested in the name given to the condition than in how it presents, and will try to make sense of that both as a local disturbance and as a manifestation of the balance of the whole system. This can mean on occasion that acupuncture treatment can achieve changes where people thought change was impossible, but this has more to do with the fact that the causal relationships on which conventional medicine relies can be misinterpreted. Nearly everyone over the age of 60 has some degeneration of the lower spine visible on X-ray but that doesn't mean that every backache is caused by it.
In the case of diabetic lumbosacral radiculoplexus neuropathy, however, the diagnosis tends to be more precise and what we can say is that there is a limited amount of evidence for the use of acupuncture in the treatment of neuropathy and considerably more evidence for the treatment of chronic pain wtih acupuncture to suggest that acupuncture treatment may be able to take the edge off your husband's pain. Working at this remove, though, and without being able to see exactly how it manifests we are somewhat limited in what we can say. The best advice we can give is that you go to see a BAcC member local to you for an informal face to face assessment of whether acupuncture treatment may be of benefit. A skilled practitioner should very quickly be able to tell you based on what they can observe whether they think that treatment applied locally may help, or indeed whether balancing the whole system may help the body's own mechanism's to function better and take charge of its own recovery.
As far as finding a practitioner is concerned, there is a 'find a practitioner' feature on our home page www.acupuncture.org.uk which should be able to provide you with a list of names of working in or near your postcode area. We always recommend using postcodes; the search engines are very specific and if you name a county you may find that someone works just over a county border who is far closer than the practitioners operating in your own town or county.
We think there is enough overlap here to answer some of your question, but we would probably place greater emphasis for you on the fact that acupuncture treats the person, not the disease itself. Given that you have a number of quite serious health problems, it is sometimes more advantageous coming at them from a different perspective to avoid taking on symptom after symptom, one at a time. We see many patients taking bucketloads of medicine as a consequence of this approach, and while we are not at all opposed to the use of medication, we are always concerned that this overloads the body with the complex interactions between the medicines and generally addes a few more symptoms.
The traditional acupuncture practitioner will try to make sense of the patterns which have developed in such a way that they can apply the minimum amount of treatment to the most needy areas to encourage the person's own healing process. While it is possible to use acupuncture treatment in a more targeted way, we believe that taking a holistic approach offers the best way not just to help the patient to get better but to stay well. In ancient times the traditional doctor was paid to keep someone well, not to get someone better after they had become ill. This was, said the Chinese, like 'digging a well when you are already thirsty, or forging a spear after the battle had started.'
The best advice, as we said in our earlier reply, is to visit a BAcC member local to you and seek a brief face to face assessment of whether acupuncture treatment may be of benefit to you.
Q: I am a doctor (MD degree)but am not registered in the UK. I have also obtained 'Master in Traditional Medicine (Acupuncture, Herbology, Laser, Electrobiomagnet), Samra University of Oriental Medicine, LA, CA, USAFor'. I would like to get some experience (training and working)in the UK and was wondering if you could provide me with some advice on how I can get registration with the British Accupuncture Council.
A:There are very few restrictions to the practice of acupuncture in the UK. In the absence of statutory regulation the only primary legislation by which practitioners are governed is generic skin piercing legislation mainly concerned with health and safety. This can differ depending on where you want to work. As we wrote to someone else from the States earlier this week:
There are very few restrictions on the practice of acupuncture in the UK, and there is what is described as a common law right to practise freely. In the absence of statutory regulation or state registration the only legal requirements are for registration or licensing by local authorities. This is primarily concerned with the standards of hygiene and safety for acupuncture as a skin piercing activity, although in more recent times many local authorities have become much more assiduous in checking that practitioners are properly trained and insured. Your training and registration in the US far more than meets the basic requirements for suitable training.
In the Greater London area the London Local Authorities Act 1991 applies, which means that you would have to obtain an annual licence at about £200 - £400 to practise. If you belong to an exempt body such as the BAcC, you do not have to pay, although you have to notify the authority of your presence and they will probably inspect the premises.
Outside London the Local Government Miscellaneous Provisions Act 1982 applies. This means that you have to be registered for every practice in which you work. Registration is a one-off process, costing again £250-£500. Only doctors and dentists are exempt from this Act.
In Scotland an annual licensing scheme exists similar to that used in London, but the only exemptions allowed are for those healthcare professionals like physios and nurses who are already state registered. BAcC members have to pay. This has been a bone of contention for many years, but we remain hopeful that we can negotiate exemption.
Your registration in California is one of the tougher ones in the States, but unfortunately there is no reciprocal recognition of qualifications as yet, so application to professional associations will almost certainly be through the individual 'external applicant' route, details of which you can find on our website. There are a number of other professional bodies whom you would be qualified to join, but we believe that we are the main and most respected regulator of Traditional Acupuncture in the UK and would hope that you would join us if you re-locate to the UK.
Q: If you are trained in the 5 point detox acupuncture protocol do you need to be recertified every year?
A: There are no hard and fast rules for re-certification in this sector. As a traditional acupuncture organisation we are not directly connected with any of the schemes, although clearly many of our members are also involved in detox projects and offer detox treatment.
Of the major training providers, we believe that NADA and SMART-UK both require annual attendance for refresher training for continued listing on their registers. We think that the same may apply for those detox groups who belong to the Microsystem Acupuncture Regulatory Working Group who are registered with the Complementary and Natural Healthcare Council. There are a number of other providers, but we would not profess to be able to speak with any confidence about them.
A great deal depends on why you ask the question. If you are receiving treatment from a detox practitioner, then it is simply a matter of checking with the association to which they belong or asking them directly. In our experience bona fide practitioners are more than happy to tell you about their skills and how they maintain them. If they aren't, it means that they probably don't. If you are someone who has trained in these skills, we strongly recommend that you do recertify as a matter of course. Although the treatment is very specific and limited, the potential for infection in a site near the brain is something which requires that someone stays abreast of the current best practice.
Q: I hear that accupuncture is good for the condition Vulvodynia. Can you tell me how I can search for an acupuncturist on this site that specialises or has treated patients with this condition?
which seem to show that acupuncture may be of great benefit. However, these are very small studies, and a much larger trial would need to be conducted for us to make a positive recommendation.
However, when we were asked a similar question two years ago we mentioned the fact that a question had recently been posted on our website forums for members which had provoked very little response. By a rather strange coincidence a similar question about vulvodynia posted a fortnight ago has created a very productive dialogue, with over fifty contributions so far.
The upshot of all this traffic is that there are a number of ways in which vulvodynia can be understood in Chinese medicine, both as a local problem and as the local manifestation of a systemic problem. As you may know, the theories of Chinese medicine are premised on the flow of energy called 'qi' and the way in which this is balanced in the body. This balancing is carried out by the Organs (capitalised to distinguish them from the conventional medical understanding of an organ), and if these are affected, then the balance of the body will be affected. Similarly, if there are local reasons why the flow of energy may have been affected, these may generate symptoms in an otherwise healthy person.
The skill and art of the practitioner lies in the ability to make sense of the symptoms within the whole picture, and to determine what adjustments are needed and where. Most problems which appear to be isolated are in fact a part of a much wider picture of imbalance, the logic of Chinese medicine being refreshingly straightforward - if the system is in balance, the body heals itself.
The best advice we can give is to visit a BAcC member local to you and ask their advice. Most will be able to offer a fairly good assessment based on a brief visit of whether the acupuncture treatment will be able to help. If they are not convinced that they can help you we are confident that they will be able to recommend other alternatives based on the signs and symptoms with which you present.
Finding a specialist in the treatment of vulvodynia is likely to be impossible, not because it has never been treated before but because the nature of Chinese medicine is to see each patient as unique. The great Canadian physicial William Osler once said, 'don't tell be about the disease the patient has, tell me about the patient who has the disease.' This is very much the focus of Chinese medicine, and in this respect all of our members are equally well qualified to be able to offer treatment which is geared to your specific needs. Finding someone who has treated the condition may involve asking each of the practitioners in your area until you find someone who has, we're afraid to say. While the condition is not rare, it is not amongst the top fifty or so complaints which members report treating. There may be some advantage in talking to any member who spends a greater part of their time working on obstetrics or fertility. In our experience these members tend to attract a wider range of patients with gynaecological issues.