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Q: I currently receive acupuncture treatment for fertility. I experience headaches after some sessions, is this common and what is it due to?

A:  There are a number of short term adverse effects after treatment which happen frequently enough that we warn patients of their possibility. Headaches, a feeling of slight dizziness and occasionally a slightly nauseous feeling are common enough to warn patients of, and much more commonly a deep tiredness after the first one or two sessions is not uncommon.

There are a number of possible reasons for the effect, although we could never say with absolute certainty why things happen because each patient is unique and different. The energy system is a closed system, and so any treatment which improves the flow of energy can occasionally uncover slight blockages in the system which were not an issue when the flow was impaired. It's a rotten analogy, but sometimes central heating systems will function fine when used occasionally in the summer but then develop major problems when cranked up full in the winter. An experienced practitioner may well be able to tell from the tongue and pulse that there are blockages and deal with them.

It is also possible that the treatment is causing functional disturbances whose outcome is to generate a headache. There has been some very lively discussion over the years between those practitioners who argue that treating the person as a whole in a traditional fashion is enough to kickstart the system into operating normally, and those who use a much more formulaic syndrome-based approach to treatment which addresses the reproductive function. This latter approach can sometimes generate unwelcome consequences elsewhere because the internal connections within the system make other parts react and sometimes over-perform. Again, an experienced practitioner should be able to make sense of either of these situations, because if a symptom develops there is always going to be some evidence in the diagnostic signs that we use.

We have answered a similar question before and there we cautioned the person not to make the assumption that the headache was caused by the treatment even though it happened immediately after it. Sometimes there are coincidences, and we are always keen to ensure that if an unusual system kicks off that people don't waste time arguing about whether the acupuncture caused it or not while it goes untreated. In your case, however, the chances are that since it has happened a few times after sessions and then subsides it is treatment related.

The best advice that we can give is to talk to your practitioner and see what can be done to make these less intrusive and hopefully stop happening altogether.

And good luck with the fertility treatment!

We are sorry to say that there are no acupuncture courses of which we are aware in Cornwall. The ones which we recognise for automatic eligibility to the BAcC are listed on the website of our sister body, the independent British Acupuncture Accreditation Board http://baab.co.uk/accredited-courses.html. This website also has a great deal of what useful information about what we regard as the appropriate level of training to become a traditional acupuncturist.

There may be other courses provided by some of the smaller acupuncture associations, but we have never heard of any being held in Cornwall, the nearest being in Bristol some years ago. However, when we trained a long time ago many several people did travel from Cornwall to undertake the training, and there are some new developments now involving larger elements of distance learning which may make a course viable even when distant.

The problem for any course provider is that setting up a suitable infrastructure takes considerable time and money, and would probably only interest someone as a project if there were a patent demand for training in an area. The current training structure sees about 200 to 250 students enrol every year, so this may give you some idea of the market into which a new provider would be emerging. That is not to say the places would not be taken up immediately; demand for training is quite high. Capital, however, after four years of recession, isn't.

Q: I had fire cupping. what do the marks indicate? For example  the colouring? I have range from light pink, dark pink and some purple.

A:  The marks which appear after fire cupping are usually bruising, which is why you have such a large range of different colours. This is a very common outcome after cupping, and our members are all recommended to warn patients that this is a possibility after the treatment. The bruises tend to be slightly different from the ones you get after a bump or thump. They are caused by blood being drawn to the surface by the suction created by the partial vacuum, and small capillaries rupturing. the theory behind cupping is that it moves the blood and draws toxins to the surface to be expelled.

For the most part the minor bruising is not an issue, but there are occasions when it might make a difference. The actress Gwynneth Paltrow may have been happy to turn up to a major event with a backless evening dress showing the marks of cupping, but in our experience that is rare. Most people, if they are aware that this will happen, are happy to trade off a short period of bruising for the undoubted benefits which cupping can bring.

On very rare occasions the marks can be indicative of minor burns if the cups have been applied for a long time or have been heated beyond their normal range. This is very infrequent in the UK where the technique is applied very gently. However, in the Far East where cupping is used a great deal more and not always by practitioners with sufficient training serious burns do occur.

The best advice we can give you is that you keep an eye on the marks. If they are bruises, as we suspect, then they will begin to fade very quickly. If they start to show any signs of irritation or infection then you would be well advised to see your GP promptly, and not attempt to treat any of the affected areas with salves or lotions bought over the counter.

Of course, it goes without saying that you should mention this to your practitioner who can check what has been done and make any necessary adjustments to future treatment.

Q:  I'm considering acupuncture to compliment a round of IVF. I've never had acupuncture before. Do you have any advice when trying to choose where to go for this therapy? I'm due to start IVF injections in 2-3 weeks - have I left it too late to start acupuncture?

A:  It's never too late to start acupuncture treatment.  There are a number of ways in which acupuncture treatment can help a woman. Our fact sheet on fertility http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/female-fertility.html provides some fairly dry information about studies which show interesting results, but away from the more academic end of things there has been a very rapid growth in postgraduate training in acupuncture for obstetrics and fertility over the last decade. Two or three organisations have developed, all of which are set up by BAcC members and mostly with BAcC members on their 'books', whose members have all undertaken additional training in the way in which acupuncture can support someone in cycles of fertility treatment. This can extend from traditional acupuncture as it is undertaken anyway, treating the person rather than the condition, to syndrome acupuncture which finds energetic reasons why the course may not take and does its best to
maximise the chances through to measures like the Paulus Protocol which is a formula treatment applied at the time of the implantation which has had clinically  demonstrable successes.

We are confident that all of these approaches can help, which means that we would also be confident that any of our members should be able to provide you with help. However, if someone focuses their work on women undergoing IVF treatment the chances are that they will be more experienced in the western medical aspects of what is happening and have through training the wealth of accumulated wisdom of the teachers who have trained them.

We are not able to name the organisations - we are committed to maintaining a level playing field for all members until such time as we have agreed the appropriate standards for postgraduate claims for expertise - but typing acupuncture, fertility and your area into google will almost certainly guarantee a hit on someone who website will mention the organisations concerned.

The only reservation that we have is that we have seen some members becoming a part of clinics which specialise in this field but which also control the fee structure and often appear to charge considerably more for this kind of treatment than for 'normal' acupuncture treatment. In this expert's view, acupuncture is acupuncture, and the only reasons for charging up are for meeting the cost of overheads on expensive premises or for years of clinical expertise. There are no chargeable magic formulae for reatment that the average competent practitioner is not already aware of anyway. But that's a personal view!

We hope that you manage to find someone suitable before you start your course of injections, and are confident that you will.

A:  It is tempting to trot out the usual information about how successful acupuncture is at treating back pain to the extent that it is one of the treatments recommended in the NICE guidelines. However, your brief e-mail hints at a very complex history, and any good practitioner would want to know a great deal more detail about the operations you have had, and also the injections, before offering a balanced view of what might be possible.

The usual operations in this sort of area, like laminectomies and fusions, always have an effect on the flow of energies in an area, and sometimes from a Chinese medicine perspective create long term blockages which are very difficult to correct. In these circumstances there is often something to be done to reduce the long term pains from which people suffer, and make them more manageable, but getting rid of the pain altogether may be a much longer shot.

That said, we have all seen patients with very long histories of back pain and often with a history of operations and all sorts of invasive treatment who have experienced great improvements. It is, though, impossible to predict which ones will benefit best, and that is why the good practitioner will be cautious and recommend that no more than four or five sessions are worth trying to see if the treatment has an effect. After that there is a second issue: the treatment may have an effect but how much and how
sustainable. This can often become a matter of cost; if a treatment gives a week's relief then unfortunately it is a matter of deciding whether the cost of achieving this much change is warranted by the opportunities it offers. If someone can remain in full time employment as a consequence the trade off is obvious. If, however, they are on a pension or reduced income, it may become more of an issue.

Treating to maintain an even keel with some pain is a legitimate way of operating. It is sometimes sensible to recognise the limits of what is possible and work within them rather than chase rainbows in the hope that a therapy will suddenly transform a long standing condition where everything else has failed.

The best advice we can give, and which we often give but which particularly in your case, is to visit a BAcC member local to you for an informal chat and brief face to face assessment of what they think they might be able to achieve. If they think that acupuncture treatment may offer some real benefits they will say so but we also trust that they will tell you if there are alternatives. like cranial osteopathy for example, which may work better or work allngside the acupuncture to give you the best shot at getting
some improvements.

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