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A:  As the Department of Health's guidelines make very clear

 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/330925/MRSA_information_for_patients.pdf 

MRSA is relatively prevalent and widespread without necessarily causing infection. As such, it is very likely that a significant proportion of patients are carrying the bug without any trace of symptoms. This applies to almost all of the other infections which sporadically cause alarm in the public; blood borne viruses are very common in what is called a 'carrier' state where the person with the virus is unaware that they have it.

  Our Codes of Safe Practice have been designed to protect patient and practitioner alike from infection and cross infection. Our health and safety consultant, a man pre-eminent in his field, was emphatic that if a practitioner followed the Code to the letter there was no chance of infection. This is reflected in the advice we issued to members in the form of Guide to Safe Practice which provides background detail to interpret the Code. We wrote there:

MRSA and other ‘superbugs’

There has been much coverage of MRSA in the media in recent years and it is understandable that the idea of admitting a potentially highly infectious patient into your practice environment might cause some anxiety. The fact is that there are various degrees of this infection as MRSA can infect a range of tissues and body systems. Therefore, symptoms can vary and some patients may not even be aware that they are infected. Our response has always been to stick to the recommendations laid out in the Code. If these are properly followed, there is virtually no risk of cross-infection.

 We have also advised practitioners, however, to use their professional judgement in these cases and to make adjustments to the Code over and above the basic requirements if they felt more comfortable this way. Some practitioners, for instance, preferred to treat the patient at home to avoid any exposure to other patients; some felt taking on an infected patient was beyond their limits and decided to refer them.

In other words we allowed our members to exercise professional judgement based on the individual circumstances of each case and also the individual circumstances of their practice. If, for example, a practitioner has several immuno-compromised patients on their list it may be sensible to maintain a safe booking distance between them and patients with potentially dangerous conditions.

That said there are few reports of problems worldwide, although one case in the UK illustrates the need to keep on one's toes:

A 15 year-old boy in the U.K. was treated with acupuncture for eczema. Two days after his fifth treatment he suffered bilateral knee swelling, fever, and subsequent endocarditis from Staphylococcus aureus (Buckley 2011). He was admitted to a hospital for weeks and was left with permanent cardiac damage. Four months prior to the initiation of acupuncture, nasal and skin swabs isolated Staphylococcus aureus. The acupuncturist was likely not aware of this finding and inserted needles at the sites of his eczema lesions on his knees and then firmly massaged the knees following acupuncture, carrying Staph deep into the tissues. This patient’s abnormal skin barrier function, leading to colonization with S. aureus, was a predisposing risk factor. Here, acupuncture caused a complication that is rare and unexpected, and yet might have been avoided.

Buckley D. Staphylococcus aureus endocarditis as a complication of acupuncture for eczema. Br J Dermatol. 2011;164(6):1405-6.

Sensible communication between practitioner and patient, however, should be sufficient to ensure that this sort of situation does not occur.

  

Q:I have just had my fist session of acupuncture for an ongoing lower back condition ( slipped disk ) - she inserted 7 needles into my back, thigh, knee and ankle. Immediately after I felt ok, but 2 days on I have been suffering with dizziness, worse pain in my back than before the session and I have diarrhea - is this normal?

A: 'Normal' is a word which we hesitate to use in these situations because it implies that this happens all the time, but it's fair to say that with all patients with lower back problems we do tend to advise them that pain and stiffness may be a little greater for the next couple of days. We are not alone in doing this; osteopaths and chiropractors routinely offer the same advice.

 What we usually tell people is that if someone has been out of shape for a long while there is often a great deal of re-adjustment to be done. We work on function rather than structure, but once muscles start to work properly some are going to relax and others to be forced to stretch, and inevitably this is going to become a bit of an issue. This should subside in a couple of days, but if it doesn't it's probably worth contacting your practitioner to ask their advice.

 The lightheadedness may be a part of the same pattern. Energy flows will be changing, and this may lead to a few ripples in the system. However, the diarrhoea is less likely to be an outcome of treatment. We have colleagues who might claim that this was the body purging itself of toxins, and if your overall history is complex and there are a number of background problems now or in the past then it is just possible that there may be a connection. We suspect, though, that taken in conjunction with the lightheaded feeling you may have a bug which has simply happened to coincide with the treatment rather than being caused by it. Here again, if it last longer than a couple of days more you might want to seek advice.

 In general, though, the best person to ask is always the practitioner looking after you. Some may get a little defensive, as is only natural, but the majority will be only too happy to reassure you and to interpret what is happening in the context of your unique case history which they will have gone through in detail on your first session.

Q:  I can't sleep I am not falling asleep till about four in the morning.   I don't feel tired.  I have tried everything it's getting me down.  I can't go on like this.  I wonder if you can help me please.

A:  There is no doubt that acupuncture has a good track record for helping with insomnia. While the studies are not really sufficient in quantity to make substantive claims such as there have been, as you can see from our factsheet

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1283-insomnia.html

 are very encouraging.

 The real strength of traditional acupuncture, however, is not in treating conditions as much as it is in treating the people with the conditions. Although a dozen people with insomnia may present for treatment with exactly the same kind of insomnia, it would be not unusual if each was treated differently. The failure to get to sleep is a sign that the system is out of balance, but the causes can be quite different. The art and skill of the practitioner lies in finding out exactly why this distressing symptom occurs in you.

 Of course, as you well know, the problem becomes a spiral of descent into despair. Less sleep means that people become more anxious, less able to concentrate, and this can all make the problem far worse. The treatment can also help with these sorts of aspects. Invariable we find that there are often life conditions or emotional states which precede the onset of the problem, and these too form a part of the diagnostic process.

 The best advice, especially for someone suffering as you are, is to visit a BAcC member local to you for a brief face to face assessment of what is going on. The advice will be much more precise than we can give here, and most members are happy to see someone without a small amount of time without charge to establish whether acupuncture is the best option. This also gives you a chance to meet them and see where they work before committing to treatment.
 

A:  There are no set limits for the amount of time for which needles can be left inserted nor specific requirements for particular conditions.

 There are many different styles of acupuncture in use in the UK. Some use a simple 'in and straight out' technique for stimulating energy, while others leave the needles in for twenty minutes or more. There are also techniques and specific treatments which could involve needles being left in for an hour. 

 Basically, then, the person you need to ask if you have any concerns about the needles being left in is the practitioner treating you. If this is a factor which concerns you about committing to treatment then we are sure that our members would be more than happy to discuss what they do and adjust treatment to your individual preferences where possible.

Q:  I'm due to begin acupuncture sessions to help me with my pain levels as I suffer with fibromyalgia. My pains are all different in types, areas and locations. My questions are;
Will they place needles in several places on my body at the same time?  What do I need to do in preparation for my first session?

A:  Each person is unique and different, and by extension each session is crafted to meet the patient's specific needs, so it is quite difficult to say how many needles will be used and where they will be placed. There are also several different styles in use in the UK, some of which are more needle-intensive than others. Very few are actually painful, however. The majority of needle insertions might induce a tingling sensation or a dull ache, but with the almost universal use of guide tubes for insertion and the very small gauge of the needle most people feel very little.

We don't 'chase symptoms' with our needle insertion, so if someone has pain all over their body we don't try to put needles where they feel. For fibromyalgia and polymyalgia this would be impossible anyway; the pains appear all over the body at various times, and treatment is supposed to be restorative, not an ordeal. Most patterns of imbalance point to problems in the system as a whole, and needles are used appropriately to rebalance the whole system. This can lead to anomalous situations where someone with headaches ends up with needles in the legs and feet, but achieving overall balance requires a sophisticated understanding of the way the whole system works and where exactly to place needles.

Don't forget also that you have to give consent to any treatment that you have, so that if someone wants to use more needles than you are comfortable with, or wants to place them where you are not comfortable with being needled, you can say 'no'. There are always ways around issues like this which respect the patient's wishes, and you should not feel that you are being unhelpful by asserting your wishes.

There are very few preparations for first sessions. We usually tell people to refrain from alcohol the night before and night after treatment, and we don't like to treat people who have just had a large meal. Similarly an empty stomach is not a great idea; this can make people feel a little faint. Heavy exercise before or immediately after a session is not recommended, and because people can often feel relaxed to the point of drowsiness we usually recommend that people do not have to drive at speed down motorways or dash off to important meetings straight away.

It is always best to wear loose fitting clothing that allows easy access to the arms and legs, the midriff and the back.  If you are taking any medications it is always useful to have a note of these for the records, and we like to record your doctor's name and address for the files. It is also very useful to have a record of illness and diseases written down; you'd be astonished how many people forget really serious illnesses from the past. We take a full case history and ask about medical history, but often we find that people will say after about five sessions 'oh, did I mention that I was in hospital for a month when I was 16'.

Most people look forward to acupuncture sessions, and we very much hope that you do too. What little discomfort there may be is usually far outweighed by the benefits treatment can bring.

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