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Q: My doctor has told me that my partner can do the acupunture on me he showed him last week then gave us some needles and packed us on our way. I  thought you had to be qualified.  I am a  bit nervous about letting him do this on me with no experience. Do you think i should go back to the doctor.?

A:Our first thought when we read this was to think 'how irresponsible' but having walked around the block and counted to ten we recalled a number of circumstances of which we are aware where patients have been given needles for self-treatment. In several cases this has been to deal with something truly unpleasant, like post-chemotherapy nausea, and we would be the last people to stand in the way of the relief which good treatment can bring.

Our main concern is that the person administering the treatment knows exactly what they have to do, makes absolutely sure that they follow the rules for hygienic procedure, and knows how to dispose safely of the used needles, which must go into a sharps box immediately after use. I It is also highly advisable that the person giving the treatment has at least a rudimentary idea of what could go wrong and what to do if it does. Needles sometimes get stuck, for example, and there are simple ways of removing them when they do. Points occasionally bleed or start to bruise. Again, there are simple procedures for what to do. The skill is as much in knowing what to do when things go wrong as much as knowing what to do in the first place.

If you are not happy with the information which the doctor has given, then ask for more along the lines we have suggested. We're not sure what the needles are being offered for, so we can't really offer alternatives if you are really worried about needles.

However, what we can say with absolute conviction is that acupuncture remains one of the safest therapies around, with minimal side effects and a very low incidence of adverse events. Even in the hands of the untrained bad outcomes are very rare, and we are sure that if there is a good reason to use the needles it would be good for you to do so. Some of our colleagues take a very different view, but we believe that a positive experience, even using rudimentary treatments, can point people towards more sophisticated treatments in the future if there outcomes have been met by acupuncture before

A:As you can see from our factsheet

the research into the use of acupuncture treatment for vertigo is relatively positive, not yet quite good enough for us to meet the ASA's criteria for an unqualified recommendation but certainly heading in that direction.

The key thing to remember is that Chinese medicine treats the person, not the symptom. This can mean that twenty people who are diagnosed with the same conventionally labelled condition might each be treated differently with acupuncture. The symptom is usually seen as the alarm bell for deeper patterms of disharmony, and it is these which the practitioner will try to address. This involves looking at all aspects of the way that the body and mind are working, and using this information, together with some diagnostic procedures unique to Chinese medicine, to form a diagnosis and treatment plan.

The best advice we can give, since each case can present in its own unique way, is to visit a BAcC member local to you and seek a brief face to face assessment from them of whether acupuncture treatment may be beneficial. We always hesitate to use the word 'cure', though. There are many occasions where the word 'manage' is more suitable, a process where the symptoms are kept under control but may require regular treatment to maintain this state. This is very much within the ethos of Chinese medicine as it was devised and first practised, aimed at keeping the patient well rather than getting the patient better. The latter was seen by the Chinese as a failure, like 'digging a well when you're already thirsty or forging a spear after the battle has started', and ancient Chinese medicine was intended to be preventative. This is very much part of the message which we try to put across in our literature, and why we believe it is a very fitting traditional medicine for modern times.

Q: For the last 3 yrs or so I have had acupuncture, for carpal tunnel issues, from my physiotherapist. It's been a very effective. She is on maternity leave and has a replacement.  I suspect that the replacement has made an error and left a needle in my arm. I have had pain in my arm for 6 weeks since my last visit. Is there a risk to my health from pieces of needle  Do I need to take measures to have it removed? It maybe that nothing is in there and this is just a side effect of poor treatment.

The first and most important thing to say is that if you believe that a needle or piece of needle is stuck in your arm, you need to have the arm X-rayed as a matter of urgency. We would be very surprised if this was the case, given that the standard of needle manufacture is very high these days and given that it would require a negligently careless practitioner to insert a whole needle into an arm or even for a whole needle to be accidentally embedded and not checked in the count of needles used. However, stranger things have happened, and an X-ray will very rapidly establish whether there is something physically stuck there.

A: The risk from a piece of broken needle in the body is minimal. The materials themselves are not toxic, although a very small number of people are allergic to the needles. The only risk would be if the piece of metal migrated by entering a blood vessel large enough to transport it around the body. This is highly unlikely, especially when you bear in mind the kinds of stories ex-servicemen tell of pieces of shrapnel which have been stuck in the same place for 50 years. If there were to be a piece of needle stuck in you, though, it would require minor surgery, probably under local anaethetic, to remove it.

The more likely outcome is that the treatment has nicked a very small blood vessel and caused a minor haematoma/bruise under the skin surface but adjacent to the nerves travelling in the area. The internal 'scab' that this may form will press on surrounding tissue for as long as it takes to heal, and this can be anything from one to six weeks. Carpal tunnel syndrome already involves considerable pressure on the nerves and blood vessels travelling to the wrist, and anything which adds to the compression in the area is undoubtedly going to exacerbate matters. However, once again, we have to say that if a problem continues to aggravate after this length of time, there has to come a point where you have to see your GP and start to arrange the investigations necessary to determine what is going on.

In all of this, your practitioner should be a resource to you. The good practitioner will be just as concerned as you about the fact that you have experienced six weeks of discomfort, and will almost certainly be as keen as you are to find out exactly what is gping on. We think you would be well advised to contact either the practitioner or your GP within the next week or so to get to the bottom of what is happening here.

Q:  Can I please ask if it is appropriate to tear off a piece of the paper roll I have laid on whilst having an acupuncture session and use it to stop blood flow when an acupuncture needle has been removed  Could I also ask if it is normal to have a lot of blood loss when a needle is removed ? I had an acupuncture session and when I was about to get up I had pain at the top of my neck ( where it joins my skull ) and mentioned that I could feel a lump. When I stood up the HCA said that there was blood flowing . . . it went down my neck and started coming onto my front before it was stopped. I have had ( and still have ) a throbbing sensation where the needle was placed and  in the surrounding area.   It is sensitive to  touch and I have consequently had a headache ever since. This being the case I wanted to ask for guidance on if I should continue with acupuncture treatment, given the outcome of my fourth session.?

A: The answer to your first question is 'no', definitely not. The BAcC's Code says:

If you draw blood, you should apply light pressure with clean cotton wool or a clean swab, avoiding contact with the patient's body fluids, and dispose of the cotton wool or swab immediately in a sharps container or clinical waste bag.

Blood loss after the removal of a needle is not common. There are a number of factors which can influence whether there is a small spot of blood - location of needle, time the needles was left in place - on removal of a needle, but a blood flow of the kind you describe is very rare. It sounds as though the practitioner has accidentally needled a slightly larger blood vessel, and that the lump is almost certainly a bruise which has formed at the site. This will probably be slightly tender for a few days until it resolves itself. We are not entirely clear why the headache has occurred. This may be simply because of the inflammation in the area causing a tightening of the muscles, in turn generating a headache, or it may be related to the energetics of the area. Without knowing what style of acupuncture was being used or with what intention it is difficult to say.

There is no doubt in our minds that you should speak to the practitioner involved and alert them to what has happened. Since they will know what they have been trying to achieve, and more critically, how deeply they needled, they will be better placed to advise you. We are aware that some people are uneasy about going back into a situation where they have been injured and do not relish the prospect of a confrontration of the 'look what you did' kind. If this is the case and you do have concerns about what has happened to you it is always a good idea to see a GP for reassurance and advice - trying to see what has happened behind your head is a challenge to say the least.

Whether you have more acupuncture is a moot point. BAcC members, as traditional acupuncturists, have a wide range of choices available to them to needle distally, i.e. away from the area where the problem is manifesting. If the treatment has been administered by a healthcare professional like a physio or osteopath, their training uses much more local treatment, and it may be that you would feel uneasy about being needled again in the same area.

Whoever has given you the treatment we can say with confidence that all UK practitioners belonging to professional associations have proper insurance cover and are accountable to their professional bodies for their standards of practice. If you do not feel that your concerns are adequately addressed you will find the professional associations are both helpful and supportive.

At this moment we have no mechanisms in place ourselves to identify practitioners who specialise in certain conditions. However this is not because of the difficulties of agreeing training standards for what counts as a specialist, but more to do with the fact that a practitioner of Chinese medicine treats the person as much as the conditions which they have. Twenty women presenting with endometriosis might have twenty different treatments. This is because from a Chinese medicine perspective, the symptom is not the disease, and the skill and art of the practitioner is to make sense of the overall picture of someone's energetic flow and find out where the root problem lies which eventually manifests as a symptom.

There are, however, two or three areas where we are investigating what we call 'expert practice' and where we believe that it may be possible to agree standards. Two of these are paediatrics and obstetrics. There are many respected and thorough postgraduate courses which prepare members for focusing their work on these particular patient groups, and it may just be possible that someone who focuses on fertility problems may have come across more cases of endometrosis than a generalist. That said, it doesn't mean that they will have learned any more Chinese medicine than everyone else, and any one of our members is just as well equipped to help you. The only thing you may find is that someone working in this area of specialty may have more experience of the presentations.

The best advice we can give, and alwys do, is to visit a BAcC member local to you and discuss with them whether they think based on a brief face to face assessment they think acupuncture treatment would be of benefit to you.