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A: Our understanding is that anyone working within the NHS is required under their contracts to have a level of Child Protection Training. One of our colleagues is a GP and she reports that there are different grades of training depending on the level of clinical exposure to children, so a practice receptionist would have a Grade 1 training, some of the secondary staff a Grade 2 training and frontline staff such as doctors and nurses a Grade 3 training. We suspect that physios within the NHS, which the majority are, have this training.

Insofar as a physiotherapist works within the NHS, the fact that they use acupuncture within their normal scope of practice would not change this basic requirement. Technically physios should restrict themselves to working within their normal scope and use acupuncture only where there is an agreed evidence base. In practice, especially where physiotherapists are working in private, i.e. non-NHS practice, we have seen a growth in people offering treatment for conditions which one would not normally associate with physiotherapy, but we have absolutely no doubt that they are required by their registering body, the Health and Care Professions Council, and their professional association, the Chartered Society of Physiotherapists, to maintain vigilance in this area as a condition of registration.

We have tried to find a specific guideline on all of the relevant websites, but without success. We have been trying to produce a similar guideline for our members for some time, but we have been challenged by the fact that none of us can see children under without a parent or guardian present, and so any suspicions, other than those which arise directly from what a child may say, are restricted to visible physical evidence. Since some kids tend to spend their young lives as human pinballs, bashing into all sorts of things, bruising is not in itself a sign of neglect or abuse. There has to be some judgement about whether this is a likely area for abusive treatment. We have advised members to contact us and our legal advisers if they have suspicions. Our experience of one or two social services departments in the last decade is that they have a very direct and interventional style, often threatening people with removal of children into care while an investigation takes place, so we want members to be as sure as they can be that there is something which they should report.

The difficulty we find with practitioners is that they concern themselves with the potential outcomes. Our understanding of current NHS guidelines is that this is not for the reporter to take into account; the duty of care extends to reporting and what is done about the report must not be a factor in making the decision to report. Easier said than done, though, if someone beloeves that a report may trigger draconian action and be a false alarm.

Q: I am presently doing IVF treatment and I am having acupuncture sessions. I would like to know if I can carry on with the sessions after the embryo transfer? Is it safe to continue acupuncture treatment after the embryo transfer and during pregnancy?

A: Generally speaking, in the hands of a properly trained and qualified acupuncturist it is perfectly safe to continue with acupuncture treatment during pregnancy. Most practitioners tend to do the least possible as maintenance treatment throughout the term, and will only see someone more frequently if a problem such as morning sickness or severe backache presents. All practitioners are trained to avoid a number of more risk-laden points at various stages of the pregnancy, but it would be fair to say that rarely do European practitioners use the same level of vigorous treatment which is common in China, and the risk would probably be minimal. However, in deference to the wisdom of 2000 years of practice all BAcC members avoid what are called 'forbidden points'.

The best person to ask for advice, though, is probably the practitioner you are seeing. He or she will be far better acquainted with your system than we could possibly be at a distance, and will be able to offer advice based on your unique balance. Many BAcC members have done additional postgraduate training in the field of obstetrics and fertility treatment, and it is one of a very small number of areas (paediatrics is another) where we have working groups looking at what defines expert practice with a view to recognising the training standards involved. It may well be that your practitioner has done this sort of training, but if he or she hasn't there are many practitioners who have who could offer expert advice based on your specific presentation.

A: We have been asked this question on a number of occasions, and one of the more recent responses was:

There are a number of small studies, two of which you can find here

http://www.ncbi.nlm.nih.gov/pubmed/14562135

http://www.ncbi.nlm.nih.gov/pubmed/10098953

which give some encouragement to the possibility that acupuncture in conjunction with conventional strategies can help men suffering from ED. However, the studies are small and far from conclusive, so we couldn't give a definite and positive recommendation.

As a general comment we would say that there are many reasons why men can begin to suffer from ED. These can range from the simple fact of ageing and the effects of conditions which become more apparent in older age, like mature onset diabetes, or to the problems associated with excessive drinking or smoking, through to the kinds of complex psychological issues which have arisen as a consequence of someone's life experience. Whether acupuncture can offer any help depends a great deal on the background against which the problem has arisen.

Traditional Chinese acupuncture is primarily concerned with the restoration of balance and flow in the energy of the body, and there are several distinct patterns of disease, or 'syndromes', in which poor flow or blockage of energy ('qi' as it is called in Chinese medicine) can cause erectile problems. If this were to be the case, and there were other confirming factors pointing to a specific syndrome in the overall diagnosis, there may be some possibility that acupuncture could provide some help. However, if the cause of the ED lies in a pathological condition which means that there has been some permanent loss or weakening of blood supply to the sexual organs, then acupuncture would be less likely to have any effect.

Our only advice to you can be to seek the view of a BAcC member local to you and discuss the matter face to face, perhaps offering them a little more background information on which they can give you a clearer assessment of whether they think acupuncture treatment may be of benefit.

We think that this is still the best advice that we can give.

A:A great deal depends on the overall pattern within which the symptoms you are experiencing sits. Even from a conventional medical perspective there are a number of different reasons why someone may be experiencing cardiovascular disease in the lower leg, and the adjuncts to treatment can range from changes of diet and lifestyle to giving up cigarettes and alcohol.

From a Chinese medicine perspective the poor flow of blood in the lower limbs can be seen either as a localised problem or as the tip of a much larger iceberg, and the skill of the practitioner lies in determining which this is and focusing their treatment accordingly. Chinese medicine is based on an entirely different way of looking at the body, mind and emotions as a flow of energy, called 'qi'. Diagnosis and treatment is aimed at identifying where the flows of energy are blocked, deficient or over-flowing and using fine needles to stimulate change towards what is normal.

The fact that the treatment is described in these terms does not mean that the Chinese were unaware of blood flow. There is considerable evidence that they were well aware of the flow of blood long before scientists like Harvey were credited with its discovery in the West. However, they saw the flow of blood as a part of a wider system of flow in which all aspects of bodily functions could be improved.

Cardiovascular disease manifests at all sorts of levels in the body, though, and in some cases there can be considerable damage to the peripheral arteries which no amount of treatment is going to be able to put right. The best advice that we can give in cases like yours, where the range of possibilities is so large, is that you visit a BAcC member local to you for a brief chat and perhaps a face to face assessment of what benefits acupuncture treatment might offer you. Most members are more than happy to spend a little time with prospective patients before they commit to treatment to ensure that expectations on both sides are realistic.

Q: I had my middle and lower right lobe removed from my lung 7 weeks ago. I have recently had an infection around the lung and been on IV anti biotics in hospital for 1 week and now home on oral antibiotics . During this time I have had severe nausea and intermittent sickness. I take anti sickness tablet cyclzine but it appears to make no difference. I also still have pain and take paracetamol . What I would like to know is could accupuncture help or cure the nausea or even help with the pain as the traditional treatment doesn't seem to be .

A: We are very sorry to hear of what you have been through

It's very heartening to be able to point to some very good quality research for the treatment of bot post-operative pain and post-operative nausea, as our fact sheets demonstrate:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html

and

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/post-operative-pain.html

We aren't able to offer this as conclusive evidence, at least not to the standards which the ASA

require us to demonstrate for claims of efficacy, but there has always been a decent consensus amongst both traditional and medical acupuncturists that nausea in particular is treatable. Indeed as the factsheet shows, there is one acupuncture point on the arm which is cited in nearly every trial as one that 'does what is says on the tin.' This is the same point which is used in the various seas sickness bands which are found on sale in most chemists.

Any practitioner taking you on will need to be a little more cautious than usual, because there is no doubt that from both an eastern and western perspective your immune system will have taken a serious knock, but as long as someone works carefully within our Code of Safe Practice or equivalent all should be well.

The best advice, which you will see repeated in most of our answers, is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture treatment may be of benefit. You may find that home visits are more appropriate at this stage, and many members are happy to do this.