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Q: I had acupuncture behind my shoulder blade (scapula?) last night & immediately after felt a weird sensation in my throat/chest.  Today I have awful pain in my back (right shoulder) but that isn't worrying me - what is worrying me is that when I breathe deeply my left lung feels "weird" kind of tight/compressed. I also got very out of breath
walking up stairs.  I have no chest pain and my  heart rate is higher than usual but probably due to worry.  My chest generally feels a bit tight on the left side.  When taking the needle out he said "ooh that took well" hinting it was harder than usual to get out.  Should I be worried about this?  Anything to look out for?  I have heard of punctured lungs and I am very slim so a bit concerned but assuming I would be in agony if this was the case?  I am flying in a few days so just want to make sure I am ok before then.

A:  Pneumothorax, or punctured lung as it is commonly known, is a very rare adverse event after acupuncture treatment. We give advice to our members to follow the recognised techniques for needle insertion, and particularly needle depth, and to take extra care when the patient is old, very thin or has a history of bronchial conditions. There will be times when even with the best precautions a pneumothorax may happen, but in the twenty years of the BAcC's existence there have only been a handful and only one or two of these where the cause was not in doubt - pneumothoraxes can happen spontaneously and there is a tendency to make illegitimate causal connections.

If, however, there is any hint of a possibility that you may have a pneumothorax, then you should present yourself at your nearest A and E department for an X-ray as soon as possible, especially if you are flying very soon. It is always best to be absolutely certain. There are degrees of pneumothorax, and it is not always the whole picture with serious breathing problems and severe pain. However, getting out of breath while climbing stairs is not a good sign, and at very least indicates some kind of intercostal strain which you may need help with before pressurisation in a plane.

We would be delighted to hear that this is a 'false positive' and that this is not a serious problem, but if it does turn out to be so we would advise you to get back in touch so that we can give you more advice about your next steps after you have been treated.

Q: Im looking to start an acupuncture course but I'm not sure what the best qualification would be? There are a few options available accredited by the BAaC but im not sure which one to choose. Basically I would like to know if its worth the extra money to get a Bsc degree from a university as opposed to a Diploma? (CNM is the only organisation offering a diploma, and the course duration is the same as other organisations).

A:  We are assuming that you have been looking at the list on the British Acupuncture Accreditation Board's website. The BAAB accredits, not us, although we are heavily involved in setting the standards for accrediting courses and institutions.

The question of diplomas against degrees is a rather thorny one. The older hands amongst us are often more sceptical about the value of a degree, especially since the degree courses often involve a more biomedical approach to some aspects of the training than we would like to see. However, there is little doubt that the more recent graduates, many of who have chosen to become acupuncture practitioners as a first career rather than those of us trained in the 80s and 90s for whom this is a second career do find that the degree is something which they want, and for obvious reasons. A degree has a transferable value, more than a diploma, and if after ten or twenty years in practice someone decides to change direction, then the degree is something which can be rolled out, especially since it is usually a BSc and quite highly regarded.

All of the courses are the same standard, offering at least 3600 hours of training over three years, and as far as becoming an acupuncturist is concerned, that are all equally good. However, the change in course fee arrangements has actually seen a rather odd transition over the last few years. Where the degree courses were becoming the predominant mode, the introduction of higher fees, nearly all at the £9K mark, have made the private teaching institutions a steal at £5k or £6K, although of course the fees may not be repayable for many years whereas the private course fees are usually payable now.

In the end, though, we are not really able to say which courses are better for obvious reasons, and our advice to prospective students is to make the best possible use of open days to find out which course and which style of teaching suits you best. There are also variations in the styles of acupuncture being taught, and these too can have a major impact in what someone chooses to do. Our view would be that these factors were probably more important than cost alone in choosing a course for a career which might last fifty years.

Q:  i have had acupuncturea  few times now.   After each treatment the symptoms come back or got worse.  Is this a good sign? I carried out  some research which says that sometimes it will re-create the symptoms in order to get better.

A:  There is a piece of received wisdom that says that symptoms sometimes get worse before they start to improve, and this is certainly something which most practitioners of any experience will have seen during their careers. After a while, though, a pattern starts to emerge which probably reflects the clinical situation and what might be going on in the energetic language of Chinese medicine. There are a number of conditions where the problem is perceived as starting from the outside and working its way in,
becoming more entrenched as it does and often causing more severe symptoms. When this process is reversed, as it is with acupuncture treatment, there can be quite a noticeable but usually short term reaction.

The homeopaths use the term 'law of cure' to describe this and it is not uncommon to see a pattern of disease re-appearing in the reverse chronological order in which it first appeared. The key thing, however, is that it this is what is happening, the effect, while possibly quite severe, is short-lived. In treating migraines, for example, we warn patients about the possibility of a really bad short-lived migraine at the beginning of a course of treatment, and advise them that if this happens it will be soon over.

If the same thing happens every time we treat someone then it is probably an indicator of something entirely different. This can very occasionally be wrong treatment; it is possible to increase an imbalance by poorly chosen treatment, and the feedback from a patient is usually enough to alert the practitioner that something is amiss with the treatment plan, especially if this happens a second or third time.

The other possibility is that you are simply energetically sensitive. There are a number of people for treatment has to be very gentle, both in terms of the number of points used and in the amount of action applied to the needles. If the practitioner does too much for the patient's system to handle, the result can be a short period of feeling very odd followed by an improvement. The balance to be struck is how much improvement at what level of disruption. If someone really doesn't get on with needles, then there may be better alternatives for them.

In the end, though, the best person to be talking to about this is your practitioner. They not only know what they have done but are best placed to make the necessary adjustments or interpret what has been happening to you. We often find that when we get these sorts of enquiries it is because the practitioner hasn't done quite enough to address the patient's concerns, and a little nudge in that direction is never a bad thing!

 

A:There is a range of prices for treatment depending on where you are based in the UK, and also on the sessions you have. First sessions in which a full diagnosis is undertaken can often take a great deal longer and are usually more expensive. In Greater London the cost of a diagnosis can be £50-70 with subsequent treatments costing between £40 and £50. These sessions can last anything from 30 minutes to an hour. Outside London, the diagnostic session can cost £40-£60, with subsequent sessions being £30-£50. These are approximations, and the more greatly experienced the practitioner or the more plush the premises, the higher the costs are likely to be. All of our members are required to publish quite clearly what their prices are and how long their sessions last.

There is an increasing number of our members who work in multibed clinics which have been set up with the express intention of making treatment more accessible and affordable for people for whom the normal fees are a little too much. The treatment is exactly the same, but the multibed setting cannot offer the same levels of individual attention and privacy as individual sessions, although we have insisted that members make sure that a patient's confidentiality and privacy are not undermined by this approach. An association called ACMAC has been set up to offer information about these clinics ( http://www.acmac.net/).

There is very little treatment which is free at point of delivery. In these harder economic times there are fewer members than ever being employed or contracted within the NHS to offer treatment. Such treatment as doctors and physios are able to offer within the NHS is usually in conjunction with conventional treatment for conditions which have a definite evidence base.

Of course, most of our members are happy to discuss reductions where people have difficulty in affording treatment, but tend not to advertise this fact to avoid spending their time bargaining over the fees for a professional service from people who can often afford the real price.

 

Q: I had accupuncture in my left foot after which my right leg felt very cold and tingling -  is this normal?

A:This is not a normal response to treatment, and although we could provide a possible explanation we would be very surprised if the treatment and this sensation are connected.

Essentially, traditional acupuncture treats the system as a whole, whatever the symptoms or conditions which the patients comes in with. Because it is an enclosed system in which all the pathways interconnect there is always a possibility that dealing with blockages or even simply improving the overall flow will cause an increase in the energy supply to areas which could deal with a weaker flow but not with something stronger. This can be diagnostically very significant, and a practitioner can often uncover other
areas of blockage as the system starts to work better.

Generally, though, cold and tingling sensations arise where the energy is lacking, and it would be most unusual for this to be the case after a treatment. However, without knowing exactly what the practitioner did and why it is difficult to comment. What we can say with certainty is that the practitioner, if there are a BAcC member, will not only be the best person to offer advice but will be delighted to discuss with you what may have happened.

The other thing to bear in mind is that the symptom may have nothing to do with the acupuncture treatment and may have arisen for some other reason. This is not a sneaky way of avoiding responsibility, but a genuine concern. We have sometimes seen situations develop where the argument kicks in about whether the treatment caused the problem or not while the problem itself goes untreated. What you are experiencing is not a normal state of affairs, and if it persists for more than 48 hours after treatment you can say with some certainty that it has not been caused by it. In this case we would always recommend that a patient visits their GP to start to establish what is happening.

In all cases, however, the practitioner is usually the best resource at your disposal, and nearly all of our members are very happy to guide patients through the options for other forms of care and attention if a problem arises which they are not able to treat or consider would be better treated by other forms of conventional or complementary medicine.

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