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Q: My father is a paraplegic and has been since he was 28. He is now 61 and is suffering with severe hip pain. His hip joint is completely worn. Is acupuncture a suitable treatment for him?

A: This is, we think, really two questions: is it OK for your father as a paraplegic to have treatment, and if so, what are the possible benefits for the problems that he has.

As far as the first is concerned there is absolutely no reason for a person with paraplegia or quadriplegia not to have treatment. Although someone may have lost conscious and voluntary nerve control of the limbs which have been affected all of the autonomic functions continue, and from a Chinese medicine perspective this means that there is energy flow which can be enhanced or corrected by suitable treatment. The main caution with problems like your father's is that there can often be a sensory deficit, so practitioners are always very careful in how they treat. If someone can't say 'stop it, that hurts' there is an increased chance of bruising, and in the case of moxibustion, an increased risk of burns. All professional acupuncturists are trained at undergraduate level in what to do with cases like this.

As far as treating hip problems themselves are concerned, a great deal depends on the level of deterioration in the joint. If the wear is great enough to warrant or nearly warrant a replacement, then we would have to be honest and say that short term pain relief would be the most we would expect to be able to offer. The question would be how much relief and how sustainable it was, and again, to be honest, this may become a question of how affordable treatment is. For people with deep pockets three or four days relief from indefinite weekly treatment may be a good deal. Most of us couldn't afford this, though, and we trust that members do their best in these circumstances to direct people to the most effective and cost-effective means of getting relief, be this herbal medicine or reflexology or any one of dozens of possible complementary medicine solutions.

The best advice that we can give is that your father visits a local BAcC member for advice about what may be possible. Nothing beats actually seeing the problems first hand in order to be able to give an accurate assessment of what may be possible, and most of our colleagues are only to happy to see prospective patients without charge to give them a good idea of what can be done.

We suspect, though, that if the wear is very considerable the amount of relief may be limited, and if someone does think treatment is worthwhile it would be advisable if they offered realistic expectations.

Q: What was the qualification to study for acupunture, and what is the cutoff  to study for acupunture?

A: Your question is a little unclear, but we think we can cover all the bases!

In order to enrol for a training course in acupuncture, most UK students have an A level standard of education which would be the normal entry standard for a university degree course, which many UK courses now are. There are obviously alternative routes depending on the kind of experience and life skills a person has. With a career on acupuncture it helps considerably to have some life experience behind you before starting to train, and many courses will offer partial exemptions and deals for people who can demonstrate that as a mature entrant, for example, they have skills which would enable them to train, even though these may not be reflected in formal qualifications.

As far as the qualifications gained are concerned these are usually licences to practice or diplomas, although the university qualifications will be degrees, usually a Bachelor of Science (BSc).

As far as cut-off is concerned, there often isn't one. In the UK it would actually be in breach of formal guidelines to refuse to take someone on as a student on the grounds of age. All that a training establishment can do is assess whether someone is fit to take the course, not factor in whether or how they can practise the skills learned or the length of time they could possibly practice.

The website of our sister institution, the British Acupuncture Accreditation Board  https://baab.co.uk/ has a wealth of information on training and a career in acupuncture, and we can think of no better resource to which to direct you.

Q: I have athritis in my hand and thumb. Will acupuncture help me?

A: As you can read from our factsheet on arthritis https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/osteoarthritis.html there is a fair bit of evidence that arthritis can be helped by acupuncture treatment, and the usual response we give says that it is more a matter of how much help and how sustainable the results are. Clearly if treatment only gives a couple of hours of reduction in pain and stiffness then acupuncture may not be the best option, but if the improvement lasts a few days there might be better prospects. The question really is whether the improvement always drops away back to the original baseline or whether there is a gradual overall improvement. There is nothing wrong with knowing that something will only work for a week if the week in question is one where additional mobility is necessary, and of course the joker in the pack is how much treatment may be doing to reduce further deterioration, or 'getting worse slower' as one waggish patient remarked.

However, with arthritis in particular it is really good to get a handle on the possible causes. Although the symptoms are universal, the causes, even in western medicine, can be very varied - repetitive use, diet, heredity, and so on. In Chinese medicine this difference can be crucial because each person will be a unique combination of factors, and treatment can address this unique quality better, we believe, in many cases than western medicine which has clearly defined clinical pathways for all named conditions.

The best advice we can give is that you visit a local BAcC member for advice, and for them to have a look at the exact nature of your symptom in the context of your overall health. There may well be other factors in play which would enable them to determine whether this is simply a local problem or the tip of a systemic iceberg. Most of our colleagues are more than happy to give up a little time without charge to prospective patients to enable them to assess the potential benefits of treatment. We are confident that they will give you honest impartial advice.

Q: I am 78 and had my third session of acupuncture yesterday to relieve soft tissue problems in my upper leg and hip. I had six needles. Today I feel exhausted, light headed as if I had vertigo and my eyes are jumpy and feel as though they are trying to cross. I feel very unsafe walking about. Would you advise me to discontinue the acupuncture?

A: We are sorry to hear of your problems. In our experience it is possible to have short term adverse effects from treatment, but these generally last for a maximum of 48 hours, if that, and then vanish.

There are a number of reasons why this can happen. As you are aware, treatment is aimed at restoring the flow of energy in the body, and this can quite often produce some odd reactions as the body adjusts. Occasionally the treatment can be a little too energetic for someone, and the practitioner needs to be made aware of this so that they can reduce the number of needles and use less manipulation. Some people are very sensitive to treatment, and can react over-strongly, although the fact that this has happened after your third treatment would suggest that this is not the reason. Sometimes it can be as simple as the fact that the treatment took place on an empty stomach, and the body is a little ungrounded and over-reactive.

In any event, there is no reason to discontinue treatment, and every reason to discuss what has happened with the practitioner. All of us are more than happy to talk to patients who experience odd reactions to treatment, and in this case the person will know exactly what they did and why, and perhaps be able to make sense of the reactions. This should give you the reassurance you need.

However, we do have to add one word of caution. Just because something happens after treatment does not mean that it has happened because of it, and we have seen cases where people have experienced some odd problems after treatment which were entirely coincidental. If the feelings persist for more than 48 hours you might want to contact your GP just to make sure that this is not something entirely separate.

The most likely explanation is that it is a period of adjustment after an effective treatment, and we hope that by the time you are reading this everything has reverted to normal, hopefully with an improvement in the problems which took you to treatment initially. If this isn't the case, though, then a call to your GP would be advisable.

Q: I am considering a career change to acupuncture but am suffering with mild osteoarthritis in both my hands. I wonder if this will affect my ability to practise, or is most of the work of a fairly gentle nature? I know this is hard to answer, but I am trying to assess whether this is a sensible career path for me. I am 48 years old.

A: There is no doubt that acupuncture is a gentle therapy, and it would be most unlikely for you to have to anything which involved great pressure or strength. The majority of needles are inserted with the help of guide tubes, which require only the strength necessary to tap the needle in, and there is not a great deal beyond this which would be a must. Some teaching institutions have training sessions in tui na, a form of Chinese massage, which you may find a little problematic, but this is not something which is a must for successful practice.

The only challenge which you might face is fine manipulation and control of the needle if the condition becomes more serious. This would have to be a very significant deterioration, because we had a colleague with rheumatoid arthritis whose hands were terribly deformed and painful who still comfortably managed a successful and busy practice. However, it is something worth exploring because there is a level of dexterity which you will need.

The best way to get advice would be to contact the nearest teaching institution or, better still, visit ones which have Open Days for people to drop in and discuss the possibility of training. We have a sister body, the British Acupuncture Accreditation Board,. which accredits courses offering automatic eligibility for membership of the BAcC on graduation, and a full list of the accredited courses can be found here:

https://baab.co.uk/accredited-courses.html The website also contains a wealth of information about studying acupuncture and the benefits of acupuncture as a career.

The only caveat to bear in mind is that teaching bodies are often obliged to take on students without necessarily having to take into account their ability to practise or to register as professionals afterwards, i.e. someone can insist on being trained and a college can't turn them away. So, being pronounced fit for study may not be the same as being fit to practise. We are as sure as we can be that no-one would be unscrupulous enough to take you on if they felt that you really would struggle to carry on in the career, but we are aware that this is the legal extent of their responsibility.

Anyway, we hope that you get good news about this and decide to take the plunge. This particular expert is thirty years in and still enjoying every moment of it, and still learning!

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