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Ask an expert - general

189 questions

Q:Because I cannot lie for any length of time I was treated first on one side then the other. I noticed that the she re used the same needles having placed them on the cupboard whilst I had cupping in between Also I got home to find a needle still in my head. Should I be concerned?

A: We don't think you have any reason to be concerned for your safety; even in the hands of the untrained and incompetent the incidence of serious adverse effects is very very low in comparison to the number of treatments performed, and in the UK, where it is rare to find untrained practitioners, the rate of serious adverse events in the 4 million treatments a year is so low that acupuncture is one of the most statistically safe medical interventions.

We, however, would be very concerned if what you are reporting is completely correct. Leaving a needle in a patient is something which should never happen. The BAcC has very clear guidelines to ensure that this never happens, and we take a very dim view of practitioners who, through negligence or poor record keeping, leave needles in a patient. This is equally because of the risk to the patient and also because of the risk to any other member of the public if a forgotten needle drops out and is trodden on or handled by a third party. This would require what is called PEP treatment, post exposure prophylaxis, because without knowing where a needle came from one has to assume the worst and check for blood borne viruses over a six month period.

More concerning is the possibility that needles are being re-used. In the BAcC members are expressly forbidden to re-use needles, even on the same patient, and anyone doing so would be subject to serious disciplinary action. As we said above, the risk of infection is so small as to be largely theoretical, but even a small risk is too much to entertain if it can be prevented by simple safe practice guidelines. Needles are very cheap, and there is no excuse for using them more than once on any level.

We sincerely hope that this is not a BAcC member, but given the fact that there are two serious defaults from basic safe practice we would be very concerned about the overall standards of practice in someone who was not attentive to these basics of safe practice. It is not our job to encourage people to complain, but if the practitioner does belong to a professional association then we believe that they should be required to give an explanation of what they have been doing. This can often be done anonymously, i.e. you could report the matter without letting your name be known to the practitioner, but in most cases this would mean a professional association could not take formal action. However, if it prevented the practitioner from behaving in this way because they were under notice, so to speak, the public interest will have been well served.

It is possible that what you thought you saw isn't what actually happened - we have had a small number of cases where a practitioner has followed the rules to the letter but from where the patient lay it didn't appear so - but our Codes are very clear that a patient must be able to see everything that is done in plain sight. This means seeing a practitioner open up a fresh needle every time, not suddenly appearing with one in their hand. This is the easiest way to assure patients of good practice standards.

We are sorry that you have had this experience and hope that it hasn't discouraged you from continuing to have treatment, even if not with this practitioner.

Q:  After treatment 2 years ago with high dose oral steroids I experienced a raft of adverse effects, including fatty deposits on my left lower leg and foot that caused extensive nerve damage and paralysis [juxta-articular adiposis dolorosa].  Clinicians tell me that there is no way of removing the fatty lumps; however, I wonder if acupuncture could stimulate the body's own mechanisms. Any information you can offer would be most appreciated.


A:  This is one of the sorts of question where we tread with great caution. Acupuncture treatment is often a treatment of last resort and we are always concerned about raising expectations where the chances of improvement are slim. However, there have been for nearly every condition we have seen cases where there has been a remarkable turnaround, and although this is often described as 'spontaneous remission or cure', often much to our colleagues annoyance, the reality is that this is the exception rather than the rule, even if it were demonstrably caused by the treatment.

 There is, as you might have expected, no research of which we are aware or could find which suggest that acupuncture treatment might help. The condition is rare, and research studies would need a much larger cohort of people to work with to have any meaningful outcome. We have not even been able to find a case study.

 However, problems such as this have been around for thousands of years, whatever the cause, and Chinese medicine would have been used to address the manifestation, just as it would for any other condition which we now recognise under a western name. Traditional acupuncture, based as it is on a flow of energy called 'qi', would have and still does look at problems like this as blockages in the flow of qi or accumulations of energy caused by stagnation. The practitioner would be keen to establish whether it was a local problem or a local manifestation of a systemic problem, and then use the needles to try to move the qi and disperse the problem.

 All sounds rather easy when put like this, but the reality is that the growth of new tissue in the body as a consequence of conventional treatment has proved very difficult to address, and if you were to present at our clinic the best that we would ever say is that it may be worth a few treatments to see if there was any noticeable change, and if so to discuss how much and how sustainable. The problem is always to determine a scale by which change can be measured. If there are clear signs that it impairs movement or causes local pain then there are scales which one can use to determine what effect the treatment has. If it's simply a matter of trying to measure the size of a fatty lump, that would be much more difficult.

 The best advice which we can give is to visit a local BAcC member to see what they make of the presentation in the context of your overall health picture. There may be something in the systemic presentation which suggests that treatment may have an impact, but in any event it would enable much more detailed advice than we can give at a distance. Most members are happy to give up a little time without charge to help prospective patients make informed decisions about their health and healthcare options.

 In summary, we think it might be a long shot to try acupuncture treatment for this problem, but we would never say 'don't' because our work is not simply about trying to get rid of specific conditions but about trying to balance the energies of the body to enable it to function as best it can. The ancient Chinese used to believe that this would enable to body to heal itself, and we have certainly seen cases where change happened against out expectations.

 

A: We fear that you may find it rather difficult to find anyone who offers Japanese acupuncture in your area.

 The major problem that we have is that there are no undergraduate courses in the UK offering training in the various forms of Japanese acupuncture. This means that we have no database entries which means that we can day with confidence that someone initially trained in this style. Even this may not be helpful, however; many practitioners change their focus over time to another style of practice or amalgamate several, and we have not yet come up with a system for being able to provide specific referrals for the public.

 The best that we can suggest is that you use the postcode search facility on our home page to discover which BAcC members work locally to you. It would then make perfect sense to ring them up and ask whether they offer this as an option, or more importantly, whether they know someone locally who does. Their local knowledge is going to be much more precise than our national material, and practitioners often have informal networks in their areas to identify specific styles or specialisms for prospective patients.

 The only other alternative is to contact some of the associations or special interest groups to see if they are aware of people using Japanese acupuncture in your area or have trained people over the years. The Toyohari Association is one such http://www.toyohari.org.uk/. There are also a number of training providers, but we are not able to make recommendations for a number of reasons, so the google search under 'japanese acupuncture training uk' will generate three or four useful hits which you may be able to follow up. It is possible that they have lists of people who trained with them and whom, subject to data protection concerns, they might be able to name for you.

 We do hope that you manage to find someone. Japanese acupuncture is a very gentle form of treatment. However, there are many other styles which borrow heavily from the Japanese traditions, as for example Five Element acupuncture, and you may find that there are local practitioners who can offer something very similar.

 

Q: Your FAQ implies that chronic fatigue is a more difficult condition to treat. How can I find a practitioner who has a lot of experience in this specific condition?

A: We're not sure which specific FAQ you may be referring to, but it is true that the treatment of Chronic Fatigue syndrome can be more challenging than some health problems. We would hesitate to say 'difficult to treat' because in Chinese medicine we treat people, not conditions. That means for us that the overall balance and rhythm of someone's energies can have a profound impact on how a condition manifests and also how easily it may be treated. This can mean on occasion that a seemingly intractable condition can resolve very quickly where an apparently trivial problem can take forever.

 What is clear, though, is that CFS often responds to treatment, as our factsheet shows

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-fatigue-syndrome.html

 but it can often be a part of a complex overall presentation which may well have emotional as well as physical components. In some cases the emotional and mental issues can be integral to the development of the condition, and in other cases the emotional and mental consequences of the health issues can make it even more difficult to shift.

 We can understand why someone might want to see an experienced practitioner in these circumstances, but the reality is that nearly every presentation is unique, and all of our members are equally well qualified to make informed judgements about how best to treat the specific manifestation. The only reason where seeking a more experienced may have some merit is that treatment of CFS can sometimes take a relatively long time, and someone who has treated many cases will have lowered their expectations a little more than an enthusiastic newly qualified practitioner. On the other hand that enthusiasm is what sometimes achieves the unlikely, so as with all things in life, there are arguments both ways.

 Our members are the best source of advice for you, though. We are not in a position to say who is or isn't more likely to be what you are looking for, but we are pretty certain that if you contact a local BAcC member and ask them who has the most experience locally of treating CFS they are likely to tell you. Our over-riding concern is to do the best we can for prospective patients, even if that means referring them on to colleagues who we think may be better suited to their needs. 

A: We're afraid the answer is not a great deal. We have trawled the research databases, and apart from one very small study about twenty years ago of two patients, neither of whom showed any improvement after treatment, there have been very few case reports at all. This does not mean that they don't exist; there are literally thousands of studies undertaken in China every year. Most, however, are not translated, and we have to work on the premise that the ones that make people sit up and take notice are the ones which generate important results. Routine studies which show minor improvements are usually acknowledged and left untreated.

 Stammering is a very complex problem with all sorts of emotional and physical causes, and it might just be possible that a skilled practitioner might see something in the overall pattern of the child's energies which might offer some hope. We are always cautious about how we express this. Chinese medicine treats the person, not the condition, and so at some level you could say that it treats anything. 'Treat', however, is often taken to be synonymous with 'cure', and this is certainly not the case.

 Although we are all by the nature of our work generalists, but there are a couple of areas like obstetrics and paediatrics where we are looking at accrediting postgraduate education in recognition of expert practice. Children are not little adults, and there are a number of well-established courses and core texts which underpin specialist treatment. Many hundreds of practitioners in the BAcC have qualified to treat children, and although in the absence of finally agreed standards we cannot make recommendations, a google search for 'acupuncture' and 'children' in your area will almost certainly generate a number of hits. Alternatively you could ask a local BAcC member which of their colleagues specialises in treating children; most will have a 'go to' person in mind.

 The point of this is to see if you can arrange a brief assessment visit to see if there is anything in the case history which might encourage someone to believe that with treatment they may be able to help the child in question. We would expect them to give an honest assessment.

 What we do know well, though, from treating adults who stammer alongside other health issues is that there is no magic wand to effect change, and only in a few cases have we come across substantial changes. These have often been as much about reducing the anxiety which surrounds the problem as about actually stopping the problem at source, but conditions like this are often perpetuated by the worry about being about to stammer. 

 We hope that you manage to find someone who can offer you good face to face advice.

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