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Ask an expert - general

201 questions

Q: Can someone on blood thinners have acupuncture?

A:We are often asked about the use of acupuncture on patients taking anti-coagulants, and we usually quote a section of the Guide which we distribute to all members (but not the public) which says:

Patients on anti-coagulant medication: You must take great care when needling patients who are taking anti-coagulant drugs such as Warfarin. Only very superficial needling with fine needles (0.20mm) is recommended. The risk appears small but internal bleeding leading to compartment syndrome can have extremely serious consequences. There is one report in the medical literature of a case of compartment bleeding following acupuncture in a patient taking anti-coagulants (see link to article at the end of this section). Warfarin prevents the body from metabolising vitamin K. Vitamin K controls the formation of a number of coagulation factors in the liver and is an essential substance for blood clotting. Vitamin K is present in most of the foods that are considered to be blood-forming according to Chinese medicine such as green leafy vegetables. This is important to consider if you are giving dietary advice to patients on Warfarin since these foods can lessen the desired effect of the drug. Patients are put on Warfarin or other anti-coagulants for a number of different reasons. These may be purely preventive if, for example, the patient suffers from atrial fibrillation or has mechanical heart valves, or because of recent surgery, stroke, heart attack or thrombosis. The dosage of the medication depends on the desired amount of anti-coagulation for that particular condition. Every patient on Warfarin has to undergo tests on a regular basis to check how long it takes for their blood to clot. The frequency of these tests depends on the dosage of their medication and their condition. It is good practice to encourage your patient to have more frequent tests while they are receiving a course of acupuncture as the treatment can positively influence their blood values and may require their Warfarin dosage to be reduced. Ask your patient for their INR (international normalised ratio). The INR is a ratio established by measuring the prothrombin time (PT), which is the length of time it takes for the patient’s blood to clot, and then by comparing this value to an average. In a healthy person the INR is about 1.0. Patients on Warfarin tend to have an INR somewhere between 2.0 and 3.0 or even higher, depending on the desired amount of anti-coagulation. A higher INR signifies a stronger effect of anti-coagulation. The main risk associated with acupuncture is internal bleeding. Depending on the depth of needling and the underlying structures involved this may be insignificant, but there is a chance that it can result in compartment syndrome. Although the risk is small this condition can have serious consequences and often requires surgery. Needling should only be done superficially and with fine needles. The higher the INR, the greater the risk of bleeding. Patients with an INR of 3.5 (sometimes therapeutically necessary in the treatment of valvular disease) or higher should be treated with greater care. It is also advisable not to use guasha and cupping on patients on anti-coagulants since these techniques tend to draw blood to the upper layers of the skin and can cause severe and prolonged bruising to larger areas of the body.

Of course, we have had to adjust this advice in the new version which we are just about to publish because there is a new generation of anticoagulants like dabigatran (Pradaxa) which do not require the regular monitoring of INR levels, so practitioners need to be vigilant in looking at what happens after they have needled someone. If the patient bruises unexpectedly or with every needle insertion then it may be sensible to refer someone back to their GP for testing to ensure that the dose is correct for them.

Our main caution in Chinese medicine would be where there are syndromes which describe the blood as 'stuck', a term often used being 'blood stasis'. It is just possible that someone being treated with Chinese medicine for blood stasis while at the same time being prescribed anti-coagulants might just find that they clotted a little less quickly than before, but change in this department is never that rapid or dramatic, and the appearance of bruises or bleeding which is harder to stop might well be the first sign of an over-effective combination of therapies. As would always be the case the practitioner would usually refer the patient back to their doctor for re-assessment.

I've been having migraines for years but in January this year I had a 14 day session (triptans helped me) so I decided to try acupuncture.The doctor is one of the best ones in my country and she gave me homeopatics (Corpus callosum and some others) as well. I had needles in my head, ear and some other parts of my body to stop having migraines. It really helped and I don't have them anymore, but since the second meeting (1st needles in my head) I had some strange feelings. First I felt tingling in my head every single day and then after the 3rd meeting I feel very strange - no tingling but like a pressure in my head which seriously never stops and I have some eye troubles sometimes (one eye has a blurry vision etc) but always for a while. Also I have dizziness sometimes. It seems that I have it close to the places I had the needles and I am now wondering what can be the cause. Could it be the acupuncture/the homeopatics or anything else? I study medicine and I was going to a neurologist before (because of the headaches) and there was no problem found accept the migraines. But I got a bit scared now as I really feel strange every day.Today I stopped taking the homeopatics and at least I stopped feeling the dizziness I hope. What would you say might be the reason of the whole strange head problems?

A: We are very sorry to hear that you have had these problems, although we are pleased to hear that your migraines have cleared up.

The one possibility that comes straight to mind is that what you are experiencing is something which has been a component of the migraine itself for a long time but hidden by the much greater pain which you must have been experiencing. This may mean that you have to continue with treatment for a little longer in order to clear the energetic problems which were the root of the migraine, some of which we have heard described in the terms which you use.

We have given careful consideration to the range of odd symptoms you have had, and we don't think that there is much likelihood of these being as a result of treatment. The vast majority of what we would call adverse effects are transient. Someone might feel dizzy after treatment, but this would last for 24 to 48 hours at most, after which the system would recover to the initial starting point. The only occasions where this would not be the case would be where there was some actual physical damage to the body, and we would be very surprised if inserting needles on the skull could do this. It is just possible that there has been a small bruise which is causing a minor energetic blockage, but you would be able to feel this as a tender point on the head.

We are, however, a little concerned that you are experiencing eye problems. We don't think for a moment that this can have been caused by the acupuncture, but were it to happen to one of our patients we would be recommending that they saw their optician or optometrist fairly soon. It may be that this problem has nothing to do with the acupuncture treatment as such but has by coincidence arisen at the same time. Whether it is or not, it would be important to get this checked as soon as possible.

We are interested to hear that you are also using homeopathic remedies, and that some of the symptoms have abated now that you have stopped using them. We think that it may be a good idea to take stock of the situation with your homeopath/acupuncturist. She, after all, is the person best placed to understand what is going on, especially since she will know exactly what your energetic balance is and was, and how she hoped to treat it. This will be far more informative than anything we can offer here.

The bottom line, though, is that if the various neurological tests have shown nothing untoward, then there is very little chance that acupuncture has caused any physical damage to generate the symptoms you are experiencing. This would imply that the effects are energetic, and your practitioner should be able to add these to the diagnostic mix and deal with them. However, we would advise that you get your eyes checked anyway, just in case this is a contingent problem.

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.

 

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