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Ask an expert - general

201 questions

File under general -- general

We think that with the range of symptoms you have, and considering their nature, the first thing to do if you haven't already done so is to visit your GP to see what they make of the signs and symptoms. There are a number of quite serious conditions which can generate symptoms like this, and the first thing we would do if you came to us would be to refer you to your doctor for examination and blood tests. This would eliminate some of the possibilities at a stroke, but may actually lead to an important diagnosis and treatment.

If it turns out that there is nothing to be worried about in conventional medicine terms, then it would be advisable to visit a BAcC member local to you for them to take a look at what is happening. We can think of a number of reasons why the problem might be manifesting, when viewed from our perspective, but without sight of the problem itself we would be reluctant to start making guesses which would in all probability be wrong.

We would also be looking at dietary and environmental factors which might be involved. A surprising number of our patients have allergies and sensitivities of which they are not aware and which cause reactions across the body. The same sometimes happens with cosmetics and detergents. We are sure you have looked at factors like this, but we always check because it can cause these sorts of problems.

Even if there is no obvious cause from a Chinese medicine point of view, we hold the view that putting the system back in balance will always help to reduce symptoms. There is also a very considerable body of evidence about the use of acupuncture for pain relief, and while this can never guarantee that the problem will go it can sometimes offer long stretches without discomfort, for which many patients are very grateful.

As we said, however, this is an unusual problem for which it would be necessary to examine what was happening before venturing a view about how amenable it would be to treatment.

 

Q: I am trying to find out if I can have acupuncture as an anaesthetic for a knee operation in the UK. Is this possible in a hospital and are there any practitioners in the UK please?

A: We have been asked about the use of acupuncture anaesthesia a number of times, and a typical answer has been:

The answer to your question is that in theory acupuncture can be used as an anaesthetic, but we suspect that you will find it very difficult to locate a practitioner prepared to do it.

After Nixon's visit to China in the 1970s, and the remarkable pictures of people having some very serious operations using acupuncture anaesthesia (AA) , there was something of a surge of interest in the West in researching the use of acupuncture for pain relief and even trying to use AA. However, what the images from China did not show was that in every case there was a bank of conventional anaesthetic equipment ready for immediate use in case the AA wore off. The effects were not always guaranteed and reliable, and in the past two decades its use has now diminished to being an occasional novelty rather than mainstream practice.

We did have a colleague who agreed with great reluctance to use AA for a rhinoplasty in a patient who could not have a general anaesthetic, but he did have to study books to work out what to do. The fact that the operation went well, there was less bleeding and the patient recovered much faster was not enough to make him succumb to the blandishments of the consultant who wanted to offer him a permanent slot. He found the whole business far too stressful.

If you can find someone willing to do this your best bet may be someone who regularly uses electro-acupuncture (EA). This has the advantage of being consistent over time, and can also be ramped up if the effect starts to diminish. You might well find that some of the medical acupuncturists are more conversant with this than traditional acupuncturists, and indeed some of the physios who use acupuncture may also use EA more. Both of their registers ( http://www.medical-acupuncture.co.uk/ and https://www.aacp.org.uk/) may offer search options, as well as our own. We think you may just have to ring around until someone points you towards a practitioner they know of who regularly uses EA and may be prepared to do AA.

We are not sure that we can say any more or better than this. The only times we have come across someone having AA in the West are when an operation is necessary but for some reason the patient cannot tolerate either general anaesthetics or epidural injections. There would have to be a very strong reason for doing it, we suspect, for a consultant to be able to take what may be an enhanced risk in working in this way.

That said, a great deal depends on the operation for which you are lined up. If we are talking serious surgery like knee replacement or similar then we think it is highly unlikely. However, for arthroscopy and a number of much simpler procedures you may be able to make a case. You would probably have to sign some very serious disclaimers and make a very robust case for sidestepping the usual procedures, but nothing ventured, nothing gained.

We wish you luck, and hope that you do manage to find someone who can help you.

Q: I finish law university but I want to become professional acupuncturist. I would like to know which schools offered the best knowledge which can be approved anywhere especially in Europe.  I would prefer to learn it in China or Japan but if there is any good school in Europe It can be my choice as well.

A: We can only really comment on the schools of which we are aware in the UK. The ones of which we have direct knowledge are those accredited by the British Acupuncture Accreditation Board, whose website https://baab.co.uk/ offers a wealth of useful information about training in traditional acupuncture in the UK. Graduates of accredited course have automatic eligibility to enter the BAcC, subject to acceptable health and criminal record checks.

The issue for you, though, is that while there is no statutory regulation of acupuncture in the UK, which means that people can practise with all sorts of level of qualification under what is called common law, this is not the case across Europe. Some countries, like France and Italy, still technically regard acupuncture practised bu non-doctors a criminal act, while others like Germany and Holland, have secondary requirements for anyone wanting to operate as a healthcare practitioner. As such there are no qualifications which guarantee that someone can move freely around Europe as an acupuncture practitioner. The same would apply even if you travelled to China or Japan to get your qualification. In the BAcC we have no reciprocal recognition of qualifications with other countries, and we interview every candidate for entry who is not a UK graduate. We believe the same applies elsewhere.

It may well be that you have to work back to front - decide where you might want to work and then investigate what the baseline qualification is for these countries, and also whether you would be able to get  away with practise as a non-doctor. In France, for example, we know of few prosecutions, even though many traditional practitioners work there, and when people are caught the fines they get are strangely equivalent to what the registration fees would have been had they been official.

We do belong to a European network, the ETCMA http://www.etcma.org/, and it may be possible to use the contact details from here to ask member colleagues what currently applies in their countries, and what the relationship is between training and registration.

Q: I have tennis elbow in both arms the right arm is worse than the left.ive had 4 treatments now which lasts half an hour each time. After I have a 15 min massage the massage is so rough that the pain wants to make me cry. I was told I have bad circulation and that's why the massage is rough. So then I spend 4 days in pain after getting over the experience to go back 3 days later to have it all over again. The problem is the gentleman doesn't speak much English so I find it hard to ask him questions and get answers  I'm not seeing any progress at the moment  my question is is this normal for me to still have pain and should the massage be so vigorous?

A: We are sorry to hear of your experience.  It certainly does not help that the practitioner is not able to communicate very easily. However, we have to say that you need to be aware that you are in charge in the treatment room, and that the practitioner can only work with your consent. If you decide that the massage is too rough and ask him to stop it, then stop it he must or be guilty of common assault. It is then his problem/challenge to use his skills to circumvent the problem of not being able to get the qi moving by vigorous massage. There are always ways!

Should there be progress by now? That is a very difficult question to answer. It depends a great deal on the severity of the initial problem. Our factsheet has some reasonable evidence for the benefit of acupuncture treatment

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

but there are widely different degrees of the problem, and in some cases it can take half a dozen sessions to get the energy moving and undo the stagnation of the energy.

However, that said, the treatment should not be causing pain four days later, and unless there are stunningly good clinical results to back up continuation it would seem entirely legitimate to question whether the course of treatment is really going anywhere. There has to come a point after about four or five sessions where one can say with some certainty whether it looks like the treatment will succeed, and if it doesn't then it is important to draw a line in the sand and stop.

It is not our job to talk one of our possible members out of a job, but you need to discuss this situation with him, and if the answer doesn't help you then perhaps you might need to re-consider whether he is the best practitioner for you. We have always been very insistent that a practitioner must have sufficiently good English to address a patient's concerns because we are all too well aware of the consequences of people feeling that they haven't been heard.

And the bottom line is that it's a buyer's market. If you aren't happy with the treatment there are probably a great many other practitioners close by to whom you can transfer.

Q: I have trapped nerves in my lower back. My pain radiates down my left leg into my foot. I have now had three sessions of acupuncture. Both of my legs feel a lot worse. They ache tingle and throb. Walking is more difficult for me and I walk a lot slower. I should be having another three sessions but I am reluctant to go back.

A: We are sorry to hear that you seem to have developed slightly worse or different symptoms after your treatment.

We would be very surprised to find that the acupuncture has actually made things worse in a directly causal way. Short of sticking a needle into a nerve there isn't a great deal a practitioner can do in the lower back which would generate the symptoms of which you speak. The only time we have come across this is when someone has a trapped nerves because of changes in physical structure, and the muscles have been guarding to hold the vertebrae apart. If treatment caused these to relax, then it is just possible that this has let bony structures change position and increase the level of impingement. We do know that physios offer this as a caution when treating lower back pains and nerve impingement, but they do tend to use more vigorous techniques than we do, and this can magnify the effects.

Another, and more likely possibility, is that the treatment has started to encourage the structure of the spine into a better shape. We do sometimes find that after long periods of operating out of shape the body's musculature can start to adapt, so when improved function starts to bring the structure back into alignment some muscles relax and others tighten to accommodate the new position, both of which can generate mildly unpleasant symptoms.

Of course, the third and less palatable possibility is that something has changed or deteriorated in the back alongside rather than because of treatment, and this has created new and unpleasant symptoms such as those you now have. This can sometimes happen, and we encourage our members not to get into pointless arguments about what caused the problem but to get the person seen by their GP as quickly as possible to establish exactly is going on. This almost invariably points to causation, but crucially it makes sure that someone gets the correct attention first.

We think your best first step is to discuss the matter with your practitioner. It may simply be a matter of adapting the treatment to suit you better, perhaps by working away from the problem area or reducing the strength of treatment. If they cannot see any reason why what they have done could have caused these problems, then they will probably refer you to your GP for further examination.

We would say 'don't panic', though - we have known of very few cases where acupuncture treatment has caused serious long term adverse effects, and the majority of these have been to do with actual physical damage caused by the needles, not reactions to treatment itself. We hope you feel confident enough to talk to your practitioner about what has happened, and remind you that you are in charge in the treatment room, so if you are not happy with proceeding, then you can just draw a line straight away and stop.

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