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Ask an expert - body - abdomen / gastro intestinal

38 questions

Q: I had my middle and lower right lobe removed from my lung 7 weeks ago. I have recently had an infection around the lung and been on IV anti biotics in hospital for 1 week and now home on oral antibiotics . During this time I have had severe nausea and intermittent sickness. I take anti sickness tablet cyclzine but it appears to make no difference. I also still have pain and take paracetamol . What I would like to know is could accupuncture help or cure the nausea or even help with the pain as the traditional treatment doesn't seem to be .

A: We are very sorry to hear of what you have been through

It's very heartening to be able to point to some very good quality research for the treatment of bot post-operative pain and post-operative nausea, as our fact sheets demonstrate:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html

and

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/post-operative-pain.html

We aren't able to offer this as conclusive evidence, at least not to the standards which the ASA

require us to demonstrate for claims of efficacy, but there has always been a decent consensus amongst both traditional and medical acupuncturists that nausea in particular is treatable. Indeed as the factsheet shows, there is one acupuncture point on the arm which is cited in nearly every trial as one that 'does what is says on the tin.' This is the same point which is used in the various seas sickness bands which are found on sale in most chemists.

Any practitioner taking you on will need to be a little more cautious than usual, because there is no doubt that from both an eastern and western perspective your immune system will have taken a serious knock, but as long as someone works carefully within our Code of Safe Practice or equivalent all should be well.

The best advice, which you will see repeated in most of our answers, is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture treatment may be of benefit. You may find that home visits are more appropriate at this stage, and many members are happy to do this.

There was a major review two years ago

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746655/

which summarised all of the trials which had been conducted, both on animals (what we sometimes refer to as 'ratpuncture') and on humans. The conclusions are cautiously positive, although as you can see the treatment rarely involves acupuncture alone. There is an interesting study just in the offing

http://clinicaltrials.gov/ct2/show/study/NCT02006329

but it will be some time before any results are available.

As we said, though, it depends in large measure what you or your consultant believes to have been the cause of the problem, and given that you think your consultant will disagree, what course of treatment is being proposed instead of or as well as which you would like to try an alternative approach. In our view there is nothing to lose by trying acupuncture, and since it can be used alongside conventional treatment no reasin why your consultant should take umbrage. It certainly won't do any harm, unless you seriously delay conventional treatment while seeing whether alternative treatments work.

Our best advice, which must seem a little repetitive to anyone looking at several answers, is that you should visit a BAcC member local to you for a brief face to face assessment if what may be possible with acupuncture treatment. They will be able to look at the condition with the benefit of being able to get more medical and lifestyle background, and may well get a very clear handle on what from a Chiense medicine perspective appears to be the underlying cause of the changes

A: There is no absolute contraindication to acupuncture after a mastectomy. The advice we give to members in the Guide to Safe Practice, an internal document which contextualises the provisions of the Code of Safe Practice, is:

Most patients who have had lymph nodes removed (eg from the axilla after a radical mastectomy) are cautioned against being needled in the limb below the site of lymph node removal due to the increased risk of infection.

It is advisable to mark your treatment notes clearly and visibly to ensure that you do not overlook this in practice.

There have been some discussions about whether the entire quadrant of the body relating to the affected limb should be avoided. Most patients are, however, just advised by their consultants only to avoid having the affected limb needled.

We recommend that in each individual case you follow the individual guidelines the patient has been given by their consultant.

We would leave it to someone's professional judgement about when it would be appropriate to needle proximate to the scar tissue itself, but members are trained to err on the side of caution. Indeed, the nature of traditional acupuncture, where points can be used to act on areas of the body far removed from the needle site means that there are always ways of treating an affected area without going near it.

This is particularly apposite when the mastectomy has been accompanied by the stripping of lymph nodes in the axilla, after which many women experience some lymphoedema. Amplifying the advice we give in the Guide in a response to another enquirer, we said

As far as needling a lymphoedematous arm is concerned, our current recommendation to members is that this is not to be done. Although there is little or no evidence to support the almost universal prohibition of acupuncture by consultants, we have to acknowledge that there is an increased risk of cellulitis and other infection from needling a limb below where lymph nodes have been removed. However, there are many ways of using the interconnections within the system as a whole to treat successfully at a distance within the body, and a qualified practitioner will have many ways at their disposal to effect change and improvement.

Indeed, one of our members, Beverley de Valois, has published several landmark papers in this area

http://www.researchgate.net/profile/Beverley_De_Valois/publications

and has shown that treating constitutionally without needling an affected limb can be very beneficial.

We have heard of instances where the prohibition of acupuncture after mastectomy has been total, and we can only re-iterate what we said in this response, there is no evidence that acupuncture has elsewhere on the body has any adverse effects on a post-mastectomy patient.

Q:  Is it safe to have accupunture 5 years after a total colectomy with new pouch and rectum. All the large bowel was taken away. So my small bowel is flopped down over over everything

A:  It is perfectly safe, as far as we are aware, to have acupuncture treatment after a colectomy. Assuming that all of the wounds caused by the operation have healed well, and that there were no post-operative complications for which you are receiving further treatment or on medication, then we believe that treatment can do no harm, and may well be of benefit.

There are a number of situations where the removal of the physical organ, such as the gall bladder, spleen, or in your case large intestine, may have implications for the Organ (we always capitalise this because in Chinese medicine Organs are functional entities ranging over body, mind and emotion) in its other functions, as understood from a Chinese medicine perspective, and we are often able to support the affected Organ when the physical part of it has been removed.

You do not say in your question whether there aspects of your post-operative situation which you would like to improve or whether it is simply for general health and well-being that you are keen to explore treatment. We do find that this latter aspect is often very important after major surgery. The whole system is often very seriously affected by major surgery, and acupuncture treatment in its most ancient traditional forms was all about helping the body to regain normal balance and function. However, there may be specific aspects of your digestive function which may continue to give you problems, and it is possible, within the constraints of working with a functionally altered set-up, that acupuncture treatment may be of benefit.

There is obviously no research, at least in English, that we can find which looks at acupuncture after colectomy, and your situation will be unique to so. This is why we always advise people to ask a BAcC member local to them for advice after a brief face to face assessment. This is likely to be more informed and informative than anything we can offer at this distance. We are sure that they will be interested in exploring with you the circumstances which led to your operation and whether this shows evidence of patterns of imbalance which might inform their advice on what is possible for you.A: 

Q:  My wife had surgery for bowel cancer 3 years ago. Since then she has had a great deal of trouble managing her bowel movements and has had daily panic rushes to the little room! She has found this very difficult and distressing. Can acupuncture help and if so is there somebody with expertise in the area of bowel cancer treatment and its after effects that could help her? We live in Pulborough, West Sussex about 12 miles north of Worthing/south of Horsham.

A:  It is extremely difficult to generalise about the treatment of bowel frequency and urgency after surgery for bowel cancer. So much depends on the amount of tissue removed and exactly where from, and it is not uncommon for it to take a long time to restore normal function. There is evidence for the treatment of urgency, frequency and discomfort within the conglomeration of symptoms under the heading of irritable bowel syndrome
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/irritable-bowel-syndrome-ibs.html
 
but this is not quite the same as surgical resection.
 
There are two possible ways in which acupuncture treatment may be of benefit. Acupuncture is increasingly used to aid normal recovery processes in a great many areas, and although the research of these cases is still broadly in its infancy, there is no doubt in our minds from the anecdotal evidence we have that people do tend to recover more quickly and 'better' from surgery. This expert has on many occasions treated patients pre- and post- cholecystectomy (gall bladder removal) to very good effect. This is not a surprise, however; although a great deal of modern focus is on treating named conditions traditional chinese medicine was primarily concerned with restoring balance and homeostasis. Whe you consider the massive disruption to the whole system caused by surgery, anything aimed at helping to restore natural order is probably going to be of benefit.
 
The other possibility is that there has been disruption to specific parts of the system in such a way as to cause frequency and urgency. From a Chinese medicine perspective knowing the cause of a problem is sometimes less important than recognising how it manifests. If the pattern of signs and symptoms which your wife has approximates to one of the recognised syndromes, then there may well be some help which a practitioner could offer. The only and best way to see if this is the case is to seek an informal face to face assessment from a BAcC member local to you. Most will offer you a little time without charge to assess better than we can here whether treatment may be of benefit.
 
As far as expert practitioners are concerned, we take the view that all of our members are properly trained to be able to offer good Chinese medicine to any patient they see. There may be some value in seeking out someone with a few more years of experience in dealing with patients with serious conditions, but that will not change the basic principles of diagnosis and treatment which we all offer. There are a number of extremely well-qualified and experienced practitioners in your area, including two in Pulborough itself, and we are sure that by using our search function you will be able to locate someone who may be able to help your wife.  

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