Acupuncture… Wish I’d had my tutor as a clinician!

In a previous blog I planned to do a blog about acupuncture and/or hydrotherapy, adding in some research, and I did start looking into the papers… but for some reason my heart just wasn’t in it! And if you have ever tried to read a research paper when your hearts not in it you will know that they are the perfect antidote to insomnia!!

 

So instead I will just give you a run down of my personal experience! I’ll try and give you a brief history of acupuncture first from my notes taken whilst training in acupuncture earlier this year, unfortunately I haven’t really had the opportunity to practice my acupuncture since the course… and you certainly can’t acupuncture yourself effectively!

 

There are two recognised types of acupuncture TCM (Traditional Chinese Medicine), and the western approach.

TCM is known to stretch back as far as 3000 years, it is a holistic concept of treatment and a recognition that the body has the ability to return to a balanced state of health/repair itself given the correct stimulus. TCM aims to balance ying and yang (two opposing energies), takes into account the 5 elements (Fire, Earth, Metal, Water and Wood), and along with assessing the pulse, and tongue (and a few other bits and bobs) TCM practitioners try to gain access to the energy that circulates in the body to restore balance and subsequently healing.

 

However, the NHS can’t really work to those guidelines!!! Western medicine needs evidence based practice, it needs proof that what it delivers is backed by clinical evidence and is cost effective. Practitioners have had a good idea that acupuncture works in certain situations, and therefore it has been dabbled in in western medical literature since the 17th Century, but only really has there been any western systemised clinical trials since 1950… so we are a touch behind the Chinese with this one! Sadly western medicine tends to ignore the wealth of evidence from China, to do it’s own. Evidence has been looking into the science behind how acupuncture works, the science behind pain, and how we can modulate pain, and has yet to look into how acupuncture can be used for asthma, gastric motility, mood, addiction, etc. etc. etc. in any great length.

 

What we do know is that acupuncture can have a strong analgesic effect… I’m not going into the science of pain and how acupuncture effects pain… that is was too much for my baby brain to take at the moment ***

 

Ok… back to my recent experience… As I said there are two approaches, I was trained by a western practicing physiotherapist who happened to be Chinese, and after learning the western way, has been to China to learn the TCM method also… He looks at papers from both sides of the globe for his evidence and teaching, and therefore stepped away from the rigid teachings of some western acupuncture societies to pass on his wealth of knowledge to hopefully produce good practitioners that get results, whilst still are able to backup their practice with evidence.

One of the main aspects of his teaching was that acupuncture needs at least 6 sessions (3 weeks getting treatment twice a week), plus there needs to be progression, so start with 6-10 needles (consider if this is unilateral or bilateral – so may need for example 6 needles per hand if treating hand pain) but increase number of or change points of needles as required, aim for 30 minutes treatment time, and make sure you stimulate the needles initially every 5 minutes until Deqi (energy – generally felt like a numbing heavy sensation – this is the sensation that enables people to undergo surgery with only acupuncture as analgesia!!) is achieved.

This is how both the western and TCM have shown that acupuncture gets results….

 

My acupuncture consisted of (despite my pain being widespread) once a week sessions of 30 minutes for 4 weeks, two needles in each wrist (this didn’t vary or change at all despite little help from the first couple of sessions), stimulated once per session, with no Deqi achieved, and a huge amount of discomfort 1) in the positioning of myself – have you ever tried to sit in one position for 30 minutes without moving an inch because you have needles sticking into your very sensitive skin, and 2) in the needle sites them selves as they were in so shallowly that they waved around in the breeze from an open window.

Acupuncture, although not a painless procedure – someone is sticking needles into you – is on the whole a very comfortable treatment. Most of your bodies pain receptors are in your skin, once the needle has passes through these into the tissues below there is very little to be felt. Acupuncture needles are sooooo much thinner than when you get an injection, and therefore are far less painful than any injection…. unless they are left in the superficial layers of the skin!!!

 

So all in all… I’m afraid despite how lovely my clinician was, my acupuncture was a huge failure, however this lady wasn’t used to treating ladies with RA, she’s used to treating pregnant ladies with low back pain and pelvic pain, and all the girls at hydro that I spoke to that were getting acupuncture for their pain were getting great relief, therefore I feel it was probably a lack of experience of treating other areas of the body!!!

I think probably my background knowledge also put me at a disadvantage as I was sitting there thinking… ‘this isn’t enough needles, there are better points around the hand and arm that could be used, the needles aren’t in enough, they haven’t been stimulated enough, I’m not getting that nice warm heavy numbing sensation’.

As they say, ‘if you believe something is going to work it probably will…. if you don’t believe in it it probably wont!’. I do believe in the benefit of acupuncture, wholeheartedly, just not my recent exposure to it!!

 

So, my advice to anyone who is considering acupuncture for RA… I’m sure it has it’s uses, but if your looking for a practitioner do your research!! Either TCM or Western I believe both have value, I think it is more important the level of experience that that practitioner has in treating YOUR condition or problem! Ask them how many people have they treated with these problems, what is their success rate, ideally get some recommendations from people who have been to them before, and check out their registration to professional bodies – anyone can do a couple of weeks course and pop a certificate up on their wall, but if they are registered with a professional body then they will be regulated!!

 

*** Pain is a really fascinating thing, and how the body and brain connect to signal pain or block pain is very interesting, so if you ever decide to look into it, there are thousands of books and websites and papers that go into it in varying amounts of detail!! Just be prepared to get your thinking cap on and give yourself plenty of time!

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A Tough and Emotional Week…

It’s the Friday afternoon, of a very tiring and emotional week. My last post stated ‘but it will get better’… The toughness and emotion have been present all week, neither better nor worse, the outcome of the week, I think all though a hard one for me to accept initially, is probably the right outcome… So I think things will get better!

Last week I self-certified a few days off sick because my joints just wouldn’t let me keep going. Back to work on Monday… a difficult decision in some ways as my very supportive boss said as I left mid-morning on Wednesday, ‘take all the time you need and make sure your right before you come back, don’t rush back’. I appreciate the sentiment, but when every morning you wake up and feel rubbish, work or no work, how do you tell which morning is the right morning to go back? However, Monday came around, and I felt I should try a new week.

Tuesday morning I had a Women’s Health physiotherapy appointment that I had arranged whilst off, she was supportive, but as I know too, there is little she can really do. She can’t cure my RA, but she did offer hydrotherapy and acupuncture, which I have accepted. I’m happy to try anything that might help ease the pain or stiffness. I have been doing my own hydro of a fashion when going swimming, but it’s also nice to get other therapists ideas on exercises/rehab.

Wednesday was a day off (using my annual leave to break up the weeks), which worked well as I was exhausted after Monday and Tuesday, and hydro is on a Wednesday at 13.30 which would have been really awkward if I had been at work.
Hydro was lovely, very gentle, and a lot less than I would do on my visits to the pool (but at the cost of £3.80 per swim I’m afraid I feel I have to get my money’s worth!!), but it was great in the warm water to take my joints through their full range of motion with very little pain. Plus as there were ladies there with pelvic girdle pain there were core exercises as well which you can never do too many of!! Now granted… getting out the pool did suddenly make my body feel twice as heavy, but it had worked wonders on the lovely water retention that has come to fruition over the last week (Just to add a little extra size to my already fat feet…!! To think I once wanted to be a foot model!).
The physio is going to add acupuncture to my treatment plan for next week as she didn’t want to overdo it in the first session. So that will be interesting, having never had acupuncture as a treatment!!

Thursday, back at work, feeling some benefit from having the Wednesday off, but still, as every morning is proving to be, a difficult and tired start to the day.
For the last week I have been sleeping in the spare bed, it has a memory foam mattress, and space! Which in this beautiful English summer weather, is worth its weight in gold!! Because by ‘eck this little baby is making me warm!! Plus the fact that I am trying my best to sleep on my side, which is very uncomfortable for my shoulders and hips no matter how many hot sweaty pillows I use in all manner of places to prop myself up! So every night without fail, I will wake up several times to sit up and turn onto the other side (rolling is impossible at the moment). This swap of beds has made for better night’s sleep for both of us… but it is weird. We don’t quite feel in the right age range to be having separate bedrooms just yet… so hopefully this won’t be a permanent thing!!
Anyway, back to work… I had a very minimal case load in comparison to my heavily burdened colleagues, which is due to their lovely support, but it does make me feel pretty useless and quite guilty. Although I do understand that if I wasn’t there at all those patients would be added to an ever growing list of patients for my long suffering colleagues to deal with. So I’m not totally useless… By the by, I got through the day. Exhausted, wiped out, fog brained, done in. The drive home was weary, and I was finding it difficult to keep my eyes open.
At home, I vegetated on the settee, despite the most beautiful summer evening (we bought out first set of garden furniture this spring – I was so excited – but I have barely used it as every evening all I want to do is go to bed!! Last year we had had barbeques coming out of our ears, using dog crates and camping chairs as furniture!!). I had a weep and a chat with Andrew about how I was feeling, and at 8.30pm we went outside to watch the dogs in the garden… that cheered me up.

This morning arrived, and I knew I had my 25 week midwife appointment. So after I had eaten my breakfast I wrote down the main things that were making my life hard (picture below). I felt I had to do this, as I knew I’d either forget (fog brain/baby brain… it’s a wonder I know how to spell!), or I’d be too upset to get the words out. For me at the moment, the worst feeling is that I don’t have the mental strength to keep going in to work and focusing. The physical side is hard, but as anyone who has RA or any other chronic pain problem will say, the pain is a given so you just keep going, working through it. But once the mental toughness has slipped, the pain becomes too much to manage.
The mid wife was lovely (I’ve not seen the same one twice yet and some have been better than others!), and very supportive, (yes I did get teary and upset). Everything baby wise is going swimmingly. But she immediately made me an appointment with the GP so I could discuss taking some time off. The GP (a very well dressed, highly made up, hard faced, slim woman) was less supportive and comforting. Very matter of fact and (I felt) suspicious. But after some rather hard questioning she signed me off for 2 weeks, and prescribed me some ibuprofen gel (10%).
I felt emotionally drained. So after letting work know, and again getting a lovely response from my boss who has been nothing but supportive the whole time I’ve been pregnant, I went home and slept!
So let’s see how the next fortnight goes… I worry I’ll have the same dilemma as I did this Monday. Every morning is tough, how will I know if I have enough strength in me mentally as well as physically to go back to work, and how will work feel if I keep popping back for one or two weeks here and there?
I’m not 100% sure about using the gel… especially not if I’m off work. I prefer to manage my pain in other ways if I can. Any thoughts on using Ibuprofen gel during pregnancy?

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