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October 2010 Ask the Expert: Acupuncture

Originating in China more than 2,000 years ago, acupuncture maintains health by removing blockages of vital energy, or qi (pronounced "chee"), in the body. Western medicine cannot fully explain how acupuncture works; however, researchers suggest that acupuncture may relieve pain and side effects by improving blood flow and stimulating the nervous system.

During the month of October 2010, Living Beyond Breast Cancer expert Mary Ellen Scheckenbach, MAc, LOM, answered your questions about how acupuncture can help improve your quality of life after a breast cancer diagnosis.

Introduction by Ms. Scheckenbach: Acupuncture involves placing very, very thin sterile needles into acupuncture points on the body. Before a practitioner can decide where to place the needles, a traditional diagnosis is done. This diagnosis uses the principles of a kind of physiology which can seem very different from what we understand in the West. Nonetheless, this diagnosis combined with the principles of acupuncture treatment can alleviate many symptoms for which there are not effective pharmacological or other treatments in our culture.

The primary objective in acupuncture is to determine where the chi, or energy as we call it, is blocked or deficient in the body. The needles regulate the movement of this chi throughout our bodies and ourselves. The goal is to martial our own chi, our own resources, to restore healthy functioning in the body, mind and spirit.

No one knows much about how acupuncture works; practitioners learn how to make it work to heal and enhance well-being.

I know that acupuncture can help reduce hot flushes. How many treatments are necessary, and do they need to be ongoing?

Can you tell me why acupuncture seems to alleviate the side effects of chemotherapy?

I have heard that patients who have a low blood count should not have acupuncture due to fear of infection. Is this correct?

Is there any acupuncture treatment that might help lymphedema?

How about acupuncture for neuropathy? Can it help restore nerves?

I get frequent acupuncture, and I find that the day I get it I cannot fall asleep in the evening. I have brought this up to my acupuncturist, and she says that it is not because of the acupuncture. I feel it is. Could it be?

Could one get too much acupuncture? How many times a week is considered safe and effective?

I have lymphedema in my right arm. Everything I read about lymphedema says to avoid skin punctures to the affected limb. How risky is acupuncture? (I have had acupuncture treatments for carpal tunnel and arthritis in my hands. The treatments have been effective, but [they] have to be repeated after about 6 months. Each time I do it, I worry.)

I have had a recommendation for acupuncture treatments from my doctor. I am open to this and had scheduled a series of appointments. However, my primary health insurance does not cover it, nor does Medicare. Are there any other options for getting acupuncture, as the private pay costs would be 1/2 my monthly income?

For women who have had a nodal dissection, would you place needles in that affected limb?

How do you determine whether someone is qualified to do acupuncture?

I have neck and lower back pain as well as cramping of the calf muscle in my left leg and neuropathy in my left foot. I want to get off pain medication (I take 2-3 Aleve and 2500 mg of Gabapentin daily and still have pain). How can acupuncture help?

I have triple-negative breast cancer. I have used acupuncture to relieve sciatic pain. It works. This past January, the doctor diagnosed me with triple-negative breast cancer. How can it be treated with acupuncture and how long?

Question: I know that acupuncture can help reduce hot flushes. How many treatments are necessary, and do they need to be ongoing?

Ms. Scheckenbach: For any condition, the number of treatments depends on many factors. The number of treatments you will need to relieve hot flashes depends on whether the hot flashes are caused by natural aging, complete hysterectomy (removal of the uterus, cervix, ovaries and fallopian tubes) or chemotherapy. The length of time you have experienced the hot flashes can be important, as well as the severity. I usually recommend 3-6 treatments in order to assess the effectiveness of acupuncture for a particular symptom.

Question: Can you tell me why acupuncture seems to alleviate the side effects of chemotherapy?

Ms. Scheckenbach: No one knows why acupuncture works to alleviate the side effects of chemotherapy. Many theories are beginning to emerge about possible reasons. From our standpoint as acupuncture practitioners, we believe the chemotherapy is taxing the body's systems, and the acupuncture is restoring their natural processes.

Question: I have heard that patients who have a low blood count should not have acupuncture due to fear of infection. Is this correct?

Ms. Scheckenbach: If acupuncture is performed properly, there is no more risk of infection than from having your blood drawn.

Question: Is there any acupuncture treatment that might help lymphedema?

Ms. Scheckenbach: Acupuncture can sometimes treat lymphedema, but the edema is best treated with a combination of therapies including specialized physical therapy. Many conditions respond to the combined effect of more than one therapy.

Question: How about acupuncture for neuropathy? Can it help restore nerves?

Ms. Scheckenbach: Acupuncture can best treat neuropathy in the early stages. It attempts to restore the proper physiology and circulation to the nerves.

Question: I get frequent acupuncture, and I find that the day I get it I cannot fall asleep in the evening. I have brought this up to my acupuncturist, and she says that it is not because of the acupuncture. I feel it is. Could it be?

Ms. Scheckenbach: Everyone reacts very individually to acupuncture treatments. Changes in sleep, digestion, bowels, etc. may occur in the first 24 hours as the body attempts to re-regulate its physiologic processes.

Question: Could one get too much acupuncture? How many times a week is considered safe and effective?

Ms. Scheckenbach: Actually until modern times, acupuncture was given on a daily basis. Undergoing 10 treatments in 10 days was considered a course of treatment. Modern schedules and distances prevent this from being practical today. Treatments three times a week, however, can be common for acute or serious conditions.

Question: I have lymphedema in my right arm. Everything I read about lymphedema says to avoid skin punctures to the affected limb. How risky is acupuncture? (I have had acupuncture treatments for carpal tunnel and arthritis in my hands. The treatments have been effective, but [they] have to be repeated after about 6 months. Each time I do it, I worry.)

Ms. Scheckenbach: Although the recommendation is to avoid acupuncture on the arm affected by lymphedema, when acupuncture is properly performed, there is very minimal risk of infection. Fortunately, with acupuncture, there are many options when choosing points to treat any particular symptom. For instance, sometimes carpal tunnel is treated on the opposite ankle!

Question: I have had a recommendation for acupuncture treatments from my doctor. I am open to this and had scheduled a series of appointments. However, my primary health insurance does not cover it, nor does Medicare. Are there any other options for getting acupuncture, as the private pay costs would be 1/2 my monthly income?

Ms. Scheckenbach: You can consider "community acupuncture.” This is a low cost alternative to private treatments and is offered in many locations. Community acupuncture occurs in a group setting where patients sit in recliners (usually) and receive treatment together. The treatments are performed by a fully qualified acupuncturist. For many conditions, this style of treatment is a good option.

Question: For women who have had a nodal dissection, would you place needles in that affected limb?

Ms. Scheckenbach: Best practice recommends against placing needles in the affected limb, but the risk of infection is no more than from inserting a needle to draw blood.

Question: How do you determine whether someone is qualified to do acupuncture?

Ms. Scheckenbach: Professional acupuncturists undergo more than 2000 hours of training in the United States. Most states license the practice of acupuncture and create strict regulations. Some physicians also practice acupuncture, but the required hours of education are much less due to their medical training. Although laws vary from state to state, you want to look for a practitioner who is licensed in your state.

Question: I have neck and lower back pain as well as cramping of the calf muscle in my left leg and neuropathy in my left foot. I want to get off pain medication (I take 2-3 Aleve and 2500 mg of Gabapentin daily and still have pain). How can acupuncture help?

Ms. Scheckenbach: Acupuncture can be very effective for a variety of pain conditions. If you are experiencing several kinds of pain, I would recommend a longer trial of 7-10 treatments before determining its efficacy.

Question: I have triple-negative breast cancer. I have used acupuncture to relieve sciatic pain. It works. This past January, the doctor diagnosed me with triple-negative breast cancer. How can it be treated with acupuncture and how long?

Ms. Scheckenbach: Acupuncture does not treat the cancer directly. Acupuncture can treat the side effects associated with some treatments and can be used for overall energy and well-being.

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