• fever
• cough
• body aches and pains
• sore throat
• sneezing
• nasal congestion
• symptoms associated with cold and ‘flu

In the last 14 days, have you:

• been exposed to someone with a confirmed COVID-19 diagnosis?
• been exposed to someone with a suspected case of COVID-19 who awaits nasal swab test results?
• been in contact with someone currently in quarantine or isolation who has had potential exposure to coronavirus?

If you are experiencing any of the above, please contact Peter Kington (by phone) to discuss whether it is appropriate for you to attend your treatment session.

During the global coronavirus pandemic, one-on-one treatment is not possible for symptomatic individuals, but a Telehealth consult with herbs being prescribed may be an option.

Thank you for your understanding.

Please note, all clients will be triaged with these same questions on arrival. Consent will also be sought to take your temperature. Please view the return to work procedures for more information.

The post Pre-appointment health assessment appeared first on Peter Kington.

~ Peter Kington – Acupuncturist & Chinese Medicine Practitioner ~

May, 2020

Introduction

Since December 2006, the state of Queensland has required acupuncturists (and other health services) to have an Infection Control Management Plan (ICMP).

The purpose of the plan is to guide health practitioners in minimising infection risk in their acupuncture practice.

The Public Health Act (Qld) 2005 defines a ‘declared health service’ as one that involves the “performance of an invasive procedure” or a procedure that exposes individuals to “blood or another bodily fluid”.

While blood and bodily fluids aren’t a routine part of an acupuncturist’s practice, sometimes blood may be present when withdrawing needles or when other techniques, within an acupuncturist’s remit, are undertaken.

According to the Act, an “invasive procedure” is one that involves “the insertion of an instrument, appliance or other object into human tissue”.

An acupuncture needle is inserted into the human body.

Criterion 1:  hand hygiene

Proper hand hygiene is the cornerstone of infection control in the health service setting.

The practitioner should perform hand hygiene:

• Before touching a patient
• Before a procedure
• After a procedure or body fluid exposure risk
• After touching a patient
• After touching a patient’s surroundings.

The minimum standard to demonstrate compliance:

• Access to:
  • hand washing sinks
  • hand washing solution
  • paper hand towels
  • alcohol-based hand product (ABHP)
• where water is not available, adequate ABHP
• gloves are worn where wounds or abrasions or exposed skin are present
• ongoing staff training around hand hygiene

Criterion 2: Personal Protective Equipment (PPE)

Personal protective equipment (PPE) includes items worn by health service providers to eliminate the risk of infection transmission by blood, body fluids, droplet or airborne particle.

The types of PPE include disposable, non-sterile examination gloves, masks, eyewear, plastic aprons, clothing (scrubs and enclosed shoes).

The minimum standard to demonstrate compliance:

• staff should wear gloves during ‘at risk’ procedures or tasks
• appropriate PPE be used in special situations which might require standard or additional procedures

Additional measures for the COVID-19 global pandemic

In the case of a global pandemic like COVID-19, the decision to wear additional PPE is based on risk management.

As every patient will be triaged, prior to entry to the clinic and certainly before treatment commences, the appropriate PPE will include:

• non-sterile, disposable gloves
• surgical mask

See criterion 6 for further information

Criterion 3: Management of blood/body fluid exposures

This criterion relates to blood and body fluids as the direct result of a needle stick injury.

A needle stick injury occurs when a practitioner inadvertently ‘jabs’ themselves with an acupuncture needle after it has been in their patient.

The minimum standard to demonstrate compliance:

• sharps containers are available where acupuncture is administered and these comply with the Australian standards AS4031/92
• used needles are immediately disposed of after use
• after use, needles are not reinserted into guide tubes
• staff are aware of the importance of Hepatitis B vaccination

All needle stick incidents must be confidentially documented and affected individuals should seek immediate medical advice.

If there is a risk the patient has been exposed they should be immediately advised and asked to seek medical advice.

Criterion 4: Infection control and employee health

This applies to staff who live with a communicable disease and undertake exposure-prone procedures with clients.

Acupuncture is not considered to be an exposure-prone procedure and therefore carries with it low risk of the transmission of blood-borne viruses like hepatitis B, C or HIV.

The minimum standard to demonstrate complianceis:

• standard precautions to be used by staff, where applicable

Criterion 5: Immunisation

The risk to health service providers and their clients is the exposure to or acquisition of, a vaccine-preventable communicable disease.

The minimum standard to demonstrate compliance is:

• initial induction and ongoing training of staff about communicable diseases, the risks of these and prevention strategies
• pregnant women, and women planning on conception, should be aware of the risks to pregnancy from communicable diseases
• staff should discuss recommended immunisations for health professionals, with their GP, as per the Australian Immunisation Handbook. These include:
  • Hepatitis B
  • Influenza
  • Measles, mumps, rubella (MMR) if not immune
  • Pertussis (whooping cough)
  • Varicella (if not immune)
• all staff should self-assess their immune status and review with the GP

Criterion 6: Environmental Hygiene

This criterion relates to the treatment space, including patient care equipment and general surfaces, and the procedures in place to minimise the risk of infection posed by that equipment and those surfaces.

In light of COVID-19 and the global pandemic, it is in this area where greatest care must be taken to reduce the risk of infection.

The minimum standard to demonstrate compliance is:

• general and clinical waste, as appropriate in an office-based practice, must be appropriately disposed of and staff must be aware of this process
• cleaning processes should be logged and reviewed/audited and available for inspection
• clinical surfaces should be cleaned with detergent and water on a regular basis (see below for COCID-19 specific requirements)
• all patient care equipment (for example, massage table) and reusable equipment (for example, kidney dishes) should be decontaminated and preprocessed according to AS 4187 or AS 4185

COVID-19 global pandemic additional measures

Safe Work Australia has made additional recommendations for health and hygiene measures in Australian workplaces which provide an adequate framework for an office-based acupuncture practice.

Cleaning

Cleaning recommendations cover two areas:

• regular, day-to-day cleaning; and
• decontamination cleaning (in the event of exposure to COVID-19)

Regular cleaning

Cleaning material include detergent which can be mixed with water, or as a wipe or in a 2-in-1 disinfectant solution or wipes.

When should cleaning take place?

Thorough cleaning should take place once/day with a detergent-disinfectant combo with warm water.

In between patients, common surfaces should be disinfected and wiped down. This includes massage tables, bathroom fixtures, door handles, light switches, common surfaces etc.

Clean anything that is visibly soiled and staff should not handle personal items (keys, sun glasses and phone) unless necessary.

Decontamination cleaning

Decontamination cleaning would take place only when the clinic space is suspected to have been visited by someone suspected to be, or diagnosed as, corona virus positive.

The cleaning routine will be:

• seal the area and prevent access
• ventilate with fresh air by opening doors and windows
• detergent and warm, soapy water
• alcohol based disinfectant with >70% alcohol and bleach
• PPE including gloves and eyewear

Where should be cleaned?

Clean and disinfect:

• areas suspected of confirmed contamination
• common areas
• points of contact

Cleaning process and disposal of cleaning waster as per staff training.

Physical distancing

The principle of physical distancing is central to preventing the transmission of the corona virus. Appropriate physical distancing is what will also minimise risk of transmission during an acupuncture session.

Peter Kington – Acupuncture & Chinese Medicine has one consult room and one treatment room.

The consult room is 10.5m square and the treatment room is 9.5m square.

The recommendation for physical distancing is 1 person/4m square which means that in each room there is sufficient space for the practitioner and client to be present.

Where a parent or guardian is present, additional precautions may need to exist and these can be determined based on individual need.

Within each of those spaces, the client and practitioner should – wherever practical – maintain a minimum of 1.5m distance between them.

This becomes problematic during the insertion of acupuncture needles. For this reason the practitioner will wear PPE:

• nitrile, disposable gloves
• surgical mask

At the conclusion of the insertion of needles the practitioner will maintain equal or greater than 1.5m, unless otherwise required.

The practitioner may also leave the treatment room and provide a bell to the client and will routinely check on the client.

Client specific issues

• when the SMS/email appointment reminder goes out, clients will be asked to visit a website link prompting them to self assess their risk:
  • fever
  • temperature
  • ‘flu-like signs and symptoms
  • potential exposure to COVID-19 positive individuals
• When the client arrives for the appointment, while outside, further triage will take place:
  • taking of temperature
  • assessment of key signs and symptoms
  • potential exposure(s)
• during the pandemic, a buffer will exist between clients to facilitate cleaning and to reduce the likelihood of clients passing each other
• clients will be asked to sanitise hands before and after treatment
• if clients demonstrate respiratory or ‘flu-like symptoms they will be asked to self isolate and contact their GP or Queensland Health

Linen

The guidelines suggest linen should be changed when:

• it is obvious the client required contact precautions (eg lice)
• the linen is visibly soiled
• blood or body fluids are on the linen

Due to the global pandemic, linen will be changed after each client and laundered using disinfectant, bleach and soap and dried in a clothes dryer.

Spill kit

In the unlikely event there is a blood spill, faeces, vomit or amniotic fluid or any other bodily fluid, a spill kit will be used and clients evacuated from the premises to facilitate cleaning.

Criterion 7: Pre treatment assessment of infection control risk

In the age of the COVID-19 pandemic, pre-treatment assessment of infection is crucial to mitigating community transmission.

Regular, minimum standards for pre treatment assessment of infection control risk include:

• patients receive pre-treatment questionnaire at the first visit or time of booking
• triage of patients, when booking, for signs and symptoms to minimise risk of communicable disease transmission in the waiting room
• patients with acute communicable diseases, or suspected communicable diseases, are isolated
• routine, on-going care is delayed until full recovery

COVID-19 global pandemic additional measures

In light of the COVID-19 global pandemic, additional pre-treatment assessment measures will occur.

• When the SMS/email appointment reminder goes out, clients will be asked to visit a website link prompting them to self-assess their risk:
  • fever
  • temperature
  • ‘flu-like signs and symptoms
  • potential exposure to COVID-19 positive individuals
• When the client arrives for the appointment, while outside, further triage will take place:
  • temperature
  • assessment of key signs and symptoms
  • potential exposure(s)
• During the pandemic, a buffer will exist between clients to facilitate cleaning and to reduce the likelihood of clients passing each other
• Clients will be asked to sanitise hands before and after treatment
• If clients demonstrate respiratory or ‘flu-like symptoms they will be asked to self-isolate and contact their GP or Queensland Health

While the global pandemic exists, treatment of clients demonstrating ‘flu-like symptoms will be restricted to tele-health consults for herbs. Acupuncture will not be available.

Criterion 8: Non-reuse of single use medical devices and reprocessing of reusable medical devices

Single-use medical devices in an acupuncture practice include acupuncture needles and dermal hammers. Reuse of these items includes a high risk of cross-infection.

The minimum standard to demonstrate compliance is:

• single use medical items are NEVER to be reused
• senior staff member evaluates all medical implements purchased for their compliance

Criterion 9: Delegation of a responsible person

The minimum standard to demonstrate compliance is:

• a delegated person will assume responsibility for the infection control program
• infection control guidelines are available to all staff, at all times.

As the sole practitioner and business owner, Peter Kington is the delegates responsible person.

Criterion 10: Investigation of infection control incidents

The minimum standard is that:

• all infection control incidents, including ‘near misses’, be reviewed and corrective measures put in place. This process should be documented by way of an incident report (including corrective action).

Download a PDF copy of this Infection Control Management Plan here:

To book online with Peter Kington visit the online bookings page.

To make a general enquiry of Peter Kington visit the contacts page and fill in the form.

The post Infection Control Management Plan appeared first on Peter Kington.

Background

There were two main reasons I decided to suspend my acupuncture practice on 23 March, 2020:

• the most important was client and practitioner wellbeing:
  • back in March Queensland’s rate of infection was exponential and I felt ill-equipped to offer a safe treatment space (in terms of avoiding potential cross-infection); and
• economic – as the government was asking us to avoid contact, people, rightly, were staying home, and working from home, and not coming for appointments.

I found myself in a position many businesses found themselves in – significantly reduced income and no change to my outgoings/expenses.

Without adequate cash flow I risked going belly-up and I had no intention of doing that.

Sadly, the clinic at New Farm – not owned by me – has become a casualty of the changing economic situation and has had to permanently close.

The solutions to those initial challenges…

To solve those initial challenges, I have been required to make a significant change to my practice.

To address the potential financial stressors in the coming months, I have decided to convert a section of my home into a clinic.

I live just off the freeway at Greenslopes – access is easy.

For those preferring public transport – or coming after work – the 120 bus runs rights past the house and the Greenslopes busway station (SE busway) is just across the road. Each stop is about 450m from the clinic/house.

There is ample, on-street parking (unlike New Farm which, I know, could be really challenging at times).

While it’s just over 4km to the city, it’s a lovely, quiet spot.

If making the trip to Greenslopes is not possible for you, and you would like to continue having acupuncture, I’ll be happy to provide you with some names of practitioners who I know will take good care of you. Please be in touch.

The clinic space has easy access and is level to the ground. There will be one treatment room, one consult/herbs room and a bathroom.

There isn’t a reception so waiting in the car is best (and I’ll come and get you) or there will be a chair outside. With physical distancing measures in place, I need to avoid people crossing paths (see below for more on this).

I have had to make some renovations which has delayed my return-to-work by a couple of weeks, but the wait will be worth it. Here is a sneak peek. 

The second challenge this change addresses is my ability to confidently and appropriately manage hygiene and reduce risk during the pandemic.

How will my treatment experience be different?

The most important thing to remember is EVERYTHING about how I will work in the future is about working SAFELY while we’re living with a (suppressed) viral pandemic.

It’s corny, but it is ‘the new normal’.

Before you attend your appointment

• self-assess: are you experiencing any of the following signs and symptoms?
  • fever
  • cough
  • other flu-like symptoms (sore throat, sneezing, nasal congestion)
  • have you been in contact with anyone who may have been exposed to the corona virus and is currently awaiting test results or has been formally diagnosed?
• if you answered yes to any of the above please call (not text or email) the clinic in advance of your appointment.
• During the corona virus pandemic acupuncture will not be administered to clients who appear sick with acute onset respiratory signs and symptoms; the alternative is a Tele-health appointment where herbs will be prescribed.
• If you are unwell and have to cancel your acupuncture session after the usual cut-off time, you will not be charged provided you call and we discuss your situation. Thank you, in advance, for your cooperation.
• each time you get your SMS/email reminder for your appointment you’ll be prompted to a self-assessment checklist on my blog just to make sure you’re OK to attend.

When you arrive at the clinic…

• please park close to the house and wait in your car or on the footpath – I will come and get you (to minimise you coming into contact with another person)
• before you enter the clinic I, with your consent, will ‘triage’ you:
  • I will take your temperature on the forehead with an infrared thermometer
  • I will ask whether you are experiencing any ‘flu-like signs or symptoms (if you do your acupuncture treatment cannot proceed)
  • I will ask whether you have been in contact with anyone who believes they have been exposed to corona virus, have positively tested for corona virus or may be awaiting the results of a corona virus test. (Depending on relative risk, your acupuncture treatment may not proceed in this situation).
• If you do not consent to the above process, I will not be able to work with you on that day. You will still be required to pay for your treatment as you will be reminded of this process in your appointment reminder.
• the outcomes of that triage will be noted in your consultation notes.

When you enter the clinic

• hand cleaning: you will be asked to sanitise your hands with hand sanitiser (or, if you’d prefer, hot soapy water is available).

The consultation

• physical distancing: we will be seated a minimum of 1.5m apart during the consultation. This might feel a bit weird, at first, but it’s what we have to do to reduce risk of cross-infection.
• personal protective equipment (PPE): I will wear a mask during the consultation.

The treatment

• hygiene:
  • to minimise the risk of cross-infection, I will now only see one client at a time
    • this means I will not be moving between two clients, across two rooms (reducing the risk of cross-infection)
  • the treatment table will have fresh linen with each client
  • the treatment table, door knobs and other points of contact will be disinfected between each client with high grade disinfectant called Viraclean which is used in hospitals, shown to kill corona virus
  • I will wear a mask and gloves while conducting the treatment. You are not required to wear a mask, but you are welcome to wear one if that makes you more comfortable. You can bring your own or I will have them for sale, at a small fee to cover costs as they are so expensive to buy at the moment ($2.20 each)
  • all the other, usual hygiene measures – like swabbing the skin before acupuncture etc – remain unchanged

• social distancing: during the treatment, one-on-one contact will be reduced to a minimum, however, I will be just in the next room, you will have a bell to ring should you require me and I will check on you to ensure your ongoing comfort.

Administrative things that will be different…

• online bookings: as I am only working with one treatment table, scheduling is easier and online bookings will be available for your convenience (or you can call on the usual number)

• availability:
  • due to only offering one client/session, I can no longer see couples together (in two rooms) and after hours appointments will be offered four nights/week (previously two nights/week) so there is sufficient availability
  • I would ask that if you don’t specifically need after-hours appointments, that you choose slots through the day so those after-hours slots are available for those who need them
• social distancing between appointments: to reduce the risk of clients passing each other, and to allow time for the cleaning and disinfection regime between clients, all appointments will have a 30 minute buffer between them
• contactless payment: this clinic will not have an EFTPOS machine – a great harbinger of disease if ever there was one. Payments will be processed online at the time of your appointment or using the ‘Square’ app which accepts EFTPOS, Visa, MasterCard and American Express
• private health funds: you will still be able to claim for your acupuncture consults with your private health provider. However, this will be done via a new facility called HiCaps Go (online, rather than a machine). Not all funds are signed up to HiCaps Go so if that is the case you’ll be required to pay the full fee and I can issue you with a receipt to claim independently.
• fees: by and large the fees remain unchanged with one exception being all follow-up appointments are now $98.00

If you made it this far….

… congratulations. I realise this has been a long read.

But, it’s an important read. The corona virus pandemic has transformed how we live our lives and, on a personal level, it has wreaked havoc for my 15+ year old business.

I’ve been out of action longer than I’d hoped, but these next few weeks will see me back, in a much sleeker, operation but offering the same level of expert care, I hope, you’ve come to expect from me.

I look forward to sharing the new clinic with you very soon. Thanks for your patience and please, be in touch, if you have any questions or concerns.

And here is the Google map link:

https://goo.gl/maps/UJiuUxNj5JJXjFuS6

Peter Kington

(07) 3367 1150

And here is the online booking link:

https://peter-kington-conceive-health.au1.cliniko.com/bookings#service

The post The new normal – a new, ‘pandemic friendly’, acupuncture clinic space appeared first on Peter Kington.

This content is password protected. To view it please enter your password below:

Password:

The post Protected: Coronavirus Update appeared first on Peter Kington.

To all my valued clients.

I have been working as an acupuncturist since 2005 and in those years I worked through the end of the SARS epidemic, bird flu, swine flu, MERS, zika and the global financial crisis … but nothing has been quite like COVID-19 (coronavirus).

The reason coronavirus is different is it has no known treatment strategy because it is a ‘new’ virus.  Because of that, public health officials are asking us all to take precautions and do our part not to spread the virus.

Until I am advised otherwise, my practice remains open and fully operational with a few modifications to ensure yours and my good health during this challenging time.

The clinic where I work, Nurture Studio, is a low-risk environment because, by and large, the types of clients we see aren’t seeing us because they have the ‘flu (more on that in a minute).

We intend on keeping it ‘low-risk’ so that you can have confidence that you can maintain your ongoing care during the coronavirus pandemic.

Until this period of uncertainty settles down, please consider the following. If you:

• think you are unwell, self-assess as per Qld Health:  https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19
• are scheduled to have an appointment with me and you have any of the following signs and symptoms, please call in advance so we can discuss whether you should attend:
  • sore throat
  • cough
  • fever
  • any other signs and symptoms of respiratory illness

From my side, I am:

• undertaking extra sanitising using hospital grade disinfectant on surfaces, in between clients 
• undertaking extra and more vigilant hand washing, with soap and warm water
• making sure hand sanitiser is available to all clients
• wearing gloves during all acupuncture treatment as gloves provide barrier protection
• assuring you I will not treat you if I am unwell

Please speak to me if you are uncomfortable about waiting in the waiting room for your session as I have a strategy in place to mitigate your concern.

If I get sick with a cold or the flu, can you still help me?

The short answer is – yes.

There is a long history in Chinese medicine of treating acute respiratory infection with herbal medicine.

If you feel yourself getting sick, call me straight away on (07) 3367 1150 to discuss your options.

Early intervention is best – so call as soon as you start to feel unwell.

Will I still have acupuncture if I have cold or flu?

While acupuncture is helpful when you have a head cold or flu, it is best you follow public health guidelines and self-isolate and not attend the clinic.

Instead, we will do a phone consult and work with herbal medicine.

You can arrange for someone to collect the herbs or I can send them to you in an Uber (you pay the delivery).

Please note, herbal consults are not claimable via your health fund and are inclusive of all follow up conversations while you are unwell (we need to stay in touch while you are ill to adjust dosage). The cost of this consult is a one-off $85.

Here’s to on-going good health and where necessary, a speedy recovery.

Remember, the clinic is still open and I am still working and ready to help.

See you soon

Peter Kington

The post CORONAVIRUS/COVID-19 UPDATE appeared first on Peter Kington.

This terminology may also be used during a stimulated IVF cycle to explain ovaries which are slower to respond to the drugs used to encourage the ovaries to produce eggs.

To better understand the concept of slow ovaries it’s important to know a little bit about the ovary and how it works.

How do my ovaries work and how does that contribute to slow ovaries?

The ovaries are a gland and they belong in the reproductive system.

The ovaries have three main functions:

1. they house the follicles in which ovum (otherwise known as oocytes or, more easily, eggs) grow
2. they produce a bunch of hormones which are central to women’s health
3. they are the site where ovulation occurs

The ovaries respond to hormones produced by a gland up in the brain. This gland is called the anterior pituitary gland.

The anterior pituitary gland produces two hormones which are crucial to the normal functioning of the ovary. These hormones are:

1. Follicle Stimulating Hormone (FSH)
2. Luteinising Hormone (LH)

FSH and LH, produced in the anterior lobe of the pituitary, a gland in the brain, reach their ‘target tissue’ via the blood stream.

As the target tissue, the ovaries have FSH and LH receptors on them. When the two meet, they bind and that prompts the ovary to kick into gear.

FSH stimulates the ovary to recruit follicles and get them to grow. Normally one follicle will win this race and that is called the dominant follicle.

The dominant follicle is the follicle that is ovulated.

When FSH levels are high, the ovaries are also producing another hormone called estradiol.

Estradiol is a form of oestrogen associated with reproduction.

When estradiol levels reach their peak, the FSH starts to fall and the anterior pituitary produces LH.

LH is the hormone responsible for two main things:

1. final maturation of the follicle (in the last 48 hours before ovulation)
2. triggering ovulation

Under normal circumstances, that whole process should take around two weeks to complete – or the first half of the menstrual cycle which normally lasts around 28 days.

When it takes longer than that it might be because your ovaries are slow to respond.

Sometimes this is called sluggish ovaries and other times it is called slow ovaries.

You mentioned follicles and eggs – what are these?

Follicles are clusters of cells which house an oocyte or ovum, which is another name for an egg.

Follicles also house granulosa cells and theca cells.

Both of these cells are important to ovulation because they convert hormones essential to normal reproductive function.

What is my ‘ovarian reserve’ and what does it mean?

The ovarian reserve is an estimation of the number of follicles which remain in the ovaries.

As women age, their follicle count declines and when there is fewer than one thousand follicles it is likely menstruation has ceased and menopause has commenced.

Therefore, the number of follicles is intrinsically linked to the likelihood of reliable ovulation and the predictability of the menstrual bleed.

As a woman’s ovarian reserve declines so does the prospect of regular, reliable ovulation.

The Anti-Müllerian Hormone (AMH) test, plus other blood markers and scans, can help determine a woman’s ovarian reserve.

Declining ovarian reserve, and the lower hormone profile associated with it, is another cause of slow ovaries.

So if my ovarian function declines as I age, when am I at my most fertile?

This is one of the most fascinating aspects of female fertility and it goes like this:

• primordial germ cells form and lodge in the correct spot in the embryo by 5-6 weeks gestation
• by 6-8 weeks gestation these cells commence mitosis, or rapid duplication
• by 16-20 weeks gestation the ovaries will house the most follicles that person will ever have – a total of 6-7 million in both ovaries
• between 20 weeks gestation and birth (around 40 weeks), two-thirds of those eggs will die off (‘arrest’) leaving around 2 million at birth
• between birth and puberty (between 10 and 14 years of age) over 1 million oocytes arrest leaving around 300 000 for the remainder of that woman’s reproductive life
• women, on average, are considered most fertile between 21 and 32 years of age
• after 32 years of age, a slow decline of ovarian reserve commences – increasing in pace as she approaches her late 30s

What is a reasonable time frame for follicular recruitment and slow ovaries?

It is a popular misconception that the dominant follicle begins and ends its life within that cycle – about 14 days from menstruation to ovulation.

The truth, however, is that follicular recruitment takes place over several menstrual cycles – somewhere around 85 days. This process is called apoptosis.

Recall, that follicles are continually ‘arresting’. When they are saved from arrest – and utilised – that is called apoptosis.

Therefore, the follicle that becomes the dominant follicle, only becomes that if it has gone through apoptosis.

It is true that the dominant follicle is only recruited within the menstrual cycle for which it will be used. It is recruited just after the commencement of menstruation.

A woman with slow ovaries may have a delay in the process of follicular recruitment.

So what does all that mean for acupuncture, herbal medicine, lifestyle modification and sluggish ovaries?

Working with someone who has slow ovaries involves the acupuncturist assessing that woman’s unique presentation of signs and symptoms.

Analysis of those signs and symptoms will lead to a Chinese medicine diagnosis.

The Chinese medicine diagnosis will lead to a treatment plan and the treatment plan is what guides your fertility acupuncture session and herbal medicine prescription.

The object is always to regulate the menstrual cycle and, given we now know that follicular recruitment takes place months before ovulation, a reasonable time frame for treatment should always bear that time frame in mind.

Your fertility acupuncture practitioner will offer guidance and advice along the way including appropriate lifestyle modifications which may assist this process.

To find out how his approach might help you, please be in touch with Peter Kington acupuncturist in his New Farm rooms.

The post Why do I have slow ovaries? appeared first on Peter Kington.

To improve sperm health with nutrients it is important to know what a ‘nutrient’ is.

A nutrient is a biochemical compound found, most commonly, in the foods we eat. A well-known example is vitamin C, found in citrus.

The idea goes that if one eats a balanced, nutritious diet with food of an acceptable quality, one will absorb the nutrients – or biochemical components – found in that food.

But, if something goes awry in the body, then it is possible that the nutrient balance may be affected and disease, or ill-health, may follow.

Conversely, when problems are diagnosed, it is sometimes possible to support the body to recovery by taking nutrients in more concentrated/potent doses (eg vitamins).

To improve sperm health there are several, well-known nutrients which have been historically well used, but with this latest information strong evidence now supports their use in this to support men with low fertility.

Where do I begin to learn more about sperm?

On your journey to improve sperm health, a good, reputable place to start is with an organisation like Andrology Australia.

Of course, if you haven’t consulted with your preferred GP that’s also important as a full medical assessment is warranted as there can be many factors which affect a couple’s chances of conception.

Once you’ve covered those bases, consider taking a read of this page to learn more about my approach to pre-conception care with male fertility acupuncture.

This page takes great care and time to explain how sperm health is assessed with the semen analysis and, regardless of how you choose to improve sperm health, it is a great place to start.

What are antioxidants and what is their role in sperm health?

Normal, healthy cellular function requires oxygen and nitrogen. The body, to help the cells make use of these gases, produces molecules called reactive oxygen species (ROS) and reactive nitrogen species (RNS). This article is of high quality and explains this well.

The reactive species include ‘free radicals’. ‘Free radicals’ are oxidising agents. When they become too many in number, they have the potential to cause cellular damage and inflammation.

Oxidative stress, caused by excess free radicals, is thought to be a major cause of male factor infertility. Therefore, ‘antioxidant’ nutrients are associated with correcting this imbalance in the body.

How do I get too many ‘free radicals’?

This is where poor dietary and other lifestyle choices might contribute to you having ‘oxidative stress’.

Examples of poor dietary and other lifestyle choices might include the consumption of alcohol, smoking, a diet with too many bad fats, too much exposure to air pollutants, too much sun and even too much exercise.

Do we know how ‘free radicals’ and ‘oxidative stress’ damage sperm?

The connection between free radical damage on sperm is becoming clearer.

Free radical damage causes oxidative stress. Oxidative stress is recognised as a contributing factor to male sub-fertility or infertility due to cellular damage associated with reactive oxygen species (ROS).

While ROS is a naturally occurring mechanism in spermatogenesis, excess levels of ROS has been linked with damaged sperm DNA and poor sperm motility (movement).

What does the science tell us about nutrients to improve sperm health?

Interestingly, the nutrients used historically to improve sperm health are, by and large, the same nutrients recently studied in a large systematic review and meta-analysis of randomised controlled trials in this area.

The nutrients used to improve sperm health caused by oxidative stress are called antioxidants.

The nutrients (and foods) covered in this systematic review include lipoic acid, selenium, NAC (glutathione), vitamin C, vitamin E, vitamin A, folic acid, zinc, omega-3 oil, CoQ10/ubiquinol, carnitine, lactobacillus paracasei, nigella sativa oil, walnuts, crocus sativa and ‘Menevit’.

The semen parameters most improved by antioxidant nutrients include:

• Sperm counts (total) improved by supplementation with omega-3 fatty acids and CoQ10
• Sperm concentration improved by supplementation with selenium, zinc, omega-3 and CoQ10
• Sperm motility improved by supplementation with selenium, zinc, orega-3, CoQ10 and carnitines
• Sperm morphology improved by supplementation with selenium, omega-3, CoQ10 and carnitines.

What about all the other nutrients examined in the study, but not listed to improve sperm health?

The study doesn’t say they’re not useful – in fact, individual studies record improvement in parameters with Vitamin C and E etc.

However, for the purposes of the systematic review and meta analysis there wasn’t enough evidence to reliably report on them – so more research is required.

What should I do next to improve my sperm health?

If you haven’t consulted with a GP and just have concerns you may be sub-fertile, then your first port of call is to them.

Beyond that, it is important to not just start taking supplements without consulting someone who has professional training in that area (even if you can easily buy products online or in the chemist or supermarket). Not all supplements are good quality, so getting advice is a good idea.

Peter Kington acupuncturist can assist so swing over here to be in touch.

The post Improve sperm health with nutrients – exciting new research appeared first on Peter Kington.

What is clomiphene citrate (also known as Clomid)?

Clomiphene citrate, commonly known in Australia as Clomid, is a medication which falls within a category of drugs called selective estrogen receptor modulators (SERM).

Most women who take Clomid do so because they have probably presented to a doctor having experienced anovulatory infertility (which means they can’t fall pregnant because they either don’t ovulate or don’t ovulate reliably or regularly).

As a fertility drug, Clomid is designed to initiate ovulation.

What is the acupuncture with Clomid relationship?

Historically, there has been no formal acupuncture with Clomid relationship.

However, there has certainly been women undergoing fertility treatment with Clomid who have also chosen to have a course of acupuncture with Clomid.

What hormones regulate the menstrual cycle?

There is a gland deep within the brain called the hypothalamus. The hypothalamus regulates the hormonal cascade women experience which initiates ovulation.

The hypothalamus produces a hormone called gonadtrophin releasing hormone (GnRH, for short).

Another gland, the anterior pituitary, has GnRH receptors on it (which means hypothalamic GnRH *binds* to the anterior pituitary).

When this binding happens, the anterior pituitary produces two hormones. One of these is called follicle stimulating hormone (FSH) and the other is luteinising hormone (LH).

FSH and LH travel via the blood stream, looking for receptors – which they find on the ovary.

The ovary responds to the FSH and produces follicles and eggs. The eggs produce another hormone called estrogen.

Estrogen travels through the blood stream and when it reaches the hypothalamus it *binds* to oestrogen receptors and turns down the hypothalamus’ production of GnRH.

How does Clomid work?

Clomid works by binding to the hypothalamic estrogen receptors and blocking them from assessing how much estrogen is circulating.

This prompts the hypothalamus to think there isn’t enough estrogen, so it produces GnRH to stimulate FSH in the pituitary which then stimulates the ovaries to produces more follicles to produce more estrogen.

For this reason, women taking Clomid are able to ovulate.

Does Clomid have any side effects?

The biggest side effect of Clomid is that it increases the prospect that a woman will ovulate and therefore, theoretically, be more fertile.

Clomid, in some women, may also stimulate the ovaries to produce multiple follicles, thereby putting her at risk of a multiple gestation pregnancy (TWINS!!!!).

Often, at least for the first time taking Clomid, a doctor will monitor the ovarian response to the medication either with scans or bloods or both.

Some women who take Clomid report experiencing hot flushes, changes in the mood (irritability and teariness), abdominal bloating and tenderness.

Clomid is a well studied drug which was invented in the 1950s and remains the world’s most widely used fertility drug.

Does acupuncture with Clomid present any risks?

This study which looked at acupuncture with Clomid as a stand alone therapy and adjuvant therapy, reported no increase in risk or other adverse events.

What did this acupuncture with Clomid study seek to examine?

Researchers looked at eight databases and studied nine randomised controlled trials (RCT).

An RCT is a piece of research which pools the results of multiple pieces of similar RCT research.

This RCT and meta-analysis involved nine trials and 1441 women – some of whom had only acupuncture; some of whom only had Clomid and some of whom had both.

What did we learn about acupuncture with Clomid?

The study demonstrated the following:

• ovulation rates and pregnancy rates were not improved when acupuncture was used as an adjuvant therapy with Clomid (adjuvant means the acupuncture was only administered while taking the Clomid)
• when used as an adjuvant therapy, acupuncture with Clomid did not appear to reduce pregnancy loss
• when acupuncture with clomid was used as a separate therapy (that is, with its own structured treatment plan across a wider timeframe) there was improved pregnancy rates. There was also evidence to suggest that women receiving acupuncture produced larger follicles (although not statistically significant)

What accounts for these differing acupuncture with Clomid results?

The authors of the study hypothesise two issues which might account for these results:

• standardised acupuncture (or predetermined acupuncture or formulaic acupuncture) protocols may not be as effective as acupuncture with Clomid which is individualised for the patient
• design flaws in the studies may have skewed the results

Is there anything else in this acupuncture with Clomid study I should know?

Yes!!!

When using acupuncture with Clomid consider a course of acupuncture across a wider period of time than when you are just taking Clomid. This is consistent with general acupuncture practice.

Also, be mindful that research outcomes involving acupuncture with Clomid may not necessarily reproduce the same outcomes in a clinical environment.

The study also has no facility to track pregnancies to birth to determine whether the intervention also increased live birth rates which underscores the difference between a pregnancy and a birth.

Finally, the RCT – while robust and of a high standard – would benefit with review and more inclusion data to produce a larger sample (although the existing sample is adequate).

More information about evidence can be found on the FAQ page.

Where can I find out more about acupuncture with Clomid treatment?

Peter Kington, a Brisbane acupuncturist, offers fertility acupuncture care for women who might be seeking acupuncture with Clomid therapy.

Or go straight here to be in touch via his contact form.

The post Acupuncture with Clomid: combined therapy may improve pregnancy rates appeared first on Peter Kington.

It can be really overwhelming.  Is endometriosis natural treatment the right approach for me?

Whether endometriosis natural treatment is the right therapy for you will depend entirely on what your desired end point is.

For some women, they seek endometriosis natural treatment because they wish to improve their fertility.

Some women choose a natural treatment for endometriosis entirely for symptom relief.

The most important thing is that you find a team of practitioners whose common goal is to devote their time with you to significantly improving your quality of life.

Before we explain what endometriosis natural treatment is, we need to step back and take a moment to understand what endometriosis is and how it affects women living with this condition.

Understanding endometriosis and how it differs from adenomyosis and endometrioma.

The word endometriosis is of Greek origin.

Wherever a word ends in ‘osis’ we know it is referring to a disease process.

The first syllable ‘endo’ mean inside and the middle syllable ‘metri’ comes from ‘metra’ for womb.

Therefore, ‘endometriosis’ is a disease inside the womb.

Except we now know that the disease itself relates to tissue, endometrial tissue, which would normally be located inside the womb grows outside the womb.

Therefore, the location of the endometrial tissue dictates the name of the pathology.

Endometrial tissue which grows on or inside the ovary is called an endometrioma referring to it being a cyst-like structure.

Endometrial tissue which grows within the muscle layer of the wall of the uterus is called adenomyosis.

It is possible for endometrial tissue to grow in other places like the uterine ligaments, bladder, large intestine, the wider pelvic cavity and more rarely, the lungs and nasal cavity.

How are women with endometriosis different from women who don’t have it?

The most common symptom associated with endometriosis is period pain (dysmenorrhoea), although some women don’t know they have endometriosis because they experience no obvious signs or symptoms.

However, the more common profile of a woman living with endometriosis includes some or all of the following:

• extremely painful periods (dysmenorrhoea)
• infertility (only an issue if trying to conceive)
• heavy menstrual loss (menorrhagia)
• unpredictable timing of the menstrual bleed
• painful sexual intercourse (dyspareunia)
• pelvic pain increasing towards the end of the menstrual bleed
• pelvic pain prior to ovulation and prior to menstruation
• isolated pelvic pain
• family history of endometriosis
• if endometriosis is located in the bowel or bladder then pain on bowel motions or urination may be present.

What causes endometriosis?

The precise mechanism behind endometriosis is unclear.

What we do know is that once menopause has passed, women living with endometriosis generally observe a cessation of the signs and symptoms they associate with their disease.

Likewise, when women are pregnant they also experience a cessation of their signs and symptoms.

The common thread between those two things is suspension of the normal, cyclical hormonal cascade associated with the menstrual cycle.

The common hormonal link is oestrogen – the hormone produced in the ovaries to help build menstrual tissue in the uterus.

It is likely that women with endometriosis have endometrial tissue outside the uterus.

This tissue responds to the normal spike in oestrogen that occurs in the menstrual cycle.

With this spike, women with endometriosis produce ‘extra’ endometrial tissue and experience pain and heavy menstrual loss.

Why some women have abnormal endometrial tissue when others don’t is not clear.

How is endometriosis diagnosed?

The gold standard for endometriosis diagnosis is laparascopy and hysteroscopy.

These procedures involve small cameras being inserted into the pelvic cavity and uterus (under anaesthetic) to allow your gynaecologist to have a look around.

How might my doctor treat endometriosis?

Again, this depends on what therapeutic outcome you are trying to achieve.

Many of the medications associated with reducing the signs and symptoms associated with endometriosis will also make you (while you are taking them) infertile.

Therefore, women seeking to conceive cannot take these medications and so this is one reason they may seek endometriosis natural treatment with acupuncture and herbal medicine.

Surgery is another treatment – the idea being removing the endometriosis provides a window of opportunity for conception.

Pain management is another treatment option involving medication to manage pain or more advanced procedures involving pain specialists.

A great resource for women living with endometriosis is QENDO (Endometriosis Queensland).

What is endometriosis natural treatment and what are my options?

Endometriosis natural treatment is a non-surgical, non-hormonal approach to the management of signs and symptoms associated with endometriosis.

The natural therapy treatment for endometriosis you choose will determine the approach taken by your practitioner.

A naturopath will work with diet, lifestyle, supplements and maybe herbs.

An acupuncture Brisbane practitioner like Peter Kington will support your desired therapeutic outcome with acupuncture, diet and lifestyle suggestions and where appropriate, herbal medicine.

Does endometriosis natural treatment with acupuncture replace standard medical care?

In short, never.

The great thing about acupuncture is that it sits beautifully alongside any medical care you might be receiving.

The application of acupuncture is dependent on your practitioner constructing a Chinese medicine diagnosis.

The Chinese medicine diagnosis is unique to the practice of Chinese medicine.

Your practitioner arrives at this diagnosis after the careful gathering and analysis of your unique set of signs and symptoms.

Acupuncture points and herbal formulas are applied according to this diagnosis.

While your diagnosis of ‘endometriosis’ is of interest to your acupuncture practitioner, it is not essential because acupuncturists will always rely on your unique presentation of signs and symptoms.

Your Chinese medicine diagnosis never replaces your medical diagnosis of endometriosis but sits alongside it, providing a framework for your endometriosis natural treatment.

What makes the information in this blog more reliable than anything else I’ve read about endometriosis?

The author of this blog is Brisbane acupuncture practitioner Peter Kington.

Having been in practice since 2005, you will be in experienced hands with an experienced practitioner able to speak with you in a language you will understand.

In addition to his acupuncture skills, Peter has a Master of Reproductive Medicine from the University of NSW so has a deep understanding of the medical approach to endometriosis.

Peter is an in-demand practitioner educator and teaches colleagues in Australia, New Zealand and the United States of America.

Peter lectures across a wide area of health conditions including endometriosis natural treatment options with herbal medicine and acupuncture.

This combined approach helps him to deliver considered and individualised endometriosis natural treatment to you.

Peter Kington, your Brisbane acupuncture practitioner, offers a range of days and appointment times for new and follow-up clients.

 Call now on (07) 3367 1150 or visit our contact page to make an online enquiry about endometriosis natural treatment.

The post Endometriosis natural treatment: acupuncture support for women living with endometriosis appeared first on Peter Kington.

Is PCOS natural treatment the right approach for me?

Whether PCOS natural treatment is the right treatment for you will depend entirely on what your short, medium and long term goals are.

But before we get into whether PCOS natural treatment is the right treatment for you, let’s step back and look at what PCOS is and what PCOS natural treatment might look like.

What is PCOS (polycystic ovarian syndrome)

Polycystic ovarian syndrome (PCOS for short) is a disorder of the endocrine system.

The endocrine system is the system which makes and regulates hormones.  The endocrine system is a signalling system.

Hormones are produced in glands.  Our body is an incredible machine and it ‘self-regulates’ the amount of hormone circulating at any given time.

When this system of self-regulation goes awry, we either end up with too little or too much hormone.

The endocrine system is finely balanced and when there is too little or too much of a hormone we can become unwell.

PCOS occurs when the signalling mechanism between the ovaries and the anterior pituitary becomes disordered.

How are women with PCOS different from women who don’t have it?

The common signs and symptoms for women with PCOS are:

• absent or irregular periods
• anovulation (failure to ovulate)
• ‘bad skin’ including oily skin or acne
• hormonal imbalance involving testosterone, luteinising hormone and oestrogen
• ‘polycystic ovaries’ visible with an ultrasound
• weight gain around the belly

Of course, no two women are the same and while some women might experience all these signs and symptoms, most women will experience some but not all of them.

The Centre for Research Excellence in Polycystic Ovary Syndrome is an excellent, evidence-based organisation to learn more about PCOS.

How is PCOS diagnosed?

Most women seeking PCOS natural treatment will already have a diagnosis from their preferred health practitioner – usually a fertility specialist.

Diagnosis involves your doctor taking a case history, running some bloods (to measure your hormone levels) and also an ultrasound so they can see your ovaries.

How is PCOS treated by a doctor?

The medical treatment for PCOS is entirely dependent on the outcome you are seeking.

For women who are not trying to conceive, treatment will either be just a ‘wait and watch’ approach.  The other approach is to put you on the oral contraceptive pill.

The oral contraceptive pill does not fix your PCOS but it helps you to bleed with the help of the hormones contained in the pill.

For women who are trying to conceive your treatment will probably include ovulation induction with drugs (like Clomid or Femara) or exogenous pituitary hormones.

Depending on other factors, your fertility doctor may recommend IVF as your best line of PCOS management.

What is PCOS natural treatment?

PCOS natural treatment will depend entirely on the practitioner you are seeing.  A naturopath will treat PCOS differently from an acupuncturist or herbalist.

However, the overarching objective for any PCOS natural treatment is to support your overall goal which, for most women, is conception.

Does PCOS natural treatment with acupuncture replace ‘standard medical care’?

So this is the really great thing about PCOS natural treatment with fertility acupuncture – it works beautifully alongside any hormonal therapy.

The practice of acupuncture is dependent on a Chinese medicine diagnosis.

The Chinese medicine diagnosis is based on an analysis of your unique presentation of signs and symptoms.  It does not replace your medical diagnosis but sits nicely alongside it.

Whether including herbal medicine in your treatment plan is appropriate will be discussed during your first acupuncture consultation.

What makes the information in this blog more reliable than anything else I’ve read?

The author of this blog is Brisbane acupuncture practitioner Peter Kington acupuncturist.

Having been in practice since 2005, you will be in experienced hands.

In addition to his acupuncture skills, Peter has also completed a Master of Reproductive Medicine from the University of NSW so has a deep understanding of the medical approach to PCOS.

Peter is an in-demand practitioner educator and teaches colleagues in Australia, New Zealand and the United States of America on PCOS natural treatment options.

This combined approach helps him to deliver considered and individualised PCOS natural treatment to you.

Peter Kington, your Brisbane acupuncture practitioner, offers a range of days and appointment times for new and follow-up clients.

 Call now on (07) 3367 1150 or visit our contact page to make an online enquiry about PCOS natural treatment.

The post PCOS natural treatment – natural fertility support for women living with PCOS appeared first on Peter Kington.