Hirudotherapy (Leeches)

The word “leech” is a derivation of the Anglo-Saxon laece, meaning “to heal“ or if literally translated means “physician”. The earliest clearly documented record of use of leeches for medical purposes appears in a painting in an Egyptian tomb dated 1500 BC”. Later Chinese, Arabic, Anglo-Saxon, Ancient Greek, Sanskrit, Roman and Persian medical texts provide frequent records of use of leech therapy. For example, Galen promoted use of leeches and Avicenna in his world-famous book Canon of Medicine wrote instructions on how to use them. 

Leeches became particularly widespread between 17th and 19th centuries, turning into lucrative commodity due to rigorous use and success among patients. In the 1830s French imported about 40 million leeches a year, England over 6 million a year and Ireland a few millions. At the same time Russia consumed about 30 million and Germany shipped about 30 million annually to the US. Carter (2005) states: “Through the early decades of the century, hundreds of millions of leeches were used by physicians throughout Europe”. Their use was so common that physicians were often called “leeches”. 

In recent years leech became part of extensive scientific research (Sig, et al 2017). Cooper and Mologne (2017) report that leech saliva contains over 100 bioactive substances:

• anaesthetic (to reduce or stop pain)
• vasodilators (to improve blood supply)
• bacteriostatics (to stop bacteria from reproducing)
• anti-inflammatories (to reduce or stop inflammation)
• anti-edematous (to reduce oedema)
• anti-coagulants (to stop blood clotting)

NHS currently uses Leech therapy to avoid unnecessary operations. The Guy & St. Thomas Hospital, London leaflet (2018) states: “Leeches may be used to help improve blood flow in an area of tissue or skin flap that has poor blood circulation. Leeches do this by removing clotted blood (congested blood), which restarts blood flow in the small blood vessels of the flap and helps to prevent the tissues from dying”.

It also has various medicinal peptides that allow wound and tissue damage healing. Leeches considerably improve quality of blood and address numerous health conditions.

Indications:

• Headaches / Migraines
• High Blood Pressure / Hypertension
• Stress, depression, panic attacks
• Anxiety, insomnia, agitation
• Neurology
• Cardiovascular disorders: stroke & heart conditions
• Poor blood circulation
• Vein thrombosis & varicose veins
• Joint problems: rheumatism – rheumatoid arthritis .
• Digestive disorders
• Skin diseases: eczema, psoriasis, etc
• Sexual health: male and female
• Gynecology / urology
• Painful periods & difficult menopause
• Healthy baby conception
• Pain / cramps or spasms
• First aid /accident help/
• Injuries
• Ear / nose /throat diseases
• Endocrinology
• Metabolic disorders
• Degenerative diseases
• Ophthalmology
• Respiratory
• Beauty
• and much more

Contraindications for Leech Therapy:

• Anaemia
• Haemophilia
• Pregnancy
• Very low blood pressure (prolonged)
• Severe exhaustion
• Strong allergic reaction to insect bites
• Any diagnosed blood disorder
• Recent treatment with anticoagulants
• Chronic alcoholism
• Hepatitis (any variety)
• HIV / AIDS
• Sexually transmitted diseases

What are leeches and why should I have leech therapy (Hirudotherapy)?

In nature, leeches attach to animals and suck out small amounts  of blood as food. Leeches used for medical purposes are known  as ‘Hirudo medicinalis’. They are specially farmed for medical use.

In medicine, particularly plastic and reconstructive surgery, leeches  may be used to help improve blood flow in an area of tissue or  a skin flap that has poor blood circulation. Leeches do this by  removing clotted blood (congested blood) from delicate areas,  such as underneath a flap of skin or on a finger or toe. Removing  the blood from the area reduces the tension, which can improve  the blood flow in the small blood vessels. This helps to prevent  the tissues from dying.

How does this work?

When the leech attaches to an area it releases three important  substances. These pass into the area, whilst the leech draws the  clotted blood away. These substances are:

• a natural local anaesthetic (to reduce the pain)
• a local vasodilator (to improve the blood supply in that area) • hirudin and calin (natural anticoagulants, which prevent further clotting).

The amount of time the leech attaches to the affected area can vary from between 15 to 60 minutes. However, one of the main advantages of leech therapy is that the blood drainage continues

after the leech drops off. This means the blood can continue to flow from the site overfilled with blood, to improve the circulation  for up to 10 hours after treatment. This provides valuable time  for the body part or appendage (such as a finger or toe) to re establish its own circulation.

What are the risks of leech therapy?

There are some risks associated with using leech therapy. These  include:

• Infection

 There is a small risk of infection from the leech. Although they  are specially farmed for medical use, they contain bacteria in  their gut which helps them digest blood. To help prevent the 

risk of an infection (which could affect the success of your  surgery), your doctor will give you an antibiotic whilst you are  having leech therapy. Please tell your medical team if you are  allergic to any antibiotics or other medicines.

• Bleeding

 The area where the leech was attached may continue to ooze  blood for several hours after the leech has dropped off. This  will be monitored and your blood levels checked to make  sure you do not become anaemic (when your blood lacks red  bloods cells).

Are there any alternatives?

We use leech therapy to try to prevent the need for another  operation. If nothing is done, your blood may clot and prevent  blood flow to the tissues or skin flap. This may lead to some or  all of the tissue dying and could result in your skin flap or finger  or toe being removed at a later stage.

Consent

Before you have leech therapy, the medical team will talk through  the treatment, including any risks or side effects. They will then  ask you to sign a consent form. This confirms that you are happy for the treatment to go ahead and you understand what is involved.

During the treatment

You will be asked to avoid drinking any drinks containing caffeine  (such as tea, coffee and cola). You will also need avoid or minimise  the use of nicotine-containing products (such as cigarettes or nicotine patches) during the course of your hospital stay. This is  important, as caffeine and nicotine cause blood vessels to narrow,  which may affect the success of your treatment.

What happens during leech therapy?

The nurse will explain the procedure for applying the leech therapy.  They will continue to monitor you whilst the therapy is applied  and during the course of treatment.

The area to be treated will be cleaned before the application of  the leech. How many leeches are used and how often they need to  be applied will depend on how severely your tissue is congested.

The nurses will guide the leeches to the affected area, where  they will attach. We may need to cover the leeches with a  dressing, to make sure they stay in the correct position during  the procedure. You will be asked to remain in one position  while the leech therapy is taking place. This helps to prevent the  therapy being disrupted.

To check if the leech therapy is working, the nurse will monitor  the colour of your skin and the amount of oozing around the site  of attachment to check on blood loss (normally there is a small  amount, which helps to reduce the congestion).

The leech will be attached for between 30-60 minutes. Once the  leech has finished feeding, it may fall off or be removed. Each  leech is used only once and is humanely disposed of.

When the leech has finished, the nurse will clean away the dried  blood to keep the bleeding going. If the colour of the tissue is  returning to normal (a healthy pink colour) then the circulation  has improved.

It is important not to stop leeching too soon, as it may take three  to five days for the new blood vessels to grow and be able to  maintain a good blood supply.

Will I feel any pain?

No. The leech produces an anaesthetic, which makes the attaching  painless. At most a small initial pinching sensation might be felt.