Leeches and Maggots to the Rescue

This is something you may not have given much thought to, but leeches have wonderful saliva.

"Within the leech saliva there is a substance in there called hirudin," Jim Tomsche said. "And there's other things in their saliva as well ... which allows blood flow to expand or vessels to open up their blood supply and also has an anesthetic effect."

If that news doesn't make your blood flow, it might some day when you need it the most.

Medically used for bloodletting purposes for thousands of years, Hirudo medicinalis — the medicinal leech — is back on the job today, occasionally even in medical settings in Duluth.

Tomsche knows. The director for acute care pharmacy for Essentia's East Region, he is the person who's on the phone ordering leeches when the critters are called upon, usually for plastic or restorative surgery.

"They're specifically used in patients that have had, say, skin grafts, (or) they've had, say, a digit on their finger that has been crushed or has had to have been reattached, etc.," said Tomsche, who earned his doctor of pharmacy degree at the University of Minnesota and has been at Essentia since 1994.

The leeches aid in healing, Tomsche said, by preventing blood from clotting. That in turn keeps blood flowing to the wound to allow it to heal.

When the leeches are called on, they're sent up to the practitioner in the same kind of bottle that would contain prescription drugs, with the patient's name on it, Tomsche said. The nurse or doctor removes the leech with a forceps and applies it to the desired spot with a syringe from which the plunger has been removed.

The leeches — one to six of them, depending on the size of the affected area — find themselves surrounded by gauze. They're checked every 15 minutes, Tomsche said, because "once they get full they will stop feeding. They'll try to release themselves."

But he has never heard of anything going wrong with medical leeches, Tomsche said.

Neither has Bobbi Aulie, clinical coordinator and pharmacist at St. Luke's hospital, who said having leeches in the pharmacy is no problem.

"They're actually relatively easy, just like using your fishing bait — you change the water every day and keep them in the fridge," she said. "It's just the heeby jeeby factor. They don't bother me, but some of my colleagues don't like it."

Medical leeches are put to use in Duluth, but not frequently. The acute care pharmacy at Essentia Health-St. Mary's Medical Center last ordered leeches a couple of months ago, Tomsche said, and before that it had been several years.

The pharmacy at St. Luke's hospital hasn't had a reason to order leeches in the past five years, Aulie said.

Leeches aren't the only creepy crawlies in use in modern medicine. Maggots also are making a comeback, although at a slower pace and apparently not so far in Duluth.

Unlike leeches, which started to return to favor for medical use in the 1970s, "maggot therapy is relatively new," said Dr. Ron Sherman, a retired researcher from the University of California, Irvine, and co-founder and medical director of Monarch Labs. The company specializes in medical maggots, although it also provides medical leeches.

Both maggots and leeches were approved (in that order) as "medical devices" by the Food and Drug Administration in 2005, Sherman said, the only animals then and since to achieve that status.

Monarch Labs doesn't yet have FDA clearance for its leeches, but it does make them available.

"I got involved in leeches because everybody mixes up maggots and leeches," said Sherman, 59, in a phone interview. "I would be called by various hospitals and physicians to assist them doing leech therapy because they didn't see it as much of a difference from maggot therapy."

"Leeches suck blood; maggots dissolve dead tissue," Sherman said. "Those two aren't anything alike."

Maggots can be used in wounds that otherwise aren't healing, he said. They promote healing by removing dead tissue from the site. His research at Cal-Irvine comparing groups treated with traditional methods of care to those treated with the help of maggots found that "the maggot therapy group healed much, much faster," Sherman said.

Maggots are being used in some of the top medical institutions and teaching hospitals in the world, he said, including the Mayo Clinic.

Neither Aulie nor Tomsche could recall any instance of maggot use via their pharmacies.

If Essentia Health used maggots, it would certainly have a policy for their use, Tomsche said. "And I'm not aware of a maggot policy."

The group that may be the most accepting of maggots, Sherman said, is the patients treated with them.

"Everyone talks about the so-called yuck factor, and quite honestly I have not found that to be a significant problem," he said. "For the patient with a stinky, draining, limb-threatening wound ... especially if they have been told about the surgical options, wearing a bandage of ... maggots for two days is not as big a deal as it is for the medical personnel."

Essentia has had a leech policy since 2010. The policy includes the 15-minute check on leeches. It also includes proper disposal of the leeches, which are destroyed after a single medical use.

The used leeches are dropped in 70 percent alcohol, and then disposed of as medical waste, Tomsche said.

"Because they do have the patient's blood in them, obviously," he said. "And so it's absolutely key that the leeches are never reused because you wouldn't want to have them sharing between patients. That would be an infection risk."

"Really the best effect comes not so much when the leech is on the area," Tomsche said. "It comes afterwards because that little leech wound will continue to ooze blood, many times for up to 10 or more hours."

Researchers developed Bivalirudin, a synthetic version of the substance in leech saliva, to prevent blood from clotting, Tomsche said. But it hasn't displaced leeches because it's injected intravenously and affects the entire body.

"The nice thing about leeches is that their saliva, it all stays local," Tomsche said.

The thought of either leeches or maggots as a treatment might rouse equally queasy feelings.

Both, although living creatures, were approved as “medical devices” by the U.S. Food & Drug Administration in 2005.

MEDICAL USE: Leech: They’re used to keep blood from clotting, allowing it to flow and promote healing in plastic surgery and other forms of surgery.

Maggot: They’re used in wound treatment to dissolve dead tissue, thus promoting healing.

HISTORY: Leech: Dates back to ancient Egypt and in common use through the mid-1800s. Began to return to usage in the 1970s.

Maggot: The positive effect of maggots on wounds was seen in battle as far back as the days of Napoleon. William Baer of Johns Hopkins pioneered the use of maggot therapy in the late 1920s, but medical use of maggots died out in the 1940s. Returning to usage over the past 15 years.

Sources: Dictionary.com, Dr. Ron Sherman, documents filed with the U.S. Food & Drug Administration

MORE CRITTERS ENLISTED IN MEDICINE Although only leeches and maggots have been approved by the U.S. Food and Drug Administration as “medical devices,” other critters are in various stages of research regarding medical use, said Dr. Ron Sherman, medical director of Monarch Labs in Irvine, Calif.

Pig whipworm eggs have been used experimentally in the treatment of Crohn’s disease. Research has been led by Dr. Joel Weinstock of the Tufts University School of Medicine in Boston.

Hookworms have been used in other countries for treatment of a variety of intestinal diseases, autoimmune diseases and neurologic diseases. Results have been “generally positive but sometimes conflicting,” Sherman said.

Bee venom therapy has been used for a variety of pain syndromes and neurological and autoimmune diseases, but no company has yet obtained FDA clearance to distribute it. “So people in the U.S. now are forced to find their own bees and sting themselves if necessary,” Sherman said.

Through the research foundation he chairs, Biotherapeutics, Education and Research Foundation, Sherman has applied for a grant to study fish therapy in treating psoriasis.

“The problem with all of these is that it’s very expensive to do research,” Sherman said.

LEECHES FROM LONG ISLAND Essentia Health gets its medical leeches from Leeches U.S.A., a company on Long Island, N.Y., according to Jim Tomsche, director of acute care pharmacy for the health system’s East Region.

Leeches U.S.A. doesn’t talk to the media, a woman who answered the phone at the company said, so what we know is second-hand. But Dr. Ron Sherman, medical director of California-based Monarch Labs, said he understands Leeches U.S.A.’s leeches are raised in ponds.

Either way, they aren’t the leeches you would get at the bait shop. The Hirudo medicinalis — medicinal leeches — are elitists among leeches.

“It was once nearly extinct, and so there are restrictions, and so it’s therefore much more expensive to get,” Sherman said. “So chances are good that the one at the local bait shop is not that species.”

The price is certainly different. When in stock, a dozen leeches costs $3.50 to $4 at Chalstrom’s Bait & Tackle, a spokesman said. From Leeches U.S.A., the medical leeches can cost as much as $18.60 apiece, according to the company’s price list.

The medical leeches also happen to be handsome as leeches go, with reddish-brown pinstripes on a dark body.

Leeches U.S.A. delivers leeches 365 days a year, Tomsche said. But since the St. Mary’s pharmacy doesn’t keep leeches on hand, he calls on the pharmacy at North Memorial Medical Center in the Twin Cities for immediate leech needs, saving hours on the initial delivery time.

Until needed, the leeches are kept in a “mini leech mobile home” made by Leeches U.S.A., Tomsche said.

The mini leech mobile home consists of a 5-inch tall, 4-inch diameter container inside an 8-inch tall, 5-inch diameter container. The leeches are kept in the smaller container, which is pricked with tiny holes. The larger container holds distilled water and a salt solution, and has to be changed every 48 hours. It holds up to 40 leeches.

Theodoric of York: Now, Mrs. Miller, you're distraught, tired.. you may be suffering from nervous exhaustion. I think you'd feel better if I let some of your blood.

Joan: You charlatan! You killed my daughter, just like you killed most of my other children! Why don't you admit it! You don't know what you're doing!

Theodoric of York: Wait a minute. Perhaps she's right. Perhaps I've been wrong to blindly follow the medical traditions and superstitions of past centuries. Maybe we barbers should test these assumptions analytically, through experimentation and a "scientific method". Maybe this scientific method could be extended to other fields of learning: the natural sciences, art, architecture, navigation. Perhaps I could lead the way to a new age, an age of rebirth, a Renaissance! ........ Naaaaaahhh!

Sorry I disagree.

Our past Americans were not for the most part not stupid. I spend a bit of time researching historical medicine

They chewed Black Willow bark .. i.e.. Aspirin. Leeches are used for finger reattachments. They inject anti-coagulates. Maggots were used to eat rotting tissue.

We did screw up Major during the Civil War. Germ theory was in Europe but hadn’t jumped the pond and so many died.

Fascinating. Our daughter works in the Medicine ICU of a teaching hospital & used leeches in the treatment of a graft patient who had blood clots impeding the blood flow to the graft. They worked, and were entertaining to boot.

I disagree. Actually, U.S. & Western doctors & researchers have pioneered the use of God’s bounty in medicine.

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