Clinical Considerations
Patient Care and Leech Application and Maintenance
Much of the following information is taken from Michalsen, Roth and Dobos, Medicinal Leech Therapy. This book may be purchased here and is an excellent source of additional information for all things related to medicinal leech.
Licensed and practiced leech therapists will be well versed in the preparation of a patient for medicinal leech therapy. However, as a guideline, the following bullet points are generally what one might expect.
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Contraindications: Although the literature is rife with the beneficial uses of medicinal leeches there are critical instances when they should not be used.
- Hemophilia anticoagulant medications
- Anemia
- Leukemia
- Hypotonia
- Pregnancy
- Acute stages of infectious disease
- Erosive gastritis and potential gastrointestinal bleeding
- Serious organic disease and immunosuppression
- Severe allergic diathesis
There is additional information in the leech library here. (Scroll through table to "Contraindications").
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Prepare the patient both psychologically and physically. There may be instances of squeamishness however, once the process and benefits are explained to the patient there is typically enthusiastic acceptance.
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Clean the application area with sterile water. Avoid disinfectants as these may cause the leech to reject the site. Perfumes, chemicals, or other local drugs should not be applied to the site for at least two days prior to treatment.
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Apply leeches to the site (see details below).
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Do not disturb the leech during feeding. You want to allow it to drink/suck without regurgitating back into the patient which may lead to infections.
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Allow the leech to feed (up to ½ hour). It will fall off on its own once it is sated.
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The decision to allow the wound to bleed or to attempt to stop bleeding depends upon a number of factors. The bleeding may continue for several hours, or, in some cases, up to 24 hours. This is a desired effect, however, exceptions exist. Consult your therapist.
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Allow the wound to heal. This may take several days and rest is recommended. Again, consult with your therapist.
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Post feeding, watch for complications. These may include:
- Patient turns pale
- Patient feels dizzy, nauseous, or faint
- Extremities become cold
- Pulse begins to become rapid and/or weak
Leech Application
Only active healthy leeches that are actively moving around should be used and actively seeks contact when in proximity to a patient or other donor. Smaller leeches are advisable as the bites are less painful, will heal faster, and will leave smaller scars. Larger leeches may be used in areas with less sensitive skin and in veterinary uses with large animals, such as horses.
Surgical gloves will keep the handler from being bitten. A cotton gauze is often helpful for use while handling. The leeches may be attached by hand, putting them in the area of interest. Other techniques include inserting them into a plastic syringe and then inverting the syringe on the area of interest. Cutting a hole in an adhesive film and placing that on the patient will target the area for the leech. Keeping the area wet may also help in getting the leech to attach. If the leech still fails to attach, pricking the area with a lancet may entice the leech to feed. Do not disturb the leeches while feeding. They may be covered with gauze or other cloth to keep them comfortable and in the dark.
When treating a small target area, the leeches have to be applied one at a time. Grasp the tail region of the leech between the thumb and index finger using a compress if necessary, and lower the head to the target site. Keep guiding the leech back to the target site until it bites and starts to feed. Wetting the application site with water sometimes make the leech bite faster. If the leech attaches it's sucker in the wrong place but has not bitten yet, the handler can carefully insert a fingernail under the edges of the sucker to detach it. Another good trick is to cut a hole in adhesive film and tape the film so that the hole is located over the intended application site. A small glass tube, a disposable syringe with the bottom cut off or a small cupping glass can also be used to selectively apply one or more leeches to one or more target sites. Before removing the cupping glass, the handler should check to make sure that the leech has not started feeding yet.
To use an open syringe tube (2 ml or 5 ml, depending on the size of the leech), cut off the bottom of the syringe bluntly or obliquely, then smooth the edges under a flame. Now pull out the plunger and let the leech crawl in back first. Use the plunger or a piece of gauze to push the leech in just far enough that its head is still touching the application site. Once the leech starts to feed, take it out of the syringe so that it has adequate room to expand during feeding. If the leech fails to bite for no apparent reason, it generally helps to prick the patient's skin with a sterile needle or lancer to draw a few drops of blood, which leeches find irresistible.
Feeding Process
The leech should be left undisturbed while feeding. If possible, it should be covered with a compress and cotton padding to protect it from cold and light and to prevent the patient's skin from cooling. The covering material also absorbs the aqueous fluids the leech secretes while feeding (water and excess blood serum). The patient should be placed in a comfortable position and the leech should have enough space to feed without the risk of being detached or crushed.
The leech will let go of its host as soon as it has finished feeding, which takes about 20 - 60 minutes. In rare cases, the leech may finish in as little as 10 minutes in parts of the body that engorged with blood, but under unfavorable conditions, the leech may feed for up to two hours. Sometimes the satiated leech will remain attached and motionless. Gently tapping the leech or stroking it with a compress can help prompt the leech to wake up and continue feeding or detach itself. Never use force to make the leech loosen its bite! This could lead to to infectious complications. Undue force could also make the leech regurgitate its stomach contents into the wound, a major cause of infection. The right way to get the leech to let go is to gently shake its entire body several times or to gently loosen the supporting rear sucker with a fingernail so that the leech is pulled down by its own body weight. The leech will then drop off the patient of its own accord.
It is strongly suggested to not use salt or other substances to make the leech let go by hurting or startling it. This can likewise make the leech regurgitate its stomach contents into the wound, resulting in wound infection.
Aftercare
The bleeding after the leech has dropped off may continue for some time, a few hours to perhaps, more than a day. The blood flow is advantageous, especially when congested venous flow is the problem being addressed. The flow also helps flush any bacteria out, thereby reducing the chances for infection. A thick sterile pad should be enough to absorb the blood for several hours and may need to be changed repeatedly. Physical activity should be kept to a minimum with a normal consumption of fluids. If bathing or swimming is desired, water proof bandages may be used to cover the wounds. Allow the scabs to heal naturally. The bite area may turn various colors while it heals. This is normal. The scar will generally disappear after a few weeks unless the patient is prone to scarring.
Some itching may occur as the bite heals and can be very annoying. Non cream or gel treatments such as hot or cold compresses may help. Icing or cold compress or heat treatments such as a hot shower have been used. Each individual will have to see which of these work for their particular skin reaction.
Creams, Ointments, and Oils
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Benadryl cream and topical antibiotics
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Benadryl gel or Calamine lotion
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Leech oil
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Almond oil
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Zinc ointment
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Tiger Balm
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Pure olive oil
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Apple vinegar
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Turmeric
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Aleo vera
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CBD-oil (10%). This may be difficult to find as this is a derivative of Cannabis and may not be legal in your area.
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Dr. Christopher’s itch ointment
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Hydrocortisone cream
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Banana peels, apple vinegar, crushed basil leaves, and lemon may also provide relief.
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