Paging Dr. Frischer - Leeches

A dear friend has severe arthritis of her knee - but that's not what today's column is about. Desperate to avoid knee replacement surgery, and tired of relying on pain medications, she has been looking for alternatives. Her acupuncturist led her to an ancient treatment that has seen a recent resurgence. Let's address the subject of leeches and their use in medicine. The field is known as biotherapy: the use of living animals to aid in diagnosis or treatment. Maggots are another example, but I'm sure that you'll agree that leeches are enough for now. To be honest, I should admit upfront that my original goal was to research this subject thoroughly, and then be able to legitimately and scientifically make fun of my friend for allowing leeches to latch onto her body and suck her blood. After educating myself, do I still feel that way? Well, it's complicated. Here in the United States leeches are making a comeback. In 2004 the FDA gave their official stamp of approval for leeches to be used as a medical device. The leech is a blood-sucking animal that is related to the earthworm and lives in fresh water. It has a rear suction cup that helps it to move and cling, and a front suction cup with three sharp jaws that make a Y-shaped bite. Once latched onto a host, it can feed on blood from 20 minutes to six hours, multiplying its body weight several times. So far, it sounds like a simple parasitic relationship: the leech is the only one benefiting. What's in it for us? Leech saliva is made up of more than 30 different proteins, and they are effective for numbing pain, reducing swelling, and keeping blood flowing. (Note how these attributes also enable the leech to keep feeding.) In fact, it was the discovery of one of its anticoagulant proteins that led to a useful alternative medication for those patients who cannot use the common blood thinner, heparin. Leeches have been used through the ages to treat everything from headaches to ear infections to hemorrhoids. Egyptians used leech therapy 3,500 years ago. The Greek philosopher Hippocrates wrote in the 5th Century BCE of using leeches to restore health by rebalancing the body's four basic humors. Other popular eras for leeches include the middle ages and the 19th Century. The use of leeches in modern medicine started 30 years ago, with the advent of reconstructive microsurgery. Maintaining blood flow is a major issue during these surgeries; if congestion isn't cleared up quickly, the blood will clot, arteries will become plugged, and tissues will die. The leech became valuable when doctors were faced with the difficulties of reattaching minute veins. In 1985, a Harvard surgeon was having great difficulty reattaching the ear of a five-year-old child; the tiny veins kept clotting. He used leeches and the ear was saved. Today, trauma doctors at Johns Hopkins, the University of Maryland and other hospitals routinely use leeches as a temporary measure to keep blood flowing as new vessels grow in damaged tissue. Treatment with leeches can keep blood moving in and out of a new skin flap. They can get blood flowing to reattached fingers. Because leech saliva works as a natural anesthetic, some doctors are looking to use them to ease pain. For my friend, it's possible that they can lessen the pain and inflammation of her osteoarthritis, where cartilage has been worn down and bones are grinding against each other. Because leeches can pick up parasites, bacteria or viruses from a patient, medicinal leeches are raised in a sterile environment, and are used on only one host for only one treatment. Their first human meal is also their last meal. Depending on the wound size, a doctor might apply anywhere from one to six leeches. Are there downsides to leech use? Their bites are quite painful. Sometimes they slip and reattach themselves in unwanted places. No matter how helpful they may be, there are many of us who would have trouble allowing a blood-sucking worm to bite into us. For the squeamish, scientists have come up with a mechanical device that looks like a small bottle attached to a suction cup, delivers an anti-clotting drug to damaged tissue, and then gently sucks as much blood as needed. Whether or not leeches will play a role in your future, they certainly are one more interesting alternative to conventional medical care. As for my friend, perhaps I owe her an apology...but I suspect that won't stop the teasing! Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: July 25, 2013 - Volume 12 - Issue 15