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Questions & Answers

 

The following frequently asked questions have been answered for you to the best of our knowledge. They are meant to provide information concerning leech therapy in theory and in practice. The information given may most definitely not be seen as a substitute for professional counselling or treatment by professionally trained and approved physicians. The answers to these questions cannot and must not be used to independently diagnose or treat complaints.

Subject Areas: 
Medical Treatment 
Veterinary Treatment

 

Medical Treatment 
Legal Aspects of Leech Therapy  
  

Question:
Where can I get the supply of leeches for treating my patients as a physician or alternative practitioner? 

Answer:
Medicinal leeches for pharmaceutical application can only be purchased from authorised producers or from the pharmacy (make sure the leech supply originates from an authorised producer). This regulation is valid for all European countries in which leeches correspond to the legal pharmaceutical product status.

 

Question:
How can I identify an authorised producer of medicinal leeches for pharmaceutical use?

Answer:
An authorised producer of medicinal leeches owns the legal producer permit and a valid GMP (Good Manufacturing Practice) certificate which must be presentable on request. 

 

Question:
Am I allowed to conduct leech therapy on third parties even if I have not completed my professional training as a physician or as an alternative practitioner? 

Answer:
No. According to § 5 of German Law concerning Alternative Practitioners Act (Heilpraktikergesetz, abbr. HPG), any person practising medicine without having an authorisation and/or license in compliance with § 1, HPG, is subject to a penalty of up to one year of imprisonment or a fine.

  

Question:
What should I do with the leeches I have used for therapy? 

Answer:
Dispose of them using, for instance, ethyl alcohol, or by freezing them at low temperatures of about –18°C for at least 12 hours.  For the commercial sector, if possible dispose of as organs and blood products according to the German Waste Code 18 10 02 (Organs and blood products).  Otherwise they can be disposed of in non-recyclable residual waste in watertight, unbreakable containers labelled as potentially infectious material.  If preferable, they can also be stored before final disposal in a closed jar with water and stones until they die a natural death.

 

Question:
May I obtain leeches as a private individual for the purpose of treatment? 

Answer:
You can obtain leeches without prescription, but they are subject to sale by pharmacists only.  Because of the risks involved in leech therapy, no nonprofessional self-treatment should be undertaken. On presentation of an attestation of the attending therapist, the leeches may also be obtained directly from the Biebertaler Blutegelzucht GmbH leech-breeding station.

 

Question:
May leeches be applied a second time?

Answer:
No.  For quality and safety reasons, subject to pharmaceutical rules and regulations, it is not allowed to apply leeches that have already been used.

  

Question:
Is there also a quality and safety risk involved if the leeches are applied to the same person a second time?

Answer:
After having once ingested blood extensively, leeches will not bite again for a period of at least three months. Storing leeches meanwhile in containers under artificial conditions increases their contamination with pathogens. Hence, there is a substantial risk of secondary infection for the patient.

 

Keeping and Caring for Leeches before Utilisation  
 

 

Question:
After delivery, how long should leeches be stored before treatment? 

Answer:
The optimal method is to keep the leeches for at least two days before treatment in a quiet place at a moderate temperature in order to allow them to recover from transport-induced stress.

 

Question:
How long can I keep leeches in my office before using them for the scheduled next treatment? 

Answer:
The duration depends mainly on the storing conditions. If the leeches are kept in a closed container with adequate water and small stones (approximately 5 leeches per litre), one should not go beyond a period of 2 to at the most 4 weeks, as storing the leeches under artificial conditions in containers leads to increased contamination of the leeches with bacteria, and therefore increases the risk of secondary infection of the patient significantly.  When stored properly, taking into account these and other problems, this period can be increased considerably.  You can ask the Biebertaler Blutegelzucht GmbH directly for advice concerning technical and other details.

 

Question:
Is it possible to keep leeches in tap water?

Answer:
This depends considerably on the quality of the tap water.  In Germany, tap water is sporadically chlorinated. Leeches will die from comparatively low dosages of chlorine in water. Moreover, the water should not contain too much calcium (overall hardness < 8 dH, corresponds to hardness range 1 low; pH < 7). Therefore, we recommend using plain distilled water (available commercially as battery water), to which 0.5 grams of sea salt per litre (about a pinch) should be added. In addition, the plain distilled water ought to be completely free of pathogens.

 

Treatment

 

Question:
How long does the secondary bleeding last? 

Answer:
The normal duration of the secondary bleeding is between 8 and 24 hours.

  

Question:
In one case, the secondary bleeding after a leech bite was extremely strong, it lasted an especially long time, and the leech had fallen off fattened and full very quickly. What was the cause of this?

Answer:
It can be assumed that the leech was placed directly above a vein running directly beneath the skin. Be especially careful when applying leeches in the extremities. The exact position for application should be determined and clearly marked when the patient is standing, as the blood vessels are then filled to the maximum, which helps avoid inadvertently applying a leech directly above a vein. 

  

Question:
Do leech bites hurt?

Answer:
The resulting pain perception is very individual and dependent on the site of the bite. Usually patients report pain perception comparable to the sting of a nettle or the bite of mosquito. 

 

Question:
Is the knowledge conveyed by the answers given here sufficient for conducting leech therapy?

Answer:
No.  These Questions & Answers serve only to convey some basic facts. Thorough training and instruction in the theory and practice of leech therapy is an indispensable requirement for successful treatment.

 

Question:
Will the leeches move about while they are sucking? 

Answer:
Sometimes the leeches will move a little, but their suction cup at the front will adhere to the site of the bite until they have finished ingesting blood. Afterwards, they will fall off or crawl away, but will not bite a second time.

 

Question:
After treatment, the wound starts itching. What can I do to prevent that? 

Answer:
Frequently, patients report itching, which is felt quite intensively by some. Scratching frequently causes secondary infections and should be strictly avoided. In order to reduce the itching, you may lightly pat the wound.  The following countermeasures may also be helpful: For external use, Fenistil®-Gel (Dimetinden), curd packings, alcohol compresses, or the homoeopathic compound Spenglersan®Kolloid G for rubbing; for oral intake: apis, ledum, or antihistamines. 

 

Question:
Why and when do the sites of the bites turn blue?

Answer:
The bluish colour is caused by haematomas that have developed as a result of the anti-coagulant effect of leech saliva in combination with the high suction pressure exerted by the leech on sensitive skin. 

 

Potential Side Effects

 

Question:
The site of the bite is inflamed and reddened, it strongly itches and the surrounding area (in most cases the extremities) is swollen and tense. What is the cause of this and which measures are reasonable?

Answer:
Possibly these are localised reactions to the leech bacteria aeromonas sp. and/or allergic reactions.  Especially after leech application below the groin or on the arm, it is extremely important to allow the respective extremity to rest by keeping it raised as much as possible for about three days.  Furthermore, cold compresses should be laid on the wounds as soon as the bleeding has ceased.  If these measures are appropriately coordinated and adhered to, severe localised side effects can often be prevented beforehand.  Measures that can be taken: raise the extremity, cold packs, local and internal application of antihistamines (Fenistil®, Ceterizin® highly dosed); as indicated, additionally highly dosed enzyme preparations, homoeopathic substances apis or ledum.  In any case, remain calm!  Symptoms usually subside after a couple of days.

 

Question:
Can infectious diseases be transmitted by the bite of the medicinal leech?

Answer:
As leeches may be used only once, transmission of human pathogens is basically impossible.

 

Question:
After leech therapy, the regional lymph nodes are swollen. How does this come about and what can be done about it?

Answer:
First of all, such regional swellings of lymph nodes are not at all dangerous.  Leech secretion accelerates the lymph flow, which can sometimes cause congestion at these “frontier posts.”  The swellings do not necessarily have to be dealt with, as they usually subside by themselves without medical treatment. It is also possible to prescribe naturopathic lymph remedies (e.g. Lymphdiaral® for internal as well as external use) to accelerate the decline of these harmless swellings.

 

Question:
The leech bites are still visible even after several months. What can be done against that? 

Answer:
Small areas of permanent depigmentation may remain on the direct bite sites. If the patient has such a tendency, keloids as well may develop. Often Keloid-Gel /Wala® can help. The attending therapist is to inform the patients of this secondary effect beforehand. Caution is advised if leeches must be applied in facial areas.

 

Question:
Is there danger of scars remaining from the bites? 

Answer:
Small scars will remain, but, depending on the type of skin, they will become mostly imperceptible after a period of approximately six months.

 

Question:
Is it possible that the bite will become infected? 

Answer:
If leeches are applied properly, local infections with the leech symbiont aeromonas sp., which are as a matter of principle possible, are rare (primary infection) and usually unproblematical. To prevent this, the leech should not be squeezed or made to regurgitate in any other way (e.g. by adding salt to induce the leech to drop off). In rare cases, the wound becomes infected with external bacteria (secondary infection) that are to be found on the leech skin if the latter has been kept for a longer period of time under adverse conditions and has not been washed before therapy.  Sometimes subsequent secondary infections are the result of introduction of external bacteria by scratching the place of the bite. Measures that can be taken:  Rivanol® baths and, as indicated, third generation cephalosporin antibiotics.

 

Potential Contraindications 

 

Question:
Can I carry out leech therapy on a patient who is taking aspirin? 

Answer:
Yes, but treatment with salicylic acid preparations has to be discontinued three days before the therapy and may only be resumed on the second day after leech therapy. As for the interruption of the use of aspirin, it is absolutely necessary to consult your respective physician.

 

Question:
Is it necessary to take into consideration the current blood count of the patient before starting leech therapy?

Answer:
Definitely.  For one thing, a possible anaemia can be identified and in general to determine the number of leeches that should be used, dependent on the red blood cell count (RBCC) and the iron content.  Keep in mind that the blood loss caused by one leech can amount to up to 40 mls. 

 

Use in Veterinary Medicine 
Leech Therapy
 

Question:
What can be done to ensure that leeches will bite at low temperatures?

Answer:
This problem arises mostly during the winter when dealing with larger animals. The safest method is to use an infrared lamp, leaving it on for the entire duration of the leech application.  Draughts should be avoided. Before leech application, the foreseen areas of application are to be treated with specific measures to increase blood circulation including hydrotherapeutic applications such as warm water, hot compresses, rubbing, or breathing on the respective skin area.

 

Question:
Is it necessary to remove the animal’s hair before starting leech treatment? 

Answer:
The area that is to be treated must be completely free of hair.  Even the tiniest hair stub can cause the leeches not to bite.

 

Question:
Should the wound be dressed? 

Answer:
In small animal veterinary practices, it is advisable to bandage the wound, mainly for hygienic reasons.  For larger animals, this is usually not practicable.  As the secondary bleeding is, by comparison, not very intensive, complications are not to be expected, but subsequent observation is recommended.

 

Question:
Which leech size should be chosen and how many leeches can be applied?

Answer:
The size and number depends on the weight and, hence, the quantity of the animal patient’s blood. Therefore, only specially trained and experienced therapists should carry out leech therapy.

 

Question:
Do animals usually put up with leech treatment without becoming upset?

Answer:
Neither smaller nor larger animals have any problems with leech therapy. It is assumed that animals accept leech bites as something perfectly natural.

  

Question:
How often may leech treatment be repeated? 

Answer:
This depends wholly on the range of indications, on the size of the animal and on the success of the initial applications.  As a rule, leech application can be repeated after 3 to 5 days.  However if after the second treatment  no success has ensued, then, at the latest, it is recommendable to discontinue treatment.  It should here once more be noted that only experienced therapists should be entrusted with leech treatment.

 

Question:
Is the secondary bleeding experienced by animals comparable to the secondary bleeding experienced by humans? 

Answer:
From observation we have learned that the secondary bleeding of animals is frequently of significantly shorter duration than that of humans. After 4 to 6 hours, the bleeding ceases.  However, exceptions to this rule may still occur. 

 

Question:
How many leeches should be held ready for a treatment? 

Answer:
When dealing with animals, leeches can sometimes be a bit choosy.  It is therefore advisable to hold ready about twice as many leeches as needed.