Wound dressing after application of medicinal leeches

Wound dressing after application of medicinal leeches is divided into two parts. The first part concerns the period when a leech does not fall off. In this case we are talking about a partial treating the wound, the aim of which is to prevent blood flow on the patient’s body. You can use gauze pads, wool or cotton swabs to treat the wound. After a leech drops off, the wound is not yet ready for final dressing, since you must first insert a leech into the prepared container and attach dressing to the wound. The aim is not to stop the bleeding, because bleeding that occurred after the application of a medicinal leech has its special significance. Gauze or cotton wool as absorbent material takes the drained blood and prevents leakage on the patient’s skin, so it will not dirty the area around.

Many hot disputes arose on the use of sterile materials. In general, sterile material is recommended. In the centers practicing hirudotherapy, I often encountered cases of using not a sterile wound dressing, as a leech treats the wound itself, and there is no threat of infection within 24 hours. This procedure is tested in this way on thousands of patients. In the opposite case, each physician will always insist on the application of sterile material directly to the wound which can always be explained.

The difference in time when the first and the last leech drops off makes about 20 – 30 minutes. While you wait till the rest leeches drop off, you’re supposed to observe the swabs on the wounds. Sometimes it happens that some of the tampons are filled up with blood, and it starts running down the patient’s skin. Then you should wipe the blood and change the swab to a new one. That is how we control and treat all the wounds from the leeches that have already dropped off till the last leech lets it go. You can then proceed to the next step, i.e. the final treatment of the wound.

The use of medicinal leeches

After preparing a place for the patient to apply the leeches, one should make sure the use of medicinal leeches is suitable for this patient and he/she is familiar with the principles of providing first aid. Only then we can say that we are ready to begin the therapy using medicinal leeches. When applying medicinal leeches, it is important to stress the following points: the first is the size of a medicinal leech. Medicinal leeches can be applied in a variety of sizes: there are cosmetic medicinal leeches which are very small and similar to living strings; next, we have leeches of medium and large sizes. Cosmetic medicinal leeches are hard to find in Slovakia, because it is difficult to take care of them and they often die very quickly. In most cases one can easily buy medicinal leeches of medium size. Taking into account that more and more people use medicinal leeches at home, there is an offer to buy medicinal leeches of a bigger size.

The size of a medicinal leech determines the depth of a bite and this determines the location of a medicinal leech application. An experienced hirudotherapy practitioner can use leeches of any size on any part of the patient’s body. In case leeches are used by people with little experience, I would recommend using that part of a patient’s body, where muscles and joints are located. Thus, it is better to avoid places with soft tissues, such as neck, groin, inner leg from the knee to ankle and the entire facial area. This brings me to another important observation: the application place choice, but we will discuss it in more detail in chapters on separate diagnoses, as there is a very wide range of places where you can use medicinal leeches. In this chapter, we will focus mainly on the preparation of a place.

Preparation of a patient to use medicinal leeches

Before applying a medicinal leech, it is very important to determine if such use of medicinal leeches is suitable for a patient. We must distinguish between a new patient and an experienced one, because a new patient using medicinal leeches has never been acquainted with the application of medicinal leeches and has no experience, and an experienced patient that has already taken the therapy, has gained a personal experience.

When we have a new patient, we should get maximum information about his health condition. We will need to find out about all his actual and previous health problems and we will need the results of blood tests. It is always useful to know the patient’s blood analysis. Blood sampling should be recently done, advisably 2-3 months before starting the hirudotherapy. If we do not have the blood test confirmation, we offer the patient to consult on the use of medicinal leeches with his or her doctor.

If we have a patient experienced in the medicinal leech application, first of all, we need to know all the details on how his body responded to the treatment, and if his or her health condition has changed after the latest application in any significant way.

In general, specific facts worth mentioning include the contradiction to apply medicinal leeches if a patient has poor blood clotting or serious blood diseases. Furthermore, it is ill-advised in case of cancer, during pregnancy, and when a patient’s body is intoxicated with alcohol or other drugs, or in case of individual intolerance of leeches. I always recommend having a consultation before using medicinal leeches where either a physician or a hirudotherapy practitioner rechecks your health condition to verify if the use of medicinal leeches to treat the problem is appropriate. It is important to note that a disease or health problems we want to treat using the medicinal leeches are not the main indicators of whether leeches are suitable or not. We consider complex health condition of a person as a primary indicator and that is why great attention should be paid to it.

Preparation of a workplace or what we need to apply medicinal leeches

Before you start, it is very important to prepare a workplace and all necessary aids when using medicinal leeches.

The workplace must be clean. There is no need for special hygienic conditions or complete sterility. It is enough to clean the area to get rid of dust and dirt to make sure that the aid you will be working with does not get dirty.

Aid: A container to store the leeches intended for use. This container should have a lid to prevent leeches from escaping. Every time when pulling out the leech from the container, the kit should be carefully closed. We may put 2-3 leeches more than we intend to use, because not every leech wants to stick immediately. If the leech does not want to suck in, after a while we simply change it for another. This matter is discussed in another chapter on the use of medicinal leeches.

The second aid you are going to need is surgical gloves without powder. It is better to prepare several pairs of surgical gloves. You may take leeches with bare hands if you are not afraid of them, or with surgical gloves without powder. In any case, surgical gloves are needed when they begin to drop off the wound and blood begins to flow. Then the repeated use of surgical gloves is necessary because leeches will be released at different intervals, and it is possible there will be a lot blood flowing.

How to take care of a medicinal leech at home

Everyone knows that medical leeches are kept in specialized farms. Wild leeches can hardly be met in nature and that is why they are protected by law. Leeches that people can buy for domestic usage are ready for application and they are not suitable for further propagation or reproduction. Furthermore, leeches used for the therapy are quite young. In order to breed them at home, a person would spend a lot of time and feed them with certified blood, which causes a lot of difficulties. On this occasion we will not talk about their cultivation, but we will focus on taking care of medicinal leeches before and after application.

After purchasing medicinal leeches, you may collect them from us or get an order package delivery with a water container or with wet balls that look like balls with gel. A water container should be prepared for leeches one day prior.

Water: the most suitable water for leeches is settled tap water. Fill a contained with tap water and leave it for 24 hours. People think that one should get water from a well or a river, however, our experience tells us that such attempts do not always end happily. There was even a case with a person who got water somewhere in nature and all leeches died in it. Therefore, from our experience, we recommend using only tap water left for 24 hours.

Container: a perfect container is a glass container with a wide neck and a lid, which is big enough to shove your hand, and yet it could be hermetically closed. A wide opening is important for easy handling, be it for pulling the leeches or cleansing the vessel. Glass is a transparent material that allows observing the leeches contained.

One can store approximately 50 to 100 leeches in a 3-liter container. However, 100 leeches are too many, so it is better to store 50 of them in a 3-liter container.

After bringing the leeches, you should take care of them appropriately. Put them into the intended container and add the water you’ve prepared. It is also possible to pour water first into the vessel and after that let your leeches in. Leeches do not need oxygen and, therefore, we are not expected to cover the container with a tissue, gauzy fabric or anything else, as it is often described in the Internet, rather simply seal the container hermetically with a lid to ensure the leeches stay within. All further care involves changing water every 2-3 days, watching the leeches, observing their health condition, vitality and sometimes cleaning the container.

Here one shall discuss this process in detail. After bringing the leeches and putting them into a container with settled water, it can be hermetically closed. What are further subsequent manipulations with them? Hungry leeches intended for use should not be exposed to high temperature or direct sunlight. It is better to leave them in the daylight, but without sun, yet they are best stored in the refrigerator, since it creates ideal conditions for leeches. If you are not going to use them right away, better leave them in the refrigerator. There they remain in a state similar to hibernation and, therefore, will be preserved for a longer term. Used leeches can no longer be put in the same container with the unused leeches. You should prepare a new one for those. Water conditions remain the same, the only difference is that you should no longer put them into the refrigerator, and it’s better to pick a dark place, certainly not too warm, for example, a cellar. A hungry leech is drawn to light looking for food. A satiated leech looks for a dark place due to the fact that it needs to absorb blood collected. In case of repeated use of a leech, for example, in the treatment course that lasts for 2-3 months, it is necessary to divide leeches into different containers. Leeches used during the first month should go to the first container, those used during the second month should go to the second one, and the third-month-leeches should be put into the third container. This system helps to have a general overview.

When talking about water temperature, it should be noted that changing water must be of the same temperature as the settled water in the vessel. For example, if we have leeches in a container with water temperature of 17 degrees, the water we leave to settle for 24 hours must also have the temperature of 17 degrees. It can be reached the following way: a water container we use in exchange should be left in the same place, where a container with leeches is situated. If leeches are kept in the refrigerator, exchange water should also be placed there. It’s really important to reduce the difference in old and new water temperatures. It is just preferable to maintain water at the same temperature.

Another important factor is health condition of the leech. One should watch the leeches on a daily basis. They must be left in a transparent glass vessel. Glass provides us with an eye contact possibility. We can see if they are healthy, ill or dead. Both new and used leeches must be checked. Even when leeches are placed in a dark place with water change every 2-3 days, their condition must also be checked. Most probably some of the leeches will die. In general, you should not be afraid of this. A dead leech should be removed from a vessel and the water in the container must be changed. If a leech that behaves strangely or looks sick is found, it is better to remove it from the container and put into a separate vessel. This applies to both used and new leeches. Each leech you suspect to be unhealthy should be kept in a special place, in a container, even if it is a small bottle. The leech should be left in this container until it is fully recovered or dead due to illness. There is a chance this leech recovers in a couple of days. In general, the thing is the sick leech should be removed from others not to transmit infection or affect negatively other healthy leeches.

It happens very often that one may notice some ring or a removed rim on a leech. The leech often removes its skin like a snake, and this old skin produces a secret coating on a body surface that looks like a ring around it. Leeches eventually get rid of it by removing the old skin, or the ring will burst, but one can remove it, so it’s not a problem.

Now let’s talk about the container cleaning. Cleaning the container is actually not an easy thing if a person is not instructed for this. We need a deep sieve, ideally if metal, and preferably the one with small holes using which the water from the container with leeches is poured out. The sieve is used to catch those leeches, as sometimes it happens that some of them are lost when pouring. After this, one should put the leeches back to the container. If you do not want to touch leeches, use surgical gloves for such manipulations. After water removing and returning the leeches left on the sieve back to the container, cleanse the container with tap water and be sure to drain the water from this container again using the sieve. Leeches found in the sieve must be placed back into the container again. If necessary, this process can be repeated several times, but usually twice are enough. When all the leeches are back in the container, one should fill the container with settled water, hermetically close it and put it in its place. When absorbing, leeches tend to leave secretion that may stay on the sieve. That is why it is good to cleanse the sieve with boiling water to sterilize it. It should preferably be done before and after each use. Be sure to leave the sieve to chill to avoid damaging the leeches. We’ll also need a brush to clean the sieve. Do not use a brush for room cleaning or an object with chemicals. It’s actually really important that the brush does not contain residual traces of chemicals. That is, you should have a separate sieve + a separate brush specifically for this. The sieve must be cleaned with a brush and tap water, to be finally sterilized with boiling water.

In general, these are all conditions. To summarize, it should be mentioned that when you take care of medicinal leeches at home, it is important to look after the container and water. However, visual observation of the leech health condition is also important when you change water in the vessel.

It is also worth saying that one can find a lot of methods to clean the blood from the leech on the Internet. For example, a method using which it would be possible to remove the blood from the leech in a shorter period of time, but I do not recommend it, because this may damage the leeches. The only method I can think of is that it is better not to leave the leech to drink blood for too long, and it is better to remove it before it drinks too much. It is best to use a few leeches right away and leave them to grow at their own pace and live their lives, in order to fully absorb the blood taken. The whole process is about trying not to interfere with nature. We shall discuss it further in the next chapters.

Finally, I have to tell you about one more case, that is when you do not want to use medicinal leeches any more. What should you do next? When you remove the applied leech from a patient’s skin, what is the next step? It is necessary that one decides for oneself whether he or she wants to put an end to the lives of leeches, or he/she wants to return them back to nature. If one wants to end their life, one can simply immerse them into alcohol solution at home which results in a quick death for leeches, and then it will be enough to flush them down the toilet or throw somewhere outside, where they will decompose. If we choose the second option to preserve and keep their lives in nature, we need to find them a stream, where people do not bathe, and pour the water with leeches out of the container there. Nature will decide on their fate.