Leeches
Leeches are bugs. We tend to see bugs in our life as unwanted. As children we don’t want to be stung by a bee, fed on by a tick, bitten by a mosquito or have a prehistoric appearing stink bug fly in the window and crash into our head as we read our phone in bed, in darkness at night. The phone– a bug beacon. No one wants this. And in our mypoic view– our answer is to typically kill the bugs. Sterilize your skin (spoiler alert- you cannot), your counters, deplete your savings with various stink bug traps, plant bee free gardens and spray for ticks. But most life seems to have a purpose.
Technically bugs are in the Animal kingdom. If you recall biology you had to memorize a sentence to recall the seven levels used to classify life. Kingdom, Phylum, Class, Order, Family, Genus, Species. All life is named by the genus and species. Though I use the term Bugs in Life for the blog, technically our ID work isn’t in the animal kingdom (where bugs and insects exist) but in the other three kingdoms–Kingdom Monera, Kingdom Protista and Kingdom Fungi. But mostly Monera. Staphylococcus aureus is my most common foe– its genus and species name in Kingdom Monera. Homo sapiens; my protagonist– our name in Kingdom Animalia.
But Thursday I got to work with a legitimate bug. In the world of ID– we deal with a ton of wounds. Our skin is our first layer of defense (one of the most important organs and parts of our immune system) and when it breaks down– all of the other kingdoms can get it. We live in a biome, we are a biome. Our skin is our barrier. Our fence. There are organisms always just waiting to get it. Some friend, some foe.
Things that weaken our skin and its blood supply (chronic steroid use, NICOTINE use), those habits that break the skin (picking and needles) and finally those diseases that either weaken our skin or our immune system (psoriasis, burns, diabetes, peripheral arterial disease, chemo etc) are much of the bread and butter of ID. Call it setting in the narrative.
I see a lot of infected wounds, dead tissue, and gangrene. At times maggots show up in the wound bed–unplanned. Other times medical maggots are placed into a wound bed to facilitate healing. Medical maggots have value– they eat dead tissue. They do not consume living tissue. Bacteria love dead tissue as well- but will consume the living tendon, joint, bone etc… Maggots have purpose in the setting of trauma, wound care, and plastic surgery. Organisms that will only consume necrotic dead cells. And can differentiate.
We also use leeches in medicine–but I have never seen them in a wound. Only in a lake and uninvited, on human skin.
In the setting of wound and limb salvage – the longer something is open to the air without its skin/fence - the more bacteria begin to colonize and often infect that area. Infected wounds mostly must heal from the inside out when there has been surgery to remove significant amounts of dead and infected tissue. If the skin is simply closed over a large empty cavity – body fluid will fill that cavity and any kind of fluid while it is sitting stagnant (much like the pond without flow in or out) waiting to be resorbed– can get infected. So we (actually the surgeons) do many things to clean out wounds, encourage healthy healing and close skin.
One of those things is to bring healthy blood supplies to spaces with muscle flaps to protect the underlying less vascularized tissue (IE a joint- bone has less blood supply than muscle) and then eventually allow for a skin graft to be placed over that muscle flap to close the wound. In these spaces of work there can be a role for leeches. Sterilized, medical leeches. You can google how it works and while you are there– google what is in leech saliva. It is amazing– anticoagulation properties and enzymes, antibiotic properties AND anti-inflammatory properties. So in the setting of wound healing, when muscle flaps are congested and we need to establish better blood flow– leeches can have purpose.
Leeches arrive from the pharmacy in a sterile jar and look just like the ones from Ahmic Lake where I worked and swam for many summers in my youth.
If you have leech experience then you already know that they are extremely stretchy and very very difficult to pull off of a foot when they don’t want to come off. If you have ever worked on a fresh water lake in Ontario (I cannot speak for all of the lakes) you know that tales of leeches are one of the top reasons campers are afraid of the water at first.
Very few things create louder screams (that aren’t true trauma) than a 7 year old girl who finds a slimy black thing stuck to her foot. We used to have salt on the waterfront and would immediately paste it onto the leech – which would cause it to die/drop. (google osmosis)There was bleeding for quite some time after removal (leech saliva has anticoagulant properties) and usually small bits of cabin hysteria.
One of my boys won an award at his camp– (NOT ADVISED BY EITHER THAT CAMP OR HIS MOTHER) for his ability to use burning sticks to “encourage” leeches to abandon their attachment on camping trips….
So this week I found myself in a room with an amazing number of life forms– because multiple hands were needed to assist the dressing change and leech application (there are Leech Protocols when they are used) and because– #leeches. A few people were building a “leech pen” in the wound bed (you can’t have them just going wherever they want to go), others were prepping the dressing materials and one was trying to transfer the leeches from their sterile jar to a container than would be easier to “dump onto a wound.”
That recommended container was the tubing of a large volume syringe (without the needle attached). However in the transfer process– as hungry, moving, curious leeches should be expected to do– it moved to the narrow end where a syringe would normally attach and somehow managed to stick half of itself out of the spout.
That leech was stuck. No one wanted to pull too hard as there was fear it would break. No one wanted to waste the leech. And everyone had gloves on, which makes this ridiculously difficult. I was standing a bit in the background, trying to see how healthy the wound was looking but it became clear to me at some point that though I had no experience with medical leeches, leech pens and was not at all about the touch the beautiful muscle flap– I had the most experience with leeches in the room.
You really cannot break a leech– with some blood on a swab for enticement and some gentle pressure– I was able to wrangle it out. And onto the wound bed it went to help with healing.
Over 20 years in medicine and still finding random skills from life that find their way into my work life.
Leech wrangling. Because it turns out that the little blood suckers that gave my campers nightmares can bring medical miracles. As I am constantly rereminded– most life forms have purpose. That we (humans) don’t always see it only speaks to our narrow perspective. Except with ticks. I am yet to find the good in ticks. But I am open to learning.
