Archive for September, 2015

It’s the LEECH I Can Do For You

September 28th, 2015. Filed Under: Skin Care.
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I was reading an old article I saved from the newspaper about leeches used to treat medical conditions. It described a leech farm in Russia called the International Medical Leech Center in Moscow, which supplies leeches to medical clinics in Russia and nearby countries.

It brought back memories of my years as a hospital pharmacist with a very specialized responsibility: leech disposal.

My experience as a Leech Disposal Specialist began in 1987 in a 600-bed hospital in Dayton, Ohio. Our pharmacy manager started our staff meeting one Wednesday morning by clearing his throat. “We have a special request from nursing. The plastic surgeons are using medical leeches occasionally on some of their post-surgical cases. After being applied to the affected area, the leeches feed for several hours, are removed and new ones applied until the surgeon discontinues the treatment. After removing the leeches, the nurses want someone from pharmacy to come and take them away for disposal.”

“Eew!” was clearly on my face as well as my fellow pharmacists. Dead silence stretched on and on and on. About a year later, I raised my hand, hearing myself saying, “I’ll do it. When the nurses call, I’ll go and take the used leeches away.”

My next step was to learn more about these small creatures that could make the difference between a successful reattachment and permanent disfigurement. Plastic surgeons in the United States performing microsurgery had just started using medical leeches in cases of last resort when reattaching skin flaps or appendages such as fingers, ears and noses. In those cases, the tiny repaired arteries worked just fine at bringing in vital fresh blood into the reattached nose or finger but the even tinier veins had clotted off, blocking them from carrying fresh blood away from the surgical area.

The result was swelling that would doom the success of the reattachment if it wasn’t relieved.  I saw the miraculous difference that medical leeches made in these patients. The application of a leech opened up the clotted veins and “bled off” the excess blood that had accumulated, giving the body time to heal itself.

Our surgeons ordered the leeches directly from a company in South Wales called Biopharm Leech, which has farmed leeches for medical use since 1812. They raise these small worms with teeth in clean, carefully controlled conditions and ship them by air, arriving ready to apply immediately. Today, Biopharm uses Carolina Medical Supply as their US distributer, and you order your medical leeches directly from them.

Medical leeches arrive “hungry”, so they’re ready to use immediately. When applied, they attach 300 tiny “teeth” into the area, and the miracle starts. Leeches are living factories of pharmaceutical magic: leech saliva contains several amazing chemicals, including a clot-busting agent, a long-acting anticoagulant and an anesthetic.

Once a leech attaches, they secrete a clot-busting agent called hirudin, which goes to work to dissolve the clots blocking blood flow through the veins. At the same time, their anticoagulant ensures they can continue to feed without clots forming in the immediate area and the anesthetic makes the process practically painless. As they feed, they draw out from 15 to 30ml of blood each, nearly one ounce per leech. After removal, the leech anticoagulant continues to encourage bleeding for up to 10-12 hours, further relieving congestion from excess blood collecting in the reattached tissue.

Once a leech is “full”, and has either dropped off or been removed, what do you do with it? Ah, that was MY job. The nurses called me and I arrived to take away the “used” leeches. The recommended disposal process at that time was to put them into a 70% alcohol solution to immobilize them, and then flush them into the sewer system. So I carried them back to the pharmacy, drained out the water from their container, poured 70% rubbing alcohol over them and then flushed them down the toilet. Biopharm now sells a leech disposal kit on their web site, www.Biopharm-leeches.com.

In 2004, the FDA approved the commercial marketing of hirudo medicinalis (leeches) for medical use, and today some hospital pharmacies actually store “fresh” leeches in their refrigerators. More information about medical leeches is available at the Biopharm website www.biopharm-leeches.com, which has the motto, “The Biting Edge of Science.”

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The Invisible Line

For the past 4 years, John, a patient of mine has been living with liver tumors that cause him uncomfortable episodes of flushing and nausea several times a day and often in the middle of the night. After trying several different types of medicine, he found good results with oxycodone, a potent pain medicine.

John takes one long-acting oxycodone tablet called Oxycontin® twice a day but if that’s not enough to tame his flushing episodes he takes two additional tablets of short-acting oxycodone. He’s been taking a combination of long and short acting oxycodone for nearly 3 and a half years and it has worked pretty well for him. But since he’s been slowly increasing the amount of oxycodone he takes to control his episodes of flushing, he needed to know about The Invisible Line.

As we sat down together one afternoon last week, he started the conversation. “I try to keep what I take as little as possible, but sometimes I wake up at night with flushing and have to take an oxycodone in order to get back to sleep. I’m not abusing it; I only take it when I really need it.”

“I agree, John. But oxycodone is a very potent pain medicine, even if you aren’t using it specifically for pain. Oxycodone, hydrocodone, methadone or morphine, all of these can do the same thing to you: if you get enough of any of them in your system, you’ll STOP BREATHING.”

I added, “I really think there should be some kind of warning sign for these medicines, telling you that you were getting close to danger, like when paddling a canoe down a river you hear a roaring sound getting louder and louder, warning you that up ahead is a waterfall.”

“What if there no warning whatsoever that a waterfall lurked ahead? It was right there but you couldn’t hear it or see it until you were swept right over the edge. That river would be very dangerous to anyone heading downstream, wouldn’t it?”

“We don’t

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