Balls and Walnuts
more than you ever wanted to know
Leech-keeper to the stars
I’m sick, folks, siiiiiiick, with some sort of gastrointestinal thing. I have no appetite, I’m bloated, and the only reason I don’t feel like throwing up is the fact I have 4 milligrams of Zofran coursing through my bloodstream. Zofran, the Mercedes of anti-emetics.
This might be my only post for the day. I want to crit a friend’s chapter, then it’s back to bed for me. But first, I wanted to introduce you to a lovely critter, Hirudo medicinalis, the medicinal leech. Here’s a hungry leech,
and here’s a well fed leech,
In residency, someone needed to take care of the leeches, so the duty fell to Karen and me. Everyone knew we kept exotic animals. At the time, we were heavy into chameleons and snakes. Leeches, well, they kinda looked like snakes.
They didn’t require much care. Keep them refrigerated, change their water every so often, and they’d be good for weeks. Like bait. Bloodsucking bait.
You’re dying to know what we do with leeches, right?
Let’s say some drunk *(^&!!ker gets thrown through his car windshield and shaves off the tip of his nose. He comes in, bleeding like stink, reeking of alcohol, combative, not the least appreciative of your efforts. What else can you do but suture the skin back on and hope for the best?
You can add a leech, that’s what you can do. The human body does a good job restoring arterial blood flow to a reattached flap, like that bit of nasal skin. It does a poor job restoring venous outflow. The result is venous congestion — sort of like a penile erection that won’t go down — and it can kill a flap. Enter the leech.
Leeches gorge themselves on this venous blood, and they also inject anticoagulants (like hirudin) which keep the wound bleeding. Here’s a neat article which discusses, among other things, the effect of garlic on bloodsucking leeches (think Nosferatu, and you can predict the results).
We also used leeches to treat venous congestion in free flaps. Free flaps are islands of tissue dissected from one part of the body (the forearm, for example, or the calf) and transplanted to another, complete with their own arterial and venous supply. Often, sensory nerves are hooked up, too. This tissue is used to reconstruct an area resected for cancer — part of the throat, the tongue, the jaw. It’s a great idea in principle. In practice, these are difficult, time-consuming operations. It was not unusual for us to be stuck in the OR for 18 to 24 hours, sometimes longer, and if the flap fails, you have no choice but to take the patient back and do more work. On one patient, we logged 40 hours of OR time in a five-day interval.
Most of us residents despised free flaps, for obvious reasons. Our empathy for our patients dried up after two sleep-free nights in a row.
As with the tip-of-the-nose example, free flaps often had problems with venous congestion. I would have to bring in the leeches and work my magic, thus proving that free flap surgery did, indeed, have a silver lining.
Karen and I had the bright idea of keeping one leech as a pet. They’re freshwater critters, so we popped him, her, it, whatever into our fish tank and watched it swim around the tank with unusual grace and beauty. Its swimming pattern seemed somehow purposeful.
It was chasing our goldfish.
By morning, we had a tank full of whitefish, belly up, and one fat and happy leech.
Okay, folks, that’s it for me.
D.
Oh dear! Did you keep the leech, or did you flush him for murdering your goldfish?
Feel better,Doug.;-(
Helping my brother-in-law’s parent dig stones of of their boat launch at their cabin, I noticed that I had tiny black flecks all through the webbing between my fingers. Dirt, I thought, silt disturbed from the bottom. Till I noticed that it wouldn’t just shake off. Ok, I thought, baby leeches. I went into the cabin and applied the salt-shaker solution.
I hate leeches. I understand they have their uses, like nuclear weapons and sugar-free sweeteners, but they’re not my thing.
We had access to cocaine solution (ENTs and ophthalmologists use it as a topical anesthetic). That was the best way to get them to detach — get ’em high.
Shelbi, we kept him as a pet for a while, but got tired of having a one-critter fish tank.
Hope you feel better.
One of the teachers in the dept. said her carpel tunnel was being treated with a leech.
She claimed it worked.
Oh, no! Poor fish. But lucky leech. 🙂
Hope you’re feeling better soon.
Yes, hope you feel better.
Of course, spending no time in the real world to speak of, I know about the leeches from watching House, one the coolest shows around. Or was it Grey’s Anatomy? All these cute young doctors and cranky old ones, where do they get these stereotypes? Anyway, the guy in the story took the leeches home to release into the wild.
sorry you feel like crud.
sorry you posted the leech picture, too. (skinny leech, ok. . . fat leech, no.)
Oh, dear. Feel better. I’m susceptible to those G/I things, was in ER 24 hours before my last c-section just hurling. They had the IV in, I was at the hospital, but since the baby was showing absolutely no distress (the bitch) they made me go home.
Bummer about the tummy bug. That kind of thing just sucks all of the energy out of you. Hope you’re feeling better real soon.
Leeches…cool.
Feel better soon, Doug.
Enjoyed the leeches. Maybe next time you can tell us about the medical uses for maggots, which I find even creepier, but still pretty darn cool.
Ew. I am SO not a leech chick.
I thought Karl Rove was heavier than that. It must’ve been taken in the mid-eighties.
Anyway, Doc, while you’re waiting for Jon Stewart to entertain you tonight at the Oscars, I have a new Assclowns of the Week.
[…] I think, however, that I can do my mom one better. It was Doug’s story about leeches that provided the inspiration. My kids won’t just get a tube pedicle when their noses fall off … they’ll get a tube pedicle WITH LEECHES! And I’ll make sure the surgeon puts at least one leech right between their eyes, to remind them of the folly of avoiding suncreen. […]
[…] The Latin name of medicinal leeches is Hirudo medicinalis. Remember my leech story? 7. How might you acquire this parasite, the cause of anisikiasis? […]