Stanford surgical helpers
are out for blood
BY MITCH LESLIE
Thirty years of skin
cancer operations had gradually whittled away William
Rambo's nose, so he was delighted when surgeon Richard
Goode, MD, promised to make him a new one.
But the retired Stanford
professor of electrical engineering owes his new look to
more than Goode's skill at molding a replacement nose
from a swatch of Rambo's scalp. Because even before the
anesthetic had worn off, stagnant blood began to swamp
the relocated tissue, coloring it a sickly blue. To
relieve the blood buildup and salvage the transplant,
Goode was obliged to call for a rarely used but powerful
therapy. He prescribed a course of hungry leeches.
That's right, leeches.
After a century of exile, these slippery parasites have
crept back to medical respectability, thanks to their
unmatched ability to drain excess blood from injured
tissue. In prestigious hospitals across the country,
leeches are biting into patients who have undergone
facial reconstruction, finger or ear reattachment, and
even breast reduction. Leech therapy has even passed the
test of scientific scrutiny.
Stanford pharmacy ordered
600 of the bloodsuckers last year, most of which were
applied to patients at Stanford or loaned out to local
hospitals.
If you're surprised, maybe
even a little queasy, at the resurrection of this antique
treatment, you've got company. Even the doctors who've
counted on leeches for years say the astonishment hasn't
worn off. "Here we are in 1999, and we're still
using leeches," Goode said.
A professor of surgery
with 30 years of experience in facial reconstruction,
Goode began leeching just over a decade ago. He was
initiated into the leech club by William Lineaweaver, MD,
former associate professor of functional restoration at
Stanford, who in turn had gotten the word from colleagues
at Davies Medical Center in San Francisco. Lineaweaver,
who now specializes in reconstructive hand surgery at the
University of Mississippi, had converted reluctantly.
"I was appalled when people started using leeches
again. I thought, 'This is terrible; this is an icky
gimmick,' " he said.
Zeal for leeches grew out
of the ancient belief that an excess of blood caused
disease. Many doctors preferred leeches as a painless and
controllable alternative to simply slicing open a vessel.
Once doctors wised up to
the true causes of disease and recognized that blood loss
was not salutary and invigorating, leeches lost their
license to practice. Except for sporadic use by a few
diehards, leeches were banished to the gruesome relics
display of medical museums.
Modern surgeons returned
to leeching in desperation, after conventional therapies
failed to dissipate the blood congestion that bedevils
reconstructive surgery. Known as venous insufficiency,
this complication destroys many a surgeon's handiwork.
Venous insufficiency is a plumbing problem in which blood
pools in damaged tissue because the veins that normally
provide drainage have been severed. Unless the buildup is
cleared quickly, the sluggish blood will begin to
coagulate, spawning clots that can plug the arteries
nourishing the tissue. If this happens, the tissue will
starve and die.
When Goode and Lineaweaver
see flesh turning puffy and blue, the external signs of
sluggish circulation, they know it's time to summon a
leech. "You can think of the leech as a substitute
vein," Lineaweaver said. By drinking off the excess
blood, leeches prevent clotting until new veins can
sprout and restore normal circulation.
Leeches arrive for work on
the wards in a small plastic container. Dark olive to
black topside, with a mustard-colored belly, they are
about one to two inches long. The job of applying leeches
often falls to nurses, who handle the animals with tongs.
The benefits of the
treatment continue long after the leech has drunk its
fill and dropped off. To keep its liquid dinner flowing,
a feeding leech drools into the wound a mix of chemicals
that prevent clotting and dilate blood vessels. These
substances ensure that blood keeps trickling from the
wound for hours.
A single leech, which can
swallow only about a tablespoonful of blood during its
half-hour to two-hour meal, usually can't do the job by
itself. Repeated sessions over several days or weeks --
involving a dozen or more leeches in total --are usually
necessary.
Careful studies on animal
and human subjects confirm that leeching outperforms
drugs and further surgery. It nearly doubles the chances
that a transplanted flap of tissue --like Rambo's nose
--will survive. For a reattached finger in which the
veins could not be rejoined, the improvement is even more
impressive -- from a slim 15 percent to a robust 65
percent.
Leeches offer economic
benefits, too. They are cheap --$4.75 to $6.50 apiece
--and can survive for months with nothing more than
simple quarters and a slightly saline solution to soak
in.
Doctors like leeches.
Hospitals like leeches. Health plans like leeches. But
what about patients? After all, they are the ones who
have to sit still while a slimy, ravenous parasite carves
open their flesh and sups their blood.
With more than 20 years of
leeching between them, Lineaweaver and Goode have never
had a patient reject the treatment out of squeamishness.
Are patients merely
gritting their teeth and enduring an unpleasant but
necessary therapy? Quite the opposite. Many patients are
surprisingly sanguine about the prospect of being
parasitized --and some even feel affection for the
leeches, said Lineaweaver.
Patients might yelp if
they felt pain. But leeches bite painlessly, and their
feeding causes no discomfort. Rambo confirms that while
he could feel the leeches squirming on his nose and
scalp, he wasn't aware of any other sensations.
After pulling off such a
comeback, will leeches take on more medical roles,
perhaps returning to their prominence in the mid 1800s? A
mechanical leech under development could cut short the
leech resurgence. Essentially an automated suction cup,
the mechanical leech would drain blood without the risk
of infection -- and it wouldn't frighten anyone. Goode
said he would use an ersatz leech, but Lineaweaver
doubted it could be as effective and cheap as the real
thing. SR
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