Couple pioneer the farming blood-sucking leeches for use in surgery
His fingers were chopped off by a skill-saw. The man lies in his starched white hospital bed, his digits newly sewn back on by a surgeon at Middlemore Hospital, and watches several leeches hinged on the tips of his fingers.
They are sucking out his blood.
These vampire-like worms that latch on to injured ears, lips, fingers and toes are being used more and more in public hospitals around the country.
A native New Zealand blood-sucking variety is found in some waterways in the North Island – and near Cambridge, Maria and Robert Lupton have spent nearly a decade learning how to breed, feed and supply them for medical use.
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Her life revolves around leeches: They need to be monitored and cared for every day. "I have researched them and we are the only people who breed and supply medical-grade leeches. They are used for all sorts of medical needs such as re-attaching lips that have been bitten by dogs, skin grafts and limbs after an accident."
They started off selling about 100 leeches a year and now they send off about 6, 500 of the medical blood suckers per annum.
The slimy segmented worms can be described as "artificial veins". The doctor can hook up arteries because they are quite thick, but veins are more fragile and in injuries like the skillsaw accident, the chopped-off part often swells up, blood clots occur and the limb "dies".
But when a leech is attached to the damaged part it sucks blood through it and also injects natural anticoagulants that prevent the blood from clotting.
Furthermore, the leech releases an anaesthetic so there isn't any pain for the patient. After about 20 minutes the leech is full so it falls off the wound. But the leech's thinning chemical allows the wound to bleed at a slow rate for several hours. The blood continues to flow through the damaged tissue while the injured person's new veins are forming.
Leech therapy has been practiced for at least 2, 500 years and was popular with Greeks, Mayans and the Aztecs. It was thought many diseases were caused by too much blood, so leeches were attached to people's skin for blood-letting.
The popularity of leeches is currently undergoing a revival as world-wide clinical evidence shows how effective they are in helping heal certain wounds. Pharmaceutical companies are also undertaking medical research into the medicinal effects of their substances.
DOWN ON THE LEECH FARM
Thirty years ago, says Maria Lupton, her children collected leeches from a pond when they were living in Northland. They sent some to Auckland Zoo for a creepy-crawly exhibit, which got lots of media attention.
"There was a surgeon at Middlemore who had a patient who had expensive surgery which was about to fail because they couldn't get the blood flowing. So he rang the Zoo which got in touch with me."
Their leeches did the trick and the surgeon started ordering more. "We could only get them in the spring as they hibernated in winter so we started storing them. I wrote to all the hospitals and we now supply about seven of them throughout the country."
Maria now breeds leeches in the summer and carefully replicates their breeding conditions so they will lay eggs. "Leeches are hermaphrodite so there's no issue with getting males and females together. Each egg will have 10 to 15 babies in it and they hatch in about 15 days. They are about one centimetre long and as thin as a piece of cotton."
Maria says the babies are fed blood, which they get from the local freezing works. "They are so small it is tedious to feed them. You have to manually pick up each leech from the tank and feed it then take it to its next tank. There are 13 thousand of them in a season. I feed them every two to three weeks at that stage. When they are adults we don't feed them as often."
She says adult leeches are not fed for three months prior to being sent to a hospital, so they are really hungry. "We only sell them when they are a decent size. I'm not going to say how much we sell them for but they are not cheap. It takes up to four years before they are ready for sale."
Maria's growing business is time-consuming and she has employed an extra person for three days a week to help clean the tanks and keep the walls clean among other leech related tasks.
"We have to look after them every day and they often escape as they have suckers on each end and can flatten themselves to get through tiny gaps. We are always picking up a few from the walls, off the floor and even on the ceiling."
The Luptons' leeches are housed in a former dairy shed in lines of tanks filled with fresh water. But Maria says more space is needed for more tanks so this summer they will be converting another room in the shed to cater for their growing leech stock.
The type of native New Zealand leech Maria breeds is called Richardsonianus mauianus which she originally collected from the wild near Dargaville and has since mixed with others of the same breed from different regions. They are very flexible, have black and yellow stripes and a suction disc at their tail ends.
Maria supplies hospitals with these hungry leeches at any time of the day or night. "I package them up in a gel which goes into pots. A courier picks them up and they are either driven or flown to where they are needed. The only time some died was when CourierPost lost them for five days instead of delivering them overnight! Oh, we also lost some when they were flown to the Northern Hemisphere to be used in research. They were left sitting somewhere on a tarmac too long."
This farming may be unusual, but it is satisfying. Maria tells of a child in Waikato hospital who had part of his finger re-attached.
"They were having trouble getting leeches to attach so they rang me and asked what they were doing wrong," she says.
"I went in there and gave them some ideas and got the leech feeding. It was great fun and I found it quite good to talk to the parents about what was going on as well."
Her leech orders don't only come from hospitals – they are perceived as a beauty treatment by some people.
"I have a customer in Auckland who is from Russia. Every two years her mother visits from Russia to get lots of leeches for anti-wrinkle treatment. Her Kiwi husband, who is very wrinkled, refuses to have a bar of it. He says the house is messy as there are leeches crawling around the bedroom and they have blood seeping from the wounds on their faces.
"It probably stimulates their skin with the increased blood flow in the short term I imagine, but doubt it really makes any difference."
THE OPERATING THEATRE
Zac Moaveni regularly uses Maria's leeches.
The Auckland constructive and plastic surgeon says he isn't aware of any other evidence-based medical use of these special worms.
"We use them when someone has chopped a small part of their body like noses, ears and fingers. I sometimes order hundreds at a time as they may be used for a week or so to help get rid of the congested blood.
"They are amazing little animals as they can suck about five times their body weight of blood before having enough and just dropping off."
Moaveni says in the 1970s microsurgery developed and that's when they developed the ability to join up small veins, and leeches began to be used to help. "Until then people would have lost their finger or ear."
Using leeches comes with risks such as on-going bleeding, he says, and sometimes people need a blood transfusion if they keep trickling blood. The other major risk is infection as they have guts like every other animals and that contains bacteria which could cause a serious infection – hence the need for antibiotics.
The leeches are used on just one person, Moaveni says, and are then disposed of.
Yes, some patients look horrified when they are told leech therapy is their best option. "It is understandable that people don't like the idea of an animal sucking their blood out. The great thing about leeches is you can control the number you put on and how long they suck for. They are a very efficient way of doing it and we do reassure the patients when it needs to be done. But there's never a joyful response!
Moaveni is adamant they don't hurt and describes them as an incredible, cheap and effective tool.
"There aren't many medicines or drugs that manage to fit those categories, and patients go home with a great story to tell!"
He is full of admiration for the Luptons who have dedicated their lives to producing medical-grade leeches. "Recently we had a patient who was coming in with multiple finger amputations and my first thought was, 'ring the ward to make sure we have a good supply of leeches'. I take my hat off to them."
A CONVERSATION STOPPER
Back in the Waikato Maria sits at her kitchen table with a view across the paddock to the leech shed.
"I am known as 'the leech lady'. If I go to a party it is a conversation stopper. There are often astonished looks. I get everything from hysterical laughter to complete silence."
What keeps Maria motivated to continue supplying these blood-sucking worms?
"It's making a difference that keeps us doing it. How could I say to a person who has just lost their hand and needs 300 leeches that I'm not feeling very well so I won't supply them? That's what drives me back to that shed day after day. We don't really go on holidays because of that."
On the rare occasion the couple do take a weekend away they take leeches with them as well. "We dispatch them from wherever we are staying. If someone has an ear or a lip they need sewn back on I can't say 'tough luck I'm not sending any leeches'.
"This is their future quality of life and that's what drives me back to that shed day after day. I think they are beautiful."
- Sunday Star Times