What may look like a scene out of a sci-fi or horror movie could actually be taking place in your doctor's office.
Live leeches and maggots are commonly used for medicinal purposes in humans, said Dr. William Mackay, professor of plastic surgery and of surgery and pediatrics at Penn State's College of Medicine.
Five years ago, Pam Mitchell, a woman in Akron, Ohio, who has had diabetes for 42 years, developed a small diabetic ulcer on the bottom of her left heel. The ulcer turned into a hole that was two inches long, half an inch wide and about one inch deep, she said.
When conventional medicines such as antibiotics did not work, Mitchell faced amputation if she did not find an alternative.
One day, Mitchell said, a friend told her about a television program on the use of medicinal maggots to heal wounds. Her doctors ordered maggots from Dr. Ronald Sherman of the BioTherapeutics Education and Research Foundation (BTER) in California -- the only supplier of medicinal maggots in the United States -- and put about 600 in her wound, she said.
"The first couple of times they died, but I called Dr. Sherman, and he said they needed to be watered," Mitchell said.
She said one of her doctors joked that examining the maggots was like watching a Wes Craven movie.
After 10 maggot treatments, Mitchell's wound had healed and left only a small scar, she said.
Ke Chung Kim, professor of entomology, said the practice of using maggots in medicine dates to the Civil War.
The maggots used in medicine, called blow fly maggots, are attracted to decomposing organic matter and eat the harmful bacteria associated with tissue decomposition, he said. Medicinal maggots are sterilized so they do not spread bacteria.
This medicinal practice stopped with the advent of antibiotics in the 1940s, but it has recently made a return due to an increase in antibiotic-resistant bacteria, he said.
Last July, the Food and Drug Administration approved maggots along with leeches for medicinal use in the United States -- the first animals ever to be given that distinction.
Mackay said leeches have been used for years around the world, and that in the 19th century many were exported from Europe to the United States.
Leeches, which are a type of bloodsucking worm, can be used to help reattach a limb such as finger, he said.
While surgeons can reattach blood vessels, the problem is re-establishing outflow, or blood flow in the veins, Mackay said.
The blood accumulates in the vein, which can ultimately cause the reattached body part to die, he said.
But leeches can suck the excess blood, and without any pain to the patient by injecting a local anesthetic they produce naturally, he said.
Mackay said the leeches also inject hirudin, an anticoagulant, to prevent blood clotting.
"Over a couple of days, the outflow is reestablished," he said.
Lisa Darmo, a biologist at Carolina Biological Supply Company, one of only two companies in the United States that supplies medicinal leeches, said leeches can also be used for other reconstructive surgeries but are usually used in reattachment surgeries.
The type of leech used most widely in medicine is the European leech known as Hirudo medicinalis, which cost about $7 to $8 each, she said.
"The number needed completely depends on the severity or complexity of the injury," she added.
One important precaution that must be taken when using leech therapy is that patients must be on antibiotics, because a leech's gut fosters bacteria, Darmo said.
Mackay said he has researched methods to sterilize the leeches but concluded that "the practical way is to give the patient antibiotics."
For Mitchell, medicinal maggots proved to be an economic solution as well, costing only $2,000 for the 10 treatments, while three previously unsuccessful surgeries had totaled about $40,000 to $50,000, she said. An amputation would have cost the same or more, she added.
Today, Mitchell serves on BETR's board of directors. BETR's mission is to educate not only the public but also the medical field about the use of medicinal maggots, she said. BETR also provides financial assistance for patients who cannot afford the therapy, she added.
"I don't want anybody to go through that," she said.
