Yes, ‘Medicinalis’ possesses all the necessary knowledge, skills, and legal authorisation to carry out hirudotherapy. I am a licensed hirudotherapist, trained in both the theoretical and practical aspects of leech therapy. My credentials include accreditations from the British Association of Hirudotherapy and the Saint Petersburg Hirudologist Association, along with permission number RIS 2.02/00221/2021.

Contraindications for medicinal leech treatment include recognised hypersensitivity or allergy to leech saliva, active bleeding disorders (such as hemophilia or thrombocytopenia), significant anemia, and the use of pharmacological anticoagulant therapies such as warfarin, dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), enoxaparin (Lovenox), and fondaparinux (Arixtra).

Additionally, immunosuppressive therapies and impaired immune response (cancer, severe infections, or skin lesions in the treatment area), nonsteroidal anti-inflammatory drugs (eg, ibuprofen, aspirin, naproxen, meloxicam, kiprofen) as well as children below 16 years of age, pregnant or breastfeeding women and women during menstruation, are also considered unsuitable circumstances for leech application. However, these factors are not categorised as definitive contraindications and may be taken into account with additional precautions.

Hirudotherapy is mostly safe but can involve risks, such as bacterial infections, hypersensitivity to leech saliva, and allergic reactions. The leech microbiome plays a significant role in its health and physiology; therefore, it is important to understand that the transmission of bacteria residing on the leech’s skin and in its gut is an inevitable and natural consequence of leech application. A healthy immune system fights off these infections within a couple of days. In some cases, antibiotics may be prescribed to anticipate and prevent complications.

To ensure and maximise safety, the first introductory session involves only a single leech.

The most frequently occurring side effects of hirudotherapy include infections caused by Aeromonas bacteria, which inhabit both the skin of the leeches and their digestive systems, as well as allergic reactions to leech saliva. These allergic reactions can manifest in a range of symptoms, from mild local irritation—such as itching, redness, or swelling—to more widespread effects that may involve nearby lymphatic nodes. Prolonged bleeding or bruising can occur, as the anticoagulants present in leech saliva can extend bleeding times significantly.

• Inform me about any medications you are currently taking. In consultation with your doctor, you may be advised to temporarily stop taking anticoagulant medications or other drugs that could affect bleeding for a few days prior to the leeches application. In some cases, you may also be asked to undergo a course of antibiotics to minimise the risk of infection.
• Take your time and familiarise yourself with what to expect during and after the treatment, including potential sensations (biting, tingling) and possible side effects.
• Avoid alcohol, sugar and excessive caffeine for at least 3 days before the application.
• Stay well hydrated.
• Consider adding alkalising foods and drinks to your diet, as well as antibacterial herbs such as andrographis paniculata and oregano oil. It’s advisable to continue this regimen for as long as possible before the application and until any side effects have completely faded away after.
• Have only a water shower. Do not use any creams, perfumes or cleaning products, such as shower gels or soaps, on the area intended for application for at least 24 hours prior to the treatment.
• Dress appropriately. Wear comfortable clothing that allows easy access to the treatment area. Consider that the application will involve bleeding, so you might want to wear old clothes or a protective covering.
• Plan for aftercare, as there is bleeding after the leeches have finished feeding. Immediately after the application you will be taken care of appropriately, but your dressings will soon need to be refreshed. It’s good to have someone to help and best to take a day off.

If there are no contraindications related to introducing one’s body to leech saliva, the second application can be administered the next day.

Generally, it is suggested to wait about one week between sessions to allow the body to recover and to monitor the effects from the treatment.

You might develop a tolerance to the medicaments found in leech saliva, which means your body may get used to these substances over time. As a result, you may notice a decrease in the effectiveness of the treatment, possibly requiring higher doses or more frequent sessions to achieve the same therapeutic results. This is especially relevant for those managing chronic pain, as you may find that to gain the same level of relief, your treatment needs increase as tolerance develops.

However, it’s important to note that responses to prolonged systemic leech applications can vary greatly from person to person. Some patients may find they need to adjust their treatment plan over time due to changes in how effective the therapy is, while others may not experience much tolerance at all and can continue with the same frequency and dosage for an extended period without the therapeutic results being affected much.

Medicinal leeches are sourced from specific farms that breed and certify them for medical use. They are not collected from the wild. These farms maintain controlled environments throughout the entire growth process to ensure that the leeches are healthy and free from diseases and infections, making them suitable for therapeutic applications in medicine.

The application of leeches is generally not painful due to the anesthetic compounds present in their saliva. Most people experience sensations like a small pinch or sting when the leech attaches, similar to a mosquito bite.

• Observe the bite sites for signs of excessive bleeding, swelling, redness, or infection. It is normal for some bleeding to occur, since leeches secrete anticoagulants that prevent blood from clotting, as well as for itchiness, swelling, or redness to be experienced, due to the natural presence of Aeromonas bacteria residing on leech skin and in their gut, which can be transmitted during the application. If these reactions do not begin to subside within 48 hours, reach out for consultation. If there are any other concerning symptoms, such as fever or severe persistent bleeding, reach out immediately.
• If excessive bleeding occurs, apply a pinch of powdered turmeric directly to the wound. Cover it with a cosmetic cotton pad and secure it with a plaster or bandage. Avoid using tight bandages that could restrict circulation.
• Do not pick at the scabs to avoid unnecessary infection or scarring. It takes time for them to drop off naturally.
• Keep the bite sites clean and dry. Do not wash them under running water for a minimum of 24 hours after application and until the bleeding stops completely. You can gently clean around them using a wet piece of cotton or a cotton cosmetic pad with a little soap. Avoid scrubbing the areas.
• Do not apply any disinfecting agents, creams, ointments, or other topical treatments directly to the wound. You can use a natural soothing ointment or cream on the itchy or swollen areas around the bite site to help with irritation.
• Avoid  swimming or soaking in baths until the bite sites have fully healed to prevent infection.
• Keep the area free of irritants, such as tight clothing or harsh chemicals.
• Avoid substances that could affect blood clotting, such as aspirin and other nonsteroidal drugs or alcohol, for a period of 48 hours after treatment.

The number of leeches required for a single session of hirudotherapy can vary depending on several factors, including the condition being treated, the patient’s body size, health status, and the area of application. The initial introductory session involves only a single leech, while a full-spectrum application consists of up to eight leeches.

Yes, leeches can be used alongside other treatments in certain medical contexts. Their use, particularly in procedures such as reconstructive surgery or the treatment of certain vascular issues, can complement other therapies. In some cases, leeches may be utilised in conjunction with pain management treatments, providing an additional avenue for relief by enhancing local blood flow and reducing swelling. Leeches can often be part of a broader treatment protocol that may include medications, physiotherapy, or other alternative therapies, although the specific combination is always decided on an individual basis, taking into consideration all the necessary aspects.

Although leeches after their application could technically be reused on the same person, ‘Medicinalis’ uses new leeches for every treatment to ensure safety, practicality, and efficacy. 

In the Netherlands, the disposal of medical leeches is subject to regulations governing the treatment of living organisms, particularly in medical contexts. When leeches have been used for therapeutic applications and are no longer suitable for reuse, they are disposed of in a humane manner that minimises their suffering and are treated appropriately as biomedical waste.

Hirudo medicinalis, a medicinal leech, rather than a parasite can be classified as symbiotic in medical circumstances. While it does feed on the blood of its host, it is also used in medicine for its unique beneficial properties. The leech’s saliva contains anticoagulants and vasodilators that enhance blood flow and reduce clotting, aiding in recovery and healing. In this context, Hirudo medicinalis demonstrates a symbiotic relationship with its host by providing therapeutic benefits rather than causing harm.