Increase in the use of Biotherapy in Today’s Medical Field

1. Some of the following presentation may be disturbing to some viewers. If worms, bugs, medical pictures or hearing about wounds makes you feel squeamish or ill please take caution before deciding to listen to this presentation.

2. Increase in the use of Biotherapy in Today’s Medical Field Jacob Pence Educ 601 Teachers as Consumers of Research

3. Vocabulary • Biotherapy – The medical use of live organisms. • Maggot – Larva of the fly. Maggots from the green blowfly are used for medical purposes. • Leech – A species of the annulose worm. Can go 6 months without a meal. • Debridement – The removal of necrotic tissue • Necrotic Tissue – Dead tissue • Blood letting – Removal of blood in certain areas of the body in order to heal illnesses. • Venous Congestion – blood continues to flow from arteries to veins, but veins become congested and tissue begins to become oxygen deprived.

4. The Resurgence of Medieval Medicine • The popularity of Biotherapy is growing in the United States and around the world. • Doctors are beginning to use medicine that had been previously used from as far back as into the middle ages. • Hospitals are turning to animals like leeches and maggots that can accomplish some tasks better than any doctor would be able to.

5. Medieval Medicine • Medieval Medicine is known as the medical system of the Middle Ages • It was a fairly sophisticated system of treating the ill, and wounded during this era. • Many individuals who were wounded during this time ended up dying because of infections and disease. • Medieval medicine utilized materials that were easy to find in their environment. • These included things such as herbs, plants, mud, and animals. • Some animals used included maggots and leeches.

6. Continued… • Leeches have been intentionally used in healing since the time of the Egyptians. • Maggots were first seen as a medical benefit in times of early medieval battles. • Maggots were used to clean wounds from battles to prevent infection. • Without the aid of maggots wounds would become infected and many people had limbs amputated because of small wounds that could not be healed.

7. An Introduction to the Leech • Leeches are a species of the annulose worm. They are a parasite that lives near or in water. • In medieval medicine leeches were used for blood-letting. • During medieval days leeches were used so much for medicine that “leech” was synonymous with physician. • In today's medical world leeches are used most often by micro surgeons, and ER doctors.

8. Continued…leech • A leech uses several secretions that benefit their use for medical purposes: • Their saliva includes an antiseptic which allows the leech to pierce the skin without any pain to the host. • Leeches release hirudin, an anticoagulant, which stops blood from clotting, and can stop venous congestion.

9. How are leeches currently used in medicine? • Plastic Surgery • Limb and body parts reattachment, • Leeches are placed on tissue before it is reattached to make sure the blood does not clot. • The leech removes stagnant blood that would otherwise clot and kill live tissue. • If clotting occurs and the tissue dies, further surgeries may be required. • Leeches can also be used to stop venous congestion in people with poor circulation, and blood clots.

10. A leech can hold up to 3 times its weight in blood.

11. Alternatives to the Leech • The Robo-Leech: • Nadine Connor, Ph.D., an associate scientist at the University of Wisconsin-Madison and other doctors are designing a robotic leech. • The robo-leech is used for patients that are squeamish about having a live parasite sucking blood from them. • The Robo-Leech is designed with a bellows system that causes blood to be removed from the area, and also can release anticoagulants into the area. • Cumadin or other blood thinners: • Some blood thinning medicine can help solve blood circulation and venous congestion problems. • But is difficult to monitor, and can be dangerous.

12. The Robo-Leech vs. The Leech

13. The larva of a fly is called a maggot. Flies lay their eggs in tissue that is dead or rotting, because maggots need to feed on the dead tissue to survive. In certain aspects of medicine, maggots can be much more effective than any physician. Maggots used for medical purposes are hatched in a controlled and sterile environment to prevent an introduction of bacteria. An Introduction to Maggots

14. How are maggots currently used in medicine? • Maggot Debridement Therapy (MDT) – The use of maggots in the removal of necrotic tissue. • Maggots are used in wounds that are non receptive to antibiotics and are deemed as non-healing wounds. • Maggots from the Green Blowfly are used, because they are a species that only eat necrotic tissue.

15. Continued… • Maggots are great for debridement for three reasons: • Digest necrotic tissue: • If necrotic tissue is not removed gangrene can develop. • Control infections: • Maggots secrete an enzyme that is microbial (kills bacteria). • Promote healing: • Maggots secrete an enzyme that turns dead flesh into a semi-liquid, but does not affect healthy tissue.

16. Maggot Debridement Therapy • Patients with non-acute, non-healing wounds are presented with the suggestion of MDT. • A dressing is applied so that the maggots will not escape the wound • The area is covered with a mesh bandage so that the maggots are able to breathe. • The maggots are left at the affected area for 48-72 hours and then removed and discarded. • If necrotic tissue is still present the process is repeated.

17. Possible Reasons for the Use of MDT • MDT is often used on patients with chronic problems such as : • diabetes patients can develop peripheral vascular disease (PVD). • Ulcers can develop because of PVD that are non-healing and require MDT. • Pressure Ulcers (Bed Sores) can usually be cleaned 50% faster with MDT than any other methods. • Gangrene develops when infection occurs at a high rate, usually appears in lower limbs.

18. THE NEXT TWO SLIDES HAVE MEDICAL PICTURES THAT MAY BE DISTURBING TO SOME.

19. After MDT Before MDT The Benefits of MDT

20. 1 2 3 4 MDT: a wound after 4 treatments

21. Alternatives to maggots • Antibiotics • Antibiotics can help some tissue heal. • Physician debridement treatment • Sometimes painful, not accurate, high rates of infection. • Whirlpool debridement • Very Painful, and difficult if patient is immobile. • Amputation • Permanent loss of limb. 

22. Conclusions • Leeches and Maggots are being used more and more in hospitals throughout the world. • The use of biotherapy seems to be a valid method for many medical procedures. • Although disturbing to some patients, animals can provide better results than physicians. • One vial of maggots can cost less than a vial of antibacterial cream.

23. References • B., K. Maggots as healers: the increasing use of maggot debridement therapy. University of Washington, Zoology, 2000. • Church, J.C.T. The traditional use of maggots in wound healing, and the development of larva therapy (biosurgery) in modern medicine. J. Alt. Compl. Med. Vol 2 Iss 4, 525, 1996. • McGovern, Celeste. Brave new world. Report/Newsmagazine, Vol. 28, Issue 10, 60, 2001. • Namias, N., Varela, et al. Biodebridement: A case report of maggot therapy for limb salvage after fourth-degree burns. J. Burn Care Rehab, Vol 21, 254, 2000. • Reames, M.K, Christensen, C., and Luce, E.A. The use of maggots in wound debridement. Annual Plastic Surgery, Vol 21, Iss 4, 388, 1988. • Sherman, R.A. et al. Maggot debridement therapy in outpatients. Archives of Physical Medicine and Rehabilitation, Vol 82, 1226, 2001. • Shinkman, Ron. Worms and squirms. Modern Healthcare, Vol 30, Iss 43, 54, 2000.

24. Questions