Wednesday, June 12, 2013

Leeches for Laminitis: Can an Old Idea Work on Today’s Horses?

A leech positioned at the coronet for treatment of laminitis in the German research of Dr. Konstanze Rasch.
In Part 1 of this article, we introduced the idea of the suitability of medicinal leech therapy for equine lameness, and especially distal limb injuries. Please read that article, which contains a great deal of background information and a video, before you read this one.

Blood suckers? Yes, that’s what they are. But, as we saw in part one of this article, leeches do much more than suck blood. As they attach to the skin and dig in, their saliva (for want of a better name) transmits a potent chemical cocktail into the bloodstream of the host--or victim, or injury site, if you prefer to think of it in a more benign way.

In this video, Delaware's David A. Puerto, DVM, DipACVS, explains why he chose leech therapy for a dog recovering from skin graft surgery.

My first introduction to leeches for hoof problems was through Nadine Hannemann, a German healer who has been very kind to videotape several leech therapy sessions on her YouTube channel with treatment for lateral cartilage ossification (sidebone). She taught me that the word for leech therapy that I should use is “ Blutegelbehandlung” in German. “Hirudotherapy” is another term.

Nadine described how leeches are used in her laminitis therapy: “There are three to six leeches at the coronet, not directly attached to arteries or veins. A leech (will) suck (for) 20-45 minutes and then fall off by itself. The leech secretes saliva into the bite; it has different secretions, such as clotting and anti-inflammatory (effects).

“Often, a spontaneous improvement occurs,” she says confidently. “The desired bleeding (after the leeches are removed) lasts about 2-6 hours. Even with a good treatment outcome, treatment should be (repeated again in) three or four days.”

She added, “In chronic laminitis, weekly treatments with 2-4 leeches per leg are useful.”

A book on leech therapy for horses for sale on in Germany shows a laminitis treatment on the cover. The book was written by Olivia Bickerle.

According to Nadine, the principal ingredients of the leech saliva, hirudin, is also the most important, since it has anti-coagulant properties, which initiate the gentle Nachbluten, or after-bleeding, which is believed to be a necessary part of the healing process.

The most accessible paper on hirudotherapy for laminitis was written by Israeli veterinarian Sagiv Ben‐Yakir, BSC, DVM, MRCVS, CVA, CVHomotoxicology, who documents mentions of leech therapy more than 2000 years ago in the annals of Chinese medicine. He even mentions a traditional Chinese herbal therapy to be taken orally that contains baked leeches.

Ben-Yakir writes: “As the worm bites, it injects a complex cocktail of proteins into the host through its saliva, which are responsible for the therapeutic effects as well. The saliva contains Hirudin, a potent anticoagulant that consists of 65 amino acids. Hirudin inhibits the conversion of fibrinogen to fibrin by inhibiting thrombin and preventing blood from clotting. Hirudin also inhibits platelets aggregation.

"Hirudin works in conjunction with a vasodilator, one that increases the diameter of blood vessels by relaxing the smooth muscle of the blood vessels, to widen the diameter of the vessel and increase the flow of blood and by that promotes blood flow. The leech’s vasodilator is a histamine-like substance.

"The effectiveness of this therapy is not simply due to enhanced blood flow, but because bleeding from a bite may continue as long as 10 hours, relieving tissue congestion mainly due to venous insufficiency, in areas where arterial flow is maintained but venous return is severely compromised, until collateral circulation re-establishes sufficient venous return in four to five days.”

A laminitis case undergoing leech therapy at the German Hoof Orthopedic Society.

Ben-Yakir’s therapy for acute laminitis in his research trial called for six or more leeches at acupuncture points on the affected limbs; the leeches were re-applied every 12 hours. “This protocol was done on 36 diagnosed horses with acute laminitis in their first 24 hours. (Of these), 34 (94%) horses (walked normally) within 36 hours after beginning therapy,” he writes.

Why are leeches successful for laminitis therapy? One of Ben-Yakir's theories is that leeches release inhibitory enzymatic proteins (as Eglin C and Hirudin) that stop the proteinases activities that destroy the basement membrane disintegration that leads to laminar destruction.

Following Ben-Yakir’s study in 2005, a German group attempted to reproduce his results in laminitis cases in that country. Konstanz Rasch PhD at the Deutsche Huforthopädische Gesellschaft e. V. (German Hoof Orthopaedic Society) kindly has been in touch to assist with this article.

Rasch’s research followed 112 leech applications in 57 laminitic horses. In 84% of the cases, evidence of improvement in the clinical symptoms was evident after the therapy.

Ben-Yakir questions the German study, since Rasch included some chronic cases as well as acute. Rasch’s study was published in Zeitschrift für Ganzheitliche Tiermedizin (Journal of Holistic Veterinary Medicine) in Germany in 2010.

These two research projects are the beginning of a new look at leech therapy for horses with laminitis. As leeches succeed in human and small animal medicine, and begin to be used more in the United States, they will surely be suggested for more applications in horses, and laminitis will be at the top of the list.

To learn more, read:
”Veterinary Hirudotherapy (VHT) or The Therapy That Sucks” by Israeli veterinarian Sagiv Ben‐Yakir in Journal of the American Holistic Veterinary Medical Association, Vol 24, #1, pp 11-18, April-June 2005.

“Blutegeltherapie bei Hufrehe der Pferde Ergebnisse einer bundesweiten Studie” or “Veterinary hirudotherapy for horse laminitis results of a nationwide study in Germany” by Dr. Konstanze Rasch. Zeitschrift für Ganzheitliche Tiermedizin 2010; 24(1): 24-29. Free download: (in German)

Nadine’s web site:

Nadine’s YouTube channel:

The book, Der Blutegel - Parasit oder medizinisches Wunder? - Der Einsatz des Hirudo medicinalis in der Tiernaturheilkunde dargestellt am Beispiel Pferd by Olivia Bickerle is sold at

BioTherapeutics, Education and Research (BTER) Foundation:

Leeches USA:

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