 The song "Ticks & Leeches" is only rarely performed live due to the immense strain on Keenan's voice.However, they have performed it at least a few times during their 2001 (Irvine, California) and 2002 tours including appearances in Sacramento, California, Tacoma, Washington, Fort Lauderdale, Florida, Katowice (Poland), London (England), and Berlin (Germany), with Keenan using heavy vocal effects and distortion.Tool added 'Ticks & Leeches' back to the set list for the 2012 North American Winter Tour.