Lawrence Lavery, DPM, podiatrist at Scott & White Memorial Hospital in Temple, Texas, clearly understands the diabetic foot.
That skill has resulted in the award of $10 million in private and government grants for Lavery’s projects over the years, and has helped create a body of work that, arguably, has prevented many deaths, as well as thousands of amputations, among people with diabetes.
Indeed, says Andrew Boulton, professor of medicine at the University of Manchester (England) and at the Diabetes Research Institute at the University of Miami (Florida), the findings from Lavery’s research garner high marks at home and in international circles.
“He’s one of the brightest podiatrists for clinical research around,” says Boulton, who is collaborating with Lavery on an international study funded by the National Institutes of Health to determine the efficacy of a commercially available therapeutic sock.
An Ulcer-Reducing Sock?
Some 400 subjects from the United Kingdom and Texas will participate in a $1.4 million study whose main objective, says Lavery, “is to see if this relatively simple but novel intervention can reduce foot ulcers.
“The simplicity and elegance of the sock study is that it’s a sock. We have these ugly shoes and insoles, and we tell people to wear them all the time. But it doesn’t do any good to provide these Herman Munster shoes that they hate and won’t wear.”
Lavery, who received his undergraduate degree in business, tends to focus his research efforts on useable, affordable and reimbursable solutions to foot problems among people with diabetes.
“There are many modalities for wound healing that are not reimbursed by Medicare,” he says. “While some health plans will pay more than $1,000 for bioengineered tissue because it is high-tech, they may not pay for some low-tech items that work better.”
Lavery’s current research, adding up to $4.2 million in grants, addresses the practical and the economical. “We rigorously study both the clinical and economic outcomes,” he says. “To improve health care, it is no longer enough to show that a device or approach works; we have to convince health plans it is financially sound as well.”
In addition, he says, internal medicine doctors need to understand the role of foot health in diabetic health. “Most internal medicine doctors don’t understand the diabetic foot,” says Lavery, who sees patients at Scott & White’s University Medical Campus in Round Rock, Texas. “First of all, they don’t even look at the foot.”
Getting People to See
He hopes to change that, or at the least, to make such omissions irrelevant. “Even if they understand the foot, they don’t know how to change it, and the patient doesn’t know either,” says Lavery. That is why he works to help patients help themselves before calling the doctor. He notes, “The most important person in the team is the patient. That’s the one person doing most of the self- care.”
Among diabetics with neuropathy, the inability to feel sensation is more than just an annoyance. It can result in serious health problems, including, amputation, says Lavery. “The foot is the barometer in many ways of the diabetics’ health.” Consequently, measuring that health can, at the same time, help assure it.
A handheld thermometer Lavery and medical colleagues have developed provides an early warning system that lets people with diabetes know when trouble is brewing.
“Your feet are numb. You don’t know if they’re hurt,” says Lavery. So patients are unable to monitor changes in their feet. The TempTouch® thermometer can, however, act as an early warning system, sensing the heat that is a precursor to the development of ulcers, which can lead to abscesses and ultimately amputations.
Lavery is a founder of and shareholder in Diabetica Solutions, the company that manufacturers the thermometer and next-generation products that include a bathroom scale-like device that also takes the foot temperature and transmits the results to a computer. “It’s a very simple concept that works,” says Lavery, “and that’s the best kind.”
Encouraging Tests in the Field
Adolf Adain, a patient of Dr. Lavery from Florence, Texas, began using the thermometer. At high risk for developing another ulcer, Adain was a prime candidate for the thermometer. Between one third and two thirds of patients with a prior history of diabetic foot ulcers will develop them again within 12-24 months, according to Lavery.
After several months using the device every day, says Adain, “I haven’t had one foot ulcer.” If he notes a four to five degree changes in temperature, Adain knows it’s time to stay off his feet for a while, and if the condition persists, to call Dr. Lavery for a check-up.
In a recent clinical trial of the device published in the American Journal of Medicine (2007) results showed a three- to 10-fold reduction in ulcers among patients that used the thermometer. The trial included Lavery and was led by Dr. David Armstrong, director of the Scholl College Center for Lower Extremity Ambulatory Research at the Rosalind Franklin University of Medicine and Science.
Lavery himself has written extensively on the foot and disease, both physical and mental. Among the articles he has authored are: “Health Related Quality of Life, Cognitive Function, and Depression in Diabetic Patients with Foot Ulcer or Amputation: A Preliminary Study” (Foot & Ankle International, 2005); “It’s Not What You Put On But What you Take Off: Debriding and Offloading the Diabetic Foot Wound (Clinical Infectious Diseases, 2002); and “The Diabetic Foot Is Not Adequately Evaluated on an Inpatient Setting,” Archives of Internal Medicine, 1997.
Family Inspires Medical Journey
Lavery’s grandmother, siblings, father and uncles all had diabetes. And each has suffered – or died from its complications. But that wasn’t the impetus for his entering the medical profession. Rather it began with his concern about his father, who had a club foot. The rest came later and stemmed, he says, “from wanting to understand what the best therapy is.”
In the process, he says, “We’ve added considerably to the understanding of the diabetic foot over the last 15 years.”