The maze of shallow waterways along the Mekong Delta proved to be a contested battlespace for Americans during the Vietnam War. The U.S. Navy was charged with patrolling the area of over 3,000 miles of rivers and canals, searching vessels carrying enemy weapons and supplies. However, Jesse Lee, who served on these small patrol boats, was on dry land the day he was injured.
“We had a call that some Marines were about to get overrun along the coast,” said Lee. “They were getting ambushed.”
Lee and his fellow sailors made a beach landing to provide medical assistance and additional fire. But as he raced toward the danger, he became a casualty himself. He stepped in a hole with his right leg, snapping it in the opposite direction and fracturing his knee.
While that severe injury ended his time in Vietnam, the tactical herbicide known as Agent Orange has left a toxic legacy for Lee in the form of Type 2 diabetes.
The Department of Veterans Affairs added the chronic disease to its list of presumptive conditions in 2001 after scientists uncovered a link between Agent Orange and the ailment.
Lee has lived with diabetes for 20 years by managing his diet, exercising and monitoring his blood sugar. What has made that easier recently is a newer technology that shows promise in not only caring for veterans with diabetes but also preventing diabetic ulcers, amputation and death.
The VA has been an innovator in recent years, partnering with a company that connects diabetic veterans with mats that detect foot ulcers before they appear, making medical intervention much more likely.
Diabetic foot ulcer severity has shown to be a better predictor of death than coronary artery disease and stroke. Not only can these wounds lead to amputation, but according to the VA, veterans also face a mortality rate of 43% five years after developing their first ulcer. One sobering study, conducted by researchers at the Edward Hines, Jr. VA Hospital in Illinois, found that 70% will die in the same time frame after the first appearance of a foot ulcer, making proactive prevention lifesaving.
One in four veterans have diabetes. In addition to grim mortality rates, diabetic foot ulcers are responsible for 80% of nontraumatic amputations at the VA. So when a VA podiatrist introduced Lee to the Podimetrics SmartMat, he thought it certainly couldn’t hurt.
To get into more VA medical centers, with the ambitious goal of ending diabetic foot amputation for veterans, Podimetrics partnered with the VA office of innovation. “The major breaking piece for us was meeting the [VA Office of Healthcare Innovation and Learning], realizing you have to adapt to the VA,” said Dr. Jon Bloom, CEO of Podimetrics and an anesthesiologist.
That office plays a significant role in improving VA health care options for veterans by expanding telehealth options, exploring the use of virtual reality for training medical professionals and developing digital tools to improve care coordination.
The device requires just a few seconds of use for a veteran. With the user standing or sitting at attention for 30 seconds, the mat scans the feet for temperature changes, an early warning sign of an impending ulcer. As damage to the foot occurs, the body’s natural healing method is inflammation, which brings a localized fever to the affected area.
“We’re looking for that spike in temperature,” said Bloom. “If there’s this imbalance in temperature of 2.2 degrees centigrade for two days in a row, that has been recognized in the literature as a hotspot predictive of an incoming wound.”
That data is transmitted to VA health care providers, who can notify the veteran and set up treatment options.
For Bloom, this care is personal. As a son of a Vietnam veteran, he gained cherished insight into the reality veterans face. In his medical residency, putting people to sleep only to remove their affected limb was far too routine. “I could spend whole days in the operating room doing nothing but amputations,” he said. “It was like a conveyor belt of Civil War-era medicine.”
So, when he was presented with an idea that could possibly end diabetic amputations for veterans, he was all in.
Podimetrics is in 15,000 veterans’ homes. Three randomized control trials—the gold standard for medical research—back its efficacy. Published clinical data shows the SmartMat can detect as many as 97% of foot ulcers five weeks before the onset of symptoms, 52% reduction in hospitalizations and 40% reduction in emergency visits.
The product has aided Lee, who said he’d recommend the SmartMat in a heartbeat.
“I think everybody that has diabetes should have one of them, because my ulcer came back that was no bigger than a BB, and that mat picked it up,” said Lee. “VA called me asking about my foot and made an appointment with the podiatrist immediately.”
