Diabetes is causing a male amputation crisis in San Antonio
At a medical facility on San Antonio's west side, patients are showing up with disturbing regularity — most of them men. They have sores on their feet that won't go away. And they leave with the same devastating news: their diabetes has progressed to the point where their leg must be amputated to save their lives.
Diabetes is on the rise around the world, and Latino communities in the United States have been especially hard hit. A deadly combination of genetics, poor access to health care, diets high in processed foods and sedentary lifestyles has created a crisis in places like San Antonio, a Mexican-American city in south Texas, where a growing number of men are losing their feet and legs. costs. legs – and ultimately, for some, their lives.
Texas has one of the highest rates in the country for people undergoing diabetes-related amputations, at about 52 per 100,000 hospitalizations. The problem in San Antonio is even worse than in the rest of Texas, especially for men, who roughly are three times more likely are more likely to lose a foot or leg to diabetes than women – possibly because of cultural stigmas that keep many Latino men from taking good care of their health.
“It's a big problem in San Antonio and I dare say it's the diabetic foot capital of the world, in terms of complications,” said Michael Sobolevsky, a podiatrist at the Texas Diabetes Institute, the facility run by University Health in the heavily affected areas. Latino neighborhoods in west San Antonio. “We amputate all the time.”
The disease is also fatal in one alarming speed. Bexar County's diabetes death rate exceeds that of the rest of Texas and the country as a whole, according to data from the Centers for Disease Control and Prevention analyzed by the city's health department.
Type 2 diabetes, the most common type of the disease, occurs when the body is no longer able to keep blood sugar levels at normal levels. It affects many parts of the body, but often especially the feet, which may require amputation if blood supply does not reach the lower extremities for extended periods, leading to serious infections progressing to gangrene.
That's why Dr. Sobolevsky warns his patients to take even the smallest sores on their feet seriously. “My job is to prevent, save, save, save.”
The problem was clear to Ralph DeFronzo, who played a key role in the development of metformin, the first-line drug for treating diabetes, almost as soon as he arrived in San Antonio in the late 1990s. He said he fell in love with the colorful and welcoming Mexican American culture and city landmarks like the Alamo and the River Walk.
But troubling health patterns became immediately apparent to him. Even as a young doctor, he knew that Latinos and Native Americans have genes that predispose the pancreas to not produce enough insulin, and other genes that cause tissues to resist this. He also knew that San Antonio's vaunted Tex-Mex cuisine—which is often heavy in fatty oils and red meat, and includes things like flour tortillas and sweets that are high in processed carbohydrates—can wreak havoc on a body.
A recent city report notes that more than 76 percent of the adult population in the San Antonio region, or more than one million adults, are considered obese or overweight.
“If you were to actually test all the people here in San Antonio, you would find that probably one in every two people over the age of 40 has diabetes,” said Dr. DeFronzo.
Dr. DeFronzo said the diabetes center where he first worked had disappeared from a basement, “literally a dungeon,” a signal to him that the problem was not being addressed with enough urgency. The practice gradually moved to the first floor and then to the second. “I finally convinced the hospital district that diabetes is the biggest problem in San Antonio,” he said.
In 1999, the Texas Diabetes Institute opened as a sprawling facility on the city's West Side, a historically Mexican-American neighborhood that, along with the city's southern neighborhoods, has had fewer medical facilities than wealthier parts of the city, a analysis from the San Antonio Express -News found it.
It's also an area of the city where healthcare costs can be an issue. Republicans in Texas have consistently opposed expanding Medicaid to low-income residents under the Affordable Health Care Act of 2013. recent study by Texas 2036a think tank, found that more than 16 percent of the state's population, or 5 million people, lack health insurance.
“If Texas expanded Medicaid, we would see fewer amputations,” said Joaquin Castro, a congressman who represents San Antonio. “It's that simple.”
The diabetes institute now treats approximately 80,000 patients per year and provides all facets of diabetes care, including research, diagnosis and treatment, nutritional education, physiotherapy and amputations. The walls are decorated with drawings of feet and legs, a constant reminder of the dangers that lurk if diabetic limb ulcers are left untreated.
The institute has particularly tried to focus on the disproportionate impact of the disease on men, and increasingly on boys. In a one-year period, boys under the age of 18 saw a 36 percent increase in hospital admissions due to diabetes, twice as much as girls.
Julius Hunter, a program coordinator at San Antonio's Diabetes Prevention and Control Program, said some of this can be attributed to culture: Men, he said, are programmed from an early age to “fight it” and have the tendency to ignore cuts and lesions. that can be a telltale sign of serious diabetes problems, even after being told they have the disease. The city's various diabetes seminars are attended almost exclusively by women, Mr. Hunter said.
“Are you a man or are you going to cry like a little boy?” These messages continue into adulthood, especially for men of color,” Hunter said.
So the city's health department started The diabetes garage, a program modeled on one in El Paso, which consists of a series of workshops using car maintenance metaphors, where men can ask questions and learn how to properly maintain their bodies in a familiar environment.
The crisis has even affected some of the city's political leaders. A grandmother of Mr. Castro, the congressman, lost a leg to diabetes and eventually succumbed to the disease. “For Hispanics in South Texas, diabetes is the big boogeyman you always have to watch out for, especially if you can't afford preventive care,” Mr. Castro said.
Robert Perez, 39, a Grammy-winning musician and recording engineer who has worked with Tejano superstars like Bobby Pulido and the band Siggno, never imagined that a Type 2 diabetes diagnosis four years ago would cost him his right leg. But a year ago, the skin on his right pinky toe broke open while carrying heavy musical equipment, and it quickly became infected.
The next morning, he said, much of his foot had turned purple, a sign that gangrene was developing. At a nearby emergency room, he said, doctors delivered the news: Give up the foot or die.
“Do what you have to do,” he told them.
Mr. Perez, known in the music industry as Anthony Perez, recently arrived at the diabetes institute to try out a new prosthetic leg. He strapped it to his right thigh and slowly rose from his wheelchair. His body trembled. It had been over a year since he had stood on two legs, he said.
Bryan Rumsey, a prosthetics and orthotics specialist, sensed some hesitation and encouraged him with the lyrics of a Christmas carol. “Put one foot in front of the other and soon you'll be walking across the floor,” he said.
Mr. Perez, who has slimmed down to 240 pounds from the 340 pounds he was previously, moved his healthy leg first, followed very subtly by his new metal limb. He caught a glimpse of himself standing upright in a full-length mirror and smiled shyly. “I'm learning to walk for the first time since I was a baby,” he said.
Moments later in the parking lot, a niece, Mikayla Sanchez, 31, winced as she watched him get into the passenger side of her truck alone. “I'm very excited for him, but also very nervous,” Ms. Sanchez said. “I don't want him to fall.”
Juan Arguello III, 50, who has been living with a prosthetic right leg for almost three years, now helps train new patients like Mr. Perez to use it. He calls his patients “the kids” because they are usually much younger than him.
“You take your leg off and show them how to put it on so you can live with it,” he said.
One of his recent patients, he said, was a child about eight years old. “That devastated me,” he said.
For Mr. Perez, the new limb meant he could work as a musician again.
On New Year's Eve, he walked on stage and played bass guitar for a performance in Midland, Texas. “I was able to stand and play for the first time in a long time,” he said. But he also knew: “I still have many steps ahead.”