At a medical facility on San Antonio’s west side, patients have been showing up at a disturbing rate, most of them men. They have scars on their legs that won’t go away. And they return with the same shocking news. His diabetes has progressed to such an extent that his leg must be amputated to save his life.
Diabetes is on the rise around the world, and the Latino community in the United States has been hit particularly hard. A deadly combination of genetics, poor access to health care, a diet rich in processed foods, and a sedentary lifestyle can lead to places like San Antonio, a predominantly Mexican-American city in south Texas. causing a crisis and more and more men are sacrificing their legs and hips. Some people lose their legs and eventually their lives.
Texas has one of the highest rates of diabetes-related amputations in the nation, at about 52 per 100,000 hospitalizations. San Antonio’s problems are even worse than in other parts of Texas, especially for men. 3 times more likely Perhaps it’s because of cultural biases that prevent many Latino men from paying close attention to their health.
“This is a huge problem in San Antonio, and I would venture to say that San Antonio is the diabetes capital of the world in terms of complications,” said Michael, a podiatrist at the Texas Diabetes Institute.・Mr. Sobolevsky said. A Latino neighborhood in west San Antonio. “We’re constantly making cuts.”
The disease is also rapidly killing people. at a huge rate. Diabetes death rates in Bexar County exceed those in the rest of Texas and the nation as a whole, according to Centers for Disease Control and Prevention data analyzed by the city’s health department.
Type 2 diabetes, the most common type, occurs when the body is unable to maintain blood sugar levels at normal levels. It affects many parts of the body, especially the feet. Amputation may be necessary if the blood supply is unable to reach the lower limb for an extended period of time, causing severe infection that can lead to gangrene.
That’s why Dr. Sobolewski warns his patients to take even the slightest injury to their foot seriously. “My job is to prevent, save, save, save.”
The problem was obvious to Ralph DeFronzo, who played a key role in the development of metformin, the first-line diabetes treatment, 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 the city’s landmarks such as the Alamo and the Riverwalk.
However, a problematic health condition soon became apparent to him. As a young doctor, he knew that Latinos and Native Americans carry genes that make it difficult for their pancreas to produce enough insulin and genes that make their tissues resistant to insulin. He also knew that San Antonio’s famous Tex-Mex cuisine (high in fatty oils and red meat, including flour tortillas and sweets high in processed carbohydrates) could be harmful to the body. Ta.
More than 76 percent of the San Antonio area’s adult population, or more than 1 million adults, are considered obese or overweight, according to a recent city report.
“Here in San Antonio, if we actually went and tested the entire population, we would find that probably one in two people over the age of 40 has diabetes,” Dr. DeFronzo said.
Dr. DeFronzo said the diabetes center where he first worked was run down in a basement and was “literally a dungeon”, showing the problem was not being addressed with enough urgency. Ta. Practice gradually moved to the first floor and then to the second floor. “We finally convinced the hospital district that diabetes is the biggest problem in San Antonio,” he said.
The Texas Diabetes Institute opened in 1999 as a sprawling facility on the city’s West Side, according to an analysis by the San Antonio Express. This neighborhood is a historically Mexican-American neighborhood, and like the city’s southern neighborhoods, it has fewer medical facilities than the more affluent parts of town. -news found.
It is also an area where medical costs are an issue. Texas Republicans have consistently opposed expanding Medicaid for low-income residents under the 2013 Affordable Care Act. Recent research by Texas 2036More than 16 percent of the state’s population, or 5 million people, lack health insurance, according to a think tank study.
“If Texas expanded Medicaid, the number of amputations would go down,” said Rep. Joaquin Castro of San Antonio. “It’s that simple.”
The diabetes institute currently serves approximately 80,000 patients a year and provides all aspects of diabetes care, including research, diagnosis and treatment, nutritional education, physical therapy, and amputations. On its walls are paintings of feet and legs, a constant reminder of the dangers that await if diabetic limb wounds are left untreated.
The institute specifically seeks to focus on the disproportionate impact the disease has on men, and increasingly on boys. Over the course of one year, diabetes-related hospitalizations increased by 36 percent for boys under 18, twice the rate of increase for girls.
Julius Hunter, program coordinator for the City of San Antonio’s Diabetes Prevention and Control Program, said part of that may be due to culture, with men being programmed from an early age to “tolerate” and avoid cuts. He said that there is a tendency to ignore symptoms and lesions. It can be a tell-tale sign of a serious diabetic problem, even after you’ve been told you have diabetes. Hunter said the city’s various diabetes seminars are almost exclusively attended by women.
“‘Are you a man or do you cry like a child?’ These messages carry into adulthood, especially for men of color,” Hunter said.
Therefore, the city health department was established. diabetes garage, The program, modeled after one in El Paso, is a series of workshops using the metaphor of car maintenance where men can ask questions and learn how to properly maintain their bodies in a familiar environment. It has been constructed.
The crisis has also affected some of the city’s political leaders. Congressman Castro’s grandmother lost her leg to diabetes, and she eventually died from the disease. “For Hispanics in South Texas, diabetes is a big thing that they always have to be on the lookout for, especially when they can’t afford preventative care,” Castro said.
Robert Perez, 39, a Grammy-winning musician and recording engineer who has worked with Tejano superstars such as Bobby Pulido and Bando Signyo, lost the use of his right leg four years ago after being diagnosed with type 2 diabetes. He said he never thought it would happen. But a year ago, while carrying heavy music equipment, the skin on his right pinky toe tore and an infection quickly developed.
By the next morning, most of the leg had turned purple, a sign that gangrene had set in. At a nearby emergency room, he was told by doctors: “Give up your legs or die.”
“Do whatever you have to do,” he told them.
Mr. Perez, known in the music industry as Anthony Perez, arrived at the Diabetes Institute one day to try out a new prosthetic leg. He placed the strap around his right thigh and slowly stood up from the wheelchair. His body trembled. He said it was the first time he had stood on two legs in more than a year.
Brian Ramsey, a prosthetist and orthotist, hesitated and encouraged him with the lyrics of a Christmas song. “Put one foot in front of the other and you’ll be able to walk across the floor in no time,” he said.
Mr. Perez, who has lost 240 pounds from his previous 340 pounds, moved his healthy legs first, followed by his new metal limbs with great delicacy. He caught a glimpse of himself standing upright in the large 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, his niece Mikayla Sanchez, 31, winced as she watched him jump into the passenger side of the truck himself. “I’m very excited for him, but he’s very nervous,” Sanchez said. “I don’t want him to fall.”
Juan Arguello III, 50, who has been living with a prosthetic right leg for nearly three years, is now helping train new patients like Perez how to use it. He calls his patients “children.” Because they tend to be much younger than him.
“You take your feet off, you teach them how to put them on, and you learn to live with it,” he said.
One recent patient was a child around 8 years old. “That devastated me,” he said.
For Perez, the new limb meant he could return to his career as a musician.
On New Year’s Eve, he took to the stage and played bass guitar at a gig in Midland, Texas. “He was able to stand up and play for the first time in a while,” he said. But at the same time, he knew there were still many steps left for him.