Diabetes Is Fueling an Amputation Crisis for Men in San Antonio

At a medical center on San Antonio’s west side, patients show 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 that their leg must be amputated to save their lives.

Diabetes has been on the rise around the world and Latino communities in the United States have been especially affected. A lethal combination of genetics, poor access to health care, diets rich in processed foods and sedentary lifestyles has created a crisis in places like San Antonio, a majority Mexican-American city in South Texas, which It is costing a growing number of men their feet and legs and, eventually, for some, their lives.

Texas has one of the highest rates in the country of people undergoing diabetes-related amputations, about 52 per 100,000 hospital admissions. The problem in San Antonio is even worse than in the rest of Texas, especially for men, who are approximately three times more likely losing a foot or leg to diabetes than women, possibly due to cultural stigmas that prevent many Latino men from taking close care of their health.

“It’s a huge 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 University Health-run center in the area. densely populated. Latin neighborhoods of western San Antonio. “We are constantly amputating.”

The disease is also killing a alarming pace. 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 that was analyzed by the city’s health department.

Type 2 diabetes, the most common type of disease, occurs when the body becomes unable to keep blood sugar at normal levels. It affects many parts of the body, but often especially the feet, which may have to be amputated when the blood supply is cut off to the lower extremities for long periods, causing serious infections leading to gangrene.

That’s why Dr. Sobolevsky warns his patients to take even the slightest foot sores seriously. “My job is to prevent, save, save, save.”

The problem was evident to Ralph DeFronzo, who played a key role in the development of metformin, the first-line diabetes treatment drug, almost as soon as he arrived in San Antonio in the late 1990s. He said he fell in love with the colorful, welcoming Mexican-American culture and the city’s iconic landmarks like the Alamo and the River Walk.

But worrying health patterns became immediately apparent to him. Even when he was a young doctor, he knew that Latinos and Native Americans have genes that predispose the pancreas to produce insufficient insulin, and other genes that cause their tissues to resist it. He also knew that San Antonio’s much-celebrated Tex-Mex cuisine, which is often high in fatty oils and red meat, and includes things like flour tortillas and sweets high in processed carbohydrates, can wreak havoc on the body.

A recent city report noted that more than 76 percent of the adult population in the San Antonio area, or more than one million adults, are considered overweight or obese.

“Here in San Antonio, if you actually tested everyone, you would find that probably one in two people over the age of 40 have diabetes,” Dr. DeFronzo said.

Dr. DeFronzo said the diabetes center where he first worked was operated out of a basement, “literally a dungeon,” a sign 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 the biggest problem in San Antonio is diabetes,” he said.

In 1999, the Texas Diabetes Institute opened its doors as an expansive facility on the city’s west side, a historically Mexican-American neighborhood that, along with neighborhoods south of the city, has had fewer medical facilities than sections richest in the city, according to an analysis by the San Antonio Express. -News found.

It is also an area of ​​the city where the cost of healthcare can be an issue. Texas Republicans have consistently opposed expanding Medicaid for low-income residents under the 2013 Affordable Care Act. recent Texas 2036 studyA think tank found that more than 16 percent of the state’s population, or 5 million people, do not have health insurance.

“If Texas expanded Medicaid, we would see fewer amputations,” said Joaquín Castro, a congressman who represents San Antonio. “It’s that easy.”

The diabetes institute now serves about 80,000 patients annually and offers all facets of diabetes care, including research, diagnosis and treatment, dietary education, physical therapy and amputations. Its walls are decorated with drawings of feet and legs, a constant reminder of the dangers that await if sores on diabetics’ limbs are left untreated.

The institute has especially tried to focus on the disproportionate effects of the disease on men and, increasingly, children. Over a one-year period, boys under 18 saw a 36 percent increase in diabetes-related hospitalizations, double the rate of increase among girls.

Julius Hunter, coordinator of the San Antonio Diabetes Prevention and Control program, said some of that can be attributed to culture: Men, he said, are programmed from an early age to “tough it out” and tend to ignore cuts and injuries. That can be a telltale sign of serious diabetes problems, even after they’ve been told they have the disease. The city’s various diabetes seminars are attended almost exclusively by women, Hunter said.

“‘Are you a man or are you going to cry like a little boy?’ Those messages carry into adulthood, especially for men of color,” Hunter said.

Then the city health department launched The garage for diabetics, a program inspired by one in El Paso, consisting of a series of workshops using car maintenance metaphors where men can ask questions in a familiar environment and learn how to properly maintain their bodies.

The crisis has even affected some of the city’s political leaders. A grandmother of Congressman Castro lost a leg to diabetes and eventually succumbed to the disease. “For Hispanics in South Texas, diabetes is the big boogeyman they always keep an eye on, especially if they can’t afford preventive care,” Mr. Castro said.

Robert Pérez, 39, a Grammy-winning musician and recording engineer who has worked with Tejano superstars like Bobby Pulido and the band Signno, never thought 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 finger split while he was carrying heavy music equipment and quickly became infected.

The next morning, he said, much of his foot had turned purple, a sign that gangrene was setting in. In 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 as Anthony Perez in the music industry, arrived at the diabetes institute on a recent day to try out a new prosthetic leg. Holding it to his right thigh, he slowly stood up from his wheelchair. His body trembled. It had been more than a year since he had stood on two legs, he said.

Feeling hesitant, Bryan Rumsey, a prosthetics and orthotics specialist, encouraged him with the lyrics of a Christmas song. “Put one foot in front of the other and soon you’ll be walking on the ground,” he said.

Perez, who has slimmed down to 240 pounds from 340 pounds, moved his good leg first, followed very delicately by his new metal limb. He saw himself standing over a large mirror and smiled sheepishly. “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 Sánchez, 31, grimaced as he watched him climb into the passenger side of her truck alone. “I’m very excited for him, but also very nervous,” Ms. Sánchez said. “I don’t want him to fall.”

Juan Argüello III, 50, who has lived with a prosthesis in his right leg for almost three years, now helps train new patients like Mr. Pérez on how to use one. He calls his patients “the kids” because they tend to be much younger than him.

“You take your leg off and you show them how to put it on and you learn to live with it,” he said.

One of his recent patients, he said, was a boy about 8 years old. “That destroyed me,” he said.

Juan Arguello helps train new amputees on how to take off and put on their prosthetic legs.Credit…Kaylee Greenlee for The New York Times

For Pérez, the new limb meant he could travel as a musician again.

On New Year’s Eve, he took the stage and played bass for a concert in Midland, Texas. “I was able to stand up and play for the first time in a long time,” she said. But he also knew it: “I have many steps ahead.”

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