La diabetes desata una ola de amputaciones entre los hombres de San Antonio

At a medical center on the west side of San Antonio, arriving patients, most of them men, are presenting with a worrying coincidence: foot ulcers that won’t go away. And, then, they come out with the same devastating news: their diabetes has progressed to such a degree that their leg has to be amputated to save their lives.

Diabetes has been increasing around the world and has especially affected Latino communities in the United States. A lethal combination of genetics, poor access to health care, a diet high in processed foods and sedentary lifestyles has created a crisis in places like San Antonio, a South Texas city with a majority of Mexican-American people, which It is costing an increasing number of men their feet and legs and, in the long run, for some of them, their lives as well.

Texas has one of the highest rates in the country of people with diabetes-related amputations: about 52 per 100,000 hospitalizations. The problem in San Antonio is even more serious than in the rest of Texas, especially for men, who have more or less. three times more likely than women from losing a foot or leg to diabetes, perhaps due to cultural stigmas that prevent many Latino men from paying attention to their health.

“In San Antonio, this is a big problem and I would go so far as to say that, in terms of complications, it is the diabetic foot capital of the world,” said Michael Sobolevsky, a podiatrist at the Texas Diabetes Institute, a center doctor run by the University Health network in the Latino-heavy neighborhoods of west San Antonio. “We are constantly doing amputations.”

This disease is also taking lives at a alarming speed. According to data from the Centers for Disease Control and Prevention that was analyzed by the city’s health department, the death rate due to diabetes in Bexar County exceeds that of the rest of the state of Texas and of the country in general.

Type 2 diabetes, the most common type of the disease, occurs when the body can no longer maintain normal blood sugar levels. It affects many parts of the body, but usually especially the feet, which may have to be amputated when the blood supply fails to reach the lower extremities for long periods, causing infections that later become gangrene.

Therefore, Sobolevsky warns his patients to take even the mildest foot ulcers seriously. “My job is to prevent and save, save, save.”

This issue was made abundantly clear to Ralph DeFronzo, who was instrumental in the development of metformin, the first-line diabetes treatment drug, almost as soon as he arrived in San Antonio in the late 1990s. DeFronzo said he fell in love with the colorful and welcoming Mexican-American culture, as well as iconic places in the city, such as the Alamo and the River Walk park.

However, he immediately noticed worrying patterns around health. 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 cause tissues to have resistance to it. He also knew that San Antonio’s vaunted Tex-Mex culinary tradition — which is almost always rich in fatty oils and red meats and includes things like flour tortillas and desserts high in processed carbohydrates — can wreak havoc on the body.

A recent city report revealed that more than 76 percent, or more than one million people, of the San Antonio area’s adult population are considered overweight or obese.

“If we tested everyone in San Antonio, we would see that maybe one in two people over the age of 40 have diabetes,” DeFronzo said.

The doctor said that the first diabetes center he initially worked at was in a basement, which was “literally a dungeon,” which told him that the problem was not being treated quickly enough. Little by little, the consultation moved to the first floor and then to the second. “Finally, he convinced the hospital district that the biggest problem in San Antonio is diabetes,” DeFronzo said.

The Texas Diabetes Institute opened in 1999 as a huge center on the West Side, a historically Mexican-American neighborhood that, along with the city’s southern neighborhoods, has had fewer health care facilities than wealthier areas of the city. city, revealed an analysis of the San Antonio Express-Noticias newspaper.

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

“If the state of Texas expanded Medicaid, there would be fewer amputations,” said Joaquín Castro, a congressman who represents San Antonio. “As simple as that”.

Now, the Diabetes Institute has 80,000 patients a year and offers all services for disease management, such as research, diagnosis and treatment, nutrition education, physical therapy and amputations. Its walls are decorated with drawings of feet and legs, a constant reminder of the danger that awaits diabetic patients if their extremity ulcers are not treated.

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

Julius Hunter, coordinator of the San Antonio Diabetes Prevention and Control program, said part of it can be attributed to culture: Men, he says, are taught from a young age to “suck it up” and tend to ignore cuts and injuries. which can be a telltale sign of serious diabetes problems, even after they have been informed that they have the disease. The city’s various diabetes seminars are attended almost exclusively by women, according to Hunter.

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

So the city health department took action The diabetes garagea 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.

This crisis has even affected some political leaders in the city. A grandmother of Congressman Castro lost a leg to diabetes and ended up succumbing to the disease. “For Hispanics in South Texas, diabetes is the big bogeyman that you always have to watch out for, especially if you can’t afford preventive care,” 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 thought a type 2 diabetes diagnosis four years ago would cost him his right leg. . . But a year ago the skin on the little toe of his right foot split open while he was carrying heavy music equipment, and it quickly became infected.

The next morning, he said, much of his foot had turned purple, a sign that it was getting gangrenous. In a nearby emergency room, he said, doctors gave him the news: either you lose your foot or you die.

“Do what you have to do,” he told them.

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. He placed it on his right thigh and slowly got out of the wheelchair. His body was trembling. He hadn’t stood on two legs for more than a year, he said.

Noticing some doubts, 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 back and forth,” he told her.

Pérez, who has lost weight to 109 kilos from the 154 kilos he weighed before, moved his healthy leg first, followed very delicately by his new metallic limb. He saw himself standing tall in a 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, a niece, Mikayla Sanchez, 31, winced as she watched him climb into the passenger side of her truck alone. “I’m very excited for him, but also very nervous,” Sánchez said. “I don’t want him to fall.”

Juan Arguello III, 50, who has lived with a prosthesis in his right leg for almost three years, now helps teach new patients like Pérez how to use it. He calls his patients “the kids,” because they are usually much younger than him.

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

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

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

For Pérez, the new limb meant being able to return to his career as a musician.

On New Year’s Eve, he took the stage and played bass at 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: “I have many steps ahead.”

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