SAN ANTONIO, Texas — At a medical center on San Antonio's west side, one type of patient shows up with disturbing regularity — men, mostly. They have sores on their feet that won't go away. And they leave with devastating news: their diabetes has progressed to the point where a leg must be amputated to save their lives.
Diabetes has increased worldwide and Latino communities in the United States have been particularly 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 largely Mexican-American city—that is costing a growing number of men their feet, their legs and, for some, their lives.
Texas has one of the highest rates in the United States 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 about three times more likely to lose a foot or leg to diabetes than women — possibly because of cultural stigmas They prevent many Latino men from taking care of their health.
“We are continually amputating,” said Michael Sobolevsky, a podiatrist at the Texas Diabetes Institute, run by University Health in the predominantly Latino neighborhoods of western San Antonio.
The disease is also killing at an alarming rate. The death rate from diabetes in Bexar County, to which San Antonio belongs, exceeds that of the rest of Texas and the entire United States, data from the United States Centers for Disease Control and Prevention show.
Type 2 diabetes, the most common type, occurs when the body becomes unable to keep blood sugar at normal levels. It affects many parts of the body, but often the feet, which may have to be amputated when the blood supply does not reach the lower extremities for prolonged periods, causing serious infections that lead to gangrene. Sobolevsky warns his patients to take even the mildest foot sores seriously.
Latinos have genes that predispose the pancreas to produce insufficient insulin and other genes that make the tissues resist it.. And San Antonio's 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.
“If you really tested everyone in San Antonio, you would find that probably one in two people over the age of 40 has diabetes,” said Ralph DeFronzo, a San Antonio doctor who played a key role in developing Metformin, the first-line diabetes medication.
In 1999, the Texas Diabetes Institute opened its doors on the West Side, a historically Mexican-American neighborhood that has had fewer medical facilities than wealthier areas of the City, according to a San Antonio Express-News analysis.
It is also an area where the cost of healthcare can be an issue. A recent study by Texas 2036, a think tank, found that more than 16 percent of the state's population, or 5 million people, do not have health insurance.
The diabetes institute serves about 80,000 patients a year and offers research, diagnosis and treatment, dietary education, physical therapy — and amputations.
The institute has focused on the disease's disproportionate effects 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 the increase among girls.
Julius Hunter of the San Antonio Diabetes Prevention and Control program said: Many Latino men are programmed from an early age to “suck it up” and tend to ignore cuts and injuries., even when they know they have diabetes. Local diabetes seminars are attended almost exclusively by women.
“'Are you a man or are you going to cry like a little boy?'” Hunter said. “Those messages carry into adulthood.”
The City's health department then started The Diabetes Garage—workshops using car maintenance metaphors where men can ask questions and learn how to properly maintain their bodies.
Four years ago, Robert Perez, 39, a Grammy-winning musician and recording engineer, was diagnosed with type 2 diabetes. The skin on his right little finger split open a year ago and quickly became infected. The next morning, much of his foot had turned purple, a sign that gangrene was setting in. The doctors gave him the news: he must give up on it or he will die.
“Do what you have to do,” he told them.
Perez, known as Anthony Perez in the music industry, recently arrived at the institute to try out a new prosthetic leg. Holding it to his right thigh, he slowly stood up from his wheelchair. His body trembled. He had not stood on two legs for more than a year.
He saw himself standing tall in a mirror and smiled shyly. “I'm learning to walk for the first time since I was a baby,” he said.
On New Year's Eve, Perez came on stage and played bass. “I was able to stand up and play for the first time in a long time,” he said. But he was also aware: “I have many steps ahead.”
By: EDGAR SANDOVAL
BBC-NEWS-SRC: http://www.nytsyn.com/subscribed/stories/7085941, IMPORTING DATE: 2024-01-25 20:22:06
#Diabetes #causing #amputation #crisis #Latino #men #what39s #happening