John*, a loving father and grandfather, comes in for a checkup, reluctantly, at his daughter’s insistence. He feels good. Everything is fine. His eyesight is worsening but that’s a normal part of aging, right? He isn’t worried about his diabetes because he’s taking his insulin.

New policy in the doctor’s office:

If you have diabetes, you must take off your shoes.

John struggles but manages to pull off his shoes and socks. The doctor comes in. His A1C levels are out of control. Managing your diabetes isn’t just about taking your shots. Yada yada, John has heard this before. I feel fine, he insists. Exercise and diet. It’s about exercising and watching what you eat. Then the doctor kneels to check John’s bare feet.

The sudden urgency in the doctor’s voice takes John by surprise. John hears the word “infection”.

John had a small green toy soldier embedded in his foot. His grandson had accidentally dropped the small toy inside of John’s shoe. Unknowingly, John had stepped into the toy without feeling a thing and had been walking on the toy for almost a week. Now his foot is infected and there is no way to salvage it. John becomes another one of the amputation statistics.

This happens 185,000 times per year, nationwide.

Diabetes causes neuropathy. When you can’t feel your foot, it’s hard to know if you cut it or burned it or stepped on something that hurt you. Diabetes decreases blood flow to the extremities. Cuts and scrapes that you didn’t even know were there quickly deteriorate into gaping wounds that then subsequently become infected. The solution? An amputation so that the infection doesn’t reach the bone because osteomyelitis could kill you.

Dr. Marin narrated this incident to a meeting room that was silenced by shock. This is why we were here. Dr. Marin, the CEO of Su Clinica, Dr. Mccormick, the Dean of the UT School of Public Health, Dr. Fisher-Hoch, our mentor and Professor of Epidemiology, Dr. Prasad, Interventional Cardiologist and numerous others. I was humbled to be working with such an ambitious team. And I was humbled by how real the shocking statistics had become.

185,000 amputations annually in the United States. The Rio Grande Valley, including Brownsville where I was stationed, had the highest rates of both amputation and diabetes in the nation… in the nation.

Something had to be done.

 

 

*name changed for confidentiality.