The Cost of Diabetes - It Affects Everyone

COST OF
DIABETES
It affects everyone
Sunday, February 9, 2014
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including signs of diabetes. Fuel good for your health today by
knowing the risks of diabetes and how to prevent it, because a
healthy community is a vibrant one.
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Dont miss the opportunity to nominate the person who has made an impact in your
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Corpus Christi Caller-Times.
Hospital
to Home
If you or a loved one is hospitalized and have a chronic
condition like diabetes or congestive heart failure, we
can help. CHRISTUS Spohn will assist your transition from
hospital to home by providing the tools and support
needed to understand and manage your condition.
To see if you are eligible for our Care Transitions Program
call, 361-902-6542.
Introducing
Care Transitions Program
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CAL L E R-TI MES Sunday, February 9, 2014 3X
INDEX
6 The silent disease
Patients often ignore warnings
11 Hard habits to break
Without follow-up, patients can lose the battle
15 Outreach program cut
Community efforts showed much promise
17 Evaluating the diseases
nancial toll
Patients arent footing huge medical bills alone
21 Area methods trail others
In the Coastal Bend, people are still affected
by Type 2 diabetes at higher rates than the rest
of the nation
25 Education wards of
disease
Plan keeps Rhode Island ahead of Texas
29 Prescription: Motivation
Atlantic City sees success in team approach
33 Clinic gets personal
with patients
Staff engaged to the point they shop with client
36 Diagnosed at 23;
dead by 38
Illness manageable; easy to ignore
40 For 10 years, life dictated
by dialysis
Kidney loss another risk of diabetes
45 State monitors dialysis
care, facilities
Companies must address deciencies
48 Set on beating the odds
Woman masters weight to defeat Type 2
diabetes
50 Unclear prognosis
Nueces County, Christus Spohn band together to
battle crisis without extra Medicaid funding
53 A tool to survive
Weight loss surgery gives woman chance to beat
diabetes while honoring her son
57 Obesity, diabetes soar
in South Texas
Rates are higher than rest of state, nation
58 Curing the culture
South Texas families seek mix of healthy recipes
with traditions
62 Taking action is key
Its acceptable, and it shouldnt be acceptable
66 Struggling to x
diabetes issue
Corpus Christis diabetes initiatives have
disappeared, zzled away or fallen short
69 Modest health
strides noted
From 5Ks to cycling groups, Corpus Christi
shows signs of shedding Fattest City label but
lacks hard evidence
73 One step ahead
Corpus Christi struggles with its health crisis;
San Antonio takes on similar problems,
nds success
77 An indicator for change
Type 2 diabetes is increasingly affecting
children; parents told to lead in making
healthier choices
81 Girls sharing
healthy message
Teen team targets poor eating habits
83 How do you change a
culture of diabetes?
With funding and resources scarce, personal
responsibility becomes more crucial
than ever before
88 Where are they now?
A look back at the local families coping with
Type 2 diabetes, their successes and challenges
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4X Sunday, February 9, 2014 CAL L E R-TI MES
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Without question, Type 2
diabetes is our No. 1 health
crisis.
One out of every six Nueces
County residents has been di-
agnosed with diabetes, more
than double the national av-
erage. Forty percent of us are
obese. Those statistics alone
are troubling enough, but in
Nueces County, the problem
is much more worrisome.
Diabetes can be debilitat-
ing, deadly even, but compli-
cations are preventable with a
healthy diet, regular exercise
and medicine. Yet, our neigh-
bors continue to get seriously
sick and die from this disease.
Its been more than a de-
cade since a national research
rm named Corpus Christi
the No. 1 place in the nation
for below-the-knee amputa-
tions but little has changed.
We now rank No. 2, dropping
behind McAllen. And we are
the third worst county in the
state when it comes to dying
from diabetes.
Why arent we getting
healthier? It would be tempt-
ing to blame the epidemic
on ignorance, but in a region
where diabetes afects every-
one not just those
diagnosed we are deeply
aware of the consequences.
Many of us know someone
who lost a toe or sufered
kidney failure or was rushed
to the emergency room for a
stroke or heart attack. Some
buried family members and
friends after watching them
grow sicker and sicker year
after year.
Awareness isnt our prob-
lem. Action is.
Several high-profile ini-
tiatives disappeared, zzled
or fell short of their prom-
ises. Other communities saw
successes and saved money
through an array of difer-
ent programs and policies
designed to help people with
diabetes understand and man-
age their disease, but we tend
to solely blame our crisis on
a failure of personal respon-
sibility.
Undoubtedly, personal re-
sponsibility plays a huge role.
Take Priscilla Boren, for ex-
ample. For years, she shrugged
off her doctors warnings
until she got diagnosed with
diabetes in 2012 and the doc-
tor warned her she could die.
She weighed 270 pounds.
Then and there, she decided to
transform her life. She gave up
carbs and started working out.
She was a few months into her
transformation when I met her
and at the time she still need-
ed insulin. By the end of 2013,
she weighed 143 pounds and
no longer needed any medica-
tion. Her blood sugar was nor-
mal. You can beat this, she
told me. But its up to you.
True. But diabetes is a
complicated and confus-
ing disease that requires
full-scale changes that
arent easy to implement
or maintain. Imagine
waking up one day and
having to alter your en-
tire diet. Give up foods
youve been eating your
entire life. Go home
with insulin, needles
and a blood sugar me-
ter, not sure what to do
next.
When Jerry Madri-
gal was hospitalized
with a foot infec-
tion and diagnosed
with diabetes, he
had no clue how
to change. And he
might have gone
home like that angry and
depressed and lost had it not
been for a persistent Christus
Spohn nurse who kept visiting
Madrigals hospital room even
though he pushed her away.
She eventually helped him
get cheap medicine, a pair of
diabetic shoes, a blood sugar
meter and lessons on how
to inject insulin and test his
blood as part of a hospital pro-
gram to prevent hospital read-
missions, resources he didnt
know existed. Today, Madri-
gal is 40 pounds slimmer, his
kidneys rebounded and his
blood sugar is normal. He got
healthy because he chose to
get healthy, but he also got
help and support along the
way that was critical to his
transformation.
The goal of this series was
to help people with diabetes
make better, informed choices
about their health, but I also
hope it sparks a conversation
about how we, as a commu-
nity, can help folks make those
better choices and, by doing
so, make Corpus Christi a
healthier place to live.
Taking action to ght diabetes crisis is overdue
COST OF
DIABETES
TODD YATES/CALLER-TIMES
Reporter
Rhiannon Meyers
attended a
weight loss
procedure and
covered the
progress of the
patient in 2013.
CONTRIBUTED PHOTO
During the year long Cost of Diabetes series, reporter Rhiannon Meyers
(right) featured Priscilla Boren who lost more than 100 pounds after she
was diagnosed with Type 2 diabetes. Meyers received an award from the
American Diabetes Association for her stories on the issue.
A look
back
A woman who lost her sight.
A photographer who took
control of her own health.
After a year long look at the diabetes crisis in the
Coastal Bend, in a special video presentation, the
Caller-Times takes a look back at some of the
people we proled and explores the reasons why
the diabetes epidemic continues.
Dr. Stephen Ponder, pediatric endocrinologist, is an advocate for diabetes education and
prevention in the Coastal Bend.
PHOTOS BY MICHAEL ZAMORA/CALLER-TIMES
Belva Robinson sits with members of a blind support group in Corpus
Christi. Robinson lost her sight because of complications with diabetes.
Photographer
Priscilla Boren
moves her
subjects into
position during
a photo shoot at
Gas Light Square
in Corpus Christi.
Boren changed
her habits after
her diagnosis of
Type 2 diabetes,
working out
and losing a
signicant
amount of weight.
/DIABETES
FACES OF
DIABETES
The silent
disease
Patients often
ignore warnings
Jerry Madrigal sits at his home as he talks about how diabetes affected his life, from his daily routine to the loss of his big toe on his left foot, due to diabetes.
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Jerry Madrigal, 49, half limped into his
hallway bathroom and closed the door be-
hind him.
It had been weeks since his surgery,
enough time to steel himself against what
lay beneath layers of bandages.
Still, as he undressed and peeled of his
sock, he couldnt look at his left foot. Not yet.
He lowered himself onto the plastic show-
er chair straddling the bathtub and reached
forward, turning the knob. Water rained
down. He forced his foot forward and pre-
pared to see the empty space where his big
toe had been.
COST OF
DIABETES
Published January 6, 2013
See SILENT, 7X
It was as he expected, and
yet worse, he thought as he
lathered his foot with a bar of
soap, almost afraid to touch
the seam where doctors closed
him up.
His wife heard him crying
through the bathroom walls,
grieving the missing piece of
himself.
More than a decade after a
national research rm named
Corpus Christi No. 1 in the
country for below-the-knee
amputations, Madrigal and
others continue to lose toes,
feet and legs casualties in
their battles against diabetes.
The 2001 label underscored
the Coastal Bends longtime
struggle with the disease and
gave birth to a urry of ini-
tiatives aimed at curbing the
rates of diabetes and diabetic
complications.
Twelve years later, little has
changed.
Diabetes remains on the
rise and the Coastal Bend
still ranks among the worst
places for diabetic complica-
tions, including below-the-
knee amputations and death,
a distressing statistic because
diabetes complications are so
preventable.
The Caller-Times is run-
ning a yearlong series examin-
ing the extent of the problem,
the consequences and what
can be done to curb the high
complications.
The Dartmouth Atlas of
Musculoskeletal Health, the
same organization that gave
Corpus Christi its 2001 label,
now ranks Nueces County at
No. 3 and Corpus Christi as
No. 6 in the country for lower
extremity amputations, al-
though the group based its
ranking on Medicare enroll-
ees only.
State reports, which are
more comprehensive, rank
Nueces Countys below-the-
knee amputation rate lower
than some other Texas coun-
ties. Nueces County is 19th
on a list ranking 133 Texas
counties amputation rates.
However, the countys preva-
lence of such procedures has
remained signicantly high-
er than the state average for
years, according to records of
hospital admissions among
people with diabetes.
More troubling, when it
comes to dying from diabetic
complications, Nueces Coun-
ty ranked third in the state in
2009, according to the most
recent state data available.
Nearly 700 people in Nuec-
es County died between 2006
and 2010 from diabetic com-
plications, including two peo-
ple in their mid- to late 20s.
And those numbers likely
dont tell the whole story. Dia-
betes likely is underreported as
a cause of death. As few as 35
percent of people with diabetes
who died had the disease listed
anywhere on their death cer-
ticates, according to the state.
OUT OF CONTROL
Diabetes is a group of dis-
eases characterized by high
blood glucose, or blood sugar.
About 5 percent of diabetics
have Type 1 diabetes, in which
the body does not produce in-
sulin, a chemical that moves
glucose out of the blood into
storage for the body to use as
fuel.
But the vast majority of dia-
betics have Type 2, a disease
that develops as the body be-
comes unable to efectively
use its own insulin. Glucose
builds up in the blood and
causes a condition that, if not
controlled, wreaks havoc on
the bodys circulation system,
nerves and organs. Those who
are sedentary, have a poor diet
or carry excess body weight
around their waists are at
greater risk of developing
Type 2.
Amputations and death
indicate poor diabetes man-
agement, and despite eforts
to reverse those trends, com-
plications remain a problem in
the Coastal Bend.
Part of the reason is purely
mathematical. Diabetes is
more prevalent in the Coastal
Bend, which is predominate-
ly Hispanic. Hispanics face a
higher risk of developing Type
2 diabetes than Anglos, a trend
blamed in part on diet, higher
rates of poverty and lack of
access to health care among
minority populations.
But a lack of education and
communication also play a
role.
Many of the patients I see
have diabetes for more than
a decade and have never seen
a dietitian or gone to a diabe-
tes class, said Corpus Christi
diabetes specialist Dr. Egbert
Miranda.
Some local doctors said pa-
tients often were noncompli-
ant, meaning they refused to
follow advice, failed to show
up for follow-up appointments
and dont go to diabetes edu-
cation classes, when recom-
mended.
People dont want bad
news to be put in their face,
said Dr. Gerald Boynton, a
family practice doctor in Cor-
pus Christi who has treated
diabetics. They pretty much
know what they are doing. ...
If their weight is going up and
their blood sugar is out of con-
trol, they dont want to come
in and have someone point
that out to them.
When patients dont follow
directions, doctors get frus-
trated, and that can lead to a
vicious cycle of miscommu-
nication and distrust between
patients and health care pro-
viders weary of giving direc-
tions that are never followed.
Diabetic complications not
only cause pain and sufering
for those losing their eyesight,
a leg or a kidney, they also
exact a nancial toll. Ampu-
tations are one of the most
expensive procedures, cost-
ing on average, $80,072 for a
person in Texas to have an am-
putation in 2010. Thats up 60
percent from the $48,939 the
same procedure cost in 2004,
according to state estimates.
People with diabetes spend,
on average, more than twice
on health care than they
would without the disease,
and an estimated one in 10
health care dollars is spent
on diabetes, according to the
Texas Diabetes Council.
The state annually spends
nearly half a billion dollars to
provide health care to people
with diabetes and diabetic
complications. Just $3 million
is spent on statewide diabetes
prevention eforts.
As long as diabetes remains
poorly controlled, taxpayers
are left footing the bill for ex-
pensive procedures and pricey
medication.
WAITING TOO LONG
Jerry Madrigal, of Corpus
Christi, knows the costs of
diabetes all too well.
Diabetes remains on the rise and the
Coastal Bend still ranks among the worst
places for diabetic complications, including
below-the-knee amputations and death.
See SILENT, 8X
Jerry Madrigal and his wife, Patricia, pose for a photograph on their
wedding day. Jerry Madrigal weighed just over 260 pounds before be-
ing diagnosed with diabetes.
SILENT
from 6X
Four years ago, he came
home from a friends house,
sank into his couch, kicked
of his house shoes and found
his white sock dyed red with
blood.
He discovered a three-
quarter inch nail that had
burrowed into his shoe and
rubbed raw the side of his big
toe.
He felt nothing.
He waited days to see a doc-
tor, who treated the wound but
issued a warning: Madrigal
should get checked for diabe-
tes, which causes poor blood
circulation and nerve damage
and makes feet vulnerable to
sores.
Madrigal brushed aside
the doctors advice. His wife
and mother urged him to get
checked, but, like many oth-
ers, he never went for a follow-
up appointment.
I was in denial, he said.
He continued to eat as if
nothing was wrong. Four
tacos to cap a late night out.
A large pizza every other
Monday. Two bags of cotton
candy in a single sitting.
He was 6 feet tall and
weighed 260 pounds. He
didnt feel sick. He wasnt in
pain. His wound seemed to
heal, except for a small sore
near his toe that refused to
close. He couldnt see the in-
fection spreading inside his
foot, eating away at the esh
and bone from inside.
When, in March, Madrigals
foot swelled so big he could no
longer t into his house slip-
pers and the reddened skin be-
gan to peel like an old blister,
he nally sought treatment.
This time the news wasnt
so ambiguous.
Hes a very sick man, the
doctor told his family.
The next morning, they
wheeled Madrigal into his
rst of four foot surgeries that
would end, months later, with
the removal of his big toe. His
kidneys were failing, and an
A1C test, which measures the
average blood glucose levels
over three months, registered
Madrigal at 14, the highest
number some meters can reg-
ister. An A1C of 6.5 or higher
indicates diabetes.
He spent 19 days in the hos-
pital.
He now needs a kidney
transplant and until then, he
requires dialysis three times a
week, four hours at a time. No
longer able to work as a labor-
er, he receives disability pay.
Sometimes, he tags along
with his friends to their jobs.
Theyll ip over a 5-gallon
bucket and hell sit there,
watching them climb ladders
and apply wall texture.
He feels worthless. Unnec-
essary.
He tried to trim the front
yard, but weak from dialy-
sis, he lost his balance. He
grabbed the push mower,
catching himself before he
hit the grass, then walked to
a folding chair and sat and
cried.
I blame myself for every-
thing thats happening, he
said. If I wouldve gone back
three years ago, they wouldve
found out I was diabetic three
years ago and I would not be
where Im at now. Thats what
I tell my friends and people
that have it. Dont take it as a
joke because I did. Now look at
whats happened to me.
NO EXCUSES
Type 2 diabetes creates in-
sulin resistance and can be
managed through a healthy
diet and exercise. In some
cases, lifestyle changes can
help people get of medication
altogether.
People should have the at-
titude that, if they have a high-
er risk, if they are Hispanic or
overweight or have a big waist
or a family history of diabetes,
they should be asking them-
selves, what are they doing
about this? Dr. Miranda said.
People with elevated blood
sugar, a condition now called
pre-diabetes, have an easier
time than someone already
diagnosed of changing their
lifestyles, thus preventing
later complications such as
blindness and amputations.
But reversing a lifetime of
bad habits takes motivation
and determination, and people
often nd myriad excuses not
to make healthy choices.
Few people have more po-
tential excuses than Priscilla
Boren.
Boren, 40, is a working
mom with three children at
home, a son, 8, a stepson, 17,
and a daughter, 22. When shes
not running her own wed-
ding photography business,
shes networking to drum up
business or volunteering for
the Corpus Christi Hispanic
Chamber of Commerce.
Her phone buzzes inces-
santly with incoming text
messages. Sundays are typi-
cally her only day of. She cant
nd time to cook, so they often
eat out.
She lives in a Westside
neighborhood without well-
lit places to exercise outdoors.
Doctors for years told her
she was pre-diabetic, warnings
she repeatedly shrugged of,
until this spring, when, weeks
after she nally got around to
having long-overdue blood
work done, the doctors ofce
called.
They had her results and
needed her to come in imme-
diately.
The doctor held my hand,
looked me in the eyes and she
says, Your (A1C) is 11.8. She
says, Everyone here in the of-
ce saw that and gasped.
She thought she felt ne, but
Priscilla Boren takes an early morning jog down Old Brownsville Road, she was diagnosed with Type 2 diabetes in spring of 2012. She uses jogging to help manage her diabetes.
SILENT
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then the doctor ticked of the
symptoms of diabetes. Exces-
sive thirst. Frequent urination.
Fatigue. Check, check, check.
What next? Boren asked.
Well, the doctor said, she
should expect to lose her
eyesight. Already happening,
Boren thought, remember-
ing the reading glasses she
recently bought. Then the
amputations start, the doctor
said. Her toes, she realized, had
been tingling for months.
And then, the doctor said,
you die.
I remember my grandma
getting insulin shots and she
was old, she said. I remember
thinking, Wow. Is that what
its come to, that they have to
put me on this insulin?
She thought about how,
when she was little, she vis-
ited her diabetic great-uncles
in Laredo. She remembered
them sitting in wheelchairs
on the front porch, their legs
missing from the knees down.
Not me, she thought.
And with that, Boren bid
farewell to her favorite carbs
bread, cake, sweet tea. That
rst week, she took her pills,
injected insulin and ate Whata-
burgers minus the buns. She
started dropping pounds, and
people noticed.
Not wanting to slow her
weight loss momentum, she
started walking. Weeks went
by and she felt good. So she
started jogging. By the time she
saw the doctor again in August,
she had shed 40 pounds and
her blood glucose levels had
dropped to prediabetic range.
Amazed, her doctor urged
her to run a 5K.
To train, Boren would force
herself out of bed at 5 a.m. and
head out on an uneven side-
walk bordering the darkened
Gabe Lozano Golf Course.
Early morning commuters
whizzed by on Old Browns-
ville Road as an eclectic blend
of Latin music, rock ballads
and Top 40 blasted through
her headphones.
She started tracking her
time and posting updates on
Facebook. She signed up for a
running app that notied her
husband when she completed
the run, and he shot back in-
spirational texts: Way to go,
babe! and Im so proud of
you!
When the big race arrived in
October, Boren ran the entire
3.1 miles, and nished with her
best time yet.
For me it meant a lot,
Boren said. The most reward-
ing part of it was, I always see
people racing on TV or run-
ning and someone hands them
water. And it was grabbing that
water from that little kid and
drinking it. Like, Hes there for
me, to give me the water. I cant
believe Im actually doing this
race.
And she hasnt stopped. She
still rises before the sun to
run, even when its cold: Ill
just pretend Im jogging thru
Central Park today, she posted
one chilly morning. She plans
to run another 5K in February.
Shes struck a healthy rela-
tionship with food: She still
eats breakfast at La Bahia but
asks the restaurant to leave
potatoes of her plate. Shell
have a taco for lunch but
just one, consumed with de-
liberately slow precision and
long breaks between bites. She
occasionally indulges in a slice
of wedding cake but pays for it
on the pavement.
Between June and Decem-
ber, she lost 65 pounds, re-
sults that turn heads. When
she stopped at a department
store to buy makeup, a Chanel
counter lady eyed her slim-
mer, 5-foot, 10-inch, 200-pound
frame in khaki shorts and black
blouse and declared, If you
lose any more weight, youre
going to change on me.
Its nice, Boren said. Ill
buy a new outt and see myself
in the mirror and think, Whos
that?
SILENT DISEASE
While Boren has maintained
her progress over several
months, few are as motivated,
as headstrong or as much of an
advocate for their own health
as she has become.
Far more often, people shy
away from ever taking that rst
step to start exercising, change
their relationship with food,
give up what they think they
cant live without.
Habits are hard to break,
Dr. Boynton said. For the
same reason why its hard to
maintain a New Years resolu-
tion, its easier to slip back into
the old ways of doing things
than maintain the new ways.
And because Type 2 diabe-
tes can wreak slow havoc on a
persons body, the kind of life-
altering complications that
motivate people to get healthy
often take years to develop. By
the time people feel sick, its of-
ten too late.
This is a disease that is
silent, said Dr. O. Alejandro
Brusco, a Corpus Christi doc-
tor who is board certied in
diabetes, endocrinology and
cholesterol control.
Jerry Madrigal nally found
got his wake-up call after his
nearly three-week hospital
stay in March. He is learning
to walk without his big toe. As
he navigates his house, a spe-
cial diabetic sock pulled tight
against the new contour of his
foot, he passes framed photo-
graphs of himself 55 pounds
heavier.
Hes unrecognizable in the
pictures.
I decided to change my
life, he said.
He dropped the weight by
cutting back on food; 19 days
in the hospital prepared him
for that. He hasnt touched beer
or liquor in nine months. He
started going to Greater Faith
Church.
And hes seen results. His
blood glucose levels hover
around 100, a healthy range.
He no longer takes insulin,
only an oral diabetic drug typi-
cally given to newly diagnosed
patients.
Still, the odds are stacked
against him. Research shows
diabetics who undergo one am-
putation are at risk of needing
additional amputations in their
lifetime.
Before they wheeled him
into surgery to remove his
toe, he told his family, If I go
in there and they come out and
tell yall something else has to
be cut of, dont let them cut it
of. Im going to agree to my
toe. And thats it.
But an infection could
spread and kill him, the doctor
said, and in that case, further
amputations could save his life.
You know what? I dont
care, Madrigal said. Thats
what I told my doctors. If it gets
to that point, Id rather just let
God take me ... I dont want to
be in this world being a little,
small person.
Some days, when hes awash
in grief and feeling especially
helpless, Madrigal thinks hed
be better of dead.
But his mother, 74, told him
she couldnt bear it if he died
before she did.
And so he pushes on
through the cycle of despair
and depression, searching for
the silver lining in all this, if
only a small one.
SILENT
from 8X
Jerry Madrigal sits at his home as he talks about how diabetes affected his life, from his daily routine to
the loss of his big toe on his left foot, because of diabetes.
I remember my grandma get-
ting insulin shots and she was
old. I remember thinking, Wow. Is
that what its come to, that they
have to put me on this insulin?
Priscilla Boren
Martin Moreno
has his rst cup
of coffee from
breakfast be-
fore taking his
daughter, Mar-
tina, to school.
Both he and
his daughter
are battling
diabetes.
Diabetes
self-management
classes reveal that
some choices are
Hard habits
to break
COST OF
DIABETES
Published February 3, 2013
See HABITS, 12X
Without follow-up,
patients can lose the battle
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Slumping in a chair against the exam-room wall, Martin
Moreno faced his doctor in her rolling chair and hospital-
issue blue scrubs.
Three months earlier, sitting across from each other
in the same clinic, Dr. Crystal Campos warned him: If he
didnt control his blood sugar, he would get diabetes.
Moreno, 50, enrolled in diabetes education classes at
her suggestion. He sat in the front row every Thursday
night for a month, watching presentations about insulin
and carbohydrates.
Back in her clinic weeks later, Campos inspected More-
nos lab results.
Your sugar, your sugar
tells me
She stopped and sighed.
Your sugar, as of today, told
me you are diabetic, Papa, her
voice dropped to a whisper.
Oh, he groaned and
slumped lower.
Self-management classes
like the ones Moreno attended
are widely regarded as one of
the best ways to prevent the
onset of diabetes and compli-
cations such as blindness, kid-
ney failure and amputations.
But in a region long plagued
by diabetic complications, the
classes fail to live up to their
potential, worsening the prog-
nosis for a disease thats one of
the biggest drivers of health
care costs.
Corpus Christis diabetes
education programs in recent
years have struggled to stay
aoat, to persuade people to
attend and to encourage them
to come back to manage their
disease over the long term.
The Caller-Times examined
results and challenges of local
classes as part of its yearlong
series Cost of Diabetes.
Even programs successful
at combating diabetes ght to
stay open. A $1 million state-
funded University of Texas
Community Outreach pro-
gram closed two years after
it opened even though par-
ticipants on average saw their
blood-sugar levels decline, re-
ducing their risks for expen-
sive surgeries and treatments.
While studies show that
self-management classes
prevent hospitalizations and
cut health care costs by up to
$8.76 for every $1 spent on the
class, the Coastal Bends self-
management programs have
been plagued by setbacks.
Corpus Christis two major
hospital systems Corpus
Christi Medical Center and
Christus Spohn hospitals
closed their outpatient pro-
grams in the past decade.
Corpus Christi Medical
Center, which has inpatient
nutrition counseling for dia-
betics, did not comment on
why its program closed.
Spohn still provides outpa-
tient programs at community
hospitals in Alice, Beeville
and Kingsville but shuttered
its Corpus Christi program in
part because of dwindling at-
tendance, spokeswoman Katy
Kiser said. The hospital now
focuses on educating patients
during their hospital visits
more than half of Spohns in-
patient admissions are related
to diabetes while referring
patients to other local classes.
Although diabetes educa-
tion exists in diferent forms
throughout the Coastal Bend,
the American Diabetes Asso-
ciation recognizes only two
outpatient programs in the
Corpus Christi area: the state-
funded Texas A&M Health
Science Center Coastal Bend
Health Education Center pro-
gram and the Corpus Christi
Food Banks grant-funded Dia-
betes Hands On program.
An estimated one in six
people, or 68,854, in Nueces
and San Patricio counties have
diabetes. But Corpus Christi
diabetes educators and com-
munity health workers say
doctors often fail to refer pa-
tients to the classes, and when
they do refer them, its a ght
to get people to attend and
return for follow-up appoint-
ments.
You would imagine that
when somebody gets diag-
nosed with diabetes, they
would be the one knocking at
our doors, said Dr. Juan Cas-
tro, a family-practice doctor
and medical director of the
citys largest diabetes class.
Thats not the case.
A LOT TO LEARN
Mark Nixon perched on
the edge of an exam table as
diabetes specialist Dr. O. Ale-
jandro Brusco reviewed his
medical chart.
Tennis shoes hid Nixons
damaged feet wrapped in
stained bandages. His eyes
were the milky blue color of
someone losing his eyesight.
His blood-sugar levels topped
300 the day Brusco saw him.
Thats more than three times
healthy levels.
When was the last time
you went to a diabetic class?
Brusco asked him.
I havent been, Nixon said.
Thats truly impressive,
Brusco said. Because, how
old are you now, sir?
Almost 40, Nixon an-
swered.
So 21 years and youve
never gone to a diabetic class,
Brusco said.
Diagnosed at 19, Nixon
doesnt know whether he has
Type 1, an autoimmune dis-
ease that used to be called
juvenile diabetes, or the more
common Type 2 diabetes.
Sunburned, with tattoos
and a bushy, graying beard,
Nixon does not have health
insurance and has not taken
good care of himself.
The Port Aransas sher-
man quit checking his blood
sugar and stopped taking his
medication for nine years. He
has not followed a diabetes-
friendly diet, and no doctor
ever recommended he attend
classes, he said.
Last year he wore a too-
tight pair of canvas shoes that
rubbed blisters into the side
of each foot. The blisters be-
came infected, and after mul-
tiple surgeries, with his blood
sugar still dangerously high,
his feet have not fully healed.
A father of a 4-year-old girl,
Nixon cant work because he
cant expose his feet to bacte-
ria in the sea.
Uncontrolled diabetes
wreaks havoc on the bodys
circulation system, nerves
and organs, yet blindness,
kidney failure and amputa-
tions expensive and debili-
tating complications are
preventable when diabetics
manage their disease and con-
trol their blood sugar through
small steps: a little exercise,
smart eating and stress man-
agement.
That may sound easy, but
newly diagnosed patients of-
ten dont know where to turn
for help.
Overworked primary care
and family practice doctors
have little time to fully explain
the disease to patients. Doc-
tors get paid based on the
number of patients they see.
As health care reimburse-
ments continue to decrease,
doctors try to see more pa-
tients in a single day, com-
pressing the amount of time
they can spend explaining the
diseases complexities, Brusco
said.
When you make a new
diagnosis for diabetes, thats
a lot, Brusco said. Youre
throwing at the patient a lot
of things, and patients who
have diabetes dont want to
HABITS
from 11X
Martina Moreno, who is dealing with Type 2 diabetes at the age of 16, tests her blood before going to school.
See HABITS, 14X
The urn of Rosalinda Moreno, who died last year after battling Type
2 diabetes, sits in her familys home. Her husband and daughter are
now battling diabetes.
Diabetes affects everyone in
our community and we are
dedicated to helping educate
our youth and promoting
research to prevent this disease
from affecting more.
Supports the Fight
Against Diabetes
361-241-3277
www.mikeshawtoyota.com
MIKE SHAW
TOYOTA
C
A
L
3
0
2
0
1
7
3232 US HWY 77
CORPUS CHRISTI TX
hear that. They have their own
thoughts and misconceptions
about diabetes. So you start
telling them how to eat, how
to move, which medications to
use. Its a lot.
Many leave their doctors
ofce with a prescription for
pills or insulin, and nothing
more.
Think about how long
the doctor spends with them,
and I guess theyre just over-
whelmed, and they say stu-
pid things like, Dont eat
anything white or Follow
a diabetes diet, said Geor-
giana Bradshaw, a longtime
certied diabetes educator in
Corpus Christi. I had a lady
say, They told me to follow a
diabetes diet, and I dont know
what that means. How are
they supposed to know?
CONFRONTING THE
DIAGNOSIS
Thats where classes come
in. They act as the safety net
for patients, a place where the
newly diagnosed can learn
how to inject insulin, exercise
and navigate a grocery store
or restaurant menu.
In Bradshaws free weekly
class at the Corpus Christi
Food Bank, diabetics are
forced to confront their dis-
ease from the moment they ar-
rive and face a catered dinner
from which they must select
the carbs they plan to eat and
measure their portions with
serving-sized scoops.
Bradshaw doesnt have dia-
betes, but she is able to con-
nect to her classes by address-
ing touchy subjects like the
insulin myth the misplaced
worry that insulin, not un-
checked diabetes, killed their
relatives and friends and by
going places others dont.
No matter how often she
does it, new class members
still cringe and gasp when
Bradshaw, champagne blond
with cherry red lipstick, hikes
up her sheath dress, pinches a
section of thigh and shoves a
needle through her pantyhose
to make a point that insulin in-
jections dont hurt.
Despite data that showed
the program was making
strides helping people lower
their blood-sugar levels, it lost
most of its county funding by
2010 before pharmaceutical
giant Bristol-Myers Squibb
gave it a three-year, $800,000
grant to continue classes
while piloting a project to con-
nect food pantry clients with
health care.
The grant ends in 2014, and
Bradshaw isnt sure what she
will do after that.
The food bank programs
nancial struggles and the de-
mise of the state-funded Uni-
versity of Texas Community
Outreach program underscore
the lack of priority placed on
these programs, even when
they are successful.
Thats disappointing, ad-
vocates say, because the pro-
grams are desperately needed
here.
Knowledge is power, Br-
usco said. A lack of knowl-
edge is the worst thing for
patients. It gets in the way for
them to improve and to be a
part of the solution, rather
than part of the problem.
Classes are vitally impor-
tant because they help diabet-
ics understand how to manage
a chronic disease that requires
lifelong reinforcement, Brus-
co said. Because people with
diabetes often dont feel sick
at rst, troubling signs and
symptoms can go unnoticed
for years until its too late and
they lose their eyesight, limbs
or kidneys.
GOING TO CLASS
When Martin Moreno was
diagnosed with pre-diabetes
in September, his health was
the least of his worries.
His wife, Rosalinda More-
no, 40, died suddenly in Feb-
ruary 2012 after years of de-
bilitating and chronic health
problems, including Type 2
diabetes.
Nearly a year later, a wreath
still hangs near the front door
adorned with a pink ribbon
and the words, We love you,
Mom. His wifes ashes are
in an engraved, rose-covered
urn overlooking the kitchen
table where their daughter,
Martina, 16, hunches over a
set of math problems.
When Rosalinda died, she
left Martin to care for Martina
by himself. Martin cant work
because of crippling arthritis
that mangled his thick hands,
so he and his daughter live on
his meager disability checks.
Like her mom, Martina has
diabetes. She was diagnosed
two years ago with Type 2,
once called adult onset diabe-
tes, which has become alarm-
ingly more common in chil-
dren. With Rosalinda gone,
Martin, still grieving, has
struggled to help his daughter
manage her disease and cope
with the loss of her mother.
The Morenos confounding
response to their diabetes
at times proactive and other
times indiferent captures
the necessity and failure of
the Coastal Bends diabetes
classes.
Martin Morenos low in-
come allows him to get health
coverage from the countys
insurance program for indi-
gent patients. The program
requires patients to attend
the classes in an efort to trim
health care costs funded by
the countys taxpayers.
Martins doctor referred
him to Texas A&Ms self-
management classes held
weekly at Del Mar Colleges
West Campus. With arguably
the regions most stable and
well-funded classes, the cen-
ter will get nearly $270,000 in
state funding this scal year
for diabetes prevention alone.
The program began in 2001
after Corpus Christi Medical
Center closed its outpatient
program and gave its space to
the health education center,
said Castro, the centers medi-
cal director.
It since has expanded, ab-
sorbing patient referrals from
practitioners from both health
care systems and all indigent
care patients, who can take
the class free. Up to 95 per-
cent of the people who attend
the classes are referred there
by doctors, according to pro-
gram ofcials. That referral
rate dwarfs that of the other
Georgiana Bradshaw, with the Corpus Christi Food Bank, pricks ngers for a blood sugar test before class begins for neighborhood people who
attend the food banks diabetes program at the Garcia Arts Center.
HABITS
from 12X
See HABITS, 15X
See HABITS, 15X
programs in town.
Still, program ofcials bat-
tle to get people to take the
classes seriously.
Fewer than half of the 1,200
people who attended in 2012
returned for follow-ups, mak-
ing it hard to grade the pro-
grams success. The follow-up
rates continued to drop dur-
ing the year, with 11 percent
of people returning for their
12-month appointments.
When Martin went to his
rst class in November, he
did not have diabetes, but his
elevated blood sugar levels put
him at risk of developing the
disease.
The A1C test measures
blood sugar averages over two
to three months. An A1C be-
low 5.6 is considered normal;
an A1C of 6.5 indicates diabe-
tes. Martins was 5.9.
Martin knew something
about diabetes already. For
years, hed watched his wife
and daughter prick their n-
gers, read their glucometers
and inject insulin.
But he went to the classes,
anyway, bringing his 28-year-
old son, Matthew, from his
rst marriage.
They sat side by side in the
front row and watched Pow-
erPoint presentations at times
lled with complicated medi-
cal jargon and terminology.
When the instructor
wheeled a television to the
front of their classroom, Mar-
tin, in tightly laced tan boots,
stood with the rest of the class
and dutifully marched in place
as the cheery aerobics instruc-
tor on screen shouted encour-
agement.
Walk, walk, walk! she
said. Nice!
The classes inspired him to
change, for a while. He tried
to eat healthy, to make home-
cooked meals instead of going
to the taquerias for dinner. But
bad habits are hard to break.
NOT ENOUGH
In 1999, not long after Mar-
tina was born, Martin and Ro-
salinda decided to lose weight
together. They tried dieting,
and Martin brought home
workout equipment, including
a stationary bike he found in
a junk pile on the side of the
road.
They tried new foods.
They worked out. They lost
weight, but their efort was
short-lived. Tempted by one
anothers cravings, the pair
quickly tumbled back into
their old routine. When one
saw a TV commercial and
got a craving for fried chicken,
the other did, too, and in no
time, they gained back all the
weight they lost.
Martins new life as a single
dad further complicates his ef-
forts to eat healthy.
Martina is a notoriously
picky eater and stubborn
about her dislikes. Iceberg let-
tuce is OK, but not its crunchy,
white ribs. Tomatoes are good,
but only the ends.
And Martina nds nothing
appealing about her dads idea
of healthy cooking: stews of
creamed soup, canned veg-
etables and boiled chicken.
Vomit, Martina called it.
OK, Martin told her.
More vomit for us, more
vomit for me and your broth-
er.
What Martina does like is
processed food loaded with
carbohydrates. After inject-
ing herself with insulin in the
morning, she removes a box
of French toast sticks from
the freezer, heats up ve for
breakfast and douses them
with maple syrup. School
lunch is gross, she said, so she
HABITS
from 14X
Community
efforts showed
much promise
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Diagnosed with diabetes in
2009, Roland Soto felt like his
life was falling apart.
Unlike others who shrug of
their doctors warnings, Soto
was frightened. Diabetes runs
in his family. His aunt lost
her legs; his father once was
hospitalized two times in one
week.
Soto, 45, readily agreed to
attend the classes his doctor
recommended. But they didnt
help.
They taught you things,
but they were basically telling
you how to read (food) labels,
he said.
Because he didnt under-
stand the efects on his body,
Sotos blood sugar levels wors-
ened.
Then Soto visited a health
fair at his sons school and
noticed a booth promoting a
new diabetes program, one
that ofered classes and home
visits for free.
The University of Texas
gram, the rst of its kind in
Corpus Christi, was the result
of state eforts to fund innova-
tive plans aimed at controlling
diabetes, a chronic disease
that is one of the biggest driv-
ers of health care costs.
Within two years, the
Nueces County program was
reporting success, saving the
state an estimated $1.2 million
in the county alone.
Despite that, lawmakers
failed to renew funding in
2011, forcing the program to
downsize and eliminate its
most innovative elements.
In the Coastal Bend, which
has not placed a high priority
on diabetes classes, the pro-
grams demise underscores
the difculty such classes face
in trying to stay aoat, even
when they show success.
INNOVATION
In 2009, as Soto sought to
control his diabetes and the
epidemic worsened statewide,
lawmakers agreed to spend $6
million on programs aimed
at lifestyle interventions
education, nutrition and
physical activity to control
and prevent diabetes in four
Texas counties where the dis-
ease is prevalent: Cameron,
Galveston, Nueces and Webb.
Armed with $1 million in
state funds, the Nueces Coun-
ty program hired a registered
nurse and seven community
health workers. They de-
scended on health fairs, com-
munity centers, schools and
churches in Nueces Countys
neediest neighborhoods to
nd and help people with un-
checked diabetes.
Program director Jacki
Siller intentionally hired
community health workers,
sometimes called promotoras,
who are not trained medical
professionals, because they
know their communities and
can relate to their clients. The
health worker model has been
embraced in other places, in-
cluding Rhode Island, where
they work in doctors ofces
and hospitals to help emergen-
cy room frequent iers and
people with chronic diseases
navigate the health system.
With its street-level, gueril-
la-style approach to diabetes
prevention, the University of
Texas Community Outreach
program set itself up to be an
example for others.
Visiting people in their
homes gave the workers un-
precedented insight into pa-
tients lives and helped them
understand environmental
factors contributing to their
disease, Siller said.
When you go into some-
ones home you can look in
their fridge you can look in
someones cupboard and get
a good idea of what theyre
cooking, of what theyre do-
ing, she said.
The visits also helped the
workers understand why some
diabetics struggled to keep
their diabetes in check. Sci-
entists believe social determi-
nants location, occupation,
income inuence health
as much as or more than the
quality of health care. Inside
patients homes, community
health workers unearthed
problems patients never shared
with their doctors.
Some diabetics had been
prescribed pills and insulin
they couldnt aford. Others
didnt have electricity. And
some drank contaminated
water, masking the foul taste
with sweetened drink mix.
Identifying barriers to
health care allowed the pro-
gram to help patients better
manage their diabetes and
Despite success, Outreach program cut
See HABITS, 16X
See OUTREACH, 16X
COST OF
DIABETES
Published February 3, 2013
When you go into someones
home, you can look in their
fridge... you can look in someones
cupboard and get a good idea of what
theyre cooking, of what theyre doing.
Jacki Siller, program director
eats Pop-Tarts instead. Dinner
is a bag of microwave popcorn
sprinkled with Flamin Hot
Cheetos or sal limn.
She hardly likes any kind
of food, Martin said in De-
cember. I stopped cooking
already because me and Mat-
thew would eat it and still
have to feed her. So mainly we
go to restaurants, and all she
orders is nachos and cheese
and beans. I dont know what
Im going to do.
As he coped with his wifes
death and struggled to raise a
teenage daughter on his own,
Martin couldnt maintain the
motivation to exercise and eat
right.
By December, they had all
started eating out again. At
restaurants, Martin snatched
up the our tortillas his son,
Matthew, judiciously un-
wrapped from his tacos and
set aside. They went to the
pizza bufet two times in one
week.
Martin went for a walk
around his Westside neigh-
borhood, but his body started
to hurt and he hobbled back
home in pain. He thought
about going again, maybe
this time pushing Rosalindas
motorized scooter in front of
him so if he got tired, he could
ride back. But it was too cold,
he said.
By the time he met with Dr.
Campos again in December,
he spent his days on his couch
drinking cofee and poring
over his dead wifes journals
while the old exercise equip-
ment rusted and gathered dust
on his back porch.
Campos told him she would
give him three months to rein
in his blood sugar, to try diet
and exercise, before she put
him on medication.
The closer we keep this
number between 6 and 7, she
said, indicating his A1C, the
less likely you are to get any
kind of damage, like in your
legs or in your eyes, OK? She
paused. I know youre disap-
pointed. I can tell.
Disappointed, but not
surprised. According to a
Caller-Times analysis of
more than 5,600 patient re-
cords between 2004 and 2012
stripped of all identifying
information before they were
released 46 percent of
those who followed up after
three months saw their A1Cs
go down.
But 20 percent returned
with A1Cs that were higher.
An additional 32 percent
stayed the same (the remain-
ing 2 percent were inconclu-
sive).
Did the classes fail Martin?
He shrugged.
I didnt change anything,
he said.
Why not?
He shrugged again.
NEW IDEAS
As the diabetes epidemic
continues to plague the Coast-
al Bend, advocates and health
care practitioners are eyeing
new ways to treat patients,
secure stable funding sources
for education and ofer new
kinds of classes.
This week the Texas A&M
Health Science center starts a
new $50 weight-management
class modeled after a national
program from the U.S. Centers
for Disease Control and Pre-
vention. It is based on a study
showing that modest lifestyle
changes, such as exercising
150 minutes per week, helped
participants lose up to 7 per-
cent of their body weight and
reduce their risk of developing
Type 2 diabetes by 58 percent.
The CDC recognizes such
programs nationwide that
follow the curriculum and re-
porting requirements. There
are only ve recognized pro-
grams in Texas. The closest is
in Weslaco, 160 miles south of
Corpus Christi.
The new 16-week program
is the rst for Corpus Christi.
The rst class lled with 23
people, and 33 have been add-
ed to a waiting list.
Christus Spohn plans to
launch a nursing program this
spring, providing training to
make select nurses go-to re-
sources for treating diabetes
in their hospitals.
And a group of advocates,
the Diabetes Community Co-
alition, is proposing plans to
hire more community health
workers and pair them with
certied educators to create
teams of people to help chron-
ically ill diabetics navigate the
health care system. That pro-
posal calls for funding from a
new federal nancing system
that is awaiting approval.
Changes are on the horizon
for the programs, too.
The diabetes coalition is
studying the Coastal Bends
education programs and out-
comes to arm program direc-
tors with data to apply for
grants.
Even with outcomes its
hard to get recognition and
funding, but ... if youre not
reporting outcomes, obviously
you dont have a chance, said
Jacki Siller, a coalition mem-
ber and director of the Uni-
Outreach diabetes program,
which has tried to rebuild it-
self since losing state funding
last year.
That study is expected to
conclude this year.
HABITS
from 15X
connect them with the care
and services they needed.
Sotos health worker went to
his house with stacks of books
and helped him understand
how uncontrolled diabetes
wreaked havoc on his body
and why it was important for
him to eat healthy and take his
medication as prescribed.
It was basically an A to Z
on being diabetic, Soto said.
By the end of the year, Soto
no longer needed medicine.
ROOM TO GROW
Bolstered by success stories
like Sotos and propelled by the
programs potential, the Uni-
Outreach bought a law ofce
on the citys poorer Westside
to create a community center.
It opened on a chilly January
morning. People crowded in-
side to sample healthy ham
and cheese breakfast cas-
seroles and watch Tai Chi
demonstrations.
Siller saw opportunity in
its surrounding vacant lots
room to grow, she thought
and even found a silver lining
in the irony of their fast food
neighbor.
On a cold day, the north
wind wafts the mouthwater-
ing smell of fried chicken over
the Healthy Living and Advo-
cacy Centers parking lot, but
Siller uses the neighboring
Popeyes as a lesson in real
world nutrition.
There are healthy choices
you can make just about ev-
erywhere, she tells clients.
You dont have to stop eating
at Popeyes.
By the time lawmakers met
in 2011 to renew the programs
funding, Siller felt condent.
At full capacity, the Healthy
Living and Advocacy Center
bustled with clients popping
in and out for cooking, aero-
bics, yoga and diabetes self-
management classes. Health
workers made almost 700
home visits in a year.
Siller reported clinical
outcomes, even though the
state didnt ask for them, and
the results were clear.
Patients make progress
when they lower their A1C,
a test measuring blood sugar
average over two to three
months. The A1C works the
same way a season batting
average measures a baseball
players success, the American
Diabetes Association says.
A person who does not have
diabetes will have an A1C
around 5; anything greater
than 6.5 typically indicates
diabetes.
In the community outreach
program, patients in their rst
three months saw their A1Cs
drop, on average, 9 percent to
7.3, a level considered in con-
trol.
Perhaps more telling, the
programs Medicaid clients,
whose health care is paid
for by the state, also lowered
their blood sugar, preventing
expensive complications and
surgeries, and saving the state
money, Siller said.
We already paid for the
program in two years, she
said. And the state just didnt
see the value in it.
DOWNSIZING
Siller traveled to Austin
throughout the summer to
meet with lawmakers and con-
vince them to renew funding.
Soto went, too, surprised that
the state would even consider
closing a class that helped him
so much.
No, that cant happen, he
said.
Despite their eforts, law-
makers cut funding for all
four community outreach
programs statewide. While
the state gave the Nueces
County program some bridge
funding, Siller was forced to
lay of most of her community
health workers.
That was the darkest cou-
ple months of my life, she
said. I thought if we did ev-
erything right and we exceed-
ed their expectations that (we
would get), at least ve years,
at least one more go-round.
Ill never stop the regret
that I felt in having to let staf
go. Ive had to let staf go for
other reasons in my career
but never like that, never this
dedicated staf that was doing
everything right.
Months later, the program
secured federal funding to
continue classes, but not
enough to restore the home
visits and the rural outreach
eforts in Banquete and the
colonias, Siller said.
This month, two new class-
es will be held for free at the
Healthy Living and Advo-
cacy Center: a cooking class
to teach people how to buy
and prepare inexpensive and
healthy food, and an aware-
ness class that teaches basic
information about the disease.
Still, at a center that was
once too busy, Siller now nds
herself trying to spread the
message that the squat beige
building with the overgrown
lawn next to the South Port
Avenue Popeyes is open.
To this day we have people
like, Oh, youre still there?
Siller said.
OUTREACH
from 15X
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Jerry Madrigals life is spent
in medical ofces.
What started as a small
sore on the 49-year-olds foot
has turned into a diabetes di-
agnosis and an endless series
of pricey procedures and pre-
scription medications.
No longer able to work,
Madrigal lives on disability
checks and his wifes part-
time pay. He has no clue how
much all of this costs; his med-
ical bills are fully covered by
government-funded Medicaid.
One of the states costli-
est diseases, the nancial toll
of diabetes extends beyond
those diagnosed, reaching
into the pocketbooks of tax-
payers and those with health
insurance who pick up the tab
for the uninsured or those on
government-funded health
care plans.
The pinch is acute in the
Coastal Bend, where diabetes
has reached epidemic levels.
The region remains among
the worst areas in the coun-
try for diabetic complications,
including below-the-knee am-
putations. At the same time,
the Coastal Bends rates of
Medicaid enrollees top the
state average.
I think that everybody
bears the cost of diabetes and
its complications resulting in
disability, because much of
that is paid for through our
taxes, said Dr. Melissa Wil-
son, a local endocrinologist
who served on the Texas Dia-
betes Council.
The Caller-Times exam-
ined the nancial toll of dia-
betes as part of its yearlong
series Cost of Diabetes.
Its impossible to say pre-
cisely how much diabetes
costs the region. Health in-
surers do not disclose their
costs. The federal govern-
ment estimates the total cost
of diabetes at $51.3 billion in
2010 but doesnt break that
number down by state. And
diabetes often coincides with
other health problems, such as
stroke or kidney failure, mak-
ing it difcult to pin down the
exact cost of the disease.
Still, publicly available data
indicate that the costs of dia-
betes are particularly high in
the Coastal Bend, where coun-
ties have some of the states
highest per capita costs for
hospitalizations attributed to
the disease.
Jim Wells County in 2010
ranked fth in the state, rack-
ing up $5.7 million in diabetes
hospitalizations, or an average
of $140 for every woman, man
and child living in the county,
according to the states health
department. Brooks County
ranked sixth, with $1 million,
or $139 per person. (Tiny, ru-
ral Culberson County in West
Texas ranked No. 1; Nueces
County ranked 41st at $91.50
per person.) The state average
was $61.40 per person.
Those costs dont include
emergency room visits or con-
ditions associated with diabe-
tes, such as stroke and heart
Evaluating the diseases
nancial toll
COST OF
DIABETES
Published March 3, 2013
Jerry Madrigal shows off the small cooler of medicine he keeps by his couch to help him control his diabetes.
See FINANCIAL, 18X
Patients arent footing
huge medical bills alone
attack, meaning the costs
of diabetes likely are much
higher.
And they continue to grow.
Nationwide, diabetes costs
nearly tripled from $18.8 bil-
lion in 1996, according to the
Agency for Healthcare Re-
search and Quality. Medicare
and Medicaid covered, on av-
erage, 42 percent, or $196 bil-
lion during 14 years, according
to the agency. Thats enough
to pay the wages of a quarter
million teachers during the
same time.
Still, while the costs of di-
abetes skyrocket, prevention
has not kept pace, another sta-
tistic painfully apparent in the
Coastal Bend.
Self-management classes,
widely regarded as one of
the best ways to prevent the
onset of expensive complica-
tions, have failed to live up to
their potential here. Corpus
Christis diabetes education
programs in recent years
have struggled to stay aoat
as funding gets stripped away.
ITS A LOT
Without Medicaid, Mad-
rigal doesnt know how he
would afford the diabetes
treatment to save his foot and
keep him alive.
Four years ago the Corpus
Christi man stepped on a nail,
but the wound refused to heal,
eventually sending him to the
hospital, where he was diag-
nosed with diabetes.
In the past year, hes had
four surgeries, including the
amputation of his big toe. His
kidneys are failing. He needs
dialysis three times per week
until he can get a kidney trans-
plant. At his sickest, Madrigal
took almost a dozen prescrip-
tion pills a day.
Madrigal worked as a la-
borer for years. He earned
$350 per week and didnt have
health insurance.
When a doctor rst treated
his foot, his mother paid for
the $65 doctors visit out of
pocket, and Madrigal kept
working.
Work dried up in early
2012, shortly before Madrigal
found out he had diabetes and
needed foot surgery.
Hospital social work-
ers helped him enroll in the
countys indigent care pro-
gram. Funded by property-tax
dollars, the program covers
health care for the countys
poorest residents. He stayed
on that plan until he was able
to enroll in Medicaid.
Madrigals situation is com-
mon in Texas, where Medicaid
and Medicare paid for two-
thirds of the states diabetes-
related hospital stays in 2010,
according to the states health
department.
And those stays arent
cheap.
Diabetes hospitalizations
on average cost $48,720, or 50
percent more than hospital-
izations not related to diabe-
tes, according to state reports
released in April 2012.
Thats because people
with uncontrolled diabetes
are more prone to infections
and have a tougher time ght-
ing them, Wilson said. A spike
in blood glucose levels, even
temporarily, can paralyze
white blood cells for up to
two weeks, compromising a
persons immune system, she
said.
Theres more u, more
colds, more urinary tract in-
fections, Wilson said. A cut
can easily become infected.
Skin infections and yeast in-
fections are very common.
Looking back over months
of procedures, medications
and doctors visits, Madrigal
and his wife, Patricia, are at
a loss to estimate the cost of
everything.
Were talking hundreds of
thousands of dollars, Patricia
said. Its a lot.
People with diabetes on
FINANCIAL
from 17X
See FINANCIAL, 19X
A blood glucose monitoring kit helps diabetics track their blood sugar
throughout the day.
JAIME DAVID SANDOVAL, M.D.
Padre Coast Medical & Clinical Research
Clinical Research Studies
with Free Care
Diabetes General Medicine
Primary Care Internal Medicine
1301 Santa Fe at Morgan 361-881-9300
Accepting New Patients
Same/Next Day Appointment
Most Insurance Accepted
C
A
L
3
0
3
5
1
1
average spend 2.3 times more
on health care than those who
dont, according to the states
most recent report on the -
nancial burden of diabetes in
2008.
Madrigal regularly gets
lab work and sees doctors to
manage his diabetes, prevent
further damage to his circula-
tory system or other complica-
tions, and to prepare himself
for a kidney transplant. To do
that, he needs various medical
professionals, from a dentist
to a cardiologist, to ensure his
body is healthy enough to ac-
cept a transplant.
Beyond that, people with
diabetes also tend to spend
more money on prescription
drugs, such as insulin and
medical supplies lancets
to draw blood for testing, glu-
cometers to monitor blood
sugar levels and syringes to
inject insulin, if necessary.
Those supply costs add up.
A local store, Medical Re-
hab Supply, sells a box of 50
test strips for $20, which could
last between two and seven
weeks, depending on how of-
ten a person tests his or her
blood.
EMPLOYER COSTS
Beyond the measurable
medical costs of the disease,
people with diabetes face
hefty indirect costs, such as
reduced productivity and
increased absenteeism from
work, which are much more
difcult to quantify.
A January 2012 study pub-
lished in a national medical
journal found that people
with diabetes have harder
times finding and keeping
jobs and earn far less during
their lifetimes than people
without diabetes. The study,
which tracked people from
high school until their 30s,
found that people with diabe-
tes earn $160,000 less during
their lifetimes than people
without the disease. Diabetics
were more likely to drop out
of high school and less likely
to go to college, according to
the study published in Health
Afairs.
Many of Corpus Christis
top employers declined to
answer questions about the
nancial toll of diabetes be-
cause of privacy reasons or
because they dont track how
many employees have the dis-
ease.
The Corpus Christi Army
Depot, the citys biggest em-
ployer with more than 4,100
employees and 1,400 contrac-
tors, is developing plans to
track wellness data, includ-
ing diabetes rates, spokesman
Jose Rodriguez said. Track-
ing that data could help the de-
pot better target programs to
workers health needs and ad-
vance its mission to promote
healthy lifestyles, he said. The
depot tries to encourage ex-
ercise by providing station-
ary bikes and other exercise
equipment for workers to use
during breaks, creating walk-
ing paths throughout the han-
gars, and ofering employees
access to the Naval Air Sta-
tions tness center, swim-
ming pool, running tracks,
baseball eld, basketball and
racquetball courts.
The depot also has a Sub-
way restaurant on site that
ofers healthy lunch options,
Rodriguez said.
FINANCIAL
from 18X
See FINANCIAL, 20X
DIABETES HOSPITAL CHARGES
BY COUNTY, 2010
U.S. DIABETES COSTS
60
50
40
30
20
10
0
1996 1998 2000 2002 2004 2006 2008 2010
Taxpayer expense Total T To
B
i
l
l
i
o
n
s
INDIGENT CARE
DIABETES COSTS
$224,132
Inpatient
TOTAL: $3,239,619
Nueces County, 2012
$2,600,537
Prescriptions
$48,794
Emergency
Room
$366,156
Clinic Claims
Cost per capita
$4.57 $176.15
$91.49
Nueces County
MILITARY HEALTH SYSTEM
DIABETES CARE
$36,754,100
Outpatient
care
$33,697,284
Pharmacy
$6,048,827
Inpatient care
In Texas, 2011
Source: Texas Department of State Health Services; Nueces County Hospital District; Tricare and U.S.
Agency for Healthcare Research and Quality
DIABETES COSTS
$9.5 billion
$18.8 billion
$51.3
billion
$21.9
billion
U.S. DIABETES COSTS
60
50
40
30
20
10
0
1996 1998 2000 2002 2004 2006 2008 2010
Taxpayer expense Total T To
B
i
l
l
i
o
n
s
INDIGENT CARE
DIABETES COSTS
$224,132
Inpatient
TOTAL: $3,239,619
Nueces County, 2012
$2,600,537
Prescriptions
$48,794
Emergency
Room
$366,156
Clinic Claims
MILITARY HEALTH SYSTEM
DIABETES CARE
$36,754,100
Outpatient
care
$33,697,284
Pharmacy
$6,048,827
Inpatient care
In Texas, 2011
Source: Texas Department of State Health Services; Nueces County Hospital District; Tricare and U.S.
Agency for Healthcare Research and Quality
DIABETES COSTS
$9.5 billion
$18.8 billion
$51.3
billion
$21.9
billion
Per capita costs shown
represent how much every
man, woman and child would
pay for these hospitalizations.
Emergency room visits are
not included.
SCRIPPS NEWSPAPERS
RACHEL DENNY CLOW/CALLER-TIMES
This is one of several coolers stocked with insulin at Christus Spohn
Hospital Memorial.
At Texas A&M University-
Corpus Christi, the citys 13th
largest employer, employees
receive a discounted rate of
$20 per month for the univer-
sitys gym, spokeswoman Glo-
ria Gallardo said. University
employees get wellness mes-
sages on email and Facebook
while the universitys health
insurer, Blue Cross Blue
Shield, provides a program
that helps people manage
chronic diseases, including
diabetes, she said.
Such incentives are becom-
ing increasingly common as
employers look to curb the
rising cost of diabetes and its
efect on insurance premiums,
said Wilson, the local endocri-
nologist.
INSURANCE COSTS
Its difcult to determine
how much insurance compa-
nies spend on diabetes.
Health insurers dont have
to disclose their costs, mak-
ing it impossible to determine
how the disease afects insur-
ance premiums and how those
premiums compare for people
living in the Coastal Bend,
where the rates of diabetes
and diabetic complications are
higher than the state average.
Still, one insurers data pro-
vided to the Caller-Times show
that the costs to treat diabetes
have been expanding, even
when adjusted for ination.
Tricare, which provides
health benets for military per-
sonnel and retirees and their
families, spent $76.5 million on
diabetes care in Texas in 2011.
Thats up 14 percent from 2007,
adjusted for ination.
Pharmacy costs made up
44 percent, or $33.7 million
in 2011, according to Tricares
reports.
Thats no surprise to Gwen
Jennings, who runs Medi-
cal Rehab Supply in Corpus
Christi.
She carries some diabetic
supplies, such as glucometers
and test strips, but she doesnt
sell other items often needed
by people diagnosed with dia-
betes, such as insulin syringes
or special diabetic shoes.
Still, Jennings estimates
about 30-40 percent of the
stores business can be linked
to diabetes care.
Perhaps more telling, about
half of the stores wheelchair
sales and leases go to people
with diabetes, she said, under-
scoring statistics that show
the Coastal Bend ranks among
one of the worst places in the
nation for below-the-knee am-
putations despite the fact that
complications are preventable
by managing blood sugar with
a healthy diet and exercise.
God gives us everything
to lead a healthy lifestyle, and
we turn around and chicken
fry it, Jennings said.
She said she wishes people
took the disease more seri-
ously.
Its as serious as cancer,
she said. Its as serious as a
heart attack and leads to heart
attack. Its as serious as a
stroke. Its every bit as serious
a condition as you can have.
Its too late for Madrigal to
prevent some of the debilitat-
ing long-term complications
of diabetes, but its not too late
for him to try to get healthy
and prevent further health
problems associated with the
disease: blindness, heart at-
tack, more amputations.
And hes doing just that
closely monitoring his diet,
exercising on the stationary
bike in his living room and
following doctors orders.
Hes lost 45 pounds. At his
last checkup, the doctor dis-
covered that Madrigals blood
sugar dropped to prediabetic
levels.
FINANCIAL
from 19X
Karlye Pesci, a clinical pharmacist at Christus Spohn Hospital Memorial, counsels patient Ernest Garcia
before he is discharged from the hospital. Garcia was in the hospital for swelling of his foot. He was told
he had diabetes six years ago and kept it under control with diet and exercise until one month ago. He is
now on medication for diabetes.
A new six-lane
interstate from
Corpus Christi to
Seattle
Six-lane
interstate
DIABETES SUPPLIES
Lancets, box of 100
$12.95
For pricking nger and
drawing blood to test
Glucometer
$15
Device for testing
blood sugar levels
Test strips, box of 50 $19.99
Insulin pen
$39.99
Diabetes socks, 2 pairs $8.97
Sharps container
$7.68
Biohazard bin for storing
used syringes, lancets
Prices are estimates and vary based
on insurance coverage, store, brand
and type
TAXPAYER COSTS
SCRIPPS NEWSPAPERS
In 2010, government-funded Medicaid and Medicare
covered $21.96 billion worth of diabetes costs
nationwide. Thats about the same as:
317,754
Registered nurses
salaries
schoolteachers
salaries
Alaskas
state debt
2,312 miles
to Seattle
432,641
Sources: Source: Agency for Healthcare Research and Quality, U.S.
Census Bureau, American Road and Transportation Builders Association, Sunshine Review,
Bureau of Labor Statistics, Medical Rehab Supply, Walmart.com, Walgreens.com
I think that everybody bears the
cost of diabetes and its complica-
tions resulting in disability, because much
of that is paid for through our taxes.
Dr. Melissa Wilson, a local endocrinlogist who served on the Texas Diabetes Council
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
When it comes to having
Type 2 diabetes, Yogendra Pa-
tel is lucky to live in Atlantic
City, N.J.
And Jerry Madrigal is un-
lucky not to.
Both Patel, 57, and Mad-
rigal, 49, are low-income mi-
norities who struggle with de-
pression. Both were diagnosed
with the disease around the
same time. Both had danger-
ously high blood-sugar.
Yet Patel got help and got
healthy, while Madrigal, of
Corpus Christi, ignored the
disease until he got so sick, he
lost a toe, his kidney function
and his ability to work.
Theres no simple expla-
nation why two men with the
same disease reacted so difer-
ently. Diabetes is a toxic com-
bination of genetics, sedentary
lifestyles, poor diet and lack of
Area methods
trail others
In the Coastal Bend, people still lose limbs,
face dialysis, go blind and die from Type 2 diabetes
at higher rates than the rest of the nation.
JOHN FREIDAH/SPECIAL TO THE CALLER-TIMES
Resident Dr. Robert Black checks the feet of patients of Rhode Island Hospitals Primary Care Clinic who participate in a diabetes self-man-
agement program. The feet are a vulnerable area for infection with diabetes patients because of the lack of sensitivity and blood ow. In the
background is instructor Lourdes Pichardo, left, and patient Eduviges Cortese.
COST OF
DIABETES
Published April 7, 2013
See METHODS, 22X
access to preventive care.
But one diference between
them does stand out the
presence of a vast and well-
funded safety net in Atlantic
City, designed to catch and
treat the sickest diabetics be-
fore they experience compli-
cations such as Madrigals.
So had Madrigal been for-
tunate enough to live in At-
lantic City or Rhode Island
or even Amarillo, with their
intensive programs aimed at
preventing long-term compli-
cations, he might still have a
big toe.
Places across the nation
have not eliminated compli-
cations, but they have seen
successes and savings with
classes, clinics and programs
funded by the government,
private hospitals and insur-
ance companies, all eager to
trim the growing costs of the
chronic disease.
But in the Coastal Bend,
people still lose limbs, face
dialysis, go blind and die from
Type 2 diabetes at higher rates
than the rest of the nation
with taxpayers often picking
up the tab.
Successful programs na-
tionwide raise an important
question: Is the region do-
ing enough to tackle its most
pressing health care problem?
SUCCESSES AND SAVINGS
The initiatives in Rhode
Island, Atlantic City and Am-
arillo show that debilitating
complications long plaguing
the Coastal Bend can be pre-
ventable when the health care
system and government take
aim at the disease.
ined these programs as part of
its yearlong series Cost of Dia-
betes. The paper will publish
stories later this month taking
a closer look at each program.
Its not fair to place all the
blame on the health care sys-
tem.
In Type 2 diabetes, the
body becomes unable to efec-
tively use its own insulin. Glu-
cose builds up in the blood and
nerves and organs. Yet blind-
ness, kidney failure and ampu-
tations expensive and de-
bilitating complications are
preventable when people with
diabetes manage their disease
and control their blood sugar
through small steps: a little ex-
ercise, smart eating and stress
management.
Research also shows pro-
grams aimed at helping people
understand and manage dia-
betes play a large role in help-
ing people and saving taxpay-
ers millions each year.
So in Atlantic City,
Madrigal might get treat-
ment where Patel did, at a
special clinic where people
with diabetes are paired with
health coaches. The coaches
meet in person with patients
as often as weekly in Patels
case to reinforce plans to
eat right, exercise, take their
medications and monitor their
blood sugar.
Clinic patients are saving
$208 per month, according
to the clinics early analysis.
More savings are expected in
the long term.
In Rhode Island, a state that
could t within the borders
of Nueces and San Patricio
counties, Madrigal could nd
an array of programs aimed
at preventing, managing and
treating diabetes long before
it leads to debilitating compli-
cations.
The states rate of diabe-
tes-related kidney failure
falls far below the national
average, with 123 people per
every 100,000 with diabetes
having kidney failure in 2008
METHODS
from 21X
See METHODS, 23X
Patients of Rhode Island Hospitals Primary Care Clinic, in Provi-
dence, are given a graphic showing the nutritional food items for
diabetes patients.
C
A
L
3
0
1
5
0
4
Diabetes...
ARE YOU AT RISK?
Your eyes will tell...
Drs. McIntyre, Garza, Avila & Jurica
Open 7 days a week for your convenience.
Find us on the upper level of La Palmera Mall.
From left to right: Dr. Alyssa Gamez, Dr. David Browning, Dr. Richard Lazarte,
Dr. John McIntyre, Dr. Cathy Avila, Dr. Adam Jurica & Dr. Edward Garza.
Dr
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(361) 994-0310
6 Second Procedure
Non-invasive - No Needles
No Fasting
compared to 192 nationwide
and 240 in Texas, according
to the U.S. Centers for Disease
Control and Prevention.
And, in Amarillo, Madrigal
could go to one place for all
his needs: classes, nutritional
questions, and eye, foot and
kidney exams. He could even
see a counselor and social
worker. Patients there have
better control of their diabe-
tes than the national average,
with 59 percent of patients in
2010 reporting well-controlled
blood sugar versus 35 percent
of Medicaid patients and 43
percent of insured people na-
tionwide, according to a clinic
report provided to the Texas
Diabetes Council.
But in the Coastal Bend,
where one in six people has
diabetes, similar eforts have
disappeared, despite the
pressing need in a region that
still ranks among the worst
places in the nation for dia-
betic complications, including
below-the-knee amputations
and death.
Corpus Christi used to
have a private clinic similar to
Amarillos one-stop-shop con-
cept, but it closed in 2010. The
Diabetes Centers of America
building on South Padre Is-
land Drive remains vacant.
Meanwhile, the company
continues to operate 13 clinics
statewide. Company ofcials
could not be reached for com-
ment.
Rhode Islands prevention
and management system is
one of the most intricate in the
nation, extending beyond state
initiatives to include private
practice doctors, insurance
companies and patients.
The Ocean State has a
population of 1 million, about
three times the size of Nueces
County. It boasts 330 certied
diabetes educators trained by
the state. Thats about one for
every 224 Rhode Islanders
with diabetes.
Texas does not have the
same training program. Elev-
en certied diabetes educators
work in Nueces and San Patri-
cio counties, many employed
by pharmaceutical companies.
That works out to one educa-
tor for every 6,259 people with
diabetes.
And unlike Corpus Christi,
where diabetes self-manage-
ment classes have struggled to
stay aoat, Rhode Island has
classes in hospitals, doctors
ofces and community cen-
ters and the state requires
insurance companies to pay
for them.
Texas does too, but Cor-
pus Christi classes rarely
seek reimbursement. Texas,
like Rhode Island, exempts
government and self-insured
plans from having to cover
the classes, a big loophole in
Corpus Christi, where many
people are covered by govern-
ment or self-insured plans.
RELATING TO PATIENTS
Perhaps one of the most in-
novative initiatives used in all
three places comes in the form
of a person like Milagros Laya,
a 36-year-old Spanish-speak-
ing immigrant from Peru who
earns a living helping people
with diabetes get healthy.
Unlike a doctor, who has at
most 15 minutes to spend with
a patient, Laya can take time to
learn about her patients, ex-
plain the disease in depth and
tailor her message specically
for them.
Using realistic rubber rep-
resentations of chicken, cereal
and corn, Laya helps patients
understand they can still eat
the foods they love, but por-
tion sizes should be no bigger
METHODS
from 22X
Patients of Rhode Island Hospitals Primary Care Clinic participate in
a diabetes self-management program at the hospital in Providence,
Rhode Island. Patients Ada Boaz, left, and Eduviges Cortese, right,
consult with Resident Dr. Elizabeth Tung, who discusses their blood
pressure results and medications.
Diabetes educator Lourdes Pichardo, left, who was diagnosed with the disease herself, teaches a diabetes self-management program at Rhode
Island Hospitals Primary Care Clinic in Providence, Rhode Island. She teaches the benets of exercise and a healthy lifestyle for diabetes
patients with Ambulatory Clinic Assistant Teresa Walls.
See METHODS, 24X
than a st. Because the clinic
pairs health coaches with peo-
ple of similar backgrounds,
cultures or ethnicities, Laya
often spends time assuring her
Latino clients that potatoes
and rice can still be a part of
their diet, just not in the same
meal.
And she knows that walk-
ing is the only exercise she
can recommend because the
people she sees are not going
to go to the gym, she said.
Laya represents the com-
munity health worker con-
cept, a key element used in At-
lantic City, Rhode Island and
Amarillo to manage diabetes.
Community health workers
dont necessarily have medi-
cal backgrounds; instead, they
have good people skills and an
ability to connect with specif-
ic groups because they share
the same language, culture
or health problems. They are
charged with helping people
with chronic illnesses such as
diabetes stay out of the hospi-
tal. And preventing hospital-
izations saves money.
In Rhode Island, the states
Medicaid pays peer navigators
to help patients who frequent
emergency rooms, spending
up to 90 days meeting with
them and tracking their prog-
ress. They connect patients
with resources to manage
their disease, whether thats
electricity to keep insulin
chilled or transportation to a
doctors appointment.
LOCAL PROGRAMS
Today, only one commu-
nity health worker program
remains in Corpus Christi.
The regions biggest health
care provider, Christus Spohn
Health System, hired three
health workers with grant
money in 2004 after a report
found that many uninsured
and underinsured people
sought treatment for prevent-
able chronic diseases.
The system now employs 14
in hospitals and family clinics
throughout the region to con-
nect patients to primary care
and community resources,
such as cheaper medicines or
the Salvation Armys Foot Sav-
ers program, which provides
free pairs of diabetic shoes.
Spohns community health
worker program has earned
national attention. An unpub-
lished report by the U.S. Cen-
ters for Disease Control and
Prevention shows Spohn saw a
35 percent reduction in emer-
gency room visits among in-
digent patients between 2004
and 2006 (the system could
not immediately provide more
recent data).
The program also saved
money.
After health workers inter-
vened, the average per patient
cost dropped by more than
half, from $64,687 in 2009 to
$26,519 in 2011.
However Spohns program
lacks the stability and strength
of programs in Rhode Island
and Atlantic City. Those pro-
grams are covered in part by
insurance companies because
Medicaid requires it (like
Rhode Island) or because
insurers partnered with the
hospital to bring down costs.
Aside from some grant money,
Spohn gets no funding for its
community health workers.
(The CDC researchers
asked) Isnt anyone paying
you to do this? Chief Op-
erating Ofcer Estela Chapa
said. No. Weve taken this as
a responsibility. And they said,
What would you do if Med-
icaid funded it? Well, wed
welcome it, but we do under-
stand theres a reason we have
to do it: In order to help make
an impact.
For example, Spohn has a
program pairing primarily
uninsured and underinsured
patients who have been hos-
pitalized with a nurse and a
community health worker.
That care team follows pa-
tients for 18 months to make
sure they take their medica-
tions, go to appointments and
follow doctors orders to stay
in shape.
However, unlike Rhode
Island, community health
workers do not make home
visits, and they largely rely
on patients to call and check
in rather than mandating that
patients come in for regular
appointments with health
workers as AtlantiCare does.
If they are considered re-
ally high risk, well let them
know, You know, I want you
to call in weekly or every oth-
er day. Or just call in monthly
(if the patient is) doing really
well and his labwork is falling
into place and he has received
access to the shoes, the eye ex-
ams, the dentist, said Liza Es-
parza, who oversees Spohns
community health workers.
So we just try to keep them
on track and educate them on
how to access care.
Esparza said patients typi-
cally respond because they
want to be involved in their
health care. The hospital sys-
tem in 2011 followed up with
more than 1,300 patients after
they left the hospital.
Its not clear what the re-
gions other major hospital
system is doing. Corpus Chris-
ti Medical Center executives
declined to be interviewed.
Spokeswoman Lisa Rob-
ertson would not say who
declined the Caller-Times
request to talk to CEO Jay
Woodall, Chief Nursing Of-
cer Kathleen Rubano and
Chief Operating Ofcer Mi-
chael Roussos.
They did not return calls
seeking comment. The medi-
cal center, owned by the for-
profit national health care
company HCA, has one cer-
tied diabetes educator who
provides inpatient nutrition
counseling.
One other group in Corpus
Christi tried the community
health worker concept in re-
cent years, but despite its suc-
cess, the state cut the program
after two years.
The University of Texas
gram in Corpus Christi had
seven community health
workers, sometimes called
promotoras, who descended
on health fairs, community
centers, schools and churches
in Nueces Countys neediest
neighborhoods to nd and
help people with unchecked
diabetes.
They visited homes, gain-
ing unprecedented perspec-
tive on why some people with
diabetes struggled to keep
their diabetes in check. Sci-
entists believe social determi-
nants location, occupation,
income inuence health
as much as or more than the
quality of health care. Inside
patients homes, community
health workers unearthed
problems patients never
shared with their doctors.
The program reported
drops in patients blood sug-
ar, but the state chopped its
funding, a casualty of the 2011
Texas Legislatures across-
the-board health care cuts.
The Coastal Bends history
of diabetes may be marred by
disappointments and failures,
but thats not stopping some
from continuing to try to tack-
le an epidemic that shows no
signs of abating.
Ideas have been proposed
to make diabetes care in the
Coastal Bend look more like
Atlantic City, Rhode Island
and Amarillos eforts. Vari-
ous groups plan to hire more
community health workers
and expand preventive care.
Those plans await federal ap-
proval.
In the meantime, ofcials
at Spohn, the regions safety
net provider, say they will
continue to lean on commu-
nity groups to help them curb
complications.
We know, as Spohn, that
we cant be an all to every-
body, but that we can be a
leader in helping to make an
impact, Chapa said.
METHODS
from 23X
Patients Ada Boaz, left, and Eduviges Cortese embrace after receiving their certicates of completion for
their diabetes education class in a Rhode Island hospital, where they were taught how to manage their
blood sugars through diet and exercise.
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
PROVIDENCE, R.I.
Among Robert Medeiros long
list of problems homeless-
ness, drug addiction, mental
illness, illiteracy its easy
to see why diabetes wasnt
his priority.
Then he blacked out on the
street while carrying plastic
grocery sacks of canned goods
to his camp underneath Rhode
Islands Route 146 bridge.
When he awoke in the
hospital, doctors gave him an
A1C test measuring his three-
month blood sugar average.
His reading topped the me-
ters, forcing doctors to guess.
They estimated 17, more than
triple a normal reading of 5.
Medeiros case is among
the toughest for health care
and social workers.
His diabetes is intertwined
with mental illness, substance
abuse, illiteracy and homeless-
ness, all factors that, on their
own, often thwart eforts to
help diabetics.
To get healthy, Medeiros
needed not just medical care
but social help, too, as well
Education
wards of
disease
COST OF
DIABETES
Plan keeps Rhode Island ahead of Texas
See EDUCATION, 26X
Diabetes patient Robert Medeiros, who was once homeless and battling a drug addiction, has since graduated from Rhode Island Hospitals diabetes self-man-
agement program. He has been clean for two years and managing his disease. Medeiros now injects himself with insulin twice a day at his home in Providence,
Rhoad Island.
as intense intervention and
follow-up.
Against the odds, Me-
deiros today has an A1C of 7.5,
well-controlled Type 2 diabe-
tes by any standard.
And Im trying to get it
lower, he said.
Ask Medeiros how hes
done it, and hell point to one
woman: a sweet but no-non-
sense Dominican immigrant
named Lourdes Pichardo, 55,
who works for the state help-
ing people control their diabe-
tes. Pichardo represents some-
thing more going on in Rhode
Island, a personication of the
vast network of state-driven
initiatives dating back more
than three decades to tackle
Type 2 diabetes, even the most
complicated cases.
ined Rhode Islands eforts as
part of its yearlong series Cost
of Diabetes.
Initiatives in Rhode Island,
Atlantic City, N.J., and Ama-
rillo show that debilitating
complications can be prevent-
able when the health care sys-
tem and government take aim
at the disease. But similar ef-
forts have disappeared in the
Coastal Bend, where 1-in-6
people has diabetes and pa-
tients are more likely to sufer
complications such as lower
leg amputations and death.
Rhode Island shows what
happens when a state the size
of Nueces and San Patricio
counties combined takes ac-
tion against diabetes. Atlan-
tic City demonstrates eforts
driven by a hospital system,
and Amarillo ofers a look at
how an indigent care clinic
has worked to curb diabetes
and complications. The Call-
er-Times is publishing stories
this month exploring the three
initiatives.
SMALL STATE, BIG FIX
So what can the nations
smallest state teach the sec-
ond largest about diabetes
prevention?
A lot, it turns out.
The Rhode Island diabetes
prevention and management
program was one of the na-
tions rst federally funded
programs, established 35 years
ago.
In the years since, Rhode
Islands prevention and man-
agement system grew into one
of the most intricate in the na-
tion, expanding beyond state
initiatives to include private
practice doctors, insurance
companies and patients.
The states rate of diabetes
is lower than Texas, and its
complication rates are among
the lowest in the nation, in
some cases.
Rhode Island had the fth-
lowest rate of diabetes-related
deaths in the nation at 16.7 per
100,000 people in 2009, ac-
cording to the Kaiser Family
Foundation, a health policy
think tank.
Texas ranked 34th with a
death rate of 22.5 per 100,000,
while Nueces Countys rate
was 48, more than twice the
Texas average and nearly
three times Rhode Islands
rate. The county ranked the
third worst in Texas in 2009
behind Panola County in East
Texas and Maverick County,
home to Eagle Pass.
Theres no easy explana-
tion why Rhode Island per-
forms better than Texas when
it comes to diabetes rates and
complications. The disease
is inuenced by a variety of
factors, including genetics,
as well as access to healthy
food, safe places to exercise
and preventive care.
But Rhode Island does
boast an array of diabetes
management initiatives more
widespread and more robust
than whats happening in the
Coastal Bend. In some cases,
programs like those in Rhode
Island are absent altogether
from the Coastal Bend.
For example, self-manage-
ment and prevention classes,
long considered the gold stan-
dard for diabetes care, are
widespread in Rhode Island.
Here, they struggle to stay
aoat.
Most YMCAs in Rhode
Island ofer a 16-week nation-
ally recognized prevention
program, based on a ground-
breaking study that showed
modest lifestyle changes
drastically reduced the risk
of developing Type 2 diabetes.
In Texas there are only sev-
en recognized programs, with
the nearest in Weslaco, 160
miles south of Corpus Christi.
(The Texas A&M Health Sci-
ence Center recently piloted
a similar program in Corpus
Christi but has not yet sought
federal recognition.)
There, the state has trained
330 nurses, dietitians and
pharmacists as certied dia-
betes outpatient educators.
That works out to one for ev-
ery 224 Rhode Islanders with
diabetes.
Here, 11 certied educa-
tors work in Nueces and San
Patricio counties, according
to a national certication as-
sociation. Thats about one for
every 6,259 people with dia-
betes, although its difcult to
draw a direct comparison be-
cause Texas does not directly
train or track educators in the
same way Rhode Island does.
And while the Coastal
Bend relies on Christus Spohn
Health System, the regions
largest provider, to pay for
community health workers
to connect patients to care
a nationwide concept proven
to make sick people healthier
and save money Rhode Is-
land mandates Medicaid pay
for it statewide, giving the
state a solid safety net to catch
and treat the sickest people
with diabetes before they lose
a limb, go blind or die.
SALVATION
For Medeiros, it was too
late to save his toes, but not
too late to save the rest of his
leg. And maybe even his life.
EDUCATION
from 25X
See EDUCATION, 27X
Diabetes patient Robert Medeiros tests his blood sugar levels as
part of his daily routine developed during the Rhode Island Hospitals
diabetes self-management program.
Diabetes educator Lourdes Pichardo, center, leads a group of some 50 people for the kickoff of the 3rd an-
nual Walking with Lourdes event at Roger William Park in Providence, Rhode Island. The morning stroll,
which was announced on a local Latino radio station, is meant to raise awareness of the importance of a
healthy lifestyle, especially for those with diabetes and other chronic diseases. Lourdes hands out apples
to the group following the walk.
Gaunt with tattooed arms,
a raspy voice and graying goa-
tee, Medeiros spent years liv-
ing on the streets, self-medi-
cating with heroin, cocaine
and booze.
He ate at gas stations where
unhealthy options abound,
such as Rhode Islands famous
cofee milk, like chocolate
milk but made with cofee syr-
up, or a state delicacy called
hot wieners, thin hot dogs
tucked inside steamed buns
and topped with a ground beef
sauce, onions and celery salt.
Rhode Islanders often order
them up the arm, where the
chef loads up the buns lined
up along his forearm.
After Medeiros collapsed
in the street and awoke in the
emergency room with a diabe-
tes diagnosis 12 years ago, he
fell through the cracks. He left
the hospital with two weeks
of medicine but ran out and
never went back.
He cycled in and out of
hospitals and jails, sometimes
taking insulin and other times
not. At times, junkies raided
his campsite and stole his
needles. Other times, he ran
out and never relled his pre-
scription.
When he nally decided
to check himself into a drug
rehabilitation center, he gave
up insulin altogether until he
could get clean. The insulin
needles were just too famil-
iar, the temptation to shoot
heroin too strong. He had to
solve his drug problem before
his diabetes.
Persistently high blood
sugar levels wreak havoc on
the circulatory system and
hinder the immune systems
ability to ght back. So when
Medeiros blistered his foot
walking across the hot sand
on a rehab center beach trip,
the wounds never healed, in-
fection spread to the bone, and
last year, surgeons removed
all ve toes from his right foot.
Salvation for Medeiros
came in the form of a
EDUCATION
from 26X
Diabetes patient Robert Medeiros had his toes amputated because of an infection that was complicated by
his disease. See EDUCATION, 28X
361-857-2900
www.fpacorpuschristi.com
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FAMILYPRACTICEASSOCIATES
OF CORPUS CHRISTI
4-foot-10-inch spunky Do-
minican woman with cara-
mel-colored hair and copper
nail polish.
Lourdes Pichardo is a
household name in Rhode
Islands growing Dominican
community, the sixth largest
in the nation.
She lived in the United
States as a child but returned
to the Dominican Republic
to marry and have children.
When her daughter was di-
agnosed with leukemia and
doctors didnt think she would
live, Pichardo, desperate and
scared, ew the baby girl to
Boston, where shed heard
the pediatric oncologists were
among the best in the world.
Her daughter survived,
and Pichardo stayed, settling
in Rhode Island. She started
running a day care on Provi-
dences Broad Street, where
Dominican restaurants and
money transfer services serve
as the backdrop to the citys
annual Dominican parade.
Then she began to help
other immigrants, working
to improve access to health
care. Shes now a bilingual
peer navigator with Rhode
Islands Communities of Care
program, where she works to
help the chronically sick get
better preventive care.
The program works like
this: Medicaid patients who go
to the emergency room four or
more times per year are paired
with peer navigators paid for
by Medicaid.
These community health
workers reach out to the pa-
tients, visit them at home, try
to gure out why they keep
going to the emergency room,
and help them access resourc-
es they need, from housing to
transportation to doctor ap-
pointments.
The peer navigators also
continuously check in with
patients to make sure they are
seeing the doctor as needed
and taking their prescriptions,
to avoid unnecessary hospital-
izations.
The goal: cut down on Med-
icaid patients emergency
room use and save taxpayer
dollars that would have been
spent on those costly visits.
We were nervous people
wouldnt welcome us into
their homes, but no, they love
it, they really do, said Laura
Jones, director of the Rhode
Island Parent Information
Network, which oversees the
peer navigators.
The program isnt only for
people with Type 2 diabetes,
but data show that many peo-
ple in the program have the
disease.
Bacterial skin infections
ranked among the top rea-
sons people went to the ER in
Rhode Island, and people with
uncontrolled diabetes are par-
ticularly susceptible to these
infections because of their
weakened immune systems
and poor circulation.
WORKING TOGETHER
Ofcials at UnitedHealth-
care, which contracts with
Rhode Island Medicaid, say
theyve seen a 30 percent
decrease in ER use and have
possibly saved up to $600,000,
according to preliminary re-
sults. And those results are
prompting people to look at
the program as a model, said
Dr. Rene Rulin, medical direc-
tor of Rhode Island Medicaid
at UnitedHealthcare.
I think everybody thought
it was interesting, but as soon
as we have results that say we
reduced ER use by 30 percent
for a small cohort, now people
are looking, she said.
Rulin said shes not sure
UnitedHealthcare would
have decided on its own to do
the program had the state not
mandated it.
I think, sometimes, people
have to be forced to play to-
gether, she said.
And the results for peo-
ple with diabetes have been
mixed.
Among UnitedHealthcares
Medicaid patients with diabe-
tes, more are screened for po-
tentially disabling long-term
complications such as blind-
ness and amputations, but
blood-sugar levels also went up.
Thats frustrating, Rulin
said, but also possibly a sign
of just how difcult diabetes
management can be, espe-
cially for a population that
struggles with so many other
challenges: mental illness,
substance abuse, poverty.
Thats why Medeiros story
is so important, and why Pich-
ardo invited him recently to
come speak to a diabetes class
she teaches at Rhode Island
Hospital.
She opened the class by re-
vealing that she, too, has Type
2 diabetes, and how devastat-
ing that diagnosis was, despite
her work helping others with
the disease.
Pichardo, who has a family
history of diabetes, was diag-
nosed in 2006. The diagnosis
was especially hard because
she already had made changes
to her diet to try to prevent the
disease, including swapping
sugar for sugar substitute. But
getting diagnosed also helped
her better relate to the people
she helps. It helped her un-
derstand how people have to
deal, in their own ways, with
diabetes.
I cried and cried, when
she received the diagnosis, she
told the group.
Then she turned to Me-
deiros. Sitting at the edge of a
semicircle in a hospital confer-
ence room lined with shelves
of medical books, Medeiros
introduced himself to the half-
dozen others gathered.
In a short, off-the-cuff
speech, Medeiros choked up
as he talked about his history
with diabetes, the loss of his
toes last year, how he met
Pichardo, and how she con-
vinced him to enroll in a free
diabetes class.
How he took two classes at
one time a state one and a
hospital one because he was
so anxious to get better.
Even though Medeiros cant
read or write, he learned how
to choose healthy foods with
the help of a book lled with
pictures of foods labeled with
a thumbs-up or thumbs-down.
He now needs about half as
much insulin as he used to.
Youve got to be really
dedicated on reading labels
and understanding what
youre going to eat and put
in your body, he said. Stick
with it, and itll help you. It
will. Itll keep you healthier.
His ability to manage this
disease gave him a newfound
sense of pride.
At his new apartment he
shares with his son, he has tak-
en his diabetes diploma the
certicate of completion from
the class and wedged it in the
seam of his bedroom mirror.
Hanging on the mirror is a
lanyard with a paper badge and
his name typed in all caps, a
souvenir from his speaking en-
gagements at diabetes classes.
Im feeling positive about
myself, thats for sure, Me-
deiros said.
EDUCATION
from 27X

Youve got to be really
dedicated on reading labels and
understanding what youre going to
eat and put in your body. Stick with it,
and itll help you.
Robert Medeiros, diabetes patient
Diabetes patient Robert Medeiros, who lost his toes to an infection, graduated from Rhode Island Hospitals
diabetes self-management program. Medeiros proudly exhibits his certicate of completion from the class in
his room.
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
ATLANTIC CITY, N.J. Yogendra
Patel is the kind of patient some doc-
tors call noncompliant.
Even after Patel, 56, was diagnosed
with Type 2 diabetes in 2007, he
didnt change his habits. He smoked
and chewed tobacco. He ate what he
wanted. He spent his days on the couch
in front of the television, packing on
pounds.
By the time he showed up at Atlan-
tiCares Special Care Center, his blood
sugar was considered uncontrolled.
While some providers may have dis-
missed Patel for failing to take care of
himself, Atlantic Citys only hospital
system saw potential to make him bet-
ter and save money at the same time.
For six years, AtlantiCare, the re-
gions largest health care provider and
the citys largest noncasino employer,
has been working to tackle diabetes,
starting with the sickest patients, like
Patel.
In 2007, facing rising health care
costs, AtlantiCare opened the Special
Care Center, an invitation-only special
clinic aimed at helping the chroni-
cally sick by pairing them with health
coaches and ofering them free medi-
cines and ofce visits. A second clinic
opened in nearby Galloway in 2011.
The clinics have treated 2,600
patients, including many with un-
controlled diabetes, and produced
stunning results: Reductions in blood
sugar levels, a 40-45 percent decline in
hospitalizations and emergency room
visits and a virtual elimination of com-
plications.
With Type 2 diabetes, the body
becomes unable to efectively use its
own insulin. Glucose builds up in the
blood and causes a condition that, if
not controlled, wreaks havoc on the
bodys circulation system, nerves and
organs. Yet blindness, kidney failure
and amputations expensive and
debilitating complications are pre-
ventable when people with diabetes
Prescription:
Motivation
Virgen Ramos, medical
assistant, right, talks
about one of her clients
with Medical Director
Dr. Ines Digenio, MD,
at the morning meet-
ing at AtlantiCare, in
Atlantic City, N.J. At
a care center there,
health coaches team
with chronically ill
patients to help them
manage their disease.
The hospital also oper-
ates diabetes outpa-
tient self-management
classes.
COST OF
DIABETES
N.J.s hands-on system
See MOTIVATION, 30X
DAVID GARD/SPECIAL TO THE CALLER-TIMES
Atlantic City
sees success in
team approach
manage their disease and con-
trol their blood sugar through
small steps: a little exercise,
smart eating and stress man-
agement.
Over the six years, weve
only had one toe amputation in
all of our patient population,
said Sandra Festa, administra-
tive director. I used to be able
to say we had no lower limb
extremity (amputations), but
we had a toe amputation.
The results were so good, At-
lantiCare has started to export
the model to its primary care
and family practice doctors.
It works, said Meaghan
Kim, AtlantiCares diabetes
educator.
ined AtlantiCares eforts as
part of its yearlong series,
Cost of Diabetes.
Atlantic City and Amarillo
show that debilitating com-
plications can be preventable
when the health care system
and government take aim at
the disease. But similar ef-
Coastal Bend, where one in
six people has diabetes and
patients sufer complications
such as lower leg amputations
and death at higher rates than
the state and national average.
Atlantic City demonstrates
how a hospital system rough-
ly the same size as Christus
Spohn can help prevent dia-
betes complications while sav-
ing money.
Spohn employs 14 com-
munity health workers in
hospitals and family clinics
throughout the region to con-
nect patients to primary care
and community resources,
such as cheaper medicines or
the Salvation Armys Foot Sav-
ers program, which provides
free pairs of diabetic shoes.
AtlantiCare connects every
Special Care Center patient
with a personal health coach
who has continuous contact
with patients, meeting them
as often as weekly to check
their progress and making
themselves available 24/7 to
their patients. The centers
nine health coaches also meet
daily in a morning huddle to
discuss their patients status.
The hospital system has ex-
panded the team approach to
care to 29 primary care prac-
tices in the region, reaching
patients in far less serious con-
dition and catching them at an
earlier stage in their diabetes.
REINFORCEMENT
In AtlantiCares Special
Care Clinic in downtown At-
lantic City, Patel, in a plaid
shirt and jeans, sat on the
exam table as his health coach
Jayshree Patel (no relation)
pulled up a spreadsheet on a
computer screen showing a
detailed history of his up-and-
down battle with diabetes.
She pointed to the top num-
ber on the screen: 11.6. That
was Yogendras A1C when he
rst came to the clinic in De-
cember 2008. The A1C mea-
sures blood sugar over three
months. A person without
diabetes has an A1C around
5; Yogendras was more than
double normal levels.
Declining health care re-
imbursements means doctors
can typically spend no more
than 15 minutes with patients,
leaving them little time to re-
ally talk to patients about the
barriers keeping them from
getting better.
As a health coach, Jay-
shrees sole job is to meet with
patients, as often as weekly in
Patels case, to reinforce plans
to eat right, exercise, take
their medications and moni-
tor their blood sugar.
AltantiCares Special Care
Center ips the health care
model on its head.
Traditionally, doctors
oversaw patients care, while
nurses, assistants and patients
were expected to follow doc-
tors orders.
At the AtlantiCare clinic,
health coaches who dont have
college degrees one was a
manager at McDonalds be-
fore AtlantiCare work most
closely with patients.
Health coaches earn the
same wages as a medical
assistant, a national average of
$14 per hour, according to the
U.S. Department of Labors
Bureau of Labor Statistics.
And they cant give medical
advice or prescribe medicine.
But they can help patients
overcome basic barriers to
care transportation, lan-
guage, understanding instruc-
tions and they help rein-
force doctors orders while
also gleaning information that
could help doctors ofer better,
more individualized care.
Talking to Yogendra in
his native language, Jayshree
found he was profoundly de-
pressed, an important discov-
ery because Type 2 diabetes
and depression often are
linked, studies have shown.
When Yogendra moved
from India to Atlantic City
in 1996, his skills and train-
ing didnt translate, he didnt
speak English and he couldnt
nd a job, leaving him to rely
upon his wife, who worked full
time to take care of their fam-
ily of ve. With one income,
the family struggled to aford
doctors appointments and
medicines, Jayshree found,
another factor afecting his
ability to control the disease.
I cant aford medicine,
Yogendras wife, Ameeta,
50, said. Every month, I was
spending maybe $50 to $60 on
medicines for him. I come in
here and everythings free.
Jayshree, also a native of In-
dia, knew it was pointless to
talk to Yogendra about food.
To change his eating habits,
she needed to reach Ameeta.
In the Indian community,
the wife always cooks, Jay-
shree said with a smile.
Ameeta joined her husband
at his health coach appoint-
ments and talked to Jayshree.
She changed what she served,
sometimes to her husbands
annoyance.
Jayshree knew she couldnt
give them the same message
she gives her American pa-
tients: Cut out carbohydrates
and read nutritional labels.
Thats because Indians
typically eat home-cooked
vegetarian meals heavy on
carbohydrates like rice and
MOTIVATION
from 29X
See MOTIVATION, 31X
Pharmacy Tech Kisha Jerkins helps a client at the in-house pharmacy. AtlantiCare, in Atlantic City, New
Jersey, operates a Special Care Center, which hopes to stem the diabetes epidemic.
roti, a traditional Indian at-
bread. Teaching Yogendra and
Ameeta to read labels would
be a waste of time because
they eat fresh, home-cooked
meals, not processed food.
Asking them to give up carbs
would be telling them to give
up their culture.
So I start explaining that
roti and rice both have car-
bohydrates, Jayshree said.
And I cannot say, Stop eat-
ing that, because they will say,
Then how can I survive? So
slowly, I start explaining cut-
ting back on carbs rst. If you
eat roti, dont eat rice. If you
eat rice, dont eat roti.
Today, Yogendra is health-
ier than he was ve years ago.
His A1C dropped from a
high of 11.6 to its lowest of 5.7,
a level considered prediabet-
ic. (His A1C recently spiked
again after a trip to India, but
Jayshree had prepared for
that, too. Trips to India bring
invites from relatives eager to
ply visitors with big meals and
sweets. So hes eating a party
dinner every night, she said.)
He stopped chewing to-
bacco and is slowly giving up
smoking, thanks to smoking
cessation programs encour-
aged by his health coach. He
works out daily on an exercise
machine. Even though he cant
go for long, he hufs and pufs
on the machine for one or two
minutes, takes a break, then
starts again, Ameeta said.
He takes his pills as pre-
scribed because he can get
them for free, and Ameeta,
who earns a living cleaning
casinos, doesnt have to worry
about how to aford her hus-
bands medicines while he
continues searching for a job.
Yogendra has been doing so
well, Jayshree has been able to
scale back her meetings with
him from weekly to monthly.
CONSTANT CONTACT
Success stories like Yogen-
dras no longer surprise any-
one at the Special Care Center.
MOTIVATION
from 30X
See MOTIVATION, 32X
Cardiologist Dr. Shetty, right, speaks with client Ghanshyam Mistry, 62, in Atlantic City, where AtlantiCare
takes special efforts to tackle the issues surrounding diabetes.
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TOWN & COUNTRY
C A F E
4228 S. Alameda
(361) 992-0360
DIABETES DATA
Atlantic Nueces
County, N.J. County
Diabetes 8.8 percent 9.8 percent
diagnosis, 2009
Leg amputations
per 1,000
Medicare 1.33 2.66
enrollees,
2003-07
Obese adults, 28 percent 30.2 percent
2009
Physical 24.6 percent 23.7 percent
inactivity, 2009
Source: U.S. Centers for Disease Control and Prevention, Dartmouth Atlas
Medical assistant Virgen Ramos takes a blood pressure reading from client Roberto Rodriguez, 58, of
Atlantic City.
Although the typical pa-
tient has diabetes for three to
ve years before they appear
in the clinic, they are able to
drop their A1Cs by 2.6 points,
on average, within six months,
Festa, the administrative di-
rector, said.
Among the clinics 940 pa-
tients with Type 2 diabetes, six
are on dialysis, she said.
We would like to have no
one on dialysis, but sometimes
we get them too late to inter-
vene, she said. But we dont
give up.
The clinics successes
have much to do with health
coaches connecting with their
patients, said Steven Blum-
berg, senior vice president of
AtlantiCare Health Solutions,
the systems accountable care
organization.
They really are in constant
contact with the patient, he
said. That builds a relation-
ship and a rapport, and really,
the patients do feel compelled
to be compliant. Because they
know the person they are in a
health care relationship with
is watching out for them, and
they dont want to disappoint.
The practice has worked so
well, AtlantiCare has expand-
ed it to primary care practic-
es, 29 in total, now accredited
as patient centered medical
homes, a designation applied to
clinics providing more holistic
approaches to care.
At those ofces, medical as-
sistants prep the patients by
screening them, including do-
ing foot exams, before hand-
ing them of to the doctor,
diabetes educator Kim said.
The doctor treats them, then
refers them to a certied in-
ofce diabetes educator who
checks their blood sugar logs,
tweaks medicines and encour-
ages exercise and healthy eat-
ing.
About 95 percent of dia-
betes care is self-care, Kim
said. So if a patient doesnt
have the knowledge and skills
to be able to self-manage their
diabetes, thats when compli-
cations and hospitalizations
and other things ensue.
Perhaps most surprising,
doctors often ask the diabetes
educators for their recommen-
dations.
The team approach is re-
ally embraced here, she said.
And thats important be-
cause all people who struggle
to lose weight, eat healthier
and exercise, not just those
with diabetes, do better with
reinforcement and education,
Kim said.
I know as adults we try
things and then we kind of
do it for a while and then we
fall of, she said. So the con-
stant reinforcement to keep
patients as healthy as possible
is important. And the lifestyle
changes that are required for
diabetes (management), well
it really does need a village.
MOTIVATION
from 31X
Staff engaged
to point they
shop with client
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
When it comes to diabetes
care, treatment doesnt get
more personalized than this.
On a recent weekday, Joe
Lozada pulled a plastic sand-
wich bag from the pocket of
his faded sweatshirt and hand-
ed it over for inspection.
What do you think? he
asked diabetes educator Cindy
Ellis.
Ellis studied the three sug-
ar-free candies inside. Three
weeks into his diabetes diag-
nosis, Lozada, 61, is learning
how to eat healthy, and Ellis
is his guide.
Her verdict?
Its OK to eat sugar-free
candy but not too much, be-
cause they can still raise blood
sugar, she said.
Shes even gone with him to
the grocery store for a lesson
on how to read food labels.
Its an extraordinary strat-
egy in todays world of 15-min-
ute doctor visits, but thats
how Amarillos J.O. Wyatt
Clinic ghts diabetes: one bag
of candy at a time.
ined the clinics eforts as part
of its yearlong series Cost of
Diabetes.
Atlantic City and Amarillo
show that debilitating com-
plications can be prevented
when the health care system
and government take aim at
the disease. But similar ef-
Coastal Bend, where patients
sufer complications such as
lower leg amputations and
death at higher rates than the
state and national averages.
In 2004, medical director
Dr. Nam Lee transformed the
J.O. Wyatt Clinic into a one-
stop-shop where people with
diabetes could access every-
thing they need under one roof
and, at times, in the same visit.
Nine years after he con-
vinced the hospital to invest
in the indigent care clinic on
the poor side of windswept
Amarillo, patients are seeing
results.
Clinic gets
personal
with patients
DAVID BOWSER/SPECIAL TO THE CALLER-TIMES
Cindy Ellis cuts toenails of patient Wayne Gordon at J.O. Wyatt Clinic in Amarillo.
COST OF
DIABETES
Published May 12, 2013
See PERSONAL, 34X
By controlling diabetes,
patients reduced their risk
for complications and saved
taxpayers who pick up the bill
for indigent care. Last sum-
mer, clinic ofcials traveled
to Austin at the invitation of
the Texas Diabetes Council to
show their successes.
We just do it, said Dr. Ar-
lene Hudson, who treats HIV
patients at the clinic. We
dont make excuses. We dont
say we cant aford it.
Rhode Island demonstrated
how a state the size of Nuec-
es and San Patricio counties
took action against diabetes,
while Atlantic City provided
perspective on eforts driven
by a hospital system.
Amarillo demonstrates
how a clinic can manage dia-
betes even among the poor
and chronically sick.
No such clinic exists in
Nueces or San Patricio coun-
ties, where one in six people
has been diagnosed with the
disease, the state estimates.
Nueces County patients who
cant aford health care are
treated at Christus Spohn
Hospital Memorial. Christus
Spohn gets reimbursed in part
by the taxpayer-funded Nuec-
es County Hospital District.
Memorial hosts an indigent
diabetes clinic once a month,
from 2:30-5 p.m. Fridays,
where patients who qualify
for taxpayer-funded Nueces
Aid can see a specialist for
free. Still, many often fail to
show up.
At the January clinic, 12
were scheduled for appoint-
ments.
Two came.
FIXING THE CLINIC
The Wyatt Clinic wasnt
always such a success story.
When Dr. Lee took over as
medical director in 2003, the
staf was skeptical he could x
a clinic saddled with the same
problems as other indigent
care clinics.
They had seen medical
directors come and go while
the clinic remained in disar-
ray, hemorrhaging cash treat-
ing difcult and complicated
patients while health care
costs continued to skyrocket.
Among his first items
of business, Lee gathered
the staf for a meeting. He
promised he wouldnt lay
of employees and told them
he wanted to retire in Ama-
rillo, so his tenure at the Wy-
att Clinic would be his last
in health care. Yeah, weve
heard that, someone said.
Then, for the rst three
months, he sat back and ob-
served.
He followed patients from
check-in to doctor appoint-
ment to the in-house pharma-
cy, jotting down how long they
spent waiting. They spent
more than half of a workday
on average, he noted. Thats
troublesome for patients with
low-wage hourly jobs that
dont pay for time spent at the
doctor.
The unwieldy pharmacy
lines clogging clinic hallways
annoyed him. Calls to the
clinics main phone line nev-
er got answered. He watched
the stafs never-ending search
for patients medical records
that were printed on paper
and tucked into thick binders
they wheeled around on gro-
cery carts.
Slender and silver-haired,
Lee is intelligent and analyti-
cal.
They say no one has read
the Afordable Care Act? He
has, Brian Gibbs, clinic ad-
ministrator, said. The whole
1,000 pages of it.
Hes also a problem solver.
Lee laid the foundation of
his medical career building
a private practice an hours
drive northeast of Amarillo
in Pampa. A native of South
Korea, Lee had long been
bothered by the chaotic nature
of the American health care
system, which seemed to him
disorganized, fragmented and
inefcient.
As medical director at the
clinic, Lee had the opportuni-
ty to experiment with his own
system for treating patients.
He devised a plan to trans-
form the clinic into a stream-
lined clinic with practitioners
working as a team to efcient-
ly treat the clinics chronically
sick patients and with respect.
Lees proposal foreshad-
owed federal health care re-
form, which came six years
later. Such models, called
patient-centered medical
homes, are being tested by the
Afordable Care Act and may
someday be the standard for
primary care providers.
The idea: Invest heavily in
preventive care, get patients
healthy, keep them out of the
hospital and emergency room,
and reap the savings later on.
TEAM APPROACH
The clinic is owned and
operated by Northwest Texas
Healthcare System, which
treats the citys indigent, typ-
ically the working poor who
dont have insurance but who
earn too much to qualify for
government programs.
Lee pitched his idea to hos-
pital management. He asked
them to change their mind-
set about the Wyatt Clinic, to
think of it as an asset, rather
than a liability.
Then he asked for a blank
check to fund staf and re-
sources necessary for trans-
formation.
Hospital management
balked, he said. Where was
the guarantee that their in-
vestment in Wyatt would pay
of in savings down the road?
He asked for them to take
a leap of faith, knowing his
job was on the line, but also
knowing he had a thriving pri-
vate practice to fall back on in
Pampa if the Wyatt gig didnt
work out.
Hospital management
agreed to give it a try.
Lee aimed to create a clinic
free of bureaucratic red tape,
where staf members worked
shoulder to shoulder and pro-
vided treatment that made
it easier for patients to get
healthy. No more long lines
or waiting for hours. Lee got
rid of what he saw as barriers
to care.
Cindy Ellis discusses what a diabetic should eat with patient Joe Lozada at J.O. Wyatt Clinic in Amarillo.
PERSONAL
from 33X
See PERSONAL, 35X
Now, doctors call Ellis, the
diabetes educator, into their
ofces during an exam to talk
to their patients. Patients such
as Lozada swing by Ellis ofce
to chat with her about diet, ex-
ercise and insulin.
The clinic hired three peo-
ple whose sole job is to work
with pharmaceutical compa-
nies to get free or low-cost
medicines through their pre-
scription assistance programs,
which ofer such medications
to needy people. The clinics
medication assistance pro-
gram has paid for itself. In one
year it snagged $4 million in
drugs.
Lab work is done in-house.
So are foot and eye screenings.
Bleeding in the eyes can be
a telltale sign of circulatory
problems hidden deep within
veins that could lead to stroke
and heart attacks, so Wyatt
Clinic stafers dilate and ex-
amine patients eyes at least
once per year.
To prevent infection that
leads to costly amputations,
nurses regularly check pa-
tients feet for sores and trim
toenails coarsened by a fun-
gus common among people
with uncontrolled diabetes.
Its a delicate procedure
improper trimming can cause
sores and lead to infections.
Wyatts nurses have been spe-
cially trained. When sores are
discovered, patients get anti-
biotics or a trip to wound care
to halt the infection before it
spreads.
Lee could not provide an
exact gure on how much the
hospital invested in the Wy-
att Clinics transformation,
saying it would be difcult to
quantify.
But the investment is sig-
nicant, including the imple-
mentation of electronic medi-
cal records, making Wyatt one
of the rst practices in Ama-
rillo to do so, Lee said. The
clinic is able to mine its data
for trends: diagnoses, average
blood sugar levels, how often
eyes get checked.
We can do a great job,
but if we cant quantify it, it
doesnt matter, said Gibbs,
clinic administrator.
SEEING RESULTS
The clinic has documented
case after case of diabetics
who have reversed eye dis-
eases, feats some health care
providers didnt think was
possible.
Well, were seeing it, El-
lis said.
About one in ve of the Wy-
att Clinics 5,400 patients have
diabetes.
In 2010, 59 percent had
well-controlled blood sugar
versus 35 percent of Medic-
aid patients and 43 percent of
insured people nationwide,
according to the clinics data.
In Type 2 diabetes, the
body becomes unable to ef-
fectively use its own insulin. If
uncontrolled, sugar builds up
in the blood and wreaks havoc
on the bodys circulation sys-
tem, nerves and organs. Yet
blindness, kidney failure and
amputations are preventable
through small steps: a little ex-
ercise, smart eating and stress
management.
By managing diabetes in-
house, the clinic has drasti-
cally decreased emergency
room visits, saving millions of
dollars. Among more than 200
Texas cities, Amarillo had the
lowest below-the-knee ampu-
tation rate in the state among
Medicare enrollees from the
2003-07, according to the
Dartmouth Atlas of Health
Care.
Corpus Christi had the
sixth highest rate among more
than 3,400 cities nationwide.
By giving patients access
to everything they need, they
have no excuses to stay sick,
said Latoya Thomas, a Wyatt
nurse practitioner.
The barriers just arent
there, she said.
Wayne Gordon, 77, has
lived with Type 1 diabetes for
so long, he can remember a
time when he had to boil in-
sulin syringes made of glass.
Yet it wasnt until he lost
his job and landed at the Wy-
att Clinic that he started to get
a good grasp on his disease.
The doctors never got through
to him, he said.
But Ellis did.
She helped him understand
how to count carbohydrates,
and why his morning glass
of orange juice, packed with
sugar, could be dangerous.
Ive always had a doctor,
but to a doctor, Im not even a
paycheck, Gordon said. Im
just one of a number. Im pa-
tient No. 3 of the day.
MUTUAL COMMITMENT
As the Wyatt Clinic invests
in making its patients healthy,
it also expects a commitment
from them.
Patients are required to
take an orientation class
where they learn the impor-
tance of keeping appoint-
ments, following doctors or-
ders, taking their medicines
as prescribed and avoiding
the emergency room for mat-
ters they could address with
their doctors. Because the
clinic lays out the rules early,
patients are expected to fol-
low them.
Noncompliant patients get
sent to Jolene Barreras the
principals ofce, the staf
jokes where she tries to
pry out the messy details of
their lives: No car to get to
appointments. No money to
pay for meds. No electricity to
keep insulin cold. Whatever
the obstacle, the clinics so-
cial workers try to overcome
it by connecting them with
resources such as bus passes
or bill pay assistance.
If noncompliant patients
still refuse to follow orders,
the clinic drops them. Its a
last resort and rarely used
after all, Wyatt patients are
there because they cant aford
health care anywhere else
but its necessary to prove a
point.
They need to take some
sort of responsibility, Gibbs
said. Were opening up a slot
for someone that is apprecia-
tive of their health care.
ROOT OF THE PROBLEM
Sometimes all it takes is a
little information to get pa-
tients to take responsibility.
Three weeks ago, Lozada
entered the clinic complaining
of a possible hernia. Dr. Ricar-
do Carrizo knew his diagnosis
before he even treated him.
Carrizo watched Lozada leave
the exam room ve times to
use the restroom while Car-
rizo saw other patients. Fre-
quent urination is a common
symptom of diabetes.
Lozadas blood sugar levels
were so high, Carrizo skipped
the pills and went straight to
insulin. Then he paired Lo-
zada with Ellis so they could
have a frank discussion.
Talking to Lozada, Ellis
discovered the root of the
problem: Energy drinks and
soda. Feeling fatigued, likely
from diabetes, Lozada tried
to combat his sleepiness with
high-sugar energy drinks,
which only made things
worse.
I never expected Cokes to
make you sick, Lozada said.
He quit drinking them.
That weekend, at home by
himself, he realized he was too
afraid to stick himself with the
needle. He returned to the
Wyatt Clinic and confessed
that he hadnt used the insu-
lin. They tested his blood. His
sugar levels had drastically
dropped anyway. Giving up
sodas and energy drinks made
a big enough diference that
Lozada no longer needed in-
sulin, only pills.
On a recent weekday, he
returned to Ellis ofce with
his glucometer, a device that
measures blood sugar. She
plugged it into her computer
and downloaded several days
of test results.
What do you think? he
asked nervously. Not too
good?
Scanning the numbers on
the screen, Ellis broke into a
wide smile.
These are wonderful!
Wonderful! she said.
Cindy Ellis cuts toenails of patient Wayne Gordon at J.O. Wyatt Clinic in Amarillo.
PERSONAL
from 34X
Illness
manageable,
easy to ignore
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Winter sunlight streamed
into the third oor ICU where
Mike Reyes lay unconscious
in a shapeless hospital gown,
his shaved head facing the
window. His wife, Danita,
stood at his feet, monitoring
him for signs of hope.
Mikes legs stifened and
relaxed involuntarily like he
was trapped in a dream, ght-
ing to wake up. Every three
seconds, a ventilator pushed
air into his lungs. Bubbles
of saliva foamed where his
mouth met the tube.
Doctors said Mike would
never talk again because the
stroke happened in his left
frontal lobe, the section of
the brain controlling speech.
But they also said he could be
paralyzed on the right side,
and he seemed to be proving
them wrong; his right arm and
leg moved, dreamlike and re-
exive, along the surface of
the hospital bed.
Danita clung to hope, re-
membering what shed heard
his doctor say. Because Mike
was so young only 38 he
may have an easier recovery
than other stroke patients who
tend to be older, more fragile.
It was January and the lat-
est complication for Mike in
his 15-year saga with Type 2
diabetes. He had gone blind,
his toes had been amputated
and his kidneys failed. Danita
and Mikes teenage daughter
and 10-year-old twins couldnt
remember a time when their
dad was healthy. He hadnt
been able to work in eight
years. Danita did everything
it seemed: raising their kids,
taking care of Mike and work-
ing full-time to support them.
She felt like a single mom.
Now this? She wasnt sure
what more she could handle.
Watching Mike ght against
the sedation, she prayed the
doctors were wrong about the
paralysis.
In a region where diabetes
complications are too com-
mon, the Reyes family ofers
a stark but familiar portrait
about the consequences of a
disease too few take seriously.
In Nueces and San Patricio
counties, one in six people
disease that can lead to am-
putations, blindness, kidney
failure and death if left un-
checked for too long. Compli-
cations are preventable with
smart eating, a little exercise
and stress management. Still,
people in the Coastal Bend
continue to lose limbs and die
at rates higher than the state
and nation.
SILENT DISEASE
Type 2 diabetes can be an
insidious disease, with symp-
toms like fatigue, slow-healing
sores, increased thirst and
Let me tell you about my husband
Diagnosed at 23; dead by age 38
COST OF
DIABETES
Published May 19, 2013
Danita Reyes sits
on the bed where
she keeps her me-
morial blanket for
her husband, Mike
Reyes, at her home
in Corpus Christi.
Mike Reyes died of
a stroke after years
of complications
from diabetes.
See REYES, 37X
MICHAEL ZAMORA/CALLER-TIMES
counties, one in six people
disease that can lead to am-
putations, blindness, kidney
failure and death if left un-
checked for too long. Compli-
cations are preventable with
smart eating, a little exercise
and stress management. Still,
people in the Coastal Bend
continue to lose limbs and die
at rates higher than the state
and nation.
SILENT DISEASE
Type 2 diabetes can be an
insidious disease, with symp-
toms like fatigue, slow-healing
sores, increased thirst and
urination appearing so slow-
ly, people often fail to notice
them for years.
In Type 2, the body be-
comes resistant to its own
insulin, a hormone secreted
from the pancreas that allows
cells to use sugar in blood for
energy. Sugar builds in the
bloodstream, damaging the
walls of blood vessels, which
can lead to nerve damage and
blindness. Diabetes dam-
ages the delicate system in
the kidneys that lters waste,
leading to kidney failure. It
also speeds the hardening of
arteries, raising the risk for
heart disease and stroke.
People with diabetes are
two to four times more likely
to die from a heart attack than
people without the disease.
Nearly 700 people in
Nueces County died between
2006 and 2010 from diabetic
complications, including
two people in their mid- to
late-20s. The county has the
states third highest diabetic
death rate.
And those numbers likely
dont tell the whole story. Di-
abetes is underreported as a
cause of death. As few as 35
percent of people with diabe-
tes who died had the disease
listed anywhere on their death
certicates, according to the
state.
Mike was diagnosed at 23
but likely had diabetes long
before. He was the youngest
in a family where everyone
has diabetes both parents,
his brother and sister.
His mother saw the symp-
toms in her son. He was
thirsty all the time, a classic
sign. But he was in denial. His
mom urged him to see a doc-
tor and when he nally did, he
left with a diagnosis and a pre-
scription, although, to Mike,
that didnt seem like a big deal.
It was like fate for Mike, born
with Type 2 diabetes written
into his genetic code.
Danita met Mike a year be-
fore he was diagnosed. They
were both 22 and studying at
Del Mar College. She thought
he was cute. He asked if she
wanted to have a drink af-
ter class. They bonded over
their commonalities: both
the babies in their families
and painfully shy. They mar-
ried in September 1998. Their
daughter, Samantha, was born
seven months later.
MISSED WAKE-UP CALL
Its hard to say exactly why
Mike never took the disease
seriously. His excuses so
closely mirror those of oth-
ers who failed to rein in their
blood sugar before permanent
damage begins.
He took a diabetes class
where he was taught the im-
portance of eating right, ex-
ercising and taking care of
himself education thats
considered a gold standard in
diabetes care.
But he didnt have health
insurance and wasnt consis-
tent about taking pills. He took
them at the wrong time or for-
got to take them altogether. He
didnt test his blood sugar. He
couldnt nd time to exercise.
He thought he could live the
same way as before and eat
whatever he wanted.
I didnt know at the time
how serious it really was,
Danita said. Even though my
mother was a diabetic and his
mother was a diabetic, I didnt
realize how serious it was.
If Mike had a wake-up call,
it was his mothers death in
2000. She had a sudden heart
attack, a leading killer of peo-
ple with diabetes.
But instead of motivating
Mike to change, his mothers
death crushed him, sapping
away any strength he had to
get healthy.
By the time his twins turned
2, Mike was going blind. He
could see only shadows and
silhouettes. Diabetes damages
tiny blood vessels, called cap-
illaries, causing them to rup-
ture and leak. A doctor discov-
ered bleeding in his eyes.
Mike had a series of laser
surgeries to save his vision.
The procedures did little but
prolong the inevitable.
He woke up one morning to
nd the world had gone dark.
Doctors replaced Mikes left
eye with a prosthetic.
He was 30.
STRAINING THE FAMILY
Unable to work anymore,
Mike applied for disability
while Danita, who had been
staying home with the twins,
went on the hunt for a job with
health insurance.
It completely changed our
lives, Danita said. We had
to learn how to live with him
being blind. It was very, very
difcult and it took a very long
time for us to adjust.
He learned to use a cane
and how to read Braille. But
he couldnt get into a more in-
tensive program at the Texas
School for the Blind and Vi-
sually Impaired in Austin be-
cause his blood sugar was still
out of control, Danita said.
Danita tried to help him re-
main independent. She used
puf paint to leave raised dots
on the microwave buttons so
he could heat his own lunch-
es while she was at work. She
urged him to take his medicine.
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from 36X
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She cooked healthy meals. But,
even without his eyesight, he
would still nd the sweets she
bought for the kids.
Dad, youre not supposed
to eat that, they would tell
him. They started hiding their
candy.
How come Daddy has to
be blind? 10-year-old Sophie
asked her mother.
Because he ate too many
bad things, Danita said.
The years that followed
were a relentless march of
new complications, each one
more severe than the next, lin-
ing up like chapters in a medi-
cal textbook.
First the boils, popping up
under Mikes arm and on his
buttocks. He went back and
forth to hospitals to get sur-
gery to drain the abscesses,
sometimes staying for two to
three days under observation.
They would tell him, You
have to eat right. What foods
to avoid, to get exercise,
Danita said. He would nod
and say, Yes, I understand. I
understand. But he never did
what he was supposed to.
Then he was hospitalized
to drain a pimple on his cheek
that didnt heal and a doctor
discovered that Mikes kid-
ney function was less than 5
percent. He needed dialysis,
a procedure to remove waste
from blood after the kidneys
no longer properly work.
I lost it, Danita said. I
was really upset I remember
him saying, Why are you so
upset? Its not like Im dying.
And I stopped crying. And I
was like, If thats how you feel
about it, OK. I learned to ac-
cept the lifestyle hes chosen
for himself and all I can do is
take care of him because he
doesnt have anyone else to
take care of him.
After Mike started dialysis,
the recurring sores stopped,
but then he began to complain
about pain in his foot. Unable
to see, he asked Danita to take
a look. She removed his sock
and discovered his toes were
black.
An oozing blister between
his toes infected his left foot.
The middle toes had to be
amputated, a heartbreaking
procedure that forced Mike to
temporarily use a wheelchair
and robbed him of the little
independence he had left.
Yet, every day was a battle
to get Mike to take his insulin.
I feel like he didnt live up
to is vows of marriage he took
when we got married, Danita
said in January. Hes selsh.
He doesnt think about me or
the kids when he doesnt want
to take his medication. And I
think after he lost his vision,
I honestly think he felt like,
Whats the point now?
HOPE DASHED
Lying in the ICU bed at
Christus Spohn Hospital
Shoreline in mid-January,
Mike looked comfortable,
peaceful almost.
Running back and forth
between home and the hospi-
tal, Danita was trying to hold
it together. The kids wanted
to visit, but Danita tried to
explain that he was very sick
and they couldnt see him or
talk to him until he got better.
She was in McAllen at a
work training session in early
January when Mike had the
stroke. His father had come
over that morning to get the
kids ready for school and
found Mike on the oor. He
responded to questions with
a blank stare. He could walk,
dress himself and tie his
shoes. But he was silent.
His father and Danitas fa-
ther helped him into the car
and took him to the emer-
gency room where doctors
discovered a blood clot in his
brain as wide as a smartphone.
Danita prayed and called
everyone she could think of
to join her in prayer. And, for
a while, it seemed like Danita
got the miracle she was look-
ing for.
Within a week, Mike
opened his left eye and
squeezed Danitas hand. He
was of the ventilator within
a month, smiling and trying
to talk.
Danita went back to work
and visited Mike on week-
ends. One Sunday at the end
of February, Danita went to
see Mike in the long-term
hospital where he was recov-
ering. She held his hand and
he kissed hers. As she stood to
go, he thrust his hand out for
her to hold, pulled her close
and wouldnt let go. He tried
to say something, but with his
tracheotomy, no sound came
out. She tried to read his lips
but didnt understand what he
was trying to say.
Mikes progress didnt last.
Within days of Danita see-
ing him, the long-term hospi-
tal sent him back to the emer-
gency room, claiming he was
having chest pains. Doctors
never found anything wrong
with is heart or lungs but
they did discover that Mike
was covered in bed sores,
including one on the outer
right leg the length of his calf.
(Attempts by Danita to get
his medical records from the
hospital were unsuccessful).
Wound care specialists
worked to heal Mikes sores,
and by mid-March, he was
strong enough to go to a skilled
nursing facility. This time
though, the Reyes couldnt
nd any Corpus Christi facil-
ity willing to accept a patient
with a tracheotomy requiring
dialysis. The nearest facility
willing to take him was in
McAllen.
I was a wreck, Danita
said. I was so upset because
nobody would take him. I felt
so bad for him.
They transferred him by
ambulance to Solara in McAl-
len on March 20, a Wednesday.
That Saturday, Danita and the
kids made the 2.5-hour trip.
He was talking, she said.
He was acting silly. Someone
had music on and I said, Do
you want to dance? And he
started moving his body like
he wanted to dance.
When Danita went to leave,
he grabbed both of her hands
and pulled her close.
Dont go, he said.
Im sorry, she told him. I
have to go. I have the kids. I
have to take care of the kids.
HAPPENED SO FAST
By itself, diabetes is a risk
factor for heart disease.
Even more troublesome,
people with Type 2 diabe-
tes may carry extra weight
around their waist, have ab-
normal amounts of good and
bad cholesterol and struggle
with high blood pressure; all
factors that raise their risk
even further, according to the
National Institute of Diabetes
and Digestive and Kidney Dis-
eases.
People living with diabetes
for a long time can diet, ex-
ercise and even lose weight,
and still not lessen their risk
of heart attacks and strokes,
a 2012 National Institutes of
Health study found.
The American Heart As-
sociation estimates that 65
percent of people with diabe-
tes die from heart attacks or
strokes.
On Monday, March 25,
Danita was taking her oldest
daughter, Samantha, to school
when she got the call.
Mike was two hours into his
four-hour dialysis treatment
when he went into cardiac ar-
rest.
I was praying for him to
be well enough so that I could
take care of him, she said. I
didnt know how bad it was
until I got there.
Danita rushed to McAllen
where she found Mike sur-
rounded by health care work-
ers taking sonograms of his
heart and drawing blood, kept
alive with a ventilator and IV
drip. Mike was still. Too still.
At his bedside, his aunt was
crying.
My husband is there on
the bed with no life in him,
Danita recalled. Alive, but
with no life.
REYES
from 37X
See REYES, 39X
Danita Reyes and her twins, Simon and Sophie Reyes, 10, place dirt on the casket of Mike Reyes, husband
of Danita and father to the twins, during his funeral at the Memory Gardens Cemetery. Mike Reyes died of
a stroke March 26, 2013 after years of complications from diabetes.
Mike was surrounded by his
family when his older brother
arrived. Like his brother, Ar-
turo has diabetes complica-
tions, including amputations
on both legs and a triple by-
pass.
Arturo made the call Danita
couldnt bring herself to think
about.
Turn it all of, he said.
What do you mean? Dani-
ta asked. Hes going to come
out of it like last time. You
dont think theres any point?
No, he said.
She knew she couldnt say
the words. Arturo agreed to
tell the doctors.
At rst Danita felt relief,
then guilt. I felt like I was
killing him, she said.
As they started the pa-
perwork, a doctor reassured
Danita the family was making
the right decision. Nothing
more that could be done. If it
were him, he said, he would
make the same decision. It
happened so fast, Danita said.
She held Mikes hand while
they withdrew the machines.
I told him that I loved
him, she said. I told him not
to worry about the kids. I told
him that I would be OK, not
to worry about me. If he was
ready to go, he could go.
Within an hour, Mike was
dead. He was six months shy
of his 39th birthday.
SAYING GOODBYE
Sophie, 10, sat in the second
row of Trevio Funeral Home,
a tiny glittery bow topping her
ponytail. As a slideshow of
photos of their dad looped on
a television screen to George
Straits I Cross My Heart,
Sophie leaned her head
against her twin brother, Si-
mon, a spitting image of Mike
at the same age.
The slideshow at the wake
showed Mike as a chubby-
cheeked boy with shaggy
brown hair and a sweet smile,
Mike as a teenager too cool to
ham it up for the camera. Mike
and Danita when they rst
married. Mike playing with
baby Samantha in a kiddie
pool. A family portrait of all of
them at the twins christening.
Then the photos stop.
Only one recent picture
made the slideshow. In the
snapshot of the family at a
pizza party, Sophie rests her
cheek on her dads shoulder
and smiles into the camera.
Mike is smiling too, but his
eyes are hidden by an oversize
pair of goofy party glasses.
He never wanted photo-
graphs taken of himself after
he went blind.
Danita and the kids said
their nal farewells to Mike
at the funeral the next day. In-
vited by the priest to stand in
the aisle of the church, they
rested their hands on top of
the casket and, one by one,
leaned down to kiss the sur-
face. First Danita, then Saman-
tha, 14, then Sophie and last,
Simon.
There is sadness now and
there are tears now and there
is grief, the Rev. Patrick Do-
nahoe said. But there is also
a sense of no mas.
HIS LEGACY
A vase of royal blue silk lil-
ies sat on an end table near the
couch in May, a dash of color
in Danitas new living room.
Months earlier, she and Mike
paid to have the house built
in a new neighborhood on the
Southside. He was nervous
about moving in, afraid he
wouldnt know how to navi-
gate the new layout. He never
got the chance to try. Danita
and the kids moved in a week
before he died.
She bought the lilies to put
on Mikes grave but hasnt been
able to aford a headstone yet.
She thought that after Mike
was gone, she would feel a
sense of relief from the pain
and sufering. Instead, she felt
lonely and sad. She still had
to stop herself from rushing
home to pick him up from dial-
ysis appointments. She found
it hard to adjust to sleeping
alone in their bed.
After he went blind, Mike
had a hard time sleeping and
often would wander between
the bed and couch. When
Danita was sad or anxious,
she would stay up late talking
to Mike, holding his hand and
listening to him tell stories
about his childhood.
One night recently, Dani-
ta stretched out her arm to
Mikes side of the bed.
Hold my hand, Mike, she
whispered into the empty
room. A buzzing sensation
crept across her palm.
You really felt something?
Sophie asked. Im going to try
that. She burrowed under-
neath her moms comforter,
closed her eyes and stretched
out her hand.
Mike remains here in other
ways, too. His legacy is a cau-
tionary tale.
When Mike had his stroke
in January and Danita was at
a training session, everybody
had left the room except Dani-
ta and the trainer. Thats when
she saw him grab a bottle of
water and down the entire
thing in a single gulp.
Are you diabetic? she
asked.
Yeah, he said
Let me tell you about my
husband, she began.
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Kidney loss
another risk
of diabetes
Jessica Savage
Special to the Caller-Times
He felt tired and achy, like
he had caught the u.
It was October 2003 and
the cold and u season had
arrived earlier than usual, so
Roland Gaona didnt think
much about what else could be
wrong. A couple weeks later
he felt better, more energetic.
Then an overwhelming sense
of lethargy returned. It was
difcult even to get out of bed.
Gaonas health ping-ponged
between those two extremes
until one day he felt like he
couldnt breathe.
Doctors told Gaona his kid-
neys had shut down. He was
42.
To keep him alive, he would
need dialysis a grueling
treatment requiring him to
be tethered to a machine 12
hours each week to lter the
toxins from his blood. Years
of living with diabetes and un-
diagnosed high blood pressure
wore down his kidneys until
they gave out. He didnt feel
the efects until it was too late.
The only ways of dialysis
would be a kidney transplant
or improved kidney function,
a very slim possibility.
He felt tired and achy, like
he had caught the u.
It was October 2003 and
the cold and u season had
arrived earlier than usual, so
Roland Gaona didnt think
much about what else could be
wrong. A couple weeks later
he felt better, more energetic.
Then an overwhelming sense
of lethargy returned. It was
difcult even to get out of bed.
Gaonas health ping-ponged
between those two extremes
until one day he felt like he
couldnt breathe.
Doctors told Gaona his kid-
neys had shut down. He was
42.
To keep him alive, he would
need dialysis a grueling
treatment requiring him to
be tethered to a machine 12
hours each week to lter the
toxins from his blood. Years
of living with diabetes and un-
diagnosed high blood pressure
wore down his kidneys until
they gave out. He didnt feel
the efects until it was too late.
The only ways of dialysis
would be a kidney transplant
or improved kidney function,
a very slim possibility.
I thought, Well, this will
be all right. Ill get through
ICU. Theyll do a couple of
dialysis things and then (my
kidneys will) kick back in and
Ill be all right, Gaona said.
Chronic kidney disease and
dialysis treatment largely are
preventable for those who
have Type 2 diabetes a
disease caused by poor diet,
lack of exercise and genetics
in which glucose builds up in
the body and wrecks havoc on
vital organs over time if not
properly managed. Kidney
failure, blindness and ampu-
tations are among compli-
cations caused by diabetes,
which afects one in six people
in Nueces and San Patricio
counties.
End stage renal disease, the
clinical term for kidney fail-
ure, is expensive and debilitat-
ing, and the cost is largely paid
by taxpayers.
For 10 years, life
dictated by dialysis
COST OF
DIABETES
Published June 2, 2013
Roland Gaona waits for Yolanda Carrisalez, clinic technician at the DaVita Dialysis Center on Swantner, to nish hooking him up for dialysis.
Gaona has been taking dialysis treatments three days a week for nine years.
See DIALYSIS, 41X
There are 716 people on
dialysis in Corpus Christi
costing about $62.7 million
a year, based on average di-
alysis costs of about $87,600
a year per patient. Medicare
pays about 80 percent of the
treatment costs for those cov-
ered by the federal program,
according to the 2012 Annual
Data Report by U.S. Renal
Data System.
ined the nancial and per-
sonal toll of dialysis as part
of its yearlong series Cost of
Diabetes.
Dialysis is a very personal
treatment process one
that many shied away from
talking about with the Caller-
Times. Gaona agreed to share
his story because he doesnt
want others to end up in the
same, preventable situation.
He thinks there needs to be
more awareness and educa-
tion in the community.
Many people know Gao-
na, who grew up in Corpus
Christi, through his volunteer
work and advocacy eforts. He
is a longtime member of the
League of United Latin Ameri-
can Citizens Council No. 1,
through which he is spear-
heading an efort to establish
a Tejano Civil Rights Museum
in Corpus Christi. Hes also
known for his environmental
activism.
Few people know he has
kidney failure and is on di-
alysis treatments.
This has drastically
changed my life, he said.
AT THE CLINIC
After his diagnosis, Gaona
spent a month in ICU and
received partial toe amputa-
tions on both feet related to
diabetic complications. Doc-
tors released him with orders
to have dialysis treatments
at an outpatient clinic his
choice instead of having the
treatment at home.
Three times a week for the
past nine years, Gaona usually
rises before 5 a.m. to get ready
for his dialysis treatments.
He set his schedule early in
the morning on Mondays,
Wednesdays and Fridays, so
he can have the weekends of
dialysis.
Gaona drives himself
to his treatment center of
Swantner Street and usually
arrives around 6 a.m. The
appointments start and end
with checking his weight. Its
how the technicians monitor
uid retention, an important
part of dialysis because the
kidneys cant lter toxins to
make urine. Some patients are
advised to drink as little as 16
ounces of uid each day.
Next Gaona is hooked to a
machine in a brightly lit room
with more than 20 stations
where other people are under-
going their treatments. A staf
member connects a tube from
the dialysis machine through
a stula in his arm. The stula
is a synthetic tube surgically
implanted in his forearm to
make it easier to reach his
veins.
About a pint of blood at a
time cycles in and out of his
body. Its fed through an arti-
cial kidney a cylindrical,
hard plastic tube with ltra-
tion inside. A typical treat-
ment takes about four hours.
I get sleepy because it gets
a little boring, Gaona said.
It didnt have to be this way.
People with diabetes should
know more about how the dis-
ease afects their kidneys be-
fore the vital organs begin to
lose function, local health care
professionals said.
Tests for kidney function
should be at the top of the list
for diabetics to check each
year through a simple blood
test, but health care profes-
sionals say kidneys often
dont receive the attention
they need until the advanced
stages of chronic kidney dis-
ease. At that point, the disease
is irreversible, but kidney fail-
ure can be delayed.
I dont think people real-
ize how many complications
there are and how many can
be prevented or delayed,
said Dr. Melissa Wilson,
chairwoman of the Diabetes
Community Coalition of the
Coastal Bend. So many peo-
ple think, It happened to my
parents. Its going to happen to
me. Thats because we didnt
have as good of care back then.
We have good care now. It
takes people participating in
their care.
DIALYSIS COSTS
In Texas, Medicaid and
Medicare paid for two-thirds
of the states diabetes-related
hospital stays in 2010, accord-
ing to the states health depart-
ment.
People with diabetes on
average spend 2.3 times more
on health care than those who
dont have it, according to the
states most recent report on
the nancial burden of diabe-
tes in 2008.
Beyond the measurable
medical costs of the disease,
people with diabetes face
hefty indirect costs, such as
reduced productivity and
increased absenteeism from
work, which are much more
difcult to quantify but just
as costly.
A majority of those on di-
alysis are unable to work be-
cause treatments can take up
to 12 hours a week and clinics
often are open only during the
day. Those who cant keep a
full-time job often qualify for
disability through Medicaid.
When diagnosed with kid-
ney failure, Gaona didnt have
health insurance. He didnt
consider the long-term con-
sequences and thought hed
get to a point where he could
afford insurance again, he
said.
At the time, he was work-
ing as a real estate agent for
an apartment locator busi-
ness. That ended with his
diagnosis because he was
no longer physically able to
work. He qualied for health
care through Nueces Countys
indigent care program, which
is funded by taxpayers. That
paid for his treatment until his
Medicare coverage kicked in,
a process that typically takes
about three months.
The unltered blood of Roland Gaona makes way to a lter that will
clean his blood and return it to him. Roland needs to take dialysis
three times a week, each session lasting four hours.
DIALYSIS
from 40X
See DIALYSIS, 42X
Blood
pump
Arterial
Pressure
monitor
Heparin pump
(to prevent
clotting)
Dialyzer inow
pressure monitor
Dialyzer
Venous
pressure
monitor
Air trap
and air
detector
Air
detector
clamp
Dialyzed
blood
returned
to body
Blood
removed
for dialysis
HEMODIALYSIS
In hemodialysis, a machine lters wastes, salts and uid from
your blood and the clean blood is returned to the body. Hemodi-
alysis is usually done three times a week and can last between
three to four hours.
Source: U.S. Department of Health
and Human Services
To me, thats the
biggest news. Who
knew that those on dialysis
are the lucky ones.
Cathy Lewis, education committee chairwoman for the Texas Renal Coalition board
Texas has a program called
Kidney Health Care to pay in
part for dialysis, access to sur-
gery and Medicare premiums
for those making less than
$60,000 a year. It covers the
three-month lapse in cover-
age.
To aford his health care,
Gaona doesnt work full time
and keeps his income below
$24,000 a year so he quali-
es for Medicaid coverage
and disability. He otherwise
wouldnt be able to aford the
out-of-pocket medical expens-
es, he said.
His monthly Medicare pre-
mium is about $77 and is paid
for by Medicaid. He also re-
ceives an $880 per month dis-
ability check, which after rent,
bills and groceries doesnt
leave much for anything else.
His prescriptions are covered
by Part D of Medicare and
cost usually between $5 and
$10 each.
In the last decade, Gaona
has spent more than 5,600
hours, or the equivalent of
two-thirds of one year, under-
going dialysis.
He has been in and out of
the hospital with several other
health complications, includ-
ing a lung infection and re-
moval of his gallbladder and
one kidney.
EDUCATION
One of the blood tests
health care professionals say
diabetics should have each
year is the glomerular ltra-
tion rate, known as the GFR,
which measures how fast the
kidneys are ltering blood.
Anything less than 60 mil-
liliters per minute usually
comes with a referral to a ne-
phrologist, a kidney specialist.
That level indicates Stage 3 of
chronic kidney disease, when
the kidneys are headed toward
failure. At that point, damage
cant be reversed, but the pro-
gression can be slowed with
management of diabetes and/
or high blood pressure.
Austin-based advocacy
group Texas Renal Coalition
is pushing for the state to pro-
mote education and awareness
of chronic kidney disease. For
example, not enough diabetics
with chronic kidney disease
are aware that taking over-
the-counter pain relievers can
speed the damage to your kid-
neys, said Cathy Lewis, educa-
tion committee chairwoman
for the Texas Renal Coalition
board.
Lewis works in San An-
tonio and outlying areas to
speak about chronic kidney
disease. Shes built a grass
roots network of interested
groups in the six years since
she started the education out-
reach program. Her primary
job is educating patients at the
San Antonio Kidney Disease
Center Physicians Group. The
center asked her to teach an
education class after seeing an
increasing number of patients
who were diagnosed during
a crisis situation similar to
Gaonas.
They dont even know they
have kidney disease, so by the
time we get a referral, their
GFR is 20 and no one knew
this, Lewis said. Its brand
new to them.
Corpus Christi nephrologist
Dr. Jack Cortese typically sees
a patient after that persons
GFR is below 60. When kidney
function drops to 15 percent
or below, dialysis usually is
needed.
When they get to me, most
of the damage is done, Cor-
tese said.
He helps patients under-
stand the decisions ahead
diet planning, ways to control
their diabetes and a referral to
a pre-dialysis education class.
But he said more education is
needed in the community.
On a recent weekday, Cor-
tese arranged a tour of a dialy-
sis clinic for group of Martin
DIALYSIS
from 41X
See DIALYSIS, 43X
1991 93 95 97 99 01 03 05 07 09 11
DIALYSIS PATIENTS
Source: Southwest Transplant Alliance
35
30
25
20
15
10
5
0
T
h
o
u
s
a
n
d
s
Number of dialysis patients
in Texas, 1991-11.
9,288
SCRIPPS NEWSPAPERS
39,177
Christus Spohn Health Plaza
5920 Saratoga, Suite 510
Corpus Christi,TX 78414
www.amaralmd.com
Committed to serving South Texas
(361) 442-2442 (361) 442-2442
Diabetes & Endocrinology
Now Accepting
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C
A
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P
0
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9
7
0
Middle School children at a
DaVita clinic on South Padre
Island Drive. Nineteen stu-
dents, a part of the schools
health care careers club,
paraded through the clinic
dressed in white gowns as
Cortese explained what hap-
pens to the body when the
kidneys shut down. Before
they had a chance to see up
close what dialysis looks like,
he briefed them about what to
expect.
How many of you think
someone on dialysis can
pee? Cortese asked them.
Cmon. Dont be shy. Raise
your hand.
A few hands went up. The
students learned those on
dialysis no longer urinate
because the kidneys cant l-
ter toxins from the blood to
release through the bladder.
That answer surprised many
of the students. Dialysis lters
the toxins for people with kid-
ney disease.
What are we going to be
seeing out there? Cortese
asked.
How to wash the yellow
out, he answered.
The students lined up out-
side the clinic area, and before
heading inside Cortese gave
one nal instruction. They
were going to see blood, so if
anyone felt queasy, dont be
shy. Let him know. The stu-
dents nodded their heads.
Inside the students saw
several people hooked to ma-
chines and learned how they
worked. Cortese invited the
students to touch one mans
articial kidney the plastic
tube with ltration inside. It
felt warm, one young boy said.
The experience hit close to
home for eighth-grader Nancy
Cortinas. Her mother is dia-
betic and she doesnt want to
see her on dialysis, she said.
Two years ago Nancy was
diagnosed as prediabetic. It
scared her into regularly ex-
ercising after school. Shes
focused on working out and
training to be a boxer.
I dont want to get it, Cor-
tinas said.
Dialysis is a growing indus-
try.
During the past 20 years,
the number of people on di-
alysis in Texas has tripled
from 9,200 in 1991 to 39,000 in
2011, the most recent gures
available. By comparison, the
state population increased by
50 percent during the same
time frame.
DaVita is one of the larg-
est dialysis providers in Cor-
pus Christi with ve of the
12 clinics. The Denver-based
company is a Fortune 500
corporation that answers to
shareholders. First quarter
earnings from patient servic-
es this year were about $2 bil-
lion. The company has about
158,000 patients worldwide.
Sam Canavati, regional op-
erations director for dialysis
provider DaVita, is alarmed at
the increasing need for dialy-
sis centers in the South Texas
area. He believes more pre-
dialysis education alongside
diabetes education is needed
to help people understand
how the disease can afect
their kidneys.
Canavati said he was drawn
to the company because his
mother is a dialysis patient
who has lived with kidney
disease for 34 years.
I was really mad at the
lack of education out there,
he said.
Canavati oversees 13 cen-
ters from Victoria to Kings-
ville. Theres a great need for
dialysis in the area related to
the diabetes epidemic, he said.
He envisions more early edu-
cation outreach, like the tour
with Martin Middle Schools
Healthcare Careers Club.
LUCKY ONES
Many people with diabetes
die of other complications,
usually cardiovascular dis-
ease, before their kidneys fail
and they need dialysis.
You are lucky if you end up
on dialysis, said Lewis, the di-
alysis educator. To me, thats
the biggest news. Who knew
that those on dialysis are the
lucky ones.
It took about a year for
Gaona to get his health under
control after he was diagnosed
with kidney disease.
Gaona struggled with his
energy levels but was deter-
mined to live a more active
lifestyle, he said. He has since
adapted and learned how to
control how he feels through
diet and managing uid reten-
tion.
Gaona enrolled in class-
es at Del Mar to learn GIS
programs. He gured if he
couldnt work, he could learn
how to do something that
would enhance his real estate
career.
Gaona also volunteered
with local political cam-
paigns, and through those
connections he landed part-
time work with Clower Real
Estate Co.
The only chance he would
have to live a fuller life would
be with a transplant. So he
added his name, like many on
dialysis do, to a kidney trans-
plant list.
Theres waiting lists for
organs from prisoners who
donate, one for cadavers and
one for living donors. Gaona
signed up for all three. About
9,200 people are waiting for
a kidney in Texas with one-
third of them because of Type
2 diabetes complications.
For Gaona, a moment of
hope came earlier this year
when an acquaintance learned
he needed a kidney and want-
ed to donate one.
It looked like Gaona could
have a kidney by the end of the
summer. All he needed were a
few more tests.
But the plan changed last
week.
DIALYSIS
from 42X
See DIALYSIS, 44X
Daniela Palmerin and Martin Middle School students in the health science club feel the lter that blood is ltered through during dialysis during
a tour at the DaVita Dialysis Center.
Late on the night of May
26, Gaona was purchasing his
weekly supply of juices and
snacks for dialysis treatment
when he received a phone call.
He learned he was No. 2 on
the transplant list and there
was kidney ready for him in
San Antonio. The news con-
fused him at rst.
He and his potential do-
nor were entering the nal
stages of tests for a trans-
plant, but this was diferent.
Texas Transplant had a kidney
match ready from him from an
organ donor who died.
Gaona needed to be at
Methodist Specialty and
Transplant Hospital for sur-
gery by 6:30 a.m. He phoned
longtime friend Chris Taylor
for a ride.
Hey what are you doing
tonight? he asked.
Taylor, a local performer
known as Aaron Davis who
owns a local bar, was at work
and nearing closing time. He
would close shop about 2:30
a.m., he said.
Do you want to go on a road
trip? Gaona asked.
Where, Taylor said.
San Antonio, Gaona said.
Im going to go pick up a kid-
ney.
Reality sank in with Tay-
lors reaction.
A mutual friend of theirs
DIALYSIS
from 43X
See DIALYSIS, 45X
Roland Gaona of Corpus Christi talks on the phone with a friend as he
recovers from his kidney transplant surgery at Methodist Specialty
and Transplant Hospital in San Antonio last year.
KIDNEY TRANSPLANT
Renal
artery
Renal
vein
Inferior
vena cava
Ureter
Ureter
Bladder
Old
kidneys
Catheter
Aorta
Incision
site
When a kidney is obtained from a live
donor, one kidney is removed by
dividing the renal artery and vein near the
inferior vena cava and aorta. As much of the
ureter as possible is removed along the
kidney. (When kidneys are obtained from a
deceased donor, both kidneys are removed).
A
The ureter is attached to the bladder, and a
tunnel is created to minimize backward
reux of urine into the transplanted kidney.
D
The original kidneys are
usually not removed,
unless they are causing sever
hypertension, are infected,
or are so enlarged that they
interfere with the transplant
operation. A catheter is used
to measure urine output
after surgery.
E
The renal
artery is
connected to the
internal iliac
artery. The renal
vein is attached
to the external
iliac vein.
C
An incision is made to place the donor
kidney in the pelvis, rather than in the
natural position in the ank. This makes the
iliac artery and vein accessible for the
attachment of the renal artery and vein, and
allows the ureter of the donor kidney to be
closer to the bladder.
B
Donor
kidney
Transplanted
kidney
Transplanted
kidney
Source: Roche Pharmaceuticals
Companies
must address
deficiencies
Jessica Savage
savagej@caller.com
361-886-4316
Dust-caked ceiling vents,
problems with running wa-
ter and a patient who wasnt
aware of the kidney trans-
plant list are a few of the more
glaring ndings during state
inspections of local dialysis
clinics.
Administrative compliance
issues, such as not properly
documenting doctors orders
on patient charts or naming a
clinics liaison with the state,
were more commonly docu-
mented in the reports than im-
mediate patient safety prob-
lems, according to 10 years of
state survey records of Corpus
Christi area dialysis clinics.
As part of its yearlong Cost
of Diabetes series, Caller-
Times reviewed more than
300 pages of inspection doc-
uments, which were released
through a public information
request.
The reports are based on
unannounced state inspec-
tions of licensed dialysis clin-
ics. Each clinic is required to
have a survey every three and
a half years to receive federal
health care reimbursements.
Rules and regulations for
dialysis clinics are set by the
federal Centers for Medicare
and Medicaid Services but en-
forced in Texas by the Depart-
ment of State Health Services.
There are 12 licensed dial-
ysis clinics in Corpus Christi
and one clinic in Robstown.
Five are owned by DaVita, ve
by Fresenius, one by DSI Di-
alysis and another operated by
Driscoll Childrens Hospital.
A state survey in October
2011 found unsanitary condi-
tions missing ceiling tiles,
blood spots with tape over
them and cigarette butts litter-
ing the patient entry way at
a clinic then owned by DSI Di-
alysis at 2222 Morgan Ave. The
state required the company to
hire a contractor to clean the
facility and replace ceiling
tiles and countertops. It also
set up unannounced visits to
make sure sanitary conditions
were being met, according to a
corrective plan of action DSI
submitted to the state.
DaVita purchased the Mor-
gan Avenue clinic about a year
ago. When the company takes
ownership of a clinic part of
that process involves reno-
vating and retrotting it with
new oors, ceilings, walls and
the latest technology, includ-
ing a water treatment system,
said Sam Canavati, DaVitas
regional operations director.
We especially take a lot of
pride because a lot of us have
family members on dialysis,
Canavati said.
Dialysis a delicate kidney
treatment process that in-
volves a machine ltering the
toxins from patients blood to
keep them alive. It relies on a
puried water treatment sys-
tem.
At a clinic in Robstown, pa-
tients often had to wait past
their scheduled dialysis time
because of problems with the
water treatment system. A
March 2011 inspection found
sinks in the patient treatment
area didnt have running hot
water a violation of sanitary
rules. It also showed the cen-
ters reverse osmosis machine,
which puries water for dialy-
sis treatment, had a pattern of
problems.
The clinic operates three
days a week. Someone at the
clinic was switching the wa-
ter treatment machines from
automatic to manual, which
caused a delay on days the
clinic was open, according to
the state report.
Those problems have been
repaired and the center has a
backup water system should
any problems occur, said
Johnathan Stone, vice presi-
dent of public relations and
communications for Fresenius
Medical Care North America.
No patient delays for treat-
ment have occurred at the
center this year, he added.
Dialysis is required to
keep someone alive after the
kidneys have failed. Years of
poorly managed diabetes can
lead to kidney failure and re-
quire dialysis treatments. A
kidney transplant is the only
way of dialysis.
One in six people in San
Patricio and Nueces coun-
ties has diabetes. Dialysis is
a growing, for-prot industry
and largely run by corpora-
tions who answer to share-
holders.
The state has 16 surveyors
trained to conduct inspections
at the more than 543 licensed
clinics in Texas last year.
While there are required
regular inspections, they
also can be prompted by
complaints where someone
is reportedly at risk or has
been harmed. Complaints are
ranked in order of the most
severe to less severe. A sur-
veyor could be on site within
two days or 45 days, depend-
ing on the type of complaint,
according to the state.
Most patients who are on
dialysis treatment pay for it
through Medicare, a feder-
ally subsidized health care
program. About 80 percent
of dialysis treatments are
covered with Medicare. If the
state receives a complaint of
improper billing, it requires
the clinic to conduct an inter-
nal investigation and report
its ndings to the state for a
review, according to Christine
Mann, assistant press ofcer
in the Texas Department of
State Health Services.
State monitors dialysis care, facilities
died ve years ago from renal
failure. Taylor didnt want to
see the same thing happen to
Gaona. He could hear Gaonas
voice wavering as he said the
words out loud for the rst
time.
There was just something
about his spirit that seemed a
little more youthful and ex-
cited about what was to come
a newfound vigor for life,
Taylor said about the drive to
San Antonio.
They arrived at 6 a.m.
Monday. Gaona completed a
round of pricks and prodding,
including a chest X-ray, blood
work, CT scan and stress test
to make sure he could handle
the anesthesia. He passed all
tests and was wheeled into
surgery about 5 p.m.
Two hours later he emerged
with a new kidney and a sec-
ond chance at life. He was the
hospitals 92nd kidney trans-
plant of the year.
At 52, Gaona plans to get
back to work full time. He
wants to use his degree in
restaurant management and
continue his part-time real
estate work, he said in a phone
interview from his hospital
room where he was recover-
ing. Travel is at the top of his
list, too.
Every day Im feeling a
little better, he said.
DIALYSIS
from 44X
Roland Gaona of
Corpus Christi
leaves his room
to take a short
walk around his
hospital oor
as he recovers
from his kidney
transplant sur-
gery at Method-
ist Specialty
and Transplant
Hospital in San
Antonio.
COST OF
DIABETES
46X Sunday, February 9, 2014 CAL L E R-TI MES CAL L E R-TI MES Sunday, February 9, 2014 47X
|ood Pressure, FREE
C|ucose, FREE
Cho|estero|, $3.99
A!C, $29.99
Comp|ete Cho|estero|, $29.99
fasting required
PLEASE JOIN US FROM 9 AM - 2 PM
ON THE 2ND SATURDAY OF EACH MONTH
FOR HEALTH SCREENINGS.
GET DOWN
Lower your cholesterol and blood
pressure numbers by:
Eating a low-fat diet lled with
fruits and veggies
Getting 150 minutes of exercise
per week
Choosing lean meats
Limiting alcohol
Normal
less than 120 systolic
or less than 80 diastolic
Prehypertension
120139 systolic
or 8089 diastolic
High Blood Pressure Stage 1
140159 systolic
or 9099 diastolic
160 or higher systolic
or 100 or higher diastolic
H-E-B can help you keep track of the numbers that are important
to your health as you set goals for healthy habits in 2014 with our
Second Saturday Screenings at your H-E-B Pharmacy.
Free Blood Pressure Screening
High blood pressure, or hypertension, can lead to heart attack or stroke. Know what ranges put you at
risk and regularly monitor your blood pressure with a quick and easy screening at H-E-B.
SOURCE: AMERICAN HEART ASSOCIATION
Manage Your Cholesterol
An important factor in the risk for heart disease, high cholesterol
has no symptoms and can easily be checked two ways at your H-E-B Pharmacy.
Basic Cholesterol Screening $3.99
Learn your basic cholesterol numbers.
Advanced Cholesterol Screening $29.99 (fasting required)
Measure all cholesterol and triglycerides, including a breakdown of the
good HDL cholesterol and the bad LDL cholesterol.
TOTAL CHOLESTEROL LEVEL CATEGORY
Less than 200 mg/dL Desirable level
200239 mg/dL Borderline high
240 mg/dL and above High
Free Blood Glucose Check
Easily monitor your blood sugar levels and
check for diabetes or hypoglycemia. A normal
fasting blood glucose reading is 90130 mg/dL.
Knowyour numbers
HEALTHSCREENINGS
heb.com/pharmacy
Limiting alcohol
Flexible Spending accounts accepted.
Must be 18+ to participate in screenings.
2014 HEB, 14-2292 CAL305334
46X Sunday, February 9, 2014 CAL L E R-TI MES CAL L E R-TI MES Sunday, February 9, 2014 47X
|ood Pressure, FREE
C|ucose, FREE
Cho|estero|, $3.99
A!C, $29.99
Comp|ete Cho|estero|, $29.99
fasting required
PLEASE JOIN US FROM 9 AM - 2 PM
ON THE 2ND SATURDAY OF EACH MONTH
FOR HEALTH SCREENINGS.
GET DOWN
Lower your cholesterol and blood
pressure numbers by:
Eating a low-fat diet lled with
fruits and veggies
Getting 150 minutes of exercise
per week
Choosing lean meats
Limiting alcohol
Normal
less than 120 systolic
or less than 80 diastolic
Prehypertension
120139 systolic
or 8089 diastolic
140159 systolic
or 9099 diastolic
160 or higher systolic
or 100 or higher diastolic
H-E-B can help you keep track of the numbers that are important
to your health as you set goals for healthy habits in 2014 with our
Second Saturday Screenings at your H-E-B Pharmacy.
Free Blood Pressure Screening
High blood pressure, or hypertension, can lead to heart attack or stroke. Know what ranges put you at
risk and regularly monitor your blood pressure with a quick and easy screening at H-E-B.
Manage Your Cholesterol
An important factor in the risk for heart disease, high cholesterol
has no symptoms and can easily be checked two ways at your H-E-B Pharmacy.
Basic Cholesterol Screening $3.99
Learn your basic cholesterol numbers.
Advanced Cholesterol Screening $29.99 (fasting required)
Measure all cholesterol and triglycerides, including a breakdown of the
good HDL cholesterol and the bad LDL cholesterol.
TOTAL CHOLESTEROL LEVEL CATEGORY
Less than 200 mg/dL Desirable level
200239 mg/dL Borderline high
240 mg/dL and above High
Free Blood Glucose Check
Easily monitor your blood sugar levels and
check for diabetes or hypoglycemia. A normal
fasting blood glucose reading is 90130 mg/dL.
Knowyour numbers
HEALTHSCREENINGS
heb.com/pharmacy
Limiting alcohol
Flexible Spending accounts accepted.
Must be 18+ to participate in screenings.
2014 HEB, 14-2292 CAL305334
Woman
masters weight
to defeat Type 2
diabetes
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Danney Boren was horried
when his wife got diagnosed
with Type 2 diabetes last year.
He remembered his friends
daughter, who lost her feet and
hands to the disease and later
died. He feared what could
happen to Priscilla. And he
worried what this meant for
their 8-year-old son.
I didnt want him to lose his
mom, Danney said.
The same troublesome im-
ages played in Priscillas head,
too her grandmother inject-
ing insulin, her great-uncles in
Laredo sitting in wheelchairs
This was life or death, she
thought, and put into that con-
text, her choice was obvious.
She had to change.
This week, almost a year
after she launched a personal
transformation that helped her
shed 80 pounds, Priscilla got a
stunning phone call from her
doctors ofce that set her ex-
military husband to sobbing.
Her blood sugar had fallen
to prediabetic levels. She no
longer needs regular insulin
injections or diabetes pills.
And although Type 2 diabetes
is a lifelong disease that can
never be fully cured, Priscilla
feels normal again.
I just started crying be-
cause I was like, You did it,
Danney said. Its achievable.
The Caller-Times has been
following Priscilla for seven
months as part of its yearlong
series Cost of Diabetes exam-
ining the extent of the problem,
complications.
About one in six people in
Nueces and San Patricio coun-
ties have been diagnosed with
diabetes, and the Coastal Bend
has some of the highest rates of
complications in the state and
nation.
Nueces County has the third
highest death rate in the state
and the third highest below-
the-knee amputation rate in
the nation among Medicare
enrollees.
Priscilla, 40, could have
been one of those statistics.
She shrugged of warnings for
years that she was prediabetic,
so by the time she was diag-
nosed in May 2012, her blood
sugar was so high, staf in the
doctors ofce gasped when
they saw it.
Set on beating the odds
Priscilla Boren, owner of D&P Photography, poses in her ofce in Corpus Christi. A year after she was
diagnosed with diabetes, Boren found out that she no longer needs medication and her blood sugar has
fallen to normal ranges.
A year after Type 2 diabetes
diagnosis led her to transform
her life, Priscilla Borens sugar
level has dropped to
pre-diabetic range.
COST OF
DIABETES
See ODDS, 49X
Woman
masters weight
to defeat Type 2
diabetes
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Danney Boren was horried
when his wife got diagnosed
with Type 2 diabetes last year.
He remembered his friends
daughter, who lost her feet and
hands to the disease and later
died. He feared what could
happen to Priscilla. And he
worried what this meant for
their 8-year-old son.
I didnt want him to lose his
mom, Danney said.
The same troublesome im-
ages played in Priscillas head,
too her grandmother inject-
ing insulin, her great-uncles in
Laredo sitting in wheelchairs
This was life or death, she
thought, and put into that con-
text, her choice was obvious.
She had to change.
This week, almost a year
after she launched a personal
transformation that helped her
shed 80 pounds, Priscilla got a
stunning phone call from her
doctors ofce that set her ex-
military husband to sobbing.
Her blood sugar had fallen
to prediabetic levels. She no
longer needs regular insulin
injections or diabetes pills.
And although Type 2 diabetes
is a lifelong disease that can
never be fully cured, Priscilla
feels normal again.
I just started crying be-
cause I was like, You did it,
Danney said. Its achievable.
The Caller-Times has been
following Priscilla for seven
months as part of its yearlong
series Cost of Diabetes exam-
ining the extent of the problem,
complications.
About one in six people in
Nueces and San Patricio coun-
ties have been diagnosed with
diabetes, and the Coastal Bend
has some of the highest rates of
complications in the state and
nation.
Nueces County has the third
highest death rate in the state
and the third highest below-
the-knee amputation rate in
the nation among Medicare
enrollees.
they saw it.
Set on beating the odds
Priscilla Boren, owner of D&P Photography, poses in her ofce in Corpus Christi. A year after she was
diagnosed with diabetes, Boren found out that she no longer needs medication and her blood sugar has
fallen to normal ranges.
A year after Type 2 diabetes
diagnosis led her to transform
her life, Priscilla Borens sugar
level has dropped to
pre-diabetic range.
COST OF
DIABETES
See ODDS, 49X
The gold standard to test for
diabetes, an A1C test measures
blood sugar levels over three
diabetes has an A1C around 5
or lower. When Priscilla got
diagnosed, hers was 11.8.
Its 5.8 today, an achieve-
ment she attributed to her
commitment to eat healthier
and exercise.
In Type 2, the body becomes
resistant to its own insulin, a
hormone secreted from the
pancreas that allows cells to
use sugar in blood for energy.
Sugar builds in the blood-
stream, damaging the walls of
blood vessels, which can lead
to nerve damage and blind-
ness. Diabetes damages the
delicate system in the kidneys
that lters waste, leading to
kidney failure. It also speeds
the hardening of arteries, rais-
ing the risk for heart disease
and stroke. People with diabe-
tes are two to four times more
likely to die from a heart at-
tack than people without the
disease.
Type 2 diabetes, however,
can be managed a healthy diet
and exercise. In some cases,
lifestyle changes can help
people get of medication al-
together.
and determination and any-
one whos tried to lose weight
knows how hard that can be.
For Priscilla, that meant
tackling nearly two decades
of weight gain. Back then, the
5-foot 10-inch native of Corpus
Christi weighed 150 and wore
a size 8 dress. By the time she
was diagnosed, she weighed
270 and wore a size 26. To
shed pounds, Priscilla cut
down portions, gave up some
of her favorite carbs and start-
ed exercising on a path near
her home on the Westside.
Walking turned to jogging
turned to running. She ran a
5K. Then another. She par-
ticipated in the Coastal Bend
Tour de Cure in April, the
American Diabetes Associa-
tions rst cycling race in Cor-
pus Christi. And she began to
slim down.
One day in late winter, Pris-
cilla stepped on the scale and
the number 199 appeared. She
couldnt remember the last
time she weighed less than
200.
I never thought Id see that
day again, she said. (Shes
now down to 190 and a size 16
dress).
Not only does she look dif-
ferent, she feels diferent.
Her whole perspective on
life is night and day, Danney
said. Shes excited. Shes ea-
ger.
She has more energy than
shes had in years. The old
Priscilla would spend Friday
nights on the couch in front
of the television with a pack of
Oreos. Now? Dancing like cra-
zy at a downtown nightclub.
And her condence has sky-
rocketed.
Priscilla, who runs her own
wedding photography busi-
ness, used to hate having her
photo taken. She didnt like
the way she looked. She never
wanted to be the center of at-
tention.
So, when the Corpus Christi
Hispanic Chamber of Com-
merce named her the Busi-
nessperson of the Year in Jan-
uary, the diference between
the old and new Priscilla was
on stark display.
The old Priscilla would
have hidden herself in an
oversize dress with a black
jacket, trying to be invisible.
The new Priscilla wore a spa-
ghetti strap, oor-length red
gown and scarlet lipstick. Peo-
ple stared at her as she walked
through the crowd, mingling
and posing for photographs.
That newfound condence
has changed her relationship
with herself, with kids, with
Danney.
Its like being teenagers,
like high school kids again,
he said. It brings back the
puppy love. Our kisses are
more intimate. Theyre not
like formalities.
People always tell her now,
Oh, I wish I could do it.
But they can, Priscilla said,
and they dont have to stop
enjoying life, either. She loves
food and hasnt stopped eat-
ing, but she takes a bite or two
rather than scarng down the
entire platter.
I like to taste things that
are really, really good and en-
joy them a lot, she said.
Her children are delighted
because the refrigerator regu-
larly features boxes and sacks
of leftovers.
But perhaps most impor-
tantly, she didnt fall victim
to her own stereotype, Dan-
ney said. Minorities, including
Hispanics, who are 45 or older,
who are overweight or obese
or who have a family history
face a greater risk. Instead of
accepting her fate as a slow
march toward terrible com-
plications, Priscilla decided
to make her future her own.
She was like, So what if
Im a Hispanic? So what if Im
a female? So what if Im over-
weight? Thats not going to
keep me there, Danney said.
has some of the highest rates
of complications in the state
and nation.
Nueces County has the
third highest death rate in the
state and the third highest be-
low-the-knee amputation rate
in the nation among Medicare
enrollees.
they saw it.
The gold standard to test for
diabetes, an A1C test measures
blood sugar levels over three
diabetes has an A1C around 5
or lower. When Priscilla got
diagnosed, hers was 11.8.
Its 5.8 today, an achieve-
ment she attributed to her
commitment to eat healthier
and exercise.
In Type 2, the body becomes
resistant to its own insulin, a
hormone secreted from the
pancreas that allows cells to
use sugar in blood for energy.
Sugar builds in the blood-
stream, damaging the walls of
blood vessels, which can lead
to nerve damage and blind-
ness. Diabetes damages the
delicate system in the kidneys
that lters waste, leading to
kidney failure. It also speeds
the hardening of arteries, rais-
ing the risk for heart disease
and stroke. People with diabe-
tes are two to four times more
likely to die from a heart at-
tack than people without the
disease.
Type 2 diabetes, however,
can be managed a healthy diet
and exercise. In some cases,
lifestyle changes can help
people get of medication al-
together.
and determination and any-
one whos tried to lose weight
knows how hard that can be.
For Priscilla, that meant
tackling nearly two decades
of weight gain. Back then,
the 5-foot 10-inch native of
Corpus Christi weighed 150
and wore a size 8 dress. By
the time she was diagnosed,
she weighed 270 and wore
a size 26. To shed pounds,
Priscilla cut down portions,
gave up some of her favorite
carbs and started exercising
on a path near her home on
the Westside.
Walking turned to jogging
turned to running. She ran a
5K. Then another. She par-
ticipated in the Coastal Bend
Tour de Cure in April, the
American Diabetes Associa-
tions rst cycling race in Cor-
pus Christi. And she began to
slim down.
One day in late winter, Pris-
cilla stepped on the scale and
the number 199 appeared. She
couldnt remember the last
time she weighed less than
200.
I never thought Id see that
day again, she said. (Shes
now down to 190 and a size 16
dress).
Not only does she look dif-
ferent, she feels diferent.
Her whole perspective on
life is night and day, Danney
said. Shes excited. Shes ea-
ger.
She has more energy than
shes had in years. The old
Priscilla would spend Friday
nights on the couch in front
of the television with a pack of
Oreos. Now? Dancing like cra-
zy at a downtown nightclub.
And her condence has sky-
rocketed.
Priscilla, who runs her own
wedding photography busi-
ness, used to hate having her
photo taken. She didnt like
the way she looked. She never
wanted to be the center of at-
tention.
So, when the Corpus Christi
Hispanic Chamber of Com-
merce named her the Busi-
nessperson of the Year in Jan-
uary, the diference between
the old and new Priscilla was
on stark display.
The old Priscilla would
have hidden herself in an
oversize dress with a black
jacket, trying to be invisible.
The new Priscilla wore a spa-
ghetti strap, oor-length red
gown and scarlet lipstick. Peo-
ple stared at her as she walked
through the crowd, mingling
and posing for photographs.
That newfound condence
has changed her relationship
with herself, with kids, with
Danney.
Its like being teenagers,
like high school kids again,
he said. It brings back the
puppy love. Our kisses are
more intimate. Theyre not
like formalities.
People always tell her now,
Oh, I wish I could do it.
But they can, Priscilla said,
and they dont have to stop
enjoying life, either. She loves
food and hasnt stopped eat-
ing, but she takes a bite or two
rather than scarng down the
entire platter.
I like to taste things that
are really, really good and en-
joy them a lot, she said.
Her children are delighted
because the refrigerator regu-
larly features boxes and sacks
of leftovers.
But perhaps most impor-
tantly, she didnt fall victim
to her own stereotype, Dan-
ney said. Minorities, including
Hispanics, who are 45 or older,
who are overweight or obese
or who have a family history
face a greater risk. Instead of
accepting her fate as a slow
march toward terrible com-
plications, Priscilla decided
to make her future her own.
She was like, So what if
Im a Hispanic? So what if Im
a female? So what if Im over-
weight? Thats not going to
keep me there, Danney said.
ODDS
from 48X
Nueces County, Christus Spohn band together
to battle diabetes crisis without extra Medicaid funding
By Rick Spruill
The Coastal Bend will not
nd out how federal health
care reform will afect diabe-
tes, the areas leading health
crisis, even though the new
law is designed to x the na-
tions health care system and
expand coverage to millions
of uninsured.
Local experts say even if
Gov. Rick Perry accepted an
estimated $100 billion in ex-
tra Medicaid funding through
the Patient Protection and Af-
fordable Care Act, they are not
sure the money would help
tackle Texas $29 billion dia-
betes problem.
The problem comes into
much sharper focus for com-
munities like Nueces and San
Patricio counties, where one
in six people sufer from dia-
betes and more than 10,000
people could receive health
care through the expansion,
which is meant to extend ba-
sic health care and prevention
services to the uninsured pop-
ulation.
Texas could have immedi-
ately added up to 1.8 million to
Medicaid rolls under the act,
according to estimates. Perry,
who has nal say on accepting
Medicaid expansion funding,
has said pumping more cash
into a broken delivery model is
the wrong way. Instead, he has
called for federal lawmakers
to get out of the way for Texas
to come up with a simplied,
outcome-based approach.
Others argue the extra
funding would have helped
improve outcomes for patients
with pre-existing conditions,
including diabetes.
Nationwide, 27 states have
said no or are undecided on
whether to participate in the
expansion, according to the
latest gures.
Diabetes accounted for
almost a third of the $105 bil-
lion charged for hospital stays
in Texas in 2012, according to
a 2013 Department of State
Health Services report to state
lawmakers.
Texas hospitals, which
stand to lose an estimated
$18.6 billion in federal health
care funding through the
expansion in the coming de-
cade, have lobbied Perry to
reverse course, said Gabriela
Saenz, director of advocacy
and public policy for Christus
Health, the parent network of
the Christus Spohn Health
System. Overall, the Christus
network, which is the states
largest nonprot network, is
going to miss out on hundreds
of millions over that same pe-
riod, she said.
Saenz said as part of the
negotiations with federal
lawmakers on the framework
of the Afordable Care Act,
hospital networks agreed to
accept lower reimbursement
rates in exchange for moving
more people onto the expand-
ed Medicaid case load.
But, since Texas is not par-
ticipating, hospitals will see
lower reimbursement rates
in the face of rising costs, she
said.
Unclear prognosis
COST OF
DIABETES
Published July 7, 2013
Jesse Moreno of Sinton talks about how he has lost both his legs below the knee to diabetes complications. Moreno was uninsured when his
diabetes developed and was unable to get Medicaid.
See UNCLEAR, 51X
Unclear prognosis
Rather than wring their
hands over what they cannot
control, county leaders and
Christus Spohn have banded
together to raise the funds
needed and extend a lifeline
to outreach programs aimed at
improving outcomes for dia-
betic and obese patients.
The Afordable Care Act,
which passed in 2010, is a
necessary, if not somewhat
clumsy, rst step, many ar-
gue, on the nations path to a
sustainable health care model.
For uninsured diabetics
such as Jessie Zamora, rst
steps, even clumsy ones, make
all the diference.
CAUGHT IN THE GAP
Lean and 6 feet 1 inches tall,
Zamora stood in the dirt front
yard of his aunts home in Sin-
ton, wiping the sweat from his
shaved head, his aluminum
legs jutting beneath a pair of
knee length shorts.
Zamora, 35 and insulin-de-
pendent, was diagnosed with
Type 2 diabetes at 23, although
he said he probably had the
disease long before then.
His diagnosis came about
the time his mother died from
complications of Type 1 diabe-
tes in 2001. She was 41.
A willing worker, he was
a carpenters helper for a
contractor in Taft, a trade he
learned after dropping out of
high school and moving to
Sinton with his mother.
The $400 he earned each
week was not enough to buy
insulin, which ran about
$1,000 per month, and still
provide for his two young
daughters, he said. His wifes
wages did little to cover the
gap.
He made the best of his
situation without insurance,
ghting a disease that can
cost more than twice that of
the average Americans health
care costs.
The dying nerves in his
lower legs and feet occasion-
ally registered the pain of the
sores hidden beneath his work
boots, he said.
He sought help from Medic-
aid. He was denied because he
was still able to work, he said.
He told Medicaid ofcials he
didnt want a handout or even
a check.
I wanted to work. I just
needed the insulin, he said.
They didnt give it to me til
they cut my leg of.
In October 2008, doctors
amputated his right leg below
the knee. He lost the other leg
below the knee three months
later.
Eager to get back to work
but unable to continue as a
carpenter, Zamora said he
took a job doing data entry.
It lasted two weeks.
Im a carpenter. I dont
know computers, he said.
Hobbled and dispirited,
embarrassed and ashamed,
Zamora said he withdrew
even from his wife. Eventually,
the two separated. She remar-
ried and now lives in Portland
with their daughters.
Zamora resorted to living
on the streets, bouncing be-
tween homeless shelters and
depending on strangers chari-
ty to stay close to indigent care
providers in Corpus Christi.
He lived at the Salvation
Army because they could
accommodate his wheel-
chair, which he also received
through charity.
After spending a day in a
local emergency room ght-
ing sepsis from an infection in
his legs, a friend wheeled him
to Catholic Charities Healthy
Living & Advocacy Center on
Port Avenue.
There he met Jacki Siller,
the centers director, who
helped Zamora get the medi-
cal attention he needed. He
spent 60 days in a nursing
home, recovering from what
Siller said was a near fatal in-
fection. Through Sillers ef-
forts, Zamora gained access
to diabetes education and
programs, rehabilitation and
wound care.
She said there are many like
Zamora in South Texas. Too
many to count.
When it comes to health
care, those that live in Nueces
County are a little more fortu-
nate because at least they have
Nueces Aid (indigent care),
she said. But when you cross
the (Harbor) Bridge, theres
very little service out there,
and what there is, you have to
make as little as $200 a month
to qualify.
A TERRIBLE PROCESS
Medicaid is a taxpayer-
funded public health care
program meant to close the
gap between someones nan-
cial situation and the cost of
health care. The federal gov-
ernment distributes the funds
to the states and provides a
general framework for the
look of the program, but the
states have the power to set
their rules.
In Texas, the burden of
providing basic health care
services falls to counties,
which are authorized to fund
indigent care programs either
through a property tax levied
by a county hospital district or
a portion of a countys general
revenue fund.
Texas in 2012 carried about
3.6 million people on its Med-
icaid rolls, of which about
58,000 were in Nueces Coun-
ty, according to Texas Health
and Human Services Commis-
sion reports.
Nueces County levies a
tax while others, such as San
Patricio County, opt to use a
portion of general revenue
funds.
But as indigent care costs
rise, ofcials are scrambling
to close the gap, said Nueces
County Judge Loyd Neal, one
of few Republicans who have
publicly asked Perry to accept
the Medicaid expansion.
Texas taxpayers, particu-
larly those that own property,
already pay at least twice for
indigent care: once in county
property taxes and once to the
federal government on their
wages, Neal said.
The Nueces County Hospi-
tal District gets 16.2 cents per
$100 of appraised property
values. In 2012, that equaled
about $31 million, Neal said.
The money is dedicated to
indigent care program called
Nueces Aid, which serves
about 10,000 adults aged 19
to 64, Neal said. It cannot be
spent elsewhere.
He said county health of-
cials estimate there are about
15,000 uninsured adults not
enrolled in Nueces Aid who
might qualify for Medicaid
under the expansion.
What (the act) does is sim-
ply open the window, Neal
said. For the rst time in our
history, were going to declare
everyone aged 19 to 64 that
meets a certain income level,
eligible for Medicaid. Well,
the governor said No, were
not going to take that money.
Neal estimated that up to 75
percent now on Nueces Aid
would be eligible to move of
the countys health rolls and
onto Medicaid, through the
expansion.
If we dont cover these
people under Medicaid expan-
sion, many become eligible for
Nueces Aid, and that cost goes
up ... where do you get more
money? By raising taxes. And
were not going to raise taxes.
But how the Affordable
Care Act will afect diabetic
care for low-income patients
in the county is a part of the
unknown surrounding the
law, Neal said.
The hospital district has
partnered with Christus
Spohn to create a bulkhead
against the rising costs of
indigent care in the form of
funding through the states
Medicaid waiver program,
approved by the federal gov-
ernment.
Under the agreement, the
district commits taxpayer
funds to the hospital, which
combines that revenue with
the hospitals own net patient
revenues.
The combined funds are
sent up to the state health dis-
trict and on to Washington
where they are used to apply
for matching funds that come
back to the hospital and health
district for use in various proj-
ects aimed at curbing diabetes
complications and addressing
other chronic diseases.
The ve-year partnership,
now in its second year, is
expected to fund about $312
million in projects designed
to help ofset the costs of pro-
viding care to people who are
not insured and cannot always
pay for services.
Neal said the county is fo-
cused on programs to combat
diabetes while the city focuses
on obesity.
UNCLEAR
from 50X
See UNCLEAR, 52X
HOW STATES ARE MANAGING
THE HEALTH OVERHAUL
Plans
expansion
Not
expanding
Decision
pending
Source: Kaiser Family Foundation
Data current
as of July 1
$31 MILLION
Taxpayer funds
for annual
county indigent
care
$29 BILLION
Estimated
annual cost of
diabetes in
Texas
58,000
Medicaid
patients in
Nueces county
3.6 MILLION
On Medicaid in Texas
The waiver is a shell game, a
way of shifting taxpayer fund-
ing from local government to
state government to Washing-
ton and back down again that
is complex and cumbersome,
he said.
The most worrisome popu-
lation are those who are dia-
betic, obese or both, are unin-
sured, are between ages 50 and
64 and are more susceptible to
complications, Neal said.
At 65, they get picked up by
Medicare. Before then, they
may fall within a few narrow
windows for other coverage,
depending on circumstances.
But for the most part, they end
up in the emergency room.
Its a terrible process, he
said. Were sitting here with
15,000 folks these people
already are here and were
paying for them through the
emergency room, the city-
county health department,
Mission of Mercy, Amistad ...
or, theyre not getting any care
at all.
He said Medicaid expansion
would free up county indigent
care funding that could be
transferred to taxpayers in the
form of a tax roll back or rein-
vested in the waiver program
for more matching funds.
If I can move 8,000 of the
10,000 people now on Nueces
Aid to the expanded Medicaid
plan, I could cut the hospital
district tax rate in half, Neal
said. Instead of 16 cents, we
could make it maybe 7 or 8
cents about what we need
to run the city-county health
department, the jail (health
care) services. Or we could
redirect it.
Neal, a member of the Ur-
ban Counties Policy Com-
mittee that met regularly in
Austin with lawmakers, said
Medicaid expansion is no lon-
ger discussed in conversations
with the governor.
Its not something you talk
about up there, he said.
County judges in Harris and
Cameron counties have joined
Neal out on the political limb
asking Perry to nd a way to
draw down the funding.
These are large-county,
Republican judges asking the
governor, Please, take this
money, Neal said. The an-
swer came back: Stop barking
up that tree. Hes not going to
do anything.
DO NO HARM
In nonprofit community
health clinics, which are the
safety nets for millions of un-
insured Texans and whose
budgets are lean and services
are basic, the future remains
uncertain.
Eddy Herrera runs the
Amistad Community Health
Clinic in a medical office
building built by Christus
Spohn that Amistad pur-
chased in 2008.
The low-prole, two-story
building is within 20 yards
of the nearest bus stop in the
heart of neighborhood where
homes have bars on the doors
and windows and businesses
tend to close before dark.
Centered as it is in a region
plagued by diabetes, Amistad
regularly sees patients need-
ing acute care for diabetic
symptoms ranging from am-
putations to vision exams,
Herrera said.
In many cases, patients ar-
rive not knowing they have
diabetes, he said.
Because Amistad is a feder-
ally qualied, nonprot health
care center operating in an
area whose population receive
little to no medical care, it is
reimbursed a percentage of
the cost of each qualied visit,
Herrera said. The percentage
is determined in part by the
clinics annual report to fed-
eral ofcials.
Twenty-seven percent of
Amistads $3.3 million bud-
get in 2012 came from Med-
icaid, he said. That money is
plowed back in to the clinics
many services, including early
childhood medical treatment,
prescription assistance and
medical professionals. The
clinic recently hired a pedia-
trician and launched a pediat-
ric practice.
Medicaid is our cash cow,
Herrera said.
Given the chance, Herrera
said he would tell the governor
to shift focus from the Oval
Ofce in Washington to the
waiting rooms in places like
Amistad.
Think of the patients.
Theyre not going to get the
help they might get other-
wise, Herrera said.
Diabetics on Medicaid start
of at a disadvantage, said The-
resa King, director of clinical
operations, because Medicaid
does not reimburse at a rate
comparable to the costs of
providing the best available
drugs.
Already, theres better
medications for diabetes that
Medicaid patients do not get,
she said. We have to stick to
the $5 dollar plan.
If Medicaid is not available
and insurance is out of the
question, a diabetic typically
cuts costs by cutting back on
doctor visits, she said.
When medications cease,
blood sugar levels rise.
Prolonged neglect leads to
neuropathy, circulatory prob-
lems, kidney failure, cardio-
vascular complications, she
said. It just snowballs.
But she said she under-
stands the calculus of diabetes
for those who must make hard
choices.
When you dont have mon-
ey, medical care is going to go
after groceries, food, car pay-
ments, she said.
She said the oath of a health
care provider is to give care.
Getting paid is, or should be,
secondary.
We dont look at pay, she
said. We treat the patient.
PERSONAL CHOICE KEY
Simply expanding Medicaid
may not be enough for diabet-
ics who daily face the tyranny
of a disease that demands un-
divided attention.
Republican U.S. Rep. Blake
Farenthold was diagnosed
with Type 2 diabetes in 2011,
not long after he rst arrived
in Congress, a term lled with
votes to repeal or defund the
Afordable Care Act.
Now in his second term,
Farenthold remains a staunch
opponent of the act, but he
said experience managing
the disease has cultivated an
appreciation for the need for
more community health cen-
ters and the importance of
patients being accountable to
their choices.
Its not just Obamacare; its
any government-run health
system, he said. Theres got
to be an incentive for patients
to take care of themselves, and
doctors must be accountable
to follow up. Both must have
a skin in the game.
In Oregon, diabetes was
better diagnosed and man-
aged after the state expanded
Medicaid in 2008, but patients
blood sugar levels did not go
down, according to a study
published in May by the New
England Journal of Medicine.
The study, done by a team
of experts from the Massa-
chusetts Institute of Technol-
ogy and the Harvard Univer-
sity School of Public Health,
tracked two years of data from
new Medicaid enrollees in Or-
egon, which in 2008 opted to
expand coverage through a
lottery program.
The study did reveal posi-
tive outcomes in the form of
fewer catastrophic medical
expenses and improved men-
tal health but did not tie it
back to overall improvements
in public health, suggesting a
tenuous connection between
expanded funding and long-
term savings.
Farenthold said the Harvard
study suggests an inherent and
perhaps unintended aw in
the Medicaid expansion plan:
linking patient outcomes with
reimbursement rates.
It took three visits for
my doctor to balance out the
meds, Farenthold said. Under
Medicaid expansion, the rst
two visits would be considered
bad outcomes the doctor would
not be compensated for.
THE OPEN ROAD
Zamora, who lives on about
$700 per month from Social Se-
curity disability and Medicaid
benets for his diabetes, still
tries to keep busy.
Because he does not own
a car, he does odd jobs when
opportunities arise, particu-
larly those that take him the
few miles to Portland where
he can see his daughters. And
though standing for long hours
on his prosthetic legs renders
him unable to continue work-
ing in construction, Zamora
has turned his sights on the
open road.
Id like to learn to drive the
tractor-trailers, he said. I can
drive a car.
The mere mention of his
two girls, who now are 13 and
11, brings a wide smile..
He also smiles and laughs
when asked about his other
great love: basketball.
Zamora played basketball
and football at Sanger High
School in Sanger, Calif., his
birthplace just outside of
Fresno.
After guring out how to
walk on prosthetics, a process
that therapists said would take
a year but that he gured out in
a few months, he found his way
back to the courts.
He plays pickup games with
friends and family, getting re-
acquainted with himself as an
athlete, relearning after almost
ve years what it is to jog up
and down the court, charge the
basket, draw a foul.
He hopes to join a league for
those with disabilities this fall.
I think I still got it.
UNCLEAR
from 51X
Its a terrible process. Were sitting here with
15,000 folks these people already are here
and were paying for them through the emergency
room, the city-county health department, Mission of
Mercy, Amistad ... or, theyre not getting any care at all.
Loyd Neal, Nueces County Judge
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
When Sunny McKinny was diag-
nosed with Type 2 diabetes in April,
the 5-foot 1-inch rst-grade teacher
was considered morbidly obese.
She had been dieting since high
school, giving up carbs, counting
calories, cutting sugar, salt and
oil from her plate. While she lost
weight, once up to 30 pounds, she
inevitably regained it and more.
With McKinny, 48, facing an
elevated risk for life-threatening
complications such as heart attack
or stroke brought on by diabetes,
her primary care doctor, to her
surprise, recommended weight
loss surgery.
Like many patients, McKinny at
rst was skeptical about a proce-
dure she considered merely cos-
metic. But with research touting
surgery as a way to reverse diabe-
tes, McKinny became convinced
it was worth changing her anato-
my, altering her eating habits for
the rest of her life and spending
thousands because her insurance
company has not agreed to cover
it. (Weight loss surgeries can cost
up to $35,000.)
A tool to
survive
Weight loss surgery gives
woman chance to beat diabetes
while honoring her son
COST OF
DIABETES
Published August 4, 2013
Sunny McKinny stands in her kitchen two week after weight loss surgery, 14 pounds lighter. McKinny is slowly retraining her body to eat with a smaller stomach.
See SURVIVE, 54X
For her, surgery promised
not only an opportunity to
treat her diabetes, but also a
chance to live a longer, health-
ier life and be there for her
children, her grandchildren
and her parents.
I need to not let this dis-
ease control me, she said.
Increasingly, people turn
to surgery as a treatment for
Type 2 diabetes as studies con-
tinue to show weight loss sur-
geries not only help patients
shed pounds but also dramati-
cally reduce their blood sugar
levels, a phenomenon that re-
mains somewhat of a scien-
tic mystery. In one study, 68
percent of patients went into
remission, according to re-
search published last year in
the journal Obesity Surgery.
Some patients have even
seen instant results with their
blood sugar levels returning to
normal immediately following
surgery.
But surgery is hardly a cure.
I think its a mistake to
think of a surgery as a magic
thing in and of itself, said Dr.
Donna Ryan, an obesity re-
searcher in Baton Rouge. Its
a tool to help people change
their lifestyle.
The same study found that
35 percent of those patients
who reversed their diabetes
redeveloped the disease with-
in ve years. That happens in
part because patients regain
weight when they dont stick
to their strict diets and fail to
get enough exercise.
This is a lifelong commit-
ment, said Dr. John E. Ander-
son, president of medicine and
science for the American Dia-
betes Association. (Surgery)
is not just a cure.
Some also theorize patients
relapse because diabetes may
already have done too much
damage to their pancreas,
which has sparked a debate
in the health care communi-
ty. Should surgery be the last-
ditch option after diet, exer-
cise and weight loss pills and
other treatments have failed?
Or should patients consider it
early on, before diabetes has
started to wreak havoc on
their bodies?
While the American Diabe-
tes Association has not taken
a formal stance in that de-
bate, Anderson said diabetics
should know that weight loss
surgery is an option for them.
And in the Corpus Christi
area, where one in six people
has the disease and compli-
cations rates are among the
worst in the nation, weight
loss surgeries are now becom-
ing an option locally.
Bariatric surgeons from San
Antonio and Victoria have
long advertised their services
here, but patients had to travel
out of town to get the proce-
dures.
In 2011, Corpus Christi
Medical Center became the
rst in the city to provide the
three most popular surger-
ies. The hospital did so in re-
sponse to the Corpus Christis
obesity crisis highlighted by
Mens Health Magazine in
2010, which named the city
the fattest in the nation, said
Jessie Newman, bariatric co-
ordinator.
Two surgeons now operate
at Bay Area Hospital, includ-
ing McKinnys surgeon, Dr.
Lloyd Stegemann. They have
performed 270 procedures at
the hospital, which is working
toward becoming nationally
accredited for weight loss sur-
gery.
Ofcials say they hope by
providing a local option for
surgery they can improve Cor-
pus Christi patients outcomes
over the long term.
We know the closer a
patient is to the center, they
better they do because they
follow up, Newman said. If
you have to travel 200 miles
to a doctors appointment a
year after surgery, youre more
likely to be like, Meh. I wont
go.
PROCEDURE EMBRACED
McKinny thought about
weight loss surgery before,
but never seriously, until she
was diagnosed with diabetes.
The diagnosis wasnt too
surprising. Her mother has
Type 2 diabetes and takes in-
sulin, meaning McKinny has a
genetic predisposition for the
disease. Still, McKinny was
disappointed.
I knew, at my size, it was
going to happen, although you
never want to think its going
to happen to you, she said.
I didnt take care of myself.
I didnt exercise. I didnt eat
properly I was heartbroken
that I allowed this to happen.
McKinnys initial skepti-
cism about bariatric surgery
is common among patients
and some in health care who
SURVIVE
from 53X
Dr. Lloyd Stegemann, who works in Corpus Christi and San Antonio,
starts weight loss surgery on Sunny McKinny in July at Victory Medi-
cal Center in San Antonio.
NEAREST CENTERS OF EXCELLENCE
The following facilities have received national accreditation for weight loss surgery. Individual
surgeons who operate at those centers also receive certicates of designation but those designations
are not available for public search as the Metabolic and Bariatric Surgery Accreditation and Quality
Improvement is undergoing re-evaluation. Corpus Christi Medical Center Bay Area Hospital is working
toward getting designated as a Center of Excellence.
FACILITY LOCATION DATE OF ACCREDITATION
Doctors Hospital of Laredo Laredo Dec. 7, 2012
Laredo Medical Center Laredo Jan. 4, 2011
McAllen Heart Hospital,
DBA South Texas Health System McAllen April 9, 2010
Rio Grande Regional Hospital McAllen Feb. 6, 2007
Foundation Surgical Hospital
of San Antonio San Antonio Nov. 25, 2009
Methodist Specialty
and Transplant Hospital San Antonio Dec. 30, 2005
Methodist Texan Hospital San Antonio April 9, 2010
Metropolitan Methodist Hospital San Antonio Nov. 18, 2011
Nix Hospital San Antonio May 31, 2007
Northeast Baptist Hospital San Antonio Nov. 27, 2007
Southwest General Hospital San Antonio May 22, 2008
Citizens Bariatric Center Victoria Jan. 13, 2006
DeTar Hospital Victoria March 7, 2012
Source: Metabolic and Bariatric Surgery Accreditation and Quality Improvement
See SURVIVE, 55X
have long thought of weight
loss surgery as an elective
procedure rather than as a
treatment for Type 2 diabetes,
Ryan said.
In their mind, its a cos-
metic procedure because you
drive down the road and see
the billboard with the before-
and-after pictures, she said.
Its been cosmetically mar-
keted, and I think physicians
have been leery of it.
But at least 15 years ago,
surgeons began noticing how
weight loss surgeries reversed
diabetes. In recent years, doc-
tors and insurance companies
have started to embrace the
procedures as a way to curb
an expensive chronic disease.
These dramatic results in
Type 2 diabetes are helping to
move that needle, Ryan said.
Still, scientists arent pre-
cisely sure why surgery has
such a dramatic efect on dia-
betes.
Researchers believe some-
thing other than weight loss
may be playing a role, such
as gut hormones. That could
explain why more invasive
procedures that rearrange the
gastrointestinal tract seem to
be more efective at reversing
diabetes than the gastric band
surgery.
After researching the sur-
geries, McKinny opted for
gastric sleeve, a newer and in-
creasingly popular procedure
in which a surgeon removes
80 percent of the stomach.
I have a shot at not hav-
ing this, she said. I have to
accept what the research is
showing and what the doctors
are telling me.
Sleeve surgery is more inva-
sive than the more well-known
band procedure, where a band
is placed over the stomach to
limit food intake. And unlike
the band, sleeve surgery is not
reversible. But its shown more
success at reversing diabetes.
Among 20 patients with un-
controlled diabetes who had
gastric sleeve surgery, half
were in remission a year lat-
er, according to research pub-
lished in the journal Surgery.
BENEFITS CLEARER
Weight loss surgeries have
become more popular in part
because they are safer than
they used to be, said David
Arterburn, investigator at the
Group Health Research Insti-
tute in Seattle who has studied
surgerys efect on diabetes.
Surgeons are able to work
inside a patients abdomen us-
ing a few small incisions and
thin instruments, reducing the
chance of infection and speed-
ing recovery time for patients.
But, as with any surgery, there
are risks, such as blood clots
and infections, and research-
ers still lack good data beyond
20 years about the long-term
efects.
Both patients and provid-
ers tend to have a lot of res-
ervations about these proce-
dures, Arterburn said. Most
procedures are permanent.
They are not easily reversible
and they do require dramatic
changes overnight in lifestyle
and the types of foods that you
can eat and tolerate.
Surgery also requires
lifelong changes. A smaller
stomach means meals must
be healthy and no bigger
than what a 5-year-old would
eat, meaning patients must
take vitamin and mineral
supplements for the rest of
their lives. And there are
consequences for those who
splurge and cheat, including
nausea, vomiting and eventu-
ally weight regain, which can
cause diabetes to return.
Still, for newly diagnosed
diabetics like McKinny who
have had little success losing
weight with diet and exercise,
surgery is becoming one of
the best solutions, prompting
a growing number of doctors
to consider calling for it as a
treatment.
Although there are cer-
tainly some unanswered ques-
tions about the risks, some of
the benefits are becoming
clearer, Arterburn said.
Those benefits far out-
weighed potential risks for
McKinny, so on a Wednes-
day night in July, she packed
a pink polka dot suitcase and
headed to San Antonio. (Al-
though Stegemann primarily
operates at Corpus Christi
Medical Center he also does
procedures at Victory Hospi-
tal, which allowed the Caller-
Times access to the surgery.)
As her husband, Gary, drove
2 hours north, McKinny ap-
peared calm, committed to her
decision.
Before surgery, she under-
went scoping procedure to
examine her stomach, receive
a psychological examination
and consume nothing but liq-
uids for two weeks.
Then, in the middle of her
preparations, her youngest
son, Caleb, 21, died suddenly
in a car accident. Her surgical
team questioned whether she
was too wracked with grief
to handle the life-changing
surgery at the same time. But
McKinny saw it as a tribute to
her sons memory. Caleb, too,
struggled with his weight and
the two talked often about it.
I dont want you to end up
like me, McKinny would tell
him. Im a horrible example.
In the months before he
was killed, Caleb repeatedly
encouraged his mom to get
surgery.
Mom, youve got to do
this, he told her.
On her trip to San Anto-
nio, McKinny thought about
her son and his enthusiasm
for the procedure. His fervor
once seemed odd to McKinny
but now held a special, almost
spiritual meaning.
She choked back tears. Her
only fear, she said, was that
she would somehow fail again
and regain the weight.
At 8:30 a.m. the next morn-
ing, McKinny was brought to
the operating room, already
under anesthesia, where
Stegemann and his team
awaited.
SLEEVE SURGERY
The surgical team made
six incisions in her abdomen
and inserted a tiny camera so
Stegemann could work within
her abdominal cavity, watch-
ing his work magnied by 10
times on a television screen
positioned over McKinnys
left shoulder.
Surgery can be tricky in
overweight patients because
their organs often are ob-
scured by pillows of abdomi-
nal fat.
Sometimes we cant even
see the stomach, he said.
McKinny was in better shape
than most of his patients, he
said.
Stegemann spent the rst
few minutes using the camera
to examine McKinnys stom-
ach, liver and spleen.
He pointed to the blotchy,
bumpy surface of her liver,
indicating that McKinny has
cirrhosis, or scarring, brought
on by obesity.
This lady is not a drinker
but her liver looks exactly like
an alcoholics liver, he said.
In the gastric sleeve pro-
cedure, the surgeon removes
ELIGIBILITY
The following may make you
a candidate for weight loss
surgery:
You have a body mass
index (BMI) greater than
40. (Someone who is 6 feet
tall and weighs more than
295 pounds has a BMI more
than 40).
You have a BMI greater
than 35 and obesity-related
health problems, such as
diabetes, sleep apnea,
arthritis, that can be
reversed with surgery.
Traditional weight loss
methods such as diet and
exercise havent worked.
You are committed to
making permanent lifestyle
changes after surgery.
You understand the risks
and benets of surgery.
Source: WebMD.com
SURVIVE
from 54X
See SURVIVE, 56X
Surgeons at Victory Medical Center in San Antonio use a video monitor to perform weight loss surgery on
Sunny McKinny in July. The process the surgeons are watching is the stapling of the stomach.
the portion of the stomach
called the greater curve, or
the stretchy part that ex-
pands when you overeat,
leaving only the 20 percent of
the stomach called the lesser
curve, which is about the size
and shape of a banana.
To do that, Stegemann rst
had to disconnect McKinnys
stomach from the surround-
ing fat tissue by cauterizing
the blood vessels attaching
the two. Once the stomach
was free, an anesthesiologist
inserted a 2 foot tube into
McKinnys mouth, down her
throat all the way to the bot-
tom of her stomach. The tube
filled the stomachs lesser
curve and served as a guide
to Stegemann to determine
where to cut. Using a tool in-
serted through a tube in McK-
innys abdomen, Stegemann
stapled along the length of
her stomach, creating a seam
that sealed 20 percent of her
stomach and cut of the rest.
The stapling must be pre-
cise: If Stegemann left too
little of the stomach, McK-
inny could face nausea and
vomiting. Too loose, and she
would struggle to lose weight.
There is also a risk for leaks if
the seam isnt sealed properly.
To double check the work, the
surgical team clamped of her
bowel, inated her stomach
with air and inserted a camera
to look inside, then sprayed
the seam with water, looking
for bubbles like checking a bi-
cycle tire for punctures.
Satisfied, Stegemann re-
moved the rest of McKin-
nys stomach, pulling it out
through a small incision on
her right side. Stegemann and
his team stitched the incisions
closed and by 10 a.m., she was
on her way to post-op.
By Saturday, she was home
at her farmhouse in Taft.
LOOKING AHEAD
While surgeries lead to
dramatic weight loss in
Sunnys case, shes initially ex-
pecting to shed up to 5 pounds
per week patients also can
risk regaining that weight if
they fail to follow a proper diet
and exercise routine.
McKinny has already start-
ed the process of rediscover-
ing her relationship with food.
A self-proclaimed control
freak, McKinny could never
understand why food was al-
ways the one thing that could
make her lose control.
Now that she is anatomi-
cally restricted to a certain
diet, McKinny is learning to
eat again. She is slowly rein-
troducing foods, chewing ev-
erything to the consistency
of toothpaste. She used to
snack throughout the day,
consuming 2,000 calories
or more. Now, her lunch is
served on a dessert plate and
eaten with a toddlers fork. A
meal comprised of 2 ounces of
fresh redsh, 2 tablespoons of
green beans and 1 tablespoon
of peaches makes her feel full.
I just hope I can get
through a yogurt before it
spoils, she said.
Two weeks after the sur-
gery, her blood sugar levels
had fallen to normal ranges.
She no longer needs diabe-
tes pills. She already lost 14
pounds.
And because she had sur-
gery early on in her diabetes,
she has a greater chance of
keeping the disease in remis-
sion, Stegemann said.
The earlier I get to a dia-
betic, the better my results
are, he said. Diabetes is such
a horrible disease. The longer
you have it, the worse it gets.
McKinny will likely con-
tinue to shed pounds, even if
she doesnt exercise, but that
weight loss should level of
within 12 months, and McK-
inny already is planning for
that. She and her husband are
transforming the barn near
their farmhouse in rural Taft
into a mini-gym with a tread-
mill, a recently purchased
rowing machine and a weight
machine now covered in cob-
webs in their garage.
If I can do it, anybody
could, and should, she said.
QUESTIONS FOR
YOUR SURGEON
Is this the right time for
me to consider weight loss
surgery?
Which type of weight loss
surgery is best for my
situation?
How will the surgery help
me lose weight?
What are the risks of this
surgery?
How could surgery affect
other health conditions I
have?
How long will I be in the
hospital, and off work
recovering?
What type of follow-up care
will be necessary?
How much food will I be
able to eat afterward?
Are there certain foods I
wont be able to eat?
Will I need vitamins after
my surgery and if so what
types?
When can I start exercising
after surgery?
How likely is it that Ill
regain weight after
surgery?
Are you board-certied
by the American Board of
Surgery?
Are you a member of
the American Society of
Bariatric Surgeons?
How many weight loss
surgeries do you do each
year?
How many of your patients
have died from weight loss
surgery? The average death
rate is less than 1 percent.
How often do your patients
have complications? What
side effects are most
common?
Source: WebMD.com
SURVIVE
from 55X
LEFT: Sunny McKinny
lays out her lunch of
sh, green beans and
peaches two weeks
after her weight loss
surgery. McKinny
underwent the surgery
help her get her weight
and diabetes under
control.
PHOTOS BY TODD YATES/CALLER-TIMES
ABOVE: Sunny McK-
inny keeps her food
supplements and her
food journal handy on
the kitchen counter.
Because of her weight
loss surgery Sunny
will have to take the
supplements the rest
of her life.
Rates are
higher than rest
of state, nation
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
The biggest health threats
in South Texas are obesity
and diabetes, a newly released
study found.
South Texas has higher
rates of obesity and diabetes
than the rest of the state and
nation, with nearly one-third
of South Texans classied as
obese. About one in nine has
been diagnosed with diabetes.
The statistics were worse
for Hispanics, which have a
higher prevalence than whites
for both diseases.
And Hispanics in South
Texas fared worse than those
living elsewhere, according to
the South Texas Health Status
Review recently published
by the Institute for Health
Promotion Research at The
University of Texas Health
Science Center at San Anto-
nio.
The study examined health
disparities in the 38-county re-
gion encompassing the border,
Coastal Bend and San Anto-
nio, an area where people are
less educated, lower-income
and have less access to heath
care. Two-thirds of residents
are Hispanic and almost 30
percent are uninsured.
Whats happening in South
Texas could predict the future
for the rest of the country, said
Michael J. Wargovich, profes-
sor of molecular medicine
at The University of Texas
Health Science Center at San
Antonio.
We are the United States
of 2050, he said. All the
battle on the front lines here,
especially in Hispanics and
the constellation of diseases,
is what the U.S. will experi-
ence by the half-century Well
be a Hispanic nation and with
that, experience all the prob-
lems that are coming along,
with obesity and diabetes and
cancer.
South Texas obesity and di-
abetes epidemic can be linked
to lifestyle choices, such as
poor eating habits and not
enough physical activity, the
study found. But that doesnt
fully explain the regions
health disparities.
About 52 percent of South
Texans dont get recom-
mended amounts of exercise,
defined as 150 minutes of
moderate physical activity per
week, and 76 percent dont eat
enough fruits and vegetables,
rates similar to the rest of the
state and nation.
Part of the problem is he-
redity obesity and diabetes
tend to run in families but
a bigger problem may be the
lack of preventive care, said Dr.
Amelie G. Ramirez, the studys
co-author and director of the
Institute for Health Promotion
Research at the University of
Texas Health Science Center
at San Antonio.
Diabetes is a silent killer be-
cause the kind of life-altering
complications that motivate
people to get healthy often
take years to develop, so regu-
lar doctors visits are neces-
sary to treat the disease early.
But South Texans fail to get
regular preventive care, with
patients getting diagnosed
with diabetes only after ulcers
develop on their feet, a com-
plication that develops after
diabetes damages the circu-
latory system, Ramirez said.
Some may not be able to
see the doctor because they
dont have health insurance.
The uninsured rates in South
Texas are double the national
average. Hispanics here had
the highest uninsured rate at
41 percent, the study found.
But even those with insur-
ance often fail to get regular
checkups, Ramirez said.
We need to educate the
community about the impor-
tance to come in for preven-
tion, she said. We are very
much a crisis-care oriented
population that seeks care in
the emergency room.
Although the study made
special note of the regions di-
abetes and obesity epidemics,
it also noted that South Texas
has a higher rates of:
Tuberculosis
Chlamydia
Cervical, liver, stomach and
gallbladder cancer
Leukemia in children
Birth defects, such as spina
bida and congenital heart
defects
Childhood lead poisoning.
Study: Obesity, diabetes
soar in South Texas
COST OF
DIABETES
Published August 25, 2013
HEALTH CRISIS
The biggest health threats in South Texas are diabetes and
obesity, a new study found.
SCRIPPS NEWSPAPERS
Percentage of people diagnosed with diabetes
Deaths linked to diabetes per 100,000 people
Nation
State
South Texas
8.9
9.3
11.6
State
South Texas
Texas Hispanics
South Texas
Hispanics
82.1
170.9
108.92
219.6
Source: South Texas Health Status Review
We need to educate the
community about the
importance to come in for
prevention. We are very much a
crisis-care oriented population that
seeks care in the emergency room.
Dr. Amelie G. Ramirez, director of the Institute for Health Promotion Research
at the University of Texas Health Science Center at San Antonio.
By Michelle Villarreal
CORPUS CHRISTI Walking through the
front door Id hear my grandmothers wooden
palote tapping the Formica counter top and roll-
ing the dough.
Tap. Back and forth.
And that smell. Mmmmmm, tortillas. The our
cooking on the gas stove drew my sister and me
to the kitchen.
We wanted to race to Grandmas side. But we
knew better. Grandpa needed a kiss hello rst.
Hi, mijita, my grandmother said as she ipped
tortillas in the pan. We greeted her with a hug and
kiss on the cheek, and without asking, she knew
what we wanted.
Curing
the culture
Lupe Villarreal makes our tortillas with her granddaughter and former Caller-Times reporter Michelle Villarreal at her home.
COST OF
DIABETES
Published September 8, 2013
South Texas families
seek mix of healthy
recipes with traditions
See CULTURE, 59X
She tore of a paper towel,
placed a hot tortilla on it and
coated the tortilla with a thin
layer of butter. The heat from
the fresh tortilla quickly melt-
ed the butter and before hand-
ing it over she rolled it like a
taco, except it didnt need any
lling.
I cradled the paper towel in
one hand and tried to keep the
tortilla rolled with the other as
I took my rst bite. The excess
our always ended up on my
ngertips, but it didnt both-
er me as I enjoyed the warm
snack.
I couldve stood next to my
grandmother and eaten each
tortilla as it came of the pan,
but I had to savor just the one
before being told to go play.
Family memories, culture
and tradition are embodied
by our food in South Texas.
Its dif cult to admit that my
grandmothers homemade
tortillas contribute to high
diabetes rates in South Texas
because admitting it somehow
distorts the memory. While
its dif cult to admit, it doesnt
change my understanding and
concerns of the health risks
associated with our food.
It is the food that helps us
grieve after someone has died.
It is the food that we share
when someone gets married.
It is the food that you miss af-
ter moving away.
It is who we are.
But it is also the food that is
killing my family and yours.
My weakness was the torti-
llas, but for others its enchila-
das, rice and beans with every
meal or pan dulce breakfasts. I
sought to nd out the connec-
tion between our food and cul-
ture, and South Texass high
rate of diabetes, and what we
can do to change that. The an-
swer isnt simple.
Mexican-Americans are
nearly twice as likely as non-
Hispanic whites to be diag-
nosed with diabetes, accord-
ing to the U.S. Department of
Health and Human Services
Office of Minority Health.
They also have higher rates
of end-stage renal disease,
kidney failure caused by dia-
betes, and are 50 percent more
likely to die of diabetes as non-
Hispanic whites.
We face those health risks
almost daily by personally
struggling with diabetes or
watching a family or friend
battle the disease.
Alicia Ramos, 74, was di-
agnosed with Type 2 diabetes
more than a decade ago.
Ramos, a Mexican native,
moved to the U.S. in 1955 and
instantly recognized the dif-
ferences in ingredients and
cooking techniques. She was
never fond of Tex-Mex but
adapted because it was aford-
able for her family of seven
children.
Ramos noticed a change in
her health when her stress lev-
els rose and she wasnt sleep-
ing. She went for a checkup
and was diagnosed with high
blood pressure, high choles-
terol and Type 2 diabetes.
Doctors prescribed her a
dozen medications, which
made her feel lethargic and
caused stomach pains, she
said.
I was having a lot of trou-
ble, Ramos said. I didnt
think I was going to make it.
Last year Ramos took con-
trol of her health and started
attending free nutrition class-
es throughout the community.
She learned about smarter,
healthier food choices such as
incorporating more fruits and
vegetables, but the one piece
of information that she stuck
with is smaller portion sizes.
Nutrition Education Assis-
tant Leonardo Trevino, with
the Texas A&M Agrilife Ex-
tension, taught one of the sev-
en week courses in July that
Ramos attended. It focused
on calorie intake and portion
control.
When you talk about nu-
trition its hard to break a
habit, Trevino said. A lot of
people get pleasure in eating
the foods they are used to, and
it usually takes something
drastic in their life for them
to change, such as them get-
ting diabetes.
With help from commu-
nity classes and doctors, Ra-
mos lost about 50 pounds in
nine months. She has doctor
checkups every three months
and is down to ve medica-
tions, which include vitamins.
She attributes her improved
health to knowing how to
enjoy cooking and not sur-
rendering to high-calorie and
high-fat foods found through-
out South Texas.
CULTURE AND TRADITION
When Ramos was 9 years
old, her mother raised chick-
ens, pigs and vegetables while
Ramos worked in homes and
hospitals, trying to earn mon-
ey and learning how to cook.
I remember the things that
my grandmother and mother
taught me, she said. I never
went to school, but I know the
customs.
Ramos raised seven boys
and quickly learned how to
cook meals that would feed
her large family.
Foods such as enchiladas,
posole, Mexican rice, beans
and tamales were prevalent in
her kitchen, but she said her
traditional homemade reci-
pes difer greatly from those
dishes served in restaurants
and many homes in Texas.
Nobody here cooks like
they cook in Mexico, Ramos
said.
Ramos said her grandmoth-
er used lard in her cooking.
She didnt waste any parts of
an animal. Much of the cook-
ing was done slowly in out-
side ovens that are similar to
a grill. Ingredients now vary
and are more accessible so
Ramos no longer uses lard in
her tamales replacing it with
Crisco, and adding broth to
the masa mix.
After she was diagnosed
with several diseases, she
didnt drastically change her
recipes or foods she enjoyed
but paid more attention to how
much she ate.
Ramos children are grown
and no longer live with her so
she doesnt nd the need to
make large meals, unless they
visit, she said. She also likes
vegetables so it was easy to
incorporate them in her daily
meals.
Ramos prefers cooking in-
stead of eating at restaurants
because she doesnt care for
the food and the portions
often are double what she can
handle, she said.
A bacon and egg taco at
a local Tex-Mex restaurant
was equivalent to two tacos
she typically makes at home,
Ramos said.
Its not just a Corpus Chris-
ti problem, but a United States
one, she said.
According to an analysis
last year about restaurant por-
tion sizes, 96 percent of Amer-
icas chain restaurant entrees
fell outside the range of U.S.
Department of Agriculture
recommendations for fat,
saturated fat and sodium per
meal.
The study, published in the
journal Public Health Nutri-
tion, examined menu items
at 245 restaurants across the
country. A majority of dish-
es were below the USDAs
667-calorie limit per meal, but
they did not meet the require-
ments for fat, saturated fat and
767-milligram limit of sodium.
I know Mexican food is
FOOD FACTS
TAMALES
Tamales come in many variations but originally started with the
Aztec and Maya civilizations in Mexico.
Tamales were used as a portable food for armies, hunters and
travelers, a concept later adopted by migrant farm workers.
They didnt use any pork products that are now traditionally used
as lling, but instead lled them with sh and tadpoles. They also
used nuts for the oil instead of lard.
With colonization and migrations, tamales made their way to
South Texas.
Tamales also were a way for women to display their skills
because they were labor intensive and time consuming.
CHIPS AND SALSA
U.S. restaurants and bars started serving the Tex-Mex snack in
the 1970s as a way to entertain customers during happy hour.
The snack appealed to the upper working class who had money
to spend on alcoholic drinks after work.
See CULTURE, 60X
CULTURE
from 58X
I know Mexican food is really
good, but a lot of it comes
down to portion sizes. (Restaurants)
serve us a lot and when we get the
food we eat it all.
Leonardo Trevino, nutrition education assistant with Texas A&M Agrilife Extension
really good, but a lot of it
comes down to portion sizes,
Trevino said. (Restaurants)
serve us a lot and when we get
the food we eat it all.
HISTORY OF TEX-MEX
There is no consensus to
what denes Tex-Mex. Varia-
tions of the food depend on re-
gion and economic status but
they each share ingredients
and cooking processes that
were adopted from Mexican
cuisine.
Tex-Mex is most commonly
thought of as an adaptation of
Mexican food, but it is a re-
gional hybrid food inuenced
by Mexican, Native American,
African-American and Euro-
pean culture, including Span-
ish and German, ingredients
and cooking techniques, said
Norma Crdenas, assistant
professor of ethnic studies
and Chicano-Latino Studies
at Oregon State University.
Most people think of Tex-
Mex as rice, beans and en-
chiladas, but it is made up of
ingredients and spices that
make the cultural food a fa-
vorite. The combination of
chilies, tomatoes, meats and
cumin infuse the senses with
a spicy aroma.
A well-seasoned molcajete,
a Mexican mortar and pestle,
carries avors from previ-
ously prepared ingredients as
they are crushed, ground and
embed in the stone.
These ingredients and tech-
niques serve as foundations of
Tex-Mex.
The change is westerniza-
tion and wanting to live the
American dream, Ramirez
said. But whats being mar-
keted to us is not always
healthier products ... but you
can feed your family for $10.
ADDRESSING THE ISSUE
Low-income families tend
to buy cheaper food that is
more calorie-dense and ll-
ing because energy-dense
foods are more afordable,
according to a March study
of 20 low-income, Spanish
speaking families. Processed
foods are more palatable and
easier to prepare than nonpro-
cessed foods. The high con-
sumption of those foods has
been linked to obesity, Type 2
diabetes, and cardiovascular
disease.
The quality of Tex-Mex
food has been widely criti-
cized and stereotyped as un-
healthy and inexpensive, but
nonetheless it remains a staple
in South Texas because of its
ties to identity and culture.
Because of cost and acces-
sibility Hispanic food prod-
ucts such as sauces, burritos,
tortillas, fajita meat, rice and
enchiladas are easily found in
grocery stores and markets
throughout the Coastal Bend.
Many Mexican food prod-
ucts sold in the U.S. do not
contain lard, but because
of tradition it is still used in
some Mexican recipes such
as tamales and pan de polvo.
Most Tex-Mex dishes also are
deep-fried. Border Mexican
cities also ofer many deep-
fried dishes, but the cooking
method differs from more
southern Mexican cooking
where foods are often boiled,
baked or pan fried. Tex-Mex
cooking also contains added
toppings such as cheese and
sour cream that are used in
excess.
About 12 percent of South
Texan adults have been diag-
nosed with diabetes, accord-
ing to a recent South Texas
health study. The percent-
age of adults with diabetes in
South Texas was higher than
the estimated 9.3 percent with
diabetes in the rest of Texas
and about 9 percent with dia-
betes nationally.
Salud America, a project of
the Institute for Health Pro-
motion Research at The Uni-
versity of Texas Health Sci-
ence Center at San Antonio,
targets Hispanic children in
preventing obesity. Director
Amelie Ramirez started fo-
cusing on Hispanic outreach
in 1992 after serving on na-
tional health committees and
realized there was far less
information and statistics on
Mexican-Americans health.
The organization, which
started in 2007, now has a
network of about 2,000 health
care specialists, educators and
community leaders who con-
tribute to and benet from the
organization.
We wanted to educate and
mobilize the Latino communi-
ty, Ramirez said. We want to
make health the right choice,
the easy choice. We dont want
them to go looking for it.
The organization takes a
proactive approach to pre-
venting obesity and diabetes
by targeting children, but
Ramirez said it ofers tips, vid-
eos and recipes for Hispanics
of all ages.
Were now the largest mi-
nority, she said. The data, for
the longest time, was white,
black, other and then Asians.
The research kept lumping us
into other. Weve been asking
for better data in our Latino
Alicia Ramos squeezes lime into a traditional posole at her apartment.
Alicia Ramos makes a traditional posole.
CULTURE
from 59X
See CULTURE, 61X
community and were nally
getting to that point. People
are recognizing we are the
future.
SMALL CHANGES ARE BIG
Grandmothers tamale or
mole recipe wont be the same
if many of the ingredients are
swapped for healthier options.
So educators and nutritionists
are taking a more subtle ap-
proach to changing Hispanic
diets.
For the most part we need
to learn and reclaim some of
those older recipes from our
ancestors that served them
well and protected against
diabetes and obesity so we
dont fall prey to those trends
for accessibility, Crdenas
said. Some have been lost
because of colonization or
convenience, so how do we
reclaim that?
One of the easiest changes
is switching from our to corn
tortillas, which is a diference
of 255 milligrams of sodium, 35
calories and 15 calories from
fat.
Randolph J. Widmer, as-
sociate professor of anthro-
pology at the University of
Houston, said many Houston
doctors already are encourag-
ing patients with diabetes to
make that switch.
Small changes instead of
drastic ones are a way to en-
sure patients will adhere to a
healthier diet and still allow
them to enjoy the foods asso-
ciated with their culture.
Food is such a traditional
item, Ramirez said, so slight-
ly tweaking them is a start at
making a diference.
We want to make the
healthy choice the easy
choice, Ramirez said. Bet-
ter foods in schools and neigh-
borhoods, healthy and more
responsible marketing and
encourage the consumption
of water. Modest changes we
can make big steps for.
My grandmother used to
make homemade our torti-
llas with Crisco, our, bak-
ing powder and salt. In the
1990s, she switched to a more
processed tortilla mix because
it was quicker to make torti-
llas and dinner after coming
home from a long day at work.
By 2000, she stopped mak-
ing our tortillas all togeth-
er. She had foot surgery that
year, and it was too painful
for her to stand for long peri-
ods of time. She also stopped
because she had to cut back
on cholesterol and fat, and
switching to corn was a
smart, easy choice.
Corn tortillas dont have
the fat our tortillas have but
they can still be bad for you
when you have too much, my
grandmother Lupe Villarreal
said. Its OK to have (our
tortillas) once in a while. Dont
neglect your taste buds all the
time.
Hearing my grandmothers
palote on the kitchen counter
brings back a ood of family
memories that make me feel
proud of my culture and tra-
dition. But it makes me feel
better to know that my grand-
mother made a choice to live a
healthier life.
CULTURE
from 60X
1 H-E-B BRAND FLOUR TORTILLA
Calories: ................................................. 90
Calories from fat: .................................. 20
Total fat: ............................................. 2.5 g
Sodium: ........................................... 260 mg
Carbohydrates: .................................. 15 g
Protein: .................................................. 2 g
1 H-E-B BRAND YELLOW CORN TORTILLA
Calories: ................................................. 55
Calories from fat: .................................... 5
Total fat: ............................................. 0.5 g
Sodium: ............................................... 5 mg
Carbohydrates: ............................... 11.5 g
Protein: .................................................. 1 g
CORN VS. FLOUR TORTILLAS
RACHEL DENNY CLOW/
CALLER-TIMES
Antonio Williams and Veronica Espinoza, students at Del Mar College, prepares ingredients for a healthy arroz con pollo and posole at the
schools west campus.
Taking action
is key
apathy [AP-uh-thee] noun:
absence or suppression of passion, emotion or excitement
Its acceptable, and it
shouldnt be acceptable
COST OF
DIABETES
Published October 13, 2013
Matthew Moreno picks up a to go order of brisket for dinner at the Bill Miller Bar-B-Q restaurant near his home.
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Here at the epicenter of an
epidemic of diabetes compli-
cations, awareness isnt the
problem. Action is.
In Americas Fattest City,
Type 2 diabetes is just an ac-
cepted part of life, like humid-
ity and potholes.
Although community
health studies and surveys re-
peatedly identify diabetes as
the citys No. 1 health crisis,
the city continues to grapple
with the question of what to
do about it.
Theres a cultural accep-
tance of diabetes as a normal
part of our population, said
Maryanne Strobel, Christus
Spohns diabetes care coor-
dinator.
Twelve years after the Dart-
mouth Atlas named Corpus
Christi the No. 1 place for be-
low-the-knee amputations, the
city still ranks in the top at No.
6. Nueces County ranks third.
Local diabetes rates are
more than double the national
average and an estimated 42
percent of people in Nueces
County are obese, according
to the latest statistics. The re-
gion has some of the highest
rates of complications, such as
and death.
That attitude may be con-
tributing to the citys repu-
tation as a place where the
healthy choice is the hard
choice.
Its acceptable and it
shouldnt be acceptable, said
Cinia Clarich Montoya, who
launched a short-lived city-
wide tness challenge after
the Fattest City designation
in 2010. People are just used
to it. And you shouldnt get
used to it.
Still, local initiatives aimed
at tackling diabetes and obe-
sity disappeared, zzled away
or fell short.
As part of its yearlong se-
ries exploring the epidemic of
Type 2 diabetes in the Coastal
Bend, the Caller-Times exam-
ined how the city has respond-
ed to the crisis. Beyond the
problems already reported by
the newspaper the lack of
a vast and well-funded health
care safety net thats worked
to curb diabetes in other cities,
and diabetes classes that have
been systematically closed,
defunded or scaled back the
city has strained to gure out
how to get a handle on an epi-
demic that feels overwhelm-
ing. Invisible almost.
Matthew Moreno, 29, comes
from a long line of people af-
icted with diabetes. A grand-
mother needed dialysis. So did
an uncle. Both later died. His
little sister, Martina, 16, was
diagnosed with Type 2 when
she was just 13.
Two years ago, Matthew
had a feeling something was
wrong.
He borrowed his sisters
glucometer, pricked his nger
and touched the blood drop-
let to a test strip. The number
294 appeared on the screen,
2.5 times normal range. Once,
his sugar level was too elevat-
ed for the meter to calculate
a number.
HIGH was all it read.
Persistently high blood sug-
ar levels like Matthews lead to
serious complications such as
blindness, kidney failure and
amputations.
But Matthew doesnt have
diabetes. At least not ofcially.
See ACTION, 64X
DIABETES RATES
Nueces
County
Texas United
States
42.3
%
29.8
%
35.7
%
Nueces
County
Texas United
States
17.3
%
10.4
%
8.3
%
OBESITY RATES
$17.5
$16.7
$5.3
$6.6
$5.2
Private
insurance
Medicare
Other
Out of
pocket
Medicaid
Where Nueces
County ranks
in the nation
3rd
Complications develop gradually but
are preventable by:
Controlling blood sugar with smart
eating.
A little exercise.
Stress management.
High rates of amputations are a sign
that the disease is poorly controlled.
Diabetes is the No. 1 reason for
nontraumatic* below-the-knee
amputations.
BELOW-THE-KNEE
AMPUTATIONS
DIABETES IS EXPENSIVE
Nueces County
ranked 41st in the
state for per capita
diabetes hospital-
ization costs,
racking up an
average of
$91.50
for every man,
woman and child
living in the county.
WHO PAYS FOR THAT
in billions
The disease is the nations seventh
costliest and cost the nation
$51.3 billion
in 2010.
HOW BAD IS IT? WHY DOES IT MATTER?
SCRIPPS NEWSPAPERS
*not caused by an accident
He hasnt been to the doctor
for an ofcial diagnosis and
has no plans to go, despite his
mothers pleas.
I probably already know
what theyre going to tell me,
he said. Im not scared, real-
ly. He paused. Well, I know
Im scared. I dont know how
to explain it. I just dont like
going to the doctor.
The sheer prevalence of di-
abetes and diabetic complica-
tions breeds a kind of fatalism
that saps away motivation to
change, ofcials say.
And with long family histo-
ries of diabetes, many people
assume theyll get it at some
point. Worse, they expect to
sufer the same fate as their
parents and grandparents:
amputations, kidney failure
and lives cut short by strokes
and heart attacks. Although
those complications are pre-
ventable.
You have to have some sort
of motivation to give a darn
about it, said Dr. Stephen Pon-
der, a pediatric endocrinologist
who worked for years on the
front lines of the citys diabe-
tes crisis until he moved away
in 2010. Yes, you can make a
diference. You dont have to
accept the fate that diabetes
is preordained. That was the
biggest challenge I had to take
up when I saw patients. Fatal-
ism is rampant down in Cor-
pus Christi and down in South
Texas.
Its the first thing Pon-
der noticed when he started
practicing in Corpus Christi
in 1998. At a lecture once,
Ponder showed a photo of a
family: grandparents, parents,
children. Every person in the
picture had Type 2 diabetes
except one: the baby.
It gets baked in, he said.
All they know is one parent
after another parent, grand-
parent after grandparent who
have succumbed to diabetes.
Apathy and fatalism are
rampant in a city known for
its inferiority complex. That
same attitude stymied eforts
to do something about the Me-
morial Coliseum and the di-
lapidated old Nueces County
courthouse and sowed doubt
that Schlitterbahn would ever
build in Corpus Christi, said
Mary Afuso. After the Fattest
City designation, she set out
to lose weight in a public t-
ness challenge that featured
a dozen community leaders.
Shes since lost 60 pounds.
Its not just tness, she
said. Its the same people who
say we dont have anything
here and our city is dirty, but
they wont pick up a diaper in
the parking lot.
She compared Corpus
Christi to Austin, known for
its obsession with healthy eat-
ing and exercise.
Austin is a great town and
Austin loves itself, but its not as
great of a town as it thinks it is,
she said. We are a much better
town than we think we are.
But changing that mindset,
especially when it comes to
the diabetes, has proved elu-
sive to city leaders because the
disease is woven into the citys
social and cultural fabric.
Jacki Siller, who ran a suc-
cessful diabetes program for
two years before the state
stripped its funding, charac-
terized the response as slow
and fragmented.
I think that if someone
who has diabetes accepts it, so
does the rest of the commu-
nity, she said. I think it takes
some real pioneers and people
to think outside the box and be
passionate about it. Because
we know its not easy.
Over the years, local doc-
tors have repeatedly expressed
frustration with their patients,
calling them noncompliant for
failing to follow their instruc-
tions to diet, exercise and take
their prescribed medication.
And that frustration propa-
gates a vicious cycle. Doctors
fed up with noncompliant pa-
tients stop trying to get them
to change. And patients no
longer get the information
they need to change.
But that noncompliant label
doesnt take into account the
other obstacles patients face
to get healthy, especially those
who are low-income or under-
educated.
Health care ofcials call
these barriers to care.
Patients sometimes dont
fully understand their doctors
instructions, especially when
it comes to diabetes, a com-
plex disease thats difcult to
manage, even for experts.
They dont have a car to get
to appointments or money to
buy medicine. They live in
neighborhoods without access
to healthy food options or safe
places to exercise.
I dont know that its all
apathy, said Dr. Melissa Wil-
son, an endocrinologist who
served on the Texas Diabetes
ACTION
from 63X
See ACTION, 65X
CALLER-TIMES FILE
Dr. Stephen Ponder examines Christopher Luengas , 13, a Type 1 diabetic at his ofce in the Sloan Building
behind Driscoll Childrens Hospital.
Amanda Torres (left) and her daughter Valerie, 13, get their blood pressure checked during the Fit & Free
by the Sea event at Cole Park in Corpus Christi. Torres said she brought her whole family to the event so
they could focus on weight loss together.
Council and has spent years
studying the citys diabetes
crisis. I dont think people
really know what to do. For
people that have been living
a certain way their whole life,
they really do need very spe-
cic help.
The hardest part for Mat-
thew Moreno and his family
has been nding the motiva-
tion to change.
Matthew with his sister,
Martina, and his dad, Mar-
tin, 50, live in the same house
where Martin grew up.
The little white-and-red
house in a Westside neigh-
borhood is close enough that
Matthew can walk to work at a
shop that manufactures auto-
matic doors. Hes been living
there since his stepmother,
Rosalinda, died at age 40 af-
ter years of battling diabetes
complications. Martina asked
him to move in.
They know that they should
be eating healthier and exer-
cising. Last year, after Martin
was diagnosed with prediabe-
tes, he took Matthew with him
to a diabetes education class
where they learned about diet,
exercise and managing diabe-
tes. But theyve struggled to
follow those instructions.
Attempts to eat healthier
were sabotaged because Mar-
tina doesnt like fruits and
vegetables.
She doesnt like to eat any-
thing but nachos and rice, her
father said.
Matthew is the only one
who works. Crippling arthri-
tis mangled his dads hands,
causing him to go on disability
years ago. That means Mat-
thew usually buys the gro-
ceries. Sometimes he brings
home healthy food, but its
never popular.
When Matthew set a sack of
mangoes on the kitchen table
near a value pack of potato
chips and a 3 pound bag of
pretzels, his sister poked one
and wrinkled her nose.
What is that, dirt? Mar-
tina asked, pointing to the
fruits speckles.
Maybe if they were intro-
duced to eating healthy food
as kids, they would feel dif-
ferent, their father said. But
he didnt grow up eating let-
tuce and tomatoes, and never
acquired a taste for something
that, to him, has no taste.
Might as well just be drink-
ing water and taking pills,
Martin said.
But just as theyve strug-
gled to eat healthier, theyve
also found it hard to motivate
themselves to exercise.
Matthew bought a weight
set, a tness video and a mem-
bership to Freedom Fitness,
but he rarely uses them.
Im trying, but I dont have
motivation to do anything, he
said. I get home from work
and I dont feel like doing any-
thing.
Martina said she would like
to work out, but no one will go
with her.
And Martin has been saying
for nearly a year now that he
wants to exercise, but old ex-
ercise equipment he rescued
from a junk pile years ago con-
tinues to rust and gather dust
on his back porch.
He said hed rather walk
around the neighborhood,
even though the sidewalks are
cracked and broken or miss-
ing. But then he wouldnt go,
complaining it was too cold or
too hot or that he didnt feel
well enough. Or he worried
his troublesome ankle would
lock up mid-walk and he
wouldnt be able to get home.
He talked about taking Ro-
salindas old motorized wheel-
chair on a walk so he could
ride it back if he needed to,
but the wheelchair hasnt left
its parking spot in the corner
of the dining room.
This summer, he and Marti-
na took two strolls, an event so
rare that Martin wrote it down
in a journal. Amid the pages of
his notes outlining household
expenses, Martin jotted down
the dates, times and distances
of the walks with his daughter
and sketched a map of their
route.
These are pretty big events
around here, he said.
But when asked why they
only went twice, Martin
seemed to search for an an-
swer.
Martina never brought it up
again, he said.
So neither did he.
Martin Moreno sits with his children Martina (left) and Matthew as
they eat dinner at their home in Corpus Christi.
ACTION
from 64X
DEATHS
The county has the third-
highest diabetes death rate
in the state.
Nueces County had 48
diabetes deaths per
100,000 people.
700 people died of diabetes
in Nueces County between
2006 and 2010, but deaths
likely are undercounted.
Source: Department of State Health
Services
Matthew Moreno talks with sister Martina Moreno, 16, as the two order food at a restaurant near their
Corpus Christi neighborhood.
Sponsors,
opinion key to
solving problem
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
For years, Dr. Stephen Pon-
der watched a growing num-
ber of children arrive at the
doors of Driscoll Childrens
Hospital, seeking treatment
for what used to be an adults-
only disease.
The problem was too wide-
spread to tackle in the clinic
or the hospital and the pedi-
atric endocrinologist won-
dered: Can we do something
as a community to efect a
change?
In January 2006, Ponder
called a meeting at the hos-
pital auditorium and invited
elected ofcials and repre-
sentatives from health care,
the Chamber of Commerce,
schools, faith-based organi-
zations and nongovernmen-
tal organizations. He gave a
20-minute lecture, peppering
the speech with dramatic im-
ages of children with diabetes
and the complications they de-
veloped from the disease.
Then he turned it over to
the ofcials in the room to
brainstorm solutions.
That meeting led to more
brainstorming sessions over
several weeks, which led to a
half-million-dollar donation
from local industry, which
created an anti-obesity mi-
litia called the Coastal Bend
Diabetes Initiative that even-
tually gave away more than
$800,000 to 41 projects.
It got a discussion going
and got people moving in the
right direction that werent
moving before, Ponder said.
Seven years later, that ini-
tiative has reached the end of
its life. The group has about
$50,000 left and is considering
giving away one last batch of
money this fall.
The funding dried up. The
group never was able to cre-
ate a permanent endowment
to keep it running. And initia-
tive lost its leader when Pon-
der moved away.
Thats the general rule of
thumb in Corpus, Ponder
said. We understood the
problem, but nobody wanted
to put money in to do any-
thing.
While diabetes remains a
problem, stories like this are
common in Corpus Christi,
which has struggled to nd a
sustainable solution to its dia-
betes crisis.
Despite studies and surveys
that repeatedly identify dia-
betes and obesity as the citys
top health crisis, there have
been no strong, concerted and
long-lasting eforts to rein in
the disease and its expensive
complications.
National attention gave rise
to several new initiatives and
programs that cropped up
after the city was named the
No. 1 place in the country for
in 2001 and called Americas
Fattest City by Mens Health
magazine.
But many of those
disappeared, zzled away or
fell short, victims of fund-
ing shortfalls and leadership
changes.
The Coastal Bend Diabetes
Initiative (CBDI), for exam-
ple, survived for seven years,
much longer than expected,
on the initial $500,000 invest-
ment from industry groups
Citgo, Flint Hills Resources,
LyondellBasell, Valero and
the Port Industries of Corpus
Christi. Those groups donated
because they were starting to
notice the efects of diabetes
on their own employees, Pon-
der said.
Those industry leaders
originally planned to spend
the money on an awareness
campaign, but surveys showed
that people in Corpus Christi
already were acutely aware of
the diabetes problem.
We found people are very
well-informed, said Renwick
Deville, a renery industry
consultant who helped sketch
out the CBDI plan on the back
of a napkin years ago with oth-
er industry leaders. They just
didnt know what to do about
it.
So instead of an aware-
ness campaign, the industry
groups decided to give away
the money to community or-
ganizations working on dia-
betes prevention. The money
was supposed to last just two
years, but additional dona-
tions owed in, and CBDI was
able to continue giving away
money for six years.
And they were reporting
successes.
The Salvation Army was
able to give out free diabetic
shoes to help prevent blisters
and sores that can lead to hos-
pitalizations and amputations
in people with uncontrolled
blood sugar. The YMCA
in November 2010 hosted a
three-day diabetes boot camp,
teaching 50 families about nu-
trition, physical tness and the
basics of diabetes manage-
ment.
But early on, ofcials fret-
ted about the sustainability of
the project. They tried to nd
a stable funding source to cre-
ate an endowment, but they
couldnt raise the $3 million.
We were hoping we would
get more money, Ponder said.
We thought more would be
coming.
They seemed to get a big
break in 2008 when a pharma-
ceutical foundation eyed Cor-
pus Christi for a donation as
part of its efort to give money
to communities in good posi-
tions to tackle diabetes.
The Eli Lilly and Company
Foundation was planning to
give Corpus Christi about $1
million, Ponder said.
Struggling to x diabetes issue
MICHAEL ZAMORA/CALLER-TIMES FILE
Aaron Villalobos, a volunteer with Catholic Charities, helped take
blood pressure in May 2010, during Fit & Free by the Sea at Cole Park.
More than 1,000 people showed up for the rst weigh-in but only 40
returned for the nal weigh-in.
COST OF
DIABETES
Corpus Christis diabetes initiatives have
disappeared, zzled away or fallen short
See STRUGGLE, 67X
Our region was consid-
ered the most prepared, most
prime, most ready to accept
the challenge, he said.
But then the economy
tanked, the United States spi-
raled into the Great Reces-
sion and the foundation no
longer able was able to give
the money. Grant applications
werent successful and CBDI
had trouble raising more cash,
a problem Deville pinned on
the complicated nature of dia-
betes prevention.
Its difcult to get people
to invest in something that it
takes a generation or more to
resolve, he said.
Deville said CBDI never
was meant to be the end-all,
be-all solution and the group
accomplished what it set out
to do spark a conversation
about how to tackle diabetes
in Corpus Christi.
Were very proud of what
we did and we feel very suc-
cessful, he said.
But, he said, the epidemic
continues and more work
needs to be done.
Many of the initiative-fund-
ed programs have been able to
stay aoat, but theyve done so
with other funding and some-
times at a nancial loss. The
YMCA plans to host another
diabetes boot camp starting
Nov. 4 but has struggled to
nd participants.
Despite four weeks of radio
advertisements and iers left
in doctors ofces and hospi-
tals, no one has registered,
said Rachel Ulibarri, mem-
bership, health and wellness
director.
I was expecting, bare mini-
mum, wed have 15 families,
she said. I dont know why
people arent coming out for
it.
The three-week boot camp
costs $30 total for a family of
four, a price that doesnt even
cover the full cost of the pro-
gram, Ulibarri said.
The class meets twice a
week for a 45-minute lecture
with a diabetes educator about
disease management and a
45-minute activity, such as
swimming. The camp also in-
cludes a healthy food tasting
and grocery store tour with a
licensed dietitian. Those who
nish get a free month mem-
bership.
Its a concept thats worked
well in other cities, but in Cor-
pus Christi, a hotbed for dia-
betes complications, Ulibarri
is worried about attracting
enough people.
Its just crazy, she said.
With an estimated 17 per-
cent of people diagnosed with
diabetes, Nueces Countys
rates are more than double the
national average. Forty two
percent of county residents
are obese. And diabetes com-
plication rates, such as ampu-
tations and death, continue to
be higher than the state and
national average.
Awareness isnt the prob-
lem here. Action is.
ed to its crisis.
Diabetes is a complicated
disease inuenced by ge-
netics, food and lifestyle
making it difcult for any
community to tackle. Success-
ful eforts are well-funded and
championed by leaders, like
San Antonios Mayor Julin
Castro who in recent years
prodded the notoriously over-
weight city to start thinking
of itself as a healthier place
by launching an array of new
programs sparked by stimulus
funding three years ago.
But changing that mindset
requires sweeping changes to
the way an entire city eats, ex-
ercises and lives, and that can
pose some thorny questions.
How do you motivate an entire
community to change? And
how far can you go to do it?
In 2010, when Mens Health
dubbed the town Corpulent
Christi, Cinia Clarich Mon-
toya launched a citywide
weight-loss challenge in re-
sponse.
That really ticked me of
basically, she said. Having
had been a tness instructor
and gained a lot of weight over
the years, I knew something
needed to be done. In three
weeks, we put together the
program.
On a Saturday morning in
May 2010, more than 1,000
people showed up at Cole
Park, marking the kickoff
of Montoyas Fit & Free by
the Sea. Volunteers weighed
people, calculated their body
mass and measured their
blood pressures. One man
was so overweight, the scale
couldnt accommodate him, so
a nurse drove him to a nearby
doctors ofce to weigh him,
Montoya said.
Then-Mayor Joe Adame de-
clared it the start of a whole
new way of life in Corpus
Christi.
Six months later, Fit & Free
by the Sea wrapped up its
challenge with a nal weigh-in
at the American Bank Center.
Forty people showed.
The group disbanded not
long afterward.
Montoya said she couldnt
nd sponsors willing to keep
giving her cash. She had big
plans for a tness festival with
healthy food vendors, health
and tness celebrities, a box-
ing match and a mixed martial
arts ght. Not anymore.
I just cant spend my en-
ergy after being defeated like
that, she said.
Citywide weight loss chal-
lenges, similar to what Mon-
toya tried, have seen disap-
pointing results in other cities.
Last year in Boston, for exam-
ple, the mayor challenged citi-
zens to shed 1 million pounds
in a year.
The city fell far short
of that goal, dropping just
95,837 pounds. And that ef-
fort was well-funded. Fueled
by $310,000 from corporate
donors, Bostons challenge
included an array of entice-
ments: free tness classes,
Weight Watchers discounts
and coupons for healthy food.
Rather, sustainable changes
seem to happen at the policy
level. But those changes are
notoriously difcult to imple-
ment and can be seen as acts
of a nanny state. Perhaps the
most notorious, New York
Citys soda ban, was struck
down by the court which said
the health board overstepped
its boundaries.
Corpus Christi hasnt tried
to change policies. Instead,
groups have tried to persuade
the city to voluntarily move
away from unhealthy food
choices and sedentary life-
styles but with little success.
Bold Future, an organi-
zation working to create
a long-term vision for the
Coastal Bend, tried to get res-
taurants to promote healthy
eating by highlighting the
healthier fare on their menus.
The committee in charge
of that initiative worked for
a year and a half to convince
restaurants to participate but
in the end, only two eventu-
ally agreed: Taqueria Jalisco
No. 19 and Kikos Mexican
Food Restaurant and Cantina.
As tough as it is to change
peoples eating habits, its just
as hard to change restaurants,
especially small, mom-and-
pop shops that must always
worry about their bottom
lines, the committee discov-
ered.
It would be easier to build a
bridge than to do this project,
said committee member Gua-
dalupe Reyes, director of the
Texas A&M Health Science
Center Coastal Bend Health
Education Center.
The public demise of these
initiatives underscores a deep-
er problem that Ponder tried
to address seven years ago
when he brought the group
together at Driscoll Childrens
Hospital. If Corpus Christi
wants to solve its diabetes
STRUGGLE
from 66X
See STRUGGLE, 68X
Olivia Megee, 15, goes through Zumba moves with other Zumama Fitness members May 22, 2010, as they
led a mass workout during the Fit & Free by the Sea event at Cole Park.
crisis, it needs a local solution,
Ponder said.
Were not going to get our
solutions from Washington.
solutions from Austin, he
said. Its got to be a local so-
lution, and its got to be grass
roots.The three-week boot
camp costs $30 total for a fam-
ily of four, a price that doesnt
even cover the full cost of the
program, Ulibarri said.
The class meets twice a
week for a 45-minute lecture
with a diabetes educator about
disease management and a
45-minute activity, such as
swimming. The camp also in-
cludes a healthy food tasting
and grocery store tour with a
licensed dietitian. Those who
nish get a free month mem-
bership.
Its a concept thats worked
well in other cities, but in Cor-
pus Christi, a hotbed for dia-
betes complications, Ulibarri
is worried about attracting
enough people.
Its just crazy, she said.
With an estimated 17 per-
cent of people diagnosed with
diabetes, Nueces Countys
rates are more than double the
national average. Forty two
percent of county residents
are obese. And diabetes com-
plication rates, such as ampu-
tations and death, continue to
be higher than the state and
national average.
Awareness isnt the prob-
lem here. Action is.
ed to its crisis.
Diabetes is a complicated
disease inuenced by ge-
netics, food and lifestyle
making it difcult for any
community to tackle. Success-
ful eforts are well-funded and
championed by leaders, like
San Antonios Mayor Julin
Castro who in recent years
prodded the notoriously over-
weight city to start thinking
of itself as a healthier place
by launching an array of new
programs sparked by stimulus
funding three years ago.
But changing that mindset
requires sweeping changes to
the way an entire city eats, ex-
ercises and lives, and that can
pose some thorny questions.
How do you motivate an entire
community to change? And
how far can you go to do it?
In 2010, when Mens Health
dubbed the town Corpulent
Christi, Cinia Clarich Mon-
toya launched a citywide
weight-loss challenge in re-
sponse.
That really ticked me of
basically, she said. Having
had been a tness instructor
and gained a lot of weight over
the years, I knew something
needed to be done. In three
weeks, we put together the
program.
On a Saturday morning in
May 2010, more than 1,000
people showed up at Cole
Park, marking the kickoff
of Montoyas Fit & Free by
the Sea. Volunteers weighed
people, calculated their body
mass and measured their
blood pressures. One man
was so overweight, the scale
couldnt accommodate him, so
a nurse drove him to a nearby
doctors ofce to weigh him,
Montoya said.
Then-Mayor Joe Adame de-
clared it the start of a whole
new way of life in Corpus
Christi.
Six months later, Fit & Free
by the Sea wrapped up its
challenge with a nal weigh-in
at the American Bank Center.
Forty people showed.
The group disbanded not
long afterward.
Montoya said she couldnt
nd sponsors willing to keep
giving her cash. She had big
plans for a tness festival with
healthy food vendors, health
and tness celebrities, a box-
ing match and a mixed martial
arts ght. Not anymore.
I just cant spend my en-
ergy after being defeated like
that, she said.
Citywide weight loss chal-
lenges, similar to what Mon-
toya tried, have seen disap-
pointing results in other cities.
Last year in Boston, for exam-
ple, the mayor challenged citi-
zens to shed 1 million pounds
in a year.
The city fell far short
of that goal, dropping just
95,837 pounds. And that ef-
fort was well-funded. Fueled
by $310,000 from corporate
donors, Bostons challenge
included an array of entice-
ments: free tness classes,
Weight Watchers discounts
and coupons for healthy food.
Rather, sustainable changes
seem to happen at the policy
level. But those changes are
notoriously difcult to imple-
ment and can be seen as acts
of a nanny state. Perhaps the
most notorious, New York
Citys soda ban, was struck
down by the court which said
the health board overstepped
its boundaries.
Corpus Christi hasnt tried
to change policies. Instead,
groups have tried to persuade
the city to voluntarily move
away from unhealthy food
choices and sedentary life-
styles but with little success.
Bold Future, an organiza-
tion working to create a long-
term vision for the Coastal
Bend, tried to get restaurants
to promote healthy eating by
highlighting the healthier fare
on their menus.
The committee in charge
of that initiative worked for
a year and a half to convince
restaurants to participate but
in the end, only two eventu-
ally agreed: Taqueria Jalisco
No. 19 and Kikos Mexican
Food Restaurant and Cantina.
As tough as it is to change
peoples eating habits, its just
as hard to change restaurants,
especially small, mom-and-
pop shops that must always
worry about their bottom
lines, the committee discov-
ered.
It would be easier to build
a bridge than to do this proj-
ect, said committee member
Guadalupe Reyes, director of
the Texas A&M Health Sci-
ence Center Coastal Bend
Health Education Center.
The public demise of these
initiatives underscores a deep-
er problem that Ponder tried
to address seven years ago
when he brought the group
together at Driscoll Childrens
Hospital. If Corpus Christi
wants to solve its diabetes cri-
sis, it needs a local solution,
Ponder said.
solutions from Washington.
Were not going to get our so-
lutions from Austin, he said.
Its got to be a local solution,
and its got to be grass roots.
Wait staff cleans up as a sign on the napkin holder advertises the healthier menu items at Taqueria Jalisco
No. 19 last year. The restaurant was one of two restaurants that agreed to use the signs to steer their
customers to healthier eating options.
solutions from Washing-
ton. Were not going to get our
solutions from Austin. Its got to
be a local solution, and its got
to be grass roots.
Dr. Stephen Ponder, Driscoll Childrens Hospital
STRUGGLE
from 67X
Citys road to
healthier living
still long, bumpy
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
Corpus Christi had a repu-
tation as an unhealthy city
long before a national maga-
zine dubbed it Corpulent
Christi.
Type 2 diabetes rates are
double the national average.
Complications are among the
worst in the nation.
Four in 10 people are obese,
putting them at risk for Type
2 diabetes, heart disease and
stroke, among other problems.
The birthplace of Whata-
burger has more fast food
restaurants per capita than the
national average. At the citys
airport, an advertisement for
the hamburger chain is the
rst thing welcoming travel-
ers to town, a visiting dietitian
noticed.
And theres a perception
that the city is unfriendly to
cyclists and joggers.
For years, it has lagged be-
hind other cities in building
safe paths for people to bike
and walk. Cars are allowed to
park in one of the citys most
visible bike lanes on Ocean
Drive, a point of frustration
for some cyclists. And more
than half of the 224 miles of
streets studied by the city had
no sidewalks or they were so
uneven or broken, they were
unusable.
While the city has struggled
with nding a sustainable and
organized solution to its obesi-
ty and diabetes crisis sever-
al high-prole initiatives have
disappeared or fallen short of
their goal there are signs
that an organic change is un-
derway that could shift those
statistics.
A wave of new gyms and t-
ness facilities have opened, in-
cluding a 30,000-square-foot
Freedom Fitness last year at
Sunrise Mall, a year after a
Planet Fitness opened in the
same location.
And the city now has two
farmers markets, one down-
town and one on the South-
side, offering vegetables
plucked fresh from South
Texas farms.
Races like 5Ks and fun runs
have grown in popularity,
with big name productions
like Color Me Rad choosing
Corpus Christi for the rst
time. A Corpus Christi run-
ning club that tracks local
races noted 28 races in the
Coastal Bend in 2003. So far
this year, its counted 60.
The number of joggers and
cyclists spotted on city streets
also seems to have exploded
in recent years, with local
Modest health strides noted
COST OF
DIABETES
From 5Ks to
cycling groups,
Corpus Christi
shows signs
of shedding
Fattest City
label but lacks
hard evidence
GEORGE GONGORA/SPECIAL TO THE CALLER-TIMES
Team Life Cyclers ride their bikes at Hazel Bazemore Park. Members say they ride for overall health and joy.
A participant strolls by the water station and 2 Mile Lounge during the
Mayors Fitness Council Healthy 5K Run-Walk at Cole Park.
See STRIDE, 70X
running and cycling clubs see-
ing an uptick in participation.
Jerry Gomez, for example,
started cycling with a co-work-
er last year in an efort to drop
pounds, get healthy and avoid
a diabetes diagnosis thats
made his mother sick. More co-
workers started to join as word
spread and one day, 30 people
showed up in the parking lot
where they met.
It was like Night of the
Living Dead, Gomez joked.
There are now 140 mem-
bers in the group that calls it-
self Team Life Cyclers. They
have uniforms, host clinics on
bike mechanics such as how to
change a at, and swap tips on
eating healthier. Gomez lost
50 pounds in one year.
We have no membership
fees, no mandatory meetings,
he said. Basically, our philos-
ophy is we ride for health and
we ride for fun.
And for safety.
In 2011, leaders at nearly ev-
ery business surveyed by the
citys parks and recreation
department said they would
like to encourage employees
to ride or walk to work, but
they didnt think it was safe
to do so, said Stacie Talbert,
assistant director for the Cor-
pus Christi Parks and Recre-
ation department. More than
900 cyclists and pedestrians
have been struck by cars in the
past seven years, according to
Texas Department of Public
Transportation data.
Back when I used to ride
by myself, Ive been clipped
by truck mirrors and (drivers)
have thrown beer cans, Coke
cans, water bottles, you name
it, he said. When we ride as
a group, cars do get away from
us.
While the anecdotal evi-
dence points to a healthier
Corpus Christi, its hard to say
whether any of it is making a
diference in the citys diabe-
tes and obesity statistics. Un-
like other cities, the Corpus
Christi-Nueces County Public
Health Department does not
collect data on the local obe-
sity and diabetes rates, mak-
ing it difcult to judge with
hard evidence whether Cor-
pus Christi is slimming down
and getting healthier.
Federal statistics dont help
either. The U.S. Centers for
Disease Control and Preven-
tion in 2011 changed the way
it counts diabetes and obesity,
making it impossible to gauge
the citys progress since the
2010 Mens Health magazine
designation as Americas fat-
test city.
Still, the joggers on Ocean
Drive, the new cycling groups,
the growing number of 5Ks
spark hope among health ad-
vocates aching for a victory.
Theres motivation out
there, said personal trainer
Victor Betancourt who owns
a race production company
thats been hosting scores of
new runs.
The challenge the city faces
is how to capitalize on that
momentum, make it sustain-
able and reach those who need
it most.
If we can change a few to
get on the path to healthy liv-
ing, to ght diabetes, to keep
t, then weve accomplished
our goal, Mayor Nelda Mar-
tinez said. But are we to our
goal? Nowhere near. We have
a lot more work to do. I think
we have to get a lot more cre-
ative on engaging the masses.
The question of how to
spread the change is what
dogs the Mayors Fitness
Council, created in 2010 un-
der Mayor Joe Adame in direct
response to the citys growing
rates of chronic diseases such
as Type 2 diabetes and deaths
from those diseases.
Backed by grant funding
and city support, the group
of health and wellness advo-
cates and leaders from educa-
tion and industry advises city
council, the city manager, city
departments and the health
district. And, as such, its well-
suited to enact widespread
and sustainable changes to
policy and infrastructure.
While tness councils in
other cities spearheaded their
own initiatives and programs
San Antonios council, cre-
ated the same year, famously
started a popular citywide cy-
cling event Corpus Chris-
tis council initially opted to
STRIDE
from 69X
Runners make their way along Ocean Drive the Mayors Fitness Council Healthy 5K Run-Walk at Cole Park in Corpus Christi.
See STRIDE, 71X
If we can change a few to get on the path
to healthy living, to ght diabetes, to keep
t, then weve accomplished our goal. But are
we to our goal? Nowhere near. We have a lot
more work to do. I think we have to get a lot
more creative on engaging the masses.
Mayor Nelda Martinez
spend its rst round of grant
funding by donating to other
already established organiza-
tions.
In the rst year, the council
gave away $48,000 to 13 difer-
ent projects.
The group gave donations
of $5,000 each to American
Diabetes Association for test-
ing materials, Conquer the
Coast to underwrite the cost
of registration for rst-time
riders in the annual bicycle
race, and Republic of Texas
Triathlon to give free triath-
lon training.
The council counted par-
ticipation, but it didnt track
health status or behaviors,
complicating eforts to judge
the donations efect on Cor-
pus Christis obesity and dia-
betes crisis.
For example, the Republic
of Texas Triathlon, an event
Adame credited the tness
council with attracting, had
475 participants its rst year.
Twenty percent came from
Corpus Christi, according to
race results. Austin had the
biggest contingent at 32 per-
cent.
Programs are great, but
theres no way to know the
impact on people who dont
participate, said Talbert,
who took over council man-
agement in 2011.
As the council discovered,
simply giving away a few thou-
sand dollars here and there
to different organizations
wouldnt make the kinds of
sweeping changes needed. So,
in 2011, the council received a
diferent grant, which shifted
the groups vision toward pol-
icy and infrastructure.
The $40,000 from the Na-
tional Park and Recreation
Association and the Centers
for Disease Control and Pre-
vention required the council
to develop a community ac-
tion plan. The plan had to ad-
dress policy, system and envi-
ronmental changes to tackle
chronic diseases, in Corpus
Christis case, diabetes. Cor-
pus Christi was one of 10 cities
nationwide to get the grant.
The councils action plan
calls for increasing access to
fresh food, adding hike and
bike trails and snufng out
tobacco use in parks within
three years.
If were going to make sus-
tainable changes, you have to
change policies, Talbert said.
Thats key.
The councils goal by 2014
is to have 33 miles of bike and
pedestrian paths, 60 miles of
roads with bike lanes, 24 com-
munity gardens and three of
the citys 13 community cen-
ters serving some sort of local
produce. And theyre pretty
close to reaching that goal.
In the past two years,
theyve added to their win
column nine miles of trails
built as part of 2008 bond park
improvements and 12.5 miles
of bike lanes, bringing the to-
tal to 27 miles of trails and 58
miles of lanes.
Theyve also spent grant
money promoting community
gardens by giving $500 sub-
grants to 12 churches, schools
and other groups to build the
gardens and putting up about
$2,000 in matching funding
for a $25,000 grant for a 32-bed
garden at Lindale Park.
The rest of the money paid
for an intern to help survey
local businesses about their
health and wellness policies.
The council also paid to pro-
mote a local data collection
project, sponsor a town hall
on sustainability and to send
board members to a confer-
ence. They have about $18,000
left, which the council still is
debating how to spend, Tal-
bert said.
The new focus on policy and
infrastructure should help the
Mayors Fitness Council reach
more people and begin to re-
verse Corpus Christis reputa-
tion as a city where its hard to
be healthy, Talbert said.
STRIDE
from 70X
0 10 20 30 40 50 60
RUNNING EVENTS
SCRIPPS NEWSPAPERS
The Corpus Christi Roadrunners tracks 5Ks, fun runs and
other running events in the Coastal Bend.
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Source: Corpus Christi
Roadrunners
28
30
36
28
30
35
43
42
48
30
60
MAYORS FITNESS COUNCIL
As part of a $40,000 grant from the National Park and
Recreation Association and the U.S. Centers for Disease
Control and Prevention in 2011, the Mayors Fitness
Council has worked to increase access to fresh food, add
hike and bike trails and snuff out tobacco use in parks
within three years.
Start (2011) 2013 Goal (2014)
Miles of hike
and bike
trails
20.25 26.875 33
Miles of
roads with
bike lanes
46.5 58 60
Community
gardens
0 14 24
Community
centers using
local produce
0 2 3
Source: Corpus Christi Parks and Recreation Department
See STRIDE, 72X
Mayor Nelda Martinez high ves a group of young runners in September as they get ready to run in the kids run during the Mayors Fitness
Council Healthy 5K Run-Walk.
Progress may seem slug-
gish, but shifting the citys
mindset and health statistics
wont be easy.
Its like turning the Ti-
tanic, Talbert said. It takes
a long time.
In September, the council
hosted its rst 5K race to raise
cash to continue its efort. The
group marketed the event as
a 5K for rst-timers. They or-
ganized couch-to-5K training
sessions and advertised inat-
able couches at the two-mile
mark for participants who
needed a break.
The response was
underwhelming.
Two weeks before the race,
the council fretted about break-
ing even. One council member
wanted to postpone it. Only 15
people had registered and the
race had attracted a handful of
sponsors, not enough to cover
the cost to organize the race.
They batted around the idea
of giving away registration to
make the crowds look bigger
on race day.
In the end, that wasnt nec-
essary. The group made a nal
push with a grass roots mar-
keting campaign and attracted
93 paid participants, enough to
bring in $1,015 in net revenue.
Among them was May-
or Martinez, speed walk-
ing through Cole Park and
shouting encouragement to
other participants. The 5K is
a good start, she said. Another
sign that Corpus Christi is get-
ting healthier.
But she wants to do more,
maybe build partnerships
with other groups in town
to extend the councils inu-
ence and gure out a way to
follow-up with participants to
see whether its making a dif-
ference, she said.
State Rep. Todd Hunter,
who has Type 2 diabetes, ap-
peared next to her on the side-
walk.
You did good, he said,
speedwalking by. Im glad
yall are doing this.
Well, she said, We gotta
sustain it. Thats the key.
0 10 20 30 40 50 60
RUNNING EVENTS
SCRIPPS NEWSPAPERS
The Corpus Christi Roadrunners tracks 5Ks, fun runs and
other running events in the Coastal Bend.
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Source: Corpus Christi
Roadrunners
28
30
36
28
30
35
43
42
48
30
60
MAYORS FITNESS COUNCIL
As part of a $40,000 grant from the National Park and
Recreation Association and the U.S. Centers for Disease
Control and Prevention in 2011, the Mayors Fitness
Council has worked to increase access to fresh food, add
hike and bike trails and snuff out tobacco use in parks
within three years.
Start (2011) 2013 Goal (2014)
Miles of hike
and bike
trails
20.25 26.875 33
Miles of
roads with
bike lanes
46.5 58 60
Community
gardens
0 14 24
Community
centers using
local produce
0 2 3
Source: Corpus Christi Parks and Recreation Department
STRIDE
from 71X
Participants take off Sept. 28, 2013 at the start of the Mayors Fitness Council Healthy 5K Run-Walk at Cole Park in Corpus Christi.
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
SAN ANTONIO A healthy revolution
sounds like the clatter of plastic training
wheels on pavement, the low rumble of skate-
boards, the boom-boom bass of Zumba classes
and an occasional bicycle bell.
On a Sunday afternoon in late September,
2.2 miles of downtown San Antonio streets
lled with thousands of people jogging, riding
bikes, skateboarding, pushing strollers and
roller skating down an open stretch of road.
Perhaps most striking was what was miss-
ing: Cars. And chairs to settle into.
Three years ago, the city set out to shed its
reputation as one of the fattest cities to one
of the ttest, and theyre doing so through an
array of initiatives, like the twice-per-year
Sclova, which has exploded in popularity.
Today, the city boasts an obesity rate at 28.5
percent, below the state average.
To Mayor Julin Castro and other health
advocates, the declining obesity rate is a testa-
ment to their eforts, a sign that their invest-
ment is paying of.
Like Corpus Christi, San Antonio has strug-
gled with some of the same Type 2 diabetes
and obesity problems.
When Mens Health magazine named San
Corpus Christi the Fattest City in 2010, San
Antonio, just two hours away, appeared on the
same list at No. 7. About 11 percent of residents
One step
ahead
Another fattest city is looking to become the ttest,
and San Antonio is seeing results
Cyclists, skateboarders and pedestrians take over Broadway Street on Sunday during the Sclova event in
San Antonio.
Cyclists use rented bikes available at locations throughout the central
part of the city during the Sclova event in San Antonio.
COST OF
DIABETES
Published November 3, 2013
See AHEAD, 74X
Corpus Christi struggles with its
health crisis; San Antonio takes on
similar problems, finds success
had diabetes and one-third
were obese. (Corpus Christi
has a 40 percent obesity rate
and 17 percent diabetes rate.)
While Corpus Christi resi-
dents looked for ways to drop
pounds and get healthier,
Mayor Castro decided San
Antonio should aim not just
to get of the fattest city list,
but to become one of the na-
tions healthiest, most active
cities. He created a Mayors
Fitness Council, at the same
time Corpus Christi created
one. And the council worked
directly with the health de-
partment, which received a
$15.6 million stimulus grant
to develop anti-obesity strat-
egies and programs.
The collaborative took aim
at the citys diet and tness
habits, launching an array of
initiatives to help transform
the way San Antonio eats and
works.
They started citywide
walking groups, a student am-
bassador program and helped
launch free tness classes at
parks across the city in a pro-
gram called Fitness in the
Park. Last week, there were
98 yoga, Zumba, aerobics, boot
camps, circuit training and
other exercise classes held
throughout the city.
But one of the largest, and
most visible, projects started
by the Mayors Fitness Coun-
cil is Sclova, an event mod-
eled after Bogot, Columbias
Ciclova where the city closes
of more than 70 miles of their
streets for residents use.
Started in 2011 with 15,000
people, Sclova has become a
point of pride for the city.
Austin was asking us for
information, said Christina
Dahlstrom, who served as the
coordinator of the Mayors Fit-
ness Council. If Austin is ask-
ing us, this is great.
At the September event,
73,000 people attended, de-
spite the mornings threaten-
ing rain clouds, and ooded
the streets with every form
bicycle: beach cruisers in
tangerine and sea foam, trick
rides with shocks and pegs,
rust-tinged bikes rescued
from the depths of garages
and tricycles with glittery
pink streamers. Many bor-
rowed rides from B-cycle, San
Antonios two-year-old bike-
sharing program. Few and far
between were the serious cy-
clists with their spandex and
aerodynamic helmets.
Thousands of cyclists cut
through the heart of the city,
rolling down Broadway along-
side moms walking hand-in-
hand with their kids, dogs on
leashes and the occasional
unicyclist.
There were no spectators
though, no chairs lining the
sidewalk like youd see at a
parade. If people stopped, they
did so to check out a combat
class or a cooking demonstra-
tion, hanging their unlocked
bikes on a portable rack
propped up on the sidewalk.
In a parking lot near a row
of food trucks selling vegan
fajitas and a yogurt, granola
and agave nectar concoction,
Donna and Eric Edison, of In-
gleside, kicked around a soc-
cer ball with their kids while
a nearby DJ blasted pop music
from his speakers. It was their
rst Sclova and they were
impressed.
Its certainly something
Corpus Christi could repli-
cate, Donna Edison said.
I think it would be cool,
she said.
The beauty of Sclova, and
perhaps a reason why its so
popular, is because its not re-
ally seen as tness or exercise,
but rather as a family-friend-
ly event, more active than a
health fair but more chill than
a race.
I hear people say it really
is San Antonios most organic
wellness event, said Sandy
Morander, director of the
YMCA of Greater San Anto-
nio, which took over operation
of Sclova and kept it aoat af-
ter the citys funding ran out,
ofsetting the $150,000 price
tag with donations from cor-
porations such as H-E-B.
Its a chance for people to
try something new. Like Elva
Escamilla, 47, who tried kale
for the rst time. Or Lorena
Silva, 27, who ran her rst 5K.
Silva said she never
wouldve had the energy and
endurance for the race before,
but then she got involved in
the YMCAs free healthy liv-
ing program ofering nutrition
education and tness classes
and a free three-month mem-
bership at the end. In the past,
her weight prevented her from
playing with her 8-year-old
son.
He would always want to
go to the park and I would say,
No, no, she said. I always
had an excuse. And then I
thought, Im not even 30 yet.
Now that shes completed
the program, she realizes its
easier than she thought to eat
right and exercise in San An-
tonio.
The park has fitness
AHEAD
from 73X
Runners sprint to the nish during the Sclova 5K in San Antonio.
Members of the Youth Orchestra of San Antonio help kick off the Sclova event in downtown San Antonio.
See AHEAD, 75X
stations, from beginner to
advanced levels ..., she said.
You dont have an excuse,
even if you dont have money.
Beyond Sclovas good
attendance gures, its also
making a measurable difer-
ence, organizers say.
More than two-thirds of
the 373 people surveyed at
the April event came from
ZIP codes known for high to
extremely high levels of obe-
sity. Nearly half said they tried
a new physical activity at S-
clova and 57 percent said they
would not have been physical-
ly active that day had they not
attended Sclova.
But despite San Antonios
improved statistics, the city
still has work to do. The health
department noted that obesity
rates rose people 65 years old
and older, underscoring the
need for more outreach that
population. And the percent-
age of overweight people
increased, as well. Doctors
dene overweight as 10 to 20
percent higher than normal
weight and obesity as more
than 20 percent. Both raise
the risk for chronic diseases
such as Type 2 diabetes, heart
attacks and stroke.
One of the citys biggest
challenges is healthy eating,
Dahlstrom said, acknowledg-
ing the need for more nutri-
tion education thats cultur-
ally relevant.
Thats a tough balance in a
city known for its Tex-Mex.
On a Saturday night at the
landmark Mi Tierra caf, there
was a wait even though the res-
taurant seats more than 500
people. The line for the restau-
rant full of tourists and locals
bled into another line at the
glowing glass display case of
baked-fresh pan dulces where
customers waited, paper num-
bers in hand, to order a fat gin-
gerbread pig or a glossy lump
of dulce de calabaza the size
of a baseball. The thick rect-
angles of pecan-studded leche
quemada were so packed with
sugar they sparkled.
AHEAD
from 74X
BELOW: Captain
HUMAN, with the
Healthy Vending
company, mounts
his bike along side
Jackson Rogers, 8,
of San Antonio.
See AHEAD, 76X
LEFT: Participants
work out with a
Zumba instructor,
one of the multiple
tness and activ-
ity stations set up
along the route.
PHOTOS BY MICHAEL ZAMORA/CALLER-TIMES
Were a town that just loves
to go out and eat, said Valerie
Gonzalez, who owns Delicious
Tamales of San Antonio.
Although her business has
grown from a $500 invest-
ment in 1980 to a multimil-
lion corporation that ships 2.1
million tamales a year across
the United States, Gonzalez
recognized that there was a
customer base she was miss-
ing: vegetarians.
So four years ago, when
she was approached by a co-
alition working to help San
Antonio residents be able to
make healthier choices when
dining out, Gonzalez saw an
opportunity.
Developed by the health
district and the local res-
taurant association, the Por
Vida! restaurant recognition
program identies menu items
deemed nutritious based on a
dietitians analysis of calories,
sodium and fat.
The program is voluntary
and pairs restaurants with a
dietitian who will help them
modify menu items to meet
the criteria: No more than
700 calories, 23 grams of total
fat, including a half gram of
trans fat, and 750 milligrams
of sodium.
While a similar program in
Corpus Christi fell short of its
expectations program lead-
ers said the mom-and-pop eat-
eries they targeted were wor-
ried it could hurt their bottom
line Gonzalez recognized a
chance to grow her business.
She added to the menu
Southwestern vegetable ta-
males. Made with canola oil,
theyre lled with corn, black
beans, red bell peppers and
cilantro. Her menu item is
one of dozens recognized by
Por Vida! at 14 restaurants
throughout the city. And,
despite its healthy label, its
popular, Gonzalez said.
People like it once they
taste it, she said. Its very
easy to have at least a prod-
uct thats a choice the person
has, whether they choose to
eat this way because of health
reasons or personal choice.
She, like others in the city,
has noticed a shift in San An-
tonios attitude and she credits
Castro for prodding the city to
get tter.
Hes always thinking about
the health of the people in San
Antonio, she said. Im very
proud of what hes done with
the city ... Strong leadership.
Thats what you need for a city
to turn around.
AHEAD
from 75X
Erica Median, a nutrition student at the University of the Incarnate
Word, hands out samples of a healthy wrap during a health7 cook-
ing demonstration by H-E-B at the Sclova event in downtown San
Antonio.
Lorena Silva of San Antonio (from left) celebrates as she crosses the nish line with son Ismael, 8, and
husband, Juan, during the Sclova event in downtown San Antonio. Lorena Silva said this was her rst time
completing a 5K, inspired by her participation in the YMCAs Y Living program she participated in with her
family over the summer.
Cyclists, walkers, runners and skateboarders take over parts of
downtown San Antonio.
Runners kick off the 5K Sunday, Sept. 29, 2013 during the Sclova
event in San Antonio.
Im very proud of what hes
done with the city ... Strong
leadership. Thats what you need
for a city to turn around.
Valerie Gonzalez, owner of Delicious Tamales of San Antonio
Parents told to
lead in making
healthier choices
Elaine Marsilio
marsilioe@caller.com
361-886-3794
Leeanna Martinez want-
ed to believe her son Adam
Hernandez could just scrub
harder and rinse away a con-
dition that shows he is at risk
for Type 2 diabetes.
A school nurse took note
this fall of darkened, velvety
skin on the 8-year-olds neck.
Martinez, a single mother
of two, wasnt sure what to
make of her oldest sons posi-
tive screening for acanthosis
nigricans, which is caused by
high insulin levels stimulating
pigmented skin cells to grow
because of extra fat.
An indicator
for change
Type 2 diabetes is
increasingly aficting children
Alex Hernandez, 8, shows his classmates the lunch his mother packed
for him Nov. 15, 2013 as they wait to go to class before school at
Crockett Elementary in Corpus Christi.
Leanna Martinez hands off an Avengers lunch bag to her son Alex, 8, as Martinez packs meals for her twin boys before heading off to Crockett
Elementary for the school day.
COST OF
DIABETES
See CHANGE, 78X
Martinez didnt expect one
of her twin boys may be at
risk for a disease that already
afects multiple family mem-
bers.
I was in denial about it that
way, she said.
Type 2 diabetes used to
be an adult disease, but it in-
creasingly is afecting more
children, physicians said. It
puts a younger generation at
a higher risk of dying before
their parents as well as forces
them to deal with health com-
plications at an early age.
An afected family must
work as one to make a difer-
ence in tackling the disease,
doctors said.
A positive AN screening
doesnt always mean a child
has Type 2 diabetes, but it is
a warning sign that a diagno-
sis may be on its way if dras-
tic steps toward a healthier
lifestyle arent made, said Dr.
Melissa Wilson, medical di-
rector for the Morris L. Lich-
tenstein Jr. Medical Research
Foundation in Corpus Christi.
Parents need to help their
children focus on preventive
eforts, which can be as simple
as eating healthier and exer-
cising more, Wilson said.
And save them, she said.
Save their life.
About 14,000 children in
Texas were diagnosed with
Type 1 or Type 2 diabetes in
2010, the latest state informa-
tion available. State health
data didnt specify how many
of those were diagnosed with
Type 2. In addition, local
health ofcials didnt have a
breakdown of how many chil-
dren are diagnosed annually
with the disease.
Even though Martinez and
her sons dont have diabetes,
they arent taking any chanc-
es.
They swapped pizzas and
doughnuts for salads and
baked chicken.
Ive been trying to hide my
neck, but Ive solved that prob-
lem by eating salad, Adam
said.
Adams twin brother, Alex,
recently checked his blood
sugar level at a relatives house
as a precaution.
I thought maybe I should
take a stand for myself, he
said.
He continually prayed he
also didnt have the disease.
I almost started crying be-
cause I thought it would hap-
pen, said Alex, who is two
minutes younger than his
brother.
That precautionary screen-
ing in the comfort of a rela-
tives home helped put him at
ease, he said.
That was my luckiest day
for me, Alex said. I was so
glad that I didnt have diabe-
tes.
The boys exercise with
their mother at the Moody
High School track most
evenings, and the boys also
are involved in multiple com-
munity activities, including a
tness program at the Boys &
Girls Club of Corpus Christi
that partners with VFit Pro-
ductions.
CHILDREN AT RISK
The AN screenings, man-
dated in 1999 by the Legis-
lature, are required in rst,
third, fth and seventh grades
as part of hearing and vision
screenings. Positive screen-
ings require children to be
seen a second time by a nurse
for height and weight assess-
ments and blood pressure
readings.
Positive screenings can
present parents and families
with an opportunity to inter-
vene, Wilson said.
Theyre not doomed yet,
but they are on the road, she
said. They can basically stop
the road to diabetes.
CHANGE
from 77X
TIPS FOR
PARENTS
Preventing Type 2 diabetes
in children can be a difcult
task for families, but these
tips aim to provide help for
parents.
Instead of focusing on
words, such as diabetes
or obesity, ask yourself:
How can I help my child be
healthy?
Have a conversation with
your childs doctor. Ask
the physician, What is my
child at risk for if I dont do
anything?
Parents need to
understand any potential
consequences for their
children.
Parents need to lead by
example. What parents
do is more important than
what they say.
Source: Dr. Melissa Wilson, medical
director for the Morris L. Liechtenstein
Medical Research Foundation
Many students in Corpus Christi Independent School District elementary schools are learning to plant and cultivate vegetables and fruits by managing school gardens during their
physical education classes. Educators said the effort is designed to teach students about healthy eating and the importance of the nutrients natural foods provide.
See CHANGE, 79X
More than 1 million Texas
children are screened annu-
ally for AN in the hope that
a quick glance may result in
eye-openers for families, ac-
cording to a University of
Texas-Pan American report
presented to Gov. Rick Perry
and the Legislature this year.
During the 2011-12 school
year, 9,713 children had the
condition, according to the
Texas Risk Assessment for
Type 2 Diabetes In Children.
The report showed more
than 10,840 children in 2010-
11 were referred to medical
professionals for care after
they were found to have AN.
Nationally, Type 1 diabetes
is more prevalent in children,
with 15,600 diagnosed annu-
ally from 2002 to 2005, ac-
cording to a study by the Cen-
ters for Disease Control and
Prevention and the National
Institutes of Health.
During that same time,
3,600 children were diagnosed
with Type 2 annually.
Locally, many pediatricians
are seeing more children with
pre-diabetes, or borderline
diabetes, which is a condition
where a patient has elevated
glucose levels that put them
at risk of developing Type 2
diabetes.
Along with the risk of de-
veloping the disease comes
increased risk for having as-
sociated complications, such
as heart disease and stroke,
medical professionals said.
The issue is that it will be-
come a larger problem, said
Dr. Ana Maria Pez, a pediat-
ric endocrinologist at Driscoll
Childrens Hospital.
The Coastal Bend has some
of the highest diabetes com-
plications rates in the nation,
including amputations. Cor-
pus Christi ranks sixth in the
nation for below-the-knee am-
putations among Medicare en-
rollees. While that is a decline
from the city taking the No. 1
rank about 12 years ago, many
medical professionals said
the key to combating compli-
cations is early screening to
prevent a Type 2 diagnosis.
Children with Type 2 have
a 47 percent increased risk
for developing a complication
compared with their Type 1
counterparts, according to a
study in the medical journal
Diabetes Care. In addition,
children with Type 2 tend to
have earlier renal and neu-
rological complications that
surface within ve years of
diagnosis.
The study found 1.1 percent
of children developed major
complications, such as blind-
ness and amputations, by 10
years after being diagnosed.
At 15 years, 26 percent devel-
oped complications, and by
20 years that number rises to
almost 48 percent.
FAMILY DISEASE
Families afected by diabe-
tes often have many relatives
who are obese, and families
tend to accept Type 2 diabe-
tes instead of combating their
situation, physicians said.
Theres a feeling ... its al-
most, like, What is the point
of changing? Pez said. Its
usually hard to battle that.
She often tells patients the
motivation is simple: better
quality of life.
But they just cant envision
it, she said.
A medical diagnosis of AN
can be difcult for families to
internalize because not many
know about the skin condi-
tion and how it can afect their
childrens health, Wilson said.
Some parents who are told
by medical professionals that
their child may have weight
concerns, a risk for Type 2 dia-
betes and an immediate need
for a lifestyle change may not
know how to take the news.
Many parents were ofend-
ed and considered it a judg-
ment on how theyre raising
their child, and so they didnt
follow-through, Wilson said.
Parents need to recognize
things need to be done difer-
ently, and the change needs to
come from within the family,
she said.
The parent says, Wow, we
need to do something here,
she said.
Parents cant be solely
blamed for children being
CHANGE
from 78X
HEALTHY LIFESTYLE
Here are some tips for parents to create a healthy lifestyle for
their families.
Dont buy junk food or have it in the house. Especially keep away
from sodas and sports drinks because those products provide
added, unnecessary calories.
Stick to greens and beans. Greens are healthy and provide
nutrients to fuel a persons energy. Beans are shown
scientically to reduce the risk of diseases, such as heart
disease. Beans also are lling and satisfying.
Get in healthy foods by drinking homemade smoothies. Its a
good way for kids to get their nutrients.
Parents have to provide the environment needed for healthier
eating and exercise.
Be active. Run and/or walk at the local high school track instead
of watching TV. Get involved in various activities, such as
swimming, dancing or walking the dog.
Encourage your child to get involved in sports or a team activity.
Be the parent. Limit your childs use of computers, video games,
handheld games. Dont have TVs or computers in the kids
rooms.
Try and tackle one thing on the list at a time. Dont try and
change all at once. If you achieve one thing as a family, then you
are more likely to try more things.
Source: Dr. Melissa Wilson, medical director for the Morris L. Liechtenstein Medical
Research Foundation
See CHANGE, 80X
Physical education coach Martin J. Flores Jr. tells students at Oak Park Elementary school about the
importance of eating healthy foods, such as vegetables and fruits. The students have a garden they learn
to manage during their physical education classes. The effort aims to teach young children where healthy
foods come from as well as the nutrients those foods provide.
diagnosed with Type 2 diabe-
tes because that makes it too
simplistic an answer, said Dr.
Siripoom McKay, assistant
professor of pediatric endo-
crine and metabolism at Bay-
lor College of Medicine and
Texas Childrens Hospital in
Houston.
Its just the structure of
our society has changed, she
said, adding most families rely
more on processed foods in-
stead of preparing more meals
at home.
Parents work longer hours,
and processed foods can seem
more convenient, said McKay,
who is an investigator for a
study group analyzing Type 2
diabetes treatments for youths.
We have to live in environ-
ments that help us with some
of these things, she said.
Children diagnosed with
Type 2 diabetes must man-
age the disease sooner, said
Amelie G. Ramirez, who is
the director of the Institute for
Health Promotion Research
at The University of Texas
Health Science Center at San
Antonio.
Ramirez said the disease can
put a burden on children and
thrust them into an environ-
ment of managing medications
while also putting them at risk
for diabetes complications.
Its a tough one to ght so
we really dont want our kids
to have to go there, she said.
Leeanna Martinez, who
has lost more than 30 pounds
since June in a tness chal-
lenge through her employer,
said it is her job as a parent to
lead her twin sons in the right
direction.
You have to show your
kids the importance of being
healthy, she said. We have
to work as a team to make it
happen.
Children depend on their
parents. They have the
purchasing power and the
most ability to afect change,
Wilson said.
The kids are going to do
what they see their parents
do, she said.
Twitter: @CallerEducation
CHANGE
from 79X
Adam Hernandez has breakfast at his desk before class at Crockett Elementary in Corpus Christi. Stu-
dents at the school are provided breakfast in the classroom, which includes 1 percent milk, lower sugar
cereal, baked goldsh crackers and a juice pack.
ACANTHOSISNIGRICANSBODYREGIONS
SCRIPPS NEWSPAPERS
Acanthosis Nigricans, or AN, is a skin condition caused by
high insulin levels that stimulate the pigmented skin cells to
grow. The high insulin levels are a result of insulin
resistance due to extra fat in the bodys muscle, liver and
fat cells. Its too much in all the cells. As a result, the
pancreas tries to compensate by making more insulin.
Most common Common
Uncommon Rare
Source: Dr. Melissa Wilson, medical director for the Morris L. Liechtenstein Medical Research Foundation
SCREENING
Under a state program, children in rst, third, fth and seventh grades are screened for acanthosis
nigricans, a skin condition that signals high insulin levels, a precursor to Type 2 diabetes. Here are the
results for local school districts in 2012-13.
Children Children Percentage Percentage Percentage
screened found with of children of kids of kids
AN found with with AN with AN
AN who had who were
high blood obese
pressure
Coastal Bend Region 29,218 2,058 7% 31% 89%
Corpus Christi ISD 12,069 708 6% 30% 89%
Flour Bluff ISD 1,251 95 8% 32% 82%
Calallen ISD 1204 105 9% 27% 83%
Tuloso-Midway ISD 587 66 11% 47% 92%
West Oso ISD 292 21 7% 38% 81%
Kingsville ISD 1327 168 13% 15% 91%
Alice ISD 1599 136 9% 40% 90%
Source: University of Texas-Pan American
Teen team
targets poor
eating habits
Elaine Marsilio
marsilioe@caller.com
361-886-3794
A group of middle and high
school students are help-
ing kids ght of bad eating
habits taking the message of
healthy eating into elemen-
tary schools.
Yeager Elementary School
kindergartners recently
learned about better eating
habits and diabetes risks
through the iConquer: Chews
Wisely program, which is
funded solely by a parent of
some group members.
Students from Carroll High
School and Baker Middle
School use puppets, songs
and food tastings as teaching
tools. The group of girls, of
which three are sisters, also
associate their rst names
with fruits or vegetables so
their monikers can resonate
with the younger students.
Many ki ndergartners
considered candy a healthy
food option at the start of
the program, which began in
schools this year as part of
the nonprot Its Your Life
Foundation.
They didnt know it was
bad for them, said Sara
Surani, a Carroll senior who
is part of the programs team.
That changed by the third
meeting.
What leads to diabetes?
group members asked the 41
kindergartners in October as
they gathered in the school
cafeteria.
Candy! students yelled in
unison.
The program also empha-
sizes the importance of stu-
dents exercising and eating
fruit and vegetables to make
strides in preventing diabe-
tes.
Celestine Barnes, 5, said
she tried carrots for the rst
time during an October visit.
Girls sharing
healthy message
COST OF
DIABETES
Sara Surani, 17, leads a quiz for students at Yeager Elementary School
during an iConquer Chews Wisely at the school in October.
Zoya Surani, 13 (left) and Leslie Salomon, 16, presenters of the iConquer Chews Wisely dance with students at Yeager Elementary School in October during a presenatation.
See MESSAGE, 82X
They were healthy, she
said after clearing her plate,
which also had other foods,
such as grapes, apple slices
and cheese cubes.
Group members said they
rely on the fact that students
are at an age where they ab-
sorb information quickly and
maybe they will share what
they learn with their fami-
lies.
It really makes a diference
to know that we inspired one
kid, said Saherish Surani, a
Carroll freshman and Sara
Suranis sister.
The program also inspired
one of its own members, Leslie
Salomon, who plays an active
role in her familys health.
Her 13-year-old brother, Ja-
cob, was diagnosed with Type
1 diabetes at 3 years old, and
she has a grandmother diag-
nosed with Type 2. Salomon
used to be a key caregiver for
her grandmother.
Salomon, a 17-year-old Car-
roll junior, buys the groceries
for her immediate family and
often opts for healthier foods,
such as lean chicken and
greens.
She said her family started
cutting meal portion sizes
and eating healthier after her
brothers Type 1 diagnosis.
Salomon, who often helps
her brother count carbohy-
drates, said childhood diabe-
tes afects the whole family.
Its basically, like, a para-
site, she said. It takes over
everything.
Salomons father, Ray, 37,
said he has relatives with Type
2 diabetes who have vision
problems, limb amputations
and loss of teeth as a result of
the disease.
Its kind of bad, he said,
adding he makes sure his chil-
dren routinely get screened
for risk factors.
He said a family has to work
together to stay active and eat
healthier.
Its a team efort, he said,
on everyones part.
Yeager Elementary School kindergarten students Daniel Soliz (left) and Cameron Salinas, both 5, try a
healthy snack of a cracker, cheese, grape and carrot during an iConquer Chews Wisely presentation by
Corpus Christi Independent School District students in October.
High school and middle school students present a puppet show to teach elementary school students how
to eat healthy during an iConquer Chews Wisely program at Yeager Elementary School in October.
Payton Tyler, 5, a student at Yeager Elementary School, puts on an
iConquer sticker during a presentation by the group at the school in
October. Middle and high school students teach students about eating
healthy and staying t to prevent diabetes.
MESSAGE
from 81X
By Rhiannon Meyers
meyersr@caller.com
361-886-3694
As local diabetes initiatives
disappear, zzle or fall short,
the debate about potential so-
lutions has been inuenced by
deep-rooted beliefs that per-
sonal responsibility not the
lack of policy solutions are
fundamentally responsible for
the regions No. 1 health crisis.
Im not sure that you can
ever, from a policy standpoint,
correct bad habits, Nueces
County Commissioner Mike
Pusley said. It takes people
wanting to change their life-
styles. We could provide the
help and support mechanisms
to do that, but people have to
be responsible and want to
change they way they live
their lives.
While other communities
found that initiatives funded
by governments, hospitals
and insurance companies
prevented complications and
saved millions in unneces-
sary health care costs, Corpus
How do you change a
culture of diabetes?
COST OF
DIABETES
Published December 22, 2013
With funding and resources scarce in the area, personal
responsibility becomes more crucial than ever before
Jerry Madrigal makes his way home after his daily walk, which is helping him keep his diabetes in check.
See DIABETES, 84X
Christi has no coordinated,
sustainable or well-funded
efort to curb Type 2 diabetes
and its expensive complica-
tions among a broad popula-
tion.
Its so hard down here to
change the culture of our eat-
ing habits and not exercising
enough, County Judge Loyd
Neal said. If were going to
solve it, we have to start in
the home.
The Coastal Bends re-
sponse is fragmented, run by
various groups with limited
and unstable funding working
on their own, at times at odds
with each other, to tackle a cri-
sis that can seem insurmount-
able. Diabetes rates are twice
the national average here and
complication rates are among
the worst in the nation.
The bottom line is that all
of these things require money,
and our budget isnt the larg-
est in the world, said Dr. Wil-
liam Burgin, health authority
of the Corpus Christi-Nueces
County Public Health District.
Its very easy for someone to
say, Thats a public health
matter so give it to public
health. Public health is only
one doctor, and thats me We
basically do the absolute best
that we can.
After a yearlong series ex-
amining the causes and conse-
quences of the local diabetes
epidemic, the Caller-Times
explored possible solutions
to curb the epidemic. The an-
swer seems to lie somewhere
in the middle, a blend of smart
lifestyle choices combined
with programs, initiatives or
policies that guide people in a
healthier direction.
Health coaches and dia-
betes education classes are
two key concepts proven to
help people manage the dis-
ease in other communities.
Good management prevents
expensive complications like
the ones dogging the Coastal
Bend.
But similar programs have
struggled to nd sustainable
funding in the Coastal Bend.
Im a rm believer that
throwing money at this prob-
lem is not necessarily the an-
swer, Neal said, arguing the
Nueces County Commission-
ers Court actively supports
diabetes initiatives.
The judge and commis-
sioners each get $10,000 per
year from the hospital district
to spend on diabetes. All but
Joe McComb, who said he
ideologically opposes giving
taxpayer money to nonprots,
spent their allotment on com-
munity outreach programs,
school initiatives, educational
supplies or healthy lunches for
employees.
Its not a matter of want-to
or program designs or even
money for that matter, Neal
said. Its a matter of convinc-
ing people to make a lifestyle
change ... Until you hit some of
these people in the head with
a two-by-four, I dont know
what were going to do.
Meanwhile, the region con-
tinues to grapple with high
complication rates 12 years
after a national research rm
named Corpus Christi No. 1
in the country for leg ampu-
tations.
The region now ranks No.
2, dropping behind McAllen,
according to 2010 Dartmouth
Atlas data on Medicare en-
rollees. And when it comes to
dying from diabetes, Nueces
County ranks third in the
state, according to state re-
ports.
COSTLY PROBLEM
The statistics are distress-
ing. Diabetes is one of the
costliest diseases. An amputa-
tion alone costs about $81,000
on average, according to Texas
estimates.
And the nancial toll ex-
tends beyond those diag-
nosed. Taxpayers and those
with health insurance pick up
the tab for the uninsured or
those on government-funded
health care plans.
The nancial burden is es-
pecially acute in the Coastal
Bend. One of the poorest re-
gions of Texas, more than a
quarter of people are unin-
sured and about 18 percent are
covered by Medicaid.
In Type 2 diabetes, the body
becomes unable to efectively
use its own insulin. Glucose
builds up in the blood and
nerves and organs.
Yet blindness, kidney fail-
ure and amputations expen-
sive and debilitating complica-
tions are preventable when
people with diabetes manage
their disease and control their
blood sugar through small
steps: a little exercise, smart
eating and stress manage-
ment.
It seems like an easy enough
answer, but controlling diabe-
tes can be difcult.
Patients must learn how to
eat again, altering recipes and
lifelong dietary habits that are
at times deeply entwined in
culture, tradition and family.
They need to learn how to
count carbohydrates, a tough
skill even for some experts.
They have to check their
feet daily for sores or infec-
tions that could lead to ampu-
tations and prick their ngers
sometimes ve times a day to
monitor their blood sugar for
dangerous spikes and drops.
And overworked primary
care and family practice doc-
tors, pressured by declining
reimbursements to see more
patients, have little time to
fully explain the disease.
So while some argue the
patient is solely responsible,
policy solutions also have
been shown to help patients
understand and successfully
manage their disease.
For example, a special in-
vitation-only clinic run by an
Atlantic City hospital system
pairs diabetics with health
coaches. This year, six of the
clinics 940 patients with Type
2 diabetes were on dialysis.
In six years of operation, the
clinic saw one amputation a
patients toe.
That thing about personal
responsibility is absolutely
right, said Bryan Helm, 47, an
AtlantiCare patient who took
diabetes classes ofered as a
partnership between Atlanti-
Care and the Joslin Clinic, a
leading diabetes research and
care institution. The Joslin
Clinic could not force me to
eat right. The Joslin Clinic
could not force me to exer-
cise right. They could explain
to me how it worked and the
rest was up to me. But, with-
out that knowledge, I would
be sputtering.
Corpus Christi has one such
health coaching program.
Run by Christus Spohn, it
has lacked the stability and
strength of Atlantic Citys.
But Spohn has been beeng up
the Care Transitions program,
which pairs nurses and com-
munity health workers with
chronically sick patients, in-
cluding people with diabetes,
to help them overcome barri-
ers to getting healthy.
This year, nurses began
visiting program patients at
DIABETES
from 83X
Trainer Brent Norman guides Priscilla Trevino Borens hand as she
tries lifting a heavier weight during her workout at Hardstyle Kettle-
bell Club in Corpus Christi.
Its so hard
down here
to change the
culture of our
eating habits
and not exercis-
ing enough. If
were going to
solve it, we have
to start in the
home.
Loyd Neal, Nueces County Judge
See DIABETES, 85X
home. No longer limited to
indigent patients, Care Tran-
sitions has been expanded to
include uninsured patients
and those on Medicaid. In
June 2012, there were 294 pa-
tients enrolled at Memorial
and Shoreline hospitals. By
March 2013, there were 522.
And Spohn plans to con-
tinue to expand the program
to all its Corpus Christi hos-
pitals.
Spohn also plans in 2014 to
transform its family practice
clinics into patient-centered
medical homes, a more inten-
sive primary care clinic where
a team of people works togeth-
er to provide a deeper level of
care, according to newly an-
nounced plans.
That could build on some of
the successes Spohn saw with
its Care Transitions popula-
tion, including reductions in
emergency room visits and
cost savings. Spohn did not
immediately provide the data.
This is a real opportunity
to inuence health status, and
at the end of the day, thats
what our job really is, CEO
Pamela Robertson said.
Ofcials with the regions
other hospital system, Corpus
Christi Medical Center, could
not be reached for comment.
CEO Jay Woodall did not re-
turn repeated messages seek-
ing an interview.
CATALYST FOR CHANGE
In the ideological debate
about how best to tackle
Corpus Christis epidemic,
Spohns success stories of-
fer an example of how poli-
cies and programs can be the
catalyst for positive lifestyle
changes that save lives and
dollars.
In 2012, Jerry Madrigal -
nally sought treatment for his
infected left foot. Instead, he
found out he had Type 2 dia-
betes and his kidney function
had dropped to 10 percent.
He would need a transplant.
Within months, a surgeon
amputated his big toe, a pro-
cedure that left Madrigal over-
come with grief.
Suddenly faced with the
consequences of warning
signs he tried for years to ig-
nore, Madrigal was lost, un-
sure about what to do next.
The Care Transitions nurse
Melissa Johnson showed up at
his hospital room ofering to
help.
At rst angry and in denial,
Madrigal shoved her away. But
Johnson kept coming back and
by the end of his 19-day hos-
pital stay, Johnson had helped
Madrigal get cheap medicine,
a pair of diabetic shoes, a glu-
cometer and lessons on how
to inject insulin and test his
blood.
After he was discharged,
she stopped by his house to
make sure he was following
his care plan, taking his medi-
cines as prescribed and keep-
ing a log of his numbers.
Nearly two years later,
Madrigal is 40 pounds slim-
mer. His blood sugar dropped
from dangerously high to nor-
mal ranges. And most surpris-
ingly, his kidneys rebounded,
allowing him to get of dialy-
sis. Johnson has never seen
that happen in two years of
working with Care Transi-
tions patients.
Madrigals success is one
of personal choice. He got
healthy by committing to
changing his habits. But its
also an example of how a pro-
gram can provide the founda-
tion for such a dramatic trans-
formation.
STUNTED PROGRESS
But for every step forward,
Corpus Christi seems to fall a
step back.
This year, for example, the
Salvation Armys Foot Savers
program that provided free
diabetic shoes lost funding,
leaving Spohn unable to se-
cure pairs of the expensive
shoes for diabetics like Mad-
rigal who need them, com-
munity health worker Linda
Garcia said.
The Corpus Christi-Nueces
County Public Health District
lost its only diabetes grant,
$60,000 from the state that
it used to help pay for local
classes.
And the state has not ap-
proved a health department
plan local experts were par-
ticularly excited about, a
proposal to use Medicaid
transformation funding to
hire community health work-
ers to coach people with dia-
betes. That raises questions
about whether more than $300
million in Medicaid transfor-
mation money estimated to
be spent in the Coastal Bend
will make a dent in the diabe-
tes crisis.
These announcements fol-
low years of similar setbacks
in the local ght.
Diabetes management
classes have been systemati-
cally closed or defunded.
Diabetes Centers of Amer-
ica shut down its local one-
stop-shop private clinic in
2010.
An anti-diabetes militia
fueled by funding from local
industries couldnt create a
permanent endowment to
stay aoat.
Funding crunches like that
force local groups into a sur-
vivalist mode, complicating ef-
forts to make a diference, said
Jacki Siller, whose successful
Catholic Charities program
lost its state funding in 2011,
forcing Siller to lay of the com-
munity health workers.
The community has to
work together, she said. We
have to nd those resources in
the community that do exist
and really be willing to share
the wealth.
What the Coastal Bend
needs, ofcials say, is a uni-
ed and coordinated regional
response, with backing from
strong leaders willing and able
to fund a response.
Mayor Nelda Martinez
hinted that she is working on
a plan to inuence a critical
mass of people but declined
to say more while details were
being worked out.
I think we as leaders in
the community have to put
together strategic plans that
are going to be substantive
and results-oriented, Mayor
Nelda Martinez said. Our
problem is that we have a
culture thats not eating right
and is not active enough and
it starts with me.
The plan would build on
some of the Mayors Fitness
Councils 2014 initiatives,
she said. The council is plan-
ning monthly walks through
a Westside park with a doctor
and recognition programs to
certify events and businesses
as healthy.
For us to really address
this monster of diabetes and
obesity, were going to have to
have a strategic plan that deals
with the masses, but we have
to start somewhere, she said.
DIABETES
from 84X
TAKE ACTION
Do you have questions or concerns about the Coastal Bends diabetes epidemic? Contact local ofcials.
MAYOR NELDA MARTINEZ
Call: 361-826-3100
Email: neldam@cctexas.com
Twitter: @Nelda4Mayor
COUNTY JUDGE LOYD NEAL
Call: 361-888-0444
Email: nueces.countyjudge@co.nueces.tx.us
Twitter: @loydneal
Corpus Christi-Nueces County
Public Health District
HEALTH AUTHORITY DR. WILLIAM BURGIN
Call: 361-826-7200
DIRECTOR ANNETTE RODRIGUEZ
Call: 361-826-7205
Email: annetter@cctexas.com
Twitter: @ccpublichealth
STATE REP. TODD HUNTER
Call: Capitol, 512-463-0672 or district, 361-949-
4603
Twitter: @toddahunter
U.S. REP. BLAKE FARENTHOLD
Call: Capitol, 202-225-7742 or district, 361-884-
2222
Twitter: @farenthold
Jerry Madrigal, who lost a toe in 2012 due to diabetes complications,
credits religion in helping him turn his diabetes around along with a
healthier lifestyle. Despite losing the toe, he is now walking up to 2
miles a day for exercise.
RACHEL DENNY CLOW/CALLER-TIMES TODD YATES/CALLER-TIMES
FACES OF
DIABETES
The Caller-Times over
the past year inter-
viewed a dozen peo-
ple on camera about
how Type 2 diabetes
afected their lives,
their families and
their health. These
are their stories.
I spent
about $3,000
in one year
eating at
Whataburger
every day,
seven days
a week.
Ridiculous.
RANDALL GONZALES
She was so young.
And she left her young
son behind.
SUZY GARCIA
Fifty-one years
of abuse and the
consequences
are Im losing a
toe. And I say,
Thank you
Jesus, thank
you God, for
just losing a toe
today.
JOE QUINTANILLA
I can see where giving
up, even though you
love this person and
you want the best
for them, the stress,
the overwhelming
responsibility to take
care of somebody
could cause somebody
to want to throw their
hands up and say
enough is enough.
MARIA BENSON-AGUAS
Forty-two
years old and
having to
learn how to
re-eat. Thats
the hardest
part.
JOE CRUZ
I have a wife and
two kids. I decided
they mean more
to me than a
cheeseburger or a
big plate of food.
TOM SORRELL
If I had lost
weight then, if
I had started
exercising
then, I really
do not believe
I would be
sitting here
with diabetes.
FRANCES STORMS
Im the bad
guy. My wife
is the one
whos always
saying Blake,
you shouldnt
eat that.
U.S. REP.
BLAKE FARENTHOLD
In the end, if you
get (bariatric)
surgery, you have
to have your mind
set on it that you
want to ght. Keep
ghting. Dont give
up. Its going to
be a life-changing
experience.
EDWARD WUEST
I think my
children
were more
afraid for
me than I
was.
BELVA ROBINSON
It does
change
your life.
TEXAS REP.
TODD HUNTER
Being diabetic is
not easy, denitely
not easy. Its very
hard. But if you
dont take care of it,
the consequences
are going to be very
bad.
HECTOR COACH SALINAS
JERRY MADRIGAL
In 2012, Madrigal sought
treatment for a foot infection.
Instead, he discovered he
had Type 2 diabetes, his kid-
neys were failing and his toe
needed to be amputated.
The amputation was partic-
ularly hard on Madrigal, 50. He
had to quit work as a laborer
and was forced to go on dis-
ability pay.
But the diagnosis also
served as a catalyst for trans-
formation.
He cut back on portion sizes,
gave up alcohol and started go-
ing to church. He also started
walking. At rst, he could only
make it to the end of the block.
Now he walks 2 miles every
day.
When he was diagnosed,
Madrigal weighed 260 pounds
and his A1C, a three-month
blood sugar average, was 14,
the highest some meters can
register. An A1C of 6.5 indi-
cates diabetes.
He now weighs 220 pounds
and his A1C dropped to 5.1.
More surprising, his kidney
function rebounded from 10 to
31 percent, allowing him to get
of dialysis this year. He no lon-
ger needs a kidney transplant.
I feel a lot better that Im
alive, Madrigal said. If I
hadnt taken care of myself
and changed my life around
I dont think I wouldve been
here anymore. Thats what I
tell everybody. God saved my
life. He gave me a wake-up call.
He did his part and now I have
to do my part.
At rst depressed about the
amputation, Madrigal now
feels grateful.
I see a lot of people get their
legs cut of up to their knees,
he said. Im very blessed it
was only my toe. When they
told me they wanted to cut
my toe of, it bothered me for
a long time. Now Im already
used to it. When I see my foot,
I know its not going to have a
toe there.
The journey hasnt been
easy, Madrigal said, and there
were times he wanted to quit.
But his pastor at Greater Faith
Church promised him a light
at the end of the tunnel. And
so he continued to ght.
Its like Im a new man, he
said.
Where are they now?
COST OF
DIABETES
For more than a year, the Caller-Times followed local families
coping with Type 2 diabetes, reporting on their successes and
challenges living with a disease that has become an epidemic
in the Coastal Bend. Heres a look at where they are now.
Priscilla Tre-
vino Boren lifts a
weight over her
head as trainer
Brent Norman
looks during her
workout at Hard-
style Kettlebell
Club in Corpus
Christi.
Jerry Madrigal talks about how he has turned his diabetes around by
leading a healthier lifestyle and religion before his daily 2 mile walk.
PRISCILLA BOREN
For years, Priscilla Boren
shrugged of warnings from
her doctors that she was predi-
abetic until, in 2012, she nally
got around to having some
long-overdue blood work done
and the doctor diagnosed her
with Type 2 diabetes.
Her A1C was 11.8. The doc-
tor put her on insulin and
warned that, left uncontrolled,
her high blood sugar could
lead to blindness, amputations
and even death.
Boren immediately gave up
carbohydrates and dropped
weight. Excited about the
weight loss, she started walk-
ing, then jogging, then run-
ning, completing her rst 5K
in October 2012.
At the time of her diagno-
sis, she weighed 270 pounds.
When the Caller-Times began
following her in late 2012, she
was down to 200 pounds, al-
though she still needed insu-
lin.
Boren, 41, continued to shed
weight this year, switching
up her workout from running
to intense workouts with
weights, and changing her
diet.
In June, her doctor told her
that her blood sugar had fallen
to prediabetic levels, meaning
she no longer needed to take
insulin or diabetes pills.
She now weighs 143 pounds
and her A1C is 5.4.
When people see me that
havent seen me in a couple of
months they freak out, they
really do, she said.
Her advice for others diag-
nosed with diabetes?
You can beat it if you want
to, but its up to you, she said.
Priscilla Tre-
vino Boren lifts a
weight over her
head as trainer
Brent Norman
looks during her
workout at Hard-
style Kettlebell
Club in Corpus
Christi.
THE MORENOS
Martin Moreno, 51, was di-
agnosed with pre-diabetes in
September 2012, seven months
after his wife, Rosalinda, 40,
died after years of debilitating
and chronic health problems,
including Type 2 diabetes.
Her death was hard on the
family, especially daughter
Martina, 16, who also has Type
2 diabetes.
At his doctors urging, Mar-
tin agreed to take a diabetes
class in November 2012 to
learn more about the disease,
and he brought his son Mat-
thew, 29, with him.
At the time, Martins A1C
was 5.9.
Matthew, who was not diag-
nosed with diabetes, tested his
blood sugar in the class and
discovered that he fell into
diabetic ranges.
The classes inspired them
for a while.
Martin tried to eat healthy,
to make home-cooked meals
instead of going to the taque-
rias for dinner. But Martina
didnt like the healthier op-
tions and Martin, still strug-
gling with grief, couldnt
nd the motivation to exer-
cise. He spent his days on his
couch drinking cofee and
poring over his dead wifes
journals.
When he returned to see Dr.
Crystal Campos in December
2012, she diagnosed him with
diabetes, but told him she
would give him more time to
rein in his blood sugar before
she put him on medication.
Throughout 2013, the More-
nos struggled to nd the mo-
tivation to get healthy. Some-
times they ate fresh fruits and
vegetables; other times, they
went back to junk food. Mar-
tin and Martina took two long
walks together in the summer,
an event so special to the two
of them, that Martin wrote it
down in a journal.
Matthew bought a weight
set, a tness video and a mem-
bership to Freedom Fitness,
but he rarely used them.
He never went to the doctor
for an ofcial diagnosis.
Martin did go back to the
doctor in late November. The
good news: He lost 7 pounds
in three months, dropping him
down to 317. His A1C dropped
to 5.8, meaning he didnt need
diabetes medicine.
The bad news: His choles-
terol and blood pressure were
high so Campos prescribed
him medication to get that
under control.
Before Martin left the ofce,
Campos made him commit to
a weight loss goal. He wanted
to lose 100 pounds by Decem-
ber 2014, but she made him
revise that down to 50 pounds.
More realistic, she said.
Every time I felt like I was
looking good, I would start
eating normal, Martin told
Campos. But its not a diet.
Its a new way of living.
Thats exactly right, Cam-
pos said.
Mathew Moreno and his father, Martin, sit the table as they prepare
for a family dinner of hamburgers. Martins wife, Rosalinda, died last
years of battling Type 2 diabetes and Martin has also been diagnosed
with diabetes.
ROLAND GAONA
In 2003, Roland Gaonas
kidneys shut down, the conse-
quence of years of unchecked
diabetes and high blood pres-
sure.
He was forced to go on di-
alysis, a grueling procedure re-
quiring him to be tethered to a
machine 12 hours each week to
lter the toxins from his blood.
To aford his health care,
Gaona, 52, didnt work full
time and kept his income be-
low $24,000 a year to qualify
for Medicaid coverage and
disability. He otherwise would
not have been able to aford the
out-of-pocket medical expens-
es, he said.
An acquaintance of Gao-
nas ofered to give him a kid-
ney and they were working
through the process when, late
one night in May, as Gaona was
buying his weekly supplies for
dialysis, he got a call that a kid-
ney was waiting for him from a
donor who died.
He hitched a ride to a San
Antonio hospital, underwent
a battery of tests and, less than
24 hours after he got the call,
Gaona had a new kidney.
The transplant changed his
life, giving him more energy
and a new lease on life. He
has two goals for next year:
Go back to work and create a
nonprot focused on education
and the prevention of diabetes
and kidney disease.
He envisions a type of local
event held in a ZIP code with
high rates of diabetes, much
like how the League of United
Latin American Citizen used to
march against gangs in neigh-
borhoods plagued by gang ac-
tivity.
We could end up at a park
with service providers doing
free blood testing, free blood
pressure testing and all kinds
of information and activities
for kids like a jump roping con-
test, Gaona said.
Before his story published
in June, not many people knew
Gaona was on dialysis, but the
article gave Gaona a chance to
share his story and advocate
for better diabetes prevention.
When state Rep. Abel Her-
rero brought it up, Gaona used
the opportunity to pitch his
idea for the creation of a diabe-
tes research center in Corpus
Christi. The two plan to meet
soon to talk about the proposal,
Gaona said.
Gaona re-
ceived a new
kidney that
he said has
given him a
new lease on
life.
DANITA REYES
Although he likely had Type
2 diabetes much earlier, Mike
Reyes was ofcially diagnosed
when he was 23.
By 30, he was blind, a com-
plication that was followed by
amputations and kidney fail-
ure, leaving his wife, Danita,
to do everything on her own:
Take care of the kids, take care
of Mike and work full time to
support them. Some days, she
felt like a single mom.
In January, Mike had a
stroke.
It seemed at rst he would
recover, but in March, two
hours into his four-hour dialy-
sis treatment, Mike went into
cardiac arrest. Danita had to
make the call to take him of
life support. He died in an
acute care hospital in McAl-
len at age 38.
His 10-year-old twins, So-
phie and Simon, never knew
their dad as a healthy man.
The slideshow that played at
his visitation April 1 featured
only one recent photograph of
him, taken at a pizza party, his
eyes hidden by an oversize pair
of goofy party glasses. He nev-
er wanted photographs taken
of himself after he went blind.
When Mike died, Danita
thought she would feel a sense
of relief. Instead, she felt lonely
and sad.
Eight months after she bur-
ied her husband, Danita said
life is starting to feel normal.
The children are adjusting,
although they still have their
moments of grief, and Danita
no longer has to worry about
rushing home to check on
Mike.
I think Im getting strong
every day, she said. Every
day that passes, I feel like Im
getting better at dealing with
not having him around and not
having him to worry about.
But she still harbors a lot of
anxiety.
Ive dealt with a lot of guilt
as well, thinking I couldve
done so much more, she said.
But I couldnt have forced
him to take care of himself. I
couldnt have forced him to eat
better. I came to realize there
really wasnt anything more I
couldve done.
She is hoping to use her tax
refund in the spring to buy a
tombstone for his grave.
Danita Reyes sits on the bed where she keeps her memorial blanket
for her husband, Mike Reyes, Tuesday, May 14, 2013 at her home in
Corpus Christi. Mike Reyes died of a stroke after years of complica-
tions from diabetes.
People with pre-diabetes have blood glucose levels that are
higher than normal, but not high enough to be diagnosed as
diabetes. Pre-diabetes can put people at increased risk of
developing Type 2 diabetes, heart disease and stroke. While
about one-third of U.S. adults have pre-diabetes, awareness of
this risk condition remains low.
Heredity: Those with a
family history of diabetes
face a greater chance of
developing it.
Weight: Adults who are
overweight develop
diabetes more frequently
than people who are in the
normal weight range.
Overweight is dened as
having a body mass index
(BMI) greater than 27.
Ethnicity: African-
Americans, Hispanics,
Native Americans, Asian-
Americans and Pacic
Islanders face a greater risk
of developing diabetes.
Age: Many develop
diabetes after
age 45.
Pregnancy: Women who
get gestational diabetes or
who deliver babies weigh-
ing more than 9 pounds face
a greater risk of develop-
ing diabetes later in life.
TYPE 2 RISK FACTORS KNOW YOUR NUMBERS
A1C (three-month average of blood sugar levels)
Greater than 6.5
Diabetic
4 5 6 7 8
5.7 to 6.4
Pre-diabetic
Less than 5.6
Healthy
Fasting glucose (mg/dl)
Healthy blood pressure Healthy cholesterol
(mg/dl)
Greater than 126
Diabetic
0 50 100 150 200
100 to 125
Pre-diabetic
Less than 100
Healthy
range
range
Diastolic
(bottom
number)
Systolic
(top
number)
LDL: Less than 100
HDL:
Greater Greater
than 40 than 50
(men) (women)
Triglycerides:
Less than 150
29 31 34 36 39 41 43 46 48 51 53 56 58 60
27 29 31 34 36 38 40 43 45 47 49 52 54 56
25 27 29 31 34 36 38 40 42 44 46 48 50 52
23 25 27 29 31 33 35 37 39 41 43 45 47 49
22 24 26 27 29 31 33 35 37 38 40 42 44 46
21 22 24 26 28 29 31 33 34 36 38 40 41 43
19 21 23 24 26 27 29 31 32 34 36 37 39 40
18 20 21 23 24 26 27 29 30 32 34 35 37 38
17 19 20 22 23 24 26 27 29 30 32 33 35 36
16 18 19 20 22 23 24 26 27 28 30 31 33 34
WEIGHT IN POUNDS
H
E
I
G
H
T
4'6
4'8
4'10
5'0
5'2
5'4
5'6
5'8
5'10
6'0
120 130 140 150 160 170 180 190 200 210 220 230 240 250
BODY MASS INDEX CHART,
AGES 20 AND OLDER
Obese
(Over 30)
Overweight
(25-29)
Healthy
weight
(Below 25)
PRE-DIABETES
Progression to Type 2 diabetes is not
inevitable. People with pre-diabetes can
prevent or delay the onset of Type 2 diabetes
by losing 5 to 7 percent of their body weight
and getting at least 150 minutes per week of
moderate physical activity.
Less than
130
Greater
than
80
Take control of your health by asking your health care provider
to check your A1C, blood glucose, cholesterol and blood pres-
sure, and make sure your numbers are in the healthy target
range. If not, ask your health care provider to help you come
up with a plan to get healthier.
Diabetes is a group of diseases characterized
by high blood glucose (blood sugar). When a
person has diabetes, the body does not
produce insulin (Type 1 diabetes) or is unable
to use its own insulin effectively (Type 2).
Glucose builds up in the blood and causes a
condition that, if not controlled, can lead to
serious health complications and even death.
The risk of death for a person with diabetes is
twice the risk of a person of similar age who
does not have diabetes.
What is diabetes?
DIABETES TYPES
Type 1:
Accounts for about 5 percent of all diagnosed
cases. Type 1 is usually rst diagnosed in
children and young adults, although it can
occur at any time. To survive, people with
Type 1 diabetes use insulin from an injection
or pump. Risk factors for Type 1 diabetes can
be autoimmune, genetic or environmental. At
this time, there are no known ways to
prevent Type 1 diabetes.
Type 2:
Accounts for about 95 percent of diagnosed
cases in adults. Healthy eating and regular
physical activity, used with medication if
prescribed, can help control health complica-
tions from Type 2 diabetes or can prevent or
delay the onset of Type 2 diabetes.
Gestational diabetes:
Develops and is diagnosed as a result of
pregnancy in 2 to 10 percent of pregnant
women. Gestational diabetes can cause
health problems during pregnancy for both
child and mother. Children whose mothers
have gestational diabetes have an increased
risk of developing obesity and Type 2
diabetes. Women who have gestational
diabetes face a higher risk of developing
Type 2 diabetes in the future.
MEDICATION HELP
Need help paying for medications?
Call 361-825-2804.
All applicants must provide:
Identication
Social Security card
Proof of income
List of medications
Physician information
Sources: Centers for Disease Control and Prevention;
Texas A&M Health Science Center Coastal Bend Health
Education Center; American Diabetes Association clinical
recommendations
COMING IN APRIL 2014
Our second Healthcare Heroes section where we will honor local medical professionals,
all of whom are nominated by the community.
Dont miss the opportunity to nominate the person who has made an impact in your
life. Watch for nomination information to be announced online at caller.com and in the
Corpus Christi Caller-Times.
Hospital
to Home
If you or a loved one is hospitalized and have a chronic
condition like diabetes or congestive heart failure, we
can help. CHRISTUS Spohn will assist your transition from
hospital to home by providing the tools and support
needed to understand and manage your condition.
To see if you are eligible for our Care Transitions Program
call, 361-902-6542.
Introducing
Care Transitions Program
ad.indd 1 1/17/14 2:44:21 PM
COST OF
DIABETES
It affects everyone
Sunday, February 9, 2014
Fueling Good Things in
the Communities We Serve.
In addition to providing good fuel, were committed to doing
good in our community. Thats why CITGO provides its
employees the Fuel Your Health Program, to monitor wellness,
including signs of diabetes. Fuel good for your health today by
knowing the risks of diabetes and how to prevent it, because a
healthy community is a vibrant one.
CITGOCorpusChristi.com | 2014 CITGO Petroleum Corporation

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