Impatient

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Why are poor diabetics more likely to lose limbs?

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A recent study from UCLA found that diabetics in low-income neighborhoods – like East Los Angeles – are up to 10 times more likely to have a toe, foot or leg amputated than diabetics living in wealthier, west L.A. neighborhoods.

When the study came out earlier this month, KPCC's Adrian Florido reported that while diabetes-related amputations have declined overall in recent years, black and non-English speaking men older than 65 are still especially at risk for them.

Why?

At that time, Florido spoke with Dr. Carl Stevens, the study's lead author. Stevens said a key factor is the lack of early and effective diabetes treatment for lower-income people.

Also, he said, there are fewer primary care doctors in poor neighborhoods, compared with wealthier ones.

Hope

Florido kept digging, and found a Boyle Heights doctor who says there's more to the story.

Florido reported Thursday that Dr. Gabriel Halperin, of New Hope Podiatry, says there's another big factor:  Many doctors tell patients that amputations are necessary, when in fact they're not.

And many patients don't seek a second opinion, says Halperin, who runs a podiatry center specializing in limb preservation.

Halperin said:

"Our Latino patients have a tremendous amount of trust in the doctors and the medical community… So they have a greater chance of going along with it than somebody on the west side who will question what the diagnosis is and ask for second opinions."

Money

Of course, money is an issue.

Florido reports that amputations are cheaper than the long, labor-intensive process of healing wounds. He writes:

"Healing an infected limb can be expensive. It can require bypass surgery to increase the flow of blood to extremities that's been impaired by diabetes, surgery to remove dead tissue, and almost weekly follow-ups to keep new infections at bay."

That could explain why doctors are more likely to recommend amputations to people who lack insurance, or whose plans resist paying for treatment, he writes.

Florido writes that only about 25 percent of New Hope's patients have private insurance, while the rest are on Medi-Cal, Medicare or uninsured. So to make up for the low margins from treating less profitable patients, the practice has to treat more of them, he writes.

'Try to save it'

Diabetics like 53-year-old Miguel Hernandez don't want to lose body parts to their disease.

When Hernandez was told he might have to lose part of his foot - or all of it - he said: "Please, try to save it... I have to work, I have to support my family."

Instead of undergoing an amputation, he was referred to Dr. Halperin at New Hope.

I recommend listening to Florido’s story here, to hear the voices of  diabetics who managed to keep their limbs.

Have you had an experience with diabetes-related amputations? Tell us about it in the comments section below, or e-mail us at Impatient@scpr.org.

 

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