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TEXANS FOSTER A WIN Arian Foster, Houston Texans defense were deep in the heart of win over the Cincinnati Bengals in AFC wild-card playoff game. SPORTS, 1C

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SUNDAY, JANUARY 6, 2013 ■ CITY EDITION

Coastal Bend cadre returns to Austin ■ Lawmakers

FOOD TREND ROLLING IN Food trucks are not a new phenomenon, but in recent years their popularity has grown, and culinary variety along with it. LOCAL, 1B

WIND-WIND SITUATION? Developers of South Texas wind farms praised the one-year extension of a major industry tax credit, but the immediate effect on about half a dozen wind farms that are yet to be built here remains unclear.

face slate of tough topics

By Rick Spruill spruillr@caller.com 361-886-3667

The November election returned a host of familiar faces to familiar spaces in the state House, where Nueces County now holds

Diabetes Coastal Bend

remains on the rise and the still ranks among the worst places for diabetic complications, including below-the-knee

amputations and death.

INSIDE Hunter goes into legislative session with high power ranking. 10A Coastal Bend House and Senate delegations. 10A

one less seat than it did in 2011. In all, the four-member Coastal Bend contingent to Austin — state Reps. Abel Herrero, Todd Hunter and J.M. Lozano, and state Sen. Juan “Chuy” Hinojo-

sa — bring with them the experience of a combined 24 legislative sessions that reach back to the late 1980s. Include longtime state Sen. Judith Zaffi rini, DLaredo, whose district includes San Patricio County, and state Sen. Glenn Hegar Jr., R-Katy, whose district now includes all of Aransas County and the North Padre Island See LEGISLATURE, 10A

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LEGISLATIVE SESSION

The 83rd Texas Legislature convenes Tuesday. The Caller-Times is previewing the session in a three-day series. time as a Republican.

TODAY

■ The 83rd Legislature will focus on education, ture g islabudget Le issues and windstorm insurance reform. ■ Todd Hunter, the Coastal Bend’s most experienced legislator, has been ranked the No. 3 most powerful representative.

2013

MONDAY

■ Abel Herrero returns to the House aiming to advocate ture for publicLeducation. eg isla

2013

TUESDAY

■ Rep. J.M. Lozano returns for second session, this

THE SILENT

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DISEASE ature

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LOCAL, 1B

CRAIGSLIST CRIMINALS Corpus Christi police in recent weeks have responded to at least three cases in which someone was robbed when meeting potential buyers through Craigslist. LOCAL, 1B

ON CALLER.COM

■ Want to know how your local lawmakers made it into office? Check Caller. com/Election2012 for fact checks, campaign claims and stories. ■ Keep up with the latest political happenings in the Political Pulse blog at blogs.caller.com. ON SOCIAL MEDIA

■ Follow @Callerpolitics on Twitter ■ Like Caller Politics on Facebook

COST OF

DIABETES

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series FACES OFthe multiple examining facets of diabetes DIABETES and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on peoples’ bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their health. UPCOMING STORIES TODAY

The extent of the problem: While the Coastal Bend does not lead the nation in prevalence of diabetes, it is near the top in complications.

THE GUN CONUNDRUM The gun issue doesn’t fit neatly into the belief that people have the right to make their own decisions about how they live their lives, as long as they respect the rights of others to do the same.

FEBRUARY

TODD YATES/CALLER-TIMES

Jerry Madrigal talks at his Corpus Christi home about how diabetes has affected his life, from his daily routine to the loss of his big toe on his left foot. Madrigal had early warning signs of diabetes and said he regrets not seeing a doctor sooner. He has since lost 55 pounds.

■ Patients often ignore warnings

INSIGHT, 15A INDEX

INSIDE

Local news now. Download our app with the QR code.

HELP CATCH A CRIMINAL

meyersr@caller.com 361-886-3694

■ Comic strip Baldo to help illustrate Caller-Times stories about diabetes epidemic. 12A ■ Faces of Diabetes: Joe Cruz, 42. 13A ■ What is diabetes? Get the information you need on types, risk factors, your numbers and medication help. 14A HEIGHT

BUSINESS 20A-21A CROSSWORDS 5G LOTTERY 2C NATION/WORLD 4A OBITUARIES 6B-9B OPINION 22A-23A WEATHER 23A

By Rhiannon Meyers

ES

DIABET

serious can lead to a controlled, death for that, if not The risk of f similar age a condition of i il and causes cations and even death. i k off a person the risk blood i th health complidi zed by high body b tes iis ttwice terized racteri ith diabet es. es, the person with diseases charac its it not have diabet son has diabetunable a group of bl tto use a person who does Diabetes is sugar). When b tes)) or iis FACTORS diabet a in the blood WHAT IS glucose (blood e insulin (Type 1 TYPE 2 RISK Those with es e builds up Heredity: DIABETES? does not produc vely (Type 2). Glucos of diabet effecti family historyr chance of own insulin r face a greate NUMBERS care provide it. KNOW YOUR your health blood presdeveloping by asking and TYPES cholesterol l of your health who are DIABETES Take contro A1C, blood glucose, are in the healthy target Weight: Adults p come rs ight develo ntly to check your sure your numbe Type 1: percent to help you r 5 overwe about provide freque care sure, and make Accounts forsed cases. Type 1 the diabetes more ask your health who are in ) range. If not, to get healthier. of all diagno diagnosed in than people range. sugar levels first up with a plan is usually e of blood as normal weight 6.5 young adults, is defined -month averag Greater than children and occur at any Overweight mass index A1C (three can 5.7 to 6.4 Diabetic 5.6 although it having a bodyr than 27. , people with Less than y Pre-diabetic time. To survive Health (BMI) greate 8 es use insulin 7 Type 1 diabet n or pump. range African6 from an injectio Ethnicity: 5 for Type 1 Hispanics, 4 Risk factors be autoimmune, Americans, ans, Asian126 l) than r (mg/d e can Greate l. At diabetes Native Americ Pacific Fasting glucos 100 to 125 Diabetic environmenta and 100 known genetic or Americans Less than y Pre-diabetic a greater risk there are no Health this time, Islanders face diabetes. 200 t Type 1 150 ways to preven of developing range 100 50 diabetes. develop terol 0 Age: Many t Healthy choles Type 2: diabetes after pressure about 95 percen (mg/dl) Accounts for cases in adults. Healthy blood age 45. than 100 of diagnosed and regular LDL: Less n who Less than ancy: Wome es or Healthy eating y, used with Pregn ic Systol HDL: ional diabet Greater 130 physical activitprescribed, can get gestat babies weigh(top Greater if than 50 medication health complicawho deliver 9 pounds face number) than 40 l (women) es or help contro ing more than of develop(men) Type 2 diabet tions from or delay the onset a greater risklater in life. Greater t : es can preven ing diabet than Triglycerides Diastolic es. 150 of Type 2 diabet (bottom 80 Less than es: r) diabet numbe Gestational is diagnosed as a is not Develops and ncy in 2 to 10 2 diabetes ssion to Type pre-diabetes can result of pregna nt women. ■ Progre pregna are 2 diabetes People with percent of e levels that inevitable. onset of Type weight ES diabetes can delay the blood glucos diagnosed as Gestational problems during PRE-DIABET t of their body prevent or betes have be to 7 percen minutes per week of with pre-dia not high enough to risk of cause health both child and by losing 5 ■ People for at increased at least 150 y. normal, but pregnancy put people e and stroke. While and getting higher than n whose betes can ess of diseas physical activit mother. Childregestational moderate diabetes. Pre-dia 2 diabetes, heart pre-diabetes, awaren Type mothers have an increased developing ird of U.S. adults have have es and diabet POUNDS 250 about one-th on remains low. ping obesity WEIGHT IN 220 230 240 risk of develo es. Women who this risk conditi 190 200 210 180 face 58 60 es 170 Type 2 diabet T, 150 160 ional diabet 51 53 56 INDEX CHAR have gestat of developing 120 130 140 54 56 43 46 48 BODY MASS OLDER 47 49 52 36 39 41 a higher risk es in the future. 52 AGES 20 AND 40 43 45 29 31 34 4'6 46 48 50 Type 2 diabet 34 36 38 40 42 44 47 49 27 29 31 Healthy 4'8 HELP 34 36 38 41 43 45 MEDICATION for medications? 27 29 31 44 46 weight 35 37 39 paying 4'10 25 38 40 42 29 31 33 Need help (Below 25) 41 43 5-2804. 33 35 37 23 25 27 40 31 5'0 38 29 Call 361-82 27 provide: 40 33 34 36 22 24 26 Overweight ants must 5'2 36 37 39 28 29 31 All applic 38 (25-29) 31 32 34 22 24 26 37 29 21 cation 35 27 5'4 ■ Identifi 32 34 24 26 36 Security card 27 29 30 19 21 23 Obese ■ Social 5'6 32 33 35 23 24 26 income 27 29 30 (Over 30) 33 34 18 20 21 ■ Proof of 5'8 23 24 26 28 30 31 medications 19 20 22 ■ List of 24 26 27 ation 5'10 17 ian inform 20 22 23 ■ Physic 16 18 19 Control and 6'0 for Disease Sources: Centers A&M Health Science Texas Education Prevention; Bend Health ion Center Coastal Diabetes Associat Center; Americanndations clinical recomme

Jerry Madrigal, 49, half limped into his hallway bathroom and closed the door behind 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 off his sock, he couldn’t look at his left foot. Not yet. He lowered himself onto the plastic shower chair straddling the bathtub and reached forward, turning the knob. Water rained down. He forced his foot forward and prepared to see the empty space where his big toe had been. 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 firm 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 Bend’s longtime struggle with the disease and gave birth to a flurry of initiatives aimed at curbing the rates of diabetes and diabetic complications. Twelve years later, little has changed. See DIABETES, 12A

Following the dollars: Millions have been spent trying to prevent and treat diabetes. Find out how effective the programs have been. EVERY WEDNESDAY

Clip healthy, diabetes-friendly recipes from the Food section. AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Learn what questions to ask your doctor about diabetes. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from the Association of Health Care Journalists fellowship program.

Campaign aids 1,044 families

Check out the latest Crime Stoppers video at

■ But goal falls

CALLER.COM.

short in area by $23,226

By Michelle Villarreal

To subscribe:

villarrealm@caller.com 361-886-3716

883-3800

INSIDE Donor list. 8A-9A

The final numbers are in for the 2012 Caller-Times Children’s Christmas Appeal.

Generous readers donated $136,774 to the campaign. The campaign’s goal was to reach $160,000, but donations fell short by $23,226. The campaign helped 1,044 area families and 2,793 children and provided them with necessities such as clothing, shoes and toys for the holiday season. Even though the goal wasn’t met, many agencies

still reported that without the donations they received they couldn’t have helped the number of families they did. “I am thankful to all of our readers and supporters of this program,” said Steve Arnold, CallerTimes vice president of marketing and Children’s Christmas Appeal campaign coordinator. “ I want all of those who donated to know that these

children and families are very grateful for their donations. They truly did make a difference in the lives of these families that were helped through our program.” Since 1973, the CallerTimes has reported the plight of needy children during the holiday season. The names of those profi led are changed to

See CHRISTMAS, 8A


12A » Sunday, January 6, 2013 »

C A L L E R -T I M E S

from the cover

Baldo comic to help illustrate coverage ■■Creators aim

to raise diabetes awareness By Rhiannon Meyers meyersr@caller.com 361-886-3694

A nationally syndicated comic strip, Baldo, is joining the Caller-Times as it takes a look at the Coastal Bend’s diabetes epidemic. The comic strip’s cocreators, Hector Cantú and Carlos Castellanos, offered to provide Baldo characters and archived content to help illustrate the series, which starts today, after learning of the newspaper’s plan to commit the next year toward exploring diabetes in the Coastal Bend. The Baldo strip, which appears in more than 200

CONTRIBUTED PHOTOs

Hector Cantú is the writer of the comic strip Baldo.

papers nationally, including the Caller-Times, features a Hispanic teen named Baldo Bermudez and his family members. Cantú and Castellanos in 2009 developed a storyline where Baldo’s father is diagnosed with diabetes as

the creators aimed to raise awareness about a disease that disproportionately affects Hispanics. “As a writer, you’re always trying to make your characters relatable, and we wanted to make our characters a little bit more

relatable and give them these very human problems,” Cantú said. Diabetes long has been a problem in the Coastal Bend, where nearly 1 in 6 people has the disease. Hundreds have died, and the amputation rates are among the highest in the state and nation. A Weslaco native, Cantú said the disease has hit

close to home. His mom has diabetes, and the disease was a contributing factor in his father-in-law’s death, he said. “Luckily I have not dealt with it myself, but it makes you certainly keep an eye on eating right and getting exercise,” he said. When the Baldo strip first introduced the diabetes storyline, readers were

If I would’ve gone back three years ago, they would’ve found out I was diabetic three years ago and I would not be where I’m at now. That’s what I tell my friends and people that have it. Don’t take it as a joke because I did. Now look at what’s happened to me.” Jerry Madrigal

COST OF

DIABETES Diabetes data

Explore the extent of the Coastal Bend’s diabetes FACES problemOF with interactive maps, charts and databases at Caller.com/ data/diabetes. ■■ Diabetes and risk factor prevalence: Physical inactivity, obesity and diabetes rates throughout the United States. ■■ Amputation rates: Rates of leg amputations per 1,000 Medicare enrollees in U.S. counties, and rates over time in Texas counties. ■■ Climbing diabetes rates: Compare rates over time in various states. ■■ Texas death rates: Deaths caused by diabetes and other major diseases in Texas.

DIABETES

Jerry Madrigal’s big toe was removed after an infection spread in his foot because of diabetes complications.

DIABETES from 1A

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, a distressing statistic because diabetes complications are so preventable. The Caller-Times is running a yearlong series examining the extent of the problem, the consequences and what can be done to curb the high rates of diabetes and diabetic 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, although the group based its ranking on Medicare enrollees only. State reports, which are more comprehensive, rank

Nueces County’s belowthe-knee amputation rate lower than some other Texas counties. Nueces County is 19th on a list ranking 133 Texas counties’ amputation rates. However, the county’s prevalence of such procedures has remained significantly higher 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 County ranked third in the state in 2009, according to the most recent state data available. Nearly 700 people in Nueces County died between 2006 and 2010 from diabetic complications, including two people in their mid- to late 20s. And those numbers likely don’t tell the whole story. Diabetes 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

grateful Cantú and Castellanos decided to take up such an important issue, Cantú said. He hopes the strip can continue to raise awareness about the disease. “If there’s anything we can do in the strip to make people think about it, that’s what we’re trying to do: Keep the issue in front of people in our own little way,” he said.

photos by TODD YATES/CALLER-TIMES

Jerry Madrigal and his wife, Patricia, pose for a photograph on their wedding day. Jerry weighed more than 260 pounds before being diagnosed with diabetes. He’s since lost 55 pounds.

death certificates, according to the state.

OUT OF CONTROL Diabetes is a group of diseases characterized by high blood glucose, or blood sugar. About 5 percent of diabetics have Type 1 diabetes, in which the body does not produce insulin, a chemical that moves glucose out of the blood into storage for the body to use as fuel. But the vast majority of diabetics have Type 2, a disease that develops as the body becomes unable

to effectively use its own insulin. Glucose builds up in the blood and causes a condition that, if not controlled, wreaks havoc on the body’s 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 management, and despite efforts to reverse those trends, complications remain a problem in the Coastal Bend.

Jerry Madrigal spent 19 days in the hospital after he was diagnosed with diabetes in March. He now needs a kidney transplant and is no longer able to work as a laborer.

Part of the reason is purely mathematical. Diabetes is more prevalent in the Coastal Bend, which is predominately 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 diabetes class,” said Corpus Christi diabetes specialist Dr. Egbert Miranda. Some local doctors said patients often were “noncompliant,” meaning they refused to follow advice, failed to show up for follow-up appointments and don’t go to diabetes education classes, when recommended. “People don’t want bad news to be put in their face,” said Dr. Gerald Boynton, a family practice doctor in Corpus 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 control, they don’t want to come in and have someone point that out to them.” When patients don’t follow directions, doctors get frustrated, and that can lead to a vicious cycle of miscommunication and distrust between patients and health care providers

weary of giving directions that are never followed. Diabetic complications not only cause pain and suffering for those losing their eyesight, a leg or a kidney, they also exact a financial toll. Amputations are one of the most expensive procedures, costing on average, $80,072 for a person in Texas to have an amputation in 2010. That’s 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 1 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 efforts. As long as diabetes remains poorly controlled, taxpayers are left footing the bill for expensive procedures and pricey medication.

WAITING TOO LONG Jerry Madrigal, of Corpus Christi, knows the costs of diabetes all too well. Four years ago, he came home from a friend’s house, sank into his couch, kicked off 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 doctor, who treated the wound but issued a warning: Madrigal should get checked for diabetes, which causes poor blood circulation and nerve

See DIABETES, 13A


C A L L E R -T I M E S

« Sunday, January 6, 2013 « 13A

from the cover

TODD YATES/CALLER-TIMES

Priscilla Boren walks out to Old Brownsville Road for an early morning jog. She started running after being diagnosed with diabetes last spring and has since lost 65 pounds.

Habits are hard to break. For the same reason why it’s hard to maintain a New Year’s resolution, it’s easier to slip back into the old ways of doing things than maintain the new ways.”

Dr. Gerald Boynton, a family practice doctor in Corpus Christi who has treated diabetics

COST OF

DIABETES TODD YATES/CALLER-TIMES

FACES OF

DIABETES

Joe Cruz AGE: 42

Joe Cruz, of Portland, was diagnosed with diabetes in October — after he lost more than 100 pounds. The diagnosis was shocking because he already had shed so much weight, he said. The most challenging aspect of the disease? Trying to figure out what he can eat. “Forty-two years old and having to learn how to re-eat,” he said. “That’s the hardest part.”

/VIDEO Watch Joe Cruz tell his story. Rhiannon Meyers

DIABETES from 12A

damage and makes feet vulnerable to sores. Madrigal brushed aside the doctor’s advice. His wife and mother urged him to get checked, but, like many others, 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 didn’t feel sick. He wasn’t in pain. His wound seemed to heal, except for a small sore near his toe that refused to close. He couldn’t see the infection spreading inside his foot, eating away at the flesh and bone from inside. When, in March, Madrigal’s foot swelled so big he could no longer fit into his house slippers and the reddened skin began to peel like an old blister, he finally sought treatment. This time the news wasn’t so ambiguous. “He’s a very sick man,” the doctor told his family. The next morning, they wheeled Madrigal into his first 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 register. An A1C of 6.5 or higher indicates diabetes. He spent 19 days in the hospital. 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 laborer, he receives disability pay. Sometimes, he tags along with his friends to their jobs. They’ll flip over a 5-gallon bucket and he’ll sit there, watching them climb ladders and apply wall texture. He feels worthless. Unnecessary. He tried to trim the front yard, but weak from dialysis, 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 everything that’s happening,” he said. “If I would’ve gone back three years ago, they would’ve found out I was diabetic three years ago and I would not be where I’m at now. That’s what I tell my friends and people that have it. Don’t take it as a joke because I did. Now look at what’s happened to me.”

NO EXCUSES Type 2 diabetes creates insulin resistance and

can be managed through a healthy diet and exercise. In some cases, lifestyle changes can help people get off medication altogether. “People should have the attitude that, if they have a higher risk, if they are Hispanic or overweight or have a big waist or a family history of diabetes, they should be asking themselves, 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 find myriad excuses not to make healthy choices. Few people have more potential 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 she’s not running her own wedding photography business, she’s networking to drum up business or volunteering for the Corpus Christi Hispanic Chamber of Commerce. Her phone buzzes incessantly with incoming text See DIABETES, 14A

ABOVE: Boren takes an early

morning jog down Old Brownsville Road. She was diagnosed with Type 2 diabetes last spring and started walking, then jogging, to help manage her diabetes. She ran her first 5K in October.

TODD YATES/CALLER-TIMES

LEFT: Boren, 40, at a mixer in February, months before she was diagnosed with diabetes. She weighed 265 pounds. CONTRIBUTED PHOTO

I remember my grandma getting insulin shots and she was old. I remember thinking, ‘Wow. Is that what it’s come to, that they have to put me on this insulin?’ ”

Priscilla Boren


14A » Sunday, January 6, 2013 »

C A L L E R -T I M E S

from the cover DIABETES from 13A

DIABETES WHAT IS DIABETES?

racterized by high blood Diabetes is a group of diseases characterized son has diabetes, the body glucose (blood sugar). When a person b t ) or iis unable bl tto use it does not produce insulin (Type 1 diabetes) its own insulin effectively (Type 2). Glucose builds up in the blood

DIABETES TYPES Type 1: Accounts for about 5 percent of all diagnosed cases. Type 1 is usually first 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 complications 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: ■ Identification ■ Social Security card ■ Proof of income ■ List of medications ■ Physician information

and causes a condition that, if not controlled, can lead to serious health complications and even death. The risk of death for a ith di b t iis ttwice i th i k off a person off similar i il age person with diabetes the risk who does not have diabetes. TYPE 2 RISK FACTORS Heredity: Those with a family history of diabetes face a greater chance of developing it.

KNOW YOUR NUMBERS Take control of your health by asking your health care provider to check your A1C, blood glucose, cholesterol and blood pressure, 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.

Weight: Adults who are overweight develop diabetes more frequently than people who are in the normal weight range. Overweight is defined as having a body mass index (BMI) greater than 27.

A1C (three-month average of blood sugar levels) Less than 5.6 Healthy range 4

5.7 to 6.4 Pre-diabetic

5

Greater than 6.5 Diabetic

6

7

8

Fasting glucose (mg/dl) Less than 100 100 to 125 Greater than 126 Healthy Pre-diabetic Diabetic range 0

50

100

Healthy blood pressure Systolic (top number)

Less than

Diastolic (bottom number)

Greater than

150

Ethnicity: AfricanAmericans, Hispanics, Native Americans, AsianAmericans and Pacific Islanders face a greater risk of developing diabetes.

200

Healthy cholesterol (mg/dl)

Age: Many develop diabetes after age 45.

LDL: Less than 100

130

HDL: Greater than 40 (men)

Greater than 50 (women)

Pregnancy: Women who get gestational diabetes or who deliver babies weighing more than 9 pounds face a greater risk of developing diabetes later in life.

Triglycerides: Less than 150

80

PRE-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.

Healthy weight (Below 25) Overweight (25-29) Obese (Over 30)

Sources: Centers for Disease Control and Prevention; Texas A&M Health Science Center Coastal Bend Health Education Center; American Diabetes Association clinical recommendations

■ 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.

WEIGHT IN POUNDS 120 130 140 150 160 170 180 190 200 210 220 230 240 250

BODY MASS INDEX CHART, AGES 20 AND OLDER

HEIGHT

messages. Sundays are typically her only day off. She can’t find 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 off, until this spring, when, weeks after she finally got around to having long-overdue blood work done, the doctor’s office called. They had her results and needed her to come in immediately. “The doctor held my hand, looked me in the eyes and she says, ‘Your (A1C) is 11.8.’ She says, ‘Everyone here in the office saw that and gasped.’ ” She thought she felt fine, but then the doctor ticked off the symptoms of diabetes. Excessive 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, remembering 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 it’s come to, that they have to put me on this insulin?’ ” She thought about how, when she was little, she visited her diabetic greatuncles 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 first week, she took her pills, injected insulin and ate Whataburgers 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 sidewalk bordering the darkened Gabe Lozano Golf Course. Early morning commuters whizzed by on Old Brownsville 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 notified her husband when she completed the run, and he shot back inspirational texts: “Way to go, babe!” and “I’m so proud of you!” When the big race arrived in October, Boren ran the entire 3.1 miles, and finished with her best time yet. “For me it meant a lot,” Boren said. “The most rewarding part of it was, I always see people racing on TV or running and someone hands them water. And it was grabbing that water from that little kid and drinking it. Like, ‘He’s there for me, to give me the water. I can’t believe I’m actually doing this race.’ ” And she hasn’t stopped. She still rises before the sun to run, even when it’s cold: “I’ll just pretend I’m jogging thru Central Park today,” she posted one chilly morning. She plans to run another 5K in February. She’s struck a healthy relationship with food: She still eats breakfast at La Bahia but asks the restaurant to leave potatoes off her plate. She’ll have a taco for lunch — but just one, consumed with deliberately slow precision and long breaks between bites. She occasionally indulges in a slice of wedding cake

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John Bruce/Scripps Howard Newspapers

photos by TODD YATES/CALLER-TIMES

Priscilla Boren takes an early morning jog down Old Brownsville Road. She has been tracking her time and posting updates on Facebook. She plans to run another 5K in February.

Jerry Madrigal no longer takes insulin, only an oral diabetic drug typically given to newly diagnosed patients.

but pays for it on the pavement. Between June and December, she lost 65 pounds, results that turn heads. When she stopped at a department store to buy makeup, a Chanel counter lady eyed her slimmer, 5-foot, 10-inch,

200 -pound frame in khaki shorts and black blouse and declared, “If you lose any more weight, you’re going to change on me.” “It’s nice,” Boren said. “I’ll buy a new outfit and see myself in the mirror and think, ‘Who’s 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 first step to start exercising, change their relationship with food, give up what they think they can’t live without. “Habits are hard to break,” Dr. Boynton said. “For the same reason why it’s hard to maintain a New Year’s resolution, it’s easier to slip back into the old ways of doing things than maintain the new ways.” And because Type 2 diabetes can wreak slow havoc on a person’s body, the kind of life-altering complications that motivate

people to get healthy often take years to develop. By the time people feel sick, it’s often too late. “This is a disease that is silent,” said Dr. O. Alejandro Brusco, a Corpus Christi doctor who is board certified in diabetes, endocrinology and cholesterol control. Jerry Madrigal finally 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 special diabetic sock pulled tight against the new contour of his foot, he passes framed photographs of himself 55 pounds heavier. He’s 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 hasn’t touched beer or liquor in nine months. He started going to Greater Faith Church. And he’s seen results. His blood glucose levels hover around 100, a healthy range. He no longer takes insulin, only an oral diabetic drug typically given to newly diagnosed patients. Still, the odds are stacked against him. Research shows diabetics who undergo one amputation 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 y’all something else has to be cut off, don’t let them cut it off. I’m going to agree to my toe. And that’s 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 don’t care,” Madrigal said. “That’s what I told my doctors. If it gets to that point, I’d rather just let God take me ... I don’t want to be in this world being a little, small person.” Some days, when he’s awash in grief and feeling especially helpless, Madrigal thinks he’d be better off dead. But his mother, 74, told him she couldn’t 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.


S U P E R B O W L X LV I I C O V E R A G E

It’s Ray Lewis’ last ride and the Ravens against the youth of Colin Kaepernick and the 49ers in Sunday’s big game. SPORTS, 1C, 6-8C

TV: 5:30 P.M., CBS

SUNDAY, FEBRUARY 3, 2013 ■ CITY EDITION

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Diabetes self-management classes reveal that some choices are

75˚/57˚ Morning fog

21A

HARD HABITS

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RUNNERS SHOW TRUE COLORS

TO BREAK

Color Me Rad 5K race scatters 2.5 tons of colored cornstarch to raise $20,000 for Ronald McDonald House Charities of Corpus Christi. LOCAL, 1B

COST OF

DIABETES The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series to examine the multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the Caller-Times hopes to help its readers understand the disease and make better informed choices about their health.

UPCOMING STORIES TODAY

Self-management classes are widely regarded as one of the best ways to prevent the onset of diabetes and complications. But in a region long plagued by complications, the classes don’t live up to their potential.

DISTRICT PAYS $60K FOR IPADS District says investment in administrators’ iPads to aid in teacher evaluations is worth it.

MARCH

LOCAL, 1B

PHOTOS BY TODD YATES/CALLER-TIMES

Diabetes educator Georgiana Bradshaw pricks fingers for a blood sugar test before class begins at the Antonio E. Garcia Arts Center on Agnes Street. The grant-funded Diabetes Hands On classes last two hours per week for eight weeks.

PENNINGTON HONORED Arizona Diamondbacks shortstop Cliff Pennington returns to his alma mater to get his number retired at Carroll High School. SPORTS, 1C INDEX NATION & WORLD 4A OPINION 20A WEATHER 21A PUZZLES 5G OBITUARIES 8B, 9B

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Diabetes is one of the biggest drivers of health care costs nationwide, eating up about one in every 10 health care dollars. Find out how much the chronic disease has cost the Coastal Bend. APRIL

Some programs in other areas of the country are successfully attacking the diabetes epidemic with community health workers and diabetes educators. Find out if those models can be replicated in the Coastal Bend. EVERY WEDNESDAY

By Rhiannon Meyers

Clip healthy, diabetesfriendly recipes from the Food section.

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 didn’t 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 Moreno’s lab results. “Your sugar, your sugar tells me …”

AT CALLER.COM/DIABETES

Martina Moreno, 16, and her father, Martin, taste some fries before sitting down to dinner. Martina and Martin have been diagnosed with diabetes.

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 re-

INSIDE  Despite success, community outreach program cut. 10A  Graphic: What is diabetes? 9A  Graphic: Diabetes class results. 10A  Faces of diabetes: Frances Storms. 11A

■ Take a quiz to test your diabetes knowledge. ■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from the Association of Health Care Journalists fellowship program.

See DIABETES, 9A

Immigrants’ remains alarm Texas group By Mark Collette collettem@caller.com 361-886-3678

A civil rights group is preparing to pressure Texas agencies that don’t take DNA samples from the unidentified remains of undocumented immigrants, saying those agencies aren’t following state law. The Texas Civil Rights

INSIDE Immigration debate persists as many fearful. 4B Study of construction industry finds issues. 4B Same-sex partner provision prompts GOP unease. 2B

Project said South Texas especially does a poor job of cataloging immigrant deaths, to the despair of those seeking missing rel-

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atives who may be buried and forgotten in nameless graves. “There’s total disarray in South Texas,” said Maria Jimenez , a Houstonbased immigrant advocate and civil rights activist. The pressure comes as South Texas experiences a surge in migrant deaths, even as overall See DNA, 9A

CONTRIBUTED PHOTO

Bodies of undocumented immigrants found in Brooks County often are so decomposed that articles of clothing and other personal effects are the only identifying markers. These shoes belonged to an immigrant found dead in 2012.

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C A L L E R -T I M E S

« Sunday, February 3, 2013 « 9A

FROM THE COVER DIABETES from 1A

garded as one of the best ways to prevent the onset of diabetes and complications such as blindness, kidney failure and amputations. But in a region long plagued by diabetic complications, the classes fail to live up to their potential, worsening the prognosis for a disease that’s one of the biggest drivers of health care costs. Corpus Christi’s diabetes education programs in recent years have struggled to stay afloat, 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 fight to stay open. A $1 million state-funded University of Texas Community Outreach program closed two years after it opened even though participants on average saw their blood-sugar levels decline, reducing their risks for expensive 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 Bend’s self-management programs have been plagued by setbacks. Corpus Christi’s two major hospital systems — Corpus Christi Medical Center and Christus Spohn hospitals — closed

DNA

from 1A immigration decreases. In Brooks County, the epicenter of deadly illegal border crossings in South Texas, the remains of 129 people were discovered in 2012. Of those, at least 47 remain unidentified, according to county records. It was the most dead in one year in local officials’ memory, and more than double the 52 recovered bodies in 2011. The county cemetery, site of dozens of “John Doe” markers, is running out of space. “We took interest in it because we saw it primarily as a humanitarian crisis in the state of Texas,” said Tom Power, a legal advocate for the project.

SIMPLE SOLUTION? Sheriff’s investigators said the tally represents a fraction of those who die because many are never found among the prickly mesquite thickets and sandy soils that make the 944-square-mile county such a deadly route for migrants. They and their smugglers choose the route more than 60 miles inland because it avoids a Border Patrol checkpoint at Falfurrias. But that means walking at least 30 miles across bleak, unforgiving terrain where it is easy to get lost or injured, or to succumb to the elements. Even with cellphones, callers who get through on weak signals can’t always tell dispatchers where they are because there are few landmarks across the wide ranches. Animals quickly find and ravage remains, making identification that much harder. Power said his initial inquiries about the handling of remains show policies vary widely among agencies, leading to inconsistencies in tracking the cases. But there may be a ready solution. The Center for Human Identification at the University of North Texas Health Science Center in Fort Worth analyzes DNA samples from unidentified remains under a federal grant. The information is fed into state and national databases. The services are free to law enforcement agencies and to relatives of the missing who can submit their own samples to see if their family members are

WHAT IS DIABETES? 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. View more information at caller.com/diabetes

KNOW YOUR NUMBERS Take control of your health by asking your health care provider to check your A1C, blood glucose, cholesterol and blood pressure, 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. A1C (three-month average of blood sugar levels) Less than 5.6 Healthy range 4

5.7 to 6.4 Prediabetic

5

6

7

8

Fasting glucose (mg/dl) Less than 100 100 to 125 Greater than 126 Healthy Prediabetic Diabetic range 0

50

Healthy blood pressure Systolic (top number) Diastolic (bottom number)

their outpatient programs in the past decade. Corpus Christi Medical Center, which has inpatient nutrition counseling for diabetics, did not comment on why its program closed. Spohn still provides outpatient programs at community hospitals in Alice, Beeville and Kingsville but shuttered its Corpus Christi program in part because of dwindling attendance, spokeswoman Katy Kiser said. The hospital now focuses on educating patients during their hospital visits — more than half of Spohn’s inpatient admissions are related to diabetes — while referring patients to other local

Greater than 6.5 Diabetic

Less than

130 Less than

80

classes. Although diabetes education exists in different forms throughout the Coastal Bend, the American Diabetes Association recognizes only two outpatient programs in the Corpus Christi area: the state-funded Texas A&M Health Science Center Coastal Bend Health Education Center program and the Corpus Christi Food Bank’s grant-funded Diabetes 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 community health workers say doctors often fail to refer

100

150

TODD YATES/CALLER-TIMES

Diabetics test their blood sugar before Diabetes Hands On classes run by the Food Bank of Corpus Christi. The classes aim to teach people how different foods affect their blood sugar.

200

Healthy cholesterol (mg/dl) LDL: Less than 100 HDL: Greater than 40 (men)

Greater than 50 (women)

Triglycerides: Less than 150

patients to the classes, and when they do refer them, it’s a fight to get people to attend and return for follow-up appointments. “You would imagine that when somebody gets diagnosed with diabetes, they would be the one knocking at our doors,” said Dr. Juan Castro, a family-practice doctor and medical director of the city’s largest diabetes class. “That’s not the case.”

A LOT TO LEARN Mark Nixon perched on the edge of an exam table as diabetes specialist Dr. O. Alejandro Brusco reviewed his medical chart. Tennis shoes hid Nixon’s 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. That’s more than three times healthy levels. “When was the last time you went to a diabetic class?” Brusco asked him. “I haven’t been,” Nixon said. “That’s truly impressive,” Brusco said. “Because, how old are you now, sir?” “Almost 40,” Nixon answered. “So 21 years and you’ve never gone to a diabetic class,” Brusco said. Diagnosed at 19, Nixon doesn’t know whether he has Type 1, an autoimmune disease 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 fisherman quit checking his

There’s a lack of communication between agencies as to what’s available. I really think there’s a lot of things that can be done that would help the situation that have to do with just coordination and deciding to set up a system.” Raquel Rubio-Goldsmith, researcher and adjunct lecturer at the University of Arizona’s Binational Migration Institute

CONTRIBUTED PHOTO

LEFT: In cases where undocumented immigrants carry cellphones, investigators may call numbers in the phone to try to reach someone who can identify the remains, but civil rights advocates argue only DNA testing is a sure way to identify the dead. This phone belonged to an immigrant found dead in Brooks County in 2012. RIGHT: Investigators may find passports, like this Honduran passport found near an immigrant’s remains in Brooks County in 2012, to help identify the dead, but a civil rights group is now pressuring South Texas authorities to use DNA testing in all cases.

among the dead. The center also provides free training for law enforcement and medical examiners.

LACK OF DIALOGUE While Washington haggles over federal immigration policy at the start of a new term, the grim task of gathering and identifying the dead remains a local problem. Tiny rural agencies such as the Brooks County Sheriff’s Office are ill-equipped to deal with the tide of bodies, bones and personal effects discovered by ranchers and Border Patrol agents in the wilderness. The Sheriff’s Office has about 10 deputies on a budget of $681,000, not counting the jail budget. That is supplemented with about $400,000 in asset seizures. Typically only one deputy is on patrol. Chief Deputy Benny Martinez said county officials are only now becoming aware of the DNA issue and were not familiar with the Center for Human Identification. He said the Sheriff’s Office and other county officials are likely to be receptive to the DNA testing program, especially if it comes at little or no cost to the county. “I think it needs to be done, absolutely,” he said. Earlier attempts to work with forensic anthropolo-

gists around Texas didn’t come to fruition because Brooks County couldn’t afford to transport bodies back and forth, County Judge Raul Ramirez said. Shipping samples to the center would be much cheaper as it would involve mailing just a few bones in most cases, said Dixie Peters, technical leader for the center’s missing people unit. “I think folks didn’t know about this,” Power said. “I think the problem arose pretty quickly, pretty rapidly and they just couldn’t deal with it.” Power said his group believes Texas law requires the DNA samples be taken from each unidentified set of remains. They are pondering legal action but may be able to work with local jurisdictions to inform them about the UNT program and convince them to participate without the need for litigation, he said. “There’s a lack of communication between agencies as to what’s available,” said Raquel Rubio-Goldsmith, researcher and adjunct lecturer at the University of Arizona’s Binational Migration Institute. “I really think there’s a lot of things that can be done that would help the situation that have to do with just coordination and deciding to set up a system.” Arizona had similar

REMAINS FOUND Brooks County

Year 2012 2011 2010

Total 129 52 20

Unidentified 47 13 5

Source: Brooks County Clerk, Sheriff

problems because its border counties had no centralized process for unidentified remains, Rubio-Goldsmith said. Things improved after the Pima County Medical Examiner started processing all of the border counties’ unidentified remains.

TO THE MORTUARY Brooks County has no medical examiner. It uses Elizondo Mortuary in Mission to handle the bodies. The Sheriff’s Office doesn’t have the staff to investigate the identity of each dead migrant, Chief Deputy Martinez said. They came in spades last year — about every other day on average, with as many as two or three on some days. “The officials that I talked with not only in Brooks but in a number of the counties were people who really wanted to do the right thing. ... But the systems don’t seem to be in place,” said RubioGoldsmith, who is in the middle of federally funded research on how immigrants’ remains are processed in local juris-

dictions across the entire U.S.-Mexico border. With only one full-time crime investigator at the Sheriff’s Office, the family-owned funeral home became the de facto entity for piecing together clues about the identities of the dead. It has been somewhat successful, identifying and reaching the families of dozens of the dead, based on body markings, notes and ID cards found with clothing, and other clues. Power said these efforts fall short of what the law requires and don’t provide enough assurance that bodies are being correctly identified. Moreover, when identification can’t be made, and DNA samples aren’t taken, the likelihood of getting an answer falls to almost zero, he said. The funeral home sends unidentified bodies back to Brooks County for burial in “John Doe” graves after two weeks, he said. If a relative calls seeking information after burial, it may be impossible to find and exhume the correct set of remains for testing.

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 tootight pair of canvas shoes that rubbed blisters into the side of each foot. The blisters became infected, and after multiple surgeries, with his blood sugar still dangerously high, his feet have not fully healed. A father of a 4-year-old girl, Nixon can’t work because he can’t expose his feet to bacteria in the sea. Uncontrolled diabetes wreaks havoc on the body’s circulation system, nerves and organs, yet blindness, kidney failure and amputations — expensive and debilitating complications — are preventable when diabetics manage their disease and control their blood sugar through small steps: a little exercise, smart eating and stress management. That may sound easy, See DIABETES, 10A

The Elizondos couldn’t be reached for comment but have said in previous interviews that they do their best to piece together information and work with consulates to help families of the dead. They installed a new refrigerated storage unit last year to handle the surge in deaths.

CRIMINAL EVIDENCE Power’s group also has concerns because the evidence could be useful in prosecuting human smugglers. Though undocumented immigrants break the law when they enter the country, they may also be crime victims when misled or mistreated by the smugglers who lead them across the wilderness. A Honduran woman told sheriff’s and Border Patrol investigators Jan. 15 that she was raped by three smugglers at a stash house near Hidalgo. The smugglers left her behind in Brooks County when she became faint and couldn’t keep up with the rest of the group. Many who are apprehended in the county tell authorities they were left behind after falling ill or injured. Those who don’t get apprehended, especially in the searing summer months, may end up at the Elizondo Mortuary. That’s where one woman from El Salvador believes her son is. Jimenez, the civil rights advocate, said she and the California-based Angels of the Desert, an aid group, have been trying to help the woman ascertain whether the remains from Brooks County are her son’s, based on a few physical characteristics. But there is no DNA sampling, Jimenez said, and the woman can’t afford the $100 per day the funeral home would charge to store the remains to keep him from being buried among the other unknowns in the county cemetery. The civil rights project and Angels of the Desert are working with the Salvadoran consulate in Houston to try to delay burial. The project has made dozens of public information requests with Brooks and other South Texas counties, including Hidalgo, Cameron and Webb, to assess their policies for handling unidentified remains. It plans to publicize its findings this year, Power said.


10A » Sunday, February 3, 2013 »

C A L L E R -T I M E S

FROM THE COVER

Despite success, Outreach program cut ■ 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 off 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 didn’t help. “They taught you things, but they were basically telling you how to read (food) labels,” he said. Because he didn’t understand the effects on his body, Soto’s blood-sugar levels worsened. Then Soto visited a health fair at his son’s school and noticed a booth promoting a new diabetes program, one that offered classes and home visits for free. The University of Texas Community Outreach program, the first of its kind in Corpus Christi, was the result of state efforts to fund innovative plans aimed at controlling diabetes, a chronic disease that is one of the biggest drivers 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 program’s demise underscores the difficulty such classes face in trying to stay afloat, even when they show success.

INNOVATION In 2009, as Soto sought

DIABETES from 9A

surgeries, and saving the state money, Siller said. “We already paid for the program in two years,” she said. “And the state just didn’t see the value in it.”

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 disease is prevalent: Cameron, Galveston, Nueces and Webb. Armed with $1 million in state funds, the Nueces County program hired a registered nurse and seven community health workers. They descended on health fairs, community centers, schools and churches in Nueces County’s neediest neighborhoods to find and help people with unchecked 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, including Rhode Island, where they work in doctor’s offices and hospitals to help emergencyroom “frequent fliers” and people with chronic diseases navigate the health system. With its street-level, guerilla-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 unprecedented insight into patients’ lives and helped them understand environmental factors contributing to their disease, Siller said. “When you go into someone’s home, you can look in their fridge … you can look in someone’s cupboard and get a good idea of what they’re cooking, of what they’re doing,” she said. The visits also helped the workers understand why some diabetics struggled to keep their diabetes in check. Scientists believe that social determinants — location, occupation,

CALLER-TIMES FILE

The 4,000-square-foot Healthy Living and Advocacy Center opened in January 2011 to much fanfare but was forced to downsize months later when lawmakers did not renew funding.

income — influence 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 couldn’t afford. Others didn’t have electricity. And some drank contaminated water, masking the foul taste with sweetened drink mix. Identifying barriers to health care allowed the program to help patients better manage their diabetes and connect them with the care and services they needed. Soto’s 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 Soto’s and propelled by the program’s potential, the University of Texas Community Outreach bought a law office on the city’s poorer west side to create a commu-

CONFRONTING THE DIAGNOSIS That’s where classes come in. They act as the safety net for patients, a place where the newly di-

Jacki Siller, program director

nity center. It opened on a chilly January morning. People crowded inside to sample healthy ham and cheese breakfast casseroles 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 mouthwatering smell of fried chicken over the Healthy Living and Advocacy Center’s parking lot, but Siller uses the neighboring Popeyes as a lesson in real-world nutrition. “There are healthy choices you can make just about everywhere,” she tells clients. “You don’t have to stop eating at Popeyes.” By the time lawmakers met in 2011 to renew the program’s funding, Siller felt confident. At full capacity, the Healthy Living and Advocacy Center bustled with clients popping in and out for cooking, aerobics, yoga

and diabetes self-management classes. Health workers made almost 700 home visits in a year. Siller reported clinical outcomes, even though the state didn’t 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 player’s 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 first three months saw their A1Cs drop, on average, 9 percent to 7.3, a level considered in control. Perhaps more telling, the program’s Medicaid clients, whose health care is paid for by the state, also lowered their blood sugar, preventing expensive complications and

DIABETES CLASS RESULTS A&M PROGRAM

but newly diagnosed patients often don’t know where to turn for help. Overworked primary care and family practice doctors have little time to fully explain the disease to patients. Doctors get paid based on the number of patients they see. As health care reimbursements continue to decrease, doctors try to see more patients in a single day, compressing the amount of time they can spend explaining the disease’s complexities, Brusco said. “When you make a new diagnosis for diabetes, that’s a lot,” Brusco said. “You’re throwing at the patient a lot of things, and patients who have diabetes don’t want to 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. It’s a lot.” Many leave their doctors’ office with a prescription for pills or insulin, and nothing more. “Think about how long the doctor spends with them, and I guess they’re just overwhelmed, and they say stupid things like, ‘Don’t eat anything white’ or ‘Follow a diabetes diet,’” said Georgiana Bradshaw, a longtime certified diabetes educator in Corpus Christi. “I had a lady say, ‘They told me to follow a diabetes diet, and I don’t know what that means.’ How are they supposed to know?”

When you go into someone’s home, you can look in their fridge … you can look in someone’s cupboard and get a good idea of what they’re cooking, of what they’re doing.”

DOWNSIZING Siller traveled to Austin throughout the summer to meet with lawmakers and to persuade them to renew funding. Soto went, too, surprised that the state would even consider closing a class that helped him so much. “No, that can’t happen,” he said. Despite their efforts, lawmakers 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 off most of her community health workers. “That was the darkest couple months of my life,” she said. “I thought if we did everything right and we exceeded their expectations, that (we would get), at least five years, at least one more go-round. “I’ll never stop the regret that I felt in having to let staff go. I’ve had to let staff go for other reasons in my career but never like that, never this dedicated staff 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 efforts in Banquete and the colonias, Siller said. This month, two new classes will be held for free at the Healthy Living and Advocacy Center: a cooking class to teach people how to buy and prepare inexpensive and healthy food, and an awareness class that teaches basic information about the disease. Still, at a center that was once too busy, Siller now finds 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, you’re still there?’” Siller said.

Initial

The city’s largest and most well-funded diabetes class, run by the Texas A&M Health Science Center Coastal Bend Health Education Center, has for years reported A1C data on its participants when they start class and when they follow up.

Follow Up

16% 20%

64%

76%

Initial

Follow Up

21%

A1C Less than 8 A1C Between 8 and 10 A1C Above 10

21%

2012

7

7.1

6.7

14

7.3

14

A1CS AMONG THOSE WHO RETURNED AT 3 AND 12 MONTHS 2004-2012

7.2 14

45

6

Inconclusive

380

5

Terri Palacios (from front), Lydia Guerrero and Maria Montoya select food from a catered dinner before the food bank’s Diabetes Hands On classes begin. Attendees have their blood sugars tested before and after eating.

84%

Average Post A1C

7.1

9% TODD YATES/CALLER-TIMES

RESULTS

8

7%

59%

FOOD BANK PROGRAM

Average Pre A1C

24%

2002

Worsened

Stayed the same Improved

4 3

613

2 1 0

2009

2010

2011

2012

902

RETURN RATE 35 %

14 117 27 254

34.6%

30 25

17.8%

20 15

7.4%

3 months

12 months

11.4%

10 5 3

6

9

Months

agnosed can learn how to inject insulin, exercise and navigate a grocery store or restaurant menu.

12

Sources: Texas A&M Health Science Center Coastal Bend Health Education Center and Dr. Melissa Wilson, endocrinologist; Corpus Christi Food Bank HandsOn Diabetes program

In Bradshaw’s free weekly class at the Corpus Christi Food Bank, diabetics are forced to confront

their disease from the moment they arrive 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 doesn’t have diabetes, but she is able to connect to her classes by addressing touchy subjects like the insulin myth — the misplaced worry that insulin, not unchecked diabetes, killed their relatives and friends — and by going places others don’t. 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 injections don’t hurt. Despite data that showed the program was making strides helping people lower their bloodsugar 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 connect food pantry clients with health care. The grant ends in 2014,

and Bradshaw isn’t sure what she will do after that. The food bank program’s financial struggles and the demise of the state-funded University of Texas Community Outreach program underscore the lack of priority placed on these programs, even when they are successful. That’s disappointing, advocates say, because the programs are desperately needed here. “Knowledge is power,” Brusco said. “A lack of knowledge 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 important because they help diabetics understand how to manage a chronic disease that requires lifelong reinforcement, Brusco said. Because people with diabetes often don’t feel sick at first, troubling signs and symptoms can go unnoticed for years until it’s too late and they lose their eyesight, limbs or kidneys. See DIABETES, 11A


C A L L E R -T I M E S

« Sunday, February 3, 2013 « 11A

FROM THE COVER She hardly likes any kind of food. I stopped cooking already because me and Matthew 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 don’t know what I’m going to do.”

e e e t

Martin Moreno, speaking about his daughter’s eating habits

n o d w , e m ” , r . e m r PHOTOS BY TODD YATES/CALLER-TIMES t h Martina Moreno, 16, and her father, Martin, chat while they have a breakfast of cinnamon sticks and coffee before heading to school; both Martina and Martin are dealing with having diabetes after the loss of Martin’s wife, Rosalinda, who died in Febru-

t ary of 2012 after battling a year of Type 2 diabetes. ” continued to drop during DIABETES the year, with 11 percent of from 10A people returning for their 12-month appointments. tGOING TO CLASS When Martin went to When Martin Moreno his fi rst class in Novem-was diagnosed with pre- ber, he did not have diabeodiabetes in September, his tes, but his elevated blood thealth was the least of his sugar levels put him at risk sworries. of developing the disease. e His wife, Rosalinda The A1C test measures dMoreno, 40, died sudden- blood sugar averages over -ly in February 2012 after two to three months. An years of debilitating and A1C below 5.6 is consid-chronic health problems, ered normal; an A1C of lincluding Type 2 diabetes. 6.5 indicates diabetes. - Nearly a year later, a Martin’s was 5.9. Martin knew something -wreath still hangs near the dfront door adorned with a about diabetes already. For spink ribbon and the words, years, he’d watched his -“We love you, Mom.” His wife and daughter prick wife’s ashes are in an en- their fi ngers, read their wgraved, rose-covered urn glucometers and inject eoverlooking the kitchen insulin. But he went to the classdtable where their daughter, -Martina, 16, hunches over es, anyway, bringing his 28-year-old son, Matthew, ea set of math problems. e When Rosalinda died, from his first marriage. They sat side by side in yshe left Martin to care for sMartina by himself. Mar- the front row and watched ctin can’t work because of PowerPoint presentations ecrippling arthritis that at times filled with complimangled his thick hands, cated medical jargon and tso he and his daughter live terminology. When the instructor ron his meager disability wheeled a television to the gchecks. t Like her mom, Martina front of their classroom, ghas diabetes. She was diag- Martin, in tightly laced tan nnosed two years ago with boots, stood with the rest -Type 2, once called adult of the class and dutifully onset diabetes, which has marched in place as the ebecome alarmingly more cheery aerobics instructor lcommon in children. With on screen shouted encourRosalinda gone, Martin, agement. still grieving, has strug“Walk, walk, walk!” she gled to help his daughter said. “Nice!” manage her disease and The classes inspired cope with the loss of her him to change, for a while. mother. He tried to eat healthy, to The Morenos’ con- make home-cooked meals founding response to instead of going to the tatheir diabetes — at times querias for dinner. But bad proactive and other times habits are hard to break. indifferent — captures the necessity and failure of the NOT ENOUGH In 1999, not long after Coastal Bend’s diabetes Martina was born, Martin classes. Martin Moreno’s low and Rosalinda decided to income allows him to get lose weight together. They health coverage from the tried dieting, and Martin county’s insurance pro- brought home workout gram for indigent patients. equipment, including a The program requires pa- stationary bike he found tients to attend the classes in a junk pile on the side in an effort to trim health of the road. They tried new foods. care costs funded by the They worked out. They county’s taxpayers. Martin’s doctor referred lost weight, but their effort him to Texas A&M’s self- was short-lived. Tempted management classes held by one another’s cravings, weekly at Del Mar Col- the pair quickly tumbled lege’s West Campus. With back into their old routine. arguably the region’s most When one saw a TV comstable and well-funded mercial and got a craving classes, the center will get for fried chicken, the other nearly $270,000 in state did, too, and in no time, funding this fiscal year for they gained back all the diabetes prevention alone. weight they lost. Martin’s new life as a The program began in 2001 after Corpus Christi single dad further comMedical Center closed its plicates his efforts to eat outpatient program and healthy. Martina is a notoriously gave its space to the health education center, said Cas- picky eater and stubborn tro, the center’s medical about her dislikes. Iceberg lettuce is OK, but not its director. f It since has expanded, crunchy, white ribs. Toabsorbing patient refer- matoes are good, but only rals from practitioners the ends. And Martina finds from both health care sysf tems and all indigent care nothing appealing about patients, who can take the her dad’s idea of healthy class free. Up to 95 percent cooking: stews of creamed of the people who attend soup, canned vegetables the classes are referred and boiled chicken. Vomit, Martina called it. there by doctors, accord“OK,” Martin told her. ing to program officials. That referral rate dwarfs “More vomit for us, more that of the other programs vomit for me and your brother.” in town. What Martina does like Still, program officials battle to get people to take is processed food loaded with carbohydrates. After the classes seriously. Fewer than half of the injecting herself with in1,200 people who attend- sulin in the morning, she ed in 2012 returned for removes a box of French follow-ups, making it hard toast sticks from the to grade the program’s suc- freezer, heats up five for cess. The follow-up rates breakfast and douses them

The urn of Rosalinda Moreno, who died last year after battling Type 2 diabetes, sits in her family’s home. Her husband, Martin, and daughter, Martina, 16, have been diagnosed with diabetes.

more than 5,600 patient records 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 remaining 2 percent were inconclusive). Did the classes fail Martin? He shrugged. “I didn’t change anything,” he said. Why not? He shrugged again. TODD YATES/CALLER-TIMES

FACES OF

DIABETES

FRANCES STORMS /VIDEO Watch Frances Storms tell her story.

Frances Storms, of Ingleside, decided to change her life after her doctor told her last year she needed to start insulin injections, seven years after she was diagnosed with diabetes. The disease runs in her family. Her dad’s left leg was amputated from the knee down. She never wanted to take insulin, but she knew she needed to get her diabetes under control. She started watching her carbohydrates and began exercising. She lost 46 pounds and lowered her blood sugar to levels considered prediabetic. If only she had made the changes earlier, she said. “If I had lost weight then, if I had started exercising then, I really do not believe I would be sitting here with diabetes,” she said.

Rhiannon Meyers

The nationally syndicated comic strip Baldo is joining the Caller-Times as it takes a look at the Coastal Bend’s diabetes epidemic. The strip’s creators offered to provide Baldo characters and archived content to help illustrate the series.

Sidney Funk watches as Hermelinda Basurto, a registered nurse and instructor of the Coastal Bend Health Education Center class, gives a demonstration on drawing blood for testing.

with maple syrup. School lunch is gross, she said, so she eats Pop-Tarts instead. Dinner is a bag of microwave popcorn sprinkled with Flamin’ Hot Cheetos or sal limón. “She hardly likes any kind of food,” Martin said in December. “I stopped cooking already because me and Matthew 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 don’t know what I’m going to do.”

As he coped with his wife’s death and struggled to raise a teenage daughter on his own, Martin couldn’t maintain the motivation to exercise and eat right. By December, they had all started eating out again. At restaurants, Martin snatched up the flour tortillas his son, Matthew, judiciously unwrapped from his tacos and set aside. They went to the pizza buffet two times in one week. Martin went for a walk

around his Westside neighborhood, but his body started to hurt and he hobbled back home in pain. He thought about going again, maybe this time pushing Rosalinda’s 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 coffee and poring over his dead wife’s journals while the old exercise equipment 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 you’re disappointed. I can tell.” Disappointed, but not surprised. According to a Caller-Times analysis of

NEW IDEAS As the diabetes epidemic continues to plague the Coastal Bend, advocates and health care practitioners are eyeing new ways to treat patients, secure stable funding sources for education and offer 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 Prevention. It is based on a study showing that modest lifestyle changes, such as exercising 150 minutes per week, helped participants lose up to 7 percent 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 reporting requirements. There are only five recognized programs in Texas. The closest is in Weslaco, 160 miles south of Corpus Christi. The new 16-week program is the first for Corpus Christi. The first class filled with 23 people, and 33 have been added to a waiting list. Christus Spohn plans to launch a nursing program this spring, providing training to make select nurses go-to resources for treating diabetes in their hospitals. And a group of advocates, the Diabetes Community Coalition, is proposing plans to hire more community health workers and pair them with certified educators to create teams of people to help chronically ill diabetics navigate the health care system. That proposal calls for funding from a new federal financing system that is awaiting approval. Changes are on the horizon for the programs, too. The diabetes coalition is studying the Coastal Bend’s education programs and outcomes to arm program directors with data to apply for grants. “Even with outcomes it’s hard to get recognition and funding, but ... if you’re not reporting outcomes, obviously you don’t have a chance,” said Jacki Siller, a coalition member and director of the University of Texas Community Outreach diabetes program, which has tried to rebuild itself since losing state funding last year. That study is expected to conclude this year.


SOUTH TEXAS

BASEBALL Expectations are high once again for several area teams this season. INSIDE

$1.50

SUNDAY, MARCH 3, 2013 ■ CITY EDITION

CCAD furloughs’ broad impact

74˚/56˚ Sunny and warmer 21A

Quick Read

■ Cuts could have ripple effect in area INSIDE

By Rick Spruill spruillr@caller.com 361-886-3667

Few thought sequestration and its consequences would happen. 11A

and Rhiannon Meyers colletter@caller.com 361-886-3694

DESTINATION IMAGINATION

Former Army Spc. Anuradha Datta, 27, understands what it is to live in the fear of death, or pain. As a member of a transport services unit attached to the 1st Infantry Division in Iraq, she participated in the dangerous job of running convoys across the desert. Now a single mother and civilian worker at the Corpus Christi Army Depot, Datta is learning to live with another uncomfortable reality.

Students tested their creativity Saturday at Destination ImagiNation as they presented skits in disguise and crafted lightweight structures that held hundreds of pounds. LOCAL, 1B

STATE OF THE LOCAL ART There are 24 businesses showcasing the works of local painters, sculptors, photographers and other styles of art during March, which is Contemporary Art Month in Corpus Christi.

COST OF

DIABETES

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining FACES OFfacets of the multiple diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their health.

LOCAL, 1B

DIABETES

HEARTBREAK FOR PANTHERS A controversial foul call during the final seconds helps send Aransas Pass’ boys basketball team to a 53-52 loss in the Region IV-2A final. SPORTS, 1C

STATES MAY HIT THE LOTTERY Some staggeringly huge jackpots have gone unclaimed. For state lawmakers in a tough budget year nationwide, the unclaimed prizes are adding up to a tempting pot of cash.

INDEX BUSINESS 18A CROSSWORD 5G LOTTERY 2C NATION/WORLD 4A OBITUARIES 8B, 9B OPINION 20A WEATHER 21A

Stay up-to-date with the latest breaking news by signing up for our Breaking News Alerts at support. caller.com/ breakingnews/ latest/.

To subscribe:

883-3800

Evaluating the disease’s

FINANCIAL TOLL

TODAY

Diabetes is one of the biggest drivers of health care costs nationwide, eating up about one inCOSTS every 10 health care DIABETES dollars. Find out how much the chronic disease has cost INDIGENT CARE the Coastal Bend.

NEWS ALERTS TO YOUR EMAIL

See CCAD, 11A

TODD YATES/CALLER-TIMES

Anuradha Datta , an employee at the Corpus Christi Army Depot , is just one of thousands of civilian employees at the depot who face furloughs after the government failed to come to an agreement over sequestration.

UPCOMING STORIES

MILITARY HEALTH SYSTEM DIABETES CARE

DIABETES COSTS APRIL

Nueces County, 2012 are successfully In Texas, 2011 Some places TODD YATES/CALLER-TIMES TOTAL: attacking $3,239,619 the diabetes $36,754,100 $33,697,284 Jerry Madrigal keeps a small cooler by his couch to organize epidemic with community$366,156 $2,600,537 Outpatient Pharmacy the medicine that helps him control his diabetes. Because health workers and diabetes Prescriptions Clinic Claims care Madrigal is unable work, Medicaid pays for his medications educators. Find out if those and other health care. models can be replicated $224,132 in Inpatient the Coastal Bend. EVERY WEDNESDAY

DIABETES HOSPITAL CHARGES BY COUNTY, 2010 Per capita costs shown represent how much every man, woman and child would pay for these hospitalizations. Emergency room visits are not included.

■ Patients aren’t footing

$48,794 Clip healthy, diabetes-friendly Emergency recipes from the Food section. Room AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. U.S. DIABETES COSTS ■ Search healthy recipes and Taxpayer T expense To Total submit your own. ■ Share your story about how 60 diabetes has affected your life. 50 ■ Watch videos, in English and Spanish, on diabetes 40 management. $18.8 billion ■ View photos showing the 30 toll of diabetes on Coastal Bend residents.

Billions

NATION, 13A

“Uncertainty,” she said. Datta is one of thousands of civilian depot workers facing furloughs, or a 20 percent pay cut for 22 weeks starting in early April, after Congress failed to come to an agreement in the political battle over sequestration. Furloughs at the city’s largest employer could cause a troubling ripple effect on the local economy, said Foster Edwards, president and CEO of the Corpus Christi Chamber of Commerce.

20

This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

huge medical bills alone

By Rhiannon Meyers meyersr@caller.com 361-886-3694

Jerry Madrigal’s life is spent in medical offices. What started as a small sore on the 49-year-old’s foot has turned into a diabetes diagnosis and an endless series of pricey procedures and prescription medications. No longer able to work, Madrigal lives on disability checks and his wife’s part-time pay. He has no clue how much all of this

2.00 10 0

$9.5 billion

1996

1998

2000

2002

2004

2006

Source: Texas Department of State Health Services; Nueces County Hospital District; Tricare and U.S. Agency for Healthcare Research and Quality

%* APY

6-Month CD

$6,048,827 Inpatient care

costs; his medical bills are fully covered by government-funded Medicaid. One of the state’s costliest diseases, the financial toll $51.3 of diabetes extends billionthose diagnosed, beyond reaching into the pocketbooks of taxpayers 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 $21.9

$91.49 Nueces County Cost per capita $4.57

billion See DIABETES, 8A

2008

$176.15 SCRIPPS NEWSPAPERS

2010

A Better Way to Save.

To open a 6-Month CD or IRA CD: Call 1-800-451-2543 | Go to ssfcu.org/6monthCD | Visit a location near you

*APY = Annual percentage yield. APY is effective as of February 13, 2013 and is subject to change without notice. This CD rate is fixed for a 6-month term, assuming a minimum deposit of $100,000. These are Share Certificates, and different rates apply to different deposit levels. CDs may be subject to early withdrawal penalty. Membership eligibility required. Federally insured by the NCUA. Visit ssfcu.org/6monthCD for complete details. IRA funds cannot be co-mingled at any time with regular savings or non-IRA funds. CAL162130


8A » Sunday, March 3, 2013 »

C A L L E R -T I M E S

from the cover

Todd Yates/Caller-Times

Blood glucose monitoring kits are among the needs for patients with diabetes.

DIABETES from 1A

LONG-TERM COMPLICATIONS

■■ Heart and blood vessel

CAL151113

Billions

Billions

diabetes has reached epidisease demic levels. ■■ Stroke The region remains ■■ Nervous system disease among the worst areas in ■■ Amputations the country for diabetic ■■ Kidney disease complications, including ■■ Eye disease below-the-knee amputa■■ Dental disease ■■ Depression tions. At the same time, Rachel Denny Clow/Caller-Times the Coastal Bend’s rates Source: Diabetes Burden Report, 2008 Jerry Madrigal waits to meet with Dr. Narain D. Mangla recently to assess his need for a kidney transplant. of Medicaid enrollees top the state average. “I think that everyinfections and have a DIABETES COSTS body bears the cost of attack, meaning the costs tougher time fighting diabetes and its compli- of diabetes likely are them, Wilson said. A INDIGENT CARE MILITARY HEALTH SYSTEM cations resulting in dis- much higher. spike in blood glucose DIABETES COSTS DIABETES CARE ability, because much of And they continue to levels, even temporarily, Nueces County, 2012 In Texas, 2011 that COSTS is paid for through grow. can paralyze white blood TES DIABET TOTAL: $3,239,619 our taxes,” said Dr. MeNationwide, diabetes cells for up to two weeks, DIABETES HO $36,754,100 $33,697,284 lissa Wilson, a local en- costs nearly tripled from compromising a person’s $2,600,537 $366,156 Outpatient Pharmacy BY COUNTY, GENT CARE MILITARY HEALTH SYSTEM docrinologist who served $18.8 billion in 1996, acimmune system, sheINDI said. Prescriptions Clinic Claims care BETES DIABETES CARE on theCOSTS Texas Diabetes cording to the Agency “There’s more flu, DIAB more $224,132 Council. for Healthcare Research colds, more urinaryNueces tract County, 2012 In Texas, 2011 Inpatient The Caller-Times exand Quality. Medicare infections,” WilsonTOTAL said. $3,239,619 DIABETES HOSPITAL CHARGES $36,754,100 $33,697,284 amined the financial toll and Medicaid covered, “A cut can easily become 537 $2,600 $366,156 Outpatient Pharmacy BY $48,794 COUNTY, 2010 of diabetes as part of its infected. Skin infections ptions Prescri Clinic Claimson average, care 42 percent, or Emergency yearlong series Cost of $196 billion during 14 and yeast infections are Per capita costs shown Room $224,132years, according to the very common.” Diabetes. represent how much every It’s impossible to Inpatient say agency. That’s enough to Looking back over $6,048,827 man, woman and child would precisely how much dia- pay the wages of a quarmonths of procedures, Inpatient care pay for these hospitalizations. $48,794ter million teachers durbetes costs the region. medications and docEmergency room visits are Emergency tors’ visits, Madrigal and Health insurers do not ing the same time. not included. Room Still, while the costs his wife, Patricia, are at a disclose their costs. The U.S. DIABETES COSTS loss to estimate the cost federal government es- of diabetes skyrocket, $6,048,827 Taxpayer Total To timates the total cost prevention has not kept of everything. InpatientT care expense $51.3 of diabetes at $51.3 bil- pace, another statistic “We’re talking hun60 billion lion in 2010 but doesn’t painfully apparent in the dreds of thousands of break that number down Coastal Bend. dollars,” Patricia said. 50 DIABETES COSTSofU.S. “It’s a lot.” by state. And diabetes Self-ma nagement ten coincides other classes, widely regarded People with diabetes axpayer expense with Total To T 40 $51.3 health problems, such as as one of the best ways to on average spend 602.3 billion $18.8 billion stroke or kidney failure, prevent the onset of extimes more on health care 30 making it difficult to pin pensive complications, than those who don’t, 50 Cost down the exact cost of have failed to live up to according to the state’s 20 the disease. most recent report on40 the their potential here. Cor$91.49 Still, publicly avail- pus Christi’s diabetes edfinancial burden of diabe10 $4.57 Nueces County $21.9 $18.8 able billion data indicate that ucation programs in retes in 2008. 30 billion $9.5 billion the costs of diabetes are cent years have struggled Madrigal regularly gets 0 Cost per capita 1996 1998 2000 2002 2004 2006 2008 2010 lab work and sees doctors particularly high in the to stay afloat as funding 20 to manage his diabetes, Coastal Bend, where gets stripped away. Source: Texas Department of State Health Services; Nueces County Hospital District; Tricare and U.S. prevent further damage counties have some of 10 Agency for Healthcare Research and Quality $4.57 $176.15 $21.9 to his circulatory system the state’s highest per ‘It’s A LOT’ billion $9.5 billion SCRIPPS NEWSPAPERS Without Medicaid, or other complications, capita costs for hospital0 1998 2000 to the 2002 2004doesn’t2006 2010 199 izations attributed and to prepare himself for Madrigal know 2008 a kidney transplant. To disease. how he would afford the I think that everybody bears the cost of as Department of State Health Services; Nueces Hospital District; Tricare and U.S. to Source: Te Jim Wells County in County do that, he needs various diabetes treatment Healthcare Research and Quality Agency for 2010 ranked fifth in the save his foot and keep medical professionals, diabetes and its complications resulting in from a dentist to a carstate, racking up $5.7 mil- him alive. lion in diabetes hospitaldiologist, to ensure his Four years ago the Cor- disability, because much of that is paid for through izations, or an average of pus Christi man stepped our taxes.” body is healthy enough to accept a transplant. $140 for every woman, on a nail, but the wound Dr. Melissa Wilson, a local endocrinologist who served on the Texas Diabetes Council Beyond that, people man and child living in refused to heal, eventuwith diabetes also tend the county, according ally sending him to the to spend more money on to the state’s health de- hospital, where he was partment. Brooks County diagnosed with diabetes. didn’t have health insur- in the county’s indigent according to the state’s prescription drugs, such ranked sixth, with $1 milas insulin and medical In the past year, he’s ance. care program. Funded by health department. lion, or $139 per person. had four surgeries, inWhen a doctor first property-tax dollars, the And those stays aren’t supplies — lancets to (Tiny, rural Culberson cluding the amputation treated his foot, his moth- program covers health cheap. draw blood for testing, County in West Texas of his big toe. His kidneys er paid for the $65 doc- care for the county’s Diabetes hospitaliza- glucometers to monitor ranked No. 1; Nueces are failing. He needs dial- tor’s visit out of pocket, poorest residents. He tions on average cost blood sugar levels and syCounty ranked 41st at ysis three times per week and Madrigal kept work- stayed on that plan until $48,720, or 50 percent ringes to inject insulin, if $91.50 per person.) The until he can get a kidney ing. he was able to enroll in more than hospitaliza- necessary. Those supply state average was $61.40 transplant. At his sickest, Work dried up in early Medicaid. tions not related to dia- costs add up. A local store, Medical per person. Madrigal took almost a 2012, shortly before MadMadrigal’s situation is betes, according to state Those costs don’t in- dozen prescription pills rigal found out he had common in Texas, where reports released in April Rehab Supply, sells a box clude emergency room a day. of 50 test strips for $20, diabetes and needed foot Medicaid and Medicare 2012. visits or conditions asMadrigal worked as surgery. paid for two-thirds of the That’s because people which could last between sociated with diabetes, a laborer for years. He Hospital social work- state’s diabetes-related with uncontrolled diaSee DIABETES, 9A such as stroke and heart earned $350 per week and ers helped him enroll hospital stays in 2010, betes are more prone to


C A L L E R -T I M E S

« Sunday, March 3, 2013 « 9A

from the cover DIABETES from 8A

two and seven weeks, depending on how often 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 difficult to quantify. A January 2012 study published 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 diabetes 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 Affairs. Ma ny of Cor pus Christi’s top employers declined to answer questions about the financial toll of diabetes because of privacy reasons or because they don’t track how many employees have the disease. The Corpus Christi Army Depot, the city’s biggest employer with more than 4,100 employees and 1,400 contractors, is developing plans to track wellness data, including diabetes rates, spokesman Jose Rodriguez said. Tracking that data could help the depot better target programs to workers’ health needs and advance its mission to promote healthy lifestyles, he said. The depot tries to encourage exercise by providing stationary bikes and other exercise equipment for workers to use during breaks, creating walking paths throughout the hangars, and offering employees access to the Naval Air Station’s fitness center, swimming pool, running tracks, baseball field, basketball and racquetball courts. The depot also has a Subway restaurant on site that offers healthy lunch options, Rodriguez said. At Texas A&M University-Corpus Christi, the city’s 13th largest employer, employees receive a discounted rate of $20 per month for the university’s gym, spokeswoman Gloria Gallardo said. University employees get wellness messages on email and Facebook while the university’s health insurer, Blue Cross Blue Shield, provides a program that helps people manage chronic diseases, including diabetes, she said. Such incentives are becoming increasingly common as employers look to curb the rising cost of diabetes and its effect on insurance premiums, said Wilson, the local endocrinologist. INSURANCE COSTS It’s difficult to determine how much insurance companies spend on diabetes. Health insurers don’t have to disclose their costs, making it impossible to determine how the disease affects insurance 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 insurer’s data provided to the CallerTimes show that the costs to treat diabetes have been expanding, even when adjusted for inflation. Tricare, which provides health benefits for military personnel and retirees and their families, spent $76.5 million on diabetes care in Texas in 2011. That’s up 14 percent from 2007, adjusted for inflation. Pha rmacy costs made up 44 percent, or

photos by Rachel Denny Clow/Caller-Times

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. Hospitalizations from diabetes cost $31 million in 2010 in Nueces County alone.

SHARE YOUR STORY An excerpt from Brian Grobe’s essay about how diabetes has affected his life: “Being diagnosed with diabetes isn’t a death sentence, or at least it doesn’t have to be. ... I know that I am only at the beginning of a long journey that will be filled with many triumphs and some disappointing failures. My hope is that the

triumphs will far outnumber the failures. So far the biggest epiphany I’ve received through this journey is that for me, diabetes may have actually saved my life.” Go to www.caller.com/ diabetes to read the rest of Grobe’s story, find personal tales from other Coastal Bend residents or share your story with us.

TAXPAYER COSTS In 2010, government-funded Medicaid and Medicare covered $21.96 billion worth of diabetes costs nationwide. That’s about the same as:

Lancets, box of 100 For pricking finger and drawing blood to test

432,641

schoolteachers’ salaries

317,754

Registered nurses’ salaries

2,312 miles to Seattle

God gives us everything to lead a healthy lifestyle and we turn around and chicken fry it.” Gwen Jennings, who runs Medical Rehab Supply in Corpus Christi

DIABETES SUPPLIES

Six-lane interstate Alaska’s state debt

A new six-lane interstate from Corpus Christi to Seattle

$12.95

Glucometer Device for testing blood sugar levels

$15

Test strips, box of 50

$19.99

Insulin pen

$39.99

Diabetes socks, 2 pa

irs Sharps container Biohazard bin for storing used syringes, lancets

$8.97 $7.68

Prices are estimates and vary based on insurance coverage, store, brand and type

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 SCRIPPS NEWSPAPERS

COST OF

DIABETES

Michael Zamora/Caller-Times

Suzy Garcia, 30, started to take a more active role in her health after a close friend died at 28 from diabetic complications. Garcia was diagnosed with diabetes in July 2011.

Some diabetics must inject themselves with insulin to help control their blood sugar levels. Insulin and other prescriptions typically are some of the largest costs for people with diabetes.

$33.7 million in 2011, according to Tricare’s reports. That’s no surprise to Gwen Jennings, who runs Medical Rehab Supply in Corpus Christi. She carries some diabetic supplies, such as glucometers and test strips, but she doesn’t sell other items often needed by people diagnosed with diabetes, such as insulin syringes or special diabetic shoes. Still, Jennings estimates about 30-40 percent of the store’s business can be linked to diabetes care. Perhaps more telling, about half of the store’s wheelchair sales and leases go to people with diabetes, she said, underscoring statistics that show the Coastal Bend ranks among one of the worst places in the nation for below-the-knee amputations despite the fact that complications are preventable by managing blood sugar with a healthy diet and exercise. “God gives us every-

thing to lead a healthy lifestyle, and we turn around and chicken fry it,” Jennings said. She said she wishes people took the disease more seriously. “It’s as serious as cancer,” she said. “It’s as serious as a heart attack and leads to heart attack. It’s as serious as a stroke. It’s every bit as serious a condition as you can have.” It’s too late for Madrigal to prevent some of the debilitating longterm complications of diabetes, but it’s not too late for him to try to get healthy and prevent further health problems associated with the disease: blindness, heart attack, more amputations. And he’s doing just that — closely monitoring his diet, exercising on the stationary bike in his living room and following doctor’s orders. He’s lost 45 pounds. At his last checkup, the doctor discovered that Madrigal’s blood sugar dropped to prediabetic levels.

FACES OF

DIABETES

Suzy Garcia /VIDEO Watch Suzy Garcia tell her story.

Rhiannon Meyers

Doctors had warned Suzy Garcia, 30, that she had pre-diabetes, but she never listened. Until her best friend died of Type 1 diabetes. She was 28. “She was so young, and she left her young son behind,” Garcia said. After her friend’s death, Garcia started noticing that she felt sick in the same ways her friend had when her blood sugar was elevated. Garcia went to the doctor and was diagnosed with diabetes. She has since tried to get healthy and has signed up to ride in the American Diabetes Association inaugural Tour De Cure race in Corpus Christi in April. “Not only is this a good way to lose weight but raise awareness to help find a cure,” she said.


ONE WIN AWAY Louisville will face off against Michigan for the NCAA men’s basketball championship. SPORTS, 1C

SUNDAY, APRIL 7, 2013 ■ CITY EDITION

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Hicks flourishing in major leagues

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reel in Hooks’ longtime voice

CALLER-TIMES EARNS HONORS The Caller-Times wins 21 statewide awards, including seven firstplace awards, from the Texas Associated Press Managing Editors Association on Saturday in San Antonio.

By Greg Rajan greg.rajan@caller.com 361-886-3702

LOCAL, 2B

MICHAEL ZAMORA/CALLER-TIMES

Texas Rangers’ radio announcer Matt Hicks laughs March 31 as he and co-host Eric Nadel get set for the Rangers-Astros opening day game in Houston. Hicks, the former Hooks radio announcer, was calling his first major-league opening day.

SCHOOL HOSTS OLYMPIC GAMES Nearly 600 athletes compete in track and field events Saturday during the Special Olympics Texas Spring Games at Flour Bluff High School. LOCAL, 1B

HOUSTON - The routine for veteran baseball broadcaster Matt Hicks has been pretty much the same for a quarter-century. Get to the ballpark about five hours before game time. Chat with the opposing broadcasters. Get in thorough preparation.

Squeeze in a meal when athletes — provide a stark possible. And last, but contrast to life in the minor leagues. not least, be ready “It’s a whole when it’s time to new life for us,” flip the switch. Hicks’ wife, EsOf cou r se , telle, said. there’s one change See video of Matt Hicks But for her husfor Hicks this sea- broadcasting band, some things son, his 25th: He on opening remain the same. does all of it in day. “It’s not right the major leagues to say it’s like any now. The lone broadcaster in Hooks his- other day because it’s not tory until last June, Hicks going to be like any other now calls games on the ra- day,” Hicks said of his first dio for the Texas Rangers. MLB opening day. “But The trappings — stay- what I have to do is pretty ing in five-star hotels, much like every other day. charter flights, rubbing See HICKS, 10A elbows with millionaire

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.

RAY WALKS OFF WITH WIN

By Rhiannon Meyers

meyersr@caller.com

361-886-3694

Ray opens the second half of District 31-4A baseball play by winning a wild game over Alice on Henry Hausman’s walk-off home run at Cabaniss Field.

FRUSTRATION FILLS MARKET

MAY

INDEX

Complications from diabetes can lead to devastating consequences, including kidney failure, amputations and death. A look at how one family has been affected.

NATION & WORLD 4A CROSSWORD 5G OBITUARIES 8B-10B OPINION 20A WEATHER 21A BUSINESS 18A-19A

EVERY WEDNESDAY PHOTOS BY JOHN FREIDAH/SPECIAL TO THE CALLER-TIMES

Family practice resident Dr. Robert Black checks patients’ feet at Rhode Island Hospital’s Primary Care Clinic. The feet are a vulnerable area for infection with diabetes patients because of the lack of sensitivity and blood flow.

W

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DIABETES

TODAY

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The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple FACES OFfacets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the Caller-Times hopes to help its readers understand the disease and make better informed choices about their healthy.

Successful initiatives nationwide raise questions about whether the Coastal Bend is doing enough to tackle Type 2 diabetes. Stories will run each Sunday this month taking a closer look at efforts in Amarillo, Rhode Island and Atlantic City.

About four years after the Great Recession ended, many Americans are still so discouraged that they’ve given up on the job market.

Stay up-to-date with the latest breaking news and information by signing up for our breaking news alerts. Go to support.caller. com/breakingnews/ latest/ to sign up and look at past alerts.

DIABETES

UPCOMING STORIES

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COST OF

hen it comes to having Type 2 diabetes, Yogendra Patel is lucky to live in Atlantic City, N.J. And Jerry Madrigal is unlucky not to. Both Patel, 57, and Madrigal, 49, are low-income minorities who struggle with depression. Both were diagnosed with the disease around the same time. Both had dangerously 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. There’s no simple explanation why two men with the same disease reacted so differently. Diabetes is a toxic combination

Patients of Rhode Island Hospital’s Primary Care Clinic participate in a diabetes selfmanagement program at the hospital in Providence. Patients Ada Boaz (left) and Eduviges Cortese consult with Dr. Elizabeth Tung.

This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

■ Faces of Diabetes: Meet Hector Salinas, a former middle school coach, who battles Type 2 Diabetes. 8A ■ A look at successful innovative programs in Rhode Island, Atlantic City and Amarillo. 8A ■ A closer look at Spohn’s Community Health Workers’ program and closed programs in the area. 8A ■ The American Diabetes Association recognizes three outpatient classes within 100 miles of Corpus Christi. 9A

%* APY

6-Month CD

AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents.

INSIDE:

2.00 See DIABETES, 8A

Clip healthy, diabetes-friendly recipes from the Food section.

A Better Way to Save. To open a 6-Month CD or IRA CD: Call 1-800-451-2543 | Go to ssfcu.org/6monthCD | Visit a location near you

*APY = Annual percentage yield. APY is effective as of February 13, 2013 and is subject to change without notice. This CD rate is fixed for a 6-month term, assuming a minimum deposit of $100,000. These are Share Certificates, and different rates apply to different deposit levels. CDs may be subject to early withdrawal penalty. Membership eligibility required. Federally insured by the NCUA. Visit ssfcu.org/6monthCD for complete details. IRA funds cannot be co-mingled at any time with regular savings or non-IRA funds. CAL172287


8A » Sunday, April 7, 2013 »

C A L L E R -T I M E S

from the cover DIABETES from 1A

of genetics, sedentary lifestyles, poor diet and lack of access to preventive care. But one difference 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 before they experience complications such as Madrigal’s. So had Madrigal been fortunate enough to live in Atlantic City or Rhode Island or even Amarillo, with their intensive programs aimed at preventing longterm complications, he might still have a big toe. Places across the nation have not eliminated complications, but they have seen successes and savings with classes, clinics and programs funded by the government, private hospitals and insurance 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 nationwide raise an important question: Is the region doing enough to tackle its most pressing health care problem?

SUCCESSES AND SAVINGS The initiatives in Rhode Island, Atlantic City and Amarillo show that debilitating complications long plaguing the Coastal Bend can be preventable when the health care system and government take aim at the disease. The Caller-Times examined these programs as part of its yearlong series Cost of Diabetes. The paper will publish stories later this month taking a closer look at each program. It’s not fair to place all the blame on the health care system. In Type 2 diabetes, the body becomes unable to effectively use its own insulin. Glucose builds up in the blood and causes a condition that, if not controlled, wreaks havoc on the body’s circulation system, nerves and organs. Yet blindness, kidney failure and amputations — expensive and debilitating complications — are preventable when people with diabetes manage their disease and control their blood sugar through small steps: a little exercise, smart eating and stress management. Research also shows programs aimed at helping people understand and manage diabetes play a large role in helping people and saving taxpayers millions each year. So in Atlantic City, Madrigal might get treatment 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 Patel’s 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 clinic’s early analysis. More savings are expected in the long term. In Rhode Island, a state that could fit within the borders of Nueces and San Patricio counties, Madrigal could find an array of programs aimed at preventing, managing and treating diabetes long before it leads to debilitating complications. The state’s rate of diabetes-related kidney failure falls far below the national average, with 123 people per every 100,000 with diabetes having kidney failure in 2008 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 diabetes 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 nationwide, according to a clinic report provided to the Texas Diabetes Council. But in the Coastal Bend, where one in six people has diabetes, similar efforts have disappeared, despite the pressing need in a region that still ranks among the worst places in the nation for diabetic complications, including below-the-knee amputations and death. Corpus Christi used to have a private clinic similar to Amarillo’s one-stopshop concept, but it closed in 2010. The Diabetes Centers of America building on South Padre Island Drive remains vacant. Meanwhile, the company continues to operate 13 clinics statewide. Company officials could not be reached for comment. Rhode Island’s 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 certified diabetes educators trained by the state. That’s about one for every 224 Rhode Islanders with diabetes. Texas does not have the same training program. Eleven certified diabetes educators work in Nueces and San Patricio counties, many employed by pharmaceutical companies. That works out to one educator for every 6,259 people with diabetes. And unlike Corpus Christi, where diabetes self-management classes have struggled to stay afloat, Rhode Island has classes in hospitals, doctors’ offices and community centers — and the state requires insurance companies to pay for them. Texas does too, but Corpus 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 government or selfinsured plans.

RELATING TO PATIENTS Perhaps one of the most innovative initiatives used in all three places comes in the form of a person like Milagros Laya, a 36-yearold Spanish-speaking 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, explain the disease in depth and tailor her message specifically for them. Using realistic rubber representations of chicken, cereal and corn, Laya helps patients understand they can still eat the foods they love, but portion sizes should be no bigger than a fist. Because the clinic pairs health coaches with people 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 walking 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 community health worker concept, a key element used in Atlantic City, Rhode Island and Amarillo to manage diabetes. Community health workers don’t necessarily have medical backgrounds; instead, they have good people skills and an ability to connect with specific groups because they share the same language, culture or health problems. They are charged with helping peo-

The nationally syndicated comic strip Baldo is joining the Caller-Times as it takes a look at the Coastal Bend’s diabetes epidemic. The strip’s creators offered to provide Baldo characters and archived content to help illustrate the series.

SUCCESS SNAPSHOTS RHODE ISLAND

The state established diabetes prevention 35 years ago, one of the nation’s first federally funded programs. State Medicaid requires its insurers to pay for peer navigators, or community health workers, who track for 90 days patients who visited the emergency room at least four times in one year. They connect patients to resources to keep them out of the hospitals. They even conduct home visits. The state has a robust program to train certified diabetes educators. Rhode Island has 330 educators, the equivalent of one for every 224 people in the state diagnosed with diabetes. They work in hospitals, doctors’ offices and for the state. YMCAs across the state offer a diabetes prevention program,

recognized by the U.S. Centers for Disease Control and Prevention, that is based on a study showing modest lifestyle changes, such as exercise, reduced the risk of developing Type 2.

individual classes and diabetes support groups. It also coordinates with the nationally recognized Joslin Diabetes Center to offer classes, support and treatment.

ATLANTIC CITY, N.J.

AMARILLO

Private hospital system AtlantiCare runs a Special Care Clinic designed to connect chronically sick patients with primary care doctors and health coaches to prevent long-term complications. Clinic patients do not have to pay co-pays and get medicines for free. Nearly 30 primary care practices adopted AtlantiCare’s model with timely appointments, electronic medical records and coordination of care among a team, including a doctor and nurse case manager. The result is better preventive care. The hospital system offers group and

J.O. Wyatt Clinic, established to provide indigent care for the Amarillo Hospital District, provides a one-stop shop, including a certified diabetes educator, foot exams, eye exams, nephrologist, dietitian, licensed professional counselor and social worker. Clinic coordinates patient’s diabetes management among a team of professionals to provide a more holistic approach to care. Diabetes awareness classes help patients understand the disease and their risks for complications.

SPOHN’S COMMUNITY HEALTH WORKERS

COST OF

DIABETES

TODD YATES/CALLER-TIMES

Hector ‘Coach’ Salinas talks about his years of dealing with diabetes and how it’s affected his life. He wants people to know the consequences of not managing diabetes.

FACES OF

DIABETES

Hector salinas /VIDEO Watch Hector Salinas tell his story.

Everyone knows Hector “Coach” Salinas, a former longtime middle school coach and now Corpus Christi ISD school board member. What people may not know is that Salinas, 68, has battled Type 2 diabetes for years, and continues to struggle with the disease. He’s been hospitalized as recent as this year. Salinas knows the importance of managing diabetes properly, including taking insulin when prescribed, even if doing so seems scary. What’s even scarier to him? Seeing some of the kids he’s coached diagnosed with the same disease who suffer terrible complications, including a boy who died last year. Type 2 diabetes used to be called adult onset but now is becoming increasingly common in children. “Being diabetic is not easy, definitely not easy,” Salinas said. “It’s very hard. But if you don’t take care of it, the consequences are going to be very bad.”

Rhiannon Meyers

Through Christus Spohn’s Care Partners program, community health workers navigate, educate and support patients and their families. They help patients: ■■ access primary and specialty care ■■ obtain prescription medications, medical equipment and supplies ■■ complete and submit applications for health and social services ■■ understand health education and information ■■ manage their health and chronic conditions ■■ communicate with health care providers ■■ change unhealthy lifestyle behaviors The goals of the program are to: ■■ improve health care access ■■ promote patient knowledge and behavior change ■■ improve health status of patients ■■ reduce nonurgent emergency department visits ■■ reduce preventable hospitalizations Coaching is done via telephone or face to face, such as when a client comes in for scheduled doctor appointment, helping reinforce doctors’ orders. Depending on patients’ needs, outreach can be done daily to weekly. From July to February, Spohn’s community health workers logged 22,126 person-to-person contacts. Source: Christus Spohn Health System

CLOSED PROGRAMS CLASSES

Corpus Christi Medical Center and Christus Spohn closed their Corpus Christi outpatient programs in the past decade. Spohn cited dwindling attendance. Medical center officials declined to comment. CLINIC

The one-stop-shop clinic Diabetes Centers of America closed in 2010. Officials could not be reached for comment. The company continues to operate 13 clinics statewide. John Freidah/Special to the Caller-Times

Ada Boaz (left) and Eduviges Cortese embrace after receiving their certificates of completion for their diabetes self-management class in Rhode Island.

ple with chronic illnesses such as diabetes stay out of the hospital. And preventing hospitalizations saves money. In Rhode Island, the state’s Medicaid pays peer navigators to help patients who frequent emergency rooms, spending up to 90 days meeting with

them and tracking their progress. They connect patients with resources to manage their disease, whether that’s electricity to keep insulin chilled or transportation to a doctor’s appointment.

LOCAL PROGRAMS Today, only one com-

munity health worker program remains in Corpus Christi. The region’s biggest health care provider, Christus Spohn Health System, hired three health workers with grant money in 2004 after a report See DIABETES, 10A

COMMUNITY HEALTH WORKERS

The state-funded University of Texas Community Outreach program hired seven community health workers who conducted home visits and saw success lowering patients’ blood sugar levels, but the state cut its funding after two years.


10A » Sunday, April 7, 2013 »

C A L L E R -T I M E S

FROM THE COVER HICKS from 1A

“Having the chance to be with the team all spring training and getting a chance to know these guys a little bit more, I feel very calm and relaxed.” Before he went to sleep the night before the March 31 opener at Minute Maid Park, Hicks played some relaxing music on his iPhone, including one of his favorite songs, James Taylor’s “Secret O’Life.” Isn’t it a lovely ride Sliding down Gliding down Try not to try too hard It’s just a lovely ride For Hicks, 52, the ride included broadcasting games at his first pro baseball job in Frederick, Md., for $50 a game and meal money after leaving a full-time job, racking up thousands upon thousands of miles on buses through sleepy minor league towns across the country and his fair share of rejection. But it also included perseverance, dedication to his craft and the belief he was good enough to work at the highest level. It also helped to answer the phone when it rang.

THE CALL The Call usually comes in the offseason, the culmination of the job search process. It isn’t supposed to come during a family vacation in June, a rare time off for baseball broadcasters. Granted time off by Ryan-­Sanders Baseball, the Hooks’ ownership group, Hicks, his wife and their 10-year-old son, Nathaniel, were in San Diego, Calif., for five days as part of a trip to the Legoland theme park in nearby Carlsbad. While his parents were getting things together for day three of their trip on June 25, 2012, Nathaniel Hicks bided his time playing a game of Fruit Ninja on his father’s phone. He was racking up an impres-

DIABETES

Michael Zamora/Caller-Times

Rangers radio announcer Matt Hicks (center) talks with Astros first base coach Dave Clark (left) and Astros assistant hitting coach Dan Radison (right) as he greets some of the former players and coaches he worked with while a radio announcer with the Corpus Christi Hooks before the Astros/Rangers season opener at Sunday at Minute Maid Park in Houston.

sive score when he noticed something on the screen: An incoming call from Hooks CEO Reid Ryan. “Nathaniel was torn between finishing his high score or bringing the phone to Matt to take the call,” Estelle Hicks said. “He saw it was Reid Ryan and he goes, ‘Dad, you better take the call.’ ” Reid Ryan was calling Hicks as a result of something that happened a week earlier, coincidentally enough, in San Diego. During a game against the Padres, Rangers television broadcaster Dave Barnett unleashed a bizarre on-air harangue, saying “Go-ahead run is at fifth … on what Adams is insisting on calling it a botched robbery. What actually happened was … his henchmen took a piece literally out of …” The incident promptly went viral, and the Rang-

ers summarily removed Barnett from the airwaves and placed him on medical leave. Barnett later called the cause of his ramble “a complicated migraine.” Meanwhile, radio announcer Steve Busby was moved to the television side, creating an opening in the Rangers’ booth. Hicks had been alerted to the incident by a friend who suggested he let the Rangers know of his availability, but Hicks disagreed, saying “I don’t want to be one of those vulture guys who say, ‘Hey, I can help.’” Now Ryan, the son of Rangers CEO and Hooks managing partner Nolan Ryan, was on the line. “I stepped outside because obviously it was going to be business of some sort and I had no idea what it was going to be about,” Hicks said. “Reid said, ‘I don’t know how long this

from 8A

EXISTING INITIATIVES

found that many uninsured and underinsured people sought treatment for preventable chronic diseases. The system now employs 14 in hospitals and family clinics throughout the region to connect patients to primary care and community resources, such as cheaper medicines or the Salvation Army’s Foot Savers program, which provides free pairs of diabetic shoes. Spohn’s community health worker program has earned national attention. An unpublished report by the U.S. Centers for Disease Control and Prevention shows Spohn saw a 35 percent reduction in emergency room visits among indigent patients between 2004 and 2006 (the system could not immediately provide more recent data). The program also saved money. After health workers intervened, the average per patient cost dropped by more than half, from $64,687 in 2009 to $26,519 in 2011. However Spohn’s program lacks the stability and strength of programs in Rhode Island and Atlantic City. Those programs 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) ‘Isn’t anyone paying you to do this?’ ” Chief Operating Officer Estela Chapa said. “No. We’ve taken this as a responsibility. And they said, ‘What would you do if Medicaid funded it?’ Well, we’d welcome it, but we do understand there’s 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 hospitalized with a

The American Diabetes Association recognizes three outpatient classes within 100 miles of Corpus Christi: ■■ Texas A&M University Coastal Bend Health Education Center classes at Del Mar West Campus ■■ Food Bank of Corpus Christi’s classes at the Garcia Arts and Education Center ■■ Christus Spohn’s classes at its hospitals in Alice, Beeville and Kingsville In November, A&M started offering diabetes classes at Spohn’s Robstown family clinic. Spohn also plans to host classes at its Westside clinic starting in April. Some doctors offer classes in their

CLASSES

will be for, but we’d like to have you come up and fill in for the Rangers.’ “He said, ‘I don’t know all the particulars. We just need to get you there as soon as possible. Can you come up?’ And I said yes.” It was The Call. The one every minor league broadcaster hopes for. For Hicks, the wait had lasted 23 and a half seasons. “So Matt took the phone call and he walked out of the room,” Estelle Hicks said. “I was thinking, ‘OK, Daddy’s probably going to leave and we’ll finish our vacation.’ Then Matt walked in and said, ‘I just got the phone call.’ I said, ‘The phone call?’ and he said, ‘The major leagues.’ “There were a lot of tears, laughter and disbelief that this is happening to us. It was shock. It was like, ‘This is really happening.’ I can’t even explain it. I wish I had the

offices, provided by educators from pharmaceutical companies. COMMUNITY HEALTH WORKERS

Christus Spohn pairs community health workers with patients who are uninsured, have Medicaid or Medicare, or who are covered by the county’s indigent care program. The health workers connect patients to “medical homes,” where a primary care doctor ensures they get treatment and screening for their feet and eyes. Health workers also connect patients to community resources, including the classes above. Health workers track some chronically sick patients for 18 months.

right words (to describe it), but I don’t.” The family finished their vacation, and five days later, Hicks was in Arlington, making his major-league debut during the Rangers’ game against Oakland.

NOT GIVING UP Matt Hicks didn’t arrive in the major leagues until June 30, 2012. However, there was no lack of people who thought he was bigleague caliber. In Baseball America’s 1997 survey of readers’ favorite baseball broadcaster, Hicks was the only minor league announcer listed. While Hicks was a fan favorite in Corpus Christi and as the El Paso Diablos’ announcer from 1995-2004, he also impressed some influential people. Nolan Ryan was said to be a fan. And Reid Ryan had been one before

The Diabetes Community Coalition proposed hiring more community health workers and pairing them with certified educators to create teams of people to help chronically ill diabetics navigate the health care system. That proposal calls for funding from a new federal financing system aimed at transforming Medicaid that is awaiting approval. OTHER SPOHN EFFORTS

Spohn staff regularly screen people for diabetes at health fairs and in some of the region’s poorest neighborhoods using its mobile CareVan donated by American Bank Center. The health system also has proposed transforming family clinics

Hicks came to work for the Hooks in late 2004. “The first time I heard Matt, he was in El Paso in 2000, and I thought he was very good,” Reid Ryan said. “He’s a very likable guy that relates to the players and has a very distinctive voice. “I’ve always felt guys in the minor leagues have to wear so many hats that they have a very wellrounded perspective of the game. From the first time I heard him, I always thought he’d be a bigleague broadcaster, all the way back in 2000.” While Ryan and many others felt that way, some MLB teams didn’t hold the same opinion. Hicks estimated being rejected for big-league jobs 14-16 times. The closest call came in September 2005, when he was summoned to Houston to interview for the Astros’ vacancy. “That was really the only extensive interview I had,” Hicks said. “I was disappointed, I really was, because I was told that I was in a very small group of finalists and thought I had an opportunity there. I was disappointed, but it wasn’t like I got that news and decided I need to start looking elsewhere.” While the rejection stung, Hicks threw himself into his new surroundings in Corpus Christi. He became one of the faces of the Hooks, from making local speaking appearances to his annual role hosting the team’s winter baseball banquet. Away from work, he and Estelle purchased their first home, and she soon got a job as a teacher. Their son was in a good school, and his soccer, swimming and chess activities kept the family busy. “(The job) doesn’t necessarily define who I am because you go to some school function and I’m not Matt Hicks, the Hooks broadcaster —

See HICKS, 11A

into medical homes, which provide a more holistic approach centered around the patient. CORPUS CHRISTI MEDICAL CENTER

Officials declined to comment. Corpus Christi Medical Center provides nutrition counseling for diabetics who are hospitalized. The medical center, owned by the national private hospital chain HCA, also plans to expand primary care capacity via Amistad Community Health Center, which treats uninsured and underinsured patients, so more chronically ill patients have access to preventive care, according to the center’s Medicaid transformation proposal.

PHOTOS BY John Freidah/Special to the Caller-Times

Rhode Island Hospital’s Primary Care Clinic provides its diabetics with a graphic explaining nutrition.

RIGHT: Diabetes educator Lourdes Pichardo (left), who also is diabetic, teaches the benefits of exercise and a healthy lifestyle.

nurse and a community health worker. That care team follows patients for 18 months to make sure they take their medications, 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 really high risk, we’ll let them know, ‘You know, I want you to call in weekly or every other 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 exams, the dentist,” said Liza Esparza, who oversees Spohn’s community health workers. “So we just try to keep them on track and educate them on how to access care.” Esparza said patients typically respond because they want to be involved in their health care. The hospital system in 2011 followed up with more than 1,300 patients after they left the hospital. It’s not clear what the region’s other major hospital system is doing. Corpus Christi Medical Center executives declined to be interviewed. Spokeswoman Lisa Robertson would not say who declined the Caller-Times’ request to talk to CEO Jay Woodall, Chief Nursing Officer Kathleen Rubano and Chief Operating Of-

ficer Michael Roussos. They did not return calls seeking comment. The medical center, owned by the for-profit national health care company HCA, has one certified diabetes educator who provides inpatient nutrition counseling. One other group in Corpus Christi tried the community health worker concept in recent years, but despite its success, the state cut the program after two years. The University of Texas Community Outreach program in Corpus Christi had seven community health workers, sometimes called promotoras, who descended on health fairs, community centers, schools and churches in Nueces County’s neediest neighborhoods to find

and help people with unchecked diabetes. They visited homes, gaining unprecedented perspective on why some people with diabetes struggled to keep their diabetes in check. Scientists believe social determinants — location, occupation, income — influence 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 sugar, but the state chopped its funding, a casualty of the 2011 Texas Legislature’s across-theboard health care cuts. The Coastal Bend’s history of diabetes may be marred by disappoint-

ments and failures, but that’s not stopping some from continuing to try to tackle 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 Amarillo’s efforts. Various groups plan to hire more community health workers and expand preventive care. Those plans await federal approval. In the meantime, officials at Spohn, the region’s safety net provider, say they will continue to lean on community groups to help them curb complications. “We know, as Spohn, that we can’t be an all to everybody, but that we can be a leader in helping to make an impact,” Chapa said.


CROUCHING TIGER

Tiger Woods makes two significant moves Saturday at the Masters — one to stay in the tournament, the other to stay in the hunt. SPORTS, 1C

$1.50

85˚/68˚ Clouds breaking

21A

Quick Read

Education wards off disease ■ Plan keeps

Rhode Island ahead of Texas

By Rhiannon Meyers meyersr@caller.com 361-886-3694

EARLY BIRD GETS THE BIRD Sure, being a good shot is beneficial in turkey hunting. But it’s the time you spend not shooting that offers lessons in patience and humility. OUTDOORS, 9C

SUNDAY, APRIL 14, 2013 ■ CITY EDITION

PROVIDENCE, R.I. — Among Robert Medeiros’ long list of problems — homelessness, drug addiction, mental illness, illiteracy — it’s easy to see why diabetes wasn’t his priority. Then he blacked out on the street while carrying plastic grocery sacks of canned goods to his camp underneath Rhode Island’s 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 meters, 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 homelessness, all factors that, on their own, often thwart efforts to help diabetics. To get healthy, Medeiros needed not just medical care but social help, too, as well as intense intervention and follow-up. Against the odds , See DIABETES, 10A

PLANS HIT BUMP IN ROAD Lawmakers at the state Capitol have made transportation a priority. However, state transportation infrastructure lacks billions of dollars. LOCAL, 1B

CARROLL WINS OVER CALALLEN

Schlitterbahn developer explains to parched Corpus Christi:

How they compare: Rhode Island, Texas, Nueces County. 10A Stories to look forward to. 11A

JOHN FREIDAH/SPECIAL TO THE CALLER-TIMES

Robert Medeiros has graduated from Rhode Island Hospital’s Diabetes Self Management Program. Medeiros exhibits his certificate of completion in his room.

CONSERVATION

POSSIBLE ■ Drought

won’t cancel water park

By Rick Spruill spruillr@caller.com 361-886-3667

POPE NAMES CARDINALS Eight cardinals are appointed to advise on running the Catholic Church and reforming the Vatican bureaucracy. WORLD, 4A INDEX NATION & WORLD 4A BUSINESS 18A, 19A OPINION 20A WEATHER 21A PUZZLES 5G PHOTOS BY MICHAEL ZAMORA/CALLER-TIMES

Park guests enjoy the Torrent River that encircles the indoor area at Schlitterbahn South Padre Island. Schlitterbahn parks are built to conserve as much water as possible, co-owner Jeff Henry said.

LEFT: Water drips from an oversized spout in the Pirates Cove children’s area at Schlitterbahn South Padre Island, but an army of maintenance workers scrambles to prevent real leaks.

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See which roads in Corpus Christi are among the best and worst — and how your street compares — at Caller.com/data.

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The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple FACES OF facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their healthy.

DIABETES

SPORTS, 1C

STREET SMARTS

DIABETES

INSIDE

Carroll continues its mastery of ranked teams, pushing across six runs in the fourth inning Saturday for a 7-5 victory over Calallen at Whataburger Field.

Local news now.

COST OF

■ Wanna ride? Get a tube-eye view in a video of Schlitterbahn South Padre Island. ■ Keep up with drought news and information at Caller.com/water.

First repor

See PARK, 8A

Old ship, burned trees just part of reuse efforts By Rick Spruill spruillr@caller.com 361-886-3667

Next Sunday

Rick Spruill will take a closer look at the environmental effects of drought in the Coastal Bend.

INSIDE

Corpus Christi’s top commercial water users, 2012

8A

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6-Month CD

Give him time, and Jeff Henry one day may find a patent on raindrops. The creative force behind the Schlitterbahn water park success story, Henry knows the value of water and has no problem explaining to a drought-parched city like Corpus Christi how a water park like his will not be a drain. It’s a skill cultivated through more than four decades of developing, designing and opening water parks in a variety of conditions, including in times of drought. His family’s first park — Schlitterbahn New Braunfels — grew during a drought that had the park’s wellspring, the Comal River, on the ropes. “In ’84 we became very cognizant of water usage because we were worried the river would run dry,” Henry said.

Jeff Henry is the last person to buy something new when he can find it used. “I have a serious problem with liking to reuse everything we can,” the Schlitterbahn coowner said in a March interview. So did his parents, Bob and Billye Henry, who, starting in the late 1960s, got to work creat-

ing the original Schlitterbahn water park in New Braunfels, between the Guadalupe and Comal rivers. “Dad was always going to auctions and sales,” said Henry, one of three children who run the family-owned chain of water parks. “He was constantly looking to stretch a dollar, and it has not changed.” The parks are filled with examples.

See HENRY, 9A

A Better Way to Save. To open a 6-Month CD or IRA CD: Call 1-800-451-2543 | Go to ssfcu.org/6monthCD | Visit a location near you

*APY = Annual percentage yield. APY is effective as of February 13, 2013 and is subject to change without notice. This CD rate is fixed for a 6-month term, assuming a minimum deposit of $100,000. These are Share Certificates, and different rates apply to different deposit levels. CDs may be subject to early withdrawal penalty. Membership eligibility required. Federally insured by the NCUA. Visit ssfcu.org/6monthCD for complete details. IRA funds cannot be co-mingled at any time with regular savings or non-IRA funds. CAL172294


10A » Sunday, April 14, 2013 »

C A L L E R -T I M E S

from the cover

COST OF

DIABETES Upcoming stories TODAY

Rhode Island has a FACES OF of statevast network driven initiatives dating back more than three decades to tackle Type 2 diabetes, even the most complicated cases.

DIABETES

THIS MONTH

Stories will run each Sunday this month taking a closer look at efforts in Amarillo and Atlantic City, N.J. MAY

Complications from diabetes can lead to devastating consequences, including kidney failure, amputations and death. A look at how one family has been affected. EVERY WEDNESDAY

Clip healthy, diabetesfriendly recipes from the Food section. AT Caller.com/DIABETES

photos by John Freidah/Special to the Caller-Times

Diabetes educator Lourdes Pichardo (center) leads a group of about 50 people for the kickoff of the third annual Walking with Lourdes event at Roger Williams Park in Providence, R.I. The morning stroll, which was announced on local Latino radio, is meant to raise awareness of the importance of a healthy lifestyle.

DIABETES from 1A

Medeiros today has an A1C of 7.5, well-controlled Type 2 diabetes by any standard. “And I’m trying to get it lower,” he said. Ask Medeiros how he’s done it, and he’ll point to one woman: a sweet but no-nonsense Dominican immigrant named Lourdes Pichardo, 55, who works for the state helping people control their diabetes. Pichardo represents something more going on in Rhode Island, a personification of the vast network of state-driven initiatives dating back more than three decades to tackle Type 2 diabetes, even the most complicated cases. The Caller-Times examined Rhode Island’s efforts as part of its yearlong series Cost of Diabetes. Initiatives in Rhode Island, Atlantic City, N.J., and Amarillo show that debilitating complications can be preventable when the health care system and government take aim at the disease. But similar efforts have disappeared in the Coastal Bend, where 1-in-6 people has diabetes and patients are more likely to suffer 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 action against diabetes. Atlantic City demonstrates efforts driven by a hospital system, and Amarillo offers a look at how an indigent care clinic has worked to curb diabetes and complications. The Caller-Times is publishing stories this month exploring the three initiatives.

SMALL STATE, BIG FIX So what can the nation’s smallest state teach the second largest about diabetes prevention? A lot, it turns out. The Rhode Island diabetes prevention and management program was one of the nation’s first federally funded programs, established 35 years ago. In the years since, Rhode Island’s prevention and management system grew into one of the most intricate in the nation, expanding beyond state initiatives to include private practice doctors, insurance companies and patients. The state’s 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 fifth-lowest rate of diabetes-related deaths in the nation at 16.7 per 100,000 people in 2009, according 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 County’s rate was 48, more

■■ Find local support groups and diabetes education classes. ■■ Explore diabetesrelated data. ■■ Search healthy recipes and submit your own. ■■ Share your story about how diabetes has affected your life. ■■ Watch videos, in English and Spanish, on diabetes management. ■■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

Diabetes patient Robert Medeiros, who was once homeless and battling a drug addiction, has been clean for two years, and is managing his disease. Medeiros injects himself with insulin twice per day at his home in Providence.

DIABETES COMPARISON

Rhode Island Texas Adults with diabetes, 2010

Medeiros lost his toes last year after a blister on his foot grew into an infection. Lower extremity amputations are a common complication from diabetes, which if uncontrolled suppresses the immune system and damages the circulatory system.

than twice the Texas average and nearly three times Rhode Island’s rate. The county ranked the third worst in Texas in 2009 behind Panola County in East Texas and Maverick County, home to Eagle Pass. There’s no easy explanation why Rhode Island performs better than Texas when it comes to diabetes rates and complications. The disease is influenced 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 what’s happening in the Coastal Bend. In some cases, programs like those in Rhode Island are absent altogether from the Coastal Bend. For example, self-management and prevention classes, long considered the gold standard for diabetes care, are widespread in Rhode Island. Here, they struggle to stay afloat. Most YMCAs in Rhode Island offer a 16-week nationally recognized prevention program, based on a groundbreaking study that showed modest lifestyle changes drastically

reduced the risk of developing Type 2 diabetes. In Texas there are only seven recognized programs, with the nearest in Weslaco, 160 miles south of Corpus Christi. (The Texas A&M Health Science 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 certified diabetes outpatient educators. That works out to one for every 224 Rhode Islanders with diabetes. Here, 11 certified educators work in Nueces and San Patricio counties, according to a national certification association. That’s about one for every 6,259 people with diabetes, although it’s difficult to draw a direct comparison because 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 region’s 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

Nueces County

6.8 %

9.8 %

9.8 %

End-stage renal 177.4 failure per 100,000 adults with diabetes, 2009

249.6

n/a

Diabetes death rate per 100,000 in 2009

16.7

22.5

48

11.6

21.5

n/a

Obese adults, 2009

23.3 %

29.6 %

30.2 %

Physical inactivity, 2009

21.6 %

27.5 %

23.7 %

Hospital admission rate, uncontrolled diabetes per 100,000 adults, 2007

Sources: U.S. Centers for Disease Control and Prevention, Kaiser Family Foundation, Texas Department of Health and Human Services

Island 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. Gaunt with tattooed arms, a raspy voice and graying goatee, Medeiros spent years living on the streets, self-medicating with heroin, cocaine and booze. He ate at gas stations where unhealthy options abound, such as Rhode Island’s famous coffee milk, like chocolate milk but made with coffee syrup, 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 diabetes 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 refilled his prescription. When he finally 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 familiar, 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 system’s ability to fight back. So when Medeiros blistered his foot walking across the hot sand on a rehab center beach trip, the wounds never healed, infection spread to the bone, and last year, surgeons removed all five toes from his right foot. Salvation for Medeiros came in the form of a 4-foot-10-inch spunky Dominican woman with caramel-colored hair and copper nail polish. Lourdes Pichardo is a household name in Rhode Island’s 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 diagnosed with leukemia and doctors didn’t think she would live, Pichardo, desperate and scared, flew the baby girl to Boston, where she’d 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 Providence’s Broad Street, where Dominican restaurants and money transfer services serve as the backdrop to the city’s annual Dominican parade. Then she began to help other immigrants, working to improve access to health care. She’s now a bilingual peer navigator with Rhode Island’s 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 patients, visit them at home, try to figure out why they keep going to the emergency room, and help them access resources they need, from housing to transportation to doctor appointments. 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 hospitalizations.

See DIABETES, 11A


C A L L E R -T I M E S

« Sunday, April 14, 2013 « 11A

FROM THE COVER

Budget plan puts Obama in tight spot ■■Entitlement

cuts irk some Democrats

By Jim Kuhnhenn and Julie Pace Associated Press

photos by John Freidah/Special to the Caller-Times

Diabetes educator Lourdes Pichardo (left) teaches a Diabetes Self Management Program at Rhode Island Hospital’s Primary Care Clinic in Providence. She teaches the benefits of a healthy lifestyle for diabetes patients with Teresa Walls.

DIABETES from 10A

The goal: cut down on Medicaid patients’ emergency room use and save taxpayer dollars that would have been spent on those costly visits. “We were nervous people wouldn’t 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 isn’t only for people with Type 2 diabetes, but data show that many people in the program have the disease. Bacterial skin infections ranked among the top reasons people went to the ER in Rhode Island, and people with uncontrolled diabetes are particularly susceptible to these infections because of their weakened immune systems and poor circulation.

WORKING TOGETHER Officials at UnitedHealthcare, which contracts with Rhode Island Medicaid, say they’ve seen a 30 percent decrease in ER use and have possibly saved up to $600,000, according to preliminary results. And those results are prompting people to look at the program as a model, said Dr. Rene Rulin, medical director 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 she’s 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 together,” she said. And the results for people with diabetes have been mixed. Among UnitedHealthcare’s Medicaid patients with diabetes, more are screened for potentially

Pichardo works with patient Ada Boaz explaining the benefits of exercise and a healthy lifestyle. Pichardo, who has a family history of diabetes, was diagnosed in 2006.

You’ve got to be really dedicated on reading labels and understanding what you’re going to eat and put in your body. Stick with it, and it’ll help you. It will. It’ll keep you healthier.” Robert Medeiros, diabetes patient

WASHINGTON — President Barack Obama’s budget overtures to Republicans may limit his bargaining power if the GOP ever returns to the negotiating table on a grand deficitreduction deal. In essence, Obama’s spending blueprint is a final offer, a no-budge budget whose central elements have failed to persuade Republicans in the past. By voluntarily putting entitlement cuts on the table, particularly a proposal to slow the rise of Social Security benefits, Obama has no other gambit to win tax increases from Republicans. With many Democrats balking at what he’s already offering, it’s not politically feasible for him to offer the GOP anything more. Puzzled Democrats maintain that Obama

Medicare shift would take toll on middle class By Ricardo Alonso-Zaldivar Associated Press

disabling long-term complications such as blindness and amputations, but blood-sugar levels also went up. That’s frustrating, Rulin said, but also possibly a sign of just how difficult diabetes management can be, especially for a population that struggles with so many other challenges: mental illness, substance abuse, poverty. That’s why Medeiros’ story is so important, and why Pichardo invited him recently to come speak to a diabetes class she teaches at Rhode Island Hospital. She opened the class by revealing that she, too, has Type 2 diabetes, and how devastating that diagnosis was, despite her work helping others with the disease. Pichardo, who has a family history of diabetes, was diagnosed 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 understand 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 Medeiros. Sitting at the edge of a semicircle in a hospital conference room lined with shelves of medical books, Medeiros introduced himself to the halfdozen 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 convinced 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 can’t read or write, he learned how to choose

healthy foods with the help of a book filled with pictures of foods labeled with a thumbs-up or thumbs-down. He now needs about half as much insulin as he used to. “You’ve got to be really dedicated on reading labels and understanding what you’re going to eat and put in your body,” he said. “Stick with it, and it’ll help you. It will. It’ll 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 taken his diabetes diploma — the certificate 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 engagements at diabetes classes. “I’m feeling positive about myself, that’s for sure,” Medeiros said.

not only has given away his leverage, he also has threatened the very identity of his party, which sees the Social Security Act of 1935 as one of its signature achievements. “If he’s trying to do it to show he is forthcoming as a negotiator, then why doesn’t he wait until he gets to the negotiating table?” said Rep. Rush Holt, D-N.J. “There’s a lot of talk about the fact that politically this is not a winner. Our brand is the party that brought you Social Security.” What’s irked Democrats the most is Obama’s decision to include a significant shift in policy in his $3.8 trillion budget that would alter the government’s calculation of inflation, or the Consumer Price Index. If adopted, this new “chained CPI” would change the way the government measures inflation and would slow the rise in Social Security benefits and other programs. In exchange, Obama is insisting on $580 billion in tax increases on wealthier taxpayers. It’s a demand that Republicans flatly reject.

WASHINGTON — Retired city worker Sheila Pugach lives in a modest home on a quiet street in Albuquerque, N.M., and drives an 18-year-old Subaru. Pugach doesn’t see herself as upper income by any stretch, but President Barack Obama’s budget would raise her Medicare premiums and those of other comfortably retired seniors, adding to a surcharge that already costs some 2 million beneficiaries hundreds of dollars a year. Due to the creeping effects of inflation, 20 million Medicare beneficiaries also would end up paying higher “income related” premiums for their outpatient and prescription coverage over time. Obama administration officials say Obama’s proposal will help improve the financial stability of Medicare by reducing taxpayer subsidies for retirees who can afford to pay a bigger share of costs. Congressional Republicans agree, making it likely the idea will become law if there’s

a budget deal this year. But the way Pugach sees it, she’s being penalized for saving diligently. Currently 1 in 20 Medicare beneficiaries pays the higher income-based premiums, which start at incomes over $85,000 for individuals and $170,000 for couples. Obama’s budget would change Medicare’s upperincome premiums in several ways. First, it would raise the monthly amounts for those currently paying. If the proposal already were law, Pugach would be paying about $168 a month for outpatient coverage under Medicare’s Part B, instead of $146.90. Then, the plan would create five new income brackets to squeeze more revenue from the top tiers. But its biggest impact would come through inflation. The administration is proposing to extend a freeze on the income brackets at which seniors are liable for the higher premiums until 1 in 4 retirees has to pay. It wouldn’t be the top 5 percent anymore, but the top 25 percent.

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LEARNING FROM LOSS Carroll High School first baseman Brandon Burns turns a bad hop into a good lesson. SPORTS, 1C

$1.50

80˚/67˚ Partly sunny

23A

COST OF

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Quick Read

SUNDAY, APRIL 21, 2013 ■ CITY EDITION

Boston N.J.’S HANDS-ON SYSTEM suspect listed as serious ■ Injuries have

him in no shape for questions By Bridget Murphy and Katie Zezima

SPURS FACE LAKERS FIRST

Associated Press

The Spurs open the playoffs against a Lakers team playing without Kobe Bryant, who is out with a torn Achilles. SPORTS, 6C

Fixing our streets BOND 2014 The city is planning a bond election to fund more street repairs. LOCAL, 1B

SIGNS OF THE TIMES Digital signs are changing the face of advertising one byte at a time. BUSINESS, 20A

NO EASY FIX A judicial committee is vetting candidates for the federal court bench vacated in June 2011 by U.S. District Judge Janis Jack. LOCAL, 1B INDEX NATION & WORLD 5A BUSINESS 20A OPINION 22A WEATHER 23A PUZZLES 5G

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The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their health.

INSIDE

Diabetes data on Nueces County & Atlantic City, NJ. 8A Tour de Cure raises more than $128K for diabetes research. 1B

UPCOMING STORIES MAY

■ Take a closer look at efforts to combat diabetes in Amarillo. ■ Complications from diabetes can lead to devastating consequences, including kidney failure, amputations and death. A look at how one family has been affected.

DAVID GARD/SPECIAL TO THE CALLER-TIMES

Health coach Virgen Ramos (right) talks about a client with Dr. Ines Digenio at AtlantiCare’s Special Care Center. The center’s health coaches are its front line.

PRESCRIPTION: MOTIVATION ■ Atlantic City

sees success in team approach

By Rhiannon Meyers meyersr@caller.com 361-886-3694

ATLANTIC CITY, N.J. — Yogendra Patel is the kind of patient some doctors call “noncompliant.” Even after Patel, 56, was diagnosed with Type 2 diabetes in 2007, he didn’t 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 At-

lantiCare’s Special Care Center, his blood sugar was considered uncontrolled. While some providers may have dismissed Patel for failing to take care of himself, Atlantic City’s only hospital system saw potential to make him better and save money at the same time. For six years, AtlantiCare, the region’s largest health care provider and the city’s 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 chronically sick by pairing them with health coaches and offering See DIABETES, 8A

EVERY WEDNESDAY

Clip healthy, diabetes-friendly recipes from the Food section. AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

BOSTON — Boston Marathon bombing suspect Dzhokhar Tsarnaev lay hospitalized in serious condition under heavy guard Saturday — apparently in no shape to be interrogated — as investigators tried to establish the motive for the deadly attack and the scope of the plot. People across the Boston area breathed easier the morning after Tsarnaev, 19, was pulled, wounded and bloody, from a tarp-covered boat in a Watertown backyard. The capture came at the end of a tense day that began with his 26-year-old brother Tamerlan dying in a gunbattle with police. There was no immediate word on when Tsarnaev might be charged and what those charges would be. The twin bombings killed three people and wounded more than 180. The most serious charge available to federal prosecutors would be the use of a weapon of mass destruction to kill people, which carries a possible death sentence. Massachusetts does not have the death penalty. President Barack Obama said there are many unanswered questions about the bombing, including whether the Tsarnaev brothers — ethnic Chechens from southern Russia who had been in the U.S. for about a decade and lived in the Boston area — had help from others. The president urged people not to rush judgment about their motives. U.S. officials said an elite interrogation team would question the Massachusetts college student without reading him his Miranda rights, something allowed on a limited basis in cases in which the public is in immediate danger, such as instances in which bombs are planted and ready to go off. The American Civil Liberties Union expressed

See BOSTON, 10A

INSIDE Obama’s legal staff prepares criminal case. 10A Reaction to fear define quality of life. 13A DAVID GARD/SPECIAL TO THE CALLER-TIMES

Digenio and resident Dr. Amanda L. Howard listen to health coach Jayshree Patel talk about a client . Patel meets regularly with patients, forming a rapport and reinforcing eating right and general care, and doctors act on her input.

Terrorism has new meaning after 9/11. 14A Americans learn from news events. 14A

Caller-Times to charge for online content starting Tuesday We’re going back to the future, starting Tuesday, by asking all readers to pay to read our local content. For the longest time — until about 1995 — if you wanted to read something in the Caller-Times, you plunked down a quarter or four or you sent a check to the circulation department for a daily commitment. We delivered a paper to your home or your local convenience or grocery store. We had an agree-

SHANE FITZGERALD COLUMNIST

ment. We would provide news, and you paid for it. Then the Internet came along. The Caller-Times, like most daily newspapers in America, saw great po-

tential value in disseminating news in this new way. A minimal number of people could receive information electronically by simply paying a monthly fee to someone else, and all they had to do was dial in through a modem and wait for that horrible noise that sounded like a dysfunctional car horn. Presto, they could look at the Caller-Times’ content on the World Wide Web. Like virtually every

newspaper in America, we gave it away for free. Hindsight is 20-20, and that wasn’t a good idea. Readers are smart. And as the Internet quickly became more accessible and more mainstream, more of them put aside their daily habit of reading the paper and just caught up on the news for free online. And we kept feeding that news-hungry beast, thinking the newsprint model where advertising

would subsidize the cost of producing journalism and the newsprint on which it was printed would work in the electronic world. Profits went down, but costs stayed the same or grew. Then they went down some more, and as with any business, tough decisions had to be made. It was obvious that a business model of free, which is what we had with the

See FITZGERALD, 10A


8A » Sunday, April 21, 2013 »

C A L L E R -T I M E S

FROM THE COVER DIABETES from 1A

them free medicines and office visits. A second clinic opened in nearby Galloway in 2011. The clinics have treated 2,600 patients, including many with uncontrolled 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 complications. With Type 2 diabetes, the body becomes unable to effectively use its own insulin. Glucose builds up in the blood and causes a condition that, if not controlled, wreaks havoc on the body’s circulation system, nerves and organs. Yet blindness, kidney failure and amputations — expensive and debilitating complications — are preventable when people with diabetes manage their disease and control their blood sugar through small steps: a little exercise, smart eating and stress management. “Over the six years, we’ve only had one toe amputation in all of our patient population,” said Sandra Festa, administrative 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, AtlantiCare has started to export the model to its primary care and family practice doctors. “It works,” said Meaghan Kim, AtlantiCare’s diabetes educator. The Caller-Times examined AtlantiCare’s efforts as part of its yearlong series, Cost of Diabetes. Initiatives in Rhode Island, Atlantic City and Amarillo show that debilitating complications can be preventable when the health care system and government take aim at the disease. But similar efforts have disappeared in the Coastal Bend, where one in six people has diabetes and patients suffer complications such as lower leg amputations and death at higher rates than the state and national average. Atlantic City demonstrates how a hospital system roughly the same size as Christus Spohn can help prevent diabetes complications while saving money. Spohn employs 14 community health workers in hospitals and family clinics throughout the region to connect patients to primary care and community resources, such as cheaper medicines or the Salvation Army’s Foot Savers 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 expanded the team approach to care to 29 primary care practices in the region, reaching patients in far less serious condition and catching them at an earlier stage in their diabetes.

REINFORCEMENT In AtlantiCare’s Special Care Clinic in downtown Atlantic 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 number on the screen: 11.6. That was Yogendra’s A1C when he first came to the clinic in December 2008. The A1C measures blood sugar over three months. A person without diabetes has an A1C around 5; Yogendra’s was more than double normal levels. Declining health care reimbursements means doctors can typically spend no more than 15 minutes with patients, leaving them little time to really talk to patients about the barriers keeping them from getting better. As a health coach, Jay-

PHOTOS BY David Gard/Special to the Caller-Times

Pharmacy technician Kisha Jerkins helps a client at AtlantiCare’s Special Care Center’s in-house pharmacy, where patients can get free medicines.

DIABETES DATA Atlantic County, N.J. Diabetes diagnosis, 2009 Leg amputations per 1,000 Medicare enrollees, 2003-07 Obese adults, 2009 Physical inactivity, 2009

Nueces County

8.8 percent

9.8 percent

1.33

2.66

28 percent

30.2 percent

24.6 percent

23.7 percent

Source: U.S. Centers for Disease Control and Prevention, Dartmouth Atlas

LEFT: Cardiologist Dr. Sanjay Shetty (right) speaks with patient Ghanshyam Mistry, 62. The invitation-only center helps the chronically ill, pairing them with health coaches.

The Special Care Center in Atlantic City, N.J., has treated 2,600 patients, including many with uncontrolled diabetes, and has produced stunning results: a 40-45 percent decline in hospitalizations and a virtual elimination of complications.

shree’s sole job is to meet with patients, as often as weekly in Patel’s case, to reinforce plans to eat right, exercise, take their medications and monitor their blood sugar. AltantiCare’s Special Care Center flips the health care model on its head. Traditionally, doctors oversaw patients’ care, while nurses, assistants and patients were expected to follow doctors’ orders. At the AtlantiCare clinic, health coaches who don’t have college degrees — one was a manager at McDonald’s before 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 Labor’s Bureau of Labor Statistics. And they can’t give medical advice or prescribe medicine. But they can help patients overcome basic barriers to care — transportation, language, understanding instructions — and they help reinforce doctors’ orders while also gleaning information that could help doctors offer better, more individualized care. Talking to Yogendra in his native language, Jayshree found he was profoundly depressed, an im-

portant discovery 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 training didn’t translate, he didn’t speak English and he couldn’t find a job, leaving him to rely upon his wife, who worked full time to take care of their family of five. With one income, the family struggled to afford doctors’ appointments and medicines, Jayshree found, another factor affecting his ability to control the disease. “I can’t afford medicine,” Yogendra’s wife, Ameeta, 50, said. “Every month, I was spending maybe $50 to $60 on medicines for him. I come in here and everything’s free.” Jayshree, also a native of India, 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,” Jayshree said with a smile. Ameeta joined her husband at his health coach appointments and talked to Jayshree. She changed what she served, sometimes to her husband’s annoyance. Jayshree knew she couldn’t give them the same message she gives her American patients: Cut

out carbohydrates and read nutritional labels. That’s because Indians typically eat home-cooked vegetarian meals heavy on carbohydrates like rice and roti, a traditional Indian flatbread. 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 carbohydrates,” Jayshree said. “And I cannot say, ‘Stop eating that,’ because they will say, ‘Then how can I survive?’ … So slowly, I start explaining cutting back on carbs first. If you eat roti, don’t eat rice. If you eat rice, don’t eat roti.” Today, Yogendra is healthier than he was five years ago. His A1C dropped from a high of 11.6 to its lowest of 5.7, a level considered prediabetic. (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 he’s eating a party dinner every night,” she said.) He stopped chewing tobacco and is slowly giving up smoking, thanks to smoking cessation pro-

grams encouraged by his health coach. He works out daily on an exercise machine. Even though he can’t go for long, he huffs and puffs on the machine for one or two minutes, takes a break, then starts again, Ameeta said. He takes his pills as prescribed because he can get them for free, and Ameeta, who earns a living cleaning casinos, doesn’t have to worry about how to afford her husband’s 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 Yogendra’s no longer surprise anyone at the Special Care Center. Although the typical patient has diabetes for three to five 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 director, said. Among the clinic’s 940 patients 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 intervene,” she said.

“But we don’t give up.” The clinic’s successes have much to do with health coaches connecting with their patients, said Steven Blumberg, senior vice president of AtlantiCare Health Solutions, the system’s accountable care organization. “They really are in constant contact with the patient,” he said. “That builds a relationship 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 don’t want to disappoint.” The practice has worked so well, AtlantiCare has expanded it to primary care practices, 29 in total, now accredited as patient centered medical homes, a designation applied to clinics providing more holistic approaches to care. At those offices, medical assistants prep the patients by screening them, including doing foot exams, before handing them off to the doctor, diabetes educator Kim said. The doctor treats them, then refers them to a certified in-office diabetes educator who checks their blood sugar logs, tweaks medicines and encourages exercise and healthy eating. “About 95 percent of diabetes care is self-care,” Kim said. “So if a patient doesn’t have the knowledge and skills to be able to self-manage their diabetes, that’s when complications and hospitalizations and other things ensue.” Perhaps most surprising, doctors often ask the diabetes educators for their recommendations. “The team approach is really embraced here,” she said. And that’s important because 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 off,” she said. “So the constant 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.”


PROBLEM?

ronmental hazards.

HIGHLOCAL, SCHOOL BASEBALL 1B COST OF WATER KIDS COMEBACK MAIN BREAKS Flour Bluff rallies past Gregory-Portland 4-2 Last Corpus Christi 1C in year, Game 3. SPORTS, repaired 1,663 water main breaks — more than twice the typical yearly number. It cost about $1.5 million. See how the city is faring this year.

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LOCAL, 1B

$2.00

84˚/63˚ A couple of t-storms 19A

SUNDAY, MAY 12, 2013 ■ CITY EDITION

Clinic gets personal with patients

ELIMINATION PAPER MAPS Quick OF Read ■ Staff engaged As more people buy

to point they $48 MILLION tems and smartphones with map featuresshop are BOND PASSES with client becoming increasingly GPS or navigation sys-

Flour Bluff ISD will beis there still popular, a By Rhiannon Meyers able to add improveplace for paper maps? meyersr@caller.com ments such as a 361-886-3694 BUSINESS, 16A new athletic facility, updated tennis courts, When it comes to diabescience labs and a INDEX retes care, treatment doesn’t vamped bus shop after get more personalized BUSINESS 16A-17A voters OK a $48 million CROSSWORD 5Gthan this. bond Saturday. LOTTERY 2C On a recent weekday, LOCAL, 1BNATION/WORLD 4AJoe Lozada pulled a plasOBITUARIES 6B-7B tic sandwich bag from the OPINION 18A-19A pocket of his faded sweatWEATHER 19A shirt and handed it over for

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Download our app with the QR code. LEMONADE DAY

Hundreds of kids across the Coastal Bend got a taste of the business world while residents got a taste of fresh lemonade. Stands popped up locally Saturday as part of Lemonade Day. LOCAL, 1B

EMT TO PLEAD NOT GUILTY

WEATHER EYE

A lawyer for theKeep Westan eye on the paramedic charged weather without looking with possessing bombat the sky with our radar making material ys and sa updated forecast at Saturday his CALLER.COM/ client will plead not guilty to WEATHER. explosive charges. NATION, 8A

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STATE STUCK IN STALEMATE

A summer session looms as the House and Senate continue a stalemate over how to pay for water, roads and tax cuts demanded by Gov. Rick Perry.

COST OF

DIABETES

inspection. “What do you think?” he asked diabetes educator Cindy Ellis. Ellis studied the three FACES OF sugar-free candies inside. Three weeks into his diabetes diagnosis, Lozada, 61, is learning how to eat healthy, a nd Ellis is his guide. Her verdict? It’s OK to eat sugar-free

DIABETES

candy but not too much, because they can still raise blood sugar, she said. She’s even gone with him to the grocery store for a lesson on how to read food labels. It’s an extraordinary strategy in today’s world of 15-minute doctor visits, but that’s how Amarillo’s J.O. Wyatt Clinic fights diabetes: one bag of candy at a time. The Caller-Times examined the clinic’s efforts as part of its yearlong series See DIABETES, 10A

DAVID BOWSER/SPECIAL TO THE CALLER-TIMES

Diabetes educator Cindy Ellis cuts the toenails of patient Wayne Gordon at J.O. Wyatt Clinic in Amarillo. No such clinic exists in Nueces or San Patricio counties .

WIND STORM

AGAINST ODDS,

n■Coastal windstorm woes

MOM TRIUMPHS swirl as state meetings near

By Rick Spruill spruillr@caller.com 361-886-3667

now lobbies on behalf of MOTHER’S math of damage claims aris- coastal communities. “I just DAY ing out of Hurricane Carla in couldn’t get the votes.”

1961, gradually started dropEven lawmakers from Corping wind and hail damage pus Christi would not get beCheriThe Ulch since 1999.he said. roadhas waslived pavedwith with a cervical policies inspinal certaincord areasinjury of hind his idea, good intentions. She’s required help from others, but raised three children a single the has Texas coast, her said former “Theiras argument was that Established in inspiring 1971 and strength, state lawmaker “Babe” hadn’t been a hurrimother with thoseA.R. who know there her say. originally named the Texas Schwartz, of Galveston. cane in Corpus Christi for ON PAGE Catastrophe Property READ Insur-HER STORY Schwartz, who 1B from 1957 decades,” he said. ance Association, the Texas through 1981 served two terms Hurricane Celia made Windstorm Insurance As- in the state House and seven landfall near Port Aransas sociation was meant to help terms in the Senate, tried for in 1970 and caused what now Texans whose lives and three terms after Carla to cre- would be an estimated $1.7 billivelihoods are rooted in the ate a consumer-friendly ca- lion in damage and lawmak14 coastal counties along the tastrophe fund to address the ers decided a windstorm pool Gulf of Mexico. growing need for coverage. wasn’t a bad idea, he said. Private property insurance “Nobody wanted it back See WINDSTORM, 8A carriers, smarting in the after- then,” said Schwartz, who

We’ve gotten ourselves in this fix. Now how do we get out? You want a 5 percent or 10 percent (increase)? That’s the only choice we get? It’s dysfunctional.” Foster Edwards, president and CEO of the Corpus Christi Chamber

The Texas Windstorm help Texas Insurance Association Windstorm has been the insurer of Insurance last resort forAssociation. property owners for coastal counties. This is the first in a three-part series before the Department of Insurance board meets twice this week, including a Friday meeting in Corpus Christi to discuss a proposal to charge a fee for policyholders along the coast.

Job hangs in the wind

TODAY: How the windstorm association began and where its problem began. MONDAY: Adjusters are the weak link in the windstorm model. TUESDAY: Texas takes pride in solving its problems. Can it solve this one?

■ Kitzman’s

hired hands irk lawmakers

By Rick Spruill spruillr@caller.com 361-886-3667

LOCAL, 8A INDEX NATION & WORLD 5A BUSINESS 16A OPINION 18A WEATHER 19A OBITUARIES 4B-7B OUTDOORS 9C COMICS 1D PUZZLES 5G

ABOUTKitzman hired consultants to THE SERIES

CONTRIBUTED PHOTO

MICHAEL ZAMORA/CALLER-TIMES

LEFT: Ulch holds her first child, Ashton, in 1992. RIGHT: Cheri Ulch (center) raised her three children Kristen, 17 (from left), Ashton, 21, and Jared, 19, with some help.

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Find out the latest weather conditions, radar from around Texas and sevenday Coastal Bend forecast at Caller.com/ weather.

To subscribe:

883-3800 CONTRIBUTED PHOTO

Cheri Ulch gets her first visit with her children on March 6, 1999, at Methodist Hospital in San Antonio.

AUSTIN — Texas Insurance Commissioner Eleanor Kitzman at many times has found herself caught in the uncomfortable space between the Texas Legislature, which makes laws that govern the insurance business, and her role in enforcing those laws. It is a difficult job, regulating the insurance industry that many in Austin say has few rivals in terms of its power to sway policymakers and steer legislation. It is made even more difficult by the presence of the Texas INSIDE W i n d s t o r m Insurance AsKitzman’s sociation, a fate now struggling, in Senate hands 11A sem i solvent, qua si-publ ic insurance entity that carries more than 265,000 wind and hailstorm policies worth about $82 billion in the 14 counties of the Texas Coast. Kitzman’s decision to hire consultants to help shore up the association’s fi nancial picture, which is under her oversight, has been among the least popular of her tenure. The consultants’ price tag has swelled to more than $2 million, and the

See WINDSTORM, 11A

South Texas Substance Abuse Recovery Services, Inc. (STSARS) CAL177351

2013 Annual Fundraiser Tickets Available Now! Call Now To Reserve Seating. Educating our Youth to be Alcohol and Drug Free

Thursday, May 30, 2013 • Ortiz Center • Dinner / Speech / Silent Auction

Individual tickets $30 Couple tickets $50 • Contact Margarita Barrera at (361) 882.9979

Featuring Maureen McCormick AKA “Marcia Brady”


10A » Sunday, May 12, 2013 »

C A L L E R -T I M E S

from the cover DIABETES from 1A

Cost of Diabetes. Initiatives in Rhode Island, Atlantic City and Amarillo show that debilitating complications can be prevented when the health care system and government take aim at the disease. But similar efforts have disappeared in the Coastal Bend, where patients suffer 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 everything they need under one roof and, at times, in the same visit. Nine years after he convinced the hospital to invest in the indigent care clinic on the poor side of windswept Amarillo, patients are seeing results. By controlling diabetes, patients reduced their risk for complications and saved taxpayers who pick up the bill for indigent care. Last summer, clinic officials traveled to Austin at the invitation of the Texas Diabetes Council to show their successes. “We just do it,” said Dr. Arlene Hudson, who treats HIV patients at the clinic. “We don’t make excuses. We don’t say we can’t afford it.” Rhode Island demonstrated how a state the size of Nueces and San Patricio counties took action against diabetes, while Atlantic City provided perspective on efforts driven by a hospital system. Amarillo demonstrates how a clinic can manage diabetes even among the poor and chronically sick. No such clinic exists in Nueces or San Patricio counties, where one in six people has been diagnosed with the disease, the state estimates. Nueces County patients who can’t afford health care are treated at Christus Spohn Hospital Memorial. Christus Spohn gets reimbursed in part by the taxpayer-funded Nueces 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 appointments. Two came.

FIXING THE CLINIC The Wyatt Clinic wasn’t always such a success story. When Dr. Lee took over as medical director in 2003, the staff was skeptical he could fix 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 disarray, hemorrhaging cash treating difficult and complicated patients while health care costs continued to skyrocket. Among his first items of business, Lee gathered the staff for a meeting. He promised he wouldn’t lay off employees and told them he wanted to retire in Amarillo, so his tenure at the Wyatt Clinic would be his last in health care. “Yeah, we’ve heard that,” someone said. Then, for the first three months, he sat back and observed. He followed patients from check-in to doctor appointment to the in-house pharmacy, jotting down how long they spent waiting. They spent more than half of a workday on average, he noted. That’s troublesome for patients with low-wage hourly jobs that don’t pay for time spent at the doctor. The unwieldy pharmacy lines clogging clinic hallways annoyed him. Calls to the clinic’s main phone line never got answered. He watched the staff’s never-ending search for patients’ medical records that were printed on paper and tucked into thick binders they wheeled around on

photos by David Bowser/Special to the Caller-Times

Diabetes educator Cindy Ellis discusses diet with patient Joe Lozada at J.O. Wyatt Clinic in Amarillo. Three weeks into his diabetes diagnosis, Lozada, 61, is learning how to eat healthy.

COST OF

DIABETES

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple FACES OF facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their health.

DIABETES

Upcoming stories Ellis cuts Gordon’s toenails. Gordon, 77, has lived with Type 1 diabetes for so long, he remembers boiling insulin syringes made of glass.

grocery carts. Slender and silverhaired, Lee is intelligent and analytical. “They say no one has read the Affordable Care Act? He has,” Brian Gibbs, clinic administrator, said. “The whole 1,000 pages of it.” He’s also a problem solver. Lee laid the foundation of his medical career building a private practice an hour’s 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 inefficient. As medical director at the clinic, Lee had the opportunity to experiment with his own system for treating patients. He devised a plan to transform the clinic into a streamlined clinic with practitioners working as a team to efficiently treat the clinic’s chronically sick patients and with respect. Lee’s proposal foreshadowed federal health care reform, which came six years later. Such models, called patient-centered medical homes, are being tested by the Affordable 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 city’s indigent, typically the working poor who don’t have insurance but who earn too much to qualify for govern-

ment programs. Lee pitched his idea to hospital management. He asked them to change their mindset about the Wyatt Clinic, to think of it as an asset, rather than a liability. Then he asked for a blank check to fund staff and resources necessary for transformation. Hospital management balked, he said. Where was the guarantee that their investment in Wyatt would pay off 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 private practice to fall back on in Pampa if the Wyatt gig didn’t work out. Hospital management agreed to give it a try. Lee aimed to create a clinic free of bureaucratic red tape, where staff members worked shoulder to shoulder and provided 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. Now, doctors call Ellis, the diabetes educator, into their offices during an exam to talk to their patients. Patients such as Lozada swing by Ellis’ office to chat with her about diet, exercise and insulin. The clinic hired three people whose sole job is to work with pharmaceutical companies to get free or low-cost medicines through their prescription assistance programs, which offer such medications to needy people. The clinic’s medication assistance program has paid for itself. In one year it snagged $4 million in drugs. Lab work is done inhouse. So are foot and eye screenings. Bleeding in the eyes can be a telltale sign of circulatory problems hidden deep

This month

n Diabetes complications can lead to devastating consequences, including kidney failure, amputations and death. A look at how one family has been affected. June

n Dialysis keeps many diabetes patients alive while they wait for kidney transplants. EVERY WEDNESDAY

n Clip healthy, diabetesfriendly recipes from the Food section. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

within veins that could lead to stroke and heart attacks, so Wyatt Clinic staffers dilate and examine patients’ eyes at least once per year. To prevent infection that leads to costly amputations, nurses regularly check patients’ feet for sores and trim toenails coarsened by a fungus common among people with uncontrolled diabetes. It’s a delicate procedure — improper trimming can cause sores and lead to infections. Wyatt’s nurses have been specially trained. When sores are discovered, patients get antibiotics or a trip to wound care to halt the infection before it spreads. Lee could not provide an exact figure on how much the hospital invested in the Wyatt Clinic’s transformation, saying it would be difficult to quantify. But the investment is significant, including the implementation of electronic medical records, making Wyatt one of the first practices in Amarillo 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 can’t quantify it, it doesn’t matter,” said Gibbs, clinic administrator.

SEEING RESULTS The clinic has documented case after case of diabetics who have reversed eye diseases, feats some health care providers didn’t think was possible. “Well, we’re seeing it,” Ellis said. About one in five of the Wyatt Clinic’s 5,400 patients have diabetes. In 2010, 59 percent had well-controlled blood sugar versus 35 percent of Medicaid patients and 43 percent of insured people nationwide, according to the clinic’s data. In Type 2 diabetes, the body becomes unable to effectively use its own insulin. If uncontrolled, sugar builds up in the blood and wreaks havoc on the body’s circulation system, nerves and organs. Yet blindness, kidney failure and amputations are preventable through small steps: a little exercise, smart eating and stress management. By managing diabetes in-house, the clinic has drastically decreased emergency room visits, saving millions of dollars. Among more than 200 Texas cities, Amarillo had the lowest belowthe-knee amputation 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 aren’t 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 insulin syringes made of glass. Yet it wasn’t until he lost his job and landed at the Wyatt 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. “I’ve always had a doctor, but to a doctor, I’m not even a paycheck,” Gordon said. “I’m just one of a number. I’m patient 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 importance of keeping appointments, following doctors’ orders, taking their medicines as prescribed and avoiding the emergency room for matters they could address with their doctors. Because the clinic lays out

the rules early, patients are expected to follow them. Noncompliant patients get sent to Jolene Barreras — the “principal’s office,” the staff 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 clinic’s social 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. It’s a last resort and rarely used — after all, Wyatt patients are there because they can’t afford health care anywhere else — but it’s necessary to prove a point. “They need to take some sort of responsibility,” Gibbs said. “We’re opening up a slot for someone that is appreciative of their health care.”

ROOT OF THE PROBLEM Sometimes all it takes is a little information to get patients to take responsibility. Three weeks ago, Lozada entered the clinic complaining of a possible hernia. Dr. Ricardo Carrizo knew his diagnosis before he even treated him. Carrizo watched Lozada leave the exam room five times to use the restroom while Carrizo saw other patients. Frequent urination is a common symptom of diabetes. Lozada’s blood sugar levels were so high, Carrizo skipped the pills and went straight to insulin. Then he paired Lozada 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 hadn’t used the insulin. They tested his blood. His sugar levels had drastically dropped anyway. Giving up sodas and energy drinks made a big enough difference that Lozada no longer needed insulin, only pills. On a recent weekday, he returned to Ellis’ office 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.


BEACH TO BAY More than 15,000 runners lace up for race. LOCAL, 1B

Did your team measure up? See a list of results. SPORTS, 8C-9C

$2.00

SUNDAY, MAY 19, 2013 ■ CITY EDITION Corpus

92˚/76˚

Partly sunny and breezy 23A

Quick Read

HURRICANE SEASON

Top tip? Be prepared

■ Insurance,

inventory key, insurer says

HIGH SCHOOL BASEBALL PLAYOFFS S.A. O’Connor King

By Rick Spruill spruillr@caller.com 361-886-3667

18-16 0-2

Moody 8 Rio Grande City 0 Sinton Kingsville Robstown Hidalgo

Worried about windstorm insurance? Hundreds of thousands of homeowners on the coast have windstorm

VIDEO

Want to see what winds from a Category 4 hurricane can do to your roof? Check it out at Caller.com.

insurance through the Texas Windstorm Insurance Association, which has been the subject of intense scrutiny from law-

makers for the last year. Though the Legislature has not passed any substantive reform this session, officials say the association will be fi nancially prepared for this hurricane season, which begins June 1. The association, a quasi-public entity, now has less than $1 billion in cash in the form of premiums, See HURRICANE, 5A

sing • Adverti er-Times

19, nt • May

Suppleme

2013

Christi Call

20u1r3ricane Guide H H

now It’s calm . a rep red but be p

First reported on

INSIDE e season Hurrican Nov. 30 1 e n is Ju

Are you ready? We’ve got everything you need to know to be prepared if a hurricane hits the Coastal Bend.

13-14 0-1 12-4 2-10

Bishop Refugio

5 0

King may have dodged a bullet with San Antonio O’Connor the night before, but on Saturday, the Panthers brought the entire arsenal. SPORTS, 1C

ETHICS MUDDY PORT HEARING

COST OF

DIABETES

Danita Reyes sits on the bed where she keeps her memorial blanket for her husband, Mike Reyes, who died after suffering cardiac arrest during dialysis. Mike, 38, was diagnosed with diabetes at 23.

‘LET ME TELL YOU DIABETES MY ABOUT HUSBAND’ FACES OF

MICHAEL ZAMORA/ CALLER-TIMES

DAN I TA R E YES

A dispute between Corpus Christi refineries and harbor pilots has raised potential conflicts of interest for port commissioners. LOCAL, 1B

LIFT STATIONS LEFT IDLE The city has four new sewer pumping stations — none of which have moved a drop of wastewater since they were built a few years ago. LOCAL, 1B

TAMU-CC GRADS WALK THE LINE Nearly 900 Texas A&M University-Corpus Christi students received diplomas during the spring 2013 commencement on Saturday in the American Bank Center arena. LOCAL, 4B INDEX BUSINESS 20A- 21A CROSSWORD 5G LOTTERY 2C NATION/WORLD 4A OBITUARIES 9B-11B OPINION 22A WEATHER 23A

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Danita Reyes and her twins Simon and Sophie Reyes, 10, place dirt on the casket of Mike Reyes during his burial at Memory Gardens Cemetery. Mike, 38, died in March after suffering cardiac arrest during dialysis. Diagnosed at age 23 with diabetes, Mike had suffered years of complications, including blindness, kidney failure and toe amputations.

Diagnosed at 23; dead by age 38 ■ Illness manageable, easy to ignore By Rhiannon Meyers meyersr@caller.com 361-886-3694

Winter sunlight streamed into the third floor 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.

Mike’s legs stiffened and relaxed involuntarily like he was trapped in a dream, fighting 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 Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the Caller-Times hopes to help its readers understand the disease and make better informed choices about their health.

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 reflexive, along the surface of the hospital bed. Danita clung to hope, remembering what she’d heard See DIABETES, 9A

UPCOMING STORIES TODAY

Complications from Type 2 diabetes can lead to devastating consequences, including blindness, amputations and death. A look at how one family has been affected. JUNE

Diabetes can irreversibly damage kidneys, leading to a lifetime of expensive and disabling dialysis procedures. Find out how some are striving to raise awareness about kidney failure. EVERY WEDNESDAY

Clip healthy, diabetes-friendly recipes from the Food section. AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.


C A L L E R -T I M E S

« Sunday, May 19, 2013 « 9A

from the cover

Michael Zamora/Caller-Times

Samantha Reyes, 14 (from left), sits with mother Danita Reyes and twins Simon and Sophie Reyes, 10, next to a vase of flowers meant for Mike Reyes’ gravesite. After years of complications from diabetes, Mike Reyes, a father and husband, died after having a heart attack.

DIABETES

I lost it. I was really upset … I remember him saying, ‘Why are you so upset? It’s not like I’m dying.’ And I stopped crying. And I was like, ‘If that’s how you feel about it, OK.’ I learned to accept the lifestyle he’s chosen for himself and all I can do is take care of him because he doesn’t have anyone else to take care of him.”

from 1A

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 latest 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 Mike’s teenage daughter and 10-year-old twins couldn’t remember a time when their dad was healthy. He hadn’t been able to work in eight years. Danita did everything it seemed: raising their kids, taking care of Mike and working full-time to support them. She felt like a single mom. Now this? She wasn’t sure what more she could handle. Watching Mike fight against the sedation, she prayed the doctors were wrong about the paralysis. In a region where diabetes complications are too common, the Reyes family offers 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 has been diagnosed with the disease that can lead to amputations, blindness, kidney failure and death if left unchecked for too long. Complications 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 symptoms like fatigue, slow-healing sores, increased thirst and urination appearing so slowly, people often fail to notice them for years. 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 bloodstream, damaging the walls of blood vessels, which can lead to nerve damage and blindness. Diabetes damages the delicate system in the kidneys that filters 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.

Danita Reyes

Mike and Danita Reyes hold their firstborn daughter, Samantha, in 1999. CONTRIBUTED PHOTO

DIABETES COMPLICATIONS Type 2 diabetes cause complications affecting major organs. These complications develop gradually but can be disabling and even life-threatening. They can be prevented by controlling blood sugar. BRAIN ■ Hardened arteries lead to two to four times higher risk of stroke, which accounts for 25 percent of deaths among people with diabetes ■ Higher risk of dementia and depression

EYES

■ Damaged blood vessels

cause reduced or blurred vision and eventual blindness ■ Higher risk of cataracts and glaucoma EARS

■ Hearing loss

LUNGS

■ Higher risk of flu and

HEART ■ Two to four times higher rate of death from heart disease ■ Heart attacks account for 60 percent of deaths in diabetic patients ■ Hypertension

related complications, including pneumonia

KIDNEY

■ Damage to kidney’s

CONTRIBUTED PHOTO

A photo of Mike Reyes as a boy appeared in a slideshow at his wake April 1.

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 state’s third highest diabetic death rate. And those numbers likely don’t tell the whole story. Diabetes 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 certificates, 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 symptoms in her son. He was thirsty all the time, a classic sign. But he was in denial. His mom urged him to see a doctor, and when he finally did, he left with a diagnosis and a

prescription, although, to Mike, that didn’t 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 before 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 after class. They bonded over their commonalities: both the babies in their families and painfully shy. They married in September 1998. Their daughter Samantha was born seven months later.

MISSED WAKE-UP CALL It’s hard to say exactly why Mike never took the disease seriously. His excuses so closely mirror those of others who failed to rein in their blood sugar before permanent damage begins. He took a diabetes class where he was taught the importance of eating right,

filters that remove waste from the blood ■ Kidney failure in 20 to 40 percent of people with diabetes, leading to need for dialysis or kidney transplant ■ Symptoms of kidney failure: swollen feet and ankles, itching, fatigue, pale skin

DIGESTIVE SYSTEM

■ Nerve damage can cause

diarrhea, nausea and vomiting

FEET

SKIN

■ Nerve damage

■ More susceptible to

(neuropathy) causes tingling, numbness, weakness, loss of sense of warm and cold, burning or pain ■ Eventual loss of all feeling, which can lead to infection and amputations

skin problems, including bacterial and fungal infections

Source: New York Times, Mayo Clinic

SCRIPPS NEWSPAPERS

exercising and taking care of himself — education that’s considered a gold standard in diabetes care. But he didn’t have health insurance and wasn’t consistent about taking pills. He took them at the wrong time or forgot to take them altogether. He didn’t test his blood sugar.

He couldn’t find time to exercise. He thought he could live the same way as before and eat whatever he wanted. “I didn’t 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 didn’t re-

alize how serious it was.” If Mike had a wake-up call, it was his mother’s death in 2000. She had a heart attack, a leading killer of people with diabetes. But instead of motivating Mike to change, his mother’s death crushed

See DIABETES, 10A


10A » Sunday, May 19, 2013 »

C A L L E R -T I M E S

from the cover

TODD YATES/CALLER-TIMES

Friends and family of Mike Reyes, who died in March after years of complications from diabetes, wait for his funeral services at Holy Family Church.

DIABETES from 9A

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 capillaries, causing them to rupture and leak. A doctor discovered 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 find the world had gone dark. Doctors replaced Mike’s 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 difficult, and it took a very long time for us to adjust.” He learned to use a cane and how to read Braille. But he couldn’t get into a more intensive program at the Texas School for the Blind and Visually Impaired in Austin because his blood sugar was still out of control, Danita said. Danita tried to help him remain independent. She used puff paint to leave raised dots on the microwave buttons so he could heat his own lunches while she was at work. She urged him to take his medicine. She cooked healthy meals. But even without his eyesight, he would still find the sweets she bought for the kids. “Dad, you’re 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, lining up like chapters in a medical textbook. First the boils, popping up under Mike’s arm and on his buttocks. He went back and forth to hospitals to get surgery 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 didn’t heal, and a doctor discovered that Mike’s kidney 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? It’s not like I’m dying.’ And I stopped crying. And I was like, ‘If that’s how you feel about it, OK.’ I learned to accept the lifestyle he’s chosen for himself, and all I can do is take care of him because he doesn’t 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 didn’t live up to his vows of marriage he took when we got married,” Danita said in January. “He’s selfish. He doesn’t think about me or

CONTRIBUTED PHOTO

This is the only recent family photograph that appeared in the slideshow at Mike’s wake April 1.

the kids when he doesn’t want to take his medication. And I think after he lost his vision, I honestly think he felt like, ‘What’s 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 hospital, Danita was trying to hold it together. The kids wanted to visit, but Danita tried to explain that he was very sick and they couldn’t 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 floor. He responded See DIABETES, 11A

TODD YATES/CALLER-TIMES

Friends and family of Mike Reyes pray over his casket during his funeral services at the Holy Family Church. Mike had suffered years of complications, including blindness, kidney failure and toe amputations.

TODD YATES/CALLER-TIMES

Belva Robinson talks about howCOST diabetesOF has affected her life and how she gets by after she was blinded from her diabetes.

DIABETES

Belva Robinson new job sewing Belva Robinson chin straps for at first thought she FACES OF military helmets was having a headDIABETES at the South Texas ache. It turned Lighthouse for the out she was going /VIDEO Blind. blind. Robinson, 44, Eight surgeries knew the conlater, Robinson, Watch sequences of who has Type 2 Belva diabetes — such diabetes, lost her as blindness and eyesight comRobinson — pletely. tell her story. amputations but never thought “I think my chilit would happen to dren were more her. afraid for me than “If you have diabetes, look I was,” she said. at all the symptoms that can She has since had to learn happen to you,” she said. how to navigate the world “And take care.” again, including getting a Rhiannon Meyers


C A L L E R -T I M E S

« Sunday, May 19, 2013 « 11A

from the cover

TODD YATES/CALLER-TIMES

Arturo Reyes Jr., a double amputee from complications of diabetes, follows his brother Mike’s casket out of the Holy Family Church along with other family members after Mike’s funeral. Mike died in March after years of complications from diabetes.

DIABETES

I told him that I loved him. 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.”

from 10A

to questions with a blank stare. He could walk, dress himself and tie his shoes. But he was silent. His father and Danita’s father helped him into the car and took him to the emergency 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 looking for. Within a week Mike opened his left eye and squeezed Danita’s hand. He was off the ventilator within a month, smiling and trying to talk. Danita went back to work and visited Mike on weekends. One Sunday at the end of February, Danita went to see Mike in the long-term hospital where he was recovering. 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 wouldn’t let go. He tried to say something, but with his tracheotomy, no sound came out. She tried to read his lips but didn’t understand what he was trying to say. Mike’s progress didn’t last. Within days of Danita seeing him, the long-term hospital sent him back to the emergency 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 Mike’s sores, and by mid-March, he was strong enough to go to a skilled nursing facility. This time, though, the Reyes family couldn’t find any Corpus Christi facility 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 McAllen 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

Danita Reyes

Danita Reyes kisses her husband’s casket during his burial at Memory Gardens Cemetery. Mike Reyes died at age 38 after suffering years of complications from diabetes. TODD YATES/CALLER-TIMES

Michael Zamora/Caller-Times

Simon, 10, and Danita Reyes finish their neighborhood walk recently at their home in Corpus Christi. Danita Reyes says she is encouraging her son to be more active after his father, Mike Reyes, died in March following years of diabetes complications including kidney failure, blindness and a stroke.

close. “Don’t go,” he said. “I’m 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 diabetes may carry extra weight around their waist, have abnormal 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 Diseases. People living with diabetes for a long time can diet, exercise 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 Association estimates that 65 percent of people with diabetes 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 arrest. “I was praying for him to be well enough so that I could take care of him,” she said. “I didn’t know how bad it was until I got there.” Danita rushed to McAllen where she found Mike surrounded by health care workers 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.” Mike was surrounded by his family when his older brother arrived. Like his brother, Arturo has diabetes complications, including amputations on both legs and a triple bypass. Arturo made the call

Danita couldn’t bring herself to think about. “Turn it all off,” he said. “What do you mean?” Danita asked. “He’s going to come out of it like last time. You don’t think there’s any point?” “No,” he said. She knew she couldn’t say the words. Arturo agreed to tell the doctors. At first Danita felt relief, then guilt. “I felt like I was killing him,” she said. As they started the paperwork, a doctor reassured Danita the family was making the right decision. Nothing more could be done. If it were him, he said, he would make the same decision. It happened so fast, Danita said. She held Mike’s 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 Treviño Funeral Home, a tiny glittery bow topping her ponytail. As a slideshow of photos of their dad looped on a television screen to George Strait’s “I Cross My Heart,” Sophie leaned her head against her twin brother, Simon, 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 first 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 dad’s 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 photographs taken of himself after he went blind. Danita and the kids said their final farewells to Mike at the funeral the next day. Invited 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 surface. First Danita, then Samantha, 14, then Sophie and last, Simon. “There is sadness now, and there are tears now, and there is grief,” the Rev. Patrick Donahoe said. “But there is also a sense of ‘no mas.’ ” HIS LEGACY A vase of royal blue silk lilies sat on an end table near the couch in May, a dash of color in Danita’s 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 wouldn’t know how to navigate 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 Mike’s grave but hasn’t been able to afford a headstone yet. She thought that after Mike was gone, she would feel a sense of relief from the pain and suffering. Instead, she felt lonely and sad. She still had to stop herself from rushing home to pick him up from dialysis 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, Danita stretched out her arm to Mike’s 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. “I’m going to try that.” She burrowed underneath her mom’s comforter, closed her eyes and stretched out her hand. Mike remains here in other ways, too. His legacy is a cautionary tale. When Mike had his stroke in January and Danita was at a training session, everybody had left the room except Danita and the trainer. That’s 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.


Moody rallies past Alamo Heights, heads back to state tournament. SPORTS, 1C

Partly sunny

23A

Quick Read

CCISD HEALTH EXAMINED More than 80 percent of 3,942 Corpus Christi ISD employees screened this spring as part of a districtwide health checkup were shown to be overweight, obese or extremely obese.

COMEBACK

SUNDAY, JUNE 2, 2013 ■ CITY EDITION

$2.00

92˚/73˚

AGICAL

Drug cases pile up in South Texas ■ Prosecutors

lack funds in local districts

By Mark Collette collettem@caller.com 361-886-3678

Some federal drug cases in South Texas are going unprosecuted, letting

smugglers go free and perhaps fueling a local pipeline for drugs and illegal migration, local prosecutors said. The lack of consequences spurs smugglers to use routes where they know they can get off easy if caught. District attorneys in Brooks and Kleberg counties view the situation as partially responsible

for the amount of smuggling on U.S. Highways 281 and 77, which also are major routes from the Rio Grande Valley to Houston. Some lawmakers are looking to shore up border prosecutions as part of a national immigration reform bill. A portion of the proposed law would authorize funding for a Department of Justice

program that pays local prosecutors for handling cases rejected by the department. But even if it gets funding, local jurisdictions routinely have been receiving less than half of what they claim in costs. That poses a problem for cash-strapped rural districts such as those in South Texas.

The movement of drugs is linked to the same gangs and cartels that move undocumented immigrants, often treating them no better than cargo. Bodies keep turning up on South Texas ranches. A record 129 migrants’ bodies were found last year in Brooks County, See PROSECUTIONS, 5A

LOCAL, 1B

“You are lucky if you end up on dialysis.”

COST OF

DIABETES “To me, that’s the biggest news. Who knew that those on dialysis are the lucky ones.”

CATHY LEWIS, EDUCATION COMMITTEE CHAIRWOMAN FOR THE TEXAS RENAL COALITION BOARD

CITY BUILDINGS NEGLECTED The city recently compiled an inventory assessing critical building needs and exploring ways to pay for a $32 million problem — poor building maintenance. LOCAL, 1B

TORNADO KILLS 9 IN OKLAHOMA The memory of the tragic tornado in Moore fresh in their minds, some Oklahoma residents tried to drive to shelter. For many, it was a deadly decision. Nine people died, and authorities said they were all in vehicles. NATION, 8A

EASING INTO RETIREMENT U.S. employers have offered workers a softer landing into retirement, allowing them to scale back hours as they prepare to take the plunge and move into part-time positions once it’s official. BUSINESS, 20A

MAN DEAD AFTER FIGHT A 25-year-old man is killed in a parking lot after he is confronted by another man for hitting his car door, Corpus Christi police said. LOCAL, 1B INDEX BUSINESS 20A-21A CROSSWORD 5G LOTTERY 2C NATION/WORLD 4A OBITUARIES 10B-11B OPINION 22A WEATHER 23A

Local news now. Download our app with the QR code.

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TO LIKE? Friend us on Facebook at ■ CallerTimes, ■ CallerSports, ■ CallerPolitics or ■ CallerEntertainment.

PHOTOS BY TODD YATES/CALLER-TIMES

Roland Gaona waits for Yolanda Carrisalez, a clinic technician at the DaVita Dialysis Center, to fi nish hooking him up for dialysis. Gaona has been taking dialysis treatments for four hours, three times per week for nine years.

For 10 years, life

dictated by

The unfiltered blood of Roland Gaona makes way to a filter that will clean his blood and return it to him. Roland needs to take dialysis three times per week, each session lasting four hours.

dialysis

■ Kidney loss

another risk of diabetes

INSIDE

Dialysis inspections reveal mostly administrative violations. 9A

Faces of diabetes. 11A

By Jessica Savage savagej@caller.com 361-886-4316

He felt tired and achy, like he had caught the flu. It was October 2003, and the cold and flu season had arrived earlier than usual, so Roland Gaona didn’t 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 difficult even to get out of bed. Gaona’s health pingponged between those two extremes until one day he felt like he couldn’t breathe.

Doctors told Gaona his kidneys 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 filter the toxins from his blood. Years of living with diabetes and undiagnosed high blood pressure wore down his kidneys until they gave out. He didn’t feel the effects until it was too late. The only ways off dialysis would be a kidney transplant or improved kidney function, See DIABETES, 9A

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their health.

UPCOMING STORIES TODAY

Diabetes can irreversibly damage kidneys, leading to a lifetime of expensive and disabling dialysis procedures. Find out how some are striving to raise awareness about kidney failure. JULY

Learn how decisions in Washington, D.C., and Austin could affect the way doctors and hospitals offer diabetic care. EVERY WEDNESDAY

Clip healthy, diabetes-friendly recipes from the Food section. AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

CONGRATS GRADS! KNOW SOMEONE WHO GRADUATED FROM HIGH SCHOOL THIS YEAR? Look for their name in our 12-page special section inside next Sunday’s paper.

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C A L L E R -T I M E S

ÂŤ Sunday, June 2, 2013 ÂŤ 9A

FROM THE COVER

State monitors dialysis care, facilities â– Companies

ONLINE

must address deficiencies

Find a dialysis clinic and read the state inspection reports from the past 10 years at Caller.com/data.

By Jessica Savage savagej@caller.com 361-886-4316

from 1A

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a very slim possibility. “I thought, ‘Well, this will be all right. I’ll get through ICU. They’ll do a couple of dialysis things and then (my kidneys will) kick back in, and I’ll be all right,’â€? 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 amputations are among complications caused by diabetes, which affects one in six people in Nueces and San Patricio counties. End stage renal disease, the clinical term for kidney failure, is expensive and debilitating, and the cost is largely paid by taxpayers. There are 716 people on dialysis in Corpus Christi costing about $62.7 million per year, based on average dialysis costs of about $87,600 per year per patient. Medicare pays about 80 percent of the treatment costs for those covered by the federal program, according to the 2012 Annual Data Report by U.S. Renal Data System. The Caller-Times examined the ďŹ nancial and personal 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 doesn’t want others to end up in the same, preventable situation. He thinks there needs to be more awareness and education in the community. Many people know Gaona, who grew up in Corpus Christi, through his volunteer work and advocacy efforts. He is a longtime member of the League of United Latin American Citizens Council No. 1, through which he is spearheading an effort to establish a Tejano civil rights museum in Corpus Christi. He’s also known for his environmental activism. Few people know he has kidney failure and is on dialysis treatments. “This has drastically

The Fresenius Medical Care dialysis clinic in Robstown was found with violations in a 2011 state inspection, and ofďŹ cials say the issues have been corrected.

federal health care reimbursements. Rules and regulations for dialysis clinics are set by the federal Centers for Medicare and Medicaid Services but enforced in Texas by the Department of State Health Services. There are 12 licensed dialysis clinics in Corpus Christi and one clinic in Robstown. Five are owned by DaVita, ďŹ ve by Fresenius, one by DSI Dialysis and another operated by Driscoll Children’s Hospital. A state survey in October 2011 found unsanitary conditions — missing ceiling tiles, blood spots with tape over them and cigarette butts littering the

patient entry way — at a clinic then owned by DSI Dialysis 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 Morgan Avenue clinic about a year ago. When the company takes ownership of a clinic, part of that process involves renovating and retroďŹ tting it with new oors, ceilings, walls and the latest technology, including a water treat-

ment system, said Sam Canavati, DaVita’s regional operations director. “We especially take a lot of pride because a lot of us have family members on dialysis,â€? Canavati said. Dialysis is a delicate kidney treatment process that involves a machine ďŹ ltering the toxins from patients’ blood to keep them alive. It relies on a puriďŹ ed water treatment system. At a clinic in Robstown, patients 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 didn’t have

running hot water — a violation of sanitary rules. It also showed the center’s reverse osmosis machine, which puriďŹ es water for dialysis treatment, had a pattern of problems. The clinic operates three days a week. Someone at the clinic was switching the water 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 president of public relations and communications for Fresenius Medical Care North America. No patient delays for treatment 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 require dialysis treatments. A kidney transplant is

HEMODIALYSIS In hemodialysis, a machine ďŹ lters wastes, salts and uid from your blood and the clean blood is returned to the body. Hemodialysis is usually done three times a week and can last between three to four hours. Heparin pump (tp prevent clotting)

Dialyzer inow pressure monitor

Roland Gaona brings blankets, juice and reading material to one of his fourhour dialysis treatments at a DaVita Dialysis Center. Gaona has been taking dialysis three times per week for the last nine years.

Venous pressure monitor

Air trap and air detector

Dialyzer

TODD YATES/CALLER-TIMES

Air detector clamp Arterial Pressure monitor

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Source: U.S. Department of Health and Human Services

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KIDNEY EDUCATION CLASSES DaVita Coastal Dialysis, 4300 S. Padre Island Drive, has classes every two weeks from 10 a.m. to noon. The next one is Friday. Classes are free and open to those diagnosed with kidney disease, a friend or family member of someone with the disease, or someone who wants to know more about managing the disease.

changed my life,� he said.

AT THE CLINIC After his diagnosis, Gaona spent a month in ICU and received partial toe amputations on both feet related to diabetic complications. Doctors released him with orders to have dialysis treatments at an outpatient clinic — his choice instead of having the treatment at home. Three times per 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 off dialysis. Gaona drives himself to his treatment center off Swantner Street and usually arrives around 6 a.m. The appointments start and end with checking his weight. It’s how the technicians monitor uid retention, an important part of dialysis because the kidneys can’t ďŹ lter toxins to make urine. Some patients are advised to drink as little as 16 ounces of uid each day. Gaona is then hooked to a machine in a brightly lit room with more than 20

stations where other people are undergoing their treatments. A staff member connects a tube from the dialysis machine through a ďŹ stula in his arm. The ďŹ 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. It’s fed through an artiďŹ cial kidney — a cylindrical, hard plastic tube with ďŹ ltration inside. A typical treatment takes about four hours. “I get sleepy because it gets a little boring,â€? Gaona said. It didn’t have to be this way. People with diabetes should know more about how the disease affects their kidneys before 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 professionals say kidneys often don’t receive the attention they need until the advanced stages of chronic kidney disease. At that

             

      

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Dust-caked ceiling vents, problems with running water, and a patient who wasn’t aware of the kidney transplant list are a few of the more glaring ďŹ ndings during state inspections of local dialysis clinics. Administrative compliance issues, such as not properly documenting doctors’ orders on patient charts or naming a clinic’s liaison with the state, were more commonly documented in the reports than immediate patient safety problems, 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 documents, which were released through a public information request. The reports are based on unannounced state inspections of licensed dialysis clinics. Each clinic is required to have a survey every 3½ years to receive

the only way off dialysis. One in six people in San Patricio and Nueces counties has diabetes. Dialysis is a growing, for-proďŹ t industry and largely run by corporations who answer to shareholders. 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 surveyor could be on site within two days or 45 days, depending on the type of complaint, according to the state. Most patients who are on dialysis treatment pay for it through Medicare, a federally 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 internal investigation and report its ďŹ ndings to the state for a review, according to Christine Mann , assistant press officer in the Texas Department of State Health Services.

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10A » Sunday, June 2, 2013 »

C A L L E R -T I M E S

FROM THE COVER DIALYSIS PATIENTS 35

Number of dialysis patients in Texas, 1991-11.

30

39,177

Thousands

25 20

9,288

15 10 5 01991

93

95

97

99

01

03

05

07

09

11

Source: Southwest Transplant Alliance

SCRIPPS NEWSPAPERS

DIABETES from 9A

point the disease is irreversible, but kidney failure can be delayed. “I don’t think people realize 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 people think, ‘It happened to my parents. It’s going to happen to me.’ That’s because we didn’t 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 twothirds of the state’s diabetes-related hospital stays in 2010, according to the state’s health department. People with diabetes on average spend 2.3 times more on health care than those who don’t have it, according to the state’s most recent report on the financial burden of diabetes 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 difficult to quantify but just as costly. A majority of those on dialysis are unable to work because treatments can take up to 12 hours per week and clinics often are open only during the day. Those who can’t keep a full-time job often qualify for disability through Medicaid. When diagnosed with kidney failure, Gaona didn’t have health insurance. He didn’t consider the long-term consequences and thought he’d get to a point where he could afford insurance again, he said. At the time he was working as a real estate agent for an apartment locator business. That ended with his diagnosis because he was no longer physically able to work. He qualified for health care through Nueces County’s 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. Texas has a program called Kidney Health Care to pay in part for dialysis, access to surgery and Medicare premiums for those making less than $60,000 per year. It covers the three-month lapse in coverage. To afford his health care, Gaona doesn’t work full time and keeps his income below $24,000 per year so he qualifies for Medicaid coverage and disability. He otherwise wouldn’t be able to afford the out-of-pocket medical expenses, he said. His monthly Medicare

premium is about $77 and is paid for by Medicaid. He also receives an $880 per month disability check, which after rent, bills and groceries doesn’t 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, undergoing dialysis. He has been in and out of the hospital with several other health complications, including a lung infection and removal of his gallbladder and one kidney.

EDUCATION One of the blood tests health care professionals say diabetics should have each year is the glomerular filtration rate, known as the GFR, which measures how fast the kidneys are filtering blood. Anything less than 60 milliliters per minute usually comes with a referral to a nephrologist, a kidney specialist. That level indicates stage 3 of chronic kidney disease, when the kidneys are headed toward failure. At that point, damage can’t be reversed, but the progression 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 promote education and awareness of chronic kidney disease. For example, not enough diabetics with chronic kidney disease are aware that taking over-thecounter pain relievers can speed the damage to your kidneys, said Cathy Lewis, education committee chairwoman for the Texas Renal Coalition board. Lewis works in San Antonio and outlying areas to speak about chronic kidney disease. She’s built a grassroots network of interested groups in the six years since she started the education outreach 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 Gaona’s. “They don’t 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. “It’s brand new to them.” Corpus Christi nephrologist Dr. Jack Cortese typically sees a patient after that person’s 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,” Cortese said. He helps patients understand the decisions ahead

PHOTOS BY TODD YATES/CALLER-TIMES

Roland Gaona weighs in before his dialysis treatments at a DaVita Dialysis Center. Dialysis requires patients to be strict about their nutrition and fluid intake.

KIDNEY WAITING LIST Of those awaiting organ transplants, most need kidneys and are dealing with complications from high blood pressure or diabetes or both. As many as two-thirds of those in need of a kidney transplant have both diabetes and high blood pressure. U.S.

117,878

people in need of organs

96,032

or 82 percent, waiting on kidneys Of those awaiting kidneys: The blood of Roland Gaona makes it way through a filter for cleaning during one of his visits to a DaVita Dialysis Center. Gaona has been repeating this process three times per week for the past nine years.

34,500

are because of diabetes of some form (27,000 because of Type 2)

25,000

are because of hypertension TEXAS

11,525

in need of organs

9,189

I don’t think people realize how many complications there are and how many can be prevented or delayed. So many people think, ‘It happened to my parents. It’s going to happen to me.’ That’s because we didn’t have as good of care back then. We have good care now. It takes people participating in their care.” Dr. Melissa Wilson, chairwoman of the Diabetes Community Coalition of the Coastal Bend

— diet planning, ways to control their diabetes and a referral to a pre-dialysis education class. But he said more education is needed. On a recent weekday, Cortese arranged a tour of a dialysis clinic for group of Martin Middle School children at a DaVita clinic on South Padre Island Drive. There were 19 students, a part of the school’s health care careers club, who paraded through the clinic dressed in white gowns as Cortese explained what happens 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. “C’mon. Don’t be shy. Raise your hand.” A few hands went up. The students learned those on dialysis no longer urinate because the kidneys can’t filter toxins from the blood to release through the bladder. That answer surprised many of the students. Dialysis filters the toxins for people with kidney disease. “What are we going to be seeing out there?” Cortese asked. “How to wash the yellow out,” he answered. The students lined up outside the clinic area, and before heading inside, Cortese gave one final in-

struction. They were going to see blood, so if anyone felt queasy, don’t be shy. Let him know. The students nodded their heads. Inside, the students saw several people hooked to machines and learned how they worked. Cortese invited the students to touch one man’s artificial kidney — the plastic tube with filtration inside. It felt warm, one young boy said. The experience hit close to home for eighth-grader Nancy Cortinas. Her mother is diabetic, and she doesn’t want to see her on dialysis, she said. Two years ago Nancy was diagnosed as prediabetic. It scared her into regularly exercising after school. She’s focused on working out and training to be a boxer. “I don’t want to get it,” Cortinas said. Dialysis is a growing industry. During the last 20 years, the number of people on dialysis in Texas has more than tripled from about 9,200 in 1991 to about 39,000 in 2011, the most recent figures available. By comparison, the state population increased by 50 percent during that time. DaVita is one of the larg-

or 80 percent, waiting on kidneys, a large majority of whom are Hispanics and blacks Of those awaiting kidneys:

4,500

are because of diabetes of some form (3,212 because of Type 2)

2,000

are because of hypertension Source: Southwest Transplant Alliance

est dialysis providers in Corpus Christi with five of the 12 clinics. The Denver-based company is a Fortune 500 corporation that answers to shareholders. First quarter earnings from patient services this year were about $2 billion. The company has about 158,000 patients worldwide. Sam Canavati, regional operations director for dialysis provider DaVita, is alarmed at the increasing need for dialysis centers in the South Texas area. He said he believes more predialysis education alongside diabetes education is needed to help people understand how the disease can affect their kidneys. Canavati said he was drawn to the company because his mother is a See DIABETES, 11A

ABOVE: Daniela Palmerin, a Martin Middle School student in the health science club, feels a blood filter during a tour at the DaVita Dialysis Center. Dr. Jack Cortese, a kidney specialist, or nephrologist, gave the students a tour as part of his efforts to increase awareness about kidney health.

LEFT: Cortese explains to a group of Martin Middle School students how dialysis works to clean the blood of patients.


C A L L E R -T I M E S

ÂŤ Sunday, June 2, 2013 ÂŤ 11A

FROM THE COVER KIDNEY TRANSPLANT a kidney is obtained from a live A When 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).

incision is made to place the donor B An 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.

Inferior vena cava Donor kidney

Incision site Aorta Ureter

renal C The artery is

Transplanted kidney

TODD YATES/CALLER-TIMES

Renal artery

At his biggest, Tom Sorrell weighed 300 pounds and had no regard for his health. Then he was diagnosed with diabetes, and he started to change his mindset. original kidneys are E The usually not removed,

connected to the internal iliac artery. The renal vein is attached to the external iliac vein.

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.

Renal vein

Old kidneys

Bladder Transplanted kidney Ureter ureter is attached to the bladder, and a D The tunnel is created to minimized backward

reux of urine into the transplanted kidney.

Catheter

Source: Roche Pharmaceuticals

DIABETES

TOM SORRELL The day Tom Sorrell was diagnosed with Type 2 diabetes, his blood sugar was at 440, more than three times over the normal rate, and he could have been hospitalized. That day his wife beat him home from work and threw out all the sugary food from their house. He decided then that he would beat the disease.

He knew he could either start to diet and exercise or start to lose limbs, go on dialysis and ultimately die. At his heaviest, Sorrell weighed 300 pounds. He was diagnosed when he weighed 266 pounds. Less than a year after being diagnosed, Sorrell lost more than 50 pounds, and his doctor took him off diabetic medi-

FACES OF

DIABETES /VIDEO

Watch Tom Sorrell tell his story. cine. “I have a wife and two kids,� Sorrell said. “I decided they mean more to me than a cheeseburger or a big plate of food.� Sarah Acosta

from 10A

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 centers from Victoria to Kingsville. There’s a great need for dialysis in the area related to the diabetes epidemic, he said. He envisions more early education outreach, like the tour with Martin Middle School’s Healthcare Careers Club.

‘LUCKY ONES’ Many people with diabetes die of other complications, usually cardiovascular disease, before their kidneys fail and they need dialysis. “You are lucky if you end up on dialysis,â€? said Lewis, the dialysis educator. “To me that’s the biggest news. Who knew that those on dialysis are the lucky ones.â€? 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 determined 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 retention. Gaona enrolled in classes at Del Mar to learn GIS programs. He ďŹ gured if he couldn’t work, he could learn how to do something that would enhance his real estate career. Gaona also volunteered with local political campaigns, 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 trans-

PHOTOS BY MICHAEL ZAMORA/CALLER-TIMES

Roland Gaona, of Corpus Christi, smiles as he talks on the phone with a friend Thursday as he recovers from his kidney transplant surgery. Gaona, whose diabetes and high blood pressure led to chronic kidney disease, lived on dialysis for nearly 10 years while waiting for a kidney transplant.

Roland Gaona, of Corpus Christi, recovers from his kidney transplant surgery at Methodist Specialty and Transplant Hospital in San Antonio.

plant. So he added his name, like many on dialysis do, to a kidney transplant list. There’s 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 wanted 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. 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 confused him at ďŹ rst. He and his potential donor were entering the ďŹ nal stages of tests for a transplant, but this was different. Texas Transplant had a kidney match ready for him from an organ donor who died. Gaona needed to be at Methodist Specialty and Transplant Hospital for

surgery by 6:30 a.m. He phoned longtime friend Chris Taylor for a ride. “Hey what are you doing tonight?â€? 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,â€? Taylor said. “San Antonio,â€? Gaona said. “I’m going to go pick up a kidney.â€? Reality sank in with Taylor’s reaction. A mutual friend of theirs died ďŹ ve years ago from

renal failure. Taylor didn’t want to see the same thing happen to Gaona. He could hear Gaona’s voice wavering as he said the words out loud for the ďŹ rst time. “There was just something about his spirit that seemed a little more youthful and excited about what was to come — a newfound vigor for life,â€? 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 Xray, 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 second chance at life. He was the hospital’s 92nd kidney transplant 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 recovering. Travel is at the top of his list, too. “Every day I’m feeling a little better,� he said.

   

             

                 

çĂ°åÚÂ

Roland Gaona of Corpus Christi leaves his room to take a short walk around his hospital oor Thursday as he recovers from his kidney transplant surgery in San Antonio.


EYEING A

After winning the opener in Miami, the Spurs look to take a commanding 2-0 lead on the Heat. SPORTS, 1C

STRANGLEHOLD $2.00

SUNDAY, JUNE 9, 2013 ■ CITY EDITION Abilene Reporter-Ne ws Abilene Repor ter-News

92˚/78˚

CL ASS OF 2013 JUNE 2013

Breezy

21A

Cor pus Chr isti are a sCh ool sal utator ian s and list s’ Val edi Cto ria ns, s of gra dua tes

Quick Read

PAY EXAMINED AT CITY HALL

CONGRATS !

No hope for a raise has prompted some City Hall employees to job hop within the city or leave, knowing that it is the only way to achieve a salary increase.

The Caller-T graduates from imes honors high scho ol across the special graduati Coastal Bend with a on section.

INSIDE TODAY

A.C. Jones......... ..........................2 George West Agua Dulce ......... .............................5 .......................2 Port Aransas Gregory-Port Alice .................. .............................8 land .................. ............................2 .5 Premont Hebbronville Annapolis Chri .................................... .............................5 stian ..............3 ..8 Pres Incarnate Wor Aransas Pass d ......................6 Pan byterian .............................3 American......... Ingleside ......... Austwell-Tivo .................. 8 ............................6 Ray li ........................3 .................................... John Paul II......... Banquete ......... ............8 .......................6 Refugio ........................... 3 .................................... Kaufer .................. Ben Bolt ......... ....9 .............................3 ........................6 Richard Milburn .................. King.................. Benavides ......... .............................6 Robs ....9 ..........................3 town .................. Dr. M.L. Bishop .................. .................9 ........................3 GonzalezGarzaRockport-Fult .................................... Calallen .................. on .....................9 .7 San Dieg .....................3 Mathis o ........................... .................................... Carroll .................. ........9 ......7 Santa .......................4 McMullen Gertrudis ......... Collegiate ......... County .................. .............9 ..........................4 Mille .7 Sinton ......... r ........................... ...............................10 Falfurrias ......... .................7 Skid ........................... 4 Moo more-Tynan......... dy ........................... Flour Bluff ......... ..........10 ...............7 Taft .........................4 Odem ......... ......... ......... Freer .................. ...................................7 ............................10 ........................... 5 Oran Tuloso-Midwa ge Grove......... y .....................10 .................. 8 Wes Pettus .................. t Oso .................. .........................8 ................10 Woodsboro ......... .....................10

Know someone who graduated from high school this year? Look for their name in our 10-page special section with lists of area graduates.

LOCAL, 1B PHOTOS BY GEORGE TULEY/SPECIAL TO THE CALLER-TIMES

Carroll High School graduate Dashun Dixon is congratulated by outgoing Principal Charles Chachere on Saturday at the American Bank Center. Dixon is graduating with a basketball scholarship.

About 20 folks better known by their pseudonyms on the Corpus Fishing.com message board gathered aboard the Pelican out of Deep Sea Headquarters. OUTDOORS, 10C

REPORT RANKS ENVIRONMENT A report ranking Texas among the worst at protecting its marine environment is drawing criticism from conservation and fisheries organizations. LOCAL, 1B

SENIORS TAKE

Family and friends of seniors from Carroll, King, Miller and Ray high schools piled into the American Bank Center on Saturday to see their loved ones walk across the stage. ABOVE: Miller graduates observe a school ritual

for the last time Saturday during the conclusion of the commencement ceremony.

The uproar over sweeping government surveillance is forcing some to ask: To live in this brave new world of technological marvels, what must we give up?

LEFT: King graduate Brianna Perez got a big wel-

come as students entered to “Pomp and Circumstance” on Saturday.

See more graduation photos on Page 10A and Caller.com.

INDEX NATION & WORLD 5A BUSINESS 18A-19A OPINION 20A WEATHER 21A OBITUARIES 9B LOTTERY 2C

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Set on beating the odds ■ Woman masters

weight to defeat Type 2 diabetes

meyersr@caller.com 361-886-3694

Game 2 of the NBA Finals between the San Antonio Spurs and Miami Heat will be updated on Caller.com/live-chat.

FALFURRIAS — South Texas has a surge this year in reports of migrants dying from exposure, raped by smugglers, and apprehended by the Border Patrol while trying to enter the United States illegally. While researchers and policy experts attribute the increases to multiple factors, the numbers suggest illegal immigration through South Texas is rising while other border regions see declines. And while overall apprehensions of undocumented immigrants on the southern border remain near historic lows, these newest indicators still are likely to play a significant role in Washington as the

See MIGRANTS, 8A

BY THE NUMBERS South Texas steadily is growing busier and deadlier for undocumented immigrants. Rio Grande Valley sector Border Patrol migrant apprehensions, first half of fiscal 2013

37,844

Valley apprehensions, same period 2012

15,009

By Rhiannon Meyers

LIVE TONIGHT

collettem@caller.com 361-886-3678

57,928

NATION, 3A

Local news now.

■ Drug busts,

By Mark Collette

GRADUATION WALK

SURVEILLANCE QUESTIONED

South Texas sees surge apprehensions rise at border

CAL199671

NO ‘CATFISH’ ON SNAPPER TRIP

MIGRANTS

Danney Boren was horrified when his wife got diagnosed with Type 2 diabetes last year. He remembered his friend’s daughter, who lost her feet and hands to the disease and later died. He feared what could happen to Priscilla Boren. And he worried what this meant for their 8-year-old son. “I didn’t want him to lose his mom,” Danney said. The same troublesome images played in Priscilla Boren’s head, too See DIABETES, 8A

Tucson, Ariz., sector apprehensions, March

16,100

COST OF

DIABETES

Valley apprehensions, March — the first time the valley sector surpassed the Tucson sector

80

Migrant deaths in the Rio Grande Valley, fiscal 2013

FACES OF

DIABETES

46

Valley deaths, same period 2012

18

Valley migrants reporting rapes, fiscal 2013

11

Reported rapes, all of fiscal 2012 Source: U.S. Border Patrol

To subscribe:

883-3800 MICHAEL ZAMORA/CALLER-TIMES

Priscilla Boren, owner of D&P Photography, poses in her office Thursday in Corpus Christi. A year after she was diagnosed with diabetes, Boren found out this week she no longer needs medication and her blood sugar has fallen to normal ranges.

CAL207210


8A » Sunday, June 9, 2013 »

C A L L E R -T I M E S

from the cover MIGRANTS from 1A

Senate begins debate on an immigration reform bill. Among the increases in reports from South Texas: ■■Border Patrol agents in the Rio Grande Valley apprehended about 58,000 immigrants through March, the first half of fiscal year 2013. It’s a 53 percent increase from the same period in 2012, when they apprehended nearly 38,000. ■■Texas and New Mexico accounted for all of the 13 percent increase in apprehensions across the Southwest Border; sectors in California and Arizona saw declines of as much as 20 percent for the first half of the fiscal year. In March, Rio Grande Valley apprehensions surpassed the Tucson, Ariz., sector for the first time. ■■More than 80 migrant deaths have been recorded in the valley this fiscal year — mostly in Brooks County where smugglers bring migrants across scorching, remote ranch land to avoid detection. There were 46 at the same time last year, Border Patrol agent and spokesman Danny Tirado said. ■■Valley agents received 18 rape reports from immigrants entering South Texas illegally so far this year; there were 11 reports for all of fiscal 2012, Tirado said. Migrants who pay smugglers to lead them through the brush may find themselves left behind or otherwise victimized by their guides when they become weak or unable to keep up. Conservatives want a measurably secure border in exchange for their support of an immigration overhaul. While pumping another $4.5 billion into border security, they want the bill to ensure that nine out of 10 illegal border crossings are thwarted before other reforms take effect. Human rights advocates hope reforms, providing citizenship opportunities for 11 million people now in the country illegally and

Photos by MICHAEL ZAMORA/CALLER-TIMES

Border Patrol agents question motorists Tuesday as they pass through the U.S. Highway 281 checkpoint in Brooks County. Illegal immigration and migrant deaths are spiking in South Texas as Washington debates reforms.

A sign at the Falfurrias checkpoint shows how many seizures Border Patrol agents had made for the year as of Tuesday at the station and surrounding areas in Brooks County.

expanding work visas, will reduce illegal crossings and the brutality they often entail at the hands of smugglers. Events unfolding in South Texas and Arizona are getting more attention nationwide as the deaths climb and the politics

heat up. Consider last week: Human rights groups in Texas and Arizona released new reports on migrant deaths, saying U.S. leaders aren’t paying enough attention to a growing humanitarian problem. Deaths are rapidly increasing relative

to indicators of overall migration, they argued. Senate leaders on both sides of the aisle differed last week over whether they have enough votes for the bill to avoid a filibuster. Sen. Marco Rubio, the Florida Republican leading the bipartisan “gang

of eight” senators who hashed out the bill, warned he would vote against his own bill in its present form, worrying its security provisions couldn’t be enforced. House Republicans showed signs that their tenuous support for the immigration compromise could be fracturing. Rep. Raúl Labrador, R-Idaho, broke off from a bipartisan group of House negotiators to craft his own legislation, rejecting the bill’s health care provisions. While the recent upswing in border apprehensions fuels the security debate, researchers say illegal migration remains close to all-time lows. They use apprehensions as a loose indicator of overall illegal immigration; there are many more who aren’t caught or detected. If apprehensions continue on pace for the rest of fiscal 2013, there will be more than 378,000 for the entire Southwest border, an increase for the third consecutive year. But that still is the third fewest in 42 years.

DIABETES from 1A

— her grandmother injecting insulin, her greatuncles in Laredo sitting in wheelchairs on the front porch, their legs missing from the knees down. This was life or death, she thought, and put into that context, 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 Boren got a stunning phone call from her doctor’s office 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 Boren feels normal again. “I just started crying because I was like, ‘You did it,’” Danney Boren said. “It’s achievable.” The Caller-Times has been following Priscilla Boren for seven months as part of its yearlong series Cost of Diabetes examining the extent of the problem, the consequences and what can be done to curb the high rates of diabetes and diabetic complications. About 1-in-6 people in Nueces and San Patricio counties 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 Boren, 40, could have been one of those statistics. She shrugged off warnings for years that she was prediabetic, so by the time she was diagnosed in May 2012, her blood sugar was so high, staff in the doctor’s office gasped when they saw it.

Priscilla Boren poses for a photo with her husband, Danney in June. “Her whole perspective on life is night and day,” Danney said. “She’s excited. She’s eager.”

The gold standard to test for diabetes, an A1C test measures blood sugar levels over three months. A person without diabetes has an A1C around 5 or lower. When Priscilla Boren got diagnosed, hers was 11.8. It’s 5.8 today, an achievement 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 bloodstream, damaging the walls of blood vessels, which can lead to nerve damage and blindness. Diabetes damages the delicate system in the kidneys that filters 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. Type 2 diabetes, however, can be managed through a healthy diet and exercise. In some cases, lifestyle changes can help people get off medication. But reversing a lifetime of bad habits takes motivation and determination, and anyone who’s tried to lose

weight knows how hard that can be. For Priscilla Boren that meant tackling nearly two decades of weight gain. Back then, the 5-foot-10inch 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 Boren 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 participated in the Coastal Bend Tour de Cure in April, the American Diabetes Association’s first cycling race in Corpus Christi. And she began to slim down. One day in late winter, Priscilla Boren stepped on the scale and the number 199 appeared. She couldn’t remember the last time she weighed less than 200. “I never thought I’d see that day again,” she said. (She’s now down to 190 and a size 16 dress). Not only does she look different, she feels different. “Her whole perspective on life is night and day,” Danney Boren said. “She’s excited. She’s eager.” She has more energy than she’s had in years. The old Priscilla Boren would

CONTRIBUTED PHOTOs

Boren is pictured at age 18 and now, at age 40. Back then, the 5-foot 10-inch Corpus Christi native weighed 150 and wore a size 8 dress. By the time she was diagnosed with diabetes, 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.

spend Friday nights on the couch in front of the television with a pack of Oreos. Now? Dancing like crazy at a downtown nightclub. And her confidence has skyrocketed. Priscilla Boren, who runs her own wedding photography business, used to hate having her photo taken. She didn’t like the way she looked. She never wanted to be the center of attention. So when the Corpus Christi Hispanic Chamber of Commerce named her the Businessperson of the Year in January, the difference between the old and new Priscilla Boren was on stark display. The old Priscilla Boren would have hidden herself in an oversize dress with a black jacket, trying to be invisible. The new Priscilla Boren wore a spaghetti strap, floor-length red gown and scarlet lipstick. People stared at her as she walked through the crowd, mingling and posing for photographs. That newfound confidence has changed her relationship with herself, with kids, with Danney Boren. “It’s like being teenagers, like high school kids again,” he said. “It brings back the

puppy love. Our kisses are more intimate. They’re not like formalities.” People always tell her now, “Oh, I wish I could do it.” But they can, Priscilla Boren said, and they don’t have to stop enjoying life, either. She loves food and hasn’t stopped eating, but she takes a bite or two rather than scarfing down an entire platter. “I like to taste things that are really, really good and enjoy them a lot,” she said. Her children are delighted because the refrigerator regularly features boxes and sacks of leftovers. But perhaps most importantly, she didn’t fall victim to her own stereotype, Danney Boren 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 complications, Priscilla Boren decided to make her future her own. “She was like, ‘So what if I’m a Hispanic? So what if I’m a female? So what if I’m overweight? That’s not going to keep me there,’” Danney Boren said.

The recent increases don’t herald a return to the 1990s and early 2000s, when millions of immigrants entered the United States illegally in a mass migration, said Michelle Mittelstadt, spokeswoman for the nonpartisan Migration Policy Institute. Research models have shown that even if the U.S. construction sector — a driver of immigration — continues to rebound, migration flows still won’t reach those earlier peaks. More migrants are coming from Central America instead of Mexico. Central America has less than half the population of Mexico. Central Americans are fleeing worsening crime and depressed economies, while Mexicans’ fortunes largely have improved, despite border violence. Analysts also say post-9/11 border enforcement has stemmed migration, Mittelstadt said. Yet as the dynamics of migration shift, so do the pathways, with a combination of border enforcement strategies, organized crime, and other factors causing more movement through deadly terrain in South Texas. Highways and rail routes make South Texas a logical point of entry, especially as Border Patrol has beefed up technology and fencing in Arizona. Local prosecutors say gangs and cartels that control human smuggling like to use routes through Brooks County because they lead to Houston, and smaller drug loads often don’t result in prosecution because of lack of funding. Tirado, the Border Patrol spokesman, said detained immigrants are telling agents of a new motivation: They have heard of immigration reform efforts and believe — wrongly — that they will be eligible for some type of amnesty if they enter the country now. Smugglers, he said, will tell potential customers almost anything to get their business. They typically charge several thousand dollars per person, federal authorities say. The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their health.

Upcoming stories TODAY

A year after she was diagnosed with Type 2 diabetes, Priscilla Boren has discovered her blood sugar levels dropped to prediabetic range. JULY

Learn how decisions in Washington, D.C., and Austin could affect the way doctors and hospitals offer diabetic care. EVERY WEDNESDAY

Clip healthy, diabetesfriendly recipes from the Food section. AT Caller.com/DIABETES

■■ Find local support groups and diabetes education classes. ■■ Explore diabetesrelated data. ■■ Search healthy recipes and submit your own. ■■ Share your story about how diabetes has affected your life. ■■ Watch videos, in English and Spanish, on diabetes management. ■■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.


Egypt’s new president asserts authority even as his opponents issue oaths to restore Mohammed Morsi. WORLD, 3A

ISLANDERS WOMEN’S SOCCER PROGRAM TAKES SHAPE. SPORTS, 1C

STRAYS ON THE STREET LOCAL, 1B

TWO DEAD IN PLANE CRASH NATION, 11A

$2.00

HOUSING SLIM IN KINGSVILLE

SUNDAY, JULY 7, 2013 ■ CITY EDITION

LOCAL, 1B

Nueces County, Christus Spohn band together to battle diabetes crisis without extra Medicaid funding

Is expanding Medicaid the right choice for Texas? Take our poll at Caller.com.

UNCLEAR PROGNOSIS By Rick Spruill

INSIDE Faces of diabetes: Todd Hunter, Blake Farenthold talk about living with diabetes. 9A What legislators have to say about the issue. 8A-9A

spruillr@caller.com 361-886-3667

The Coastal Bend will not find out how federal health care reform will affect diabetes, the area’s leading health crisis, even though the new law is designed to fix the nation’s health care system and expand coverage to millions of uninsured. Local experts say even if Gov. Rick Perry accepted an estimated $100 billion in extra Medicaid funding through the Patient

Protection and Affordable Care Act, they are not sure the money would help tackle Texas’ $29 billion diabetes problem. The problem comes into much sharper focus for communities like Nueces and San Patricio counties, where 1 in 6 people suffer from diabetes and more than 10,000 people could receive health care through the expansion, which is meant to extend basic health care and prevention services to the uninsured population. See MEDICAID, 8A

HOW STATES ARE MANAGING THE HEALTH OVERHAUL Plans expansion

Not expanding

Decision pending

COMING OCT. 4 Data current as of July 1

$31 MILLION

Taxpayer funds for annual county indigent care

$29 BILLION

Estimated annual cost of diabetes in Texas

Sherri Shepherd, co-host of “The View,” will talk about living with Type 2 diabetes as part of Texas A&M UniversityCorpus Christi’s Distinguished Speaker Series, sponsored by the Caller-Times.

58,000

Medicaid patients in Nueces county

3.6 MILLION

s On Medicaid in Texa Source: Kaiser Family Foundation

BY ILLUSTRATION

Changes ahead for police protocol ■ Chief: We

ONLINE

must prioritize call responses

93/76˚

A few t-storms 19A

VIDEO: Police Chief Floyd Simpson discusses these possible initiatives.

By Katherine Rosenberg

Have a look at the “blue form” motorists will have to fill out if they are in a minor wreck.

rosenbergk@caller.com 361-886-3778

Police Chief Floyd Simpson has spent more than a year looking at ways his department can better perform. As the fiscal year comes to a close, now he’s trying to make his department more efficient by looking to change things such as responding differently to minor wrecks and alarm calls and not immediately sending an officer to reports of barking dogs or uncooperative children.

PAPERS

CRIPPS NEWS

JOHN BRUCE/S

CALLER-TIMES FILE

A wreck in 2003 is attributed to heavy rains. This is the type of crash officers would consider minor and change their response to, should the Corpus Christi Police Department revise its policies .

“We’re pretty lean right now, which causes people like me at the helm of this department to look at doing things differently. I’ve

got to multiply the force with the money we’re given,” Simpson said. “I don’t See POLICE, 10A

INDEX

OFFICERS EMPLOYED PER YEAR 2006 2007 2008 2009 2010 2011 2012 2013

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8A » Sunday, July 7, 2013 »

C A L L E R -T I M E S

FROM THE COVER

WHAT LEGISLATORS HAVE TO SAY As the elected representatives of a large uninsured population, some Coastal Bend lawmakers view Medicaid expansion as a matter of practicality over political ideology. Here is what they had to say about Gov. Rick Perry’s refusal to accept additional Medicaid funding under the Patient Protection and Affordable Care Act. Perry has said the funding will fall short of

the actual costs. Advocates have said the funding is a necessity for controlling the costs of providing health care for a fast-growing, uninsured population. STATE REP. ABEL HERRERO, D-ROBSTOWN

“Gov. Perry’s decision to refuse funding for the expansion of the Medicaid program isn’t the right decision for Texas and

especially for South Texas. ... The program would be paid for entirely for the first three years, after which Texas would receive a $9 to $1 match in federal dollars. By not accepting this costsharing agreement, Texans wouldn’t get the benefit of their own tax dollars at work — the money would

instead go to the roughly 30 states that are choosing to participate in expanding Medicaid coverage. And Texans will continue to pay billions for the cost of health care for those who can’t afford it through costly emergency room visits.” STATE REP. J.M. LOZANO, R-KINGSVILLE

“Texas is unique in that

it has a large Medicaid program, and it cannot be a one-size-fitsall approach. I am hopeful that, like many other states, Texas will be able to work out a compromise with the federal government to allow Texas to administer its own program. Not reclaiming those tax dollars will hurt

our communities, which is why I am eager the federal government can work out a compromise as they have done elsewhere.” STATE REP. TODD HUNTER, R-CORPUS CHRISTI

“Medicaid expansion is a concept that needs to be reviewed during the

MEDICAID from 1A

Texas immediately could have added up to 1.8 million to Medicaid rolls under the act, according to estimates. Perry, who has final 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 simplified, 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 figures. Diabetes accounted for almost a third of the $105 billion 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 decade, 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 state’s largest nonprofit network, is going to miss out on hundreds of millions over that same period, she said. Saenz said as part of the negotiations with federal lawmakers on the framework of the Affordable Care Act, hospital networks agreed to accept lower reimbursement rates in exchange for moving more people onto the expanded Medicaid caseload. But, since Texas is not participating, hospitals will see lower reimbursement rates in the face of rising costs, she said. 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 diabetic and obese patients. The Affordable Care Act, which passed in 2010, is a necessary, if not somewhat clumsy, first step, many argue, on the nation’s path to a sustainable health care model. For uninsured diabetics such as Jessie Zamora, first steps, even clumsy ones, make all the difference.

CAUGHT IN THE GAP Lean and 6 feet 1 inches tall, Zamora stood in the dirt front yard of his aunt’s home in Sinton, wiping the sweat from his shaved head, his aluminum legs jutting beneath a pair of knee-length shorts. Zamora, 35 and insulindependent, 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 diabetes in 2001. She was 41. A willing worker, he was a carpenter’s helper for a contractor in Taft, a trade he learned after dropping out of high school and moving to Sin-

TODD YATES/CALLER-TIMES

Jessie Zamora, 35, lost both of his legs below the knee to Type 2 diabetes. Caught between a job that did not pay enough for insurance and a Medicaid system that denied him because he was able to work, Zamora said he was forced to choose between paying the bills and buying insulin. When he became disabled, he received benefits, he said.

I wanted to work. I just needed the insulin. They didn’t give it to me till they cut my leg off.”

Jessie Zamora, 35, Type 2 diabetic and double amputee

ton 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 wife’s wages did little to cover the gap. He made the best of his situation without insurance, fighting a disease that can cost more than twice that of the average American’s health care costs. The dying nerves in his lower legs and feet occasionally registered the pain of the sores hidden beneath his work boots, he said. He sought help from Medicaid. He was denied because he still was able to work, he said. He told Medicaid officials he didn’t want a handout or even a check. “I wanted to work. I just needed the insulin,” he said. “They didn’t give it to me till they cut my leg off.” 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. “I’m a carpenter. I don’t know computers,” he said. Hobbled and dispirited, embarrassed and ashamed, Zamora said he withdrew even from his wife. Eventually, the two separated. She remarried and now lives in Portland with their daughters. Zamora resorted to living on the streets, bouncing between homeless shelters and depending on strangers’ charity to stay close to indigent care providers in Corpus Christi. He lived at the Salvation Army because they could accommodate his wheelchair, which he also received through charity. After spending a day in a local emergency room fighting sepsis from an in-

fection in his legs, a friend wheeled him to Catholic Charities Healthy Living & Advocacy Center on Port Avenue. There he met Jacki Siller, the center’s director, who helped Zamora get the medical attention he needed. He spent 60 days in a nursing home, recovering from what Siller said was a near fatal infection. Through Siller’s efforts, 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 fortunate because at least they have Nueces Aid (indigent care),” she said. “But when you cross the (Harbor) Bridge, there’s 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 taxpayerfunded public health care program meant to close the gap between someone’s financial situation and the cost of health care. The federal government 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 county’s general revenue fund. Texas in 2012 carried about 3.6 million people on its Medicaid rolls, of which about 58,000 were in Nueces County, according to Texas Health and Human Services Commission reports. Nueces County levies a tax while others, such as

25.5 million

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the Caller-Times hopes to help its readers understand the disease and make better informed choices about their health.

24

UPCOMING STORIES

COST OF

DIABETES BY THE NUMBERS Texas population, 2011 (estimated) percent of uninsured Texans

16

percent of Texans on Medicaid/CHIP

10

percent of Texans on Medicare

$155 billion

overall federal funding cuts to Texas hospitals under the Affordable Care Act

$18 billion

Medicaid cuts to Texas hospitals under the Affordable Care Act Sources: U.S. Census Bureau, Texas Medical Association, Texas Hospital Association

San Patricio County, opt to use a portion of general revenue funds. But as indigent care costs rise, officials 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, particularly those who 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 Hospital 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 ages 19 to 64, Neal said. It cannot be spent elsewhere. He said county health officials estimate there are about 15,000 uninsured adults not enrolled in Nueces Aid who might qualify for Medicaid un-

TODAY

AT CALLER.COM/DIABETES

Learn how decisions in Washington, D.C., and Austin could affect the way doctors and hospitals offer diabetic care.

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents.

AUGUST

Weight loss surgery has been proven to reverse diabetes but at what cost? Learn about the benefits and risks of bariatric surgery for people with Type 2 diabetes. EVERY WEDNESDAY

Clip healthy, diabetesfriendly recipes from the Food section.

This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

der the expansion. “What (the act) does is simply open the window,” Neal said. “For the first time in our history, we’re going to declare everyone aged 19 to 64 that meets a certain income level, eligible for Medicaid. Well, the governor said ‘No, we’re not going to take that money.’ ” Neal estimated that up to 75 percent now on Nueces Aid would be eligible to move off the county’s health rolls and onto Medicaid, through the expansion. “If we don’t cover these people under Medicaid expansion, many become eligible for Nueces Aid, and that cost goes up ... where do you get more money? By raising taxes. And we’re not going to raise taxes.” But how the Affordable Care Act will affect 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 state’s Medicaid waiver program, approved by the federal government. Under the agreement, the district commits taxpayer funds to the hospital, which combines that revenue with the hospital’s own net patient revenues. The combined funds are sent up to the state health district 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 projects aimed at curbing diabetes complications and addressing other chronic diseases. The five-year partnership, now in its second year, is expected to fund about $312 million in projects designed to help offset the costs of providing care to people who are not insured and cannot always pay for services. Neal said the county is focused on programs to combat diabetes while the city focuses on obesity. The waiver is a shell See MEDICAID, 9A


C A L L E R -T I M E S

« Sunday, July 7, 2013 « 9A

FROM THE COVER

interim. Our hospitals and doctors and nurses need to be included in the review and discussion. It is an issue that will have an impact in South Texas. It has been discussed, and we need to have a comprehensive review to learn the advantages and disadvantages. And we need to involve the medical community in the process.”

STATE SEN. JUAN “CHUY” HINOJOSA, D-MCALLEN

“I support Medicaid expansion. We have 6.2 million uninsured people in Texas — that’s 25 percent of our population. We have a lot of working poor whose cost for health care doesn’t go away, it is just

shifted to different parts of our community. Those are our tax dollars already being sent to Washington, D.C., so we need to look at all options and study Medicaid expansion before rejecting the federal funding outright. The cost of expansion will be 100 percent funded by the federal government for the first three years and then 90 percent, thereafter

— $76 billion in federal funding is on the table for Texas over the next 10 years. This would have a very positive impact to our health care system and on our economy.” STATE SEN. JUDITH ZAFFIRINI, D-LAREDO

“As provided by the Affordable Care Act at the option of the states,

CONTRIBUTED

FACES OF

DIABETES

TODD HUNTER AND BLAKE FARENTHOLD

TODD YATES/CALLER-TIMES

State Rep. Todd Hunter manages his Type 2 diabetes through exercise and diet.

STATE REP. TODD HUNTER learned in 2007 he is a Type 2 diabetic during a routine checkup. “It does change your life,” the longtime lawmaker said. Hunter, 59, said he has avoided having to take medications by managing

his diet and exercising regularly. A big part of the formula is a willingness to say no to certain foods, even in Austin, where catered meals and delicious snacks are a normal part of life, he said. Rick Spruill

It’s a terrible process. We’re sitting here with 15,000 folks — these people already are here and we’re paying for them through the emergency room, the citycounty health department, Mission of Mercy, Amistad ... or they’re not getting any care at all.” Loyd Neal, Nueces County judge

We don’t look at pay. We treat the patient.” Theresa King, director of clinical operations at Amistad Community Health Clinic

MICHAEL ZAMORA/CALLER-TIMES

U.S. Rep. Blake Farenthold said his hectic work and travel schedule sometimes make it difficult to stay on course when managing his Type 2 diabetes.

U.S. REP. BLAKE FARENTHOLD said he struggles with balancing the hectic schedule of a federal lawmaker with the reality of being a Type 2 diabetic. The second-term Republican learned soon after being elected to office that he had joined the ranks of Coastal Bend residents who are either diabetic or prediabetic. A staunch opponent of the historic expansion of Medicaid and Medicare

MEDICAID from 8A

game, a way of shifting taxpayer funding from local government to state government to Washington and back down again that is complex and cumbersome, he said. The most worrisome population are those who are diabetic, obese or both, are uninsured, 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

under the Affordable Care Act, Farenthold, 51, said he has developed a deeper appreciation for the importance of personal choices in any health care delivery model, government or otherwise. When it comes to his health, Farenthold confessed, “I’m the bad guy … my wife is the one who’s always saying ‘Blake, you shouldn’t eat that.’ ” Rick Spruill

a few narrow windows for other coverage, depending on circumstances. But for the most part, they end up in the emergency room. “It’s a terrible process,” he said. “We’re sitting here with 15,000 folks — these people already are here and we’re paying for them through the emergency room, the city-county health department, Mission of Mercy, Amistad ... or, they’re 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

reinvested 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 Urban Counties Policy Committee that met regularly in Austin with lawmakers, said Medicaid expansion is no longer

It’s not just ‘Obamacare’; it’s any government-run health system. There’s 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.” U.S. Rep. Blake Farenthold, R-Corpus Christi and type 2 diabetic

discussed in conversations with the governor. “It’s 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 find a way to draw down the funding. “These are large-county, Republican judges asking the governor, ‘Please, take this money,’ ” Neal said. “The answer came back: Stop barking up that tree. He’s not going to do anything.”

DO NO HARM In nonprofit community health clinics, which are the safety nets for millions of uninsured Texans and whose budgets are lean and services are basic, the future remains uncertain. Eddy Herrera runs

Medicaid expansion would benefit not only South Texas, but also the entire state. Because Texas leads the nation in percentage of population uninsured (26 percent), expanding access to health care is critical. Nearly 15,000 people in San Patricio County lack health

insurance, for example, and by participating fully in Medicaid expansion, our state could reduce that number by more than half. Medicaid expansion would benefit hundreds of thousands of Texans without material cost to the state budget, and it would relieve counties from bearing the brunt of the cost for indigent care.”

the Amistad Community Health Clinic in a medical office building built by Christus Spohn that Amistad purchased in 2008. The low-profile, twostory building is within 20 yards of the nearest bus stop in the heart of a 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 needing acute care for diabetic symptoms ranging from amputations to vision exams, Herrera said. In many cases, patients arrive not knowing they have diabetes, he said. Because Amistad is a federally qualified, nonprofit 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 qualified visit, Herrera said. The percentage is determined in part by the clinic’s annual report to federal officials. Twenty-seven percent of Amistad’s $3.3 million budget in 2012 came from Medicaid, he said. That money is plowed back in to the clinic’s many services, including early childhood medical treatment, prescription assistance and medical professionals. The clinic recently hired a pediatrician and launched a pediatric practice. “Medicaid is our cash cow,” Herrera said. Given the chance, Herrera said he would tell the governor to shift focus from the Oval Office in Washington to the waiting rooms in places like Amistad. “Think of the patients. They’re not going to get the help they might get otherwise,” Herrera said. Diabetics on Medicaid start off at a disadvantage, said Theresa King, director of clinical operations at Amistad, because Medicaid does not reimburse at a rate comparable to the costs of providing the best available drugs. “Already, there’s 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 problems, kidney failure, cardiovascular complications, she said. “It just snowballs.” But she said she understands the calculus of diabetes for those who must make hard choices. “When you don’t have money, medical care is going to go after groceries, food, car payments,” she said. She said the oath of a health care provider is to give care. Getting paid is, or should be, secondary. “We don’t look at pay,” she said. “We treat the patient.”

PERSONAL CHOICE KEY Simply expanding Medicaid may not be enough for diabetics who daily face the tyranny of a disease that demands undivided attention. Republican U.S. Rep. Blake Farenthold was diagnosed with Type 2 diabetes in 2011, not long after he first arrived in Congress, a term filled with votes to repeal or defund the Af-

fordable 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 centers and the importance of patients being accountable to their choices. “It’s not just ‘Obamacare’; it’s any governmentrun health system,” he said. “There’s 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 managed 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 Massachusetts Institute of Technology and the Harvard University School of Public Health, tracked two years of data from new Medicaid enrollees in Oregon, which in 2008 opted to expand coverage through a lottery program. The study did reveal positive outcomes in the form of fewer catastrophic medical expenses and improved mental 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 flaw 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 first 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 Security disability and Medicaid benefits for his diabetes, still tries to keep busy. Because he does not own a car, he does odd jobs when opportunities arise, particularly 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 working in construction, Zamora has turned his sights on the open road. “I’d 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 figuring out how to walk on prosthetics, a process that therapists said would take a year but that he figured out in a few months, he found his way back to the courts. He plays pickup games with friends and family, getting reacquainted with himself as an athlete, relearning after almost five 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.”


Part-time jobs account for more than 65% of the jobs employers added in July and 77% of those added this year. NATION, 5A

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SUNDAY, AUGUST 4, 2013 ■ CITY EDITION

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Weight loss surgery gives woman chance to beat diabetes while honoring her son

IMMIGRATION

Reform debate taking shape ■ Both sides

take their case to Farenthold By Mark Collette collettem@caller.com 361-886-3678

PHOTOS BY TODD YATES/CALLER-TIMES

Sunny McKinny stands in her kitchen two weeks after weight-loss surgery, 14 pounds lighter. McKinny is slowly retraining her body to eat with a smaller stomach.

COST OF

DIABETES

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple FACES OFfacets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make better informed choices about their health.

DIABETES

A tool to

survive

/VIDEO

INSIDE LOOK

Midway through the Caller-Times’ yearlong series examining the scourge of diabetes in the Coastal Bend, reporter Rhiannon Meyers discusses what the series has discovered and what’s to come.

TODAY

AUGUST

Learn how Hispanic culture and traditional South Texas foods could be linked to Type 2 diabetes and what implications the disease has for Hispanics, who face a higher risk. EVERY WEDNESDAY

Clip healthy, diabetesfriendly recipes from the Food section. AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

See FARENTHOLD, 8A

MEET THE CONGRESSMAN Blake Farenthold, R-Corpus Christi, will hold a series of open houses at district offices during the August recess.

UPCOMING STORIES Weight loss surgery has been proven to reverse diabetes but at what cost? Learn about the benefits and risks of bariatric surgery for people with Type 2 diabetes.

Rep. Blake Farenthold’s hometown is in the thick of a drought, but it could be a stormy August for him. As the Republican returns to Corpus Christi and travels the 27th Congressional District during the House’s summer recess, he will be bombarded with constituents clamoring to be heard on immigration reform. The district once Farenthold stretched to the U.S.Mexico border at Brownsville before it was favorably redrawn for conservatives, and it still has an evolving political identity. It is 50.8 percent Hispanic, according to the U.S. Census. But 60.5 percent of voters in the district chose Republican Mitt Romney in the 2012 presidential election, according to information compiled by Daily Kos, a politically liberal website that

INSIDE Man keeps weight off but still struggles 8 years later. 11A

McKinny undergoes weight-loss surgery July 11 at Victory Medical Center in San Antonio.

Information for those considering surgery. 10A

By Rhiannon Meyers meyersr@caller.com 361-886-3694

When Sunny McKinny was diagnosed with Type 2 diabetes in April, the 5-foot-1-inch first-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 first was skeptical about a procedure she considered merely cosmetic. But with research touting surgery as a way

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Download our app with the QR code. Get local news now. McKinny lays out her lunch of fi sh, green beans and peaches two weeks after her surgery.

VIDEO Watch a video of Sunny McKinny’s surgery and see more photos.

to reverse diabetes, McKinny became convinced it was worth changing her anatomy, altering her eating habits for the rest of her life and spending thousands because her in-

surance company has not agreed to cover the procedure. (Weight loss surgeries can cost up to $35,000.) For her, surgery promised not only an opportunity to treat her diabetes, but also a chance to live a longer, healthier life and be there for her children, grandchildren and parents. See DIABETES, 10A

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10A » Sunday, August 4, 2013 »

C A L L E R -T I M E S

from the cover Diabetes from 1A

“I need to not let this disease control me,” she said. Increasingly, people turn to surgery as a treatment for Type 2 diabetes as studies continue to show weight loss surgeries not only help patients shed pounds but also dramatically reduce their blood sugar levels, a phenomenon that remains somewhat of a scientific mystery. In one study, 68 percent of patients went into remission, according to research 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 it’s a mistake to think of a surgery as a magic thing in and of itself,” said Dr. Donna Ryan, an obesity researcher in Baton Rouge. “It’s a tool to help people change their lifestyle.” The same study found 35 percent of those patients who reversed their diabetes redeveloped the disease within five years. That happens in part because patients regain weight when they don’t stick to their strict diets and fail to get enough exercise. “This is a lifelong commitment,” said Dr. John E. Anderson, president of medicine and science for the American Diabetes 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 community. Should surgery be the lastditch option after diet, exercise 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 Diabetes Association has not taken a formal stance in that debate, 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 complications rates are among the worst in the nation, weight loss surgeries are becoming 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 procedures. In 2011, Corpus Christi Medical Center became the first in the city to provide the three most popular surgeries. The hospital did so in response to Corpus Christi’s obesity crisis highlighted by Men’s Health Magazine in 2010, which named the city the fattest in the nation, said Jessie Newman, bariatric coordinator. Two surgeons now operate at Bay Area Hospital, including McKinny’s surgeon, Dr. Lloyd Stegemann. They have performed 270 procedures at the hospital, which is working toward becoming nationally accredited for weight-loss surgery. Officials say they hope by providing a local option for surgery they can improve Corpus Christi patients’ outcomes over the long term. “We know the closer a patient is to the center, the better they do because they follow up,” Newman said. “If you have to travel 200 miles to a doctor’s appointment a year after surgery, you’re more likely to be like, ‘Meh. I won’t go.’ ”

PROCEDURE EMBRACED McKinny thought about weight-loss surgery before, but never seriously, until she was diagnosed with diabetes. The diagnosis wasn’t too surprising. Her mother has Type 2 diabetes and takes insulin, meaning McKinny has a genetic predisposition for the dis-

Photos by TODD YATES/CALLER-TIMES

Dr. Lloyd Stegemann suits up to perform weight-loss surgery on Sunny McKinny on July 11 at Victory Medical Center in San Antonio.

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 haven’t worked. ■■ You are committed to making permanent lifestyle changes after surgery. ■■ You understand the risks and benefits of surgery. Source: WebMD.com

A McKinny family photograph hanging in their kitchen shows how Sunny looked about a year ago.

SEMINARS

QUESTIONS FOR YOUR SURGEON

Corpus Christi Medical Center Bay Area Hospital hosts informational seminars for those interested in weight-loss surgery. All seminars are in the hospital’s first floor conference room. 9 a.m. Saturday 9 a.m. Sept. 7 6 p.m. Sept. 19 9 a.m. Oct. 5 6 p.m. Oct. 17 9 a.m. Nov. 9 6 p.m. Nov. 21 9 a.m. Dec. 7 6 p.m. Dec. 19 Source: Bay Area Hospital

ease. Still, McKinny was disappointed. “I knew, at my size, it was going to happen, although you never want to think it’s going to happen to you,” she said. “I didn’t take care of myself. I didn’t exercise. I didn’t eat properly. … I was heartbroken that I allowed this to happen.” McKinny’s initial skepticism about bariatric surgery is common among patients and some in health care who 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, it’s a cosmetic procedure because you drive down the road and see the billboard with the before-and-after pictures,” she said. “It’s been cosmetically marketed, and I think physicians have been leery of it.” In recent years doctors and insurance companies have started to embrace the procedures as more than cosmetic. “These dramatic results in Type 2 diabetes are helping to move that needle,” Ryan said. Still, scientists aren’t precisely sure why surgery has such a dramatic effect on diabetes. Researchers believe something other than weight loss may be playing a role, such as gut hormones. That could explain why more invasive proce-

TODD YATES/CALLER-TIMES

McKinny’s family members gather in the lobby of Victory Medical Center as they wait for McKinny to come out of weight-loss surgery.

NEAREST CENTERS OF EXCELLENCE The following facilities have received national accreditation for weight-loss surgery. Individual surgeons who operate at those centers also receive certificates 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

Doctors Hospital of Laredo Laredo Medical Center McAllen Heart Hospital, DBA South Texas Health System Rio Grande Regional Hospital Foundation Surgical Hospital of San Antonio Methodist Specialty and Transplant Hospital Methodist Texan Hospital Metropolitan Methodist Hospital Nix Hospital Northeast Baptist Hospital Southwest General Hospital Citizens Bariatric Center DeTar Hospital

Date of Accreditation

Laredo Laredo

Dec. 7, 2012 Jan. 4, 2011

McAllen McAllen

April 9, 2010 Feb. 6, 2007

San Antonio

Nov. 25, 2009

San Antonio San Antonio San Antonio San Antonio San Antonio San Antonio Victoria Victoria

Dec. 30, 2005 April 9, 2010 Nov. 18, 2011 May 31, 2007 Nov. 27, 2007 May 22, 2008 Jan. 13, 2006 March 7, 2012

Source: Metabolic and Bariatric Surgery Accreditation and Quality Improvement

■■ Is this the right time for me to consider weight-loss surgery? ■■ Which type of weightloss 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 followup care will be necessary? ■■ How much food will I be able to eat afterward? ■■ Are there certain foods I won’t 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 I’ll regain weight after surgery? ■■ Are you boardcertified 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

dures that rearrange the gastrointestinal tract seem to be more effective at reversing diabetes than the gastric band surgery. After researching the surgeries, McKinny opted for gastric sleeve, a newer and increasingly popular procedure in which a surgeon removes 80 percent of the stomach.

“I have a shot at not having this,” she said. “I have to accept what the research is showing and what the doctors are telling me.” Sleeve surgery is more invasive 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 it’s shown more success at reversing diabetes. Among 20 patients with uncontrolled diabetes who had gastric sleeve surgery, half were in remission a year later, according to research published 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 Institute in Seattle who has studied

See Diabetes, 11A


C A L L E R -T I M E S

from the cover

COST OF

DIABETES

TODD YATES/CALLER-TIMES

Edward Wuest talks about his life since gastric bypass surgery eight years ago. Wuest had the surgery when he was 18 and has been able to keep off the weight, although he struggles to eat the right foods sometimes. He has not needed his diabetes medication since the surgery.

At 18 years old, Edward Wuest faced a death senFACES OF tence. DIABETES He weighed 427 pounds, had pre-diabetes and was in chronic pain. His doctors told him he could die by the time he was 38. Wuest’s life changed after a Houston-based /VIDEO surgical team offered him free gastric bypass surgery in 2005. The Caller-Times Watch Edward extensively covered his Wuest tell his CALLER-TIMES FILE surgery and recovery for story. Edward Wuest, then 18, is shown before his years. gastric bypass surgery in 2005. Back then, Wuest says, he works on offshore oil rigs. the medical community He wants people with diabetes to was split about the surgery. understand the risks and challenges “There was a lot of controversy,” he that come with surgery. said. “There were doctors saying no, Wuest says the surgery saved his you shouldn’t get it and doctors that life. He weighs about 250 pounds and were way for it. It was one of those has not needed medication in eight 50-50 things that people were either years. for or against.” “In the end, if you get the surgery, Today the surgery is touted as a way you have to have your mind set on it to reverse Type 2 diabetes. that you want to fight,” Wuest said. It’s been eight years, and Wuest “Keep fighting. Don’t give up. It’s has been able to keep off the pounds, going to be a life-changing experialthough he admits he continues to struggle to eat right, especially because ence.”

edwarD wuest

Rhiannon Meyers

WEIGHT LOSS SURGERIES GASTRIC BYPASS

Considered the gold standard in weight loss surgery.

A small pouch is created at the top. The pouch is the only part of the stomach that receives food, limiting what you can eat and drink.

Bypassed segment

Duodenum Flow of food

The small intestine is cut and connected to the new pouch, bypassing a portion of the small intestine.

PROS ■ Leads to the most weight loss, about 60 percent of excess weight ■ Most people lose 10 to 20 pounds a month in the first year after surgery.

The stomach, duodenum, and upper intestine no longer have contact with food, meaning fewer nutrients and calories are absorbed.

CONS ■ Risk of infection, digestive problems, ulcers and bleeding, when performed by experienced centers, risk of complications is lower. ■ Stomach contents may also move too quickly to small intestine, leading to “dumping syndrome,” marked by nausea, sweating, faintness, and occasionally diarrhea after eating.

... creating a small pouch above the band with a narrow opening to the rest of the stomach and reducing the amount of food your stomach can hold, making you feel fuller faster.

PROS ■ Reversible ■ Considered least invasive ■ Band can be adjusted to minimize side effects and improve weight loss. ■ Less likely to cause nutritional problems

Intestine

Gastric band

A small, braceletlike band is placed around the upper part of the stomach ...

Port

Gastric sleeve

An increasingly popular surgical option, the surgeon separates 80 percent of the stomach, called the greater curve, and removes it. New Stomach Pouch

y

d

« Sunday, August 4, 2013 « 11A

The size of the band can be adjusted.

The remaining 20 percent, called the lesser curve, is the size and shape of a banana and cannot hold as much food. Removing the greater curve may decrease ghrelin, a hormone that prompts appetite.

CONS ■ Typically results in less weight loss. ■ Risks include band slippage, passageway blockage, infection, leakage, reflux disease and malnutrition PROS ■ Lower complication rate than bypass surgery, but higher rate than band surgery CONS ■ Relatively new, few long-term results known, insurance companies not as likely to cover. ■ Risk of chronic nausea and vomiting ■ Irreversible ■ Weight loss not as significant as gastric bypass

Copyrighted and used with permission of Mayo Foundation for Medical Education and research, all rights reserved SCRIPPS NEWSPAPERS

TODD YATES/CALLER-TIMES

Stegemann begins surgery on McKinny.

Diabetes from 10A

surgery’s effect on diabetes. Surgeons are able to work inside a patient’s abdomen using a few small incisions and thin instruments, reducing the chance of infection and speeding recovery time. But as with any surgery, there are risks, such as blood clots and infections, and researchers still Sherri Shepherd, lack good data beyond 20 co-host of “The View,” years about the long-term will talk Oct. 4 about effects. living with Type 2 “Both patients and prodiabetes as part of viders tend to have a lot of Texas A&M Universityreservations about these Corpus Christi’s procedures,” Arterburn Distinguished Speaker said. “Most procedures Series, sponsored by are permanent. They are the Caller-Times. not easily reversible, and they do require dramatic changes overnight in rible example.” In the months before he lifestyle and the types of foods that you can eat and was killed, Caleb repeatedly encouraged his mom tolerate.” Surgery also requires to get surgery. “Mom, you’ve got to do lifelong changes. A smaller stomach means meals this,” he told her. On her trip to San Anmust be healthy and no bigger than what a 5-year- tonio, McKinny thought old would eat, meaning about her son and his patients must take vita- enthusiasm for the promin and mineral supple- cedure. His fervor once ments for the rest of their seemed odd to McKinny lives. And there are con- but now held a special, sequences for those who almost spiritual meaning. She choked back tears. splurge and cheat, including nausea, vomiting and Her only fear, she said, eventually weight regain, was she would somehow which can cause diabetes fail and regain the weight. At 8:30 a.m. the next to return. Still, for newly diag- morning, McKinny was nosed diabetics like McK- brought to the operating inny who have had little room, already under anessuccess losing weight with thesia, where Stegemann diet and exercise, surgery and his team awaited. is becoming one of the surgeriesSURGERY are designed SLEEVE best solutions, promptingThese to help patients weight by team The lose surgical a growing number of doclimitingmade how much they can eat, six incisions in her tors to consider calling for reducing the absorption abdomen andof inserted it as a treatment. nutrients, or both. a tiny camera so Stege“Although there are cerweight, patients mann could workcan in her tainly some unansweredBy losing reduce their risk of potentially abdominal cavity, watchquestions about the risks, life-threatening health ing his work magnified by some of the benefits are problems, such as Type 2 10 Candidates times onfor a surgery television becoming clearer,” Ardiabetes. screen positioned terburn said. have a body mass index greater over left shoulder. Those benefits far outthan 40McKinny’s or have a BMI between Surgery can weighed potential risks 35 and 40 and have heart be tricky overweight patients for McKinny, so ondisease, a indiabetes, high because their organs Wednesday night in July, cholesterol or obstructive sleep often bylose pillows of she packed a pink polka apnea. are Theyobscured also cannot dot suitcase and headed weightabdominal on their own.fat. “Sometimes we can’t to San Antonio. (Although Stegemann primarily op- even see the stomach,” he erates at Corpus Christi said. McKinny was in betMedical Center, he also ter shape than most of his does procedures at Victo- patients, he said. Stegemann spent the ry Hospital, which allowed the Caller-Times access to first few minutes using the camera to examine McKthe surgery.) UNDERWEIGHT As her husband, Gary, inny’s stomach, liver and drove 2½ hours north, spleen. WEIGHT (pounds) 100 105 to 110 the 11 He pointed McKinny appeared calm, blotchy, bumpy surface of committed to her decision.HEIGHT 22 21 19 20 5'00" Before surgery, she(feet,her liver, indicating that McKinny underwent scoping pro-inches) 21 20 18has19cirrhosis, 5'01" cedure to examine her or scarring, brought on by stomach, receive a psy- obesity. 21 20 18 19 5'02" “This lady is not a chological examination 20 17 her18liver19looks 5'03" but and consume nothing but drinker, exactly like an alcoholic’s liquids for two weeks. 19 18 17 18 5'04"he said. Then, in the middle liver,” In the gastric sleeve of her preparations, her 19 18 16 17 5'05" the surgeon youngest son Caleb, 21, procedure, removes the portion of the died in a car accident. 18 17 16 17 5'06" Her surgical team ques- stomach called the greater tioned whether she was curve, 18 17 part 15 stretchy 16 5'07"or the too wracked with grief to that expands when you handle the life-changing overeat, 17 16 the 15 16 only 5'08" leaving surgery at the same time. 20 percent of the stomach 17 16 14 lesser 15 5'09" the curve, But McKinny saw it as a called tribute to her son’s mem- which is about the size and 16 15 15 5'10"of a14 banana. ory. Caleb, too, struggled shape To do that, Stegemann with his weight, and the 16 15 14 first5'11" had 14to disconnect two talked often about it. stomach from “I don’t want you to McKinny’s 15 14 13 14 6'00" end up like me,” McKinny would tell him. “I’m a horSee Diabetes, 12A


12A » Sunday, August 4, 2013 »

C A L L E R -T I M E S

nation/from the cover

Health care law causes concern

Diabetes from 11A

the surrounding fat tissue by cauterizing the blood vessels attaching the two. Once the stomach was free, an anesthesiologist inserted a 2½-foot tube into McKinny’s mouth, down her throat to the bottom of her stomach. The tube filled the stomach’s lesser curve and served as a guide to Stegemann to determine where to cut. Using a tool inserted through a tube in McKinny’s abdomen, Stegemann stapled along the length of her stomach, creating a seam that sealed 20 percent of her stomach and cut off the rest. The stapling must be precise: If Stegemann left too little of the stomach, McKinny could face nausea and vomiting. Too loose, and she would struggle to lose weight. There is also a risk for leaks if the seam isn’t sealed properly. To double check the work, the surgical team clamped off her bowel, inflated her stomach with air and inserted a camera to look inside, then sprayed the seam with water, looking for bubbles like checking a bicycle tire for punctures. Satisfied, Stegemann removed the rest of McKinny’s 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 Sunny’s case, she’s initially expecting to shed up to 5 pounds per week — patients also can risk regaining weight if they fail to follow a proper diet and exercise routine. McKinny has started

■■Governors

nervous about implementation

By Thomas Beaumont and Scott Bauer Associated Press

TODD YATES/CALLER-TIMES

Surgeons use a video monitor to perform surgery on Sunny McKinny. The surgeons are watching as McKinny’s stomach is stapled.

rediscovering her relationship with food. A self-proclaimed control freak, McKinny could never understand why food was always the one thing that could make her lose control. Now that she is anatomically restricted to a certain diet, McKinny is learning to eat again. She is slowly reintroducing foods, chewing everything 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 toddler’s fork. A meal comprising 2 ounces of fresh redfish, 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 surgery, her blood sugar levels had fallen to nor-

mal ranges. She no longer needs diabetes pills. She lost 14 pounds. And because she had surgery early on in her diabetes, she has a greater chance of keeping the disease in remission, Stegemann said. “The earlier I get to a diabetic, the better my results are,” he said. “Diabetes is such a horrible disease. The longer you have it, the worse it gets.” McKinny likely will continue to shed pounds,

even if she doesn’t exercise, but that weight loss should level off within 12 months, and McKinny is planning ahead. She and her husband are transforming the barn near their farmhouse in rural Taft into a minigym with a treadmill, a recently purchased rowing machine and a weight machine now covered in cobwebs in their garage. “If I can do it, anybody could, and should,” she said.

Hooks vs. RockHounds Sunday, August 4 | 6:05pm

MILWAUKEE — Democratic governors say they are nervous about getting the new federal health care law implemented but add they will be better positioned in next year’s elections than many of their Republican counterparts who have resisted the farreaching and politically polarizing measure. Several of the 12 Democratic governors shared that sense of nervousnessveiled-by-optimism at the National Governors Association meeting Saturday in Milwaukee. “There’s some angst, and you can see that from the decision the administration made a couple weeks ago,” said Delaware Gov. Jack Markell. “There’s a lot of work to do.” By next Jan. 1, most people will be required to have insurance. States have to set up exchanges by Oct. 1, when uninsured individuals can start buying subsidized private health coverage that would go into effect Jan 1, and busi-

nesses with more than 50 employees working 30 or more hours a week were supposed to offer affordable health care to their workers or risk a series of escalating tax penalties. But businesses said they needed more time, and on July 2, President Barack Obama’s administration abruptly extended the deadline one year — to Jan. 1, 2015. That caused some Democrats in Congress to worry the program would not be ready on time, as states are building online platforms for their residents to use to comply with the law. Republicans have stated they plan to use the slow economic recovery and the health care law to attack Democrats in the 2014 congressional elections. But Iowa Gov. Terry Branstad, a Republican, said GOP governors could get blamed next year, even if they worked to meet its requirements, a situation that could be aggravated by Republicans in the U.S. House who continue to hold votes to attack it. Wisconsin Gov. Scott Walker, a possible 2016 Republican presidential prospect, said Obama delayed the employer mandate out of fear voters would blame Democrats if the economy suffered as a result of the new law.

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2013 Corpus Christi Heart Walk Saturday, October 5, 2013

Heritage Park Fun Begins : 8:30 a.m. | 5K Walk/Run

Chairs: Steve Arnold VP/Marketing CC Caller-Times and Wade Smith President and COO of AEP Texas Invites you to join them in taking a step towards a healthier lifestyle.

Visit our Heart Walk website to register : www.CorpusChristiHeartWalk.org

Registration is FREE, however, fundraising is encouraged! Contact our local office for more information: (361) 692-0606 or corpuschristiheartwalk@heart.org

Thank you from the American Heart Association for joining the Executive Challenge and committing to raise $1000 for Heart Walk! Jeremy Garza Gloria Hicks Mukul Maheshwari

Steve Arnold Libby Averyt Mike Carrell Michelle Gallagher

Nelda Martinez Charlie Massey Jeff Munro

Bob Parker Diana Schultz Wade Smith

Locally Sponsored by:

* Sponsors as of print date

CHRISTUS Spohn Health System | Security Service Federal Credit Union | CITGO Refining & Chemicals Munro Safety Apparel | LK Jordan | KIII | Frost Bank | Radiology and Imaging of South Texas | Turner Industries Gulf Coast Federal Credit Union | OxyChem | Kiewit | Grande | Ed Hicks Automotive | Driscoll

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Our South Texas Football Preview has the rundown on area teams.

INSIDE

Study: Obesity, diabetes soar in South Texas

PHOTOS BY MICHAEL ZAMORA/CALLER-TIMES

State Rep. Abel Herrero talks with concerned residents after a Dona Park neighborhood meeting with representatives from state environmental and health services departments at St. Theresa’s Parish Hall. Herrero’s office helped organize the event. Herrero, a Democrat, has taken some criticism for voting in favor of controversial abortion limits. He was one of five Democrats to vote for the bill.

■ Democrat maintains his beliefs,

sets himself up for leadership roles

By Rick Spruill spruillr@caller.com 361-886-3667

STATE REP. ABEL HERRERO Age: 43 Party: Democrat Hometown: Robstown Terms in House: 2005-2010, 2013-current Education: Bachelor of Arts, Texas A&M University, Juris Doctor, University of Texas Occupation: Lawyer Of note: Herrero was a Robstown city councilman. He also was valedictorian at Robstown High School.

ROBSTOWN — State Rep. Abel Herrero returned to Austin this year energized after regaining the seat he held for three sessions and lost in 2010. Almost 60 percent of voters chose Herrero over Republican Connie Scott, amped up by his promise to restore funding cut from public education. He quickly asserted himself and was recognized by his peers as an experienced leader. He said his experience combined with

his two-year hiatus gave him a fresh perspective on the legislative process, a message he used to campaign for the House Democratic Caucus chairmanship, which he lost by just one vote. Herrero was for the fi rst time in his legislative career picked to chair a committee, one of about 15 Democrats selected for a leadership role in a Republican-dominated session. A lawyer, Herrero led the House Committee on Criminal Jurisprudence, one of more than 40 committees in the House. The fourth-term lawmaker adjusted See HERRERO, 10A

First reported on

See a video of state Rep. Abel Herrero discussing his amendment to recent abortion legislation.

ature

2013

ture

Herrero talks with Suzie Canales on July 25 during a Dona Park neighborhood meeting with representatives from state environmental and health services departments at St. Theresa’s Parish Hall. Herrero believes his education was what changed the course of his life.

1.25

State Sen. Juan “Chuy” Hinojosa, D-McAllen

ature

Leg isl

2013

L

2013

by the Institute for Health Promotion Research at The University of Texas Health Science Center at San Antonio. FACES OF The study examined health disparities in the 38-county region encompassing the border, Coastal Bend and San Antonio, an area where people are less educated, have lower income and have less access to heath care. Two-thirds of residents are Hispanic and almost 30 percent are uninsured. What’s happening in South Texas could predict the future for the rest of the country, said Michael J. Wargovich, professor of molecular medicine at The University of Texas Health Science Center at San Antonio.

DIABETES

See DIABETES, 12A

Couple of storms 19A

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INDEX

Leg is

ture eg isla

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 classified as obese. About 1 in 9 have been diagnosed with diabetes. The statistics were worse for Hispanics, who 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

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12A » Sunday, August 25, 2013 »

C A L L E R -T I M E S

From the cover

We are the United States of 2050. All the battle on the front lines here, especially in Hispanics and the constellation of diseases, is what the U.S. will experience by the halfcentury … We’ll be a Hispanic nation and with that, experience all the problems that are coming along, with obesity and diabetes and cancer.” Rachel Denny Clow/Caller-Times file

Deborah Bynum, a physical therapist assistant certified in wound care, prepares to install a device intended to vacuum an infection from her abdomen in a patient with diabetes at Christus Spohn Hospital Memorial on Feb. 20. South Texas’ obesity and diabetes epidemic can be linked to lifestyle choices, such as poor eating habits and not enough physical activity, a recent study found.

from 1A

“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 experience by the half-century … We’ll be a Hispanic nation and with that, experience all the problems that are coming along, with obesity and diabetes and cancer.” South Texas’ obesity and diabetes epidemic can be linked to lifestyle choices, such as poor eating habits and not enough physical activity, the study found. But that doesn’t fully explain the region’s

HEALTH CRISIS

The biggest health threats in South Texas are diabetes and obesity, a new study found. Percentage of people diagnosed with diabetes Nation

8.9

State

9.3

South Texas

11.6

Deaths linked to diabetes per 100,000 people State

82.1

South Texas Texas Hispanics South Texas Hispanics

170.9 108.92 219.6

Source: South Texas Health Status Review SCRIPPS NEWSPAPERS

health disparities. About 52 percent of South Texans don’t get

recommended amounts of exercise, defined as 150 minutes of moder-

This is Hooks Baseball.

“We need to educate ate physical activity per treat the disease early. week, and 76 percent don’t But South Texans fail the community about the eat enough fruits and veg- to get regular preventive importance to come in for etables, rates similar to the care, with patients getting prevention,” she said. “We HEALTH CRISIS are obesity, very much a crisis-care rest of the state nation. diagnosed The and biggest health threats in Southwith Texasdiabetes are diabetes and Part of the problem is only after ulcers develop oriented population that a new study found. heredity — obesity and on their feet, a complica- seeks care in the emerdiabetes tend to run in tion that develops after gency room.” Although the study families —Data: but a bigger diabetes damages the cirPERCENTAGE OF PEOPLE DIAGNOSED WITH DIABETES made special note of the problem may be the lack culatory system, Ramirez region’s diabetes and of preventive care, said said. State South Texasmay not be able obesity epidemics, it also Dr. AmelieNation G. Ramirez, Some 9.3and 11.6 the study’s 8.9 co-author to see the doctor because noted that South Texas has director of the Institute they don’t have health in- higher rates of: ■■Tuberculosis for Health Promotion Re- surance. The uninsured Data: ■■Chlamydia search at theDeaths University of rates in South Texas are linked to diabetes ■■Cervical, liver, stomTexas Health Science Cendouble the national averper 100,000 people ter at San Antonio. age. Hispanics here had ach and gallbladder cancers Diabetes is a silentSouth killer highest uninsured State Texasthe Texas Hispanics South Texas Hispanics ■■Leukemia in children because the kind of life-al- rate at 41 percent, the study ■■Birth defects, such as tering complications that found. 82.1 170.9 108.92 219.6 motivate people to get But even those with spina bifida and congenital Source:take South Texas Health Status Review healthy often years insurance often fail to heart defects ■■Childhood lead poito develop, so regular doc- get regular checkups, soning. tors’ visits are necessary to Ramirez said.

Post Game Concert Saturday, August 31st Whataburger Field 6:05 vs.

CAL226336

diabetes

Michael J. Wargovich, professor of molecular medicine at The University of Texas Health Science Center at San Antonio.


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SUNDAY, SEPTEMBER 8, 2013 â– CITY EDITION

Drilling, leases for Eagle Ford go north, east â– Leon County

leaders said they are ready By Rick Spruill spruillr@caller.com 361-886-3667

PHOTOS BY RACHEL DENNY CLOW/CALLER-TIMES

Lupe Villarreal (left) makes our tortillas at her Corpus Christi home with her granddaughter and reporter Michelle Villarreal.

Curing

the

culture

â– South Texas families seek mix

of healthy recipes with traditions By Michelle Villarreal villarrealm@caller.com 361-886-3716

Walking through the front door I’d hear my grandmother’s wooden palote tapping the Formica countertop and rolling the dough. Tap. Back and forth. Tap. Back and forth. 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 Grandma’s side. But we knew better. Grandpa needed a kiss hello ďŹ rst. “Hi, mijita,â€? 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. She tore off a paper towel, placed a hot tortilla on it and coated the tortilla with a thin layer of butter. The heat

quickly melted the butter, and before handing it over she rolled it like a taco, except it didn’t need any ďŹ lling. I cradled the paper towel in one hand and tried to keep the tortilla rolled with the other as I took my ďŹ rst bite. The excess our always ended up on my ďŹ ngertips, but it didn’t bother me as I enjoyed the warm snack. I could’ve stood next to my grandmother and eaten each tortilla as it came off 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. It’s difficult to admit that my grandmother’s homemade tortillas contribute to high diabetes rates in South Texas because admitting it somehow distorts the memory. While it’s difficult to admit, it doesn’t change my understanding and concerns of the health risks associated with our food. See CULTURE, 8A

COST OF

DIABETES The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining the multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make informed choices about their health.

UPCOMING STORIES TODAY

The food choices South Texans make and how much we eat contribute to our Type 2 diabetes epidemic.

Which type of tortilla is healthier for you — corn or our? 8A

EAGLE FORD BY THE NUMBERS $25 billion 2011 economic output

$18 billion 2011 gross domestic product of Afghanistan

352 Barrels per day in oil production in 2008

599,000 Barrels per day in oil production in 2013

26 Drilling permits issued in 2008

2,653 Permits issued between January and July 31, 2013 Source: Texas RR Commission, Eagle Ford Shale Task Force

ing begin as soon as midOctober. And if the shale play boom caught some sleepy South Texas communities off-guard, it is nothing new to Leon County, he said. “We’ve seen ebbs and ows as drilling technologies and other shale formations come into play.â€? He said the experience of past booms have taught the county, where annual revenues equal about $15 million , how to manage the See EAGLE FORD, 4A

OCTOBER

The Coastal Bend seems to have a sense of fatalism about Type 2 diabetes. Is complacency affecting our response to this epidemic? EVERY WEDNESDAY

Watch Lupe Villarreal make homemade tortillas in her Corpus Christi kitchen and reporter Michelle Villarreal recall the childhood memory.

The already proliďŹ c Eagle Ford Shale play, now a mainstay in a host of South Texas counties marked by scrub brush and mesquite thickets, is being linked to oil and gas exploration activities in places notable for their piney woods and east Texas twangs. Portions of the play, which since 2010 has left its indelible print in two dozen South Texas counties, are now showing up on monthly commission reports that place leasing and permitting operations in areas less than a halfday’s drive to Louisiana. Oil and gas companies in 2012 ďŹ led 98 permit applications in Leon County, a rural patch with less than 17,000 residents, and based on mid-2013 numbers, nothing is slowing down. And while industry message boards and user groups indicate increased leasing activity, the signs of increased truck traffic and the sudden appearance of drilling rigs are yet to appear. A publisher at a rural Leon County newspaper said last week he’s seen a few gravel trucks on back roads but overall, the landscape remains void of rigs. It’s about to change, said Leon County Judge Byron Ryder. Landmen — oil company workers whose presence at the local permit office signals a potential rush — are leasing land “as fast as they can,â€? Ryder said Friday. He said county officials are preparing to see drill-

Caller.com devotes an entire page to Eagle Ford Shale reporting, in-depth features and data. Check it out online at caller. com/eagle-ford-shale.

92Ëš/77Ëš

Some sun, storms 23A

Clip healthy, diabetes-friendly recipes from the Food section. AT CALLER.COM/DIABETES

Lupe Villarreal makes  our tortillas . She’s used the same palote (tortilla rolling pin) for more than 25 years. Learn how the ubiquitous TexMex snack of chips and salsa came to be. 8A

A cookbook offers healthier versions of tradtional recipes. 9A

Faces of Diabetes: Maria BensonAguas shares her story. 9A



Tamales date back to Aztec and Maya civilizations in Mexico. 10A

  

   

â– Find local support groups and diabetes education classes. â–  Explore diabetes-related data. â–  Search healthy recipes and submit your own. â–  Share your story about how diabetes has affected your life. â–  Watch videos, in English and Spanish, on diabetes management. â–  View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

Get local news now. INDEX BUSINESS 20A, 21A COMICS 1D CROSSWORD 5G OBITUARIES 10B, 11B LOTTERY 2C OPINION 22A

HELP CATCH A CRIMINAL Check out the latest Crime Stoppers video or Nueces County most wanted mugshots at Caller.com/crime.

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8A » Sunday, September 8, 2013 »

C A L L E R -T I M E S

FROM THE COVER CULTURE from 1A

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 after moving away. It is who we are. But it is also the food that is killing my family and yours. My weakness was the tortillas, but for others it’s enchiladas, rice and beans with every meal, or pan dulce breakfasts. I sought to find out the connection between our food and culture, and South Texas’ high rate of diabetes, and what we can do to change that. The answer isn’t simple. Mexican-Americans are nearly twice as likely as nonHispanic whites to be diagnosed with diabetes, according 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 diabetes, 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 diagnosed with Type 2 diabetes more than a decade ago. Ramos, a Mexican native, moved to the U.S. in 1955 and instantly recognized the differences in ingredients and cooking techniques. She was never fond of Tex-Mex but adapted because it was affordable for her family of seven children. Ramos noticed a change in her health when her stress levels rose and she wasn’t sleeping. She went for a checkup and was diagnosed with high blood pressure, high cholesterol 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 trouble,” Ramos said. “I didn’t think I was going to make it.” Last year Ramos took control of her health and started attending free nutrition classes 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 Assistant Leonardo Trevino, with the Texas A&M Agrilife Extension, taught one of the seven week courses in July that Ramos attended. It focused on calorie intake and portion control. “When you talk about nutrition, it’s hard to break a habit,” Trevino said. “A lot of people get pleasure in eating the foods they are used to, and it usually

PHOTOS BY RACHEL DENNY CLOW/CALLER-TIMES

ABOVE: Alicia Ramos spoons out a ladle full of traditional posole at her apartment last month. BELOW: She squeezes lime over the bowl of posole.

Nobody here cooks like they cook in Mexico.” Alicia Ramos, was diagnosed with Type 2 diabetes more than a decade ago

takes something drastic in their life for them to change, such as them getting diabetes.” With help from community classes and doctors, Ramos lost about 50 pounds in nine months. She has doctor checkups every three months and is down to five medications, which include vitamins. She attributes her improved health to knowing how to enjoy cooking and not surrendering to high-calorie and high-fat foods found throughout South Texas. CULTURE AND TRADITION

When Ramos was 9 years old, her mother raised chickens, pigs and vegetables while Ramos worked in homes and hospitals, trying to earn money 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 recipes differ 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 grandmother used lard in her cooking. She didn’t waste any parts of an animal. Much of the cooking was done slowly in outside 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 didn’t 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 doesn’t find 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 instead of eating at restaurants because she doesn’t 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. “It’s not just a Corpus Christi problem, but a United States one,” she said. According to an analysis last year about restaurant portion sizes, 96 percent of America’s chain restaurant entrees fell outside the range of See CULTURE, 9A

POSOLE

A MORE PERFECT POSOLE Students at the Del Mar College test kitchen developed a recipe for a healthier version of posole that incorporates more vegetables and lean meats than traditional recipes.

RACHEL DENNY CLOW/ CALLER-TIMES

CORN VS. FLOUR TORTILLAS 1 H-E-B BRAND YELLOW CORN TORTILLA

1 H-E-B BRAND FLOUR TORTILLA

Calories: ................................................ 55 Calories from fat: .................................. 5 Total fat: ............................................ 0.5 g Sodium: ............................................. 5 mg Carbohydrates: ...............................11.5 g Protein: ................................................. 1 g

Calories: ................................................ 90 Calories from fat: ................................ 20 Total fat: ............................................ 2.5 g Sodium: ......................................... 260 mg Carbohydrates: ..................................15 g Protein: ................................................. 2 g

VIDEO See step-by-step videos of how to make healthy versions of posole and arroz con pollo. And find the recipes in Spanish.

INGREDIENT S 2 pounds lean be (or skinless, bo ef, cubed ¼ cup fresh cil antro, chopped ne chicken breast less 1 can (15 ounc ) es) stewed 1 Tbsp. olive oi tomatoes l 1 large onion, 2 ounces tomato chopped 1 clove garlic, 1 can (1 pound, paste finely 13 ounces) chopped hominy ¼ tsp. salt Lime, lettuce, cilantro, ¹/8 tsp. pepper radish and onio n for garnish PREPARATIO N 1. In a large po t, heat olive oi l. Add beef an 2. Add onion, d sauté. garlic, salt, pe pper water to cover meat. Stir to m , cilantro and enough ix pot and cook ov ingredients ev er low heat un enly. Cover til meat is tend 3. Add tomatoe er. s and tomato pa about 30 minut st e. Continue co es or until tend oking for er. 4. Add homin y and continue cooking another 25 min Exchanges ut ally. If too thick es, stirring occasionMeat: 3 , add water fo r de consistency. Ga Bread: 1 rnish with lime, sired cilantro, radish le Vegetable: ½ and onion if de ttuce, sired. Fat: 1¹/3 Nutrition info

rmation

■ Serving Si ze: 1 cup ■ Calories: 220 ■ Calories fr om Fat: 70 ■ Total Fat: 7g ■ Saturated Fat: 2 g ■ Trans Fat: 0g ■ Cholestero l: 70 mg ■ Sodium: 39

0 mg

■ Total Carb ohydrate: 17 g ■ Dietary Fi ber: 3 g ■ Sugars: 5 g ■ Protein: 21 g ■ Vitamin A: 4% ■ Vitamin C: 10% ■ Calcium: 4% ■ Iron: 15%

FOOD FACTS ON 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.

RACHEL DENNY CLOW/CALLER-TIMES


C A L L E R -T I M E S

« Sunday, September 8, 2013 « 9A

FROM THE COVER CULTURE from 8A

LIVING WITH TYPE 2 DIABETES

U.S. Department of Agriculture recommendations for fat, saturated fat and sodium per meal. The study, published in the journal Public Health Nutrition, examined menu items at 245 restaurants across the country. A majority of dishes were below the USDA’s 667-calorie limit per meal, but they did not meet the requirements for fat, saturated fat and 767-milligram limit of sodium. “I know Mexican food is 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.”

Sherri Shepherd, co-host of “The View,” will speak Oct. 4 about living with Type 2 diabetes at Texas A&M UniversityCorpus Christi’s Distinguished Speaker Series, sponsored by the Caller-Times.

HISTORY OF TEX-MEX

There is no consensus to what defines Tex-Mex. Variations of the food depend on region 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 regional hybrid food influenced by Mexican, Native American, African-American and European culture, including Spanish and German, ingredients and cooking techniques, said Norma Cárdenas, assistant professor of ethnic studies and ChicanoLatino Studies at Oregon State University. Most people think of Tex-Mex as rice, beans and enchiladas, but it is made up of ingredients and spices that make the cultural food a favorite. 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 flavors from previously prepared ingredients as they are crushed, ground and embedded in the stone. These ingredients and techniques serve as foundations of Tex-Mex. “The change is Westernization and wanting to live the American dream,” said Amelie Ramirez, director of the Institute for Health Promotion Research at The University of Texas Health Science Center at San Antonio. “But what’s being marketed 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 filling because energy-dense foods are more affordable, according to a March study of 20 low-income, Spanish-speaking families. Processed foods are more palatable and easier to prepare than nonprocessed foods. The high

RACHEL DENNY CLOW/CALLER-TIMES

Maria Benson-Aguas talks about coping with her father, who has diabetes.

MARIA BENSON-AGUAS Type 2 diabetes wreaks havoc on people’s bodies, leading to an array of complications from kidFACES OF ney failure to heart disease and possibly dementia, DIABETES new research suggests. But the disease also wreaks havoc on the families friends of those who have diabetes. /VIDEO and For Maria Benson-Aguas, 47, caring for her father has been a challenge. He is legally blind and has Watch Maria diabetes and dementia and has lived with BensonAguas for the past three months. It was difficult Bensonand time-consuming trying to balance his medicaAguas tell tions and diet, but Benson-Aguas believes he is finally in a good place. Still, she can see how careher story. giving is frustrating. “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,” she said. Rhiannon Meyers

Read studies about Hispanic food choices and diabetes statistics in South Texas.

consumption of those foods has been linked to obesity, Type 2 diabetes, and cardiovascular disease. The quality of Tex-Mex food has been widely criticized and stereotyped as unhealthy and inexpensive, but nonetheless it remains a staple in South Texas See CULTURE, 10A

The change is Westernization and wanting to live the American dream. But what’s being marketed to us is not always healthier products ... but you can feed your family for $10.” Amelie Ramirez, director of the Institute for Health Promotion Research at The University of Texas Health Science Center at San Antonio

EW BEEF SL T APOR) ROSY’S V A A D A GUIS (CARNE

ass cia, Eagle P of Rosy Gar minutes n he tc ki e From th 30 to 40 tion time: ■ Prepara ings: 6 rv se f o ■ Number e, crushed NTS 1 garlic clov o, chopped INGREDIE at ef m be to lean 1 large 1 ½ pounds salt ¼ teaspoon egano 1 cup water er, sliced on or po as te 8 pp ¹/ 1 green pe ion, sliced er to taste on Black pepp ½ medium ur s flo 2 teaspoon t into long ION T A R eat. Cut mea PREPA e fat from m bl si vi y an out 15 1. Remove cook for ab ng pan and pieces. yi fr to er t and wat 2. Add mea e. t juice asid . es ut in m meat and se e th t. Stir ea om m fr e juice flour to the 3. Strain th , onion and er pp pe n gree lt. 4. Add the 5 minutes. ano and sa r , garlic, oreg e meat juice. er and cook fo pp pe k tomato, blac ly adding th 5. Add the 2 more minutes, slow -1 10 r fo Cook n informatio Nutrition g) in rv (per se of calories ■ Fat: 20% ) (l t from fa ow an ss th le : er b Fi ■ ) 1 gram (low 0 20 : es ri lo ■ Ca

Updated traditions

Tip and brown rice Serve with tortillas. at as whole whe meats, such Choose lean loin, flank, or er nd te sirloin, shank.

The Institute for Health Promotion Research is organizing a community submitted cookbook that combines traditional recipes with some alternative and healthier ingredients. The cookbook “Nuestra Cocina Saludable: Recipes from Our Community Kitchen” is planned for release in the fall and contains 46 recipes from Latina kitchens. The community submitted their recipes and a Latina dietitian added measurements and suggested ways to improve the recipes to make them lower in fat and richer in fiber and vitamins.

AURORA’S BE ANS WITH CA CTUS N NOPALES)

(FRIJOLES CO

From the kitche n

of Au

rora Rodriguez, ■ Preparatio Eagle Pass n time: 35 to 40 minutes ■ Number of

servings: 6 INGREDIENT S 1 ½ cups cact us (nopales) 1 ½ cups cook 1 teaspoon mar ed pinto ga beans 1 tablespoon cil rine antro 1 medium onio ½ cups shredded n, 1 large tomato, cut small rella cheese (o mozzacut small ptional) PREPARATIO N 1. Boil cactus in ½ cup of wat er for 15 minut set aside. es. Drain and 2. Sauté onio n in margarine in a nonstick fry browned (abo ut 5 minutes). ing pan until 3. Add tomato and sauté anot her 5 minutes. 4. Add cooked beans, cactus and cilantro. Co over low heat for 10 minutes ntinue cooking . 5. Pour mozza rella cheese on top (optional). Nutrition info

rmat

ion (per servin ■ Fat: 22% of g) calories from fat (low) ■ Fiber: 2 gr ams (high) ■ Calories: 101

Source: Re

cipes from “N Source: Recipe uestra Cocin Re es from s from “Nuest Saludable: ra Cocina Salauda Our Commun Reccip ipes from Our ble: ity Kitchen” coo Community Kitc h ” kbook

RACHEL DENNY CLOW/CALLER-TIMES

Antonio Williams, a culinary student at Del Mar College, prepares ingredients for a healthy version of arroz con pollo in August at the college’s west campus.


10A » Sunday, September 8, 2013 »

C A L L E R -T I M E S

FROM THE COVER CULTURE from 9A

because of its ties to identity and culture. Because of cost and accessibility, Hispanic food products 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 products 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 offer 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 diagnosed with diabetes, according to a recent South Texas health study. The percentage 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 diabetes nationally. Salud America, a project of the Institute for Health Promotion Research at The University of Texas Health Science Center at San Antonio, targets Hispanic children in preventing obesity. Ramirez started focusing on Hispanic outreach in 1992 after serving on national 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 contribute to and benefit from the organization. “We wanted to educate and mobilize the Latino community,” Ramirez said. “We want to make health the right choice, the easy choice. We don’t want them to go looking for it.” The organization takes a proactive approach to preventing obesity and diabetes by targeting children, but Ramirez said it offers tips, videos and recipes for Hispanics of all ages. “We’re now the largest minority,” she said. “The data, for the longest time, was white, black,

CONTRIBUTED PHOTO

Michelle Villarreal cooks tortillas at her grandmother’s home when she was about 10 years old.

Amelie Ramirez

GALLERY See more photos of Michelle making tortillas with her grandmother. RACHEL DENNY CLOW/CALLER-TIMES

Lupe Villarreal makes fl our tortillas with her granddaughter and reporter Michelle Villarreal at her Corpus Christi home on Thursday.

other and then Asians. The research kept lumping us into ‘other.’ We’ve been asking for better data in our Latino community and we’re finally getting to that point. People are recognizing we are the future.” SMALL CHANGES ARE BIG

Grandmother’s tamale or mole recipe won’t be the same if many of the ingredients are swapped

Spanish Style

) 1½ tsp. salt (optional cken 2½ cups low-fat chi broth 3 medium tomatoes, chopped 1 cup frozen peas 1 cup frozen corn ns 1 cup frozen green bea nish gar for es oliv en Gre (optional)

PREPARATION -stick pot. Add r medium heat in a non mushrooms. 1. Heat olive oil ove and s per , red/green pep minutes or until onion, garlic, celery 3 for t, stirring often, Cook over medium hea tender. minutes, stirring rice and sauté for 2–3 2. Add whole grain ingredients. constantly to mix all and tomatoes. chicken broth, water t, sal n, 3. Add chicke Bring water to a boil. let the casserole dium-low, cover, and der, about 40 4. Reduce heat to me ten is e ric absorbed and simmer until water is minutes. for 8–10 minutes. and beans and cook 5. Stir in peas, corn, is hot, the casserole When everything is Exchanges sh with olives or ready to serve. Garni Meat: 5 capers, if desired. Bread: 3 bles eta veg get to y wa Vegetable: 1 6. This is a good xed mi a h wit rve Fat: 1 into the meal plan. Se eat wh ole e wh green salad and som bread. on Nutrition informati cup ■ Serving Size: 1½ ■ Calories: 400 Fat: 60 ■ Calories from ■ Total Fat: 7g 1.5g ■ Saturated Fat: ■ Trans Fat: 0g g ■ Cholesterol: 85m mg 530 m: diu ■ So

Michelle Villarreal makes tortillas 18 years later at her grandmother’s house on Thursday.

We want to make the healthy choice the easy choice.”

RICE WITH CHICKEN INGREDIENTS 2 Tbsp. olive oil pped 2 medium onions, cho d 6 cloves garlic, mince 2 stalks celery, diced en 2 medium red or gre ips str o int cut s, per pep pped 1 cup mushrooms, cho ole 2 cups uncooked wh grain rice cken 3 pounds boneless chi d ize e-s bit o int cut , ast bre d pieces, skin remove

RACHEL DENNY CLOW/CALLER-TIMES

drate: 46g ■ Total Carbohy 3g er: Fib y ■ Dietar ■ Sugars: 5g ■ Protein: 37g ■ Vitamin A: 30% ■ Vitamin C: 70% ■ Calcium: 4% ■ Iron: 20%

for healthier options. So educators and nutritionists are taking a more subtle approach 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 don’t fall prey to those trends for accessibility,” Cárdenas said. “Some have been lost because of colonization or convenience, so how do we reclaim that?” One of the easiest changes is switching from flour to corn tortillas, which is a difference of 255 milligrams of sodium, 35 calories and 15 calories from fat. Randolph J. Widmer, associate professor of anthropology at the University of Houston, said many Houston doctors already are encouraging patients with

diabetes to make that switch. Small changes instead of drastic ones are a way to ensure patients will adhere to a healthier diet and still allow them to enjoy the foods associated with their culture. Food is such a traditional item, Ramirez said, so slightly tweaking them is a start at making a difference. “We want to make the healthy choice the easy choice,” Ramirez said. “Better foods in schools and neighborhoods, 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 flour tortillas with Crisco, flour, baking powder and salt. In the 1990s, she switched to a more processed tortilla mix because it was quicker to make

tortillas and dinner after coming home from a long day at work. By 2000, she stopped making flour tortillas all together. She had foot surgery that year, and it was too painful for her to stand for long periods 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 don’t have the fat flour tortillas have but they can still be bad for you when you have too much,” my grandmother Lupe Villarreal said. “It’s OK to have (flour tortillas) once in a while. Don’t neglect your taste buds all the time.” Hearing my grandmother’s palote on the kitchen counter brings back a flood of family memories that make me feel proud of my culture and tradition. But it makes me feel better to know that my grandmother made a choice to live a healthier life.

RETOOLING RICE WITH CHICKEN Students at the Del Mar College test kitchen developed a recipe for a healthier version of rice with chicken, or arroz con pollo. The recipe incorporates more vegetables and lean meats.

VIDEO See step-by-step videos of how to make healthy versions of posole and arroz con pollo. And find the recipes in Spanish.

FOOD FACTS ON TAMALES

RACHEL DENNY CLOW/CALLER-TIMES

Tamales come in many variations but started with the Aztec and Maya civilizations in Mexico. Tamales were used as portable food for armies, hunters and travelers, a concept later adopted by migrant farm workers. They didn’t use pork products now traditionally used as filling, but instead filled them with fish and tadpoles. They also used nuts for 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.


Senate leaders take command of the effort to prevent a default and end a partial government shutdown. NATION, 8A

TEXAS FIGHT

WATER MULLED FOR MIGRANTS LOCAL, 1B

Longhorns beat Oklahoma in the Red River Rivalry for the first time since 2009. SPORTS, 1C

BIKERS SNAKE SHORELINE LOCAL, 1B

$2.00

ANGLERS SNAP INTO SEASON

SUNDAY, OCTOBER 13, 2013 ■ CITY EDITION

SPORTS, 9C

Bond’s backers outraise opponents 45-1 ■ Destination Bayfront supporters

report $102,850; opponents $2,265 By Kirsten Crow kirsten.crow@caller.com 361-886-4316

Destination Bayfront supporters have raised 45 times as much money as

opponents of the project, but both camps are optimistic that their message is reaching residents preparing to cast their votes on a bond for its construction. In all, Citizens for a Bet-

ter Bayfront — a specificpurpose committee supporting the $44.6 million bond for the park’s development — raised $102,850 through Sept. 26. Neighborhoods First!, a group that is opposed to the measure and is pushing for more focus on infrastructure repairs, raised $2,265.

The bond, if approved, would fund the first phase of Destination Bayfront, a proposed 34-acre public space along Shoreline Boulevard that would incorporate a veterans memorial, outdoor activities and a permanent festival grounds. The City Council unan-

imously voted to send the bond to voters for approval. Councilman David Loeb, Mayor Nelda Martinez and Councilwoman Lillian Riojas contributed money to Citizens for a Better Bayfront, while Councilman Rudy Garza Jr. contributed

Want to see every page of the campaign finance reports? Read them online at Caller.com.

See CAMPAIGN, 4A

apathy [AP’-uh-thee] noun: absence or suppression of passion, emotion or excitement

TAKING ACTION IS KEY COMING SOON

HOW BAD IS IT? DIABETES RATES

The Caller-Times is dedicating four stories to analyzing why the city has struggled to tackle its No. 1 health crisis and what can be done to shift Corpus Christi’s longstanding reputation as a place where the healthy choice is the hard choice.

WHY DOES IT MATTER? DIABETES IS EXPENSIVE

OBESITY RATES

The disease is the nation’s seventh costliest and cost the nation

17.3 %

Nueces County

10.4 % Texas

29.8 %

8.3 % United States

Nueces County

Texas

35.7 %

WHO PAYS FOR THAT in billions

Where Nueces County ranks in the nation

OCT. 20

Anti-diabetes initiatives have disappeared, fizzled away or fallen short. What happened?

Medicaid $5.2

$17.5

Private insurance

OCT. 27

There are signs that Corpus Christi is trying to get healthier, but progress has been difficult to measure.

Out of pocket

$6.6 $5.3

Diabetes is the No. 1 reason for nontraumatic* below-the-knee amputations. 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 has become an accepted part of life in Corpus Christi, leading to fatalism.

in 2010.

United States

BELOW-THE-KNEE AMPUTATIONS

3rd

TODAY

$51.3 billion

42.3 %

Other

NOV. 3

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San Antonio faced the same diabetes crisis, but residents made an effort to change. And they’re seeing results.

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Nueces County ranked 41st in the state for per capita diabetes hospitalization costs, racking up an average of

Type 2 diabetes was long considered an adult disease, but it is on the rise among children, a phenomenon linked to the childhood obesity epidemic.

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for every man, woman and child living in the county.

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series FACES OFthe multiple examining facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make informed choices about their health.

DIABETES

AT CALLER.COM/DIABETES

*not caused by an accident SCRIPPS NEWSPAPERS

By Rhiannon Meyers meyersr@caller.com 361-886-3694

■ Find local support groups and diabetes classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

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Matthew Moreno picks up a to-go order of brisket for dinner Thursday at the Bill 50 Miller Bar-B-Q restaurant near his Westside neighborhood. Moreno, 29, comes from a long line of people afflicted with diabetes. A grandmother needed dialysis. So did40 an uncle. His little sister was diagnosed with Type 2 when she was 13. 30

examined how the city has responded 20 to the crisis. Beyond the problems already reported by the newspaper — 10 the lack of a vast, well-funded health care safety net that’s worked to curb0 diabetes in other cities, and diabetes classes that have been systematically closed, defunded or scaled back — the city has strained to figure out how to See APATHY, 10A

Annual ‘Dancing through Downtown’ walk raises more than $159,000 for American Diabetes Association LOCAL, 1B

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Stepping out to stop diabetes

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toya, who launched a short-lived citywide fitness challenge after the Fattest City designation in 2010. “People are just used to it. And you shouldn’t get used to it.” Still, local initiatives aimed at tackling diabetes and obesity disappeared, fizzled away or fell short. As part of its yearlong series exploring the epidemic of Type 2 diabetes in the Coastal Bend, the Caller-Times

DIABETES

EVERY WEDNESDAY

■ ‘It’s acceptable, and it shouldn’t be acceptable’ Here at the epicenter of an epidemic of diabetes complications, awareness isn’t the problem. Action is. In America’s Fattest City, Type 2 diabetes is just an accepted part of life, like humidity and potholes. Although health studies and surveys repeatedly identify diabetes as the city’s No. 1 health crisis, the community continues to grapple with the question of what to do about it. “There’s a cultural acceptance of diabetes as a normal part of our population,” said Maryanne Strobel, Christus Spohn’s diabetes care coordinator. Twelve years after the Dartmouth Atlas named Corpus Christi the No. 1 place for below-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 region has some of the highest rates of complications, such as below-the-knee amputations and death. That attitude may be contributing to the city’s reputation as a place where the healthy choice is the hard choice. “It’s acceptable, and it shouldn’t be acceptable,” said Cinia Clarich Mon-

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10A » Sunday, October 13, 2013 »

C A L L E R -T I M E S

From the cover apathy

Randal Gonzalez

from 1A

get a handle on an epidemic that feels overwhelming. Invisible almost. Matthew Moreno, 29, comes from a long line of people afflicted with diabetes. A grandmother needed dialysis. So did an uncle. Both later died. His little sister, Martina, 16, was diagnosed with Type 2 when she was 13. Two years ago Matthew had a feeling something was wrong. He borrowed his sister’s glucometer, pricked his finger and touched the blood droplet to a test strip. The number “294” appeared on the screen, 2.5 times normal range. Once his sugar level was too elevated for the meter to calculate a number. “HIGH” was all it read. Persistently high blood sugar levels like Matthew’s lead to serious complications such as blindness, kidney failure and amputations. But Matthew doesn’t have diabetes. At least not officially. He hasn’t been to the doctor for an official diagnosis and has no plans to go, despite his mother’s pleas. “I probably already know what they’re going to tell me,” he said. “I’m not scared, really.” He paused. “Well, I know I’m scared. I don’t know how to explain it. I just don’t like going to the doctor.” The sheer prevalence of diabetes and diabetic complications breeds a kind of fatalism that saps away motivation to change, officials say. And with long family histories of diabetes, many people assume they’ll get it at some point. Worse, they expect to suffer the same fate as their parents and grandparents: amputations, kidney failure and lives cut short by strokes and heart attacks. But those complications are preventable. “You have to have some sort of motivation to give a darn about it,” said Dr. Stephen Ponder, a pediatric endocrinologist who worked for years on the front lines of the city’s diabetes crisis until he moved in 2010. “Yes, you can make a difference. You don’t have to accept the fate that diabetes is preordained. That was the biggest challenge I had to take up when I saw patients. Fatalism is rampant down in Corpus Christi and down in South Texas.” It’s the first thing Ponder 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, grandparent after grandparent who have succumbed to diabetes.” Apathy and fatalism are rampant in a city known for its inferiority complex. That same attitude stymied efforts to do something about the Memorial Coliseum and the dilapidated federal 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 fitness challenge that featured a dozen community leaders. She’s since lost 60 pounds. “It’s not just fitness,” she said. “It’s the same people who say we don’t have anything here and our city is dirty, but they won’t pick up a diaper in the parking lot.” She compared Corpus Christi with Austin, known for its obsession with healthy eating and exercise. “Austin is a great town, and Austin loves itself, but it’s 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 diabetes, has proved elusive to city leaders because the disease is woven into the city’s social and cultural fabric. Jacki Siller, who ran a successful diabetes pro-

Randal Gonzalez talks about how diabetes affected his life.

COST OF

DIABETES TODD YATES/CALLER-TIMES

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 first weigh-in but only 40 returned for the final weigh-in.

CALLER-TIMES FILE

Five years ago Randal Gonzalez weighed 416 pounds, ate fast food FACES OF every day and had trouble walking up DIABETES stairs. An infection in his hand sent him to the emergency room in 2009. That /VIDEO led to a diabetes diagnosis, which led Gonzalez to change his life. He had Watch seen his mother die of a heart attack. He watched his father suffer six Randal strokes in 11 years. Their medical bills Gonzalez were astronomical. tell his Gonzalez hired a personal trainer and starting eating healthier, shedding story. 169 pounds along the way. Friends criticized him for spending money on a trainer, but Gonzalez said he’s saved himself a lifetime of medical costs. He also saved money in another unexpected way — giving up fast food. “I spent about $3,000 in one year eating at Whataburger every day, seven days a week,” he said. “Ridiculous.” Rhiannon Meyers

Dr. Stephen Ponder is a pediatric endocrinologist who worked for years on the front lines of the city’s diabetes crisis until he moved in 2010. Fatalism is rampant in Corpus Christi, he said.

Michael Zamora/Caller-Times

Matthew Moreno talks with sister Martina Moreno, 16, as the two order food Thursday at the Bill Miller restaurant near their Westside neighborhood. Martina was diagnosed with Type 2 diabetes when she was 13. Matthew is prediabetic and hasn’t been tested by a doctor despite his mother’s pleas.

gram for two years before the state stripped its funding, characterized the response as slow and fragmented. “I think that if someone who has diabetes accepts it, so does the rest of the community,” she said. “I think it takes some real pioneers and people to think outside the box and be passionate about it. Because we know it’s not easy.” Over the years, local doctors have repeatedly expressed frustration with their patients, calling them noncompliant for failing to follow their instructions to diet, exercise and take their medication. And that frustration propagates a vicious cycle. Doctors fed up with noncompliant patients stop trying to get them to change. And patients no longer get the information they need to change. But that noncompliant label doesn’t take into account the other obstacles patients face to get healthy, especially those who are low-income or undereducated. Health care officials call these barriers to care. Patients sometimes don’t fully understand their doctor’s instructions, especially when it comes to diabetes, a complex disease that’s difficult to manage, even for experts. They don’t 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 don’t know that it’s all apathy,” said Dr. Melissa Wilson, an endocrinologist who served on the Texas Diabetes Council and has spent years studying the city’s diabetes crisis. “I don’t think people really know what to do. For people that have been living a certain way their whole life,

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

they really do need very specific help.” The hardest part for Matthew Moreno and his family has been finding the motivation to change. Matthew and his sister Martina and his dad, Martin, 50, live in the same house where Martin grew up. The little white-and-red house in a Westside neighborhood is close enough that Matthew can walk to work at a shop that manufactures automatic doors. He’s been living there since his stepmother Rosalinda died at age 40 after years of battling diabetes complications. Martina asked him to move in. They know that they should be eating healthier and exercising. Last year, after Martin was diagnosed with prediabetes, he took Matthew with him to a diabetes education class where they learned about diet, exercise and managing diabetes. But they’ve struggled to follow those instructions. Attempts to eat healthier were sabotaged because Martina doesn’t like fruits or vegetables. “She doesn’t like to eat anything but nachos and rice,” her father said. Matthew is the only one who works. Crippling arthritis mangled his dad’s hands, causing him to go

Michael Zamora/Caller-Times

Martin Moreno (top) sits with his children Martina (left) and Matthew Thursday as they eat dinner at their home. Last year, after Martin was diagnosed with prediabetes, he took Matthew with him to a diabetes education class where they learned about diet, exercise and managing diabetes. But they’ve struggled to follow those instructions.

on disability years ago. That means Matthew usually buys the groceries. Sometimes he brings home healthy food, but it’s 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?” Martina asked, pointing to the fruit’s speckles. Maybe if they were introduced to eating healthy food as kids, they would feel different, their father said. But he didn’t grow up eating lettuce and tomatoes and never acquired a taste for something that, to him, has no taste. “Might as well just be drinking water and taking pills,” Martin said. But just as they’ve

struggled to eat healthier, they’ve also found it hard to motivate themselves to exercise. Matthew bought a weight set, a fitness video and a membership to Freedom Fitness, but he rarely uses them. “I’m trying, but I don’t have motivation to do anything,” he said. “I get home from work, and I don’t feel like doing anything.” 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 exercise equipment he rescued from a junk pile years ago continues to rust and gather dust on his back porch. He said he’d rather walk around the neighborhood, even though the sidewalks are cracked and broken or missing.

But then he wouldn’t go, complaining it was too cold or too hot or that he didn’t feel well enough. Or he worried his troublesome ankle would lock up midwalk and he wouldn’t be able to get home. This summer he and Martina 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 answer. Martina never brought it up again, he said. So neither did he.


Several hundred gun rights activists rally Saturday at the Alamo, breaking a long tradition at the site. STATE, 10B

PINK IN SYNC

MORE JOINING TEA PARTY LOCAL, 1B

About 11,000 walkers move along Shoreline on Saturday for breast cancer awareness. LOCAL, 1B

COACH ONE OF TOP IN STATE SPORTS, 1C

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SUNDAY, OCTOBER 20, 2013 ■ CITY EDITION

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TODD YATES/ CALLER-TIMES

DESTINATION: VOTING BOOTH CONTRIBUTED RENDERINGS

Park, beach users show their support ■ They’d like improvement,

even if it proves inconvenient By Kirsten Crow |

kirsten.crow@caller.com

|

361-886-4316

S

upport for the proposed Destination Bayfront project wasn’t hard to find in downtown parks days before voters prepared to cast their ballots on a proposed bond. While citywide discussion of approving the $44.6 million bond to fund the first phase of the project grows more contentious, many of those who use the area regularly or live in the area said they supported the park’s construction, even if it will raise property taxes and create inconvenience during construction. Proponents frequently cited the opportunities to enhance the area as a more recreational site for tourists and locals as well as the potential for economic growth among their reasons to back the project. Peter Davidson, Corpus Christi Marina superintendent, said the area already is a favorite among residents

You determine if the city moves forward with Destination Bayfront, a proposed $44.6 million, 34-acre public park. Early voting begins Monday. Election Day is Nov. 5. ■ 100 words for & against ..............8A ■ City Council members weigh in ....8A ■ Destination Bayfront FAQs .........9A ■ MAP: Early voting locations ........8A ■ MAP: Who owns the land ............9A ■ Turnout from past elections .......8A

Low turnout could thwart grand plans ■ History shows referendums

falter in stand-alone elections By Mark Collette |

collettem@caller.com

COST OF

DIABETES

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series FACES OFthe multiple examining facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make informed choices about their health.

DIABETES

The Caller-Times is dedicating four stories to analyzing why the city has struggled to tackle its No. 1 health crisis and what can be done to shift Corpus Christi’s longstanding reputation as a place where the healthy choice is the hard choice. OCT. 13

Diabetes has become an accepted part of life in Corpus Christi, leading to fatalism. TODAY

Anti-diabetes initiatives have disappeared, fizzled or fallen short. What happened? OCT. 27

There are signs that Corpus Christi is trying to get healthier, but progress has been difficult to measure. NOV. 3

San Antonio faced the same diabetes crisis, but residents made an effort to change. And they’re seeing results. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

361-886-3678

C

ity leaders and Destination Bayfront proponents took a big gamble when they put the measure on the November ballot. Placing it in an election that has nothing else but referendums on constitutional amendments — no marquee matchups like Obama vs. McCain or Abbott vs. Davis — may be tantamount to sabotage. Voter turnout is almost always dismally low for elections in odd-numbered years when there are no heated races. And history shows that local referendums that stand alone, or on an otherwise bland ballot, tend to fail. Coastal Bend political analyst Bob Bezdek arrived in 1973 and watched a series of bond elections for school districts, city initiatives and Packery Channel. More than half failed, usually in low-turnout elections

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Struggling to fix diabetes issue

■ Sponsors,

opinion key to solving problem By Rhiannon Meyers meyersr@caller.com 361-886-3694

For years Dr. Stephen Ponder watched a growing number of children arrive at the doors of Driscoll Children’s Hospital, seeking treatment for what used to be an adults-only disease. The problem was too widespread to tackle in the clinic or the hospital, and the pediatric endocrinologist wondered: “Can we do something as a community to effect a change?”

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In January 2006 , Ponder called a meeting at the hospital auditorium and invited elected officials and representatives from health care, the Chamber Download our app with the QR code. of Commerce, schools, Get local news now. faith-based organizations and nongovernmental organizations. INDEX He gave a 20-minute lecture, peppering the BUSINESS 20A, 21A speech with dramatic COMICS 1D images of children with diabetes and the compliCROSSWORD 5G cations they developed OBITUARIES 10B, 11B from the disease. LOTTERY 2C Then he turned it over OPINION 22A to the officials in the room to brainstorm solutions. That meeting led to more brainstorming sesTo subscribe: sions over several weeks,

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10A » Sunday, October 20, 2013 »

C A L L E R -T I M E S

FROM THE COVER DIABETES from 1A

which led to a half-milliondollar donation from local industry, which created an anti-obesity militia called the Coastal Bend Diabetes Initiative that eventually gave away more than $800,000 to 41 projects. “It got a discussion going and got people moving in the right direction that weren’t moving before,” Ponder said. Seven years later that initiative 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 create a permanent endowment to keep it running. And the initiative lost its leader when Ponder moved. “That’s the general rule of thumb in Corpus,” Ponder said. “We understood the problem, but nobody wanted to put money in to do anything.” While diabetes remains a problem, stories like this are common in Corpus Christi, which has struggled to find a sustainable solution to its diabetes crisis.

PREVENTION IS KEY Despite studies and surveys that repeatedly identify diabetes and obesity as the city’s top health crisis, there have been no strong, concerted and long-lasting efforts 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 belowthe-knee amputations in 2001 and was called America’s Fattest City by Men’s Health magazine. But many of those disappeared, fizzled away or fell short, victims of funding shortfalls and leadership changes. The Coastal Bend Diabetes Initiative, for example, survived for seven years, much longer than expected, on the initial $500,000 investment 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 effects of diabetes on their employees, Ponder 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 refinery industry consultant who helped sketch out the CBDI plan on the back of a napkin years ago with other industry leaders. “They just didn’t know what to do about it.” So instead of an awareness campaign, the industry groups decided to give away the money to community organizations working on diabetes prevention. The money was supposed to last just two years, but additional donations flowed 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 hospitalizations and amputations in people with uncontrolled blood sugar. The YMCA in November 2010 hosted a three-day diabetes boot camp, teaching 50 families about nutrition, physical fitness and the basics of diabetes management. ECONOMIC COLLAPSE But early on, officials fretted about the sustainability of the project. They tried to find a stable funding source to create an endowment, but they couldn’t 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

COASTAL BEND DIABETES INITIATIVE The Coastal Bend Diabetes Initiative, created in 2006 with a half-million-dollar investment from industry, gave away $821,750 over six years to various groups working to tackle diabetes and obesity in Corpus Christi. YEAR

ORGANIZATION

PROGRAM

Winter 2007 $125,000

Food Bank of Corpus Christi

Prepare backpacks with nutritious foods for hungry children

Coastal Bend Breast-feeding Coalition

Breast-feeding website

Del Mar College Foundation

Diabetes center to provide glucose testing, monitoring, prevention and nutrition and exercise education at no cost

South Texas Colonia Initiative

Diabetes education classes, cooking demonstrations and physical activity sessions in the colonias

Summer 2008 $118,350

Spring 2009 $125,000

Winter 2009 $113,400

Corpus Christi Parks and Recreation Sajai Wise Kids healthy living program for kids Education Service Center Region 2

Healthy Active Early Years anti-obesity program for at-risk youth

Mission of Mercy

Diabetes diagnosis, treatment and education for uninsured

The Salvation Army

Foot Savers diabetic shoe program

KEDT TV/FM

Children’s health initiative programming

Coastal Bend Breast-feeding Coalition

Website publicity

Christus Spohn Health System Foundation

Create awareness of 211 helpline

YWCA of Corpus Christi

Taekwondo for teen girls

Mission of Mercy

Diabetes diagnosis, treatment and education for uninsured

American Diabetes Association

Diabetes awareness campaign

Southeast Texas Lighthouse for the Enhance computer/professional skills for Blind those with vision loss Driscoll Children’s Health Planning

Providing mothers with eduction, care and nutrition before and after pregnancy

Christus Spohn Health System/ Coastal Bend Diabetes Community Coalition

Develop website to provide information about diabetes prevention, treatment

Food Bank of Corpus Christi

Eight-week diabetes self-management program

Mary McLeod Bethune Day Nursery Youth classes about healthy habits and lifestyle choices

Summer 2010 $160,000

Summer 2011 $90,000

Summer 2012 $90,000

Junior League of Corpus Christi

24-hour outdoor fitness center for children

Boys &Girls Clubs of Corpus Christi

Lessons for children on how to eat right, stay fit and build positive relationships

Education Service Center Region 2

Diabetes and nutrition classes via video conference to schools and training to school staff to boost physical activity using the Wii Fit

Amistad Community Health Center

Community garden

The Salvation Army

Foot Savers diabetic shoe program

YMCA of Corpus Christi

Three-day diabetes boot camp

Mission of Mercy

Diabetes diagnosis, treatment and education for uninsured

Texas A&M Health Science Center Foundation-Irma Lerma Rangel College of Pharmacy

Texas Obesity Prevention Program for kids

Timon’s Ministries

Improve nutritional quality food offered, host nutritional training classes, distribute monthly grocery bags

Amistad Community Health Center

Walking groups and build a walking path

Catholic Charities

Diabetes program for the homeless

The Salvation Army

Foot Savers diabetic shoe program

Texas A&M University-Corpus Christi

Teach prediabetic women about making healthy choices, exercising more and sustaining change

Deaf and Hard of Hearing Center

Diabetes information to those with hearing loss

Junior League of Corpus Christi

Kids in the Kitchen efforts to promote healthier family lifestyles

Texas A&M Health Science Center Foundation-Irma Lerma Rangel College of Pharmacy

Challenge middle and high school students to produce videos on diabetes awareness and prevention

Diabetes Community Coalition

Model to document and measure local diabetes project successes

Corpus Christi Metro Ministries

Testing, education, management and treatment for diabetes

Texas A&M University-Corpus Christi

Study neighborhood food environment contributions to diabetes risk

TOTAL $821,750

MICHAEL ZAMORA/CALLER-TIMES FILE

Olivia Megee, 15, goes through Zumba moves with other Zumama Fitness members May 22, 2010, as they lead a mass workout during the Fit & Free by the Sea event at Cole Park. More than 1,000 people showed up for the event, but only 40 returned for the final weigh-in.

big break in 2008 when a pharmaceutical foundation eyed Corpus Christi for a donation as part of its effort to give money to communities in good positions to tackle diabetes. The Eli Lilly and Company Foundation was planning to give Corpus Christi about $1 million, Ponder said. “Our region was considered the most prepared, most prime, most ready to accept the challenge,” he said. But then the economy tanked, the United States spiraled into the Great Re-

cession and the foundation no longer able was able to give the money. Grant applications weren’t successful, and CBDI had trouble raising more cash, a problem Deville pinned on the complicated nature of diabetes prevention. “It’s difficult 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 endall, be-all solution and the group accomplished what it set out to do — spark a conversation about how to tackle diabetes in Corpus

Christi. “We’re very proud of what we did, and we feel very successful,” he said. But he said the epidemic continues and more work needs to be done. Many of the initiativefunded programs have been able to stay afloat, but they’ve done so with other funding and sometimes at a fi nancial loss. The YMCA plans to host another diabetes boot camp starting Nov. 4 but has struggled to find participants. Despite four weeks of radio advertisements

MICHAEL ZAMORA/CALLER-TIMES FILE

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.

Check out archived stories and other documents used to report this story.

and fliers left in doctors’ offices and hospitals, no one has registered, said Rachel Ulibarri, membership, health and wellness director. “I was expecting, bare minimum, we’d have 15 families,” she said. “I don’t know why people aren’t coming out for it.” The three-week boot camp costs $30 for a family of four, a price that doesn’t cover the cost of the program, Ulibarri said. The class meets twice per week for a 45-minute lecture with a diabetes educator about disease management and a 45-minute activity, such as swimming. The camp also includes a healthy food tasting and grocery store tour with a licensed dietitian. Those who finish get a free month membership. It’s a concept that’s worked well in other cities, but in Corpus Christi, a hotbed for diabetes complications, Ulibarri is worried about attracting enough people. “It’s just crazy,” she said. With an estimated 17 percent of people diagnosed with diabetes, Nueces County’s rates are more than double the national average. Forty-two percent of county residents are obese. And diabetes complication rates, such as amputations and death, continue to be higher than the state and national averages. Awareness isn’t the problem here. Action is.

CHANGING MINDSETS As part of its yearlong series exploring the epidemic of Type 2 diabetes in the Coastal Bend, the Caller-Times examined how the city has responded to its crisis. Diabetes is a complicated disease — influenced by genetics, food and lifestyle — making it difficult for any community to tackle. Successful efforts are well-funded and championed by leaders, like San Antonio’s Mayor Julián Castro who in recent years prodded the notoriously overweight 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, exercises 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 Men’s Health dubbed the city “Corpulent Christi,” Cinia Clarich Montoya launched a citywide weight-loss challenge in response. “That really ticked me off, basically,” she said. “Having had been a fitness 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 Montoya’s Fit & Free by the Sea. Volunteers weighed people, calculated their body mass and measured their blood pressures. One man was so overweight, the scale couldn’t accommodate him, so a nurse drove him to a near-

by doctor’s office to weigh him, Montoya said. Then-Mayor Joe Adame declared 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 final weigh-in at the American Bank Center. Forty people showed. The group disbanded not long afterward. Montoya said she couldn’t find sponsors willing to keep giving her cash. She had big plans for a fitness festival with healthy food vendors, health and fitness celebrities, a boxing match and a mixed martial arts fight. Not anymore. “I just can’t spend my energy after being defeated like that,” she said.

LOCAL SOLUTIONS Citywide weight loss challenges, similar to what Montoya tried, have seen disappointing results in other cities. Last year in Boston, for example, the mayor challenged residents to shed 1 million pounds in a year. The city fell far short of that goal, dropping just 95,837 pounds. And that effort was well-funded. Fueled by $310,000 from corporate donors, Boston’s challenge included an array of enticements: free fitness classes, Weight Watchers discounts and coupons for healthy food. Rather, sustainable changes seem to happen at the policy level. But those changes are notoriously difficult to implement and can be seen as acts of a nanny state. Perhaps the most notorious, New York City’s soda ban, was struck down by the court which said the health board overstepped its boundaries. Corpus Christi hasn’t tried to change policies. Instead, groups have tried to persuade the city to voluntarily move away from unhealthy food choices and sedentary lifestyles but with little success. Bold Future, an organization 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 1½ years to convince restaurants to participate, but in the end, only two eventually agreed: Taqueria Jalisco No. 19 and Kiko’s Mexican Food Restaurant and Cantina. As tough as it is to change people’s eating habits, it’s just as hard to change restaurants, especially small mom-and-pop shops that must always worry about their bottom lines, the committee discovered. “It would be easier to build a bridge than to do this project,” said committee member Guadalupe Reyes, director of the Texas A&M Health Science Center Coastal Bend Health Education Center. The public demise of these initiatives underscores a deeper problem that Ponder tried to address seven years ago when he brought the group together at Driscoll Children’s Hospital. If Corpus Christi wants to solve its diabetes crisis, it needs a local solution, Ponder said. “We’re not going to get our solutions from Washington. We’re not going to get our solutions from Austin,” he said. “It’s got to be a local solution, and it’s got to be grass-roots.”


Mexican students are enrolling at Texas A&M University-Kingsville to avoid the drug cartel violence in Mexico. LOCAL, 1B

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SUNDAY, OCTOBER 27, 2013 ■ CITY EDITION

SPORTS, 1C

SIGNS OF

INTEREST

GEORGE GONGORA/SPECIAL TO THE CALLER-TIMES

Team Life Cyclers ride Thursday evening at Hazelbasemore Park . Members say they ride for overall health and joy.

Modest health strides noted

■ City’s road to

healthier living still long, bumpy

By Rhiannon Meyers meyersr@caller.com 361-886-3694

Corpus Christi had a reputation as an unhealthy city long before a national magazine 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 Whataburger has more fast-food restaurants per capita than the national average. At the city’s airport, an advertisement for the hamburger chain is the first thing welcoming travelers to town, a visiting dietitian noticed. And there’s a perception that the city is unfriendly to cyclists and joggers. For years it has lagged behind other cities in building safe paths for people to bike and walk. Cars are allowed to park in one of the city’s 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.

TODD YATES/CALLER-TIMES

For and against Destination Bayfront signs dot the landscape Monday around the Nueces County Courthouse on the first day of early voting.

See DIABETES, 10A MICHAEL ZAMORA/CALLER-TIMES

J.J. Hart, a Destination Bayfront supporter, cheers on some of the elected officials at a voter rally Wednesday.

kirsten.crow@caller.com 361-886-4316

The battle over a $44.6 million bond that would help fund the construction of Destination Bayfront has migrated from the virtual world to front yards, television sets and the sea wall itself. Interest in the election is high. Five days into voting, 6,094 people in the county had cast their ballots. Officials believe the driver at city polling sites is the bond for Destination Bayfront, a proposed 34-acre public space along Shoreline Boulevard that

ELECTIONS

John Kelley (from left) Matt Stevens and Jack Gordy discuss the bond at a Neighborhood First! rally.

2013

would include play areas for children, improvements to the veterans memorial and permanent festival grounds. In the tug of war over votes that could help see the park to fruition or its ultimate dismantling, specific-purpose political committees that have organized in support and opposition of the bond are taking their message to new platforms to reach residents. The committees are working with disparate budgets. Citizens for a Better Bayfront, which is in favor of the bond, reported raising $102,850 through Sept. 26, while Neighborhoods First!,

ELECTION

GUIDE

DIABETES

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series FACES OFthe multiple examining facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make informed choices about their health.

DIABETES

APATHY SERIES The Caller-Times is dedicating four stories to analyzing why the city has struggled to tackle its No. 1 health crisis and what can be done to shift Corpus Christi’s longstanding reputation as a place where the healthy choice is the hard choice. OCT. 13

Diabetes has become an accepted part of life in Corpus Christi, leading to fatalism. OCT. 20

Anti-diabetes initiatives have disappeared, fizzled or fallen short. What happened? TODAY

There are signs that Corpus Christi is trying to get healthier, but progress has been difficult to measure. NOV. 3

San Antonio faced the same diabetes crisis, but residents made an effort to change. And they’re seeing results. EVERY WEDNESDAY

Clip healthy, diabetes-friendly recipes from the Food section. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

TODD YATES/CALLER-TIMES

■ Destination Bayfront plans fuel tug of war By Kirsten Crow

COST OF

which is against issuing the bond, raised $2,265 as of Oct. 5. Both political action committees have relied heavily on social media to get information to residents in the weeks leading up to early voting, organizers said. Early Saturday afternoon the Neighborhoods First! Facebook page showed 404 “likes,” while Destination Bayfront showed 7,435 — an increase for both from just the evening before. But other tactics are ramping up as Election Day nears. “It’s that peak, that crescendo,” See VOTE, 11A

Get the information you need to know before heading to the polls at Caller.com/elections. See what people are saying about local elections on our social wall. Join the conversation by using #CCelect or #DestinationBayfront on Twitter, Facebook and Instagram. Early voting locations, 2B.

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10A » Sunday, October 27, 2013 »

C A L L E R -T I M E S

FROM THE COVER DIABETES from 1A

While the city has struggled with finding a sustainable and organized solution to its obesity and diabetes crisis — several high-profile initiatives have disappeared or fallen short of their goal — there are signs that an organic change is underway that could shift those statistics. A wave of new gyms and fitness facilities have opened, including 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 downtown and one on the Southside, offering vegetables plucked fresh from South Texas farms. Races such as 5Ks and fun runs have grown in popularity, with big name productions such as Color Me Rad choosing Corpus Christi for the first time. A Corpus Christi running club that tracks local races noted 28 races in the Coastal Bend in 2003. So far this year, it’s counted 60. The number of joggers and cyclists spotted on city streets also seems to have exploded in recent years, with local running and cycling clubs seeing an uptick in participation. Jerry Gomez, for example, started cycling with a co-worker last year in an effort to drop pounds, get healthy and avoid a diabetes diagnosis that’s made his mother sick. More coworkers started to join as word spread, and one day 30 people showed up to ride. “It was like ‘Night of the Living Dead,’” Gomez joked. There are now 140 members in the group that calls itself Team Life Cyclers. They have uniforms, host clinics on bike mechanics such as how to change a flat, 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 philosophy is we ride for health, and we ride for fun.” And for safety. In 2011 leaders at nearly every business surveyed by the city’s parks and recreation department said they would like to encourage employees to ride or walk to work, but they didn’t think it was safe to do so, said Stacie Talbert, assistant director for the Corpus Christi Parks and Recreation 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, I’ve 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 evidence points to a healthier Corpus Christi, it’s hard to say whether any of it is making a difference in the city’s diabetes and obesity statistics. Unlike other cities, the Corpus Christi-Nueces County Public Health Department does not collect data on the local obesity and diabetes rates, making it difficult to judge with hard evidence whether Corpus Christi is slimming down and getting healthier.

MICHAEL ZAMORA/CALLER-TIMES

Participants take off Sept. 28 at the start of the Mayor’s Fitness Council Healthy 5K Run-Walk at Cole Park in Corpus Christi.

RUNNING EVENTS The Corpus Christi Roadrunners tracks 5Ks, fun runs and other running events in the Coastal Bend. 2003

28

2004

30

2005

36

2006

28

2007

30

2008

35

2009

43

2010

42

2011

48

2012

30 60

2013 Source: Corpus Christi Roadrunners

0

10

20

30

40

50

60

SCRIPPS NEWSPAPERS

MAYOR’S 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 Mayor’s 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)

Now

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

Federal statistics don’t help, either. The U.S. Centers for Disease Control and Prevention in 2011 changed the way it counts diabetes and obesity, making it impossible to gauge the city’s progress since the 2010 Men’s Health magazine designation as America’s fattest city.. Still, the joggers on Ocean Drive, the new cycling groups, the growing number of 5Ks spark hope among health advocates aching for a victory. “There’s motivation out there,” said personal trainer Victor Betancourt who owns a race production company that’s been hosting scores of new runs. The challenge the city faces is how to capitalize on that momentum, make it sustainable and reach those who need it most.

“If we can change a few to get on the path to healthy living, to fight diabetes, to keep fit, then we’ve accomplished our goal,” Mayor Nelda Martinez 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 creative on engaging the masses.” The question of how to spread the change is what dogs the Mayor’s Fitness Council, created in 2010 under Mayor Joe Adame in direct response to the city’s 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 advocates and leaders from education and industry advises the City Council,

GEORGE GONGORA/SPECIAL TO THE CALLER-TIMES

A group of women meet Thursdays to ride their bikes for exercise and health.

Can we chart this, please? RUNNING EVENTSThe Corpus Christi Roadrunners tracks 5Ks, fun runs and other running events in the Coastal Bend. 2013 60 2012 30 2011 48 2010 42 2009 43 2008 35 2007 30 2006 28 2005 36 MICHAEL ZAMORA/CALLER-TIMES 2004 30 A participant strolls by the water station and 2 Mile Lounge on Sept. 28 during the Mayor’s 2003 28 Fitness Council Healthy 5K Run-Walk. The Mayor’s Fitness Council was created in 2010 under Mayor Joe Adame in direct response to the city’s growing rates of chronic diseases.

Check out materials used to report this story, including maps, websites and archived stories.

the city manager, city departments and the health district. As such, it’s wellsuited to enact widespread and sustainable changes to policy and infrastructure. While fitness councils in other cities spearheaded their own initiatives and programs — San Antonio’s council, created the same year, famously started a popular citywide cycling event — Corpus Christi’s council initially opted to spend its fi rst round of grant funding by donating to other already established organizations. In the first year, the council gave away $48,000 to 13 projects. The group gave donations of $5,000 each to American Diabetes Association for testing materials, Conquer the Coast to underwrite the cost of registration for first-time riders in the annual bicycle race, and Republic of Texas Triathlon to give free triathlon training. The council counted participation, but it didn’t track health status or behaviors, complicating efforts to judge the donations’ effect on Corpus Christi’s obesity and diabetes crisis. For example, the Republic of Texas Triathlon, an event Adame credited the fitness council with attracting, had 475 participants its first year. Twenty percent came from Corpus Christi, according to race results. Austin had the biggest contingent at 32 percent. “Programs are great, but there’s no way to know the impact on people who don’t participate,” said Talbert, who took over council management in 2011. As the council discovered, simply giving away a few thousand dollars here and there to different organizations wouldn’t make the kinds of sweeping changes needed. So in 2011 the council received a dif-

ferent grant, which shifted the group’s vision toward policy and infrastructure. The $40,000 from the National Park and Recreation Association and the Centers for Disease Control and Prevention required the council to develop a community action plan. The plan had to address policy, system and environmental changes to tackle chronic diseases, in Corpus Christi’s case, diabetes. Corpus Christi was one of 10 cities nationwide to get the grant. The council’s action plan calls for increasing access to fresh food, adding hike and bike trails and snuffing out tobacco use in parks within three years. “If we’re going to make sustainable changes, you have to change policies,” Talbert said. “That’s key.” The council’s goal by 2014 is to have 33 miles of bike and pedestrian paths, 60 miles of roads with bike lanes, 24 community gardens and three of the city’s 13 community centers serving some sort of local produce. And they’re pretty close to reaching that goal. In the past two years, they’ve added to their win column 9 miles of trails built as part of 2008 bond for park improvements and 12.5 miles of bike lanes, bringing the total to 27 miles of trails and 58 miles of lanes. They’ve also spent grant money promoting community gardens by giving $500 subgrants 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 promote a local data collection project, sponsor a town hall on sustainability and to send board members to a conference. They have about $18,000 left, which the council still is debating how to spend, Talbert said. The new focus on policy and infrastructure should

help the Mayor’s Fitness First reach more people Council reported onreverse Corand begin to pus Christi’s reputation as a city where it’s hard to be healthy, Talbert said. Progress may seem sluggish, but shifting the city’s mindset and health statistics won’t be easy. “It’s like turning the Titanic,” Talbert said. “It takes a long time.” In September the council hosted its first 5K race to raise cash to continue its effort. The group marketed the event as a 5K for firsttimers. They organized couch-to-5K training sessions and advertised inflatable couches at the 2-mile mark for participants who needed a break. The response was underwhelming. Two weeks before the race, the council fretted about breaking 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 wasn’t necessary. The group made a final push with a grassroots marketing campaign and attracted 93 paid participants, enough to bring in $1,015 in net revenue. Among them was Mayor Martinez, speed walking through Cole Park and shouting encouragement to other participants. The 5K is a good start, she said. Another sign that Corpus Christi is getting healthier. But she wants to do more, maybe build partnerships with other groups in town to extend the council’s influence and figure out a way to follow up with participants to see whether it’s making a difference, she said. State Rep. Todd Hunter, who has Type 2 diabetes, appeared next to her on the sidewalk. “You did good,” he said, speedwalking by. “I’m glad y’all are doing this.” “Well,” she said, “We’ve got to sustain it. That’s the key.”


South Texas Human Rights Center honors migrants who have died in Brooks County. LOCAL, 1B

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SUNDAY, NOVEMBER 3, 2013 ■ CITY EDITION

Corpus Christi struggles with its health crisis; San Antonio takes on similar problems, finds success

COST OF

DIABETES

The Caller-Times and reporter Rhiannon Meyers have committed to a yearlong series examining FACES OFthe multiple facets of diabetes and its effects on the community. Although largely manageable through diet and exercise, Type 2 diabetes long has plagued the Coastal Bend, wreaking slow havoc on people’s bodies and costing taxpayers millions in prevention and treatment. Through stories, multimedia and a host of resources, the CallerTimes hopes to help its readers understand the disease and make informed choices about their health.

DIABETES

GALLERY Check out more photos, see a map of Síclovía and read documents used to report this story.

UPCOMING STORIES TODAY MICHAEL ZAMORA/CALLER-TIMES

Runners sprint to the finish Sept. 29 during the Síclovía 5K in San Antonio.

SAN ANTONIO — A healthy revolution sounds like the clatter of plastic training wheels on pavement, the low rumble of skateboards, 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 filled 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 missing: 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 fittest, and they’re doing so through an array of initiatives, such as the twice per year Síclovía, which has exploded in popularity.

ONE STEP

NOVEMBER

AHEAD

By Rhiannon Meyers ■ meyersr@caller.com | 361-886-3694 APATHY SERIES

The Caller-Times is dedicating four stories to analyzing why the city has struggled to tackle its No. 1 health crisis and what can be done to shift Corpus Christi’s long-standing reputation as a place where the healthy choice is the hard choice. OCT. 13

Diabetes has become an accepted part of life in Corpus Christi, leading to fatalism. OCT. 20

Anti-diabetes initiatives have

disappeared, fizzled or fallen short. What happened? OCT. 27

There are signs that Corpus Christi is trying to get healthier, but progress has been difficult

San Antonio faced the same diabetes crisis, but residents made an effort to change. And they’re seeing results.

to measure. TODAY

San Antonio faced the same diabetes crisis, but residents made an effort to change. And they’re seeing results.

Type 2 diabetes was long considered an adult disease, but it is on the rise among children, a phenomenon linked to the childhood obesity epidemic. EVERY WEDNESDAY

Clip healthy, diabetes-friendly recipes from the Food section. AT CALLER.COM/DIABETES

■ Find local support groups and diabetes education classes. ■ Explore diabetes-related data. ■ Search healthy recipes and submit your own. ■ Share your story about how diabetes has affected your life. ■ Watch videos, in English and Spanish, on diabetes management. ■ View photos showing the toll of diabetes on Coastal Bend residents. This project is produced with support from a reporting fellowship sponsored by the Association of Health Care Journalists fellowship program and supported by The Commonwealth Fund.

See DIABETES, 10A

ELECTION ELECTIONS

2013

NEWS

Voting locations, 3B Sample ballot, 4B

FALL BACK

LIVE COVERAGE

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Reporters throughout Election Day will give you: ■ An inside look at the polls. ■ Answer readers’ questions through social media. ■ Up-to-the-minute results.

See what people are saying about local elections on Caller.com/ elections. Join the conversation by using #CCelect or #DestinationBayfront on Twitter, Facebook and Instagram.

Did you remember to set your clocks back one hour today?

City’s future lies with bond vote ■ Pass or fail,

INSIDE

voters sending a message By Kirsten Crow kirsten.crow@caller.com 361-886-4316

There’s no doubt that interest in the fiercely fought Destination Bayfront bond proposition led Nueces County to some of the highest early voting turnout percentages in the state, election experts say. But it remains anyone’s guess whether Corpus Christi residents will approve or vote down the $44.6 million bond, which would be used to develop 34 acres of Shoreline Boulevard along the bay into a multipurpose public space and park.

Lawmakers, groups urge people to vote. 1B

The county saw a 6.06 percent turnout — 11,078 of 182,670 registered voters — through Thursday, which at the time ranked Nueces as the county with the highest percentage of early voters, when compared with statistics from the state’s 15 most populous counties. The Texas secretary of state reported Saturday a 6.94 percent voter turnout, or 12,677 voters, following the largest early voting turnout yet of 1,601 ballots cast in a single day. Records from the elections office indicate that ballots through Friday — at least 11,661 of the 12,681,

Voter ID requirement trips up politicians, too. 5B

or about 92 percent of the total vote — were cast in Corpus Christi polling sites, where ballots included the bond measure in addition to nine proposed amendments to the Texas Constitution. There’s no real way to estimate how many people will show up to the polls Tuesday, Election Day. Historically, there’s a lower turnout — primarily traditionalists — as compared with early voting, officials said. But the Destination Bayfront referendum represents a different case altogether, said Bob Bez-

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dek Coastal Bend political analyst and retired Texas Partly cloudy 21A A&M University-Corpus Christi political science professor. “This is a unique election in the sense that I cannot remember where we’ve had constitutional amendments ... packed on with what seems to beDownload a our app with the QR code. Get local news now. hot-button local issue,” he said. “What I’m saying is, a lot of traditional rules of voting can be thrown out.” INDEX

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IF IT FAILS By the time voters hand down a decision on the bond, construction on a project intended to realign traffic along the stretch of road where the park would be laid out already will be underway. The realignment of See BAYFRONT, 9A

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10A » Sunday, November 3, 2013 »

C A L L E R -T I M E S

FROM THE COVER

PHOTOS BY MICHAEL ZAMORA/CALLER-TIMES

Cyclists, skateboarders and pedestrians take over Broadway Street on Sept. 29 during Síclovía in San Antonio.

DIABETES from 1A

Today, the city boasts an obesity rate at 28.5 percent — below the state average. To Mayor Julián Castro and other health advocates, the declining obesity rate is a testament to their efforts, a sign that their investment is paying off. Like Corpus Christi, San Antonio has struggled with some of the same Type 2 diabetes and obesity problems. When Men’s Health magazine named 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 had diabetes, and one-third were obese. (Corpus Christi has a 40 percent obesity rate and 17 percent diabetes rate.) While Corpus Christi residents looked for ways to drop pounds and get healthier, Mayor Castro decided San Antonio should aim not just to get off the fattest city list, but to become one of the nation’s healthiest, most active cities. He created a Mayor’s Fitness Council at the same time Corpus Christi did. And the council worked directly with the health department, which received a $15.6 million stimulus grant to develop anti-obesity strategies and programs. The collaborative took aim at the city’s diet and fitness habits, launching an array of initiatives to help transform the way San Antonio eats and works. They started citywide walking groups, a student ambassador program and helped launch free fitness classes at parks across the city in a program called Fitness in the Park. Last week there were 98 yoga,

Lorena Silva, of San Antonio (from left), celebrates as she crosses the finish line with son Ismael, 8, and husband Juan during Síclovía in downtown San Antonio. Lorena Silva said this was her first time completing a 5K, inspired by her participation in the YMCA’s Y Living program she participated in with her family over the summer.

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 Mayor’s Fitness Council is Síclovía, an event modeled after Bogotá, Columbia’s Ciclovía, where the city closes off more than 70 miles of their streets for residents’ use. Started in 2011 with 15,000 people, Síclovía 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 Mayor’s Fitness Council. “If Austin is asking us, this is great.” At the September event, 73,000 people attended, despite the morning’s threatening rain clouds, and flooded the streets with every form of 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 borrowed rides from B-cycle,

San Antonio’s 2-year-old bike-sharing program. Few and far between were the serious cyclists with their spandex and aerodynamic helmets. Thousands of cyclists cut through the heart of the city, rolling down Broadway alongside 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 you’d see at a parade. If people stopped, they did

Erica Median, a nutrition student at the University of the Incarnate Word, hands out samples of a healthy wrap Sept. 29 during a healthy cooking demonstration by H-E-B at Síclovía in downtown San Antonio.

so to check out a combat who tried kale for the first class or a cooking dem- time. Or Lorena Silva, 27, onstration, hanging their who ran her first 5K. Silva said she never unlocked bikes on a portable rack propped up on would’ve had the energy and endurance for the race the sidewalk. In a parking lot near a before, but then she got inrow of food trucks selling volved in the YMCA’s free vegan fajitas and a yogurt, healthy living program ofgranola and agave nectar fering nutrition education concoction, Donna and and fitness classes and a Eric Edison, of Ingleside, free three-month memkicked around a soccer bership at the end. In the ball with their kids while past, her weight prevented a nearby disc jockey blast- her from playing with her ed pop music from his 8-year-old son. “He would always want speakers. It was their first Síclovía, and they were im- to go to the park, and I would say, ‘No, pressed. no,’” she said. “I It’s certainly always had an exsomething Corcuse. And then I pus Christi could thought, ‘I’m not replicate, Donna Get a look even 30 yet.’” Edison said. Now that she’s “I think it would inside completed the probe cool,” she said. some of the activities the gram, she realizes The beauty of Sí- San Antonio it’s easier than she clovía, and perhaps Mayor’s a reason why it’s so Fitness Council thought to eat right and exercise in San popular, is because is hosting to Antonio. it’s not really seen keep the city “The park has as fitness or exer- fit. fitness stations, cise, but rather as from beginner a family-friendly event, more active than a to advanced levels,” she health fair but more chill said. “You don’t have an excuse, even if you don’t than a race. “I hear people say it re- have money.” Beyond Síclovía’s good ally is San Antonio’s most organic wellness event,” attendance figures, it’s also said Sandy Morander, making a measurable difdirector of the YMCA ference, organizers say. More than two-thirds of of Greater San Antonio, which took over opera- the 373 people surveyed at tion of Síclovía and kept it the April event came from afloat after the city’s fund- ZIP codes known for high ing ran out, offsetting the to extremely high levels of $150,000 price tag with do- obesity. Nearly half said nations from corporations they tried a new physical activity at Síclovía, and 57 such as H-E-B. It’s a chance for people percent said they would to try something new. Like Elva Escamilla , 47, See DIABETES, 11A

VIDEO


C A L L E R -T I M E S

« Sunday, November 3, 2013 « 11A

from the cover

Captain HUMAN with the Healthy Vending company mounts his bike along side Jackson Rogers, 8, of San Antonio, Sept. 29 during the kickoff for Síclovía in downtown San Antonio.

photos by Michael Zamora/Caller-Times

Cyclists, skateboarders and pedestrians take over Broadway Street on Sept. 29 during Síclovía in San Antonio.

DIABETES from 10A

not have been physically active that day had they not attended Síclovía. But despite San Antonio’s improved statistics, the city still has work to do. The health department noted that obesity rates rose for people 65 and older, underscoring the need for more outreach to that population. And the percentage of overweight people increased, as well. Doctors define 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 city’s biggest challenges is healthy eating, Dahlstrom said, acknowledging the need for more nutrition education that’s culturally relevant. That’s a tough balance in a city known for its TexMex. On a Saturday night at the landmark Mi Tierra café, there was a wait even though the restaurant seats more than 500 people. The line for the restaurant full of tourists and locals bled into another line at the glowing glass display case of bakedfresh pan dulces where customers waited, paper numbers in hand, to order a fat gingerbread pig or a glossy lump of dulce de calabaza the size of a baseball. The thick rectangles of pecanstudded leche quemada were so packed with sugar they sparkled. “We’re a town that just loves to go out and eat,” said Valerie Gonzalez, who owns Delicious Tamales of

Cyclists use rented bikes available at locations throughout the central part of the city.

San Antonio. Although her business has grown from a $500 investment in 1980 to a multimillion-dollar corporation that ships 2.1 million tamales per year across the United States, Gonzalez recognized that there was a customer base she was missing: vegetarians. So four years ago, when she was approached by a coalition 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 restaurant association, the ¡Por Vida! restaurant recognition program identifies menu items deemed nutritious based on a dietitian’s 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 halfgram of trans fat, and 750 milligrams of sodium. While a similar program in Corpus Christi fell short of its expectations — program leaders said the

mom-and-pop eateries they targeted were worried it could hurt their bottom line — Gonzalez recognized a chance to grow her business. She added to the menu Southwestern vegetable tamales. Made with canola oil, they’re filled 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 it’s healthy label, it’s popular, Gonzalez said. “People like it once they taste it,” she said. “It’s very easy to have at least a product that’s 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 Antonio’s attitude, and she credits Castro for prodding the city to get fitter. “He’s always thinking about the health of the people in San Antonio,” she said. “I’m very proud of what he’s done with the city ... strong leadership. That’s what you need for a city to turn around.” Twitter: @CallerRhiannon

Participants work out with a Zumba instructor, one of the multiple fitness and activity stations set up along the route Sept. 29 during Síclovía in downtown San Antonio.

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