FRESNO, Calif. (FOX26) — Fresno County has more amputations than nearly any other county in California.
A big part of that, is because the Central Valley is dealing with a diabetes crisis.
One study out of UCLA finds almost half of adults in Fresno County alone have pre-diabetes, and doctors are overwhelmed.
They say too many aren't taking measures to keep their diabetes under control -- or taking the disease seriously.
FOX26 News reporter Liz Gonzalez talked to 37-year-old Alex Ramirez, who was diagnosed with diabetes at the age of 30, which is considered young, but it runs in his family.
"I have a grandfather that's diabetic. My mother is diabetic," says Ramirez.
Diabetes can lead to many complications.
Ramirez immediately took steps to take better care of himself. "Soda was my favorite thing. Pepsi, all the time," he says. "It was like taking your favorite toy away."
He lost a lot of weight.
But one misstep in the Fall of 2018 changed everything.
He stepped on a sticker or thorn in his yard, while chasing his dog. "I didn't notice it. It wasn't that big. As days went by, it got worse and worse," Ramirez says.
Days later, he stubbed the same foot on a wall. In a matter of days, "The top of my foot was black. I thought it was a bruise on my foot. I tried to self-heal, use an ice pack," he says.
He developed cold-like symptoms, but kept up his daily activities and going to work. "On my way to work, I passed out on the freeway," he says. "I woke up and cars were honking at me. I pulled over on the freeway, called my wife and told her I’m going to the hospital."
"We thought it was the flu," says his wife, Patricia.
Doctors immediately helped him.
He learned the foot, that he thought was just bruised, was infected. "They started putting IV's in me, giving me medicine. The doctor told me he was going to have to amputate," Ramirez says.
Dr. James Lee was Ramirez's vascular surgeon.
Last year, Dr. Lee performed just over 50 amputations -- almost one amputation a week. "There are way too many amputations I'm performing on a week-to-week basis," Lee said.
FOX26 News used the state public records act to investigate why our area has such a high number of amputations.
We got documents from the state that paint a frightening picture.
Fresno County had 598 diabetes-related lower limb amputations in 2017.
That means parts of legs or entire legs had to be removed.
That translates into 60 per 100,000 people -- a big jump from 38 per 100,000 in 2010.
Fresno County now ranks second in the state, behind Yuba County, which had 68 amputations per 100,000 people.
And other counties in our area aren't much better.
Merced County had 57 per 100,000.
Tulare County had 50 per 100,000.
Compare that to 35 per 100,000 in Los Angeles and San Diego Counties.
There were 25 amputations per 100,000 in San Francisco.
"The frustrating part and sad was that many of those amputations could have been prevented with the appropriate education on the patient's part," Lee said.
Lee says one crucial mistake diabetic patients make is not caring for their feet as they should. "When you or me, a non-diabetic, injure our foot or have an ulcer, we say, 'Ouch,'" Lee says. "But in a diabetic population, since they don't have sensation, they can let the infection go on for many, many days."
Lee says too many are waiting too long to see a doctor when they spot an injury. "One day, they look down and there's pus coming out. Necrosis and gangrene," Lee says.
Some blame the lack of doctors they can see, or a lack of transportation to appointments, while others say it's because of their insurance company.
And, in that time, "It can spread from toes to foot and sometimes even to the leg. By that time, it's too late for me to do any intervention to spread an amputation," Lee says.
In Ramirez's case, the infection had spread so much it took three surgeries to clean out the bacteria.
He lost his lower leg, too.
He now relies on a wheelchair, until he can be fitted with a prosthetic leg. "If you stub your foot, bruise your ankle, if you're diabetic and hurt anything, go to the doctor," Ramirez says. "I could have been at home with my kids and not woken up."
According to the Office of Statewide Health Planning and Development, more than three of every five lower-limb amputations in Fresno County are paid for by Medi-Cal or Medicare.
In 2017, taxpayers spent more than $28 million on amputations in Fresno County alone.
According to the American Podiatric Medical Association, the average cost of each amputation is $70,434.