Embrace family, friends with your heart during the COVID-19 pandemic

This story was originally published by NEWS4SA and can be found here

High Pollen Counts Provoke Angst for Those With Allergies

High Pollen Counts Provoke Angst for Those With Allergies

This story was originally published by San Antonio Report and can be found here

San Antonio saw whopping pollen counts over the past week, with oak dust skyrocketing to 30,900+ parts per billion on March 30 – some of the highest counts in a decade.

The severe pollen load has made those who suffer from allergies wonder if they are more vulnerable to the novel coronavirus than those who manage to escape the seasonal sniffling, sneezing and itchy eyes common to the Alamo City, which is considered an allergy hotspot.

“I’m probably super paranoid like most since all this COVID-19 viral pandemic, but I started feeling a sore throat coming on and I’m freaking myself out,” Nikki Rabon posted in the San Antonio Covid-19 Coronavirus Community Care Facebook group. “Anyone else? Probably just allergies….”

Rabon’s comment generated 143 comments, including this one from Anne Therese Cakins: “I suffer from allergies and asthma…I freak myself out on the daily! Trying to stay calm, though.”

“People are rightful to be anxious,” said Dr. Erika Gonzalez, CEO and president of South Texas Allergy & Asthma Medical Professional. Symptoms for allergies and coronavirus are similar, but the immune mechanism behind allergies is not the same one that would be involved with coronavirus.

Generally, those with seasonal allergies endure itchy eyes, runny nose, sneezing and wheezing and possible shortness of breath. Coronavirus symptoms generally include dry cough, tiredness, and fever.

“If you get a fever, it’s not allergies, but some type of viral infection,” said Gonzalez. “Sneezing and itching – those are ‘good signs’ that it’s allergies and not viral.”

People with allergies generally have stronger immune systems than nonallergic folks, since their bodies are overreacting to perceived threats, said Dr. Robert Ramirez, immunologist with the Certified Allergy Asthma and Immunology Center.

“It takes a strong well-coordinated immune system to pick out allergens in our environment to mount immunity against,” said Ramirez.  “I often use the word ‘bias’ when describing how and why the immune system would attack these seemingly harmless targets.”

That said, when pollen levels get this high, even people who are not allergic to oak will begin to have allergy-like symptoms. “This reaction is more of an irritant or pollutant response rather than an allergic mechanism,” Gonzalez said.

Those receiving allergy treatment, however, are wondering if it’s wise to continue receiving allergy shots given coronavirus social distancing guidelines.

allergy serums
Allergy serums are ready for use in treating seasonal allergies. Credit: Courtesy / South Texas Allergy and Asthma Medical Professionals

Typically, allergy treatment involves getting injections of specially concocted serums that allow patients to gradually build their immunity to allergy-causing compounds. At the beginning of treatment, injections are generally administered multiple times a week. Over time, the dose is increased and frequency reduced. This can take several years, involving a shot once every month or less.

A routine allergy shot requires heading to a doctor’s office, signing in, waiting your turn, getting an injection, then sitting for 30 minutes in the waiting room to make sure no adverse reaction to the shot occurs.

Allergy doctors have had to adapt to a new reality in the wake of the coronavirus pandemic. Ramirez is administering allergy shots and injectable biologics in the office breezeway of his practice’s Lincoln Heights location.

“They drive up, they call us, we come outside and meet them in the covered breezeway, and they wait the 30 minutes in their car,” said registered nurse Jackie Sorenson, adding that the office only takes one patient at a time.

Gonzalez is offering “drive-thru allergy shots.”

Established patients call the doctor’s office from the parking lot. A medical assistant draws up the patient’s custom allergy serum, dons PPE, then goes out to the car to administer the shot.

“The patient then waits in the car for the appropriate amount of time, and upon completion of their waiting period, our medical assistant goes out to the car to check in on them and discharge them home,” said Gonzalez.

If patients prefer to come into the clinic, they can stay in the waiting room where chairs are spaced at least six feet apart. “We keep the number of patients at a minimum and don’t have more than one or two patients in the clinic at the same time,” said Gonzalez.

When consultations are necessary, doctors are adopting telemedicine.

“Telemedicine is something that a lot of doctors have considered incorporating at some point in their careers,” said Ramirez. “Now, with the loosening of restrictions by Governor Greg Abbott, it’s easier to implement,” he said, referring to the governor’s March 17 waiver of restrictions on telemedicine. Doctors and insurance companies can now charge and collect for phone visits just as they would for in-person visits.

With recent rains, sunny days, and longer, hotter seasons ahead, high pollen counts will continue through May, perhaps longer.

“Global warming has prolonged all our pollen seasons and made them worse in the sense that they linger for a longer time,” said Gonzalez.

In the meantime, doctors recommend those with allergies embrace the same best practices as the general public.

“Wash your hands. Stay home. Be nice to each other. We will get through this,” said Ramirez.

Monika Maeckle


San Antonio Report co-founder Monika Maeckle writes about pollinators, native plants, and the ecosystems that sustain them at the Texas Butterfly Ranch website. She is also the founder and director of… 

In San Antonio, Asthma Hits Kids in Low-Income Zip Codes Harder

In San Antonio, Asthma Hits Kids in Low-Income Zip Codes Harder

This story was originally published by San Antonio Report and can be found here

After she found out her children had been denied free state health insurance, Jessica Gutierrez started crunching the numbers.

With a 6-year-old daughter and 4-year-old son in need of regular medication to treat the asthma they’ve both had since they were babies, Gutierrez was faced with a tough choice: buy health coverage through the federal exchange or go with her employer’s plan, even though it would eat up most of her recent raise. Plus, the rent on her Westside house near Woodlawn Lake just went up.

Editor’s Note

Disconnected is a series about economic segregation in San Antonio.

The series debuts a new story every Monday and looks at economic segregation through the lens of the major beats the Rivard Report covers. The goal was to create a human-centric look at one of the city’s biggest problems.

For more information on why we chose this project or to catch up on any missed stories, visit the Disconnected home page.

“That just means it’s going to put me back to where I’m not bringing home as much as I originally thought I would,” Gutierrez said. “I feel like I take five steps forward and then I have to take three steps back. … But their health is very important for me, and we have these medications every month, and I have to have insurance for them.”

Gutierrez and her kids are among the thousands of San Antonio families dealing with asthma, a complex disease that robs people of breath as their airways constrict and fill with mucus.

Health experts also have said asthmatics are at high risk of serious illness if they contract COVID-19, the disease that has infected nearly 170,000 people around the world, including three San Antonio residents, and caused the death of nearly 7,000 people worldwide. San Antonio officials have not yet confirmed that the virus is spreading from person to person in the community, though many health experts believe that’s only because of a lack of available testing.

State health records show that San Antonio consistently has the highest asthma rates of any major city in Texas. However, a closer examination makes it clear that asthma does not affect all parts of the city equally.

Zip codes in low-income neighborhoods on the East, West, and Southwest sides had some of the highest rates of people going to the hospital for asthma in San Antonio, according to public health data shared by San Antonio’s Metropolitan Health District.

“We see that areas that have higher poverty levels that are the ones that tend to have the most problems, and a lot of this has to do with access to care,” said Erika Gonzalez, an asthma and allergy doctor who also chairs the San Antonio Hispanic Chamber of Commerce.

From 2015 to 2017, the zip codes with the highest rates of asthma hospital visits were the near Eastside zip codes of 78203 and 78208, where hospitalizations added up to 14 to 15 per 10,000 residents on average over those three years.

That’s around five times higher than the hospitalization rate 2 miles away in 78209, which covers the wealthy enclave of Alamo Heights and the adjacent Broadway neighborhood of Mahncke Park. There, the rate is just over 3 per 10,000 people.

Gutierrez, 33, has spent most of her life in a neighborhood within the 78228 zip code, one of three Westside zip codes where rates averaged around 11 per 10,000.

Asthma has a strong relationship to allergies, and its triggers vary widely. Pollen, air fresheners, smoke, cleaning products, mold spores, smog, pet dander, dust mites, cockroaches, and rodents all can bring on attacks, under certain circumstances.

Aside from the human costs of poor health and premature deaths, asthma also can drag down a region’s economy when it leads to days of missed work and school. Researchers with the American Thoracic Institute and New York University have estimated that San Antonio’s ozone pollution alone is responsible for nearly 107,000 instances in 2019 when a person had to miss work or school because of a lung condition

“There is a financial burden of asthma on the government and on residents,” said Haley Feazel-Orr, an epidemiologist at the San Antonio Metropolitan Health District. “It takes up taxpayer dollars and insurance money, and [it affects] hospitals when someone can’t pay for their hospital bills because they had to go the emergency room because they were having an acute attack.”

Jessica Gutierrez walks with her children Zara and Josiah Walker down the waterfront at Woodlawn Lake Park. Credit: Stephanie Marquez for the San Antonio Report

Finding Asthma Triggers

Health researchers have noted that asthma tends to run in families, though its genetic influences are complicated. Gutierrez and her brother both developed asthma as children. As an adult, she still experiences the coughing, wheezing, and shortness of breath that characterizes the disease.

Doctors diagnosed both of her kids by the time they were a year old, Gutierrez said. She recalls when she used to lug around the machine used to administer albuterol, the bronchodilator medication that helped open their tiny airways when they suffered attacks.

It took a visit to an allergist around a year and a half ago to find out what triggered their attacks, she said. They each got an allergy test, conducted with a series of pinpricks to see if their skin reacted to certain allergic triggers. Gutierrez found out that she’s mostly allergic to mountain cedar. For her son, it’s mold spores. Her daughter suffers from grass allergies.

Once Gutierrez knew this, she could plan ahead for allergy seasons. Plus, she found a doctor who would answer her phone calls, offering advice that could keep the family out of urgent care clinics.

“We’ve been under control for about a year and a half already,” she said. “It’s been a while since we’ve had to go in [to urgent care].”

Lately, however, there’s been the question of insurance.

That became an issue only after her recent raise, when she took a new job as an administrative coordinator at the nonprofit SA2020. It boosted her income to a level at which her kids no longer qualified for the Texas Children’s Health Plan, she said. She thinks she’ll go with her employer’s insurance plan, even though the extra money she’ll pay in premiums will eat up all of the extra money she’s bringing in.

Overall, asthma is still a factor in Gutierrez’s life, but not a barrier. After earning her associate degree in business administration, she expects to get her bachelor’s degree in the same field in the next couple of years. She’s also spoken to a mortgage lender who says she can get on the right track to eventually borrow enough to buy her own house. All of this has been easier with their asthma under control, she said.

“Right now, we’re in a really good spot compared to where we were three years ago,” she said.

Oak Pollen and Air Fresheners

San Antonio is home to several programs focused on helping people like Gutierrez learn how to manage asthma on a daily basis.

For example, the City’s SA Kids BREATHE program sends community health workers, also known as promotoras, into residents’ homes, teaching people how to find their asthma triggers and use medication properly. From May through November, the program had more than 80 participants.

“We’ve had positive outcomes, for sure,” said Paul Kloppe, a respiratory therapist who oversees and mentors the team of health workers who visit participants’ homes three to five times over a six-month period.

However, there’s been much less local interest in tackling one of the broader issues associated with asthma: poor air quality.

Federal regulators consider San Antonio’s air quality to be officially unhealthy because of ozone, a pollutant tied to vehicle exhausts, industrial sites, and chemical use, among other sources. In Bexar County, nearly 60 percent of emissions of the nitrogen oxides that help form ozone come from mobile sources, such as vehicles and construction equipment, according to the Texas Commission on Environmental Quality (TCEQ).

(From left) Danny and Lisa Olivares, with neighbor Marie Smith, look at the Monarch Silica sand mine from the Olivares’ property on the South Side. Credit: Bonnie Arbittier / San Antonio Report

Despite this, the TCEQ this year produced a study focusing on the relatively small amount of ozone wafting in from foreign countries as part of an argument to federal authorities to avoid more stringent air quality regulations in San Antonio.

At a February TCEQ hearing, Alamo Area Council of Governments (AACOG) Executive Director Diane Rath, San Antonio Chamber of Commerce CEO Richard Perez, and Bexar County Commissioner Kevin Wolff (Pct. 3) all praised the study. Each emphasized the negative effect that more stringent air quality rules could have on the local economy.

During the hearing, which lasted less than an hour, Terry Burns, a retired doctor who chairs the Alamo Group of the Sierra Club, was the only speaker to mention public health.

“As a physician, I think that should be remembered that … the purpose of this activity we’re all engaged in [is] to protect people’s health,” Burns said. “I call upon San Antonio and the AACOG to actually get busy and take action to reduce our local ozone production.”

Some asthma triggers are beyond anyone’s ability to control. Some of the worst times for asthmatics are during the dreaded Ashe juniper season, December through February. Oak pollen and mold spores also spike at different times of the year.

Others factors are up to individual choices, such keeping a clean home, not smoking, and avoiding fragrant products. These factors are often the focus of Diane Rhodes, an asthma educator with North East Independent School District who in early March taught a free class for parents.

Diane Rhodes, asthma educator for North East Independent School District, sits behind her desk with visual aids she uses to teach children about that triggers asthma attacks.
Diane Rhodes, asthma educator for North East Independent School District, sits with the visual aids she uses to teach children what triggers attacks. Credit: Brendan Gibbons / San Antonio Report

“Asthma doesn’t happen overnight,” Rhodes explained to her lone attendee, a mother of five children. “It happens over a period of days.”

Rhodes explained how allergic and other triggers stack up until a person reaches a “symptom threshold” and suffers an asthma attack. An asthmatic might be OK during a smoggy day in the middle of oak pollen season until they enter a room with too many air fresheners. Identifying triggers is the way to get to a normal life with as little medication as possible, she said.

That’s how the fight against asthma in San Antonio continues – family by family and home by home.

“We have the time to meet families, to get to know families,” said Tracy Compean, a community health worker with SA Kids BREATHE.

‘Just Keep Moving Forward’

Recently, Compean and Kloppe have been visiting Monica Casillas at the mobile home park in south Bexar County where she lives with her husband, Miguel, and their 8-year-old son, also named Miguel.

A former elementary school teacher, Monica Casillas met her husband in 2007 at a family barbecue. They fell in love, and she ended up leaving teaching to raise their son. Now, young Miguel has severe health problems, including asthma and diabetes. An asthma attack landed her son in the hospital in November, she said.

“He turns red and can’t stop coughing,” she said.

For a long time, her husband made a living doing landscaping and construction work, despite having high blood pressure and diabetes, she said.

But starting last April, he suffered a series of four strokes and has not been able to work since. The family could end up waiting until next year to hear whether her husband qualifies for health insurance through Medicare, which is available for certain people under 65 with disabilities. For now, the family is uninsured, and their medical bills are stacking up, Casillas said.

Free programs are helping fill some of the gaps. Casillas found out about SA Kids BREATHE through a City social worker who also helped her son get enrolled in a homeschool curriculum through his district. Compean has been able to find them free food and clothing through local charities and government programs.

“San Antonio has a lot of resources,” Compean said during an interview last week at the Casillas home. “I have a lot of connections I can call upon.”

However, those resources can be intermittent, with funding and other support sometimes running out, Compean said. Coordinating her family’s care is also a full-time job for Casillas, who said she spends hours on the phone talking to health providers, social workers, and others who might help. That’s in addition to her efforts to make sure her son and husband get the daily monitoring and medication they need.

Still, Casillas said the asthma issues have been better since getting her son on the right medications. Sometimes, however, the challenges can seem overwhelming.

“Just keep moving forward, and have patience,” Casillas said. “That’s all you can do.”

Brendan Gibbons


Brendan Gibbons is the San Antonio Report’s environment and energy reporter. 

“A light Mt Cedar is worse than a bad anything else,” says local allergist

This story was originally published by News4SA and can be found here

If you’re feeling a bit under the weather, it may be because of mountain cedar. Friday’s count is extremely heavy at 17,770.

“So he would always scratch his eyes – he would scratch them so much he would start getting cuts around his eyes,” said Veronica Reyes, mother of allergy sufferer.

According to allergy specialist, Dr John Dice of South Texas Allergy & Asthma Medical Professionals, STAAMP, we are in the peak of mountain cedar season.

“It usually explodes around the last week of December, the first week of January,” said Dr. John Dice, STAAMP Allergist.

Mountain cedar trees thrive on these dry, sunny days and they’re producing billions of grains of pollen each day.

“Compared to other pollens, most pollen never even make a thousand, so mountain cedar is in its own category and even a light mt cedar is worse than a bad anything else,” said Dr. Dice.

Max Reyes is highly allergic to mountain cedar and his family would go to all extreme measures to make sure his symptoms get better.

“At my jualita’ s house they literally had to put really big ice pack and wear towels on my eyes so I can just see, but it was actually pitch darkness because it was on top (of my eyes),” said Max Reyes, Mt Cedar sufferer.

The next cold front is Monday .. so we can expect the counts to be in the tens of thousands again early next week. Mountain cedar season usually tapers off around February 10th.

Hispanic Chamber’s Erika Gonzalez Wants to Keep Small Businesses Healthy

Hispanic Chamber’s Erika Gonzalez Wants to Keep Small Businesses Healthy

Hispanic Chamber’s Erika Gonzalez Wants to Keep Small Businesses Healthy

Dr. Erika Gonzalez, who leads a large allergy and asthma practice, is the 2020 San Antonio Hispanic Chamber of Commerce Chair-Elect. Credit: Scott Ball / San Antonio Report

Dr. Erika Gonzalez joined the San Antonio Hispanic Chamber of Commerce in 2014 when she started her private practice and soon became involved in the group’s efforts related to health care and biosciences.

Starting in January, Gonzalez ascends to chairwoman of the board, a role she plans to use to amplify her voice on issues impacting the San Antonio business community, including health, and encourage others to do the same.

“I think it’s important for the Latino community to realize that our chamber was first started as the voice for the small-business community at a time where the Latino small businesses didn’t have a voice,” Gonzalez said. “I want to empower the community to realize that they have platforms and when we speak up, on whatever the issue may be, there’s a lot of power and a lot of change can happen with that.”

The daughter of immigrants – her dad was an Air Force veteran who served as a physician’s assistant and her mother was a dentist – Gonzalez grew up in San Antonio with two sisters and a brother. She attended Health Careers High School and St. Mary’s University before earning her medical degree at the University of Texas Medical Branch at Galveston through the military’s Health Professions Scholarship Program.

Gonzalez’s career as a physician began at Keesler Air Force Base in Biloxi, Mississippi, with a residency in pediatrics, then due to Hurricane Katrina, she went to Naval Medical Center Portsmouth in Virginia. She returned to San Antonio for a fellowship in allergy and asthma at Wilford Hall Medical Center.

“The military obviously is a great kind of opportunity to grow into yourself and to grow in leadership skills and abilities,” she said. “You learn by fire. You’re a young captain coming out of med school and they [tell you] ‘You’re in charge of this division now’ [even though you’ve] never done it in your life.”

Her nine years in the military taught the 43-year-old Gonzalez leadership, but it also inspired a sense of service.

“When I came out [of the service], I wanted to be making a difference in my own community, especially the community that I grew up in,” she said.

Gonzalez spent two years in private practice before being recruited to lead the allergy, immunology, and rheumatology division at Children’s Hospital of San Antonio for four years.

Those post-military medicine experiences were eye-opening for her, she said, as she watched her patients struggle with access to health care and affordability of treatment. She began working with the South Texas Asthma Coalition and the San Antonio Metropolitan Health District to develop a program called SA Kids BREATHE.

“So that really started to get to me and that’s when I started to become a lot more civically engaged,” she said. “And I’ve been blessed to be in a situation where I do have [practice] partners that are extremely supportive.”

Since 2017, Gonzalez also has served on the Mayor’s Commission on the Status of Women.

As president and CEO of the South Texas Allergy & Asthma Medical Professionals (STAAMP) and its clinical research center, Gonzalez leads three clinic sites staffed with two other former military physicians. She sees patients in the clinic three days a week and uses the other two days for administrative work, chamber leadership, and community service.

Gonzalez sought guidance from the Hispanic Chamber when setting up the practice, and early on, she was asked to serve on a chamber panel discussion of health care disparities in the community. “I was impressed they were tackling that issue and that they were trying to raise awareness,” Gonzalez said of her decision to lead a chamber committee.

In January, she will succeed Chairman John Agather, who leads an investment company specializing in real estate, aviation, and the music business, and plays acoustic rhythm guitar in a rock band.

“Erika Gonzalez is a retired veteran and dedicated physician,” Agather said. “She has been a quick study as a chair-elect of the full range of activities that the Hispanic Chamber engages in.”

Melissa Aguillon, a board member and president of the public relations firm Aguillon & Associates, described Gonzalez as “extremely impressive.”

“She knows the business climate first-hand, supports economic growth and development, and will be able to advocate on behalf of Hispanics in business and Hispanic businesses,” Aguillon said.

Board member and chair advisor Hope Andrade believes young entrepreneurs will be able to relate to Gonzalez and she will serve as a role model for others.

“The community will certainly benefit from her leadership, and I think it’s only the beginning – I think she’s got a bright future,” said Andrade, who served as chairwoman 20 years ago. “I’m looking forward to being alongside her, watching her as she just goes from one position to another because she has those leadership qualities.”

Dr. Erika Gonzalez

But Gonzalez has her eyes fixed on the coming year, and said she believes the position will provide her a platform to be able to have a bigger, broader impact.

“I would be doing a disservice if I didn’t take advantage of the opportunity that was presented to try to use it to raise awareness with some of these issues that are kind of important, because health care contributes to workforce development,” she said.

However, the issue of a local paid sick leave ordinance is one that Gonzalez will have to negotiate carefully. She said that her professional and personal experience inclines her to be in favor of the ordinance, but the Hispanic Chamber has opposed it as a mandated benefit. Thus, as a chamber leader, she will represent members’ interests. The ordinance remains in limbo because of a lawsuit.

“That’s been one of the more conflicting things for me as a physician because I also understand the impact that can have financially [on businesses],” she said. “It’s hard when you look at some of these small businesses and realize that their profit margins can sometimes be so thin that you really want to set them up to succeed.

“Obviously we’re very pro small business and I think that the majority of our members feel that it’s not in the best interest of small businesses to have that put on them.”

In San Antonio, the Hispanic Chamber is one of multiple groups representing business interests, a fact some say splinters economic development efforts in the region.

“I would kind of argue that there might be a lot of chambers, but they all have a place and they all have a role and they’re all making a difference,” Gonzalez said.

In 2020, the Hispanic Chamber will be working to raise awareness about the census as well as encouraging members to vote in upcoming elections. But Gonzalez also wants to see the chamber take the lead on health matters.

“As a physician, if I don’t use this platform now to help further some health care initiative, then shame on me, [and] one topic that doesn’t get talked about a lot that I’m an advocate of is mental health awareness,” she said.

It’s a new era for the chamber. The board hired Diane Sanchez as president and CEO of the Hispanic Chamber in early 2019 when Ramiro Cavazos left to head the U.S. Hispanic Chamber of Commerce.

Gonzalez isn’t the first physician in the chamber’s 90-year history to lead the board. But she is the first female physician who is also a veteran to serve as chairwoman.

Taking time from her busy practice is a priority for Gonzalez, who is also a mother to two young sons. “I think now more than ever with all the issues that are going on … health care needs to be represented at a lot of these tables where policy decisions are being made,” Gonzalez said.

“Historically, we haven’t had physicians … and so I think that most of us are realizing we need to be at the table to voice our perspective because it really does bleed into all of these other things that are crucial in our community.”

Shari Biediger


Shari Biediger is the business beat reporter at the San Antonio Report. 

Best Immunologists in San Antonio

This story was originally published by Kev’s Best and can be found here

Dr. Dice graduated from the University of Notre Dame and then received his medical degree from the University of Virginia.  He entered military service with the Air Force completing a residency in Internal Medicine at Wright-Patterson AFB in Ohio and a fellowship in Allergy & Immunology at Wilford Hall Medical Center in San Antonio.  He had a distinguished military career and achieved the rank of Lt. Colonel before leaving for private practice.  Dr. Dice loves to teach and has lectured on a variety of allergy-related topics at both the local and national level.

Dr. Dice is certified by the American Board of Allergy and Immunology and the American Board of Internal Medicine.


Allergy Testing, Patch Testing, Penicillin Testing, Rush Immunotherapy, HAE Treatment, Oral Challenges, Allergy Shots, Sublingual Immunotherapy


Address: 10447 TX-151, San Antonio, TX 78251
Phone: (210) 616-5385
Website: www.staampallergy.com


The staff is always friendly. Dr. Dice is really great. He listens to the individual needs and knows how to talk the children. He really works with the parent as well in planning for your child.” – s de luna

Dr Dice is awesome! Friendly staff too! Thank you for helping my son!” – Robmisty rodriguez

Cedar allergies to reach fever pitch this winter in San Antonio and South Texas

This story was originally published by San Antonio Express News and can be found here

Recent rains, especially following a long, hot summer, have benefited the Edwards Aquifer and lawns alike. But in addition to a bountiful blessing of mosquitoes (tamped down by last month’s cold snap), the rains also left the ash juniper trees in the Hill Country locked and loaded with pollen sure to make cedar fever sufferers miserable for the next several months.

“We’re bracing for it,” said Dr. Erika Gonzalez, medical director of the South Texas Allergy and Asthma Medical Professionals, which treats plenty of allergy sufferers. “Cedar season usually runs from mid-December to mid-February, but this year the first cedar pollen was detected on Dec. 1, two weeks ahead of schedule. And we expect it to last longer than usual, too.”

While the highest pollen counts ever recorded in the area occurred about 10 years ago, when they topped 90,000 grains per cubic meter of air, the count already has spiked to 18,000 several times this season.

To put that in perspective, Gonzalez said people start experiencing allergy symptoms — congestion, runny nose, itchy, watery eyes — when the pollen count reaches 20 or so. That’s 20, not 20,000.

The Asthma and Allergy Foundation of America recently named San Antonio one of the fall 2018 allergy capitals of the country. The city came in fourth overall, following McAllen, Louisville, Kentucky, and Jackson, Mississippi, based on pollen and mold counts, allergy medication usage and the availability of board-certified allergists.

Not long ago, that would have been bad news for Chris Willis. A “lifelong” allergy sufferer, he’s been getting allergy shots at the Gonzalez’s far West Side allergy clinic for about three months, and already his symptoms are diminishing.

“I couldn’t breathe, I couldn’t sleep, I had a sore throat and I sometimes missed work,” said the 32-year-old IT worker. “I’d have allergies all year, but cedar fever season was the worst.”

To protect yourself this winter, it’s important to understand the enemy. So here are some things you need to know about cedar fever.

First, despite the name, it’s not caused by cedar trees nor does it cause a fever. Instead, cedar fever is an allergic reaction to the microscopic pollen launched into the air by the male Ashe juniper tree. Prevailing winds can send these tiny grains hundreds of miles.

If they land on a berry produced by the female tree, the result is often a baby ash juniper. If they land in your nose, they can make your life torture.

That’s right, the symptoms that make you more miserable than those post-holiday credit card bills are nothing more than the unintended consequence of a complex woodland mating dance.

While ash juniper is a Texas native, back in the day it was restricted to canyon areas and along creeks, according to Jim Rooni, head of Central Texas operations for the Texas A&M Forest Service.

“Because we don’t generally have wildfires anymore, these trees have extended their range across about 12 million acres of the Texas Hill Country,” Rooni said.

As development spreads ever deeper into the Hill Country, he said he finds it funny when homeowners clear their property in the belief that eliminating the trees will eliminate their allergies.

“Cedar fever isn’t a local problem, it’s a regional problem,” he said. “I tell these homeowners to drop the chainsaw and visit the drug store.”

That’s where allergy sufferers should start the fight against the fever. In recent years, new drugs and strategies have become available that not only can prevent symptoms, they can actually cure the allergy.

Over-the-counter antihistamines such as loratadine (brand name Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra) target all the symptoms of cedar fever except the stuffy nose. For that, a saline nasal spray or neti pot can help flush out the nasal cavity.

Because these drugs aren’t as effective once symptoms have set in, it’s best to start early.

“We tell people to begin taking their meds at Thanksgiving, even if they don’t have symptoms, and to not stop until Valentine’s Day,” Gonzalez said.

More effective are nasal steroid sprays, such as fluticasone (Flonase), which has been available over the counter since 2015 and, by prescription, mometasone furoate (Nasonex). These do more than treat the symptoms, they help prevent the allergic reaction from taking place.

It can take 10 to 14 days for steroid sprays to reach their maximum efficacy, so it also makes sense to start using them before you start feeling symptoms.

Gonzalez recommends against long-term use of nasal decongestants such as oxymetazoline (Afrin). While they’ll clear up congestion in the short term, after about three days of use they’ll cause what’s known as a “rebound effect,” in which the congestion gets worse than it was initially.

For those truly hindered by cedar fever, allergy immunotherapy can often cure the condition, although this can take three to five years.

“The full course takes a while, but you may start seeing results in as little as five months,” Gonzalez said.

Fourteen-year-old Andrew Palacio has been getting shots at the clinic for eight months and said he’s already seeing benefits.

“My allergies would make my eyes so puffy I couldn’t open them,” Andrew said. “I had headaches and would sometimes even miss school.”

He said he hopes things will continue to improve, although the cedar pollen already is so thick that he’s had to take an occasional Zyrtec.

“I just needed an extra little boost,” he said. “But I’m feeling much better.

And those results are nothing to sneeze at.

This article has been updated to correct the spelling of Ashe juniper.

Operation Rapid Relief: Dr. Joel A. Reyes, DO

This story was originally published by MD Monthly and can be found here

As a physician who frequently deals with life and death situations, it is hard to believe that Dr. Joel Reyes at one point did not even want to go into medicine. Born in Baguio City, Philippines, he grew up in a family where music was always in the air and politics, both Filipino and American, was the talk in the household. His mother was a teacher for several years, as was his father who was even the principal of a high school at one point.

Even though in 1983 they were successful owners of a restaurant and a poultry business, they decided to immigrate the whole family to the United States in order to give their children better opportunities.

Growing up in Northern California, Joel was heavily involved in music playing, first the flute, drums and then the clarinet. In middle school, his teacher gave him the school tenor saxophone, an instructional book, directed him to the practice room and told him to learn how to play. He played the saxophone throughout high school and considered music as a career until one summer when he was visiting his aunt in a hospital intensive care unit. This visit inspired him to look into medicine, and he decided, after graduating second in his class, that he would become a doctor.

He entered and successfully completed New York University’s pre-medicine program, but he could not quite quit the music. In 1998, he received a bachelor’s degree in music performance, Jazz/Contemporary Studies. After a year off and working in New York City, he moved to Kirksville, Missouri to attend the Kirksville College of Osteopathic Medicine, now the A.T. Still University.  During this time, he received a scholarship through the Air Force’s Health Professions Scholarship Program. After two years in Kirksville, he successfully completed his clinical medical school training in various hospitals in St. Louis and Kansas City, Missouri, subsequently receiving his Doctor of Osteopathic Medicine degree in 2003.

His first official assignment through the military was his pediatric residency at Keesler Medical Center, an Air Force hospital at Keesler AFB in Biloxi, Mississippi. That is where he met his future wife, Dr. Erika Gonzalez, who was also a pediatric resident in the program. In August 2005, Hurricane Katrina swept through the Gulf Coast, and as a result, the hospital and program was shut down. After picking up the pieces and moving, he finished his residency in the Naval Medical Center – Portsmouth in southeast Virginia.

In the summer of 2006, he started a pediatric critical care medicine fellowship at the Texas Children’s Hospital, but after a year, Reyes transferred to the program in the University of Texas Health Science Center at San Antonio in order to be closer to his wife, whom he married in 2007. He completed his training in 2009 and was back in uniform as one of two pediatric critical care physicians in the whole U.S. Air Force.

Reyes served as a pediatric intensivist at Wilford Hall Medical Center and then the San Antonio Military Medical Center, and eventually, he took over as the medical director of the Pediatric Intensive Care Unit at SAMMC from 2011 to 2015. Starting in 2011, Reyes began working at Doernbecher Children’s Hospital in Portland, Oregon on his free time.


In 2012, he was deployed to Bagram Airfield in Afghanistan to serve at the Craig Joint Theater Hospital. Although he was there primarily to take care of the civilian Afghan children caught in the crossfire, as an intensivist, he was also able to assist in taking care of the critically injured American and NATO ally troops. He returned home after six months, just in time for the birth of his second son. A year after returning from his tour, Reyes was also moonlighting at the Children’s Hospital of San Antonio, and he continues working with that group as a pediatric intensivist and has an appointment as an Assistant Professor of Pediatrics through the Baylor College of Medicine. In 2015, after 12 years of service, he separated from the military at the rank of Lieutenant Colonel and was awarded the Meritorious Service Medal.

In addition, he started working at the PICU in El Paso Children’s Hospital at the end of 2015, which he finds especially rewarding because of the huge need of pediatric specialists in that city. He also now helps with the operations of South Texas Allergy & Asthma Medical Professionals, an allergy clinic located at Westover Hills.

Dr. Reyes is very active with the San Antonio Hispanic Chamber of Commerce and sits on the Executive Board as the chairman of the Healthcare & Biosciences Committee. He also recently joined the ARTS San Antonio board of directors and sits on the Artistic Planning committee helping bring great performers and artists to the city. He is passionate about exposing more children to the arts. He currently lives in San Antonio with his wife Dr. Erika Gonzalez-Reyes and their two 4- and 6-year-old sons, and he continues to love playing music,  especially making up songs with his boys.


For more information visit www.staampallergy.com or call 210.616.5385. STAAMP Allergy is located at 10447 TX-151 in San Antonio, TX 78251.

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