Panel to Discuss Entrepreneur Anxieties Fueled by Coronavirus Pandemic
This story was originally published by San Antonio Report and can be found here
In an effort to address the unique challenges small business owners and entrepreneurs have faced during the coronavirus pandemic, the San Antonio Hispanic Chamber of Commerce (SAHCC) is hosting a mental health webinar on Thursday to discuss stress and anxiety in the business community. The goal is to help “normalize the conversation” and empower those in need to reach out for help. “The mental health concerns experienced by [small business owners] and entrepreneurs is something that we have seen” increase over the years, with more people dying by suicide and experiencing crises, SAHCC Chairwoman Dr. Erika Gonzalez said. “When the pandemic occurred, there were more and different mental health issues that arose as small business owners struggled to keep their doors open and people employed.” The COVID-19 Mental Health Webinar, moderated by Rivard Report Editor and Publisher Robert Rivard, will discuss mental health challenges for small business owners, including entrepreneurs with children juggling work and home life demands, stresses and risks involved in owning a small business, and information about available resources for those needing support. Panelists include Clarissa Aguilar, behavioral health consultant with the Center for Health Care Services, Bexar County’s mental health authority, Adriana Dyurich, a licensed counselor with UT Health San Antonio, and Dr. Ted Williams, founder of Genesis Psychiatric Center and UT Health San Antonio psychiatry professor. Dr. Lyssa Ochoa, chair of SAHCC’s healthcare and bioscience committee, said the panelists were selected because of their mental health expertise but also their entrepreneurial experiences that “help give insight and reflection into the stresses of small business ownership.” “How small business leaders have been handling the stress of COVID-19 is something important to talk about because mental health has quite a stigma attached to it, and at the same time, we have the least resources in San Antonio [to address it],” Ochoa said. “If a person had a previous mental health concern, it might be even worse for them now, and we need people to keep checking in on how they are being impacted.” Ochoa said SAHCC’s health and bioscience committee had planned to spend this year creating a health and wellness program for employees of small businesses that included a strong mental health component, but “this pandemic turned everything upside down” and the focus shifted to the employers. The committee is now dedicating that time to discussing how the anxiety and uncertainty already attached to the entrepreneurial experience is exacerbated due to coronavirus, and that it is more important than ever to reach out for help. “As small business owners, we are used to handling stressful situations, but we are trying to make sure we put out there that despite the ability to handle stress, it’s OK if a person needs help,” Ochoa said. The webinar will air on Zoom from 10 a.m. to 11:30 a.m. on Thursday, May 28, and is open to the public free of charge. To register in advance, click here.
Roseanna Garza


Roseanna Garza reports on health and bioscience for the San Antonio Report. 

City officials collect more than 16,000 cloth face coverings to donate to senior centers

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

On The Record | COVID-19 impact on telemedicine

This story was originally published by PBS and can be found here
  Host T.J. Mayes talks with Dr. Erika Gonzalez, CEO of STAAMP Allergy, about how the COVID-19 pandemic might have changed the future for telemedicine. San Antonio Chamber of Commerce President and CEO Richard Perez discusses the return of customers to business, and why the next step for success is to make customers feel safe. Aired: 05/14/20 Rating: NR

How to distinguish allergies and COVID-19 symptoms, according to a San Antonio expert

This story was originally published by MYSA and can be found here
The coronavirus pandemic has added a layer of uncertainty and anxiety to allergy season. San Antonio residents are turning to professionals to make sure their symptoms are allergies and not something else.
Dr. Erika Gonzalez of South Texas Allergy and Asthma pointed to a couple of symptoms that can help people tell the difference. "If they're having a dry cough and fevers, then that definitely should clue them in that this is not allergies," Gonzalez said. "It's not necessarily COVID — it could be another flu or another virus — but it's not allergies." Itching, on the other hand, is associated with allergies. "If people are having itchy eyes, itchy nose, itchy throat, or even itchy ears — you know when your ears are itchy inside — that's a very reassuring symptom that this is an allergy," Gonzalez said. The allergist noted that people should feel reassured if their symptoms improve after taking an antihistamine like Zyrtec or Allegra. If you have something other than allergies, you're not going to feel better by taking those medications. Gonzalez screens patients for COVID-19 and can test for the virus at her practice if they meet the criteria. So far, there have not been any positive cases. The primary treatment for any allergy is to avoid the allergen, Gonzalez said. But that's difficult as people seek any way to get a little fresh air under a stay-at-home order. While Gonzalez would not recommend against going outside, she did advise people with allergies to avoid peak pollen times early in the morning. She also said taking an antihistamine 30 minutes before going outside can alleviate symptoms. Plus, those masks we're all being asked to wear will decrease our exposure to pollen, she said. There has been plenty of pollen to avoid this year. Gonzalez noted that oak allergen counts reached a peak of about 3,000 last week, the highest in at least 10 years. On Tuesday, oak — the pollen that leaves a yellow powder behind — counts stood at 2,380. Expect the high pollen levels to stay with us through April, then dwindle in the beginning of May. The levels tend to rise two to three days after rain. Gonzalez said people who suffer from allergies can start with over-the-counter medications, before moving to nasal sprays or allergy shots if necessary.

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 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 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. 

San Antonio’s Top Doctors 2020

Allergy & Immunology

This story was originally published by San Antonio Magazine and can be found here
Erika Gonzalez South Texas Allergy & Asthma Medical Professionals 10447 Hwy. 151 210-616-5385

“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.
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