AUSTIN, Texas -- COVID-19 has forced many families to make end-of-life decisions without clear direction from their loved ones, which is why Texans are being encouraged to set aside time for such discussions over the holidays.

Maria Otero, national Latino outreach manager for Compassion & Choices, said it's an especially important conversation for Hispanic and Latino families, because of their higher risk of dying from the virus.

Compassion & Choices has created a free, online and bilingual end-of-life toolkit that Otero said can help families communicate about what often is a difficult subject.

"This toolkit walks you through each of the steps of planning the process from understanding your options to reducing your risk using telehealth," Otero explained.

Otero added Spanish-speaking communities often prefer to receive health-care information in their own language, and the toolkit has been designed to accommodate that.

In addition to language barriers, she said cultural traditions in some Latino families can inhibit end-of-life planning.

Cecilia Vasquez Vigil had not prepared end-of-life instructions when she was hospitalized for 34 days with COVID-19 in March.

She said her extended family faced more tough conversations when their 88-year-old mother contracted the virus and later died.

Since then, Vigil has been using the toolkit's step-by-step planning instructions. She said the conversations have not been easy for her children, but have helped reduce anxiety in such an uncertain time.

"I've definitely learned that, having those tough conversations with them, that the toolkit has been very rewarding in that I know my kids are going to be OK," Vigil commented. "I know my husband's going to know what to do."

Compassion & Choices is urging Texans to fill out and share their advance-care directive with their family and health-care providers.

The document spells out the kind of care you want or don't want, and designates a proxy to make medical decisions for you in case you can't speak for yourself.

About 200,000 kids in Michigan have asthma, and nearly five million suffer from the condition nationwide. Research from Michigan State University shows school-based asthma therapy helps kids manage their symptoms while reducing medical costs. According to the study, school-based therapy relies on collaboration between school staff, nurses, health care providers, insurers, pharmacies, and families.

Kimberly Arcoleo, Michigan State University nursing professor, said the program began as a randomized controlled trial in Rochester, New York in the late 90's. It was launched by a doctor who noticed the same children repeatedly visiting her clinic for asthma treatment - often missing school.

"She came up with actually the very simple idea, on the face of it, to have the school nurses give the kids their asthma controller medications during the school day," she said.

Arcoleo added that the program allows kids to get at least one of their two recommended doses of asthma medication at school. She said that the therapy costs $1,500 per student but saves up to seven thousand in medical expenses by reducing asthma symptoms.

Eighteen U.S. states have passed legislation allowing schools to give out common asthma medications. Michigan has guidelines for school-based asthma plans, but not always asthma therapy. Arcoleo says an unpublished study shows school-based asthma therapy reduces the amount of time students spend away from the classroom, while improving their behavior.

"So, they're sleeping better at night. They're not waking up cranky and irritable - and so therefore they're not acting out as much in the classroom, or on the bus," she continued.

Arcoleo said team is using six years of data to evaluate the cost of asthma therapy in schools - including medical expenses, staff time, and caregiver work loss. She expects results sometime this year.


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About one in four adults and one in five children suffer from seasonal allergies in Maryland, and experts have tips on how to treat them. You may know the feeling - the runny nose, sneezing, coughing and itchy eyes that come with spring allergies.

Dr. Jody Tversky, associate professor with Johns Hopkins University's Division of Allergy and Clinical Immunology, explained allergic reactions happen when you come into contact with an allergen that prompts the body to produce chemicals called histamines, creating the uncomfortable symptoms. Tversky says nasal allergies in particular can make day-to-day activities much harder.

"Folks with allergies of the nose and sinus tend not to be life-threatening, which is a good thing. But they can cause lots of suffering. Headaches, poor concentration, poor sleep, inability to sleep or breathe through the nose. It's like walking around with a constant cold or sinus infection," Tversky said.

UnitedHealthcare has a fact sheet on fighting seasonal allergies. It says you can run the air conditioners in your home or car, shower before bed, and use air purifiers to reduce pollen levels.

If preventive measures don't work, over-the-counter medication can provide some relief.

Dr. Greg Carvenale, chief medical officer with UnitedHealthcare, said those may not always be effective, and recommends giving them a little time to kick in.

"Taking the same medication and expecting a different result, as the old saying goes, likely won't be successful. So if it's been a week or two of you having continued symptoms without relief of taking some of the over-the-counter medications, it's probably time for you to see your health care professional," he explained.

He also recommended avoiding allergens by staying indoors on windy or high-pollen days between the hours of 5 a.m. and 10 a.m.

Black Maternal Health Week runs through April 17th, and according to the American Heart Association, heart disease is the leading cause of maternal death, in Missouri and across the nation. Black women
are more than three times as likely as white women to die from pregnancy-related heart complications.

Tiara Johnson, a St. Louis resident, was diagnosed ten years ago, at just 25, with peripartum cardiomyopathy or PPCM, a rare type of heart failure in the last month of pregnancy or within five months after giving birth. She says at the time, she was living in Michigan and was initially misdiagnosed before doctors confirmed PPCM.

"Every time it's like, 'Oh it's normal, it's postpartum, it happens to moms.' And the other hospital - where I finally decided, 'I'm going somewhere else, I need a second opinion - and that's where they were able to detect that I was actively in full-blown congestive heart failure at this point," she explained.

Johnson received a heart transplant - but is still paying off the medical bills. She has a 'GoFundMe' page to help. PPCM can mimic pregnancy, so symptoms like fatigue, swelling and being out of breath may signal serious heart trouble and require prompt medical attention. To stay healthy, doctors recommend regular exercise, a balanced diet and avoiding alcohol and smoking.

Risk factors for PPCM include maternal age over 35, high blood pressure, multiple pregnancies and ethnicity, as the condition is more commonly seen in Black women. Johnson emphasized the importance of listening to your body and remembering that self-care isn't optional - it's essential.

"As part of the narrative, you know, as moms, we want to be 'super woman' and do all of the things. But we have to tend to ourselves. Because if we don't care of ourselves first, we can't take care of our children, our spouses or anyone else," she continued.

PPCM affects more than 1,000 women each year in the U.S., though experts say it may be underdiagnosed.