Happy Thanksgiving to all!

Our holiday hours are as follows:
Wednesday, 11-22-23 from 8-12
Closed 11-23-23 to 11-26-23
Open Monday, 11-27-23 from 8-5.

As always, you can reach us on our emergency call line at 239-415-1131. Listen to the message and press #1 for our answering service. Our Nurse Practitioner Telephone Triage line or Dr. MacKoul will call you back within an hour.

Power Outage 11/16/2023

Power is out at the office. Our phones are working! We will update when we have more information.

Mitochondrial Disease Awareness ( 9/18 – 9/24/2023 )

Hello All,

This week is Mitochondrial Disease Awareness and it is a week to talk about and celebrate all the progress we have made as an organization (ie, the United Mitochondrial Disease Association ) in research and raising awareness about Mitochondrial Disease. All of my social media accounts (Facebook, Linked In, Twitter, Instagram) have had daily and twice daily updates.

Here we go! Some Mito Basics…
Every 30 minutes, a child is born who will develop a Mitochondrial Disease by age 10. Each year, 1,000 to 4,000 children in the United States are born with a Mitochondrial Disease.
Mitochondria are present in nearly every cell in our bodies. They are responsible for producing over 90% of the energy needed to sustain life. Mitochondrial Diseases result from the failure of these tiny “powerhouses.” When the mitochondria fail, less and less energy is generated and cells stop performing and start to die. As this process repeats itself throughout the body whole systems begin to fail and the life of the person in whom this is happening is severely compromised and ultimately leads to death.
Mitochondrial Disease can be very difficult to diagnose because symptoms can arise in almost any part of the body. Often the first indicators are problems with organs that need a lot of energy like the brain, heart, muscles, and stomach but any organ can be involved. Generally, if three or more organ systems are involved Mitochondrial Disease should be considered.
You can not catch Mitochondrial Disease–you are born with it. Mitochondrial Disease is a genetic condition which means it’s caused by an error in your DNA. This error prevents a vital gene from doing’ the job it needs to do. The error may have arisen for the first time in the affected person or it might have been passed down through the family. One in 200 people are born with genetic changes that can result in Mitochondrial Disease.
Mitochondrial Disease can affect anyone at any age, but for young children with the disease it can be debilitating and their lives can be cut tragically short as Mitochondrial Disease is often progressive. Affected children may not survive beyond their teenage years. Adult-onset can result in drastic changes from an active lifestyle to a debilitating illness is a short amount of time.
There are still no effective, proven treatments for Mitochondrial Disease and no cure.

Research shows that faulty mitochondria are linked to a number of other conditions such as Cancer, Diabetes, Parkinson’s, Alzheimer’s, Autism, Epilepsy, Multiple Sclerosis, Lou Gehrig’s disease, ALS and could also be an explanation for Sudden Infant Death Syndrome.

Figuring out how to cure Mitochondrial Disease will have implications that go far beyond it.
Join us this week in learning more about Mitochondrial Disease!

Hurricane Idalia update 8/30/23 at 0700

We are all praying for Florida as Hurricane Idalia passes through.

For the safety of all of our patients and staff, we will stay closed until 1 pm. Those with appointments this afternoon are welcome to come to those appointments. If you are concerned about driving or getting to your appointment, please stay home and do not come.

As always, we are here for you. 239-415-1131.

Annette St. Pierre-MacKoul, MD

Tropical Storm / possible Hurricane Idalia update:

For the safety of our patients and their families, along with our work family, we will be closing at noon on 8-29-23 and reopening on 8-30-23 at 10 am if the storm continues on its present path.

As time progresses, if anything changes, I will update as soon as I can.

Please be safe and heed all warnings.

Annette St. Pierre-MacKoul, MD

To mask … or not to mask … that is the question!

I was quite surprised when I brought up the idea of making masks optional in the office for ‘Well Child Visits.’ My staff was adamant that we continue wearing masks. They have been healthier and enjoy having full staff attendance due to everyone being well.

I checked with many sources and I think the ‘Pediatric News,’ had the best summary on: Medical Review supports continued mask-wearing in health care written by Jay Croft:

A new study urges people to continue wearing protective masks in medical settings, even though the U.S. public health emergency declaration around Covid-19 has expired.
Masks lower the risk of catching the virus, according to the study, published in Annals of Internal Medicine (2023 May 16. doi: 10.7326/M23-0570). And there was not much difference between wearing surgical masks and N95 respirators.
The researchers reviewed 3 randomized trials and 21 observational studies to compare the effectiveness of those and cloth masks.
‘Masking in interactions between patients and health care personnel should continue to receive serious consideration as a patient safety measure,’ Tara N. Palmore, MD, of George Washington University, Washington, and David K. Henderson, MD, of the National Institutes of Health, Bethesda, Md., wrote in an accompanying opinion article (Ann Intern Med. 2023 May 16. doi: 10,7326/M23-1190).
‘In our enthusiasm to return to the appearance and feeling of normalcy, and as institutions decide which mitigation strategies to discontinue, we strongly advocate not discarding this important lesson learned for the sake of our patients’ safety,’ Dr. Palmore and Dr. Henderson wrote.
While masks are not 100% effective, they substantially lower the amount of virus put into the air via coughing and talking.
Dr. Palmore received grants from NIH, Rigel, Gilead, and AbbVie, and Dr. Henderson is a past president of the Society for Healthcare Epidemiology of America.

Baby Navigator

I had a wonderful meeting this morning with community leaders at The Healthy Start Coalition of Lee County. We had a speaker who discussed a program that needs to be shared with every pregnant woman and parent of children less than 10 years old.

Baby Navigator: https://babynavigator.com/

I would encourage everyone to look at this site. So much information and you can also register your child to have them followed for their developmental milestones.

Coronavirus Vaccine Update

Children ages 6 months and older are now eligible for the coronavirus vaccine booster.

Up until recently, under 5 years old were not eligible for the coronavirus vaccine booster.

We offer these vaccines in the office. Please call for any questions: 239-415-1131.

Update on masks


Salmonella and eggs:

Here’s the CDC Guidelines on properly cooking eggs:

Red Tide

Dr. Bayrun’s Blog re: Red Tide:

What is Red Tide?

There have been many families recently in the office that are asking about red tide, so I wanted to quickly talk about this subject.

So what exactly is this red tide? Red tide is a harmful algal bloom and is caused by the toxic dinoflagellate Karenia brevis. Blooms typically last until winter or spring but sometimes can remain for more than 1 year.

When inhaled, it can cause Aerosolized Red Tide Respiratory Irritation (ARTRI), which can cause symptoms such as nasal and respiratory irritation, runny nose, and bronchoconstriction (causes the airways to constrict causing a sensation of shortness of breath). Normally symptoms are temporary while exposed, but those with asthma or other chronic lung disease can have a flare up of respiratory symptoms. If having persistent symptoms, you should seek medical care.

When sea life is exposed to this algal bloom, it can cause large scale death, which if you have been to the beach recently you may have seen. People and animals (including pet dogs) who drink or come in contact with the water can also become sick. Exposure can cause eye and skin irritation. Ingestion can cause GI upset. Ingesting contaminated shellfish, can cause neurotoxic shellfish poisoning which can cause symptoms such as nausea, vomiting, diarrhea, dizziness, changes in speech, and tingling.

What does the Health Department recommend to do to protect your family from Red Tide?
-Check your local health department’s website for information about red tide.
-Look for signs posted at the beach for information regarding red tide
-Avoid coming in contact with affected water and dont let your animals near the water as well.
-Those with asthma or chronic lung disease should especially avoid the beach areas affected by red tide.
-If you live near a beach affected by red tide, make sure you close your windows and run your A/C. Make sure your filter is changed as per the manufacturer’s instructions.
-If you, your family, or a pet has come in contact with red tide, wash with soap and clean water as soon as possible. Wash your clothes that have come in contact with it as well.
-Consider wearing a mask if you are near an affected area.
-Avoid eating affected sealife. Cooking/heat it does not get rid of the red tide. Check out the health department website for specifics on what to avoid.

If exposed to red tide and having concerning symptoms, call 1-800-222-1222 to discuss with a poison specialist and seek medical care. Please report symptoms to the Florida Poison Information Center.

If your animal was exposed and having symptoms, contact their vet immediately.

If you have any further questions, please check out the Lee Health Department website (link below) or you can call the Florida Department of Health in Lee County at 239-690-2100.

2023_03_06-HealthOfficials Issue Red Tide Alert For Lee County | Florida Department of Health in Lee (floridahealth.gov)
2023_03_06-HealthOfficials Issue Red Tide Alert For Lee County | Florida Department of Health in Lee

Healthy Media Plan:

The AAP has a newly enhanced Family Media Plan. It’s free and customizable for the whole family.


Dr. Bayruns Blog

Happy New Year! We hope you and your family had a wonderful holiday season, and have a safe and happy new year. As our kids go back to school, the flu season is definitely here! We hope this post helps you while navigating this respiratory season.

What is the flu? The flu is caused by a virus called influenza. The most common types of flu viruses are influenza A and influenza B. The flu can cause fever, chills, cough, runny nose, sore throat, congestion, body aches, vomiting, headache, and poor appetite. It is commonly caught through respiratory droplets like when someone sneezes into the air, coming in close contact with someone who has the flu, or by touching objects that has the flu virus on it.

What can you do to protect your child and your family? Have your child wash their hands often and especially before they eat or touch their face. Practice with your child sneezing into their elbow rather than their hands. Avoid being around others who are sick. Maintain a healthy lifestyle such as getting good sleep, eating healthy, and exercising. Have your child receive their annual flu shot. It is a great proactive defense against the flu and the vaccine does not cause the flu. Flu shots are available here in office and you can schedule a dedicated vaccine visit to receive it.

What prescriptions are available when your child has the flu? After your child has been diagnosed with the flu, their doctor may offer you a medication such as oseltamivir (a common brand name of this medication is called tamiflu). Oseltamivir is an antiviral medication (not an antibiotic) for the flu that prevents the release of more flu virus from the cells in your body. This medication can be given if symptoms have started within the last 48hrs. If it is given within 48 hours of your child’s symptoms starting, it can reduce symptom duration (the number of days that they feel sick) by 24hours. It can cause some side effects, most commonly nausea and vomiting. Because the flu is a virus and not a bacteria, no antibiotics can be used for the flu unless your child has another infection such as strep throat or an ear infection.

What can you do to help your child feel better at home? Other things that we can do to make your child feel better would be treating the symptoms. It is what you may hear doctors saying is “supportive care.” Having your child drink plenty of fluids (or for babies under 1 year of age, their regular formula or breastmilk) and get plenty of sleep are some of the best things you can do to help your child feel better. For children over 1 year of age, warm fluids like tea or soup are great to loosen up that mucus to help make it easier to remove. Just make sure it’s not too hot in temperature to avoid burns. A cool mist humidifier in the room can also help loosen up secretions, just make sure to clean it often. For babies, suctioning their nose with a bulb suction or nose frida with nasal saline drops is important. Try doing this before feeds and before bedtime. 1 teaspoon of honey can be given to children over the age of 1 year old, and can help soothe a cough that tickles the back of their throat. Children 7 and up who can follow directions can have cough drops if supervised to prevent choking. Some over the counter medicines can help as well. Acetaminophen (commonly known as tylenol) can be used for children 2 months and older, and Ibuprofen (commonly known as motrin and advil) can be used for children 6 months and older. Both acetaminophen and ibuprofen can help with pain, body aches, and fever. Avoid cough and cold medications for children under 7yrs of age. Never give a child under 18yrs of age any medication that contains “salicylates” (commonly seen in pepto-bismal and aspirin) as this can cause a rare and life-threatening syndrome called Reyes syndrome.

When should you seek medical care? If you have any concerns over your child’s health, you should always contact your healthcare provider. If your child is having trouble breathing, you should seek medical care. For your little ones, signs of problems with breathing would be if they are breathing fast, their nostrils are flaring outward, belly breathing, and if the skin in-between their rib cage or near their neck is pulling inward. If your child is not able to drink fluids or your baby is not taking their formula or breast milk, you should seek medical care. We want to prevent dehydration. Signs of dehydration are dry mouth, crying without tears, or decrease in urination (babies should make 4 or more wet diapers in 24hrs and children that are potty trained should urinate at least every 8hrs). If your child is 2months and younger and has a fever of 100.4, this is a medical emergency and should be seen by a doctor immediately. If your child has a fever above 104.5 or if your child has a fever above 100.4 that lasts for more than 4 days, you should seek medical care.

Any time you have questions or concerns, we are happy to see you for a same day sick visit or answer questions over the phone during our normal business hours (8am to 5pm, Monday through Friday). If you have urgent concerns after business hours, please call our after hours urgent line and our nurse practitioners will help assist you. If you feel your child is having a life threatening emergency, please call 911 or head toward the nearest emergency room.

Have more questions about the flu? Don’t hesitate to call our office at 239-415-1131.