From Dr. K

By: Shaan Kunwar, DO

As a physician here at East County Internal Medicine, my goal has always been to ensure our community has access to the highest level of care without needing to trek across the bridge to Tampa or down to Miami. Today, I’m incredibly proud to highlight a massive milestone for Bradenton: Manatee Memorial Hospital has performed the county’s first-ever tricuspid valve replacement using the Edwards EVOQUE system.

Why This Matters to You

For years, the tricuspid valve was often called the “forgotten valve.” When it fails—a condition known as tricuspid regurgitation—it leads to heart failure, fatigue, and swelling. Traditionally, the only fix was high-risk open-heart surgery, which many of our senior or high-risk patients simply couldn’t undergo.
This new procedure is a total game-changer. Using a minimally invasive catheter-based approach (entering through a small incision in the leg), surgeons can now replace the valve without ever opening the chest.

Your PCP should be Aware

As an Osteopathic Physician, I look at the “whole person.” Seeing this level of technology arrive in Bradenton means:
• Faster Recovery: My patients can get back to their families and their daily walks in Lakewood Ranch much sooner.
• Local Excellence: You don’t have to leave your support system. Your doctors, your hospital, and your recovery are all right here.
• Proven Capability: This proves that Bradenton is no longer a “small town” in terms of medical capability—we are operating at a Tier-1 cardiac level.

We’re Here to Help You Navigate Your Health

If you or a loved one have been told you have heart valve issues or are struggling with symptoms like shortness of breath and leg swelling, let’s talk. My role is to help you navigate these advanced options and ensure your heart is getting the care it deserves.
We are proud to be part of a community that is leading the way in Florida’s medical future.
Stay healthy, Bradenton.

By: Shaan Kunwar, DO & Gemini Cross-posted from eastcountyim.com
As we serve our patients here in Lakewood Ranch and Bradenton, it is our responsibility at East County Internal Medicine to stay ahead of the legislative and fiscal changes affecting healthcare access in Florida.
This morning, a major conversation is unfolding in Tallahassee regarding the AIDS Drug Assistance Program (ADAP). While the headlines are dominated by protests, it is important for our community to understand the fiscal realities and the shift toward program sustainability.
The $120 Million Reality Check
The Florida Department of Health (DOH) has identified a projected $120 million shortfall in the ADAP budget. For any healthcare program to remain effective, it must first be solvent. The DOH points to two primary factors:

1. Rising Insurance Premiums: Surging healthcare costs have made the "premium assistance" portion of ADAP increasingly difficult to maintain.
2. Stagnant Federal Funding: Federal Ryan White Grant funding hasnt kept pace with Florida’s growth, leaving the state to bridge a widening gap.

Prioritizing the Most Vulnerable
The new proposal shifts income eligibility from 400% of the Federal Poverty Level (FPL) down to 130%.
While this is a significant change, the logic is rooted in resource prioritization. By narrowing the focus to those at or below 130% FPLroughly $20,748 annually for an individualthe state aims to ensure that those with the least financial flexibility have guaranteed medication access. In a world of limited resources, prioritizing the most vulnerable is often the only way to prevent a total system collapse.
Encouraging Market Independence
The healthcare marketplace has evolved significantly. Many individuals between the 130% and 400% FPL markers now have access to alternative paths for care:

• ACA Marketplace Subsidies: The Marketplace remains a viable path for moderate-income Floridians to secure coverage.
• Manufacturer Assistance Programs: Most major pharmaceutical companies offer robust programs that provide medications at low or no cost to those who fall outside state-funded eligibility.

By moving away from a model where the state pays full premiums for moderate-income residents, Florida is shifting the weight to the private market and federal exchangesthe systems they were designed for.
The Path Forward
Fiscal responsibility in medicine is rarely popular, but it is necessary to ensure that Floridas public health infrastructure remains standing for decades to come. As the 21-day public comment period continues through March 4, we encourage our patients to stay informed on how these shifts affect local access.

Tired of Waiting? How to Manage Urinary & Prostate Issues Without the 4-Month Wait
If you live in East Manatee County, youve likely noticed a frustrating trend: trying to see a specialistespecially a urologistcan feel like a full-time job. With our growing population in Lakewood Ranch and Bradenton, wait times for new urology patients can now stretch into late spring or even summer.
But when youre dealing with Lower Urinary Tract Symptoms (LUTS), "waiting" isn’t just an inconvenienceits a quality-of-life issue.
What exactly is LUTS? LUTS is a "catch-all" term for several symptoms that many assume are just a normal part of aging. Common signs include:

• Frequency: Feeling like you have to go every hour.
• Urgency: That sudden, "must-go-now" feeling.
• Nocturia: Waking up multiple times a night to urinate.
• Weak Stream: A slow start or a "stop-and-start" flow.

The Specialist Shortage in Florida Current 2026 projections show that Florida has a significant physician gap. For urology, this means that while a specialist is necessary for surgery, they are often too backed up to handle the initial "workup" and medical management of common issues like BPH (Benign Prostatic Hyperplasia).
Why East County Internal Medicine Should Be Your First Stop You dont need to wait months to start feeling better. As an Internal Medicine practice, Dr. Kunwar can begin the essential "Phase 1" of your care immediately.

1. Same-Day/Next-Day Initial Testing: We can perform necessary urinalysis and PSA blood tests right away to rule out infections.
2. Medical Management: Many urinary symptoms respond well to medications. We can start these therapies now, often providing relief in days.
3. The "Bridge" to Specialty Care: If you eventually do need a urologist, youll arrive with your labs and treatment history already completed, making that specialist visit much more productive.

Dont Wait in Silence Urinary issues impact your sleep, travel, and confidence. If youre struggling with prostate-related symptoms, don’t let a "specialist waitlist" stop you from getting help.
Call us at East County Internal Medicine or Book ONLINE to see Dr. Kunwar this week.