For many, it’s almost mindless, a small break from the stress of their day-to-day lives.

But for David Todd, simply placing one foot correctly in front of the other is stressful.

“I can’t do things now that I used to in the past,” David said. “My endurance … I get tired easier than normal people. I get brain fatigue. Sometimes, it’s not that my body’s tired; it’s that my brain wants to shut down and recalibrate.”

Two days a week, David puts his brain and his balance to the test in the Norton Mobility Lab, using advanced technology and tools to regain his abilities. On this particular Tuesday, David is using the Gait Real-time Analysis Interactive Lab (GRAIL). It’s a multisensory system built for people with impaired walking.

He’s strapped in a harness, walking on a treadmill, looking at and responding to the virtual scenarios projected on the screen in front of him.

This has been David’s reality for nearly three years. Slowly but surely, he’s improving.

“I feel good [now],” David said. “We talk about neuroplasticity [the ability of the brain to reprogram itself after injury], and it’s true. You don’t see it now, but somewhere down the road, the switch is going to flip and then everything for the most part will be gone and you’re doing things now that you did before. You have to be patient and you have to keep working on it.”

‘My life had changed forever’

David’s life changed forever on July 3, 2022.

It was 2:45 a.m., unusually late for the self-described early bird. He and his wife were watching a movie on the couch. He began to feel weird.

David — who has Type 1 diabetes — thought this strange feeling was simply his blood sugar getting low. He asked his wife for his glucometer. She placed it in his right hand. He dropped it. Again, same result. Then a third time. Then David’s wife noticed he didn’t sound like himself. She told him he was slurring his words.

Worried, he stood up and walked clumsily to the bathroom, needing the wall for support. He looked at himself in the mirror and saw the droop in his face.

He knew what was happening.

“I knew it; I knew a stroke was occurring,” David said. “But how bad it was, I did not know. And I knew — on my way to the hospital — that my life had changed forever and there was nothing I could do. And that was stressful.”

David’s went directly to Norton Brownsboro Hospital, a Comprehensive Stroke Center certified by DNV. When he arrived in the emergency department, the only word he could say was “stroke.” It had been 40 minutes since his symptoms started.

David spent five days in intensive care, receiving blood-thinning medication to help treat his condition.

From there, he was discharged to begin the rehabilitation process.

‘This equipment is so vital’

David started at Norton Neuroscience Institute Cressman Neurological Rehabilitation, where the team provided outpatient physical, occupational and speech therapy three days a week. Eventually, he transitioned to Norton Specialty Rehabilitation Center – St. Matthews.

That’s where David was introduced to the Norton Mobility Lab and Robert Beury, M.Ed., a rehabilitation activity-based technician. Robert became David’s de facto personal trainer, working with his physical therapists to individually craft David’s therapy program and get his gait and balance back.

“I start very conservatively when we do our first bit of training,” Robert said. “And I have various speeds that I can put [David] at, the velocities of the interactions, and I keep track of how those change over time. As we kept going, we began to see the old numbers we were using weren’t challenging enough, and he was interacting more. Then he started to walk. And in time, we got to a point where we were doing all we could do.”

The two have been working together for roughly a year, using the GRAIL’s 10 motion-capture cameras to analyze and interact with specialized software. David was able to walk, reach, turn, balance and test his muscles with unique movements — all processes that can be difficult for stroke patients.

“It’s so daunting to get to a point where you are post-stroke, but the body begins to heal itself almost immediately,” Robert said. “So what it really needs is interaction. And that’s why I think this equipment is so vital, because it is interactive activity.”

The Norton Mobility Lab is the only facility in Kentucky with GRAIL gait analysis, allowing David and Robert a personalized approach to rehab. The dual-belt treadmill and virtual-reality environments allowed them to measure and analyze David’s walking pattern and target ways to improve it.

A Comprehensive Stroke Center

Every 40 seconds, someone in the United States has a stroke, according to the Centers for Disease Control and Prevention. That means there are more than 795,000 strokes each year in the U.S.

Stroke is a leading cause of long-term disability, and it’s estimated one person dies from a stroke every three minutes. But, advancements in medical treatment and increased awareness have improved both the survival rate and quality of life for survivors.

Stroke can affect almost anyone, so it’s important for people to take steps to reduce their risk, such as maintaining a healthy diet, exercising regularly, not smoking, and managing stress.

Norton Brownsboro Hospital offers extensive, comprehensive stroke care: It’s prepared around the clock to deliver lifesaving and brain-saving stroke treatment by restoring blood flow to the brain when seconds count.

The symptoms of stroke can be easiest to remember through the acronym BE FAST^*. They are:

• Balance — loss of balance, coordination or dizziness
• Eyes — having trouble seeing or change in vision in one or both eyes
• Face — uneven smile or face looks uneven, droopy or is numb
• Arms — one arm drops when raising both arms; numbness or weakness in one arm
• Speech — trouble speaking; slurred or difficult speech
• Time — Note the time when symptoms start: Time lost equals brain lost.
  
  *Adapted from Intermountain Healthcare. BE FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. Copyright 2011, Intermountain Healthcare.

What happens after a stroke?

A stroke typically happens suddenly, with no gradual progression.

That said, many patients will recover quickly and fully from a stroke. Some may have post-stroke conditions such as difficulty swallowing, weakness and paralysis, incontinence, difficulty speaking or understanding, emotional challenges, or poor attention span.

If a stroke happens on the right side of the brain, there may be left-side weakness, impulsiveness, overconfidence in abilities and vision issues to deal with. A stroke on the left side of the brain can be associated with weakness on the right side of the body, along with difficulty speaking, reading, writing or understanding language, and cautious behavior.

Norton Neuroscience Institute Resource Centers offer a number of services to patients recovering from strokes, including support groups, exercise classes, art and music therapy, and more. The effects of a stroke also can impact someone’s mental health. Changes and stress that come with caring for a stroke survivor can put caregivers and family members at risk for depression and anxiety.

“It’s important to remember stroke is a brain injury, and patients need a lot of reinforcement and repetition,” said Rosa Hart, BSN, R.N., SCRN, patient navigator with Norton Neuroscience Institute Resource Center. “So I’ll talk to patients and their families a lot about how to avoid stroke at home. And they may have received all of that information in the hospital, but they probably only remember a little piece of it. So knowing they have a human they can ask questions to when they don’t even know for sure what to do, helps them know they’re not left out on their own with no one to call.”

Rehabilitation services at Norton Healthcare offer specialized outpatient physical, occupational and speech therapy at locations downtown, on the Norton Brownsboro Hospital campus and on the Norton Healthcare – St. Matthews campus. These programs offer access to some of the most advanced technology and specialized services in one location to help with gait, balance, strength, flexibility, speech, fine motor skills, swallowing, driving, cognition, vision and more.

“Stroke symptoms may be reversed, but a lot of the time patients need that rehab after the fact,” Rosa said. “That could be in a facility for a while, until they get strong enough to go home. But we’ve learned, with neuroplasticity, the healing process can go on for years. So going to outpatient offices, giving access to physical, occupational and speech therapies to help people get back to their natural functioning, is really pivotal.”

‘Be positive all the way’

Nearly three years since his stroke, David continues outpatient physical, occupational and speech therapy, showing steady progress despite small, periodic setbacks.

He’s returned to his career at the Pleasure Ridge Park Fire Protection District, though he has shifted into an administrative role. He’s also slowly returned to his favorite hobbies, with a few adjustments. Cooking sessions are now completed under the watchful eye of his wife as sous chef. Hiking and backpacking are done with more caution, and the 5K races are run with an eye on finishing, not on time and speed.

Through it all, he’s thankful for the team that cared for him three years ago and continues that care today.

“We try something new every day,” David said. “We cook dinner more together and we do things differently. We have family help, so that’s important. But I have had a great team here. They’ve pushed me in ways that have helped make progress every step of the way. I tell people all the time, be positive all the way and keep going. Don’t stop.”

For more on David’s recovery journey, watch this video interview with David and Rosa.

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His last name traces back to the Kentucky frontiersman Daniel Boone, legendary for his wilderness exploits. Given that family history, no wonder Eddie loves spending time in nature.

The career electrician built his Nelson County log home with his bare hands back in the ’70s. If you look closely, you can see Bernheim Forest from his back deck. And, adorning the walls are elk busts and antlers, memories of family hunting and backpacking trips as far west as Alaska.

“It’s always fun to know that [my family] can enjoy the outdoors as well, and I used to say I’ve got to be in shape enough to make the trek,” Eddie said.

In 2019, Eddie and his family drove to Dotsero, Colorado, for a horseback hunting trip. While driving through the mountains, Eddie noticed his left shoulder would seemingly catch when he turned the steering wheel.

“Extensive driving became a problem,” he said. “Maybe [it was] the hills and stuff out there, but I was noticing a little trouble then.”

Then it got worse. Eddie couldn’t saddle his own horse. He knew he had a bigger issue. He was losing hope.

“I was thinking, ‘Something’s got to change,’” Eddie said.

‘My shoulder was completely damaged’

Eddie started conservative treatments on his shoulder.

He began a series of injections, both with and without steroids. He tried dry needling, a physical therapy treatment that involves inserting thin needles. Those treatments worked, but only for a short time.

“I didn’t know my shoulder was completely damaged,” Eddie said. “I’ve had several shots, but … every time I had that, it would only help it for a little while, and then it would get worse.”

Making matters more complicated was the damage in Eddie’s knees, both of which needed to be surgically repaired. He put off the shoulder issue for a little while longer and visited Chad E. Smith, M.D., orthopedic surgeon with Norton Orthopedic Institute. In robotic-assisted surgeries, Dr. Smith repaired both of Eddie’s knees.

Meanwhile, the pain in Eddie’s shoulder only worsened. It affected his everyday life.

“Even though I’m right-handed, you don’t realize how much that left hand assists everything you do,” he said. “And one major thing right now that I notice is just trying to do anything toward your belt — getting your pants on the right way, or even getting them on, period. Putting a shirt on. Brushing your hair. All this is normal stuff that is showing me I’ve got to have my shoulder better than it’s been.”

He was introduced to Justin M. Givens, M.D., shoulder and elbow orthopedic surgeon with Norton Orthopedic Institute, who determined Eddie was a candidate for a reverse shoulder replacement.

“He had a big rotator cuff tear that was unrepairable,” Dr. Givens said. “He had arthritic changes. And so, you have two issues going on that the reverse shoulder replacement was specifically made for. And then you say, ‘OK, is it affecting his life?’ He can’t lift his arm. He’s in terrible pain. He can’t sleep at night. So for me, that’s someone who has an injury we have a fix for and has an issue that’s significantly affecting his life.”

‘We’ve never had this level of accuracy’

Dr. Givens and Eddie discussed the options and determined Eddie was a candidate for an innovative shoulder procedure. Eddie was a candidate for robotic-assisted reverse shoulder replacement.

This new technology is designed to elevate Dr. Givens’ control and confidence by providing him with a 3D image of the patient’s unique shoulder anatomy. Dr. Givens then can study those 3D simulations before surgery and view them on a screen during the procedure. The robotic arm assists him in shaving down the patient’s glenoid (shoulder socket), creating the ideal surface for the implant. From there, the robotic arm’s capabilities help ensure that the implant is positioned within the preplanned boundaries, while aiming for improved accuracy. The goal is to allow for a more natural range of motion and better long-term outcomes for patients.

In March 2025, Dr. Givens became one of the first five surgeons in the country — and the first in Kentucky — to perform this procedure.

“This technology gives me precision to ensure every cut and movement is exactly what the individual patient needs,” Dr. Givens said. “We’ve never had this level of accuracy before in this field. Now, the procedures we’ve theorized can be put into practice. And for me, when I’m talking about trying to give you the best outcome, and I have technology that can get within 0.1 millimeters of precision, it’s a pretty easy decision to make.”

Eddie, who’d had the two robotic-assisted surgeries performed on his knees, knew the benefits of the new technology and agreed to have it done. So on March 19, 2025, Dr. Givens performed the successful robotic-assisted reverse shoulder replacement.

“If there’s a medical procedure to fix this, then I’m all for it,’” Eddie said. “And Dr. Givens came up with this diagnosis that [my shoulder] is completely shot, and told me he’s got a new robotic application. Like I said, I’m ready for it. That’s what it’s all about for me.”

‘Technology needs to be the major push’

In the first two weeks since surgery, Eddie already has seen dramatic improvement. He was out of his sling in just seven days. His range of motion is returning closer to normal by the day.

“This is something that I was not able to do just a few days ago,” Eddie said as he swung his arm around.

Now, Eddie’s goal is to rest up, continue his physical therapy regimen and eventually get back to the outdoors, spending time hiking, hunting and fishing with his family. He also wants others to know there is hope for them too, if they’re experiencing daily pain.

“I hope they can see that there is light at the end of the tunnel as far as your health goes. If you can just stay with it and be lucky enough to run across good surgeons, like Dr. Smith and Dr. Givens. And the technology needs to be the major push, as far as I’m concerned, because of the accuracy, and this is a pretty good show of it.”

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“This collaborative effort continues to elevate Norton Neuroscience Institute to a national stage,” said Gregory E. Cooper, M.D., Ph.D., neurologist and director of Norton Neuroscience Institute Memory Center. “It’s an affirmation of what we’ve already done, while also incentivizing us to continue pushing the limits of dementia and Alzheimer’s care in our community.”

The program funds a dedicated nurse navigator, Deborah Lockridge, R.N., BSN, CCRC, at Norton Community Medical Associates – Preston, whose job is to collaborate with primary care providers at the practice to identify patients who are at high risk and may be experiencing early symptoms of cognitive decline. The goal is to more quickly connect those patients with treatment at Norton Neuroscience Institute Memory Center and provide personalized education and support services along the way. The hope is to more efficiently diagnose and treat Alzheimer’s disease and other forms of dementia in their earliest stages. If the pilot proves successful, this clinical pathway may be used as a worldwide model for future Alzheimer’s care.

“This grant enhances the comprehensive care services we offer here at Norton Healthcare,” Lockridge said. “We all agree having a point of contact who can answer questions, encourage patients and caregivers and point them in the right direction is going to be a tremendous benefit to our community. We will use this opportunity to develop a collaborative, easy-to-navigate care model that can be scaled not just throughout Norton Healthcare, but across the country.”

Alzheimer’s disease is growing into a worldwide epidemic. According to the National Institute on Aging, more than 6 million Americans currently are living with Alzheimer’s, and more than 13 million will be living with the disease by 2060. The current care model requires multiple medical providers to coordinate to ensure patients who are eligible for disease-modifying therapies receive them during the early window of opportunity, when they will most benefit.

Yet, there are pathways for prevention, early detection and accurate diagnosis that could change the course of the disease forever. For example, in August 2023, Norton Neuroscience Institute became the first site in Kentucky to administer disease-modifying therapies to patients with mild cognitive decline and mild Alzheimer’s disease. In addition to early treatment, Norton Neuroscience Institute is actively pursuing brain health and prevention strategies.

“We’re very proud of our memory program and what we’ve created so far, but we know there is still much work to be done,” Dr. Cooper said. “We won’t rest until we’ve tried to perfect our system to quickly identify, diagnosis and treat people at the earliest possible stages, when we believe we have the greatest chance to slow this disease in its path.”

The six pilot sites will serve as start-up incubators for the development of materials and best practices for the program’s long-term sustainability and expansion — without the need for external funding. The learnings and resources from the Brain Health Navigator program will be incorporated into Davos Alzheimer’s Collaborative’s Early Detection Blueprint.

The other sites included in the program are Dartmouth Health (New Hampshire), Memorial Healthcare (Owosso, Michigan), Sharp Rees-Stealy Medical Group (California), UC Health (Ohio) and Keck Medical Center of USC, part of Keck Medicine of USC (California). Patients can schedule an appointment by calling (502) 446-4664 or visiting NortonHealthcare.com/MemoryCenter.

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Brushing your teeth, pouring coffee, lifting food to your mouth — things millions of people do each day without a second thought. But for many who live with essential tremor, simple tasks like these can become impossible. The constant, uncontrollable body tremors can be embarrassing, frustrating and exasperating.

For as long as they can remember, Patrick Murphy and Bob Bender lived this struggle daily.

“As time has gone on, it’s become very obvious,” Patrick said. “I am constantly self-conscious about how [noticeable] it was. And then as soon as I think about it, it gets 10 times worse. You worry about people thinking, ‘What’s wrong with this guy?’ So it kind of builds on itself.”

The experience has been similar for Bob.

“It’s gotten so bad in the past year, that it’s become unbearable,” Bob said. “I will literally go some places and keep my hands in my pockets so people can’t see it. [I wonder if] people ask, ‘Is he going through detox? Is he on drugs?’ I mean, I think about that … I really do.”

After years of this struggle, Patrick and Bob finally found relief at Norton Neuroscience Institute, in the form of a new, incisionless brain surgery that relieved their tremor symptoms in a matter of hours.

On Nov. 13, 2024, Patrick and Bob were the first two people in the state of Kentucky to undergo high-intensity focused ultrasound treatment, sometimes called HiFU, for their tremors.

‘I see the frustration’

Patrick knew as a child that essential tremor was going to be an inevitable part of his future.

The disorder runs in his family, affecting Patrick, his father, brother, nephew and daughter.

“I remember watching my dad,” he said. “We used to work on cars together when we were younger. He would get way more frustrated than I do. But I can remember a lot of cuss words and throwing tools. It just makes you mad.”

Patrick officially was diagnosed with what was then called familial tremors in the early ’90s. Since his diagnosis, life has grown progressively harder.

“I wake up in the morning and immediately notice it,” Patrick said. “It can get better or worse throughout the day, depending on the day — doing things like drinking coffee, moving my mouse around the computer screen, little things.”

‘We do laugh about it, because that’s how we get through it’

“I see the frustration,” Patrick’s wife, Diane, said. “And he says he doesn’t get mad, but he does. In the beginning, I didn’t recognize it at all. But now, I really try to help. Sometimes it’s just easier if I do things, because he’ll spill it. Just watching him eat and miss his mouth [is so hard]. And we do laugh about it, because that’s how we get through it. But I know how frustrating it is.”

He tried several medications, but they didn’t work. He began scouring for a more permanent answer.

Patrick first discovered HiFU roughly five years ago, as he was researching new treatment options for essential tremor patients. He wanted to have the surgery immediately, but he’d have to travel to receive it. Plus, his insurance wouldn’t cover the procedure at the time. But this past summer, he learned Norton Neuroscience Institute had acquired the technology. He quickly scheduled an appointment with movement disorders neurologist Justin T. Phillips, M.D., at Norton Neuroscience Institute. Then Patrick underwent evaluation and was felt to be a good candidate for the surgery.

‘The things that I’ve stopped doing’

Bob noticed his tremors back in the 1970s. Small tremors were made worse by intense exercise. They were frustrating, but they were something he could live with.

In 2012, however, Bob’s life changed dramatically when he was involved in a motorcycle crash. Six months later, the tremors came on with a vengeance. They got progressively worse, affecting every aspect of his life. Roughly three years ago, they became insufferable.

“I don’t go out to eat; I don’t pour milk or coffee; I have to drink from a straw,” Bob said. “It’s unbelievable when you think about it, the things that I’ve stopped doing.”

A recent visit to the gas station showed how tremors can make otherwise routine tasks impossible.

Bob was there to buy some protein bars after a workout. He didn’t have cash at the time, forcing him to pay with his card. Only problem — his tremors prevented him from steadying his hand enough to fit his debit card into the card reader. The line was building up behind him. So was his embarrassment. Eventually, after a few seconds that felt like hours, Bob had to give his card and his PIN to the clerk, who completed the transaction for him. He ran out of the store and immediately changed his PIN.

“It was packed in there,” Bob said. “And there was a big line and they could see it. And it’s just so embarrassing. People are looking and saying, ‘What’s wrong with this guy?’ And I saw a lady and this guy just looking at me. I wanted to say something, because it’s irritating. But this is why I carry cash. That way, I can just pay in cash and if there’s change to give me back I just tell them to keep it for the next person. I don’t even keep track of my change. You have no idea how many times I just want to run out of stores and back to my car and not go in.”

Bob knew he needed help.

He visited with Jason L. Crowell, M.D., also a movement disorders neurologist at Norton Neuroscience Institute. Dr. Crowell explained HiFU and advised him on next steps. After a few evaluations, Bob was felt to be a good candidate for the procedure, to be performed by Abigail J. Rao, M.D., stereotactic and functional neurosurgeon with Norton Neuroscience Institute.

“I was nervous, but I was more excited than nervous to have it done,” Bob said. “When Norton Neuroscience Institute called me and told me they scheduled me to see Dr. Rao, I was shocked.

“I told her, ‘You’re going to be able to get me before Christmas?’ She said, ‘I believe I can do that.’”

What is HiFU

HiFU treatment, also known as high-frequency focused ultrasound or MRI-guided focused ultrasound, is an incisionless brain surgery, in which more than 1,000 ultrasound waves are focused down to the millimeter, creating heat that forms a small lesion, or ablation, in the tremor-causing area of the brain.

The roughly two-hour procedure is performed while patients are lying in an MRI machine. Brief, frequent scans monitor the location, size and temperature of the lesion as it’s created. Patients are awake and alert, allowing the surgeon to test the tremor and neurologic function in real time.

After the procedure, most patients experience dramatic and immediate relief of hand tremor and do not require a hospital stay. That said, the procedure only treats one side of the brain at a time, meaning some patients may wish to have a 2^nd surgery at least nine months later to treat the other side.

“This treatment’s exciting to participate in as a physician, because we see these immediate effects and we can interact with the patient,” Dr. Rao said. “I mean, that’s not why we do it, but instant results are part of what makes it satisfying. With a lot of our surgeries, we’re very happy with great outcomes, but we don’t always see them right then and there. So that’s part of what makes it really special.”

The HiFU procedure was approved by the Food and Drug Administration in 2016 after years of clinical trials to determine its safety and efficacy.

Norton Neuroscience Institute Cressman Parkinson’s & Movement Disorders Center is the only site in Kentucky to offer HiFU for essential tremor and tremor-dominant Parkinson’s disease. Norton Neuroscience Institute is also one of the first health care systems in the country to use an upgraded version of HiFU called Exablate Prime. This upgraded technology allows for a faster procedure and improves the patient’s comfort on treatment day. The technology was purchased with $2.8 million in funding through the Norton Healthcare Foundation.

“We have several patients who’ve reached out to us to learn more and are still considering their options,” Dr. Rao said. “And I think it’s only going to continue to expand. Another thing that will expand is its indications, meaning what we might be able to treat with this technology in the future. It’s really amazing to see. I mean, this is not the only or the first neurosurgical treatment that has immediate effects, but getting testable results that don’t involve any implantation into the brain, or even incision, is very exciting.”

Bob: ‘I am 100% happy’

The surgery was successful for both Patrick and Bob.

Within two hours after surgery, each stood up from the MRI scanner and walked out. As friends and family looked on in tears of joy, and as the clinical team removed the patients’ helmets, the two men looked down at their hands.

For the first time in years, they didn’t shake.

Both Patrick and Bob performed simple post-procedure tests _— drawing spirals, signing their names, even drinking water from a bottle. No shakes. No spills. The improvement was dramatic. The two men stayed for roughly an hour to be monitored for any side effects.

When they were cleared to go, the two men walked out of the hospital visibly changed, ready to do the little things again _— go out to dinner, pour a cup of coffee, put their debit card in a card reader.

For the first time in decades, Patrick and Bob finally felt steady.

“I just want everybody to look at it,” Bob said. “I just want everybody to see it. I mean, it was crazy. It was just … it’s unbelievable. I still can’t wrap my mind around it. I am 100% happy. Emotional, of course. It’s crazy.”

Patrick: ‘Feels like it’s normal’

“It feels amazing,” Patrick said. “It feels like it’s normal, the way I should be. [I’m] just looking forward to people not being able to see me shaking and thinking, ‘Wow, is this person really nervous?’ So that’s the biggest thing — being still in just about everything I do.”

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Six months ago, Gene could only dream of doing that.

“I couldn’t even go like this,” he said as he reached for the sky. “I had some reservations, but I wanted more mobility and [Dr. Givens] made me feel good. So I went for it.”

‘I’d been in pain for 10 years’

Gene’s whole career has been reliant on his hands.

The former meat cutter and maintenance man is retired now but spent more than 30 years doing manual labor. Among other things, the constant use wore away the cartilage in his shoulders. He developed arthritis and eventually tore the rotator cuff in both shoulders.

He was in pain 24/7.

“I’ve been in pain for 10 years,” he said. “I could barely do anything. It affected me every day. I knew I needed help, so that’s what led me down the path to surgery.”

In 2019, Gene had his right shoulder replaced at a facility in Florida. It was a traditional shoulder replacement, but came with unexpected complications. Gene experienced internal bleeding, requiring a seven-day hospital stay. He continues — five years later — to experience neuropathy down his right arm. It was more than three months following that surgery before he could return to work.

“I still have pain in my right shoulder,” Gene said. “And it made me scared to have my left one done. I knew I needed it, but I put it off for a while just because I didn’t want to repeat what happened during the first one.”

Eventually, the pain in his left shoulder became unbearable. He had to find a solution. His primary care provider referred him to Norton Orthopedic Institute and to Dr. Givens.

“I always tell my patients, ‘I don’t save your life; my job is to make your life better,’” Dr. Givens said. “I want you to leave my office with a better life. And so, that’s the way I approach each patient — how can we get them the best long-term result but without a year of torture in between.”

‘I want you to go out and live your life’

Dr. Givens knew Gene needed surgery.

In addition to his arthritis, Gene had a retroverted left socket, a condition that develops when the shoulder socket, called the glenoid, is abnormally angled in relation to the shoulder blade. A  healthy shoulder has about 5 degrees of retroversion. In Gene’s case, it was 45 degrees, meaning his socket was essentially pointing out the back of his body.

To repair it, Dr. Givens needed to reconstruct Gene’s socket and fully replace his shoulder joint. This procedure would be nothing like the one Gene underwent in 2019.

Dr. Givens specializes in a subscapularis-sparing total shoulder replacement, an innovative surgical technique that aims to minimize damage to the subscapularis muscle, which is responsible for shoulder stability and arm mobility. This technique drastically improves surgical outcomes and reduces recovery time, allowing patients to return to their usual, day-to-day lives quicker.

After the doctor and patient discussed the options, Gene agreed to have the surgery. On April 24, 2024, Dr. Givens performed a successful shoulder replacement, using a 3D model to create a custom implant _— fit perfectly for Gene’s body — to reconstruct his glenoid and reposition his shoulder to its correct position.

“I’m big on getting things as they’re supposed to be and then letting you use them,” Dr. Givens said. “Other surgeons put restrictions on patients — either with lifting or movement — but there’s no data that’s ever supported that with the shoulder.

“We know it’s a mechanical part and, in theory, could wear out. But there’s no data to support that it will, so why are we keeping people from being active, working out and bettering their overall health? I want you to go out and live your life.”

Gene was out of a sling in seven days, which is typical for the method used by Dr. Givens. Gene began physical therapy shortly thereafter. In two weeks, he had 140 degrees of motion. By the six-week mark, he was able to lift his arm straight over his head, a stark contrast from where he was in 2019.

This is why when Gene steps into Dr. Givens’ office for his follow-ups, he smiles. He knows it’s a testament to how far he’s come and how the right doctor can make all the difference.

“I was amazed,” Gene said. “Because the right [shoulder] had so many complications … so when Dr. Givens told me I’d be out of a sling in a week, I said, ‘Are you kidding me?’ But he was right. I think during my first follow-up, I waved at him from down the hall. Every time I’m in [the office] the staff is shocked at how much I can move, how far I bend.”

“This is a team approach,” Dr. Givens said. “And so, that helps us get people seen and get them seen efficiently as well. And that’s the point of orthopedic specialty clinics and why bring these to our community.”

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Vascular integrity and blood flow

The brain is an energy-intensive organ, accounting for about 20% of the body’s total oxygen demand. The heart supplies oxygenated blood to the brain through a vast network of blood vessels. If the heart or vascular system is compromised, this can limit the brain’s oxygen and nutrient supply, impairing cognitive functions over time. Conditions such as high blood pressure, heart disease and hardening of the arteries can reduce the elasticity of blood vessels or lead to blockages, which may prevent adequate blood flow to the brain. These interruptions, in turn, can lead to brain cell damage, stroke and cognitive impairment.

Research also has shown that high blood pressure, particularly in midlife, is a major contributor to the risk of developing vascular dementia and other forms of cognitive decline. When blood pressure remains consistently elevated, it can damage the small vessels that supply critical areas of the brain responsible for memory and decision-making, causing “silent” ministrokes that impair mental function.

Shared risk factors between heart and brain health

Heart disease and cognitive decline share numerous risk factors, which partly explains their close association. Major factors include high cholesterol, high blood pressure, diabetes, smoking, obesity and physical inactivity. Each of these conditions can damage blood vessels, making it difficult for the heart to maintain proper blood flow, which impacts the brain as well. Additionally, inflammation plays a central role; it damages blood vessels, leading to plaque buildup and narrowing of the arteries, affecting the cardiovascular system as well as cognitive function.

Diabetes has a strong correlation with both heart and brain health. High blood sugar levels can damage blood vessels over time, leading to complications like heart disease and an increased risk of Alzheimer’s disease. Insulin resistance, often associated with diabetes, also may impact the brain’s ability to utilize glucose efficiently, which can lead to impaired cognition.

Lifestyle changes and preventive measures

The good news is that many lifestyle choices that protect the heart also benefit the brain. Regular physical activity, for instance, strengthens the cardiovascular system and improves blood flow to the brain. Exercise has been shown to boost mood, reduce stress and support neurogenesis, the process by which new brain cells are created, particularly in the hippocampus — the brain region associated with memory.

A brain-healthy and heart-healthy diet, such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains and healthy fats, also has been linked to better cognitive outcomes. Foods like fish, nuts and olive oil provide essential nutrients like omega-3 fatty acids and antioxidants, which have anti-inflammatory properties that benefit both heart and brain health.

There are also lifestyle changes you can make to help ward off dementia or other types of cognitive decline. These include the above diet and exercise changes, but also social interaction, stopping smoking and other modifications.

Maintaining a healthy heart is essential for protecting the brain. The connection between these two vital organs is largely based on their shared reliance on a healthy vascular system, along with common risk factors. By focusing on lifestyle adjustments like exercise, balanced nutrition and managing chronic conditions, you can reduce your risk for cardiovascular disease and cognitive decline simultaneously. Through these proactive measures, it’s possible to support both heart health and brain health, promoting a longer, healthier life.

Have concerns about your brain health? Take this short quiz

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What is a ‘healthy brain’?

A healthy brain has optimal structure and function that leads to social, mental and physical well-being. The brain retains cognitive function and has little or no memory loss. 

Christopher B. Shields, M.D., has been focused on the links between lifestyle and brain health for quite some time. As a neurosurgeon and chairman of Norton Neuroscience Institute, he has a vested interest in educating the community on dementia and memory loss. 

RELATED: The connection between heart and brain health is key to overall wellness

Here are some of Dr. Shields’s guidelines for ways to potentially delay the onset of diseases like dementia and Alzheimer’s and keep your brain healthy:

1. Chow down on brain food. In general, people should drastically reduce the amount of sugar, carbohydrates and starch in their diets, especially that found in processed and fast foods. Eat a good amount of high-protein foods from sources like salmon and chicken, and include good fats. Also include fresh vegetables, vitamin B and omega-3 and omega-6 fatty acids.
2. Get good sleep. Adequate sleep has been shown to keep some diseases at bay, including diabetes. It also can help with depression, anxiety and weight maintenance.
3. Get moving. It may seem that every doctor tells you exercise will fix whatever ails you. Physical activity does seem to have benefits across the board, from building muscle and lung function to strengthening the heart and relaxing the mind. Even walking for 20 minutes a day five days a week can improve the body. 
4. Mental health is important, too. Emotional coping mechanisms are critical to overall health. Work on reducing stress and building emotional resiliency. Meditation, reading self-help books and watching motivational videos are all ways to keep your mind healthy.
5. Pump some iron. You don’t have to bench press a bulldozer, but weight-bearing exercise and lifting weights can help maintain bone and muscle as we age.
6. Maintain a healthy weight. Weight causes the body to age faster. A healthy, high-protein/low-sugar diet slows aging and possibly can ward off dementia for a time.
7. Check your gut. There are about 10 times as many bacterial cells in your gastrointestinal tract as there are cells in your whole body. These bacteria produce your own unique gut microbiome, the contents of which can affect your mood, personality, behavior and more. Consuming foods like kefir that support a healthy gut microbiome can be extremely good for you.

Heart health is also linked to brain health. You may be more likely to develop cognitive impairment if you have heart conditions such as heart disease or heart failure. The above steps can help with heart health, too. 

To sum it up, Dr. Shields said, “There are things we can do earlier in life that can really beneficially affect our health and delay or prevent dementia.”

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“This procedure is a game changer for our ability to treat patients with essential tremor and tremor-dominant Parkinson’s disease,” said Abigail J. Rao, M.D., stereotactic and functional neurosurgeon with Norton Neuroscience Institute. “Acquiring this technology advances our mission of giving patients the best possible outcomes, while further establishing Norton Neuroscience Institute as the regional leader in advanced neurological care.”

The treatment is an incisionless surgery, by which several ultrasound beams are focused down to millimeter accuracy, carefully creating a small lesion in a specific part of the brain. The patient lies in an MRI scanner that allows frequent scans to monitor the location, size and temperature of the lesion being created. During that process, the patient wears a helmet-like device filled with cool water that has more than 1,000 ultrasound transmitters, while the surgeon also tests the patient’s tremor and neurologic function. The newly created lesion provides immediate and dramatic relief of hand tremor and other symptoms of movement disorders, allowing for better motor control for life’s daily tasks or hobbies, as well as better quality of life.

The surgery does not require any anesthesia or hospital stay.

“This is truly groundbreaking technology that will allow us to help so many people in new ways,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “As focused ultrasound progresses, we hope to see its benefit in treating other conditions.”

The focused ultrasound surgery has been approved by the U.S. Food and Drug Administration since 2016 and is backed by years of data, which has shown most patients experience immediate, significant relief from tremor symptoms. The most common side effects include imbalance and numbness, but these usually subside within a few weeks.

To qualify for the treatment, a patient must have a confirmed diagnosis that is not adequately controlled by medication. The patient’s anatomy is carefully studied, and the surgery is planned, with CT and MRI scans taken prior to the day of the procedure. After the procedure, the patient receives a follow-up MRI to evaluate the lesion.

Start Your Journey With a Free Seminar

If you’re interested in learning more about high-intensity focused ultrasound treatment, be sure to join us for a free informational session. During this session, our team will address treatment options tailored specifically to individuals diagnosed with essential tremor and/or Parkinson’s disease.

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Key components of a brain health diet

1. Fruits and vegetables: Rich in antioxidants, vitamins, and minerals, these foods combat oxidative stress and support brain health. Leafy greens, berries, and cruciferous vegetables, like broccoli, are particularly beneficial. Berries, for instance, are linked to improved memory and cognitive function.
2. Healthy fats: Omega-3 fatty acids are crucial for maintaining brain health. They support brain cells and reduce inflammation. Older adults should include sources such as fatty fish (like salmon and mackerel), walnuts, flaxseeds, and chia seeds. Extra virgin olive oil is also an excellent source of healthy fats.
3. Whole grains: Whole grains provide a steady supply of glucose, vital for optimal brain function. Options such as oats, brown rice, quinoa and whole-grain bread can help sustain energy levels and support cognitive function.
4. Lean proteins: Proteins are essential for neurotransmitter production, influencing brain health. Older adults should focus on lean sources like poultry, fish, beans, lentils and low-fat dairy products, providing the necessary amino acids for cognitive support.
5. Nuts and seeds: Nuts, particularly almonds and walnuts, are high in vitamin E, which has been linked to lower rates of cognitive decline. A handful of nuts can serve as a nutritious snack that supports overall brain health.
6. Hydration: Staying well-hydrated is often overlooked but is essential. Dehydration can contribute to confusion and cognitive impairment. Older adults should aim for adequate water intake, considering their activity level and environmental conditions.

RELATED: The connection between heart and brain health is key to overall wellness

Foods to limit

While it’s essential to focus on brain health, limiting certain foods is equally important. Highly processed foods, sugary snacks and excessive salt can contribute to inflammation and cognitive decline. Reducing saturated and trans fats found in fried and processed foods can further benefit brain health.

Diet is only one tool

While your diet is critical to brain health, there are other lifestyle changes you can make to boost your brain health, prevent dementia and combat cognitive decline. These include:

• Getting adequate quality sleep
• Maintaining a healthy weight
• Addressing health conditions like high blood pressure, stress and diabetes 
• Getting regular checkups with your primary care physician
• Social interactions

Creating a brain-healthy diet doesn’t need to be complicated. Focus on variety and balance to ensure a wide range of nutrients for cognitive function. Regular meal planning can help older adults obtain the necessary nutrients to support brain health. Combined with physical activity and social engagement, a balanced diet can enhance the overall quality of life and mitigate risks associated with brain disorders like dementia and mild cognitive impairment.Norton Neuroscience Institute Memory Center Dementia Prevention Clinic can help you understand your possible risks for developing memory disorders, dementia, Alzheimer’s and other cognition-related conditions.

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A wake-up call before the sunrise, followed by a 4 a.m. drive to the backside of Churchill Downs. Cloaked in darkness, he makes his way to Barn 38 — the one belonging to his father, Steve. He changes clothes, learns his schedule and mounts his first horse. By 5:15 a.m., he’s underneath the bright, fluorescent lights of the 1-mile dirt, oval racetrack.

It’s time for morning exercise rides — a chance for Keith and Steve to prepare their thoroughbreds to race. Early-morning practice, if you will: Keith on horseback, Steve waiting at the rail with a stopwatch.

At 9:30 a.m., Keith dismounts and changes again. This time, it’s out of his riding clothes and into a pair of exercise shorts. He gets back in the car and makes his way to KORT Physical Therapy on Westport Road, across town. Two hours there, rebuilding the strength in his legs, hips and core.

For the past three months, this has been Keith’s routine.

“This whole recovery’s been incredibly smooth,” Keith said. “I’ve been more than well taken care of. It’s just an invigorating feeling to be backed by so many professionals.”

Keith’s preparation and work ethic have been paramount as he prepares to ride in his first race in more than 90 days, returning from the scariest moment of his young career.

‘I was conscious the entire time’

June 1, 2024, was supposed to be a big race day for Keith. He was set to ride in five of Churchill Downs’ 11 races.

But his day would come to an early, abrupt end.

In Race 1, Keith’s filly — Singsational — was bottlenecked after the start and clipped heels with another horse. She fell, tumbling to the dirt, but walked off uninjured.

Keith was not as lucky.

In the spill, he fractured his left femur and three ribs and experienced a right hemopneumothorax, a pressure-causing condition in which blood and air enter the cavity between the lungs and underneath the chest wall.

He would require surgery and a weeklong hospital stay.

“I was conscious the entire time,” Keith said. “I had recognized what happened and was fully aware of the circumstances. I don’t think I was ever overly scared and was attended to immediately by the ambulance. Yes it hurts, but I think the thing that hurts the most about getting hurt as a race rider is just the loss of momentum of success. I don’t think any rider is afraid of getting hurt or anything. It’s more just the fear of being away from the sport and the time it takes to get back.”

At that point, the 26-year-old jockey wasn’t sure what his future would hold, or when he’d be able to ride again.

‘I’ve just been so fulfilled by this position’

Horse racing is, quite literally, in Keith’s blood.

His grandfather was a jockey. His father is a Hall of Fame trainer. His brother, Erik, is also a jockey. Despite that pedigree, Keith’s journey into the saddle was unlike most in the business.

He was in college at the University of Texas at Austin, in the process of earning his master’s degree in professional accounting. But like millions of people, 2020 turned his career and life around. During the COVID-19 pandemic, his classes went remote. Keith came home and spent more time around the track.

He was bitten by the bug.

“I don’t want to call it a pipe dream, because it was very real situation to me, but I’d always thought of being a race rider, and I was always incredibly infatuated with the profession,” Keith said.

He started riding in June 2020 at Lone Star Park, just west of Dallas. He got his first win nearly a month later, one of his six that season. When the summer ended, he promised his parents he would go back and get his degree.

“As soon as I got that diploma, I sprinted right back to the race track,” Keith said.

He couldn’t stay away.

Keith started riding full time in 2022. Ever since, his career has taken off. He’s tallied more than 130 wins in that time, culminating in his victory in the Steel Valley Sprint in November 2023. Keith’s success earned him his first Kentucky Oaks and Kentucky Derby mounts in 2024, riding both races for Hall of Fame trainer D. Wayne Lukas.

“There’s no feeling like being on a thoroughbred race horse in full flight,” Keith said. “It’s such a profound feeling. It’s impossible to describe, and I’ve been so helplessly addicted to it. I’ve just been so fulfilled by this profession.”

‘We want to make a positive impact on their lives’

In the world of professional sports, injury management has risen to the forefront of the conversation.

In the NFL, the culture surrounding concussions has changed drastically, as independent neurologists now roam the sidelines, scanning the field for players who may have experienced a head injury during play. In the NBA, “load management” has become a topic of conversation, as teams become more careful with their star players and what injuries they attempt to play through. In MLB, arm care has become a priority, as more pitchers experience shoulder and elbow injuries than ever before.

But thoroughbred horse racing is different.

Unlike other professional athletes, whose health care is provided by their teams, jockeys are responsible for coordinating and overseeing their own medical care. Furthermore, if they’re unavailable to race, they aren’t compensated, meaning a debilitating injury is more than a physical obstacle. It’s also a lost paycheck. That’s why for decades, many jockeys chose not to seek care.

“[It’s] changing and not changing at the same time,” Keith said. “It’s a very fragile profession. It’s kind of a meritocracy, like, ‘What did you do for me yesterday?’ And so there is that fear of getting hurt and losing that momentum, and that’s why the population rushes back [from] injury, or has a propensity to. I feel like the population of jockeys today is way more receptive to receiving medical care and mental wellness care [than in years past]. And I think that’s kind of the general direction we’re headed.”

It’s a trend Norton Sports Health and Churchill Downs recognized and are collaborating to change.

In April 2022, Norton Sports Health became the official medical provider of Churchill Downs, as the racetrack was looking for a partner to help elevate jockey safety and welfare. This partnership coincided with new regulations from the Horseracing Integrity and Safety Authority (HISA), which went into effect July 1, 2022, with the goal of making the industry safer as a whole. Those changes included mandatory baseline concussion and physical exams for jockeys. They also required a physician be present at all live race days.

“It’s crucial that we provide the care these athletes need,” said Tiff L. Haub, M.S., ATC, director of Norton Sports Health. “Anytime you have a horse going 40 miles per hour on a track with someone on top, you know it can be dangerous. And we know concussions can have long-lasting effects. So, giving the jockeys that peace of mind prerace, letting them know they’re physically and mentally fit to race, is critical to their success and safety.”

Norton Sports Health has taken those mandates a step further, providing comprehensive care for the jockeys, coordinating and scheduling primary care and specialty visits, based on the athletes’ needs. Norton Sports Health physicians, nurses and certified athletic trainers are stationed at Churchill Downs for all 75 live race days each year. In addition, Norton Sports Health has supplied a performance dietitian and mental health professionals to provide care for the whole person. In spring 2023, Norton Sports Health began hosting jockey educational seminars, providing the riders with in-depth information on a variety of topics, including mental performance, nutrition and weight management.

“We want to make a positive impact on their lives, in any way we can,” Tiff said. “We always educate and emphasize to the jockeys, owners and trainers that the goal is for the jockey to ride, but only if they’re safe to do so. We want to support them being their best selves, so they can have their best ride.”

Furthermore, Norton Sports Health has initiated communication and training with other health care providers across the country, in an attempt to elevate care and safety at every American Thoroughbred racetrack. Finally, before each season, Norton Sports Health collaborates with Churchill Downs and Alpha Event Medicine to discuss and revisit the track’s emergency action plan, in the event of a trackside emergency.

“Since we’re the ones overseeing care at a racetrack as prestigious as Churchill Downs, we feel like it’s our duty to collaborate and elevate care across the country, to improve the health and safety of all jockeys, no matter where they’re riding.”

The overall goal is to bring horse racing in line with America’s other major sports.

‘We were working together’

After a week in the hospital following his on-track spill, Keith was discharged.

He connected with Tiff, who introduced him to Tyler Curry, P.T., DPT, OCS, physical therapist with KORT Physical Therapy. Together, the three created Keith’s physical therapy (PT) program. He started PT two weeks after discharge, beginning with light balance exercises, range-of-motion exercises and strength training. Eventually, he folded in cardiovascular exercises — jogging, swimming and biking.

“Around the month-and-a-half or two-month mark, we realized he was progressing enough in his goals and that he was driven and motivated enough that we could discuss a return-to-ride protocol and how we were going to attack that goal,” Tiff said.

Getting back on the track for the fall meet

“Keith’s been one of the most motivated athletes I’ve worked with,” Tyler said. “It was a learning experience for all three of us, in terms of trying to determine what Keith needed and understanding how to work him through a major injury. But he stayed focused on his end goal, and that made everything easy for us to work backward and put together a plan for each step in his recovery.”

When the calendar turned to August, Keith graduated to sport-specific exercises, with the goal of getting back on a horse. He started with basic galloping and exercise riding. The work was minimal and supervised. He would self-report his progress to Tiff and Tyler, and worked with them to create goals for his next ride.

“It was very uplifting,” Keith said. “I’ve worked with such a professional staff at Norton Sports Health and KORT — people who were well-versed in the sport — that I was able to give feedback and they were malleable enough to alter our progress. If that meant I needed more balance here, and a little less muscle mass there, they were always receptive to my feedback. It made me feel like we were working together.”

Two weeks later, Keith was cleared for a faster pace and for short-race simulations. The return to real racing was getting close.

Then on Sept. 12, a little more than 90 days after his spill, Keith was medically cleared to race again. He took his first mount Sept. 21, on a horse appropriately named Payne.

He finished fifth, but more importantly, came away from the race in good health.

“You heal as most appropriately and just find the optimal way back to the sport,” Keith said. “You get paid for what you do, but you pay for what you do. There are consequences to rushing back [from] injuries. And there’s a very strong propensity to do that. I feel like I’ve been attended to with extreme professionalism, and I feel like I’ve taken this injury incredibly seriously and focused on how to optimally return so that I’m 100% when I get back.”

‘Physically and mentally 100%’

“We were just as motivated to have Keith return to ride as he was,” Tiff said. “We wanted to make sure he didn’t ever have to feel like he was on his own. We wanted him to feel like we were on his team, guiding him through every step of the process. That way he could truly be physically and mentally 100% before he returned to race.”

Now with a few races under his belt, Keith can reset his sights on his goals, both short and long term. And while he tries to stay in the moment, it’s hard not to allow his mind to wander, about what a victory might look like on the first Saturday in May, riding one of his dad’s horses across the finish line.

But until he gets to next spring, he takes comfort in knowing he’s where he needs to be, surrounded by those who want to see him succeed.

“It’s impossible not to be that sentimental,” Keith said. “But right now, I’m trying to stay in the present. [We’ve made] very targeted progress. I don’t feel like we were ever guessing. We’ve constantly addressed what needs to be improved and what’s doing well and just refocusing, refocusing, refocusing to where it’s all progress. And I don’t feel like I ever plateaued. Even if it was one more rep, one more step each day, if it was a step in the right direction, it was something to be excited about.”

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