Cassandra and Carlton Moore prepared to welcome their third child in late August. This was another milestone in their love story that started when the two first met at Noe Middle School in Louisville. They have been together for nearly 30 years. Having had two babies already, they thought they knew what to expect as they headed for the hospital for a planned cesarean section.

Everything was going as just as planned, until it wasn’t. Baby girl Indigo arrived, and Carlton took a quick peek. When he looked toward Cassandra, he saw she was no longer awake.

Monitors started beeping, and the staff began working together to save Cassandra’s life, doing chest compressions to try to resuscitate her. Teams from throughout the hospital poured in, delivering blood and medications and assisting in any way possible.

Cassandra had experienced an amniotic fluid embolism, where amniotic fluid enters the bloodstream. The cause is not known, but it’s extremely serious and life-threatening. It can happen without warning, and very few people survive.

“An amniotic fluid embolism is not a common event, but when it happens, it’s devastating and it’s hard for everyone,” said Maria R. Schweichler, M.D., an OB/GYN with Norton Women’s Care who is Cassandra’s obstetrician. “We knew instantly what had happened and began chest compressions.”

After 20 minutes, Cassandra’s heart started again, and she was transferred to the intensive care unit (ICU) — where her heart stopped again. This time the team worked again to revive her. The team at Norton Women’s & Children’s Hospital did not give up. Cassandra also experienced a stroke, and her heart was beginning to fail.

“You can’t wrap your mind around the situation,” Carlton said. “Thinking what could happen but not wanting to …”

“We kept chest compressions going until we were able to get enough blood and platelets in her that she had a pulse,” Dr. Schweichler said. “We just all took turns and rotated. Everyone was amazing.

“Everyone said, ‘She’s healthy; she’s young. We can save her.’ And that’s how everybody felt. So we just kept doing it.”

After 40 minutes, Cassandra’s heart started again.

The advanced heart failure team from Norton Heart & Vascular Institute arrived to help the Norton Healthcare Adult Transport Team take Cassandra to Norton Audubon Hospital. There, she was placed on extracorporeal membrane oxygenation (ECMO), a machine that takes over for the heart and lungs and allows the body to heal. She also needed dialysis to help her kidneys regain function.

Cassandra’s condition was grave.

“It is hard to describe how sick she was,” said Maroun M. Ghossein, M.D., a pulmonary critical care physician with Norton Pulmonary Specialists. “I think it’s best to describe it on a scale of 1 to 10, and she was well off the scale.”

“She was definitely the sickest person in Louisville that day,” said Bassel Alkhalil, M.D., cardiologist with the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program. “We were really worried that she would not be herself if and when she woke up.”

Over the next three weeks, Dr. Schweichler and others from the team at Norton Women’s & Children’s Hospital continued to visit and provide support and encouragement. The Norton Audubon Hospital ICU team went above and beyond, learning how to help Cassandra. Carlton knew that Cassandra, who is both an occupational therapist and a lactation consultant, wanted to be able to breastfeed their daughter.

“We had nurses who had never had a child before, and they’re [saying], ‘Show me what I’m doing,” said Sandy Corbin, R.N., a registered nurse in the Norton Audubon Hospital ICU. “We had communication with Norton Women & Children’s Hospital lactation consultants. We learned how to help Cassandra pump. We helped with skin-to-skin contact, even when Cassandra was still on ECMO.

“When I saw Cassandra move her hand, gently cupping Indigo’s head, I knew she was there,” Sandy said.

After a few weeks, Cassandra regained consciousness. At first, she began moving and opening her eyes. Then she began focusing and looking around.

“Just all of a sudden the light turned on and, you could see her personality starting to come back,” Dr. Alkhalil said.

“When we were able to, we got Cassandra up and took her outside in a special chair,” Sandy said. “When she moved into our medical ICU from the cardiac ICU, we knew she was going to be there awhile, so we put her in one of the front rooms that has the big windows that look out over top of the park, and you have more trees and scenery. We needed as much stimulation as we could for her.”

In all, more than 20 different departments between the two hospitals worked to save Cassandra.

“It is an army of people who took care of her,” Dr. Alkhalil said. “Medicine has become so specialized, and the human body is so complex, but one person, one discipline, one service is not enough. So you really need all the expertise to take care of those patients.”

After five weeks, Cassandra was able to start rehabilitation. After eight weeks, she was home with her family.

The Moores now have a new outlook on life.

“When I think about it, I’m in disbelief that I was able to get through all of that. It’s thanks to so many people who offered support — the teams at the hospitals and my family,” Cassandra said. “I’m so thankful for everything.”

The post Woman’s life-threatening heart event makes her ‘sickest person in Louisville’ appeared first on Norton Healthcare.

Unfortunately, a medical crisis and devastating diagnosis in 2025 makes it likely they will not see their 21st wedding anniversary. Bonny came to Norton Audubon Hospital on Monday, Jan. 27, with severe abdominal pain. After undergoing emergency surgery, she learned that she has a life-changing terminal diagnosis. She recently transferred to hospice care.  

Bonny learned that her cousin, who was visiting her in the hospital on Jan. 31, had just taken a course to be ordained to perform weddings. She looked over and asked Robert if he would like to renew their vows. 

Robert replied, “Of course I will, honey.” 

When Bonny’s care team at Norton Audubon Hospital found out about the vow renewal plan, they made it their mission to make the event — happening that day — as beautiful as possible. Reaching out to colleagues to assist, one ordered a dozen white roses on Door Dash while another supplied the couple with a plant for the bedside ceremony.

Two decades ago, what made them decide to marry after seven years of dating?

“He’s just a very good man,” Bonny said.

Robert made them both giggle with his reply: “Because she is hot and still is hot!” 

He called Bonny the “biggest-hearted person” he’s ever met. 

Bonny’s care team agrees and calls her an amazing woman who remains upbeat despite her diagnosis.  

“In the short time Bonny has been at Norton Audubon Hospital, she has won over the staff,” said Lindsay Lewis, BSN, R.N., director, invasive cardiology, patient care services “I’m pretty sure they are fighting over who gets to take care of her. 

“I let her know that even though there are times when we are with our patients only for a short time, they leave an impact on us that will stay with us forever.”

Bonny has been one of those patients for the staff on the Progressive Care Unit.  

What would Bonny share with others?

“When you love someone, let them know it — let them know it a lot,” she said. “You can’t lose your mind at the same time, but when you know, you just know.”

She takes it a step further. Each year on her husband’s birthday, she sends Robert’s mother a thank-you card.  

Bonny also wanted to share that the caregivers she has met at Norton Audubon Hospital are amazing, and the list of those who she raved about could go on and on. 

At a time when she was not able to drink or eat anything, yet was craving coffee, she said one of her favorite nurses smelled of coffee, and that just made her morning.

“He smelled so good!” she said.

It’s an important reminder to appreciate the small blessings in life — to be thankful during the good times and make the best of out of the bad. 

When we are given the opportunity to provide blessings during another’s bad time, it can make all the difference in the world.

The post When you love someone, let them know — a lot appeared first on Norton Healthcare.

Today, he’s a bit more cautious about how much time he spends in the sun. In the past three years, Randy has had two basal cell carcinoma skin cancers removed from his face, the first requiring significant reconstruction due to the lesion’s proximity to the left side of his nose and eye socket.

Randy said he didn’t think too much about the initial spot at first. When it grew more noticeable, he asked his primary care physician about it. According to Randy, his family medicine physician, Karalee Bessinger, M.D., at Norton Community Medical Associates primary care in Carrollton, Kentucky, referred him to a dermatologist in LaGrange, Kentucky. That doctor wanted to refer him to a facility in Louisville, Kentucky, because of the lesion’s location and the intricate surgery it would take to remove it.

Not one for city traffic, Randy sought another opinion, turning to Jonathan Hanson, M.D., otolaryngologist (ear, nose and throat specialist) with Norton King’s Daughters’ Health in Madison, Indiana. Dr. Hanson met Randy in January 2022 and assured him that he could remove the lesion and provide any necessary reconstruction.

“The art of facial reconstructive surgery takes into account a lot of factors,” said Dr. Hanson, adding that about 15% of his practice includes skin cancer removals on the face, ears, head and neck. “Elasticity of the skin varies from the nose to the cheek to the eye. It’s also important to factor in the shape and location of a patient’s natural skin lines and contours. The goal is to meet surgical needs while minimizing any noticeable incisions when healing is complete.”

During Randy’s first surgery, Dr. Hanson opened a large flap on the left side of Randy’s face, following the natural skin lines under his eye to the edge of his mouth. After fully removing the cancerous lesion, he carefully stitched the seam back together using the natural skin folds along his cheek and eye. Today, you would never know Randy underwent significant facial surgery.

“He’s a fabulous doctor,” Randy said. “He told me exactly what he was going to do and followed up with everything he said he was going to do.”

In May 2024, Randy returned to Dr. Hanson for a second area of concern: an elongated bump just below his right eye. A less extensive surgery was needed, and Dr. Hanson again developed a plan of action and executed it perfectly.

“One reason I enjoy the work is the creativity,” Dr. Hanson said. “Every face and every person is unique. There’s no cookbook or recipe.”

After a life spent farming, working at a factory and serving his country in the Army, Randy relishes his slower pace. He enjoys being home, spending time in his self-proclaimed man cave and watching car racing on television. He and his wife, Carolyn, still live on a 60-acre farm outside Carrollton, near family and friends.

These days on the farm, one thing is different. If you see Randy outside mowing or working on a project, he’s wearing a straw hat. It’s a small price to pay to help keep the sun off his face.

“The earlier we find skin cancers, the better,” Dr. Hanson said. “The smaller they are, we get much better results. It’s easy to ignore them. Any spot that is raised or pigmented or grows or changes needs to be reviewed by a family provider. If they think it’s suspicious, the patient can be referred for follow-up.”

The post Reconstructing damage from skin cancer appeared first on Norton Healthcare.

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.”

The post Norton Neuroscience Institute successfully completes its first high-frequency focused ultrasound procedures appeared first on Norton Healthcare.

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.”

The post Norton Orthopedic Institute surgeon’s shoulder replacement method brings reduced recovery times, better outcomes appeared first on Norton Healthcare.

Around 4:30 p.m., the 64-year-old licensed cosmetologist sets up shop in the salon of The Pendennis Club of Louisville. It’s very “Hemingway” inside — vintage decor, lots of wood built-ins. The salon is small, just two chairs and a large mirror. It sits right outside the club’s dining room, convenient for when a customer needs to kill time before an appointment with a cocktail.

It’s in this small salon where Michael gets to live out his passion, one scissor snip at a time.

“I get to come down here and kind of just hang out with the guys and cut their hair,” Michael said. “It balances me out, and it’s a lot of fun. I enjoy it more than anything, to tell you the truth. I just love the camaraderie.”

Michael’s officially been a hairdresser since 1986, when he graduated from Roy’s Beauty School on Dixie Highway. But he’s been cutting hair since he was 16, while still a student at Iroquois High School.

“When I first started it, I liked what happened when I lifted hair up, cut it and let it fall,” Michael said. “Then somebody put a $5 bill in my hand. At age 16, I was looking at that, and that was the hook. I said, ‘You’re going to pay me to do this?’”

It became his life’s work, decades behind the chair. He’s opened and closed salons over the years, and eventually began teaching young hairdressers at Empire Beauty School, sharing the skills necessary to begin their careers. But since 2004, Michael’s been at The Pendennis Club on Fridays, caring for the members who helped him begin his life outside the salon.

“When I first started working, I was apprenticeship teaching, and only making $13,000,” Michael said. “I was engaged to be married at the time, and working at the club allowed me to make the loan for my first home.”

On this particular Friday, Michael’s cutting the hair of his older son, Jared, getting him looking right before the weekend. His hands move smoothly, as though meant for this kind of work.

It’s work that, just a few months ago, Michael was unable to do without excruciating pain.

‘I put it off and kept working’

It was February 2013.

Michael was on his way out the door, when he slipped on ice and fell on top of his car. His arm bent like a wing. He was immediately in pain, and later was diagnosed with a dislocated right shoulder and a torn rotator cuff.

He visited Ryan J. Krupp, M.D., orthopedic surgeon at Norton Orthopedic Institute, who determined Michael needed a shoulder replacement. Michael, however, wasn’t ready to dedicate the time and resources for that extensive of a procedure.

“I was only 55 years old at the time,” Michael said. “So I put it off and kept working. I didn’t want to do [surgery], so I waited and did physical therapy, lightweight exercises. I would just have to stop and rest my arm and go back to it.”

The pain impacted his work dramatically. Michael could only cut hair for two to three minutes before having to stop and shake his arms out. His haircuts began to double in time. He knew he couldn’t go on like this forever.

“It was terrible,” Michael said. “It put me in a bad mood. In my business, time is money. And then I was taking over-the-counter pain medication, which was messing up my body. So it was just something I couldn’t put off any longer.”

‘We had a great plan’

As coincidence would have it, Michael found the answer to his shoulder issues while getting his knees examined.

He was introduced to Joshua J. Christensen, M.D., orthopedic surgeon at Norton Orthopedic Institute, who talked to Michael about the possibility of a reverse shoulder replacement. The two of them collaborated on a treatment plan, and Michael finally agreed to have the procedure.

“Typically, a rotator cuff tear is something we see on an MRI,” Dr. Christensen said. “But, when the tear is big enough or has been there for long enough, we can actually see the changes with the ball shifting up the socket on the X-rays. So [in Michael’s case] we already knew his rotator cuff tear was unrepairable. He was having symptoms on a daily basis, symptoms of pain and limited range of motion and strength that were preventing him from doing his job. And so, this was the perfect solution for him in that case.”

On Feb^. 6, 2024, Dr. Christensen performed successful reverse shoulder replacement surgery. During the roughly 45-minute procedure, he removed the old shoulder ball, placed a short stem down the center of Michael’s humerus and fixed a new socket to the top of that stem. Where the old socket used to be, Dr. Christensen inserted a base plate with screws and placed the new ball on that site.

This surgery, unlike a conventional shoulder replacement, relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. It essentially recreates the function of the rotator cuff to allow for better mobility and strength.

Michael went into surgery around 7:30 a.m. and was back in his recliner chair at home by lunchtime.

“I can’t say enough about Dr. Christensen’s technique,” Michael said. “We had a great plan before, a great plan during and a great plan after. And it all turned out well.”

“When you meet somebody like [Michael], somebody’s who’s really struggling to do the things they need to do, that is why we get into doing what we do,” Dr. Christensen said. “On an everyday basis, sometimes it’s a tough slog to get through a long day in the operating room. But when you see someone back like him, who’s really doing amazing, it really does make it worth it.”

‘I’ll always be behind the chair’

Michael’s recovery went as smoothly as he had hoped.

He was diligent about icing his arm. After one week at home, he began walking 3 to 5 miles a day. It helped him lose almost 15 pounds after surgery. After just six weeks, he was back at work.

Now four months after his procedure, Michael’s life has returned to normal, and he’s cutting hair like he did when he was 16.

“I just did a full highlight and a haircut in my salon and knocked it out in 48 minutes,” Michael said. “I did it like I used to do.”

He’s thankful to be back at The Pendennis Club on Fridays, in his rightful place behind the chair of the old salon. He’s thankful for the clientele supporting him through his recovery. And, he’s thankful for his new shoulder and the man who created it.

“You’ve got to be here because you want to be here. It can look like a glamorous job, but it’s hard work,” Michael said. “[The surgery] was everything. I like to say I’m going to live ’til 100 years old. And eventually, I’ll retire from teaching, but I’ll always be behind the chair. I enjoy doing this so much; it’s who I am.”

The post 40-year hairdresser back behind the chair after successful reverse shoulder replacement surgery appeared first on Norton Healthcare.

At the front of the room, Lloyd Kelly greets his class of about 20 with a fist-to-palm salute. He bows his head and says, “ni hao,” greeting them in Chinese. The class repeats it back to him.

From there, he leads them in a 1½-hour tai chi course. The Chinese art form is known for its slow, intentional movements as a form of gentle exercise and meditation.

For this group, though, tai chi is much more than just a 90-minute class, two times a week. Almost all the class participants have been diagnosed with a neurological condition, and the slow movements are a way to improve balance, stability and movement — all things the neurological conditions have robbed from them over the years.

It’s also a chance to connect with people and form a bond with those who’ve shared similar life experiences.

This class, made possible by Norton Neuroscience Institute Resource Centers and the Norton Healthcare Foundation, is celebrating 10 years in existence.

‘My passion is to help people’

Lloyd Kelly found tai chi at 10 years old.

His father was a pilot in the Air Force. His commanding officer had a passion for martial arts and would practice them on base. The officer loved it so much, he even offered classes for the pilots and their families at the base gym.

Lloyd tried tai chi and was instantly hooked.

“I saw that going on, and I said, ‘I don’t know what that is, but that’s cool,’” Lloyd said.

Lloyd practiced it ever since, and eventually went from student to teacher, quickly earning his certifications and teaching tai chi across the state of Kentucky. Ten years ago, Norton Neuroscience Institute called and asked Lloyd to lead a class for patients with neurological conditions. He agreed.

The first class in 2014 on the Norton Brownsboro Hospital campus had fewer than 10 participants. Ten years later, the class has grown to roughly two dozen people; many haven’t missed a class in years.

“My passion is to help people, so I’m really into the medical aspect of tai chi,” Lloyd said. “It’s been gratifying and life-changing for me, and I have a lot of gratitude to Norton Healthcare, because they had the foresight [to offer this program]. A lot of people see tai chi and they think, ‘Oh, it’s woo woo. It might be alternative medicine.’ This is not alternative medicine. It’s complementary. It’s to complement other medications and therapy. So it’s not to compete. It’s to add on.”

‘It just feels comfortable’

Susan Small was diagnosed with multiple sclerosis (MS) in 1985.

Her diagnosis came with a flurry of emotions, but mostly fear of the unknown and the future. Susan was a pharmacist, and scoured libraries to find information about her condition. While she dug for knowledge, she bounced from doctor to doctor, looking for someone who could help her.

At the same time, she began to lose her balance. She fell several times, needing multiple surgeries as a result of her injuries.

In the beginning, it was scary.

“There were no [disease-modifying] drugs, no internet, no place for me to go for information,” Susan said. “By the time you get in to see a neurologist, they couldn’t even give you a diagnosis. But at the time, they couldn’t do anything about it anyway. So by then, I just got on with my life and stopped drowning in my condition. I decided, ‘you know what, I’m not going to let this possess me.’”

Determined not to allow her diagnosis to define her, Susan stayed active and eventually came across information about the “Neuro Tai Chi” class. She decided to give it a try and showed up for the first day of class back in 2014.

“I remember the first day of class,” Susan said. “It was so early in the morning. I remember I had to set my alarm, roll out of bed — and my husband made me a huge thermos full of tea. And I was sitting in the chair so tired.”

Despite the early wake-up calls, Susan quickly noticed something was changing. The more she attended class, the more her balance and stability improved. More than that, she felt like her memory was beginning to improve. It was exhilarating. She didn’t miss a class for 18 months.

“This class has helped me in so many ways,” Susan said. “It was like I was eating it up. I couldn’t not come, because I could tell it was helping me. I had to come, even if it was at 8:30 every morning. It was like this drive in me, and I could sense it in my body. It wasn’t just weight distribution and balance. It was my brain. There was something I was sensing that my brain was making the new connections. I can’t even really explain it, but I could do things [that I couldn’t before]. It was like my brain was picking up the signals. Now I know it’s neuroplasticity in the brain, where one side takes over for the damaged cells on the other.”

From there, she began recruiting others to join. Edi Deering was one of them.

Edi, diagnosed with MS in 1986, already had been taking tai chi at a different location. She agreed to try the class at Norton Healthcare. She hasn’t looked back either.

“It just feels comfortable, and it’s very good,” Edi said. “The balance and exercise of it, but the camaraderie of it too: People are very compassionate here, and Lloyd is fantastic about not making us feel bad. He shows us how to do it right and then allows us to do it as right as we can. Because everybody has their own limitations and body mechanics that either work or don’t work.”

‘That is the promise we made’

Norton Neuroscience Institute Resource Center was officially established in 2013, as a place to provide help with the day-to-day challenges of living with a neurological condition. It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition.

The goal is to offer ways to improve access to care, provide information on disease management and address quality of life issues. The support is offered at no cost patients and their families, thanks to the support of donations through the Norton Healthcare Foundation.

“That is the promise we made our community, to give them the support they need free of charge,” said Yvette Cabrera-Rojas, director, Norton Neuroscience Institute Resource Centers. “Without the Norton Healthcare Foundation, we would not be able to offer these incredible classes to our community. It’s plain and simple — without the Foundation, we would not have a Resource Center.”

At Norton Neuroscience Resource Centers, licensed clinical social workers help individuals who are in crisis and work with patients to determine short- and long-term plans. Four nurse navigators are tasked with educating patients and families about their conditions and available treatments, while ensuring there are no barriers between patients and treatment plans. Coordinators are also on staff to create and develop programming for each condition.

“We focus on what [patients] can do and what they cannot do,” Yvette said. “We also give them a platform so they can make friendships with people who share the same life experiences as them. It’s all because they have things in common. These groups truly understand each other. They know.”

Norton Neuroscience Institute Resource Center programming is offered both virtually and in person. Offerings include exercise classes, therapeutic classes, educational programs and support groups. In 2023, attendance reached nearly 10,000 across the platforms. Also in 2023, the Norton Healthcare Foundation committed a minimum $100,000 to general programming and support and $64,000 to Parkinson’s disease programming.

’It’s an awesome bond, it really is’

Ten years in, Edi and Susan are still here, practicing tai chi with Lloyd and their tai chi family.

“For me personally, it’s been a wonderful experience,” Lloyd said. “It’s so gratifying to see people doing well, feeling better, be able to have a better quality of life. That’s life-changing to be able to provide that.”

Edi just celebrated her 80^th birthday, while Susan is now a certified tai chi instructor. They’re just two of many who’ve benefited over the years, thanks to Lloyd’s instruction and love of tai chi.

“It’s an awesome bond; it really is,” Susan said. “Because you get to a point where you think, ‘This is the group, and we protect the group.’”

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The phones are ringing. Emails and referrals are coming in from physicians trying to connect their patients with the resources they need outside the doctor’s office.

Patient navigators are meeting with patients, both newly diagnosed or in transition, providing help with the day-to-day challenges of living with a neurological condition.

The entire ecosystem is buzzing.

It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition.

At the helm is Yvette Cabrera-Rojas, the resource center’s director. She responsible for making sure the office runs as it should.

But for Yvette, this work is more than just a career. It’s personal.

‘I didn’t know what my future was going to look like’

Yvette’s symptoms started in 1989.

She was driving on the highway when — all of a sudden — two lanes became four.

“I had double vision,” she said. “I had pain in my eye. They thought at the hospital I had vertigo, so they sent me home. And then I received a phone call from a doctor at the hospital that I needed to see an ophthalmologist.”

She went through a series of tests, and on the week of July 4, officially was diagnosed with multiple sclerosis (MS). At the time, the news hit her hard.

“I was not happy,” she said. “And I didn’t know what my future was going to look like. I was in my mid-to-late 20s, married, the mother of a baby boy, and I was worried about how my life would turn out.”

Yvette knew how debilitating the disease could be. MS made her father quadriplegic, leaving her to care for him for the final 10 years of his life. She also knew that, at the time of her diagnosis, there were no treatments available. Her symptoms continued to worsen.

“The first five or six years were a nightmare,” she said. “It was one MS attack after another. I had lost my vision [at times]. I had lost hearing in my right ear for stretches at a time. I was numb on one side of my body for over a year.  In 1991, I woke up one day and lost the use of my right leg [temporarily]. And the only kind of treatments they could use back then were steroids. They would bombard you with steroids for five days at the hospital. It was very bad. There was a lot of uncertainty, a lot of fear. No planning for the future.”

But in 1994, Yvette’s world changed forever.

The Food and Drug Administration approved interferon beta-1b (IFNbeta-1b) for the treatment of relapsing forms of MS. It became the first disease-modifying medication, but was available to patients only through a lottery. Yvette won it, and traveled to Lexington routinely to receive the intramuscular treatments.

“[The shots] were pretty bad and would give you flu like symptoms,” she said. “But back then, the medication only had a 30% to 34% ability to reduce the amount of relapses, attacks a person would have per year. So I took that 30%. It’s better than zero.”

‘What is MS?’

According to the National Institutes of Health, multiple sclerosis is the most common neurological disease of young adults, with symptoms usually beginning between ages 20 to 40.

In MS, the immune system cells that normally protect us from viruses malfunction. Bacteria and unhealthy cells mistakenly attack myelin in the central nervous system. Myelin is a substance that makes up the protective sheath (myelin sheath) that coats nerve fibers (axons).

MS affects different people differently. A small number of people with MS will have little to no disability, whereas others will have a steadily worsening disease leading to increased disability over time. Most people, however, will have short periods of symptoms followed by long stretches of relative MS inactivity.

Symptoms of MS can include vision issues (blurred or double vision), muscle weakness and stiffness, imbalance, bladder control issues, dizziness and more. MS also can cause mental or physical fatigue, mood changes and cognitive dysfunction.

There are four main types of MS.

Clinically isolated syndrome refers to the first episode of symptoms, such as eye movement pain or numbness and tingling that lasts more than 24 hours. These symptoms can be caused by inflammation or damage to the myelin that covers nerve pathways. Sometimes there is an indication of MS on an MRI scan, sometimes not. If the diagnosis is a condition known as clinically isolated syndrome, starting patients on medication soon can help improve their condition in the future. In some cases, the condition may warrant close monitoring without medication.

Relapsing remitting MS is the most common form of MS and represents about 85% of patients. Life with relapsing remitting MS means going for periods of no symptoms, then encountering a relapse or exacerbation where symptoms last for more than 24 hours. Symptoms can last for days or months before going away in part if not completely. The level of symptoms after a relapse establishes a new baseline until the next exacerbation. Sometimes the new baseline is no symptoms; sometimes it’s something that lingers that wasn’t there before.

Secondary progressive MS is the type of MS that comes later in the disease’s progression. Rather than sudden onset, symptoms are more gradual. Patients may develop new brain lesions or more disabilities and other symptoms.Generally, secondary-progressive MS represents a transition from relapsing-remitting MS over time.

Primary progressive MS affects only about 10% to 15% of patients. Rather than stair-step symptoms of relapsing remitting MS, primary progressive MS gradually progresses without remissions or relapses. These patients often will have trouble walking or will have another symptom that gets worse over time. It’s typically difficult for the patient to pinpoint a specific episode of worsening or improving symptoms.

‘A one-of-a-kind organization’

In the 30 years since interferon beta-1b was introduced, treatment has changed drastically for patients with MS. There are now roughly two dozen disease-modifying therapies readily available. They can be given orally, through injection or even through infusion. Even more, treatment plans can be tailored to the individual, to manage their specific symptoms.

It’s a far cry from where things stood when Yvette was first diagnosed in 1989.

“I think of all the people who have suffered, of those who were diagnosed before any of the medications were available to us,” Yvette said. “And, you know, for me it’s sad, because it all boils down to timing. My father had MS at a time when nothing was available to him except steroids. He would not live to benefit from these new treatments. What we know today, and what we have available in treatment options, are all due to advancements in science. And who knows? Twenty years from now, maybe today’s medications [will be] naught compared to what will be available in the future.”

Norton Neuroscience Institute Resource Centers have developed into regional leaders in providing help to patients with the day-to-day challenges of living with neurological conditions. More specifically for MS, the Hussung Family Multiple Sclerosis Center provides a full range of patient support options, including remote and in-person classes, on-demand patient education videos and a well-rounded team with expertise to provide care for the whole person.

The clinic is recognized as a Center for Comprehensive MS Care by the National Multiple Sclerosis Society.

“The resource center is a one-of-a-kind organization,” said Andrea V. Rogers, R.N., patient navigator for patients with MS, Norton Neuroscience Institute Resource Centers. “And that’s the thing with chronic illness. It’s not just, ‘Hey, take this medicine and go about your way.’ There are so many other factors. So it’s been huge, you know? We’ve gone from having essentially no hope [30 years ago], to patients living a completely normal life. They get to plan vacations, have children and all sorts of other things.”

Each year, they help thousands of people gain that hope of living their lives to the fullest. And while progress sometimes can be hard to quantify, there is proof the work is paying off. To see it, just ask the person who’s experienced it herself over the past 30 years.

“It feels wonderful to witness the progress,” Yvette said. “I mean, this is my purpose.  I have a quote up on my wall that says, ‘Be the change you wish to see in the world.’ And that’s what I wanted to do. I saw a void in the community with all of these individuals living with MS, and I didn’t want anyone to go through what I had gone through. And so it feels good. It’s been healing actually. Helping people is a way to heal.”

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“I was 19, a sophomore in college,” Susan said. “I started having pain in my hip and couldn’t figure out what was causing it.”

She bounced from doctor to doctor, looking for answers. Several months later, her right leg was paralyzed. She needed a MRI, which confirmed she’d ruptured a disc in her lower back. It was compressing her nerve roots, and she needed to have surgery immediately.

“[The doctor] said, ‘I don’t want to fuse your spine; you’re too young,” Susan said. “But he also told me, ‘this won’t be your only surgery.’”

The recovery was arduous. She was directed to stand up straight or lie flat on her back for 30 days. From then on, she battled chronic daily pain, derived from a combination of arthritis and spondylolisthesis, a condition when one vertebra slips in front of the other.

“It wasn’t severe most of the time, but I always knew it was there,” she said. “And as I got older, it started getting worse and worse. And I usually had one to two bad weeks per year, but I always dealt with it.”

In 2015, the pain became insufferable.

She couldn’t perform daily tasks, like bending down to tie her shoes. She went to see Jeffrey L. Gum, M.D., orthopedic spine surgeon with Norton Leatherman Spine, who — in June of that year — performed a successful lumbar fusion of Susan’s L4 and L5 vertebrae.

During the nearly three-hour, “open-technique” surgery, Dr. Gum made a roughly 6-inch incision in Susan’s back and removed bone spurs and disc fragments that were pressing on her nerve roots. Then, he took pieces of bone from Smith’s hip and placed them between vertebrae in her spine, then fused the bones together using screws and rods. She spent three nights in the hospital and started her recovery, which compared to her first surgery, was night and day.

“When I went home, it was no lifting, bending or twisting,” Susan said. “But Dr. Gum told me to live my life and we’ll check in in 30 days.”

But she didn’t even need that long. After just two weeks, she was cleared to return to work.

“I have not had pain since the day of my surgery,” Susan said. “Everyone tweaks their back every now and then, but I have not had back pain for almost nine years.”

‘Like daughter, like mother’

Sharry Waldeck has a theory.

She believes her back pain is derived from the day she fell off a horse when she was 10 years old. Though the riding accident didn’t impact her severely at the time, she’s had some back pain from then on.

Fast forward roughly 60 years, and that pain began to worsen.

“Probably for the [last] two years, I have had quite a bit of pain that last year became intense,” Sharry said. “And the last few months was to the point that I could hardly do my household chores or get dressed.”

Luckily for Sharry, her daughter Susan had some experience and knew who to call.

In 2023, Susan connected her mother with Dr. Gum, who diagnosed Sharry with the exact same conditions — spondylolisthesis and arthritis. Sharry also was dealing with slight scoliosis, or sideways curving of the spine. She needed surgery to correct it.

“She had a lot of voices telling her it might not go great,” Susan said. “And I knew better. And I knew Dr. Gum would never have suggested surgery if he didn’t think he could improve her quality of life. So my role in all of it was to counteract the negative [stigma] around back surgery.”

In November, Dr. Gum performed the same surgery on Sharry as he did on Susan — a lumbar fusion of the L4 and L5 vertebrae. And while the premise of the surgeries was the same, Dr. Gum was able to perform Sharry’s procedure as minimally-invasive surgery, with the help of a robot.

The robot — called the Mazor X Stealth Edition— helps expedite surgery time and get patients into the recovery room quicker. It uses imaging software and GPS capabilities to help surgeons map out a plan before surgery, increasing the accuracy of screw placement and improving the overall efficiency of the surgery. Because the robot guides the screws, the size of the patient’s incision decreases to less than 2 inches. Even more, the new surgical technique also affects how surgeons manage pain. Dr. Gum used a preoperative nerve block, helping reduce the need for opioids to manage pain post-surgery.

“I love it,” Dr. Gum said. “I always want new technology that can help us do things better, and I love proving that it adds value to our specialty. For me, it’s like seeing what’s not just available now, but what can be available in two years, five years or 10 years; that’s what gets me excited about what I do. When you decide to go into a surgical specialty, you’ve checked the box of being a lifelong learner and always being receptive to new technology or new techniques. So I think it’s one of the most exciting things we get to do.”

Sherry’s recovery was just as advertised.

Just hours after surgery, she was sitting in a chair and had already walked the hospital floor without issues. After an evaluation from Dr. Gum, she was cleared to go home. So, Susan helped her mother get dressed and walked her out of the hospital that same night.

“It is truly amazing to see,” Susan said of her mother. “I was waiting to go back to recovery, and it was taking pretty long. And finally they came out and said, ‘She wants to go home.’ It’s crazy to think here I was 30 years younger and in the hospital for three nights, very long incision, with drains and ports and the whole bit,” Susan said. “And here she is, 30 years older, with no hospital stay. And I only stayed with her one night, and that was it.”

‘I get goosebumps talking about it’

Now five months after surgery, Sharry is back to normal, living her life without restrictions. Susan is still doing well too, eight years after her procedure.

They compare scars from time to time and have the usual mother-daughter discussions about their procedures. But, they don’t give too much thought to the gravity of it all, until you ask.

“When I had mine done, I knew it was going to be better than my first surgery 20 years before that, but I didn’t appreciate the difference in the two,” Susan said. “To go from my first surgery to what I had done [in 2015] is amazing. But that was 20 years, and so it makes sense. But then to think, ‘Oh, in nine more years there’s going to be a robot that’s going to do this surgery, and you’re going to have this tiny incision and you’re not going to have to stay in the hospital, that didn’t cross my mind. And I definitely didn’t think [the example] would be my own mom.”

The same can’t be said for Dr. Gum, who continues to push the limits of what is technologically possible, while looking ahead to what the next advancement might be, and how that may make patients’ lives even better.

“I almost get goosebumps talking about that,” Dr. Gum said. “Every day you enter that operating room, you need to understand how you can do better the next time you go in. And so part of that learning or critique process is asking yourself, ‘Why are we doing it this way?’ If there are techniques to do it better, we need to learn those techniques. So to me, every day is an evolution of how I look at the [operating room]. I want to walk out of there learning something new or better. And when you take a step back and put it all together, I think it’s beautiful and awesome that we’re seeing robots in the OR. There’s all this new technology that’s evolving that’s going to make it easier and safer for what we do.”

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Every other Friday morning, at the same time of day, they drive to the Norton Infusion Center on the Norton Brownsboro Hospital campus. After some time in the waiting area, Pam is admitted back into a room, where she receives her biweekly infusion of lecanemab, the first drug approved by the Food and Drug Administration (FDA) for the treatment of Alzheimer’s disease.

For six months, this has been the Jeffries’ reality.

“It has become a routine,” Rick said. “It’s just part of life now. It’s not an extra burden. It’s just something we do every other Friday. Sometimes on our ride out, Pam will ask me, ‘Why are we going out here again?’ And I’ll have to remind her, ‘We’re going here for your memory.’ Sometimes she’ll say that she doesn’t want to go, but it doesn’t take too much convincing. She’s put her trust in me.”

On Aug. 25, 2023, Pam made history as the first patient in Kentucky to receive the lecanemab treatment. It was an exciting, yet nerve-wracking time for Rick, who often remembers what his wife once was, yet is reminded daily of what Alzheimer’s disease took from them.

Pam’s recollection of the day-to-day is slipping. She sometimes forgets where she puts her jewelry. Her hearing aids occasionally find themselves wadded up in a napkin.

His hope is that her biweekly appointments halt the progression of a disease he still cannot bring himself to outwardly name in front of her. He sees the flashes of success and hopes he’ll see more of them as they continue treatment.

“I try to take it as it comes,” Rick said. “My fear is that she’s going to progress beyond that stage where the medicine is even a possibility. But I try my best to live in the moment, and I know that’s hard to do, but I work really hard at it.”

‘You just wouldn’t believe Mom. She’s back.’

Nobody really knows you, like you do. It’s why doctors tell their patients to listen to their bodies.

And though Ralph and Bobbie West have been married nearly 52 years, that saying became apparent a few years ago, when Bobbie noticed she was acting different.

“Her sister had Lewy body dementia, and she would tell me, ‘I’m starting to act more and more like her,’” Ralph said.

At that point, Ralph began to pay attention. He started to notice it too.

From there, Bobbie spent months visiting doctors, taking written and oral exams. The goal — funny enough — was to prove to both herself and her physicians that her memory was not what it once used to be. For a while, they told her she was fine. She didn’t believe them.

“She would say, ‘I know I’ve got it; I know I’ve got it,’” Ralph said.

Eventually she was referred to Rachel N. Hart, D.O., a memory disorders specialist at Norton Neuroscience Institute. Dr. Hart confirmed — through a series of tests — Bobbie’s suspicion.

She has Alzheimer’s.

“I was relieved that I thought maybe I could deal with it if I knew for sure I had it and maybe get some help somehow,” Bobbie said.

Dr. Hart introduced them to lecanemab and got Bobbie started in the program. By the fall, Bobbie had begun her infusions, the sixth patient in Kentucky to have the treatments. Bobbie’s experience with lecanemab has felt dramatic. Her first two infusions brought little change, which was to be expected. But after her third dose, for whatever reason, Bobbie felt oddly normal.

“The first two times, it was fine,” Bobbie said. “I didn’t have any pain. I didn’t have any worries. Nothing happened. And then a couple days after the third one, I said, ‘Ralph, have you noticed anything different about me? I think I’m more aware of things.’ And we continued over that week … I just really felt like my old self by the end of the week. Ralph called our son and said, ‘You just wouldn’t believe Mom. She’s back.’”

‘What is lecanemab?’

The FDA granted lecanemab full, traditional approval in July, paving the way for Norton Healthcare to receive the drug and become the first health system in the region to administer it to patients.

Lecanemab — branded under the name Leqembi — is a medication designed to remove the protein beta amyloid from the brain. The buildup of beta amyloid is thought to be the driving cause of plaques that are characteristic in Alzheimer’s disease. The thought is that removing the beta amyloid will slow down or stop the progression of Alzheimer’s.

“I think when the historians look back on this, we will see this as one of the most important steps towards the eventual cure of Alzheimer’s disease,” said Gregory E. Cooper, M.D., Ph.D., director of the Norton Neuroscience Institute Memory Center. “It is the first treatment that addresses — what we believe is — the underlying cause [of Alzheimer’s] and bends the curve, slows the progression. At the same time, I’m aware that it’s only slowing it down.”

In order to qualify for the medication, people need to meet a specific set of criteria. To begin, the potential patient must undergo tests to determine the extent of their cognitive decline. Lecanemab is designed only for patients with mild cognitive impairment or mild Alzheimer’s. Anything beyond that threshold excludes them from treatment. Then, the patient needs an MRI and a genetic test to determine risk factors, and a spinal fluid exam to test for beta amyloid in the brain.

From there, the patient can begin the process of receiving the medication. Lecanemab is given via infusion every two weeks and is thought to slow progression of Alzheimer’s disease by about 30%.

“It’s kind of like stroke,” Dr. Cooper said. “Twenty-five years ago, when we had the first clot-busting medication for stroke, the first time we could potentially reverse the signs of stroke, we still had people coming to the hospital 24 hours after their stroke. It took a long time to convince people time is brain. I think this is a little bit the same way. More and more, people are going to realize there’s a treatment that’s not just going to treat the symptoms, but slow this down. And yes, it matters if I’m evaluated now as opposed to a year from now.”

Despite the benefits the drug has shown in clinical trials, there is a risk for side effects. As many as 1 in every 5 people will have some degree of ARIA, or amyloid-related imaging abnormalities. This is presented most commonly as swelling or bleeding in the brain. Fortunately, only about 3% of patients have symptoms related to ARIA. In most cases, this resolves without treatment.

Still, lecanemab’s breakthrough is a game-changer, placing a greater emphasis on early detection of Alzheimer’s disease. The earlier a physician can diagnosis the disease, the earlier the patient can begin the treatment process.

‘We’re seeing really positive findings’

Since Pam began her treatments in August, the lecanemab program has grown significantly, and Norton Neuroscience Institute has continued to be one of the top programs in the country for administering the drug.

As of March 1, 2024, 71 patients have had at least one infusion, and roughly two dozen more are in various stages of beginning the process.

Dr. Cooper and other Norton Neuroscience Institute neurologists have begun to see the first lecanemab patients — people like Pam and Bobbie — for their six-month follow-up exams. These meetings are the doctors’ first chances to reevaluate the patients, test their memory and determine if the disease has passed from mild to moderate, thus eliminating them from eligibility.

“It is a little bit of a fuzzy line; it’s an arbitrary line,” Dr. Cooper said.

To determine this, neurologists often will use the Mini-Mental State Examination, grading patients on a score from zero to 30. A score ranging from 20 to 30 is considered mild, while 10 to 20 is considered moderate. Scores ranging from zero to 10 indicate severe cognitive decline. To remain qualified for lecanemab, patients need to score 22 or above. That said, there are also real-life barometers of cognitive function.

“We can look at activities and daily living,” Dr. Cooper said. “Do the patients need more help monitoring things like daily finances, day-to-day activities, shopping, meals, picking out clothes? These are things caregivers can observe and report, and that gives us a better idea of where the patients are.”

So far, in six months of treatment, the results have come back positive.

“All the signals we’re getting back are really optimistic,” Cooper said. “People are telling us they think they’re doing well, that they’re not seeing much disease progression. Now, there are potential reasons for that. What I’d really love to find out is that the drug is working even better than we thought it would from the clinical trial. That’s the perfect scenario. It’s also possible that we’re so early on and someone has not really changed over three or six months. So it may be too short of a period to measure change. Also, with the excitement and the optimism that comes with this, [there is] the increased stimulation of being part of it. So people might be doing relatively well because they’re now engaged. So we’re seeing really positive findings early on.”

The Memory Center has established support groups for lecanemab patients and their caregivers — a once-per-month Zoom meeting that gives them a chance to share experiences with other people who are at similar stages of their battle with Alzheimer’s disease.

Ralph and Bobbie have been attending and have found the sessions eye-opening.

“You find out that everybody knows or has been through [the same thing], and they’re willing to share their experiences,” Ralph said. “We’ve really heard and shared some bad stories, but I think it helps to be able to communicate and get that stuff off your chest, and you know there are other people outside that are fighting the same battle.”

‘I am beautiful’

It was just a few days before vacation.

Rick and Pam were set to head to Florida to get out of the cold, Kentucky winter. But before they could leave, Pam had her six-month follow-up exam with Dr. Cooper.

Despite Rick’s fears, Pam scored one point higher on her cognitive exam than she did some months ago, an encouraging sign her disease has not progressed much.

Still, the evidence of her decline is there.

Dr. Cooper, as part of her exam, gave Pam three words to remember — ball, flag and tree. A little while later, before the end of the visit, Dr. Cooper asked her to repeat the words back to him.

Pam looked around the room and, with a big smile, confidently gave her answer.

“I am beautiful,” she said.

They all laughed.

It’s obvious. Though Alzheimer’s disease already has robbed Pam of some of her memory, it has not wiped out her sense of humor. Nor has it broken the bond between her and Rick. In fact, it may have strengthened it.

To see the evidence, all you have to do is look down.

As Pam and Rick walked out of the exam room, she grabbed his hand and squeezed. The small public display of affection is not something the two of them — in all their years of marriage — had ever done.

That is, until Pam started her infusions.

Now, holding hands is the norm. Maybe it’s because Pam’s knees aren’t what they used to be. Maybe it’s because she knows, deep down, she needs her support system more than ever. Whatever the reason, it’s been an unexpected, positive side effect of Alzheimer’s disease.

And so, they walked out of Dr. Cooper’s office — hand in hand — ready for what the next six months may bring.

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