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.”

The post New robotic-assisted shoulder replacement gives Nelson County man new outlook on life appeared first on Norton Healthcare.

Justin M. Givens, M.D., orthopedic surgeon with Norton Orthopedic Institute, is among the first five surgeons in the country — and the first in Kentucky — to perform a new groundbreaking, robotic-arm assisted reverse shoulder replacement surgery with Mako SmartRobotics. This procedure hopes to offer a higher degree of precision and accuracy compared with traditional methods.

“It’s an honor to be among the first to use this technology,” Dr. Givens said. “This new procedure allows me to give my patients a level of accuracy unlike any other. It’s a more personalized approach to each patient’s needs, which can lead to improved results and faster recovery times.”

The technology is designed to elevate the surgeon’s control and confidence by providing the surgeon with a 3D image of the patient’s unique shoulder anatomy. Dr. Givens can then study the 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 new surface and inserting the implant.

“I still do the approach, meaning I make the incision and move the soft tissue, nerves and veins out of the way,” Dr. Givens said. “But now, the technology helps me to know the movements I’m making are exactly the ones I want to make. This gives us precision to ensure every cut and movement is exactly what the individual patient needs.”

The robotic arm’s capabilities help provide enhanced feedback to ensure 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.

“We’ve never had this level of accuracy before in this field,” Dr. Givens said. “Now, the procedures we’ve theorized can be put into practice, and that’s why it’s so exciting to be at the forefront of innovation.”

Reverse shoulder replacement is ideal for patients with severe arthritis, rotator cuff tears or other degenerative shoulder conditions that do not respond to conservative treatments. Furthermore, shoulder arthroplasty (reconstruction or replacement) is the fastest-growing joint arthroplasty in the U.S. According to Dr. Givens, more than 90% of patients are satisfied with their replacements, but doctors are consistently striving for more accuracy and reproducibility to improve that number and help patients achieve a higher level of satisfaction in a shorter amount of time.

Dr. Givens’ orthopedic surgery practice is focused on shoulder and elbow care, including arthroscopy, fracture repair, and joint replacement and revision. In 2024, he performed more than 150 shoulder arthroplasties and anticipates performing more than 200 in 2025.

“My goal is to restore the shoulder to where it’s supposed to be and allow my patients to get back to their normal activities,” Dr. Givens said. “I want my patients to go back to living their normal lives as soon as possible, and this new technology is another tool that will allow them to do so.”

The post Norton Orthopedic Institute surgeon performs new robotic-assisted shoulder replacement appeared first on Norton Healthcare.

What is hip replacement surgery?
The amount of pain you experience after surgery may depend on several factors, including type of surgery, the implants used and your overall health.

“Joint replacement procedures have a certain amount of discomfort no matter what,” Dr. Himschoot said.

There are different types of hip replacement or partial replacement surgeries. There are also hip resurfacing procedures that cap the bones with metal or ceramic implants, instead of replacing them with a synthetic joint. The goal of a hip replacement, either total or partial, is to restore or maintain movement and flexibility in the joint.

The causes of hip pain and damage can include:

• Osteoarthritis, which commonly occurs with normal everyday activity over time: Osteoarthritis damages the cartilage at the ends of the bones and helps joints move smoothly.
• Rheumatoid arthritis is caused by an overactive immune system, which creates inflammation that can erode cartilage and occasionally underlying bone, resulting in joint damage.
• Osteonecrosis is a less common condition, when there isn’t enough blood supplied to the ball portion of the hip joint, which can cause the bone to collapse and deform.

You also may need a partial or total hip replacement if you injure the joint. Hip fractures are more common as we age, especially in women. 

Hip replacement may be an option if your chronic pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from sitting down

Your doctor can help you decide whether you’re ready for joint replacement surgery.

Pain during and after hip surgery

You will be given anesthesia (pain management) for the surgery. Depending on your specific situation, you may be given a regional anesthetic, which blocks nerves to a certain part of your body. You are still awake during the procedure, but you may have a light sedative to help you relax. You may be given a general anesthetic, which acts on the brain and nervous system and puts your body to sleep. 

Immediately after surgery, you will spend time in recovery. There will be some pain and soreness at the incision site. There may be some bruising, and you may feel very tired. Your pain will be monitored and managed by hospital staff. You will get up to walk as soon as possible after the operation, using a cane or walker. Many people report feeling more pain on the second day after surgery.

“The goal is to stay a step ahead of your pain with ice or pain medication,” Dr. Himschoot said. “You will go home with prescriptions for your pain management and directions on how to use those medications, as well as other pain relief techniques.”

Your experience will be unique to you, but many people report:

• Discomfort in the hip for one to three months after surgery
• Discontinuing pain medication one to four weeks after surgery
• Resuming normal activity, with possible mild discomfort, in about six months
• Being pain free in about a year

Recovering from a hip replacement

Hip replacement recovery also may include:

•  Physical therapy (PT): You will start PT in the hospital after surgery and continue for several months. This includes stretches for mobility and strengthening exercises for the muscles around the new hip. 
• Assistive devices such as a walker or cane
• Nondrug approaches like ice, heat or massage.
• Medications including opioids, nonsteroidal anti-inflammatory drugs (also called NSAIDs) or other medicine.

Hip replacement recovery experiences vary from person to person. Factors that affect your pain levels include:

• Your individual tolerance for pain and discomfort
• Age, health and overall fitness level
• How well you follow your doctor’s instructions for your recovery after surgery, including for physical therapy and medications

Your surgeon and the rest of your medical team will be there to guide you through your hip replacement recovery and beyond. 

If you or a loved one has questions about minimally invasive hip replacement surgery and other replacement procedures, ask your doctor. They can help dispel myths about joint replacement, assess whether you may be a good candidate for hip surgery and help you choose an orthopedic surgeon.

The post Many factors affect how much pain you may have after joint replacement: Age, overall health and more appeared first on Norton Healthcare.

New knee replacement technology is allowing surgeons to create a more natural-feeling joint, while getting you home sooner and started on your recovery. 

A total knee replacement, sometimes called total knee arthroplasty, may be necessary after arthritis has developed to the point that too much cartilage has worn away and you have bone-on-bone contact causing knee pain. A partial knee replacement describes having just one side of the knee joint replaced, often to treat an injury.

“While the aim of knee replacement surgery remains unchanged — relieving pain and helping patients return to an active life — today’s technology makes the procedure more precise and personalized,” Dr. Khalily said. “We still replace the worn joint surfaces, but now use advanced robotics, custom 3D-printed implants and smart sensors to optimize each patient’s results.”

Dr. Khalily was the first person in the world to perform a Food and Drug Administration-approved cementless total knee replacement with the CORI robotic-assisted system.

Today’s advances

Robotic-assisted surgery

Think of it like GPS for your surgeon. Using real-time imaging and computer guidance, surgeons now can plan and perform total knee replacement surgery with greater precision, tailored to your exact knee anatomy. This helps ensure better alignment and implant positioning, potentially improving longer-lasting results.

3D printed custom implants

Just like getting a custom-fitted suit, your knee replacement now can be made specifically for you. Using 3D printing, surgeons can create implants that match your knee’s unique shape and size. This is especially helpful for complex cases or revision surgery.

Smart knee implants

These high-tech implants contain tiny sensors that track how your new knee is working. Your doctor can monitor your recovery remotely, adjust your rehabilitation plan as needed and spot potential issues early. This means fewer in-person follow-up visits and more personalized recovery care.

On the horizon

Augmented reality

Surgeons are beginning to use augmented reality technology — similar to what’s used in some video games — to see detailed 3D images of your knee during surgery. This technology helps them place implants with even greater accuracy.

More outpatient surgeries

Thanks to these advances and better pain management, many knee replacements are now done as outpatient procedures. This means you may go home the same day as your surgery. By 2026, more than half of all shoulder, knee and hip replacement are expected to be outpatient procedures.

The post The latest knee replacement technology in 2025 appeared first on Norton Healthcare.

Kevin J. Himschoot, M.D., orthopedic surgeon with Norton Orthopedic Institute, suggests thinking about the following:

Pain

Does your pain in your hip come and go? Does it occur only during strenuous activity? Or is it constant hip pain that interferes with daily life?

If your pain comes and goes, you’re likely not ready for surgery. The good news: There are some nonsurgical ways to get pain relief. These may include taking nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injections for pain relief. Physical therapy exercises and stretches can improve strength and mobility by loosening muscles, ligaments or the hip joint capsule — ligaments and fibers that surround the joint. 

Read more: Don’t ignore these 5 symptoms of joint pain

Age and activity

Next, think about your age and activity level. If you are active and would like to stay active for many years to come, a hip replacement may make that possible. Surgeons are performing joint replacement surgery on younger patients than they have in the past. However, surgery typically will not be considered until you are in your 50s. Also, unless X-rays show moderate to advanced hip arthritis, nonsurgical treatment will be recommended.

Weight and overall health

Finally, how is the rest of your health, including your weight? Carrying extra weight is a big factor in hip pain. Surgeons typically will not perform hip replacement surgery on patients with a body mass index over 40, as it increases complications during and after surgery.

However, there are physical therapy programs tailored to help with weight loss while supporting and aiming to improve chronic hip pain. Your health care provider can help you find a physical therapy or weight loss program to suit your needs.

Do you have heart disease or diabetes? Is your diabetes under control with an appropriate hemoglobin A1C level? Optimizing chronic medical conditions will be necessary prior to surgery.

You’ll also want to make sure you’re mentally prepared for a tough couple of weeks after surgery.

Can you push through pain during physical therapy as you work on strengthening and moving your new joint?

Total hip replacement surgery versus partial hip replacement

If you have extensive hip joint damage due to conditions such as osteoarthritis or rheumatoid arthritis, you may be a candidate for a total hip replacement. In this procedure, known formally as total hip arthroplasty, both the ball (femoral head) and socket (acetabulum) are replaced with an artificial joint.

A partial hip replacement replaces only the femoral head. This is considered in cases where the acetabulum is healthy. An example of such an instance is a hip injury such as a fractured femoral head.

The post How can you tell if you need a hip replacement? appeared first on Norton Healthcare.

Kevin J. Himschoot, M.D., orthopedic surgeon with Norton Orthopedic Institute, suggests thinking about the following:

Pain

Does your pain come and go? Does it occur only during strenuous activity? Or is it persistent knee pain that interferes with daily life?

If your pain comes and goes, you’re likely not ready for surgery. The good news: There are some nonsurgical ways to get pain relief. These may include taking nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injections for pain relief. Physical therapy exercises and stretches can improve strength and mobility by loosening muscles, ligaments or the knee joint capsule — ligaments and fibers that surround the joint.

Read more: Don’t ignore these 5 symptoms of joint pain

Age and activity

Next, think about your age and activity level. If you are active and would like to stay active for many years to come, a knee replacement may make that possible. Surgeons are performing joint replacement surgery on younger patients than they have in the past. However, surgery typically will not be considered until you are in your 50s. Also, unless X-rays show moderate to advanced knee arthritis, nonsurgical treatment will be recommended.

Weight and overall health

Finally, how is the rest of your health, including your weight? Carrying extra weight is a big factor in knee pain, as the knee has significant weight-bearing responsibilities. Surgeons typically will not perform knee replacement surgery on patients with a body mass index over 40, as it increases complications during and after surgery.

There are, however, physical therapy programs tailored to help with weight loss while supporting and aiming to improve chronic knee pain. Your health care provider can help you find a physical therapy or weight loss program to suit your needs.

Do you have heart disease or diabetes? Is your diabetes under control with an appropriate hemoglobin A1C level? Optimizing chronic medical conditions will be necessary prior to surgery.

You’ll also want to make sure you’re mentally prepared for a tough couple of weeks after surgery.

Can you push through pain during physical therapy as you work on strengthening and moving your new joint?

Additional signs you might be ready to consider knee surgery

• Persistent knee stiffness or swelling that doesn’t improve with rest or medication
• Visible bowing of the leg due to knee osteoarthritis progression
• Knee instability or “giving way” that affects your ability to walk safely
• Grinding, clicking or catching sensations that limit movement
• Limited range of motion, such as difficulty straightening or bending the knee

Total knee replacement surgery versus partial knee replacement

If you have extensive knee joint damage due to conditions such as osteoarthritis or rheumatoid arthritis, you may be a candidate for a total knee replacement. In this procedure, known formally as total knee arthroplasty, all three compartments of the knee joint are replaced with artificial components.

A partial knee replacement replaces only the damaged compartment of the knee (either the medial, lateral or patellofemoral compartment). This is considered in cases where the arthritis is confined to just one area of the knee and the ligaments are intact. This less-invasive option often results in quicker recovery times and more natural knee movement for suitable candidates.

Whether you’re having total knee replacement surgery or having just one side of the knee replaced, the ends of the thigh bone and shin bone are replaced with artificial components. Sometimes, the kneecap or patella is replaced as well.

Advancements in robotics help your surgeon improve precision, which can reduce recovery time and give you a more natural-feeling knee.

The post How can you tell if you need a knee replacement? 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.

Gout, an especially painful type of inflammatory arthritis, is caused by a buildup of uric acid that forms sharp crystals in your joints. Diet changes can reduce the amount of uric acid in your body and make it easier for your kidneys to flush it away.

Your body makes uric acid naturally when breaking down purines that are abundant in certain foods. Alcohol slows your kidneys’ ability to process uric acid and pass it into your urine, contributing to excess uric acid in your body.

Avoiding high-purine food and drink can reduce your chances of a gout flare-up or lessen its severity.

High-purine foods that trigger gout

• Beer. Even nonalcoholic beer can be high in purines and increase the levels of uric acid by as much as 6.5%, according to the Arthritis Foundation. Some beers are lower in purines than others, and some brewers say their beer is purine-free.
• Sugary foods, drinks and sweets. Table sugar is half fructose, which elevates your uric acid level.
• Processed foods. Snacks and other packaged foods tend to have high levels of high-fructose corn syrup, a concentrated form of fructose.
• Organ meats like liver, kidney, sweetbreads and tripe are high in purine.
• Some meat. Red meat is generally higher in purines and should be eaten only occasionally. Turkey has high purine levels.
• Certain seafood, like mussels, scallops, squid, shrimp, oysters, crab and lobster. Tuna, salmon and trout have high purine levels, but when eaten in moderation their heart benefits may outweigh the risks of a gout flare.
• Game meats like venison and duck should be eaten sparingly or avoided altogether.

In addition to avoiding high-purine foods, effectively managing gout symptoms includes maintaining a healthy weight through proper diet and exercise. Drinking plenty of water can help flush out excess uric acid. Coffee can reduce the risk of developing gout, but its effect on preventing recurrent gout attacks isn’t as clear.

“I highly recommend getting daily exercise, such as a 30-minute walk, to reduce flare-ups. Being overweight increases the risk of gout, so maintaining a healthy weight can help lower the risk,” said Amanda R. Dewees, APRN, nurse practitioner and family medicine provider with Norton Prevention & Wellness Mobile Primary Care.

Gout symptoms often are described as starting in the big toe, typically while sleeping, and affecting primarily those assigned male at birth.

Gout symptoms in women can be different. For those assigned female at birth, gout can strike differently and affect several joints over time. It can show up in joints already damaged by osteoarthritis, such as the hands, according to the Arthritis Foundation.

In addition, the role estrogen plays in gout can complicate the condition for women. Natural estrogen can help flush uric acid out of the body, and after menopause, uric acid levels tend to increase. It’s rare for premenopausal women to get gout.

Foods that help with managing gout symptoms

• Citrus and other fruits high in vitamin C can lower uric acid levels. But fruit also includes fructose, so look at options like grapefruit, oranges, pineapple and strawberries that are high in vitamin C, but have less fructose. Be cautious about fruit juice that may be naturally high in fructose or have added sugar.
• Plant foods and other nonmeat proteins don’t raise uric acid levels. Think peas, beans, lentils, tofu and greens.
• Proteins in dairy products can help promote passing uric acid in urine. Low-fat milk and other low-fat dairy products are recommended as part of a healthy gout diet.
• Cherries may lower your risk or the severity of a gout attack. There are some indications that the antioxidants in tart cherries can help those who experience gout.

The post Foods that trigger gout: What to avoid and what to eat appeared first on Norton Healthcare.

Victor J. Kremser, M.D., will return to Hardin County as a nonsurgical orthopedic physician to serve Elizabethtown and the surrounding communities. In addition to his medical practice, Dr. Kremser also will serve as medical co-director of Churchill Downs racetrack, beginning during the 2024 Fall Meet.

“It’s an honor to return to Hardin County,” Dr. Kremser said. “This community has been like my home since I was a teenager. It’s where I met my wife and began studying medicine. Now, I join a talented staff at Norton Orthopedic Institute, with the goal of giving back to the people who’ve made a deep impact in my life and career.”

Dr. Kremser comes to Norton Healthcare after completing a fellowship at Andrews Sports Medicine & Orthopaedic Center, a world-renowned orthopedic clinic in Birmingham, Alabama. During his fellowship, he served as a team physician for Troy University in Troy, Alabama, helping the football team to a Sun Belt Conference championship. Additionally, he provided medical coverage for the Birmingham Barons, Birmingham Squadron, Samford University men’s and women’s basketball, Birmingham-Southern College men’s and women’s basketball, and the Alabama Ballet.

“In addition to being a great physician, Dr. Kremser brings a unique perspective to Elizabethtown because of his personal connection to the community,” said Sam Zuege, system vice president, orthopedic services, Norton Healthcare. “I can’t think of a better person to expand our care in the Hardin County community.”

Born in Cologne, Germany, Dr. Kremser’s Kentucky journey began in 2009, when he participated in a student exchange program in Bardstown, Kentucky. While there, he met his wife, whose parents are from Hardin County. He returned to Germany to finish high school, but came back to Kentucky in 2012 to pursue a bachelor’s degree in biomedical science from Morehead State University. He then attended medical school at the University of Kentucky in Lexington.

“The United States is home to the greatest sports culture and greatest athletes in the world,” Dr. Kremser said. “So it only made sense for me to pack my bags and chase my dream to become a sports medicine physician in America.”

The post Norton Orthopedic Institute welcomes new doctor to Elizabethtown appeared first on Norton Healthcare.

He’s the director of Heaven’s Door Chapel in Burnside, Kentucky, and spends his days serving his community. That can mean he’s out on his farm and garden, tilling the earth, gathering fresh produce.

Ministry, for David, also can mean he’s communicating with local officials and other pastors, organizing school supply and food drives for the upcoming year. Many of the students in that district — more than 90% — are on free lunch.

Or, it can mean he’s leading a Thursday night prayer session, “drive-up prayer” as he calls it, sharing the word of God with his Pulaski County community.

“Ninety-five percent of our work is outside the chapel walls,” David said. “What that means is that we are out in the community. It’s kind of a process. You feel God lead you in a direction, and then you put a foot out in that direction.”

Read more: How can you tell if you need a knee replacement?

Despite his success, David’s ministry was slowed down by chronic pain in his left knee. It hurt every day and forced him to take action.

‘We started from nothing’

In 2000, David was living in Florida and working as head of maintenance at a local Christian school.

He also maintained his Florida teaching certificate, while working through the process to become an ordained minister. As fate would have it, his teaching certificate expired as the ordination paperwork came through.

He had a decision to make — the classroom or the pulpit.

“I had my ordination paper here and my teaching certificate here,” David said. “And God said to me, ‘Teaching was your choice, and this was mine.”

David set his teaching certificate aside for good and set out on his mission. He became a successful children’s pastor in Florida, blending his passion and God’s purpose into one. After 19 years, he was released from his church and started work in home repair while he waited for his next calling.

In 2019, it came.

Through family, he discovered Meridzo Center Inc., a ministry group based in Lynch, Kentucky. David and his wife attended a conference to learn more about the Eastern Kentucky ministry and its subsidiaries. He instantly felt something.

“We go to a conference about living by faith right as the time of severance pay ran out,” David said. “It was all God’s timing. So after the conference, I felt that I was called to be there. So we just said yes.”

David sold his home in Florida and moved to Kentucky to work for Meridzo Ministries. They stationed him in Burnside at Heaven’s Door Chapel and he’s worked there ever since, reviving a mission that was near dormant in the years before his arrival.

“We started from nothing and built this through God’s calling,” David said. “We live by faith without a salary and pray for what God wants. That’s our salary — when we need something, we pray and God supplies. That’s how it works.”

‘You don’t have any cartilage left’

David’s left knee pain began in 2010.

He noticed the pain lasted longer and set in more frequently than in years past. It swelled constantly. He wore a knee brace for support.

David talked to his father — a retired doctor who had practiced at Red Bird Mission — to learn more about hyaluronic acid and how it can be used to lubricate and cushion the cartilage in his knee. He also saw an orthopedic specialist in Florida, who drained the fluid from his knee and gave him a cortisone injection, while providing him with a long-term diagnosis.

“He told me, ‘I can see it; you don’t have any cartilage left,’” David said. “The only way to fix it was to replace it. And I knew I had to do something, but I wasn’t ready. I had had friends who had replacements, so I had seen some go poorly. So I was hesitant.”

David opted for the oral hyaluronic acid supplements for nearly a decade, and successfully kept the pain at bay for a while. But eventually, he knew he needed a long-term answer. In 2021, after his wife passed away, David began spending more time with his extended family in Louisville. His nieces could tell he was noticeably slower, avoiding activities if they required too much time on his feet.

“I started quantifying whether I wanted to go places based on how much walking I had to do,” David said. “It hurt every time you put pressure on it, and it was starting to get in the way of everyday life.”

His family recommended he see a doctor in Louisville, and he made and appointment with Ryan E. Modlinski, M.D., nonsurgical orthopedic sports medicine physician with Norton Orthopedic Institute.

“Of all the Norton doctors I’ve ever been to, he had the best bedside manner,” David said. “He really made me feel at ease and took an interest in my life activities.”

“Every patient needs to determine, on a unique set of circumstances, their needs and functions,” Dr. Modlinski said. “So we try to really narrow it down and then we try to tailor and provide them a thorough explanation of the options that can help them. “We really try to focus in on what they’re struggling with and then target and tailor our treatments to meet those needs.”

The two created a treatment plan — try a round of hyaluronic acid injections, to see how long they lasted and use that period to find a date for surgery. In the meantime, Dr. Modlinski would confer with his colleagues and find David the right surgeon.

David agreed. While the injection provided some short term relief, after just one injection, he needed surgery. He was diagnosed with extreme osteoarthritis, and bone spurs were beginning to form along the inside of his left knee.

Dr. Modlinski introduced him to Samuel D. Carter, M.D., orthopedic surgeon with Norton Orthopedic Institute. Dr. Carter and David discussed the options and agreed on a partial medial knee replacement.

Dr. Carter performed the procedure successfully in November 2022.

Compared with a full knee replacement, a partial replacement provides patients with a faster procedure and recovery time, while reducing the risk for postoperative complications. Patients also maintain their own knee ligaments, providing a more natural feeling than a full knee replacement.

“In an ideal scenario, the patients almost forget they’ve had it, and they go back to their everyday lives,” Dr. Carter said. “But the No. 1 priority is to relieve the pain. It can be hard to know when the best time is for a knee replacement. It’s really patient-dependent. But being here with Dr. Modlinski, being in the same office, allows us to talk to each other frequently, be it a text message or a message on our electronic system. We’re able to keep each other up to date on how patients are doing and when to cross that threshold into surgery.”

“Dr. Carter was great,” David said. “They made the process extremely easy for me. I had confidence in this team. Watching them collaborate and weigh what my outcome needed to be, and then tell me they were going to give me the tools to succeed, meant the world to me. The approach truly felt custom to me.”

‘That’s the ideal outcome’

Nearly two years post-surgery, David’s ministry continues uninterrupted and pain-free. Now age 67, he’s still out in his community daily, working to make it a better place.

His knee no longer gives him issues, no matter what physical activity he takes on.

He attributes his success to his faith, both in the men who repaired his knee, and in the man who pointed him in their direction.

“I live by the quote from Philippians 4:6-7, which is, ‘Don’t worry about anything, pray about everything and thank God for what he’s done,’” David said. “If you really take that to heart, you’re not going to worry about anything.”

“That’s the ideal outcome,” Dr. Carter said. “Seeing happy postoperative patients is the best part of my job, and seeing them get back to get back to their normal lives and the things they’re used to doing is a huge payoff.”

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