• Podcast
  • Apr 07 2020

'Behind the Blue': UK Sports Medicine Research Institute’s Equestrian Athlete Initiative

Kentucky is a wonderful place to be involved with horses, whether for breeding, racing, showing, pleasure riding, you name it. And the University of Kentucky’s Sports Medicine Research Institute is a terrific place to be involved with athletes, studying various aspects of performance.

On this week’s edition of the “Behind the Blue” podcast, Carl Nathe of UK Public Relations and Strategic Communications talks with Nick Heebner and Kimberly Tumlin about a new research effort, the Equestrian Athlete Initiative.

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CREW:                    From the campus of the University of Kentucky, you're listening to Behind the Blue.

CODY KAISER:       Kentucky is a wonderful place to be involved with horses, whether for breeding, racing, showing, pleasure riding, you name it. And the University of Kentucky's Sports Medicine Research Institute is a terrific place to be involved with athletes studying various aspects of performance. I'm Cody Kaiser with UK Public Relations and Strategic Communications. On this week's episode of Behind the Blue Carl Nathe of UK PR talks with Nick Heebner and Kimberly Tumlin about a new research effort, the Equestrian Athlete Initiative.

CARL NATHE:        Hello and welcome in to this edition of the Behind the Blue podcast. And we have a special discussion regarding the Equestrian Athlete Initiative, which is happening here at the University of Kentucky within the realm of the Sports Medicine Research Institute, College of Health Sciences, also involving some other people on campus, collaborative research. Much of the information we will be discussing during this podcast will be of particular interest to male and female equestrians of all ages. We will give you the web site at the end of the podcast to find out more information.

Michaela Keener is the coordinator of this project, not able to be with us this morning. But we do have the director of the Sports Medicine Research Institute, Nicholas Heebner, Nick Heebner. And also with us, we have Kimberly Tumlin. Dr. Kimberly Tumlin is assistant professor of epidemiology in the College of Public Health, and also has a secondary appointment in the College of Health Sciences as athletic training and clinical nutrition, one of the specialists in that area in the College of Health Sciences.

So first of all, let's start with you, Nick. Tell us a little bit about the Sports Medicine Research Institute. You're the director. What does the Sports Medicine Research Institute do on an ongoing basis?

NICK HEEBNER:    Yeah, absolutely. So the Sports Medicine Research Institute is really focused on improving health and wellness of active individuals. And we really focus on designing ways to prevent injury, ways to rehabilitate and treat after an injury occurs. And we really boil that down into a few key populations, those who are active.

So we have traditional athletes. We have aging athletes. We also have an initiative looking at active duty and veterans. And this specific initiative is looking at the equestrian athlete, which is a unique factor, especially here in this region.

CARL NATHE:        In Kentucky, of course, when we're talking about equestrian athletes, not only jockeys in terms of racing, but also equestrian in terms of lots of different kinds of events that take place at the Kentucky Horse Park and elsewhere.

NICK HEEBNER:    Yeah, exactly. There's a lot more to it than just who we watch at Keeneland or at the Derby. This initiative really encompasses the whole gamut of those who are riding and competing in different equestrian sports.

CARL NATHE:        I want to hear from Kimberley Tumlin as far as this goes. And Kimberly, as the director of the Equestrian Athlete Initiative, what is this Equestrian Athlete Initiative tackling specifically?

NICK HEEBNER:    Yeah, I'm really excited to share with you our expansion of this initiative to include not only jockeys, as we just mentioned, but also [? adventurers combined driving, ?] which are not riding actually the horses, but they are interacting with horses, the equestrian teams here at University Kentucky, anybody that actually has some interaction with these horses in a riding or performance capacity. And so what we're able to do here is actually characterize what that performance is and, as Nick mentioned earlier, be able to start to look at some risk factors and ways to rehabilitate those individuals as well.

CARL NATHE:    I suppose through the years there's been people that have been in the equestrian fields in some way or another that have looked at this. And they say, well, we have anecdotal evidence about injuries and about how this impacts the equestrian athletes. But this is to get scientific about it. Am I right?

KIMBERLY TUMLIN: Absolutely. I think the first thing is to actually recognize that equestrians are athletes. It is a form of athletic performance. Whether you are working around animals on the ground or you're actually riding them, you have to have some level of fitness and physical ability to be able to do that. And so we're really excited to be able to try to characterize that for different sports that are out there. Before

CARL NATHE:        Before we go any further, I did promise our listeners that we'd get a little bit about your background. You have titles such as MPH, master of public health; MS, master of science; PhD. So tell us a little bit about your background. Where'd you grow up? And where were you educated? And how'd you get interested in all of this?

NICK HEEBNER:    I actually was born in Hawaii. And I lived all over the country. And in that, from a very early age, I was interested in horses. I used to really give my parents a hard time that I hadn't seen a horse in a long time. And I needed that. And it was just something ingrained in me. I did not grow up on a farm. And I lived all over the country. But I've been a lifelong equestrian.

So I was very fortunate early on that my parents supported me being involved as a rider. And I worked on a lot of different farms. So I've ridden a number of different disciplines. I've had horses for a while. And throughout that, when I went to college, initially it was in animal science, to be educated in that field. And as I've developed through my master of science, and MPH, and doctorate degree, I was really interested in combining that interaction between animals, humans, and the environment. And so I'm excited that this initiative really allows me to bring that entire background to fruition.

CARL NATHE:        Just as a follow-up, so where did you earn your degrees? What places did you earn your degrees? And when did you come to the University of Kentucky?

KIMBERLY TUMLIN:  Sure. My undergraduate and first masters were at Virginia Tech. And my doctorate was here at University of Kentucky, a few years ago. And then I actually returned to University of Alabama, Birmingham to get my MPH degree, because I really wanted to get into this concept of public health.

CARL NATHE:        In addition to this Equestrian Athlete Initiative, you're an assistant professor of epidemiology in the College of Public Health. And you're also in athletic training and clinical nutrition in the College of Health Sciences. That's your secondary appointment. What is epidemiology, for those-- a lot of people have a basic opinion of what they think epidemiology is. But what is it to you?

KIMBERLY TUMLIN: I think, in its most basic form, epidemiology is really about the science of disease and risk and transfer in a population. So it's of the people. And in this case, I'm really looking at the concepts of performance that can be a positive aspect of health as well as also the risk factors. So I'm looking at that bigger picture of the population. So what's really nice about my different roles that I have is that I get to look at both the population level, from an epidemiological perspective, but I also get to look at individual, clinical-based levels here and in the Sports Medicine Research Institute.

CARL NATHE:        And when we talk about athletic training and clinical nutrition, these are essential parts, these days, of all major sports, and equine sports. Athletic training clinical nutrition, if you're an athlete in today's world, you better be tuned into those two things, right?

KIMBERLY TUMLIN: Well, sure. But you have to also consider that equestrian sports is often an individualistic approach instead of a team sport. So your team is really with you and your horse in things like eventing. You might have that horse-rider relationship for a long time or in dressage.

But in a jockey, they have a little bit different approach. So they're riding different horses when they come to the track. So it's a different type of occupation in that sense. So it definitely changes the paradigm a little bit of how we think about an athlete and what support systems that they have. So that's part of what we want to do, is help figure out what those things that these athletes actually need.

CARL NATHE:        Kimberly Tumlin is who you're just listening to. And she is the director of the Equestrian Athlete Initiative within the Sports Medicine Research Institute in the College of Health Sciences here at the University of Kentucky, and also one of our guests. And we're going to turn back to you, Nicholas Heebner, Nick Heebner. Tell us a little bit about how you got interested in all this, where you grew up, and were educated, and so forth. Go ahead.

NICK HEEBNER:    Yeah, I grew up in North Wales, Pennsylvania. And from there, I went to Penn State University for my undergraduate degree, where I majored in athletic training. So that's where I got started in athletics and sports medicine.

From there, I went to graduate school for both my masters and my PhD at the University of Pittsburgh. And that's really where I got interested in obviously research, but also looking at the mechanisms for injury and how we both study how injuries occur and how to prevent them from happening and develop those interventions.

But then also, how do we further rehabilitation research? How do we develop new ways to treat athletes, depending on what their needs are, to get them back into a high performing environment? And that's the unique collaboration we have here today between Kimberly, myself, and public health, and College of Health Sciences is how do we both deal with both the risk of injuries occurring, but then also how do we develop interventions to get those sorts of athletes-- any type of athlete-- back to doing what they need to.

And the really cool thing about it is we can take somebody who's really a high performer and try to balance the line of pushing them, so they're performing at their best, but then also keep them healthy or getting back to a high level performance. And equestrian athletes aren't very different from any of the other athletes we deal with. And the note I like to say is, if you're trying to train a cross-country runner, you need to do that differently than maybe one of our basketball athletes or football players, because they have different demands.

And the equestrian athletes are different. They're trying to do something very specific at a high level. But we need to look at, well, what are the mechanisms for how they get hurt? Or if they do get hurt, what do they need to get back to doing, so that we can do that appropriately and keep them functioning at a high level?

CARL NATHE:        Nick Heebner, director of the Sports Medicine Research Institute here at the University of Kentucky College of Health Sciences. And I want to ask you a little bit more about the Sports Medicine Research Institute and where you're housed on campus. But you mentioned, in your background, Penn State, University of Pittsburgh. Dean Lephart, who is the founding director, I guess you'd say, or the founder of the Sports Medicine Research Institute, helped to bring it here to the University of Kentucky several years ago. So you came to UK exactly when?

NICK HEEBNER:    I came UK in 2015, and actually through Dr. Lephart. So I studied under Dr. Lephart when I was getting my PhD at the University of Pittsburgh. And that's how we made that connection. And we had an opportunity to work on a lot of Department of Defense projects and really take what we are doing in athletics, in Division 1, in professional athletics, into the Department of Defense and work with different units there, figure out what their needs were, how they needed to perform at a high level, and develop those same sort of interventions for them.

CARL NATHE:        So in addition to being the director of the Sports Medicine Research Institute-- that's the title I think a lot of people know you as. But you've also been at a research university. You have a professorial rank and all that. What is that?

NICK HEEBNER:    Yeah, correct. I'm an assistant professor in athletic training and clinical nutrition, where we also cross over. And with that, we work with a lot of our students to help engage them in research, and then also getting a better clinical understanding of how we translate the things we're finding into clinical interventions, right?

And in the continuation of research, we really fall towards the end in translational science, right? So we're trying to figure out not only what sort of clinical problems exist, and then try to develop that into better research questions. But then also, how do we take what we're doing in research to get it back into the field, right? So we need to make sure the knowledge we're providing and gaining actually make its way to the athletes.

CARL NATHE:        Sports Medicine Research Institute is housed in a facility, the exterior of which has been on campus for some time, the original Nutter Training Facility, Athletic Training Facility. But it used to be the home basically of UK football and some other things in UK athletics, not to be confused with the big Nutter Fieldhouse, where the football team, and the indoor track, and some of the other activities happen.

But that was renovated and made into specifically the Sports Medicine Research Institute, much of that. And you've got some neat things over there. I've been over there a couple of times when there's been announcements. It's really some high tech stuff.

NICK HEEBNER:    We're really lucky with the partnerships we've been able to gain over the years and the things we get to work on. We originally had this renovated and got into our space in, I think, 2017, which originally the football team was over in that building. And when they built their new facility-- Athletics still owns that. But they were able to, through our partnership with University of Kentucky Athletics, and then also the College of Medicine and UK HealthCare, and the College of Health Sciences were able to help outfit that space and renovate that space.

So we sit in that building. But athletics is still there as well, which is unique for our opportunity, because we get to crossover. And when we have collaborative projects with Athletics, we're in the same building. So it's really a unique opportunity to really work hand-in-hand and help our athletes here on campus.

CARL NATHE:        And I want to get your take, and Kimberly then, the take on the same word, because it's a word that you hear time and again across the University of Kentucky. And we're proud to say it. This is a collaborative place for doing research. What does collaborative mean to you?

NICK HEEBNER:    Oh, collaborative really means being able to sit together in the same room, or bring people from different backgrounds and expertise to solve a common problem. And that's really what we're doing here with the Equestrian Athlete Initiative and our other initiatives at the SMRI. What we really like to do and what we feel like we do best, our best work, is when we're bringing other experts in to really solve the same problem, because we can't always do things on our own.

And if we really want to be innovative, we really need to work together as a team. And I feel like being here at the University Kentucky really has a really good atmosphere to do that in. And it's really been a pleasure ever since moving here to engage in that sort of activity.

CARL NATHE:        Kimberly, what about you and collaboration? That is a real advantage. And in fact, anymore, if you're going to do any serious research and get funding from various sources, you better be collaborating across disciplines.

KIMBERLY TUMLIN: Oh, I absolutely agree. And this opportunity is really twofold for collaboration. Internally, here at university Kentucky across colleges, there's that collaborative piece. And being able to have different perspectives-- so our research coordinator, Michaela Keener, actually comes from a biomechanics background. And I do not come from a biomechanics background.

And so we make a really good collaboration. Within this initiative, to be able to bounce ideas off working with Nick and the other faculty and staff and students that are involved in the Sports Medicine Research Institute gives me the opportunity to both provide a different perspective from my background, being in animal science and public health background, but also from theirs as well in terms of rehabilitation. Then secondly, a big piece here that's important for collaboration are our community collaborators.

For this initiative, we rely heavily on our community collaboration out in the equestrian community. The equestrian community is amazing. I've been a part of it my entire life, different aspects of it. And having those individuals come in-- and the combined driving research project, for instance, was spurred by a community partner who said, have you ever considered looking at [? grip ?] strength and arm strength in any of your combined drivers?

CARL NATHE:        And when we say combined driver, you're talking harness?

KIMBERLY TUMLIN: So no. So there's actually a sport that involves-- it's similar to a marathon. So there's three phases in combined driving. So there's carriages and horses-- teams of one horse, two horse, or four horses. And they actually have-- similar to you would see at the Land Rover event, you have a dressage phase. But it's in a carriage with the horses drawing the carriage. And there are drivers and navigators that are part of this carriage.

And they have a different requirement for performance that you would have than if you're riding a horse or, as you're referring to, the race driving, because it's over an extended amount of time that they're actually engaging in this sport. And so that community collaboration that we had really made us think, oh, wow, this is a good opportunity for us to reach back out to that community and work with them particularly on that question that they had. So for me, that's what's most exciting about this. It's internal, but also external collaborations.

CARL NATHE:        Well, the more I think about it, here we are in Lexington, Kentucky. And we like to call ourselves, with good reason, the horse capital of the world. Some people think of it as the thoroughbred capital of the world. But there's standardbreds. There's all kinds of breeds that are on display at the Kentucky Horse Park. There is, as you mentioned, the Land Rover-- the three day event, which really has got two days of the opening. So it's like a four day event, right?


CARL NATHE:        And hopefully, as we record this, we are in the midst of this health crisis, to be frank about it, as people-- we're at home. And hopefully, we get out of this eventually, and things like enjoying Keeneland, and the Red Mile, and the Kentucky Horse Park, and just horse farms and all of that stuff comes back around. Meantime, let's talk about the Equine Athlete Initiative. Basically, we have that unique diversity of equestrian athletes. And now, you get a chance to expand the reach of this research. Am I right?

KIMBERLY TUMLIN: That's absolutely correct. So we are launching several new studies that do expand that. We have a registry that is open to any equestrian that wants to come in and just find out what their performance level is. So part of what we're doing is establishing baseline across multiple disciplines.

So we need individuals who want to come in and be a part of that registry. And they get feedback on what their performance level is in terms of strength and balance. If they gallop horses, so if they're in a sport where they're galloping, we have the riding simulator that they have the opportunity to gallop on and have their biomechanics recorded. So we have a lot of really amazing tools here that we can provide information to riders.

And what's most exciting about that is that, if they come in and have that opportunity to actually establish a baseline for themselves, and they want to come back after maybe they've had a fall or an injury or some setback in their training, and they want to learn what level of strength or balance or flexibility they need to return to, we can help provide that information to them. So I think it is very mutually beneficial. Even though we're doing research in the context of our perspective, we are also there to help the equestrian community. And that's for all riders.

The other new part of our initiative that we're going to be launching soon is actually for equine service providers. This is a population that don't necessarily ride. But we're really interested in their wellness and some of their health lifestyle factors. Equine service providers include veterenarians, veterinary technicians. These are workers that provide all the care for the horses. They're an important part of the service industry, farriers, and then other non- traditional medical providers. And we're interested just starting to collect some qualitative data, information on there they're self-report of their wellness and lifestyle factors, so that we have a better understanding of how the lab can actually integrate and help with those individuals as well.

CARL NATHE:        If we talk about big picture-- and that was Kimberly Tumlin, who is the director of the Equestrian Athlete Initiative, which is part of a work going on across the campus, but housed directly at the Sports Medicine Research Institute. And we have the director, Nick Heebner, with us as well. Nick, when we talk about the big picture, because this is scientific research. But when we talked research, it's advantageous to what you do in the Sports Medicine Research Institute that you get basic research, but also very much applied research. Am I saying that correctly?

NICK HEEBNER:    We may classify this as applied research mostly. We do have a fair bit of really good collaborators in the College of Health Sciences that do a lot of great basic science research, too. And you have to acknowledge that, because that's a big continuum of what we do, especially when we look at mechanisms for injury, or different ways we can change the way we rehabilitate or treat injuries.

In that continuum of research when we think about basic and applied, it's really critical to not forget one or the other, rights? Because we have a lot of great basic scientists in the college health sciences that are critical to what we do when we think about treating injuries and rehabilitating individuals back to sport, because they develop a lot of new and innovative techniques, especially at a cellular level, that give us better techniques to then progress that into the clinic environment and into patients. What we do in the sports medicine research-- Sports Medicine Research Institute really falls on the applied side, because we're taking some of those techniques and new techniques we develop into actual patients and athletes.

The other note, which Kimberly brought up with this new initiative in the service provider piece, is people don't typically conceptualize sports medicine as involving occupational workers. But even in our athletic training and clinical nutrition department, we have new partnerships developing with the Lexington Fire Department, Toyota Manufacturing, and other sorts of occupational workers, because, when you're having somebody do physical labor or other sorts of physically demanding tasks, the way the body moves and our mechanics don't necessarily change. It's not all that different. It's just the task and what they need to do that changes. And we can apply that same sort of science and scientific process to those individuals to make sure they stay healthy.

CARL NATHE:        Very good. What are we looking for? if you look back on some of this work several years from now, where do you hope to be?

KIMBERLY TUMLIN: First goal with that is to help spread the message that equestrians are athletes, and the diversity of those equestrians that are out there. So I use that term to encompass anybody that's actually interacting with horses. But considering that whether you are actually engaging in a competitive sport or not, if you are riding, there is a certain level of performance that you need to have. And that's going to vary based on what your goals are with that.

So part of it is just getting enough individuals in to characterize that, so a data set. My goal is to have those data sets to be able to go back and actually be able to make decisions on risk, and injury, and performance. And what are those positive factors as well as potential challenges that population might face in the long run?

And then secondly, I think to really help advance this concept of Kentucky equestrians. So occupationally, I think it's really important that we have this resource here in the state and be able to provide some opportunity for how to get those tasks. What are those tasks that those individuals that work with horses in various fashions-- what do they need? And how can we as a university be a resource for those individuals to reach that level of performance?

CARL NATHE:        Nick, you want to add to that at all, where you see this, what you'd like to see down the road?

NICK HEEBNER:    Yeah, what I'd really like to see-- and I think where the SMRI really sees value in this is we really want to see the view of how we treat the equestrian rider a little differently and treat them more like an athlete. I think what we mentioned before-- people don't tend necessarily think of an equestrian or those engaging in those sorts of competitions necessarily as an athlete. But they really are. And we do want to change that concept by describing where they really flourish and what they really are focusing on and performing at a high level.

But the other thing that you mentioned was we're considered the horse capital of the world, right? And really, we want to take that a step further. And we want to be the place in the world where people think of rider health and rehabbing and treating riders with injury. We want to be that central resource and be the leaders in that field.

CARL NATHE:        Very good. And I want to follow-up one thing, because Kimberly stresses the fact that this is across many things of equestrian. But if when we have this current health crisis, the COVID- 19, when we get beyond this-- as we're taping this, it's very much part of our lives day in and day out. But when we have things like Keeneland and Churchill Downs and people going to the races, I've always felt that a lot of people-- while at the horses are running in a thoroughbred horse race, yes, the quality of the horse, the performance of the horse-- but hey, if they don't have the right partner on horseback, the right jockey, there's a lot of stuff that can not work out. Or conversely, a lesser horse, a great jockey might be able to pull that husk through to victory.

NICK HEEBNER:    Yeah, definitely. I guess you can look at it in other sorts of sports, like whether it's other sorts of driving type of sports, like car automotive racing. It's great. You can have the best sort of engine underneath you. But if you don't have a good driver, really it may not even get you to the finish line. And we really-- our research, especially in the thoroughbred industry, but also the other equestrians, too-- I mean, we're really being able to classify and characterize the asset they really are when it comes to sports performance, and being able to show the world what an elite level jockey looks like and what they need to be.

I mean, there's a reason, when somebody is trying to win those high stakes races, that you see the same 10 jockeys in those races. It's because they're at such an elite level. It's not just because of happenstance, they happen to be there. They do recognize really quality riders when they see them, and when they see them perform. And there's a reason for that, right? And that's really what we're able to characterize.

CARL NATHE:        We've been going about the length of time that I guesstimated, if you will. But I want to give you each a chance to add something, or if there's something that I haven't asked you about that you want to bring out, or a closing comment. Kimberly, what about what about you? What would you like to say?

KIMBERLY TUMLIN: I'd like to add that we started our research with the jockeys. And they have just, as a community, been really gracious to participate in that. And we've expanded to our exercise riders. And so in terms of racing, there are so many aspects to that horse that require training throughout their entire lifespan. And so the jockeys get to see that horse when they're at a high level of performance. And we get to see the jockeys at a high level performance. But there's a lot of people involved in bringing that horse up.

And so we're also really excited that we have some exercise riders who are on the farms, or on the tracks, that are providing that daily riding for those horses as part of their training, and also characterizing what their performance is. What do they need? And I think that's an important part of that broadening of thinking about our initiative and being able to provide that across multiple sectors, and how important it is to us, and how exciting it is.

I've been a lifelong equestrian. And I still ride. I still have horses. And so it's just really neat to listen to my friends that have also ridden for a long time. How does this affect us over our lifespan? Is our health better? Are there advantages of riding? So there's a lot of questions that I'm excited about being able to start to ask with this initiative.

CARL NATHE:        Nick?

NICK HEEBNER:    Yeah, I think I've got two points I want to add. And both are really trying to conceptualize and really engage why this is a really important thing that we're doing, that maybe we haven't touched on yet, and the first being thinking about the longevity of these elite level riders, and the exercise riders, and others equestrians that are doing this for competition and performance. The real critical thing we think about-- or that we think about at SMRI and the Equestrian Athlete Initiative is how are we getting these athletes to maintain that level of performance when-- whether you're talking about a racer or you're talking about one of the exercise riders, their knowledge they gain year after year and become a better rider, a better exercise rider, a better competitor is critical.

And when we're thinking about an industry that's trying to push that performance, that knowledge is priceless. And without being able to sustain their health and wellness over time, you'll lose that. And you're not going to have the quality of riders you're going to have as we move forward. And the same goes for the recreational athlete too, which is included in this, right?

We're really looking at some of the things Kimberly just mentioned, quality of life. And what are the real big benefits of this? We want to make sure those who are engaging in this and like this for recreational activity, and for their quality of life, can sustain that into later ages of their life. I mean, if they're getting hurt or maybe sustain a back injury or some other mishap, if there's not ways and resources for them to get better and get back on the horse, that really makes an impact on their quality of life. And those are the things in the long term we really want to be able to change

CARL NATHE:        That was Nick Heebner, Nicholas Heebner, who is the director of the Sports Medicine Research Institute. It comes under the umbrella of the College of Health Sciences here at the University of Kentucky. And also, we've heard, over these last 30 minutes or so, from Kimberly Tumlin. And Kimberly is director of the Equestrian Athlete Initiative. She is the director of this research effort.

And along with Michaela Keener, coordinator not able to be with us today, but they and others across the University of Kentucky, a really exciting multidisciplinary effort here, the Equestrian Athlete initiative. We thank you both for coming on with us. And we wish you much success as you go on this ambitious road, but exciting from the standpoint that really a lot of untapped, unresearched things I might say, right?

NICK HEEBNER:    That's absolutely true.

KIMBERLY TUMLIN: Absolutely. Thank you.

CARL NATHE:        Thank you. For more information, go to uky.edu. In the search box, type in SMRI/EQA. Again, go to uky.edu. In the search box, put in SMRI/EQA. And thank you for tuning in. We will see you next time on the Behind the Blue podcast.




CREW:                    Thank you for joining us on this edition of Behind the Blue. For more information about this episode or any other episode, visit us online at uky.edu/behindtheblue. You can send questions or comments via email to behindtheblue@uky.edu, Or tweet your questions using #BehindtheBlue.. Behind the Blue is a joint production of University of Kentucky Public Relations and Marketing and UK HealthCare.