Episode #40: Helping Kids Heal From Concussions with Dr. Scott Lewis

December 6, 2019

Show Notes:

Speaker 1: (00:00)
Hey everybody, what's going on? Dr. Chad Woolner here. And I'm Dr. buddy Allen. And this is episode 40 of the health fundamentals podcast. And on today's episode, we're here with our good friend, Dr. Scott Lewis, and we're going to be talking about how to help kids heal from concussions. So let's get started.

Speaker 2: (00:13)
You're listening to the health fundamentals podcast. I'm Dr. Chad Woolner and I'm dr buddy Allen. And this show was about giving you the simple but powerful and cutting edge tools you need to change your health and your life. So sit back and enjoy the show as we show you the path to your best life down to a science.

Speaker 1: (00:33)
Alright everybody. So we're here with our good friend, Dr. Scott Lewis. Uh, he's actually just down the road from us, which is really cool, really exciting. Uh, we've known Scott for quite a while here and, uh, he does some really, really cool stuff. And so rather than me do a poor job of giving a synopsis of what it is that he does, uh, well the first question we'll start with kind of tell everybody a little bit about, uh, who you are, kind of what got you into the field that you're in. All right, great.

Speaker 3: (00:58)
So I'm what's called a developmental optometrist. And I went to optometry school thinking I was going to sell glasses and contacts like every other optometrists. But what I didn't realize is when I started optometry school, my eyes weren't teaming together. So I got through high school and college reading with one eye covered and leaning over because if I tried to look with both eyes the words, then it makes sense to me. They kind of moved on the page and I'd get a lot of headaches. And it wasn't till I was in optometry school that said, Hey, or somebody said, your eyes aren't working. And I'm like, what do you mean? I see 2020. When I cover one eye? They're like, who cares? Your eyes aren't lining up. And so I did therapy in school and I got my eyes lining up and it made it so I could track.

Speaker 3: (01:43)
Um, my grades went to a 4.0 life was good after I did therapy. And that's what I made the decision. I've got to figure this out. And then my wife and I were thinking I had a concussion when I was 12. And at that point I had been in gifted classes all the way through elementary school and in the beginning of middle school. And then once I had that head injury, I was getting a 1.9 GPA, 2.0 GPA, headaches every day. Life was not fun. Um, and I just had to cope because I'd go to the eye doctor and I saw 20, 20 because everybody checks with one eye than the other eye, but nobody looks to see how well, how well are the eyes lining up? How well are you tracking? Do you process the information you see? And so it was that revelation. And after being going through therapy myself and life was so much easier. That's when I decided I've got to practice this way.

Speaker 1: (02:38)
So you finished optometry school, which is what, four years after? Uh, it's a graduate level program. Right. Doctorate level program. Uh, and then after that, what did you S cause cause you weren't specialized at that point in time, right? No, I I really like vision therapy,

Speaker 3: (02:52)
but I did a three year fellowship, um, with the college of optometrist envisioned development and I worked a doctor in DC for 18 months who only did vision therapy before I moved to Idaho for my practice. And what sorts of cases, I mean obviously you talked about a concussion. What, what sorts of cases do you typically see at your clinic? All right, so the majority of my patients are, um, kids that don't learn to use their eyes correctly. I see a lot of kids with eye turns, lazy eyes. And then about second, third, fourth grade, there's a lot of kids that are falling behind in school because they're struggling learning how to read and, and comply in the classroom because their eyes are playing tricks on them. And so they're really smart kids, but they're now falling behind because of the mechanics of reading haven't developed.

Speaker 3: (03:41)
Um, then I see a lot of patients with, um, post ABI post TBI, so strokes, um, head injuries, concussions, we see a lot of patients, um, to do that rehab side. But we also have a lot of athletes that come in that want us to take their visual system and make them better. So I'm the eye doctor that works the visual system, so eyeballs back. Okay. So I don't do the front of the eyes, I don't do glasses contacts. I make sure that the brain's processing the information and using what we see and understanding it and interpreting it correctly and then that the brain's controlling the eyes so that they move correctly. You know, a lot of it sounds to me like you're a very neurologic based optometrist or a neurology type optometrist. Is that a fair thing to say in terms of description? That's a really fair, some of my colleagues are now using the term neuro optometrist.

Speaker 3: (04:34)
Okay. Yeah. So, um, that's interesting. So I mean in two broad categories you could say that that your patients either fall into a camp of they've got a problem and they want to help get your help solving the problem. Uh, which is I think what most doctors typically think of. But then there's another where it's kind of more of a performance based kind of a group of individuals that you're working with where things are working. Okay. There's no real clear pathology or problem, but rather you've got these people who want to, who want to improve that area. Uh, in terms of their sports performance, baseball players flip, I mean, people absolutely coordination. Uh, this morning we had a basketball player and a baseball player in the office. I'm on the coaching staff for Boise state. I'm on the baseball team. Um, we see all the players every week and if there is a deficit, we definitely take care of it. But then we take them and we make them take them to the next level. If we can make that fast ball look 20 miles an hour slower, if we can develop reaction time depth, the focus speed of focus, if we can improve that, it makes a world of difference when you're on the field. Yeah. Um, what would you say in terms of do how many people like cause cause for me, uh, prior to even meeting you, I didn't even know there was such a thing as, as what you do. Is that a pretty common

Speaker 1: (05:57)
thing? Do most people not know that this is even in existence? Like

Speaker 3: (06:01)
no, I get that everyday patients come in and go, I was referred here but you're an eye doctor, how can you help my brain injury?

Speaker 1: (06:08)
Right. Well how about the symptoms? I mean you kind of said some of them for young kids, you know, like, and even for yourself, like you were doing great and then all of a sudden things, you know, like things stopped matching up or things stopped working correctly. Like, what are some of the symptoms that both children and then maybe even adults would be like, wait a second, that might be me. You know what I mean? Yeah, that's a great question. Yeah.

Speaker 3: (06:31)
Um, it's interesting because children sometimes don't understand their symptoms because that's their normal. And so symptoms are a little different in kids. You have to ask lots of questions. Um, and then they go, Oh, you mean that's not right? And so the thing I look for in kids, especially if the eyes aren't lining up, I always ask about double vision words moving on the page. If they lose their place, if they get done reading a page and forget what they read, um, we look at me, I know, right? Big time. And I also talked about headaches. Vision, headaches happen in two places. They happen frontally right here. And then they'll happen at the back of the neck. And people always go, well, how can a vision headache happen at the top of your neck? Well, if you're holding your head in a funny posture, trying to figure out a place where your eyes will line up or make it clear, well then your neck is sore because it's holding this huge head of yours of funky. And you guys

Speaker 1: (07:29)
absolutely. Um, you know the thing that when you, when you talked about that as far as like kids doing well at a certain age and then all of a sudden there's this decline. I'm curious if, you know, any statistics of kids who just get lumped into this category of, you know, special education, right? Where they just, they need a special plan and curriculum for them because they're just not at that normal level in terms of reading and testing and all that stuff. What percentage would you save if you were to guess or maybe, you know, this fall into the category as a direct or indirect result of some of these things? So it's [inaudible]

Speaker 3: (08:04)
interesting. They actually say that, um, every child that's in special ed should have a good, thorough visual examination and not a quick 10, 15 minute I check, can you see the letters far away? But to find out, they actually say it's as high as about 60%. Um, it's interesting because like my mentor practiced in San Diego and the San Diego school district will actually pay for vision therapy because they've found it so much cheaper to fix a kid in third grade than to keep them in special ed for the next nine years of their Scholastic career. Oh wow. Right. That makes a huge difference there. Yeah, it actually does. It's, it's fascinating. Um, they, the national PTA put out a statistic years ago that said one in four kids has a vision issue that affects their ability to read and learn. And if you think about 25% and you know you that there's not a lot of developmental optometrists out there. I'm the only board certified developmental optometrist in the state

Speaker 1: (09:02)
and the entire state of Idaho. It's crazy. That is crazy. Wow. You know, it's funny you say that, cause you know my, I didn't even know this until probably five, 10 years ago. My dad, he said, he says, I had an instance when I was in grade school. He says, my teacher said I was the dumbest kid she had ever met and he didn't find out until after getting made. Hey, you made it all the way through high school, managed to, you know, just eke it out. You know? And it was, the whole thing was a struggle. He found out after he graduated that he had processing issues with reading and an issue. And so it was like, here he was, he thought he was stupid, you know? And it was just because of a teacher saying, you're a dummy, you know, and you know, that's a horrible thing. So doubt. Well, obviously you focus a lot of attention on concussions. Um, what would you say for parents, um, are some things that you do to help with that area? And I, I guess maybe a better question is what's kind of the general accepted kind of standard of care right now in terms of concussion recovery? You know,

Speaker 3: (10:07)
well, the best tests that you can do for a concussion, and let's talk about testing because we have to diagnose a concussion. Self-reporting of a concussion is the worst diagnostic criteria pay. How do you feel you fill in? Okay, yeah, coach put me back in. And then they go back in and they get a second hit. And now we're dealing with second hit syndrome, which is a whole other topic, right? Um, one of the best things you can do for a concussion, especially for yourself, for your children, is to have a processing speed check. Because if your brain is under some sort of duress, your information processing is going to be reduced. There's a test we run in our office called the Dem or the development time movement test. There's another one called the King [inaudible] and the King DVBIC. Recently I'm joined forces with the impact test.

Speaker 3: (10:54)
Um, all it does is it looks at eye tracking and it measures how long it takes you to track your eyes process information. There's the ran, which is the random random automaticity of number naming correlated with eye tracking. And if you're in the middle of a sporting event, um, it's a perfect sideline test. So when you're in the middle of a sporting event and they run that test with your adrenaline up and if you're pumped for the game, your speed should be faster than sitting in my office. But if it's slower at all, we've got to pull you from the game. We've got to figure out what happened, what's going on. Because what we don't want is that second hit syndrome. Right. You know, with the typical concussion, um, and well I assume everybody knows it typically takes about two weeks to recover. A concussion is normal. So when we talk about concussion, let's, do you mind if we talk about the pathophysiology that happens with the kids?

Speaker 1: (11:49)
Sure. No, that, that, that's totally fine. I think the thing, just back one quick before, no, no, no, no, no. I was just going to say, you know, in terms of looking at it from a mile up, the problem with the current state of things that you're saying that you just said is subjective tests. Don't give us an accurate picture because there's, there's a hidden agenda or not a hidden agenda, but there's a clear bias in terms of the individual. They're not going to want to be sidelined from the game. And so subjectively, when you ask them, you know, and a lot of these questionnaires are purely just that, is these subjective assessments? Do you have headache? Do you have blurred vision? Do you have [inaudible]? Are you experiencing these things? And they're like, no, no, no, no, no, no, no, not really. You know, I'm, I'm good.

Speaker 1: (12:30)
You know, like, get me back in the game. Whereas what you're talking about here is objective performance to base measures that give us a clear and very accurate, unbiased picture of what's really happening. And so parents need to be aware of that so that they can know that, you know, if, if, if the doctor or whoever is assessing your child or you, if it's you, um, you know, the, that just asking subjective questions is not going to get to the heart of the matter. So, so dig in further then in terms of the pathophysiology of concussion. Right. I'm glad he's here to clarify what I say.

Speaker 3: (13:04)
And one thing I thought of when he was talking is these two tests I'm talking about, they're eye tracking tests, but looking at information processing while you're moving your eyes. So it's a divided attention type test, right? And so the pathophysiology that happens when you have a concussion, if you think about your skull, it's about the consistency of concrete. And then the brains the consistency of jello. If something hits that, that skull, the school's gonna move and the brain stationary, so the brain hits against the wall, or the head's moving and a hit against another object and the brain moves and runs into the wall of the brain or the of the skull. Well, everybody thinks about the actual impact site as where the damage happens. What we don't think about is the tension on all the neurons coming up through from the spinal cord up into the head.

Speaker 3: (13:55)
And if that brain gets twisted and turned, there's all that tension that happens. If you have a very severe head injury, sure you're going to have bleeding on the brain, you're going to have some ripping, tearing of the tissue. But what if you just have a single nerve who gets twisted or bent and now it can't send the signal because the microtubules are broken? Well, now you lost a pathway that will never be picked up on an MRI. It will never be picked up. We have to look at function, right? So if we can look at objective functioning, we can find out, Hey, there's some deficits. Now let's figure out what it is and let's figure out how to rehab them. Um, they're now saying that concussions don't have to necessarily be a head hit, but any hit on your body that causes that pressure to change, kind of like whiplash or even a bad football hit, the head's stationary body starts moving and now you get that torsion or that polling on all these neurons.

Speaker 1: (14:56)
Right? And that's, that's really surprised. I think that's surprising to hear. You know, that, that it does. Most people equate concussion and that would make total sense. You either knock heads with somebody else, you get your head knocked into something, you fall, you know, that sort of thing. But you're exactly right. You know, any sort of force that's going to take the body one way and the head and neck, you know, I mean it's, I keep thinking of that, uh, what's that movie? So she married an ax murder where he's talking about his son with a massive head, like an orange on a toothpick is, you know, uh, that's what our heads are though, right? They, they weigh a a significant amount and so there's, there's this weight and so, uh, you know, you're vulnerable to a lot of those issues. You know, a lot of people, especially when they come in after accidents, they don't hit their head on anything, but they have this brain fog, that cloudiness, which is that, that first symptom, I think this easy to be.

Speaker 1: (15:48)
It's just like, you can't, you can't carry on, uh, you lose your train of thought easily. You know what I mean? Like just, yeah, you're like, man, I just don't feel like I can, you know, you know, roll like I normally would. So the standard of care right now currently is such where it's just kind of a wait it out and hope everything heals and then looking at again, symptoms or absence of symptoms. If there's no more headaches, if there's uh, no more pain, no more fatigue, et cetera, et cetera, you're good to go as typically kind of a the standard approach.

Speaker 3: (16:20)
Well that's typically what you hear about is Hey, stay in a dark room for a couple of days. No TV, no cell phone, no reading. Um, what we found is if a concussion is going to heal on its own, usually takes about two weeks. First couple of days. You do want to avoid tasks that cause increased pressure, headaches, increased brain fog. But then after a couple of days you want to slowly start introducing things back in, especially for kids at about two weeks. They're back at school, they're back doing homework. It's the patients that it takes longer than two weeks. Those are the patients we really want to talk about because they're the ones that aren't self healing and they're the ones that usually fall through the cracks. A lot of my patients, they've been dealing with their post-concussion issues for five, six years. By the time they come in to see me, I am definitely the last box they're checking,

Speaker 1: (17:16)
right. They've gone through all the other different people. Chances are they probably seen medical doctors, chiropractors, physical therapists, et cetera, et cetera, et cetera. Yeah, you name it.

Speaker 3: (17:26)
And it's interesting because people don't usually think about the eye doctor as fixing a concussion cause we think of glasses and contacts. But if you think about the visual system and the visual pathway, it traverses from the eyeball back to the primary visual cortex and then it comes back forward to process all the information. And so when we start looking at that, then my job, it takes me about two, two and a half hours to do a thorough evaluation, which I have to do on multiple days because these patients don't have the stamina before it get fatigued. Sure. Yeah. Um, then we could start to figure out, Hey, where are the deficits? What do we have to put back together? Um, what can you do? 70% of all sensory information comes in through our visual system. And so there's not a part of the brain that's not primarily or secondarily involved in vision.

Speaker 3: (18:14)
Vision is pervasive in the brain. And so when we start looking at that, we can start to figure out what's going on. A lot of my patients have trouble teaming their eyes, tracking their eyes, focusing. Um, a lot of times they're, their filters are, are broken. So all the sensory information comes in and they don't know what's good information and what's bad. So sometimes they filter out things that they need to pay attention to and they pay attention to noise. It's kinda like, okay, right now, do you feel your feet inside your shoes? Can you feel your shoes right? But did you three minutes ago, right? Because you weren't paying attention to it, you filtered it out. Well, sometimes after a concussion, sometimes the brain fog, the way I relate it is you don't know what to pay attention to. One, not to say you're paying attention to all this background noise that needs to be ignored.

Speaker 3: (19:06)
And so a lot of it is even knowing what information to process or pay attention to. That sounds exhausting. Very much so. Um, a lot of my patients are at their wit's end, let's be honest. Oh, sure. Yeah. Yeah. They're frustrated with life and so what we have to do is we have to make them feel comfortable. Um, if you think about the typical symptoms of what you'd imagined PTSD to be, I don't feel like myself, I can't do what I used to be able to do. Or a spouse might go, they just act different. I used to be able to rely on them if I said, Hey, I need you to run to the store after work and do this. They come home without doing that because they can't remember. They're so overwhelmed and exhausted just doing their activities of daily life. Right. It's like the brain is in survival mode.

Speaker 3: (19:53)
Just trying to do what it can to cope with anything. So. So w in a general sense, I mean obviously we could be here for hours talking about it, but what are some of the things that you typically will do to help, um, kids and or adults for that matter, uh, recover from concussions at your office? Great question. So the first thing we do is we do what's called awareness of process. We show them how it feels to line up their eyes to focus, to track. We want them to start to fill it, all the things that we take for granted so that they can learn how to control everything. Again, we teach them how to process information. We do a lot of puzzles, we do transpositions, Hey, how would this look flipped upside down, side to side. We start to get their brain processing information and we give them feedback loops because I need to teach a patient how to self monitor and self correct. Because if they're at work and that brain fog comes on, Hey, what do you do? Okay, okay. When this happens, I've got to get up. I've got to go get a drink. I've got to disconnect from the activity that's causing the symptom reset myself. Now I can come back and work for another half an hour. Does that make [inaudible]?

Speaker 1: (20:59)
Sure. Yeah. It almost sounds very similar to like what an occupational therapist would do for, for like a stroke victim or whatever in the physical realm, in terms of manual [inaudible] teach, teaching them how to use those motor skills. Again, you know, you're basically doing that for the eyes is what it sounds like a very similar process. It's very similar. Yeah, that's powerful. So kind of moving away from the clinical side, I would assume I know kind of what you love about what you do based on what you're saying. I mean that sounds like pretty rewarding, but I'll let you kind of answer that question. You know, what is it that you love most about what you do?

Speaker 3: (21:36)
I like being able to fix patients. The other professionals have said, this is all we can do. I like being able to take a person and make them so that they can function life again. I want to give them their life back and day in, day out when we see that happen, I go home well and sleep well. That's awesome. Um,

Speaker 1: (21:55)
we had an episode, uh, not, not too long ago where we talked about, you know, one of the greatest disservices that doctors can do for their patients is putting these very, um, stringent kind of caps on, you know, you'll never be able to do this again. You'll never be able to go to the gym or to play football, whatever. You know what I mean? Things that you used to do that you enjoyed there, they'd be like, Oh, because of this injury, you can't do this. We had a, we had a patient, uh, uh, who came in, um, about six months ago and he, he had some lower back issues he's had, he had on his x-rays, some degeneration and some other things like that. Uh, he younger guy, I think in his late thirties, um, but he was told by a doctor that he would never be able to play sports again, that he was going to be virtually crippled by the age he was by the time he was like in his forties is pretty much what the doctor told him.

Speaker 1: (22:51)
And so he was in this state of like constant fear of like his life was just this ticking time bomb that once he got to, you know what I mean? He was resigned to the fact that in his forties, he was going to be disabled, you know? Yeah. Just disabled, you know? And so it's, it's powerful when you can get doctors who are willing to help people break through those kind of mental and emotional barriers. And it sounds like a lot of your job is doing that with patients, really helping, um, exceed expectations, you know, that they might have fixing the unfixable. Yeah. That's awesome. Amazing. Um, so for those who are watching, who are local here, um, and that say they or someone they love a child or whatever, they're like, man, a lot of the things that he's talking about sounds like our situation or, or they just know, yeah, my son sustained a concussion or daughter sustained concussion. Um, how would be the best way for them to reach out,

Speaker 3: (23:48)
do you? Um, the easiest way is to go to our website. It's focused idaho.com and all of our office information's there. If they're not local, the best website to go to is cob D. dot org and that's the college of optometrists and vision development. Okay. And you say find a doctor and that has a nationwide search worldwide. Actually they will find a doctor that's closest to you. How many are there worldwide would you say? There's about 550 of us that are board certified. Okay. So basically like

Speaker 1: (24:23)
a handful in every state pretty much is what that is. So. Wow. That's crazy. Um, wow. So, uh, and, and we've been, I've, I've been to, uh, Dr. Lewis, his office. It's a state of the art facility, brand new facility. Amazing. Um, you've got a full basketball court in there for athletes to be able to train on and do specific drills there. Some other cool equipment that I didn't even recognize or know what it did, but it was awesome looking. Um, yeah, it's, it's amazing. It really is an amazing facility. And so, uh, Dr. Lewis has, is able to help a lot of, uh, patients that a lot of other doctors quite frankly, aren't able to help. And so, um, you know, hopefully if nothing else from this episode, what happens is you become less of the last resort and now more of a, Oh, you know, I'm just gonna put this away in the back of my head that if I notice this, we'll call Dr. Lewis in his office sooner or a, a, a vision development. A optometrist is, did I say that right? Vision. Developmental developmental optometrist. Right. So, um, any other final thoughts on this? Anything you want to share? Dr. Lewis? No, just thanks for your time and thanks for letting me come on. Yeah, no, awesome. It was awesome having you, man. Uh, yeah. If you guys know, uh, somebody that could benefit from this, share it with them. Subscribe to the podcast, uh, holler at Dr. Lewis. Uh, if you or someone you know, needs help and we'll talk to you guys on the next episode. Have a good one.

Speaker 2: (25:49)
Thanks for listening to the health fundamentals podcast. Be sure to subscribe so that you stay in the loop and in the note with all of the cutting edge health information that we share, if you know other people that could benefit from this information, please share it with them as well. Also, be sure to give us a review. These really help us to ultimately help more people. Last but not least, if you have questions that you want answered live on the show, or if you have ideas for topics that you would like us to cover, please shoot us an email and let us know at info@thehealthfundamentals.com.

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