Dec 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)
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