Since You Put It That Way
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Since You Put It That Way
Concussions: Protect Your Melon!
All about concussions: the symptoms, the actual damage not just to the brain, but to the systems of the whole body, how to detect a concussion, and how to begin healing from a concussion. Mary Louder, DO speaks with Jill Olson, PT, CLT, founder of Peak Performance Physical Therapy and one of the organizers of the Dylan Steiger Concussion Project, about the advances in medicine and physical therapy surrounding concussions over the past 15-20 years, where the science stands now, and how physicians and patients can help to advocate for proper care for concussions, whether they are sustained by young athletes or older adults. Listen for all the details!
Intro for "Since you put it that way" podcast.
Outro for "Since you put it that way" podcast
Hi, Dr. Louder. Welcome back to Since You Put It That Way. Our guest today is Jill Olson. And she is the owner of Peak Physical Therapy in Missoula, Montana. And we're gonna be talking about concussions today. And it's more than what you think--it's more complicated than just a tonk on the melon. And it's going to be very interesting to learn how Jill handles concussions, as one of the leading experts there in the state of Montana, where she lives. Little known fact, Jill and I go way back to college days at the University of Montana, go Grizz, and we are classmates together in physical therapy athletic training school. So stay tuned for a great conversation on Since You Put It That Way.
Mary Louder:Great. Welcome, everybody. And we are entering into conversation here with Jill Olson, who is the owner of Peak Physical Therapy in Missoula, Montana. And we're going to talk about concussions today, we got lots of things to go over. Full disclosure, you know, always when we have our--give lectures and stuff, we have to, you know, lists conflicts of interest. And I don't have any conflicts. I've tried to avoid conflicts, I have nothing interesting. But full disclosure, Jill and I go way, way, way, way back to the University of Montana, go Grizz. And we were classmates in physical therapy school athletic training school. And--
Jill Olson:Just a couple years ago.
Mary Louder:Yeah, just--exactly. Last, yep, I think about five years ago. But I met you on your wedding day. When you were getting married, you were downtown at a bookstore. I don't know if you remember that.
Jill Olson:I totally remember that.
Mary Louder:Yeah. And then we started, you know, whatever, life went on. And then that was the spring, and then that following fall, we literally we're sitting next to each other in class, and we were like, you look familiar. And then the rest is history.
Jill Olson:That was my number one lesson. You always find people who are smarter than you and you surround them, you surround yourself with them, and they make you look really good. You sucker.
Mary Louder:Well, then what you do is you find people who are more beautiful than you and you invite them to your wedding and you put them in your wedding, so there you go. That was how that all went. But let's see, I've held your babies, I petted your dogs, I've stayed in your home, you've stayed in our home. You know, we just had such a rich and dear friendship for so many years that it's fun now to be able to be in the professional setting, to pick your brain on the things that you're an expert in and go forward and give our listeners some good things to think about. So thanks for being here.
Jill Olson:I'm really excited to participate.
Mary Louder:Yeah. And also we're going to give a shout out to our alma mater, the University of Montana, go Grizz, at the time of this recording, we are in the national finals for football.
Jill Olson:Championship game.
Mary Louder:Yeah.
Jill Olson:January 6.
Mary Louder:So yeah. So that's awesome. So go Grizz. So that's great. All right. So, concussions. Now, tell us a little bit about your background as a physical therapist, and how you got interested in the topic of concussions.
Jill Olson:Well, I had worked at the rehab center at community hospital for about seven years and worked with a lot of mild and severe brain trauma and spinal cord trauma at that time. And really enjoyed that aspect of my practice, but was really interested--interested in sports medicine and orthopedics. And I branched out into my own private practice and opened up Peak Performance Physical Therapy in 1995. And we really immersed into the whole sports medicine arena with Missoula, and we grew so many of those programs. And in 19--9--1990s, we really got interested in concussions and I'd sent a group of my therapists to a national conference. And they came back and said, we've got to change the way Missoula is handling concussions, and we've got to do it right away. And at that time, they were getting better at identifying concussions and they would hold the, you know, anyone with a suspected concussion, pull them from play and bench them, and we thought it was about seven to 10 days it was taking concussions to heal. So we'd shut them down, put them in dark rooms, take away all activity, give them rest, wait till the symptoms to go away. And at least we were identifying concussions. And we started giving seminars to all the teams and coaches and started baseline concussion training. And coaches didn't really want to hear it, what we had to say. Hockey coaches were saying, if I follow those rules, I'd have to bench my whole team. I wouldn't have a team to play with. And I was like, yeah, that's pretty true. And they really were very resistant to what we had to say. And very, very sadly, in 19--it was 19, late 1990s, Dylan Steigers passed away and he was a Missoula youth. He went to Sentinel High School, he grew up with my, my kids, and was really close to them. I'm sorry, it was 2010 when Dylan passed away. And he went on to play for Eastern Oregon. And when he played for Sentinel High School, his--he would refuse to report his symptoms. He took so many hits, he was such an aggressive player, and would refuse to report his symptoms. But both his parents and athletic trainer were very aware that he was having concussions, his athletic trainer would literally have to lock up his helmet so he couldn't play. And he went on to develop a lot of behavioral issues, suicidal thoughts, really irritable, struggling with school, grades dropping. And that whole sequelae of symptoms that we see with our young adults when their concussions aren't identified and managed appropriately. And then he went on to play football for Eastern Oregon. And very sadly, on Mother's Day of 2010, he was in a spring scrimmage and parents were there watching the game and the last play of the game, he took a knee to the head, went down, walked off the field, and was confused, started vomiting profusely, and then collapsed. And they had to life-flight him to Boise. And he was on life support for a couple of days. And tragically, his life was ended from that. And it was just such a tragic event. And I said to my staff, I said sadly, Missoula is going to listen now. They're going to listen to what we have to say. And I asked the family months later if we could name our program in honor of him, and they were so honored and joined us in full force. And in 19--in 2010, we started the Dylan Steigers concussion project, and we named our whole concussion program after Dylan. And through the efforts with the Dylan Steigers Concussion Project, we really promoted community education. And it really worked to advance the legislation. The mission of the Dillon Staggers Concussion Project is to educate, test and protect. And we have been able to have such a big bandwidth in all areas of that with concussion throughout Montana. We were very active in legislating for the Dylan Steigers Youth Protection Act, which was our state law that has been enacted. And I think all 50 of the states have their own state laws now. And that's for early identification and removal of players from any sports, and then requiring an evaluation from a skilled healthcare provider in concussion before they're released to play again. And we've had I think, seven golf tournaments, the Dylan Steigers Memorial Golf Tournament, and we've raised over probably$150,000 through our golf tournaments and grants and other activities to finance and support the advancement of concussion education. Peak for--I launched Peak Performance in 1995. And we've worked so closely together between Peak Performance and then Dylan Steigers Concussion Project to finance the advanced certification and education and all of our practitioners here in frontline concussion identification and management. So it's been exciting of, of what we've been able to do to really grow and advance the ability to identify and treat and manage concussions.
Mary Louder:That's amazing. And you're right, it is absolutely tragic that someone lost their life, number one, that they didn't fully disclose things, number two, that happens. And number three, that's the impetus for change for really the whole state, not just the city, the whole state. I dare say Montana might be ahead of the curve on this. Because back in the Midwest here, in Michigan, it's not that--that defined.
Jill Olson:Yeah, it's amazing when I talk to athletes from all over the United States that have had concussions and not just the athletes, but you know, athletes and adults, in asking them, you know, who they've seen, how they've been managed, what kind of treatment they've had. And it's very similar to what you said, Mary, and it's, it's, it's alarming. And I think as medicine is so late to the party, we're all very, very late to the party in the amount of education and abilities to identify and treat concussions. So if I were to ask you, back in your athletic training school days, how much education did you get on the vestibular system? Or the ocular motor system? Or the autonomic nervous system?
Mary Louder:That which I got in class with you.
Jill Olson:Okay, which was very minimal, couple hours. And how about in med school? What did you get?
Mary Louder:Well, we certainly had it in neurology, and we had a systems approach. But then we didn't--and then you would have a neurology rotation. So that was a clinical application. And that was one to two months, but it was, we rarely saw people with concussions in that setting. We saw people with advanced or nondescript neurologic conditions we were trying to describe, or managing MS or other things that were neurologic.
Jill Olson:Right.
Mary Louder:Or stroke, stroke was a big thing. We skipped concussion and went right to stroke. But back in the athletic training days, there is an athlete that stands out that I had to manage on the sidelines at the stadium. My senior year, the guy got hit, and then hit again. And we were like, gosh, he's sort of acting funny. Next thing, you know, he's out there lining up on the opposite side of the ball he needs to be and he's playing defense, when he played offense. Or reverse that, he was playing offense when he's a defensive player. And we're like, oh, my gosh, we had to go get him off the field. I had to watch him in the locker room. He probably needed to be in the hospital getting monitored and evaluated. But he just kept going, what happened? And then I'd tell him, and then two minutes later, what happened? And then I'd tell him again. What happened? Was--that, that was my the rest of my afternoon, \was playing Groundhog Day with this guy, because he was so concussed. And even when I was in high school, I had a concussion, I flipped off my bike. And I was knocked out for five minutes. I know it was five minutes, because they did time it and they--with flipping off my bike, there's some unknown guy dragged me off the street, and it's a good thing. I my neck wasn't broken, because I would have been paralyzed. And, you know, sat me up against the telephone pole, and then I went to the hospital in the ambulance, and I, that was me going to my Dad, what happened? And then he would tell me, then, you know, two seconds later, what happened? And I did that.
Jill Olson:Right.
Mary Louder:So, I mean, those--these things are are real to that extent. And then even there, what about you know, the range of concussions, do you think? So, so to answer your question, not much. And then to have those experiences that stand out are, are alarming, you know, because you just--you don't know what to do. I didn't know what to do. You just kind of--we didn't know what to do. That's just it. Yeah, we didn't. And then even when I was concussed, the doctors didn't do anything about it. They just say, Oh, she has a concussion, and sent me home.
Jill Olson:Right. Rest, rest and wait and see.
Mary Louder:Yeah, and it's--
Jill Olson:And that was hard. Oh, go ahead.
Mary Louder:No, I was gonna say even in the, like the Center for Disease Control, the biggest thing is you're watching for danger signs.
Jill Olson:Mm hmm.
Mary Louder:So they're waiting for you to crash as we call it. Right? The headache that gets worse and doesn't go away. Significant nausea, repeated vomiting, unusual behavior,
Jill Olson:Sure. confusion, restlessness, agitation, I mean, those are advanced neurologic signs. Right. So you're, you're looking for more of a subdural hematoma or internal structural damage versus the functional damage of a concussion.
Mary Louder:Okay. All right, you might have lost some of us on that one. So let's back that one up. And let's go maybe if we go like the acute care, identifying what a concussion really is, let's define that. I mean, how would you give a definition of a concussion? What would you say?
Jill Olson:Mild traumatic brain injury that can occur with a jolt to the head or a jolt to the body that causes you know, movement and impact to the head. You don't even have to hit your head really to get a concussion. But it causes functional damage, which is changing the chemistry in the brain. So you've got a blood-brain barrier, a barrier that's supposed to keep certain chemicals on one side and other chemicals on the other side. And if you picture like a sheet of elastic or Theraband if you know what a Theraband is, or a stretch band, if that stretches out, if their little pinholes in that, you wouldn't see it but if it gets stretched out, and with concussions, we call like a shearing force, an axonal shearing force that can happen where you get this stretching, and then all those little holes open up, and then you've got sodium and potassium and all these other chemicals going where they're not supposed to be. And it causes a multi-system inflammatory issue within the whole--within the whole body, primarily in the brain. And the more we're learning about concussions, it's very similar to COVID. COVID is a multi system inflammatory process, concussions are the same. So is this internal chaos and chemistry, it's a metabolic crisis as a storm. Oftentimes, I'll shake a snowglobe for patients and say, this is kind of what it's like in your brain and the snow's all blowing, and it's like, rain over here and hail over there, flooding over here. And it's an internal storm that causes a whole metabolic crisis. And it impacts multiple systems. And that's where we've gotten in trouble with those quick sideline assessments or the acute assessments, because it can impact multiple systems. And with our--traditionally, sports concussions are traditionally handled by athletic trainers, and then sports medicine physicians. And that's what got us in trouble with the NFL and the NHL, they would do kind of I call it the cursory side glance, you know, they'll do a quick side glance at what they know, but they don't know how to look what they don't know. And, and that's the same with all medicine, you know, we know what we know, we don't know what we don't know, but being able to identify and refer is what's most important. So, for a really thorough assessment of a concussion, concussions can impact your vestibular system, your oc--which is your your balance and your equilibrium. And as you've got a peripheral vestibular system in your inner ear that communicates with your central vestibular system and all these cross connections in your brain, closely married to the ocular motor system, which controls dynamic eye tracking. So we move beyond how many fingers do you see to what happens with repeated eye tracking and eye movement, and then very specific reflexes, one is called the vestibular ocular reflex, that's the ability to keep sharp focus while your head's motion--head's moving. And when that's impaired, you don't how often is our head moving with vision, it's always moving. If we're breathing, your heads moving, if you're walking, your heads moving, and your ability to keep sharp focus with your head moving is oftentimes paired with concussions. So you got your vestibular system, ocular motor system, cervicogenic system, your your neck and the impact with whiplash injuries that couldn't reproduce. So many of the systems. That usually is treated, you know, assessed well, in the emergency rooms, they always look at the neck to see if there's any cervical fracture. Your it can impact the vagus nerve, the longest nerve in your bo--in your body, that can cause what we call autonomic dysregulation. That nerve can impact your breathing and your gut and your heart rate. And we're seeing a lot of issues down the road with impact to the autonomic nervous system. And it can bring on disordered sleep. It can bring on--they often look at mood disorders, and they kind of want to put it like in the mental health or you've got anxiety. But there again, we've got to dig deeper because what's causing the mood disorder of anxiety, depression, irritability? Oftentimes, it's information overload from your vestibular system, or your ocular motor system or your autonomic nervous system. And when those systems aren't firing, right, we see huge anxiety, irritability and depression.
Mary Louder:So is that--those areas coming up into the midbrain then, is that right? Right. Okay, so folks, let's break this down for just a second. The frontal cortex is your executive function, the decisions you make day to day to live your life, the back part of your brain, there's of course the ba--the balance and movement with cerebellum, but there's also where you store your memories. Midbrain is where a lot of the processing occurs. So what Jill is saying is the processing that occurs from the periphery, from the balance centers in the ears, from your eyes going to the middle of your brain, and then from the vagus nerve, which actually floods up more than goes down because there's more pathways going up than down, causes all that dysregulation that meets in the midbrain, that just makes a jumbo, jumbo jumble.
Jill Olson:Both-and. I mean, it can impact any of those areas you talked about. And if you've treated one concussion, you've treated one concussion. If you assess one concussion, you've assessed one concussion. And I think there's--
Mary Louder:So, sorry, you're saying the Nano the other ones that that person's had? Is that--
Jill Olson:That, and they're all different. Every one is different, and that's why we don't have good protocols. For the--these are the exact--I mean with assessments, we're getting better, to make sure we're assessing all of those systems with protocols of treatment. They're growing rapidly, but it--you know, if you had a total knee replacement, you kind of fit into a black and white protocol on day one, two and three, you're gonna do A, B, and C. And by four months, you should be here, in six months, you're here, concussions are so muddy and messy and they play dirty and they go to your weakest link. And, and one day, you might present with a lot of vestibular issues, the next day, it might be a lot of visual blurring, ocular motor issues. The next day, it may be more autonomic dysregulation issues. So there--it's like I always refer to the movie 50 First Dates with Drew Barrymore, every time I see my same concussion patient, each day is a new date with that one as to what's kind of wrapped up and what symptoms are showing that day.
Mary Louder:And sometimes, hopefully, it's not like Groundhog's Day.
Jill Olson:Exactly.
Mary Louder:Same thing over and over and over. Both-and. I have seen that too. And I've lived that. So I, I get that one too. Okay, so we've got this acute inflammation that occurs, and this this scrambling, this metabolic change in the blood-brain barrier, and then the pathways. So what do we want to look for? Or what can we know to do to treat this? Now I know physical therapy, you treat in the realm of your activities and your exercise prescriptions, you're not prescribing medicines, I'm not asking you to do that. But what have you seen being used in your advanced approach to concussions that your informed physicians have used or your informed providers that have used to come alongside with the work that you're doing?
Jill Olson:It's really exciting to see the objective biomarkers we do have to work with now. Typically, if someone goes to the emergency room or urgent care, they don't have a lot at their--a lot of access to instruments and test measures within that setting at this point. It's growing. Typically, it's like you said, Mary, they want to look for all the red flags and determine Is there something structural going on? Is there an internal brain bleed? The misconception of so many is, I went to the emergency room and they didn't even do a CAT scan or an MRI. They should have done that. And it's like well, we've, we've changed in what we know now, in that truly a concussion is a functional injury. It's more of the chemistry, the metabolic crisis. That, you can't pick up on any imaging at this point. They're on the--they're constantly researching all sorts of types of testing that might pick that up, but at this point, there's nothing approved that can assess that. And like I said, like you said, if there's major red flags and major critical issues that they think there might be more severe moderate or severe brain trauma, then they will do one. So you passed those tests, you didn't need that. So, so typically, there's diagnosing more by their subjective complaints, what their complaints are and what the mechanism of injury is. And that's how I usually derive the concussion diagnosis within an urgent care setting. What we have and what more advanced vestibular specialists have are vestibular assessments that we can look at the vestibular ocular reflex, so we can do a vestibular ocular motor screen, and challenge the vestibular system and the ocular motor system and see if that drives symptoms. If it does, then most likely they've had impact to their vestibular and ocular motor systems. Over 65% of people that have sustained a concussion have vestibular trauma, over 90% of people that have sustained a concussion have dynamic vision issues. And that's the most exciting tool that we have in our clinic. It's called the right eye neurovision assessment tool. And that was the it's a computerized software program. And it has it's a, just like a small laptop. But it's got two little digital retinal sensors in the computer that plug into each retina. And then it takes them through a series of ocular motor tracking, smooth pursuits, there's a circular smooth pursuit. So you watch the circle, and you keep your eyes right on it. And then there's horizontal smooth pursuits and vertical smooth pursuits. And that's all controlled by the cerebellum, and then different cranial nerves that control that and it should have specific readings. And this computerized program can look specifically at both the right eye and the left eye individually and see if one's off and typically, it would give a readout of the circle and then you can dynamically see how the eyes track around that circle. And if we see these little jagged lines, we know they have what's called psychotic intrusions. Their eyes aren't working as smoothly the way they should, or their their way off of the circle or instead of a circle, they make an egg pattern or some distorted pattern or one is good. And the other eye's like way off in left field. And so we at least know what's going on there. Maybe they had pre existing vision problems, which we tease out. This test also looks at psychotic movements, which is your fast tracking from point to point, both vertical and horizontal. So if you're driving, or if you're, you know, athletes have some of the--the best athletes have the fastest dynamic eye tracking, and that's what makes them so good. When that slows down, you're not reading your world as well, your peripheral vision can be off, you're not as quick to react, so reaction time is impaired. And when it's weakened, then they typically get these headaches and tension behind the eyes and they get headaches at the back of the head. And it increases headache, dizziness, nausea, fogginess. So we have very objective markers on dynamic vision and what happens with fatigue and what symptoms that drives. So that's giving us a really good biomarker on dynamic vision. And then we can assess the vestibular ocular reflex and other vestibular reflexes and see if they're impaired. We do a--what's called the buffalo concussion treadmill test so we can see what happens with exertion. And we monitor closely their heart rate and their symptoms scale. And we'll also look at blood pressure to see what exertion does and--
Mary Louder:And bring in the sympathetic nervous system then when you're talking about this.
Jill Olson:Exactly. And sadly, we are seeing such a rise of POTS syndrome, both with COVID long haulers and with our concussions. So that's Postural Orthostatic Tachycardia Syndrome. And that's where their reaction to their blood pressure causes--or, reaction to gravity and standing up or exertion, can cause the heart rate to go up. And then bring on all of these symptoms of lightheaded and dizziness and occasionally pass--passing out or syncope events. And so those are objective markers when we start to push those systems to see what's going on. And those are a few of many things that we can do. And when you have vestibular specialists and dynamic vision specialists and the ability to stress those symptoms--systems, then we can come up with a more accurate diagnosis of what's involved.
Mary Louder:Okay. So, by and large, I would say, I don't see that happening. And sad--I'm sad to say that and that's one of the reasons I wanted to have this discussion and conversation with you. Because I see the accidents that occur. And some of the ones where you know, maybe they're in a car, they're The barriers I run into there are prior authorization, non hit from the side, it's that axial loading that longitudinal or that long axial loading where the brain is twisted. That is one of the most difficult to treat. Now as an osteopath, how I as I probably, hopefully, I think I do a better job, but I'm not where that is, not doing what you guys have done. I don't have those tools. Right didn't have that information. I know enough that when people, when the patients aren't recovering more quickly, we've got to get them to the specialist. coverage misunderstanding, misinformation, disinformation. And basically, then the ancillary things like work, return to play, return to work, all those things begin to kind of get in the way of being able to truly care for a concussed patient and then, then you've got the whole concept of the motor vehicle. Now, I will call it a situation where it's the--rather, if it's the insurance on that part, or how you access care with that type of insurance and coverage, which varies obviously, from state to state, but the inconsistencies and even the diagnosis, you know that--you're right, they go the ER, they didn't do an image. They didn't--sometimes they leave without a full neurologic exam. Honest. And then the follow up is just do what you can until you can do more. Right. And then we see and you know, probably some of our listeners are going, oh, you guys are just explaining and describing what I've been through. I'm like, exactly. That's why we're talking about this. And then you know, for medication I've seen anything from you know, usually not narcotics, because that depresses a lot of the breathing and things. I've seen ibuprofen, Tylenol, which are, you know, inherently are safe enough in this situation, but you don't want to mask symptoms. You know, from an integrative standpoint I use magnesium, B vitamins and a lot of omegas. Omega-3s as anti-inflammatories and then get them shuttled into a specialist. And even so, like if we're in the workman's comp situation in Michigan, what I've run into, a person that I know had a concussion, and they're two and a half months out, and they still haven't been referred, they've been referred to a specialists, but the treatment is just, well, I guess you just rest until it's better. And I'm like, isn't there rehab? Isn't there some, you know, and then they go, Well, physical therapy. And I said, well, no, within physical therapy, right.
Jill Olson:Right.
Mary Louder:What should the messaging be? What's your best advice to me as a physician to tell my colleagues about how we should be doing this differently?
Jill Olson:Well, you brought up so many good points. So many research shows that the average person with a concussion has seen seven healthcare providers, before they're finally referred to the right healthcare provider that can appropriately assess and address their issues.
Mary Louder:Wow.
Jill Olson:So what I tell you--and you're right, you can go to physical therapist, and they'll do physical therapy, but they're not vestibular specialists. So when I tell people, I say look for the buzzwords if you're researching concussion rehab, you want to see vestibular specialization, vestibular ocular specialization, dynamic vision issues with concussion, autonomic dysregulation with concussion. So when you're kind of doing your Google research for the specialists in your area, those are the buzzwords that should come up with that. But vestibular is one of the most important--you know, it's also interesting how many people that have had concussions also sustain Benign Paroxysmal Positional Vertigo. So the BPPV, or vertigo what people say when they got the loose crystals in their ears. And that frequently happens, and then really clouds and profound all their other system is symptoms. And that can be cleared up pretty quick. So it's the vestibular specialist, and also speech language pathologist that specialize in cognitive executive functioning skills. Because the other major part is that cognitive fatigue, and the thinking--concentrating, focusing, scheduling, all of those things that come--all those activities that we don't think about in maintaining schedules and concentration, focus, attention memory, when those are impaired, it's the speech language pathologists that specialize in those areas, the neuropsychologist can also be really good, I find that they can be great at assessing if they do that function. You'd think psychologists and neurologists should be doing those, but we've also had some neuropsychologist that deal more with anxiety and depression, but not the executive functioning from mild traumatic brain injury. And so finding those right specialists that specialize in those areas, and it is hard, and but fortunately, we're growing, just like you said, we're all learning and growing and in this together. We're late to the party. But those are the buzzwords that you need to look for.
Mary Louder:Yeah, interesting when you said about the neuro psych testing, because that's like a three to four hour test in it's fullness. And so that would be hard to complete if you're having cognitive fatigue, number one.
Jill Olson:Right.
Mary Louder:But quick side story on that, when I was a med student, I did neuro psych testing, can't tell you for results--no, joke. But But what happened was, it came out that I had difficulty with spatial relationships. So sure, in 10th, grade, you do the, I forget the name of this, like the Stanford achievement tests and things like that. And they give you a diagram that says, if you were to fold it, what would it look like? I'm like, check, check, check. Check out super high with that. Right? Well, that summer, I had my concussion. The following year I took geometry, and I could listen in Oh, wow. class here, go home, and I couldn't figure out how to do my geometry. And then went back and I try and do the, the the solutions and the problems. And I got a really low grade in geometry and they just kept thinking I was goofing off. Then I had--then I kind of got in trouble for
Jill Olson:Yeah. attention things and stuff like that. And then--and then as I went through college, graduate school, med school, and then they do the testing in med school, and the lady goes, Did you ever have a concussion or brain injury? I go, what do you mean? She goes, Yeah, Your spatial stuff is horrible. Well, and I go, Yeah, and they go, Well, it's back on the left kind of the left posterior part of your brain and the left side of your brain. And like, yeah, that was the part where I landed on the concrete was knocked out for, you know, five minutes. Wow, and how helpful, had you learned early on and given some new strategies and coping mechanisms and new tools to you know, work through that?
Mary Louder:Right and well, and then I honestly went to the emotional component of that, I felt ashamed I couldn't do geometry, because I loved it.
Jill Olson:Yeah.
Mary Louder:And to excel, and then some of the structural, some of the functional things with physics didn't make sense. And--so, that impacted, you know, how I was as a student, it was very concerning.
Jill Olson:You know, well, and the other issue, I've had a couple of different patients that have gone through a whole neuro psychological battery of tests. And they've struggled so much, and they're trying so hard to get back to work or get back to school and regain those skills. And they'll go for those full day of testing, and they'll come back and they'll say, he was trying to attribute all my issues to my childhood relationship with my mother. And they're mortified. She has nothing to do with what I'm dealing with now.
Mary Louder:Paradoxical universe, this-and you know, both things can be true, right. But--
Jill Olson:It is mortifying, when you can't do geometry, and then you go to the wrong neuropsychologist, and they tell you, it's because of your childhood upbringing issues with your mother. And it's really hard when people with concussion, especially if they're dealing with anxiety and depression, and they're put in the mental health tract, and that's where we've seen a lot of, they're put in the wrong lane, they're treated with the wrong mental health medications. It's like, well, maybe you've got some issues there. But you really have some impairments with your vestibular ocular systems. And every time I challenge those, we're exploding anxiety, dizziness, nausea, your fogginess, you know, the things that have been attribute--attributed to the wrong tract.
Mary Louder:Yeah.
Jill Olson:And that's what I think happens so much as we're all learning more, we all want to treat what we know and kind of put it in our lane. And so if you see dizziness, fogginess, anxiety, that could either be PTSD--it can be totally treated as PTSD--it could be total mental health, and treated as that, it could be total autonomic dysregulation. It could be completely from vestibular system or completely from the ocular motor system. Usually it's both-and, but when it gets just put in one lane and the other lanes are not assessed. That's our conun--concussion conundrum. That's where these people are struggling. And that's where we're learning more. We're getting more specialists, and they're few and far between.
Mary Louder:Yeah, I would agree. I would agree. So we've outlined the problem. Let's talk about a few solutions, because there's things we can do if--so, I think of prevention. Helmets.
Jill Olson:Helmets are really important, but don't get me And I've listed a case, you know, correct me where I'm wrong here, bike riding, skiing, snow and skateboarding, rollerblading, motorcycle, horse riding, when else should we be wearing a helmet? wrong, they don't prevent concussions. And--they prevent skull fractures, they prevent more, more trauma, they may make you more cau--they could go either way, you know, they can make you more cautious because you have a helmet on and you're remembering that you have to protect your head. But Mary, you put a helmet on a seven year old little boy who's playing youth football, and you put a helmet and pads on him, what a little boys do when they have helmets and pads?
Mary Louder:They run into--
Jill Olson:They do what they see on NFL and football every weekend, they run a tackle. There's also there's almost been studies of what if we took helmets out of football? They'd learn to keep their head out of the game. And it's one of the biggest things we need to do is change the way we play and change the rules. And we've come a long way with that, they've changed a lot of the rules with checking with youth hockey. With football we're seeing a lot more time out of helmets and pads, a lot less time in contact. That's the biggest change we can make with football, especially our youth is get them out of their helmets and their pads and do very little contact play, very little contact practice. And learn to tackle like lacrosse, and learn to tackle like rugby, and get your head out of the game. And I think the Seattle Seahawks were one of the first ones to really integrate a lot of the rugby tackling tactics, more with shoulders and hips, getting their heads out of the game. So it's the safety and getting the heads out of the game and making a lot of those changes that are really important.
Mary Louder:So do you think--so let me pick on soccer a minute. Football.
Jill Olson:Right.
Mary Louder:Called soccer here. That has a very high concussion rate.
Jill Olson:Very high.
Mary Louder:Okay, so do we need to modify that sport too, or--I mean, what do we do, do we take out--I mean, that's--because we've got like, so there's--to be sure there's contact, but then there's collision sports, football is obviously a collision sport. Hockey is a collision sport. It's not a contact sport, it's a collision sport.
Jill Olson:Soccer is a collision sport.
Mary Louder:It is a collision sport. You know? Do you think, so, do you know the statistics, if there are more concussions in rugby versus soccer or soccer versus rugby?
Jill Olson:I don't, but I think soccer has more than rugby. But I don't know for sure.
Mary Louder:Okay. Yeah. It's the kind of figure-- Which is, which is really astounding to think that, but like I said, rugby players, they've learned to keep their head out of the game. Yeah, yeah. And they're more, they're more on the ground in a scrum. They're--
Jill Olson:Right.
Mary Louder:They're Ruben in the mud.
Jill Olson:Well, and if you looked at total number of injuries, rugby players probably have more orthopedic injuries. But yeah, but as far as concussions, I don't know the numbers on that.
Mary Louder:Right. Okay, so we got prevention. Okay, so helmets, I thought they were a little bit stronger than that. But I get it. I, you know, I said, and, yeah.
Jill Olson:They're coming up with, they're coming up with new technology all the time. There's some that have kind of a rotating component in it to help minimize the shearing force of the brain when it's hit, and all sorts of levels of cushioning and comfort. So I would, I would guess, that they're decreasing the impact. But it's still out for jury. And it's still in the evolving phases.
Mary Louder:All right. So helmets, plus or minus, coming more on the scene. What else can we do from a prevention standpoint, do you think?
Jill Olson:Well, you know, let's talk about our aging population. They have, actually 65 and older have the the largest number of concussions, the largest percentage of concussions, and, and they're often mismanaged, misdiagnosed, unidentified, untreated, and they have so many other issues, and oftentimes, a whole sequelae of health issues. So if you have an aging person, come see you. And they say, Yeah, I just fell. That's one of many issues that you have, but they're oftentimes not totally identified. Or if they don't fall, and they come in and say I have dizziness and fogginess. Well, let's look at your medications. Well, every medication you're on, that's the number one side effect, is dizziness, fogginess, nausea. Blurry vision.
Mary Louder:Yeah, let alone polypharmacy when you have more than two, you know, medications at a time, right?
Jill Olson:Plus, now we've got the medical--the medicinal side effects, which can lead to more falls and more concussions. And then we talked about no disclosure or full disclosure, they don't want to come in and tell you they're falling. And I call it the don't-tell-Jill phenomenon. Because when my kids were little, and they were in high school, it was it was like, Don't tell mom, don't tell Mom, what we're doing. Well now with aging parental figures in my life--and luckily, they come to my clinic, I get him right into my physical therapist for physical therapy. But every time there's a fall, don't tell Jill, don't tell Jill. They don't want to have their independence taken away. They don't want you worrying. They don't--they want to drive, they want to live independently. So they're not disclosing their falls. And they'll come in here and they'll tell their therapist, but don't tell Jill. I call it you know, don't tell Jill, they're the worst at disclosing their falls.
Mary Louder:Yeah.
Jill Olson:So, the the astute physician and the astute healthcare practitioners to tease out those falls and what's driving the symptoms. Is it a medication side effect, or have they had a concussion or multiple concussions? And so how do we prevent that with that population, really close management of medications, get them on what they need, get them off what they don't need, and the balance training and the strength and the mobility that they need to keep them at the safest levels of movement and function.
Mary Louder:Yeah, so I can see in lifestyle medicine balance and equilibrium training, you know, from basically from when you get your AARP card going forward.
Jill Olson:Right.
Mary Louder:It's 50. By the way, I still offer on mine. I don't have it yet. But haven't been using it. But if you--yeah, so you've got that balance you've got to do. So, dynamic balance, watch your medications. I would even do things like simply stay hydrated.
Jill Olson:Oh, huge.
Mary Louder:You know, watch your electrolytes. If there's any of your medications that cause electrolyte disturbances. Make sure you manage those, right? With a glass of wine one or two. Yeah, yeah. Watch out for the yeah, watch out for alcohol.
Jill Olson:Then you watch the alcohol. And then what did COVID do to our senior population with isolation, anxiety, decreased activity and increased intake of alcohol. It's a--it's a perfect storm. So it's--yeah. The health and the wellness and this activity and the exercise and--
Mary Louder:And I think, too, then, from a physician standpoint, where we need in our continuing education, we need more education on the evaluation for identification.
Jill Olson:Right.
Mary Louder:Concussed patient--are we really asking the right questions knowing the vesti--vestibular ocular motor reflex testing.
Jill Olson:Right.
Mary Louder:You know, and so then we can identify these folks. And you know, really get them going much quicker. So, the hope would be if you're concussed and you're listening, and you have some of these symptoms, check for vestibular therapy in your local area, right? Reach out to physical therapy, who then might know or go back to your physician and have them or healthcare provider and have them help you find somebody and don't take no for an answer.
Jill Olson:Right.
Mary Louder:Don't take just rest in a dark room for an answer. Don't take this will just go eventually away for an answer. Oh, no, this is all in your head, meaning you have anxiety. And this is from your childhood, and, you know, whatever, whatever. Don't take those as answers and say there really must be something going on here. And you want to get to the bottom of this. So sounds like some advocating on the side of the patient.
Jill Olson:That's exactly what I tell our patients and I say, welcome to the frontline of the Dylan Steigers Concussion Project, because you need to be a strong advocate to get your needs identified and met. And just as they give their whole litany of all the providers they've seen that didn't help them or led them down the wrong path. I said, you're now on the frontline. And you're part of the our, our mission to educate, test and protect. So be a strong advocate and ask for those services that you think you may need, and understand that your physician or your health care provider may not be familiar with them as you are. You may be more familiar with what these issues are than they are. And be a strong advocate. And keep pushing hard until you find someone that is.
Mary Louder:Yeah. And so and from my side of the exam table, I would say listen to your patients, because they'll tell you what's wrong with them.
Jill Olson:Right.
Mary Louder:So I think with that combination, we can have a much better identification, treatment, and outcome and potentially move the needle on something that's just super, super important, you know, to care for with folks.
Jill Olson:Yeah.
Mary Louder:Well, Jill, I'm fully impressed with the work that you're doing out there in Montana. And I am just so glad that you're doing what you're doing not only in Missoula, but how it affects the whole state. And I'm just--I'm just super glad you're my friend, too. And--
Jill Olson:Well, it's like I said, I learned from a very early age, just surround yourself with the smartest people, turn them loose and watch them go. And I have the most amazing team of incredible specialists. And it's that think tank and that working together, and with such a desire to grow and learn. So I'm very blessed.
Mary Louder:Yeah, so you've got--
Jill Olson:People like you, Mary.
Mary Louder:Yeah, yeah, well, and so, and I appreciate too, just how candid you were with how difficult this is, but yet how important this is, and that you've taken this on as one of the key things in your career to really, you know, for advocacy for patients. So, thanks for coming on our podcast, and since you put it that way, you know, it's the podcast that we go, hmm. Something to think about. And since you put it that way, let's do something differently. So this fully outlines that entire philosophy. So thanks, Jill, for being our guest today. Appreciate you being here.
Jill Olson:I'm honored. Thanks, Mary. Go Grizz!
Mary Louder:That's right, go Grizz!
