added information here. So here's my question, so what about return to play? Are we gonna have a blood test? Is this something that can diagnose and track? So the the blood test that has the greatest promise right now is something called GFAP, glial fibrillary acidic protein, GFAP, and it's most informative in the first 72 hours and hyper most informative in the first 24 hours. It's a diagnostic biomarker. There is a separate biomarker which ironically is called NFL, neurofilament light, and neurofilament light is the biomarker that appears to be giving us the strongest information about resolution of the injury process. And so we think it's gonna end up being a different blood test that ends up being what we call a monitoring blood test. So we'll have one to diagnose and one to then track recovery? Exactly. We're still we're still several steps removed from being able to assign a clinical significance to the monitoring piece. The diagnostic piece the FDA has already said yes three times. All right we just have a few minutes for questions. It was great. What is your typical time frame, athletes not getting better, so I'm gonna think about medications? Good question Nancy. I think like we've said again and again it's individualized to some degree and so I'm often a bit quicker to pull the trigger on that and someone that has pre-existing problems. So if I have someone that's already seeing our therapists because we know they have mental health problems and now it's exacerbated, I may be a bit quicker to integrate medical management in the form of prescriptives. You know in someone that has no health history and comes just with their first concussion and and we have these symptoms that present in particularly sleep if that's really the biggest thing as a lot of we've all mentioned sleep is really key and so if the typical things aren't working a bit again I may be quicker on that but it's really a couple weeks two or three weeks. I'm not sort of in that first week rushing to throw people on any sort of prescription medication. So I've got one last question. So do you find yourself quicker to involve psychologists in the management at this stage of the game? I mean David on your comments with the mental health. I mean I think like so for us in Pittsburgh we have three pathways of concussion management. There's the sports medicine concussion pathway and that's led by neuropsychologists. It's heavily populated by neuropsychologists. There's the neurosurgical pathway but that's really for the folks who are brought through the emergency room and then we have a physical medicine or rehabilitation pathway but we're all we're all collaborating so it's we we have a really really low threshold to engage neuropsychology in the management of concussion. And how much of the neuropsychology dealing with the depression and that are they you know if Mickey Collins were sitting here he would he would he would be sharing with you how that is eating a larger and larger percentage of his time because the demographics have shifted so dramatically in such a short period of time and if you don't get these athletes or these civilians or these service members to understand the impact and the overlay of their mental health disorder on their concussion manifestation and concussion recovery you don't get to the finish line. Yeah and I will just comment on that that overall it comes down to the resources available to you and so the power a lot of the power five schools and anyone here who works that they know that the focus has been in fact on mental health and a lot of our athletic departments are hiring therapists not neuropsychologists but as you said right clinical social social workers perhaps PhDs in sports psychology that are there to treat all of those things so when when available we're integrating it very early but I feel like in general there's a crisis because there is so much mental health as David had pointed out and our resources for the overall community are quite limited and so for your high school kid while that would be amazing to integrate that early and many of our communities it may be very difficult to find those resources. It's a nine-month waiting list right so what are you guys doing? No I think you know Dr. Schoeneck you speak to it better than better than anybody but at least ten years ago you'd never thought about I mean now you have weekly meetings with our medical staff with the behavioral psychologist and and just review the whole roster it doesn't have to be concussion related but the the behavioral health in our building is is there and and it's great to have someone on site to manage it and speak about it it transcends concussion it kind of goes. As a wrap up comment you know my frustration has been more not on the team side but on trying to convince parents that this is a good idea side and the pushback that you got because they there's just still a lot of the parents don't want to admit that that would be beneficial to their to their youth so I'll use it. Thanks.

blood tests

concussions

diagnosis

monitoring

biomarkers