Do all the concussions need to wreck us?

Source: diamondduste

I’ve been giving a bit of thought to all the reports of concussions in the news, lately. Football players, ice hockey players, soccer players… not to mention all the reports of kids heading to the ER. Conflicting as those reports may be — some say more pre-teens are being treated, some say more high-school age teens are being treated — the picture is still pretty significant. And the concern is increasingly palpable.

The message, like in a recent blog post of the Chicago Times Union, frames the issue from a concerned parent’s point of view. This isn’t an isolated case, either. Soccer/hockey moms/dads are becoming increasingly vocal about concussion risks in youth sports, and plenty of times there’s an accompanying dismay at the apparent cluelessness of the coaches regarding the risks of unsafe return to play.

Here’s the thing, from where I’m sitting — as a multiple concussion survivor and a former student athlete myself: If we funnel all our energy into fear and avoidance and attempted prevention of injuries like concussions, aren’t we possibly missing a big lesson that sports can teach us, in the first place — namely, that it’s part of human experience to get hurt… and it’s vital that we learn to pick ourselves up, dust ourselves off, and head back into the fray, facing our fears and dealing with what is.

Getting bent out of shape over concussions is understandable, but does it need to derail the very important process of learning from screwing up that often comes from childhood and youth? Since when did we start believing that all the lessons we can learn should be framed in positive terms, with no harm or danger involved? I would argue that by avoiding and trying to prevent risks, we are depriving the next generation of really critical lessons they need to learn, in order to deal effectively in the world.

If they don’t learn how to handle injury and adversity now, when they are relatively safe within the fold of their parents’ house, how will they handle it when the shit really hits the fan?

It inevitably does, you know. No parent can prevent that, hard as they  may try.

Now, I’m sure that there are plenty of parents who will take issue with this attitude. And coming from a multiple mild traumatic brain injury survivor, I realize that credibility is an issue. How can someone who’s gotten clunked on the head as often as I have be a trusted source for judgment about how to deal with sports concussions? I’ve talked about my judgment around risk being a bit impaired in the past, so why listen to me now?

Here’s the thing — it’s not that I’m advocating that we put our kids in harm’s way and not give a damn about their safety. Far from it. But at some point, the helicoptering starts to genuinely prevent the most valuable part about childhood and youth — the learning gained from trying and failing and trying again. That includes the learning gained from falling down, getting hurt, getting up and assessing the severity of your injury, letting yourself heal, and then getting back into the game when it is genuinely safe to do so.

Granted, with concussion, the threshold of safe return to play is often elusive and unpredictable.  But the opportunity — indeed, the teachable moments — that healing from an injury provides, can be invaluable in later life.

Concussions happen. They happen a lot. And I suspect they’ve been happening since the beginning of time — we just haven’t always had emergency departments at the ready to accept the steady stream of kids whose parents have good enough insurance and the level of understanding and concern to get them there.  I’m not sure there are more concussions happening today than before — we’re just more keenly aware of them. And this increased awareness means we’ve got a shining opportunity to learn all about the injury — as well as how to heal.

And learn we must. It’s not enough to wring our hands over all those mild traumatic brain injuries. It’s not enough to rush the kids to the ER and lecture the coach about their insensitivity and putting our kids in danger. It’s not enough to turn our heads away from danger and injury and/or do everything in our power to prevent it. We must learn to deal directly with this in a way that actually works, so that it doesn’t get the best of us. We need to learn to face up to the danger, the risk, the harm, the inevitable hurt, and master our skills in overcoming it.

After all, if concussions are endemic to the human experience and people have been experiencing them since the beginning of time (which I believe is accurate), and we’re all still here (more or less) and we haven’t all died off due to chronic traumatic encephalopathy and our societies haven’t completely disintegrated into a dust cloud of demented violence (or maybe we have?), isn’t that at least some evidence that concussions can and do heal — and that we can probably find a better, more effective way to heal than we’ve seen in the past 50 years or so?

Rest alone won’t always do it.  Concussion and TBI experts tend to agree that resting (and doing nothing else) doesn’t always fix the problems that come from post-concussive syndrome. Exercise, on the other hand, has been shown to clear issues with people with remarkable success — as SUNY’s University at Buffalo Concussion Clinic has found. Even professional ice hockey players are turning to them for help, and it appears to be helping. After decades of partial solutions, we’re getting to a point where we’re learning new ways of dealing with the somewhat staggering numbers of head injuries, and we should use them.

Let’s use them. Let’s deal with the issues around concussion — both the prevention of needless injury, and the healing from the hurt. Short-term recovery should be actively evolved and pursued and talked about in every public forum, from youth/amateur sports to professional circles. And long-term recovery should be addressed as well. Nobody who’s sustained a concussion (or more) should have to live under the dark cloud of the depression, the mood disorders, the behavioral issues, and the cognitive problems… not to mention the public stigma that comes from being considered “brain damaged”.

Concussions happen. But they shouldn’t have the last word.

At least, that’s what I think.

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How Can I Recognize a Possible Concussion?

One of the nice things about being a blogger is that I can add my information to the general wealth of data about subjects of interest to me – in this case, mild traumatic brain injury. This blog is about more than telling my side of the story — it’s about fleshing out info that other trusted sources provide, in ways that are personal and individual… and hopefully contributing to the general understanding about traumatic brain injury, and sports-related concussion in particular.

The CDC has a wealth of information on concussion in youth sports over at their Heads-Up site.

What’s missing is a bit of in-depth explanation about the different points they make.

Since this month is Brain Injury Awareness Month, I hope to contribute to the awareness piece with further info and examples from my own concussion experiences.

From the CDC site about recognizing concussions:

To help recognize a concussion, you should watch for the following two things among your athletes:

  • A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.

AND

  • Any change in the athlete’s behavior, thinking, or physical functioning.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

Signs Observed by Coaching Staff

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms Reported by Athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right” or is “feeling down”

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.

Now, for some explanation to fill in the blanks…

To help recognize a concussion, you should watch for the following two things among your athletes:

  • A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.

The head, atop the neck, holds our precious brain — which has the consistency of pudding, and is surrounded by fluid which protects it from the bony inside of our skulls. Unfortunately, the bony insides of our skulls can have rough/sharp edges which can rake across the surface of the brain and cause damage that way, should the head/bodybe knocked so hard that the brain pushes past the protective fluid and scrapes against the inside of the skull.

You can see a video of different types of brain injury at YouTube. It’s very informative, and I recommend it.

When the body or head is hit hard enough, the brain can hit against the front inside part of the skull, be injured there — and then fly back against the rear of the skull (called coup-contracoup — which means head-back0fhead — injury), causing damage to the rear part of the brain as well. Under ideal conditions, the protective fluid provides an ample buffer to shelter the brain, and the inside of the skull is not really sharp and uneven. Unfortunately, there are no guarantees that that’s the case.

Forceful bumps or blows or jolts to the head can be things like:

  • being hit on the head by a ball, such as in soccer or baseball
  • colliding with another player and bumping heads
  • being elbowed or kicked in the head
  • colliding with the catcher and slamming your head against his/hers when you’re trying to steal homebase
  • falling and hitting your head on the basketball court floor

Another way the brain can be injured by a hard hit to the body, is a whiplash effect — where the connections that are located at the base of the skull and neck are twisted and torn by the head snapping forward and backwards really hard. You don’t need to be knocked out, and you don’t even need to have your head hit, to sustain a concussion in sports.

Forceful bumps or blows or jolts to the body can be things like:

  • being tackled hard in football
  • being fouled hard and knocked to the floor in basketball
  • falling during a soccer game
  • colliding with another player when going after the same ball
  • landing hard after any kind of fall, even if your head doesn’t hit the ground
  • running into the wall when you’re eplaying squash/raquetball

It’s important to remember that these very common collision/impact occurrences (which are part and parcel of just about any sport) will NOT necessarily lead to concussion. If everyone who was tackled hard, or fell, or was fouled hard and ended up on the floor/ground sustained a concussion, there would be a whole lot of impaired people walking around.

Being hit or tackled or falling during a game or practice is NOT a guarantee of a concussion. This is where the next criteria comes in… the “and” part.

AND

This AND is important. The first set of criteria — the bump, blow, or jolt to the head or body are no guarantee that a brain injury has occurred, but they can serve as a trigger to watch out for the following. The next point is what acts as an alert that a concussive event has occurred.

  • Any change in the athlete’s behavior, thinking, or physical functioning.

Signs Observed by Coaching Staff

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms Reported by Athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right” or is “feeling down”

Here are some examples from my own experience:

When I sustained a concussion from a hard tackle during a football game in high school, there was an immediate change in my thinking and physical functioning.

  • First of all, I was not thinking as quickly as I was before the hit. Even I could tell I was slower — I wasn’t following the calls by the quarterback very well, and I was clearly a little dimmer than I had been before the hit. I had trouble understanding what was said in the huddles before the following plays, and I had trouble following the instructions I was given. For example (I can’t remember the exact details, but this is how it was), when I was told to go long and then cut left at a certain point, I went long, but I didn’t cut left.
  • Secondly, I was not as coordinated as I had been before the hit. I ran clumsily — like I was drunk — and I couldn’t catch the ball when it was thrown right to me. I also stumbled a lot, and I fell a few more times. For all I know, I did more damage to myself, but I was so totally focused on continuing the game and not letting my teammates down, I refused to take myself out of the game. They had to stop the whole game, completely, to get me to quit playing. I was that stubborn.

When I sustained another concussion from a fall during a soccer game a year or two later  in high school, there was yet another immediate change in my physical functioning and behavior.

  • First of all, I was a lot less coordinated than I had been before I fell. I couldn’t control the ball as well as I had before, and it felt like I was moving in slow motion. I stumbled and fumbled, and there was obviously something different about how I was playing.
  • Second, I was not the same player I’d been before my fall. Before, I had been aggressive and confident on the field. Afterwards, I was hesitant, confused, and I hesitated before shooting on the goal (or just plain failed to shoot). I had a number of opportunities to score, but I didn’t, because I was uncertain and confused. I was also less able to be a team player. I didn’t pass the ball to my open teammates as frequently as I should have. I also became more withdrawn and was not communicating with the coaching staff on the sidelines. It was like I was in my own little concussed world, suspended in a foggy soup that slowed down all the input and output.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

Absolutely, positively. This must be done. Unfortunately, I myself never received any medical evaluation or treatment for my injuries. But on the bright side, I was removed from play in both instances. Nobody watched me afterwards to make sure I was symptom-free and it was OK for me to return to play. Then again, by the time I got to those games, I’d had a number of TBIs already, so I already showed symptoms of impairment. Still, the changes I did experience, on those two separate instances, were clear indicators that I’d undergone a concussive event. I only wish someone had known what to look for, and helped me out.

Another important piece of the CDC info is:

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.

This cannot be overstated. Concussion, hidden as it is inside the skull, can also be hidden by time. It can take hours or days for symptoms to show up, which is why it is so important that not only coaches, but also teachers and parents and teammates are all familiar with the danger signs and informed about how to respond appropriately.

One of the things that can show up later, are behavioral issues. Indeed, behavioral issues are the bugaboo of mild traumatic brain injury, because on the surface everything looks fine, and the brain may have recovered from its initial trauma, but there are microscopic changes under the surface that can have long-lasting effects. If you know someone who plays sports, whose behavior has suddenly started to change for the worst – suddenly they have a lot of anger, rage, irritability, distractability, sensory issues, fatigue, insomnia —  it could be they had a concussion during a game or some other event — and nobody realized it, including them.

Concussion doesn’t just affect the student athletes — it affects everyone who interacts with them, everyone who loves and cares about them. It’s in all our best interests to learn about it, learn what to watch for. And to report it to someone who can help.

As the CDC says, most people recover quickly and fully, and it doesn’t need to wreck their lives. But if you don’t pay attention to the first warning signs, it is all too easy to re-injure yourself (having a concussion increases your chances of experiencing another one from 2-6 times). So, paying attention, right from the get-go can help prevent other problems from happening.

In retrospect, I wonder what might have happened, if I’d stuck with track and field and cross country exclusively, and not played any team sports that involved tackling or the danger of falling/collisions. I wonder if I would have been so susceptible to drugs and alcohol, if my behavior would have been so problematic. Thinking back, I had a ton of problems when I was a kid that actually resolved as a result of organized sports. Unfortunately, the thing that helped me most, also introduced more problems to my mix.

Well, I can’t worry about it. What’s done is done, in my case. I’m just happy I’m as functional and well-off as I am, today.

I also hope that coaches and trainers and teachers and teammates are learning enough, today, to help avoid the kinds of situations I got myself into… and help address the after-effects of the kinds of injuries that I — and hundreds of thousands of others young athletes — experienced. The CDC material is really helpful, and they have lots of free information and additional materials available.

Check ’em out. It’s worth the trip.

Concussions: the silent injury

If I had gotten help for my TBIs sooner…

I have been wondering a lot about how my life might have been different, had I gotten help for my TBIs when they happened.

If I had gotten help when I was 7 and fell down the stairs, and again when I was knocked out by a rock when I was 8… If I had been given strict orders to rest, and then watched carefully and given extra help in school and life to teach me better how to deal with classroom and social situations… not to mention being treated as an injured person, rather than a bad seed… I wonder if my grades would have been better and if my talents would have been better used.

If I had gotten help after my sports concussions in high school… again, being forced to rest, sit out of sports, take it easy, address my balance issues and get help dealing with social and attentional issues… I wonder if I would have slipped so quickly into drugs and alcohol (that numbed the pain), or if I would have been such a contrary rebel who didn’t have a good grasp on the consequences of my choices.

I wonder if my grades might have been better, if my academic career might have been better, if my ability to pursue opportunities might have been better, earlier on in life… which could have made a difference in my career path, my ability to earn, my ability to pay taxes, my ability to hold down jobs for longer than a year or so.  I wonder if I would have become so fond of risky ventures and certain kinds of danger. I wonder if I would have chosen the friends and associates I chose over the year — many of whom were bad choices, and I never realized it. Till too late. I wonder if I might have sustained some of my friendships with people over the years who meant so much to me, but whom I hurt terribly because my brain was broken and I had no clue.

I wonder if I might have been able to really contribute something of value to the world — a great book or a great discovery or a great body of research… Or just steadier, more reliable participation in my society and culture. I wonder if I might have achieved a level of participation that, given my personal commitment to make the world a better place whenever and however I can — might have helped people more than I have, thus far.

I usually get upset at tax time, when I look at how much (or little) I’ve earned and paid out, and I think about how much better I might have done for myself, had I not been so injured so often over the course of my life… so impaired… so under-achieving… so clueless about what was wrong with me. Now, I don’t want to feel sorry for myself and I don’t want to punish myself for things I had no control over. My injuries started when I was a kid, and they pretty much changed the course of my life without my understanding how or why. I know with all my heart that I have been tremendously blessed in so many, many ways. But I always feel a sense of inadequacy around this time of year. I just don’t feel like I’ve done enough with myself. I haven’t made the most of my potentials. What a waste.

On the bright side, a Washington State concussion bill would help protect young athletes, which is truly awesome! My injuries are part of my past, part of my present, and very much a part of my future. I never got adequate help after my concussions, when I was a young athlete. My chance at full recovery immediately after hard tackles, falls, and various accidents may have passed me by, but for lots of young kids, that doesn’t necessarily need to be the case.

And that gives me hope for our future.

A Tale of Two Concussions – What went wrong, what went right

It’s Brain Injury Awareness Month, and this year there is special focus on sports injuries, especially concussions, among young/student athletes.

This is such an important topic… and it’s had such a vital part to play in my own life. I think it’s safe to say I would not be the person I am today who experienced the difficulties I’ve had, if I hadn’t had two concussions in high school. It’s my hope that teachers and coaches and other folks who are concerned about the health and safety of kids in school-sponsored sports will read this and become a little more sensitive to the issues and hazards that can accompany sports-related head injury.

My first school-sports-related concussion came in my freshman or sophomore year. I was playing flag football at the high school, under the supervision of a regular football coach who agreed to take on intramural players on Saturdays. We were having a great time — I remember the day was bright and crisp, one of those amazing Saturday afternoons in the fall, when summer is well over and everyone is all too keenly aware that winter is just around the corner.

We had a great time playing football… such a great time, in fact, that we all started really feeling our oats, and someone said they didn’t want to use the flags anymore. They wanted to play tackle football. Like everyone else, I agreed – I was totally into it. I was feeling strong and vital and full of bravado, and I wanted to take my play beyond just dodging and diving for flags.

I wanted to tackle. I wanted to hit — and be hit. And I wanted to play free of pads and guards. I wanted to get back to basics and play football the way God intended — down and dirty and full-contact. Amen.

Well, we had a grand time. I dodged some close calls and fell flat on my face a bunch of times, trying to take other kids down. Then, in a carrying play, when I had the ball tucked under my arm and was making a break into the open midfield, I got sideswiped by another player who was bigger and stronger and a lot more solid than me.

I felt the hit land hard against my side and shoulder, and I tried to spin away from it and keep running downfield, but my feet suddenly buckled underneath me, and I went down. I don’t recall whether or not I hung onto the ball. I suspect it popped out of my arms and bounced away, but it doesn’t really matter. When I stumbled and crumpled to the ground, it was like everything ground to a slow-motion halt, and I found myself looking at grass.

The coach who was keeping an eye on us came over to me and checked me out. They asked me if I was okay and if I could walk. I said, yes, but I had a hard time picking myself up off the ground. They asked again if I was okay, and I insisted I was. I was feeling really woozy and out of it. Rattled and echo-y. Like my bell got rung and there was a long, lingering ring to it. I was embarrassed that I’d gone down so easily, and I wanted to get back to the game and redeem myself. And for a while I did. But I played badly. I was off-balance and slow and foggy — a noticeably different player than I’d been prior to the tackle.

The coach kept asking me if I was okay, and I kept saying yes, but the longer we played, the more out of it I got, and they finally called the game before we could finish it. I was so disappointed! Disappointed in myself for having been such a wuss who couldn’t take a hit. Disappointed with the coach for thinking so little of me. Disappointed in the game that I hadn’t had the chance to really shine the way I wanted to.

I’m glad the coach called the game. In retrospect, they probably should have forced me to sit out sooner. But I was so adamant about keeping on playing, there was no telling me “no” unless the game was over.

And it was.

The other concussion I had was in an intramural soccer match. It was senior year, and there weren’t going to be that many more opportunities for me to just play. College was just around the corner, and I was keenly aware that my “childhood”, such that it was, was about to disappear on me. My days of careless abandon couldn’t last, and all through my last year of high school, I devoted every spare moment to savoring the taste of youthful abandon.

That included sports. I had a strong feeling that once I was out on my own, I wouldn’t have any more time to play sports, so I wanted to really go for all the gusto I could get, however I could get it.

Well, I went for it in that soccer match. And I think I played pretty well. But at one point in the match, I was either tackled, or I tripped, and the next thing I remember, I was on my back, looking up at the sky. I was kind of out of it… not quite right… and I lay there for a little while. At first, I wasn’t sure I could move, but then I did a sort of body scan, and I could feel my whole body, so that was good. I didn’t quite feel like I could get up, though, so I lay there for a little while longer, eyes closed, collecting myself. I didn’t want to be injured. I didn’t want to be hurt. I wanted to finish the game and have a good time.

I’m not sure how long I lay there, but before too long, some of the teachers came running over to me to see if I was okay. By that time, I had collected myself and was sure I could stand and walk and play, so I bounded up and reassured everyone that I was fine. They wanted me to sit out for a little while, but I refused. I wanted to play on. If I recall correctly, one of the teachers whom I really respected managed to convince me to sit out the game and let others play in my stead.

Even though I was antsy to get back in the game, I realized that I was kind of wobbly on my feet, and I needed to take a break, so I agreed to sit out for a while. It had sunk in that my bell had gotten rung, and I wasn’t much use to my team, anyway. Plus, the weird feeling in my head made me a little nervous, so I was a little relieved to have been taken out. After a while, I was allowed back in the game, but like with the football injury, I was slower, less coordinated and not as adept at handling the ball. I really struggled, which was embarrassing.

Those two head injuries — both of them knocking me silly and altering my consciousness in the process — came at different times and under slightly different conditions. In retrospect, I wish that the coaches and teachers in charge had been more adamant about me not getting back in the game right away — or at all. But in the first case with the football game, I was so eager — hungry — to play, that wild horses couldn’t have kept me from it. I think I may have had some recollection about that football experience, when I was dealing with the soccer experience. I was much more compliant — though grudgingly — with the folks in charge. I think also the nature of the games made a difference — in the football game, it was all about drive, all about pushing onward, where in the soccer match, it was much more of a thinking-game than brute force. I suspect that made a difference in my own thinking process.

One thing that made it easier for me to sit out part of the game, after my soccer injury, was the fact that I had other team members who wanted to play. If I played the whole game, my classmates wouldn’t have gotten the chance. In the football game, there weren’t that many of us playing, and if I was out, the game came to an end — which is what happened — and I didn’t want the game called on my account. I do recall making peace with the idea of sitting out of the soccer match by agreeing to cheer my teammates from the sidelines. My teachers specifically asked me to do that, I recall, so that gave me something to do while I was recuperating from my fall.

I suspect that folks who continue to play after concussions are often such loyal and dedicated team players, that they don’t want to let their team down. Or they feel some pressure of some kind — whether from their coach or their teammates or themselves — to stay in the game. Don’t let the team down. Be a part of the group effort. Those kids often have such a spark, such a dedication, such a devotion to their team that’s really refreshing, in our me-first, winner-takes-all, I’ll-get-mine society. But that dedication can work against us in the long run, if we’re not protected by folks who know better than us — in the school sports case, coaches and trainers and teachers who supervise student athletes.

I was fortunate to have been supervised by teachers and coaches who cared very much about my well-being and safety, and who managed to prevail on me to get the hell out of a dangerous situation. I was also fortunate to have the kinds of coaches and teachers I truly respected, so when it came time for them to outrank me, I could listen to them, hear them, and follow their instructions, even though I didn’t want to.

When it comes to protecting kids from the after-effects of sports-related head injury/concussion, there’s nothing like mutual caring and respect, when it comes to making and enforcing the right decisions. And there’s nothing like keen awareness of the dangers of unmanaged concussion, to hasten the decision-making and enforcing process.

So teachers and coaches, please learn all you can about head injury and concussion. And for the sake of your students and student athletes, don’t let them play injured. I don’t care what they say or how hard they beg or how far behind you are in the game. One short-term win for the team means nothing, if it costs a player the long-term loss of their cognitive, behavioral, and physical well-being… not to mention their future.