Thursday, August 23, 2018

What's next for Cowboys All-Pro center Travis Frederick after autoimmune disease diagnosis?



Cowboys All-Pro center Travis Frederick revealed Wednesday that he has been diagnosed with Guillain-Barré syndrome, a rare autoimmune disorder that causes the body's immune system to attack its nerves.

While the condition doesn't appear to threaten Frederick's long-term career in the NFL, it has a dramatic impact on this season. There is no timetable for the Pro Bowl center's return, but once he does return, his strength and conditioning are likely to be compromised.

This puts the Cowboys in the position of anticipating Frederick's return yet not knowing when it will take place and how effective he'll be once he's back on the field. The club must now determine if backup Joe Looney can step in as the full-time starter or if it needs to go outside the organization for a replacement.

The uncertainty affects how the roster is constructed, but club officials stress that all of that takes a back seat to the player's health. A person who spoke to Frederick on Wednesday characterized him as positive while realistic about what lies ahead.

"In the last 48 hours, I have received two treatments that address my condition, and I am feeling much better from an overall strength perspective," Frederick said in a statement. "I will continue these treatments over the next few days. I am very optimistic about my condition and the immediate future, as I have been told that the illness was detected at a fairly early stage."

Frederick added that his doctors had said it wasn't possible to say when he would be able to return to the field. According to the Mayo Clinic, there's no known cure for Guillain-Barré (pronounced gee-YAH buh-RAY), but several treatments can ease symptoms and reduce the duration of the illness.

"I am deeply grateful for all of the people who have expressed concern for me throughout the past four weeks," Frederick said, "and my teammates and the Cowboys organization have provided me and my family with tremendous support."


Recovery takes time



Dr. Spencer Miller, a neurologist at Baylor University Medical Center in Dallas, often treats patients with Guillain-Barré syndrome, or GBS. Frederick isn't one of Miller's patients.

Miller said Frederick may not have seen the worst symptoms yet. He said patients typically don't reach peak disability until seven to 14 days after the onset of the symptoms.

Miller said patients typically undergo a "prolonged recovery" of "at least a couple of weeks and then months of rehab and rest." He said a general rule of thumb is that one-third of patients show signs of recovery within two weeks, the next third take four weeks and the final third can take up to three months.

Miller said GBS shouldn't threaten Frederick's career in the NFL. He said only 2 of every 100,000 people with GBS have a recurrence.

"Once the nerves are healed, they are fully healed," he said.

"If my patient's job was football, I'd be very hesitant to let him go back to football within a month or two. I'd be very surprised if someone could."




Spencer said the concern isn't the contact so much as "the intensity of the workout."

"It would slow down his recovery if he was hastened back into the game," Miller said. "It could slow down his recovery or hasten reoccurrence if he overdrives his body early in the recovery period."

Miller said that, on average, 80 percent of patients with an early diagnosis and early treatment -- Frederick checks both boxes -- recover fully. He said Frederick's recovery should also be helped by his youth and athletic conditioning.

There are two treatments commonly used for acute GBS. Both are considered equally effective, Miller said, if started within two weeks of onset of GBS. One is plasma exchange and the other is intravenous immunoglobulin therapy (IVIg).

IVIg is easier to administer because it's given to patients through a vein in their arm via an IV.
Miller said a patient would receive five treatments in one form. He said the plasma exchange route would require a treatment every other day for 10 days. He said a patient undergoing IVIg would receive one treatment for five consecutive days.

Frederick said in his statement he had already received two treatments "in the last 48 hours" and he would "continue these treatments over the next few days." Considering that timetable, Miller said, it's likely that Frederick's treatment plan is IVIg.