Travis Frederick Out until further notice

[Gannon12]

Wow! That is horrible! It’s going to be extremely hard to replace his talent. I hope he can overcome it.

[sammymvpknight]

4 minutes ago, Broncofan said:

 

The other part that argues against AIDP is the acute presentation, it really does fit more with GBS.

Those reports about paralysis and life being changed are usually because the extent of the disease causes loss of strength that people aren't fit enough to recover from - spending weeks in ICU on ventilators, you lose a TON of muscle mass.   If you are in your 20's/30's, it's a tall order to get it all back.  It's a bigger problem as you get older.   But this is not what Frederick is suffering from, if he's still mobile, and getting treatment this early carries an excellent prognosis for recovery.  

And to be clear, GBS is a different disease than spinal cord trauma - here, the sheath of the nerve is damaged (called demyelination).   In this type of injury, the nerve often does recover in re-building the sheath (remyelination).  But first the damage has to be stopped.   And then the nerve itself needs time to remyelinate.  It's estimated the nerve remyelination takes place at very slow rates (some quote 1mm/day).  So how injured the nerve is determines the length of recovery.  And then once the nerve is healed, the patient has to then rebuild the muscle strength lost.  So how injured he is now with treatment, is the key to how long it takes to recover.   When the nerve is extensively damaged to the core (often called the "axonal" variant), that's when people are ventilator-dependent in the ICU (on life support) for weeks, and in hospital/rehab for months, and like some of the stories read, take up to a year or longer to get back to normal life - but not necessarily athletic capacity.  But that's not at all what's being described by Frederick, and the fact he's young, athletic, and was practicing recently, all suggest strongly this is the milder variant caught early.   Which would be great news, and far from the doom/gloom stories people read about.  The chances and expectations for a fully normal life and even elite athletic career are actually very reasonable with mild disease treated early.

Obviously we don't have all the info, but the fact Frederick has received IVIG x 2 (the other treatment is plasma exchange, but that's way more invasive line-wise, and it subjects him to long-term transufusion risks, which while small, aren't present with IVIG, so no doubt he's gone that route).  The normal protocol means he'll get 5 treatments total, and if he's recovered, then needs to wait until he's cleared to resume exercise.  He's said he's lost strength - so he's going to be out a bunch of games.  But the prospects of resuming a fully normal life, and a normal career arc, are excellent if this is GBS at the severity he's described.   

This should not be a death sentence to his career if it's as mild as he's described.   However, if he's lost a fair amount of strength, keep in mind he has to get treated, the nerves have to heal, he gets discharged from medical care, and then cleared to exercise - and THEN has to rebuild strength.   So this isn't going to be a 2-3 week recovery if he's lost strength.   It could be he only misses a few games - but if he's really lost strength, he needs to get treated to stop the inflammatory phase.  Then the recovery phase begins.  So he could miss a bunch of games, could miss the season - depends on how much he's lost, and how long it takes to get him to where he can rebuild strength.  But the hope he can resume a normal life, and a normal career arc, given what he's described, are excellent.   The normal life is obviously most important - all we can really do is see his recovery arc to forecast, so that's going to take time.   In the meantime, just wish him well, and hope he avoids any rare but more devastating complications while getting treatment (like blood clots, etc).   Wishing him a speedy recovery, with a lot of hope from what we know.

AIDP is Guillan-Barre. Did you mean CIDP? Even CIDP patients start as AIDP patients  

[Broncofan]

6 minutes ago, sammymvpknight said:

AIDP is Guillan-Barre. Did you mean CIDP? Even CIDP patients start as AIDP patients  

 

6 minutes ago, sammymvpknight said:

AIDP is Guillan-Barre. Did you mean CIDP? Even CIDP patients start as AIDP patients  

Sorry, my bad, yes CIDP lol, autocorrect.  The incidence of CIDP is so incredibly low in comparison to GBS in his age group and otherwise lack of prior health issues, while it's always a fear, the odds really are against that.   With CIDP, it's usually a much more insiduous, hard-to-define onset - Frederick's illness and ability to practice normally until very recently are much more compatible with GBS.   Still, it's fair to say you can't be 100 percent sure until you see him recover, but the odds are incredibly stacked in his favor here.

[sammymvpknight]

2 minutes ago, Broncofan said:

 

Sorry, my bad, yes CIDP lol, autocorrect.  The incidence of CIDP is so incredibly low in comparison to GBS in his age group, while it's always a fear, the odds really are against that.   

Agreed. Just saying...most CIDP patients were originally diagnosed with AIDP. But yes, long term the odds are that Frederick will be ok. But this year is very much in question. But assuming they’ve got the right diagnosis, this shouldn’t be a Shazier type situation 

[Broncofan]

6 minutes ago, sammymvpknight said:

Agreed. Just saying...most CIDP patients were originally diagnosed with AIDP. But yes, long term the odds are that Frederick will be ok. But this year is very much in question. But assuming they’ve got the right diagnosis, this shouldn’t be a Shazier type situation 

Yeah, the ominous part to 2018's outlook is him saying he's lost strength.  That means Frederick's got to get treatment, stop the nerve injury (very likely with GBS & IVIG at this severity, but how long does it take?), and then after that - get cleared to exercise, and only then can he rebuild the lost muscle strength.  I only deal with cases when it's awful - so I can't predict that on experience, but to be a little weaker than normal and to get back to NFL-level strength, it's going to take a while.   The season is very much a possibility to miss.  Best-case is a pure guess because the loss of strength isn't quantified, but this isn't a few-weeks scenario at all.  On the flip side, career-threatening talk is very premature, given the odds.   Especially when they are that young, I've been impressed at the ability to return to normal life in severe cases - so mild cases, I'd be nothing but very optimistic on career-arc resuming unchanged in 2019, barring a rare wrong diagnosis or a really unfortunate complication while receiving therapy (rare, but always possible too).  Still, all we can really do is wait, and see his recovery trajectory to getting cleared, and that's going to be inform us a lot more (given we won't get the actual info).

[sammymvpknight]

53 minutes ago, Broncofan said:

Yeah, the ominous part to 2018's outlook is him saying he's lost strength.  That means Frederick's got to get treatment, stop the nerve injury (very likely with GBS & IVIG at this severity, but how long does it take?), and then after that - get cleared to exercise, and only then can he rebuild the lost muscle strength.  I only deal with when it's awful - but to be at NFL-level strength, it's going to take a while.   The season is very much a possibility to miss.  Best-case is a pure guess because the loss of strength isn't quantified, but this isn't a few-weeks scenario.   

I haven’t had a professional athlete with AIDP, but the timeline to recover typically isn’t quick...even with IVIG. IVIG slows the autoimmune response but it doesn’t regrow myelin. If he’s lost strength there will be some level of Wallerian degeneration and that will probably take months of recovery. If it was just foot weakness it’d be one thing, but I’m guessing he had more proximal weakness than that to seek medical attention. Neuromuscular submax rehab is a painful time consuming process. Doing leg presses all day will likely only make this worse. 

[Broncofan]

10 minutes ago, sammymvpknight said:

I haven’t had a professional athlete with AIDP, but the timeline to recover typically isn’t quick...even with IVIG. IVIG slows the autoimmune response but it doesn’t regrow myelin. If he’s lost strength there will be some level of Wallerian regeneration and that will probably take months of recovery. If it was just foot weakness it’d be one thing, but I’m guessing he had more proximal weakness than that to seek medical attention. Neuromuscular submax rehab is a painful time consuming process. Doing leg presses all day will likely only make this worse. 

Yeah, most neurologists quote me the 1mm/day of regeneration.  Which obviously is a problem if it's proximal muscle involvement - and as you said, most patients don't usually seek attention and most MD's don't think AIDP/GBS until they hear a history of trouble standing up/etc. (or physical exam shows diminished/absent reflexes).   On the other hand, if Frederick went from practicing to that type of weakness, it would really scream GBS - but the missing part is how much involvement he's dealing with now.   The only real rough approximation of real info will be how long it takes for him to be discharged - realizing he'll still have rehab (which is where my experience stops).

[sammymvpknight]

Just now, Broncofan said:

Yeah, most neurologists quote me the 1mm/day of regeneration.  Which obviously is a problem if it's proximal muscle involvement - and as you said, most patients don't usually seek attention and most MD's don't think AIDP/GBS until they hear a history of trouble standing up/etc. (or the nerve exam shows diminished/absent reflexes).   On the other hand, if Frederick went from practicing to that type of weakness, it would really scream GBS - but the missing part is how much involvement he's dealing with now.   The only real rough approximation of real info will be how long it takes for him to be discharged - realizing he'll still have rehab (which is where my experience stops).

He also noted that he’s been dealing with this for a few weeks and is just now undergoing treatment. That’s a bit of a red flag in regards to a rapid recovery. Perhaps the presentation wasn’t as acute as initially thought. The only benefit is that they may be able to get an EMG for a pretty definitive diagnosis...because it typically takes a few weeks to get much from that study.

 

 

[Chargers]

Damn the Cowboys have worst luck. I hope he can make a full recovery, some are saying this is career ender.

[Krauser]

Frederick’s symptoms were initially pain in the arm and shoulder (I gather just on one side), then weakness. The initial concern was a pinched nerve in the neck, and he’s seen several spine surgeons in the last couple of weeks, and had MRIs.

He last played in the preseason game against SF on Aug 9th, basically 2 weeks ago. Around 8 days ago, he was being investigated for a possible spinal problem and was cleared to return to practice, though I gather he never did. Frederick’s note says he’s been checked out for a few weeks, which suggests he might have been having some symptoms even before the Niners game. 

Here’s a discussion I found of a couple of Cowboys fans discussing the situation before the GBS diagnosis was made: https://www.bloggingtheboys.com/2018/8/21/17763270/why-travis-fredericks-back-injury-could-be-more-than-just-a-stinger

GBS often does produce nerve root type (“radicular”) pain, because the inflammation can attack the nerve roots. It doesn’t typically start in the arms, let alone in one arm, but it can do that. It doesn’t sound from the context that Frederick had significant weakness or numbness in the legs, or else the GBS diagnosis likely would have been suspected sooner.

The more detailed medical information in this thread about axonal damage to the nerves, Wallerian degeneration (no such thing as Wallerian regeneration) and the rate of nerve regrowth won’t necessarily apply in Frederick’s case. Mild cases of GBS can involve pure demyelination (the immune system strips off the coating around the nerves, which affects the nerves’ function even though the nerves themselves are still healthy) with little or no axonal damage (actual damage to the nerve itself).

Demyelination can repair itself fairly quickly, even within days to a few weeks, as long as there is no underlying axon damage (to the nerve itself). 1 mm per day is often quoted for axonal regrowth, but that’s not the same thing as remyelination (myelin repair). GBS doesn’t necessarily damage the entire length of the nerve anyway — any given nerve that loses myelin at one or a few spots stops working (or at least drops off in function significantly) enough to cause symptoms, even while the rest of the nerve would otherwise work fine. 

So if it’s true that Frederick’s had fairly limited neurological deficits, mainly in one arm, he may be able to recover fairly quickly with treatment. I wouldn’t expect him to necessarily follow the course of a more full blown case of GBS, or be at risk for deep vein clots and other complications (from what’s been reported, I gather he’s still walking, not bedbound).

I would be surprised if he isn’t out for at least a few weeks, but the recovery timeline beyond that depends a lot on how bad the disease is in this particular case, and aside from imagining what might be the case based on the media reports, it’s hard to know what lies ahead of him. In general, GBS is a better diagnosis to have than most neurological diseases that can cause weakness in young people (MS, ALS, spinal cord injury, stroke, etc) — it’s treatable, usually not part of a bigger or lifelong problem, and most people recover very well, at least over the long term. 

[Danger]

4 hours ago, Calvert28 said:

Thank God, with all the lack of injuries and arrests since the offseason started I was getting worried our luck might have changed.

Luck? You mean being one of the healthiest teams in the NFL last year? It's unfortunate for Frederick, who knows how long this will keep him out, but lets not act like there's a black cloud over player availability in Dallas. 

[sammymvpknight]

2 minutes ago, Krauser said:

Frederick’s symptoms were initially pain in the arm and shoulder (I gather just on one side), then weakness. The initial concern was a pinched nerve in the neck, and he’s seen several spine surgeons in the last couple of weeks, and had MRIs.

He last played in the preseason game against SF on Aug 9th, basically 2 weeks ago. Around 8 days ago, he was being investigated for a possible spinal problem and was cleared to return to practice, though I gather he never did. Frederick’s note says he’s been checked out for a few weeks, which suggests he might have been having some symptoms even before the Niners game. 

Here’s a discussion I found of a couple of Cowboys fans discussing the situation before the GBS diagnosis was made: https://www.bloggingtheboys.com/2018/8/21/17763270/why-travis-fredericks-back-injury-could-be-more-than-just-a-stinger

GBS often does produce nerve root type (“radicular”) pain, because the inflammation can attack the nerve roots. It doesn’t typically start in the arms, let alone in one arm, but it can do that. It doesn’t sound from the context that Frederick had significant weakness or numbness in the legs, or else the GBS diagnosis likely would have been suspected sooner.

The more detailed medical information in this thread about axonal damage to the nerves, Wallerian degeneration (no such thing as Walleran regeneration) and the rate of nerve regrowth won’t necessarily apply in Frederick’s case. Mild cases of GBS can involve pure demyelination (the immune system strips off the coating around the nerves, which affects the nerves’ function even though the nerves themselves are still healthy) with little or no axonal damage (actual damage to the nerve itself).

Demyelination can repair itself fairly quickly, even within days to a few weeks, as long as there is no underlying axon damage (to the nerve itself). 1 mm per day is often quoted for axonal regrowth, but that’s not the same thing as remyelination (myelin repair). GBS doesn’t necessarily damage the entire length of the nerve anyway — any given nerve that loses myelin at one or a few spots stops working (or at least drops off in function significantly) enough to cause symptoms, even while the rest of the nerve would otherwise work fine. 

So if it’s true that Frederick’s had fairly limited neurological deficits, mainly in one arm, he may be able to recover fairly quickly with treatment. I wouldn’t expect him to necessarily follow the course of a more full blown case of GBS, or be at risk for deep vein clots and other complications (from what’s been reported, I gather he’s still walking, not bedbound).

I would be surprised if he isn’t out for at least a few weeks, but the recovery timeline beyond that depends a lot on how bad the disease is in this particular case, and aside from imagining what might be the case based on the media reports, it’s hard to know what lies ahead of him. In general, GBS is a better diagnosis to have than most neurological diseases that can cause weakness in young people (MS, ALS, spinal cord injury, stroke, etc) — it’s treatable, usually not part of a bigger or lifelong problem, and most people recover very well, at least over the long term. 

Wallerian regeneration was an autocorrect...I changed it. Indeed his presentation is atypical. There really is no telling the timeline of his return. Being so atypical it makes me wonder if he’s going to need ongoing evaluation for this. 

[Broncofan]

12 minutes ago, Krauser said:

Frederick’s symptoms were initially pain in the arm and shoulder (I gather just on one side), then weakness. The initial concern was a pinched nerve in the neck, and he’s seen several spine surgeons in the last couple of weeks, and had MRIs.

He last played in the preseason game against SF on Aug 9th, basically 2 weeks ago. Around 8 days ago, he was being investigated for a possible spinal problem and was cleared to return to practice, though I gather he never did. Frederick’s note says he’s been checked out for a few weeks, which suggests he might have been having some symptoms even before the Niners game. 

Here’s a discussion I found of a couple of Cowboys fans discussing the situation before the GBS diagnosis was made: https://www.bloggingtheboys.com/2018/8/21/17763270/why-travis-fredericks-back-injury-could-be-more-than-just-a-stinger

GBS often does produce nerve root type (“radicular”) pain, because the inflammation can attack the nerve roots. It doesn’t typically start in the arms, let alone in one arm, but it can do that. It doesn’t sound from the context that Frederick had significant weakness or numbness in the legs, or else the GBS diagnosis likely would have been suspected sooner.

The more detailed medical information in this thread about axonal damage to the nerves, Wallerian degeneration (no such thing as Wallerian regeneration) and the rate of nerve regrowth won’t necessarily apply in Frederick’s case. Mild cases of GBS can involve pure demyelination (the immune system strips off the coating around the nerves, which affects the nerves’ function even though the nerves themselves are still healthy) with little or no axonal damage (actual damage to the nerve itself).

Demyelination can repair itself fairly quickly, even within days to a few weeks, as long as there is no underlying axon damage (to the nerve itself). 1 mm per day is often quoted for axonal regrowth, but that’s not the same thing as remyelination (myelin repair). GBS doesn’t necessarily damage the entire length of the nerve anyway — any given nerve that loses myelin at one or a few spots stops working (or at least drops off in function significantly) enough to cause symptoms, even while the rest of the nerve would otherwise work fine. 

So if it’s true that Frederick’s had fairly limited neurological deficits, mainly in one arm, he may be able to recover fairly quickly with treatment. I wouldn’t expect him to necessarily follow the course of a more full blown case of GBS, or be at risk for deep vein clots and other complications (from what’s been reported, I gather he’s still walking, not bedbound).

I would be surprised if he isn’t out for at least a few weeks, but the recovery timeline beyond that depends a lot on how bad the disease is in this particular case, and aside from imagining what might be the case based on the media reports, it’s hard to know what lies ahead of him. In general, GBS is a better diagnosis to have than most neurological diseases that can cause weakness in young people (MS, ALS, spinal cord injury, stroke, etc) — it’s treatable, usually not part of a bigger or lifelong problem, and most people recover very well, at least over the long term. 

Agreed on all counts there.   Again, I only end up involved in the severe cases - and even then, I am amazed at the recovery seen with young patients, albeit, over long periods of time (but again, with more severe disease in my experience).  If it's the mild form, and it's not proximal, then 2018 isn't necessarily lost.  And yeah, the risk of major complications almost disappears if he's still mobile.   But as you & @sammymvpknight have alluded to, we are speculating on the severity of his current weakness.  That would tell us a LOT more on the timeline, given the likelihood of response to therapy.   

[JaguarCrazy2832]

Best wishes Travis. This seems kind of serious. I hope he can make it back at some point in his career

[Xmad]

Hopefully it's not a long term issue/he can recover from it. At least they caught it early enough and it's not a spinal defect or something worse.