Medical evaluations at the 2013 NFL Scouting Combine took a slightly different turn when doctors discovered Southeastern Louisiana University cornerback Robert Alford suffers from Crohn's Disease (h/t Russell Lande, National Football Post).
Unlike many injuries, Alford's ailment does not necessarily produce any readily visible signs or symptoms. In other words, it's not like a hamstring strain that affects speed or a separated shoulder that affects throwing mechanics. Rather, Alford's disease is silent—sometimes.
In a way, that's the problem.
The nature of Crohn's disease makes it extremely difficult to predict how it will affect Alford's football future. On the one hand, he could very well never feel its effects for the entirety of his career. On the other, particularly bad cases of Crohn's disease can prove debilitating and severely affect quality of life. Where Alford will fall on the disease spectrum remains to be seen.
Part of the uncertainty surrounding Alford stems from the fact that the precise cause of Crohn's disease remains unclear. However, much is known about its effects and possible treatments.
As it is an autoimmune condition, the manifestations of Crohn's disease occur due to the body's immune system attacking itself. The attack primarily occurs within the digestive tract and causes sections of the walls of the small or large intestines to become inflamed. Sometimes, severe inflammation can produce wall erosions or perforations.
When Crohn's first sets in, the most common way the disease announces itself is by producing a bout of abdominal pain that can range from minor to downright paralyzing. Weight loss, food intolerance and other intestinal symptoms can precede or follow the pain.
It is unclear how Alford's disease presented. Perhaps abdominal pain set in before or at the Combine, prompting investigations such as blood tests or an endoscopy—where doctors use a camera to look at the lining of the bowel. Perhaps he had no symptoms at the time but already carried the diagnosis—a diagnosis made public by the Combine media.
Regardless of how it presents or is discovered, the core of Crohn's disease treatment aims to control symptoms—there is no cure.
The disease tends to occur in cycles. First, an episode of pain and other symptoms arises, prompting medical evaluation. Pain control and the administration of medications aimed at reducing inflammation—including corticosteroids, drugs similar to aspirin and direct immune system suppressants—generally follow.
Once a disease flare resolves, diet change, maintenance medications and other treatments are usually employed in an effort to keep the disease in remission. Vitamin and nutrient replacement may also be required if the disease results in a decreased ability of the intestines to absorb food.
However, those treatments are only so effective, and repeat disease flares occur in many cases. Additionally, sections of inflamed intestinal wall can become infected or blocked. Such complications often make surgical intervention necessary—up to and including the removal of sections of bowel.
In some cases, maintenance medications that modify the immune system actually lead to higher rates of infection.
For still-unknown reasons, the frequency, timing and nature of disease flares are extremely difficult to predict, and there are many types of Crohn's disease. That said, with proper treatment, Crohn's can enter periods of remission that can last for decades. Alas, the possibility of severe and recurrent disease also exists.
Fortunately, the information available suggests Alford's disease is, for now, on the less-severe side. According to Southeastern Louisiana University's official athletics website, Alford played in 10, 11 and 11 games in the 2009, 2011 and 2012 seasons, respectively. He missed the 2010 season due to a shoulder injury unrelated to his disease (h/t official NFL.com draft profiles).
In other words, nothing yet hints that Alford's disease has limited him on the football field.
Hopefully that remains the case, as Alford carries with him the potential to be an effective NFL defensive back. His official profile lists him as standing at 5'10'' and 188 pounds with a blazing 40-yard dash time of 4.39 seconds. He also touts an impressive 40-inch vertical leap for good measure.
When will Alford be selected during April's NFL draft? Matt Miller—Bleacher Report's NFL draft lead writer—weighed in on Alford's diagnosis and its likely effects, or lack thereof, on his draft stock:
Alford has mid-second round potential due to his size, speed and potential in coverage and on special teams. I haven't moved his stock down since learning of his Crohn's disease, but there are definitely NFL teams who may.
As with all players carrying medical concerns, teams will weigh Alford's diagnosis against immediate need at the defensive back position. Additionally, each team's medical staff must come to its own conclusion.
Said another way, it all comes down to risk versus reward—just like all Sports Medicine decisions. If a team decides Alford's upside outweighs whatever risk level its medical staff determines he carries, his stock may not fall at all. On the other hand, the opposite scenario is also possible.
So what's the bottom line?
Simply, Alford possesses the skill set to be a productive NFL player at his position, and at this point, there is no evidence to indicate his disease currently poses a serious threat to his career.
Unfortunately, his situation still cannot be taken lightly. According to USA Today's Robert Klemko, former New England Patriots tackle Matt Light nearly died from complications surrounding the surgical resection of a portion of his gut—an operation made necessary by a particularly nasty disease flare:
"I basically got to the point, over the three to four years of being diagnosed with Crohn's, that I couldn't handle the pain anymore," Light said. "The pain became so difficult that in the offseason it just paralyzed me. I'd hit the ground. You can't wake up. You can't sit down. You can't do anything without this becoming a problem."
Doctors removed 13 inches of Light's intestines in summer 2004, but complications from the surgery had him fighting for his life. He couldn't eat for a month and went from 315 pounds to 260.
Nevertheless, current New York Jets quarterback David Garrard continues to play despite being diagnosed with the disease in 2004. According to the official website of the David Garrard Foundation, he underwent a surgery similar to Light's later that year.
In short, precedent exists of players who suffer from Crohn's disease leading productive NFL careers. Alford wants to add to that legacy.
When his disease is under control, Alford will not be limited in the slightest. However, if it progresses quickly, his career could get complicated.
In the end, nothing is more important than Alford's well-being. Football fans and teams can only hope that he remains healthy for as long as possible, and his home and family lives trump all.
Yet when push comes to shove, NFL teams must make a decision. That decision that will be based on one thing and one thing only: risk versus reward.
Dave is a medical writer for Bleacher Report. In June, he will join the University of Washington as a Family Medicine resident physician. Medical information discussed above is based on his own knowledge, and quotes were obtained firsthand unless otherwise noted.