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Ron Rivera knows he’s ‘going to struggle,’ and he needs his players to step up

The players’ pace and urgency in the final minutes of practice failed to meet Rivera’s standard — the team’s new standard — and that alone irked the 58-year-old coach. “Imagine going into the fourth quarter, reaching the three-hour mark, and we’re walking,” he told reporters after practice.

So when the workout ended and his players gathered around, Rivera was brash and blunt in an expletive-laced speech.

“I said it wasn’t good enough, in all honesty,” he told reporters after practice. “… We have to take ownership of ourselves, and that really was my message.”

In an offseason full of significant moments, franchise-altering events and historic change, Saturday’s speech — one of the more common sights in football under normal circumstances — may be remembered as one of the most important yet for Washington. Less than two days earlier, Rivera had informed his players that he has squamous cell carcinoma, a treatable cancer, and he encouraged them to be mindful of their attitude and their approach to life — just as he plans to do with his health.

“I’ve got to continue to be the person that I am and be disciplined about it, go about my business, do things that I need to do, take care of those things,” he said. “But more importantly, and one of the doctors said it very eloquently, is that: ‘At some point, Coach, you’re going to have to be selfish. Take care of you.’ ”

In a statement, the team said Rivera’s cancer is in its early stages and his prognosis is good. He plans to continue working while undergoing treatment, but should he need to step away, defensive coordinator Jack Del Rio will fill in as the interim coach. Del Rio did that once before, in Denver in 2013 when the Broncos’ John Fox had heart surgery.

Over the past eight months, since he was hired to fix the team’s culture and performance, Rivera has been thrust to the forefront as the voice of the franchise. He viewed the job as a challenge of sorts, but no challenge has been as personal as this one.

His desire to maintain “business as usual” while undergoing treatment — which he has said will be five days a week for seven weeks and include proton therapy — was encouraged by his doctors, because the distraction can be mentally beneficial. But the physical toll could be significant, and it could be enough to sideline a man described by many across the league as tough and resilient.

“I’m realistic about this,” Rivera said. “I’m trying to be realistic about the approach.”

According to Neil Gross, the director of clinical research in the department of head and neck surgery at MD Anderson Cancer Center, squamous cell carcinoma in a lymph node is an indicator that Rivera’s cancer originated elsewhere, such as inside the mouth or the tonsils. Some patients have surgery to remove the cancerous tissue, while others are treated with nonsurgical options — radiation of some kind, often paired with chemotherapy.

Proton therapy is a form of radiation, and because it’s more targeted it’s believed that it causes less collateral damage to healthy tissue, Gross said. But the treatment is relatively new, and research is ongoing about its side effects compared with radiation. Both are often (though not always) used in conjunction with chemotherapy to enhance the effect of radiation.

“It’s a pretty intense treatment,” Gross said. “While the prognosis is good, it’s a hard treatment for patients, and that’s because the throat is so exquisitely sensitive. … It’s very common for patients to lose weight — sometimes a lot of weight. … Part of the reason for that is radiation zaps the taste buds, so nothing tastes right. Then they can have sores in the throat and dryness in the mouth, and all that adds up to people being pretty miserable.”

Rivera’s days as an NFL coach are long and currently require him to be around 80-plus players, a full coaching staff and other staff members. Though he may be able to remain on the sidelines during his seven weeks of treatment, his challenges may not end there.

“The hardest time for patients after radiation is the week after,” Gross said. “So it’s not like they go seven weeks and they’re suddenly feeling good. They’re at their worst at the seven-week period, and then it usually takes two or three months for the symptoms to subside and patients start to feel normal. But their energy level, if they lose a lot of weight, can be really diminished. Everyone’s different, and I imagine he has a lot of support around. So I imagine he can get through, but it’ll take a lot of help.”

Perhaps the most significant hurdle for Rivera will be time management, especially if he travels to road games. But that he’s dealing with this during the novel coronavirus pandemic raises more questions. Among them: Is he at greater risk of contracting the virus because of his treatment? Given the infancy of coronavirus research, there’s not enough information to state definitively whether cancer patients are more susceptible to contracting the virus.

“Some people have a really severe response to covid-19, and some people seem to have minimal side effects,” said Christine Gourin, an otolaryngologist at Johns Hopkins Hospital in Baltimore. “Anybody who is immunocompromised is going to be at risk for having more severe side effects from the virus, and people that are under treatment for cancer are certainly immunocompromised.

“Chemotherapy causes immunosuppression because it reduces the body’s immune cells’ ability to fight infection. Radiation itself causes an inflammatory reaction in the body. … So I would think that anyone undergoing radiation … is still at risk for increased toxicity from covid and they need to be very careful.”

Gourin stressed the importance of Rivera and those around him wearing masks and social distancing — in other words, that they’re mindful of their approach.

“Believe me, I’m not being rosy about this. I’m being honest: I’m going to struggle,” Rivera said. “So those days that I do, I’m going to have to ask the coaches to step up, and I’m going to have to ask the players to step up and take ownership.”

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