Indianapolis Colts head coach Chuck Pagano has been hospitalized since last Wednesday to be treated for an acute form of leukemia. Pagano has taken an indefinite leave of absence that team owner Jim Irsay and Pagano's doctor believe will last several weeks.
"It's been a very difficult week," Irsay said at a press conference in Indianapolis on Monday to announce Pagano's condition.
Pagano began feeling extreme fatigue during the Colts' bye week and had blood work done to find the cause after the bruising became more prominent and his wife, Tina, encouraged him to seek medical attention.
"I am optimistic," Irsay said. "I feel with every fiber in my body -- Chuck feels the same way -- he can beat this thing."
Offensive coordinator Bruce Arians has been named interim head coach at the recommendation of Pagano, which was endorsed by Irsay and general manager Ryan Grigson.
"We have to move on today, get through today, and get ready for the Packers," said Arians, who was the only coach to know of Pagano's condition until the team was informed in a meeting.
"The light will remain on in Chuck's office until he gets back. We're going to get ready for the Packers."
It's unlikely Pagano will return and be "all in," Irsay said, in a coaching capacity this season because of the peaks and valleys that come with recovery.
"Being into the season three or four weeks, he has set the tone," Irsay said. "In meeting with the team and meeting with the coaches, there's nothing more we'd like than to get that Green Bay game ball, the victory game ball, and take that into the hospital and present it to him."
Pagano has acute promyelocytic leukemia, which is a subtype of leukemia and a cancer of bone marrow tissue. A marrow transplant is not typically used in first remission.
"I met coach Pagano last Wednesday when, as Mr. Irsay said, he was evaluated for bruising," said Dr. Larry Cripe. "He was hospitalized Wednesday and treatment began at that time."
Pagano's bone marrow is no longer producing a normal number of factors needed. Cripe said the type of leukemia is "favorable" to recovery and there are specific treatments available to treat this particular disease. He is in the induction phase, and remission is the goal -- meaning Pagano feels well and his blood count is back to normal and no signs of leukemia remain.
"I know the life of a coach is pretty arduous," Cripe said. "I don't know when he will feel well enough to assume full responsibilities. I know he's anxious to return in any capacity he can."
The disease is considered treatable with remission induced in 80 to 90 percent of patients.
"The case here is we feel, and I know he feels, he will battle and get this disease in remission," Irsay said. "It's a marathon. In being with him this week and with Tina, they're doing very well. They were able to Skype with their daughters, who are scattered across the country. ... From him and I talking, we talk about how grabbing that Lombardi Trophy is going to be that much sweeter having overcome this."
The first phase of treatment requires hospitalization and normally lasts four to six weeks, and includes transfusions and antibiotics to repress complications. The full treatment schedule lasts several months and includes periodic outpatient treatments.
"The goal of the treatment ... is to cure the disease," Cripe said. "That means he's returned to a fully functional life. The life that he's worked so hard to earn. He's looking forward to leading the Colts to some Super Bowls.
"However, the process is long and complicated. And we're just starting right now. For the next several weeks, this will be day-by-day."
Pagano was disheartened that he didn't have NFL Network in his hospital room -- Irsay said he'd do his best to change that -- and wants to remain engaged with the team in some capacity.
"We know the demands in this league of being a head coach," Irsay said.
Patients with APL might develop serious blood-clotting or bleeding problems, according to the web site.
Cripe said he visited with Pagano on Monday and described his spirits as good but shared that there is no doubt Pagano is receiving chemotherapy and is feeling "less well."
Pagano turns 52 on Tuesday.
"Chuck is very dear to the organization," Irsay said. "The special thing about Chuck: He's a salt of the Earth man. He'll spend 10 minutes with the janitor asking about how his ill mother is. He goes out of his way to treat people in a special way."
He was hired by Grigson to replace Jim Caldwell. Previously Pagano served as defensive coordinator of the Baltimore Ravens.
Pagano's brother, John Pagano, is in his first season as defensive coordinator of the San Diego Chargers. He had been linebackers coach for the team from 2005 to 2011.