We were originally given a tentative date of Monday 21 November to begin his first of six SMILE chemotherapy cycles, but the delay to Radiotherapy due to the peritonitis episode pushed that date back once again. One thing you have to accept with cancer, is nothing going to plan, or to date. Not easy if you a control freak like me.

Each Chemo cycle will last 28 days. Day 1-4 will be in the Teenage Cancer Trust Unit (TCT), Cardiff. Days 5-28 will be either at home recovering or in Glangwili Hospital, Carmarthen for bloods and chemo injections. I will put a full breakdown of the 5 drugs that SMILE stands for, how they are given and on which days onto a separate post here for anyone who is interested in that much detail.

Before chemotherapy could commence Ryan needed to have a Hickman Line fitted which meant operation number 7 on 1st December 2016. Most teenage and adult patients have a PICC line, but due to Ryan's malnutrition the veins in his arms are approx 25% of their normal size meaning a PICC was not a viable option.

Cycle 1 commenced on Sunday 4 December 2016, when Ryan was admitted to TCT for pre-chemo hydration to prepare his liver and kidneys for the onslaught of poisoning.

As it goes Ryan breezed through the 4 days of chemo and made it look all relatively easy considering what we have been through with the sepsis and peritonitis. He cleared the methotrexate level to the required number by day 4 and although he was extremely fatigued this was to be expected.

We were discharged on day 5 and had to travel to our local hospital on day 6 to be shown how to self administer the GCSF injections to assist with neutrophil recovery. Unfortunately we had to travel all the way back to Cardiff on day 8 for this PEG asparaginase injection, but they did agree if he didn't suffer any adverse reaction then would be allowed to have the future injections in our local hospital. Fortunately all went well.

On Day 16 Ryan woke to a bed full of hair, intense muscle and bone pain and was unfortunately sick for the next 6 days. It was quite a shock to see him lose all his hair in one go. We hadn't necessarily expected it to all go at once, or even so soon into cycle 1.

The stats for his allowed discharge and next cycle commencing are as follows.

Next cycle if:

Neutrophils >1

Platelets >75

Urinary ph >8

Discharge allowed if:

Methotrexate level <0.05 micromol/L

Neutrophils >0.5

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