Howard Levell was just 16 when he was diagnosed with a rare form of leukaemia, but he's handled the consequences and the ongoing treatment with a maturity and a strength of character that's nothing short of inspiring, says Joy Orpen.

Howard Levell may be only 18, but he has the wisdom and the emotional intelligence of someone much older. Whether or not he got those qualities from having cancer is hard to tell. One suspects they were there all along, but there is no doubt that they are helping with his recovery.

This Co Kildare lad first noticed something was wrong during the Christmas holidays of 2006.

"I was tired and sleeping a lot," he recalls. "On Stephen's Day I slept until two; that was very unusual for me."

A couple of weeks later, Howard found a large lump in his neck. It looked like an abscess, or the mumps, so the subsequent appearance of spots added to the mystery.

But when Howard began to have trouble swallowing, his doctor whisked him off to the local hospital where the considered opinion was that his 'abscess' needed further attention. He was then referred to St James's Hospital in Dublin. A few days later, the world of the Levell family shattered when Howard was diagnosed with biphenotypic acute leukaemia (BAL).

"It's not all that common," explains Howard. He says he was so convinced his problems weren't serious that he wasn't paying attention when the doctor was explaining the diagnosis.

"While I did understand that leukaemia was cancer of the blood, I didn't know anything else about it. You don't really worry about getting cancer as you think it only happens to older people. But at my age [16] it was a terrible shock," he recalls.

When Howard's mother sat down and talked to him privately, the reality finally hit home.

"She asked me who I wanted to tell about this. That's when the enormity of what the doctor said sank in. I just broke down and cried," he says.

But almost in the same breath, Howard rushes on, and says: "Then I thought: 'I am going to beat this.'"

So, where does his resilience come from? This ability to bounce back?

"I think from my mum. If we were in a plane, we might worry about it crashing. But if it did, we would probably take over," Howard says with a grin.

Howard emphasises that his particular form of leukaemia was acute, in other words, fast acting. "It was probably lucky I got that kind," he says, "as it led to an early diagnosis."

He was immediately rushed to the radiology department, where a Hickman line was inserted through his chest wall and into a vein. This tube remains in place so that all medications can be easily administered intravenously and blood can also be taken when required.

Howard was then sent to an isolation ward as his immune system would be compromised during his chemotherapy, leaving him susceptible to all infections.

Treatment continued for more than five days.

"I wasn't eating that much at the time, so the chemo didn't make me feel any worse," he comments.

Howard says people were surprised at how well he was dealing with the trauma. "I tried to blank out the seriousness of the situation. I didn't go on the internet to check out the mortality rate. After all, I'm an individual and every case is different," he says.

Following chemotherapy, Howard remained in isolation. His hair fell out, but he didn't mind as he had short hair anyway.

Five weeks later, he was tested to see if the chemo had worked.

"I had a bad feeling about it," he says. "Even though I was still positive about the eventual outcome, I did think I might need more chemo. And I was right -- the treatment hadn't been effective."

So, a more vigorous approach had to be taken. Howard was subjected to a very intensive, three-day chemo cycle. Afterwards, the teenager felt as if a steamroller had flattened him.

"The chemo was so strong I hardly knew what was going on. My sisters said they were really scared as my heart was thumping loudly."

Howard took a good couple of weeks to recover from this aggressive, but essential, intervention.

Six weeks later it was discovered that, though the treatment had worked, the cancer could return unless further steps were taken.

It was decided to give Howard a stem cell transplant. When it was discovered his parents and two sisters were not suitable, an unrelated donor was found.

The first step was to kill off all Howard's cancer cells -- unfortunately zapping his healthy cells in the process -- and to replace them with good donor cells.

The hope was that Howard's body would then start producing its own supply of healthy material.

He had two more days of intense chemo, followed by radiotherapy, to make absolutely certain all the cancer cells had been destroyed.

"If I thought the chemo was bad, the radiotherapy was 10 times worse. I was sure I was dying. My head was banging, and I thought: 'This is it. I've had it."'

That night, he was fed the life-giving donor stem cells through his Hickman line: he felt ghastly for the next four or five weeks.

But, eventually, he was able to go home.

However, he soon suffered another setback when he developed acute graft-versus-host disease (GVHD) -- a fairly common situation following transplants where some of the donor's immune cells attack cells in the recipient's body. The mild to severe symptoms generally begin with a skin rash that may blister; it can then spread to different parts of the body causing diarrhoea and jaundice.

As a result, Howard was taken back into hospital for two weeks and put on steroids.

Then, last January, amid much excitement and relief, he finally returned to fifth year at school.

But in March he developed more skin problems. This time chronic GVHD was diagnosed and he was again put on steroids. It's a pattern that appears to be repeating itself, but Howard is hopeful that he is on the final leg of true recovery.

The swelling on his face is receding, and he is concentrating on his upcoming Leaving Certificate.

In the meantime, Howard is an active member of CanTeen, an organisation for young people who have experienced cancer.

He says he has found it really useful to be around youngsters who understand what he is going through: "Other people don't know whether to talk about it or not, whereas when we are together we may not even discuss it [cancer], we might be too busy having fun."

Now that Howard is finally on the road to recovery, he is again able to consider his future. And although he is really grateful to the "wonderful" nurses and doctors who devoted themselves to getting him well, he is not drawn to medicine at all, but thinks he would like to pursue a career in business.

Whatever Howard decides to do, he will do it well; that's for sure.

Contact CanTeen Ireland, tel: (01) 872-2012, or see www.canteen.ie, or email canteen@oceanfree.net

- Joy Orpen