Clay Misar wasn't eating, and he was experiencing fatigue. Then his parents noticed purple spots on his skin.
"We didn't know what was going on," said his mother, Annitta Misar.
When the Oldham teen started throwing up on May 23, she knew it was time to consult a doctor. She took him to Brookings, but ended up leaving without him.
"They came in and said they were airlifting him to Sioux Falls," Annitta recalled.
Clay, who finished seventh grade at Oldham-Ramona School earlier in the month, found the flight to be a welcome distraction in a scary situation.
"I'd never been in a helicopter. It was different being up that high," he said. Looking through the tiny window got his mind off his situation.
By the time his mom pulled into the hospital parking lot, he was getting settled in a room at Sanford. At that point, they didn't know a lot, except that results from bloodwork done in Brookings had come back abnormal. Clay's white blood cell count was astronomically high.
"They started chemo a few hours after he got there," Annitta said.
The assumption was that Clay had some form of leukemia. However, because it was a holiday weekend, the family would not learn more until Tuesday. At that time, they learned he had acute myelocytic leukemia (AML).
AML affects about 500 children annually in the United States, according to the website for St. Jude Children's Research Hospital. With this form of leukemia, the white cells produced are abnormal and crowd out normal ones so the body has a more difficult time fighting off infection.
Complicating matters, Clay has the FLT-3 mutation. Healthline.com indicates this gene mutation results in a more aggressive form of ALM because the mutation promotes the growth of abnormal cells.
"We signed up to do the regimen like St. Jude's would do," Annitta said.
Normally, this would involve four weeks of hospitalization while Clay receives chemotherapy and then a week at home before starting another round. But, Clay has only had passes to leave the hospital for short periods of time since being admitted in May. Not only did the first round of chemo not knock back the leukemia to an acceptable level for discharge, but he also ended up with typhlitis.
The condition, which affects those receiving intense chemo, affects the large intestine, according to Healthline.com. Annitta said it was "super painful" and prevented Clay from eating or drinking anything for eight days.
"That was the hardest part," Clay said. When he could finally eat, he had three saltine crackers.
To monitor progress, Clay has daily blood tests and weekly spinal taps. He's also had several bone marrow biopsies. Waiting for the results of the next one is causing his family some anxiety.
"We cross our fingers that he won't have to have a bone marrow transplant in Minneapolis," Annitta said.
All of Clay's siblings -- 17-year-old Clint, 15-year-old Kylee and 5-year-old Cody -- have been tested to see if any were a match. Only Cody was. Clay doesn't want to talk about how he feels about that.
"I hope it doesn't go there," he said.
While there is never a good time to get cancer, Clay's diagnosis came at an especially inopportune time. With the COVID-19 pandemic, only one parent -- either his mom or his dad, Mike -- could be with him at any one time, and he wasn't able to see his siblings for at least a month. Even now, his contact is limited.
"He's allowed to see them outside," Annitta said. While he can visit with them, he's not allowed to hug them, which is hard for family members.
Despite the diagnosis and the difficulties it poses, the family is grateful for so many things. They are grateful for the staff at Sanford.
"They don't scare you about anything," Annitta said. They have assured the Misar family that there is nothing unique about Clay's case, and they do what they can to make sure he is comfortable following chemo, adjusting medications so he experiences as little discomfort as possible.
They are grateful for the day his classmates visited him in Sioux Falls. Clay got a pass to leave the hospital and played golf with them at Thunder Road.
"They bought him a guitar at a pawn shop," Annitta said. "He's teaching himself to play guitar."
The family is grateful for the community support they have received. One wall in Clay's hospital room is papered with pictures, cards and letters from well-wishers. In addition, various groups have done fund-raisers, including his 4-H club which sold T-shirts with the family's motto for facing this battle: Pray for Clay.
On July 25, the Jimmy Fitzgerald Memorial Poker Run in Watertown will be raising money for Clay. The poker run has been held annually since 2005 to benefit children with cancer. Registration begins at 11 a.m. at Woody's Sports Bar, located at 1612 S.W. 9th Ave. in Watertown.
In addition to these fund-raisers, an account has been established at First National Bank in Ramona to accept donations.
"There's no way I could thank everyone," Annitta said. "He gets care packages from people he doesn't even know."
The Seattle Seahawks, his favorite professional football team, sent him a pennant, bracelet and team towel. The Oldham-Ramona volleyball team sent him a Seahawks blanket and pillowcases. The South Dakota State University Jackrabbits sent all kinds of swag.
At present, the future holds a number of uncertainties. Some are relatively minor -- such as how Clay's eighth-grade year will go. He will not be starting classes in person, and distance learning was tough for him after schools closed in March.
"That did not go too well with me," he admitted. "I didn't want to do my homework."
Other concerns are more serious -- such as the course of Clay's treatment. Best case scenario is six months of chemo, with monthly breaks at home. Worst case scenario is a bone marrow transplant.
Whatever comes, the family knows there's one thing they can count on: Clay's attitude.
"Clay is a strong kid," Annitta said. "You don't see him without a smile."