Hair We Go with Chemo

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If you were playing a word-association game and someone said “chemo”, your first response might be “cancer” or “hair loss”.  Although there are many side effects to chemo, hair loss is the one that first comes to mind for most people. It’s noticeable, something that everyone can relate to, and it’s how cancer patients are portrayed on TV, the internet, and in movies. While people who have never had chemo can’t imagine what it’s like to have chemo, they can imagine how they would feel if they lost all their hair.

Cancer patients who are about to experience it want to know what it’s like, if they should shave their heads ahead of time, and when it will likely happen. Without knowing all the other side effects, the initial focus is on upcoming hair loss. Questions about nausea, fatigue, mouth sores and muscle and joint pain come later if any of those side effects occur.

Ironically, although hair loss is one of the first side effects associated with chemo, not all types of chemo result in hair loss. The chemo used for treating breast cancer is one of the ones that will almost guarantee hair loss.

The Reason for Hair Loss
Chemo does not discriminate. It travels through the body and attacks both healthy and unhealthy cells. Chemo targets cells that divide quickly, which not only includes cancer cells but the cells that make up hair follicles, teeth, fingernails, and toenails. Some patients have toenails and fingernails that change shape (more flat than curved) and change colour. Sometimes it goes one step further and fall off.  Some people develop trouble with the integrity of their teeth and they break easily. 

Now, before you panic, unlike hair loss, not everyone experiences all these side effects. Some side effects may occur later in the treatment process and some may occur even after treatment has ended. Hair loss itself usually occurs somewhere between day 10 and 14 after the first chemo treatment.
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On a side note, there are cold caps and machines that are receiving attention right now because they are allowing some women to keep their hair, even during chemotherapy for breast cancer. This technology works by applying very cold temperatures to the scalp. The cold temperatures cause the blood vessels in the scalp to constrict so that less chemo can reach the hair follicles, which means less hair is lost. While I haven’t used this technology and don’t have statistics on its success rate, I thought it was worth mentioning in a blog post about hair loss.    

What's Actually Lost
While people associate hair loss with going bald, it came as a surprise to me that hair loss included all hair, even nose hairs. If my nose ran, I had no sense that it was about to drip until it was too late to grab a tissue. Not having nose hairs also meant that there were no filters to keep things like pollen and dust out of my nose, so my nose ran more than usual. No one told me about this hair loss and, since it isn’t as noticeable as losing the hair on your head, I had to use my powers of observation to figure it out.  

Hair loss also meant losing the hair on my arms, legs, and underarms. This hair I didn’t mind losing. It meant I didn’t have to shave my legs or underarms. My chemo also meant losing my eyebrows and eyelashes. Since I wear glasses, the loss of my eyebrows was not as noticeable as it could have been.  For once having glasses was a good thing, because I never mastered drawing on eyebrows.

My lack of eyelashes became really noticeable when I tried to put on mascara and thought it was clumping. Finally, after close inspection, I discovered I only had a few eyelashes left so I was effectively putting mascara on air. The mascara was not defective; my eyelashes were.
Once I understood why I was losing my hair, it only made sense that my hair loss would include all hair.

The Emotional Element
For some women their hair is part of their identity.  Losing their hair means not being the person they were before cancer. While they know they’re the same person inside, the adjustment to hair loss can be difficult.

I didn’t fall into this category. Personally, seeing clumps of hair on my shoulders was amazing to me. I couldn’t believe it was happening. When I got home from work one day and decided to pull my hair out of my head, I couldn’t believe how easy it was. Of course, even the chemo couldn’t seem to get to penetrate my grey hair. I couldn’t pull it out so I had to shave it off. 
Although I waited for my hair to start falling out before taking any action, others choose to be proactive by cutting their hair short ahead of time or shaving their heads before the hair actually starts to fall out.

Patients who have already had surgery have already had to adjust to a new body image. With hair loss, the process has to be repeated. Some women will decide to celebrate their baldness by not wearing any kind of head covering. Others will opt for a wig, hat, scarf, or combination of options. I chose hats, a wig, and in-house baldness. I was not brave enough to go outside my house without any kind of head covering.

For me, there was no sense of loss when my hair fell out. In fact, my strongest emotion was fascination. The whole process amazed me. In fact, the following are a few positives I found about losing my hair:

• I could put on a wig or hat and be ready for the day and not have to worry about styling my hair.
• I could never have a bad-hair day.
• I could change my look more frequently than I could with my real hair.
• I got more compliments about my haircut (wig) than I ever received about my real hair.
• I got to learn what it’s like to have the wind skim your head instead of going through your hair. It’s a cool feeling, quite literally.
• I could always see everything going on around me because my hair was never in my eyes.

The Excitement of Hair Growth
Just like I had a fascination with my hair falling out, I had a fascination watching my hair grow back. First I had a sense it was growing but I had to keep looking in the mirror until I could see a definite hairline before I truly believed it was growing back. This daily inspection was a lot more exciting than watching paint dry. When your hair grows back, it may not be anything like the hair you originally had. It may be a totally different colour or different texture. I know people who had black hair and then it came back white/grey. Others had straight hair prior to losing it only to have it come back curly. This is why I say that watching hair grow is a lot more interesting than watching paint dry. With paint you know the colour and whether it’s a flat, satin, or a glossy finish. 

As my hair started to grow back, I had to decide when I felt comfortable walking around in very short hair. I hadn’t thought about how long my hair could grow under a very short wig versus a wig that was a little longer. As it was, some of my co-workers who knew I had cancer could see my new hair sticking out from under my wig. I ended up taking my wig off more and more frequently at work so that people could see how much hair I had.  The first day I went to work without my wig, I put it in a lunch bag so that if I felt uncomfortable or people made any comments I could pull the wig out of my lunch bag and wear it again. It was like a security blanket. In the end, everything was fine and I stopped bringing my wig to work.