Hair Loss-Medicine Wheel-body
Hair Loss (The "Body" of the Medicine Wheel)

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What does it mean to say I will lose my hair? You may lose all, some or none of your hair with cancer treatment. Hair loss is temporary (hair will grow back) with chemotherapy, but may be permanent (hair does not grow back) with radiation therapy. The amount of hair you will lose and the places you will lose it from depend on what type of treatment you have.

Chemotherapy. Why hair loss occurs during chemotherapy

  1. Why does chemotherapy (chemo) cause hair loss?
  2. Cancer cells grow and duplicate quickly. Chemotherapy uses drugs that kill cells or slow down their duplication. These drugs affect any cells that grow and duplicate quickly. Hair cells grow and duplicate quickly. Chemo affects both the healthy hair cells and the cancer cells. Most chemo will cause some hair loss. The amount is related to the type of chemo you receive. It is also dependent on how long you receive chemo and the dose of the chemo drug you get.

  3. How does chemo cause hair loss?
  4. Chemo can harm the hair follicle (pouch that holds each hair) so that it makes brittle, weak hair that breaks off easily at the scalp or is easily pulled out. Chemo can also affect the DNA or genetic material within the hair root (found at the base or bottom of the hair "follicle") so that it does not duplicate for most of the time while the drugs are given to you to fight the cancer cells.

  5. Which chemo drugs are more likely to cause hair thinning or loss?
  6. Below are some of the more common chemo drugs used for breast cancer Click on the drug that you are taking or are thinking about taking to see its possible effect on hair.

    Click on Commercial Drug Name to see the common Effect

    Commercial Drug Name Generic Drug Name Effect [Most people have:]
    5-FU adrucil, efudex fluorouracil
    Adriamycin doxorubicin
    Cisplatin Platinol
    Cytoxan cyclophosphamide
    Evista raloxifene
    Folex methotrexate
    Gemzar gemcitabine
    Herceptin traztuzumab
    Nolvadex Tamoxifen
    Novantrone mitoxantrone
    Taxol paclitaxel
    Taxotere docetaxel
    Oncovin vincristine
    Navelbine vinorelbine
    Xeloda capecitabine
    Zoladex goserelin

  7. Why do some people not lose their hair when others using the same chemo preparation lose all of their hair?
  8. People react differently to the same chemo drugs. You may be taking exactly the same drugs, same strength (dosage) of those drugs, and same frequency (schedule) of those drugs as the woman sitting next to you in chemo. She may lose all of her hair and you may lose a little or have some thinning. For example, Adriamycin is usually used with one or two other drugs for most women who have breast cancer. Most women will lose all of their hair when receiving Adriamycin, but some women will lose more than others. When you receive more than one drug that can cause mild hair loss, you are more likely to lose your hair.

    "My chemotherapy started I think March 16th of '95 and by April 10th, I was totally bald. I don't think I had hair left on my body. The dramatic experience of losing your hair -- it's incredible. There's a tingling sensation that'll run from your head to your toes and ... the numbness that came over the top of my head and I remember running my hand through my hair and just gobs of it coming out."

    Some people don't lose their hair during chemo, even when others using the same chemo drugs lose all of their hair. Others just have some thinning of the hair. And others lose all of the hair on their scalp, eyebrows, underarms, pubic hair - everything!

    "I had a year of chemo... I went in there and they told me the possibility of me losing my hair, I could handle that."

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    "I did lose a lot of hair when I'd take a shower I felt like wolf man, just pulling my hair there was gobs of hair just in my hands. Luckily I have thick hair and I will never ever complain about having thick hair, thank you God."
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    "I lost some hair, but not all that much."

    to play Video Vignette - click audio only

    "I used to hear a lot of scary stuff about chemo, you know how it makes you sick and you lose your hair and all this stuff. And i WAS scared of that more than anything else. But, when I started the treatment and went through it, it was just like, it was so easy. The only thing I did was lose my hair and that was also very drastic, you know. The very first treatment and my hair started falling out, but other than that, ah, it just went real smooth."

    to play Video Vignette - click audio only

    "I quit work,s I mean, because that time because I was embarrassed, I mean, having no hair and then I wanted to wear really baggy clothes, and I did for a while."

    to play Video Vignette - click audio only

  9. When does the hair grow back? Some people notice their hair beginning to grow back before their chemo ends.
  10. For others it begins to grow back after chemo is over. The hair usually comes in a little fuzzy at first, but then grows in. In some cases, people say their hair became curlier after it grew in or a little darker. But for most people, the hair is a little different than it was before chemo. Your hair usually will grow back within 3-5 months.

    "I didn't get as sick as I thought I was going to get. It wasn't fun, but it was worth it all. Um, my husband went with me and when I did the chemo he would stand behind me, you know, with his hands on my shoulders. And it was really neat because I got sick and he got sick at the same time. Um, when I started losing my hair, he lost his hair too."
    to play Video Vignette - click audio only

  1. Why hair loss occurs during radiation therapy.
  2. Most people who have radiation therapy only lose their hair in the area where the radiation beam is targeted. For example, if you were having radiation to your head and scalp for a brain tumor, the hair is likely to fall out on that area of your head. Depending on how strong the dose of radiation and how many treatments you have, the hair may or may not ever grow back. Some people find that their hair is different when it grows back in. If you get chemo and radiation together, you will often lose your hair or have thinning. The hair will grow back except for where the radiation beam was targeted.

    "Well, I went through my chemotherapy and I had to tell the guys in the band that now am going to lose my hair. ...Okay, now I was bald and I don't know, I thought it was okay. It wasn't as bad as I thought. But, anyway, so I cut all my hair off. I got it short about as short as Dawn's. Because I did not want to lose it from this. So I told cancer you can have my hair. That's all your getting. No more. That's it. Take my hair."

    to play Video Vignette - click audio only

  3. What you can do to prepare for the possibility and to deal with hair loss
    1. What does it feel like?
    2. Many people going through chemo or radiation notice that their scalp feels tender. Some say they felt a tingling sensation and others a burning sensation. Some say their scalp didn't feel any different from how it normally feels.

    3. How does it happen?
    4. You may experience no hair loss at all; patches of baldness or the baldness may be over your whole head and body (eyelashes, eyebrows). For most people, the hair loss begins within a few weeks of starting the chemo. It may begin to slowly thin or it may feel like you are suddenly losing large bunches of hair all at once. It may come out in clumps over several days. Sometimes you get up in the morning and notice large gobs of hair left on your pillow and sheets, or in the shower after washing your hair. Hair loss can be very different in the same patient between one series of treatments and another. If you have a series of chemo treatments and then have a break of a few months before your next series, you may experience some hair loss during one series, but not the other. That will depend on the amount and type of chemo you get.

    5. What may help reduce the hair loss and protect my hair as it grows back
      • Use baby shampoo or some other very gentle, mild shampoo when you wash your hair.
      • Use a satin pillowcase.
      • Use a soft bristle brush.
      • Avoid brushing, pulling (such as during braiding), scratching or rubbing your hair or scalp.
      • Avoid braiding your hair. Braiding involves pulling on the hair to make a tight braid. This can result in pulling out large clumps of hair.
      • Avoid using a curling iron, hair rollers, and don't tease (rat) your hair.
      • Avoid using a hair dryer.
      • Do not dye your hair or get a permanent.
      • If your hair is longer than a few inches,You may want to cut it.:
        • The long hair is heavier in comparison to short hair and breaks off more easily during chemo.
        • You may want to braid your long hair and have someone cut it so that the braid can be donated to make wigs for yourself or others
          • Place an elastic band about two inches from your scalp for the "top" of the braid and an elastic band at the bottom of the braid
          • The additional two inches at the top of the braid is to allow for a short hair style unless you want to go for a very short (1/4 to 1/2 inch hair length hair style)
          • Cut right above the top elastic band
        All result in pulling the hair and can increase hair loss.

      "I cut my hair (it was only about 5 inches long) and added it to my other collected hair from before I had cancer. I made a satin pillow and used my own hair for the padding. I did ceremony with our traditional healer, then she blessed my head, my hair and my pillow."

    6. Protecting your scalp from weather (cold and sun)
    7. If you do have some hair thinning or hair loss, you need to protect your scalp from both the sun ray's and from the cold. You may be more sensitive to sunburn while going through chemo or radiation and your scalp is used to having the protection of hair. If you are outside, wear sunscreen and a hat or head covering of some type. During the cold weather you lose a lot of body heat from your head. You need to keep it covered to avoid becoming chilled.

    8. How to deal with hair thinning or loss (wigs, turbans, hats)
      1. Wigs.
      2. The American Cancer Society provides wigs free-of-cost. Many Native women have had difficulty finding a wig from the American Cancer Society because they were primarily blonde or light-haired.

        "I was really insulted. It was like they thought everybody wants to be blonde or something. I was embarrassed to ask them why they didn't have any black-haired wigs. I never went back."

        When the NACR Native Patient Advocates called the American Cancer Society where the woman above had visited, the staff was very willing to help her find a wig that matched her normal hair coloring. After this experience, they purchased additional black and brown hair wigs for other women. Sometimes we have to speak up so that others understand what it is we need or want. The woman above did finally go back and accept their help in finding a wig that fit.

        The American Cancer Society recommends that you get a wig or toupee before hair loss begins so that you can match the color of the wig to your natural or normal color of hair. They also recommend that you get a prescription from your provider for the wig if you have insurance. Wigs are made of different types of materials. Some may make you feel hot and sweaty. Others have linings of fabric to which you may be allergic, or it may feel itchy.

        "I was too embarrassed to go out being bald. I called my daughter who lives in the city and she couldn't come down to get me for a few weeks. So I just stayed in the house or was in the hospital getting my treatments. I didn't do nothing. Just stayed in the house and waited. I was really mad by the time my daughter came down, picked me up and brought me back up to the city. I was kinda mean to the sales lady who was trying to help me with the wig. My daughter told her that I was really mad at her and then I just started crying. I didn't want to be there. But I wanted the wig. And I didn't want to be crying. ... After I finally got my wig. I wore it to the store and I felt really good. I saw my neighbors and they were surprised about how good I was Looking."

        Obviously, no one can buy the wig for you. You need to make some time in your busy schedule to find a wig that is comfortable and looks good on you. The Look Good Feel Better program may send a volunteer to meet with you to help you with your wig fitting and with make-up (especially if you have also lost your eyebrows and eyelashes).

        If you live in the city, you may find many places that sell wigs. But if you live on the reservation or in a rural area, you may not have a lot of choices or any choices of where you can find a wig. Some wigs are sold over the Internet, but then you have no way of knowing which ones are comfortable and look good on you.

        Synthetic wigs wash better than real-hair wigs. They are also cheaper and more likely to be cooler than real-hair wigs.

      3. Turbans, Scarves and Shawls.
      4. Turbans and scarves can be purchased over the Internet or through mail order. Turbans wrap around your head and most include instructions fordifferent ways to wear your turban. Scarves can also be worn in many different ways. Some include traditional Indian styles. Occasionally our women prefer to use their regalia shawl worn over the head. In one of our Native survivor support groups a Moslem woman was visiting and shared different ways to wear a shawl from her culture. Scarves and shawls have a lot of variability in how they can be worn in very stylish fashions.

    9. What are some other alternatives?
    10. Prescription drugs.
      There are some prescriptive medications that may or may not be helpful. They do not work for all people, even when the patients are taking the same chemo preparation. Be sure to talk with your doctor before trying anything.

      Scalp cooling products.
      Debate continues about how beneficial scalp cooling products may be. The idea behind them is that blood carries the chemo drugs to all of your body. If you cool down your scalp, you are slowing down blood flow to the scalp where the hair roots are located. This means less blood and chemo drugs are getting to your hair roots. Products include:

      • Caps that hold ice cubes against your scalp
      • Gel-filled caps that are placed in a special freezer in between use
      • Electrically cooled cap that mean you have to remain sitting in the chair while this is plugged into the wall
      • Cold Air Pocket Caps

      Because cooling causes less chemo to get to the scalp where some cancer cells may be hiding, many providers do not recommend their use. Current literature suggests that when appropriately used, hair loss is lessened in about 52% of those who use cooling products. Not everyone is a candidate for the use of scalp cooling and it is still considered experimental by many providers and insurance carriers. Talk with your healthcare team about whether you might be a candidate and the risks and benefits for you.

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