Hair (and Lack Thereof)
I have spent a lot of time over the years talking with breast cancer patients about hair. Hair loss and nausea are the two things everyone knows and fears about chemotherapy; great progress has been made on the anti-nausea front, but hair loss remains pretty much a certainty. Most women find, once it has happened, that they gradually adjust to a bald head—although most of us never like it.
When chemo is finished, hair again usually becomes a major focus. When will it begin to grow? When will there be enough to stop wearing the wig or hat? Will it be curly? What color? Most women find that their hair grows in curly, very curly. Approximately 80% of women will have a gradual return to their "real" hair within two years. That leaves about 20% of us with very different hair than we had pre-chemotherapy; I seem to be in that smaller percentage and am slowly adjusting to curls. If you are over 40, it is also likely that your new hair will be gray. If you decide that you want to color it, it is perfectly safe to do so as soon as it is long enough to handle.
Everyone hates losing her hair! Many women find that hair loss is one of the hardest parts of the whole breast cancer experience. It helps a little to know what to expect, to have a plan, and to have a range of options for covering your head (or not).
Your doctor and nurse will tell you specifically what to expect from your particular chemotherapy treatment. Note that hormonal treatments (Tamoxifen and aromotase inhibitors) do not cause hair loss although some women find that their hair thins over the years they take these medications. Most women receiving adjuvant chemotherapy for breast cancer can expect total, or almost total, alopecia (hair loss). It won't help to imagine that you might be the one in a million women who won't lose her hair—all that fantasy will do is leave you less well prepared for the reality.
This is the most common scenario:
Between 14 and 21 days after your first chemotherapy, you will lose your hair. If you were a betting woman, you could put your money on day #17. Some women will experience intense scalp tenderness one or two days before the hair starts to come out. This does not always happen, but, if it does, consider it to be your 48 hour warning.
Your hair will not all fall out at once. You will not awaken in the morning to find yourself completely bald. Instead, it will come out in patches when touched/combed/brushed, and will shed constantly. Some women are bald within a day; others have wisps here and there for several weeks. A few hold on to some of those wisps for the duration.
There are a range of strategies for dealing with the process of hair loss. You can:
Have your hair buzzed or shaved. Some women do this before it starts to fall out; in this case, make an appointment approximately 10-12 days after your first chemotherapy. Other women choose to wait until they experience scalp tenderness or until the hair is coming out. You can ask your hairdresser, a family member, or friend to do this for you. Some wig stores also can buzz your hair. I have known a few women who had a party for a few close friends and asked them to shave her head while all sipped champagne or other adult beverages. IF YOU ARE WONDERING IF YOUR HAIR IS FALLING OUT, IT IS NOT. ONCE IS STARTS, THERE IS NO QUESTION ABOUT WHAT IS HAPPENING!
Try to hold on to as much hair as possible for as long as possible. If this is your wish, consider sleeping in a hairnet or soft hat to minimize the rubbing of the pillow on your scalp. Touch/brush/comb it infrequently, and wash it as rarely as possible. You may keep a little hair this way, but it is not likely to look well enough to go out in public.
If it is late winter or spring, consider saving the hair and placing it in bushes around your yard. The birds will gratefully use it to weave beautiful nests.
If your hair is very long, you can donate a ponytail of at least 10" to Locks of Love. This group makes wigs for children who have lost their hair from chemotherapy, burns, or other medical problems.
It is normal to be very upset when your hair comes out. On the other hand, some women are relieved to have this part behind them and recognize that they are one step closer to being finished with cancer treatment.
What to Put on Your Head:
There are some choices about what to wear on your head and, even, if you want to cover your head. Some women feel (and are) brave and beautiful when bald and choose to meet the world on their own terms. All of us admire their courage and style, but most of us can't do similarly.
Considerations during cold weather:
Your mother was right when she told you that much body heat is lost through your head. You will be more cold than usual. During the winter, even at home, most women are more comfortable with something on their head. You will want a couple of soft caps for sleeping.
Considerations during hot weather:
Wigs are hot during the summer. It helps a little to keep a package of baby wipes in the freezer. In the morning, put a frozen wipe on your head and then cover it with your wig or hat. When it thaws, moisture will not run down your face, and you still will be more comfortable than with the wig right on your skin.
You don't need to buy a very expensive 100% human hair wig. They are hotter and more difficult to maintain in addition to carrying a much heftier price tag. Look for a wig that is a synthetic/human hair blend or 100% synthetic. Most insurance companies help with the cost of a wig; you will need a prescription from your doctor.
If you want a style that is like your own hair, go wig shopping before you lose your hair. Remember that most wigs have too much hair in them, and you will want it trimmed or shaped by your own hairdresser or an expert at the wig shop.
Even if you doubt that you will ever wear a wig, consider buying an inexpensive one. There may be times or events when you don't want to announce your patient status.
There are innumerable hats to compare and choose. Look for hats that come low enough over your ears and forehead to camouflage the baldness. Most baseball hats have a large hole in the back; unless you wear a bandanna under it, your scalp will be visible. Remember that scarves, headbands, pins can all be used to add color and interest to solid color hats.
Cotton or rayon scarves will stay on a bald head. Silk scarves make an excellent second layer, but will slide right off your skin. Take a few minutes to practice tying scarves in a variety of ways. Ask another woman, whom you see in the treatment area or waiting room, how she tied her scarf. Look for other ideas online, including at bcforum.org or tlcdirect.org.
Finally, remind yourself that this, too, will pass. Even if you are sure you will never look at them, take a few pictures of yourself bald and with very short growing hair. They will be proof later of how far you've come.