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Debbie Dorsey sat with her family on Christmas morning in 1997 opening presents. She was watching her children and mindlessly touching her hair when seven dark strands clung to her fingers. She continued pulling at her hair so that by the time all the gifts were unwrapped, Dorsey had constructed a hill of hair on the coffee table. She might have felt shocked, except this was the exact day her doctor predicted her hair would start to fall out.
"It actually felt great, because my scalp was sore. I wanted to pull out all that hair, even though it also terrified me," says Dorsey.
Dorsey experienced a condition called alopecia, or loss of hair. Although there are many reasons for hair loss, it is a common side effect in people receiving radiation and chemotherapy. The amount of hair loss varies with the type of treatment.
Joan Gallagher, an oncology clinical nurse specialist at Massachusetts General Hospital, explains hair loss with chemotherapy, "Certain chemotherapy treatments cause alopecia more than others. Some drugs don't cause it at all. But despite the extent of damage, chemotherapy-related hair loss is temporary."
Chemotherapy destroys quick-growing tumor cells. At the same time, it can damage other fast-growing cells, such as those in hair and nails. The hair follicle cells absorb the drug, which thins the hair shaft or completely blocks hair cells from dividing and growing. When the hair root at the scalp becomes fragile, it breaks easily or falls out. The patient not only loses hair on the head, but also may lose hair in other areas such as the legs, arms, pubic area, eyebrows, and eyelashes.
"Radiation, on the other hand, can cause permanent hair loss. High amounts of radiation beams passing through a specific treatment area including the hair can destroy the hair root entirely. But it is only the target area where the radiation hits that you may see a bald spot," says Gallagher.
With chemotherapy, hair loss usually begins within two to three weeks after the start of treatment, and may continue over the next month. In some cases, total hair loss occurs in 24 hours. There are factors that affect how quickly hair loss occurs, such as the type and amount of the drug given.
Gallagher adds, "Consider the weight of the hair--long hair is heavy and tugs on the roots. Taking a shower and wetting the hair will add even more weight and increase the chances of hair falling out. Trimming long hair may help lengthen the time it takes for complete hair loss." If hair loss is expected, Gallagher also recommends avoiding harsh chemicals found in permanents, hair dyes, and some hair sprays.
Many people may feel scalp tenderness right before the hair loss, as described by Dorsey. "The sensation has been compared to the feeling of when you wear your hair part one way for a long time and then switch it the other way," says Gallagher.
Hair regrows in about three to five months, although the exact time will vary. The hair root recovers and begins a new cycle of growth, often visible before chemotherapy treatment ends. Complete regrowth can take up to one year. Hair may reappear in a different color or texture. Dorsey recalls her surprise when her hair grew back in big, thick curls--opposite from the ironed-straight hair she was born with.
Hair loss can cause anxiety or depression. This reaction may be related to a loss of control over the image that the person desires the public to see.
"To some degree, hair defines who you are because it's one of the first things people notice," says Dorsey. "For women, hair symbolizes femininity. We spend so much time styling, coloring, and caring for it. When I lost all my hair, I'd walk by beauty salons and wish they could do something--anything--for me. I couldn't even get a manicure because the chemotherapy had weakened my nails."
David Nicholas, a Boston-based make-up artist and licensed esthetician, believes that the right beauty salon can do wonders for people with hair loss. Nicholas, a pioneer in reconstructive and corrective make-up, helps many women and men with hair loss gain back some control of their appearance. He counsels people to make plans early on.
"Being prepared creates a sense of control, which helps one deal better with the change," says Nicholas.
When Nicholas sees people who are anticipating hair loss, he first refers them to a reputable wig organization before the hair loss occurs. "The wig specialist needs to see the existing hair if the client wants a close match," he explains. Gallagher shares that her patients who bought wigs unlike their own color and style were often ultimately unhappy with them. Wigs can be made of synthetic material, human hair, or a combination of the two. Prices range from a few hundred dollars for a synthetic wig to a few thousand for human hair. He recommends clients to wear the wig before actually losing their hair, so they feel comfortable with it when they have to wear it. Nicholas then teaches make-up techniques for lost eyebrows and eyelashes or to correct the sallow skin color that often occurs with chemotherapy treatments.
Nicholas warns that not every wig store or beauty salon is trained to work with clients with hair loss. He suggests getting referrals from other cancer clients, hospitals, or a local chapter of the American Cancer Society. "Ask the store or salon if they work with people who have cancer. A good establishment also deeply respects the confidentiality of their clients," says Nicholas.
Gallagher agrees that privacy is a top priority. "People with cancer can choose whom to tell about their diagnosis, but hair loss makes that information very public. Look for a wig shop that accepts private consultations or has concealed areas where clients will not feel they are on display," she says.
Dorsey admits that her doctors didn't give much attention to her hair loss. "It's just not a big deal to them; it's the mouth sores, dry mouth, and horrible gas pains they worry about." Dorsey turned to support groups, wig shops, cancer books, and chat rooms on the Internet for information.
According to Gallagher, getting a wig that works is an important step for many people with hair loss, but some need much more guidance. "Nurses can provide support and guidance about the sensations and experiences of hair loss," she says.
"Patients can usually predict how they will react to hair loss. Some view it as a minor annoyance; others see it as the worst part of the chemotherapy treatment. After listening to those concerns, a nurse can help create a plan of action with the patient." Gallagher reports that patients also appreciate hearing direct advice from their nurse or doctor--knowing when the hair is expected to fall out, how much, and practical tips on how to deal with it. "One of my patients reported that when she started losing hair, it would fall into her food or onto her pillow at night, leaving hair in her mouth. We found that wearing a turban to catch the hair during those times helped prevent feelings of resentment that surfaced. Nurses can offer small but real details like these."
Dorsey was often frustrated by how strangers reacted to her appearance. "I remember the first time I wore a turban and walked into a bakery--I scared the hell out of this woman. She looked at me with an expression that said 'cancer has just walked in.' I understood, though, because I used to be terrified of cancer too. Even in hospitals, if a friend and I walked down the hall wearing turbans, people would give us funny looks."
Nicholas shares a tip he learned from a client, "Wearing a scarf over a bald head looks unnatural because the scarf is too close to the scalp. Creating layers such as wearing two scarves or a scarf under a hat simulates the bulk of hair."
Dorsey felt pressured to wear her wig in certain settings, such as in front of strangers and children. "When you wear a wig, you're pretty much invisible. But wigs can get hot and uncomfortable." She and Libby Levinson, a woman in her support group, eventually tired of worrying about people's reactions and opted to wear scarves under baseball hats with various logos, dubbing it 'Chemo Chic.'
Hair is a protective shield for the scalp from sun, extreme temperatures, and other harsh elements. Both Gallagher and Nicholas recommend gentle hydrating scalp care--using a mild facial cleanser instead of shampoo, a daily moisturizer with an SPF of 15 or higher, and drinking adequate fluids (6-8 glasses of non-alcoholic, non-caffeinated beverages daily).
The American Cancer Society sponsors a community-based, free national program for women with cancer called "Look Good... Feel Better." These workshops are offered in cancer centers, hospitals, and other community settings across the country. Teams of trained beauty professionals teach skin care, makeup, hair and nails, and the use of wigs, hats, turbans and scarves. For more information, visit the American Cancer Society web site or call 1-800-395-LOOK to find programs in your area.
Now that Debbie Dorsey's hair has completely grown back, she sports a short, stylish cut. Reflecting on the experience she says, "I never really accepted or felt comfortable with the hair loss. But I learned that being bald didn't rob my femininity."
Gallagher says that she doesn't know if her patients overcome their feelings through the hair loss experience, but they eventually feel that they are managing it. "That's what I'm aiming for. If a person says "Oh everything's fine, I'll be fine,' I get nervous. That overly bright persona tends to be more fragile than someone who has natural ups and downs."
Dorsey's message to readers is for people to learn and talk about cancer and cancer prevention. "Until they can find a cure for cancer, we need to stop fearing it and take a proactive role by getting yearly screenings." Dorsey was featured in a recent PBS documentary titled "No Hair Day," which follows the making of a photography exhibit and the experiences of Dorsey and two other women undergoing chemotherapy.