Hair Changes (The Return of Side Eff@cks)

Tina 0:00

Welcome to episode 37 of the cancer pod. Join us as we discuss hair loss from cancer treatments, including what to expect, how to reduce the risk and how to support hair regrowth with proper nutrients. I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 0:17

and I'm Dr Leah Sherman and on the cancer inside

Tina 0:21

And we're two naturopathic doctors who practice integrative cancer care

Leah 0:25

But we're not your doctors

Tina 0:27

This is for education entertainment and informational purposes only

Leah 0:32

do not apply any of this information without first speaking to your doctor

Tina 0:36

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 0:42

Welcome to the cancer pod

Intro

Leah 1:01

Hey, Tina.

Tina 1:02

hi, Leah.

Leah 1:03

Today we are talking about something. It's a side that I don't has a really big impact on a lot of patients.

Tina 1:12

Mm-hmm yeah, I would say it's one of the side effects that

Leah 1:16

Ooh, you said it

Tina 1:17

I said it it's one that impacts the patient and is more incidental to the medical oncologist. So there's not a lot that is offered in way of preventing the side.

Leah 1:32

So, what we're talking about today is hair loss, alopecia related to cancer treatments. And it's, well, it's not funny, but it is kind of funny that like I went into treatment totally prepared for this absolutely prepared. I knew it was gonna happen. You know, my husband's like shaving my head into like Mohawks threatened to give me a Mr. Tea and everything. And I, I even have a video somewhere of me getting my hair shaved and I'm just joking. And I, you know, everything's like humorous. And at one point as my hair continued to fall out, I had a complete and utter meltdown in the shower. Like knowing that this was gonna happen, working with patients where this happens all the time,

Tina 2:14

Mm-hmm

Leah 2:15

what it for me. And I think for many people, because I've talked to my patients about this too, is that's when it sets in. That's when it sets in that this is real.

Tina 2:25

You mean the entire experience?

Leah 2:27

experience becomes real at that point, because it's not a typical hair loss. Like it's like, it's just melting off of you. There's no control. So it's the ultimate loss of control. And it's the really, it's how people on the outside now can see what is going on with you.

Tina 2:47

yeah, that's that's an interesting point in that. If it is something like you worked through it, you held your chin up and you kind of forged on and I can see how that would be kind of shaking the very reality. You not only put forth to other people, but to yourself as well.

Leah 3:05

And hair is such an identity thing. I remember my sister at. I don't know if it was during my treatment or maybe it was another time when I just like happened to cut my hair off. But my sister at one point was like, you know, like, that's your identity? Your identity's your hair? Like talking about me specifically because I always had very long straight hair. Um, and so it was a really big deal. I mean, my hair was really, really long and then it wasn't.

Tina 3:30

Well, yeah, and I think that is true depending on, on how you wear your hair, because I can think of someone back in college who came home from France and she had beautiful black curls before she left and she came back and it was shaved so close. She could have been in the, in the arrow TC at that point. I mean, it was super shaped. I didn't recognize her. She walked up the driveway. I literally looked at this person and didn't know who she was. And so it was profoundly different. I mean, she was the same person, of course, but you're right. hair is a big part of our exterior identity to people and how they perceive us. So, yeah, it is. It's a, it's a major side effect. And I think it's one that probably doesn't get as much attention because it can be written off as superficial or not important or whatever, by the, conventional care team.

Leah 4:15

And by, you know, friends and family. Oh, it's just hair. It'll come back, you know?

Tina 4:21

Mm-hmm

Leah 4:22

And it's not, it's a lot more than that. So this is what we are going to cover on this episode. let's just do a short little musical break and come right back

Why do we have hair?

Tina 4:36

All right. We're back. So I think we should just talk about what hair does on our bodies. Just in general. Why do we even have hair?

Leah 4:45

So some of our hair is protective. I would say like a lot of our hair is protective. And you don't really realize it until you lose it. So, you know, your eyebrows, your eyelashes, your nose hairs, they're all protecting you from, from what's on the outside. Um, the tiny little hairs on your body, yeah. I mean, it's, it's kind of an important thing that you don't realize until you don't have it.

Tina 5:11

yeah. I can totally understand how we all, any one of us who hasn't lost our hair and especially our eyebrows and, things that have a clear, functional purpose on a day to day, take it for granted. And then when they're gone, you're like, oh right. This keeps my, sweat out. It keeps dust out your eyelashes have a serious purpose of keeping debris and, pollen and dust out of your eyes. I mean, it's just, it's so simple, but it's so taken for granted and let's, it's not there.

Leah 5:39

Right. Yeah. The sweat thing was a really big thing. And not everybody, not every treatment, you know, you lose your eyebrows or your eyelashes, but, um, when, and if that happens, it's yeah, you're kind of like, oh, now I get why I had those in the first place.

Drugs most likely to cause hair loss

Tina 5:55

Yeah. Should we go through some of the drugs that our most common, I have a little list. It's alphabetical. I'll just run down the list.

Leah 6:03

Okay. Are you gonna say like their, their trade names or their

Tina 6:06

Oh, I was just gonna go generic.

Leah 6:08

Okay.

Tina 6:09

If you wanna throw in a trade name

Leah 6:10

I might, I might. Yeah, just cuz you know

Tina 6:13

All right. Ready? I just pulled this off of, uh, up to date. I think cyclophosphamide, when it's given

Leah 6:20

So that's cytoxin for breast cancer typically and other cancers.

Tina 6:24

Dinino mycin Donna Rubin, docetaxel docer Rubin epi Rubin.

Leah 6:30

the Rubin family

Tina 6:32

Yes. Known as the Rubin family. We got the cousins, the brothers, the Rubins.

Leah 6:37

oh, I do wanna mention docetaxel actually. Um, which is tax secure. That is one where for some people hair loss can be.

Tina 6:45

Mm-hmm

Leah 6:46

Because they're lawsuits. And you hear about those a lot. If you start Googling Doax for any other reason, you'll start getting ads for the lawsuits. And so,

Tina 6:53

all right. Um, her Buin

Leah 6:56

E R I B U L I N that's the one that's derived from a sea bunch.

Tina 7:01

mm-hmm ETOP side. Ida Rubin.

Leah 7:04

Okay. We're back to the Rubin family.

Tina 7:06

Yep. It's a large family. Um, ICAN, I phosphamide paclitaxel Topotecan and Alvin, and these are the ones associated with the highest risk of hair loss. The kind you're talking about, where it comes out quickly and, and, and a lot. And there are other drugs associated with hair thinning and have a little bit lower risk, but those are the, all the big dogs.

Leah 7:30

So, yeah, hair thinning can be, a side effect as well. I think I've told this story before, well, I may be repeating myself,

Should you pre-shave your head?

Leah 7:40

but yeah. So one of the that isn't listed or some of the regimens that aren't listed would be like five F, U and oxaliplatin. I have had patients that come in for their appointments before even getting their chemo teach and just like shave their heads in preparation. And that was their plan treatment.

Tina 8:00

Uh, huh?

Leah 8:01

Don't do that. Cuz you're most likely not gonna lose your hair. It may thin a little bit, but don't yeah. Don't, pre-shave your head unless, you know, for sure you're gonna lose your hair or unless you just wanna shave your head, maybe you just wanna shave your head.

Tina 8:15

Sure. There are quite a few agents associated with hair thinning. Those two that you just mentioned as well as carboplatin cisplatin, There's several others. So there's a lot of 'em that are associated with hair thinning. The first list had to do with complete hair loss and more severe effects.

Leah 8:31

like for breast cancer patients, you've got, the three big hitters, right? You've got do Rubin cyclophosphamide and any taxine and so, yeah, it's pretty much guaranteed.

Tina 8:42

yep. And I should add that there's a few oral agents too. Like, cetuximab is one of the very first targeted agents for a specific receptor E G F R in any case, that can often have side effects, including hair thinning.

Leah 8:56

And we're not only talking about like hair thinning and hair loss. We're also will mention things about hair texture and color changes. And there are some treatments that can change the color of your hair.

Tina 9:09

Mm-hmm

Hair color changes

Leah 9:10

Um, and after hair loss hair can come back and it can be a completely different texture. So we'll touch on that too.

Tina 9:18

Yeah. Yeah. Well, that happened to my father. When he got chemotherapy,

Leah 9:23

His hair color changed.

Tina 9:25

Yeah. His hair color changed when it was fairly gray, salt, and pepper with a good amount of salt. And after getting high dose methotrexate, um, it turned more peppery. So he was happy about that.

Leah 9:37

and it can also happen with cisplatin and cyclophosphamide. It's not a guarantee, the hair color changes. Yeah.

Tina 9:44

mm-hmm

Leah 9:45

but you know, that's just something to kind of keep in mind. Um, hair loss can also happen with radiation to the scalp. And, um, I mean, that's a completely different mechanism. I mean, that's just, you're just getting direct blast to the, the hair follicles. So, I mean, I guess it, you know, why do we even lose our hair with these treatments? And it all goes back to what we talk about pretty much every side effects issue rapidly dividing cells

Tina 10:13

Yep.

Leah 10:13

and hair. I mean that has some of the the most rapidly dividing cells in our body.

Tina 10:18

Mm-hmm

Leah 10:19

And so that definitely, is a target.

Tina 10:22

Yep. That's part of that whole idea of collateral damage because except for those oral targeted agents, all of these chemotherapies that go in intravenously are non-selected, they're just killing rapidly dividing cells regardless of where they are. And in the process of killing the cancer cells, like take out other rapidly dividing cells, like the hair follicles.

Leah 10:44

And what I thought was cool in review for this, and I'm not gonna go into it a lot, but, um, just the fact that here grows in cycles.

Tina 10:52

Mm-hmm

Leah 10:53

So there's like a growing phase, a changing phase and a resting. And so when our hair naturally falls out, it's because there's another hair in coming in behind it, it kind of pushes it out. Um,

Anatomy of a hair follicles

Leah 11:06

and the other thing I thought was kind of neat is like, you know, if you think about hair follicle, but then there's also like this bulb that's down as part of our whole hair makeup. And that bulb has tiny little capillaries.

Tina 11:21

mm-hmm

Leah 11:22

And so that's how those drugs get to your hair is through the little blood, you know, there's a blood source down there. So that's why when our hair falls out naturally that it doesn't bleed. But you know, if somebody was to yank you know, your hair really hard, then, um, could bleed,

Tina 11:38

Yeah. Right.

Types of hair- terminal, vellus, lanugo

Leah 11:40

oh, I wanted to cover, um, the different types of hair too. There is the terminal hair, which is what we see what we think of our eyebrows, our eyelashes, our pubic hair, you know, our hair on our heads, our facial hair. and then there's this, I think it's pronounced VES or OUS hair,

Tina 11:56

Mm-hmm

Leah 11:56

which is that tiny fuzz that we like. It's more mono noticeable. I think on women is just, and, um, babies have it too. It's just kind of like that peach fuzz that's,

Tina 12:07

mm-hmm

Leah 12:07

on our, you know, kind of the rest of our bodies. And then there is this, I don't know how it's pronounced LGO lanugo hair and that's what babies are born with. Like there with babies that are kind of born with like this coding of hair. And it's also something that. Can be seen in people with eating disorders and that's kind of like a diagnostic for if somebody does have an eating disorder. And I believe that also is very protective. And so that helps with temperature regulation, because I would think if someone has a lot of weight loss, then their body needs to compensate So those are the different types of hair. And with certain chemotherapies, you're gonna lose the terminal and the, the VES yeah. And then they grow back in interesting ways, but we'll get to you know, I got a story for, for almost every side of fuck,

Tina 12:58

that's right. Yeah. When we talk about all of these, these side effects, basically, uh, it was listed, you got it.

Leah 13:04

except for the nausea. Yeah. And the

Tina 13:07

Oh, except the nausea, which you were on top of

Leah 13:08

Well, the, the,

Tina 13:09

took a medication. So

Leah 13:11

check a medication and that's why I also didn't have the diarrhea, but there you go. Okay. So we move on. Let's move on. Um, patients always wanna know what they can do to prevent hair loss.

Tina 13:22

yes. So can I just say, as far as natural agents go, unless it's been proven, stay away from a natural agent that's claimed to fame is I'm taking this to prevent hair loss because you could be doing it because you're decreasing the effectiveness of the actual treatment. Right? So I say that because this is where those areas where I'm really cautious. and I look more towards nutrient deficiencies that might be induced and making sure someone's not deficient in certain things, which we're gonna talk about. But I'm saying that because when something out there has proof saying, oh, it you don't get that side effect. If you just take this, I don't care if it's a drug or a natural agent, you have to ask yourself, Am I doing that at the cost of effectiveness of the actual chemotherapy? Cuz if you speed up its breakdown in your body, you might be getting rid of it more quickly than is planned

Cold caps

Tina 14:14

by your medical oncologist.

Leah 14:15

And really the only thing that's been looked at are the cold caps, cryotherapy. a lot of cancer centers now have them for their patients or patients can buy them themselves and bring them in.

Tina 14:27

Mm-hmm

Leah 14:28

And even those aren't a hundred percent. I know some patients start off really like, I'm gonna do this, I'm gonna use this cap and I'm gonna preserve my hair. And then weeks later I'll see them and they don't have their cap on. because it just, it was just too much either whether it's the cold induced headaches or, you know, their hair still was thinning. And so they're just like, oh, I'm just gonna cut it all off. I mean, so they're mixed results. Some people have great results using a cold cap.

Tina 14:54

yeah. Yeah. I understand the desire for that. Um, when I was a resident back in 2000, 2002, they were frowned upon because that was the early generation and all medical oncologists saw the data, the preliminary data back in the nineties, or maybe it wasn't even in the eighties that said that they were associated with increasing the risk of cancer, to the skull itself, which the skull is a bone. So if you have a cancer that travels to the bone, or has a propensity to go to bone, there was some concern around that now. Fast forward 15 years later, the FDA did approve a cold cap. specifically, I don't know what year it was, but about 15 years later and there appears to be safety studies already done on that. There's still echoes of those concerns though. Um, so I know that there are differing opinions out there even within the medical oncology community. Should you, or shouldn't you wear it? My feedback from patients who have done it, who have tried it is I had a lot of people quit as well because of the discomfort, you know, I think the headache induction and then just incredibly cold on their head. And they're like, they took the hair loss over the discomfort.

Leah 16:02

And when looking at up to date to see what, they discussed with cold caps, it's for patients with solid tumors only, it's not for patients with hematologic malignancies like leukemia lymphoma. Um, small cell,

Tina 16:20

mm-hmm

Leah 16:21

um, and squamous cell lung cancer, certain skin cancers, they were very, very specific as to, which cancers it's contraindicated.

Tina 16:29

Yeah. Which makes sense. wherever you put cold to the vascular system, whether it's your head or your hands or your feet, if you're putting cold to that area, you're gonna reduce blood flow, which reduces the delivery of the chemotherapeutic. And if that's undesirable, Then it's gonna be contraindicated

Leah 16:48

Yeah. So any patients that I have that are like, oh, well I was gonna take biotin during treatment. I mean, there's such debate around using biotin in the first place, but I'm like, that's like throwing a pebble at it at a giant, Like you were saying, Make sure that you're taking in all of the nutrients to grow healthy hair.

Tina 17:07

exactly. Yeah. So,

Biotin?

Tina 17:09

so biotin is one of them. Cuz if you're deficient in bio 10, you will have hair growth, regrowth,

Leah 17:16

where do you and biotin comes from eggs?

Tina 17:18

mm-hmm yeah, so I think that's, that's one that's top of mind. So if you're eating eggs, then egg yolks is a great source. And where else is it found?

Leah 17:27

Um, legumes, nuts and seeds, um, and some other stuff Liva oh, I said it. I wasn't gonna say Liva cuz I always have to say Liva like, I'm in New York

Tina 17:38

it's the only way oh, liver is also high in zinc. That's another nutrient deficiency.

Leah 17:44

Ooh. So are nuts and seeds, nuts and seeds high in zinc.

Zinc

Tina 17:48

look at that. Zinc is one of those things that a lot of people are deficient in during treatment. And I can say that because we used to test it routinely and then we just stopped testing and just assumed everyone needed a little bit because we tested enough people, um, after hundreds of people and the vast majority were deficient in zinc when they were being treated for cancer at the hospital where I was at. it was basically a lot less expensive and a lot easier to just give a, give a small dose of zinc or have people eat high zinc foods than it was to test them, which costs them money. So we just, you know, after saying the chances of this are really good. Um, so make sure that you're getting zinc in your diet, or you're taking a supplement and then protein in general, if you're low in protein, if you're not eating well, amino acids are needed. and then some other B vitamins besides biotin, which is in the B vitamin family.

Leah 18:43

is vitamin B seven

Tina 18:45

biotin is B seven. Yes. And folate is benign. Remember our folate, right? We had a folate episode anyways, um,

Vitamin B12

Tina 18:54

especially B12. So if you're low in vitamin B12, which is uncommon. in those with cancer, but does happen if you're not eating well, or if you're vegan. and then selenium, selenium is one of those with, uh, hair loss, where too little selenium and selenium toxicity, too much selenium, cause loss of hair.

Leah 19:15

So protein from animal sources has B12 in it, cuz I am not one to. Encourage people to take B12, usually during treatment, unless they have a Frank deficiency and some people may not be digesting properly because of whatever treatments they're on, you know, whatever procedures they've had, you know, from stress can kind of cause issues in terms of, um, breaking down foods. So maybe just even taking some sort of a digestive enzyme to make sure that you know, that when eating animal protein, that you're actually breaking it down.

Tina 19:53

Yeah. And for those who do have a cancer that affects their stomach or their upper intestines, um, that's one scenario where B12 under the tongue or some kind of sublingual would be needed, but that's the only one I can think of where it would be necessary. Or if you're vegan. I mean, you know, this is the other folks who might need a B12 supplement

Leah 20:13

and it doesn't need to be that super high dose. It doesn't need to be a thousand micrograms. I mean, it can be a very, very low dose.

Tina 20:21

yet it, and it doesn't have to be daily. B12 is stored up in the liver a little bit. So generally speaking, we can have enough stored up for a good six months or so. So you don't have to be, you know, it's not one of those, it's not like vitamin C, like you have to take an in every day cuz we can't store it. It's not like that. Um,

Fish oil?

Tina 20:39

I do wanna mention that in people who are losing their hair, this is slight tangent, but I wanna mention it cause we're talking about supplements. If it's due to. An androgen dominant state, meaning they have a lot of testosterone or women on aromatase inhibitors who relative to the estrogen. There's more testosterone cuz yes. You still make testosterone. Um, fish oil has been used. So making sure that you're not deficient in omega-3

Leah 21:06

fatty acids. Ooh, jinx.

Hair follicle pain

Leah 21:10

Um, I do wanna talk about something that I think a lot of people don't really think about until it happens to them. It's the, the pain that can happen, scalp pain from hair loss. Um, that is a very real thing. And it could be described different ways. You know, oftentimes people feel it when they're just, you know, the, the pressure of their head on a pillow. Um, I describe it as, as if somebody yanked your ponytail really hard, but nobody's pulled your hair and sometimes you don't even have any hair, but you have that pain. What I used for myself, after I, my head was shaved, I would massage coconut oil into my scalp regularly, and sometimes I'd

Peppermint oil

Leah 21:52

put a drop one little drop of peppermint oil to distract.

Tina 21:56

oh,

Leah 21:56

I even used that Dr. Bronner's, um, peppermint soap. On my scalp and a little, what are those, those like plastic, like shower proofs, the little plastic Lua type things.

Tina 22:08

yeah.

Leah 22:08

And I gently massaged my scalp with that too.

Tina 22:12

And that helped

Leah 22:13

I think the peppermint worked to distract and then the massaging was just to kind of keep those like the follicles and the, you know, whatever they call the Sacious glands, the oil glands in my hair, you know, my head, keep them open. Cause I, I think people don't always realize you continue to, you know, keep washing your scalp, even though you don't have hair. Um, and then I liked that gentle exfoliation just to kind of keep circulation. And

Tina 22:40

Yeah.

Leah 22:40

know, that was just a little thing that I did.

Tina 22:42

Well, that's interesting cuz yeah, I, I like that idea. That's a, that's a really nice idea.

Leah 22:47

And when the hair comes. Sometimes people get folliculitis, which is a infection of the hair follicle. And so I just figured by, you know, just gently, I'm not scrubbing until it's red, but just gently keeping that dead skin off.

Tina 23:01

mm-hmm

Leah 23:01

make sure that the oils are still coming through.

Tina 23:03

and I would imagine. The coconut on top of that also is good for the, the biome, the skin bacteria and preventing folliculitis as well.

Leah 23:13

Oh, cuz it has like an, uh, antimicrobials naturally. Yeah. And that smells good. And it just, yeah, I mean, I was babying skin that hadn't been seen since I was a baby.

Tina 23:22

Yeah. Well, on that note, some folks also go out and buy baby shampoo, which has very little in it. Burt's bees makes a nice one that has no fragrance and no nothing else in it. and I'm thinking about you adding the peppermint oil and how essential oils in general are antibacterial. Um, you do have to dilute it cuz they can also be very drying and, and somewhat irritating directly on the skin. So you, you diluted it and your coconut oil and used it that way or on the Lofa or not. It's not a Lofa, it's a, it's a scrunchy. It's a poof

Leah 23:53

it's a poof

Tina 23:54

you diluted it on your bath. Poof.

Leah 23:57

on my poof.

Tina 23:57

in any case that also worked as an antimicrobial

Leah 24:01

Yeah. But that, yeah, so, so that pain is something that is, and it, you know, some people it's painful and some people it's just discomfort. Like I said, you feel it mostly when you're still laying in bed. Um, I would think I did not try this, but I would think using like a silk pillow case would even help because that has less friction on your scalp cuz you really wanna reduce friction. so maybe like a silk or satin pillow case would probably be helpful.

Tina 24:28

Hm. I like that idea too.

Leah 24:30

And I'm trying to think, what else, what do, what do we go to next? We've got um, oh, when it comes to the hair loss in general, usually it's not immediate. It usually starts, I wanna say about like three weeks in two to three weeks in depending on your treatment. Um, and it's not just on your head. It can be anywhere that there's hair I've had female patients say like, why is my leg hair still here? Like, why have I not lost my leg hair? It's you know, it's, it's not, it's not picky. I mean, it can happen eventually. And then what I found ironic was my leg hair was the first to grow back. I'm like really, really my leg hair. Thanks a lot.

Loss of eyelashes

Leah 25:13

And I don't know other things that are kind of interesting, you know, with the, the loss of eyelashes is there are people who put on fake eyelashes and I did not do that because I held onto my last eyelash to its last possible moment. Like. Have pictures of like a closeup of my eye of like, this is my last lash, but yeah. I mean, you can use fake eyelashes. Um, they have those like magnetic eyeliners that the lash can stick to. But I mean, there are all kinds of little makeup tricks.

Tina 25:43

stop. There's magnetic eyeliner that eyelashes can stick

Leah 25:47

yeah. yeah. yeah.

Tina 25:49

me.

Leah 25:49

never used those and I've heard mixed results from people, but yes, it's kind of a weird thing. Um, I do have one tip for people who are concerned about eyebrows. you know, like people like me who really aren't

Eyebrows- Tip!

Leah 26:03

into doing a lot of makeup and aren't, don't have practice with withdrawing eyebrows on, I went to Sephora beforehand at somebody's recommendation and I learned how to draw on my eyebrows and they sold me like the brush and the little kit, and someone taught me like, this is the shape of your eyebrows, and this is how you should draw. I was great at it. I mean, you got a little art school thrown in

Tina 26:26

was just gonna say you are an art.

Leah 26:28

No, but it was like, it was, I got a good lesson too. So that's kind of a little, that's a hot tip.

Tina 26:34

All right.

Leah 26:35

I guess I could have included that in the hot tip section, but I didn't.

Tina 26:38

no, I like that. That, that's a great idea. It's kind of along the same lines of, I know, I would always advise patients who are taking a treatment that is likely to lead to complete hair loss, to go see a if, if they choose or they plan to get wig, I would tell 'em to go do that beforehand so they could see their hair. So the person who does the wigs can see the natural hair and go from there.

Leah 26:59

Oh, that's a good, that's a good segue to the coverings. Yeah. So the wig thing, I mean, it's a cranial prosthesis, right? I mean, you get a prescription the last cancer center, where I worked at had a salon

Tina 27:13

Mm-hmm

Leah 27:14

where patients could go, the stylist could see what their hair looked like. And then often they would have their hair cut a little shorter, which is another good tip is if you do have long hair transition, just don't go from long to bald, but you can transition to a shorter haircut

Tina 27:31

mm-hmm

Leah 27:32

and yeah. Get fit for a wig. You can order them off of Amazon, but why not go to a salon that specializes in this and have it cut to your face and show you how to actually fit a, a wig. I do encourage people if they want to go to Amazon order a bunch of 'em, but then yeah. Team would take that and like adjust it because that was something I really didn't know a lot about was. You cut wigs to your face, you

Tina 27:59

Uh,

Leah 28:00

and you someone who knows what they're doing so that cuz it's not gonna grow back.

Tina 28:04

yeah. And I know out in the community, cuz you worked at a cancer center that was integrative. So they were taking care of patients on an individual basis and they had a great system there. Um, down in Eugene, when I was seeing patients in my clinic, there was in the community, there was a hairdresser hair salon who. would see the patients from the cancer center specifically, and I'm guessing they took insurance and that's why the patients were sent to that particular one. And they were well versed in hair loss and how to help people out. And of course they had the other stuff there too, but seeing them before you lose your hair is ideal. I know that much, I had been told that a few times by people, people in the business. So that makes a lot of sense.

Leah 28:40

there also are

Scarves and buffs

Leah 28:42

some resources for tying scarves. Um, I used. A YouTube video series, a woman who goes by Rapunzel, w R a P Zel Rapunzel. And she is an Orthodox Jewish woman who the it's the tradition to cover your, your head. And so she would demonstrate all of these really interesting ways of doing scarves. There also is someone I'm sure there are several people on Instagram, but there's one account in particular, Natasha after cancer. And she does head wrap with tutorials on Instagram. And so that's another great resource because scarves can be beautiful.

Tina 29:29

Mm-hmm

Leah 29:30

The other thing that I found really nice because the scarves were beautiful, but they. Were hard during if you have hot flashes and then trying to take it off, it was the same with the wig. I, I wore the wig once. Um, I got a Raquel Welch blonded wig. It was really nice and it was too hot with my

Tina 29:51

Mm-hmm

Leah 29:51

And so I used a buff

Tina 29:55

mm-hmm.

Leah 29:56

through like those, um, tubes that people, Gators

Tina 29:59

yep.

Leah 30:00

that people wear and they come in a whole bunch of different patterns and colors, and that was easy. I learned that from a patient actually, and you just kind of put the tube on your head and you can tuck it underneath and it's nice to have to sleep in. Um, it's nice to just take it off if you have a hot flash and then you can put it back on without a mirror.

Tina 30:20

Mm-hmm

Leah 30:21

So those are some tips. oh, another little tip. Um, in shaving one's head is to use an electric razor and don't go straight to the skin. You wanna avoid any sort of Knicks or cuts? so don't pull out the straight razor in the shaving cream and you know, that that's really not recommended. It's typically just go with the lowest, um, guard

Tina 30:48

mm-hmm

Leah 30:49

razor

Tina 30:50

so you're saying leave just an itty bitty bit of stubble. So you're not going all the way down to the skin.

Leah 30:54

mm-hmm

Tina 30:55

That makes a lot of sense, cuz your immune suppressed during that time too.

Leah 30:58

exactly. So I think we kind of covered hair loss and so we can take a break and then come back and talk about what happens when the hair comes back.

Tina 31:08

Here's some factoid on hair. Our hair grows fastest between the ages of 15 and 30 blondes have 10% more hair follicles than brunettes And your hair grows faster in summer to winter.

Leah 31:22

All righty. So we are back, we covered hair loss with treatment, and now we're gonna talk about what the heck happens as hair starts to come back.

When hair come back

Leah 31:32

And I'm not gonna say after treatment, because there are patients where hair starts to grow back during treatment

Tina 31:36

Right.

Leah 31:37

and they get concerned. And I don't think that there's any evidence out there showing that if your hair starts to come back during treatment, that it means anything.

Tina 31:45

that I know of. I've never seen anything that gives it any kind of meaning.

Leah 31:48

Yeah. And so that's not unusual. Um, what is rare, as I mentioned at the beginning is sometimes hair does not grow back. I've only seen one patient where that's happened. So in however many years I've been practicing, I've only had one patient and she was not treated at the cancer center where I was working. It was a previous treatment.

Tina 32:11

Yeah. I think it's more common in those who undergo a stem cell transplant. So that might be some of the lymphomas leukemias, multiple myeloma. When they undergo a stem cell transplant, some of the drugs they use and the, the extremity of the dosage as well goes into that. And it becomes permanent.

Leah 32:31

Right. and as I mentioned previously, um, docetaxel is the one that's the most common for this rare occurrence of hair not coming back.

Tina 32:41

yeah, well, the docetaxel, I know that it's dose and duration dependent, And so if it's given in, in higher doses for longer periods of time, they're more likely to lead to permanent damage of the hair follicle and permanent alopecia, which is our fancy.

Leah 32:56

which is the fancy, that's the fancy term for hair loss. Yeah. We're already like towards the middle end and we just start dropping the fancy terms.

Tina 33:03

Well, we mentioned alopecia in the beginning. I think

Leah 33:06

did one of us say that? Okay. I wasn't sure. and so, as we mentioned at the beginning, it's not only hair, you know, your hair comes back, but sometimes it looks different.

Tina 33:17

mm-hmm

Leah 33:18

So chemo curls are kind of like how they're known. Amongst cancer people. And sometimes it's just that initial hair that comes back. That's curly. I remember flying from Arizona to New York to have my favorite hairdresser. Who'd been cutting my hair since like, it was my early twenties. He was the one who cut my hair officially for my very first haircut after it grew back. And he was like, yeah, I think I got those chemo curls out. And I was so excited. You know, he gave me this cute little kind of pixie cut. It was adorable that I was just so happy cuz I just wanted my straight hair back and then I kept growing and it was still curly and it's still curly to this day. So why does it happen? I don't really know because I looked throughout the interwebs and it could be because of damage from. The chemotherapy to the hair follicle. It could be hormonal changes that happen because I am now postmenopausal. And that happened during treatment because of drugs I was given to, you know, to stop those hormones from being produced. So it could be about a bunch of different reasons. Um, but yeah, it happens because that little hair shaft is a different shape depending on the texture of one's hair. And that can apparently change

Tina 34:35

Yeah. And I read somewhere that up to 65% of people who get chemotherapy hair changes afterwards when they do have a hair thinning or hair lost

Leah 34:47

permanent hair changes, like,

Tina 34:49

mm-hmm yeah. What was straight becomes curly? What was curly become straight? What was brown becomes gray? What was gray becomes brown that kind of like permanent changes. 65% in one study. And I I'm trying to find the study. If I can find it a link to it in our show notes.

Leah 35:01

Okay. Yeah. I, I remember patients complaining that, oh, my hair came back and it's curly and I would just look at them and just think like, oh my gosh, you have the most beautiful curls. Like, I wouldn't say that to them, but, you know, but in my head I'm like, oh,

Tina 35:14

Mm-hmm

Leah 35:15

I would die for those curls. Well, now I have beachy waves and I have no idea what to do with them.

Tina 35:22

Beachy waves.

Leah 35:23

Beachy waves.

Tina 35:25

learning all sorts of things about magnetic, eyeliners and beachy waves.

Leah 35:30

Oh yeah. So you could have like these haircuts that are specific for curly hair. And they are like so expensive. They're like hundreds and hundreds of dollars, which is funny because like, back in the day I used to work as a receptionist at a hair salon. That was like my first job when I moved to New York. And I remember like people getting their haircut and it would be like $200. And I thought that's outrageous to get that much money, you know, to spend that much. Yeah. If you want a specific hair haircut in Portland was like close to $400,

Tina 36:03

get outta here.

Leah 36:05

I'm serious. And so I just don't cut my hair and I pilot on my head. Like you see it. And every once in a while, I'll trim off the dead bits. Speaking of the dead bits, I do wanna mention that the cancer center salon would recommend that when. Hair comes back in when it's about maybe half an inch or so long,

Tina 36:26

Mm-hmm

Leah 36:27

which would probably be like a, a good month of growth or so to shave your head again,

Tina 36:32

shave it all the way down.

Leah 36:34

shave it back. Yep. Because it'll come in healthier. Apparently I, what I experienced was I had a lot of split ends, a lot of fuzz, a lot of damaged hair as it came in. So I, because I did not do that. I was like, oh yeah, sure. I'll totally do that. And then that, you know, you get like a half inch of hair and you're just like, I am holding onto this.

Tina 36:58

Right.

Leah 36:59

You, you're not gonna take it away from me. So I didn't do that. And I don't know. I, like I said, I eventually, I ended up buying a plane ticket and flying to New York and spending a lot more than $300 to get my haircut. But, um, yeah. Just that that's another little bit of advice for people. Is that just to kind of get rid of that, like initial hair that comes back in, I would get questions from patients as to when they could dye their hair.

Tina 37:29

okay.

Leah 37:29

So I think the recommendation is about six months. you know, as your hair gets, all of the schmutz that you know has been in your body. I mean, think about like people use hair for drug testing, right? Like if someone takes in drugs, it comes out through their hair. Well, guess what? You just got a bunch of drugs. It's gonna come out through your hair. And so I believe the thought is that the hair color might not take the right way. You might not have the right pigment and all of that. So waiting six months and I'm sure, definitely cutting your hair to make sure all of that. What did I call it? Schmutz is out I'm full on New York, this

Tina 38:07

I know you're you're full on New York. New York is coming out in you today. that's that's not a bad thing. I'm just, just so we're clear. Hey, so in an ideal world, me being an idealistic naturopath that I am, if one is on the fence about coloring their hair, then not putting chemicals on your hair is probably the ideal scenario or using pigments of nature that you might get on your hands when you're gardening anyways, or using henna or using, you know, things that are non-toxic is the ideal scenario. And just putting that out there. don't hate on the messenger. I'm just saying in an ideal world, you you're going to ingest what you put on your skin and you're taking great measures and maybe great costs, literally financial costs to eat organically and do all these things to not put things in your body. So you might wanna consider that for anything you put on your skin as well, whether it's hair dye or lotion doesn't matter.

Leah 39:00

I wish people could see my face right now.

Tina 39:02

yeah, I think if Lao was sitting next to me, she might me.

Leah 39:07

well, because. So I did, I have sort of semis stopped dying my hair and it was mostly because it started really coming in gray and I was dying it with semi-permanent like low toxic stuff, formulas. it was gentler on the hair too, but yeah, it was, I was having to dye like every four weeks. And so it was just, I was doing it myself and it was just really tiresome. Um, every once in a while I'll throw on something to kind of tone down the, the graze, cuz they're not quite coming in the way that I would like my graze to come in. But yeah, I mean, I'm not, I'm not commenting on it. I would say do use something gentler. There are non ammonia, non for Malda hide formulas. Um, there was a really cool hair color I used for Halloween when I dye my hair dark purple. And it didn't have anything that it mixed with. I don't know what was in the actual cream that I put on my head, but it didn't use a developer or anything that was just kind of smelly or toxic. You just kind of put it in your hair and it lasted for some time and it kind of tinted the, the grays purple and it was kind of cool.

Tina 40:17

well, and you know me, I, I do not. I am not vested in people's decision. I feel like each person can weigh the risk and benefit to themselves. That is not for me to do so. whatever decision someone makes is their own, because the risk benefit is a personal decision. And so my job is to define the risk benefit for people and let people make their own decisions. That's how I see it. So I just wanna say it's not without risk. That's why you move towards the most natural substances possible. If you're living by naturopathic principles.

Leah 40:48

You pick your poisons, literally pick your poisons. So there are products. I was looking at up to date to see if they had recommendations for regrowth, because like I said, they really didn't have anything for prevention other than the cold cap. Is more, you know, risk reduction. It's not gonna prevent anything. Um, one of the things I thought was interesting is that product LAIs, LAIs, which is to grow eyelashes. So it's not really a recommendation, but it's more just like this has been looked at for people to use, to help with their eyelashes growing back. Because when things grow back, they don't always grow. Like we said, that doesn't always come back the way that it was previously. Um, things that I noticed were that for years I had like waxed and tweezed my face. And when the hair came back, all that stuff that I had spent a lot of money grooming, all of that came back. So my uni brow came back. I mean, I got hair places where I was like, I don't

Tina 41:53

Wait,

Leah 41:53

it's been so long.

Tina 41:54

you saying places that you had, like, did you have something done that was supposed to be P.

Leah 42:00

Well, if you TWE your hair, like your facial hair long enough, it does stop growing back. If you wax enough, it does come back thinner or, you know, it, it doesn't, it comes back more sparingly or whatever. So, yeah, I mean, I even had electrolysis to have hair removed from my bikini line, and yeah, all of that comes back.

Tina 42:22

All right.

Leah 42:23

So that was a, that that's a little heads up for folks.

Tina 42:27

I hadn't heard that before.

Leah 42:28

The other thing, maybe it was just me then, but

Tina 42:31

no,

Leah 42:32

the other thing which I thought was interesting was, um, that, that peach fus, the VES hair,

Tina 42:39

mm-hmm

Leah 42:40

I noticed that that came back white and thick. Like I looked. Like a puppy

Tina 42:46

Aw.

Leah 42:46

in my mind, but I didn't like do anything about it. I was like, oh, this will probably just fall out or whatever. And I was like, I'm not gonna do anything about it. Cuz I had like this, like on my cheeks, I had like a, like a, Downey fur. And I was, uh, I was sitting by the pool with my husband and our feet are in the pool and we're just sitting there and all of a sudden he looks at me and he takes his finger and he brushes it along the side of my face And I was like, wait a minute. And I just stormed in the house. I got out my wax strips and I waxed my face.

Tina 43:19

Wow.

Leah 43:20

Yeah.

Tina 43:21

right.

Leah 43:21

So it wasn't until somebody like pointed it out to me that this is really noticeable that I did anything about

Tina 43:27

So can I just say you. Started the explanation by saying it was like a puppy and then ended it with your husband giving it a little like, oh, I'm so soft. I gotta touch it. Mm-hmm

Leah 43:40

Well, cuz I didn't know. I don't know how to describe it. It

Tina 43:42

I know. Well, I'm saying it, it confirms exactly what you

Leah 43:46

Oh, cuz he does like the puppies.

Tina 43:47

Um, yeah, I'm saying, I know your husband. I know he likes dogs and I'm just saying, he's like, oh, look at that. I gotta touch it.

Leah 43:53

Yeah. And he's probably listening too, so

Tina 43:56

Well, we'll find out won't we

Leah 43:57

yeah, I will find out anyways. Okay. So, um, other things that can be used once, you know, hair comes back, I have seen patients use a product called Nioxin. It's like a hair care system and I think it has minoxidil in it. So minoxidil it is available over the counter. Um, I survey. A naturopathic doctor that I know Dr. Sheia Manning. And she told me that uh, Jennifer Lopez has a product that is available also. That is a 2% Minal formula. She gave me some recommendations that some people have used for

Tina 44:39

Huh? Okay.

Leah 44:40

So,

Tina 44:41

Yeah. There's there's definitely data on Monod topical,

Leah 44:46

yeah. So it's just, I know with the ox and people had to be careful, um, to just make sure that it's not like running down your back or anything as you're shampooing, just to kind of make sure that your head's like over the sink or the bathtub so that you're not encouraging hair growth where you really don't want it.

Tina 45:03

wow. It's that good? Huh?

Leah 45:04

I don't know. That's what, that's what the stylist told me. So then that's why I didn't use it. cause I'm not that careful. Um, and then, yeah, so, and then going back to, you know, whether or not to use biotin, again, it hasn't been shown to help unless there is a, a Frank deficiency. So, but there are a lot of those products. I know there's that Nutriful product, which when you start Googling hair loss, those ads start showing up on Instagram. Um, I have no experience with that at all.

Tina 45:36

no, I see the commercials. So neutrophil looking it up online, as we speak has ashwaganda Marine collagen peptides, vitamin E curcumin, SA Palmetto, kelp minerals, resveratrol, horsetail, and keratin, and then several nutrients. Some of which we talked about bio and zinc and then selenium is in there and some amino acids and such ha UR acid. So yeah, it's a, it's a combo of everything that's kind of being researched for hair loss. so think it like a shotgun approach in that if too much testosterone is your issue, then there's SA Palmetto in there which should lower the active form of testosterone, which should lead to better hair growth. Um, Marine collagen peptides have what are called bioactive peptides in there that can encourage growth. Um, I don't know if I would go this far. That's fairly expensive for what's in it.

Leah 46:37

I think sticking with nutrition, cuz you're gonna get a lot of that from food.

Tina 46:42

Again, you know, I do go back to the, what can you get nutritionally at 79 to $90 a month?

Leah 46:49

Ugh. That's a lot of money.

Tina 46:50

It's a lot of money. So if you're paying that per month, well, you've just increased your, your allotment for groceries a little bit, if you don't take it. So I always think that there is a finite number of dollars people are using. So.

Leah 47:04

And, you know, people continue to be on different treatments. And so I just am concerned with just, you know, whatever is in a pill. You know, again, looking back to see if there are any potential for interactions, anything with biotin will potentially interact with the lab. So what I kinda like topical things I mentioned using coconut oil, you could also use, you know, Sesame oil on your scalp, um, during treatment, but after treatment, I, my hair is thinning. I also pull my hair back really tight so that doesn't help in terms of hair loss.

Tina 47:39

mm-hmm

Leah 47:40

But I do, I try once a week, I haven't done it. Months, but I was using, uh, a hair oil, an ive hair oil. Um, it, something you just leave on your scalp for 15 minutes and then wash your hair you can use it a few times a week. And that I really liked, I think when I was using it more regularly, I think I did notice a little bit more thickening.

Tina 48:02

yeah. There's several ive formulas. I have definitely tried those in patients as well. It's always hard for me to tell what's working and what's not right, because we do so many things. Patients, but I have also recommended IUR herbal formulas that are topical, topical soaks, you know? Um, yeah. And I think they help. I mean, at the very least, a lot of 'em are oil based and you're doing what is basically remember what was that called? The hot oil treatments that we used to do in the seventies and eighties VO five

Leah 48:33

Oh my gosh. Oh, that's awesome. Yeah, for

Tina 48:36

it's kind at the least at the very least you're doing that. and maybe the plants are helping. I don't know.

Leah 48:42

Yeah. I mean, they have essential oils and plant extract. So that's something that I do recommend. I used it myself. I'm to be using it and I'm just not doing it. But, um, yeah,

Tina 48:54

So basically first and foremost, we I'm gonna end it with this nutrition, nutrition, nutrition, make sure you're replete in all your amino acids and your vitamins, and that you're getting enough protein in your diet. And really it comes down to that. Cuz deficiencies will show up in hair and it'ss not prioritized as high as your organ function. So if you only have a finite amount of zinc, for example, the zinc is gonna be used by your liver before you get to make new hair with it. So just make sure you, you have plenty of nutrients going in. That's probably number one thing to do post-treatment is make sure that you get your, your nutritional status back. It's all about replenishment post-treatment cuz treatment tends to be deplete.

Leah 49:37

So I just wanna add again saying that it is more than just hair and if for any reason you feel like this is stupid, I shouldn't be so upset over something. That's so superficial. It's it's okay. I mean, for those of us who've been there. We've been there. We get it.

Tina 50:01

mm-hmm right, Well, I think we should end on that.

Leah 50:06

Okay. So yeah, we don't have a song. If anyone can think of a song, let me know. And

Tina 50:12

As usual

Leah 50:13

as usual subscribe, rate and review, speaking of subscribe, subscribe to our newsletter, I might start throwing in a few more emails. I've only sent out one, but I might do a little update every now and then and bias coffees, cuz these are long days recording multiple episodes

Tina 50:38

oh,

Leah 50:39

And on that note, I'm Dr. Lea Sherman,

Tina 50:41

and I'm Dr. Tina Caer

Leah 50:43

and this is the cancer pod.

Tina 50:44

until next time.

Leah 51:30

Liver. chopped liver beef liver.