To my patient who is going to lose her hair from Chemotherapy

Dear patient,

I understand that the biggest fear you have about going through chemotherapy is that you will lose your hair. I just want to tell you. You will be fine. Trust me.

I know it’s barbaric. In this day and age, why don’t we have medicines to treat cancer that will not make you lose your hair? Strange, right? But science has its limits. Work is being done on finding such drugs but we are not there yet. If you google “Forced Standing,” a black and white picture of a girl from a couple of hundred years ago pops up who is being forced to stand, by tying her neck and arms with ropes to the ceiling and walls. Her head is slightly slumped over to one side as if she does not want to stand. The caption will inform you that this is actually how clinical depression was treated at that time. The idea perhaps was that if someone is depressed and is lying in bed all day, forcing them to stand up would somehow cure depression. When we look at that picture today, it seems like a scene out of a horror movie. Whoever I have shown that picture to, has gasped. But at that time, this treatment was likely endorsed by some, if not all, psychiatrist societies of the world. Human history, after all, has no deficit of theories and rituals that were popular at the time but later considered abhorrent.

Now we think that we are living a very modern life. We are proud that medicine has advanced tremendously over the last few decades. The human life span has doubled over the last century due to medical marvels like vaccines and antibiotics. But we don’t realize that still, some of our medical practices would be considered barbaric and horrific after a century or two. One of them will be the fact that we had to give a drug so toxic to kill cancer cells that it would destroy normal cells too. A man of the next century will gasp similarly when shown a picture of a woman from today, bald as a result of her cancer treatment.

But describing chemotherapy like that falsifies its perception in people’s minds. As of the current knowledge of human beings, it still is the best treatment out there for cancer. Thankfully, most of the new categories of anti-cancer treatments do not cause baldness but we are still a few decades away from having these new drugs fully replace chemotherapy but the era has already begun.

For as long as we are stuck with chemotherapy, you will have to take it. It will save your life. Yes, you will lose your hair after a few weeks. Most women tell me that they are fine for the first couple of weeks but then they start having chunks of hair coming out, typically while taking a shower. From then on, depending on the chemotherapy regimen you’re getting, it comes out fast and you are left with very thin hair with your scalp showing. Some women, once the hair starts falling, will get their hair shaved saving themselves from the trauma of losing more hair every day. Get rid of it all at once, they say.

As your oncologist, I have to worry about dozens of very serious side effects that you can get from chemotherapy. Several of them can actually end your life before the cancer does. From that standard, losing hair does not seem to be such a big deal. You lose your hair to save your life, not a big deal. But I am not so cruel or stone-hearted not to understand that your worries and perception are different than mine. You are not thinking about neutropenic sepsis or disabling neuropathy. You are worried about how you will look. Will people look at you with sympathy? How will you face people? I want you to know that your worries for yourself are as important to me as my worries for you. So please allow me to try and allay them.

For how long have you had the same hairdo? Most women (and men) tell me that they have had the same hairstyle for so many years. We are so resistant to change in life. But change can be refreshing. It can be uplifting. Look at movie stars. Look at Tom Hanks and Meryl Streep. They are always changing their looks and appear in each new movie with a new hairdo. We get so used to their different appearances that we don’t even remember what their “original look” is like. In life, we all know some people who are changing their appearances not too infrequently and we learn to mentally accept them in any of their getups. Some women who I have seen that deal with losing hair from chemotherapy best, are always “rocking” new looks at each stage of their treatment. They either carry a bald look or use very beautiful and cool scarves and bandanas. Others use wigs that, please don’t tell them, often look better on them than their own hair! When their hair starts re-growing, they have a new way of styling any length of hair. They look beautiful at any stage of their hair loss and regrowth.

You should also know that your fear of losing hair is actually your fear of the opinion of others about you. If you were to be alone for those months that you would lose your hair, you tell me that you would be fine. You would not want to see people or go to places and rather stay at home.  I understand that can be intimidating, but I want you to identify this fear and tell yourself that the last thing you should be worried about is “what would people say.” This is your body, you are fighting a deadly cancer and it is nobody’s business to think or say anything about how you look. In fact, this may just be in your head, because any person who knows and loves you and is caring for you right now, will accept you any way you look.

Think of it like when you were pregnant and had your baby. You went through several months of nausea, bloating, weight gain, and other unflattering symptoms. Your body was changing as you could never imagine. There was a point when you looked at yourself in the mirror and became tearful at your appearance. After your baby was born, with some effort, your body went back to close to where you wanted it to be. In fact even more beautiful than prior. You developed the glow of a new mom. When you look at your child, you have a feeling that it was all worth the effort and you would be willing to go through a hundred more pregnancies like that to have your child. Losing your hair with chemotherapy is similar where the reward is in the shape of a saved life.

Trust me when I say that I feel as frustrated as you do about losing your hair to chemotherapy. But this is the best I can do for you. For now.