Chemotherapy Preparation for Cancer

My post-surgical treatment was chemotherapy only. I don’t have experience with radiation or immunotherapy, though I’ve had friends and family members who’ve had both. No treatment is fun. All have side effects and risks, both short and long-term.

Before Starting - Buying Wigs or Preparing for Cold-Capping

Chemotherapy is the type of treatment most likely to lead to significant or total hair loss. Chemo is a bomb that kills all rapidly-dividing (cells that grow fast) cells in the body. Cancer cells grow rapidly, but so do healthy cells like hair and nails, which is why you lose your hair and why your nails stop growing during chemotherapy cycles.

Many people want to know how long it will take for their hair to fall out after their first treatment. The answer is, “It depends.” The type of chemo and how your body reacts seems to create some variety, at least based on what I’ve learned from discussions with other patients. In my case, the hair started falling out in clumps within days of my first treatment. I was glad I already had wigs ready to go.

I didn’t shave my head, I cut my hair short. But it didn’t matter because it fell out so quickly. I chose to purchase wigs rather than cold-cap because cold-capping wasn’t a thing when I first did chemo in 2008. Wigs are generally not covered by insurance (though you may be able to claim a tax deduction if it’s prescribed by your doctor as a “cranial prosthesis”) so you’ll have to pay for them (or scarves/hats) yourself.

They vary quite a bit in price but in my experience owning at least one wig that is of decent quality is worthwhile. I didn’t buy any human-hair wigs, which are most expensive. But I was only going to be bald for about 6-8 months total so I didn’t see the need.

I DID have fun with it (as much as you can) by purchasing five wigs of varying colors and styles. Two were “everyday” wigs that looked natural and could be worn to work and out in the world. Three were very different cuts and styles that I only wore for fun. Still, I managed to enjoy wearing them. I styled them with clips and barrettes, named each of them to give myself an alter-ego while wearing them (I had Patty, Jackie, Reddy, 90s-b****, and Anchorwoman.)

You might want to purchase some kind of soft cap to wear beneath your wig to protect your scalp. Almost like pantyhose. They can be hot and itchy and a cap can help. I also bought a soft cap to wear when I slept because I couldn’t wear the wig to bed and didn’t want to be bald in front of my husband. That was my choice, but I could see others feeling the same. And then there are some of you who wear your baldness everywhere with pride. I think that’s awesome. It just wasn’t me.

Cold-capping is a process used to help reduce hair loss. I have yet to hear of it stopping hair loss entirely, by the way, but it can reduce it. I’ve had friends who’ve done it. If you are considering cold-capping (I discuss this more below), you’ll want to discuss it with your doctors and hospital so a.) they KNOW you want to do it and are scheduling the machine on your infusion days, b.) have it prepared for you on those days and expected, and c.) YOU are ready for the extra time the process tacks on to your infusions because you have to get there earlier if you’re cold-capping.

Pre-chemo testing

Prior to receiving chemotherapy, you’ll undergo pre-treatment testing to make sure you’re healthy enough to receive chemo. It will also include your complete blood cell counts. Chemo kills rapidly growing cells, including the blood cells being grown in the bone marrow in the middle of your bones (where new blood cells are created by the body). This can include red blood cells, which carry oxygen and contain hemoglobin with iron in it, and white blood cells, which are responsible for fighting infections. The reason they test your counts before starting is to make sure they are healthy and get a baseline for you. The chemo may lower your blood cell counts and is something they will check each time before the next dose.

Infusion Day - Cold-capping

Cold-capping is a process used to try to reduce the hair loss that accompanies most chemotherapy. You have to begin the cold-capping an hour or more before receiving the chemo drugs, keep going during the infusion, and may have to continue for an hour or more after the infusion of drugs is over. Patients wear a tight-fitting cap on their heads that freezes the scalp down to temperatures that constrict the blood vessels feeding the hair follicles. This helps reduce the amount of chemo drugs that can reach the hair follicle and kill the new hair cells.

From what I’ve been told, it is painful. Some say the pain is not that bad, others say it’s like a continuous migraine. It may reduce hair loss but many patients still end up wearing wigs or scarves because the hair preservation is not enough for them to feel comfortable. Still, many who’ve done it are glad they did. It’s a personal decision. Just know if you’re going to be doing it that your infusion days will be longer. 

Chemo cycles

Chemotherapy can be administered in pill form or as intravenous infusions or injections. I had infusions. These are given in “cycles,” meaning that the drugs are pumped into your veins so they can be circulated throughout your body, then there is a period of time in between to allow the drugs to work, and then wear off enough that you’re ready for the next dose. You may have a device put into your body called a port to make the administration of the chemo easier. In my case, I did not have a port, they just inserted a new IV with each infusion.

I had six cycles of Taxol and Cisplatin, the latter being a platinum-based drug. We still lean hard on the toxicity of heavy metals to kill cancer. My infusions were given three weeks apart.

They don’t just include the chemotherapy drugs. My infusions also included steroids and Benadryl to reduce my body’s inflammatory and allergic response. The first time I received those, I actually had an allergic response to the Benadryl itself because it was such a large dose. They almost had to give me an Epipen. It was scary when the nurse noticed my shortness of breath and left for a moment. But she returned swiftly with an oxygen tank and a whole team of people. They were ready and it all turned out okay. I started breathing normally again, the reaction stopped, and I was able to receive my first infusion.

It never happened again in subsequent infusion cycles.

But s*** happens.

You just work with the professionals around you and tell them how you feel. When she asked if I was having trouble breathing, I said, “Yeah, I am.” I didn’t say, “No, it’s all good.” Or “I’m fine.” Good thing, because I wasn’t fine. Don’t downplay pain or gloss over weird feelings. This is your medical professionals’ job. They want you to tell them everything so they can step in and help you when needed.

Chemo is cumulative

Chemo is cumulative, meaning the effects of the drugs (poisons) build upon each other over time. This is likely to make your side effects feel worse the longer (more treatments) you’ve been doing it. I can say that was true in my case.

I got through my treatment program with grit, like everyone else. The first week after a cycle, I’d feel like I had the flu. The second, like I’d had the flu the week prior. By the third week after treatment, with the next looming on the horizon, I’d feel most like myself. I could eat a bit and engage in light exercise. Over time, each cycle of chemo had a bigger effect on me, making me more tired, achy, and nauseous than the one prior. This is typical with chemotherapy.

You will have the full blood tests each time you do a chemo treatment to make sure your blood cell counts aren’t dropping to dangerous levels or your other organs aren’t showing signs of stress (heart, liver).

If you’re doing chemo during cold and flu season they will want you to get a flu shot usually, because your own immune system will be depressed by the chemo. Now they may also recommend COVID shots, I’m not sure.

You get to know the drill though. When you have infusions they take time. Mine took about 3-4 hours. They have you sit in a recliner-like chair or in a hospital bed and wait it out. Some of the drugs they give like Benadryl may make you sleepy. I tended to drift in and out of sleep. Some people bring things to read or movies to watch. You may have friends or a partner join you to chat while you receive the drugs.

It’s a hospital and all hospitals are kept at 1000 degrees below zero for some reason, so I recommend bringing a BLANKET or warm jacket you can place over yourself. It’s hard to wear a sweatshirt because you can’t take it on and off over the IV/port so that’s why I say blanket or jacket (which you can use like a blanket). If the hospital offers you blankets, I’d say yes. Worst case, you don’t use them. But being cold in a hospital while being pumped full of nasty drugs is a pretty crappy feeling so at least let yourself be WARM if possible.

Individual Experience

Every response to chemo is individual. I have a friend who did the same treatment protocol as a first cousin with the same cancer and they had vastly different side effects So know that what I share below is my experience. My individual response to treatment. I kept in good touch with my doctors and followed advice that was given to me about the drugs—what to expect, as well as side-effects.

I had minor nausea, but food mostly tasted either bad or like nothing. The only exception was Wendy’s Frosteys for whatever reason. I ate a lot of Frosteys. Whatever you CAN eat, do it. This is not the time to worry about weight loss.

I didn’t lose much weight and I was able to exercise the third week between cycles. It was FAR less. I was used to running five miles three times per week. During chemo I plodded along for about a mile once or twice. But it felt great being out there. Like I was still alive. I recommend doing whatever you can that brings you joy and keep your body moving, even if your walk is now a shuffle. It reminds your body, mind, and spirit that you’re still you.

I did lose ALL my hair including eyebrows, eyelashes, everything. For some reason I kept getting carded??? Does being without eyebrows make one look younger? I don’t know. I was wearing decent wigs so I felt like I looked pretty normal but obviously people could tell something was off. It took about a month after treatment was over for peach fuzz to return. By 6 weeks I had a buzz cut and stopped wearing wigs because I was so sick of them. They are hot. And itchy. Even the nice ones.

I was fatigued and achy, particularly the week after chemo. The fatigue got worse with each cycle. I still was able to work most days and did to keep myself busy and distracted from cancer-world. But some people face crippling fatigue that prevents them from working, or deeper aches, or neuropathy, or other side-effects specific to their chemo. In my case, I developed tinnitus (ringing in the ear) and then 10 years later, major hearing loss in one ear. That’s likely due to the Taxol. I will never know for sure but that’s a possible side effect of Taxol.

Here’s the truth. Chemo absolutely sucks. You’re poisoning yourself in order to take out an enemy within.

But did I get through it with jokes and heart?

Yeah.

Eventually.

And so can you.

Some other forms of treatment you may have to prepare for:

• Surgery

• Radiation

• Immunotherapy