PITTSBURGH (KDKA) - Amanda Agwuocha, a mother of four young children, was facing breast cancer, chemotherapy and losing her hair.
Knowing her cancer would show in this way, or having to hide it with a wig was distressing.
"It was something that was going to be difficult for me to change my appearance for my children," says Amanda.
"One of the first things patients express when they hear the word chemotherapy is am I going to lose my hair, and how quickly?" says Dr. Shivani Duggal, a breast surgeon at the Allegheny Health Network.
Amanda's sister-in law suggested she try cold capping.
The idea is to apply a cold, fitted cap to the head during chemotherapy to constrict the blood vessels and keep the anti-cancer medicine that targets rapidly dividing cells away from the hair follicles.
"Chemotherapy is unfortunately toxic and not very selective," says Dr. Duggal.
"It wasn't painfully cold for me. I felt like I had maybe been out on the ski slopes all day long and had that little edge of chill in me, but it was definitely tolerable," says Amanda.
Cold capping involves bringing coolers of dry ice to the chemo treatments, protecting the face and ears with self-adhesive pads, getting the caps out of the dry ice, checking the temperature of the cap to make sure it's cold enough, fitting it to the head, securing it with a swim cap, strapping it all in place and setting a timer.
Eight cold caps are kept frozen in the cooler for rotation every 15 minutes, starting 45 minutes before chemo, during the intravenous infusion, and after the treatment for four hours.
It takes a devoted assistant to coordinate this process. Her sister-in-law watched a training video to learn what to do.
Studies of scalp cooling have conflicting results. The best outcomes have been from the Netherlands, and perhaps the type of cap or how it's used is different there.
The FDA has cleared certain cooling caps, meaning the agency deems them safe, but not necessarily effective. This was based on a clinical trial of 122 women getting chemotherapy for breast cancer. More than two-thirds of the women reported losing less than half their hair.
"It doesn't always work. Personally, I've seen it not work as well as it should," says Dr. Duggal. "If the hair is retained, it's not 100 percent."
The cold caps run $300 to $600 a month to rent, plus supplies in some cases.
There were moments Amanda had her doubts.
"Well, it's too good to be true, so does it really work?" she asked herself. "I kind of went back and forth, like is it worth it, is it not worth it? It does cost money, and my insurance did not cover that."
"It's an out of pocket cost, it's not mandatory," Dr. Duggal cautions, "It's not something that's indicated for breast cancer treatment."
Amanda says it did work for her.
"After the first round, I didn't notice any shedding of hair. After the second round, I did start to shed hair, but it never like bald spots of patching," she describes. "I would just go through my hair like this, and hair would shed. I'm two months out, and obviously you can see I still have hair."
All the while, she kept the big picture in mind.
"My life was number one, the most important thing. My hair is not the most important thing," she says.
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