The tiny room was spinning like an off-kilter gyroscope. I grabbed the sides of the chair with the hope that I would not fall off and further injure myself. The lights were interrogation-level bright as I closed my eyes to ward off an oncoming wave of nausea and a gnawing headache.  An unsettling buzzing near my left ear was growing in intensity as I realized that the point of no return was close at hand.

“Last chance. I don’t want to hurt you if I don’t have to. Sure you want me to do this, Sean?”

“Yes, I’m sure… I think... Let’s get it over with.”

“I’ve never done this before.”

“Me either. Go ahead and do it.”

With that, Jack Bauer, I mean my wife, Karen, took the loudly buzzing, shiny chrome clippers, placed it on the crown of my head and began shearing me like a sheep.

In my battle against multiple myeloma, the initial induction round of high-dose chemotherapy made my hair start to fall out in just a few short weeks. On my pillow, in the shower, here, there, and everywhere. Hansel and Gretel could have easily tracked me down by following the salt and pepper trail I left behind.

I was tired of dealing with the fallout, so to speak, and had no misgivings about entering the realm of the follically challenged. Not many misgivings, that is.

By the time Karen had begun Edward Scissorhands-ing me, I had already shaven off the mustache that I had been cultivating for more than thirty years. Boy, I hated to see all that work go down the drain! And with my somewhat round, Charlie Brown-esque head fully shorn, I was afraid that I’d end up looking like the Not-So-Great Pumpkin.

As Karen finished, I noticed that she had reacted rather emotionally to what I thought would be a fairly humorous adventure. With tears in her eyes, she said, “I know it’s silly, but seeing you like this makes this nightmare seem all-the-more real to me.”

Inwardly, I was hoping that she was equating the ‘nightmare’ to my battle with cancer and not to my newly christened homage to a hardboiled egg. Outwardly, my head was, well, cold.

I rose to my feet and gave Karen a reassuring hug to thank her, and then I slowly turned toward the bathroom mirror. I was, suffice it to say, a bit taken aback by what I saw.

Staring back at me was someone I vaguely recognized. When I finally figured it out, I was the one choking up.  I looked like my father. The same blue eyes.  The same upper lip. The same worried expression of a cancer patient that my dad wore a decade earlier during his short-lived battle with prostate cancer.   I was, no doubt, my father’s son—only balder.

I was diagnosed with multiple myeloma (IgG kappa) in November 2008 and began my first induction phase of chemotherapy on December 9, 2008, at the University of Arkansas for Medical Sciences’ Myeloma Institute for Research and Therapy (MIRT).

One of the things that I learned early on in my myeloma journey was that chemotherapy, in very simple terms, is designed to target and damage rapidly dividing cancer cells.

Unfortunately, also caught in the chemical dragnet are other rapidly dividing cells, such as those found in our digestive system and, yes, our quickly growing hair follicles.

In my limited experience, hair follicles damaged through chemo normally lead to your wife shaving your head with the clippers that she swears she never used on the dogs. Your experience may be different.

As a curious sort, I had wondered which of the prescribed medications I could blame for my hair falling out. Enrolled in MIRT’s Total Therapy IV clinical trial, my regimen included the following chemotherapeutic agents, which are abbreviated by the letters M-VTD-PACE:

M = melphalan ^[1] (Alkeran)
V = Velcade ^[2] (bortezomib)
T = thalidomide ^[3] (Thalomid)
D = dexamethasone ^[4] (Decadron)
P = cisplatin (also known as cisplatinum)
A = Adriamycin ^[5] (doxorubicin)
C = cyclophosphamide ^[6] (Cytoxan)
E = etoposide (Eposin)

By talking with my nurses and doctors and by visiting various cancer-related websites, such as the American Cancer Society ^[7] and the American Society of Clinical Oncology ^[8],  I discovered that doxorubicin often causes significant hair loss in patients.  Etoposide’s effects range from mild hair thinning to total loss, and cyclophosphamide is very likely to cause hair loss.  Melphalan, in the dosages we myeloma patients use, often times causes follicle damage, while cisplatin doesn’t usually cause hair loss.

But as they say, individual results may vary. Some people lose hair, and some people don’t. Go figure.

Over a nine-month period, I underwent four rounds of M-VTD-PACE (two induction rounds and two post-stem-cell-transplant consolidation rounds), and my hair, everywhere,  was missing in action the entire time.

Interestingly, I have now been through nearly two years of weekly maintenance chemotherapy with the VRD regimen (Velcade, Revlimid ^[9] (lenalidomide), and dexamethasone), and my hair eventually came back in its original pre-cancer color, texture, and geographic location.

One of my warm-hearted research nurses quipped in her Scottish brogue, “I wish for you that your hair comes back shiny red, twice as thick, and oh so curly!”  I’m not exactly sure what I ever did to her to deserve that sentiment! She probably wished freckles for me, too.

It should be noted that most chemotherapeutically-driven hair loss is usually not permanent. It may initially come back a bit different in texture or color, but given time and the stoppage of offending medications, one’s hair often returns to its original state.

In my hairless days, I chose to treat the condition as a minor inconvenience and always had a ball cap and a sense of humor handy for going out and about.  A case in point:

While undergoing my M-VTD-PACE treatment in Arkansas, I was afforded a couple of opportunities to come home to Missouri for short breaks to recuperate.  It was during one of those breaks that I was feeling well enough to go to a Sunday morning church service.

Karen and I planned to slip into the service and then leave quickly as I didn’t want to shake the hands of dozens of well-meaning, but germ-wielding, congregants. I also didn’t want any of my numerous fractured bones further crushed in the countless bear hugs that I knew would come my way.  But before we could make a getaway, we were surrounded by several of the lively, spirited, and caring gray-haired ladies of the church heading toward the kitchen.  After a few pleasantries were shared, the conversation went like this:

“Take off your hat, Sean!  Being bald is very ‘in’ these days.  Men are cutting their hair off all of the time.  Some even think that it’s … sexy.”  I guess the ring leader said this to make me feel better, but more likely to have a little fun at my expense. They all, including my wife, chuckled at my embarrassment.

Not one to leave a feisty volley unanswered, I replied, “Thank you! But you know, most guys don’t go so far as to shave their eyebrows, too. That takes commitment. I think that your heartthrobs, Yule Brenner, Telly Savalas, and Uncle Fester, actually had eyelashes and eyebrows. Wimps. And here I am, no hair on my head, no eyebrows, no eyelashes, no chest hair… do I need to go on?”

You’ve never seen a gaggle of giggling church ladies run away as fast as they did.  Karen just gave me that ‘I know you can’t help yourself, but for the sake of the kids, let’s not get kicked out of church’ look before she grabbed me by the sleeve and drove me home.  Those ladies didn’t make any eye contact with me the next time I made it back to church.

Of course, it isn’t just the hair on your head that goes AWOL. I must say, it sure made showers, shampooing, and shaving a breeze.  And for a year I didn’t have to contribute to the billions of dollars of revenue that the hair care products industry receives, although I probably ratcheted up my spending for ball caps, stocking hats, and sunscreen.

Cancer patients can be physically and emotionally affected by chemo-induced hair loss in many different ways. Some see it as a non-event, just an inconvenient speed bump to put up with and laugh off. Others are devastated at the thought of losing their hair. Perhaps it’s a concern about one’s ‘not normal’ outward appearance to the world or dismay with the fact that cancer has taken away more control over us than we want to give it.

Talk to your medical professionals if you need help dealing with any side effects of chemotherapy, including hair loss.  Connect with reputable cancer agencies, hospitals, oncology clinics, support groups, and fellow patients to discover where you can find wigs, hats, scarves, turbans, and the like, to make your experience more comfortable.

In any event, I wish you good health and exciting haircuts in the future!