Ask Dr. Etingin: Preventing hair loss from chemotherapy; Sleep apnea and anesthesia
Is there a cap that can be worn when receiving chemotherapy treatment that can help keep your hair from falling out?
You’re probably referring to a device called a “cold cap,” which helps some women keep some or most of their hair during chemotherapy treatment. A cold cap looks similar to a swim cap; it fits tightly on your head and is filled with a gel coolant that’s chilled to between -15 to -40 degrees Fahrenheit. Other devices that can help prevent hair loss are called “scalp cooling systems.”
Cold caps and scalp cooling systems are said to work by narrowing the blood vessels beneath the skin of the scalp, which reduces the amount of the chemotherapy drug that reaches the hair follicles. The cold also decreases the activity of the hair follicles, which slows down cell division and is believed to decrease the effect of the chemotherapy on the follicles. Studies have shown that cold caps and scalp cooling systems were considered highly effective in 50 to 65 percent of the women who used them.
You wear the cold cap or scalp cooling system before, during, and after each chemotherapy session.
Cold caps are similar to ice packs. They are kept in a special freezer before they’re worn. Cold caps thaw out during a chemotherapy infusion session and need to be replaced with a new cap about every 30 minutes. Women usually rent the caps and the special freezer. The cost of using the caps varies depending on the manufacturer and how long you will be using the caps. Check with your insurance company to see if they cover some or all of the cost.
With scalp cooling systems, the cap is attached to a small refrigeration machine that circulates liquid coolant in the cap, so the cap doesn’t need to be changed during chemotherapy. An outer cap is then placed over the first cap for insulation. Usually, scalp cooling systems are purchased by cancer treatment centers, and patients then pay a fee to use the system. It is estimated that the cost of using a system during a complete course of chemotherapy is between $1,500 and $3,000.
If you’re interested in trying a cold cap or a scalp cooling system, talk to your oncologist about whether they are appropriate for you.
My doctor has recommended that I have hip replacement surgery, but I have sleep apnea and I’ve heard that it’s dangerous to have general anesthesia with this condition. Is this true, and, if so, why?
It is true that people who have sleep apnea and are given general anesthesia are at increased risk of respiratory complications during and after surgery.
The most common type of sleep apnea, obstructive sleep apnea (OSA), occurs when the muscles in the throat relax, causing tissues to block the airway and interrupt breathing. General anesthesia further relaxes the upper airway muscles and slows your breathing. In addition, OSA can make you more sensitive to the effects of anesthesia. If your breathing slows down too much, you may stop breathing. It’s also common for people with sleep apnea to take longer to regain consciousness following surgery.
Clear communication is key for reducing the potential dangers associated with general anesthesia. Informing your doctors and the anesthesiologist that you have OSA prior to surgery means that you will be very closely monitored during and after surgery to ensure your breathing isn’t compromised. Knowing you have OSA also may influence the choice of anesthetic the anesthesiologist chooses to use.
To reduce your risk of complications, be sure to follow your surgeon’s pre-op instructions closely. If you use a continuous positive airway pressure (CPAP) machine, take it with you to the hospital so you can use it once you regain consciousness and during the remainder of your hospital stay.
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