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Part 1: Hair, Hair Loss and Cancer as a Woman of Color

In this two part series, StyleEsteem Founder Sonya interviews Dr. Alexea, a cancer survivor and Infectious Disease and Internal Medicine Physician, on her hair insights as a woman of color who faced diagnosis and hair loss.  

Sonya: Dr. Alexea, before we get started, tell us a little bit about yourself.

Dr. Alexea: I am a breast cancer survivor who was diagnosed with Stage 3 breast cancer at age 37. My treatment included 8 rounds of chemotherapy, 25 cycles of radiation, and a bilateral mastectomy with reconstruction. I am also a triple-board certified Infectious Disease and Internal Medicine Physician, a speaker, an author, a coach, and a mother.

Sonya:  Let’s talk about the terminology around different hair types. What are some words that are helpful in describing different hair types, including your own?

Dr. Alexea:  The best way to do it is just to describe the hair. Is it straight? Is it wavy? Is it curly, you know spiral vs ringlet? What about texture? Is it more kinky or coarse?

There are also a range of “Types” when we talk about hair. Bone straight hair being Type 1 hair, and really tightly wound, coily or even zig zag hair being Type 4 hair. And then there are gradients in between – 2A, 2B, 2C, 3A, 3B, etc. This depends on the nature of the curl pattern.

The wonderful thing about the internet is there are so many charts and tools to look at to help you determine what your hair pattern is. This helps you describe your hair to someone else who may be taking care of it for you. It may help you pick out hair products or styling techniques that are better for your particular type of hair pattern.

For example, if your hair is more on the 4B or 4C side where it's more curly, coarse or kinky, it may not take to certain types of styling methods. So coloring it, and using products that straighten or loosen the hair maybe a little more challenging. Cause even the way you would handle and comb the hair – or maybe not comb it – makes a huge, huge difference.

It also helps to know your hair type so you can better communicate your needs to a stylist and find someone who knows how to work with your hair type. In fact, the way in which we characterize our hair came from a black hairstylist, to help women of color identify and take better care of their hair. So it's just another tool in our arsenal to care for our hair.

Sonya:  That’s such a great point because there are an infinite number of hair products out there – for shampoo and conditioner alone! Hair Type is a really helpful way to navigate your own hair products and routine. What is “porosity” and how does that play into hair care?

Dr. Alexea:  Porosity determines how well the hair absorbs water or moisture. High porosity hair absorbs water and product really well, so it will dry really quickly. The moisture gets absorbed by the hair shaft itself and you don't have the issue of products caking up and sitting on top of your hair. On the flipside, this hair is also prone to getting frizzy and tangled.

And then of course, low porosity hair would be the opposite. It's more challenging to get the hair to absorb water and moisture. One helpful technique is using warm water when you're putting products in your hair to help the hair to take up the water better. Or you can steam it or use heat.

Sometimes women will put a plastic shower cap over their hair and sit under a hairdryer to help seal in moisture to the hair and scalp. I can always recall seeing this at black hair salons and not really understanding why. Nobody talked about it, we just did it. And now, going through this process, I know.

Sonya:  So there are lots of little hair hacks that you use, if you know exactly what type of hair that you have.

Dr. Alexea:  Exactly, knowledge is power!

Sonya:  On that note, I know this can be tricky for those who want to be respectful but still acknowledge the uniqueness of different hair types. What are some terms that are not okay for someone to use when talking about your hair type?

Dr. Alexea:  Nappy. It's just not an okay word. It's derogatory. I can remember hearing that word so many times and it’s never been nice.

The worst scenario was when I was a trainee and had to attend deliveries and care for the babies being born. There was a white woman who gave birth to a biracial baby. She was there with her family. And the second this baby is born, they hand us the baby because it was a high risk delivery. The grandmother walks over to the little incubator table we're working on the baby on and she says, “Looking at that nappy hair!” I was mortified. Like, this baby is a minute old. And the baby's hair is already being stigmatized and talked about in a way that is derogatory.

From birth, the world wants us to conform. There are laws written about if our hair is acceptable. Is it professional? Can it be worn in its natural state? Does it comply with the school dress code? And this is a worldwide problem. So, I think you could use any word and be hurtful and derogatory, but yeah, just don't call my hair nappy.

Sonya:  Yeah, there are certain words that just have that tone. There's really not a nice way to use that word. It doesn't matter what your intention is really. What about “kinky”? Is it okay for someone outside of your community to use that word when describing your hair?

Dr. Alexea:  If you are using that word to describe a hair type, then I think that is okay. I know it’s hard because we're having these conversations and we're all just trying to help one another and be inclusive. As long as you're being thoughtful and sensitive that's all that really matters, you know?

Sonya:  Exactly! And I think it’s important to not use kinky interchangeably with race or skin color terms like “African” or “black”. Kinky should be used to describe hair, and hair alone.

Dr. Alexea:  Right. Because black people can have fine hair, bone straight hair and so on. We are all unique human things.

Sonya:  Agreed! What was your hair identity like earlier in life and leading up to the cancer diagnosis?

Dr. Alexea:  When I was a child, probably 9 or 10 years old, my hair was relaxed.

Sonya:  What exactly does it mean to relax your hair?

Dr. Alexea:  When you relax your hair, you use a chemical compound which usually comes in a cream. It contains lye or a substance like it that chemically straightens your hair. So it literally strips all the hydrogen bonds out of your hair that holds your curls, and makes your hair bone straight.

Now, the interesting thing is, my mother never intended for my hair to be relaxed. It was long, it was curly, but it was very manageable. And I was not a kid who was what we call tender headed. That’s when you're very sensitive to someone touching or manipulating your hair. So getting my hair done was not painful for me.

Even as a kid, I was very much in love with my hair. I loved getting my hair beautified and getting my hair braided. My mom was such a great nurturer of our hair. She would sit us on the floor, she'd sit on the couch and you know, we turned the TV on and everybody would get their hair done. I have two sisters and we all have completely different hair types, which was always interesting to me.

So when it comes to the hair relaxing, this happened by mistake because the beautician misunderstood my mother. And relaxing is one of those things that once you start, you kind of can't stop because the hair will break off. So you either make the decision to grow all of your hair out or cut it off because the hair is permanently changed.

When other people say they perm their hair, they're getting permanent curls. But when we say perm, we're actually getting a relaxer and we're permanently straightening our hair. So I had relaxed hair most of my life. There were a few years in between where I had cut off my hair and grew it out. But the vast majority of my adult life, I relaxed my hair.

Sonya:  When did your view on relaxing your hair change?

Dr. Alexea:  When Kennedy was born, as a mom, I decided I wouldn't want to do that to her hair. So I stopped relaxing my own hair and I had to relearn my own hair, how to take care of it. It took me almost two years to find my own curl pattern, and figure out what hair products worked for it. Finding my curls helped me fall in love with my hair again.

Sonya:  How was the mental process for you initially when you were diagnosed and realized you’d lose your hair?

Dr. Alexea:  I was really at a great place with how I felt about just myself overall as a woman, you know, appreciating and respecting my body. Loving how I looked. Loving my hair. And then, here comes cancer and it's like, my body's betraying me. I'm cutting off my breast. I'm going to lose my hair to chemo. Like you gotta be kidding me. So I was kind of devastated that I was gonna lose my hair. But rational me put mind over emotions and said, listen, you’ve got to lose your hair. And it's a small price to pay to get back your health. It's a sacrifice, but you will get through it.

So as my hair started to fall out, I just sort of embraced it as part of the process. But for my sisters, actually, it was very traumatic. Because I was recovering still from my mastectomy, doing things like washing or styling my hair was challenging. So they helped me get dressed and do my hair for the times I had to go to chemo right after surgery. And they saw firsthand when the clumps of hair started to come out.

Sonya:  How did you cope with this clumps? Did you consider getting a haircut?

Dr. Alexea:  I was a weirdo about my hair. I couldn't bring myself to shave it off until as much of my hair that was going to fall out had fallen out. And I had like a hundred little strands of really gangster hair that just wouldn't let go. I look like Smeagol or something. I finally decided to cut off the rest of it to give myself a clean baldy. And that to me was so beautiful, when I just cleaned up my scalp and I was perfectly bald and I was just there seeing myself fully for the first time. And I was like, wow, I never appreciated my face until I didn't have hair on my body.

I was always the girl with, you know, the Aaliyah sweeping bangs, pulling my curls or twisting my hair, and it fell in my face. And when I didn't have hair to hide behind, I finally saw myself and I'm like, wow, I’m kinda cute!

Sonya:  So it seems like your lifelong hair journey was not just experienced by you, it was also experienced by your tribe – your sisters. And such an important part of your cultural identity going missing, taught you a great deal about yourself. How did hair loss affect other aspects of your beauty routine?

Dr. Alexea:  Not going to the salon as much was a big change. The salon is not just about getting your hair done. And you don't just walk into a random place and let anybody do your hair. Your stylist is your lifelong friend. It’s the person you spend a lot of time with, especially venting and talking about stressors and how that may be impacting your hair. It's just a very community oriented and nurturing space.

And so to have months and months of your life go by where you don't get to have that particular self-care experience is hard.

 Sonya:  How did you lean into other aspects of your beauty during hair loss?

Dr. Alexea:  I felt like, alright, my face is all out here. I can't hide it. But I don't want to look sick. Prior to chemo I had never penciled in or filled my eyebrows. Other than my wedding day, I don't think I had ever worn false eyelashes. I certainly had never put them on myself. And so, dressing up my face became a thing. I found myself paying more attention to other aspects of my beauty regimen compared to what I did in the past because chemo was very hard on my skin and I no longer had my hair to hide behind.

So, filling in my eyebrows, wearing mascara and winged eyeliner, putting on a little eye shadow and a bright lipstick became very much a part of my pre-chemo routine. In my previous life, if I put on makeup it was because I was going out. I rarely wore makeup to work beyond some lip gloss. And I realized, in retrospect, I spent a lot of my life hiding. And now, because of chemo and hair loss, and being sick with cancer and not wanting to be seen as this sick person, I stopped hiding. And I started presenting myself the way I wanted to be viewed. And I wanted to be viewed as someone who was beautiful and confident and thriving when I was going through cancer treatment.

Sonya:  The way you perceive yourself during that time is such an important thing. It can make all the difference in how worthy you feel of healing and of coming through something like that.

I know you loved your bald head, but did you attempt to wear a wig?

Dr. Alexea:  Well, my oncologist said to me, on day 16, 17, your hair is going to just drop and it's not gonna come out slowly. And on day 14, a whole twist fell off my head. I remember thinking, oh my God, it's starting. At that point it started to fall quickly, which I wasn’t expecting. I thought I had time to shop around and decide what head wraps I’d wear – I hadn’t met you and had a wonderful StyleEsteem head wrap yet. And it was getting to a point where I couldn’t cover the bald spots with a head band or comb over.

So my ex-husband brought me my wig – probably more out of concern for our daughter Kennedy. Especially when taking her to family events, like our summer barbeque, it helped me blend in as I worked on embracing my baldy.

Sonya:  Did you notice any side effects from wearing the wig?

Dr. Alexea:  I remember how tender and sensitive my scalp was and that having the wig on was very uncomfortable at first because my scalp just felt very raw. I knew I wasn't going to be wearing a wig every day because it was just too uncomfortable for me.

Sonya:  As a woman of color, how did your wig shopping experience go?

Dr. Alexea:  At first I thought this would be a chance to experiment with wigs, maybe with bold colors or fun cuts. And in reality, it became very painful and hard. I bought some bad wigs online in my desperation to have hair. Like, who can deliver what the quickest? And some things were like literal trash. I just threw those in the garbage. I can't even.

And so there's just so much trial and error that you don't expect when it comes to having a wig. You think it’s going to be “Do I like this hair?” and you put it on your head, and that’s that. Meanwhile, does it even look natural on your head? Does it fit your face? Does it fit you?

And then the cost is so variable. You could buy a really inexpensive wig that might be synthetic, but looks great. You could spend a lot of money on a wig and it's still wrong for you because it's too heavy or uncomfortable on your scalp. And so there are many nuances that I didn't anticipate. I thought that this part was going to be fun and it was anything but fun.

Sonya:  It is a really tough process if you do decide to wear a wig. Especially finding something that looks like your beautiful natural hair, and then dealing with the side effects of actually wearing it. How did the time of year impact how you dealt with hair loss?

Dr. Alexea:  I got treated in the spring and fall, so sweats and hot flashes were definitely an issue. Which made it very hot underneath some of those wigs. Especially if the wig was really dense, then it was just too much and too hot to wear. So I learned that during the summer months I liked a more low to medium density wig. And as much as I could, I embraced my baldy, and just accepted that sometimes, I would experience other people's discomfort around me for looking sick. But I rocked my baldy for me, like if I was just out doing my own thing or with my family.

Sonya:  I see, so it might make sense, even if you have high density hair naturally, to bring that down a notch or two for the wig, depending on the season in which you are being treated.

What did you eat during treatment to keep healthy and prepare for hair regrowth?

Dr. Alexea:  I ate lots of fruits and vegetables that were high Vitamin A, Vitamin C, Vitamin E and Zinc. So carrots, tomatoes, red, yellow and green peppers. I lived on avocados, especially in salads, because they’re a good source of protein and healthy fats. It's technically a fruit, but it's green. So I felt like I ate a vegetable too.

Sonya:  Avocados are also great for nausea. So something like avocado toast would be a soothing and hair-healthy meal. Anything else?

Dr. Alexea:  I ate lot of almonds and mixed nuts, which are very nutritious, especially for hair growth.

I ate a high protein diet, with fatty fish, like salmon. You could also do lean meats. I didn’t feel good eating meat during chemo, but if it works for you that could be a source of protein in your diet.

I also had lots of legumes and beans, because they have lots of protein.

And last but not least, I hydrated A LOT. We have to hydrate. It's just so important. We forget how valuable water is to our life and for maintaining the health of our hair and skin. If our bodies are hydrated, then our skin, hair and scalp will be hydrated as well. This is vital for hair growth.

Sonya:  Did you take any vitamins or supplements, for hair or otherwise, during chemo?

Dr. Alexea:  I didn't take the hair, skin and nails vitamin during chemo. But I did start taking it right afterwards. And that was because my oncologist warned me about vitamins and nutritional supplements very close to the chemo doses. And I really tried during chemo to emphasize nutrition to prepare for hair regrowth. I limited supplements to medical needs only, like neuropathy.

Sonya:  What sort of self-care habits did you practice during hair loss? As you know, just because we are bald, doesn’t mean we can’t care for our hair health.

Dr. Alexea:  I was very gentle whenever caring for my scalp because that skin was very tender and fragile. I treated it the same way I treated my face – which I wouldn’t scrub or be super rough with.

I did shampoo my scalp with a moisturizing shampoo, but I didn't condition my scalp. It would be dry, flaky and itchy at times. So I would apply Aloe Vera gel because it's soothing, healing, moisturizing and has anti-inflammatory, anti-itching properties.

Sometimes I would keep the Aloe Vera leaf or gel in the fridge and apply it to my scalp cool to create an even more soothing effect. And when your hair starts to regrow, you can put the Aloe Vera gel in a spray bottle with water and spray it onto your hair for added hydration.

I would also use coconut oil on my scalp because it was light and absorbed into my skin very well. It’s something I now use on my hair also. So coconut oil, biotin oil, grape seed oil, jojoba oil, avocado oil and castor oil. These are all super hair growing, natural things you can use. You could put it on your brows and lash line as well. And you can use it to maintain scalp moisture and hair health, even during regrowth. I still incorporate all of those products into my hair care regimen. It's just that now I'm using more cream moisturizers on the hair itself to help maintain moisture and just to define my curls.

Sonya:  Shampooing to cleanse then skipping conditioning and going straight for the oils is a great routine to maintain, especially during the bald phase. It’s all about making these small adjustments to keep your scalp – your beautiful hair canvas – as healthy as possible during treatment.

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