Month: May 2012

I have been asked over and over again if I can you predict a balding future for the young man with a family history of balding. I have also been asked to explain how I would go about such a prediction. I have two tools: miniaturization analysis and bulk measurements. Below, I’ll discuss the difference between the miniaturization studies we have been preaching about in the past and the bulk measurements we are now also doing in our patient assessments.

Miniaturization mapping:
I use miniaturization measurements to get a general idea if there is genetic balding present. It can not give us (without special software) a metric on what is going on. From a practical point of view, checking for miniaturization over the course of months could never truly be in the exact same areas unless we place a tiny dot tattoo as a reference point. Then months after the first exam, we could examine the exact area again by finding the tattoo and measuring the degree of miniaturization at a point anterior, posterior, or lateral to the dot. In those people with a measurement of miniaturization, it varies from place to place even within a defined area (without a tattoo). The area observed is often just over a square mm. In other words, it’s using educated guesses.

Hair bulk analysis:
On the other hand, bulk measurement using a tool like HairCheck can cover a relatively large area (square inch) and finding anything in that area as measured by distance from the nose is replicable. So from a value point of view, it can give the doctor an assessment of bulk comparison to a person’s normal hair bulk when compared with the donor area in the back of the scalp. If the measurement changes over time, it will allow the doctor to produce a metric (number) which reflects the status of our hair bulk. In everyone with genetic balding, some part of the scalp hair will lose bulk.

To identify areas that can not been seen grossly for bulk measurement, we can do a miniaturization analysis to identify the worst areas on the scalp and then do a bulk assessment in those areas. It can also distinguish the differences that we can not ascertain from the naked eye or a photograph. I have seen people who report balding, my eye says no, but the bulk measurement shows significant differences to the donor area, confirming the diagnosis of genetic balding. I am sure that over a year, these bulk measurements will be able to help us show change (positive or negative) with the treatments we are prescribing.

So… am I going to go bald?
I am asked over and over again by young men with a history of balding in the family, “Am I balding like my father?” There’s no way I could answer that over email, but with the ability to do miniaturization analysis and bulk analysis during examinations, we can now tell much more about the status of a balding young man and we may be able to refine a prediction as the young man matures. Diagnosis and measurement is the backbone of any Master Plan we come up with.

I had a hip procedure in Oct then Back surgery in Dec. Since then, my beautiful THICK LONG hair has gone.Also, my finger nails are really brittle. Nothing in my diet or my life has changed except that I am taking vicodin. My PCP and pT have told that vicodin is causing this. Is there anyway to fix this. I can’t come off the meds because the PT is terrible.

It is not unusual to develop hair loss after a traumatic event like what you went through. This is called telogen effluvium and it usually passes, unless you are male and have invoked the genetic balding process.

A telogen effluvium usually reverses in time, and a doctor can make this diagnosis with a simple pull test.

Thank you for baldingblog, a wonderful source of information on hair issues. My wife just started on chemotherapy for colon cancer with a drug known to cause hair loss. She wrote this to a friend about her chemotherapy and the Cold Cap experience and with her permission, allowed me to send it to you to post on your site.
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“The chemo was on Tuesday – and I slept through the entire event. I thought to call Dr. Rassman and thank him for the reference to this cold cap therapy. He is among the most caring people I know.

They loaded me up with lots of anti-nausea meds and some Benadryl which really made me sleepy. Now you might wonder how one can sleep with a turban at -24 degrees Fahrenheit on your head – well I did. In part to counteract the cold, you wrap yourself in an electric blanket set to sizzle – and that put me right to sleep. My husband had to wake me every 30 minutes or so to trade the cold cap for a newly chilled one. You keep up the cold caps till 4 hours after chemo is done so I didn’t really wake up till about 6:15 PM on Tuesday – that included the drive home. We were quite the spectacle at the clinic and had many doctors and nurses coming in and out to see the changing procedure. I actually think my husband was enjoying the attention. Almost everyone at the clinic knew about cold cap but none had direct experience with it and all were very interested to see if they work. Needless to say I am too.

I did hook up a small group of patients in a support group, a couple have used the cold caps successfully for their chemo. It is more involved than just the turbans – there is a lot of extra hair care but all say that it is worth it. So we are “all in”. We did look like we were moving in to clinic for a week wielding our two coolers on a rolling dolly, a rolling suitcase filled with the blankets and extra needed accoutrements (including welders gloves to handle the dry-ice), and an extra bag of layering clothing.

I am feeling ok – I wear out easily and then crash hard. I am still not sleeping well – what they have given me is helping a bit but I don’t get more than 5 hours of solid sleep and then doze as best I can. Today is the last day on the heavier anti-nausea meds and when the steroids will wear off – they say that tomorrow is the trail day.”

I try to get involved in the lives of my patients and have developed many close friends from this group of wonderful people. I’m glad I could offer some help to this patient and his wife, and I wanted to post this so people considering using Cold Cap Therapy during chemotherapy might know what to expect. There’s a good article about this treatment here.

This reminds me of another time that I wanted to share, when a hair transplant patient got a routine heart scan on my recommendation and found that he had an aortic aneurism. This is a time bomb that kills almost everyone when the aorta (the main blood vessel that exits the heart) leaks and bursts. I helped him find a great doctor who brought his body temperature very low at the time of surgery, stopped his heart, and replaced the blood vessel with a cloth one while everyone hoped that his brain would function after they restarted his heart. He lucked out and survived, brain fully intact.

Right place, right time.