Monika Dockendorf talks about using a DigniCap to keep most of her hair during chemotherapy treatment for breast cancer at the Baltimore Washington Medical Center in Glen Burnie.
Monika Dockendorf didn’t usually do breast self-examinations. But a close friend was diagnosed with breast cancer and that was all the impetus Dockendorf needed.
She did an exam in December. There was nothing.
A month later, as she was in bed, her hand grazed her left breast. Dockendorf felt a lump. She sat up and did an exam. It was definitely a lump.
What followed is a familiar story to women who have made the same discovery: consultations, decisions, surgery and chemotherapy.
But Dockendorf’s story has a new outcome — she kept most of her long, dark blonde hair.
The 30-year-old Annapolis woman is one of a growing number of breast cancer patients to have access to the DigniCap, a technology that delivers “cold cap” therapy for the scalp that reduces hair loss for chemo patients.
“The cap is not just vanity,” Dockendorf said. “It’s about privacy. It’s about feeling like yourself and not looking in a mirror and being reminded you have cancer.”
She said, “My hair is part of my identity. It is part of who I am.”
After that morning discovery, Dockendorf told her husband, Tyler. After that, things moved quickly. An appointment was scheduled for an ultrasound the next morning, followed by a mammogram and, ultimately, a biopsy four days later.
The call she dreaded came Jan. 11. The diagnosis was invasive ductal breast cancer — Stage 1 but bordering on Stage 2 — and it was a form of cancer called triple-negative breast cancer. The general prognosis can be similar to other breast cancers at the same stage but usually require a more aggressive treatment.
To determine their options, the couple met with surgeons, oncologists and plastic surgeons in the area and asked a lot of questions before selecting Chesapeake Oncology and Hematology Associates at the Tate Cancer Center at the Baltimore Washington Medical Center in Glen Burnie.
Dockendorf tested negative for breast cancer genes and 11 other genetic mutations. There was no history of breast cancer in her family. To ensure there would not be a recurrence of the cancer, and to avoid undergoing radiation after surgery, she decided on a course of chemotherapy to shrink the growing tumor, followed by a double mastectomy and breast reconstruction.
From Feb. 3 through June 15, she underwent 16 chemotherapy treatments, each lasting six or seven hours. For 12 of them, she was infused with Taxol. Four used Adriamycin — called Red Devil treatment — and Cytoxan. She was medicated with the sedative Ativan and would sleep through most of the treatment.
The 16 rounds of chemo meant the likely loss of her hair.
“Chemotherapy is poison to cells — cancers and growing cells, like those in hair follicles that are rapidly dividing,” said Dr. Young Lee, an oncologist for more than 20 years at the Tate Cancer Center. “Ninety-five percent lose their hair going through chemotherapy.”
Lee told her about the “cold cap” therapy. At BWMC, DigniCap, manufactured by Dignitana Inc., has been in use since it was cleared by the Food and Drug Administration in December 2015. It had already been in use in Europe for 10 years. In July, the FDA has approved it for use for all cancers except leukemia.
“Dr. Lee said, ‘We have this and it works,’ ” Dockendorf said. “I just assumed everyone loses their hair.”
Chemo patients started wearing ice caps during treatment 30 to 40 years ago. Researchers learned cooling the scalp during chemotherapy reduces the flow of blood and cell metabolism. The reduction of blood flow to the scalp lessens the amount of chemo drugs reaching the area and helps protect the hair follicles — saving most of the patient’s hair.
Early caps were crude and inefficient, but the technology has improved. The Tate Cancer Center was the fifth cancer center in the United States to obtain the DigniCap system, and is the only center in Maryland with it. It costs $400 per treatment, but the practice does not charge after eight treatments. Recently, AETNA insurance began covering DigniCap treatments.
Dockendorf wore the DigniCap through all 16 chemo treatments and for an additional two to three hours after each treatment ended. Though her hair is naturally straight, the cap works on all hair textures.
“I lost about 30 (percent) to 40 percent of my hair,” she said.
Dockendorf tugged at a cluster of hair on top of her head and lifted her long hair to show the short hairs growing at the base of her hairline. “That sounds like a lot, but I still looked like a normal person.”
She has discovered that her hair is now a little curly.
“It’s called ‘chemo curls.’ The hair usually grows back curly and gray,” Lee said.
Dockendorf was careful to not color or highlight her hair during treatment and only washed her hair once a week.
“My hair did get drier,” she said. “But I didn’t use things that would make it worse like styling products, curling irons or flat irons.”
Patients using the cap thoroughly wet their hair before a snug silicone cooling cap is placed on the head. The caps are color coded by head size.
During a recent return to the Tate Cancer Center, registered nurse Tanya Bell adjusted a yellow cap, the smallest size, on Dockendorf’s head. The cap is connected to a cooling and control unit which circulates a glycol coolant through channels in the cap. The coolant is room temperature at first, but quickly cools to 32 degrees Fahrenheit. A jaunty neoprene cap is attached over the silicone cap.
The temperature of the coolant is constantly regulated and distributed evenly on the scalp. Lee said the treatment is less labor intensive that cooling systems that are kept in a freezer. New, more comfortable caps are arriving in November.
“The technology keeps improving,” Lee said. “We hope in the future no person should go bald during chemotherapy.”
Dockendorf considers the cap an amazing buffer against total hair loss other women needed to know about.
A few weeks into her chemo treatments, she set up an Instagram account at www.instagram.com/canceratthirty. She has shared dozens of photos of herself during every step of her treatment and surgery. As a result, Dockendorf said, she’s been in touch with women all over the world.
“There is a network of other women going through what I’m going through: living life with cancer,” she said.
For more information about the DigniCap, call Donna Crouse at 410-553-8155.