Pretty Sick

CHAPTER 1

THIS STINKS!

how treatment affects your sense of smell

Smell. I know this is the last thing you are probably thinking about right now. But as a cancer survivor, and former beauty director, it's the first thing I'm going to ask you to consider. Here's why:

From this point forward, every minute of this journey you are now on is going to be captured forever in your brain by your sense of smell. Mundane moments, even fleeting seconds, that you will most likely forget: sitting in the chemo suite with a drip in your arm; putting your wig on in the morning; taking a shower weeks after surgery—will be stored in your mind like a Polaroid picture by your sense of smell. One familiar whiff—and bam!—you will be transported back to any of these moments by your sense of smell. Memories, emotions, will feel as raw and real as they did when you first lived them. This phenomenon is called "scent memory."

Scent memory is a normal—yet unique—occurrence that we've all experienced: the aroma of fresh peeled apples brings you back to baking with your grandma; a breeze of lilac and you're playing again in the yard of your childhood home; a specific hair spray reminds you of prom night twenty years ago. Over half of the patients in chemotherapy treatment will experience temporary changes to their sense of smell. Those having radiation therapy for head and neck cancers can also experience a reduced or heightened sense of smell. This change of sense can trigger powerful memories months and years down the road.

So why am I telling you this? What does this have to do with cancer and your beauty regimen? A lot actually. I'm going to share a story to explain why.

A year before I was diagnosed with breast cancer, I had major back surgery. During that time, I used all of my regular skin care products. Why wouldn't I, right? A year later—after a rotation of different cleansers, serums, and toners—I came back to that same La Prairie face cream that I had used during my recovery from surgery. Instantly, I started having flashbacks to the days when I was out of work on disability, and, in essence, learning how to walk again. It was one of the most difficult times in my life and the memories brought up by the smell of that face cream made me feel depressed and helpless all over again. The emotions were so terrible, so tangible, I felt like I was reliving the whole experience.

Obviously, I didn't want a reoccurrence of this during my battle with breast cancer. So, after my initial doctors appointments and a week before my first surgery, I switched out all my staple (and favorite) beauty products. Instead of opting for inexpensive drugstore replacements, I decided to be a bit indulgent and choose some really luxurious products. I mean, why not? The road ahead was going to suck. This was the least I could do to pamper myself both emotionally and physically. I stocked up on La Mer moisturizer, Rodin Olio Lusso body oil, and Fresh Hesperides Grapefruit Bath & Shower Gel. I figured that the high-end ingredients would be essential in healing my ravaged skin and I wouldn't miss the hefty price tags if the smells reminded me of this shitty time in my life.

So, why does our sense of smell change?

"One theory is that a number of chemotherapeutic agents alter cell turnover in the olfactory pathway, the olfactory hypothelium, or the cells at the top of the nose," says Dr. Richard Doty, the director of the Smell and Taste Center at the Perelman School of Medicine at the University of Pennsylvania. "Those cells die off and are replaced by stem cells that produce new olfactory receptor cells and then the process of regeneration is inhibited by the chemotherapeutic agents. As a consequence, smell is affected."

Specific chemotherapy drugs responsible for affecting smell include: carboplatin, cisplatin, cyclophosphamide, dacarbazine, dactinomycin, doxorubicin, 5-fluorouracil, levamisole, mechlorethamine, methotrexate, paclitaxel, and vincristine.

In her book The Scent of Desire, Dr. Rachel Herz, one of the leading experts in the psychology of smell, discusses the very realness of this phenomenon. "More than any other sensory experience, fragrances have the ability to trigger our emotions: to fill us with joy and rage, to bring us to tears and to make our hearts ache, to incite us with terror, and to titillate our desires." Herz goes on to write how many New Yorkers who survived the attacks on the World Trade Center on September 11, 2001, have this experience whenever they smell anything charred or dusty. She adds one stunning fact that can't be ignored. "Not only do odors trigger emotions, they can become emotions." How is this possible? The reason is this: No other sensory system (sight, taste, touch, hearing) makes direct contact with the amygdala, the area of the brain where emotion and emotional memory is processed and the hippocampus, where associative learning takes place. Because of this, Herz writes, "odors can literally be transformed into emotions through association and then act as proxies for emotions themselves, influencing how we feel, how we think and how we act." The two are fundamentally interconnected while being independently functional.

Studies show that children and adults exposed to "frustration-associated odors" during tests were less creative and motivated to solve the problems compared to their peers who weren't exposed and ultimately successful at the tasks presented. Just think about the effect a scent memory—linked to the day of your surgery, wig shopping, or your radiation treatments—could do to your positive attitude and recovery process. It can be life-altering, I will tell you that.

Here's the thing: most beauty products—even the unscented ones—have a smell. And because of that, they aren't exempt from scent memories. So, here's my advice:

Now is the time to shelve your favorite beauty products.

This includes obvious items like your perfume and body lotion but it also applies to things you normally won't think twice about, like toothpaste and hand wash. Making this swap early—as close to the day of your diagnosis as possible—will prevent them from having any connection to your cancer. After all your treatments and surgeries are over, you can swap your favorites back in. But during this time, treat yourself to a few items you wouldn't normally splurge on. You deserve it—and so does your body!

perfume: to spritz or not to spritz

In many ways, perfume tells the story of a person's life. For me, each chapter of my life is defined by the perfume I was wearing at the time. In high school I wore Giorgio Beverly Hills. In college, it was Elizabeth Arden's Red. For my first job I wore YSL's Opium—a scent I thought was mature and sophisticated. The day I was offered the beauty director position, I had traces of Jo Malone Orange Blossom lingering on my wrists and neck. Today, I'm all about Tom Ford Private Blend. For most women—and many men—perfume helps us project to the world who we aspire to be. This is certainly true for me. So, when I was sick, I didn't want to give that up. I still wanted to smell feminine, sexy—like my (regular) self. I wanted, no, needed, that element of normalcy and happiness.

Studies show that the very existence of scent elevates one's mood. People who have lost their ability to smell—no matter what the cause—are more likely to experience depression. So, while it can be tricky for cancer patients to use products with fragrance, if you're anything like me, it's still very important to have some wafting around. So, if you are going to wear perfume, my advice is that you set aside your signature scent and find a temporary replacement.

Now I know what you're going to say: You've worn the same fragrance for the last ten years. It's your absolute favorite and everyone knows when you enter a room by the gorgeous aroma that trails behind you. This is precisely why you don't want to wear it now. Besides the fact that you don't want to create cancer-affiliated scent memories, the changing chemicals in your skin will most likely cause the perfume to produce a different smell than what you are used to. "I think this is essential information for patients who are being treated," says Dr. Avery Gilbert, psychologist from the University of Pennsylvania and author of What the Nose Knows: The Science of Scent in Everyday Life. "It's very important to shelve your favorite fragrance for a while, so that you don't link it to the negative aspect of the experience." Instead, choose a backup blend that you love almost as much but could stand to live without in the long run. Here's how to do just that…

determine your skin's sensitivity

The first thing you want to do is evaluate how sensitive your skin is to determine the concentration that it can handle. Granted, this may change once chemotherapy or radiation treatments commence but it will give you a baseline gauge for how reactive your skin is and might be. If your skin tends to get itchy, red, or irritated from the cold weather, allergies, or a sweat-filled workout—that indicates it could be supersensitive once you are in the thick of treatment. "Fragrances are categorized by the range of concentration that they fall into," says Lisa Lewis, senior vice president and Fragrance Academy Director at Givaudan, global leader in the creation of fragrance and flavors. The Swiss-based company is behind some of the most iconic and best-selling fragrances including Calvin Klein Obsession, Dior J'adore, Angel by Thierry Mugler, Gucci Guilty, and Dolce & Gabbana—to name a few. "Going from a lower concentration to a higher concentration you have: body mists/splash, eau de toilette, perfume/parfum, and then essential oils."

start light, finish strong

If your skin seems a little sensitive but you still want to wear a scent, it's safest to try a body mist or splash first. These contain the lowest concentration of fragrance, making them the mildest option and the fastest to evaporate in the skin, hence the least irritating. My advice: Do a patch test on a hidden part of your body and see how your skin fares. If no reaction occurs, you can probably handle a more concentrated fragrance like an eau de toilette. If an eau de toilette is no problem, move on to perfume. You will only know by giving it a test run.

spray, delay, then decide

Selecting a "swap in" fragrance when your skin and sense of smell are changing can be challenging. The pH of your skin, your body chemistry, has a direct impact on how a fragrance smells. Conversely, the change in the mucous membranes of your nose will affect how you interpret that smell. So, it's important to test potential candidates on your skin before making a decision. "You should give a fragrance an hour to really experience it," says Lewis. "When you first spray, you get the top notes. Then, over the next ten to thirty minutes is what we call the mid-notes. Followed by the residual, the dry down, which is what lingers on your skin." That ending aroma often smells completely different from how it started, so it's important to give it time to diffuse completely before breaking out the benjamins.

give it time, before you rewind

When can you go back to wearing your oldie but goodie? The earliest would be one month after chemo ends. "The figures given for the complete turnover of the cells in the nose is something in the order of thirty to thirty-five days," says Dr. Gilbert. His advice: "Because cell turnover has been slowed down or knocked down a bit, it might take a little bit more time. Two months would be the safe waiting time to bring back your signature scent or the original brands you used to use."

scentsational notes

Scent has the amazing ability to change how we feel—so why not harness that to enhance your mojo? When you're shopping for a new fragrance, consider the notes it contains. Over the last two decades, Givaudan and International Flavors & Fragrance (among others) have studied the subjective and physiological effects of aromas and fragrances on emotions via "mood mapping." "There are studies about how different fragrances can impact different moods and that can be extremely effective for patients," says Lewis, whose mother is a two-time breast cancer survivor. Below are some notes that work wonders for your well-being.

uplifting

Need a quick pick-me-up? Instead of grabbing a coffee, spritz a citrus-based scent instead! Notes including orange, grapefruit, bergamot, and lemon are energizing. So are certain florals. A study conducted in 2010 revealed that the tiny flower jasmine could help relieve depressive thoughts and increase alertness with one whiff!

soothing

Studies show that if you are looking to attract a mate you should select a fragrance with gourmand notes including honey, chocolate, and vanilla, which have aphrodisiacal powers. (Men think they are absolutely scrumptious!) But they also have the ability to calm the nerves. This capability also extends to warmer notes like amber (which smells like vanilla) and sandalwood. But there is one surprising scent that acts like an air-based Xanax: green apple. During a control panel conducted in 2008, the scent helped control feelings of anxiety during stressful moments and provided a noticeable reduction in headaches including migraines. Apparently, "An apple a day keeps the doctor away" isn't just some stupid expression…

relaxing

There's a reason why lavender oil is used in almost every spa—it's well documented for easing both the mind and body. But did you know that green, leafy notes do too? Researchers in Australia found that a chemical released by newly mown grass makes people more joyful and relaxed. Pine also has some relaxing powers. A study conducted at Japan's Kyoto University examined the Japanese custom of strolling in the forest, known as shinrin-yoku or "forest bathing." On the days participants walked through the pine-filled woods, their levels of depression and anxiety were significantly reduced. Here's my advice for those who celebrate Christmas: The next time your relatives are coming over for the holidays, it might be wise to get a real pine tree…

a word about oils

Fragrance or perfume oils are typically made with essential oils. Because the scent is more concentrated, it also tends to be more irritating on the skin. Besides the potential to cause headaches and nausea, they can also prompt hives, rashes, and sores. For those with estrogen-positive cancers, like myself, there are some oils that should be avoided. These essential oils contain phytoestrogens that can mimic estrogen in the body, enhance the effects of estrogen, or cause symptoms of estrogen depletion—any of which may result in a hormonal imbalance. While the levels are probably nothing to worry about in dab-sized applications, it's important to be informed and aware of any potential side effects they could cause. Three oils are especially known to exaggerate changes in estrogen levels: lavender, rosemary, and tea tree oil. Others to avoid include clove, chamomile, licorice, oregano, peppermint, nutmeg, thyme, sage, and verbena.

fragrance-free

With all the products we use every day—from hand wash to hair spray—it's almost impossible to use all fragrance-free beauty products. Finding a shampoo without a "fresh" scent is tough! But your health is worth the hunt. When shopping, labels can often be misleading. Terms like "hypoallergenic," "natural," and "organic" don't necessarily mean they are fragrance-free or gentle. You have to read the ingredient list and give the product a good whiff to know for sure. Some products are scented with fruit or herb extracts and those are generally natural and nonirritating. Choosing scent-free beauty products is the safer route and will help keep your skin smooth, supple, and rash-free. An extensive list of brands and specific scent-free products can be found in Chapter 3 (here). Use that list as a guide for what products to buy and use while in treatment.

where to wear your fragrance