Wondering what to make of life before the Necessary End

I’ve had acrylic nails for 15 years. My natural nails are paper-thin, soft, and tear easily. As well as tearing horizontally, they also tear vertically. And that hurts! Acrylic nails, by providing a tough outer coating, have given me decent-looking nails for a long time.

No longer. The carboplatin—and I assume it’s the chemotherapy, for there appears to be no other cause—has caused my acrylic nails to lift. After my first chemo cycle, 7 out of 10 had lifted off completely. I braved the nail salon again, and had them all re-done. After the second chemo cycle, they all fell off again.

I’ve googled for info about chemo and acrylic nails, of course. Most of what I found was what I’d call ‘motherhood’ statements that urge people to forego acrylic nails during chemo. I couldn’t find any solid reasons why. I got the impression that this advice was up there with ‘eat your greens’ and ‘take a clean hanky’. That is: risk-free and/or what appears to be common sense. You can’t be sacked for buying IBM; you can’t be in trouble for saying ‘no nails’.

What I can not find—oddly enough<g>—is a Stage III, double-blind, randomized, multi-centred trial that investigates whether carboplatin causes acrylic nails to lift.

I’m now resigned to living without good nails until chemo is over. Every time I look at my hands, I get another nasty reminder of the nasty things that are happening to me.

Two weeks after chemotherapy started, most of my acrylic nails fell off. Within days, my paper-thin natural nails had torn down to be ugly little stumps.

I had assumed that the chemotherapy itself caused the acrylic nails to lift. But I’m beginning to wonder. Living now with au naturel nails for some weeks, I’ve realized that my nails have developed some unusual features:

• I have vertical ridges, quite pronounced, running from base to tip of all my nails.
• The skin beneath my nails is pale reddish-brown from the tip down about 1/3 of length of the nail.
• I have irregular white horizontal flecks near the tips of most nails.
• Some of the nails are flaking like fillo pastry.

I assume that nails are lagging indicators. Maybe these features reflect the time before surgery, when I was pregnant with the whales, when I barely ate anything for several weeks. Maybe they reflect the effects of the cancers themselves. Maybe they reflect the effect of the chemotherapy. And maybe they are completely unrelated to any of my health problems.

On the other hand, maybe the lifting of the acrylic nails was caused by, for example, the vertical ridges, rather than, say, the chemotherapy.

Who knows? There’s any amount of information on the web provided by nail salons; but I’m not likely to take that as medical information at face value. There are any number of cancer-related sites that say vague things like “you may notice changes to your nails”. 10 points to Michigan State University that’s done better than most at discussing chemo-related nail changes. But I’m getting frustrated because I can’t find much real, hard, information.

Here are a few things I’ve found from what I would consider to be reputable medical sources:

• Lawrence E. Gibson of the Mayo Clinic says that vertical ridges are not a concern and are more common as we age. Perhaps all these changes I’m seeing are just because I’m getting old!
• Gibson also says that acrylic nails are “generally are safe and won’t harm your natural nails”.
• It seems that horizontal white streaks are called Transverse Leukonychia. It’s likely to be caused by the chemo rather than by the cancer. Here’s a picture.
• A few studies report transverse lines (“Beau’s lines”) across nails in people given chemotherapy:
  • one person with Hodgkin’s disease
  • one with lymphoma
  • one with myeloma and
  • seven patients receiving taxane chemo.

  If this picture is anything to go by, the transverse lines are clear and distinct. Mine aren’t. (For what it’s worth, in at least some of these cases, the problems went away after chemotherapy stops.)

• There have been a few studies describing small numbers (1 here, 4 or 5 there) of people who are allergic to the acrylates in acrylic nails.

  One study, however, left me entirely perplexed. It was conducted by A. Lazarov of Tel Aviv University, published in 2007 in the Journal of the European Academy of Dermatology and Venereology, and it’s titled ‘Sensitization to acrylates is a common adverse reaction to artificial fingernails’.

  A “common” reaction, says Lazarov. To me, a common reaction would affect a large proportion of the people with acrylic nails. But Lazarov’s study didn’t look at people with acrylic nails and work out what proportion of them had problems. The study was a retrospective study of patients with suspected allergic contact dermatitis from artificial nails.

  Well of course problems would be common amongst patients! That’s why they’re patients!

  I don’t understand how the paper could conclude that sensitization to acrylates is “common”. It would be like concluding that sensitization to dust is common amongst people with hayfever.

While trying to find out what effects, if any, chemotherapy may be having on my nails, I ran across this. Geez, it made me mad:

J Hinkelbein, H Koehler, H V Genzwuerker and F Fiedler did some research on the accuracy and precision of those pulse oximetry gadgets on people with acrylic nails.

Surprise, surprise: the study found that

Acrylic finger nails may impair the measurement of oxygen saturation depending on the pulse oximeter used and may cause significant inaccuracy.

It wasn’t that finding that made me mad; it was the conclusion:

Hence, removal of artificial acrylic finger nails may be helpful to assure an accurate and precise measurement with pulse oximetry.

“Helpful”? Helpful to whom? The nail owner?

No! No! If the machines don’t work properly, fix the machines. Or use another way to measure pulse oximetry. Fix the problem—don’t try to get patients to conform to a medical system that designs inaccurate machines. The world market for oximeters is over $US200m a year. We (the taxpayers) are the clients. The medical industry is the supplier. Don’t treat us with inaccurate machines. Treat us like paying clients, because we are.

However, I remain confused. Ten years before Hinkelbein et al’s study, S M Peters concluded that unpolished acrylic nails do not affect pulse oximetry measurements of oxygen saturation.

You can barely walk through the door of a hospital without someone sticking one of these little machines on a finger. Are these machines accurate? Peters concluded they are; Hinkelbein et al concluded they are not. Who’s right?

PS The article by Hinkelbein et al was named ‘Artificial acrylic finger nails may alter pulse oximetry measurement’. I suppose that’s to distinguish them from natural acrylic nails.<**sigh**>

PPS For what it’s worth, TM Brand, ME Brand ME and GD Jay, from Brown Brown University School of Medicine, found that nail polish does not interfere with pulse oximetry readings.

My last session of chemotherapy was 20 April 2010. When I first started chemo, my acrylic nails all lifted. And underneath, my real nails were even more fragile than normal. They were like fillo pastry: flaking, tearing and splitting. And looking terrible.

But that’s all behind me. Last week I decided that my nails had recovered enough to brave the nail salon again. It’s 15 years since I first had acrylic on my nails, so it was strange getting a full set done again. But my natural nails really had improved. I’m stuck with tips for some nails (acrylic nail users will understand how ‘dull’ that feels!), but some of the natural nails were long enough that they didn’t even need tips.

So I’m now sporting 10 bright red fingernails!