Jun 07, 2022

Liana: You want oval or squares?

Emily Ornberg: I think an oval, maybe even pointy. What do you think?

Liana: No, don’t do the pointy.

Emily O: OK! Liana is a nail expert who is as tough as the tips of her acrylic fingernails, but she treats every customer with love as if they were her own family. She also really loves things that are new.

Liana: We use, each time when people are coming to us, we use a new file, a new buffer, we—every time opening a new. Even in the pedicure, we open new buffer, new, uh, new files. We open new scrub, new cream, new mask, new soap. We open—we never reuse. You can take it home with you, but don't bring it back because we will not—we will still open a new one.

Emily O: The name of her salon is Fancy Schmancy, but her passion to give her customers a premiere pedicure isn't just for the sake of being fancy, it's to protect them from infection. Something that's a little too common in nail salons and a little too risky for people with cancer.

Liana: So for me, the sanitation and that everything will be one-time use and will be a high quality, it's the number one. I just cannot redo something on someone else. Even if I do your nails now and I'm going to groom your cuticles, I'm taking a risk for your life. Those things, people think that this is so minimal, but it's actually important because I'm playing—I'm actually playing with your—I'm playing with your body right now. And then what will happen?

Emily O: Should I do this one?

Liana: You know, I have this one. This is really pretty.

Emily O: Oh, let's do that. This one?

Liana: You see I have the ring finger.

Emily O: Oh, OK. Cookies and cream.

Liana: We'll do like a rose or something. It'll be pretty.

Emily O: OK. Thank you.

Caitlin Kiernan: Cancer is not pretty. The side effects can impact not only how you feel, but also how you see yourself, whether you want help learning how to create eyebrows from scratch, need to know how to treat a radiation burn or just looking for wig-shopping tips, you've come to the right place. Welcome to the Feel More Like You Podcast, presented by Walgreens and Pretty Sick: The Beauty Guide for Women with Cancer. I'm the book's author and your host, Caitlin Kiernan. In each episode, we'll break down the important information to help you look and feel more like you. In this episode.

Csilla: My nails turn black or, you know, they turn flaky and ju—just ugly.

Carin: And I had white spots, it was bad.

Susan: By the time that happened I'm like, "Of course. Yep. Yeah, of course."

Jean: And it was just amazing how fast they grew.

Liana: You're beautiful anyway, doesn't matter. It's a process, it will come back.

Caitlin: The views, information and opinions expressed in this podcast are those of the individuals involved and do not necessarily represent those of Walgreens and its employees. While we care about you and your health, this podcast is meant for informational only and is not intended to be a substitute for professional medical advice, diagnosis or treatment from a qualified healthcare professional. Walgreens does not recommend or endorse any specific tests, products, procedures or other information that may be referenced. Always seek the advice of your physician or qualified healthcare professionals to see what the best treatment is for you. On today's episode, we're going to discuss nail changes, a side effect that is most often unexpected. To go over what to anticipate, please welcome Walgreens pharmacist Emily Shafer, beauty consultant Laura Catron and health editor Emily Ornberg. Hi, ladies.

Emily O: Hi.

Emily Shafer: Hello.

Caitlin: So probably about a year before I was diagnosed, I got very deep, horizontal ridges in my thumbnails, like, super, super deep. And I thought it was like a vitamin deficiency, I went through a million things in my head. The long and short of it was is, like, I did everything I could to kind of buff it down, to put a nail ridge- ridge filler, you know, I kind of tried to cover it on a cosmetic level. Fast forward, I get diagnosed with cancer. I start talking to my oncologist and she basically says, like, sometimes nail changes are the first thing to show that there is something going on in your body. Your—your nails are one of the first places to show signs of health issues that you might have when you get little spots on your nails or whatever, like they are—they can be a telltale to your health, and I just found that really fascinating. After I was done with treatment and all that kind of stuff and my nails started to kind of like grow back, they grew back without the ridges. So I found that just really fascinating. And from a clinical standpoint, I'm curious, like, what's happening in your body and like what—what—what do you experience on the clinical level, Emily?

Emily S: So it's going to largely depend on the chemotherapy medications that you're on. Taxane medications like docetaxel and paclitaxel are among the most devastating medications for your nails.

Caitlin: All the tals, yeah.

Emily S: Yeah. Exactly. That whole class.

Caitlin: They call them the red devil.

Emily S: Well—

Caitlin: I think that's what they call them.

Emily S: There you go. These changes could include that your nails may look bruised, maybe turning black or brown or blue or green. People with darker complexions notice these color changes more. You could develop blemishes on your nails, like a horizontal or vertical line as you spoke about. These marks reflect the timing of your chemotherapy, it may even have multiple lines or indentations that mark the different cycles of chemo.

Caitlin: It's so fascinating, really, you know.

Emily S: Well, and to your point earlier, talking about, like, your nails are showing the stress that your body's going through—

Caitlin: Yeah.

Emily S: —and they would, for many people, can show that they even have cancer before it's diagnosed. But then you add to that how treatment can affect it. Definitely treatment can add to, you know, brittle nails and affect even your cuticles in the nail beds and be an area that could be prone to infection because it's very susceptible, depending on how you're treating them and how you're using them—

Caitlin: Right.

Emily S: —while you're going through treatment. Nails can even lift off your nail bed, and obviously, that could increase your risk of infection in that area, too—ingrown nails both in your fingers and on your toes. So being aware, you're checking your feet, making sure that you are cutting your nails appropriately. Often we say, you know, especially for patients with diabetes, I'm going to cut them straight across. We want to decrease your chance of ingrown nails. However, if your nails are brittle and kind of, you know, weak from your treatment or from the way you're using them, having nails straight across in the little edges could potentially snag and rip. So it's important to make sure that you're, you know, being aware of—of what's going on with your nails if you're cutting them a little bit differently while you're undergoing treatment.

Caitlin: Yeah. I think one thing that's really fascinating, because when I started my chemotherapy and, like, you know, a month in, I'm like, "This is great, nothing's happening with my nails, it's all good." And then, like, two, three months later, I started having nail issues and it's because your nails grow so slowly that while you see hair changes immediately, you're not going to notice nail changes for several months, which, that makes sense when you think about it, but like, who's thinking about that, really?

Emily S: And again, you see the hair changes because your hair stops growing, so your hair falls out.

Caitlin: Correct.

Emily S: Your nails—hopefully, your nails don't fall off, but that's, you know—

Caitlin: Right.

Emily S: —something that—that some people may experience. I don't think that's very common though. Again, it can be dependent on your treatment if that would even be an option. But you

know, when you talk about they grow so slowly, well, they're not growing at all for a little bit based on the treatment you're on because those rapidly dividing cells are what we're stopping.

Caitlin: Yeah.

Emily S: So it—it is interesting to see the different rates that maybe you notice the changes, and then to kind of figure out, like, wha— what am I going to see? The anxiety of that sometimes can be a little overwhelming.

Caitlin: Yeah. Emily Ornberg, when I was—when I talked to a lot of nail dermatologists, they—a lot of what I heard was people that experienced nail loss and—and nail lifting and some of the harsher side effects in regard to their nails, felt like that was more devastating than their hair loss because with hair loss, you can cover your head, you know, you can do things to kind of deal with that. But nails, they're on your hands. What did you hear from survivors? What was the feedback you got about that experience?

Emily O: I think similarly to the way survivors say that they could find energy and confidence through makeup, by putting a bright lip on or some glittery eye shadow. Having a little nail polish is important, you know, it—it kind of helps their mood, too. So when they started to see their fingernails sort of be more brittle than before, it's another part of your body that—that you use to have that is kind of falling from you, it's—you know, you don't have that control. And so finding ways to take care of your nails at home, being careful with them but still being able to put maybe your favorite color on was huge for them. Yeah.

Caitlin: Laura, what are some things people can do to just power through that?

Laura Catron: So one main thing is going back to that hygiene. And so, when you talk about maybe going to a nail salon, check with your doctor beforehand, because you have to really make sure that— that hygiene is first and foremost, the biggest—

Caitlin: Yeah.

Laura: —you know, thing that you need to be worried about. But—

Caitlin: Shared tools and how to—

Laura: Shared tools, yes.

Caitlin: Pedicure baths harbor a lot of germs.

Laura: Absolutely. And so—but when you're at home, you never want to cut your cuticles, just push them back. One that people don't think about is, like, when you're washing dishes, that's a lot of bacteria that's in that dish water.

Caitlin: Yeah.

Laura: And so you want to wear, like, longer gloves when you're doing your dishes, too.

Caitlin: Well, water is also the most damaging thing for our hair, skin and nails. It's so—it is counterintuitive because when you drink water, it's the best thing for your body, but externally, it's one of the harshest elements for those—you know, for—for your hair, skin and nails. So putting your already compromised, weak nails in wa—a bath, you know, of water while you do dishes will just make them worse. So, yeah.

Laura: Yeah. And—and then, kind of to go off of what Emily said earlier, not doing like square nails just so you don't catch them. And if you're a nail biter, just be really careful with that because, uh, just of that risk of infection, so maybe just keep your nails a little bit shorter at the time—

Caitlin: Yeah. And sort of round them off on edges, like—

Laura: Round them of on the edges, yeah.

Caitlin: Yeah. Which is so on trend right now, by the way. Ladies, those were great tips. Let's get right into the episode. We ask survivors how their nails were impacted by treatment. Here's what they had to say.

Susan: Hi, my name is Susan Perkins, I am a mother. I am a wedding planner who also does documentary work. I am a daughter, I am a sister, and I am a cancer survivor. Chemo in your body is killing off good cells and killing off the cancer, right? So you're losing your toenails because your toenail's literally dead, that's why it's falling out. There's nothing I've ever been told about preventing that, and that was such a low priority. I—I mean, by the time that happened, I'm like, "Of course. Yep. Yeah, of course." You know, not everyone it happens to. Me, it was like every other toenail, and it doesn't hurt at all. When I heard about, you know, you could lose your toenails, I was thinking, "Ouch," you know. But it really—it doesn't hurt. In—in showering, just be mindful of keeping everything as clean as you possibly can, making sure that your countertops are extremely clean. It's everything to prevent you getting any kind of infection.

Carin: I'm Carin. I am a BRCA1 positive survivor and also a wife and a mother—out feminist, lesbian, activist, artist. My nails were breaking like crazy, like all the way down low, like really low. They were brittle and breaking and flaking, and I had white spots. It was bad. Over time, they grew back to be stronger. They're pretty strong now. They don't break, but that also took time. Also changes in diet, and eat—I eat a lot of vegetables now. I take a lot of vitamins. I think the vitamins—I think you lose a lot of vitamins and nutrients. My doctor put me on kind of a vitamin regimen, so I think that probably also helped my nails.

Jean: Hi, I'm Jean and I'm an eight-year acute myeloid leukemia survivor. I've always had strong nails, but these—these actually grew really fast during chemo. I mean, I've got one that grew to an inch and a half in a matter of, like, less than two months, and it was just amazing how fast they grew. I just kind of made a joke out of it, I just wanted to see how long they would go, so I would trim them down except for my ring fingers. I would keep—let those keep growing and growing and growing, and you know, just like, seriously, Jean, you got to cut that. And I'm like, "Well, I want to see how long it's going to grow." And—and actually, you know, I actually broke it, but it grew back so quickly that you couldn't really tell. I've never had my nails grow that fast. What the heck, I mean, I don't know. It's—and I know it's the chemo, I say, because that's the only thing that's different that's been changed in—in me. But I'm like, I've— they've always been strong. I said, but they're just growing so fast. They became—they were stronger, too. They were a lot stronger than what they took—when the—what they were before to begin with. And I said, I don't know. I said, I don't know.

Csilla: Hi, I'm Csilla. I'm a mother, a teacher, a boxer, an artist, and I had triple negative breast cancer. I really enjoyed painting my nails. And I read up on it, and I thought, OK, painting your nails—my nails turned black or, you know, they turned kind of bad-looking, flaky, and ju—just ugly. And I thought, "All right." And then I started painting them, so that was something fun to do. Of course, you got to find that type of polish that is maybe not too chemically ridden, but it was so fun. I wore a lot of sparkles.

Adam Walker: Hi, I'm Adam Walker, the host of Real Pink, a podcast from Susan G. Komen. Over the last year, I've had the opportunity to meet so many people affected by breast cancer. I've interviewed thought leaders, celebrities, doctors, and men and women living with breast cancer. Their stories are so inspiring and really informative. We're taking conversations from the doctor's office to the living room. Please join us by looking up Susan G. Komen's Real Pink on your podcast app and subscribe today.

Emily O: As she meticulously finishes my manicure, Liana tells me the strict cleanliness in her salon is a testament to how much she cares. After she arrived to America from Israel, her salon regulars have become a second family to her. And for that, Liana says she could never take advantage of them.

Liana: I cannot lie. My mom taught me I cannot lie. I just cannot do it, I just feel bad. Especially if I'm taking money, I just feel bad, it just—it's just not me. And why I care about my clients because, besides my husband and my two girls, I don't have no one here. So all the clients that come in here and its clients already, they're becoming like my family, like my—the mother that I don't have here, you know. So I care about these people. Well, I just feel bad that other places they care about the money-wise and not about the health-wise.

Emily O: With the help of her medical training, Liana is dedicated to protecting her dear clients from infection with guidelines that most nail salons don't often enforce.

Liana: In Israel, I was working as the medical aesthetician. And in Israel, it's by the law, we have to learn medical, pedicure and manicure. So we know how to treat ingrown toenails, we know when it's a fungus. When there is a skin fungus, we—I can say, "You have a skin fungus, go to the doctor, you need to have antibiotic cream." Here, they don't know those things. Here in schools, they don't teach those things. But when, actually, when I'm touching someone and I'm doing something good, then I know I make—actually making a change. If it's a big change, if it's a small change, it doesn't matter, it's a change.

Emily O: Bacteria, fungus and viral infections from unsanitary nail salons can become serious and have even led to amputations in some cases.

Liana: I know that it's only nails, but it's your body. Every little mistake could influence on your body even when it's only a nail.

Emily O: Liana said clients at the highest risk for infection are those with health conditions, such as diabetes or cancer.

Liana: Because their immune system is so low, then taking a risk that they can have an infection, then we asking a doctor's note. For just in case for a doctor to—is it OK that she will have actually any grooming in your cuticles, even if she will say to me yes, I don't want to take any chance. Not for my sake, I mean, for her sake.

Emily O: When Liana was studying to get her medical aesthetician's license, she was inspired to study permanent makeup and nipple tattooing to help women reclaim the scars that cancer left behind.

Liana: And then when I started to learn medical aesthetician, and they were taking us to the hospital to see, like, different surgeries, like facelift, eyelid lift, and then it was the mastectomies and the reconstruction. And when I saw those women fighting this battle and when they actually saw that they have a new breast, it was like from—for me, it was phenomenal to see their reaction from nothing and suddenly they feel better with themselves.

Emily O: Because Liana still does microblading and tattooing, the health department checks in on those procedures often. They review the tools she uses, how sanitary they are and if she's using them correctly. But Liana wonders why her nail salon doesn't get the same level of inspection.

Liana: I wish that once in couple of months there will be someone that will come out of the blue, without any problem and goes, I'm always ready, I'm—I'm okay with that. And just coming to inspect, it's have to be in each salon like that. It's have to be. And unfortunately, it's not happening.

Emily O: Next time you go to any salon, Liana says to keep an eye out for their sterilization procedures. And if you don't see them, it's your right to ask.

Liana: So people need to always to ask all those questions. You have the right to ask all those questions. And if you don't getting the right answer, ask more until you will not get all the information, because in the end of the day, it's your body.

Emily O: If you're still undergoing treatment, it might be best to stick with at-home manicures. Liana says there are simple things you can do to help keep your nails strong. For example, keep them trimmed.

Liana: But I always say, don't have long nails because your nails are very brittle right now, they're very thin, you don't need them long. You're pretty when it's short, and it's really—it doesn't matter. Keep them short. Keep them a little bit rounded in the edges that it will not cut on anything because sometimes the nails can start to split because they're not that strong, and it could, you know, if you have a little split, you can cut it in your hair or your top and everything, and it could hurt. Cuticle oil, cream, it's always good. So those kind of things. She can use a nice, good, uh, base coat and a top coat as a treatment. Uh, but again, first to check if it's okay to use it while she's in chemo, to see that the doctor's saying okay, and if okay, not a problem.

Emily O: Having healthy nails isn't just an accessory. Liana notices firsthand that a good manicure can transform your spirit. For her, seeing how fresh nails can brighten someone's day proves that she wants to dedicate the rest of her life to helping women feel better.

Liana: And when I saw the change in how they feel better even with those little things that a nail polish, a color on their nails, or a little bit of a massage, you know, on their feet and a mini pedicure. So for me, it was—I said, that's—this—this is what I wanna do.

Emily O: To recap, here are the top three things I want to make sure you take away from this episode. Number one, mani-pedis at salons are risky. Wait until treatment is over to book your next appointment. Number two, little things like filing your nails or using a little cuticle oil can make a huge difference in how your fingertips look. Number three, while the side effects of chemo are hard to deal with, they are temporary. A year from now, this will all be but a memory. Thanks for listening. Be sure to rate and subscribe and tune in next time to hear—

Male 1: It's fabulous. You wanna to talk about empowered?

Female 2: OK. Now, I can do everything. I'm not stuck in a hospital bed or on my couch anymore.

Female 3: As for the future, yeah, worry. There's a possibility it can come back.

Male 2: Everything you promised yourself you will do if, do.

Emily O: Special thanks to the survivors for sharing their stories. This Walgreens podcast was clinically reviewed by Emily Shafer. It was written, reported and produced by me, Emily Orenburg, Taylor Banasik, Laura Locsmondy and Stephan Clark. It was co- produced by Caitlin Kiernan, author of Pretty Sick: The Beauty Guide for Women with Cancer. Follow her on social media at @CaitKiernan. Recording and mixing by Matthew Lejeune with Connor Boyle at Chicago Recording Company. For more oncology side effect help, visit to find oncology-trained pharmacists and beauty consultants in your area.