At her side: Derm's solutions help wife through cancer treatment

Norman, Okla.

- Dermatologist Joel Holloway, M.D., is accustomed to relying on his training as a pharmacist to come up with treatment solutions for his patients’ skin conditions.

Little did he know that his expertise would also help his wife, Twyla J. Smith, M.D., when she experienced extreme treatment-induced side effects during her recent bout with breast cancer. Dr. Holloway developed formulations and protocols that the couple now share with others through their support group Hope Oklahoma, which addresses both the physical and emotional aspects of cancer treatment.

Joel Holloway, M.D., and his wife, Twyla J. Smith, M.D. (Photo: Joel Holloway, M.D.)

Dr. Smith, a board-certified psychiatrist practicing in Norman, discovered breast cancer after a routine mammogram. She and Dr. Holloway, her husband of 15 years, knew they were headed into a treatment regimen of surgery, chemotherapy and radiation, but they did not expect the onslaught of crippling side effects.

“She had every side effect known to man from the chemo,” Dr. Holloway says. “None of the people who were doing the treatment had any answers. They were sympathetic, and that was about it.”

Following chemotherapy, Dr. Smith’s hands and feet burned, to the point that she could not stand or walk. She lost her fingernails and toenails. Her body excreted the drug through her tears, and she had second-degree burns on her face and eyelids.

Her skin dried and peeled. She experienced generalized muscle aches and pains, which limited her motion. And that was not all.

“Some of these things come out of the blue. You are not expecting to have your feet [feel as though they will] catch on fire … it is just really bizarre,” Dr. Smith says.

Dr. Holloway did more than console; he created a regimen of treatments to address each of the side effects. Today, he speaks to cancer patients and their care providers about how to lessen the physical effects of treatment.

Step by step

The dermatologist was behind the eight ball when Dr. Smith first started feeling side effects from chemotherapy. So, his initial course of action was not to prevent, but rather to address, her pain.

He discovered that inflammatory responses from treatment, whether from radiation or chemotherapy, are almost always mediated by two mechanisms. One is the prostaglandin cascade; the other, singlet (free radical) oxygen reaction.

“If you can do something to interrupt those two things, you can usually do a lot to stop the inflammatory responses,” he says.

To address the burning sensation in Dr. Smith’s hands and feet, Dr. Holloway made a solution of aspirin and vitamin C powder. “Back in the mid '70s, there was a paper that came out on treating and preventing sunburn after UV exposure, with topical aspirin. I just took that information … and projected that onto what would happen in any inflammatory response,” he says.

“We would soak her feet and hands during the time of infusion. You may do it twice a day, every day … and it was pretty remarkable, the relief that she got.”

He used desonide ointment (Desonate, Intendis), applied four times a day on the eyelids and cheeks, to protect the skin from tear burns. The ointment stopped the burning almost immediately, according to the dermatologist.

Relieving mouth pain

Dr. Smith said her mouth hurt and burned during treatment, and she did not get relief from sucking on ice, which is what patients are often told to do. Instead, Dr. Holloway gave his wife chewable baby aspirin and vitamin C tablets to suck on during infusions.

“The aspirin inhibits the prostaglandin cascade and the vitamin C inhibits the singlet oxygen-induced inflammation,” he says.

Dr. Holloway used a different approach to address Dr. Smith’s muscle pain, after serendipitously discovering that she had small, infected fissures. Using doxycycline twice a day to address the secondary infection, he was able to stop the muscle pain in less than an hour after the first dose.

“We know that doxycycline is the most anti-inflammatory of all the tetracycline antibiotics, but I had no idea that it would work like that,” he says.

By the time Dr. Smith underwent radiation treatment, the couple anticipated the resulting burns and prevented them with wet soaks of aspirin and vitamin C powder every day - applied as soon as possible after radiation.

“Then, I made a formula [a lotion] that contains CQ10 and alpha lipoic acid - both strong antioxidants. You put that on the area,” Dr. Holloway says.

To address the very dry skin his wife experienced from treatment, Dr. Holloway used CeraVe creams and lotions (Coria Laboratories), applied four times a day. The company that manufactures the cream now provides it free in “goody” bags given to patients when Dr. Holloway speaks.

Hope in Oklahoma

Dr. Holloway and his wife now are reaching out to help other cancer patients, with a group they call Hope Oklahoma.

“We have a seminar once a month at the hospital here,” Dr. Holloway says. “I give the scientific part of it first, and give [patients] handouts telling them how to use all the products, with little bags with all products in them.”

Even if the treatments he recommends do not help 100 percent, he says, “They really help a lot.”

The work he and his wife put into Hope Oklahoma is charitable. They say they have had no trouble convincing pharmaceutical manufacturers, a local pharmacist, and even the person who provides the hats to help.

“Anybody that wants the formulas, I will give them to them. I do not want this to go commercial,” Dr. Holloway says.

In the meantime, Dr. Smith is back at work more than a year after her diagnosis. The hope, she says, is that something positive will come out of the experience.

“It was really a blessing to have him, with his knowledge and caring,” she says of her husband. “He put a lot of things together.” DT