Colleen Keough should be bald. But her long, blond locks suggest otherwise.

Keough started chemotherapy treatments more than a month ago, and one of the side effects of the chemicals she uses is hair loss.

What’s her secret?

The Penguin Cold Cap.

Since her first round of chemo in early July, Keough has been using Penguin Cold Cap therapy to prevent hair loss.

The cap, which looks like a giant cooling bonnet and is secured onto the head via straps, freezes the scalp, decreasing the amount of chemo that reaches the hair follicles. Inside the cap is a special lightweight gel designed to stay pliable at extremely cold temperatures - temperatures so cold patients must use moleskin pads and pantiliners to protect the skin exposed directly to the cap from frostbite.

“It gave a sense of control over things that may seem pretty minimal to other people,” said Keough, a professor of communication at the University of Southern California. “Not having to look sick is very important for some of us.”

On May 18, Keough was diagnosed with breast cancer. Just a few days after her diagnosis her husband found an article in the Minneapolis Star Tribune about the Penguin Cold Cap.

“It’s cold,” said Keough. “If you do not have the padding in the right place, it’s quite painful.”

During each chemotherapy session, patients must have a helper or two change the caps (the caps are too difficult for the patients to change themselves) to make sure the hair follicles stay cold enough.

“Having to switch the caps out does make chemo seem to go faster,” said Keough. “…. because otherwise you are sitting there in this chair for a few hours.”

Keough has a total of 14 caps she switches out. The first two caps stay on for 20 minutes each, and then caps three through 14 stay on for 30 minutes each.

While the procedure is similar for each Penguin Cold Cap user, Frank Fronda, the cap’s developer, has patients fill out a questionnaire with the types of chemotherapy drugs they will receive, infusion times, number of treatments and hair type.

“I take a lot of care to tell people what to do,” said Fronda, who often stays up late hours speaking with patients, tailoring the therapy for each person.

Fronda decided to develop a cap after seeing a little girl with a bald head who couldn’t afford or stand the therapy currently in use to prevent hair loss. After that, he spent seven years researching and working toward the cap used today.

“I did work hard and I discovered what you had to do. Patented the idea. Patented the gel. Patented everything,” said Fronda. “Just to make sure that I would get it out there safely, and I did.”

The Penguin Cold Cap is widely used in Europe and other parts of the world, but it hasn’t quite caught on in the United States.

Dr. Augustin Garcia, an oncologist at the USC Norris Comprehensive Cancer Center, said this lack of U.S. popularity is due in part to a stigma from similar treatments used in the 1970s and 1980s. The earlier treatments did not work; thus many doctors believe the newer treatments won’t work.

But Garcia believes new cold cap systems, like the Penguin Cold Cap, do work.

“They are thoroughly effective,” said Garcia. “But it depends on the number of cycles of chemotherapy.”

If a patient doesn’t have more than four cycles of chemo, the cold caps will work, he added.

However, Fronda said one of the patients he worked with used Penguin Cold Caps during two years of chemo sessions, and she kept her hair throughout the treatments.

Doctors also have another concern with cold caps: scalp metastases, rogue cancer cells that make their way to the scalp.

If a patient has a scalp met and uses the cold cap, the chemo may not be able to reach the rogue cell and the cell may return later.

While scalp mets are possible, cold cap users don’t seem to have higher incidences of them, said Garcia. But doctors are still uncomfortable with recommending them, he added.

“My doctor told me it wouldn’t work,” said Sherrie Boutwell, a Penguin Cold Cap user who kept her hair after four rounds of chemo. “I think he was really surprised.”

But keeping your hair does come at a price.

Patients rent each cap on a monthly basis from Fronda’s company, Medical Specialties of California, which is actually based in London. And, if there isn’t a freezer at the hospital to get the caps to the right temperature, patients must buy dry ice to get the caps cold enough. By the time all the costs are added up, the therapy could cost as much as $1,500, and getting insurance to cover the caps can be difficult.

An estimated 1,529,560 new cancer cases will be diagnosed in 2010, and an estimated 569,490 people will die this year from cancer.

Keough said some patients have been able to get insurance coverage for the caps as cranial prostheses or in lieu of wigs. But they usually only get a few hundred dollars.

Fronda is currently working on getting the caps approved by the FDA. Once that happens, it may be easier for patients to get coverage.

“Cold cap therapy is going to happen in the states,” Fronda said. “But unfortunately there is a premium.”

That premium is that hospitals and doctors are going to have to accommodate cold cap therapy users, putting freezers in more hospitals and lengthening chemotherapy room hours so patients can finish their cold cap treatments in the hospital.

But despite all of the expenses, many chemo patients would love the chance to keep their hair.

“It was well worth the cost and the hassle,” said Boutwell, who was able to get up every morning during chemo, look in the mirror and feel normal.

By keeping her hair, she could keep her identity.

“My idea is to help people save their self esteem and let them feel good about themselves,” said Fronda. “And it does take their mind off the chemo.”

Can we really put a price on that?

“I don’t want to walk out and be a walking billboard for breast cancer,” said Keough. “I don’t want strangers coming up to me and talking to me about oh I have this too.”

To reach new editor Jessika Walsten, click here.