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radiation doses were small, the burning continued to destroy cells even between treatments, and this was the result. Jan's medical team was surprised to see such severe blistering this early in the treatment series; although every person reacts differently, this was something they expected at the end of a six-week program, not in the middle. They persisted for another week—the halfway point—and by that time the pain was intolerable. The sessions were halted for a week. Jan's lip was so swollen she couldn't talk or eat. She lost 10 pounds, and healing was slow. When it was time to resume treatment, they used a device called a bolus over her lip to limit the radiation scatter, and thus the collateral damage that was causing so much pain and tissue destruction. Treatment number 30 fi nally concluded. It took two weeks for the swelling to subside, and several more weeks before the blistering cleared up. She couldn't brush her teeth throughout the whole process; she used special toothpaste in a dental tray. The fatigue that accompanies radiation was maddening, but slowly improved. "It's not the way I wanted to start my retirement," she says, "but it's good I had nothing else to do." The pain of the blistering on the inside of her lip was intense. Oxycodone was helpful during the worst of it, making it possible to eat a little (mostly through a straw), so she could fi ght the fatigue and weakness. She used a mouth rinse with lidocaine, Benadryl, and Maalox to numb her lips so she could eat. Not surprisingly, everything tasted like Maalox for the duration of that intervention. When salivary glands are exposed to radiation, they die. With less saliva in the key area, the blistering skin would frequently become glued to her top teeth—for weeks she essentially had to rip off the healing layers and start fresh every day. She couldn't touch her burned lip with her fi ngers, so she put shea butter or Aquaphor healing ointment on her lower lip to apply to the upper lip as best she could. Resources Adams, C., B. Thomas, and J. Bingham. "Cutaneous Squamous Cell Carcinoma with Perineural Invasion: A Case Report and Review of the Literature." Cutis 93, no. 3 (March 2014): 141–44. www.mdedge. com/cutis/article/80830/aesthetic-dermatology/cutaneous- squamous-cell-carcinoma-perineural-invasion-case. Campbell, S. M., et al. "Skin Cancer Education Among Massage Therapists: A Survey at the 2010 Meeting of the American Massage Therapy Association." Journal of Cancer Education 28, no. 1 (March 2013): 158–64. https://doi.org/10.1007/s13187-012-0403-7. Carter, J., et al. "Outcomes of Primary Cutaneous Squamous Cell Carcinoma with Perineural Invasion, an 11-Year Cohort Study." JAMA Dermatology 149, no. 1 (2013): 35–41. www.jamanetwork. com/journals/jamadermatology/fullarticle/1557780. Johnston, M., E. Yu, and J. Kim. "Perineural Invasion and Spread in Head and Neck Cancer." Expert Review of Anticancer Therapy 12, no. 3 (2012): 359–71. www.medscape.com/viewarticle/759617. The Skin Cancer Foundation. "Skin Cancer Facts & Statistics." Last updated February 2, 2017. Accessed January 2018. www.skincancer.org/skin-cancer-information/skin-cancer-facts. Trotter, S. C., et al. "Skin Cancer Education for Massage Therapists: A Novel Approach to the Early Detection of Suspicious Lesions." Journal of Cancer Education 29, no. 2 (June 2014): 266–9. https://doi.org/10.1007/s13187-013-0589-3. THE TREATMENT When the time came to start treatment, a medical physicist (who knew such a specialty job existed?) determined the appropriate radiation dose, which had to be delivered with pinpoint precision. To achieve that, they made a mask: a fl at piece of plastic mesh was heated and then put on Jan's face to conform to her shape as it cooled and shrank, a process that took about 45 minutes. In some ways, making the mask was harder than the early radiation treatments: "It was the most horrible feeling to have your face, muscle by muscle, compressed," Jan says. "You can't move at all. I'm not claustrophobic, but this was really anxiety-producing. I could feel my heart racing, I was clenching and unclenching my fi sts. They told me they could stop if I needed, but then they'd have to start over from the beginning. I made it through." After the mask was made, the radiation treatments were fast and effi cient. The setup took about fi ve minutes ("They have to bolt you down," Jan says), and the radiation itself lasted 40 seconds each session. Jan came through the fi rst several appointments with fl ying colors and no big side effects. After the 10th treatment, Jan noticed a tiny blister on the inside of her upper lip. By the end of the weekend, the blister had spread to the entire inside of her upper lip. Although the Jan is bolted to the table under her mask for radiation treatment. Jan Schwartz at her celebratory reception in 2017. 44 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 8