- 3 weeks ago
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00:00This programme examines dermatological conditions and the procedures involved
00:04with treating them. Due to their graphic nature, viewer discretion is advised.
00:11What a bit of butterflies.
00:13OK, I'm going to have a quick look at it now, if that's OK.
00:16I would say it's more like an avocado than a lemon.
00:21It'd be great to look like I did before I had cancers on my face.
00:26It's a lot of words.
00:27A lot of people.
00:29I'm sorry that you're having to go through that.
00:32Every day I see people in despair and it's all because of their skin.
00:36It's been 20 years since they are just getting bigger and bigger.
00:40Some of the patients have been suffering in silence for many years.
00:44It's ugly. I don't want it.
00:46And others have tried multiple treatments and nothing has worked.
00:50And that's why they come to see me.
00:53I can't wait to have it gone. It's just going to change everything.
00:57I treat everything from the most extraordinary and extreme.
01:01Well, there's certainly a lot here, isn't there?
01:04I try not to look at it, to be honest.
01:06To the common skin conditions that we see every day.
01:09Woo! That was a good one.
01:12Do you want to see this?
01:13Yeah.
01:14Oh.
01:16It is hard at the moment because resources are stretched and people aren't able to get the treatment that they
01:22need.
01:23That's it out.
01:24Oh, good riddance.
01:25And all I want to do is to help make a difference.
01:28Thank you so much.
01:29Oh, it's my pleasure.
01:30It's gone.
01:31It's gone.
01:32It's gone.
01:32That is amazing.
01:34What are you saying?
01:34I am so grateful.
01:35You just don't know what you've done.
01:56Good morning.
01:57Good morning.
01:59Good morning.
01:59Good morning.
02:01Good morning.
02:02Good morning.
02:04Josh is coming in today.
02:06Oh, yeah.
02:06so i've got the uv meter and if we just check everywhere because ultraviolet radiation could
02:11damage the skin so it's zero in here it needs to be zero or one or even two at the
02:19most
02:20that's fine and just check it
02:25oh you see look that's like a reading of 33 so we'll not put that one on
02:33it's me i remember when you were first diagnosed and this picture look you can see underneath
02:42your eye blistering okay yeah no one really knew what it was i have a condition called zero derma
02:50pigmentosum that means my skin is more susceptible to uv damage and extremely vulnerable to skin cancer
03:02when i go out i have to wear some cream long sleeve clothing my main protection is this uv protective
03:12visor the goal is to really make sure that none of my skin is exposed whatsoever when the first cancer
03:21came i think it was probably around age four or five and i know that those next few years he
03:27had
03:27quite a lot in succession in 2017 i noticed a scab that wouldn't heal on my left eyebrow
03:37this turned out to be angiosycoma a rare and aggressive form of cancer
03:43this was serious josh had this mega operation then they discovered it spread and it was in his lymph nodes
03:54and they told us very quickly it was terminal and there's not much more they can do for him
04:05and so we got him home
04:14and then a couple of weeks later
04:19he actually got a message from one of the team from saint thomas's
04:24they're saying they came up with this treatment that they thought may be able to help him
04:32it was a miracle an absolute miracle now and i'm pleased to say that i'm cancer free
04:43but my face has got a lot of scarring on it i'm kind of patchwork really
04:51it would be lovely to look in the mirror and not be reminded of previous surgeries and a lifetime of
04:58sun
05:03damage
05:04hi my name's josh i'm here to see dr emma lovely would you like to take a seat sure josh
05:09is a very
05:10special patient to me we see each other a lot for regular skin checks but he's very self-conscious of
05:18the appearance of his face now as a consequence of these life-saving surgeries that he had to have
05:35so you've come today because we are trying to explore ways to make this look a little bit fancier for
05:41you
05:41yes yeah yeah okay i'm gonna have a quick look at it yeah if that's okay so you might want
05:47to close
05:47your eyes because i know that the light's a bit irritated and we've also checked this light and it's
05:51fine so there's a few different things that are going on really with the graft where did i take the
05:59flat front my wrist oh wow so um the main thing really josh isn't it is it the number one
06:07it's
06:08the color is quite different to the color of the rest of your skin and that's one of the first
06:12things
06:12that makes your eye get drawn to this the second thing is obviously you don't have an eyebrow here
06:20so you don't have that natural boundary that you know you have on the other side um okay
06:27so my plan for you josh is that um i'd like you to go and meet two of my colleagues
06:35so and the first
06:37one does a very specialist form of tattooing so she will change these white colors into the color of your
06:49surrounding skin pretty much exactly oh cool that's amazing and then the second person i'm going to
06:55send you to see um is a world expert to be honest in hair transplants what he can do is
07:02we give you a
07:03real eyebrow with real growing hair okay great thank you yeah they all sound very exciting let's uh crack on
07:12yeah excellent yeah really good that's what we wanted to hear
07:24good afternoon dr craven's office
07:30so should we go through these feedback forms yeah hi hey here's some good for you back
07:35oh a patient's dropped off some champagne right should we um go for a cup of tea
07:49it's hard not to think about this on my back
07:54it's always there i know people see it
07:58how are you feeling you nervous yeah i am but excited nervous but excited yeah
08:07hello was it juicy yeah nice to meet you i'm dr emma do you want to come with me
08:11yeah yeah come on through i like that jumper that's good colors thank you this is rosie he's our
08:19nurse nice to meet you come and have a wee seat so tell me a little bit what's been happening
08:25with your
08:25skin well 10 years ago um i noticed just a little lump it was a bit like a baked bean
08:33and um it just grew and grew and now it's like the size of half a lemon oh gosh basically
08:40i feel
08:41a bit like a freak yeah you know what i mean and have you spoken to any doctor about it
08:46in the past
08:47yes i spoke to my my own gp um he just said don't worry about it's just a fatty lump
08:53he said
08:54can we get in and have a look at your lemon yeah that okay yeah sure
09:01oh yeah i would say it's more like an avocado than a lemon
09:08so you just tell me if i'm hurting you at all okay yeah it's nice and held together which means
09:14it's encapsulated it's moving nice and freely over the top of that muscle that's underneath
09:20okay okay so this certainly feels like a lipoma so if you are in agreement we'd be really happy to
09:29do this today for you wow yes yes she's like i want it gone and then we would be beside
09:38ourselves
09:38with excitement to remove it for you oh wow yes i can't wait yeah yeah we'll do that today for
09:45you
09:45today oh marvelous thank you okay perfect see you in a minute then yeah she's gonna do it now she's
10:04gonna do it now she's gonna do it now yeah yeah wow exciting wow
10:20i'm just gonna mark this up is that okay yeah
10:25it's about 12 centimeters by about eight this is gonna sting a little bit we scratch okay we scratch well
10:33done very good i'm so excited i can't wait to get started i'm not even getting started am i
10:40dr emma's doing it it's a team effort yeah rosie juicy and emma yeah
10:52now are you okay in there yeah i'm fine all right good okay juicy i'm just going to check along
10:57the
10:58area and you just tell me if you feel anything sharp or sore or uncomfortable i can't feel
11:03nothing excellent
11:08now what we're just doing is working our way around nice and slowly of our little pal here
11:16okay it's really coming in i don't want it to come out yet stay in he was like hello get
11:23back in
11:24you're not allowed out yet you've got still some little friends in here that are not freed up yet
11:32yeah so should we try and give it a wee push ready
11:38sorry juicy it's all right
11:45there it is wow yeah wow you've got a wee bit still in here come on now out you come
11:54there beautiful
11:58there we go and we'll just go round and free up the little stock that holds it in place
12:09your baby is delivered really and it looks nothing like a lemon or like an avocado
12:18there you go josie peace and i we're just going to stitch you back up
12:24oh you'll be so pleased with this josie
12:29that's it done can i make glasses so i can see oh brilliant cheers there we go
12:37oh wow thank you so much absolute pleasure oh my god you're a marvel
12:43hi leone hey do you want to come in and have a little look
12:47oh a lot bigger than i expected it's gone it's gone it's gone i love operating on cases like juicy
12:57if i had a whole day of operating on patients just like this the operation and the joy and
13:03happiness when they leave well that would almost be a perfect day
13:09i'm feeling absolutely over the moon over the moon i am with it my life has already changed i'm already
13:18happier
13:31josh has had a skin flap taken from his arm to cover this defect that was created
13:36after the surgery but there is a great difference between the skin on the arm and the skin on the
13:42face and most notably it's the color and the texture so i've referred him to one of my colleagues
13:48for a technique called skin micropigmentation hi i'm kelly nice to meet you what i'm hoping to achieve
13:55is to make my eyebrow scar look a lot less obvious fade it in a bit more so today we're
14:04going to match
14:04your natural skin color for where the skin graft is and we're going to blend it in that sounds good
14:13we have five different colors and i'm going to layer those colors in first thing i'm going to do
14:20is a little bit of shallow camouflage it's just going to take the edge off the whiteness
14:24it's just going to the top of the skin the upper dermis how's that it's a little bit
14:30like having a shiver run over the area and that is your base and now i'm going to start adding
14:39a
14:39little bit of texture colors and that helps mimic skin tone and i'm going to do it tiny little punctures
14:45into the area scar tissue it's quite shiny and hopefully the texture of the scar is going to feel
14:51better yep that's colors starting to go in quite nicely and then we're going to build up build up
14:57build up and then we're going to have our true results in about four sessions i'd say yeah okay
15:04you're doing so well is it as painful as what you thought i wasn't really sure what to expect i've
15:10never had a tattoo before so this is your first tattoo then it is ah i'm a lot more rock
15:17and roll
15:17now aren't i you sure are a medical tattoo is different from a regular tattoo though as well
15:24a regular tattoo goes a little bit deeper in the products that i'm using they are pigment rather than
15:31ink they do eventually fade away they do need maintaining because your skin tone changes as you
15:37get older yeah yeah last tiny little bit now that's it all done wow color is in the graft okay
15:49here we go i'm going to hand you the mirror oh wow look at that i mean obviously it's a
15:54little bit
15:55darker now and a little bit more red in color that's going to die down very quickly um and then
16:00you'll be left with your true true result in about four weeks time all right great thank you so much
16:06for your help today oh it was lovely that went all right yeah i've got three more sessions to go
16:12and the end result i'm really looking forward to
16:32all right you will sammy i'll change its water hello she's my best friend if i was allowed i would
16:43hold her 24 7. they don't really care about my warts but this little one is trying to get down
16:50the couch
16:51you're not getting down the couch i have over 40 warts on my hands i hate having them i'm actually
17:06scared if they're going to grow all over my body i've seen people with warts and they only have a
17:14few
17:14i've never seen anybody with that many warts all right what color do you want that one please all
17:23right nice shade would you like put your hand out for me what's the worst thing about having warts
17:29people always stay away from me because of them and they're scared if they get them
17:36to me lily's really brave going to school because she knows someone might mention awards but yet she
17:45still goes there with a red-held eye people hate being my friend my classmates always say i hate you
17:56and i don't want to touch you are you feeling a bit nervous
18:21oh yeah are you lily hiya lily you want to come with me who are you bringing with you nice
18:26to see
18:27you both come and have a seat up on the bed and this is nurse motty so what have you
18:37come to see me
18:37about um i've got warts yeah so tell me the story of these warts i actually touched a frog when
18:45i was
18:45little and they've been growing ever since okay tell me about this frog my uncle and me went fishing
18:53and my uncle said oh look lily a frog anyways i picked it up and i kept that as a
19:00pet oh and what
19:01what did you call the frog frogger you are so funny lily well you know we actually can't catch
19:09warts from frogs so how old were you when you had your first wart four or three so you're 10
19:16now so
19:17seven years you've had these near enough yeah that's quite a long time to have warts for isn't it really
19:23and they're on this hand which i can see and on the other side they're like little jewels on your
19:28hands
19:29really aren't they and does anybody comment on them some people say what are those that's not
19:37very nice sure it's not sometimes she'll try and hide them especially when she's meeting new people
19:44they make you feel a bit embarrassed that they're there it feels like a little bit nervous and upsetting
19:50because i know they're gonna pick on me okay and has somebody ever picked on you before because of them
19:55yeah a lot of people oh dear i'm sorry that you're having to go through that that is a horrible
20:01thing isn't it it really is does that upset you a little bit but mostly i try and get it
20:08over my
20:09head good for you are you sure you're only 10 yeah i don't think so how old do i actually
20:16look you look
20:17like you're 10 you act like you're 35 okay let me have a wee look at your hands
20:27you got loads of them yeah one two three four five six seven eight nine ten eleven
20:3412 13 14 15 16 17 18 19 20 21 22 22 on one finger it's a lot of words
20:42yeah now they've got quite a red edge to them and they're fairly soft to touch and haven't you got
20:49just incredibly soft skin i mean incredibly soft skin and it's the kind of skin that warts love to live
20:57in okay so these are definitely viral warts and it's from a virus called the human papilloma virus so
21:04the virus gets in and takes over the normal skin cells and tells it to replicate and it makes these
21:09little bumps that you have now most people their immune system will come in and say you know there's
21:16a wart here let's get rid of it but yours has gone on without the immune system jumping in to
21:21say can we
21:22get rid of you please so i would just like to do a blood test have you ever had a
21:27blood test done before
21:28no so the blood test just lets me have a look at what your immune system is doing that's the
21:33first step
21:33and then the second step of what i'm going to do is something with one of my lasers and it
21:41doesn't
21:41hurt and i use it on children and essentially what i'm going to do is try and let the the
21:49laser energy
21:50interact with the wart virus and try and get your immune system to be excited about the fact that
21:58there's a wart virus there so it can come along and start getting rid of them how does that sound
22:03yeah yeah you're up for that perfect good girl
22:11i'm going to send lily for some blood tests because it's pretty unusual for somebody to have
22:17quite so many warts for quite so long it might well be that there's a change within her immune system
22:24which means it can't really recognize the wart virus quite so easily so the warts can take hold
22:32i was actually happy that it wasn't from frogs because frogs are like my favorite animal
22:44i'm very excited because i'm seeing dr emma for my laser treatment because i'm having more warts
22:52i'm still waiting for lily's blood tests to come back but she's come in today
22:59for her first laser treatment here we go one two three how was that okay i'm going to use the
23:10pulsed
23:10dye laser this laser works by targeting the vessels within the wart and stops the wart from growing
23:17and this side and again but also that incites the immune system to then get rid of the rest of
23:24the
23:25warts that are there and last one good girl
23:35it's been a week since i've seen dr emma i've had my first laser treatment out of six since the
23:43treatment all of them are actually turning black i think they're all ready to fall off
23:48the treatment felt like um elastic band but i got used to it by the end
24:03the next stage of josh's treatment is to recreate an eyebrow for him and i'm referring him to one of
24:10my
24:10hair transplant surgery colleagues he's going to be taking the hair follicles one by one
24:16from the back of his head and implanting him where the eyebrows should be
24:23okay josh you're going to start shaving the back just so the hair is a bit shorter all right
24:28the way that an eyebrow hair transplant is done is very similar to hair transplants to the scalp
24:33except they're much more prominent on the face and so one has to be very careful with the placement of
24:38the hairs
24:42so today what we're going to do is you extract the hairs in the back of your head uses a
24:47little drill
24:47with a cord punch and then i'll be pulling the the hairs out
24:56and then we'll be implanting those in the eyebrow area and probably take about uh two three hours
25:09okay josh so um i've finished doing all the extractions now and then we're going to turn
25:14you over and start the process of implanting the hairs yeah wonderful just going to start making
25:20some of the incisions i'm going to use a little blue dye shows up uh where the incisions are a
25:27little
25:27clearer okay so your eyebrow will i'm afraid temporarily have a bit of a blue appearance
25:37right uh josh so i'm just going to get started now implanting the hairs into their new little homes
25:49you know the idea obviously here is to create a very natural looking eyebrow so their single hair
25:54is usually at the periphery for a bit of softness and i'm just putting in the the two hair groupings
26:00centrally for a bit more density
26:04so there are no guarantees with a hair transplant the biggest challenge is to try and match the
26:09transplanted eyebrow to the normal side you expect about 90 of the hairs to grow but not all of them
26:14will and so in some ways it's better to put in a bit too many and then you can um
26:22in the same way
26:23that you're going to have to be trimming your eyebrows every five to seven days because they're
26:26going to grow long like your scalp donor hair would have yeah you might want to uh treat yourself to
26:32an eyebrow bar do a little plucking and shaping um all right josh all gone really well okay so i'm
26:41going to sit you up all right do you want to have a look yeah certainly do certainly do let's
26:45see oh wow
26:47it's obviously very blue uh that will all wash off in the next couple days yeah i mean it looks
26:52uh really
26:53good so those little hairs are going to fall out after a couple weeks don't worry about that that's
26:58normal and then they'll slowly start to grow out uh they'll start off soft and finding they will
27:04gather more strength in terms of diameter and color yeah but it'll be about six to eight months before you
27:09see the final result right okay thank you very much great good stuff i think it went very well
27:16i'm starting to see um the eyebrow that i used to have before my uh surgery and um yeah feeling
27:24good
27:29all right i'll break that
27:34look at that yeah he's a good dad he's funny
27:40oh he's aggravating as well but like in a funny way oh that nearly went in i talked to my
27:51daughters
27:51about how i'm feeling you know with the condition recently one of my friends said that his face looks
28:02like moon craters when i told him i think he was quite upset i think that was the final step
28:12where i
28:12realized that i had to get this sorted i'm not having my daughters suffer particularly if it's something
28:18that can be dealt with hi you david hello how are you doing yeah good thanks good to see you
28:29come with me
28:32so david tell me a little bit about what's been happening with your skin i've got these sort of
28:37lumps as you can see they're mainly focused around this area but they have spread up there when did these
28:44all first start it started with just sort of a small one about 10 years ago i thought there's nothing
28:50to that cut it shaving and things that that was about it and then more of them grew and they
28:58sort of
28:58turned into a cluster how does it affect your day today do you think having these well i mean
29:05it is embarrassing yeah and i know that you see people with far worse conditions
29:10um but that doesn't make it you know any easier for me do you mind if i get in and
29:15have a look is that
29:16okay of course
29:21and hold your wee head up for me
29:25yeah this area here it feels firm and it's uh shiny and then these are coming up in quite raised
29:34patches
29:35and then right to this side so you can see the vessels on them it's red and it is angry
29:47okay so these are called trichoepitheliomas and they are benign it is a rare condition round about one
29:56in 300 000 something like that it can be related to a slight mutation on a gene
30:03david has multiple facial trichoepithelioma and this is a consequence of a mutation within the
30:11hair follicle itself and it means that he develops these small tiny little bumps and it's usually
30:17clustered in areas around the lips and the upper forehead and they are growing and unless we do
30:24something to try and stop them growing they will just continue to keep getting bigger and spreading out
30:31okay so there's certain parts of it that we can target with creams that we apply to the skin and
30:38and it will just halt this in the in its in its growth and then the second thing i'd like
30:43to do is
30:44treat some of the blood vessels that have formed with one of my lasers that will get rid of the
30:50redness
30:50in those ones and then i have another laser called the carbon dioxide laser and it essentially works
30:59like a very posh piece of sandpaper and and it goes over where the bumps are and burns them down
31:06yeah
31:06sounds good so i'd like to start doing the laser while you're on the cream in about four to six
31:12weeks
31:12time does that sound okay sounds great great it's gone far better than i could have ever imagined really
31:22you know fingers crossed it will work out because if it does it would make my daughters happy it'll
31:28improve my life drastically
31:46be able to do that
31:49hi dr emma would like to request this test for a patient please okay great thank you
31:59how you doing hello you doing okay yeah good come on down okay
32:06come on in i think that these have got smaller i think it's a small improvement but
32:12yeah so the cream is now doing the trick so that is good so today we're going to use one
32:18of the
32:18lasers to treat the redness right and then i'll use the other laser to treat some of the bumpy ones
32:25and start to flatten those down a bit right okay let's do this okay so lie yourself down here
32:33goggles on now this one doesn't need to have any anesthetic on it you're going to have some gel
32:43and you're going to feel a one two three there we go how was that good this is actually an
32:50intense
32:51pulse light converting the light energy into heat and it gets taken up by the thing that's red it's
32:57got a special filter on it so as this redness settles down so too will the redness that was the
33:03vessels
33:05nearly there well done good super um so now i'm going to pop the bit of anesthetic and use this
33:13laser to flatten those down okay yeah okay wriggly fingers really fast with those fingers well done
33:23thank you so just you tell me if you feel anything so this is a carbon dioxide laser essentially it
33:31burns the
33:32skin but it's a controlled targeted burn so all we're doing is going over the areas that are raised up
33:55so this is going to take 10 days until it's healed over but you have to use the cream to
34:06keep it
34:07away or else it'll start to come back right yeah okay okay yeah thank you
34:17mothy you won't be able to no i can't reach them you're taller than me so not much
34:28this is crispy i can't believe you're going to just sit and watch me eat it
34:32i didn't get one because i am behaving myself emma i've got my tea emma yeah i've got my coffee
34:40and
34:40my and your pastry
34:56mystery hello lily hi nan hiya you look very fancy i like this outfit all in blue
35:07okay welcome back so your warts we've been treating with the lasers now we've done three full sessions
35:14of it and also you had some blood tests done and your blood tests it does actually show that the
35:22white
35:23blood cells which are important for getting rid of these warts is actually not really behaving exactly
35:29as it should do lily's blood tests showed she has something called a primary immunodeficiency syndrome
35:37where those cells meant to fight away viruses or bacteria for some reason can't quite do it to the
35:44same effect as somebody else who doesn't have that syndrome the problem with this is is that these laser
35:50treatments actually involves the immune system so what would normally take three or six treatments
35:56it's going to take a whole lot more when you last laser diamond when i'm writing with my pen they
36:04started stinging you can feel them starting to tingle okay that's good that's a sign that they're
36:09going to start to shrink down some of them are actually already disappearing yeah and it's actually
36:16fell off today oh there we go and that is actually going as well it looks really promising to me
36:24actually because we've only done three treatments and the ones that have actually reduced are not
36:29the ones that we've had to be with the laser so showing that the immune response is starting to
36:34kick in this is really really promising i'm actually very happy to see that you can treat them and
36:41very excited for high school because then i know that i'll make more friends then you're looking
36:47forward to and you start then yeah and them going that makes you feel good when you see you go
36:52bye bye
36:58i'm happy with treatment so far seeing the change in the attitude like with her hands she's not adding
37:04them so hopefully fingers crossed she'll only need a few more dr emma has actually given me more
37:11confidence so i'm not ashamed about my body anymore
37:28when i look in the mirror it's a big improvement and when i touch my chin it feels like most
37:34chins
37:35do you know how it should feel so i'm very happy the most noticeable improvement is the clusters of
37:43little bumps have more or less gone which obviously is a big step forward which cue do you want jess
37:51my kids were mocked and i'm pretty sure that they won't go through that again
37:57so liza you're up close to daddy's face what are your thoughts on the process
38:02well there's a big improvement um better than i expected really yeah do you think i won't have to
38:08hide away from your friends when they come over um hopefully not and there won't be any more moon
38:14crater comments well that would mean that it's been a big success then
38:30i see josh regularly from st thomas's hospital for his skin checks and this morning i'm really
38:36super excited he's been going through a course of treatment to help rebuild an eyebrow and also help
38:42to blend in the color of the scar created when the skin cancer was removed this is a treatment that
38:49he's been asking about for a long time so i'm dead excited to see what it's looking like
38:55hi josh hi emma come on in thank you
39:00come on in josh have a seat how are you doing i'm very very good thank you good i mean
39:06from here
39:07actually you can't really see at all where the surgery had been yeah i mean it's what a difference
39:13yeah yeah it's wonderful the skin tone is more closely matched we have eyebrow hairs that's great
39:24it is early stages but yeah things are happening it's amazing yeah it's fantastic isn't it can i get
39:30in and have a wee look at it is that okay of course you can yeah yeah bright light okay
39:35tested for uv
39:36okay oh that's brilliant the color of this is fantastic it's unbelievable how she does it yeah it's
39:46really cool and the the eyebrow hairs are actually growing in already yeah how many were there 280
39:54some of them are quite long as well aren't they yeah you might need to get a little trim
40:00because it's normally about eight or nine months after the transplant yeah the hair growth for the
40:05eyebrows yeah and okay so it's been really interesting actually going through all of your
40:11story again yeah yeah when you think about how ill you were and now we're we're doing the eyebrow
40:18from one extreme to the other yeah yeah it's wonderful it's amazing and i think the results have
40:24been fantastic so if i can have a more scar free face then that's a good thing yeah and i
40:31can't wait
40:32to see yeah what he's finally going to end up looking like yeah oh that was amazing seeing josh this
40:40morning you know having these scars was never going to be something to hold him back but i can see
40:45what
40:45a difference it has actually made to him and knowing that this isn't even anywhere near the complete
40:51treatment it is just wonderful i'm so pleased i'm really happy with the help i've received from dr emma
40:59he's been fantastic to finish the job on my surgery it's still work in progress but it's looking great
41:21so
41:26you
41:28you
41:29you
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