- 4 hours ago
Save My Skin S05E09 Episode 9 Engsub
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Short filmTranscript
00:00This programme examines dermatological conditions and the procedures involved with treating them.
00:05Due to their graphic nature, viewer discretion is advised.
00:13Hello, I'm Dr Emma. Come and have a wee seat.
00:17These ones at the front, they are so red.
00:21They're sore.
00:22And itchy.
00:23It then progressed so much that I was in A&E almost once a week.
00:28Oh my goodness.
00:30I'm here to get rid of the unsightly mess that's in front of my face.
00:33Every day I see people in despair and it's all because of their skin.
00:38It's been 20 years since they are just getting bigger and bigger.
00:41Some of the patients have been suffering in silence for many years.
00:45It's ugly. They don't want it.
00:48And others have tried multiple treatments and nothing has worked.
00:52And that's why they come to see me.
00:55I can't wait to have it gone. It's just going to change everything.
00:59I treat everything from the most extraordinary and extreme.
01:03Well, there's certainly a lot here, isn't there?
01:06I try not to look at it, to be honest.
01:07To the common skin conditions that we see every day.
01:11Woo! That was a good one.
01:13Do you want to see this?
01:14Yeah.
01:16Oh.
01:18It is hard at the moment because resources are stretched and people aren't able to get the treatment that they
01:23need.
01:24That's it right.
01:25Oh, good riddance.
01:26And all I want to do is to help make a difference.
01:29Thank you so much.
01:31Oh, it's my pleasure.
01:32It's gone.
01:33It's gone.
01:33It's gone.
01:34That is amazing.
01:36I am so grateful.
01:37You just don't know what you've done.
01:50Good morning.
01:51Hi.
01:51Do you know what time the first patient is arriving?
01:54At nine o'clock.
01:58I spoke to that patient yesterday and she really loves that cream that we especially made for her.
02:03So it's changed her life.
02:05Amazing!
02:26It's been 20 years since I have my keloids.
02:31They are very painful and they are very itchy.
02:36There's one in the middle.
02:37They are the ones that hurt when I touch.
02:44It's quite hard.
02:45Like, when we are going to sleep, I can hear him scratching his chest.
02:52Okay.
02:53You just feel helpless.
02:56I don't think nobody should live with pain, like, 24-7.
03:02Let's just stop, stop.
03:04Would you mind taking this bag for me?
03:05It's just, it's hurting my keloids.
03:08I'm married to Samantha for four years now.
03:12It was a good day, wasn't it?
03:14Yes.
03:15It was a very good day.
03:16We have put off having a family now until we find out what can be done regarding this condition.
03:31I just wish they were gone.
03:34If Dr. Emma could just treat them, it would be a life-changing for me.
03:41Hi, Mauricio.
03:42Hi.
03:42Hi, nice to meet you.
03:43I'm Dr. Emma.
03:50Come and have a seat.
03:51All right.
03:52How are you?
03:52I'm all right, yourself?
03:54Good.
03:54So, tell me what's been happening with your skin.
03:57Well, since I was five, my family and I knew that I had keloids.
04:04So, my grandfather had keloids and my mum as well.
04:07Okay.
04:07So, they have been becoming bigger and which has been concerning me is that they are growing very quick.
04:15Painful.
04:15Yeah, they are very painful and they age a lot.
04:19I mean, five is really young to start getting keloids.
04:23Keloids are types of scars where the cells that are responsible for making the scars have kind of gone out
04:30of control.
04:31I see.
04:31And where on your body did they come?
04:33Well, I have some in my knees which came from when I fall off from a bike.
04:39But the most concerning ones that came out of spots, it was from my back.
04:44After you had acne?
04:45Yeah, I had some acne and they just grow up from there.
04:48Once I shaved my chest, as I have a lot of hair.
04:52Yes.
04:53And they just grow up as well.
04:55So, tiny little injuries, that's all it's taken to trigger it all.
04:59Yeah.
04:59Okay, so, do you mind to take your top bits off and I can have a look?
05:02Yes, of course.
05:03It's fine.
05:04Just allow me a sec.
05:09They are good going keloids, aren't they?
05:11Yeah, they are.
05:13Yeah, they really are.
05:16And these ones at the front because they are so red.
05:20They're sore.
05:21I can tell that they're the sore ones and itchy.
05:23And you can also see because the direction in which they go is almost the direction in which we expand
05:30our chest.
05:31So, whenever you made the comment about the things that you were doing at the gym, it's the strain in
05:36that area is actually the stimulus for these cells to grow and that's why it grows in this pattern.
05:42Okay, so, I'm going to look around the back now.
05:48They're almost like little mushrooms, aren't they?
05:51Yeah, they are.
05:51Because they have a stalk and then they have a cap.
05:54And if they weren't so itchy and uncomfortable for you, they look quite splendid.
06:01They really do, these ones.
06:03That's the first person who tells me that.
06:05But they're causing you discomfort and that's not good.
06:09Okey-dokey.
06:11In your case, you have something called a keloidal disease.
06:15In other words, it's not just one area that this is happening in.
06:19All of the parts of your skin are prone to this happening.
06:24And it's a genetically inherited tendency, which is why your mother had it and why your grandfather had it.
06:30And I do need to scratch my head for a little bit with you to come up with the best
06:34plan.
06:35Because it's not an easy thing to actually do.
06:37No, it's not.
06:38And we need to do the right thing first time because an injury causes a keloid.
06:44And if you injure a keloid to get rid of it, it can just make the whole thing spiral out
06:49of control.
06:49All right.
06:51So I work with a team of people at our scar clinic.
06:55Some of which have devoted their entire lives just to treating keloidal disease.
06:59So we need to have our case conference and then I will have our conversation about what the plan is
07:05going to be.
07:06All right. Thank you very much.
07:19Oh, I think this looks like it here. Yeah.
07:23Warwick Street, help me out. There we go.
07:26I'm here to get rid of the unsightly mess that's in front of my face.
07:29Good morning. I've come to see Emma.
07:31Oh, that's great.
07:32The doctor, Emma. Yeah.
07:33That's great. Would you like to see it?
07:34Yeah, sure. Thank you.
07:37Dad's always been a very confident chap.
07:39He was a very handsome man in these youth and he was in the RAF and they instilled pride in
07:48his appearance.
07:49You know, it's inevitably going to make a difference to your confidence.
07:55Hello, David. Oh, hello. Good morning.
07:57Hi, nice to see you. I'm Dr. Emma.
07:59Oh, Dr. Emma.
08:00And come and have a seat.
08:02I'm going to guess you're here to see me about the nurse.
08:05I'm definitely here to see you urgently about these because they are growing while we look at them.
08:10And I'm really worried about them because I've lived with them for a long time, but now they're getting aggressive.
08:15The change in the last three, four years, they've got bulbous.
08:18But before that, there was always an impediment there of sorrel.
08:22The last ten years at least.
08:23What did it look like ten years ago?
08:26Just a spot.
08:27A little spot.
08:28I was always having spots.
08:29And then it started to get bigger and bigger and bigger.
08:31And now it's, it's, it weeps.
08:34Now, yesterday was a big build up because I was shaving to come here and it squirted and whack in
08:39the mirror.
08:41It was a good one.
08:41So it would go so far when you touch it to hit the mirror?
08:43It would go right across, yeah.
08:45It would go right across.
08:46It's okay if I come and have a close-up look at it.
08:48Well, that's the idea.
08:49That's why I'm here.
08:53Okay.
08:54Let's have a wee peek.
08:58So what we've got is this thickened change, this phymatous change, we call it.
09:04And then your dangly bit.
09:06Yeah.
09:07We might be able to see if there's some.
09:08I wouldn't stand too close.
09:09Yeah.
09:11There we go.
09:12Yeah, we could see.
09:12I could feel that coming.
09:13Yeah.
09:14It's called sebum and it's made by the follicles.
09:17So at the bottom of those pores, there's a little tunnel that goes down and it goes into a gland.
09:22Right.
09:22And that gland makes sebum.
09:26So this is a diagnosis of something called rosacea.
09:30Yes.
09:31With rhinophyma.
09:33Right.
09:33And rosacea is a condition that causes inflammation in the skin.
09:38Yes.
09:38And it typically causes inflammation around the follicles or the sebaceous glands.
09:43Yeah, it's true too.
09:44And then in a very small number of people, it can cause rhinophyma.
09:48Yeah.
09:48So rhino meaning the nose and phyma meaning the thickening or the swelling.
09:52When it comes to trying to treat it, I would use my laser.
09:57Yep.
09:58And that will get rid of the main bulk of things.
10:00It would actually be important to try and get the rosacea under control.
10:04And we can do that with a combination of a tablet and with a cream that you put on at
10:08night time.
10:09It will stop it from coming back.
10:11Right.
10:12How does that all sound?
10:12Sounds wonderful.
10:13Okay.
10:14Good.
10:14Progress.
10:15Progress.
10:17Would you like to do it today?
10:18Yes.
10:19Please.
10:19Now.
10:20Get cracking.
10:21Get the knife in.
10:27I'm sorry about this, okay?
10:29Because this is the little anaesthetic that you're going to feel.
10:31Wriggle your toes for me.
10:33Wriggle the toes.
10:33Great stuff.
10:34Well done.
10:37We're going to start now, but if you just let me know if you feel anything sharp or sore, okay?
10:41Sure.
10:45So we're using the laser so that we can cut it nice and precisely
10:49and allow us to peel this surface layer of the skin off to get rid of all of the bulk.
10:56And you also want to try and do this with as minimal scar tissue as possible
11:00because the scar tissue will look different to the normal nose tissue.
11:08So I've just cut into this gently, so I'm going to try and now just squeeze out
11:13what we can see in terms of the sebum.
11:22We can see the jet that you were talking about.
11:24How can you?
11:25This has been a little bit like a balloon.
11:28Yeah, it has, hasn't it?
11:29Yeah.
11:29Yeah.
11:30Good spot.
11:31So these are the little glands that are inside.
11:33These are the little cysts.
11:34Oh, look at that.
11:35It's a little micro-cyst.
11:41So this is the larger dangly down bit that we've now removed.
11:45Mmm.
11:46But do you take the whole flap off?
11:48I've taken the whole thing away there, yeah.
11:49Wonderful.
11:53So the main aim really is to get rid of this big bit that was blocking his nose.
11:57And then the second aim is to try and reduce the size of the wing part of the nose.
12:07So you can see that's all a little cold.
12:11So now what we want to do is blend this down.
12:21You doing all right in there?
12:22Yeah.
12:23All right.
12:23Good.
12:30There we go.
12:31We'll just let that heel up at that side now.
12:36Can you feel that?
12:37No.
12:42Good.
12:43Good.
12:44Good.
12:44Good.
12:44Good.
12:44Good.
12:51Good.
12:52You know, I do love...
12:55Stitching.
12:55I think you're very, very clever at it.
12:58People and clothes.
13:02Lovely, lovely.
13:03As this heals now, it will start to reform the shape of his nose over the next couple of weeks.
13:10How did you find all of that?
13:12I found it wonderful.
13:15there you go you can take a hold of this and have a little look oh yeah it's lovely it's
13:20100 better isn't it would you like to have a look at what we took off yeah wow that was
13:27that
13:28was the big boy that's nice isn't it it's like it's like mushroom that's a little capsule so
13:32that was where don't squeeze it oh look at that
13:39new man wonderful it's a very proper beautician's job
13:48all right we're all done everything's done she's brilliant absolutely brilliant she was
13:53i couldn't feel anything i just if i thought i was going to sleep at one time
14:05i'm really keen to hear what your thoughts were on mauricio i would probably say that
14:11mauricio is within the top five in terms of patients with very severe colloidal disease
14:16i mean this is really very challenging it's so extensive and i know that it's not possible to get
14:23rid of all of them we're just not at that part in medicine at the minute but these ones in
14:29the
14:29central chest and the lateral aspect of his shoulders are the ones that were causing him
14:33the most grief he'll get a lot of benefit from the removal of these ones and make the other ones
14:39probably a lot more manageable just in his mind and then when it comes to the chest clearly there is
14:45no way that we can actually remove any of the keywords unless we generate new skin in one way or
14:52another because there isn't enough skin to cover the keloid removal on a central chest that's right
15:01how would you approach that by far the best way of doing that is to do what we call tissue
15:07expansion
15:08this will allow us to remove the large keloid cluster and then bring the skin edges together
15:14this is really my main concern here
15:25today's the first of mauricio's operations mr gutas is going to tackle the largest of the keloids on his
15:32back and also start to prepare the chest for a future surgery the chest will be expanded using tissue
15:41expansion and mr gutas is going to insert these today i have never had any operation before this is
15:50the first time i will be going through a surgery it's hard to express in words how i'm feeling now
15:57i am very anxious thank you tissue expansion is a pretty uncommon technique and we only really have
16:10to use it whenever there isn't enough skin to cover an area i'm gonna have to go here because
16:19the that's the only entry i have this has taken a lot of planning and i'm really excited to see
16:26what can be achieved with such cutting edge keloid surgery
16:34first we are going to remove the biggest keloids from each shoulder
16:48perfect we're going to do this 10 blade
16:57i've just removed the large cluster from mauricio's right shoulder
17:06we're just going to go ahead and make start putting the suture follow me
17:13and i'm gonna need another one of those
17:21right let's go on the other side
17:39all right
17:41right let's tie this
17:43right the second part of the operation inserting two tissue expanders on either side of the large
17:56keloid in the center of the chest yep
18:00right right okay so we have created the pocket underneath the skin that will accommodate the tissue
18:07expander tissue expanders are essentially deflated silicone balloons and then go back in and these are
18:17going to be gradually blown up in order to stretch the surrounding skin
18:25and we're now closing the wound
18:28after the surgery today mauricio will have some radiotherapy
18:32the radiotherapy works by telling the cells that make the collagen and the scar tissue to stop
18:38multiplying and stops the keloid from coming back
18:44radiotherapy can actually carry with it a very very small risk
18:48of developing a skin cancer over the rest of mauricio's lifetime
18:55so i will be seeing mauricio back in clinic to keep a close eye on him
19:02the right shoulder is a little bit uncomfortable but i'm feeling okay overall
19:28and i suffer from an undiagnosed condition that causes swelling
19:37all over my body and my face.
19:41My condition can be very painful.
19:43It can get so itchy that I just scratch so much that I bleed.
19:48When it first started four months ago,
19:50I was completely convinced that it was an allergic reaction,
19:54but there were no trends in what I was doing, touching, wearing.
20:00I've just woken up and my top lip is starting to swell.
20:08It's red. It's numb.
20:11I'm so tired.
20:15So, my lip has swelled even more.
20:20It's really, really hot.
20:22All of my face is really hot at the minute.
20:27My lip's starting to swell.
20:30It's now gone.
20:32Oh, this is so much quicker.
20:33I'm starting to panic quite a lot about it
20:36because I see it starting to swell as well.
20:40I'm struggling to breathe.
20:52Are you ready?
20:53I'm scared.
20:55Yeah, I'll be all right.
20:58The condition that she has now, it's debilitating.
21:03She cannot do the things that she wants to be able to do
21:07as a 19-year-old woman.
21:11Hi, is it Olivia?
21:12Hiya.
21:13Nice to meet you.
21:14I'm Dr Emma.
21:15Do you want to come with me?
21:16Yes.
21:19So, Olivia, tell me a little bit about what's been happening
21:22with your skin.
21:23So, I started to have red, inflamed lumps all over my body
21:29about four months ago.
21:30When it first started, it was only on my left wrist
21:32and my left thigh.
21:33It spread to my stomach, my chest,
21:35but it then progressed so much that I was in A&E
21:38almost once a week.
21:40Oh, my goodness.
21:41Because my face would swell and I wouldn't be able to breathe.
21:44And what has any doctor told you that this is?
21:47I've had different forms of allergy testing,
21:51but then been told that it's not an allergy.
21:53And what kind of treatment have you been given?
21:57Strong amounts of steroids.
21:59Yeah.
22:00Liquid forms of antihistamine.
22:02Settles it for a while, but doesn't really solve it.
22:06When was the last time you had a flare?
22:10About a week and a half ago.
22:11So, there's nothing to see on the skin at all today?
22:14I have pictures and videos.
22:16OK, good. I want to have a look at those in a second.
22:18And how do they make you feel
22:20whenever you're having a flare?
22:22Awful.
22:23I've, you know, spent a lot of time
22:25hidden in my bedroom.
22:29This is some of the flare-ups.
22:32OK, that is really bad, actually.
22:35And I'm not surprised it was interfering with your life
22:37because that is really extensive.
22:40Undoubtedly, this is an articaria.
22:42An articaria is essentially where something is causing white blood cells
22:48that live within the skin.
22:49And in response to certain triggers, they release histamine.
22:53And then the histamine causes the swelling and redness and itchiness
22:57that you can see as hives.
22:59And sometimes it's just spontaneous and it just happens.
23:03And we have no idea why it happens.
23:06Has anyone ever given you a diagnosis like that before?
23:09I've, you know, had people say,
23:11oh, it could be this, it could be that,
23:12but I've never had something so set in stone.
23:14So, thank you for that.
23:15Honestly, it's a massive, massive relief.
23:18Because it started so quickly, just by itself,
23:21I suspect it might just ebb away.
23:23But if not, then we've got a really clever injection
23:27called omelizumab that tells the white blood cells
23:30to stop releasing as much histamine.
23:33And this means the disease starts to settle.
23:35I think one of the things that we'll need to do then going forward
23:39is if you're able to keep a very, very strong diary
23:42so that I can get an idea of how frequent the flares are,
23:46then we can work out what we can do to intervene.
23:51OK, are you happy with our plan?
23:53Yeah, thank you so much.
23:55It's OK.
23:57The fact that Dr Emma knew what it was straight away
23:59was wonderful and so reassuring, so I'm happy.
24:03So, come on, what's happening?
24:05It was good, it was really good.
24:07Seeing you come out the door with that smile on your face,
24:11it's brilliant.
24:12I'm just pleased that you're getting the information
24:14and the assistance that you need now.
24:28It's been four months now since Mauricio's surgery
24:32and he's been coming to London every week
24:35to get these tissue expanders in his chest inflated.
24:38These are inflated with medical-grade salt water
24:41and only a small amount can go in each time
24:45so there isn't too much stress on the skin.
24:47We are slowly putting the fluid in.
24:51Everything OK, man?
24:52Yeah, I can feel the pressure right here.
24:54That's great.
24:55It's always.
24:56The expanders can each take 400 ml of salt water into each one
25:01and he's already had 200 ml inserted.
25:04And we're nearly done on this side.
25:07So he'll need another six inflation sessions
25:09before he's ready for this next surgery.
25:14Process with the inflation, it's not very comfortable.
25:20Very well done.
25:21But it is something that I can take
25:23and I know it's for a good purpose as well.
25:27We are halfway through, which is good news,
25:30and then Dr. Guthers will be able to remove those keloids
25:34that really annoys me.
25:44All right?
25:46Yeah.
25:52Olivia's still getting these debilitating flare-ups
25:55despite starting the injections about a month ago.
25:58But it will really take until 12 weeks
26:01until we know whether this drug has worked or not.
26:04How's the situation now?
26:06My, um...
26:07I think my arms are starting to swell, like, both arms.
26:11For the minute, Olivia,
26:12we're in the right place at the right time.
26:14Yeah.
26:16Hiya, Olivia.
26:17Hiya.
26:17Hi, good to see you.
26:19So, you've had one dose of the omelizumab,
26:23which is the uber-gold standard treatment that we have
26:27for this resistant, chronic, spontaneous urticaria.
26:30And that was only, what, five weeks ago now?
26:32Yeah.
26:33And where are we now with you?
26:36I used to flare maybe two, three times a week.
26:40Since having those injections,
26:41I've flared every single day without fail.
26:43OK, so you've got a flare today that we can see.
26:46Can I have a look at the skin?
26:48Is that OK?
26:48Yeah, yeah, of course.
26:50These are essentially, like, hives.
26:53It's red and it's swollen and it sits up above the skin.
26:58And then when they get...
26:59..get shrugged, because they're very itchy,
27:03they then start to coalesce and make these larger ones.
27:07This is a good example,
27:08because you can see how widespread it is.
27:11They must be driving you mad.
27:12It's almost like that feeling of just insect bites everywhere.
27:16And when you know how annoying even one insect bite can be,
27:18let alone the hundreds that you've got.
27:21When we're on the omelizumab,
27:23we wouldn't say that it hasn't worked, really,
27:26until we get to about 12 to 16 weeks of treatment.
27:30This is a drug that essentially controls the disease
27:34in the best way that we know.
27:36We've just got to keep our fingers crossed
27:38that this is the one that's going to be the right thing for you.
27:41As silly as it may sound, I'm desperate.
27:44Yeah, I know.
27:44So, you know, even if it takes two months, three months, five months,
27:49I don't care, just anything.
27:51So it's worth it.
27:53This is the early days of this new medicine
27:55and, you know, everything is all crossed.
27:59OK.
28:01Poor Olivia.
28:02This is a difficult condition to manage generally
28:05and it's also quite a difficult condition for people to cope with
28:09because they feel very uncomfortable with it
28:11and it can be a bit scary.
28:15We now have these medicines that are very, very targeted to treat it
28:19but there are always some people who just don't respond.
28:24There hasn't been a massive amount of change.
28:26It's still steps in the right direction.
28:28That was OK, wasn't it?
28:31We've just got to think about what's going to happen next.
28:33Yeah.
28:43Hi, Matheus.
28:44Hi, baby.
28:45How are you?
28:47It has been a very huge change in my life.
28:49I have become a father.
28:51Let's come to bed.
28:53There has been some challenges when it involves me getting my baby around
28:58because he wants to explore everything.
29:02I've had around 16 inflation procedures.
29:08My chest, it feels very big at this moment like a balloon.
29:13I won't lie, the process hasn't been easy at all.
29:16It demands a lot of cautiousness.
29:19All right.
29:20You want to go to mama?
29:21It's challenging but I know how bad it is to have the keloid
29:25so it'll be worth it because he'll be able to enjoy life more after the treatment.
29:35For me.
29:35For me.
29:36It's a week until my next surgery
29:39and I'm very excited and also nervous.
29:43I want to get this over with.
29:55You're going first?
29:56Yeah.
29:57Yeah.
30:01Mauricio's really keen to get to the end of his treatment
30:04but this is not a quick fix.
30:06He's already had some radiotherapy to try and stop some of these keloids from coming back
30:11but there's also a few areas that need some steroid injections
30:15and that's what I'm going to do today.
30:17Yanis has done the surgery on the back
30:20and then you've got tissue expanders on the chest.
30:24Exactly.
30:24Makes you look like Superman.
30:26Yeah.
30:26A little bigger.
30:28I also got my baby born.
30:30Did I cry?
30:31No.
30:31Congratulations.
30:32Wait a minute.
30:33That's how long it's been.
30:34There wasn't a baby the last time.
30:36No, there wasn't.
30:36So I'm excited to see what's been happening.
30:39Can I have a little look?
30:40Is that okay?
30:41Of course, yes.
30:41Great.
30:44Oh yeah, look at those tissue expanders.
30:46Gosh, yeah.
30:48Oh wow.
30:50What a big difference.
30:52You can see along here is the scar line is a bit stretched
30:55and then there's certain little bits within it
30:57that are a bit slightly thickened up
30:59and we want to stamp on top of that before it becomes anything more.
31:08Can we scratch?
31:11The steroid injections just tell those fibroblasts
31:14to kind of stop growing in quite the same way
31:18where they've gone a little bit bumpy.
31:20So that's all it's doing.
31:22It's a radiotherapy that's really doing all of the job
31:24but this is just to give it an extra bit of help.
31:30I didn't feel that one.
31:32Good.
31:40But anyway, I'm number one welfare.
31:42Yeah.
31:43I've been going around with this great growth on my end of my nose
31:46and suddenly it's all disappeared and it's lovely.
31:52How are you, David?
31:53Hello, hello.
31:53How are you?
31:55How are you?
31:55How are you?
31:55Good.
31:56Come on through.
31:57There's a bit of you missing.
31:59I wasn't going to show you.
32:04How has this been going for you?
32:06It's been going splendid.
32:07People are amazed.
32:09Nobody mentioned it and then when it has happened
32:11they go, oh my God.
32:13So they only talk about it after the fact.
32:16After the fact, they can see the difference.
32:18Let's have a wee look at you.
32:19Come on.
32:21Those wee dangly bits that we took off.
32:23They've all gone, haven't they?
32:24They're good, yeah.
32:25Yeah, yeah.
32:26And then it's nice and symmetrical.
32:29You've got these even at both sides, the wings.
32:31Yeah.
32:32So I'm super pleased with how things have healed.
32:35One of the things that really struck me about your nose in particular
32:38was the dangly down bits were actually blocking you from breathing.
32:43That's right.
32:43That's the big difference.
32:44I used to have to flick it back and out of the way
32:47then I could pursue sleep again.
32:49And now what's it like not having to do that?
32:51Well, I don't know.
32:51I sleep.
32:56Dr. Emma looks at me all over and she said,
32:58it's wonderful.
33:00Oh, hi, Doc.
33:02Right.
33:02I've seen Dr. Emma.
33:03She said, all is well.
33:04Brilliant.
33:05No trouble at all.
33:06We can go home now.
33:08Oh, I've had to thank her personally
33:10because I'm just so pleased with her.
33:12Well, we're not going to come back, have we?
33:14No, I don't think so.
33:15No, I don't think so.
33:16All in all, a great success.
33:26So today's the day.
33:28The day we've been working towards for the past seven months.
33:31Mauricio is having surgery on these large keloids on his central chest.
33:37Mauricio has gradually been getting his skin expanded
33:40and currently has 800 millilitres of liquid in his chest.
33:47Mr. Gutos is going to remove this liquid
33:49so that when it comes to the keloid removal,
33:52he can use this skin to cover the defect.
34:04Right, excellent, guys.
34:05We have now deflated both of the tissue expanders
34:08and on either side of that big keloid,
34:11there is plenty of lax skin for us to remove most of that keloid.
34:29Clearly, Mauricio is unfortunate to suffer with so many keloids
34:35to the extent that it is unrealistic
34:37that we can ever target to remove every single one of them.
34:41but the central chest cluster was the most troublesome part
34:46of his keloidal condition.
34:50Give me the bipolar, please.
34:53Pedal.
34:59That is a massive keloid on this chest.
35:03Yeah, it's humongous.
35:05That's why we had to have an expander
35:07because how would I ever close?
35:10Yeah.
35:30I can move this flap of skin all the way past the midline.
35:35If we had not done the tissue expansion process,
35:38because this would not have been possible.
35:50Cut, please.
36:01I'm feeling fine at the moment.
36:05I know that Dr. Gutus was able to remove most of my keloids.
36:11I didn't get to see them yet,
36:13but I'm feeling happy.
36:27Hello, Olivia.
36:28Hello.
36:29How are you?
36:30Not the best at the minute.
36:32Still having constant flare-ups.
36:34We are almost at the very end now of this trial of the omeluzumab.
36:38Are you happy to carry on with the injection?
36:40I would like to go ahead, obviously, with the next set of injections.
36:45I think that would be probably the best solution.
36:48Yeah, I mean, I think we've got just a few more weeks
36:50to see whether it would make the cutoff of helping or not.
36:53But with this condition that you have,
36:55in the same way that it just very abruptly came,
37:00for many people, it just very abruptly goes.
37:04This is not something that you're going to be living with for forever.
37:08One of the positives from all of this happening
37:11is that if you would have said to me two years ago
37:13that random flare-ups all over your body are going to start happening,
37:17you know, for a while, you're not going to know why they happen,
37:19but you made it through the other side,
37:20and it's not forever.
37:23It's great, and I appreciate it.
37:24They're not just light words being delivered to make you feel good.
37:28They are, it's the truth.
37:29It's definitely helped us.
37:30Thank you. Thank you very much.
37:32Bye.
37:33Bye-bye.
37:37I think one of the most important things
37:39about a doctor-patient relationship
37:41is to realise that you've got somebody on your side.
37:44We can give her the knowledge about the condition.
37:47We can give her likely timeframes of what's going to happen.
37:50Just having that support and person to ask
37:53actually means a lot,
37:54so you're not feeling that you're out there on your own.
38:06I can't wait to show her how the treatment went,
38:11how the surgery looks nice.
38:13Let's go to see Dr. Ingmar.
38:23Hi, Mauricio.
38:25Good to see you come with me.
38:28Your baby is gorgeous.
38:31Oh, he's so lovely.
38:34Have a seat just here.
38:35The last time I saw you,
38:38I was just treating some areas with a steroid.
38:40Yes.
38:41And then you had the next surgery, which was a big one.
38:44It was, yeah, definitely.
38:45How has that gone?
38:46This recovery process was very easy and quicker as well.
38:50I can hold my baby without any concerns.
38:54I don't feel any more of those pain that I had.
38:58I can't wait to see it.
38:59I really can.
39:02I can't wait to see it.
39:03I can't wait to see it.
39:03I can't wait to see it.
39:04Do you think so?
39:08Yes.
39:09It's very noticeable, isn't it?
39:11Unbelievable.
39:12It looks like it never had any keloid here.
39:14It really does.
39:16It's quite remarkable.
39:17I mean, so this is only three weeks post the surgery,
39:20and once all of those stitches have kind of completely gone,
39:25and once we've got this scale and things like that,
39:27which is the normal thing to come away,
39:29there is really going to be very little to see along that scar line.
39:33And how do the ones on the back feel now?
39:36It looks very good.
39:38Yes.
39:38So you can see the colour change,
39:40which is the brown from where the radiotherapy has been.
39:45That will settle down.
39:46I mean, these ones here, it's lovely and flat, isn't it?
39:49Yeah.
39:50I mean, overall, this just looks so much better in terms of how you can move,
39:55and I can even just see the movement of your shoulders better.
39:59Exactly.
39:59I mean, that is the point.
40:00This is done for the feeling and the function as opposed to the look,
40:05because it was stopping you from doing things.
40:07That is the main aim of this treatment, and this looks great.
40:11Really good.
40:12Great.
40:12You can pop your top on.
40:16What do you think now?
40:18Are you glad you've gone through all of this?
40:20I knew it would be a long journey,
40:21but I'm glad that I went through it,
40:23and I'm also glad to have met you and Dr Guthers,
40:27because you were like an angel in my life.
40:29You helped me a lot, so I'm very glad that I went for it.
40:32I'm glad that you're glad.
40:34Yeah.
40:37Mauricio is one of the Swedish's loveliest patients,
40:41and the journey that he has had to go on is intense.
40:45So it's really lovely to see him here today,
40:48starting to feel and see the benefits from having gone through all of this.
40:54I'm feeling very happy.
40:56I feel like a different man.
41:00So how was it?
41:01That was nice.
41:03I think Dr. Emma was very pleased to see how the treatment went.
41:08Yeah, it went amazing.
41:10Yeah, exactly.
41:12Very
41:12good.
41:20Music
41:20.
41:20.
41:20.
41:29Transcription by CastingWords
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