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00:01One, two, three, whoa!
00:04Hello, mate. You understand Irish?
00:07Animals from all over the world
00:09Ah, bonjour.
00:11Come to see one extraordinary man
00:14who's known as the Bionic Vet.
00:16High five. Yes!
00:18Professor Noel Fitzpatrick.
00:21You only get one shot at this. Here we go.
00:23Noel and his team offer some of the most advanced treatments available anywhere.
00:28The perfect marriage of mechanics and biology.
00:30This is what we have now. A brand new knee.
00:33Oh, wow!
00:35For some, it's a last chance.
00:38It is a life or death situation because we cannot leave him like he is.
00:42I just want you to do anything you can for him, really.
00:45Sorry.
00:46As Noel continues to devise new ways of healing...
00:49You're going to be Bionic. Thank you so much.
00:52He transforms the lives of his patients.
00:55That is just unbelievable.
00:57He's raring to go.
00:58Against all the odds.
01:00Boom!
01:01One small step for a dog, one giant leap for mankind.
01:04Well done.
01:11It's winter and at Fitzpatrick referrals there's excitement in the air.
01:16Charlotte, pay attention. Deck the halls.
01:19Christmas is coming.
01:21Ta-da!
01:26Oh, I think the thingy's here.
01:28Christmas tree is here.
01:29Oh, that's a big one.
01:31Fitzpatrick's at Christmas.
01:34There's always a Christmas spirit. Everyone gets really happy.
01:37Here we go. What's in here?
01:40We open presents with them, they have stockings.
01:43I think we get more excited than they do because they don't understand it's Christmas.
01:46It's a Christmas hat.
01:47I just like it all. I just love Christmas.
01:49Well done.
01:53Over 4,000 pets have been seen at the practice this year and as the festive season approaches,
02:03the team make an extra effort to get their patients back with their families.
02:08If we can get an animal home in time for Christmas, then I don't think that there's any greater gift that we could give a family.
02:20In the wards this year are three dogs who everyone hopes will be home and healthy in time for the holidays.
02:28Peppa, Luna and Tatiana.
02:35Her story began over a year ago.
02:46Phil and Angie are dog lovers from Derbyshire.
02:51Good girl.
02:54I was on Facebook one day and I saw Tatiana and they was appealing for a foster home.
03:03We had already got eight dogs at the time and I was thinking, well, Phil's not going to let me have another one.
03:08But you love me, don't you? So we had Tatiana.
03:14She was just four months old with badly deformed front legs when she was rescued from Romania.
03:22What did worry the other dogs when Tattie first come?
03:29She frightened them. They couldn't make sense of her legs and all she wanted to do was play.
03:35But they soon got used to that, didn't they?
03:38Right, come on then. Mrs. Wibble, come on.
03:41They are my babies. Yeah, they are my life.
03:45Good. Go on Missy. Bed. Night-nights.
03:48Wherever I am, the dogs are aren't they? It's like a shepherd and sheep.
03:54Right, come on then.
03:56If you go out, they're sat at that gate until you come back.
04:00Yeah. But if you go out and I'm here, they're not bothered.
04:05I just love them. I'd have twice as many again if I could. But...
04:17You can't. I can't.
04:19Are you alright there, Queenie?
04:21Tatiana had such a tough start to life, Angie and Phil just want to do the best for her.
04:28It's painful to watch her running around with her back up like this.
04:40Hey, it's scratchy, scratchy.
04:42It's late summer and Angie has come to Fitzpatrick Referrals with Paul and Donna from the charity,
04:48Hope, who rescued Tatiana.
04:51Tatiana?
04:52Hello.
04:53Yeah, he's ready for you.
04:54You got a pen?
04:55Yes.
04:56Hi guys, hello.
04:57Hello.
04:58Please take a seat.
04:59There you go.
05:00So has anybody discussed the nature of these deformities with you so far?
05:04Not in great doubt.
05:06Okay.
05:07Alright, let's pop her down.
05:08Pop her down there for you.
05:09There you go then.
05:11She has a congenital luxation of both of her elbows, meaning that the three bones that make up her
05:17elbow, the humerus, the radius and the ulna have never been in the same alignment.
05:23Because these two bones slipped out of the joint probably in utero inside the womb.
05:29Hello, munchie.
05:31So she just gets on with it, doesn't she?
05:34She does.
05:35She's never known any different.
05:36Yeah.
05:37So as opposed to her, that's the way it is.
05:39Yeah, that's right.
05:40And therein lies the ethical dilemma.
05:43I mean, if for her this is the way life is, why don't we just leave her like this?
05:50Because she can't go out without really on the streets or go walking with the rest of the dogs.
05:57But is that really necessary for her quality of life?
06:00I mean, she could have a quality of life just being cuddled and living in a home.
06:07The amount of surgery that you would have to put her through would be huge.
06:12The elbows would need to be chopped off and rotated around and put into a position in alignment for the shoulder and the wrist,
06:21which would significantly stretch blood vessels and nerves.
06:26And it's entirely possible that those blood vessels and nerves might not be capable of coping with that twist.
06:35And in which case, the bottom part of the leg would die.
06:40Clearly, this little dog would be better off standing up.
06:44But if you go down the route of surgery and if you fail, she'll probably end up getting put to sleep.
06:50I'm sorry, sweetheart. Do you want to get a breath of fresh air?
06:53A little chat?
06:54I don't want to lose her.
06:55No.
06:57The risks of surgery are much higher than they all realised.
07:01If there's any chance at all that we're going to lose her, Paul, I'd sooner stay as she is.
07:07Well, there's always a chance with everything.
07:10I just wanted to be able to fit in with the others and do at least some of what they can do.
07:17Angie must make up her mind.
07:20In reception, Peppa's family are hoping that she will be fighting fit in time for Christmas.
07:31But first, she needs a challenging spinal operation.
07:34She's come because she's had lots of problems with her neck and she had a surgery about two and a half years ago, but unfortunately it's gone wrong.
07:43So hopefully Noel's going to fix her for us.
07:47At home in Surrey, Peppa has had a history of problems since Julie and Clive got her eight years ago.
07:58We knew there was something wrong right from the beginning really.
08:01She hasn't wanted to jump in and out of the car.
08:04She hasn't wanted to jump on and off the bed or the sofa and things.
08:08And when we first started taking her for a walk, she would be ever so stiff when she got home.
08:13And when she did have her bad times, we just gave her pain relief and got on with it.
08:19Peppa gradually got worse and was referred to a local surgeon who diagnosed a spinal problem.
08:27They suggested that she needed to have implants in between the vertebrae to separate them and take the tension off her spine.
08:36Now one of the implants has moved and is sticking into her spinal cord, putting her life in danger.
08:43She's a part of our family.
08:45She's all we've got now. The children have grown up as well.
08:48She's the baby now.
08:52Revision surgery at Fitzpatrick's.
08:54Hi guys. Hello.
08:55Might be her last chance.
08:57Right.
08:58You had a situation where the diagnosis was that two discs in the lower neck were bulging and pressing on the spinal cord.
09:09Yes, exactly.
09:10And it was deemed at that point that they wanted to do two things.
09:15They wanted to push the vertebrae apart so the bulge wouldn't affect the spinal cord.
09:19And they wanted to maintain the movement by putting in an artificial disc.
09:24Yes.
09:25The problem is that the artificial disc has slipped.
09:28In this case you have been unlucky because I've seen cases of this disc that have worked well.
09:35So if we look at the actual images then, it has overridden and slid up into the spinal canal.
09:42That's a very bad situation.
09:45Noel is concerned that the metal implant pressing into the spinal cord is causing damage or myelopathy.
09:51Let me do a physical examination.
09:53Just want to check for myself.
09:55No, she's not.
09:56No, she's hardly able to bring that one back there.
09:58See that?
09:59Yes.
10:00See how tentative that is?
10:03That suggests major long tract disease.
10:06I know you can't give us a complete answer, but how awkward is it trying to get it out?
10:12Is it difficult to take out the piece of metal?
10:15Yes.
10:17How am I going to do it?
10:19I'm going to scoop down in here and take out that chunk of bone and then lever that off gently.
10:25What I do not want is to push that any further into the spinal canal and cause more spinal damage to the spinal cord.
10:33Then I put in my spacer device.
10:35So the spacer device is like an upside down Christmas tree.
10:38We screw that in at exactly the right angle and then bridge those three vertebrae with two screws in each vertebrae.
10:46And put the saddle clamps on and that's what it looks like.
10:50The three factors that are going to determine outcome are one, that I don't get any complication when I'm taking out the other two implants.
10:59Two, that I get good bone purchase with my implants so it's rock solid.
11:03And three, during the first week that I haven't made the myelopathy worse.
11:08Okay.
11:09Are we mad doing it when she's nine years old, all of this?
11:11You're not mad.
11:13You are sitting on a time bomb with that implant where it is.
11:16I know.
11:17All right mate, you're coming with me.
11:20There we go.
11:21Okay.
11:22See you later guys.
11:27Before we brought her today, it was literally the next jump out of the car, the next, that implant's going to split and move, isn't it?
11:34And then we're going to end up with having to put her to sleep.
11:37So if the worst doesn't happen then, you know, it'll be great from then on.
11:41It's sad because she doesn't realise that all she wants to do is run around.
11:45Yeah.
11:46And be like a dog.
11:48But we've just got to wait and see.
11:50Angie and the rescue charity have been discussing whether to go ahead with surgery to fix Tatiana's badly deformed front legs.
12:05Hi guys, hello.
12:07Hello.
12:08There you go.
12:09Okay, so what's the verdict?
12:11We're going to go for it.
12:13It's just a short term thing for a long term gain, isn't it?
12:16Let's hope I can get a result for you and give a quality of life that she and you deserve.
12:21Okay, I think we're all on the same page.
12:24Yeah, definitely.
12:25Yeah.
12:26All right, big cuddles for me then.
12:27Can I just kiss?
12:28See you, Tati.
12:29Of course you can.
12:30So, Tati for short, right?
12:31Yeah.
12:32Okay, Tati.
12:33Bye-bye, family.
12:34Bye-bye.
12:35See you in a little while.
12:36Bye-bye.
12:37It was an odd decision.
12:40Really hard.
12:41It was very hard.
12:43But we was all in agreement in the end.
12:47We've got to give her a chance.
12:49You know, just give her that little bit of a chance.
12:53Shhh.
13:10At Fitzpatrick Referrals.
13:16Oh.
13:18Preparations for the festive season are underway.
13:21She is so cute.
13:23Look at that.
13:24What a lovely tree.
13:25Well done, guys.
13:37There we go.
13:38Tatiana's family hope she will be walking tall this Christmas.
13:43She was born with badly deformed front legs and needs intricate surgery to straighten them.
13:50We can see just how deformed bones are here.
13:54We can see how completely dislocated that elbow is.
13:59Both of them.
14:02We've got to somehow try and get them back into an alignment where she can stand up on them without damaging the blood and nerve supply.
14:09That's going to be very challenging because the muscles are all in the wrong position.
14:14All right, let's go.
14:18To realign Tatiana's deformed arms, Noel will need to cut some ligaments and tendons around the elbows and rotate the radius and ulnar bones through more than 90 degrees.
14:29He'll drill out the elbow cartilage and pack the joint with bone graft and then fuse it solid using pins and an external frame.
14:43It's a complicated procedure and it carries risk.
14:51Okay, so we've cut into the joint now.
14:54Just flipping out the ulna and the radius now.
14:58I'm going to drill the cartilage off the radius and the ulna and try and flip it back on.
15:02Noel has to cut the tendon and ligament to allow the arm bones to sit in the correct position.
15:07When I fuse the elbow solid, this tendon won't be needed to move the elbow anymore.
15:13He uses the pins to hold the bones in their new position.
15:18Then bone graft to help the elbow fuse together.
15:22Okay, so now we can see that the shoulder is back in alignment with the foot.
15:28The foot's rotated about 90 degrees in toward where it should be.
15:31The pins are holding the ulna and the radius bone onto the humerus bone, rock solid.
15:39So we're just going to close this up now.
15:43Noel performs the same procedure on Tatiana's other front leg.
15:50Okay, so now we can see that the elbows are back in alignment, roughly.
15:54The feet are still facing out a bit and that's because the wrists are crooked.
15:59There's not a lot I can do about that unless I want to fuse the wrists solid,
16:03which I don't want to do at the moment because I want to see what happens with the tendons and with some rehab.
16:07The pins will not be strong enough to support Tatiana's body weight while she heals.
16:13So Noel fixes a supporting frame to each leg.
16:17We've got two frames on now, we've got two legs moving in the right direction.
16:20Obviously we don't know what's going to happen with the wrists here, we'll just have to see how these respond.
16:25Right, good. Let's go to x-ray please.
16:33In the Swiss Alps, the winter snow is already falling.
16:36In the town of Neuchâtel, all the Monin family want for Christmas is for Luna, their golden retriever, to be back to full health.
16:49Pascal and Veronica have four daughters and got Luna as a puppy.
16:53Okay, that was me who wanted to have Luna. Pascal was not sure about having a dog, he didn't want it really.
17:05I was doubtful at the beginning, but of course she managed to change my mind.
17:11She's mild, she's sweet, she's very affectionate.
17:16She's funny.
17:17Yeah.
17:19But soon after they got Luna, it became apparent something was wrong.
17:24We noticed that she had a problem when she was four months old.
17:29Because she started limping.
17:32And we've been to the vet and he gave her anti-inflammatories.
17:36Up to the day when she was about five, she started limping every day.
17:46And the vet here, he says, you have a disabled dog and that will be forever.
17:53We can't do anything for her.
17:55Yeah, now it's really bad.
17:58Because she can't walk anymore.
18:01She's in pain.
18:02The only hope I can have still, to just search for a cure for her.
18:12Their search has brought them to Fitzpatrick referrals.
18:16It's been a two-day drive to get here.
18:19Bonjour, how are you?
18:22Noel has been brushing up his schoolboy French.
18:25Bonjour, how are you?
18:27Nice to see you, please come in.
18:28Okay, so I've read the history and I've had a little look at the x-ray pictures.
18:33Yes.
18:35So you went to your own vet recently.
18:37Yeah, and he did an infiltration of cortisone.
18:42Into the joint?
18:43Yeah, for the very first time.
18:45And which leg was that?
18:47Left.
18:49Only the left?
18:50Because it was worse.
18:51Does she only ever limp on the left or does she also limp a droite?
18:56A droite or a gauche?
18:57Usually both of them.
18:59Usually both of them.
19:00Les deux?
19:01Les deux.
19:02Okay.
19:03Les deux.
19:05La droite et à gauche aussi.
19:07And when he did the injection in the elbow joint.
19:10Yeah.
19:12Oh, he did a shoulder.
19:13Shoulder.
19:14She's got a problem with the shoulders, not the elbow.
19:16Ah, well, that's...
19:17Well, let's...
19:18The jury is out about that, actually.
19:21And how did you end up here?
19:23It was because her vet in Switzerland said that he could do anything for her.
19:27And I said, so I would like to go to England and ask them if they can do something for her.
19:33And he said to me, they can't do magic.
19:35That's a piece of advice from someone at home.
19:38Well, no, I am not a magician.
19:39That is...
19:40That is true.
19:41But I wouldn't want to be a magician.
19:43We'll try and...
19:44We'll try and do some medicine instead.
19:46Yeah.
19:47Um, okay.
19:48We've got to have a little look.
19:49Now, I'm doing the test that I think may be the one.
19:52So I apologise in advance if I hurt her.
19:59Okay, well done.
20:00Well done.
20:01Thank you, everybody.
20:03Now, let me explain.
20:05This is the elbow.
20:06The reason that I believe she resented that was that she is painful on the inside of her left elbow.
20:15And I believe that it's likely that the problem is a condition called developmental elbow disease or elbow dysplasia.
20:24And effectively what happens is these bones don't fit together properly.
20:29Okay.
20:30And that results in rubbing and cracking inside the joint.
20:34So my recommendation would be we do an anaesthetic.
20:38We do a CT scan.
20:40Then I would suggest I stick the camera in the shoulder and look around.
20:44Yeah, yeah.
20:45And then we also stick the camera in both elbows.
20:48And then we'll have to decide what to do.
20:50Okay.
20:51So thank you very much for coming all this way to see me.
20:54All right.
20:55A bientôt, ma famille.
20:56A bientôt.
20:57Bye-bye.
20:58Luna is anaesthetized for scans and an arthroscopy investigation on her elbows and shoulder.
21:08Unfortunately, it's quite common to have a situation where a dog is dropping the shoulder as they walk and it looks like a shoulder lameness when in fact it's an elbow lameness.
21:18Okay, here we go.
21:20The CT scan already tells us that there's a massive fragment in here.
21:25The clinical examination was pretty compelling.
21:27So I'm not expecting good news in here.
21:29All righty.
21:30So that there is worn cartilage.
21:33And here is a huge fragment.
21:35Very, very large fragment.
21:38This really is a bad situation.
21:41And we've got grade four cartilage disease in some patches and grade three in others.
21:48Okay, so I'm going to take that fragment out.
21:50The fragment is a piece of bone that's broken away inside Luna's elbow.
21:55Taking this bit out will make things temporarily better for Luna, but unfortunately will not fix her.
22:00Next thing I'm going to do is cut that tendon down there that pulls this piece of bone against that piece of bone.
22:06There we go, cut.
22:09It's like releasing the belt on the belly of a fat man.
22:13It doesn't make the fat man any less fat.
22:15It just makes it more comfortable.
22:17The right elbow is also diseased, but not as badly.
22:21Noel performs the same procedure to remove a fragment and cut a tendon.
22:26Okay, that's that side done.
22:28We're now going to go to scope the shoulder.
22:31Wow.
22:32Well, something incredibly rare has happened here.
22:35In actual fact, there's a problem in the shoulder as well.
22:39You can see right there where the biceps tendon is actually being pulled off the front of the shoulder blade.
22:47That's super strange.
22:48Noel cuts the tendon off the bone, which will allow it to reattach with the scar further down the joint.
22:55This should help reduce Luna's shoulder pain.
22:58Okay.
22:59All right.
23:00Let's go ahead and wake up.
23:02Luna will stay in overnight.
23:05It's been a week since Tatiana had the operation to straighten both of her badly deformed front legs.
23:19She's having physiotherapy to teach her to use her newly straightened legs.
23:26But at last, she's well enough to go home and continue her recovery there.
23:33Today, Phil has come with Paul and Donna from the rescue charity to collect her.
23:40I'm a bit apprehensive about her coming home.
23:44Because from what I understand, she's going to have pins coming out of her.
23:48And I'm a bit schemish there.
23:51So, I don't know.
23:54We'll see.
23:55Hey, guys.
23:56Hi.
23:57So, she's doing great in terms of her psychology.
24:01In terms of her physiology, who knows?
24:04One of my big fears early on was would the blood vessels and nerve supply hold up
24:09and would you get effectively gangrene or paralysis of the feet?
24:14Fortunately, she has feelings, she has circulation.
24:17And the shoulder is now in alignment with the wrist.
24:21So, that looks really good.
24:23Okay?
24:24Push your chairs back a bit.
24:25We'll bring her in.
24:31Now.
24:32Okay.
24:33Hello.
24:34There we go.
24:35Now, you can see how the wrist is still coming out.
24:38Yeah.
24:39And you can see that it comes out because that ligament's loose.
24:42So, I do think, ultimately, we're going to have to fuse those wrists.
24:46Tatiana is still a puppy.
24:48So, Noel will wait until she's finished growing before making a final decision about surgery on her wrists.
24:54All right, guys.
24:55Lovely to meet you, sir.
24:56Thank you very much.
24:57Pleasure.
24:58My entire pleasure.
24:59Great to meet you.
25:00Thanks for everything.
25:01My pleasure.
25:02My pleasure.
25:03All right, sweetie.
25:04I shall miss saying goodnight to you.
25:05I sleep here.
25:06So, I go up and say...
25:07Watch this.
25:08Night-night, Tati.
25:09What do you do?
25:10Night-night, night-night.
25:11And she does that.
25:12You're going to miss her.
25:13She's a wonderful little dog.
25:15All right.
25:16I'll leave that to you.
25:17Take care, guys.
25:18God bless.
25:19Look after yourselves.
25:20Always brilliant to have her back.
25:23And she looks so well as well.
25:25A lot better than I imagined.
25:27And she'll be over the moon when I get home.
25:29It's going to be a case of calming her down, I think.
25:32It's early afternoon, and Peppa the Dalmatian is facing the complex spinal surgery to remove
25:44metal implants from her spine.
25:47It is a life or death situation because we can't leave her like she is.
25:51She's in a lot of pain.
25:53She can't really move about her neck too much because when she does, the piece of metal
25:57that's in her spinal canal is hitting her spinal cord.
26:00If that piece of metal from the disc migrates more, then it's game over.
26:05Because she will be paralysed in that scenario.
26:07So we've got to make this happen.
26:13Right.
26:14Let's do this.
26:16No will get access to Peppa's spine from beneath her neck.
26:20So unfortunately, the anatomy is very much distorted here by the new bone formation.
26:25So it makes my life very difficult.
26:27I can't actually see the discs.
26:29I'll need goggles, please.
26:31So we may get some metal shards here as I try and drill.
26:42Okay, I think I can finally see a little shiny piece of metal.
26:46Right, this is an absolute nightmare.
26:51The metal is welded in at the base of the hole I'm drilling, which is right next to the spinal cord.
26:56If I take off too much bone, I can't fuse the vertebrae back together again.
27:00So I think what I'm going to have to do is actually drill through metal.
27:04Physically drilling titanium.
27:06Nightmare.
27:07Go.
27:08Drip.
27:09Drip more.
27:10More.
27:11More.
27:12More.
27:13More.
27:14So the other big problem with we're producing an horrendous amount of heat.
27:19That could also damage the cord.
27:24This is absolutely outrageous.
27:26So the problem is I've got to press pretty hard to drill the metal out.
27:30And if I press too hard and poke through the other side, I could paralyse her or even kill her.
27:37Noel is at a crossroads.
27:39All right, we're going to need to get them on the phone.
27:41Get the phone.
27:42The operation is now so risky he needs Julie and Clyde's permission to continue.
27:48Hey, it's Noel here.
27:50I'm in the middle of surgery now.
27:53It's not good.
27:54This is a very, very, very difficult situation.
27:57The piece of titanium from the disc is pushing right up into the spinal canal.
28:03The bottom line is that I can't get this out without drilling out the titanium because it's stuck to the bone,
28:09it's stuck to the cord, it's stuck everywhere.
28:11So either I bail at this point or I go for it.
28:15I've got zero millimeters for error.
28:18But you need to understand that she could die.
28:31In the operating theatre, the surgery to remove the metal disc from Pepper's spine is at its most dangerous point.
28:38The family are on the phone.
28:41It's very high risk now.
28:43OK, I'll call you later.
28:46All right, we go.
28:47Glasses.
28:48Get all of the rescue drugs ready.
28:51Have them all on standby.
28:52What's the anaesthetic like?
28:54Be all over it.
28:56Give me any warning.
28:58Go.
28:59If Noel pushes against the spinal cord, it could be fatal.
29:04It could be fatal.
29:07OK, it's moving.
29:08So I think I've got one piece ready to come out.
29:11OK, so this is one of the top pieces of the disc right there.
29:16Now the other piece is the one that's really squishing the cord.
29:19Right, ladies?
29:20If anything's going to happen, it's going to happen now.
29:22Here we go.
29:23Take these glasses off me.
29:25Thanks.
29:26Here we go.
29:27We're coming up.
29:29Don't move.
29:30What a nightmare.
29:32Oh!
29:33There it is.
29:34Look at that.
29:36All of that was sticking up into the spinal canal and squishing the spinal cord.
29:42It's taken over an hour to remove the first metal disc.
29:46And there's still one more to take out.
29:49All right, here we go.
29:51We're going to drill the second disc.
29:57Don't move.
29:58Don't move.
29:59Don't move.
30:00OK, so this one is easier to get out.
30:02That's half of it.
30:04This is the other half.
30:06So there's all the bits we have.
30:09Two big holes where we've taken out the broken discs.
30:12Now we're going to do something to hold these vertebrae together.
30:15Noel fits two Christmas tree spacer devices between the vertebrae
30:20and uses saddle plates, screws and rods to hold the bones rigid.
30:24OK.
30:26Now we put the bone graft in,
30:28in an effort to fuse these three vertebrae solidly together forever.
30:34All right, let's stitch up.
30:39Noel has been operating for three and a half hours,
30:43but it will be several days before he knows if Pepper's spinal cord may recover,
30:48or if surgery has made it worse.
30:51All righty, let's go to x-ray and CT, please.
30:54Good girl, Pepper.
30:56It's the morning after Luna, the Swiss golden retriever,
31:06had scans and an arthroscopy investigation on her elbows and left shoulder.
31:11OK, bonjour.
31:12Hello.
31:13How are you? Nice to see you.
31:14Nice to see you.
31:15The family stayed in the UK for the results.
31:18In summary, there's a major elbow problem and also,
31:24it kills the breeze, there's also a shoulder problem.
31:27Noel has treated Luna's shoulder.
31:30So what I did was I just cut the tendon because it was hurting,
31:33because it was pulling off.
31:35OK.
31:36This will settle down with scar tissue, holding it where it is.
31:40But one of her elbows is still a problem.
31:43We now know that the right elbow will probably settle down in the next six weeks.
31:48The left elbow, it'll probably be better, but get slowly worse again over the next couple of years.
31:55So the decision we need to make is, do we do any further surgery on the left?
32:01In my opinion, if we are to do another operation,
32:06it would be to shift the load towards the radius away from the ulna.
32:12So we cut in half the humerus and we transfer more of the weight, l'autre côté.
32:20OK.
32:21How much do you think she'll feel less pain?
32:24We would hope that the pain associated with the rubbing of the bone is gone.
32:29Yeah.
32:30But there will still be some pain associated with osteoarthritis.
32:34You would do that for your doctor?
32:36That would be my recommendation.
32:38OK.
32:39But it's obviously up to you.
32:41Come on, babe.
32:42Come on, babe.
32:44No.
32:45Now, we have to keep this on because otherwise she will lick this.
32:49OK.
32:50There's two stitches here and there's two stitches in here.
32:53All right.
32:54I think we're done.
32:55Come on, Bob.
32:56Oppsa-daisy.
32:57Now, off we go.
32:58Good.
32:59Come on, sweetheart.
33:00There we go.
33:01Hey.
33:02Well, before coming here today, I was a bit nervous.
33:05I was a bit frightened.
33:07But now, I'm happy we've done that.
33:10Oops!
33:11The family are heading back to Switzerland.
33:13As the Christmas holidays approach, they'll have to decide whether Luna should have another operation.
33:19Right now, I have mixed tailing.
33:20I don't know exactly what we should do, but what I know that I would like to do the best for her.
33:34It's three days since Pepper had dramatic surgery to remove the metal disc that was sticking into her spinal cord.
33:46She's already back on her feet.
33:49Good girl.
33:50Good girl.
33:51Well done.
33:52Look at you raring to go.
33:53Well done.
33:54Good girl.
33:55Good girl.
33:56Oh, well done.
33:59She's doing much better than I thought she would.
34:01This is fantastic.
34:02We've weaned down the pain-killing drugs now.
34:04She's no worse than she was before the operation, which is fantastic.
34:07I was really worried about making her worse.
34:10But the most important thing is that she's out of pain.
34:15Pepper's doing so well that Noel is sending her home.
34:24This is Patrick O'Farrell's orthopaedic and neurology Natalie speaking.
34:27How can I help you?
34:29For little Tatjana, the countdown to Christmas has begun.
34:34No.
34:35You can't play.
34:37It's six weeks since the operation on her front legs.
34:41Hello Tats.
34:42Let's get down there and see you walk.
34:44Now the little pup, for the first time in her life, is standing straight and tall.
34:51God, she's really getting up on that left wrist, isn't she?
34:54Yeah.
34:55Yeah.
34:56She's tons better than she was.
34:57Oh, yeah.
34:58Well, anything was better than she was, wasn't it?
35:00Yeah.
35:01Yes.
35:02It's remarkable, really, considering how bad and horrible things were.
35:07Well, we never dreamt she'd ever be like this.
35:09Well done.
35:10You're motoring now, aren't you?
35:12Different dog.
35:13Happy.
35:14Different dog.
35:15Okay.
35:16Come on, mate.
35:18Come on.
35:19That's fantastic.
35:20That's fantastic.
35:21Well done.
35:25Tatjana is taken through for scans.
35:27If the x-ray pictures show that the elbows are sufficiently fused, Noel will remove the rest of the frames.
35:34Okay, so this looks pretty solid.
35:39We can see the elbow on the right-hand side is fused very well.
35:42There's no lines of the joint visible anymore.
35:45The frames can come off, but Noel is still concerned about Tatjana's right wrist.
35:52The foot is slightly out to the side and knuckles over a bit because the tendons are weak.
35:57I might have to fuse it in the future.
36:00The left wrist is excellent.
36:02It's actually in a really good line and it's good footfall.
36:05I'm stunned by that because this is really accommodated well, considering this leg was a flipper and sticking out to the side originally.
36:13Good girl.
36:14I'm very proud of you.
36:15Well done.
36:18Now, Tatjana's family, please.
36:20Yeah.
36:23Hi, guys.
36:24I have good news for you.
36:26So, bottom line, I think the elbows are fused enough to remove the frames.
36:31Right.
36:32Yeah.
36:33That's the most important thing.
36:34So, are they off now then?
36:35Yes.
36:36Oh, right.
36:37Or should we please?
36:38Yeah, she'll be delighted.
36:39I have to say I'm overwhelmed with how good the feet have remodelled with the growth.
36:46It's been quite extraordinary.
36:48I mean, I did it and I'm impressed by it.
36:50Yeah.
36:51Yeah.
36:52On the left, they're pretty much normal.
36:54I mean, extraordinary.
36:56And on the right, the flexor tendons are fine.
36:58It's the collateral ligament that's loose.
37:00Right.
37:01So, the wrist is, if you hold it there, it's straight.
37:04And if you don't hold it there, it goes out because the collateral ligament's loose.
37:08My gut feel is we should fuse it.
37:10Yeah.
37:11All right, Hannah.
37:12Hey, yo.
37:13They're going to, yeah, be very careful because she's just had her pins out.
37:19Right.
37:20Right.
37:21Right.
37:22So, she's going to be super sensitive.
37:23All right, lovely.
37:24Thank you so much.
37:25Well done.
37:26My pleasure.
37:27My pleasure.
37:28My pleasure.
37:29Please, God, watch out for your glasses there.
37:30Okay.
37:31Look after yourself, mate.
37:32Thank you so much.
37:33All right, guys.
37:34God bless.
37:36Take care.
37:37We're on tentacles, really.
37:38I'd be frightened to death.
37:39I'm going wrong now.
37:40Tatiana's transformation has been remarkable, but she still faces another surgery to fuse
37:51her right wrist.
37:52At Fitzpatrick referrals, some of the patients will be spending the holidays in the wards.
38:20We try and make the animals feel like they're at home because when they're away from their
38:23families at Christmas, it can be quite sad for them.
38:26So, we give them extra cuddles, extra laugh, kisses.
38:30Hi, my baby.
38:32Hi.
38:33Hi.
38:34Peppa is in for a checkup six weeks after her dramatic neck surgery.
38:52She's still showing some pain, so Julie and son Adam have asked Noel to do further scans.
39:01There we go.
39:02Good girl.
39:03Hiya.
39:04Hi.
39:05How are you doing?
39:06Everything is fine in terms of the neck.
39:07Oh, good.
39:08The implants are all fine and have integrity and everything's fine in that department.
39:18And you can see there where the bone is physically growing through the implant there.
39:22Though that whole segment from here to here to here is now solid.
39:26Brilliant.
39:27OK, so I'm happy with the neck.
39:29OK.
39:30The scans have highlighted another problem.
39:33Oh, my goodness.
39:34This is the MRI scan from today on her lower back.
39:38The disc in her lower spine is dramatically dried out here.
39:41Right, OK.
39:42If we take a close-up look at that, you'll see here where the disc is bulging upwards.
39:47Yeah.
39:48And the top of the vertebrae is going downwards.
39:51OK.
39:52Now, even more importantly, you've got compression on either side as well.
39:57Yeah.
39:58With the L7 nerve roots that give rise to the sciatic nerve.
40:02So she's got bilateral sciatica.
40:04Oh, OK.
40:05So we only have three options, oral medicine or injection medicine, physiotherapy or surgery.
40:14It was just really hard seeing him in so much pain.
40:17She's come so far and she's done so well.
40:19Well, it's whether we go through surgery on the lumbar sacral spine.
40:23I want to.
40:24The risks are, as you stretch that open like so, you may get tethering of these nerves
40:30to chronic scar tissue down there in that hole and sometimes they stick down.
40:35So when you stretch them, they can get what's called neuropraxia.
40:39I do think that she is a candidate for this because I think she's in quite a lot of pain.
40:45She defied the odds before.
40:47Yeah, she did.
40:48And she's a real fighter and she deserves it.
40:50OK, yeah, that's fine.
40:55To try and get Pepper out of pain, Noel is placing a third Christmas tree spacer,
41:04this time in her lower spine, to push the vertebrae apart and take the pressure off the nerves.
41:13Give me another 3-5 drill bit, please.
41:15Then he stabilises the joint between her vertebrae.
41:18OK, we now have one screw on the right and on the left on each of the L7 vertebral body and the sacrum.
41:27And on each side, the C-shaped clamps are linked together by a dumbbell here and a dumbbell there, locked down with nuts.
41:34So we now have a very rigid construct.
41:37Hopefully, the nerves will recover fairly quickly.
41:43Right, good.
41:44Let's go to x-ray, please.
41:46In the Swiss Alps, it's already a picture postcard Christmas.
41:58Luna had the further operation on her elbow and now she's able to enjoy the snow.
42:04When you see her running, excited, she really enjoy life.
42:08Now we can see the difference, really.
42:10Yes, it's a great time now.
42:12Hey, Luna!
42:13She can be happy and run around.
42:18That's what she can do now, but she couldn't do before.
42:21Hey, it's good, Lulu! It's good, Lulu!
42:23Snow is a playground.
42:25She likes doing holes in the snow.
42:28She's full of energy, full of joy.
42:32Much noisy.
42:34She's happy.
42:35She's happier than before because she's not in pain anymore.
42:46At home, the family have their companion back for the holidays.
42:51Put money away,rite it up, put money into the threats that need k худz точima details.
42:53gen Puis,ナ educations, contact, lessen quelques menus.
42:54She is our Christmas present now.
42:56Are recovering, it's really a present.
43:02Search, search!
43:03I think she had a second chance in her life.
43:06Now she can be a dog like the other ones, play, run and be happy.
43:13and run, and be happy.
43:22In Surrey, too, festive preparations are underway.
43:28Peppa has recovered well from her latest surgery.
43:32She's out of pain and finally can enjoy Christmas,
43:36much to the relief of Barney, the family's other dog.
43:39They haven't been able to play together for a long time,
43:43and Barney hasn't really understood why she won't play with him,
43:47so it's just so lovely to watch them playing together now.
43:49Puppy-like. She's nearly ten and she thinks she's a puppy.
43:53Fantastic to see her like she is now. She's just so happy.
43:58It's been several years since Peppa could enjoy running in the woods.
44:03Come on.
44:06We've never really known her to be this agile,
44:08and being able to run around like this.
44:12She loves being outside and going through all the bushes
44:16and around the trees.
44:18Look how happy she looks.
44:20Peppa!
44:21It's something that other people take for granted.
44:23You take your dog for a walk and you let them loose,
44:24but now we can do that too
44:26and see her running around and having a whale of a time.
44:29Peppa, come.
44:30This way. Come on.
44:31I don't have any regrets.
44:32I'm very glad that we went through it all together.
44:35Come, Peppa. Let's go home now.
44:37Come on.
44:41In Nottingham...
44:43Come on, good girl.
44:44...Tatiana is having hydrotherapy.
44:48In the end, Noel did have to fuse her right wrist.
44:52Swimming is helping to strengthen her front legs.
44:55Thanks ever so much for that, Steve.
44:57You're welcome.
44:58Bye.
45:03It's been a long journey from Romania
45:05where she was rescued from the streets as a disabled puppy.
45:09But now, she's back home with the pack
45:11and ready to be spoilt at Christmas.
45:13Tati's doing really excellent now.
45:15She'll never be a ballerina dog.
45:16She'll always throw her legs out.
45:17Noel expects her.
45:18She's happy.
45:19Just clumsy.
45:20It don't bother her at all, does it?
45:21Nothing bothers her.
45:22There you go.
45:23The journey to get from there to here has been...
45:24Time-consuming.
45:25Yeah.
45:26Heart-breaking.
45:27Come on then, everybody.
45:28Back-breaking.
45:29Back-breaking.
45:30Back-breaking.
45:31Oh, look here.
45:44Before the operation, she was walking on her elbows.
45:47She couldn't go on anything hard.
45:49It had always got to be soft.
45:50Well, she can get everywhere now.
45:51Yeah.
45:52She's walking on her elbows.
45:53She couldn't go on anything hard.
45:54It had always got to be soft.
45:56Well, she can get everywhere now.
45:57Yeah.
45:58Yeah, she's got more freedom.
46:00Come on then, tat.
46:02This Christmas will be her first Christmas of her life,
46:05pain-free.
46:06Good girl.
46:07And doing what she wants.
46:08Good girl.
46:10Good boy.
46:12Good girl.
46:13Good boy.
46:15Mrs. Wibbles?
46:17She is one of the family now, isn't she?
46:20She is, and that's it.
46:23No more dogs.
46:24And this is recorded.
46:28Back at Fitzpatrick Referrals, another year is over.
46:39Here we go.
46:40Three, two, one.
46:42Yay!
46:45Merry Christmas, everybody.
46:47Merry Christmas.
46:52Are you ready?
46:53Yay!
46:54Merry Christmas, everybody.
47:01Where's my present?
47:02Here.
47:03Merry Christmas, everybody.
47:03Merry Christmas, everybody.
47:04Merry Christmas, everybody.
47:04Merry Christmas, everybody.
47:04Merry Christmas, everybody.
47:05Merry Christmas, everybody.
47:06Merry Christmas, everybody.
47:06Merry Christmas, everybody.
47:07Merry Christmas, everybody.
47:07Merry Christmas, everybody.
47:08Merry Christmas, everybody.
47:08Merry Christmas, everybody.
47:09Merry Christmas, everybody.
47:09Merry Christmas, everybody.
47:10Merry Christmas, everybody.
47:10Merry Christmas, everybody.
47:11Merry Christmas, everybody.
47:11Merry Christmas, everybody.
47:12Merry Christmas, everybody.
47:12Merry Christmas, everybody.
47:13Merry Christmas, everybody.
47:13Merry Christmas, everybody.
47:14Merry Christmas, everybody.
47:14Merry Christmas, everybody.
47:15Merry Christmas, everybody.
47:16Merry Christmas, everybody.
47:17Merry Christmas, everybody.
47:18Merry Christmas, everybody.
47:19Merry Christmas, everybody.
47:20Merry Christmas, everybody.
47:21Merry Christmas, everybody.
47:22Merry Christmas, everybody.
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