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00:01One, two, three, whoa!
00:05Hello, 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.
00:21We only get one shot at this. Here we go.
00:23Noel and his team offer some of the most advanced treatments available anywhere.
00:28It's a perfect marriage in mechanics and biology.
00:31This 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.
00:55Oh, that is just unbelievable.
00:57He's raring to go.
00:59Against all the odds.
01:00Boom!
01:01One small step for a dog, one giant leap for mankind.
01:04Well done.
01:15Every week, the staff at Fitzpatrick referrals welcome hundreds of patients through the doors.
01:21Hello.
01:22Take a seat, guys. Thank you.
01:25Oh, hello, darling.
01:28Many will only require Noel's help once, but some become repeat visitors.
01:34Some patients are unlucky and they might have multiple problems.
01:38And seeing them back again and again, you really do get to know them and their family.
01:43You see them come in for the rechecks and you kind of develop, like, this love for them.
01:50The amazing thing is they always come in wagging their tails.
01:54They're always happy, even though they might be in a lot of pain.
01:59Here to see Noel today are June and her eight-year-old clumber spaniel, Scrumpy.
02:05Oops, careful. Sit down. That's it. Lie down.
02:08That's it. Roll over. Good boy. Roll over.
02:11I've brought Scrumpy in today to have a scan, an MRI scan, on his back.
02:18Unfortunately, he appeared to be very lame.
02:21He was like a drunk man. He was wobbling at the back.
02:24Scrumpy and June are no strangers to Fitzpatrick's, as this isn't the first time he's had mobility issues.
02:31He's had six operations before, and if anyone can fix him, Noel can.
02:38Scrumpy lives in Hampshire with June and brother Jack.
02:53His first operation was elbow dysplasia.
02:57Within months he broke his first leg, and then about nine months later he broke his second leg.
03:04Come on, here.
03:05Then we had the hip done, and then 18 months later we had his knee done.
03:11Despite Scrumpy's history of ill health, he spends time working as a therapy dog, visiting the elderly in care homes.
03:20Sometimes it's just something different for the resident in the home, that a dog coming in to see them.
03:27There you are, have a treat.
03:29Oh, that's a lovely treat.
03:33Sometimes they don't have visitors.
03:35Maybe their own family doesn't live close by, and a dog's sometimes the only visitor they get.
03:41But Scrumpy's problems have got so bad recently that he's unable to perform his duties.
03:47They know he's off his feet at the moment, but they fully hope that he'll be back soon.
03:57Is my friend a companion?
04:00At the moment I can't think of I'm not being here.
04:05So, we shall see what Noel can do.
04:11Noel has sent Scrumpy for a CT and MRI scan to work out what's causing the problem in his back legs.
04:21So, you can see here where the disc at the very base of the spine, between the lumbar spine and the sacrum, is completely collapsed.
04:29That's pretty much as bad as it gets.
04:31So, Scrumpy's in a bad situation, and he has multiple joints affected by arthritis, and he has major spinal issues.
04:39And I guess the question is, the universal question of love for an animal, when is it time to say goodbye?
04:46Okay, Scrumpy's mum.
04:48Oh.
04:51Hi, June. He is ready to go now, and I just wanted to fill you in on the details.
04:55I mean, I'm struggling with it, from an ethical point of view, as well as you are.
04:59He's already been through one hip replacement, one knee surgery, and two elbow surgeries.
05:04Yes.
05:05He's got severe elbow arthritis on both sides, which we are going to somehow have to treat.
05:10Plus, every disc in his spine is dried out.
05:13Plus, the disc in his lower back, you know, has effectively exploded.
05:17I mean, you can only take it step by step, and I guess the decision we have to make at the moment is, do we take the next step?
05:23And at the moment, that step is either leave him in pretty severe pain, or just try drugs which are not working, or do major surgery.
05:30Yes.
05:31Okay.
05:32We'll give him the chance.
05:33Okay.
05:34So, I've looked at the logistics of potentially doing the disc surgery on his lower back at the same time as doing a stem cell harvest for his elbows.
05:48That's a big deal.
05:49Yes.
05:50Uh-huh.
05:51I understand.
05:52Yes.
05:53In the best case scenario, there's a chance that he won't be able to wag his tail for a period of time.
05:57In the worst case scenario, the nerves that go to his urinary bladder, or his back legs, could be permanently damaged.
06:07Yeah.
06:08I've been through so much that I don't want to give up now.
06:12Yeah, I know, but you do, I'm deadly serious, you have to understand there's a line in the sand.
06:19Yes, I know.
06:20And I can't be doing it for you, you know that.
06:22Oh yes, I know.
06:23If it comes to the point that he is suffering, we would have to let him go at that point, which you know.
06:33OK?
06:34Yes.
06:35I'll get him for you.
06:36I'm sorry.
06:38I know.
06:39I know.
06:40Yeah.
06:42Come on, mate.
06:43Scrumpy will go home with June tonight, but will be back next week for his seventh operation.
06:49Hello, my boy.
06:51Hello.
06:52Hello, my boy.
06:54All right.
06:55Take care.
06:56Thank you very much.
06:57You're welcome.
06:58Thanks again.
06:59See you next week.
07:00See you soon.
07:01You can't judge a person until you're in their shoes.
07:04That's the bottom line.
07:05That's like the nicest woman in the world.
07:08How many surgeries is too many surgeries?
07:10Seven, eight.
07:12We wouldn't think twice about it if a human needed it.
07:15I think when an animal is a part of a family, then we need to have a little more compassion
07:20and understanding.
07:22If we can help him and make his life a bit easier, then we'll go for it.
07:27And this is probably the last chance.
07:30I can only put him through so much.
07:34This will probably be the last time.
07:37It's early evening and an emergency case has just arrived in reception.
07:5515-month-old Dachsund Ralph is in pain and having difficulty moving.
08:00He's been brought in with his sister Lauren by Denise and Wilson after being referred to Fitzpatrick's by their local vet.
08:08He's not right.
08:09And his yelping has been not good.
08:13Oh, no, no, no, no, no, no, no.
08:16That's what he's doing when he moves sometimes.
08:20So we don't know what quite is wrong.
08:30Now, Ralph.
08:31Where is Ralph?
08:32Here.
08:33Hello.
08:34Sorry about the delay.
08:35I've been busy operating.
08:36Hello, mate.
08:37How are you?
08:38So which one is the injured one?
08:39This is the injured one.
08:40Ah, I see.
08:41Come on in.
08:42No, so Wilson and Denise, D-E-N-I-S-E?
08:44That's correct.
08:45OK, please take a seat.
08:46All right, tell me what happened.
08:48Well, we're not absolutely sure.
08:50There's a commotion outside.
08:51Right.
08:52He and she are running after, I think, a squirrel.
08:54Yeah.
08:55Disappeared behind a bush.
08:56And there's this almighty yelping going on.
08:58And she is?
08:59Lauren.
09:00The sister?
09:01Yeah.
09:02Oh, right, I see.
09:03Yeah, yeah.
09:04But they were very subdued.
09:05Hang on.
09:06Ralph and Lauren?
09:07Yeah, I get it.
09:08Boom.
09:09OK.
09:10Right, I'm with the programme.
09:12OK.
09:13Ralph Lauren.
09:14He doesn't like standing an awful lot.
09:16Well, that's what I was just going to ask you.
09:18Is he able to stand?
09:19He's able to, but he's very hunched.
09:21OK.
09:22Oh!
09:23Oh, mate.
09:24That's not good.
09:25That's what I mean.
09:26Let me take that.
09:28Good boy.
09:29Good boy.
09:30I mean, he's roach like a banana, isn't he?
09:32Yeah.
09:36Yeah.
09:37OK, buddy.
09:38Yeah, yeah.
09:39Sorry about that, mate.
09:40No.
09:41All right, he can go back in your arms.
09:42Hold him tight.
09:43So we've got an MRI him, like, now.
09:45But I won't know the prognosis just yet until I see what that looks like.
09:48Yeah.
09:50Ralph's condition is puzzling because it doesn't fit the normal pattern for spinal disc problems,
09:56which are common in Dachsons.
09:58Yeah.
09:59Noel wants to seek the expertise of his neurology team.
10:03So I can't determine where the pain is coming from, Ricardo.
10:07And I just, can you have a look at the pain on earth for me, please?
10:10Ricardo is a neurologist at the practice.
10:14All right, big guy.
10:17All right, big fella.
10:18Big fella.
10:23Out reflex?
10:24Presence, yeah.
10:25Yeah, OK.
10:26Well, we'll get a scan.
10:30Ralph is sent for an MRI scan of his spine and brain.
10:41He's holding one.
10:42I know.
10:49The MRI scan has revealed something unexpected.
10:54There's swelling in Ralph's brain.
10:57So we're going to take a sample of fluid from just behind the brain.
11:01And the constituents of that fluid may give us some hints of what's going on here.
11:05OK, so we just, there's a little hole here behind the skull where we put in the needle and the fluid pops out and we just catch it.
11:15OK, done.
11:17It will be a few days before the test results from the brain and spinal fluid plus blood and urine samples are back.
11:26OK, so, turns out there is in fact no disc issues.
11:33So we then scan the brain.
11:36And in the brain we saw this diffuse whiteness.
11:40So that is not normal.
11:43That is swelling, fluid.
11:47It's markedly abnormal.
11:49And that's where Ricardo comes in.
11:52Because this is not my field of expertise, but it is his field of expertise.
11:57So when we have this image where you see all this whiteness and this inflammation in the brain, there are three main things that pop into consideration really.
12:06One, inflammatory or immune-mediated diseases.
12:11Possible tumour.
12:13Would be very unusual in such a young dog.
12:16OK, and just because we had a couple of pictures, OK, that they can fit, for example, with an hemorrhagic stroke.
12:23I think probably the best way to go is to treat for some of the complications that we certainly have in the MRI, like the inflammation and see how things go on.
12:33So what we're going to have to do is give a potent steroid to try and decrease the inflammation and the swelling.
12:40And we're going to give an antibacterial therapy as well.
12:42But at the moment we simply don't know. Nobody knows.
12:46Ralph will remain at Fitzpatrick's while Noel and his neurology colleagues try to work out the cause of his mystery brain condition.
12:56We may think he's not in pain at the moment.
12:58Yeah.
12:59So he's not going to be pertained.
13:00But we had hope that it was just a disco.
13:03Yeah, yeah.
13:04So it's a bit worrying that it's something in his brain.
13:07Only when Noel and the team discover the cause will they have a chance to treat Ralph successfully.
13:13Ralph the Dachshund was admitted yesterday with a mystery brain condition, but overnight there has been a dramatic turn of events.
13:28He's been having seizures.
13:29Hello?
13:30Oh, hi Denise. Good morning.
13:31He's very sedated, but he had another seizure event at 7am.
13:34Oh, no.
13:35Whatever the process is that is occurring in the brain is causing the seizures.
13:37At least we feel he's in the best place.
13:38So that's the only comfort we're getting at the moment.
13:39Yeah, it's a tough one. It's a real tough one. I mean, it's not a typical scenario at all.
13:40But all we can do is, is do our very best, which is exactly what we will do.
13:43I think we feel he's in the best place. So that's the only comfort we're getting at the moment.
13:45Yeah. Yeah, it's a tough one. It's a real tough one. I mean, it's not a typical scenario at all.
13:52But all we can do is, is do our very best, which is exactly what we will do.
13:57Okay, thank you. Thank you, Noel. Okay, bye.
14:13With Ralph's situation deteriorating, time is running out to get to the bottom of his mysterious condition.
14:20We see loads of dogs that come through Fitzpatrick's and they're the usual, like Labradors or Daxies or French Bulldogs.
14:33I'd quite like to see an Afghan hound with the long, flowing, sort of perfectly groomed hair.
14:39When an English Bulldog comes in, I'm in paradise.
14:45We don't see very many chow chows, but they're always quite fun when they come in.
14:53Oh, talking of chows, there's another one.
14:56Oh, easy, darling. It's like buses. You never see one and get two at once.
15:02Randomly, you'll get this really kind of foreign breed or one that's just not quite well known.
15:07And as soon as that comes through, you're like, oh, that's new. That's different. That's nice.
15:12Morning. Who have we got there? Buster.
15:17Hello, Buster. Take a seat for us. Thank you very much.
15:22In reception, a seven-year-old Briard called Buster is waiting to be seen with Lara and Ian.
15:28They are also no strangers to the practice.
15:31We were here when Buster was a pup seven years ago and Noel did a pioneering operation on him in his hog.
15:38I believe he was the second dog only to have had this operation.
15:42Since the operation, Buster has led a pain-free life, until recently.
15:48In August of last year, he was lame in his back left leg, so it's the same leg.
15:54So I thought we'd better get it checked out.
15:58I guess the worst case scenario is that Noel says the operation hasn't lasted and it needs to be redone.
16:07That would be the worst case.
16:09Buster is a French Briard. He's a sheepdog.
16:11I didn't want a small dog because she grew up with poodles.
16:16Nothing wrong with poodles.
16:19The compromise was Buster's wool so doesn't molt, but he's huge.
16:24The kids have grown up with Buster.
16:27One of them is now at university, the other is at college doing A-levels.
16:30Yeah, I mean, he has been an absolutely integral part of the family.
16:36He's been fantastic. I mean, you couldn't have a more loyal dog, actually.
16:47Hi, how are you?
16:48Hello. Long time no see.
16:50How are you doing? You haven't changed a bit, unlike me.
16:52Nice to see you. Hey, mate. How are you?
16:55Oh, good boy.
16:57He's like me. He's got the sprinkling of black and grey now.
17:00Well, he has indeed.
17:02Seven years, my goodness.
17:04So you're concerned about lameness, are you?
17:06Yeah. Was he OK for six years?
17:08Yeah. And what happened then?
17:10Then he just started limping and not wanting to bear any weight on his back left leg.
17:18I mean, we were wondering whether that maybe it was a bit of arthritis.
17:22It is entirely possible that the osteoarthritis, which was kicked off by the original disease process, is getting worse.
17:29OK. Entirely possible. Let's have a look.
17:32All right on the other legs?
17:34Yes. Yeah, yeah.
17:38It's actually not got that much swelling around there. Interesting.
17:42Range of motion is actually quite impressive.
17:45Hold tight.
17:46He seems to be more painful higher up in the limb.
17:53OK. Yeah.
17:55Doesn't like that, does he?
17:58This is his sciatic nerve. Hold tight.
18:00He definitely doesn't like that. You can let him go.
18:04It's all right. It's all right. It's all right. It's all right.
18:07All right, mate. Hey, mate. It's fine.
18:09I think he's got a different problem.
18:11OK. OK.
18:12Which is good and bad news. It's good news for me because the surgery that I did several years ago seems to still be working.
18:18Yeah. It's bad news for him because it looks like he's got lower back pain.
18:22This breed and several other large breed dogs can get a condition called degenerative lumbosacal stenosis.
18:29Yeah.
18:31You've had it yourself, sir?
18:32I have. And I had an x-ray and mine is the same.
18:35It's very, very common.
18:37The one thing that's changed my life, actually, is turmeric.
18:40Oh, I see. So you're using a natural anti-inflammatory.
18:43Yeah. It has changed my life.
18:45Ultimately, there's three outcomes from this.
18:46One is you just give medical management, either pharmaceuticals or natural.
18:52One of the things that can be done is injections of steroid into the back.
18:56The second port of call is physiotherapeutic intervention.
19:00Surgery is always an option.
19:02And we do it when we can't get any result from medical management and you've got pain all the time.
19:08Yeah.
19:09Because you want to try and avoid picking up a scalpel blade if you can.
19:12Absolutely, yeah.
19:13My recommendation to you is you need to get a scan.
19:15Yeah.
19:16Let's do that. Let's find out what's going on.
19:19Yeah. All right, catch you later.
19:20See you later.
19:21Thank you very much.
19:22See you guys. God bless.
19:25Noel's diagnosis was not what Ian and Lara were expecting.
19:29I was hoping that it was just arthritis or something.
19:34Having been through the process six and a half years ago, we know just how tough the recovery process is on both the dog and us as a family.
19:44I mean.
19:45But it was reassuring to know that there were other options and that surgery wasn't the immediate first port of call.
19:53We just have to wait till this evening when we come back to hear the verdict.
19:57The family will go home and wait in the hope that they will not need to resort to surgery.
20:03This afternoon, a familiar face is back at Fitzpatrick's.
20:13Good boy!
20:14Eight-year-old therapy dog, Scrumpy.
20:16Scrumpy's booked in today, hopefully for surgery.
20:20And this is really one of the last chances we've got to get him back in his seat again.
20:27I think my nerves are worse than his.
20:30He's such a friendly dog.
20:31He's a good companion, not only to me, but everybody else.
20:35And it's just what's best for him.
20:41June has made the difficult decision to admit Scrumpy for his seventh operation at Fitzpatrick's.
20:48Hello, I've got Scrumpy.
20:51Yes, that's right, thanks.
20:52Today, he will undergo major spinal surgery to correct a collapsed disc in his back.
20:59So, our friend Scrumpy's in again.
21:00Go on, you want to sit here?
21:02It's a big old surgery.
21:04We're going to minimise risk as much as we can.
21:07And even then, there's still risk.
21:09All right, Scrumpy then, please.
21:12Hi, here we go again.
21:14Once more into the fray.
21:16Come on, that's a good boy.
21:18All right, sweetheart.
21:20Let me have a look at you, Scrumpy.
21:21Scrumpy.
21:22Yeah, still wobbly, mate.
21:24Let's get you out of pain if we can.
21:25Yes.
21:26Good boy.
21:27OK, boy.
21:28Are you ready?
21:29Yes, yes, ready as the liver be.
21:31OK, thank you.
21:33Thank you very much.
21:34OK.
21:35Stay brave.
21:36I'll be ready.
21:37See you later.
21:39Thanks a lot.
21:43It doesn't get any easier, but this is his seventh operation.
21:47Scrumpy, I think, is better used to it than I am.
21:50You know, he's strong in willpower and he's stubborn, so he'll get through this.
21:58It's me.
22:00Just wait for the phone call now.
22:04I'm sure he'll be fine.
22:06Out in the prep area, Buster, the seven-year-old Briard's hind-leg lameness, has been investigated.
22:28He had ankle surgery when he was a puppy, and the family are concerned about putting him through another invasive procedure.
22:37Noel has the results.
22:39Hello?
22:40Oh, hey, Lara.
22:41It's Noel.
22:42Hi, Noel.
22:43So, it is what we thought it was, which is a bulging disc in the lower back.
22:47And that's causing compression of the nerves going down the backs of his legs.
22:52Right.
22:53It's not mild.
22:54It's not severe.
22:55It's moderate, I would say.
22:56So, that pushes him toward the likelihood of having surgery.
23:00But I would try epidural steroids first, would be my advice.
23:07OK.
23:08Are you going to inject him now, then?
23:09Literally now, yeah.
23:10Under the same anaesthetic.
23:11But if that's fine with you...
23:12Yes, please.
23:13See you both later.
23:15OK.
23:16Bye now.
23:17Bye-bye.
23:18Alrighty.
23:21Here we go.
23:23I'm just going to inject some normal saline into the hub of the needle here.
23:27If I'm in the right spot, you can see that the fluid gets sucked down the needle, like so.
23:36Now, he can inject the steroid into the epidural space around the spinal nerves.
23:45OK, wake up.
23:46Thanks.
23:51Lara and Ian are back with their daughter, Evie, to pick him up.
23:54Can't wait to see him.
23:58OK, Buster, please.
24:00Hi, guys.
24:02When we look at the CT scan of the ankle, it looks like the implant has held up,
24:09although the inevitable progression of osteoarthritis has occurred.
24:12That's the implant there.
24:14Wow.
24:15OK.
24:16And it's still there.
24:17So, you must be thrilled.
24:18I'm pleased with that.
24:19Yeah.
24:20Yeah, that's as good as we could have hoped, because we got, you know, you've grown up quite a lot in those years,
24:24and this has stood the test of that time.
24:27That's the disc.
24:28Yeah.
24:29A normal disc is like a jam donut.
24:31They have a fibrous outer ring, and they've got a pulpy inner center.
24:34So, that's a normal-ish donut.
24:36That's normal, normal, normal, and so on.
24:38This one's certainly not normal.
24:39It's black.
24:40Yeah.
24:41So, inside the scanner, we put him in the position as if he was jumping.
24:45OK.
24:46So, you can see that the top of the sacrum comes down, the disc goes up, and it pinches the nerves.
24:52Yeah.
24:53What we've done today is we've opened up this space and injected some steroid into it here.
24:59OK.
25:00We normally do three injections.
25:01The first one today, the second one in two weeks, the third one in five weeks from now.
25:05But it'll only help ease the pain, that's it.
25:07OK.
25:08And so, the only way to solve the problem long-term is to operate.
25:13Yeah.
25:14Please, God, we don't get to that point.
25:16Yeah.
25:17Yep.
25:18Oh, Buster!
25:20He's carrying a little bit of podge as well.
25:22OK.
25:23Because he hasn't exercised enough.
25:25So, he's about four or five kilos overweight, by comparison to what I'd like him to be.
25:30Bit of podge going on.
25:31OK.
25:32I'm just saying.
25:33Yeah, we have banned the gravy bones.
25:35Yeah, I'm just saying.
25:36Looks like Buster and I could be on the same diet.
25:38Yeah, I know Rob.
25:39Same pills, same diet.
25:41I'm not going to make any comment.
25:43I'm staying well out of that.
25:45All right, grab a seat for a second.
25:47I will go and get him for you.
25:49Oh, lovely kisses.
25:51I suffer from back pain, so I kind of know exactly what he must be suffering.
25:58And I do really sympathise with him.
26:01All right, mate.
26:02Here he is.
26:03Here he is.
26:04Good boy.
26:05Hello, darling.
26:07Right.
26:08I will see you soon.
26:09See you soon.
26:10All right, guys.
26:11Two weeks, five weeks.
26:12Take care.
26:13God bless.
26:15Thankfully, Buster has managed to avoid surgery for now.
26:18He will continue a course of three steroid injections in the hope it will alleviate his pain.
26:34Unlike Buster, eight-year-old therapy dog Scrumpy's spinal condition is at a more advanced stage.
26:41He's been prepped for surgery.
26:43Poor Scrumpy.
26:44He's just got so many things wrong with him.
26:47And he brings so much joy and love to the world.
26:50It's such a shame.
26:51So he's cheering up other people while he's in a lot of pain himself.
26:55So no pressure.
26:57Much.
26:59Today, Noel will be replacing the collapsed disc in Scrumpy's spine with a metal spacer,
27:05releasing the pressure on the nerves that are causing pain and making it hard for him to walk.
27:11Once the spacer pushes the vertebrae apart, Noel needs to stabilise the vertebrae in front
27:18and the sacrum behind the spacer with screws, clamps and rods to hold them in position.
27:24But as with any spinal surgery, there are risks of potential life-changing nerve damage.
27:30Sadly, Scrumpy's affected by a really severe disc problem.
27:35So the disc has dried out and bulged really badly into the base of the canal here.
27:40The nerves could get damaged.
27:42So those nerves are stuck to the roof as well as to the disc underneath.
27:47The disc underneath is down here.
27:49Man, this is just a congealed mess of fibrous scar.
27:52I think this is in the textbook of neurology under F for freaking mess.
28:02We've now got a big hole in here where we've scooped down in between the two discs.
28:07What I'm going to try and do is I'm going to try and put a spacer in here.
28:10It's going to be tough because the nerves all have to be pulled over to one side
28:14and also it's bleeding like crazy, as you can see.
28:16So this is the most difficult part of the surgery and the most risky part.
28:21And you only have one shot, as Eminem once said.
28:26Noel needs to be very careful moving the nerves to avoid the risk of permanent damage
28:31which could lead to incontinence or possible paralysis.
28:36We're getting a lot of blood loss here.
28:39Concentrate guys, concentrate.
28:41With the nerves finally moved to the sides,
28:44Noel drives the metal spacer between the two vertebrae.
28:47Okay, so I think I've got the spacer in now.
28:50You can see it's a real difficult drive to get it in between those nerves.
28:55There's lots of blood.
28:57And then you can see the spacer right down in there.
29:00Noel puts a small screw through the spacer so it stays in place.
29:04And then he uses large screws, clamps and rods
29:07to stabilise the vertebrae on either side.
29:10Okay, so we've got the clamps in now.
29:12You can see that the rod here gets pulled right down on top of the vertebrae.
29:17And that stops anything moving.
29:20Whew! That was a toughie.
29:23Before Scrumpy is taken to recovery, Noel is harvesting some fat
29:28as he wants to use a cutting edge treatment
29:30to try and ease Scrumpy's debilitating elbow arthritis.
29:34There's plenty of fat here.
29:35We're going to take some of it and we're going to send it off to the lab
29:39from which we're going to extract some potentially anti-inflammatory stem cells
29:44that we can put in the elbows to try and calm down the pain.
29:48Plenty of potential for harvesting cells there.
29:53So that was very, very challenging.
29:57Scrumpy certainly keeps me on my toes.
30:01All right, Scrumpy. Just rock and roll.
30:08It will be an anxious wait to see if the procedure has had any adverse effect
30:12on the nerves controlling Scrumpy's bladder and back legs.
30:16Hello, June. It's Noel.
30:17Hello.
30:18It was a tough surgery but we didn't expect it to be anything less.
30:21No.
30:22We had to stretch the nerves quite a lot to get all of the material out
30:26and get the spacer in.
30:28I don't know whether they'll recover or not.
30:30Yes, right.
30:31So we just need to be patient.
30:33Uh-huh, yeah.
30:34OK?
30:35Thank you so much.
30:36All right, take care.
30:38Bye.
30:39Bye.
30:40Bye.
30:41Bye.
30:49Emergency admission Ralph is still very unwell with a serious but unknown brain condition.
30:56He's being monitored around the clock in case he has further seizures.
31:01Senior neurologist Colin Driver has come to discuss Ralph's brain fluid test results with Noel.
31:08So are we any closer to knowing what the stuff is with the fluid?
31:10It's quite likely to be an infection.
31:13I would imagine you've got clumps of bacteria that have arrived in the bloodstream and have set up an infection in the brain.
31:22So he had spinal pain.
31:23Yeah.
31:24But in fact, it was just the area of the brain that perceives spinal pain that's being stimulated by this stuff in the midbrain.
31:30Yeah.
31:31We call it central pain syndrome.
31:32I mean, what are the chances of that? Less than 10%, I would have guessed.
31:35Yeah, absolutely.
31:36It's really unusual.
31:37I mean, I wouldn't say that I'd seen an MRI that was exactly like this possibly ever.
31:43Well, I can tell you categorically I've never seen it ever.
31:47With infection being the likely cause of Ralph's problems, Noel and Colin's plan is to treat it with antibiotics.
31:53We do not think the cause is a direct trauma.
31:58Okay.
31:59The fluid sample has narrowed it down to probable infection or inflammation.
32:05Okay.
32:06Have you any inkling of how this would have happened?
32:09I mean, ultimately, it's one of those things, really.
32:11You can get bacteria into your bloodstream from cleaning your teeth.
32:14You know, it's quite possible that infections can just happen sporadically.
32:19And unfortunately, it's unlikely that we're going to find an explanation as to why it did.
32:24Okay.
32:25The team hopes the antibiotics will bring the probable infection in Ralph's brain under control.
32:31For now, his life hangs in the balance.
32:33Come on, mate. Good boy. Come on, boy.
32:49It's now been a week since Scrumpy's spinal surgery.
32:52He's up and walking, but he's yet to have a pee without a catheter,
32:56and Noel is concerned that the nerves to his bladder have not yet recovered.
33:01Come on, mate. Come on.
33:02Come on. We've got to go.
33:04So, I've been waiting for Scrumpy to piddle for a few days now.
33:08His legs are getting stronger all the time, but his bladder's quite slow to recover.
33:13Come on, mate. Pea time.
33:14He's also very fussy where he wants to pee.
33:17Oh, yeah, baby.
33:20Oh, yeah, mama. You do that. Good boy. Oh, yeah.
33:24Oh, I'm so proud of you. Oh, that's fantastic.
33:28Oh, a nice big piddle. Fantastic.
33:30That's really encouraging.
33:32So, he's definitely cocking his leg and he's definitely peeing.
33:36I've never been more happy to see some peabody.
33:39Never been more happy. You're such a good boy.
33:41Now that Scrumpy has had his first post-op pee, June and husband Paul can finally take him home.
33:50I'm sort of looking forward to getting him back again at home and looking after him and hopefully he's going to make a full recovery. That's the plan.
33:58Right, June. And your husband.
34:04You actually exist.
34:06I thought she was pretending.
34:09But she actually has a minder.
34:13Brilliant. So good to see you, sir.
34:15Please come in.
34:17So, he walked pretty quickly within a couple of days and that was good news, but he couldn't pee.
34:23And I knew that that was because these nerves have been traumatized by the original injury plus the surgery.
34:29And they are recovering. So, just keep an eye on that. He's very fussy about where he pees. He likes to get exactly the right spot.
34:40In the bushes.
34:42That's right. Usually under a bush. So, he drags me towards anything that can cover his modesty.
34:48So, I'm delighted to say that I think he's on the mend now.
34:52Terrific.
34:53Thanks for coming in.
34:55So good to see you.
34:56You actually exist.
34:58You actually exist.
35:00Wonderful. Thanks for your help.
35:02Right. Okay.
35:04Come on, mate. This way. Good boy.
35:07Come on, buddy.
35:09Come on, buddy.
35:11Now.
35:12Oh, my boy.
35:13There we go.
35:15There we go.
35:16Oh, yes. It's good to have Scrumpy back.
35:19Yeah, I'm looking forward to getting him back.
35:21We've got a couple of months of physio to go through.
35:24It's doing a slow process.
35:26Yes. Aha.
35:27But you're a fighter. You'll get there, won't you?
35:30Yes.
35:31Hey.
35:32Good boy.
35:33Good boy.
35:34Good boy.
35:35B
35:49identified as the culprit which caused central pain syndrome in his brain
35:54treatment is working well and he's making a miraculous recovery we're here today to pick up
36:00ralph and we're very excited and the poor chap all along it was in his brain and and apparently
36:07was in a part of his brain which deals with pain so he was feeling pain all over and that's that's
36:12desperate he's just 15 months old and uh yeah but shows that he's a fighter now ralphie's mum and
36:19dad please you look splendid today sir i love the cravat it's a scarf i don't know what it is but it's
36:29great right good morning okay a long journey a long journey we've had what um colin and i and the rest
36:38of the team are looking for is a resolution of this and what that is we're convinced now is oedema
36:46pus associated with infection in the midbrain um he may still have some structural abnormality in
36:54his brain in the longer term but we're confident that we're treating it so i know obviously you
36:59didn't know him before we brought him in so before he was in that state but from your observation it's
37:04fine you'll see any minute you will see a dog right now that you will recognize
37:11but until the infection is under control ralph's symptoms will continue to be managed at home with
37:17medication as you can see he's fine so i've done my best for you okay all right right guys look after
37:27yourself thank you very very much thank you sir you inspire me if i could look half as elegant as
37:33you i'd be doing all right all right i'll send hannah down god bless okay bye bye he seems good he's lost
37:41a little bit of weight and i think he's he's a bit frightened that we're going to leave him again
37:47because he's a bit agitated he was never the sharpest knife in the box so it might be difficult to tell
37:52if he's got some brain injury i'm going but but so far so good he looks fine
38:04therapy dog scrumpy has been recovering at home from the major surgery on his spine
38:13today he's back for treatment which will hopefully help relieve the pain in his elbows
38:18so in here we've got 5 ml of the biological cocktail which comprises the fat derived stem cells
38:27which are potentially anti-inflammatory we're injecting a very specific cocktail of two very
38:34special ingredients into scrumpy's joints okay let the battle begin the first ingredient are specialized
38:41stem cells called pericytes which are extracted from the little blood vessels within fat concentrated
38:47in a specific number to have the maximum anti-inflammatory effect the elbows are particularly
38:54bad scrumpy has horrendous elbow arthritis the second ingredient are platelets from the blood
39:00which have within them granules which also release anti-inflammatory molecules
39:08what our team have done over the last several years is to try and make the process of treating
39:13osteoarthritis with stem cells and platelets very scientifically evidence-based the mixture
39:20only treats inflammation and pain it does not regenerate tissue and it does not cure arthritis
39:28all right well done scrumpy good boy well done my best
39:33now where's my mummy there's my mummy there she is now i'm feeling a bit stiff mum because uh i've had uh
39:46i've had both of my elbows and my hip all injected all of them i'm hoping this will last maybe six months
39:56maybe longer we'll see his cells are banked so we can thaw them out again if we need to
40:01okay okay hey clever boy all right big fella yeah take care thank you very much thank you
40:10where are you off to come here oh come here he's he's heading for the door
40:15he can move fast when he wants to come here he's going home
40:31for the past four months dax and ralph has been treated for his brain infection at home in east sussex
40:37he's hugely better um he's not 100 i think that's that's fair but uh but as you can see he's a lot
40:47happier now unfortunately there has been some permanent brain damage so he will never fully
40:53recover he's on a course of antibiotics and on a course of tablets to stop him having seizures
41:00we're just hopeful and to be honest when we left him on that first time the state he was in i didn't
41:05think i'd see him again so to be honest every day we have him back he's a blessing so it's been nice
41:19buster has now had a course of three steroid injections and it seems he's no longer suffering
41:25from his old back pain prior to the injections he was a creaking chair he was in a lot of pain
41:31and he couldn't put his left leg his left foot down on the floor you know he's not experiencing
41:36any of that anymore so that's brilliant he's just a lot more nimble and moving around without discomfort
41:45buster may still need further treatment in the future he's seven and a half years old now so
41:51we are going to do everything we can to not go the invasive surgical route
42:04definitely back to his old self i mean he is markedly pain-free now you know he's happy as larry
42:13aren't you buster yeah clumber spaniel scrumpy is back he's been having regular rehabilitation
42:26to help him recover after his spinal surgery good boy this one
42:34today june's here to find out if his seventh operation has been a success
42:40scrumpy hopefully he's going to have his sign off today he still walks a bit odd a bit like john
42:46wayne but he's not dragging his feet straight he's not in pain so it does look as though he's improving
42:55noel has sent scrumpy for a final ct scan and the results are in now scrumpy's mom
43:02well you'll be pleased to hear us good news all around oh wonderful thank you so this looks very
43:10nice indeed i designed this device so that the bone would physically grow through it into the other
43:16vertebrae which is exactly what's happening wow so i'm happy okay don't cry it's all good thank you so
43:24much it's all good hey it's all good it's all good isn't it it's all good it's all good huh just keep
43:31thinking what i've put me through yeah well you've you've done the right thing you know i'm out of pain
43:36yes well you're giving her a new lease of life really the operation was a success because i think
43:45roll had her doubts about what was going to happen because he's had so much done good boy
43:52he's not in pain he's not had any painkillers since his surgery and the stem cells have obviously
43:59helped yeah i think we could all do with a dose of stem cells couldn't we
44:05i did do the right thing he's got through it and we hope he's not got to do it ever again
44:14sorry
44:21two months later and scrumpy is finally fit enough to resume his duties and visit some old friends
44:32where are we going you want to see all your friends
44:34he's walking he's walking very well he's not in pain he's happy enough he's very alert so he really
44:42has come on very very well right looks good boy look there we are there we are we're back
44:52he looks so well doesn't he and his new coat's growing well you look lovely and fluffy and clean like
45:01a new baby you do oh it's lovely it's lovely to see him back and looking well considering
45:07it was a big operation wasn't it june yes yes it's nice to see him back in action it's been a
45:19long time watching him trying to recover at one point we never thought we'd see this day but um
45:25um thankfully he's uh he's bounced back i think quicker than i have hasn't he oh that's lovely
45:34it's not just the older generation that scrumpy is having a positive effect on
45:39so the question is does a veterinary profession have the right to withhold choice
45:43he's been helping noel to educate the next generation of super vets at the university of surrey
45:49about veterinary ethics how far is too far what if you have a dog that not only needs knee surgery
45:56not only needs both elbows operated on a few times but also has a severe lumbosacral degenerative stenosis
46:02shall we put that dog to sleep this is a really important moral dilemma now for you because
46:08the future is yours it's not mine i want you to look june in the face and tell her that nothing can be done
46:14it's not mine this is real life because that's that dog
46:44so
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