- 1 week ago
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00:00Oh my goodness, what a difference, a couple of days made.
00:06Professor Noel Fitzpatrick...
00:08All right, Mrs. Cuddlemonster incoming.
00:11...is the super vet.
00:13We have issues.
00:15I knew I should have got chihuahuas.
00:17...at his unique vet practice, he merges mechanics and biology.
00:21That's the point of no return now.
00:24Don't be pulling apart my repair, Mrs.
00:26...to heal the nation's pets.
00:29Sorry about coronavirus.
00:30Oh, because you're responsible?
00:31I'm responsible for almost everything else.
00:34Even in the darkest days...
00:36I'm so sorry this has happened to you.
00:38...Noel imagines the impossible.
00:41Oh, my little baby gives leg.
00:44Let's go.
00:46Sometimes you have to bend the rules of mechanics to fit the biology.
00:50...and offers hope.
00:52We've definitely made the right decision.
00:54Good boy!
00:55We've got my boy back.
00:57...for families and their friends.
01:00Look at you!
01:01Bionic doggos!
01:02I'd love to work here, but I think it would be such a hard job.
01:07You'd just want to take them all home.
01:08I would!
01:09It's late afternoon at Fitzpatrick Referrals.
01:14I read that as Fitzpatrick Ferals.
01:15I read that as Fitzpatrick Ferals.
01:16I was thinking, what, they've got a whole part for feral dogs.
01:20Sick and injured animals are waiting to check in to this one-of-a-kind animal hospital.
01:23I'm Lauren, I'll be your anesthesia nurse today.
01:25And whilst a visit to the vets may not be everyone's idea of a fun day out...
01:28Oh, look at them are going!
01:29...for nine-month-old cockapoo Betsy...
01:30Yes!
01:31...for nine-month-old cockapoo Betsy...
01:32Yes!
01:33... it's become part of everyday life.
01:34What's going on?
01:36It's been a part of everyday life for watching...
01:38...I don't know where to play, but the Kendrick cannot say this, huh?
01:41Even one of the things you me and walking out.
01:46Oh, Iised độ, the dogs and dogs have decided, the animal is going out to get toф.
01:57It's become part of everyday life.
02:00What's going on?
02:03This is probably our tenth time down here or something like that.
02:07We've been coming since Betsy.
02:10Our dog was unfortunately hit by a van.
02:12Yes! Yes!
02:15You'd think that she'd be scared of the vets now after everything,
02:18but nope, she's amazing.
02:20Yeah, she's full of managing. I think everyone here loves her.
02:22Everyone loves Betsy.
02:27Betsy, wait.
02:29What's this? Good girl.
02:31Good girl!
02:34Silly poo.
02:40Betsy was just four months old when she was hit by a van.
02:46I was taking her out for a walk.
02:48I was trying to put her back on the lead
02:50and Betsy spotted it must have been a bird or something.
02:54And she just ran out straight across the road
02:58and a big van went right over the top of her.
03:01She had fractures all the way down her spine
03:04and she'd also torn nerves in her armpit,
03:08which meant that she lost feeling in her front right paw.
03:11You're good girl.
03:13I can't imagine the pain she must have been in.
03:16She was wagging her tail after.
03:19No!
03:22She's unbelievable.
03:25Betsy was so ill.
03:27There was multiple times that we thought that we had to let her go
03:30and she was always the most bouncy, happy puppy that you'll ever, ever see.
03:35Unable to feel her front paw, Betsy drags and tears her skin.
03:41Yeah!
03:43There's no treatment for the nerve damage.
03:45So Sophie and Dan are considering amputation
03:48but want to know if Betsy could have a custom-made prosthesis,
03:51called a perfits.
03:53We're hoping this bionic foot will allow her to move around much more naturally.
04:00She's got a long life ahead of her
04:03and if we can give her the opportunity to live that on four legs instead of three,
04:07I think that's the best thing to try for.
04:14The couple are also expecting a baby in five weeks' time.
04:18We've had a big course in adulting this year, I think it's fair to say.
04:22Yeah.
04:26Until now, the cheerful cockapoo has been under the care of Fitzpatrick's neurology team.
04:32Hi, guys.
04:33But as the only vet in the world performing perfit surgery,
04:37today Betsy will be meeting Noel.
04:41Hello, hello, hello, hello.
04:42You're about to pop any minute.
04:44Almost.
04:45Technically in five weeks.
04:46Alright, well listen, if it happens in here, you're in good hands.
04:48I'm all over it.
04:49What an adorable doggy.
04:51Oh!
04:52Come on, missus.
04:53Here we go.
04:54Now, so you know that what Johanna's been investigating is whether the radial nerve is working
05:00and whether the ulnar nerve is working.
05:02And what I was particularly interested to see when we were outside in the yard earlier,
05:07she can retract the limb.
05:10Now, that's critical to function.
05:11Yeah.
05:12Because if she couldn't pull that leg forward and pull it backwards from there up...
05:17It would be an easy decision, wouldn't it really?
05:19Yes.
05:20Then we would be recommending a full limb amputation.
05:22Yeah.
05:23And this far out from the injury, if she has bicep function and if she has tricep function, I can see why it's a difficult decision for you to chop her leg off.
05:35Yeah.
05:36So, then we come to the ethical dilemma.
05:41Yeah.
05:42With a dog this size, nine out of ten people would choose to chop the leg off because this is a very light dog and can run around happily on three legs.
05:53Hmm.
05:54So, you need to understand from the get-go, of course I can do this surgery, but is it ethically right to do it?
06:01Yeah.
06:02So, my job today is to simply tell you the pros and cons.
06:06Yeah.
06:07And send you away to have a think.
06:08Yeah.
06:09The implant comprises two metal plates and one or two pegs that goes up into the bone.
06:15Yeah.
06:16The challenge is what the bit that comes through the skin.
06:19Yeah.
06:20And the reason that's a challenge is infection.
06:23Yeah.
06:24If you get a firm seal around the spigot by 21 days, you're good to go.
06:29We would generally say to people that if it's not working out by one month post-op to take the leg off.
06:36Right.
06:37Joe's going to go and change the dressing and we'll have a look at it now.
06:39Yeah.
06:40I'll have a look at the wounds, okay?
06:41Yeah.
06:42Yeah.
06:43So, you have the facts now anyways.
06:44Yeah.
06:45Betsy's treatment will have to be reviewed by an independent ethics panel before it's given the go ahead.
07:00Every surgical procedure should be subject to appropriate ethics.
07:05And there's no blanket answer.
07:07Every patient is an individual.
07:09I know.
07:10We'll be finished.
07:11We'll be finished, okay?
07:12As a result, we have an ethics review panel to get a consensus of opinion if the family do choose a more advanced surgical option.
07:22Even if they get the green light, there's a lot for Sophie and Dan to consider.
07:29Well, objectively, I think based on that discussion, the...
07:37I'm trying to figure out, say the...
07:40On a probability-weighted basis.
07:43And then there's the overlap of it with...
07:47Baby Adams.
07:49Yeah.
07:50Hello.
07:51Hello.
07:52Hi.
07:53Hi.
07:54No, Betsy.
07:55She's my best friend.
07:56I love you to millions and millions.
07:57If she has the perfect, she'll be here for a lot, won't she?
07:58Oh my God, I'll have a meltdown.
07:59I'll never...
08:00I'm not going to work.
08:01Yes.
08:02It's not straightforward.
08:03Lots of pros and cons to weigh up and Noel's explained all those to us, so...
08:06We've got some thinking to do.
08:07Yeah.
08:08What do you think, Betsy?
08:09Birds.
08:10Yes.
08:11Yes.
08:12Yes.
08:13Yes.
08:14Hello, puppy.
08:15Hello, puppy.
08:18Hi.
08:19Hello, puppy.
08:22Hello, puppy.
08:23How are you?
08:25Hello, puppy.
08:26Hi.
08:29Nice.
08:30Hi.
08:31Hi.
08:37Hi.
08:38Hi.
08:39Hi.
08:40OK.
08:41I think everyone loves puppies. It's impossible not to love them.
08:52Oh my goodness. Oh, so cute.
08:56When I see a puppy, I just need to cuddle him and kiss him. She's just amazing, right?
09:03Everyone drops what they're doing to just cuddle the puppies.
09:08You see this little ball of fluff and it's like your ovaries just start to flutter.
09:17Hi.
09:22They are so vulnerable and they need our care even more than an adult dog.
09:29Oh my God, he is so cute. I think I need to get another puppy.
09:38Very cute.
09:44There's another puppy stealing hearts at Fitzpatrick's.
09:48I don't think she knows what to think of today at the minute.
09:52But unlike Betsy, who's a regular at the practice.
09:58There you go. Angel. Angel. Say hello.
10:01It's nine months old puppy Angel's first visit.
10:06She's cross. No, she's full. She's nine months old but she's tiny.
10:15Angel was the smallest of the litter. So the other dogs I would say are sort of up here.
10:20So she can actually walk under there.
10:23Although Dog de Bordeaux Angel is half the size she should be, it's not her pint-sized proportions that has brought her to Fitzpatrick's.
10:33So Angel got a problem with her two front legs. We have taken her to the vets and they said they hadn't come across it before.
10:41We were told that surgery may be successful. We were also told that it might not help at all.
10:49We came down for a second opinion just to see what Noel's thoughts were.
10:55Kirstie and her family have always loved Dog de Bordeaux's. It started with their first dog, Bella.
11:04I had Bella from when she was nine months old and my partner wanted to breed Bella.
11:10So we did and then we had six beautiful Dog de Bordeaux puppies.
11:18They were very, very noisy.
11:21I named Angel because she was really good.
11:26Angel was definitely the cutest puppy.
11:29Angel stood out right from the beginning.
11:33Because she was a bit of the runt of the litter, she wasn't getting fed as much.
11:38I had to step up and start bottle feeding her myself.
11:41In your arms like a baby actually, yeah.
11:44So I just naturally had that bond with her from day one.
11:48I think it's safe to say she likes that.
11:53Angel!
11:54As the puppies grew, it became obvious that Angel wasn't just smaller.
11:58Sadly, like many short-nosed breeds, she had genetic problems.
12:03When we go out for a walk, her brothers and sisters were and Angel just bottles.
12:09We always thought, oh, she's small, she's just compensating, maybe she's just not walking as right.
12:15But we started to notice with her front legs that they were sort of not growing as we think that they should have.
12:21Sort of more as a bow defect.
12:23I'm really concerned about Angel.
12:26I just want to make sure that she gets the best treatment that she can get, get the best possible outcome.
12:32I want Angel to get better so she can be happy and healthy and run around.
12:39Hello, hello, hello lovely people, come on in here.
12:46Hello mate, you're a beauty aren't you?
12:49Oh, look at those lovely eyes.
12:50Yes.
12:51So I read the imaging report from the last place.
12:54Yeah.
12:55Why did you want a second opinion in the first place?
12:57They suggested sort of surgery to cut the top and the bottom bones.
13:01Yes.
13:02To have two external frames on each leg, but they weren't sure if it was going to be successful.
13:09So let's begin at the beginning.
13:12There's three bones, humerus, radius, ulna.
13:16Sometimes there's an asynchronous growth between the radius and the ulna.
13:21In other words, the two bones don't grow at the same rate, the origin of which is genetic.
13:27And as a result, this acts like a bow string and this acts like a bow.
13:33Growth deformity occurs because of premature closure of the growth plate in the ulna.
13:39So that's keeping growing and that one isn't.
13:42You with me?
13:43Yeah.
13:44It subluxates the radial head.
13:47It pushes it out of the joint because it's in a finite space and it wants to keep growing, pushing it that way.
13:54So the question is, is she actually going to get worse?
13:59So it looks to me like on this CT scan that that growth plate in the radius is still wide open,
14:06which means the leg's going to bend more.
14:09So my opinion is we should take a chunk out of the ulna here and allow the radius,
14:16the breathing space it needs to complete its growth.
14:19I do not think that we should go down the route of a major and expensive surgery
14:24because I think that she'll probably cope without it.
14:27Yeah, that's great.
14:28That's, yeah.
14:29Okay?
14:30Yeah.
14:31Do you want me to proceed?
14:32Yeah.
14:33Right, missus.
14:34You're going to come and meet all the girls and they'll all fall in love with you.
14:39Aw, I didn't expect that.
14:42Oh, you didn't?
14:43No.
14:44You happy enough to leave her?
14:47Yeah, yeah.
14:48Yeah, time is of the essence, I think.
14:50Aw, great.
14:52I love you so much.
14:54All right, missus.
14:56Good girl.
14:57All right, cuddle monster incoming.
15:00Sometimes the patients presented to me warrant complex surgical intervention,
15:07but simple solutions should always be considered.
15:10And for me, it is what is in the best interest of this individual patient.
15:15For Angel, an age-old technique may provide a very satisfactory solution.
15:21I feel much more positive than I did this morning, that it's, you know, a simpler surgery.
15:28Hello, lovely girl.
15:29How are you?
15:30I just feel a bit sad because I've just had to say goodbye to her and wasn't really expecting
15:35that today.
15:36But I know she's in the best hands, so she'll be just fine.
15:41She's a very good girl.
15:45You're ridiculously cute.
15:51You're nice too.
15:54Aw, okay, okay.
15:56I'm gonna be in the middle.
15:57Right, that's fine.
15:58That's all right.
15:59Stay, but don't get too excited.
16:01I'm in.
16:07Good girl.
16:08All right, okay.
16:10Cock-a-poo Betsy wasn't due back at Fitzpatrick's for another week.
16:14Oh, man.
16:15That's, that's, that's really horrendous.
16:21But this afternoon, the nine-months-old puppy has been rushed in with a badly infected foot.
16:26I just can't unsee that gruesome, rotting core.
16:36Yeah, it was bad.
16:39We've got an acutely critical situation, and I'm gonna need to have a very serious chat
16:45with mum and dad.
16:46All right, sweetie pie.
16:49We've been to the local animal hospital today, and they described it as her toes are actually falling off.
16:58The next level of concern, I think, is that the operation that we thought she was gonna have
17:03is not gonna be possible now because of the level of infection in her leg.
17:07So we might be, I feel like we've come here to have a conversation with Noel about a full amputation today.
17:13Which is not what we were hoping for, but we had in mind as an outcome.
17:22Betsy is still waiting for a decision from the ethics review about her perfits.
17:27But this infection may change everything.
17:32I just feel like, I don't know, like guilty or something.
17:39Guilty?
17:40Well, yeah, because, like, we'd been the ones doing the bandages and stuff.
17:47Hi, guys.
17:48I'm just gonna chat to you where you are, if that's okay.
17:50Yeah.
17:51Gotta maintain social distancing, so we're all set.
17:54It's bad.
17:55Yeah.
17:56Did the one just get worse and worse?
17:58Actually, on Wednesday night, it looked fine.
18:00And then it started smelling really badly, and we realised it was the dressing,
18:05and we took it off this morning, and it was just like, holy shit.
18:07It's the worst thing I've ever smelled.
18:10I just don't know, I don't understand what happened in the course of a week.
18:13I think that you've got a combination of abnormal sensation, sweating and impairment of blood supply, and necrosis has ensued.
18:27Is it normal for it to progress that quickly?
18:30Yeah.
18:31Nothing about this is normal.
18:32No.
18:34This does change the ball game in terms of what we do next, because I have to take the foot off.
18:39Yeah.
18:40We truly can't know if bacteria from that lesion gives rise to bacteria elsewhere, which can affect a stump.
18:53Yeah.
18:54So the infection could come back.
18:56So it could be quiescent there that we don't know about.
18:59And right now, we only have two options.
19:04So option one is to do a partial amputation above that site and see how that heals,
19:10and then consider a limb amputation prosthesis into that stump at a later date.
19:14Right.
19:15And option two is to take the full limb off.
19:21So you don't need to make a decision right now.
19:26We will take care of her here.
19:28She needs to stay here now.
19:30Last thing I want to stress for you.
19:32I don't want it on my conscience, and I don't want it on your conscience.
19:35Don't get stressed.
19:36Leave the stress of your other baby to me.
19:39Okay.
19:40Okay.
19:41We need to decide whether we do a full amputation now or have a partial amputation.
19:50And then in a month's time, we'll try and do the implant operation.
19:54But if there's any sign of infection, you can't go on and put an implant into her bone.
20:00I mean, that's just too risky.
20:03So we'll see.
20:04I'm sure it will work out in the end.
20:06That's our attitude to everything in life.
20:08So be fine.
20:11There's too many lunches.
20:29Can people just not need lunch?
20:31Then life would be a lot easier.
20:33Angel, darling.
20:35Sleepy sleeps.
20:36Angel, the bijou dog de Bordeaux, is being prepped for surgery.
20:43God.
20:44That hit the spot, didn't it, Angel?
20:49The puppy's radius bones have grown more than her ulnar bones, bending her front legs out of shape.
20:55Right, let's go.
20:57Noel is going to attempt to address the deformity and give her a better quality of life.
21:04This is the joint surface here.
21:06This is the growth plate here.
21:08I'm putting a screw below the growth plate and above the growth plate and I'm going to bridge it on the inside here.
21:13To prevent Angel's still growing bones from distorting any further, Noel puts wire, in a figure of eight, between the screws to act as a bridge and halt the growth on that side.
21:28This bridge will mean that the growth plate is going to stop growing as long as the bridge is in there.
21:34So this side won't grow.
21:35That side will grow a bit more.
21:37And it will push the paw, hopefully, a bit more towards here.
21:42Two metragethalon, please.
21:44Right, we're going to do the second part of the procedure now, which is to chop out a segment of the ulna on both sides.
21:53Removing a section of the ulna will relieve the bowstring effect and stop the leg bending any further.
22:14Just going to pack it with collagen now.
22:16That stops the bleeding.
22:23No then performs the same surgery on Angel's left forearm.
22:28If the bridge I've put in there across the growth plate is causing too much ceasing of growth, then the foot could turn the opposite way.
22:38I may need to take this bridge out at a later date, depending on how things go.
22:44Hopefully this will get a good result for Angel.
22:47Alright, drop her slowly, move her back.
22:51There we go now, Angel. Well done.
22:54That's much better, isn't it? Good girl.
22:56It will be several weeks before Angel's legs stop growing.
23:00Only then will Noel know if the life-changing surgery has been a success.
23:06Come on, Angel. Angel.
23:11You better wake up. Come on.
23:16Wake your wakey.
23:21In theatre two, Cockapoo Betsy's infected foot is about to be removed.
23:30Towel clip.
23:32After consulting with Noel and much deliberation, Sophie and Dan decided against amputating the whole leg.
23:39Jack the table up, please.
23:41In the hope that if they get the green light from the ethics review, they may be able to proceed with the perfits if the infection clears up.
23:49I'm placing a tourniquet around the leg.
23:53And that stops it bleeding while I chop the foot off.
23:56Takes about 60 seconds.
24:02Okay, so now we've got a stump and we've removed the infected foot.
24:09Betsy will have a course of antibiotics.
24:12Well done, Betsy. Good girl.
24:15And there's a chance that in a few weeks' time she may finally get her bionic foot.
24:22Oh, Bab.
24:27Mwah.
24:29Carefree Cockapoo Betsy is back at Fitzpatrick's.
24:33Do you want this?
24:35But this time, she's not alone.
24:36Good boy, Hugo.
24:37He's smiling.
24:38The happy-go-lucky pup has been as accepting of new baby brother Hugo as she is of everything else in her life.
24:41We were surprised that she's not that bothered.
24:42But she seems to recognise that this is a small person, not an animal.
24:47Don't you?
24:48Not a cat.
24:49Not a cat.
24:50Not a cat.
24:51We'll wait until he starts trying to ride her around the place or feeding her all her treats out of the cupboard.
24:57You're going to be in cahoots, aren't you?
24:58Yes.
24:59Partner's in crime, yeah.
25:00Since Betsy's gangrenous paw was removed, she wasn't lost, she didn't budding her as a citizen for her.
25:01And she wasn't even and he wasn't able to live that into the room.
25:02Remember the dog?
25:03I don't have a dog.
25:04I don't have a dog.
25:05The cat is too late.
25:06It's a dog.
25:07You don't have a dog.
25:08I don't have a dog.
25:09I don't have a dog.
25:10But there's a dog.
25:11I don't have a dog.
25:13I don't know how to teach myself.
25:14But then I'm holding a dog.
25:15There's a dog.
25:16Where's the dog over the house?
25:17Here's the dog.
25:23I don't have a dog.
25:24I'm liking her.
25:25Well, you know, don't you?
25:27Since Betsy's gangrenous paw was removed there's been no sign of infection and
25:33after being given the go-ahead from the ethics review, right, little scamp, Sophie
25:39and Dan have decided to proceed with the perfect surgery.
25:43Oh look at that waggy tail. Always wagging. Betsy may be facing another operation
25:52but she's delighted to see her Fitzpatrick's family.
25:59Betsy is happiness in a little fluffy black ball.
26:10She is always just so happy to see everyone.
26:13Yeah, look at me. Look at me.
26:16She basically grew up with us and I think she feels like a part of this family.
26:27I think that she knows that we saved her life.
26:35She's very grateful.
26:37She really deserves to have the best that life can give her. Life and us can give her.
26:45Do you want to have a new foot?
26:47Do you want to leave?
26:48Do you want to have a new foot?
26:49Yes.
26:50Yes.
26:52She's just the best dog.
26:56We're going to put the perfect device inside Betsy's leg now.
27:00A lot of people think that a bionic limb is any limb that just fits on a human or an animal.
27:06That's not true.
27:07The vast majority of so-called bionic limbs are just a socket that fits on the stump and does not directly link onto the skeleton.
27:16Perfitts are a permanent part of the body but of course their success depend on mechanical and biological factors.
27:24And if infection gets in, that's a massive problem.
27:33Table up please.
27:35To give Betsy her bionic foot, Noel begins by removing the lower part of her remaining limb.
27:41We've taken the carpal bones away now. The wrist is gone.
27:49Then he uses 3D printed cutting guides
27:52To shape the radius and ulnar bones ready for the implant.
28:10We leave as much of the skin as we can at this stage.
28:13Betsy's endoprosthesis consists of five elements.
28:22A peg is inserted into the radius.
28:25The radius and ulnar bones sit on a platform.
28:29Two plates are secured to the bones with overlapping locking screws.
28:34Bone graft from the amputated bone is packed between the radius and ulnar.
28:38Then the muscle is stitched onto one half of a mesh dome and the skin onto the other.
28:45Finally, an external prosthesis is attached to the spigot of the implant using a clamp.
28:57After drilling a hole inside the radius, Noel pops the implant into position.
29:02It should fit like a glove because we've measured it like so.
29:07Okay, so now we screw the plates onto the bone.
29:16After packing in the bone graft, Noel can stitch up.
29:22So the skin will gradually shrink onto the dome in coming days.
29:28And hopefully it will form a permanent seal around the end of the metal.
29:34So that infection can't get in.
29:36And if infection gets in, that's a massive problem.
29:41Give me the foot, please.
29:43Finally, the exoprosthesis, which is Betsy's new foot, is screwed into place.
29:49An hour can be the difference between having a leg and not having a leg.
29:54Right, Betsy. There you go.
29:58We've got a new bionic paw, sweetheart.
30:01With the mechanics in place, it's now down to biology.
30:07Only if the skin seals and Betsy avoids infection will the surgery be a success.
30:13In the wards, nine-month-old Angel is recovering from the operation to treat her bowed front limbs.
30:34I can't believe we're going to see her.
30:38Now three days since the surgery, Kirstie and daughter Freya have arrived to take the puppy home.
30:44It's been horrible, hasn't it?
30:46It's been, oh, it's been emotional.
30:49We've got three days' worth of kiddles and snuggles to give her, so she's going to get loads of attention.
30:54She's your doggie, isn't she? So you picked her, yeah.
30:58Mm-hmm.
30:59And she's little like us, too.
31:01Hiya.
31:03Hello. I don't think we've met before, have we?
31:05No.
31:06What's your name?
31:08Freya.
31:09What's your friend you've got there? What's this one's name?
31:12Mini Angel.
31:14Mini Angel.
31:16Oh, I see, so that's Mini Angel and I've been looking after Maxi Angel.
31:20Have I?
31:21Yeah.
31:22All right, well, Maxi Angel is doing very well.
31:25Oh, brilliant.
31:27So, Mummy, what I've done is I've taken a bit out of the ulna and I've put a bridge across here.
31:32And what this bridge does is it stops that bit growing, this bit may grow more and push the foot back in.
31:38Perfect, yeah.
31:40I may have to take that out.
31:41Yeah.
31:42In a few weeks' time, depending on how things go.
31:45Are we ready for little Angel to see big Angel?
31:48Yeah.
31:49OK, here we go.
31:53Now, who've we got here, Angel?
31:55Angel!
31:57Now, there we go.
31:59There we go.
32:00Look at that.
32:01Aw, baby!
32:02Look at that.
32:04Now, doesn't she look well?
32:06So much!
32:08Yeah, perfect.
32:09Well done, Angel.
32:10Thanks ever so much.
32:11No problem.
32:13Aw, amazing.
32:14I've missed her so much, so...
32:16Aw, I can't even explain how happy I am to have her back.
32:20Yeah, as you can see, she's quite energetic, so it's going to be, I think, quite difficult.
32:25But, I mean, it's got to be done, so we'll find a way.
32:29Hey!
32:30We'll find a way!
32:34Aw.
32:35Aw, what do you go good, yes!
32:48Yes, she's very good.
32:51Oh, she's so good.
32:53Look at her.
32:54Look at her.
32:55Since her bionic limb surgery last week...
32:59Kisses everywhere! Kisses everywhere!
33:02Eager to please puppy Betsy has been having daily bandage changes...
33:07Good girl!
33:09...to check if the skin is sealing...
33:11So far, so good. Good girl, Betsy.
33:14...and to make sure there's no sign of infection.
33:18Scratch my head, because with a bustle collar you cannot, can you?
33:22Hi, mate. Hi, buddy.
33:28Betsy's doing pretty good. She's now five days post-op...
33:31...and she is standing on the leg.
33:37That's not good.
33:42All right. Hmm.
33:45Right, I need to ring mom. I'm gonna need to open it up.
33:48Can you get Lisa to get the Allen keys...
33:50...so I can take the foot off, please?
33:56This dog's now gonna have to go to ISO.
34:00Oh, Betsy, whoop.
34:02Hello.
34:03Oh, hi, Dan. It's Noel here.
34:05So, as you know, we're changing the dressing daily on Betsy.
34:08Unfortunately, there is discharge from the wound tonight...
34:12...of probably the same bacteria that was in the foot originally.
34:16And that leaves us with only two options...
34:19...trying to treat the infection or taking the leg off entirely.
34:22What's the option, then, in terms of trying to treat it?
34:24The option is open up all the skin around the dome, flush it...
34:28...and then try and re-suture at a later date.
34:31But, of course, there's the ethical issues of putting her through all of that.
34:34And we either go down that route for a few days and see...
34:38...or we go for full-time amputation in the next 24, 48 hours.
34:41Yeah, and that's the case.
34:42We're not gonna have to help you get in this case.
34:43We're not gonna have to help you get in this case.
34:45But of course, there's the ethical issues of putting her through all of that.
34:50And we either go down that route for a few days and see,
34:55or we go for full amputation in the next 24, 48 hours.
35:00Yeah, and there's no guarantee that if you manage to clear this infection,
35:05she wouldn't get another one, right?
35:07That's right.
35:09She's in good spirits.
35:11It's not affecting her in terms of her demeanor.
35:14But clearly, we could fail no matter what we do now.
35:22One of the reasons why limb amputation prosthesis surgery is not more widely adopted is failure.
35:30When you've put more than a decade of effort into the evolution of the prosthesis
35:35and the engineering and surgery have all gone to plan,
35:40but yet biology doesn't smile.
35:44It's utterly devastating.
35:48Can I have the key, please?
35:50Most people do opt for full limb amputation, which is entirely reasonable.
35:55But at every stage, you discuss the ethics with the family.
35:59And if they choose to fight on, then decisive and definitive action is required
36:05because you're fighting a war and you've got one week to win that war or that limb is lost.
36:12Any further treatment must be ethically in Betsy's best interest.
36:16But action cannot be delayed.
36:18Tonight, I'm going to treat the infection and overnight, Sophie and Dan are going to decide if they want me to take the limb off completely.
36:27The area is flushed with saline.
36:33Be conscious that everything you touch has bugs on it.
36:37Then Noel makes an attack on the bacteria causing the infection.
36:41We will only do this for a very limited time period, because otherwise, it's not in Betsy's best interest.
36:50We're seeking to decolonize the area.
36:55Then we're going to give antibiotics.
36:58And we're going to pray.
37:17It's been six weeks now since Angel the puppy with little limbs had surgery on her bowed front legs.
37:25Angel.
37:26She's been on cage rest at home.
37:30It's definitely like having a baby, full-time work.
37:34But to be fair, she hasn't cried one.
37:35She hasn't whimpered.
37:36She's been excellent, yeah.
37:38Angel.
37:39Noel wants to check if he needs to remove the screw and wire bridges he put into Angel's legs.
37:46Oh, it's Angel.
37:48If the scan shows the bones are twisting in the other direction...
37:52Hello.
37:53Angel could face further surgery.
37:58Hi, guys.
38:14Come on in.
38:15So, what you will notice is that that growth plate is now closed.
38:25There's going to be no more growth there.
38:27Yeah.
38:28Which is good.
38:29Also, what you'll notice is that the wrist straightened up a bit because the growth continued a bit on the outside for a few more weeks.
38:37And the ulna is filling in with fibrous tissue, which is becoming bone, so I'm happy to say that we do not need to take the implants out and that, in fact, her legs are perfectly functional and happy.
38:49In terms of exercise, my strong advice to you is get her fit and don't let her get fat because she'll have a big body and short legs and there's nothing you can do about that.
39:03But at least you've saved her from significant joint incongruity, significant osteoarthritis, and that is a massive thing you've done for her.
39:16Cheese.
39:16Cheese.
39:17Oh, my God.
39:19I am absolutely over the moon.
39:21We've got to make sure that she stays fit and healthy because we don't want to put any pressure on her bones, really.
39:26And he doesn't have to do any more operations at all.
39:30So, that was the best result that we could have got today.
39:40Good girl.
39:41Come on, then.
39:44Well done, Betsy.
39:45Good girl.
39:46In the isolation ward...
39:48You're such a good girl. Well done.
39:51..it's been a tense few weeks.
39:53Betsy's been in isolation now for the last couple of weeks
39:56because of the infection in her leg.
39:59Now the skin looks good.
40:02The plucky pup has overcome infection again.
40:06And she's got the all-clear to go home.
40:12We've been really looking forward to bringing her home.
40:14And we weren't sure if we'd get to bring her home this soon.
40:18So I'm very excited.
40:20Hugo's very excited.
40:21He looks really excited.
40:29How are you today and how's Hugo?
40:31He's doing well today.
40:32He was having a bit of a wah, but that was OK.
40:34I heard it, I heard it.
40:36So far, you've been incredibly unlucky and incredibly lucky.
40:41Yeah.
40:41You've been incredibly unlucky that the infection from the gangrene foot
40:44came back.
40:45You've been incredibly lucky that, so far, the revision surgery has worked.
40:51Most people opt for amputation at that point.
40:55One of your interns can write a nice case report.
40:57Yes, yes.
40:58Well, everything in science is going to be based on evidence.
41:02Any questions before the missile comes through the door?
41:04The missile of love.
41:05To what extent do we need to keep her limb kind of protected?
41:10You don't need to protect her limb.
41:11You need to protect yourself from her knocking you out with her limb.
41:15Right.
41:15Because this is like a pogo stick of pudge.
41:19Yeah.
41:19I'll get her.
41:20No, missus.
41:22Come on.
41:23There we go.
41:24Look at you.
41:26Hi.
41:27Look at you.
41:29Bionic doggo.
41:30Oh, I can see you could do some damage with that.
41:32Yeah, she would definitely bash you with that foot.
41:35Yeah.
41:36Yes, well done.
41:38Shall we walk outside a little bit and just show you the walk?
41:45Come on, then.
41:46At last, Betsy has her bionic foot.
41:51But she's still got some practising to do.
41:54Yeah, that's it.
41:55Perfect.
41:56Just a one-foot rope.
41:56A little shorter.
41:57A little shorter, please.
41:59That's it.
41:59That's it.
42:00And she'll get the hang of it over time.
42:02She just, when she calms down, she uses it much better.
42:05Yeah.
42:06All right.
42:07Well done, missus.
42:08Well done.
42:08We love you.
42:09And we shall miss you.
42:11Seven months since the accident.
42:13Thanks, dog.
42:14OK.
42:14God bless.
42:14It's a moment the family thought they'd never see.
42:20It's been such a long journey.
42:22It's a huge relief.
42:23Just amazing.
42:25So happy.
42:26It was the right decision to have one last try at saving it.
42:32Look at your silly cone head.
42:34Good girl.
42:40Angel!
42:41In the Midlands, bite-sized dog-de-bordeaux puppy Angel...
42:45Yeah.
42:50...has been perfecting her doggy paddle.
42:53As part of Angel's recovery, Noel recommended that we took her to some phototherapy sessions
42:58just to help aid with her recovery and to build her strength back up.
43:02Yeah.
43:02It's ten weeks since she had the surgery on both her front legs.
43:07She's going really well.
43:09We've had to keep her on strict bed rest.
43:11I think it's been harder because she's a puppy, but obviously we've had to make sure that we're quite strict with her.
43:17Angel!
43:17Now she's allowed out with one of her brothers.
43:24Oh, it's brilliant.
43:26It's so nice to see her out and about and playing.
43:29That's all we could have ever hoped for, really.
43:31And as you can see, she's loving it.
43:33No pain at all.
43:34So, yeah, it's actually fantastic.
43:36Good girl!
43:37It makes me feel happy that Angel actually gets to run around with her brother for the first time in ages.
43:51It's like she's got a new lease of life.
43:54She wants to get out for a walk.
43:56So, she's absolutely loving life.
43:58Yeah, she's loving life.
44:00Come on, baby.
44:01Come on, you can do it.
44:04Absolutely over the moon, yeah.
44:07Good girl, Betsy.
44:16Show us your foot.
44:17Come on.
44:18Yeah.
44:20It's been nearly a year since the accident that left puppy Betsy in a critical condition and unable to use her right front paw.
44:30Good girl!
44:32Betsy's doing really well.
44:34She's taken to this new foot and she's just so happy.
44:37She's amazingly quick on it, especially when running after the cat in the house.
44:41She's running so well.
44:44She's like a normal dog.
44:46Wait until she finds out how to use it to dig.
44:48It did at times feel like everything was against Betsy.
44:56And she's off again.
44:56The second infection was really a blow.
45:00I mean, I thought after everything that we'd done, we were going to have to amputate her leg.
45:06And it was, yeah, it was really hard.
45:09Good girl!
45:10So then when Noel managed to save it, it was amazing.
45:16I feel like Betsy is the reason why we are here, you know, because it would have been so easy to have given up on Betsy from day one.
45:27Snow.
45:28We've never seen snow before.
45:30And I think Betsy just represents what teamwork and family can achieve when we actually believe that the outcome can be successful.
45:40I think we're very glad that we possessed it through all the complications she had.
45:45You know, we had to take some risks along the way, but we're very lucky in that it's all paid off.
45:51We're here today with Betsy on her all four boards.
45:53Good girl!
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