- 1 week ago
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00:00It's early morning at Fitzpatrick referrals and the team are
00:29dealing with an emergency.
00:38Late last night, a 13-year-old Border Terrier was hit by a car in the practice car park
00:44and suffered life-threatening injuries.
00:50Everyone is in shock because it's Noel's beloved dog, Kira.
01:00I was leaving the practice like I always do.
01:05I never have run a lead between the back door and the car and I've done it thousands of
01:13times.
01:15I held the door open and then a car came speeding from the left.
01:24It was going too fast and he wouldn't stop, he didn't see me.
01:32It all happened in less than two seconds.
01:49Kira is in a critical condition with a smashed pelvis and possible abdominal damage.
01:56No one knows if she'll pull through and the vet known for finding solutions for even the
02:05most complex challenges, must face the fact that his own dog may not be fixable.
02:19I remember vividly the very first day Kira came into my life.
02:37I was working in my very first referral practice and at the time things were really tough at
02:43the practice I was trying to raise the money to build what has become Fitzpatrick referrals.
02:50So this is Halfway Farm, this is going to be the main practice building.
02:56I think I was in like a seven hour op or something.
02:59And then when I came out of theatre and she was there, it just blew my mind.
03:05I was just like a tidal wave of love flowed over me and she was just this ball of furry joy.
03:16And you couldn't look at her without wanting to smile.
03:20I was very infatuated with Kira Knightley and I called her Kira.
03:28Kira, which was very funny actually because I met her husband and I said to him,
03:35I'll call my dog after your wife.
03:38He was very, he took it in very good spirits.
03:43Lovely guy.
03:45I, yeah, good looking, charming, talented.
03:50Kira.
03:55Originally from Ireland.
03:58How are you today?
03:59What are you up to?
04:00World class neuro orthopedic surgeon Noel Fitzpatrick has spent the last 25 years evolving surgical techniques in veterinary medicine.
04:09OK then Billy.
04:10Barney please, Barney.
04:12Now Adam.
04:13From his practice in Leafy Surrey.
04:16When I was 17 I got offered veterinary school and human medical school the same day.
04:21And I remember I chose animal medicine because it was abundantly clear to me from day one that animals were not being given a fair deal.
04:33So this is a swimming pool for the dogs.
04:37I wanted to build the best hospital in the world to give animals the very best level of care that I could provide.
04:44And Kira was by my side all the way.
04:47When Kira first came in she was like a little tiny bundle of fluff.
04:53She was absolutely gorgeous.
04:55What's happening?
04:56How is your day today?
04:57Hmm?
04:58How is your day today?
04:59She literally moved into the new practice when it was built so she's been here from the beginning.
05:04Kira was certainly a sort of inspiration for Noel and like a bit like a muse.
05:11Kira has just been unbelievably important for me.
05:16OK.
05:19And I would say that she's as big a reason that Fitzpatrick of Frost exists as I am.
05:27She gave me a reason, big enough really, a reason to go on.
05:36So she's just getting quite distressed, we just want her to be a bit calmer.
06:01She just responds dramatically to your voice.
06:06Noel's colleague Poreg was one of the first people on the scene when Kira was rushed into the practice last night.
06:14For the first few seconds I didn't really know what to do.
06:18No, no, no.
06:20It's me.
06:22We're used to dealing with emergency situations but because Kira's one of our own and Noel was so upset, it affects all of us.
06:31It's OK, baby. It's OK.
06:34We had a full team of vets ready with everything needed to start resuscitation if it came to that.
06:41OK.
06:42Then you have to just do the job that needs doing.
06:47Kira is a patient.
06:49She's no longer Kira that trots around the practice.
06:52She's Kira that needs her life saving.
06:55I know that unless we act quickly, she's going to die.
07:05CT and ultrasound scans show that Kira's pelvis and sacrum have been crushed, her hip dislocated and she may have abdominal damage.
07:14She was really quiet and not very responsive.
07:20The team know there's the likelihood that she has further injuries that they can't yet see.
07:27When an accident comes in, it's not always obvious what the problem is.
07:31It's almost like you have a puzzle and you have to put the pieces together.
07:36Please, baby girl, you look so sad.
07:39We didn't know if there was a major organ compromise or a major bleed that could actually take her life in the middle of minutes.
07:50Noel fixes things. That's what he does every day.
07:53He comes to work and he fixes things and he wanted to fix it.
07:57I wanted to be there as a vet. I wanted to be there as a dad.
08:01But I couldn't help because I wasn't thinking straight.
08:05He could not make good decisions.
08:09So, I had to ask him to leave.
08:13He's all right.
08:15It's a late start, Rob.
08:17For somebody who's always in control of the situation and always making the decisions of life and death, that was tough.
08:28Yeah.
08:30I told him, Noel, just let us do the work that you taught us to do.
08:35It's OK.
08:36I know, I know, I know.
08:39You have to put the family aside, even if the family is not Fitzpatrick's.
08:45You have to say, we will do it. We will do our best.
08:50Having managed to stabilise Keira, the team start to take a more detailed look at her injuries.
08:57And that's when we found out that her urine output was not matching how much fluid we were putting in.
09:07So we went looking for it.
09:08And we found that Keira has urine leaking into her tummy.
09:15That is life-threatening.
09:19My poor old daddy is so upset.
09:23Sometimes knowing medical knowledge in those situations can make them worse.
09:29Because you know that maybe not everything is going to be OK.
09:32She's having trouble regulating her blood pressure and her heart rate has been all over the place.
09:39Keira needs emergency treatment.
09:42Should I just go? I probably should just go, should I?
09:45Yeah.
09:48This evening she'll be transferred to Fitzpatrick's sister clinic in Guildford
09:53that specialises in injuries of soft tissues, including internal organs.
10:03This place was built for her.
10:08And now, I just hope that the team will save her life.
10:15And again, I will.
10:17it's me.
10:20It's me.
10:22It's Daddy.
10:25Daddy is here.
10:40Daddy's here.
10:42Daddy's here.
10:44Daddy's here.
10:45Noel's beloved border terrier, Kira, is in a critical condition after being hit by a car.
10:52Daddy's here.
10:54Good girl.
10:57Good girl.
10:58Earlier this evening, Noel transferred her to his oncology and soft tissue surgery hospital in Guildford.
11:05We discovered that she wasn't able to pee when it turned out that there was urine leaking into our belly.
11:12I mean, I'm not a soft tissue surgery specialist, but that's what this other hospital exists for.
11:21So I got her in the car and I brought her straight over here.
11:30Noel's second animal hospital celebrated its launch in September 2015.
11:35To treat cancer and offer specialist soft tissue surgery.
11:44Sarah's just placing an IV in him now.
11:48The world-class team also undertake clinical research to help define the treatments of the future.
11:54Noel's vision for the clinic, when you distill it down, he just wants to be able to help any animal that calls on us to help them.
12:10I really feel that Kira has been a driving force behind that.
12:13You have this little friend that you want to ensure is looked after and cared for.
12:22He's pulled that team together, created this perfect recipe to help get animals out of pain.
12:29Help! Help!
12:31She is my muse.
12:33When I think about any animal that comes through these doors, I think about how would I treat her, what environment would I like for her, what choices would I like for her, and most importantly, how much love would I like her to have.
12:49Whenever you're on call, you're going to get something which is slightly out of left field and slightly unexpected.
13:05And call came to say that Noel's dog's been hit by a car and she needs to come across.
13:12Everyone was kind of on tent hooks as soon as we heard.
13:14You don't really know what you're going to see when she arrives.
13:17The urine leaking into Kira's abdomen is causing her to go downhill fast.
13:24Urine is not meant to be in the body.
13:27The body has a very sophisticated mechanism for getting rid of toxic wastes.
13:33When it's outside those organs, the body's not getting rid of those toxins.
13:38So we have a patient who is becoming profoundly sick.
13:42I could see it in her eyes.
13:45She was on the way out for sure.
13:47I reckon that she would have died within a couple of hours.
13:53The team runs CT contrast studies of the urinary system and the bladder.
13:58By putting Di into her bloodstream and then into the bladder itself, they can track it and locate the leak.
14:04Thankfully, the kidneys and both of her ureters were okay, but there was a very obvious leak coming from the bladder.
14:15Urine was just flowing into her abdominal cavity.
14:19To have any chance of surviving, Kira needs emergency surgery.
14:23I needed to make a decision whether it was ethically right to keep going with a 13-year-old dog or should we let her pass peacefully away.
14:37I am not married and I don't have children, so Kira has been the one relationship that I have had consistently throughout the evolution of Fitzpatrick Refrost.
14:55No leaves for this job.
14:59Come on.
15:00Certainly you're not going to work nine to five, we know.
15:04Does he sleep?
15:06Does he know that Netflix exists?
15:09I wonder.
15:10Your veterinary career isn't the easiest thing in the world and we all depend on our animals at home.
15:19We depend on them to be there for us.
15:25She hasn't just been my best friend, she's been my confidant, my cuddle pal, my reason to get up in the morning some days.
15:40She's his life and it's not any different from a father and a dora.
15:52It is his girl.
15:54It is a very special relationship.
15:56I think no one but the two of them can really understand.
16:01It's a special bond for sure.
16:05Good girl, good girl.
16:10So we're just going with two IVs.
16:14I wonder if we should put some bottom or whatever for absorbing urine.
16:21After consulting with his colleagues about the ethical considerations, Noel has decided to fight for Kira and go ahead with the abdominal surgery.
16:31It did feel more tense than normal because he is the boss.
16:36Noel wanted to come in and observe what we found during surgery and it was clearly pretty tough for him to see what was going on.
16:45When Jonathan made the first incision, I felt like vomiting my guts up because my little girl was lying there on the table.
16:53And I remember thinking to myself, if I stay in here, that would probably not be good for Jonathan.
17:01So I walked outside.
17:03When something that small has been hit by something as big as a car, there's a lot of injury.
17:14The six centimetre hole in Kira's bladder is sewn up, but it isn't the only damage.
17:20All of the abdominal muscles down one side of her spine had been pulled off.
17:26The muscles that had to hold sutures terribly well.
17:29So that was the more challenging part of the surgery.
17:32If we hadn't have seen her in that day or within the following day, she would have died for sure.
17:38Kira is still in a very critical condition.
17:49Coming from primary care, you see cases like this and normally they don't tend to have great prognosis.
17:54You know, the older they are, the more.
17:56The longer it takes them to recover and the riskier it is for them to pull through.
18:01I love you, Bobby.
18:03If she makes it through the next few days, the team will be able to consider the major pelvis operation that is planned for her, to allow her to walk again.
18:15I just hope she moves over here.
18:33Although Kira has just been through major surgery...
18:42Fitzpatrick referrals is a 24-7 hospital.
18:50Hey guys, how are you doing today? Come on in.
18:53And she isn't the only animal in need of Noel's help.
18:57Right, mister.
18:58You take that lead off, I'll pop this one on, and then off we go.
19:01And how's your dog doing now?
19:04Not good.
19:05So I'm very worried today.
19:07It's incredibly tough to keep going when you know that your family member, albeit a furry one, is stuck in hospital.
19:15It's very scary.
19:17Yeah, it's extremely scary. I love her as much as you love him, you know.
19:20Yeah.
19:21That voice at the back of your head never stops.
19:24How are they? Are they comfortable enough? Is their pain relief all right?
19:28It's hard being on the other side of the fence.
19:31Hi, mate.
19:32Hi, mate.
19:33How are you?
19:33How are you?
19:34How's Kira?
19:35Not good.
19:36No?
19:38Something that we advise all of our clients, if you don't get up every day and do what you normally do every day,
19:44you're going to drive yourself crazy.
19:47And I'm really, really glad that he actually followed his own advice, because sometimes he doesn't.
19:51I've never really understood what it felt like before. I've been doing this for 30 years, and I didn't know.
19:59Yeah.
20:00That's really hit me like a tsunami of awareness, that I'm not just fixing an animal, I'm fixing an entire family.
20:10I'm fixing lives.
20:12Kira has been up and down since the surgery on her abdomen. It's been utterly nerve-wracking every single day, waiting for news.
20:26Hey, hi, guys. Thank you so much for looking after her.
20:30Noel has been spending every moment he can at Fitzpatrick's Hospital in Guildford.
20:34Hey, Boopie. Are you lifting your head for Dada? Are you lifting your head for Dada? Hi, Boopie. It's Dada.
20:46Over the last 24 hours, Kira has had two blood transfusions and is finally showing signs of improving.
20:54She's looking much more alert, which is the most important thing, and she seems much more comfortable, too.
20:59She's under the care of internal medicine specialist Gerard McLaughlin.
21:04You can see we put the tube in her nose there, just to allow us to start giving her some nutrition.
21:10So she's got some protein and calories.
21:12Exactly, exactly.
21:14I've treated Kira before, so we all love her over here. She's super cute.
21:18She's very much a spoiled princess when she comes over here, but I suspect she's a spoiled princess in her day-to-day life with Noel,
21:24because I know that he absolutely worships the ground she walks on.
21:28She looks so much brighter.
21:29So much better, and I think we're going to get to that point where she will...
21:32There'll just be an upward trajectory now, hopefully.
21:34What we want to do is just make sure she's strong enough to go through the anaesthetic for the pelvic fracture repair.
21:39Of course, yeah.
21:41Kira's pelvis and sacrum were crushed in the accident, and she's unable to stand.
21:47To have any quality of life, an operation to repair the multiple fractures is planned.
21:53Oh, Bopey.
21:54Oh, Bopey.
21:55You're so much better.
21:57Good God.
21:59And Noel will need to decide if it will be him performing the surgery.
22:04It's difficult, isn't it, because I know a lot of vets don't, you know, they don't want to operate on their own dogs.
22:08No.
22:08What John did saved her life, and that's not my skill set, so I can't do what John did.
22:13But I would judge anybody's screw if they were one millimetre out on the x-ray picture, in terms of fixing her pelvis.
22:23I understand why he doesn't want other people to have the pressure of doing it.
22:27It's pressure enough looking after the bossy's dog.
22:30It's probably doubly stressful doing orthopaedic surgery on Noel Fitzpatrick's dog.
22:35I know that psychologically I'll be fine as soon as I go into theatre, but I'd be more worried if somebody else was doing what I do every day of the week.
22:49He's Professor Noel Fitzpatrick, the super vet.
22:52Of course he's going to operate on his own dog, but sometimes operations don't go well, you know, and he has to be successful for her to be able to walk again.
23:05Noel has operated on thousands of animals in his 30-year career, performing some of the most complicated orthopaedic and neurosurgery in the world.
23:15You've got to get your strength up, and then I'll make sure you can walk again, okay?
23:22But fixing Kira will be unlike anything he's ever faced before.
23:30I'll fix it.
23:31I can just tell that dog's saying, sausages, sausages.
23:54I can smell sausages.
23:56Keira, Noel's Border Terrier, is recovering from major surgery after being hit by a car.
24:08Donna, any updates on Keira?
24:12And across the practice, there's talk of little else.
24:17Poor little...
24:18Keira.
24:19Yeah, Keira.
24:19No, it's such a tragedy.
24:23We're getting calls from all over the world.
24:26Everybody within the team, within the practice, we're calling each other randomly.
24:31Just, have you heard anything, any updates on Keira?
24:34Let's hope she pulls through.
24:37Because she's not a spring chicken, bless her.
24:38No, she's not.
24:39She's going to take longer to heal.
24:41Come on, pups.
24:48Since she was a pup, Noel has shared the parenting of Keira with former Fitzpatrick's nurse Amy and her son, Kyle.
24:56Because I spend 12 to 16 hours a day consulting and operating, I'm just worried that Keira will be lonely.
25:05I don't do the kisses. That's what Dad does, yeah.
25:10Sharing has been fantastic because Keira and Kyle have obviously grown up together.
25:14She's always there for me. She's always around.
25:17I've never known anything different. It's just how it is.
25:20She's grown up in the practice or being at Noel's or at mine, so I think she's just got three homes and rules them all.
25:29It's wonderful that she has a mum and a brother and a dad.
25:33Hi, girls.
25:34Not to mention her extended Fitz family.
25:38As much as Keira is Noel's baby, she's our baby too.
25:41Come on, come on.
25:43She knows she's important here. It's her home.
25:47Hi, Keira.
25:49Hi, Keira.
25:50Do you just see her plodding up and down the corridors?
25:53It's just like, yeah, this is my building and yeah, you're taking me for a walk.
25:58Come on.
25:59Hi, sweetie.
26:01Hi, Keira.
26:02It's almost like in a way she's also our boss, you know, a little bit of source of authority.
26:08I think it's good to go to theatre.
26:10Probably Keira gave me the job.
26:12Oh, got a little tail wag. Oh, that's nice.
26:21Over at Fitzpatrick's sister hospital, there's good news for all of Keira's family.
26:26Oh, I have never been happier for you to stick your tongue up my nose. Oh, thank you, boofy. Oh, I love it.
26:34Every day she is starting to look a little bit more interested in us and a bit more responsive to us. Just a bit of her personality starts to come back.
26:42Yeah, we'll try something to eat, sweetie.
26:44The question remains whether she's yet strong enough to have the surgery on her pelvis.
26:50We essentially just need to give her time for her body to recover because, you know, there's no point fixing a leg in a dog who doesn't make it through the anaesthetic, let's be brutally honest here.
27:01Oh, oh, it's my favourite.
27:05Noel's asked me if he can do the surgery on her and obviously there was no question.
27:11This is what he does and this is what she needs right now and he's the only guy for the job.
27:18We've been designing a special plate to fix the main fracture in her pelvis because if the plate's already anatomically contoured and it's perfect,
27:29then the surgery will take less time.
27:33Oh, yeah. Oh, yeah. Good girl.
27:40Kira's plate is being designed and created by another brainchild of Noel's, Fitts Bionics.
27:47We have just two to three days to design and process an implant for a Kira.
27:55We process the CT images and we can manipulate the bone fragments.
27:59Realign them and then design a solution for that particular problem.
28:05For the last 15 years, Noel and his team have been creating implants for animals with complex challenges.
28:12We're effectively reinventing a body part.
28:17I feel very strongly that dogs and cats deserve the best level of treatment akin to what happens in human medicine.
28:25And sometimes that requires us to think beyond what is currently available.
28:31And we've got a mechanical disc now replacing the biological disc.
28:37And to innovate implants with good ethics, good evidence and good efficacy to solve problems.
28:44And that's why Fitts Bionics exists.
28:47Take out the owner now, Jay, and we're going to have to move the radius.
28:50Trying to figure out what's going on inside Noel's head is the most difficult part of trying to learn something that he's doing.
28:57Let's see what you do with those bad boys.
28:59He's definitely a mad genius.
29:02Look at that.
29:04A little bit like Leonardo da Vinci I would say.
29:08He's got the curvature of a piece of art.
29:12Noel's brain is like a computer and he just thinks ten hours ahead of everybody else.
29:20So we're probably going to have to go with a solid one again.
29:23No, I can thicken them up.
29:25But obviously we, as mere mortals, are way behind.
29:31Boom.
29:32That's straight.
29:33I'm actually really pleased with that.
29:39This looks good at the moment.
29:41That's probably about halfway through.
29:43Kira's implant is being 3D milled from raw titanium, a metal that's highly compatible with the body.
29:55I didn't think in my wildest imagination that Fitts Bionics would provide a solution for my own dog.
30:02But boy, am I glad that all those years of effort will help Kira.
30:08Listen to daddy, if you stay eating and you get stronger, then I will fix your pelvis in a couple of days.
30:17Okay?
30:18We're making a special plate for you right now so that it's exactly right for my girl.
30:25Okay.
30:27See you tomorrow, okay?
30:30See you tomorrow.
30:38They're on their way now.
30:53He's left.
30:54So he's on his way.
30:55Yep.
30:56We've got to just keep this...
30:58Low key.
30:59This is just...
31:00This is what we do every single day of the week.
31:03Just over a week since the car accident that shattered her pelvis and sacrum...
31:08Off we go.
31:10...Kira's custom-made implant is ready.
31:13All right, Boopie. Good girl. Good girl. It's okay.
31:16And Noel is about to attempt the most emotionally challenging operation of his life.
31:21Good girl.
31:22It's gonna be fine, sweetheart. It's gonna be fine.
31:25Although it's something that I do every day, it's Kira.
31:31And that changes everything that I'm thinking because I'm picking up a scalper blade on my baby.
31:42Kira's on her way and I'm worried.
31:44I'm worried about Kira.
31:46I'm worried about Noel.
31:48He's got to perform.
31:51And I'm worried about the team.
31:53They know how important Kira is to Noel.
31:59Kira is important to them.
32:02And it adds a lot of pressure.
32:09Morning.
32:10Hello, Kira.
32:11Morning.
32:12Hey, Kira.
32:13Morning.
32:14Hey, little one.
32:15Good to see you.
32:17You're looking a lot better.
32:18What's our plan?
32:21It's over to you.
32:23We'll give her a little epidural and crack on.
32:26Yeah.
32:35Now, her ultimate survival and function rests on my shoulders and my shoulders alone, really.
32:42I'll go prepare my head and you guys get the rats.
32:46Yeah.
32:47I'm afraid.
32:48But I've got to manage the fear.
32:49That's it.
32:50So I've got to switch off part of my brain now and become a surgeon.
32:53I've got to try not to think about her as my baby.
32:56I've got to try and go into battle and do my job.
32:57Are you ready for this?
32:58I think so.
32:59It's what we went to school for.
33:00Okay, here we go.
33:02You ready for this?
33:04It's what we went to school for.
33:05Okay, here we go.
33:22Kira's pelvis is fractured and steel...
33:25Keira's pelvis is fractured and separated from her fragmented sacrum, and her right hip
33:35is dislocated.
33:38Noel plans to realign the sacroiliac joint, then reattach the ilium to the sacrum with
33:43screws.
33:45He will then attempt to fix the fracture behind the left hip socket using the custom-made
33:50plate.
33:52Finally, Noel will use a toggle technique to replace the torn ligament of her right hip
33:58joint and stop it slipping out of place.
34:07Show me the diagram, please.
34:15Using templates made at Fitz Bionics, Noel attaches a 3D printed guide.
34:21This allows him to drill precisely in the right place to attach the ilium back onto the sacrum.
34:28It's quite amazing that he can put his emotions to one side and proceed with a surgery.
34:37He believes in himself.
34:39Whoever's on the table, under his hands, is treated with utmost care and respect.
34:46But for Keira, it just must have been overwhelmingly pressured.
34:51First, we've drilled a hole into the sacrum.
34:56Now we've drilled a hole into the ilium.
35:00As Noel inserts the screw, it should position the ilium back onto the sacrum.
35:05The ilium bone has been dislocated for over a week and it's refusing to budge.
35:24I've repaired this kind of injury hundreds of times.
35:39But Keira's situation was the perfect storm.
35:43It was a long time after the car had hit her so the muscle had clamped down in the wrong position.
35:50And it was really difficult to move the bones.
35:54No, forget it, forget it, forget it. It doesn't want to move.
35:58And that wasn't the only problem.
36:00What the CT scan did not show was all the tiny fissures within the side of the sacrum.
36:09And basically, when I tried to put screws into it, it started to crumble like an avalanche of rocks.
36:16That's a disaster.
36:30Oh, I'm having real difficulty getting this back in here.
36:41It doesn't want to go.
36:44Noel is partway through one of the most crucial surgeries of his life.
36:50Let go.
36:51Attempting to repair his precious Keira's smashed pelvis.
36:57Yeah, it just does not want to go back far enough.
37:01But it's taking twice as long as it should.
37:08There was a moment when I just felt like crying.
37:12I'm like, why is it happening now to Keira when a lot of the time I can just do this straight away in half an hour?
37:21You can't translate it back enough to get the screw in.
37:24That's right.
37:25Keira's ilium is wedged in the wrong position, and the sacrum is crumbling when Noel attempts to connect them back together.
37:36Watching another surgeon struggle to complete a task is one of the hardest things to do.
37:42I've operated by his side for ten years now.
37:45There's lots of incredibly difficult cases that we've encountered, but Keira adds something very different to the mix.
37:52Relax, relax, it doesn't want to go.
38:01Hasn't gone well, Plorik.
38:02No.
38:03This was always going to be horrible.
38:05After an hour of trying, Noel finally manages to move the ilium into position.
38:11But the sacrum is crumbling where the screws should go.
38:15So Noel discards the surgery guides and repositions the screws by eye.
38:23To be able to adapt is just an ability that Noel has developed over the years, that he can just see the potential that he will then go for.
38:35I shouldn't have gone with the guides at all.
38:38I should have just gone old school.
38:39I thought I was doing the best for her, but I should have just eyeballed it.
38:44Now the ilium is reconnected to the sacrum, Noel needs to address the second fracture behind Keira's opposite hip joint.
38:55So I'm trying to isolate the sciatic nerve here so I don't damage it.
39:02The fracture is directly beneath a major nerve to the leg, and the jagged bone has been causing Keira pain.
39:13OK, so we've moved the bank up roughly into position now.
39:18The bone segments aligned, Noel can insert the plate, custom made by Jay and the team, which should sit smoothly under the nerve.
39:28So the plate fits perfect, which is good news.
39:32Thank God for something.
39:37Finally, Keira is repositioned, so that Noel can repair her hip ligament that was ripped apart in the accident.
39:49Come.
39:51Hold it steady, Johnny.
39:54Noel uses a toggle technique to replace the original ligament with a synthetic one.
40:01Mini tight rod, please.
40:03But Keira has now been in surgery for a long time.
40:08The longer the anaesthesia goes on for, you worry that, is she going to decompensate? Is something going to go wrong?
40:15And we pull them all tight, we slide the button down.
40:18You just kind of want to wake her up and get her sort of in recovery as fast as possible.
40:27Yeah.
40:28So that's tight.
40:30Doesn't want to come out now, so that's good.
40:33I think she'll be a lot happier now that she's got a solid hip.
40:46Right, missus.
40:47Off to x-ray, please.
40:48Good girl.
40:49Keira can finally leave theatre.
40:52Well done, Boop.
40:59Good girl.
41:00Thank you, everybody.
41:02The presents are in the post.
41:05So I've done my best.
41:09Let's hope that my best is good enough.
41:14I had prepared for 30 years for that moment to step up to the plate and take the shot.
41:25And it's her kennel ready.
41:28VIP.
41:30I was really glad it was me.
41:34It's an even pain study.
41:37She's by no means out of the woods because there are so many factors at play here.
41:50Good girl.
41:51Don't get upset.
41:52It's okay.
41:53It's okay, puppy.
41:54It's okay.
41:55Her recovery will take some time.
41:59Where are you, Boop?
42:00Where are you?
42:02Where are you?
42:05No.
42:084 days later, and Noel has an appointment with Gerard to discuss Keira's progress.
42:24I just thought that she wasn't as bright as she had been.
42:30used to managing his clients expectations this time it's noel who's the worried parent so my
42:38concerns in order are number one inflammation in her abdomen noel's the worst client in the world
42:45he will pick up the phone at any hour of the day and night and wake someone up that he
42:49thinks kieran needs last night when i saw her she was very depressed if i was the vet dealing with
42:56me i would my patients will be severely tried obviously she had a lot of urine in the abdomen
43:04and that's very irritating i know too much i ask too many questions and i'm obsessive about detail
43:11number two i'm concerned about the swelling in her back legs he's dealing more pessimistic than i am
43:16i think at times about her what do you see in audrey um she still has a bit of reactive peritoneum
43:24which is not unexpected i think he just feels it's a bit of out of his control at the moment
43:30so it's all looking quite as expected i would say noel good in kira's case she's lucky to have noel
43:38as her dad we'll be able to name a ward after you when you pay this bill yeah that's right yes
43:45yes or at least one kennel
43:56you're not going to make daddy get in hello everybody i'm having my hydrotherapy today
44:02i'm getting stronger all the time despite noel's concerns that's it good girl over the last few
44:11months kira has slowly been recovering nerve function and building up her weakened muscles
44:17you love gravy bones come on it's like suddenly the whole weight of the world has been lifted off
44:24my shoulders you know are you ready one p oh yeah i know she's not going to live forever completely
44:31understand that but she's my little girl well done sweetheart well seven months since the accident
44:40today kira's finally strong enough to return to reign over the practice
44:45hi guys hey hi hi everybody it's just a miracle really everyone's just really happy to see her doing
44:57so well hello everybody i'm back i'm back i'm back to supervise she's probably lived to 100 that's what
45:07we're aiming for anyway thank you everybody thank you for looking after me for noel i think seeing her
45:13recover is hopefully a reaffirmation of what we do that the team that he created has actually saved
45:20kira's life come on off we go i hope he was proud of us and i hope he was proud of himself because we
45:28are all in this together thanks to him come on good girl good girl good girl
45:4212 years ago kira and i stood right here in this field and looked at derelict farm buildings
45:48she is the reason this practice exists high five good boy i feel like the two hospitals were built
45:58for her and for dogs just like her and people just like me i'm very lucky that we have this magnificent
46:07team they've allowed my baby to live
46:10there's hope there always has to be hope because love hope and faith is all we got
46:22and she's all of that to me every single day
46:40and she's all of that to me
46:58so
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