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00:00Hello mate, you understand Irish?
00:02Animals from all over the world
00:04Ah bonjour
00:06Come to see one extraordinary man
00:08Who's known as the Bionic Vet
00:11High five!
00:12Yes!
00:13Professor Noel Fitzpatrick
00:15We only get one shot at this, here we go
00:18Noel and his team offer some of the most advanced treatments available anywhere
00:23The perfect marriage of mechanics and biology
00:25This is what we have now, a brand new me
00:28Oh wow!
00:30For some, it's a last chance
00:33It is a life or death situation because we cannot leave him like he is
00:37I just want you to do anything you can for him really
00:40Sorry
00:41As Noel continues to devise new ways of healing
00:44You're going to be Bionic, thank you so much
00:47He transforms the lives of his patients
00:50Oh that is just unbelievable
00:52He's raring to go
00:53Against all the odds
00:55Boom!
00:56One small step for a dog, one giant leap for mankind
00:59Well done!
01:10Every week the staff at Fitzpatrick referrals welcome hundreds of patients through the doors
01:16Hello!
01:17Take a seat guys, thank you
01:20Oh hello darling
01:22Many will only require Noel's help once, but some become repeat visitors
01:29Some patients are unlucky and they might have multiple problems
01:33And seeing them back again and again, you really do get to know them and their family
01:38You see them come in for their rechecks and you kind of develop like this love for them
01:46The amazing thing is that they always come in wagging their tails, they're always happy
01:51Even though they might be in a lot of pain
01:53Here to see Noel today are June and her eight-year-old clumber spaniel, Scrumpy
01:59Oops, careful, sit down, that's it, lie down
02:03That's it, roll over, good boy, roll over
02:06I've brought Scrumpy in today to have a scan, an MRI scan on his back
02:13Unfortunately he's appeared to be very lame
02:16He was like a drunk man, he was wobbling at the back
02:19Scrumpy and June are no strangers to Fitzpatrick's
02:23As this isn't the first time he's had mobility issues
02:26He's had six operations before and if anyone can fix him Noel can
02:44Scrumpy lives in Hampshire with June and brother Jack
02:48His first operation was elbow dysplasia
02:52Within months he broke his first leg and then about nine months later he broke his second leg
02:59Come on, here
03:00Then we had the hip done and then 18 months later we had his knee done
03:06Despite Scrumpy's history of ill health, he spends time working as a therapy dog
03:12Visiting the elderly in care homes
03:15Sometimes it's just something different for the resident in the home
03:20There's a dog coming in to see them
03:23There you go, have a treat
03:24Oh, that's a lovely treat, that is
03:28Sometimes they don't have visitors, maybe their own family doesn't live close by
03:33And a dog's sometimes the only visitor they get
03:37But Scrumpy's problems have got so bad recently that he's unable to perform his duties
03:43They know he's off his feet at the moment but they fully hope that he'll be back soon
03:50He's my friend, a companion
03:55At the moment I can't think of I'm not being here
04:00So we shall see what Noel can do
04:09Noel has sent Scrumpy for a CT and MRI scan to work out what's causing the problem in his back legs
04:16So you can see here where the disc at the very base of the spine between the lumbar spine and the sacrum is completely collapsed
04:24That's pretty much as bad as it gets
04:26So Scrumpy's in a bad situation
04:28And he has multiple joints affected by arthritis
04:32And he has major spinal issues
04:34And I guess the question is the universal question of love for an animal
04:39When is it time to say goodbye?
04:41Okay, Scrumpy's mum
04:43Oh
04:45Hi June, he is ready to go now and I just wanted to fill in on the details
04:50I mean I'm struggling with it from an ethical point of view as well as you are
04:54He's already been through one hip replacement, one knee surgery and two elbow surgeries
04:59Yes
05:00He's got severe elbow arthritis on both sides which we are going to somehow have to treat
05:05Plus every disc in his spine is dried out
05:08Plus the disc in his lower back, you know, has effectively exploded
05:12I mean you can only take it step by step
05:14And I guess the decision we have to make at the moment is do we take the next step
05:17And at the moment that step is either leave him in pretty severe pain
05:21Or just try drugs which are not working or do major surgery
05:25Yes
05:26Okay
05:28We'll give him the chance
05:29Okay
05:31So I've looked at the logistics of potentially doing the disc surgery on his lower back
05:38At the same time as doing a stem cell harvest for his elbows, that's a big deal
05:44Yes, I understand
05:46In the best case scenario, there's a chance that he won't be able to wag his tail for a period of time
05:52In the worst case scenario, the nerves that go to his urinary bladder or his back legs could be permanently damaged
06:01I'm sorry so much that I don't want to give up now
06:07Yeah, I know, but you do
06:09I'm deadly serious, you have to understand there's a line in the sand
06:14Yes, I know
06:15And I can't be doing it for you, you know that
06:17Oh yes, I know
06:18If it comes to the point that he is suffering
06:24We would have to let him go at that point
06:27Which you know
06:28I agree
06:29Okay
06:30Yes
06:31I'll get him for you
06:32I'm sorry
06:33Thank you
06:34I know
06:35I know
06:36Yeah
06:37Come on mate
06:38Scrumpy will go home with June tonight
06:41But will be back next week for his seventh operation
06:44Hello my boy
06:45Hello
06:46Hello
06:48Hello my boy
06:49Alright, take care
06:50Thank you very much
06:51You're welcome
06:52Thanks again, see you next week
06:54See you soon
06:55You can't judge a person until you're in their shoes
06:59That's the bottom line
07:00That's like the nicest woman in the world
07:02How many surgeries is too many surgeries?
07:05Seven, eight
07:07We wouldn't think twice about it if a human needed it
07:10I think when an animal is a part of a family
07:13Then we need to have a little more compassion and understanding
07:16If we can help him and make his life a bit easier then we'll go for it
07:22And this is probably the last chance
07:25I can only put him through so much
07:29This will probably be the last time
07:32It's early evening and an emergency case has just arrived in reception
07:5015 month old Dachsund Ralph is in pain and having difficulty moving
07:55He's been brought in with his sister Lauren by Denise and Wilson
07:59After being referred to Fitzpatrick's by their local vet
08:02He's not right and his yelping has been not good
08:07Oh no no no no no no no
08:11That's what he's doing when he moves sometimes
08:14So we don't know what quite is wrong
08:17Um
08:25Now Ralph, where is Ralph?
08:27Here
08:28Hello, sorry about the delay, I've been busy operating
08:30Hello mate, how are you?
08:32So which one is the injured one?
08:33This is the injured one
08:34Ah, I see, come on in
08:36Thanks very much
08:37Now, so Wilson and Denise, D-E-N-I-S-E?
08:39That's correct
08:40Okay, please take a seat
08:41Alright, tell me what happened
08:43Well, we're not absolutely sure
08:45There's a commotion outside
08:47Right
08:48He and she are running after, I think, a squirrel
08:50Yeah
08:51Disappeared behind a bush
08:52And there's this almighty yelping going on
08:54And she is?
08:55Lauren
08:56The sister?
08:57Yeah
08:58Oh, right, I see
08:59But they were very subdued after
09:00Hang on, Ralph and Lauren?
09:02Yeah, I get it
09:03Boom
09:05Okay, right, I'm with the programme
09:07Okay, Ralph Lauren
09:09He doesn't like standing an awful lot
09:11Well, that's what I was just going to ask you
09:13Is he able to stand?
09:14He's able to, but he's very hunched
09:16Okay
09:17Oh
09:18Oh, mate
09:19That's not good
09:20That's what I mean
09:21Let me take that
09:22Thank you
09:23Good boy
09:24Good boy
09:25I mean, he's roached like a banana, isn't he?
09:27Yeah
09:31Yeah
09:32Okay, buddy, yeah
09:33Yeah, yeah, sorry about that, mate
09:34No
09:35Alright, he can go back in your arms
09:36Hold him tight
09:37So we got an MRI like now
09:39Okay
09:40But I won't know the prognosis just yet
09:41until I see what that looks like
09:42Yeah
09:43Ralph's condition is puzzling
09:47because it doesn't fit the normal pattern
09:49for spinal disc problems
09:51which are common in Dachsons
09:52Yeah
09:53Noel wants to seek the expertise of his neurology team
09:57So I can't determine where the pain is coming from, Ricardo
10:01and I just
10:02Can you have a look at the cranial nerves for me, please?
10:05Ricardo is a neurologist at the practice
10:08Alright, big guy
10:10Alright, big fella
10:13Light reflex?
10:18Okay
10:19Presence, yeah
10:20Yeah, okay
10:21Well
10:22We get a scan
10:23Ralph is sent for an MRI scan of his spine and brain
10:29The MRI scan has revealed something unexpected
10:48There's swelling in Ralph's brain
10:51So we're going to take a sample of fluid from just behind the brain
10:56And the constituents of that fluid may give us some hints of what's going on here
11:00Okay, so we just
11:01There's a little hole here
11:03Behind the skull
11:04Where we put in the needle
11:05And the fluid pops out
11:07And we just catch it
11:10Okay, done
11:13It will be a few days before the test results from the brain and spinal fluid
11:18Plus blood and urine samples are back
11:21Okay
11:22Okay, so
11:23Turns out there is in fact no disc issues
11:29So we then scan the brain
11:31And in the brain we saw this diffuse whiteness
11:35So that is not normal
11:37That is swelling, fluid, it's markedly abnormal
11:44And that's where Ricardo comes in
11:47Because this is not my field of expertise
11:50But it is his field of expertise
11:52So when we have this image where you see all this whiteness and this inflammation in the brain
11:57There are three main things that pop into consideration really
12:01One, inflammatory or immune-mediated diseases
12:05Possible tumour
12:07Would be very unusual in such a young dog
12:10Okay
12:11And just because we have a couple of pictures
12:13Okay, that they can fit for example with an hemorrhagic stroke
12:18I think probably the best way to go is to treat for some of the complications that we certainly have in the MRI
12:25Like the inflammation and see how things go on
12:28So what we're going to have to do is give a potent steroid
12:31To try and decrease the inflammation and the swelling
12:34And we're going to give an antibacterial therapy as well
12:37But at the moment we simply don't know
12:39Nobody knows
12:41Ralph will remain at Fitzpatrick's
12:43While Noel and his neurology colleagues try to work out the cause of his mystery brain condition
12:51We may think he's not in pain at the moment
12:53Yeah, so he's not going to be hurting
12:56But we had hope that it was just a disc
12:58Yeah, yeah
12:59So it's a bit worrying that it's something in his brain
13:02Only when Noel and the team discover the cause
13:05Will they have a chance to treat Ralph successfully
13:08Ralph the Dachshund was admitted yesterday with a mystery brain condition
13:11But overnight there has been a dramatic turn of events
13:15He's been having seizures
13:16Hello?
13:17Oh hi Denise, good morning
13:18He's very sedated
13:22But he had another seizure event at 7am
13:23Oh no
13:24Whatever the process is that is occurring in the brain is causing the seizures
13:26I think we feel he's in the best place
13:27So that's the only comfort we're getting at the moment
13:29Yeah
13:30Yeah, yeah, it's a tough one
13:31It's a real tough one
13:32It's a real tough one
13:33I mean it's not a typical scenario at all
13:35But all we can do is do our very best which is exactly what we will do
13:39Okay, thank you
13:40Okay, thank you
13:41Thank you, Noel
13:42Okay, right
13:43With Ralph's situation deteriorating, time is running out to get to the bottom of his
13:48mystery brain
13:50But he had another seizure event at 7am
13:51Oh no
13:52Whatever the process is that is occurring in the brain is causing the seizures
13:54I think we feel he's in the best place
13:55So that's the only comfort we're getting at the moment
13:56Yeah, yeah, it's a tough one
13:57It's a real tough one
13:58I mean it's not a typical scenario at all
14:00But all we can do is do our very best which is exactly what we will do
14:04Okay, thank you
14:05Thank you, Noel
14:06Okay, bye
14:07With 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
14:28I'd quite like to see an Afghan hound with the long flowing sort of perfectly groomed hair
14:33When an English Bulldog comes in, I'm in paradise
14:43We don't see very many Chow Chows but they're always quite fun when they come in
14:48Talking of Chows, there's another one
14:51Oh, easy darling
14:53It's like buses, you never see one and get two at once
14:56Randomly you get this really kind of foreign breed or one that's just not quite well known
15:02And as soon as that comes through you're like, oh, that's new, that's different, that's nice
15:08Morning
15:09Who have we got there?
15:11Buster
15:12Hello Buster
15:13Take a seat for us, thank you very much
15:17In reception, a seven-year-old Briard called Buster is waiting to be seen with Lara and Ian
15:24They're also no strangers to the practice
15:27We were here when Buster was a pup seven years ago and Noel did a pioneering operation on him in his hog
15:34I believe he was the second dog only to have had this operation
15:37Since the operation, Buster has led a pain-free life
15:41Until recently
15:43In August of last year, he was lame in his back left leg, so it's the same leg
15:49So I thought we'd better get it checked out
15:52I guess the worst case scenario is that Noel says the operation hasn't lasted and it needs to be redone
16:01That would be the worst case
16:04Buster is a French Briard, he's a sheepdog
16:07I didn't want a small dog because she grew up with poodles
16:11Nothing wrong with poodles
16:13The compromise was Buster's wool so doesn't molt
16:18But he's huge
16:20The kids have grown up with Buster
16:22One of them is now at university, the other is at college doing A-levels
16:26Yeah, I mean he has been an absolutely integral part of the family
16:32He's been fantastic, I mean you couldn't have a more loyal dog actually
16:37Hi, how are you?
16:43Hello
16:44Long time no see
16:45How are you doing? You haven't changed a bit
16:46Unlike me
16:47Aw
16:48Nice to see you, hey mate
16:49How are you?
16:50Aw, good boy
16:52He's like me, he's got the sprinkling of black and grey now
16:54Well he has indeed
16:56Seven years, my goodness
16:58So you're concerned about lameness, are you?
17:00Yeah
17:01Was he okay for six years?
17:02Yeah
17:03Yeah
17:04And what happened then?
17:05Then he just started limping and not wanting to bear any weight on his back left leg
17:12I mean we were wondering whether that maybe it was a bit of arthritis
17:16Yeah, yeah, well it's entirely possible that the osteoarthritis which was kicked off by the original disease process is getting worse
17:24Okay
17:25Entirely possible, let's have a look
17:26All right on the other legs
17:28Yes
17:29Yes
17:30Yeah, yeah
17:31It's actually not got that much swelling around there, interesting
17:36Range of motion is actually quite impressive
17:39Hold tight
17:41He seems to be more painful higher up in the limb
17:48Okay, yep
17:49Doesn't like that, does he?
17:52No
17:53This is his sciatic nerve
17:55Hold tight
17:56He definitely doesn't like that, you can let him go
17:58All right
17:59It's all right
18:00It's all right
18:01It's all right
18:02It's all right
18:03All right mate
18:04Hey mate, it's fine
18:05I think he's got a different problem
18:06Okay
18:07Okay
18:08Which is good and bad news
18:09It's good news for me because the surgery that I did several years ago seems to still be working
18:13Yeah
18:14It's bad news for him because it looks like he's got lower back pain
18:17This breed and several other large breed dogs can get a condition called degenerative lumbosacral stenosis
18:24Yeah
18:25You've had it yourself, sir?
18:26I have and I had an x-ray and mine is the same
18:30It's very, very common
18:32The one thing that's changed my life actually is turmeric
18:35Oh, I see
18:36So you're using a natural anti-inflammatory
18:38Yeah, it has changed my life
18:40Ultimately there's three outcomes from this
18:42One is you just give medical management
18:45Yeah
18:46Either pharmaceuticals or natural
18:48One of the things that can be done is injections of steroid into the back
18:51Yeah
18:52The second port of call is physiotherapeutic intervention
18:55Yeah
18:56Surgery is always an option
18:57And we do it when we can't get any result from medical management and you've got pain all the time
19:03Yeah
19:04Because you want to try and avoid picking up a scalpel blade if you can
19:07Yeah
19:08My recommendation to you is you need to get a scan
19:11Yeah
19:12Let's do that
19:13Let's find out what's going on
19:14Yeah
19:15Alright, catch you later
19:16See you later
19:17Thanks
19:18Thanks
19:19Thank you
19:20Noel's diagnosis was not what Ian and Lara were expecting
19:24I was hoping that it was just arthritis or something
19:28Having been through the process six and a half years ago
19:33We know just how tough the recovery process is on both the dog and us as a family
19:40I mean
19:41But it was reassuring to know that there were other options and that surgery wasn't the immediate first port of call
19:48We just have to wait till this evening when we come back to hear the verdict
19:52The family will go home and wait in the hope that they will not need to resort to surgery
19:59This afternoon a familiar face is back at Fitzpatrick's
20:08Good boy
20:09Eight year old therapy dog Scrumpey
20:12Scrumpey's booked in today hopefully for surgery and this is really one of the last chances we've got to get him back in his seat again
20:21I think my nerves are worse than his
20:24He's such a friendly dog
20:26He's a good companion
20:28Not only to me but everybody else
20:30And I just want what's best for him
20:36June has made the difficult decision to admit Scrumpey for his seventh operation at Fitzpatrick's
20:43Hello, I've got Scrumpey
20:45Scrumpey
20:46Yes, that's right, thanks
20:48Today he will undergo major spinal surgery to correct a collapsed disc in his back
20:53So our friend Scrumpey's in again
20:55Go on, he wants to sit here
20:57It's a big old surgery
20:59We're going to minimise risk as much as we can
21:02And even then there's still risk
21:04Alright, Scrumpey then please
21:07Hi, here we go again
21:09Once more into the fray
21:11Come on, that's a good boy
21:13Alright sweetheart
21:14Let me have a look at you Scrumpey
21:16Scrumpey
21:17Yeah, still wobbly mate
21:19Let's get you out of pain if we can
21:20Yes
21:21Good boy
21:22Okay boy
21:23Are you ready?
21:24Yes, yes, ready as I'll ever be
21:26Okay, thank you
21:27I love you tonight
21:28Thank you very much
21:29Okay
21:30Stay brave
21:31I'll be ready
21:32See you later
21:33Thank you, thanks a lot
21:34It doesn't get any easier
21:37It doesn't get any easier
21:39But this is his seventh operation
21:42Scrumpey, I think, is better used to it than I am
21:45You know, he's strong in willpower
21:48And he's stubborn
21:50So he'll get through this
21:52It's me
21:53Just wait for the phone call now
21:56I'm sure he'll be fine
21:59I'm sure he'll be fine
22:01Out in the prep area
22:16Buster, the seven-year-old Briard's hind leg lameness, has been investigated
22:22He had ankle surgery when he was a puppy
22:26And the family are concerned about putting him through another invasive procedure
22:33Noel has the results
22:35Hello
22:36Oh, hey Lara, it's Noel
22:37Hi Noel
22:38So it is what we thought it was
22:40Which is a bulging disc in the lower back
22:43And that's causing compression of the nerves going down the backs of his legs
22:47Right
22:48It's not mild
22:49It's not severe
22:50It's moderate, I would say
22:51So that pushes him toward the likelihood of having surgery
22:56But I would try epidural steroids first
23:00Would be my advice
23:02Okay, are you going to inject him now then?
23:05Literally now, yeah
23:06Under the same anaesthetic
23:07If that's fine with you
23:08Yes, please
23:09See you both later
23:10Okay
23:11Bye now
23:12Bye-bye
23:13Alrighty
23:14Here we go
23:17I'm just going to inject some normal saline into the hub of the needle here
23:22And if I'm in the right spot, you can see that the fluid gets sucked down the needle
23:28Like so
23:31Now he can inject the steroid into the epidural space around the spinal nerves
23:40Okay, wake up
23:41Thanks
23:44Lara and Ian are back with their daughter Evie to pick him up
23:50Can't wait to see him
23:53Okay, buster please
23:55Hi guys
23:57When we look at the CT scan of the ankle
24:01It looks like the implant has held up
24:03Although the inevitable progression of osteoarthritis has occurred
24:07That's the implant there
24:09Wow
24:10Okay
24:11And it's still there
24:12So you must be thrilled
24:13I'm pleased with that
24:14Yeah
24:15Yeah, that's as good as we could have hoped
24:16Because we got
24:17You know, you've grown up quite a lot in those years
24:19And this has stood the test of that time
24:22That's the disc
24:23Yeah
24:24A normal disc is like a jam donut
24:26They have a fibrous outer ring and they've got a pulpy inner center
24:29So that's a normal-ish donut
24:31That's normal, normal, normal and so on
24:33This one's certainly not normal, it's black
24:35Yeah
24:36So inside the scanner
24:37We put him in the position as if he was jumping
24:40Okay
24:41Okay
24:42So you can see that the top of the sacrum comes down
24:44Yeah
24:45The disc goes up and it pinches the nerves
24:47Yeah
24:48What we've done today is we've opened up this space
24:51And injected some steroid into it here
24:54Okay
24:55Normally do three injections
24:56The first one today, the second one in two weeks
24:58The third one in five weeks from now
25:00But it'll only help ease the pain, that's it
25:02Okay, and so the only way to solve the problem is long-term is to operate
25:08Yeah
25:09Please God, we don't get to that point
25:11Yeah
25:12Yep
25:13Oh, both there
25:15He's carrying a little bit of podge as well
25:17Okay
25:18Because he hasn't exercised enough
25:20So he's about four or five kilos overweight
25:22By comparison to what I'd like him to be
25:24A bit of podge going on
25:26Okay
25:27I'm just saying
25:28Yeah, we have banned the gravy bones
25:30Yeah, just saying
25:31Looks like Buster and I could be on the same diet
25:33Yeah, I know
25:34Same pills, same diet
25:36I'm not going to make any comment
25:37I'm staying well out of that
25:39All right, grab a seat for a second
25:42I will go and get him for you
25:43Oh, lovely kisses
25:46I suffer from back pain
25:48So I kind of know exactly what he must be suffering
25:53And I do really sympathise with him
25:56All right mate
25:57Here he is
25:58Here he is
25:59Good boy
26:00Hello darling
26:02Right, I will see you soon
26:04See you soon
26:05All right guys, two weeks, five weeks
26:06Take care, God bless
26:07Thank you
26:08Thankfully Buster has managed to avoid surgery for now
26:12He will continue a course of three steroid injections
26:16In the hope it will alleviate his pain
26:19Unlike Buster, eight year old therapy dog Scrumpy's spinal condition is at a more advanced stage
26:36He's been prepped for surgery
26:38Poor Scrumpy, he's just got so many things wrong with him
26:42And he brings so much joy and love to the world, it's such a shame
26:46So he's cheering up other people while he's in a lot of pain himself
26:50So no pressure
26:52Much
26:54Today, Noel will be replacing the collapsed disc in Scrumpy's spine with a metal spacer
27:00Releasing the pressure on the nerves that are causing pain and making it hard for him to walk
27:06Once the spacer pushes the vertebrae apart, Noel needs to stabilise the vertebrae in front
27:13And the sacrum behind the spacer with screws, clamps and rods to hold them in position
27:19But as with any spinal surgery, there are risks of potential life-changing nerve damage
27:25Sadly, Scrumpy's affected by a really severe disc problem
27:30So the disc has dried out and bulged really badly into the base of the canal here
27:35The nerves could get damaged
27:37So those nerves are stuck to the roof as well as to the disc underneath
27:42The disc underneath is down here
27:44Man, this is just a congealed mess of fibrous scar
27:48I think this is in the textbook of neurology under F for freaking mess
27:53We've now got a big hole in here where we've scooped down in between the two discs
28:02What I'm going to try and do is I'm going to try and put a spacer in here
28:05It's going to be tough
28:06Because the nerves all have to be pulled over to one side
28:08And also it's bleeding like crazy as you can see
28:11So this is the most difficult part of the surgery and the most risky part
28:16And you only have one shot
28:19As Eminem once said
28:21Noel needs to be very careful moving the nerves to avoid the risk of permanent damage
28:26Which could lead to incontinence or possible paralysis
28:31We're getting a lot of blood loss here
28:34Concentrate guys, concentrate
28:36With the nerves finally moved to the sides
28:39Noel drives the metal spacer between the two vertebrae
28:42Okay, so I think I've got the spacer in now
28:45You can see it's a real difficult drive
28:48To get it in between those nerves
28:50Lots of blood
28:51And then you can see the spacer right down in there
28:54Noel puts a small screw through the spacer so it stays in place
28:59And then he uses large screws, clamps and rods
29:02To stabilise the vertebrae on either side
29:04Okay, so we've got the clamps in now
29:06And you can see that the rod here
29:09Gets pulled right down on top of the vertebrae
29:12And that stops anything moving
29:15That was a toughie
29:18Before Scrumpy is taken to recovery
29:21Noel is harvesting some fat
29:23As he wants to use a cutting edge treatment
29:25To try and ease Scrumpy's debilitating elbow arthritis
29:28There's plenty of fat here
29:30We're going to take some of it
29:31And we're going to send it off to the lab
29:34From which we're going to extract some potentially anti-inflammatory stem cells
29:39That we can put in the elbows to try and calm down the pain
29:43Plenty of potential for harvesting cells there
29:48So that was very, very challenging
29:52Scrumpy certainly keeps me on my toes
29:56All right, Scrumpy
30:01Just rock and roll
30:03It will be an anxious wait to see if the procedure has had any adverse effect on the nerves controlling
30:09Scrumpy's bladder and back legs
30:11Hello, June, it's Noel
30:13Hello
30:14It was a tough surgery but we didn't expect it to be anything less
30:17We had to stretch the nerves quite a lot to get all of the material out and get the spacer in
30:23I don't know whether they'll recover or not
30:25Yes, right
30:26So we just need to be patient
30:28Uh-huh, yep
30:29Okay
30:30Thank you so much
30:31All right, take care
30:32Thank you
30:33Bye
30:34Bye
30:35Emergency admission Ralph is still very unwell with a serious but unknown brain condition
30:51He's being monitored around the clock in case he has further seizures
30:56Senior neurologist Colin Driver has come to discuss Ralph's brain fluid test results with Noel
31:03So are we any closer to knowing what the stuff is with the fluid?
31:06It's quite likely to be an infection
31:08I would imagine you've got clumps of bacteria that have arrived in the bloodstream
31:14And that have set up an infection in the brain
31:17So he had spinal pain
31:18Yeah
31:19But in fact it was just the area of the brain that perceives spinal pain that's being stimulated by this stuff in the midbrain
31:25Yeah, we call it central pain syndrome
31:27I mean what are the chances of that? Less than 10% I would have guessed
31:30Yeah absolutely, it's really unusual
31:33I mean I wouldn't say that I'd seen an MRI that was exactly like this possibly ever
31:38Well I can tell you categorically I've never seen it ever
31:41With infection being the likely cause of Ralph's problems, Noel and Colin's plan is to treat it with antibiotics
31:49We do not think the cause is a direct trauma
31:53Okay
31:54The fluid sample has narrowed it down to probable infection or inflammation
32:00Okay
32:01Have you any inkling of how this would have happened?
32:04I mean ultimately it's one of those things really
32:06You can get bacteria into your bloodstream from cleaning your teeth
32:10You know it's quite possible that infections can just happen sporadically
32:14And unfortunately it's unlikely that we're going to find an explanation as to why it did
32:18The team hopes the antibiotics will bring the probable infection in Ralph's brain under control
32:25For now, his life hangs in the balance
32:28Come on mate, good boy
32:42Come on boy
32:43It's now been a week since Scrumpy's spinal surgery
32:47He's up and walking but he's yet to have a pee without a catheter
32:51And Noel is concerned that the nerves to his bladder have not yet recovered
32:55Come on mate, come on
32:58Come on, we gotta go
32:59So I've been waiting for Scrumpy to piddle for a few days now
33:02His legs are getting stronger all the time but his bladder's quite slow to recover
33:08Come on mate, pee time
33:09He's also very fussy where he wants to pee
33:12Oh yeah baby
33:14Oh yeah mama
33:16You do that, good boy
33:18Oh yeah
33:19Oh I'm so proud of you
33:21Oh that's fantastic
33:23Oh a nice big piddle, fantastic
33:26That's really encouraging
33:28So he's definitely cocking his leg and he's definitely peeing
33:31I've never been more happy to see some peabody
33:34Never been more happy, you're such a good boy
33:37Now that Scrumpy has had his first post-op pee, June and husband Paul can finally take him home
33:44I'm sort of looking forward to getting him back again at home and looking after him and hopefully he's gonna make a full recovery
33:52That's the plan
33:54Right, June
33:56And your husband
33:58Yeah, he doesn't
33:59You actually exist
34:01I thought she was pretending
34:03But she actually has a minder
34:07That's brilliant
34:08It's so good to see you sir
34:10Please come in
34:11So he walked pretty quickly within a couple of days and that was good news but he couldn't pee
34:17And I knew that that was because these nerves have been traumatized by the original injury plus the surgery
34:24Yeah
34:25And they are recovering so just keep an eye on that
34:29He's very fussy about where he pees
34:31He likes to get exactly the right spot
34:35In the bushes
34:36Yeah
34:37That's right
34:38Yeah, usually under a bush
34:40So he drags me towards anything that can cover his modesty
34:44So I'm delighted to say that I think he's on the mend now
34:47Terrific
34:48Thanks for coming in to me
34:49So good to see you actually exist
34:53You actually exist
34:54Wonderful
34:55Thanks for your help
34:56Go get him
34:57Okay
34:58Come on mate, this way
35:00Good boy
35:01Come on buddy
35:03Come on buddy
35:05Now
35:06Oh my boy
35:07There we go
35:08Hello
35:09Hello my boy
35:10There we go
35:11Oh
35:12Oh yes, it's good to have Scrumpy back
35:14Yeah, I'm looking forward to getting him back
35:16We've got a couple of months of physio to go through
35:19Just doing a real slow process
35:21Yes
35:22Aha
35:23But you're a fighter, you'll get there won't you
35:25Yes
35:26Hey
35:27Good boy
35:29Dax and Ralph have spent the past two weeks at Fitzpatrick's suffering from a mystery brain condition
35:43An infection has now been identified as the culprit which caused central pain syndrome in his brain
35:49Treatment is working well and he's making a miraculous recovery
35:54We're here today at Pick up Ralph and we're very excited
35:57The poor chap all along it was in his brain and and
36:01Apparently was in a part of his brain which deals with pain. So he was feeling pain all over
36:07That's desperate. He's just 15 months old and yeah, but shows that he's a fighter
36:13Now Ralphie's mom and dad, please
36:15You look splendid today, sir. I
36:19Love the cravat. Oh, that's a scarf. I don't know what it is, but it's great
36:24Right
36:26Right. Good morning. Okay a long journey a long journey
36:30We've had what Colin and I and the rest of the team are looking for is a resolution of this
36:36And what that is we're convinced now is
36:39oedema
36:41pus
36:43associated with infection in the midbrain
36:47He may still have some structural abnormality in his brain in the longer term, but we're confident that we're treating it
36:53Mm-hmm. So I know obviously you didn't know him before we brought him in so before he was in that state
36:57But from your observation. Oh, he's fine. You'll see any minute. You will see a dog right now that you will recognize
37:06But until the infection is under control Ralph's symptoms will continue to be managed at home with medication
37:13As you can see he's fine, so I've done my best for you. Thank you. Okay. All right
37:20Right guys look after yourself. Thank you very very much. Thank you. Sorry you inspire me
37:26If I could look half as elegant as you I'd be doing all right
37:29All right, I'll send Hannah down. God bless
37:34He seems good he's lost a little bit of weight and I think he's a bit frightened that we're gonna leave him again
37:40Because he's a bit agitated
37:42He was never the sharpest knife in the box, so it might be difficult to tell if he's got some brain injury
37:49I'm going but but so far so good. He looks fine
37:59Therapy dog scrumpy has been recovering at home from the major surgery on his spine
38:04Yes
38:08Today he's back for treatment which will hopefully help relieve the pain in his elbows
38:15So in here we've got five ml of the biological cocktail which comprises
38:19The fat derived stem cells which are potentially anti-inflammatory
38:24We're injecting a very specific cocktail of two very special ingredients into scrumpy's joints
38:30Okay, let the battle begin
38:33The first ingredient are specialized stem cells called pericytes which are extracted from the little blood vessels within fat
38:41Concentrated in a specific number to have the maximum anti-inflammatory effect
38:47The elbows are particularly bad scrumpy has horrendous elbow arthritis
38:51The second ingredient are platelets from the blood which have within them granules which also release anti-inflammatory molecules
39:02What our team have done over the last several years is to try and make the process of treating osteoarthritis with stem cells and platelets very scientifically evidence-based
39:13The mixture only treats inflammation and pain. It does not regenerate tissue and it does not cure arthritis
39:22All right
39:24Well done scrumpy
39:25Good boy
39:27I've done my best
39:28Now where's my mummy?
39:32Oh, scrumpy
39:33There's my mummy
39:34Come on there
39:35Come on
39:36There she is
39:37Now I'm feeling a bit stiff mum because I've had both of my elbows and my hip all injected, all of them
39:47I'm hoping this will last maybe six months, maybe longer, we'll see
39:52Yeah
39:53His cells are banked so we can thaw them out again if we need to
39:55Right
39:56Okay
39:57Okay
39:58Hey, clever boy
39:59All right big fella
40:00Take care
40:01Thank you very much
40:02Thank you
40:03Bye
40:04Where are you off to?
40:06Come here
40:07Oi, come here
40:09He's heading for the door
40:13He can move fast when he wants to
40:16Come here
40:17He's going home
40:22For the past four months, Daxson Ralph has been treated for his brain infection at home in East Sussex
40:35He's hugely better
40:37He's not 100%, I think that's fair, but as you can see he's a lot happier now
40:44Unfortunately there has been some permanent brain damage, so he will never fully recover
40:49He's on a course of antibiotics and on a course of tablets to stop him having seizures
40:54We're just hopeful and to be honest, when we left him on that first time, the state he was in, I didn't think I'd see him again
41:00So, to be honest, every day we have him back, he's a blessing, so it's really nice
41:05Buster has now had a course of three steroid injections and it seems he's no longer suffering from his old back pain
41:22Prior to the injections, he was a creaking chair, he was in a lot of pain and he couldn't put his left leg, his left foot down on the floor
41:29You know, he's not experiencing any of that anymore, so that's brilliant
41:34He's just a lot more nimble and moving around without discomfort
41:39Buster may still need further treatment in the future
41:43He's seven and a half years old now, so we are going to do everything we can to not go the invasive surgical route
41:52Definitely back to his old self, I mean, he is markedly pain-free now
42:05You know, he's happy as Larry, aren't you Buster?
42:10Yeah
42:11Clumber Spaniel's Scrumpy is back, he's been having regular rehabilitation to help him recover after his spinal surgery
42:24Good boy, this one's Buster
42:29Today, June's here to find out if his seventh operation has been a success
42:35Scrumpy hopefully is going to have his sign off today
42:38He still walks a bit odd, a bit like John Wayne
42:42But he's not dragging his feet straight, he's not in pain, so it does look as though he's improving
42:49Noel has sent Scrumpy for a final CT scan and the results are in
42:55Now, Scrumpy's mum
42:58Well, you'll be pleased to hear us good news all round
43:00Oh, wonderful, thank you
43:03So, this looks very nice indeed
43:06I designed this device so that the bone would physically grow through it into the other vertebrae, which is exactly what's happening
43:13Wow
43:15So, I'm happy, okay? Don't cry, it's all good
43:18Thank you so much
43:20It's all good, hey, it's all good, it's all good, isn't it?
43:23It's all good, it's all good
43:25Huh?
43:26I keep thinking what I've put me through
43:28Yeah, well, you've done the right thing
43:30Get him out of pain?
43:31Yes
43:32Well, you've given him a new lease of life, really
43:34Mm-hmm
43:37The operation was a success
43:39I think Raul had her doubts about what was going to happen
43:43Because he's had so much done
43:45Good boy
43:47He's not in pain, he's not had any painkillers since his surgery
43:51And the stem cells have obviously helped
43:54I think we could all do with a dose of stem cells, couldn't we?
44:00I did do the right thing
44:02He's got through it
44:04And I hope he's not got to do it ever again
44:09Sorry
44:10Two months later, and Scrumpy is finally fit enough to resume his duties and visit some old friends
44:26Where are we going? Are you going to see all your friends?
44:30He's walking very well
44:32He's not in pain, he's happy enough, he's very alert
44:35So he really has come on very, very well
44:40Right, look, good boy
44:42Look, there we are
44:44There we are
44:46We're back
44:48June, he looks so well
44:50Doesn't he?
44:52And his new coat's growing well
44:54You look lovely and fluffy and clean like a new baby
44:57You do
44:58Oh, it's lovely
45:00Lovely to see him back and looking well
45:02Considering it was a big operation, wasn't it, June?
45:04Yes, yes
45:06Oh, you're right
45:08Yes
45:10I knew I'd do it
45:11It's nice to see him back in action
45:13It's been a long time watching him and trying to recover
45:17At one point we never thought we'd see this day
45:19But, thankfully, he's bounced back, I think, quicker than I have
45:26Hasn't he?
45:27Oh, that's lovely
45:29It's not just the older generation that Scrumpy is having a positive effect on
45:34So the question is, does the veterinary profession have the right to withhold choice?
45:38He's been helping Noel to educate the next generation of super vets at the University of Surrey
45:44About veterinary ethics
45:46How far is too far?
45:47What if you have a dog that not only needs knee surgery, not only needs both elbows operated on a few times
45:54But also has a severe lumbosacral degenerative stenosis
45:58Shall we put that dog to sleep?
46:00And this is a really important moral dilemma now for you because the future's yours, it's not mine
46:05I want you to look June in the face and tell her that nothing can be done
46:10This is real life
46:12Because that's that dog
46:13So that's that dog
46:14So that's that dog
46:43You
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