- 3 months ago
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00:01One, two, three.
00:04Hello, mate. You understand Irish?
00:07Animals from all over the world
00:09Ah, bonjour.
00:11Come to see one extraordinary man
00:13who's known as the Bionic Vet.
00:16High five. Yes!
00:18Professor Noel Fitzpatrick.
00:20We only get one shot at this. Here we go.
00:23Noel and his team offer some of the most advanced treatments available anywhere.
00:28The perfect marriage of mechanics and biology.
00:30This is what we have now.
00:32A brand new knee.
00:33Oh, wow!
00:35For some, it's a last chance.
00:38It is a life or death situation because we cannot leave him like he is.
00:42I just want you to do anything you can for him, really.
00:45Sorry.
00:46As Noel continues to devise new ways of healing...
00:49You're going to be Bionic. Thank you so much.
00:52He transforms the lives of his patients.
00:55Oh, that is just unbelievable.
00:57He's raring to go.
00:59Against all the odds.
01:00Boom!
01:01One small step for a dog, one giant leap for mankind.
01:04Well done.
01:09Hello, Ms. Patrick.
01:11Fitzpatrick referral is orthopaedic and neurology.
01:13Pizzlespeaker.
01:14That's no help.
01:16There's a buzz of excitement in the air at Fitzpatrick referrals this morning as a very unusual patient arrives.
01:24Oh, my God.
01:25Oh, my God.
01:26Hello.
01:27Oh, hello.
01:28Five-year-old Hermes is a one-legged Herman tortoise.
01:29I want to take him home.
01:30He's got a very good personality.
01:31When I first introduced him to the other tortoises, he chased them, he chases the cat.
01:45You talk to him when you come in.
01:47If he's asleep, he'll wake up and put his head up.
01:49Full of guts, I think you could say.
01:51Very gutsy tortoise.
01:52Hermes got his two front legs amputated to the elbow and, at the moment, one back leg amputated to the toes.
02:00So, he's just come here to see if they can work out a way we can get him walking because, at the moment, he can't walk.
02:06Self-confessed tortoise lover, Helen, adopted Hermes from another family two years ago.
02:12I've got two tortoises.
02:14This is Thomasina.
02:16This is what a tortoise should look like with their four legs.
02:21She's 11 now.
02:23So, this is Hermes.
02:24There's a good boy.
02:25How's that good?
02:26Hermes, he's only little.
02:30He's a baby, so he needs looking after.
02:33Following a vicious attack, Hermes has been left with multiple injuries and sometimes needs the help of a tube to feed.
02:42I mean, he's a cute little fella.
02:44I've never been able to explain why I like tortoises.
02:46I just, I just do.
02:48They've got funny little faces.
02:50I've had them since I was about nine, I think, on and off.
02:53This is where it happened.
02:56There was a fence along here.
02:58He was just about here.
03:00And he was kind of on his side, propped up against the fence.
03:04As soon as I got up to here, I could see immediately that he, he was hurt.
03:09And, er, I guessed straight away that he'd been attacked by a rat.
03:14OK, Hermes, please.
03:17Hermes.
03:18Helen has come to see Noel to see if there might be a way to make Hermes mobile again.
03:24Now, what have we got here?
03:25Hello.
03:26Hello, I'm Noel.
03:27I'm Helen.
03:28Helen, grab a seat there for me.
03:30You've got a little friend in here.
03:31We have, yes.
03:32Unusual for a Monday morning for me.
03:35Yes.
03:36Hello, mate.
03:37Do you understand Irish?
03:39Oh, look at you.
03:41You're so cute.
03:42Oh, look at that.
03:44Gosh, what happened?
03:47He was attacked by rats.
03:49And, er, he ended up having his front, um, legs amputated.
03:53But, um, his back leg looks better.
03:56OK.
03:57And did all of the injuries happen at the same time?
03:59Er, yes.
04:00They're very slow healing.
04:01Oh.
04:02Oh.
04:03So, yeah.
04:04They've got very slow metabolism, so they take a long time.
04:06Yeah, yeah, yeah.
04:07No, I get it.
04:08Oh, dearie me.
04:09Look at that.
04:10Yeah.
04:11Oh, that's horrible.
04:13Oh, dear.
04:15That's still infected, isn't it?
04:19No, that tip's going to go.
04:21Yeah.
04:22It's definitely going to fall off.
04:24Or be taken off, because it's necrotic.
04:28I have to say, it looks a bit worse than it did the last time.
04:31They did the dressing.
04:32And I would, well, at the moment, I would almost certainly get an infection in that if I did anything.
04:40He's very forthcoming, isn't he, with his head?
04:43Yeah.
04:44I mean, he's very outgoing.
04:46Yeah.
04:47Of everything else, he's doing so well.
04:49Well, you're certainly setting me an unusual challenge.
04:52I've done wheels on tortoises.
04:55Yeah.
04:56His problem is propulsion, though.
04:58Absolutely.
04:59If he had two back legs that worked, then I could put a wheel here.
05:02Yes.
05:03And he'd be fine.
05:04But the fact that he's missing one back leg is deeply disappointing.
05:07Yes.
05:08You are aware that nobody's ever done a limb amputation prosthesis on a tortoise.
05:13Yes, yes.
05:14I don't know what to tell you at the moment.
05:17No.
05:18Because I don't know if it's possible.
05:20It's a very difficult moral dilemma, isn't it?
05:23Because it's easy to put to sleep.
05:26Mm-hmm.
05:27It's just about whether it's morally right.
05:29Mm-hmm.
05:30What do you think, mate?
05:32He's very cute, isn't he?
05:34Very cute.
05:35Okay, right.
05:38I'll tell you what I'm going to do.
05:40We only have two options here.
05:41Either I investigate what's possible or we put him to sleep.
05:43Mm-hmm.
05:44Because we can't leave him as he is.
05:46Because he's going to have no quality of life at all.
05:48No, no.
05:49In order for us to do anything at all, I'm going to have to do a CT scan.
05:52Mm-hmm.
05:53Some of that right hind leg will have to be amputated anyway
05:55if we're going to keep him alive.
05:57Yeah.
05:58Do you want to say bye-bye for now?
06:00Yeah.
06:01Aww.
06:02He'll be a good boy, hey?
06:04Try and get better.
06:06I know you love him, and I know it would be heartbreaking for you to say goodbye,
06:09but we've got to do the right thing, don't we?
06:12Yeah, yeah, okay, thank you.
06:13That's all I can say, and it's an absolute pleasure to see you.
06:15Thank you very much.
06:16He's been blessed.
06:17Leave him with me.
06:18Yeah.
06:23Not as hopeful as I thought.
06:24I think I'll be saying goodbye to him.
06:30Sorry.
06:34Yeah, I think he'll have to be used.
06:36I don't think they'll be able to do anything for him.
06:38But keep my fingers crossed.
06:40I think it was important.
06:41I think this is a great thing for him to be able to do something for him to be able to
06:42be able to do something.
06:43For Hermes to have any chance of survival, Noel must act quickly to curtail the infection.
06:47He removes the necrotic tibia from his right hind leg.
06:55All right, let's go to CT and see what you've got. Thanks.
07:08Hermes is having a CT scan to establish how much bone stock he has left.
07:14To enable Hermes to walk, Noel is considering attaching prosthetic limbs to his three damaged legs.
07:21This is an x-ray picture of Hermes.
07:25We can see that the left back leg is fine.
07:29There's only the femur left of the right back leg.
07:32And there's only the humerus left on the two front legs.
07:35And the CT scan allows us to actually take the pelvis out of the body.
07:41And you can see where one leg only has a femur bone and we've amputated at the knee.
07:47But you can also see that that femur is not normally in the socket.
07:51Tortoises can live with a dislocated hip.
07:53The big problem is that every amputation prosthesis that I've ever done has been below elbow or below knee.
08:02So it's unlike any other amputation prosthesis that's ever been done in the world, ever.
08:07I mean, I often say everything is possible, but this may in fact be pushing things too far.
08:20Hey Helen, it's Noel. How are you?
08:22Oh, hello. It's fine, thank you, yes.
08:24Now then, so most of the weekend myself and the engineering department have been thinking about Hermes and what we might or might not be able to do.
08:35The engineers and I have calculated implants that in theory could work.
08:43Yeah.
08:44But it would require a gigantic leap of faith.
08:48Mm-hmm.
08:50And there is considerably more risk than normal of failing.
08:55So do you think it would be better off than just to let him go now?
09:07Um, I think we need to think about it.
09:12We are willing to try, because...
09:15Well, it's a great picture of tried and failed and never tried at all.
09:19It's a very difficult one.
09:21I think you need to sleep on this.
09:24I guess the bottom line, Helen, is we would be closer than we have ever been to committing to a procedure with as much chance of failure as success.
09:39It's a lively morning at Fitzpatrick Referrals and six-year-old Rottweiler Dave has come to see Noel after experiencing problems with his right hip.
10:02Dave.
10:04Lovely.
10:06We've come with our Rottweiler Dave today.
10:09He's had two hip replacements.
10:12The one on his right side is failing and all the bones deteriorating.
10:16So what we're having to do is look at alternative solutions to how to fix it, really.
10:21Every now and again, he has a strain if he runs into the garden.
10:24But he would never let the kids, though, would he?
10:26No, he's all right. He still plays.
10:27But when he's in pain, he's in a lot of pain.
10:36At home in Kent, despite the hustle and bustle of family life, Dave is always in demand.
10:43Dave, give me a kiss.
10:46We've got six children.
10:48Taylor, Sean, Sasha, Charlotte, May and Riley.
10:52Ranging from 22 to six.
10:55Six.
10:56And two dogs, two Rottweilers, Dave and Tony.
11:00Dave is six.
11:01We've had him since he was 12 weeks old.
11:04But since the failure of one of his previous hip implants, Dave's quality of life has deteriorated significantly.
11:11Every time he moves, he cries.
11:13It's really scary when he falls and he is screaming in agony.
11:19The kids are scared.
11:20And the kids are crying and it's awful.
11:23We're not prepared to just replace Dave's implant with exactly the same implant and hope that this one works.
11:31Our biggest fear was it would then result in possible amputation.
11:37And because he's such a big dog, I just didn't think that was very fair on him.
11:41But he's a young dog.
11:42He should be enjoying his life and he's not.
11:44He's in constant agony and it's not fair.
11:53A veteran of two surgeries, Dave can be a little wary of vets.
11:58Oh, yeah.
11:59Matt.
12:00Matt, nice to see you.
12:01Hello, mate.
12:02How you doing?
12:03Hey, mate.
12:04How are you?
12:05Good boy.
12:06This is Dave.
12:07Yeah.
12:08Hi, Dave.
12:09How are you?
12:10How old is he?
12:11Six.
12:12Okay.
12:13Good boy.
12:14You kept him in pretty good shape.
12:15Yeah.
12:16Try to.
12:17Okay, so I've read your history.
12:18Yeah.
12:19You had the first hip replacement in 2011, was it?
12:20Yeah.
12:21And then the second one in 2013?
12:22Yeah.
12:23Okay.
12:24And which is it that has failed?
12:25That's the first one.
12:26So initially, was it okay?
12:28Yeah.
12:29Absolutely no problems at all.
12:30And then we just noticed that he started limping.
12:33But it's not all the time.
12:34The only other thing I wanted to add, ever since he had the second op, as he's going
12:41to the toilet, he's panicking and he takes off like a scalded cat, four years.
12:46We spoke to the vet and they said they thought it was psychological, but it never happened
12:49until he had the operation.
12:50And literally, as he goes to the toilet, it'll be three or four droplets as he's running off.
12:55You know, the toilet is never in one heat.
12:57Well, I don't have enough information yet.
12:59I'll need to watch him walk, and we will need a CT scan.
13:03Let's go outside.
13:08That's great. Slowly, please.
13:10Keep him away from me.
13:12Yeah.
13:13Come on, baby.
13:16Okay.
13:17Stop there.
13:18Come over here, please.
13:20Come on, darling.
13:24Hold tight.
13:25Hold tight.
13:26Hold tight.
13:27Muscle mass is very poor.
13:29Slow. Slow.
13:30Slow.
13:31Slow.
13:32Okay.
13:33All right.
13:34That's enough.
13:35I'm not going to push it.
13:36Okay.
13:37Come on, mate.
13:38Let me go straight in there.
13:39I note on your clinical history that three options have been given to you.
13:44One is revision of the total hip replacement.
13:46Yeah.
13:47One is ephemeral head and neck excision, where you excise the hip replacement and leave him with no head.
13:51Yeah.
13:52And the third one is full hem amputation.
13:54Yeah.
13:55Full hem amputation generally isn't something that we would consider off the get-go.
13:59Brilliant.
14:00Ephemeral head and neck excision is an option, but it would not be as good as a revision total hip replacement.
14:06But bear in mind, I would have to take all of those implants out.
14:11These are big potential problems.
14:13Take off your beautiful collar.
14:15There we go.
14:16Yeah, he's a lovely dog.
14:17See you.
14:18All right, bye.
14:20Bye.
14:21All right.
14:22All right.
14:23Here we go.
14:27He's going to be pretty out, babe.
14:29Normally it takes you a couple of days to come down from there.
14:32Yes, he's going to be even soppier than normal.
14:39Noel needs to establish just how severely the existing hip replacement has deteriorated and how much bone stock remains.
14:47Right.
14:48So this is a three-dimensional CT scan of the limb.
14:51And you can see that this stem is loose.
14:53Now if you look at this...
14:55How do you...
14:56No.
14:57How do you see that this one's loose?
14:58So this is a cross-sectional view.
15:00So you can see here...
15:01Right.
15:02Yeah.
15:03Okay.
15:04Black shadow.
15:05That's the void.
15:06That's the gap.
15:07Is the void, yeah.
15:08Yeah.
15:09So that shaft is windshield wapering.
15:10Yeah.
15:11Like so.
15:12Yeah.
15:13So when you rock the leg, that goes like that.
15:15Right.
15:16So you know that stem has to come out.
15:17Yeah.
15:18Right.
15:19This piece of the bone here would almost certainly fracture off.
15:22Yeah.
15:23Once you take the stem off.
15:25Mm-hmm.
15:26Therefore, my plan will be to make a plate that goes up over here, goes all the way down here
15:31and then that's secure.
15:32Blimey.
15:33Yeah.
15:34It's all doable.
15:36Good.
15:37The risks are we could get a fracture on the table.
15:40Usually I can mend that.
15:41Yeah.
15:42Okay.
15:43Infection, because you're going in a second time, that's a risk.
15:45Okay.
15:46Sciatic nerve trauma, meaning that they sometimes drag their leg.
15:50Okay.
15:51It can take them a few weeks to recover.
15:52Oh, that's fine.
15:53It will be unlikely it doesn't come back, but it's possible.
15:56All right.
15:57Let me go get him for you.
15:58Okay.
15:59All right, guys.
16:00Cheers.
16:01Okay.
16:02Different size.
16:03He's going to be really hard to wake up.
16:08Shall we go?
16:09You ready?
16:10Shall we go?
16:11Shall we go?
16:12Shall we go?
16:13Come on then.
16:14Come on.
16:15Come on, mate.
16:16You can do it.
16:17Come on.
16:18Come on.
16:19Oh, you're not going to get up from me, mate.
16:20You're not going to get up.
16:21Oh, come on.
16:22Let me see.
16:23All right.
16:24I'm bringing mum and dad in.
16:25If you just stand back, please.
16:26We're all good.
16:28Now.
16:29Okay, big guy.
16:30Mum and dad are here.
16:31There we go.
16:32Okay.
16:33There we go.
16:34You ready?
16:35Come this way.
16:36Come on, darling.
16:37Come on, mate.
16:38Come on.
16:39Come on, buddy.
16:40You're getting grumpy with everybody.
16:41There we go.
16:42That's fine.
16:43I think he's just nervous on his hip.
16:44Come on, buddy.
16:45You're getting grumpy with everybody.
16:46There we go.
16:47That's fine.
16:48I think he just, he's nervous on his hip.
16:50Yeah, yeah, yeah.
16:51Oh, thank you.
16:52Okay.
16:53Great to see you.
16:54I can't wait.
16:55Yeah, and thank you for that.
16:56Really appreciate everything.
16:57My pleasure.
16:58Okay.
16:59All right, mate.
17:00Be a good boy.
17:01Be a good boy.
17:02By the way.
17:03Let's do it again.
17:04I'm done.
17:05It's been nine days since Hermes' tibia amputation, and Helen is ready to pick him up.
17:12A bit nervous, a bit worried.
17:15Originally, we were hoping we could save his one rear leg that's injured so that he would
17:21just have wheels for the front.
17:23but Noel phoned me and said a viable option could be three prosthetic legs.
17:29As Hermes has a dislocated hip and has lost one of his knee joints...
17:33Right, Hermes, Mum, please, Hermes.
17:36Placing just one back leg prosthetic is unlikely to be enough to get him walking again.
17:42Hello, mate.
17:44Oh, hello, darling.
17:46OK, now...
17:48Oh, dear, oh, dear.
17:49OK, so I've removed the infected tibia.
17:55It's extremely important, given all the anaesthetics that he has in hydration,
18:00because otherwise his toxic excretion will be a problem.
18:05Obviously, eating is an issue, and make sure he's well fed up.
18:10But in his case, other than the fact that he's got three stumpies, he's fine.
18:15The problem that we've got is that we only have a femur and we only have a humerus.
18:22That's all you've got left on the front legs, which is two very curved bones,
18:26really difficult architecture.
18:28It's three millimetres across, and it's approximately 14 millimetres in length.
18:34So we've done a lot of sums on this, and this is what we've come up with.
18:37So that's the front leg, that's the back leg,
18:42and that small implant has two plates on it and a tiny peg.
18:47Yeah.
18:49The titanium implants will need to be attached to the remaining bone in the legs,
18:55the humerus in the front two legs,
18:57and the femur in the hind leg.
18:59No hopes that within six months, when the implants have bonded to the bone,
19:05specially designed flipper-like feet can be attached.
19:10Nobody knows if this is even theoretically possible.
19:14No.
19:15In terms of the computer modelling, it is possible,
19:19but the risks are the bone fractures during the op,
19:23the bone fractures after the op,
19:25infection, skin breakdown, anything could go wrong.
19:29And unfortunately, with him, I would say it's 50-50 at best.
19:35I very rarely go into surgery with 50-50 odds, almost never.
19:41And if we fail, then we have to put him to sleep.
19:47Well, yeah, I've been thinking about whether we need to,
19:51whether I should put him through it.
19:54And I think that because he's so well,
19:58we should give it a go.
20:03Well, I'm willing to try.
20:04OK.
20:05I think it's probably going to weigh heavily on our consciences if we don't try.
20:10And that animal can live longer than me and you.
20:12Mm-hm.
20:13If this works.
20:15But no matter what, we cannot operate at the moment
20:19until the back leg heals over.
20:20Mm-hm.
20:21I do love him.
20:22It's great.
20:23All right, mate.
20:25He loves a little head stroke.
20:27He does, yeah.
20:28Loving it.
20:29Loving it.
20:33Listen, we'll talk.
20:35My pleasure.
20:36There's a big challenge ahead for Helen
20:42if she's to help Hermes' wounds heal.
20:45I'm a bit worried that I'm asking too much of Noel and Hermes to do it.
20:51But he's done so well so far
20:52and fingers crossed that he just carries on.
20:56Hi, Hermes.
20:57Of course, this is a very difficult ethical dilemma.
21:02Hermes is a fighter.
21:04He has a lot of life left in him.
21:06He could live up to 80 years of age.
21:08And just because he's a tortoise,
21:10why should he be precluded from the same technology
21:13that's being deployed in dogs and soon even in humans?
21:17At the end of the day, to a vet, all life matters.
21:20And Hermes has very few options.
21:27It's a tense day for big, softy Dave the Rottweiler,
21:35who needs a revision to a hip replacement that has failed.
21:39And with the pain worsening, it couldn't have come a day sooner.
21:43He's really deteriorated recently, so I'm glad this...
21:47Perfect timing.
21:47Perfect timing.
21:49So we're all a bit anxious.
21:50Kids are a bit anxious.
21:51Everybody, all the kids are up this morning,
21:53giving him extra cuddles, lying all over him,
21:56hugging him, kissing him.
21:58Oh, no, he's not a tough dog.
22:00No, he's a baby.
22:03Now then, Dave, please, Dave.
22:05Hi, guys.
22:06Hi.
22:07How are you?
22:08Come on.
22:09Hey, mate.
22:10How are you?
22:10What's this, then?
22:12Oh, a double marathon.
22:14Did you run that?
22:14Yeah, yesterday, yeah.
22:15Not him?
22:16No.
22:16Oh, well done.
22:17Was it good?
22:19Hilly.
22:19We've got to get him to run a marathon now.
22:21Yeah.
22:21So I've got a custom-made plate, which is this,
22:25which is specifically built for his bone.
22:30So this will follow the curve of the top of the femur,
22:32like a hook to put small screws in the top.
22:36Yeah.
22:36And I've made two new heads
22:39to go on my stem,
22:43which will look something like that.
22:45Okay.
22:45So if I can get the angle on this right
22:47to fit the existing cup, that's my preference.
22:50Yeah.
22:51If I have to fracture that cup,
22:54which is plan B,
22:55my plan then is to put this fella
22:59on there, bolted to the side of the ileum.
23:02Your first preference is to get it in the existing cup, yeah?
23:05That's right.
23:06If there's an 80% chance it's going to work,
23:09I'm going to leave it.
23:09Yeah.
23:10If there's a 50% chance, swap it.
23:12That's right.
23:13Okay.
23:13Yeah.
23:14All right, friends, that's it.
23:16Sorry, mate.
23:17Oh, baby.
23:19All right, big guy.
23:21Congratulations again.
23:22I totally need to get back running myself.
23:24Well, it's difficult to get in the time
23:26when you're running at midnight.
23:28Yeah.
23:28I mean, I have three businesses, six children.
23:32Holy schmolly.
23:33And I still manage, so there's no excuses.
23:35Holy schmolly.
23:35No, there is no excuses.
23:37Oh, my God.
23:38I'm just going to go in and feel inadequate.
23:40See you later.
23:40Get some time running, yeah?
23:42See you later.
23:42Bye.
23:46Joking aside, Noel has a tough job ahead.
23:49Both he and the family hope that he will not have to replace
23:52the cup of the original implant during surgery.
23:55He's in the best, he's in the best, best hands possible.
24:00If he can't fix it, no-one can fix it.
24:03No-one seems to know what he's talking about.
24:05I'm confident.
24:07I think he'd say.
24:09He does, doesn't he?
24:09Yeah.
24:12Dave will be operated on tonight.
24:14Dave, the Rottweiler, has been anesthetized for his surgery
24:31to revise a previous hip replacement that has failed.
24:39Noel first needs to see whether he will be able to salvage the original cup.
24:45OK, so it looks like the cup that is in there might work.
24:49The poly, which is the plastic liner, is still intact.
24:54I'd like to keep it in if we can, because if we have to take it out,
24:58then I'll have to fracture here and here to get it out.
25:01The remainder of the implant needs to be removed
25:04without causing further trauma.
25:07There's a lot of debris coming out now.
25:10It's just bone debris from the metal rocking around in the bone.
25:16So I've made a custom plate that's going to go down along the femur here
25:19because I'm worried that the top part of the femur may fracture off
25:24because of that big hole.
25:26Slide it down there.
25:29And it should hook over the top nice and neatly
25:32because it's made specifically for this bone.
25:34It should be rock-solid.
25:43Noel closes off the old hole with titanium mesh.
25:49Then he's ready to begin inserting the new implant.
25:54All right, here we go.
25:56It is time.
25:57Noel fills the canal of the femur with quick-drying surgical cement,
26:03ready for the stem.
26:04I need another cement on standby in case I don't have enough.
26:13Next, it's the challenging task of trying to place the new head on the stem
26:17at the best possible angle for the existing cup.
26:22So I'm setting the angle of version of the neck right now.
26:26You've got to get that right so that it hits the cup exactly right
26:31so that we get that wrong.
26:35That's game over, really.
26:39Okay, so now we're going to try and put the custom-engineered head
26:42back into this cup.
26:45I'll say a little prayer that it fits well
26:48and that we do not need to take the cup out.
26:52One thing is for sure, if I have to take this cup out of the bone,
26:55I am going to have to break the pelvis to get it out.
27:03Hold on.
27:05As you can see, it's not hitting the cup exactly straight.
27:09I mean, it's pretty solid.
27:11I'm lifting it now and it's not pulling the hip out of the socket.
27:15I think it's much better than 50-50 that it'll stay in,
27:18but I could be wrong.
27:22With the existing cup still in place, Dave is sewn up.
27:26All right, let's go get some radiographs, please.
27:30And rushed straight off to radiography
27:32to ensure Noel has made the right decision
27:35and that the revision hip surgery has the best chance of success.
27:39Hello.
27:43Hey, it's Noel.
27:44Oh, hi, Noel.
27:46Zop went fine.
27:47Yeah.
27:48I took the original stem out
27:50and then I put my new stem in there
27:53and my new head in the existing cup.
27:56So we went with plan A.
27:58Oh, brilliant.
28:00I was happy that there was a much better than 50-50 chance
28:03that it was not going to dislocate.
28:05My entire pleasure.
28:07Take care now.
28:08Bye-bye.
28:08Bye-bye.
28:09Bye.
28:11Lovely people.
28:12I cannot believe that guy has six kids.
28:14What have I been doing?
28:25Dave will be under the care of Fitzpatrick's night shift,
28:28who've taken over from the three daytime shifts
28:31and are doing their rounds.
28:33This is S.G. Bruce.
28:34He had CT and x-rays and a work-up today.
28:37He's been eating, he's urinating,
28:40and he's going to go for surgery tomorrow.
28:44The night team work really hard.
28:46They have to give all the treatments, all the painkillers.
28:48They have to check bandages.
28:52They have to feed.
28:54They have to walk.
28:55Hi, Lola.
28:56They have to do a lot.
28:57You can go for a walk.
28:58It takes a very special person to come in
29:01and be able to give the dogs all to TLC
29:04in between all the treatments.
29:05You just had a nice clean, haven't you?
29:07He's so lovely.
29:08He's a good boy.
29:11Sometimes you'll get a dog who can be aggressive
29:13or who won't settle.
29:16And in the meantime, they have to keep really quiet
29:18so the dogs can keep asleep.
29:21They really have to work on their tiptoes like little fairies.
29:23Hi, Dave.
29:31It's OK.
29:32Hey, hey, hey, hey, hey.
29:33It's all right.
29:34Good boy.
29:36Next morning, Dave is still recovering from his anaesthetic,
29:39but overnight he's been feeling confused and uneasy away from his family,
29:44and Noel has called them in.
29:48We got a call about an hour ago.
29:52Um, from Noel, saying that Dave's not happy.
29:57Although he's doing well, he's better off at home.
30:01He gets a bit scared, doesn't he, when he goes to the vets,
30:03so he can come across a little bit grumpy.
30:07So I think it's better for him to be at home.
30:10All right, buddy, you're a good boy.
30:12You're a good boy.
30:13I would not normally send a patient with this degree of surgery home
30:17at this point post-operatively,
30:19but I think that's in his best interest.
30:22He's not an intrinsically aggressive dog.
30:24He's just a little bit afraid.
30:26Okay, one, two, three.
30:27There we go.
30:28All right, big fella.
30:29Dave is sedated again,
30:31so that the team can move him safely without causing him any distress.
30:36Good boy.
30:38Well done.
30:39Okay, so...
30:42Okay, big fella.
30:44There you go.
30:45Good boy.
30:45It's fine.
30:46It's okay, buddy.
30:47It's all right, mate.
30:49Right, my friends, we're ready.
30:52Oh, baby.
30:53It's all right.
30:54Wait.
30:55It's all right.
30:55We weren't able to wipe out the inside of his dribble,
30:58because he wouldn't let us.
31:00How long will that cone need to stay on until his stitches are...
31:02Two weeks.
31:03Two weeks.
31:04This is now what he has, friends.
31:06Why?
31:07I took that implant out completely.
31:10Yeah.
31:11The problem is that the head is not hitting the cup at the angle it should be,
31:16but I can't make it that way unless I take the cup out.
31:18So does that mean it's going to pop out easy?
31:20Not necessarily.
31:22It might do, but it's unlikely.
31:23Okay, that's good.
31:24And if it comes out, we've got to replace that cup.
31:27Yeah, okay.
31:28Yeah.
31:28How confident you are, you're not going to have to see me again.
31:31With...
31:31With...
31:32Um...
31:33I would say I'm confident.
31:36I'm not 100%.
31:37No, I do, yeah.
31:39There we go.
31:40Up we go.
31:40One, two, three.
31:41Up we go.
31:41Up we go.
31:42There we go.
31:43Now.
31:43Now we're set.
31:45Yeah, yeah.
31:45You take that.
31:46Good boy.
31:47Oh, we're going home.
31:49It's your favourite.
31:50This is the dog walking car.
31:51It's his favourite car.
31:51All right, mate.
31:52You lift the front.
31:52I lift the back.
31:53You got him?
31:54Yeah.
31:54We want him to lie on the good side.
31:57That's it.
31:58And he's all set.
31:59Well done.
32:00See you soon.
32:01All right.
32:01Good.
32:01Thanks, Noel.
32:03It sounds as if it's all gone well.
32:06But I think he just wants to be at home.
32:08Yeah.
32:08Everyone wants him at home.
32:09So we're getting back now.
32:11Back in Worthing, intensive care nurse Helen has been looking after Hermes the tortoise.
32:35It's taken him 11 months to fully recover from his infected leg.
32:43They have very slow metabolism.
32:45So it's taken a long time for his back leg to heal.
32:50There we are.
32:51How's that?
32:52This is Hermes' special feed with all the nutrients he needs to help him grow and stay strong and
33:00ensure he gets all the calcium and different vitamins and things that he needs.
33:06Hermes has got a feeding tube, mainly it was to build him up to make him strong enough to get through the surgery, to make sure his bones are strong enough to take the prostheses.
33:21There we go.
33:22Yes.
33:23Yes.
33:24Hello.
33:25Yes.
33:26Hello.
33:27Yes.
33:28Hello.
33:29Yes.
33:30Hello.
33:31Yes.
33:32Hello.
33:33I'm hoping that this operation will be a good success.
33:35And it's Hermes' last chance, I think.
33:36Finally, Hermes is well enough to come in for surgery, and Helen's husband Robert has come
33:49along as moral support.
33:51Hiya.
33:52Hello.
33:53I've got Hermes the tortoise a little bit early on the plane.
33:55Oh, Hermes.
33:56The tortoise?
33:57How's he doing?
33:58Very well.
33:59Oh, can I see?
34:00No.
34:01I love tortoise.
34:03Today, Noel will fit Hermes with his three prosthetic limbs to try to give him a chance of walking again.
34:10Oh, my God, he's gorgeous.
34:15How is Hermes doing?
34:17Let me have a look.
34:18Fine.
34:19Let me have a look at the legs.
34:20Hi, mate.
34:21How are you doing in there hiding?
34:23How's his tube?
34:24Yes, that's fine.
34:26Okay, so the stumps are all healed, more or less?
34:29Yep.
34:30Right.
34:31Well, there's a very good reason why this is never done before, and that's because, number
34:35one, it's very hard, and number two, there's a very high chance of failure.
34:39So, I've designed this implant.
34:42That's the size of him.
34:44Oh, gosh.
34:46So, this is going to be incredibly difficult.
34:50Incredibly difficult.
34:52We've designed feet, which we'll consider in due course, but my main worry, to be perfectly
34:58frank with you, is that he may not make it through.
35:02It's true.
35:03Yeah, yeah, I know that.
35:04Yeah.
35:05But, you know, if it works, it'd be much better for him than the life he's got now.
35:10Yeah.
35:11So, we've got to try something.
35:14Yes.
35:15Okay, so, I'll do my very best.
35:17Okay.
35:18All right, big fella.
35:20Okay.
35:21Okay.
35:22Lovely, all right.
35:23Look after yourself.
35:24Lovely, thank you, thanks.
35:25All right.
35:26Sorry, look after yourself.
35:27I'll do my very best.
35:28Bye, Hermes.
35:29Good night.
35:30Okay, lovely.
35:31Thank you very much.
35:32You're welcome.
35:33Bye.
35:39I was quite calm before.
35:42I've got a slight finger of doubt has now raised itself and, you know, I'm very worried.
35:52Hopeful, but worried.
35:56After almost a year of dedicated nursing from Helen, the stakes couldn't be higher for Hermes.
36:03So, this is high risk, high reward stuff.
36:07Basically, it's life or death.
36:09Either I'll be able to replace all three legs and allow him to walk again or I won't.
36:17And if I can't, he's going to have two foot to sleep.
36:20Can I meet Hermes?
36:22Assisting Noel with the surgery is exotic animal expert, Neil Forbes.
36:27With reptiles in particular, when we give anaesthetic injections, we want to put it in the front of the body.
36:32Yes.
36:33You put it in the back and it goes out through the kidney before it gets around the body.
36:36It's really important to have an expert in exotic species by your side when you're doing a long procedure on an animal like a tortoise.
36:45Because their metabolic rate and their demands under anaesthesia are very different to cats and dogs.
36:51Good morning, everybody.
36:59Hello, hello.
37:01Okay, right hind implant, please.
37:06It's mine.
37:10So, the bone is exposed here.
37:12I'm going to drill a tiny hole down into its center to take the peg of the implant now.
37:17Right.
37:22Be careful I don't fracture this.
37:25It's a very, very, very delicate bone.
37:37Very poor bone holding power for these screws.
37:40They're not all as tight as I would like them to be.
37:43Okay, so we've got five little screws.
37:47Of course, all of this depends on biology smiling on us a little bit.
37:52It could fail.
37:54But so far, so good.
37:55This implant's in.
37:58All right, number one done.
37:59Two to go.
38:01Give me the right front implant, please.
38:06Got it, thanks.
38:13The bone stock's much better in this bond than it was in the other one.
38:25Much better.
38:27These screws have fantastic purchase.
38:34The third implant is finally in, and Hermes happily has remained stable throughout.
38:39It'll be brilliant if this works, Neil, won't it?
38:42It'll be absolutely fantastic.
38:45Okay, so that's as good as I can achieve.
38:48It's in the lap of nature now.
38:49We've done our best.
38:51Off we go.
38:52Yeah, go, go, go.
38:53Noel is keen to get Hermes into radiography and recovery as quickly as possible.
39:02Hello, Helen, it's Noel.
39:03Oh, hello.
39:04Well, that was a Herculean task.
39:07Right.
39:08We did manage to achieve it, but of course we're by no means out of the woods yet.
39:13No, no.
39:14Now it depends, of course, on biology, which means the bone needs to grow in and the skin needs to grow in.
39:21And, of course, that's a $6 million question.
39:25We don't know, but we've built a very nice home for Hermes here.
39:29Lovely, thank you very much, thank you so much.
39:31Take care, Helen.
39:32You're welcome.
39:33Bye-bye.
39:35Bye.
39:36I really hope we get a result.
39:39Long road ahead, though.
39:40Long road ahead.
39:41Long road ahead.
39:56Noel's Orthopaedic Referral Centre carries out an average of 20 surgeries a day.
40:00With most requiring sedation or anaesthesia, the sight of sleepy patients is commonplace.
40:13Today, it's pretty dreary outside.
40:16All right, off we go.
40:17But six-year-old Rottweiler Dave's family are looking on the brighter side.
40:22Keep going.
40:23Straight line.
40:25Great.
40:26Excellent.
40:27Good.
40:28That's what I need.
40:29Let's come back in.
40:30Dave's six-week radiographs show the implants are stable.
40:33And pleased with his obvious improvements since his surgery three months ago, Matt and Teresa are hopeful that Noel will sign him off today.
40:42All right, great.
40:43And I will have a little look.
40:44All right, big fella.
40:45Good boy.
40:46Good boy.
40:47It's all right.
40:48It's all right.
40:49Well, it's still in.
40:50Yeah.
40:51And the tissue's healing very well.
40:53Muscle mass is actually remarkably good.
40:55He's doing so well.
40:56I don't have any concerns at the moment.
40:59That's fine.
41:00Honestly, it's brand new again.
41:02He takes off down the garden when he is something...
41:04Oh, so he's already done that.
41:05I was just going to talk to you about going off lead, but I guess that's already happened.
41:08Yeah.
41:09Yeah.
41:10So...
41:11Sorry.
41:12How many weeks did he actually follow the plan?
41:14Zero weeks?
41:15The theory is, remember we said he'd go to the toilet and run?
41:17Yeah, yeah, yeah.
41:18Not done that at all since.
41:19Oh, good.
41:20Excellent.
41:21You're not afraid of your poo anymore, mate.
41:22No.
41:23That's a triumph.
41:24My job is simply just to sign you off and to give you the okay to crack on.
41:27We've got our dog back.
41:28I'm delighted.
41:29100%.
41:30That's great.
41:31Look after yourself, mate.
41:32Take care.
41:33Thanks for everything you've done.
41:34Thank you so much.
41:35Okay.
41:36Thanks very much.
41:37Yeah.
41:39Come on in, baby.
41:40Just so relieved.
41:41Unreal.
41:42To know now that he can live the rest of his life as a normal dog, run around with children.
41:51Just, we couldn't have asked for anything better.
41:53We've got our dog back, really, haven't we?
41:55Yeah.
42:08Hermes, the tortoise, now has his three prosthetic leg implants.
42:12But before Noel can fit his feet, he needs to go home and recover.
42:17Hello.
42:18Helen, come to pick up Hermes.
42:21Special tortoise he is.
42:23I'm feeling really excited at coming to pick up Hermes today.
42:26I'm a bit nervous about having to continue his care at home.
42:30I don't want anything to go wrong.
42:32So a big day today, folks.
42:34Big day.
42:35Let me get that and let me give this to the girls out here.
42:38Girls, here you go.
42:40Good, good.
42:42So this, my friends, is what we've got.
42:46It looks very strange.
42:49Now, clearly we can't put the feet on yet because we need the bone to grow on and we need to make sure that it doesn't get infected.
42:58So I'll bring him in.
43:00Naomi.
43:01There we go.
43:02There we go, Mummy.
43:03Hello, baby.
43:04Hello.
43:05Oh, gosh.
43:06I'll have to call you Peggy.
43:09Hello.
43:10Oh, hiya, handsome.
43:12Hello.
43:13Yes.
43:14So as you can see, the little stumps are quite neat.
43:17Yes, yeah.
43:18And the same on the back one.
43:19Yeah.
43:20So at the moment, I'm very happy with him.
43:22I will not be going near him with prosthetic feet until well into next year.
43:28Okay.
43:29Thank you for looking after me.
43:30Thank you for looking.
43:31Doing everything you did.
43:32It's my pleasure.
43:33It's my pleasure.
43:34So pleased.
43:42In Kent, Dave the Rottweiler is back enjoying life.
43:46So get off.
43:47Tony!
43:48With Tony and the family.
43:51Since he's recovered really well, it's nice for him to have a bit of companion.
43:55They sleep together.
43:56They do enjoy each other's company.
43:58He seems to have brought the puppy back out in him, in Dave.
44:03And the kids enjoy them both.
44:08He's probably 100% improved from what he was, or certainly from what he was going to be.
44:13The biggest improvement is just his everything.
44:15You know, he's a different dog.
44:16He's happier.
44:17He can do everything a normal dog should be able to do.
44:20Yeah, he's a lot happier in himself, you can tell.
44:23Look at him there.
44:24Yeah.
44:25You know, he's running.
44:26Walks, runs, no problem, plays.
44:27Yeah.
44:28He's just thoroughly enjoying his life again.
44:29Yeah.
44:32Dave!
44:37Good boy.
44:38Go on, Dave.
44:39Good boy.
44:40Good boy.
44:41Every so often, Noel is confronted with a case where the odds are simply stacked against him.
44:53The wounds on his leg, his leg wounds were still fantastic and healing.
44:57The last three or four days, he just suddenly looked a bit sorry for himself.
45:01So I took him to the local exotic vet and they kept him in for two days.
45:10And when I left him, I just thought, no, I think this is it.
45:14Just something about him made me think I wasn't going to see him again.
45:18I got a phone call at half past eight in the morning and he died in the night.
45:27It's difficult when we lose any patient, but myself and the team are devastated that Hermes
45:31didn't make it.
45:33His legs were doing great, but at the end of the day, he had internal organ failure and
45:39he passed away.
45:49So this is where we've buried Hermes.
45:52There's a little memorial for him.
45:57He was always quite a fighter and there we are.
46:02He couldn't fight anymore, I don't think.
46:05He fought for two years.
46:08Well, 18 months.
46:35πό deri
46:40We'll see you in the next video.
46:41We'll see you in number one next one.
46:57europé,
47:03We'll see you in the next video.
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