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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! Yes!
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 knee
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
00:50That is just unbelievable
00:52He's raring to go
00:53Against all the odds
00:55Boom!
00:56One small step for a dog
00:58One giant leap for mankind
00:59Well done
01:06It's winter
01:07And at Fitzpatrick referrals
01:09There's excitement in the air
01:11Charlotte, pay attention
01:13Deck of the halls
01:14Christmas is coming
01:16Ta-da!
01:21Oh, I think the thingy's here
01:23Christmas tree is here
01:24Oh, that's a big one
01:26Fitzpatrick's at Christmas
01:29There's always a Christmas spirit, everyone gets really happy
01:32Here we go
01:34What's in here?
01:35We open presents with them, they have stockings
01:38I think we get more excited than they do
01:40Because they don't understand it's Christmas
01:41Christmas hat
01:42I just like it all
01:43I just love Christmas
01:45Welcome
01:48Over 4,000 pets have been seen at the practice this year
01:55And as the festive season approaches
01:57The team make an extra effort to get their patients back with their families
02:02If we can get an animal home in time for Christmas
02:06Then I don't think that there's any greater gift that we could give a family
02:11In the wards this year are three dogs who everyone hopes will be home and healthy in time for the holidays
02:24Peppa
02:25Luna
02:28And Tatiana
02:31Her story began over a year ago
02:34Phil and Angie are dog lovers from Derbyshire
02:46Good girl
02:49I was on Facebook one day
02:52And I saw Tatiana
02:55And they was appealing for a foster home
02:58We'd already got eight dogs at the time
03:01And I was thinking
03:02Well Phil's not going to let me have another one
03:04But
03:05You love me don't you
03:07So
03:08We had Tatiana
03:11She was just four months old
03:13With badly deformed front legs
03:15When she was rescued from Romania
03:18What did worry
03:20The other dogs when Tatiana first come
03:24She frightened them
03:26They couldn't make sense of her legs
03:28And all she wanted to do was play
03:30But they soon got used to that didn't they
03:32Right
03:33Come on then
03:34Mrs Wibble
03:35Come on
03:36They are my babies
03:37Yeah
03:38They are my life
03:39Good
03:40Go on Missy
03:41Bed
03:42Night nights
03:43Wherever I am
03:45The dogs are aren't they
03:47It's like
03:48A shepherd and sheep
03:49Right
03:50Come on then
03:51If you go out
03:52They're sat at that gate
03:54Until you come back
03:55Yeah
03:56Yeah
03:57But if you go out and I'm here
03:59They're not bothered
04:00They're not bothered
04:06But I just love them
04:07I'd have twice as many again
04:09If I could
04:11But
04:12You can't
04:13I can't
04:14Are you alright there Queenie?
04:16Tatiana
04:17Tatiana had such a tough start to life
04:19Angie and Phil just want to do the best for her
04:22It's painful to watch her running around
04:25With her back up like this
04:34Hey, hey, scrunchy scrunchy
04:36Scrunchy scrunchy
04:37It's late summer
04:39And Angie has come to Fitzpatrick referrals
04:41With Paul and Donna from the charity Hope
04:44Who rescued Tatiana
04:46Tatiana
04:47Hello
04:48Yeah, he's ready for you
04:50Is that a pen?
04:51Yes
04:52Hi guys, hello
04:53Hello
04:54Please take a seat
04:55There you go
04:56So has anybody discussed the nature of these deformities with you so far?
04:59Not in great doubt
05:01Okay
05:02Alright, let's pop her down
05:03Pop her down there for you
05:04There you go then
05:06She has a congenital luxation of both of her elbows
05:10Meaning
05:11That the three bones that make up the elbow
05:13The humerus, the radius and the ulna
05:15Have never been in the same alignment
05:18Because these two bones slipped out of the joint
05:21Probably in utero inside the womb
05:24Hello munchie
05:25So she just gets on with it, doesn't she?
05:29She's never known any different
05:31So as opposed to her
05:32Yeah
05:33That's the way it is
05:34Yeah, that's right
05:35And therein lies the ethical dilemma
05:39I mean if for her this is the way life is
05:42Why don't we just leave her like this?
05:44Because she can't go out without really on the streets
05:50Or go walking with the rest of the dogs
05:52But is that really necessary for her quality of life?
05:56I mean she could have a quality of life just being cuddled and living in a home
06:02The amount of surgery that you would have to put her through would be huge
06:07The elbows would need to be chopped off and rotated around and put into a position in alignment for the shoulder and the wrist
06:16Which would significantly stretch blood vessels and nerves
06:20And it's entirely possible that those blood vessels and nerves might not be capable of coping with that twist
06:29And in which case the bottom part of the leg would die
06:34Clearly this little dog would be better off standing up
06:38But if you go down the route of surgery and if you fail she'll probably end up getting put to sleep
06:44I'm sorry sweetheart
06:46Do you want to get a breath of fresh air?
06:48Yeah
06:49I don't want to lose her
06:50No
06:51The risks of surgery are much higher than they all realised
06:55If there's any chance at all that we're going to lose her Paul I'd sooner stay as she is
07:02Well there's always a chance with everything
07:04I just wanted to be able to fit in with the others and do at least some of what they can do
07:11Angie must make up her mind
07:18In reception Peppa's family are hoping that she will be fighting fit in time for Christmas
07:26But first she needs a challenging spinal operation
07:30She's come because she's had lots of problems with her neck
07:33And she had a surgery about two and a half years ago but unfortunately it's gone wrong
07:38So hopefully Noel's going to fix her for us
07:43At home in Surrey Peppa has had a history of problems since Julie and Clive got her eight years ago
07:53We knew there was something wrong right from the beginning really
07:57She hasn't wanted to jump in and out of the car
07:59She hasn't wanted to jump on and off the bed or the sofa and things
08:04And when we first started taking her for a walk
08:06She would be ever so stiff when she got home
08:09And when she did have her bad times we just gave her pain relief and got on with it
08:16Peppa gradually got worse and was referred to a local surgeon who diagnosed a spinal problem
08:22They suggested that she needed to have implants in between the vertebrae to separate them and take the tension off her spine
08:30Now one of the implants has moved and is sticking into her spinal cord putting her life in danger
08:38She's a part of our family
08:40She's all we've got now the children have grown up as well
08:42Yeah
08:43So she's like, she's the baby now
08:47Revision surgery at Fitzpatrick's
08:49Hi guys, hello
08:51Might be her last chance
08:53Right, you had a situation where the diagnosis was that two discs in the lower neck were bulging and pressing on the spinal cord
09:05Yes, exactly
09:07And it was deemed at that point that they wanted to do two things
09:11They wanted to push the vertebrae apart so the bulge wouldn't affect the spinal cord
09:15And they wanted to maintain the movement by putting in an artificial disc
09:20The problem is that the artificial disc has slipped
09:23In this case you have been unlucky
09:25Because I've seen cases of this disc that have worked well
09:29So if we look at the actual images then
09:33It has overridden and slid up into the spinal canal
09:38That's a very bad situation
09:40Noel is concerned that the metal implant pressing into the spinal cord is causing damage or myelopathy
09:47Let me do a physical examination
09:49Just want to check for myself
09:51No, she's hardly able to bring that one back there, see that?
09:54Yes
09:56See how tentative that is?
09:58That suggests major long tract disease
10:01I know you can't give us a complete answer, but how awkward is it trying to get it out?
10:08Is it difficult to take out the piece of metal?
10:11Yes
10:13How am I going to do it?
10:15I'm going to scoop down in here and take out that chunk of bone
10:18And then lever that off gently
10:20What I do not want is to push that any further into the spinal canal and cause more spinal damage to the spinal cord
10:28Then I put in my spacer device
10:31So the spacer device is like an upside down Christmas tree
10:34We screw that in at exactly the right angle
10:37And then bridge those three vertebrae with two screws in each vertebrae
10:42And put the saddle clamps on and that's what it looks like
10:46The three factors that are going to determine outcome are
10:50One, that I don't get any complication when I'm taking out the other two implants
10:54Two, that I get good bone purchase with my implants so it's rock solid
10:59And three, during the first week that I haven't made the myelopathy worse
11:03Okay, are we mad doing it when she's nine years old, all of this?
11:06You're not mad
11:08You are sitting on a time bomb with that implant where it is
11:12I know
11:14Alright mate, you're coming with me
11:16There we go, okay
11:18See you later guys, thank you
11:20Before we brought her today, it was literally the next jump out of the car
11:26The next, that implant's going to split and move isn't it
11:30And then we're going to end up with the having to put her to sleep
11:33So if the worst doesn't happen then you know, it'll be great from then on
11:37It's sad because she doesn't realise that all she wants to do is run around
11:41Yeah
11:43And be like a dog
11:44Well, we've just got to wait and see
11:53Angie and the rescue charity have been discussing whether to go ahead with surgery to fix Tatiana's badly deformed front legs
12:01Hi guys, hello
12:03There you go
12:05Okay, so what's the verdict?
12:07We've got to go for it
12:09It's just a short term thing for a long term gain, isn't it?
12:12Let's hope I can get a result for you and give a quality of life that she and you deserve
12:17Okay, I think we're all on the same page
12:20Yeah, definitely
12:21Alright, big cuddles for me then
12:23Can I just kiss?
12:24See you Tati
12:26So Tati for short, right?
12:27Yeah
12:28Okay Tati, bye bye family
12:30Bye bye
12:31It was a hard decision, really hard
12:37It was very hard
12:40But we was all in agreement in the end
12:43We've got to give her a chance
12:45You know, just give her that little bit of a chance
12:48Shhh
13:06At Fitzpatrick Referrals
13:07Preparations for the festive season are underway
13:17She is so cute
13:19What a lovely tree
13:21Well done guys
13:22There we go
13:23Tatiana's family hopes she will be walking tall this Christmas
13:38She was born with badly deformed front legs
13:42And needs intricate surgery to straighten them
13:45We can see just how deformed bones are here
13:50We can see how completely dislocated that elbow is
13:53Both of them
13:57We've got to somehow try and get them back into an alignment
14:00Where she can stand up on them
14:02Without damaging the blood and nerve supply
14:05That's going to be very challenging because the muscles are all in the wrong position
14:09Alright, let's go
14:10To realign Tatiana's deformed arms
14:16Noel will need to cut some ligaments and tendons around the elbows
14:20And rotate the radius and ulnar bones through more than 90 degrees
14:25He'll drill out the elbow cartilage and pack the joint with bone graft
14:30And then fuse it solid using pins and an external frame
14:34It's a complicated procedure and it carries risk
14:46Okay, so we've cut into the joint now
14:49Just flipping out the ulna and the radius now
14:53I'm going to drill the cartilage off the radius and the ulna and try and flip it back on
14:57Noel has to cut the tendon and ligament to allow the arm bones to sit in the correct position
15:02When I fuse the elbow solid this tendon won't be needed to move the elbow anymore
15:08He uses the pins to hold the bones in their new position
15:12Then bone graft to help the elbow fuse together
15:17Okay, so now we can see that the shoulder is back in alignment with the foot
15:22The foot's rotated about 90 degrees in toward where it should be
15:27The pins are holding the ulna and the radius bone onto the humerus bone rock solid
15:35So we're just going to close this up now
15:38Noel performs the same procedure on Tatiana's other front leg
15:42Okay, so now we can see that the elbows are back in alignment roughly
15:49The feet are still facing out a bit and that's because the wrists are crooked
15:55There's not a lot I can do about that unless I want to fuse the wrist solid
15:58Which I don't want to do at the moment because I want to see what happens with the tendons and with some rehab
16:01The pins will not be strong enough to support Tatiana's body weight while she heals
16:08So Noel fixes a supporting frame to each leg
16:12We've got two frames on now, we've got two legs moving in the right direction
16:16Obviously we don't know what's going to happen with the wrists yet
16:18We'll just have to see how these respond
16:20Right, good, let's go to x-ray please
16:22In the Swiss Alps, the winter snow is already falling
16:32In the town of Neuchâtel, all the Monin family want for Christmas is for Luna, their golden retriever, to be back to full health
16:42Pascal and Veronica have four daughters and got Luna as a puppy
16:48Okay, that was me who wanted to have Luna
16:55Pascal was not sure about having a dog, he didn't want it really
17:00I was doubtful at the beginning, but of course she managed to change my mind
17:06She's mild, she's sweet, she's very affectionate
17:10She's funny
17:12Yeah
17:14But soon after they got Luna, it became apparent something was wrong
17:19We noticed that she had a problem when she was four months old
17:24Because she started limping
17:27And we've been to the vet and he gave her anti-inflammatories
17:31Up to the day when she was about five, she started limping every day
17:41And the vet here, he says, you have a disabled dog
17:46And that will be forever, we can't do anything for her
17:50Yeah, now it's really bad
17:52Because she can't walk anymore, she's in pain
17:58The only hope I can have still, to search for a cure for her
18:07Their search has brought them to Fitzpatrick referrals
18:11It's been a two day drive to get here
18:14Bonjour, how are you?
18:17Noel has been brushing up his schoolboy French
18:20Bonjour, how are you?
18:22Nice to see you, please come in
18:24OK, so I've read the history and I've had a little look at the x-ray pictures, yes
18:29So you went to your own vet recently
18:32Yeah, and he did an infiltration of cortisone
18:37Into the joint?
18:38Yeah, for the very first time
18:40And which leg was that?
18:42Left
18:43Only the left?
18:44Only the left
18:46Because it was worse
18:47Does she only ever limp on the left or does she also limp a droite?
18:51A droite or a gauche?
18:53Usually both of them
18:55Les deux?
18:56Les deux
18:57Les deux
18:59La droite est à gauche aussi
19:02And when he did the injection in the elbow joint
19:06Yeah
19:07Oh, he did a shoulder
19:08Shoulder
19:09She's got probably the shoulders, not the elbow
19:12Well, the jury is out about that actually
19:15And how did you end up here?
19:18It was because her vet in Switzerland said that he could do anything for her
19:22And I said, so I would like to go to England and ask them if they can do something for her
19:28And he said to me, they can't do magic
19:30Such a piece of advice from someone
19:33Well, no, I am not a magician, that is true
19:36But I wouldn't want to be a magician
19:38We'll try and do some medicine instead
19:41Yeah
19:42OK, we've got to have a little look
19:44Now I'm doing the test that I think may be the one
19:47So I apologize in advance if I hurt her
19:49If I hurt her
19:54OK, well done, well done
19:56Thank you everybody
19:58Now let me explain
20:00This is the elbow
20:02The reason that I believe she resented that
20:05Was that she is painful on the inside of her left elbow
20:10And I believe that it's likely that the problem is a condition called
20:15Developmental elbow disease or elbow dysplasia
20:18And effectively what happens is these bones don't fit together properly
20:24OK
20:25And that results in rubbing and cracking inside the joint
20:29So my recommendation would be we do an anesthetic, we do a CT scan
20:35Then I would suggest I stick the camera in the shoulder and look around
20:38Yeah
20:39Yeah
20:40And then we also stick the camera in both elbows
20:43And then we'll have to decide what to do
20:45OK
20:46So thank you very much for coming all this way to see me
20:49All right, à bientôt ma famille
20:52À bientôt
20:53Bye-bye
20:54Luna is anaesthetised for scans and an arthroscopy investigation on her elbows and shoulder
21:02Unfortunately it's quite common to have a situation where a dog is dropping the shoulder as they walk
21:09And it looks like a shoulder lameness when in fact it's an elbow lameness
21:14OK, here we go
21:16The CT scan already tells us that there's a massive fragment in here
21:20The clinical examination was pretty compelling
21:23So I'm not expecting good news in here
21:25All righty, so that there is worn cartilage
21:28And here is a huge fragment
21:31Very, very large fragment
21:34This really is a bad situation
21:36And we've got grade 4 cartilage disease in some patches and grade 3 in others
21:43OK, so I'm going to take that fragment out
21:45The fragment is a piece of bone that's broken away inside Luna's elbow
21:50Taking this bit out will make things temporarily better for Luna
21:53But unfortunately will not fix her
21:55Next thing I'm going to do is cut that tendon down there that pulls this piece of bone against that piece of bone
22:02There we go, cut
22:04It's like releasing the belt on the belly of a fat man
22:08It doesn't make the fat man any less fat
22:10It just makes him more comfortable
22:12The right elbow is also diseased, but not as badly
22:16Noel performs the same procedure to remove a fragment and cut a tendon
22:21OK, that's that side done
22:23We're now going to go and scope the shoulder
22:26Wow
22:28Well, something incredibly rare has happened here
22:31In actual fact, there's a problem in the shoulder as well
22:35You can see right there where the biceps tendon is actually being pulled off the front of the shoulder blade
22:43That's super strange
22:44Noel cuts the tendon off the bone, which will allow it to reattach with the scar further down the joint
22:51This should help reduce Luna's shoulder pain
22:54OK
22:56Alright, let's go ahead and wake up. Thank you
22:58Luna will stay in overnight
23:00It's been a week since Tatiana had the operation to straighten both of her badly deformed front legs
23:15She's having physiotherapy to teach her to use her newly straightened legs
23:21But at last, she's well enough to go home and continue her recovery there
23:29Today, Phil has come with Paul and Donna from the rescue charity to collect her
23:35I'm a bit apprehensive about her coming home
23:40Because from what I understand, she's going to have pins coming out of her
23:44And I'm a bit schemish there
23:47So, I don't know, we'll see
23:50Hey guys
23:51Hi
23:52So, she's doing great in terms of her psychology
23:57In terms of her physiology, who knows
24:00One of my big fears early on was would the blood vessels and nerve supply hold up
24:04And would you get effectively gangrene or paralysis of the feet
24:10Fortunately, she has feelings, she has circulation
24:13And the shoulder is now in alignment with the wrist
24:17So that looks really good
24:18Okay?
24:19Push your chairs back a bit
24:20We'll bring her in
24:26Now!
24:27Okay!
24:29Hello!
24:31Now you can see how the wrist is still coming out
24:34And you can see that it comes out because that ligament's loose
24:38So I do think, ultimately, we're going to have to fuse those wrists
24:43Tatiana is still a puppy
24:44So Noel will wait until she's finished growing before making a final decision about surgery on her wrists
24:50All right, guys, lovely to meet you, sir
24:52Thank you very much
24:53Pleasure
24:54Great to meet you, yeah
24:55Thanks for everything you do
24:56My pleasure, my pleasure
24:57All right, sweetie
24:58I shall miss saying goodnight to you
24:59I sleep here
25:00So I go up and say
25:01Watch this
25:02Night-night, tatty
25:03What do you do?
25:04Night-night, night-night
25:05And she does that
25:07You're going to miss her
25:08She's a wonderful little dog
25:09Thank you
25:10All right, I'll leave that to you
25:12Take care, guys, God bless
25:13Look after yourselves
25:16Always brilliant to have her back
25:18And she looks so well as well
25:20A lot better than I imagined
25:22And she'll be over the moon when I get home
25:24It's going to be a case of calming her down, I think
25:32It's early afternoon
25:33And Peppa the Dalmatian is facing the complex spinal surgery
25:37To remove metal implants from her spine
25:40It is a life or death situation
25:43Because we can't leave her like she is
25:45She's in a lot of pain
25:47She can't really move about her neck too much
25:49Because when she does
25:50The piece of metal that's in her spinal canal
25:52Is hitting her spinal cord
25:54And if that piece of metal from the disc
25:57Migrates more
25:58Then it's game over
25:59Because she will be paralysed in that scenario
26:02So we've got to make this happen
26:08Right, let's do this
26:09No will get access to Peppa's spine
26:13From beneath her neck
26:14So unfortunately the anatomy is very much distorted here
26:18By the new bone formation
26:20So it makes my life very difficult
26:22I can't actually see the discs
26:24I'll need goggles please
26:26So we may get some metal shards here
26:29As I try and drill
26:30Okay, I think I can finally see a little shiny piece of metal
26:40Right, this is an absolute nightmare
26:45The metal is welded in at the base of the hole I'm drilling
26:50Which is right next to the spinal cord
26:51If I take off too much bone
26:53I can't fuse the vertebrae back together again
26:55So I think what I'm going to have to do
26:57Is actually drill through metal
26:59Physically drilling titanium
27:01Nightmare
27:02Go
27:03Drip
27:04Drip
27:05Drip
27:06Drip more
27:07More
27:08More
27:09More
27:10More
27:11Big problem with producing an horrendous amount of heat
27:14That could also damage the cord
27:16This is absolutely outrageous
27:21So the problem is I've got to press pretty hard to drill the metal out
27:25And if I press too hard and poke through the other side
27:28I could paralyse her or even kill her
27:32Noel is at a crossroads
27:34Alright, we're going to need to get them on the phone
27:36Get the phone
27:37The operation is now so risky he needs Julie and Clyde's permission to continue
27:44Hey, it's Noel here
27:46I'm in the middle of surgery now
27:48It's not good
27:49This is a very, very, very difficult situation
27:52The piece of titanium from the disc is pushing right up into the spinal canal
27:58The bottom line is that I can't get this out without drilling out the titanium
28:03Because it's stuck to the bone, it's stuck to the cord, it's stuck everywhere
28:06So either I bail at this point, or I go for it, but I've got zero millimetres for error
28:13But you need to understand that she could die
28:17In the operating theatre, the surgery to remove the metal disc from Pepper's spine is at its most dangerous point
28:33The family are on the phone
28:36It's very high risk now
28:38Okay, I'll call you later
28:40Alright, we go
28:42Glasses
28:43Get all of the rescue drugs ready
28:46Have them all on standby
28:47What's the anaesthetic like?
28:49Be all over it
28:50Give me any warning
28:52Go
28:54If Noel pushes against the spinal cord, it could be fatal
28:59Okay, it's moving
29:03So I think I've got one piece ready to come out
29:06Okay, so this is one of the top pieces of the disc right there
29:12Now the other piece is the one that's really squishing the cord
29:14Right, ladies?
29:15If anything's gonna happen, it's gonna happen now
29:17Here we go
29:18Take these glasses off me
29:20Thanks
29:21Here we go
29:22We're coming up
29:24Don't move
29:26What a nightmare
29:27Oh
29:28There it is
29:29Look at that
29:31All of that was sticking up into the spinal canal and squishing the spinal cord
29:37It's taken over an hour to remove the first metal disc
29:41And there's still one more to take out
29:44Alright, here we go
29:46We're gonna drill the second disc
29:47Don't move, don't move, don't move
29:52Don't move
29:53Okay, so this one is easier to get out
29:57That's half of it
29:58This is the other half
30:00So there's all the bits we have
30:02Two big holes where we've taken out the broken discs
30:06Now we're gonna do something to hold these vertebrae together
30:09Noel fits two Christmas tree spacer devices between the vertebrae
30:14And uses saddle plates, screws and rods to hold the bones rigid
30:19Okay
30:20Now we put the bone graft in
30:23In an effort to fuse these three vertebrae solidly together forever
30:27Alright, let's stitch up
30:34Noel has been operating for three and a half hours
30:38But it will be several days before he knows if Pepper's spinal cord may recover
30:43Or if surgery has made it worse
30:46Alrighty, let's go to x-ray and CT please
30:49Good girl Pepper
30:58It's the morning after Luna, the Swiss golden retriever
31:01Had scans and an arthroscopy investigation on her elbows and left shoulder
31:06Okay, bonjour
31:07Hello
31:08How are you? Nice to see you
31:09Nice to see you
31:10The family stayed in the UK for the results
31:13In summary, there's a major elbow problem and also, Kelsa Breeze, there's also a shoulder problem
31:22Noel has treated Luna's shoulder
31:25So what I did was I just cut the tendon because it was hurting because it was pulling off
31:30Okay
31:31This will settle down with scar tissue holding it where it is
31:35But one of her elbows is still a problem
31:38We now know that the right elbow will probably settle down in the next six weeks
31:43The left elbow, it'll probably be better but get slowly worse again over the next couple of years
31:50So the decision we need to make is, do we do any further surgery on the left?
31:56In my opinion, if we are to do another operation, it would be to shift the load towards the radius away from the ulna
32:07So we cut in half the humerus and we transfer more of the weight, lo tricote
32:14Okay
32:15Yeah
32:16How much do you think she'll feel less pain?
32:18We would hope that the pain associated with the rubbing of the bone is gone
32:24Yeah
32:25But there will still be some pain associated with osteoarthritis
32:28You would do that for your doctor
32:31That would be my recommendation
32:33Okay
32:34But it's obviously up to you
32:36Come on, babe
32:37What are you doing?
32:39No
32:40Now, we have to keep this on because otherwise she will lick this
32:44Okay
32:45There's two stitches here and there's two stitches in here
32:48Alright, I think we're done
32:49Come on, Bob
32:51Up-sa-daisy
32:52Now, off we go
32:53Good
32:54Come on sweetheart, there we go
32:56Hey
32:58Well before coming here today I was a bit nervous, I was a bit frightened
33:02But now, I'm happy we've done that
33:05Oh
33:06The family are heading back to Switzerland
33:09As the Christmas holidays approach, they'll have to decide whether Luna should have another operation
33:16Right now, I have a mixed feeling
33:20I don't know exactly what we should do but what I know that I would like to do the best for her
33:26It's three days since Pepper had dramatic surgery to remove the metal disc that was sticking into her spinal cord
33:41She's already back on her feet
33:44Good girl, well done, look at you raring to go
33:48Well done, good girl
33:50Good girl
33:51Oh, well done
33:53She's doing much better than I thought she would
33:56This is fantastic, we've weaned down the pain killing drugs now
33:59She's no worse than she was before the operation which is fantastic
34:03I was really worried about making her worse
34:05But the most important thing is that she's out of pain
34:10Pepper's doing so well that Noel is sending her home
34:14This is Patrick O'Farrill's orthopaedic and neurology Natalie speaking, how can I help you?
34:24For little Tatiana, the countdown to Christmas has begun
34:28No, you can't play
34:31It's six weeks since the operation on her front legs
34:35Hello Tats, let's get down there and see you walk
34:38Now the little pup for the first time in her life is standing straight and tall
34:44God, she's really getting up on that left wrist, isn't she?
34:49Yeah
34:50Yeah
34:51She's tons better than she was
34:52Oh yeah
34:53Well anything was better than she was, wasn't it?
34:55Yeah, yes
34:57It's remarkable really
34:59Considering how bad and horrible things were
35:02Well we never dreamt she'd ever be like this
35:04Well done
35:05You're motoring now, aren't you?
35:07Different dog
35:08Happy
35:09Different dog
35:10Okay
35:11Come on mate
35:13Come on
35:14That's fantastic
35:16Well done
35:19Tatiana is taken through for scans
35:22If the x-ray pictures show that the elbows are sufficiently fused
35:26Noel will remove the rest of the frames
35:32Okay, so this looks pretty solid
35:34We can see the elbow on the right hand side is fused very well
35:37There's no lines of the joint visible anymore
35:40The frames can come off
35:43But Noel is still concerned about Tatiana's right wrist
35:47The foot is slightly out to the side and knuckles over a bit because the tendons are weak
35:52I might have to fuse it in the future
35:54The left wrist is excellent
35:56It's actually in a really good line
35:58And it's good footfall
36:00I'm stunned by that
36:01I'm stunned by that
36:02Because this is really accommodated well
36:04Considering this leg was a flipper and sticking out to the side originally
36:08Good girl
36:09I'm very proud of you
36:10Well done
36:13Now, Tatiana's family please
36:15Yeah
36:18Hi guys
36:19I have good news for you
36:21So
36:22Bottom line
36:23I think the elbows are fused enough to remove the frames
36:26Right
36:27Yeah
36:28That's the most important thing
36:29So are they off now then?
36:30Yes
36:31Oh right
36:32Or should we be pleased?
36:33Yeah, she'll be delighted
36:34I have to say I'm overwhelmed with how good the feet have remodelled with the growth
36:41It's been quite extraordinary
36:43I mean, I did it and I'm impressed by it
36:45Yeah
36:46Yeah
36:47On the left, they're pretty much normal
36:49I mean, extraordinary
36:50And on the right, the flexor tendons are fine
36:53It's the collateral ligament that's loose
36:55Right
36:56So the wrist is, if you hold it there, it's straight
36:59And if you don't hold it there, it goes out
37:01Because the collateral ligament's loose
37:03My gut feel is we should fuse it
37:05Yeah
37:06Right, Hannah
37:08Hey, yo
37:09They're going to, yeah, be very careful
37:13Because she's just had her pins out
37:15Right
37:16So she's going to be super sensitive
37:18Lovely, thank you so much
37:19Well done
37:20My pleasure
37:21My pleasure
37:22Please, God, watch out for your glasses there
37:23Look after yourself, mate
37:24Thank you so much
37:25Thank you
37:26All right, guys, God bless
37:27Take care
37:34We're on tentacles, really
37:36I'd be frightened to death
37:38Of someone going wrong now
37:40Tatiana's transformation has been remarkable
37:43But she still faces another surgery
37:46To fuse her right wrist
37:48At Fitzpatrick referrals
38:01Some of the patients will be spending the holidays in the wards
38:15We try and make the animals feel like they're at home
38:17Because when they're away from their families at Christmas
38:19It can be quite sad for them
38:21So we give them extra cuddles
38:23Extra laugh
38:24Kisses
38:25Hi, my baby
38:27Hi
38:28Hi
38:29Peppa is in for a check-up six weeks after her dramatic neck surgery
38:47She's still showing some pain
38:50So Julie and son Adam have asked Noel to do further scans
38:55There we go
38:56Good girl
38:57Hiya
38:58Hi
38:59How are you doing?
39:00How are you doing?
39:01Everything is fine in terms of the neck
39:02Oh good
39:03The implants are all fine and have integrity and everything's fine in that department
39:12And you can see there where the bone is physically growing through the implant there
39:16Though that whole segment from here to here to here is now solid
39:21Brilliant
39:22Okay, so I'm happy with the neck
39:24Okay
39:25The scans have highlighted another problem
39:28Oh my goodness
39:29This is the MRI scan from today on her lower back
39:33The disc in her lower spine is dramatically dried out here
39:36Right, okay
39:37If we take a close-up look at that
39:39You'll see here where the disc is bulging upwards
39:42Yeah
39:43And the top of the vertebrae is going downwards
39:46Okay
39:47Now even more importantly
39:50You've got compression on either side as well
39:52Yeah
39:53With the L7 nerve roots that give rise to the sciatic nerve
39:57So she's got bilateral sciatica
39:59Oh, okay
40:01So we only have three options
40:04Oral medicine or injection medicine
40:06Physiotherapy or surgery
40:09It was just really hard seeing him in so much pain
40:12She's come so far and she's done so well
40:14Well, it's whether we go through surgery on the lumbar sacral spine
40:18I want to
40:19The risks are as you stretch that open like so
40:23You may get tethering of these nerves to chronic scar tissue
40:27Down there in that hole
40:28And sometimes they stick down
40:30So when you stretch them
40:31They can get what's called neuropraxia
40:34I do think that she is a candidate for this
40:37Because I think she's in quite a lot of pain
40:39She defied the odds before
40:42Yeah, she did
40:43And she's a real fighter and she deserves it
40:45Okay, yeah, that's fine
40:47Thank you
40:48Thank you
40:49Thank you
40:53To try and get Peppa out of pain
40:55Noel is placing a third Christmas tree spacer
40:59This time in her lower spine
41:01To push the vertebrae apart
41:03And take the pressure off the nerves
41:05Give me another 3-5 drill bit please
41:09Then he stabilises the joint between her vertebrae
41:13Okay, we now have one screw on the right and on the left
41:18On each of the L7 vertebral body and the sacrum
41:21And on each side the C-shaped clamps
41:24Are linked together by a dumbbell here and a dumbbell there
41:27Locked down with knots
41:28So we now have a very rigid construct
41:31Hopefully the nerves will recover fairly quickly
41:36Right, good, let's go to x-ray please
41:40In the Swiss Alps it's already a picture postcard Christmas
41:50Luna had the further operation on her elbow
41:56And now she's able to enjoy the snow
41:59When you see her running, excited
42:02She really enjoy life
42:03Now we can see the difference, really
42:05Yes, it's a great time now
42:07Hey, Luna
42:10She can be happy and run around
42:12That's what she can do now
42:14But she couldn't do before
42:16It's good, Lulu
42:17It's good, Lulu
42:18Lulu
42:19Snow is a playground
42:20She likes doing holes in the snow
42:25She's full of energy, full of joy
42:27Much noisy
42:31She's happier than before
42:32Because she's not in pain anymore
42:41At home, the family have their companion back for the holidays
42:45She is our Christmas present now
42:53Her recovering is really a present
42:55Cherche
42:56Cherche
42:57Cherche
42:58I think she had a second chance in her life
43:02Now she can be a dog like the other ones
43:06Play
43:07And run
43:08And be happy
43:10And be happy
43:17Peppa
43:18In Surrey too, festive preparations are underway
43:23Peppa has recovered well from her latest surgery
43:27She's out of pain
43:28And finally can enjoy Christmas
43:30Much to the relief of Barney
43:32The family's other dog
43:35They haven't been able to play together for a long time
43:38And Barney hasn't really understood
43:40Why she won't play with him
43:42So it's just so lovely to watch them playing together now
43:44Puppy-like
43:45She's nearly ten and she thinks she's a puppy
43:48Fantastic to see her like she is now
43:50She's just so happy
43:51It's been several years since Peppa could enjoy running in the woods
43:58Come on
44:00Good girl
44:01We've never really known her to be this agile
44:04And being able to run around like this
44:07She loves being outside
44:09And going through all the bushes and around the trees
44:13Look how happy she looks
44:15Peppa
44:16It's something that other people take for granted
44:18You take your dog for a walk and you let them loose
44:20But now we can do that too
44:22And see her running around and having a whale of a time
44:24Peppa
44:25This way
44:26Come on
44:27I don't have any regrets
44:28I'm very glad that we went through it all together
44:30Come Peppa
44:31Let's go home now
44:36In Nottingham
44:37Come on good girl
44:39Tatiana is having hydrotherapy
44:43In the end
44:44Noel did have to fuse her right wrist
44:47Swimming is helping to strengthen her front legs
44:51Thanks ever so much for that Steve
44:52You're welcome
44:53Bye
44:58It's been a long journey from Romania
45:00Where she was rescued from the streets as a disabled puppy
45:03But now she's back home with the pack
45:06And ready to be spoilt at Christmas
45:08Tati's doing really excellent now
45:10She'll never be a ballerina dog
45:11She'll always throw her legs out
45:12Noel expects her
45:13She's happy
45:14Just clumsy
45:15It don't bother her at all does it?
45:16Nothing bothers her
45:17There you go
45:18The journey to get from there to here has been
45:19Time consuming
45:20Yeah
45:21Heartbreaking
45:22Heartbreaking
45:23Come on then everybody
45:24Backbreaking
45:25Backbreaking
45:26Oh look here
45:27Before the operation she was walking on her elbows
45:29She couldn't go on anything hard
45:30It had always got to be soft
45:31Well she could go on her legs
45:32Just clumsy
45:33Just clumsy
45:34It doesn't bother her at all does it?
45:35It doesn't bother her at all does it?
45:36No
45:37Doesn't bother her at all does it?
45:38No
45:39It doesn't bother her
45:40There you go
45:41The journey to get from there to here
45:42There you go
45:43The journey to get from there to here
45:45Has been
45:46Time consuming
45:47Yeah
45:48Heartbreaking
45:49Come on then everybody
45:50Backbreaking
45:51Well she can get everywhere now
45:53Yeah
45:54She's got more freedom
45:56Come on then tat
45:57This Christmas will be her first Christmas of her life
46:00Pain free
46:01Good girl
46:02And doing what she wants
46:03Good girl
46:04Good boy
46:06Good girl
46:08Good boy
46:09Mrs Wibbles
46:11She is one of the family now isn't she?
46:15She is
46:17And that's her
46:18No more dogs
46:19And this is
46:20Recorded
46:29Back at Fitzpatrick Referrals
46:31Another year is over
46:34Here we go
46:35Three
46:36Two
46:37One
46:38Yay
46:39Merry Christmas
46:40Merry Christmas everybody
46:42Merry Christmas
46:43Merry Christmas
46:48Are you ready?
46:49Yay
46:50Merry Christmas everybody
46:53Where's my present?
46:55Where's my present?
46:56Yeah
46:57Where's my present?
46:58Yeah
47:25Where's my present?
47:26Look at the
47:26noses
47:27And we'll thank you
47:28Who's
47:32How you want to do it?
47:33Yeah
47:34We're all right
47:35To bless you
47:36Even if you leave
47:37You're leaving
47:38There's no room
47:39I don't know
47:40You have to leave
47:41You're loving
47:42They're all right
47:43You're going to do it
47:44No
47:45And we're not
47:46You're not
47:47You're not
47:48You're not
47:49You're not
47:50You're not
47:51You're not
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