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00:01One, two, three, whoa!
00:05Hello mate, you understand Irish?
00:07Animals from all over the world
00:09Ah, bonjour!
00:11Come to see one extraordinary man
00:14who's known as the Bionic Vet
00:16High five!
00:17Yes!
00:18Professor Noel Fitzpatrick
00:21We 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, a 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
00:55That 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
01:10Pets of every shape, size and variety arrive at Fitzpatrick Referrals for the specialist treatments they offer
01:17This morning, Wren, a six year old Terrier crossbreed, is in urgent need of help
01:24I've brought Wren in today because the dog ran up to her and attacked her and bit most of her front foot off
01:32She runs like a mad thing and I think he just saw it as some sort of prey item
01:37Wren's injury is severe and Julie's own vet suggested taking her leg off but she wants to investigate other options first
01:46We've come to see whether she can have an implant rather than a complete leg amputation
01:51At home near Dunstable Julie runs a rescue centre
01:58Come on
01:59And kennels
02:00Come on scary
02:01I came here 25 years ago and it was just a boarding kennel then
02:06Hello
02:07Hello
02:08But in 1999 we started taking the stray dogs for one council, we now take for two
02:13And because many of those dogs don't get claimed we set up a rehoming charity
02:18We home just over 200 dogs a year
02:21I've always been a dog lover
02:23Come on young man, go to bed
02:25The rescue has taken over my life now so I can't actually ever retire probably but
02:31It totally gets under your skin
02:33Julie has a big heart
02:37She now has nine dogs of her own
02:40We had settled at six for quite a long while but the last three were completely unhomable
02:45And if they hadn't come to us they'd have stayed at the kennels for the rest of their lives
02:49So we had them
02:52Wren is a rescue dog who had a tough start in life
02:56Wren was found as a stray sitting in amongst a whole load of rubbish in the field
03:01When she was round about five months old
03:03She was actually in fairly good condition but not very confident
03:07It's a little bit intimidating being lost when you're such a tiny baby
03:13Julie has come to Fitzpatrick's hoping Noel may be able to give Wren a bionic implant
03:18To replace her badly damaged foot
03:22Hi there
03:23Hello
03:24Hello I'm Noel, how are you doing?
03:25What's your first name? Julie
03:26Julie please take a seat
03:27Thank you
03:28Hi
03:29How are you?
03:30Hi fluffy head
03:31She could be happier
03:32Yeah I can imagine
03:33Okay so I hear from the report that another dog attacked her
03:37Yeah
03:38I'm sorry about that
03:39Okay
03:40So the x-ray pictures that they have sent through show that the paw is gone from here down
03:47Yeah
03:48Okay so the end bit has been ripped off
03:51So it's entirely possible to give this dog a new foot
03:55Yeah
03:56That doesn't make it morally right though
03:58For me, we could take the leg off
04:01Right
04:02Because she's small, she is probably going to be just fine on three legs
04:08No I do get that
04:09But she's always one of the ones that's out front when we're on a walk
04:12Let me see a walk
04:13Let me see a walk
04:14And I'll have a little look myself
04:16Good girl
04:17Have a little walk around there
04:19Well done
04:21Well done, Baba
04:25Good girl
04:26Look
04:27She's very cute isn't she
04:29She's a sweet little dog and she's got a super temperament
04:31Yeah
04:32Boop, boop, boop, boop, boop
04:33Boop, boop, boop, boop
04:34Yeah she's super cute
04:37But that aesthetic shouldn't sway us
04:40No, no, no, no
04:41And they haven't at all
04:42Yeah
04:43Absolutely don't come into it
04:44But she's what halfway through her life probably
04:48So she's got quite a lot of years ahead of her
04:50I would be very reluctant to recommend a limb amputation prosthesis
04:57Which is skeleton anchored for her
04:59Because we would put her through an awful lot
05:02And she would probably be fine on three legs
05:04Yeah
05:05Okay, that's fine
05:06I mean, I will always go with what you say
05:08And what about a suction cup prosthesis?
05:10Have you considered that?
05:11Do you know I haven't really looked at those?
05:13I think that might be something we would consider for her
05:16Uh-huh
05:17Noel suggests creating a prosthetic foot for Wren that's removable
05:21Rather than one that's fixed permanently
05:23If you're prepared to try it
05:25I'll work with our human prosthetist friends
05:27And we would try and make a stump socket prosthesis
05:30That would be amazing, I'd love that
05:31Let's do that
05:32Let's try that
05:33And let's see how you get on with a little socket on there, sweetie pie
05:37Pleasure to meet you
05:38Yeah, you too, thank you
05:39Look after yourself
05:40I will take care of this little one
05:41My pleasure
05:42We'll do our very best
05:43That went really well
05:44I'm ever so pleased
05:45We've ended up with a different plan
05:47To the one that I was originally expecting
05:49But I'm very, very happy with it
05:51And I think for her it's even better
05:57It's Patrick O'Farrill's orthopaedic
05:58And Roger Natalie speaking
05:59How can I help?
06:00No, no
06:02No
06:03No
06:04No
06:05No
06:06Nole's next patient
06:07Is at the other end of the scale
06:09Yeah, she's spotted the life
06:11Tallulah the Newfoundland is five
06:14And weighs over 70 kilograms
06:17But over the past six months
06:19She's been suffering from lameness
06:21That no one can resolve
06:23So Carla and Steve have been referred to Noel
06:26To see if he can find out the cause
06:28We'd like to know what it is
06:30Or what's caused it
06:31Because she wants to play
06:32But she can't play
06:33Because she's in pain
06:34And she's just down
06:35It's not her
06:36She's not a dog that's down
06:37She's always a dog that's really bubbly and lively
06:39Tallulah means well to me
06:40Without her
06:41Erm
06:42I don't know what I'd do
06:43So
06:44I'm really dreading today actually
06:46Sorry
06:47It's been a 200 mile trip for Carla and Steve
06:49From their home in Wakefield
06:50Oh, I know, I know
06:51Tallulah is an emotional support dog for Carla
06:54Who suffers from dissociative identity disorder
06:56Which means she has multiple personalities
06:58It's mine, it's mine
06:59Stress can trigger a change
07:01I've got eight different people inside me
07:03I have to be able to do
07:04It's been a 200 mile trip for Carla
07:05It's been a 200 mile trip for Carla and Steve
07:07From their home in Wakefield
07:08Oh, I know, I know
07:09Tallulah is an emotional support dog for Carla
07:11Who suffers from dissociative identity disorder
07:12Which means she has multiple personalities
07:14It's mine
07:15It's mine
07:16It's mine
07:17Stress can trigger a change
07:19I've got eight different people inside me
07:23I have children, I have men
07:26I have an old lady
07:27As I'm not in control of them
07:30At any one time they can be violent
07:32Or they can be a six year old child
07:36Who's very vulnerable
07:38And Lulah will come along
07:40And she'll interact with each one differently
07:42Depending on who they are
07:43When Carla switches to Lulah
07:46We'll recognise when she's switching
07:48She'll go up and she will help her
07:50With the children she's very soppy
07:52She's playful
07:53But with the mean men
07:55She really barge into you
07:57And it's a full force jump
07:59To try and get them out and me back
08:03I know that Tallulah will protect Carla no matter what
08:06And Tallulah's given Carla that push
08:08You know, a little bit of extra freedom
08:10She's been part of the family since she was a puppy
08:13We met her at two days old
08:17So we've just had that process of knowing her
08:20And loving her and letting her bond with us
08:22She's such a lovely, loving dog
08:27She is everything to me
08:30I'm hoping when we see Noel
08:33That he actually finds out what is wrong with her
08:35Because she can't keep carrying on in this sort of pain
08:39Other vets and specialists they've seen
08:46Suspect Tallulah may have a tumour in her leg bone
08:49But so far all the biopsies that have been done have come back inconclusive
08:53Come on
08:55Hiya
08:56Hello
08:57Hi
08:58Hello
08:59How are you doing?
09:00Hello
09:01How are you? Nice to see you
09:02Nice to see you
09:03What's your first name please?
09:04I'm Carla
09:05Carla
09:06And you are?
09:07Steve
09:08Steve, great
09:09This is my colleague Laura
09:10Hi
09:11Okay
09:12And this is a big brown bear isn't it?
09:13Yeah
09:14Yeah
09:15Now then, I've spoken to my colleagues over at our sister hospital
09:17And I know that they've been trying to work up what's going on
09:20First thing I'm going to do is we're going to go outside
09:23I'm going to take a little walk so I can have a look at the gait pattern myself
09:26Come on babe
09:28First things first, go down to that red wall
09:31And walk up this way for me
09:33Go on
09:34Tallulah has already been diagnosed with hip dysplasia
09:37But the latest problem is with her front leg
09:41Good girl
09:43Good girl
09:45All right, no
09:46No, no, no, no
09:48Stop
09:49Okay
09:50I'm sorry guys, but I had to do that
09:52Okay, let's go back in
09:56All right, now
09:57There's no question unfortunately that that's painful
10:00But I have to say
10:02Based on what I'm seeing there and on the imaging so far
10:05That in my opinion
10:07It's likely to be a tumour
10:13The dilemma we have is we can't get a big enough biopsy sample
10:16To definitively tell what it is without cutting it out
10:18Yeah
10:19But if this is a primary osteosarcoma and it could be
10:23The median survival time is only 11 months
10:26Yeah
10:27So that means she could die of cancer elsewhere in her body within a year
10:31Best of next year
10:32Best of next year
10:34All right, Baba, relax, relax
10:36I can see she's very attached to you and you to her and I understand that, that's normal
10:41The last CT scans of Tallulah's leg were taken a month ago
10:45So Noel wants to perform an MRI with a powerful scanner
10:49To have a look at what's really going on inside the bone
10:52And what may have changed since then
10:55Everything hinges on what this MRI says
10:58It's vital
10:59Leave it to me
11:00Okay, off you go sweetheart
11:02Off you go
11:03Good girl
11:04We need an MRI of the humerus
11:11We're a little bit scary
11:14All right, come on
11:15Okay
11:16Carla and Steve are going to wait for the results
11:20We thought, you know, the cancer thing was pushed to one side and it was something else
11:24But now the cancer's back on the table, which is kind of shocking
11:28I've just got to think of Tallulah in the long run and her quality of life, sorry
11:37Yeah
11:38Yeah
11:49The MRI results are back for Tallulah the Newfoundland
11:53Hi guys, please come in
11:56Sorry about the delay
11:58I wanted to be as confident as I could before I give you news
12:01Look, I'm just going to level with you
12:03I'm pretty convinced this is a tumour
12:05Okay
12:06Jesus
12:07Hi
12:08That's my opinion
12:09I am going to get other people's opinions
12:11I'm going to talk to my colleagues
12:12I know that this has dramatically changed since we had our tumour conference last week
12:19The minute I saw the dog, I'm like, this is too painful to be anything other than tumour
12:23The problem you've got is it's been growing inside the bone, you see
12:26Okay
12:27And nobody could tell
12:28Because every biopsy they took was inconclusive
12:30And I'm sorry, but I'm 99% sure that that is a cancer
12:35Because on the MRI scan, what you can see is this
12:38You can see this lesion growing inside the marrow cavity
12:44And you can see quite clearly how far up it's extending and how far out it's extending
12:49And it's the ubiquitous nightmare of intraosseous tumours
12:53Terribly difficult to pick up until they explode
12:55And this volcano has only erupted in the last week
12:58Yeah
12:59And that's been your problem
13:01And you've searched high and low for six months to try and find this
13:04And you couldn't have done any more
13:05You can't beat yourself up
13:06Nobody could have done any more because it's inconclusive
13:09Yeah
13:10So you've done your best
13:11The only bit of good news is that as yet
13:13The tumour hasn't dramatically infiltrated the soft tissues
13:17I'm really sorry, I know that it's heartbreaking for you
13:20But we now are going to have to talk about options
13:23Okay
13:24All right, Ian?
13:25Mm-hmm
13:26You okay for me to continue?
13:27Mm-hmm
13:28So now we've got the moral and ethical implications of the three options
13:32Euthanasia, full limb amputation, or limb salvage
13:37Limb salvage would mean saving the leg by cutting out the tumour and the bone around it
13:42And replacing it with a metal implant
13:45Now that is all doable
13:47And given the fact that the chest CT is still negative
13:50We could do that
13:51But bear in mind that even if we save the leg
13:54It's possible she could die in six months
13:57Or who knows?
13:58Yeah
13:59I guess the fourth option is we just keep her going on painkillers until that fractures
14:03Or until it's a disaster zone
14:05Yeah
14:06The thing is you do not need to decide now
14:09But you do need to decide soon
14:12Decided
14:13It's all right
14:15It's all right
14:16Right, no, no, that's fine
14:17I don't want to in any way influence your choice
14:21It's your decision
14:22If you can do it for us, please
14:26Well, I can do my best
14:28But I still could fail
14:29That's okay
14:30You're a lovely girl
14:31Thank you
14:32You're a nice guy
14:33And I'm really, really, really sorry, okay?
14:35Thank you
14:36I'm really sorry, I know it's tough
14:38Thanks a lot
14:39Cheers
14:40It will take two weeks for Tallulah's 3D printed implant to be manufactured
14:44In the meantime, she's been given painkillers
14:47And what can we do?
14:50We can take this leg off, we can put her to sleep
14:53Or we can try and save her leg
14:55If we take the leg off, she'll have great difficulty getting up because of her hip arthritis on both sides
15:02Or rocking a hard place
15:05I'm just devastated
15:08Every day with her is going to be a bonus
15:11Come on Tallulah, good girl
15:13Euthanasia was not an option
15:15Palliative care, you know, yeah, we could do that, but it's unfair
15:19I wouldn't want it
15:20The only other option was leg salvage
15:22You know, we wanted to be happy and out of pain
15:24At the end of the day
15:26Out in the prep area, little Wren is due to have the surgery to amputate her foot
15:40Noel is worried about infection
15:43I've seen what the x-ray picture looks like
15:46And unfortunately the other dog bit the foot off
15:48So it's probably going to look pretty ragged down here
15:51Yeah
15:53Okay, so it's fairly straight forward
15:57I'm going to chop it off here at the wrist
15:59Get above this area of infection
16:01Make a little stump
16:03And then we get a little stump socket prosthesis that we may be able to use
16:06Alright, that's fine, clip up, go to theater, thank you
16:18Alrighty
16:19We're going to keep skin enough to cover the stump
16:23To reduce the risk of infection, Noel cuts well above the damaged area
16:28I want to leave as much skin as I can
16:31I've left the top row of carpal bones on there
16:35It could be argued that that will provide more cushioning
16:38Because we're leaving the stopper pad on here
16:41We're going to leave as much limb length as we can
16:43And I'm going to see what we can get
16:45With the foot removed and skin and tendons stitched over the stump
16:49Noel needs to take a cast of the lower leg
16:52So I'm going to make a little boot out of this casting material
16:57And this is going to set solid
16:59And that will give us an exact fit for a stump prosthesis
17:03So that's our cast that we can make a little mould out of
17:09Alright mate, are you under there?
17:12There you are
17:13She's such a sweetie pie
17:14She's really cuddly
17:16I'm pretty confident that I've got all of the infected tissue removed now
17:20And hopefully this will just settle down
17:23Okay sweetie pie, wake up, good
17:26Ren will spend the next few days in the wards
17:29While she recovers from the operation
17:33Do you want a little pillow?
17:35There we go
17:37Hey
17:38In reception, Claire and her mother Liz have brought in Dave, their young French bulldog
17:59Dave has a painful spinal deformity that's making his life a misery
18:05Sometimes he just sort of sits there and just doesn't want to move
18:09It's horrible to see and especially when he cries out in pain
18:12You just, it's not very nice to see at all
18:15Today he's booked in for surgery with Noel
18:18Hopefully it all works and we can have him back and running around in the future again
18:24But yeah, I'm nervous
18:29At home in Hampshire, Dave's quality of life has steadily been getting worse
18:34He started having problems quite early on
18:38He had to come out with me on walks
18:40And in the evenings he had to get up and then he'd yell and cry out in pain
18:46And I could throw a bit of cheese, ham, you know, any morsel
18:50He just wouldn't move for it because it was just too painful for him
18:55Claire took him to see her local vet who diagnosed the lower spinal problem
19:00Dave used to do agility, obviously because of the problem that's arose with his back
19:06We've stopped doing that, but he absolutely adored it
19:09He was, he was pretty fast at it, I mean I had trouble keeping up with him
19:13Claire's two dogs are her constant company
19:16My husband works abroad for three and a half months at a time
19:20Comes home for 18 days and then goes for three and a half months
19:25Thank you, thank you
19:27Maisie and Dave, just my absolute world
19:30Everything revolves around them, definitely my closest companions
19:34Good boy!
19:36Dave's very young, he's just over a year old
19:39So, for a dog of that age, not able to do what he wants to do, what he can do
19:47It's quite hard to think, gosh, this could be the rest of his life
19:54Dave's already been assessed at Fitzpatrick's and given medication
19:58But because he's still in pain, he's been booked in for surgery with Noel
20:03You're gorgeous, aren't you mate?
20:05Alright
20:06OK
20:07Hey mate, how are you?
20:08Ohhhh
20:09Ohhhh
20:10Ohhhh
20:11Ohhhh
20:12Ohhhh
20:13You alright?
20:14Beautiful dogs, but unfortunately genetically
20:16Yes
20:17In the spinal department not so good
20:19No
20:20And unfortunately we see an increased instance of this now in this breed
20:23Yeah
20:24And this breed is growing in popularity all the time
20:26Tell me what the clinical signs are
20:28Basically when he had a good whom with his mate
20:31Come back, slept and got back up
20:34That's when he used to yelp out in pain
20:37Stop, pull up
20:40We done agility
20:42Agility?
20:43Yeah
20:44So he was intended to be a champion
20:47He was, he was on that route, bless him
20:49He really was
20:51Alright, well let's have a little look at him
20:53Arse towards me, please
20:55We know from the scans that we've already taken
20:58That he has a deformity right here
21:00Yeah
21:01And I'm just going to check his nerves coming out of there
21:04Yeah, he's quite sore
21:08Dave is being affected by two things
21:12A genetic malformation of his sacrum and lumbar vertebrae
21:16Plus excess bone where the nerves travel to his legs
21:19It will require delicate surgery
21:24So in order to plan what we're going to do
21:27Because this is a very complex deformity we've made his spine
21:30The plastic model was created by 3D printing from a CT scan
21:35It will help Noel navigate through this difficult operation
21:39The deformity is pronounced
21:43And there's significant encroachment of the nerve canal
21:48You can see how narrow that hole is there
21:50Nothing there is there really
21:52So there's no room for the nerves at all
21:54As you can see
21:55And that was only going to get worse
21:57That is going to get worse
21:58So we have a very clear option
22:01We either leave him with the painkillers
22:03Or basically we've got to make that hole bigger
22:07And stabilise it by putting pins and cement in
22:11That's a big job
22:13And there's three possible outcomes
22:16Outcome one, it works great and he's out of pain
22:18Outcome two, something bad happens to the nerves in the surgery
22:22And he ends up paralysed
22:24And outcome three is somewhere in between
22:27He doesn't end up paralysed but he's still in pain
22:30The problem with this surgery is that it is high risk
22:33Yeah
22:34And there's no getting away from that
22:36Unfortunately
22:38Hi big fella
22:40Hi mate
22:42Hi
22:44We knew he was bad
22:49But didn't probably realise he was that bad I guess
22:54It was major risk and you know
22:56It could end up with him paralysed
22:58We really hope not because we just want the best for him
23:00We want to make him better
23:02And that's why we've, you know
23:04That's why we've done it
23:05Fingers and paws crossed
23:07Alright guys, did I know something about this David?
23:12Nice to meet you
23:13Are you the artist?
23:14I certainly am
23:15Oh wow
23:16He wanted to do a representation of your logo
23:17Oh I see
23:18I knew nothing about it
23:19Yeah
23:20That's amazing
23:21Wow
23:22Wow
23:23He's got a bionic leg on there
23:24That's very nice
23:25Two weeks after their first consultation with Noel
23:28Carla and Steve are back with Tallulah
23:30She's having surgery to cut out her tumour
23:31Hello Carla, how are you?
23:32And replace the bone with a metal implant
23:33Nice to see you
23:34How has she been?
23:35Yeah she's been fine
23:36Hello babe
23:37That's great
23:38Let me have a little look
23:39That's growing isn't it?
23:40You can feel that bump
23:41So it's massive now
23:42Nice to see you
23:43How has she been?
23:44Yeah she's been fine
23:45Hello babe
23:46That's great
23:47Let me have a little look
23:48That's growing isn't it?
23:49You can feel that bump
23:50So it's massive now
23:51As far as I can spread my hand
23:52There
23:53That's all tumour
23:54Okay
23:55Wow
23:56This is a massive surgical undertaking
23:57Noel plans to remove the entire tumour in the humerus
23:59He'll cut out more of the tumour
24:00He'll cut out more of the tumour
24:01He'll cut out more of the tumour
24:02He'll cut out more of the tumour
24:03Hello Carla, how are you?
24:04Hello Carla, how are you?
24:05And replace the bone with a metal implant
24:06How are you?
24:07Nice to see you
24:08How has she been?
24:09Yeah she's been fine
24:10Hello babe
24:11That's great
24:12Let me have a little look
24:13That's growing isn't it?
24:14You can feel that bump
24:15So it's massive now
24:16As far as I can spread my hand
24:18There
24:20Most of the bone from the shoulder joint
24:22To just above the elbow
24:24Then fuse the shoulder joint solid
24:26And replace the humerus
24:28With a custom designed 3D printed implant
24:32My major worry is first of all getting it done
24:35Because it's a big long operation
24:37Yeah
24:38And secondly tumour recurrence
24:41I'm really worried about that
24:42I'm worried about
24:43Yeah
24:44And I guess the last thing to say is
24:46She will die anyway from tumour spread
24:49Okay
24:50No matter what we do
24:51So I'm definitely worried going into this
24:53And we could lose
24:54But we'll give it everything we've got
24:57Okay it's a big day
24:59Alright then guys, big cuddles
25:02Thank you now
25:03You're welcome
25:04I'll do my very best
25:05Thank you
25:06Off you go sweetheart
25:07There we go
25:08Right guys, God bless
25:10Bye bye
25:11Thank you
25:12Thank you
25:13Thank you
25:14Come on this is
25:15Come on
25:17Come on
25:18Come on
25:19Come on
25:20Come on baby
25:21In the prep area, Tallulah is being readied for major surgery
25:36This is a very challenging procedure
25:41It's going to be difficult to get all the tumour out
25:43It's going to be difficult to get the implant in
25:46And at the end of the day we may not succeed
25:49Okay let's do it
25:55Incision
25:56Obviously this is a very invasive procedure
26:01We're chopping from the top to the bottom of the humerus
26:04The tumour is in the humerus bone
26:08To remove it, Noel must first take the bone out of the shoulder joint
26:14We've got to be very careful at this point
26:16Because we're coming in towards the major blood vessels of the arm
26:19If we hit those, we cut off the blood supply to the bottom of the arm
26:23Which would mean a full limb amputation
26:29Okay so my finger is hooked around the tumour now
26:32I'm going to cut it out
26:36Okay so that's our tumour
26:46The family have already decided that they do not want a full limb amputation
26:50So for them it's either a limb salvage or euthanasia
26:53And therefore I'm going to try and do my best to save this leg
26:57But they've got to know that there may already be tumour further down
27:01And I can't be sure there isn't
27:02We're going to take a sample
27:04We're going to submit it to the lab
27:06And we're going to treble check
27:07Right I need a formalin pot
27:09It will take two weeks before the lab has a definitive diagnosis
27:14On the samples Noel's taken
27:16So we push back the dirty tray with which we took the tumour out
27:19And we move to a clean tray
27:21With no possibility of tumour cells on it
27:24Okay so this is the implant
27:26It's going to go inside the leg
27:28He cuts off the bottom of the shoulder blade
27:32And then attaches the top section of the implant with two plates
27:35So we've got loads of screws along here now
27:45Seven screws in the front plate
27:46And seven screws in the back plate
27:48Give me a glove change
27:49Noel fixes the lower section of the implant
27:52To the stump of the humerus
27:54Using locking screws through the peg
27:56This peg's going to go inside the bone
27:58And these three plates are going to go outside the bone
28:00Because the bone segment, as you can see, is very, very small
28:04So we need all the holding power we can get
28:06This is specific and custom designed for this particular humerus
28:10So it should fit like it'd love
28:16Okay so I'm just going to join the two bits back together now
28:19We just pick up the two pieces of metal
28:22Swing the leg down
28:24Slide it back up
28:25Slot it into place
28:27Got a new humerus
28:28Pull the foot
28:30So these two big nuts
28:32Hold the top bit and the bottom bit together
28:34And that allows us to put the two pieces on separately
28:36Which was vital to get all the screws in
28:39Okay we're finished now
28:41We're going to stitch all those muscles back in place
28:43The elbow moves fine
28:45And the shoulder blade will move up and down the side of the chest
28:48All right sweetie
28:53You're still under there
28:54The new bionic leg
29:01There are seven operating theatres at the practice
29:03With almost 100 surgeries each week
29:06Noel often performs four operations a day
29:09All right here we go
29:11Dave the French bulldog is ready for his spinal surgery
29:15Okay so this is a routine but risky procedure
29:21Risky in this case because the vertebrae are dramatically deformed
29:27Meaning that the nerves may not be entirely where we predict they should be
29:33So we got this bone model here and you can see tiny hole here
29:37Very large hole there
29:38Same on the other side there
29:40That hole should be the same size as that hole but clearly it's not
29:44So I'm going to take the entire roof off here to enlarge these holes
29:47To release the pressure on the nerves that are in here
29:49There's a big defect there which is evident on the model here there's a hole
30:01So that's just filled with fibrous tissue so if I was to drill through that like I normally would
30:07I'd hit nerves and potentially paralyse the urinary bladder or alternatively the legs
30:12So I'm going to prise up that fibrous tissue away from the nerves and try not to damage them
30:19With the excess bone and tissue cut away the nerves are now free
30:26I think that's as much as I dare
30:28I think that's as much as I dare
30:30Noel will place pins and cement to stabilise the vertebrae
30:34So I've covered the nerves with collagen and I'm going to pour the cement around the pins to hold everything together
30:49Once the cement is set solid that's it these vertebrae are held in this position forever
31:03Hopefully
31:05All right, let's go to CT
31:15All animals who've had surgery spend some time recovering in the wards
31:20Little Wren has been here for five days now after the operation to amputate her foot
31:26Wren is fine, no issues
31:30Yeah, I wasn't too worried about her
31:32She's quite tough
31:34She's right outside here
31:36All right then
31:37Come on gorgeous
31:38There we go
31:39She has her swimming collar on there to stop her licking it
31:42Thank you, Laura, that's fine
31:44Thank you
31:46She's happy to see you, isn't she?
31:48Yeah, I'm not worried
31:50I mean to some extent it's nice not to chop the whole leg off just because the rest of it's normal
31:54I've taken a cast and we're working with our colleagues who make the stump sucker prosthesis for humans
32:00Yeah
32:01And we're trying to develop a little foot
32:03It'll be a few weeks before Wren's prosthetic foot is ready
32:06That's amazing
32:07Wonderful
32:08Look after yourself, take care
32:10It's being made at a local company
32:13Their clients include Paralympians and wounded soldiers so Wren's prosthetic is a little different
32:20This has been a bit of a discovery in thinking that actually that technology that we do with humans can be applied to animals in the same way
32:28The team have taken the cast Noel has made and filled it with plaster to create an exact model of Wren's lower leg
32:36This material is carbon fibre, same material what Formula 1 cars will be manufactured out of
32:42It's flexible in this stage, there's no resin so you can put it to any shape you want
32:47It'd be about five layers in total and then once we've done that, add the resin
32:53Once the resin has set, the leg is machined to the ideal shape
32:58Whether Wren will know that she has the prosthesis, I would say yes
33:04But it's going to be very subtle
33:07I hope that she will be happy and happy to wear it
33:25Try to be serious
33:27Back at the practice, Claire and Mum Liz have come to collect Dave, the French Bulldog
33:33Good boy
33:34Just two days since his major spinal surgery and he's already walking well
33:39Good boy
33:40Really excited, nervous, anxious, but yeah, so looking forward to seeing him
33:46Good morning
33:48Good morning
33:49So this is a three-dimensional CT scan of the actual construct
33:54Oh my gosh
33:55And at the moment, Dave's doing great
33:58So I'm happy with his progress
34:00Other than the fact that he's got scrunched up lower back, he's beautiful
34:04I'll get it, bye
34:05Okay
34:07Oh, wow, thanks
34:09It's good, isn't it?
34:10Yeah
34:11Hello, Mum, go down to his level so he doesn't jump
34:17There you go
34:18Hello, guys
34:19How are you doing?
34:20I'm all right, thank you very much
34:22Thanks
34:23I'm fine
34:24I'd like some more dinner, please
34:25He looks much better than I thought he would, doesn't he?
34:30Yeah, he's happy enough
34:31As long as he doesn't jar it, it'll be fine
34:32Yeah
34:33Thank you so much
34:34And you'll need that, Mum
34:35Lovely
34:36Give it up to yourself
34:37Thank you so much
34:38Pleasure, it's nice to see him doing so well
34:39Thank you
34:40Nice to see you
34:41Take care
34:42Make sure nothing bad happens now
34:43No, it won't
34:44God bless
34:45Cheers, bye-bye
34:46I'm so surprised at how well he looks, you know
34:49And going, yeah, hi, and just getting on with it like he does
34:53Hope he's going to be a good patient
34:55Smothering in cotton wool
35:06All right, go
35:11All right, sweetheart, good girl
35:14Come on, Baba
35:15It's 36 hours since Tallulah had major surgery to cut out the tumour in her front leg
35:22And replace it with a custom-made metal implant
35:25Good girl
35:27She's using the leg with every step now, which is really good
35:30She also seems much brighter today
35:33We don't know how long she's going to live
35:35But as long as she does live, she'll have four legs to walk on
35:38Which will significantly help her
35:40Given that she already has trouble on her back legs
35:42And I think she'd find it difficult on three legs
35:44So, so far, I'm very pleased
35:46We're only on day two and she seems much happier now
35:49Five days later, she's going home
35:52There we go
35:53Now, hello, Mum, hello, Dad
35:55Hello, hello, good friend, hello
35:56Hello, hello, hello, hello
35:58Hello, baby
35:59Hello, hello, everybody
36:01Now, we'll just take this off for the moment
36:04Hello
36:05Hello
36:06Hello
36:07Hello, I love you too
36:08She's already using it really well
36:10As you can see
36:11And what we do is, we walk from this side
36:13And we just take it slow
36:14There you go
36:15Okay, so you can see she's pulling me along
36:17Yeah
36:18And you can see she's placing it pretty good
36:20Yeah
36:21If you just give her a little support on here
36:23Yeah
36:24She'll get the hang of it
36:25So, she's happy
36:26Yeah
36:27And she still has her leg
36:28She's actually in really good shape
36:30Alright, Bubba
36:31Take care
36:32Look after yourself
36:33It's an amazing thing that he's done for us
36:36I keep thinking she's just going to live forever
36:39So, erm, that's my optimism on it
36:42Yeah, I'm not living up to reality
36:44Gonna bring the mattress in and sleep with her every night
36:47So, she's not alone
36:48I'm just so happy, yeah
36:49Oh, sorry
36:50Gonna start crying again
36:54Tallulah has pulled through her first challenge
37:00But even with regular checks and chemotherapy
37:04Her future remains uncertain
37:06Two months ago, little Wren lost her foot
37:18After being attacked by another dog
37:20The family have decided on a removable stump socket prosthesis
37:24To try to help her walk on the limb again
37:27Now the prototype is ready
37:29And Julie has brought Wren in for her first fitting
37:32How are you, sweetheart?
37:34Yeah, very good
37:35Nice to see it
37:36Come on, pop it
37:37This is my colleague, Cameron
37:38Hi there
37:39So, Cameron helps me with all of these design prosthetics
37:41Hi, sweetheart, how are you doing?
37:43Hi
37:44Hi, Munchie
37:45So, the plan is to use this
37:48And this has two basic components
37:51One is a silicone liner
37:52Yeah
37:53So, we just take that
37:54That silicone liner, put your finger in it
37:56You can see it's super soft
37:57Yeah
37:58So, that's intended to buffer the skin
38:01So that, hopefully, sores don't occur
38:04Yeah
38:05The second component is a carbon fibre sleeve
38:08Which you can see we've made with a rubber foot
38:12Yeah
38:13To try and encourage weight bearing
38:15But, of course, we haven't yet been able to judge what length that should be
38:18How tight that should be
38:20Yeah
38:21It's pretty rigid
38:22It's really light though, isn't it?
38:24Super, you can feel it, feel it
38:25Super light
38:26Brilliant
38:27You hold her for one second
38:28Yeah, that should be great
38:29And then hopefully
38:30Oh
38:31Good
38:32Now, let's see what that works like
38:34Yeah, so too short, I'd say
38:35Get the lead on
38:36We're going to take her outside
38:37Okay
38:38Come on, sunshine
38:39Run
38:40Keep going
38:41Good
38:42I'm back down again, please
38:43That's not too bad
38:44It's amazing
38:45Yeah
38:46Yeah
38:47Because, actually, at that speed, she would normally hold her leg right up
38:50Yeah
38:51I think if we got another centimetre on that, that might be interesting
38:53Hold tight, this machine might help
38:54Good
38:55Right, let's put another centimetre on here, and then see how we got it
39:10Okay
39:11Cameron makes the adjustments on site
39:15This won't be the final version
39:18Once they've got exactly the right length, a new one will be made
39:22Because she's such a lightweight little doggy. There's a bit of give-and-take on the distance
39:26So we reckon we need about a centimeter centimeter half extra, so we're gonna sandwich these together super glue them
39:32Then pop them on the end there
39:34We'll just give that a bit of time to bond and then we'll pop it back on rent. It looks really good. I'm really happy with it
39:43Keep going
39:45That is much better wow that that's actually she's standing on it for the first time now isn't she
39:51I'm delighted about that. She hasn't even looked at it amazing. All right good. Thank you. Bye. Thank you so much
39:57The new measurements will be sent to the prosthetic company to build the final model
40:03I am absolutely over the moon with what's happened today
40:06Really really chuffed she's so laissez-faire about it. I'm really surprised
40:11She hasn't even sniffed at it or licked at it or looked
40:14It's just like I got my leg back. She just put her foot down and went as if that's what she'd been waiting for
40:21It shows that it is still a proper vets where actually the result is the important thing
40:27You know
40:27It's not all about the high-tech stuff. It's about getting what they want as a result for the animal and I think that's brilliant
40:38In Hampshire Dave the French Bulldog has recovered from his spinal operation and is once again enjoying life with Claire and his best mate Maisie
40:48Dave is doing brilliantly well
40:54He's happy he's free he's running around
40:58Just enjoying life
41:00He can do most of the things he did before his spinal operation
41:04Except one
41:05Noel advised us not to do agility with Dave because it's just so high-impact
41:11It's just not worth putting him at that risk
41:13He can run about and do all the other things a dog normally can do
41:18He just loves to run just loves to hoon about and just loves being an idiot
41:26He has two speeds he is stop or just zooming off at a million miles an hour
41:31He's just got this permanent grin on his face
41:34He's just a happy dog
41:37Good boy
41:37Back at the practice it's three months since Tallulah had her tumour removed the lab results have confirmed it was an osteosarcoma for which she's been having chemotherapy
41:58But in the past week she's been lacking energy
42:01Carla and Steve have brought her back for scans and blood tests
42:08Something's not quite right with her
42:11Hoping for the best with her today
42:12Hoping the cancer hasn't spread
42:15If not then
42:16Yeah
42:17Decision time
42:18Yeah
42:19Make the decisions then
42:22Hard ones
42:24Now the images are back
42:25The implant is fine
42:29But unfortunately I think I can see some meds
42:33Some cancer?
42:34Spread
42:35Yeah
42:35I thought it was cancer
42:37Yeah
42:37Not in the leg
42:39Okay
42:40But there's some early stages in the chest
42:42I'm sorry about that
42:44The implant looks fine
42:45There's no problems there
42:47It all looks absolutely fine
42:48Now the chest I can see that it has changed
42:52In the sense that we have a small blotch there
42:55Almost certainly that is a tumour spread
42:57And there's another one right there
43:00Look you have a few months
43:03And I don't know how long those months will be
43:06Just let her have a normal life
43:07As normal as you can
43:10And enjoy every day you have with her
43:11That's all you can do
43:13It's heartbreaking cancer
43:14You know there's some cancers you can't cure
43:17And unfortunately this is one of them
43:18I'm really sorry
43:22I'm really sorry
43:23I'm sorry
43:24It's a tough one
43:25It's a tough one
43:25It's a tough one
43:25It's a tough one
43:25It's a tough one
43:27I'm sorry
43:27I'm sorry
43:28Thank you for you've done that
43:30Well
43:31You've done your best
43:32You have done your best
43:33You could not be nicer human beings
43:36It's heartbreaking
43:37Get a breath of fresh air
43:39I'll see if she's awake
43:40I'll get okay
43:40Okay
43:41I'm sorry
43:42I thank you very much for you
43:43I'm sorry
43:43No problem
43:44Okay
43:45Thank you
43:45All right
43:46Okay
43:51It's uncertain how much longer Tallulah has left
43:54But Noel has given her medication
43:57To make her as comfortable as possible
43:58For the rest of her days
44:00What can you say
44:02We just give her the best couple of months she's got
44:05Extra hugs
44:05Extra kisses
44:06More treats
44:07That's my main concern
44:09It's Carla
44:09Tallulah both together
44:14Well done
44:20Back home in Wakefield
44:21The family are taking things a day at a time
44:24In her head she thinks she's well
44:26But the body's going
44:28No I'm not
44:29Love her
44:30Yeah
44:31Each day's different
44:32You know
44:32She pushes herself one day
44:33And the next couple of days
44:34She's pretty more lame
44:36And then she's back
44:37Bouncing again
44:37So it's two steps forward
44:39One step back
44:40No
44:40You're not going in there
44:42She's very stoic
44:43Sometimes you question
44:44Whether you've done the right thing
44:46So long as she's happy and not in pain
44:49Then I'm happy
44:51As soon as it changes any
44:53Then we shall have to make that decision
44:56Sadly
45:00Oh the ducks look
45:02In the meantime
45:03Carla and Steve are making every moment special for her
45:06No Tallulah
45:08They got a bit close
45:09Come on in
45:12Good girl
45:13Plan to go to the beach with her
45:15While she can still do it
45:17Taking each day as it comes
45:20That's all we can do
45:21That's my girl
45:27Wren!
45:28Come on
45:29In Bedfordshire
45:31Little Wren has got her new prosthetic foot
45:35Come on
45:36Wren's really doing well
45:38She just has a completely normal life now
45:40It's absolutely fantastic
45:42Come on
45:42Good dogs
45:43The other dogs
45:44Don't appear to have noticed there's any difference to her
45:47It's really funny
45:48They were thrilled to have her back in their group
45:51They just treat her exactly as they always did
45:53She's one of the playmates
45:55And you know
45:55The same order for everything that we do
45:58Dogs are really resilient
46:00Good girl
46:01Come on
46:02Her running is no different to how it was
46:03Before she had an accident
46:05She absolutely flies along
46:06Good dogs
46:07She just thinks she has four legs
46:09When she's got her prosthetic on
46:11She is exactly who she was before
46:13And I never ever could have hoped for that
46:16It's just amazing
46:46It's just amazing
46:48You won't want
46:48No
46:48Nothing
46:49No
46:51No
46:51Number
46:51No
46:51Nothing
46:53No
46:54No
46:55No
46:55No
46:55No
46:56No
46:57No
46:57No
46:59No
46:59No
46:59No
47:10No
47:11No
47:12No
47:12No
47:13No
47:13No
47:13No
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