- 3 months ago
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TVTranscript
00:00Oh my goodness, what a difference. A couple of days made.
00:06Professor Noel Fitzpatrick...
00:08All right, Mrs. Cuddlemonster incoming.
00:11...is the super vet.
00:13We have issues.
00:14I knew I should have got chihuahuas.
00:16...at his unique vet practice, he merges mechanics and biology.
00:21We're past the point of no return now.
00:23Don't be pulling apart my repair, Mrs.
00:26...to heal the nation's pets.
00:28Sorry about coronavirus.
00:30Oh, because you're responsible?
00:31I'm responsible for almost everything else.
00:34Even in the darkest days...
00:36I'm so sorry this has happened to you.
00:38...Noel imagines the impossible.
00:41Oh, my little baby kills leg.
00:44Let's go.
00:46Sometimes you have to bend the rules of mechanics to fit the biology.
00:50...and offers hope.
00:52We've definitely made the right decision.
00:54Good boy.
00:55We've got my boy back.
00:57...for families and their friends.
00:59Look at you!
01:00Why don't I go?
01:01Yes, mate, I love you too.
01:06I need a nurse or bed, please.
01:11Emergency cases that have been referred to Fitzpatrick referrals...
01:15She's taking him.
01:16...are often challenging, as well as unpredictable.
01:19When an accident happens, it can take time for us to understand the true extension of the trauma.
01:26Can we get a circuit?
01:28So there's definitely some very obvious and clear to the eye.
01:33Laryngoscope.
01:34But there are others that depending on how ill they are when they arrive...
01:39...that might remain hidden until we actually get to the bottom of it.
01:43We've got a femoral, we've got a femoral.
01:45Can you feel?
01:46Yeah, yeah, yeah.
01:47It's fine.
01:48It's fine.
01:49We're breathing.
01:50Hey, gorgeous man.
01:55It must have been a pretty horrendous last few weeks.
01:58Hopefully this is the beginning of turning the corner.
02:02Four weeks ago, Angus, a five-year-old golden doodle, went through a terrifying ordeal...
02:07...and sustained life-changing injuries.
02:10We've come because Angus fell off a cliff in the Forest of Dean.
02:15He's definitely got some big problems and he can't carry on as he is...
02:21...because he's in lots of pain and he can't really go anywhere.
02:24So we're hoping to show him some kindness by bringing him here and see what we can do for him.
02:32Zoe lives in Northamptonshire with her four children.
02:3613-year-old Coco...
02:38It'd be nice.
02:39No, Coco, thank you.
02:40No.
02:41There we go.
02:4211-year-old Bertie...
02:43Super careful on the steps, Cakes, OK?
02:458-year-old Purdy...
02:47...and 10-year-old Serafina.
02:51Plus a menagerie of other animals, including Hamish the Spaniel.
02:58We currently have three ducks and four ducklings.
03:02Three hens and four baby hens and a cockerel.
03:06Go!
03:07Most of our leisure and lives revolve around the animals and we are very outdoorsy.
03:12Come on, mate!
03:14From the moment Angus arrived, Zoe knew he was the ideal dog for her boisterous brood.
03:20Angus, hey, he has the most amazing character.
03:24If anyone's a bit down, he knows.
03:26He's always the first one to turn up with a big, heavy, soft Angus head to give someone a cuddle.
03:32Last month, Zoe and boyfriend Paul took the two dogs with them for the weekend to the Forest of Dean.
03:41And so on the Saturday morning, we set off to do a really long walk.
03:47It was fantastically wet and gloomy.
03:51Hamish and Angus were running all over the place.
03:54And unbeknownst to me, obviously, they'd gone up to the top of the cliff.
04:00And I was sort of like wandering along and having an amazing time.
04:04I literally just then started to count my blessings.
04:07And literally 20 seconds later, the terrible noise.
04:13Both dogs had tumbled down the cliff.
04:17Angus had fallen 20 metres and suffered catastrophic injuries.
04:23Zoe and Paul eventually managed to get Angus to an emergency vet.
04:28Angus had gone into respiratory distress because of the impact and trauma
04:33he couldn't breathe.
04:35And the vet felt that he may need to be put to sleep.
04:41I didn't really want to consider that.
04:45Against the odds, Angus's breathing stabilised.
04:49But investigations revealed a broken right wrist and severe nerve damage to his left front leg.
04:56At the moment, he can barely move predominantly because he's just in so much pain.
05:00And when you part his fur, he's black and blue.
05:04We do have him on painkillers.
05:07The vet has told Zoe if the nerves in Angus's left leg don't recover, the leg will have to be amputated.
05:14Angus is in such a mess.
05:16And we're really worried that he's not going to be able to get a viable quality of life.
05:21Would you like to come through?
05:22Zoe and Coco have come to ask Noel what can be done for Angus.
05:27It's alright.
05:29To give him a chance.
05:31Good morning. Oh, what a beautiful dog. Hello. Please come in.
05:34My understanding is that there is paresis of the left front leg in the sense that the nerves have been damaged.
05:39And that the right front leg carpus is busted.
05:43Yeah.
05:45Okay. So we're just...
05:46Mary, if you come this side for me, please.
05:48That's it. I just want to double check that there's nothing neurologic with his back legs.
05:52When was the accident?
05:54It'll be four weeks from Saturday.
05:56So it's...
05:58From my initial clinical examination, I can tell you the following.
06:01The back legs seem okay, which is good news.
06:02That's great.
06:03The spine seems okay, which is good news.
06:06Now, leaving the left front leg to the side for the moment.
06:08Yeah.
06:10The right front leg has a dramatically disrupted carpus, meaning that all three levels are disrupted.
06:18One, two, three.
06:21But I think it's saveable.
06:23Okay.
06:24I have had dogs manage quite happily on a wrist fusion, but they bounce.
06:29And the downside is there's a lot of pressure in the elbow and the shoulder.
06:33So I'm going to need to look at an x-ray picture of the elbow and the shoulder to make sure that they're okay.
06:38We're going to do a few checks.
06:39Yes, please.
06:41I'll come and find you soon.
06:46Before he's scanned, Joanna, a neurologist, double checks for any remaining nerve function in Angus's left front leg.
06:55Ready?
06:57Muscular cutaneous.
07:00There's nothing.
07:02Something there.
07:03You can see he's trying to pull them.
07:05Well, we can wait up to six weeks, but the way this is going, even if he recovers these parts, he's never going to put any weight back again.
07:13He's completely contracted already.
07:15This is a losing battle and it's going to give them more pain trying.
07:19Thanks so much for your time.
07:21Thank you, Jo.
07:22That's it, thanks.
07:24Noel also needs to investigate Angus's right shoulder, elbow and wrist.
07:28That's better.
07:30It's crucial the joints are strong enough for him to bear weight on one front leg if the wrist is fused.
07:36Okay, Zoe, Coco, come on back in, please.
07:38This is the study that we've just done.
07:43The wrist is indeed disrupted at all the different levels.
07:47There are splinters that have come off this impact because it goes like a nutcracker.
07:50Gosh.
07:51Okay.
07:52And crushes the front of the bone.
07:53Ow, ow, ow.
07:55Exactly.
07:56I think he does have some degree of developmental elbow disease, but it's low grade.
08:02Do we still in the ballpark of which it's worth doing this?
08:04Correct.
08:05Exactly right.
08:06However, what I felt about Angus's left front leg, those muscles are never going to work again.
08:12This muscle's never going to work again.
08:14This muscle's never going to work again.
08:15Okay.
08:16So the left front leg justifies removal.
08:19He's already tripping up on it, even with it just dangling when he's trying to move around.
08:24Yes, indeed.
08:25It's a hindrance to him.
08:27And it's controversial whether you take the leg off first and then fuse the wrist second.
08:31But my professional opinion is that if the wrist fusion didn't work, why put him through the amputation?
08:36Because we'd end up having to put him to sleep.
08:38Therefore, I would recommend that we do the wrist fusion first.
08:41Okay, great.
08:42As a quick question, do you feel that with a successful fusion of the wrist and a well-working back end, that he can have a good life?
08:52To be brutally frank, I think it is a decision between euthanasia and a three-legged dog with a fused wrist, because we can't leave him as he is.
08:59Oh, crikey, no.
09:01Thank you so much for your time.
09:02Okay, no worries.
09:03Cheers.
09:04Thank you, Angus.
09:05Well done.
09:06Come on, handsome.
09:07Noel and his team will design a custom-made implant for Angus's wrist to give the fusion surgery the best chance of success.
09:15You can't go after him, no.
09:16We're very relieved that it looks like we've got a really good chance of not losing him.
09:21He's been hobbling around the kitchen for a month almost now, hasn't he?
09:25Yeah, so I think we're sort of slightly worried that we'd be going home with broken hearts, which we're definitely not.
09:31We've got hopeful hearts.
09:33Poor old Angus.
09:35Rocky, come on. Rocky, shh. Rocky, a nine-year-old Springer Spaniel, has arrived at Fitzpatrick referrals with Tanya and Ian.
09:50Rocky, you're very smart. Very smart.
09:52No, stop it.
09:54Despite his enthusiasm for life, he's coping with severe pain after a failed operation on his elbow.
10:02Rocky.
10:03He had an unfortunate incident with another vet.
10:08Instead of just going into the bone to stop a little fissure, he managed to put a screw right through the middle of the joint itself.
10:16So he's really, really badly limping.
10:20Rocky.
10:21Rocky shares his home with Sasha, the couple's other dog.
10:25But there's no doubt who's the more energetic of the two.
10:28Poor. Good boy.
10:30Even though Rocky's getting on a bit, you wouldn't believe it, to look at him.
10:35I mean, he even climbs trees.
10:37You can't help but think of Winnie the Pooh's tigger.
10:39He is a tigger dog.
10:41Good boy.
10:42Irrepressible Rocky arrived in their lives two years ago when they found him in a nearby animal shelter.
10:49He'd ended up there. It was a marriage break-up. The two dogs had to be given up.
10:54And after about seven or eight months, the brother was rehomed and Rocky was left.
11:00So we got him. You know, it's like everybody else's loss, you know, it's our game.
11:04Since starting his new life, Rocky has become an invaluable part of the family, particularly for Tanya, who has multiple sclerosis.
11:18Rocky's just been so great, because should I be having a bad day?
11:22He's there almost like showing you support, you know, yeah, come on, here's my lead, you know, take me out, you know, things to do.
11:31But Rocky's enthusiasm for life started to wane when he developed a limp.
11:36Investigations revealed a small crack in the humerus bone of his left elbow.
11:40We ended up being referred to a specialist vet who said the best solution would be to put a screw through the bottom of the humerus.
11:50But unfortunately, it didn't quite go through the humerus.
11:54It ended up going through the joint pocket. Come on.
11:57Rocky is now struggling to walk for more than 20 minutes at a time.
12:01And Tanya and Ian are desperate to get him back to his old self.
12:05I feel bad for him, but he's such a brave boy and so very hopeful that Noel will be able to get him back to feeling good again.
12:23Noel has already performed imaging on Rocky to investigate the damage to his elbow.
12:28So we can see here how Rocky's elbow has collapsed down. The screw is physically sticking into the joint.
12:38And we can see this particularly clearly in the arthroscopy where the screw has gouged out the joint surface.
12:45The reality here is that Rocky is in significant pain all of the time.
12:49There are very limited options to treat this elbow.
12:53One option would be to take the leg off completely.
12:57The second option would be to fuse the elbow solid.
13:02That would, however, leave the elbow without any movement.
13:06And therefore, Rocky would move in this way, circumducting the limb.
13:12Therefore, we are considering a third option, which is total elbow replacement.
13:18If we could make that work, it would give Rocky a moving, pain-free elbow.
13:25Rocky is so enthusiastic. Every day for him is a good day.
13:31And he's so bouncy. We've opted for a total elbow replacement because we just want to give him every chance to get him back to his pre-op condition.
13:40That's it. Good boy. Come on.
13:42After 15 months of managing on his painful elbow, Rocky is having his surgery today.
13:49Hello. How are you today? Nice to see you.
13:53Right, so today's the day.
13:55Today's the same day.
13:57OK, please grab a seat. How you doing? How you doing?
13:59So he's been much the same.
14:01I can feel a very, very bad crackling in there associated with the progression of osteoarthritis and also the metal rubbing inside the joint.
14:08I just want to explain the objectives of the surgery today again.
14:15So this is the new implant.
14:17So this part is a tray which fits on the radius and ulna.
14:24And we use a very special cutting guide system for this implant to go in here.
14:29And it's specifically made only for this dog and this implant.
14:32Right.
14:34Now, there's a shed load of new bone formed around the periphery of the joint.
14:41When I get in there, that's going to be like a bag of marbles.
14:44So I'll be trying to scoop out much of these bone fragments, but I won't be getting all of them.
14:50And the reason I won't be getting all of them is some of them are intrinsically fused onto the bone.
14:56Right.
14:57So if we fail for whatever reason, we have a fusion plate ready here, that's our fall back position intraoperatively.
15:03Right.
15:05And that could happen today.
15:07It's a big job, a big, big job.
15:09Any questions about this?
15:11All set?
15:12All set.
15:13All right, big cuddles then for Dad.
15:15Big cuddles for Mum.
15:16All right.
15:18Good.
15:19Well done.
15:20You can go ahead, Johnny.
15:23Good.
15:25God bless.
15:26Take care.
15:27Cheers, guys.
15:28Bye-bye.
15:29Bye.
15:30I realised it was going to be complex.
15:33But then hopefully, you know, at least the pain he's having at the moment will be taken away.
15:38Double fingers crossed.
15:40Good boy.
15:43I know.
15:44Zoe and son Bertie have returned with Angus, who fell 20 metres off a cliff, irreparably damaging his left front leg and smashing his right wrist.
16:06We've come back today because Angus is having hopefully the first of two operations with Mr. Fitzpatrick.
16:15Angus's life really hinges on the success of today.
16:20So, yeah, worst case scenario, doesn't really bear thinking about.
16:25Good boy, Angus. Steady.
16:26Come on, sweetheart.
16:28Bertie's coming.
16:29Now then, so what the plan is, we have made a very special plate in the factory over the past week, which is this here.
16:41OK?
16:42Oh, wow.
16:43The point of this plate, as you can see, it has special screws in it.
16:46Yeah.
16:47In different positions.
16:48And each of those screw holes is threaded.
16:50Do you see a little thread in them?
16:52Yep.
16:53And we have special screws that lock in those threads and also lock in the bone.
16:57And that fuses the joint.
17:00Now, so that's the fusion bit.
17:02Now, what I wanted to come onto were the risks.
17:04My main worry always with this is swelling-impairing blood supply.
17:08But I obviously do my best.
17:11Infection is also a risk.
17:13He must not lick it.
17:14Are we clear?
17:15Yes.
17:16Yeah.
17:17So, give him a big hug now, Bertie.
17:19We're going through now.
17:20Yeah.
17:21OK.
17:22OK.
17:23I'm just going to lift my visor.
17:24So, you go ahead.
17:26That's it.
17:27Now.
17:28There we go.
17:31OK?
17:32Sorry about the visor.
17:33All right.
17:34Well done.
17:35I'll talk to you tonight, Bertie.
17:37OK?
17:38See you later.
17:39It's going to be all right, sweetheart.
17:40I promise.
17:42I promise.
17:43I promise.
17:44See you later.
17:48OK.
17:49Thanks.
17:52I'm very worried about Angus.
17:55It's been a long time, hasn't it?
17:57I haven't got my hanky.
17:58I'm afraid.
17:59Oh, no!
18:00I'm going to sleep tonight.
18:02Thanks.
18:03Don't have a hug.
18:04You sure?
18:05Too cool for a hug.
18:06If it all goes OK.
18:07Hello.
18:08Can I have a back leg, please?
18:09Angus is being prepared for surgery.
18:10His left front leg is beyond repair.
18:12So everything rests on the success of the fusion of his right wrist.
18:13All right, let's do it.
18:14Incision.
18:15An implant has been created using 3D modelling based on Angus's CT scan.
18:46The first one is to remove the bone grafts of the bone grafts.
18:47Angus will be able to remove the bone grafts from all of the carpal bones.
18:49Then he'll pack in bone grafts and position the plate using temporary non-locking screws.
18:54Then locking screws are placed in the radius and the carpal and metacarpal bones.
19:00The design will allow Angus to distribute his weight gradually through the narrower plates,
19:06to the thicker plate and up towards the elbow.
19:09There's a lot of swelling here as a result of the explosive trauma.
19:15Noel must carefully move the blood vessels, nerves and tendons to one side, preventing any further damage.
19:24The biggest reason for failure in this operation is that the cartilage isn't properly removed from every surface.
19:40With the cartilage removed, the carpal bones will, over time, fuse together.
19:45Okay, now we're going to pack bone graft into all of the areas from which we've removed the cartilage.
19:52This is taking it from Angus's left front leg.
19:56I'm going to pop the plate on and have a look.
19:59The plate is designed like a kind of chisel, so it goes down underneath the tendons like so.
20:05Then we just slide the plate back up into place like so.
20:09Noel uses pins to centre the plate on the metacarpal bones,
20:13then uses temporary screws to pull the plate against the bones.
20:18Okay, and now I'm just going to check for alignment.
20:21So it should be that the foot is in the normal standing posture,
20:24which is slightly externally rotated when Angus is standing, which is what that is, so that's good.
20:30We've placed a temporary screw here before. We're going to put permanent screws in now.
20:43Yeah, I need two-metric monocryl, please.
20:52There you go.
20:56All right, let's go to x-ray and let's pray that it's all fine.
20:59Well done, Angus. Well done.
21:02Okay, great. Thank you, everybody.
21:04The first stage of Angus' treatment is complete.
21:12But it will be several days before Noel can be sure that the blood and nerve supply to his foot is intact.
21:18Hello.
21:23Hi, Zoe, it's Noel.
21:25Are you okay?
21:26The operation went fine, yes.
21:29Zoe and the kids will be updated on Angus' progress over the next days.
21:36It's one of the most important tasks for the team at Fitzpatrick's.
21:40If I was the mum or dad of the pet dog at home, I'd be sitting on my couch rocking back and forth.
21:49Like, I'd be an absolute nightmare. Like, I'd want to know every detail.
21:53Who's a good boy?
21:55It's equally important to let them know when something good is happening versus when something bad is happening,
21:59so they're always kept in the loop and always involved in decision-making.
22:02He's comfortable sleeping a lot.
22:04People really appreciate the simplest of things.
22:08So just saying, yep, he's eaten his dinner tonight, can really just comfort people more than I think we tend to realise.
22:16Okay, thank you. Take care. Bye-bye.
22:18Take care. Bye-bye.
22:19Bye-bye.
22:20Bye-bye.
22:48Rocky.
22:50Can you go me, please?
22:53It's early morning and Noel is preparing for one of the most complex surgeries he performs.
22:59An independent ethics committee has given the go-ahead for the surgery,
23:04so Noel is going to attempt to give Rocky a total elbow replacement.
23:10Okay, good.
23:14Hold that.
23:16Concision.
23:17We cut down on the muscles, elevate them from the bones, and get into the joint.
23:23This is all the new bone formation around the joint.
23:27Looks like a bag of marbles there.
23:29Effectively, it's mineralisation of the inflamed tissue, which happens through the disease process of osteoarthritis.
23:35We're going to cut off as much of this new bone as we can.
23:40As well as that, this new bone formation on the periphery of the bone is actually attached.
23:47It's also as a result of inflammation as called osteophyte.
23:52Noel opens the joint and accesses the screw that's been causing Rocky so much pain.
23:57These are the tram tracks where the screw has been gouging down into the ulna.
24:04So the correct position for that screw is straight through the condyle there.
24:09Unfortunately, it went into the joint.
24:11This will have been excruciatingly painful for Rocky.
24:18He is an extraordinary dog to tolerate this pain with such grace.
24:25Show me the diagram, please.
24:29It's only low to 1.8mm drill bit.
24:35Guides that fit to bones gauge exactly where to cut in preparation for the replacement implants.
24:44Show me the diagram again.
24:49But there's a problem.
24:51No matter what way I put that, that doesn't want to sit down.
24:56Further deterioration of the bones means the cutting guides no longer fit exactly.
25:01I can't see any way to make both of them fit.
25:04And everything depends on this.
25:10I wonder, should I just proceed to fusion?
25:13Because this is way off.
25:16Noel makes the difficult call to Rocky's family.
25:20Hi Ian, how are you doing?
25:22So I'm in the middle of the operation now.
25:24Unfortunately, the elbow is very collapsed and the tissues around the elbow are very badly affected by osteoarthritis.
25:30And I can't get the elbow into a position where I'm comfortable putting in the total elbow replacement that we've designed.
25:37So I think in Rocky's best interest, I should have brought the mission on the total elbow replacement and fuse the elbow solid with your permission, please.
25:44Thank you, bye-bye.
25:47Goggles, please.
25:51With permission to proceed, Noel will now fuse Rocky's elbow.
26:00These are the two components of the plate with an axle between them.
26:04And it's designed to be at the standing angle for Rocky.
26:07Noel inserts the implant components which will immobilise the joint, but hopefully get Rocky out of pain.
26:18The thing about surgery is you've always got to think about what's in the best interest of the patient.
26:23And I'm going to go for a second best surgery, which is in between a total elbow replacement and a full in amputation.
26:33I'm going to try and help Rocky as best I can to get him out of pain.
26:39So that's the plate construct in position now.
26:48That elbow is locked solid.
26:51No matter how well you plan a surgery, you always need a plan B.
26:56The previous surgery didn't work out.
27:00And unfortunately, failure in surgery can happen to anyone.
27:04Sorry I couldn't give you an elbow replacement, buddy, but I've done my best with your poorly anatomy.
27:23Good boy.
27:25It's been 10 days since beloved golden doodle Angus had an operation to fuse his wrist after falling down a cliff, damaging both front legs.
27:40Don't sit on my biscuits.
27:42Mum Zoe and all four children have come to visit him.
27:46I made the best ones.
27:48Bye bye.
27:49We've made him some special dog biscuits.
27:51And they do smell.
27:53Smell beefy.
27:54Right.
27:55Gosh, got the entire posse.
27:57How are you, everybody?
27:58Come on in.
27:59I'm very glad you could come in, because I wanted to show you.
28:02And that one's for Angus as well.
28:03Well, you can give this to Angus yourself, because Angus is going to be on this rug in a minute.
28:08Now, we have done this big operation on the right front leg, which fused the wrist solid.
28:16Now, this is the result.
28:19So he's a week out from surgery now, and now that I've got this all stabilized, and as well as that, the swelling after the operation has now come down, and now that that's done, I feel leaving the left leg just dragging is no good for him.
28:36It's weighing him down, so we must take it off.
28:40So this, this will be the last time that he will have his left front leg.
28:44Yeah.
28:45Okay.
28:46We just want the best friend, don't we?
28:48I'll bring him in.
28:49You can spend as long as you wish.
28:51Now, who's here?
28:54Now, are you okay?
28:56Now, take as long as you need, okay?
28:58All right?
28:59Hi, Angus.
29:00Hello, baby.
29:01Goodness me, it's lovely to see you.
29:04Thanks so much.
29:06He's got a biscuit for Angus.
29:09Like, like pizza, though.
29:11Yeah, that's right.
29:12Dear Angus, I love you so much, and in the past few days, I've missed you so much.
29:17Hamish is missing you too, and it has been a super long week.
29:20We made you some biscuits.
29:22I can't wait to see you on Sunday.
29:24Lots of love, Serafina.
29:26Do you want another one?
29:29It's an amazing fool.
29:31All right, guys, I'm going to bring him now.
29:33Okay.
29:34And we just got to be brave and do the right thing, don't we?
29:39All right.
29:40Amazing, amazing, Angus.
29:42Bye, guys.
29:45See you later, guys.
29:47God bless.
29:56I think we should clip a little, would you want to clip a little lower down there?
30:00Because the scapula is here.
30:03The next morning, Angus is being prepared for his amputation surgery.
30:08All right, let's go.
30:11I have a syringe and needle.
30:14It takes Noel just over an hour to remove his front left leg.
30:21The final objective of full limb amputation is to prevent infection.
30:27And we do that by obliterating all dead space so there's no free fluid at all.
30:34So I'm making sure that there's a nice skin seal with a small wound.
30:37Okay, Angus, good boy.
30:42With both front legs now treated, Angus should be well enough to go home in 48 hours.
30:49Okay, wake up, please.
30:58Oh, look.
31:00Good boy.
31:02You're such a heartbreaker.
31:08Come on then, darling.
31:11Well done, mate.
31:12Well done.
31:13You're such a good boy.
31:15It's been a week since Rocky had the surgery that resulted in Noel fusing his left elbow.
31:21Today, Tanya and Ian are taking him home.
31:25Quite excited.
31:27Yes.
31:28It's been a long time since we've seen him, so we're really looking forward to it.
31:33All right.
31:34Now.
31:35Wow.
31:36Now.
31:38Now.
31:39Look at that.
31:40Look at that.
31:41Look at that.
31:42Exocet missile.
31:44Ladies, can you mind him for a moment while I speak to mum and dad?
31:47Now, so yes, it was disappointing that I had to ring you during the op and say, look, I can't put an elbow replacement in.
31:54Yeah.
31:55It was a mess.
31:56I mean, it's a big screw to begin with, wasn't it?
31:58And when it's in the wrong place, it does a lot of damage.
32:00Yeah.
32:01So we made that different choice and this is what that different choice looks like.
32:06And that should grow into solid bone over the next 12 weeks.
32:08Now, come on outside to house, please.
32:14Grab that tight.
32:15Grab that tight.
32:16And I will see you in, I'll see you in five weeks.
32:20Oh, easy, easy.
32:21Yeah, that's it.
32:22There you go.
32:25It feels brilliant having Rocky back.
32:26Absolutely fantastic.
32:28Yeah, I mean, we were expecting sort of the worst, that he'd be barely hobbling and just, you know, slowly moving his arm out like a penguin or something.
32:35But it was almost as if there was nothing wrong with him.
32:39Our superstar has returned.
32:40Do you guys, do you guys have a thermometer?
32:54Angus is due to go home today following amputation surgery.
32:59But routine checks have revealed his temperature has spiked.
33:04Can I have a scissors, please?
33:06We have some really bad news with Angus.
33:10All of a sudden, his wound became quite swollen.
33:13And then a discharge began from the bottom extent of his amputation wound.
33:20And that can only mean one thing, which is infection.
33:24So this is special irrigation fluid that breaks down the complex structures that bacteria produce to act together as an army.
33:34We're packing swabs into this now to suck out residual infection.
33:40All infections like this can be life threatening.
33:44So sadly, it's still possible that we may lose Angus's life.
33:47Noel calls mum Zoe.
33:48Hi Zoe, Noel here.
33:58So, we do have problems I'm afraid.
34:02Angus, he has a bad infection.
34:05And having done probably hundreds of amputations, I've never seen one like this.
34:09It's aggressive and we won't have the culture result anyway for four days or five days.
34:18OK, I don't want the children to see him as he is, but may I come and see him?
34:23Sure.
34:24I do.
34:25Is that OK?
34:26Yes.
34:27Yeah.
34:28OK.
34:29All right, try and keep the faith.
34:30OK.
34:31Thank you, yeah.
34:32OK.
34:33God bless.
34:34All right, bye-bye.
34:35Angus will be carefully monitored and kept in the isolation ward.
34:56There have been times, such as with Angus, where we've been in 24-7 with him, making sure that he's OK.
35:02Hey baby, what happened?
35:04I sometimes, like, get a lump in the back of my throat when I'm with patients that are that gravely ill,
35:09imagining what the poorer family at home are going through and you're just hoping that the medication works
35:15because it's either that or they'll have to be euthanised.
35:26How's it going?
35:27We have better times.
35:29Angus's wound is now dressed every six hours and flushed every day.
35:34Get me an NF kit.
35:35She's taking off some dead tissue here.
35:36The bacteria has killed.
35:37This is called debridement.
35:38The hope is that over the next couple of days, with the intravenous antibiotics, Angus will turn the corner.
35:52This is still life-threatening at this point.
36:00Zoe arrives on her own to visit Angus.
36:05Thank you. It is cold.
36:07I'm very worried that it's where we're asking too much of him.
36:13I'm very worried that we'll carry on doing this and then he still won't be OK.
36:18And there is still, even if we get over this, there are still so many ifs and buts.
36:23If the pankal perfusion is a success and if...
36:28So at the moment it just feels very frightening and very confusing.
36:33Come on in, Zoe.
36:35He's not in here, so don't worry.
36:37I just want to brief you beforehand because I know you'll have loads of worries.
36:40Yeah. Come on in, come on in.
36:43So, we now know that the bug is a bug called Enterococcus.
36:48And I wonder whether it's because he was on antibiotics for a while beforehand,
36:52which suppressed his gut flora and allowed Enterococcus to grow.
36:57Fortunately, we got him on the correct intravenous antibiotics.
37:00But it's still producing?
37:02So, yes, last night there was still discharge coming from the hole.
37:07So you think it's still not quite under control?
37:09It's definitely not quite under control.
37:11So I once again flushed it and packed it with this special cream.
37:17And in conjunction with flushing, which dilutes the number of bacteria,
37:22debridement, which takes away their home,
37:25and the antibiotic, which kills the bacterium itself,
37:28one would hope that that does the job.
37:30I think if we can get him through the next ten days,
37:33his long-term prognosis will be good.
37:35I'll bring him in.
37:39Come on, mate.
37:41There we go.
37:42Now, Mama's here.
37:44Hi.
37:45Now listen, you take your time.
37:46Okay.
37:47We'll be back.
37:49Oh, sweetheart.
37:50Come on, Angus.
37:51Shh.
37:52Calm down.
37:53Calm down.
37:54Come on, Santa.
37:55I know.
37:56I know.
37:57Angus, Angus, Angus, Angus.
37:58I know.
37:59Shh.
38:00Shh.
38:01Shh.
38:02Shh.
38:03I'm not going anywhere.
38:05Angus.
38:07Oh, darling.
38:09Shh.
38:10Angus, shush.
38:11Shush.
38:12Shush.
38:13Shh.
38:14Angus, shush.
38:15Shh.
38:16Shh.
38:17I know.
38:18Shh.
38:19Shh.
38:20Shh.
38:21Your leg looks amazing.
38:22It looks amazing.
38:24You are amazing.
38:26I'm so sorry.
38:29I'm so sorry this has happened to you.
38:32Poor Bertie Barson's tears in school.
38:34You did.
38:35I didn't know what to do without you.
38:36You know?
38:37I'm sorry.
38:38You must have been so frightened.
38:39Thank you so much for dying so hard for us.
38:46Good boy.
38:47Angus, the golden doodle who fell off a cliff, is fighting an infection that took hold
39:01after his left front leg was amputated.
39:02Zoe asked Noel to continue treatment.
39:03And at last, there are signs of improvement.
39:04So the tissue looks a lot better now.
39:05It's a lot less oozy.
39:06Today, Noel is hoping to insert a drain which will draw out any remaining fluid helping
39:35it, helping the wound to heal.
39:37So the big sharp needle comes through the skin, and we pull it all the way through.
39:43Can I have, please, a 3-metric PDS-NF needle?
39:47Finally, Noel is able to close the wound.
39:51OK, good, last stitch.
39:57If the drain works, Noel will be able to remove the tube in a few days' time, in the
40:01hope that Angus will finally be clear of the infection.
40:05OK, Angus, good boy.
40:14Rocky!
40:17It's been six weeks since spirited spaniel Rocky had surgery to fuse his elbow.
40:25Today Tanya and Ian have returned to discuss how Rocky is adjusting.
40:31Are we ready?
40:32Hello.
40:33How are we getting on?
40:35His nose is certainly working.
40:36Looks like we're raring to go.
40:38We are.
40:39He's so keen to, he's obviously not in anywhere near as much pain, or any pain at all.
40:44I mean, he's still, I think he realises his leg is weak, so as soon as he's in a hurry to
40:52get anywhere, it's shoulder blade up, and leg just moved out of the way.
40:56He's just getting used to having a fused elbow.
41:00Let's take him through for x-ray, we'll have a look, and then I'll have you back in.
41:04Come on, big fella.
41:06Good.
41:07Good.
41:08Well done.
41:09Good.
41:10I'll come and find you soon.
41:11Good.
41:12X-ray pictures will reveal how well the elbow bones are fusing together.
41:18Hi guys, come on in.
41:22There we go.
41:23Everything's going fine.
41:24Brilliant.
41:25Brilliant.
41:26Brilliant.
41:27So I'm very pleased with how the healing is going.
41:29Excellent.
41:30Implants working beautifully well as designed.
41:32It's all now about rehab.
41:34Right.
41:35That is a combination of range of motion exercises plus hydrotherapy.
41:41Yeah.
41:42I will bring him through.
41:43Brilliant.
41:45If all else is equal, in six weeks from now he can run around happily.
41:49Good.
41:51God bless.
41:52Take care.
41:53Bye.
41:54Craft yourself.
41:55You too.
41:56You too.
42:01Oh yeah, he's definitely a happier dog.
42:04He's doing more of his little smiling.
42:06He might not be smiling just at that moment because he's a bit dopey.
42:08I suppose it's up to us now to take him to his hydrotherapy and physiotherapy sessions
42:14so we can all practice together.
42:16You're right.
42:17You're right.
42:18I think I just missed him.
42:19It's fine.
42:20It's fine.
42:21It's fine.
42:22It's fine.
42:23It's fine.
42:24It's fine.
42:25It's fine.
42:26Yeah.
42:27It's fine.
42:28It's fine.
42:29It's fine.
42:30It's fine.
42:31It's fine.
42:32Yeah.
42:33It's been a long road journey.
42:34Oh.
42:35Now.
42:36Now.
42:37Now.
42:38Now.
42:39Yeah.
42:40But after three weeks of intensive treatment, Angus is finally ready to go home.
42:44I've already seen him.
42:45You guys say hi.
42:46Yay.
42:47Oh wow.
42:48Hello everybody.
42:49Hello.
42:50I'm so happy to see you all.
42:51Hi.
42:52Hi.
42:53Hi.
42:54Hi.
42:55Hi.
42:56Hi.
42:57Hi.
42:58Hi.
42:59Hi.
43:00Hi.
43:01Hi.
43:02Hi.
43:03Hi.
43:04Hi.
43:05Hi.
43:06Hi.
43:07Hi.
43:08Hi.
43:09Hi.
43:10Hi.
43:11Hi.
43:12Hi.
43:13Hi.
43:14Hi.
43:15Oh.
43:16Come on.
43:17It's so nice toenys.
43:18Dingus.
43:19Come on, can you're doing.
43:20Hi.
43:21Well done you.
43:22You're such an amazing man.
43:23Really, the most extraordinary thing is to still him.
43:26He's just taking it all in his three-legged stride.
43:29I mean really, he's, he's being incredible, isn't he?
43:33And thank goodness, because actually I was waverying and it was my team of four who said,
43:39No, Mommy, please, please keep going.
43:43And we did.
43:44And look, it was all worth it, wasn't it?
43:47Amazing, amazing boy.
43:52Good boy.
43:54Rocky.
43:56It's been 12 weeks since Rocky had his elbow fused.
43:59And to help him with his mobility, Noel has recommended hydrotherapy.
44:04Rocky's been doing laps of the pool and he's also been, had goes on the underwater treadmill.
44:13Good boy, go on, you can do it.
44:15Apparently egged on by the reward of cheese from a tube.
44:20Boy, that's better.
44:23Despite making progress though, Rocky is now facing another hurdle.
44:28He's been diagnosed with cancer and has had further surgery to remove a tumour from his abdomen.
44:38Rocky, come on.
44:41Ever the fighter, Rocky is once again off the ropes.
44:46Currently he's tumour free and we're hoping he stays that way.
44:50And because he's now able to do his hydrotherapy and physiotherapy,
44:54he seems to be making great steps forward.
44:57Good boy, Rocky.
44:59Good boy.
45:00It's so good to see him back to his old self and his usual enthusiastic ways.
45:07Now that Rocky's pain free, I just think he's going to be enjoying life to the full,
45:12chasing pheasants, partridges.
45:13Rocky loves life so much and just couldn't be more grateful.
45:19What a superstar.
45:20What a good boy.
45:21In Northamptonshire,
45:28Come on boys.
45:30Angus, him it.
45:31A three-legged Angus is getting back to life in the big outdoors.
45:36Having Angus back is completely extraordinary.
45:40He's just slowly building his fitness and his physiology is changing to cope with it.
45:45His back end is getting much stronger.
45:47Having survived a 20 metre fall and a life-threatening infection,
45:53Zoe is in no doubt that Angus is a very special dog.
45:57If I think back now to sort of a few weeks we had him literally dragging himself around.
46:06It's so extraordinary, the difference.
46:08It's amazing.
46:09It's wonderful.
46:12Daddy Angus, Hamish.
46:13I'm just deeply grateful that we stuck with it and that he's still here.
46:19And I think we've learned a lot of lessons from him and from life.
46:43To be continued...
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