- 2 weeks ago
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00:00Oh my goodness, what a difference a couple of days make.
00:06Professor Noel Fitzpatrick...
00:08All right, Mrs. Cuddlemonster incoming.
00:12...is the super vet.
00:13We have issues.
00:15I knew I should have got chihuahuas.
00:17At his unique vet practice, he merges mechanics and biology.
00:21Past the point of no return now.
00:24Don't be pulling apart my repair, Mrs.
00:26...to heal the nation's pets.
00:28I'm sorry 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, Gilder.
00:42Oh, my God.
00:44There's God.
00:46Sometimes you have to bend the rules of mechanics to fit the biology.
00:50...and offers hope.
00:51We've definitely made the right decision.
00:53Good boy.
00:55We've got my boy back.
00:56...for families and their friends.
00:59Look at you!
01:01Bionic, doggo!
01:05Yes, mate, I love you too.
01:10This way.
01:11Good girl.
01:12Oh, I love it when she does that.
01:15If I could pick a dog nose, I'd pick yours.
01:18The bond between humans and animals is at the heart of Fitzpatrick referrals.
01:24They're just your best friend, aren't they?
01:25Like, they are constantly giving you an unconditional love,
01:29which you don't necessarily get from people.
01:32You being a good boy?
01:33I think it's like the air of innocence that they carry
01:36just really makes you want to make life better for them.
01:39I can't believe you brought the dirtiest toy in.
01:41You devote your life to giving something back to them.
01:44You love your Ellie, don't you?
01:46They always have that love and patience with you,
01:49and even when they're in so much pain,
01:51they'll still wag their tails and want to lick your face.
01:54If you'll be back soon, don't worry, puppy.
01:57Don't worry.
01:57Unconditional love is the reason I became a vet.
02:01Oh, are you little cute scruffs?
02:04Looking after that bond of friendship
02:06that exists between an animal and their family
02:08is the greatest reward you could ever wish for.
02:14Stop chewing him. Stop chewing him.
02:19Golden Retriever brothers Bertie and Buddy...
02:21No, it's not food. It's not food.
02:24..have a special relationship with each other...
02:27Gently, gently, gently, gently, Bertie, your nutcase.
02:30..and their mum, Rachel.
02:32Come on! Come on!
02:35Look at you, look.
02:36One-year-old Bertie was born with a growth deformity.
02:40I know!
02:42Yes!
02:42I walked into this crate of 11 puppies, and there was Bertie.
02:46Jazz, look at his little tail, look.
02:48With a little kink in his tail
02:50that went round like a little propeller.
02:52Bertie!
02:53Good boy, there you go.
02:56Bertie is the calm dog.
02:58Bertie is the nutcase, and he just makes me smile.
03:03At 10 weeks, he went for his normal check-up,
03:05and the vet said, I think he's got dislocated hips
03:08and curvature of the spine.
03:10I believe he's also got missing vertebrae as well,
03:13which makes him shorter.
03:14This is why they can't play together.
03:18He's just such a fun pup.
03:21Idiot.
03:22He's just...
03:23He loves life.
03:25In the last few months, Bertie has begun to limp,
03:29because his hip is dislocated due to his genetic deformities.
03:33What's this?
03:34Ah, that's a good one.
03:36Rachel is desperate to help the unique pup,
03:39as he and his brother, Buddy, have brought her back from the brink.
03:43I lost my partner three and a half years ago.
03:45It's a brain tumour.
03:47Um...
03:48I only got Buddy eight months after.
03:53And, er...
03:55I know you sound stupid, but I think he was sent to me from Stu.
03:58Because I begged Stu to send me somebody.
04:02And when I picked him up in my arms,
04:05I just had this heat that went all the way through me.
04:07And it was Stu saying, here you go, here's your mate.
04:10They're everything.
04:11Without them, I'm not sure I'd be in such a good place, to be honest.
04:15And they get the best of everything.
04:17And Noel's the best.
04:19You know what I mean?
04:20If he can't fix him, nobody can fix him.
04:23Bertie has had previous consults at Fitzpatrick's,
04:26but as complex surgery may be indicated,
04:29he's now been referred to Noel.
04:32Hello.
04:32Hello.
04:33How are you?
04:33Good morning.
04:34I'm all right.
04:34Good morning.
04:34Nice to see you.
04:35Grab a seat.
04:36Oh, you get snuggles for all day.
04:38All day.
04:39Can't get enough of it.
04:40All day snuggles.
04:41Now, so you knew that he had a deformity since birth, then, did you?
04:46At ten weeks, he went for his injections and then said he's got a curvature of the spine.
04:51And then I started to know if he was limping and I asked him to refer you to you.
04:56By your own request, was it?
04:58Yeah, absolutely.
04:58Because you're our dog god in our house.
05:00Oh, I see.
05:01We watch her.
05:02Oh, I see.
05:02Do you watch the telly, mate?
05:03We all watch.
05:04Okay.
05:05I'm just going to feel the hip now.
05:09Yeah, that really is painful, isn't it?
05:12See, you've got a completely luxated hip.
05:16All right, mate.
05:16Well done.
05:17All right.
05:18I've had a three-dimensional reconstruction of what his spine looks like.
05:22Wow.
05:24That's mad, isn't it?
05:25So, that's extremely deformed.
05:29And...
05:29Sorry about that.
05:32Sorry.
05:33I mean, clearly, you have to understand what the nature of this deformity is.
05:37Now, that isn't fixable.
05:38No.
05:40But that is not Bertie's problem.
05:43Bertie's problem is pain coming from the right hip joint here.
05:47And the pelvis is significantly twisted.
05:51So, there's two big issues.
05:52One is the mechanics of getting an implant that actually would work for him and keep that hip in,
05:58because it is dislocating all the time.
06:00Yeah.
06:01And the second issue is what is going to be the effect of the spinal deformity over time,
06:07and is a hip replacement here in the patient's best interest or not?
06:14Whatever it is, it's got to be worth it for him.
06:16Yeah, yeah.
06:17It's not about me, it's about him.
06:18Absolutely.
06:20Sorry to make you upset, but...
06:22There you go.
06:26I'm not going to do this.
06:27Okay.
06:31If he's going to be struggling, and he's going to be in pain, and he can't run around after him,
06:37then it's not life.
06:40Right.
06:41It's not life.
06:43It's not about me.
06:44But it is what it is.
06:46It's not about me.
06:46Yeah.
06:47Yeah.
06:48If a hip replacement were to work for him, his function could be pain-free.
06:53So what I would suggest that we do is get an ethics review done.
06:58And that will take a few weeks.
07:00Okay.
07:01Okay?
07:02You're a beauty, aren't you?
07:03Yeah, he's a beauty.
07:05Oh, well done.
07:06Well done.
07:08Talk about emotional.
07:10That's me thinking he was coming for his operation today.
07:12And it turns out he's got to be put in front of an ethics board.
07:17And I suppose if I'm honest, it's me to think about what to do as well.
07:21You know, it's about being selfless, not as selfish.
07:41It's about his life, you know what I mean?
07:43If he's going to suffer, will I know when he's suffering?
07:46Because dogs don't show it, he doesn't show it.
07:49It's just what's right for him at the end of the day.
07:51You're part of the family, aren't you?
08:05When it comes to the bond with man's best friend...
08:09Come on.
08:10Good boy.
08:12There's no more shining example than nine-year-old Tibetan terrier Sonny and his family.
08:18Imagine, though, this is literally as heaven, just smelling all these doggies.
08:21After a year desperately seeking help for an unusual condition, today they've arrived for long-awaited surgery.
08:29I don't think I've ever been more nervous than when I gave birth, to be honest.
08:33I've had a Tibetan terrier before, so I knew exactly what I was going in for.
08:41Two.
08:42Two.
08:45They partner with monks in Tibet and they will stay by your side because that's where they're happiest.
08:50Right from the beginning, he did not want to be left alone.
08:54I used to tie him to a tree when my daughter was at school and he chewed through nine leads.
08:58And...
08:59Because he just couldn't bear the thought of a few minutes of us being gone.
09:06I see him as one of my children.
09:08I'm willing to do anything for him.
09:10Over the last year, the family noticed a change in their usually contented dog.
09:17He wouldn't want to go up the stairs.
09:21He wouldn't want to come out of the car.
09:24And for the first time ever, he would snap.
09:28It was said that he had arthritis throughout his body.
09:34The arthritis had badly damaged Sonny's right knee.
09:38But a surgical procedure failed.
09:40And despite seeing several vets, Sonny was still in pain.
09:44He lost five kilos.
09:46That was a third of his body weight.
09:48I was watching him die.
09:51And no one...
09:52I felt like no one would help at all.
09:55It's a good thing.
09:56I always thought there's something else that can be done.
10:00We don't give up on humans when they can't move around.
10:04We've all just adjusted our lives to cater for his needs.
10:09OK, you got it. Down you go.
10:11I think I'm probably the mad dog woman.
10:15A month ago, Sonny was referred to Fitzpatrick's,
10:18where Noel identified problems affecting many of his joints.
10:22I feel like someone else is caring now
10:25and wants to get to the bottom of it.
10:27Good boy.
10:28Fixing my dog, it would be like winning the lottery to me.
10:32There's nothing more.
10:36OK, so Sonny's in real trouble
10:38because his joint problem is due to an immune-mediated condition
10:42whereby his immune system is effectively attacking his joint structures
10:47and the connective tissue around his joints
10:49and within his joints is being destroyed.
10:53There are those that would say he should be put to sleep
10:56and there are also those that would say give him a chance.
11:00We're going to replace his right knee today,
11:03but he's got severe arthritis in his left knee as well.
11:07So his overall situation is still very worrying.
11:13Sonny's knees are the most damaged by the disease,
11:16but if his other joints decline,
11:18he may need long-term medication
11:20or, worse still,
11:22his family may need to consider euthanasia.
11:27All right.
11:28So I've been through a vast ethics approval process.
11:33So four different vets have looked at this
11:36and they're supportive of this surgery
11:40to try and save the right hind leg.
11:42OK.
11:43All of us are aware that the left hind leg
11:47is going to need surgery.
11:49So, of course, the big decision
11:51that will need to be made for the left knee
11:52is what we're going to do in due course.
11:55Oh, there's a lucky spider.
11:57A lucky spider.
11:59That's very lucky.
12:00Very lucky.
12:01I'm going to bring him outside for good luck.
12:04Good boy.
12:05Saving a spider.
12:07A lucky spider.
12:10Just going to give him a new home right there.
12:13Now, that's good.
12:15We had the lucky spider come from the universe,
12:17so it's all good.
12:19Right, Sonny, big hugs for the family
12:21and we're going to take you through now, buddy.
12:23Good boy.
12:24All right.
12:25All right, we'll see you later, mate.
12:26Off you go.
12:27Try and stay calm.
12:29I'll ring you tonight.
12:30You've had a lucky spider,
12:31so I'm hoping that's all going to be fine.
12:35Sonny's right knee will be replaced this afternoon
12:38because it's collapsed
12:39and been worn down by the inflammatory disease.
12:42He's shaking.
12:43His left knee will hopefully be operated on in the future
12:47to try to improve the loyal boy's quality of life.
12:59Euthanasia will really be the only option
13:02if this doesn't work
13:04because all his joints are failing.
13:07I don't know if I can deal with that.
13:20Good boy.
13:21You're OK.
13:22Before surgery, the team checks the cells
13:24in Sonny's other joints for signs of IMPA,
13:28immune-mediated polyarthritis.
13:31All of these joint smears here
13:33will tell us whether we've still got an active inflammatory disease
13:37that could attack all of Sonny's joints.
13:41Even if Sonny's knee surgery is successful,
13:44if his other joints deteriorate too quickly,
13:47it may affect plans for future treatment.
13:50So we can see what an immune-mediated disease does.
13:58It destroys the connective tissue around
14:01as well as within the joint.
14:02Where's the 2.7 screws, please?
14:09To replace Sonny's knee joint,
14:11Noel will use a 3D-printed guide
14:13to remove the bottom of the femur
14:15and excavate the marrow cavity.
14:19He will then repeat the process with the tibia.
14:21After pumping in cement,
14:25the femoral and tibial components are fixed in place.
14:30Finally, Noel will insert a hinge he's invented,
14:33which will allow the knee to flex, extend and rotate,
14:37but avoid it dislocating.
14:46Noel's first job is to prepare the femur and the tibia
14:49ready for the implant.
14:52You've got to be super careful here
14:54because the bone is incredibly thin
14:56and it's very easy to perforate.
14:59All right, give me some cement, please.
15:02Then he can cement in the first part of the implant.
15:06Get ready to rumble.
15:11OK, so we've got the femoral component in now.
15:17And that's looking good.
15:19Happy with the placement,
15:20he inserts the tibial component.
15:24OK, we've got bone graft here
15:27that we've harvested from the bottom part of the femur
15:31so that we get dual fixation,
15:33immediate stability from the cement
15:35and ongoing stability from bone growing in.
15:38Finally, Noel connects the two components
15:41with a plastic bushing to form a rotating hinge.
15:44We push it in.
15:48And we lock it into position.
15:51In a week, the results of the other joint fluid tests
15:54will determine what's next.
15:56All right, let's go as quick as we can to x-ray.
15:59But it's the first step on the road to recovery
16:02for the devoted dog and his family.
16:05Hello, good evening.
16:08Hi, good evening.
16:09It's Noel here, the vet.
16:11Yeah, hi, Noel.
16:11I was just going to put you on loudspeaker, if that's OK.
16:13Sure thing.
16:14I've done the operation.
16:15It went fine.
16:17Great.
16:19My hope is that within a week,
16:21we'll get to a point where he's more comfortable.
16:23That's the first news from a vet
16:27that we've spoke to, you know, in the last year
16:29who's done what they said they were going to do.
16:32So thank you for that.
16:34If you can just keep doing what you said you were going to do,
16:36we're going to have a very happy family.
16:38Excellent.
16:39Well, I shall intend to do exactly that.
16:53It's boring, isn't it?
16:56Oh, it's so boring.
16:57Yes, me the s***.
16:59Good girl.
17:01Come here.
17:03You see all these dogs struggling to walk,
17:06and then Edith's jumping around like a bloody lunatic.
17:09It's not every day that a dog is jumping for joy
17:13at a visit to the vets.
17:15She is quite funny.
17:16She's quite funny, yeah.
17:17But for four-year-old Edith,
17:18her enthusiastic Springer Spaniel personality...
17:22Stop there.
17:23..may be hiding a serious problem.
17:28Edith, about two years ago, hurt her back.
17:31She started acting a little bit aggressive towards the cats,
17:34who she'd previously been best friends with.
17:37The other vets have examined her and said,
17:39we can't find anything wrong,
17:40but we know that there's something not right.
17:45Edith lives with Val and Tara and their two cats
17:48on the edge of the Peak District.
17:50Ruff!
17:51Ruff!
17:52Edith is crazy, nuts, luthy, energetic.
17:57Wait, wait, wait, wait, wait, wait, wait, wait, wait, wait.
18:00She's hilarious.
18:02She'll steal things, like your phone or shoes.
18:05Her favourite thing ever is songs.
18:07God.
18:09Are you going to give it back?
18:11Good girl.
18:11There's never a dull moment when Edith's around.
18:17The couple believe that Edith's recent aggressive behaviour
18:20could be caused by pain from a disc problem in her back.
18:24But they've been unable to get a definite diagnosis.
18:27When you come into the vets and you've got a bouncing dog running around,
18:33you do kind of see their point of view that there is nothing wrong with the dog.
18:37But when you know them well, you know that that dog isn't right.
18:43We can't take her on long walks.
18:46The cats are too scared to come down the stairs almost.
18:49We're stressed.
18:51She's just not right.
18:52And we came to so many dead ends at the moment
18:54that we just hope that at the very least we'll get an answer
18:58to what is actually wrong with her dog.
19:01Oh, hi there, guys.
19:05Hi there.
19:05Please grab a seat.
19:07How are you doing?
19:07Cheers.
19:08Now, I see you've been through the wars.
19:10I have 12 reports here, which I've just been looking through.
19:14Tell me what happened.
19:16We went for an MRI.
19:18And in a way, I kind of got the impression
19:20that they thought we were kind of overreacting.
19:24Because she just doesn't give anything away.
19:28He decided to do steroid injections.
19:30Did that help?
19:31And that did help.
19:32And then about six months or so after that,
19:36she started showing signs again.
19:38But what we're noticing this time is
19:40she is starting to self-mutilate herself.
19:45We're just in that stage now where...
19:47What's wrong with her?
19:49Yeah.
19:49Is there something that...
19:50Because I don't think the meds are helping.
19:54Sorry that you've been through all of that.
19:56It's obviously very emotional for you.
19:58Yeah.
19:59So you're worried about her
20:01that she's in pain all the time?
20:03Yeah.
20:04I get that.
20:05And it's very tough when you see your friend
20:07going through significant pain.
20:10So I'm going to do a physical examination
20:13of the lumbar sacral spine.
20:15Hold tight.
20:18Hold tight.
20:20All right.
20:28That subjectively would suggest to me
20:31that there is sciatic pain,
20:33but this is intermittent.
20:36Yeah.
20:37And the reason for that is
20:38that the disc will bulge in a different way
20:41depending on what position the dog's in.
20:43Right.
20:44So when we look at your MRI scan from before,
20:48what we can see is
20:49there's a relatively mild disc bulge.
20:51Yeah.
20:51However, I would bet a million dollars
20:54that if we put the spine in that position
20:56that disc will bulge more.
20:57Right.
20:58Okay.
20:58Yeah.
20:59Makes total sense.
21:01Sometimes you can have a bulging disc
21:04that won't show up in neutral positioning
21:07on an MRI scan.
21:09Right.
21:09Give her a big cuddle.
21:10And it can be quite challenging
21:12to get a correct diagnosis.
21:15We have developed a technique
21:17known as dynamic MRI
21:19whereby we place the dog
21:21inside the scanner
21:23in the jumping position.
21:25Only then can you see
21:27the true extent of compression
21:29of the nerve roots
21:30that causes the severe sciatic pain.
21:33So what you will see
21:47if we look at the hyper-extended view
21:49is this disc
21:50at the lumbar-sacral junction
21:52is significantly bulging
21:54causing an hourglass compression
21:56of the nerves.
21:58So that is the normal diameter
22:00of the neuroforamen
22:01by comparison with this one
22:03that disc is bulging
22:06right up into that hole
22:07through which the nerve should come.
22:09Oh God, that looks painful.
22:12I know she has her moments of pain
22:15but you think that must be...
22:16She's in pain all the time.
22:18Oh God, yeah.
22:23And it just gets worse
22:24depending on motion.
22:28So unequivocally, girls
22:30you've got a bad situation.
22:32Yeah.
22:35So it needs to be operated on?
22:38No dog ever needs anything
22:40because any dog can be put to sleep.
22:43And currently euthanasia
22:45is still considered a treatment.
22:48So at least you know
22:49the situation definitively.
22:51Sorry that it's so tough.
22:53I think it says it all, doesn't it really?
22:55Yeah, that is...
22:56Yeah.
22:57Yeah.
22:59With spinal surgery
23:00there are many considerations
23:02and when the ethics and risks
23:04are discussed with different families
23:05they may make different decisions
23:08based on what they perceive
23:10their friend may go through
23:11and what the prognosis
23:13for a good quality of life may be.
23:16No worries.
23:17Now we know why she's sore
23:19having seen a better quality MRI.
23:22I suppose there's only two decisions
23:24it's whether we go through the operating
23:26or it's whether we get to put to sleep.
23:29I'm sounding blasey at the moment
23:31but I probably...
23:32I just want to burst into tears
23:33like I did
23:34but I'm not going to
23:35I'm going to hold it together
23:36so, yeah.
23:37Yeah.
23:37Bless him.
23:52Three months have passed
23:53since Bertie the pup
23:55with Twisted Anatomy
23:56was last at Fitzpatrick's.
23:59Last time it was quite upsetting
24:00to the point that
24:02I got on the M25
24:03and had to pull off
24:04to service station
24:04because I was that upset.
24:05and then when I got home
24:07he did something a bit mad
24:09that he's never done before.
24:10He jumps up on the bed
24:11he shoves his head
24:12underneath my arm
24:13as if to say
24:14I'm not done yet.
24:16The golden retriever
24:17isn't ready to throw in the towel
24:19and thankfully
24:20his hip replacement surgery
24:21has been approved
24:22by the ethics panel.
24:25Oh!
24:26Sorry.
24:27Sorry, didn't mean to scare you.
24:29It's all right, I'm still chilling.
24:32Bertie's deformed spine and pelvis
24:33mean an off-the-shelf implant
24:36won't work.
24:37This is a little nutcase.
24:37Hi, nice to meet you.
24:39You're adorable.
24:41So Noel has created
24:42a custom-made hip socket
24:44to fit the pup's unusual shape.
24:46OK, so a lot of planning
24:49has gone into this
24:50and what I want to emphasise
24:52is a few things
24:53before the surgery.
24:55I'm going to have to get the hip
24:57from an abnormal orientation
24:58up here somewhere.
24:59Yeah.
25:00Down into where it needs to be.
25:02Right.
25:02So I may have
25:04serious complications
25:06inside the operation
25:07which is my next point
25:08because if I do have
25:10serious complications
25:12the ethics committee
25:13have said that
25:14the only route
25:16that they would
25:17conscience
25:18if it failed
25:20was euthanasia.
25:25I don't have any choice
25:26in that matter.
25:27No, I know.
25:30Hi, big guy.
25:30Good boy.
25:31OK, thank you.
25:34See you later.
25:35Bye.
25:40Rachel will head home
25:41to wait for news.
25:43This is Bertie.
25:44He has the right length
25:45but it's just all bent.
25:46It's bent.
25:47Wow.
25:48There's a lot riding
25:49on the operation
25:50being a success.
25:51OK, let's go.
26:07Golden retriever Bertie
26:09has had a dislocated hip
26:10since birth.
26:13Noel plans to replace
26:14his malformed joint
26:15using a custom-made implant
26:17called an ace fits
26:18built to fit
26:19his unusual anatomy.
26:20Because the pelvis
26:22is markedly deformed
26:23it's like trying
26:25to take a very long
26:26journey
26:27with the wrong road map.
26:29The old head
26:30of the femur
26:31is cut off.
26:33Go.
26:36We use this disco ball
26:39with cutting edges
26:40on it
26:41to open up
26:42the socket.
26:46Give me the implant,
26:48please.
26:49This implant
26:50is designed
26:51based on an ice cream
26:52scoop
26:52and it's coated
26:54in trabecular metal
26:55into which the bone
26:56should grow.
26:58Noel packs bone graft
26:59from Bertie's old joint
27:00into the enlarged hole.
27:03Once the bone
27:04grows into it
27:05it should become
27:06a permanent part
27:07of the body.
27:11Once locked
27:14in place
27:15with screws
27:15a plastic cup
27:16is cemented
27:17into the metal socket.
27:29Then Noel
27:30can insert
27:30the new hip stem
27:32which is secured
27:37with a bolt
27:38before the head
27:39is attached.
27:41So we can see
27:47the head
27:48is now in position
27:49inside the new cup.
27:51When I grab
27:52the top of the femur
27:53like this
27:53and pull on it
27:55the hip
27:56doesn't dislocate.
27:58So what we've
27:59managed to do here
28:00hopefully
28:00is use mechanics
28:02to overcome
28:03the limitations
28:04of the biology.
28:07Good job everybody.
28:08After two and a half
28:10hours
28:11Bertie
28:12can leave
28:12theatre.
28:17Hi Noel.
28:18Hey Rachel
28:18I'm sure you're
28:19sitting on the phone
28:20like a hot call.
28:21Oh
28:21I felt sick
28:22all day.
28:23Yeah
28:24I can imagine.
28:25So I've done
28:26the operation
28:26and
28:27so far
28:28so good.
28:30Oh.
28:30So things went
28:33according to plan.
28:34It was tough.
28:35It was a tough op.
28:38You okay?
28:42Yeah.
28:44I was widowed
28:45three and a half
28:47years ago
28:47and without these dogs
28:48I wouldn't be in
28:49as good a place
28:50as I am now
28:51and that's not
28:52being melodramatic.
28:53These dogs
28:54make me move.
28:57Yeah of course
28:57they do.
28:58Of course they do.
28:58And I know
28:59it sounds
29:00really stupid
29:01and I don't care
29:02what anybody says
29:02but they were
29:03gifted to me.
29:05From above.
29:05These dogs
29:06were said
29:06from above.
29:07They absolutely
29:08100%.
29:09Oh God.
29:11Well I'm glad
29:12you feel that way.
29:13No no listen
29:14let it all out.
29:15Let it all out.
29:16It's good.
29:16It's all good.
29:17It's all good emotion.
29:19Oh shaking.
29:20Noel.
29:20Wow.
29:20You are
29:21a dog god.
29:23I'm just glad
29:24to be able to help.
29:25I'll let you crack on
29:25because you must be shattered.
29:26I am pretty tired.
29:27Thank you very much.
29:28God bless.
29:29We'll give you a call tomorrow.
29:31God bless.
29:31Lovely.
29:32Bye bye.
29:33Thanks Noel.
29:33Bye.
29:34Bye.
29:50Drink.
29:52Drink.
29:52Drink.
29:52Drink.
29:52Drink.
29:53Drink.
29:54In Somerset
29:55Steadfast Sonny
29:57is making good progress
29:58after his knee replacement surgery.
30:00Up son.
30:02Ready.
30:03Good boy.
30:04And his family
30:05are fully committed
30:06to their Tibetan friend's recovery.
30:09He's coping very well
30:10with the new routine.
30:12We stay in this room
30:13practically all day.
30:15He has his physio.
30:17He eats and drinks in here.
30:19He sleeps in here.
30:23It's getting a bit boring
30:24to be honest.
30:25This was the one
30:28I was scared of doing
30:29but it's not too bad.
30:32His right leg
30:33is definitely getting stronger
30:35and he's on the least medication
30:36he's been on in a year.
30:37So something's definitely worked.
30:40I'm hoping that they
30:41would say yes
30:42to do the left knee
30:44but I'm scared
30:45if his IMPA
30:47this arthritis
30:48will go to other joints.
30:51That's what I'm scared of.
30:52In here.
30:53Good boy.
30:55I'd love to take him
30:56to the beach.
30:57I can't even remember
30:59what he looks like to run.
31:01Good boy.
31:02Good boy.
31:03But to be able to
31:04watch him do that
31:06it would be amazing.
31:08Absolutely amazing.
31:10Want to pee?
31:13Not a number two.
31:14Good boy.
31:22Look at that.
31:23Look at him go.
31:24Good boy.
31:25Good boy.
31:26Five days after hip surgery
31:28Look at your little tail.
31:30Quirky Bertie
31:31the golden retriever
31:32with a twisted spine
31:33and pelvis
31:34is on the move.
31:36Bertie, Bertie, Bertie.
31:37Bertie is so flirty.
31:39And Rachel
31:40and big brother Buddy
31:41Burp, burp, burp, burp.
31:43Burp.
31:44Come on.
31:44Now sit, sit.
31:46Can't wait to get him home.
31:47He's been a bit down in the dumps.
31:50It's been very quiet.
31:52Does he bark?
31:53Not cold.
31:54Oh, that's so nice.
31:58The next bit's down to me.
31:59Noel's done his bit
32:00so it's going to be a long 12 weeks
32:02but it's well worth it.
32:04Morning.
32:05How are you?
32:06Happy, happy.
32:07Grab a seat.
32:08You are hilarious.
32:10Why?
32:11Oh, I've been listening to your book
32:12all the way down.
32:12You're so funny.
32:14Well, I didn't think
32:15it was that funny.
32:15It's made me laugh,
32:16it's made me smile,
32:18it's made me cry,
32:19it's made me gag.
32:22So thanks for coming down.
32:23How are you feeling today?
32:25Excited.
32:26Well, that's good.
32:28Let's season that
32:29with just realism.
32:30Yes, of course.
32:31Obviously.
32:32I'm very realistic.
32:33Obviously we still have a way to go.
32:34Absolutely.
32:35I understand that fully.
32:36But I wouldn't be sending him home now
32:39if he wasn't comfortable
32:40and able to walk.
32:42Yeah.
32:43It's just been weird
32:44not having him
32:44on the back of my ankles
32:4524-7.
32:46Of course.
32:47Because that's what he does.
32:49He also talks a lot as well.
32:51A bit like me, I suppose.
32:52Runs in the family.
32:53Yeah.
32:55It does.
32:56Let me get him.
33:02Now, who's here?
33:04Bertie.
33:07There we go.
33:07Hello, baby.
33:09Hello, baby.
33:10There we go.
33:11Hello.
33:12Oh, look at you, skinhead.
33:13Let's go in reception.
33:14I want to show you
33:15how to do that walking.
33:17So you can see
33:17that he's walking pretty good.
33:20Yeah.
33:20His little turkey tail
33:21is wagging,
33:22so he's happy.
33:23His little cute tail, yeah.
33:24I'm pretty happy with that.
33:26Are you happy?
33:27Yeah, definitely.
33:28Looks good, doesn't he?
33:29Considering what the other outcome was.
33:31He looks lovely, bless him.
33:32He's a little star.
33:33He is a little star.
33:35All right?
33:36You're a star.
33:37You're all a star, guys.
33:37We want our best.
33:38I really appreciate it.
33:39God bless you.
33:40Come on then, Bert.
33:41Bertie will need
33:42six weeks of cage rest
33:43followed by rehab.
33:45Well done, little man.
33:46Look, there's your brother.
33:49Only then will he be able
33:51to rough and tumble
33:52with his best buddy again.
33:53The boys are back in town.
33:54The boys are back.
33:56We're a team,
33:57the three of us.
33:58So, yeah, great.
33:59Great.
34:00We've got a long way to go,
34:01but can't wait to see him
34:03running around together again.
34:04You all right, weasel?
34:16It's been a month
34:17since Noel confirmed
34:18that spirited springer spaniel Edith
34:20has a bulging disc
34:22in her lower back,
34:23causing her significant pain.
34:26So, we've came back down
34:27with Edith
34:27because we had to make
34:29a difficult decision
34:30as to whether we were
34:31going to put her to sleep
34:32because she was in so much pain
34:33or whether we were going
34:34to go ahead and get surgery.
34:37So, we had a good think about it
34:39and we had a good chat with Noel
34:40and we made the decision
34:42that we were going to go ahead
34:43with the surgery.
34:44So, if we hadn't have to do the op,
34:46we'd always be thinking
34:47we could have maybe fixed her,
34:50you know,
34:50and we never gave it a good shot.
35:02Edith's bulging disc
35:04is pressing on the roots
35:05of her sciatic nerves.
35:07To access the disc,
35:09Noel would need to negotiate
35:10other vital nerves
35:12leading to the tail,
35:13bowel and bladder.
35:15Edith has a deceptively
35:16small skeleton.
35:18It makes my job more difficult.
35:22Suction, please.
35:23Noel's first job
35:31is to remove the roof
35:32of the vertebrae.
35:33It's very tight here.
35:37So, there's a big blood vessel here.
35:39We've got to dissect very carefully
35:41between that and these nerves
35:43and the nerves are like small threads
35:45in a patient of this size.
35:48Treading a tight rope
35:49between the nerves
35:50and the blood vessel,
35:51Noel carefully scrapes out
35:53the centre of the bulging disc.
35:56So, this is all the disc material
35:58we've taken out
35:58of the centre of the disc.
36:00With the disc bulge
36:02and nucleus removed,
36:03Noel inserts one of his
36:04most successful inventions,
36:07a Christmas tree-shaped
36:08spacer screw
36:09that will open up the disc space
36:11between the vertebrae.
36:13OK, so we put a screw
36:15through the centre
36:16of the spacer device
36:17to stop it backing out.
36:19Then, nerves come back over the spacer.
36:23The next part of the process
36:25is to fuse the lumbosacral junction
36:28so that even dynamic movement
36:30like jumping
36:31cannot compress the nerves.
36:34We've put a screw
36:35and a clamp
36:35into either side
36:36of the L7 vertebral body now.
36:38And what we're going to do next
36:40is we're going to
36:41put a screw
36:43on either side
36:43of the sacrum.
36:46Dumbbell-shaped rods
36:47connect the clamps
36:48and stabilise the area.
36:51If I move these vertebrae now,
36:52they move together.
36:54Rock solid.
36:58Hopefully, what I've done here
37:00is enough
37:00to get Edith out of pain.
37:03Despite its risks,
37:07neurosurgery can deliver
37:09fast results.
37:10The next few days
37:11will determine
37:12if Val and Tara
37:13will be happy
37:14with their decision
37:15for Edith.
37:16Good girl.
37:27It's been three months
37:28since trusty Tibetan terrier
37:30Sonny
37:30was last
37:32at Fitzpatrick's.
37:34Hey.
37:35Yes, Amanda Heda.
37:37Yes.
37:38Finally, he's been
37:39given the go-ahead
37:40for surgery.
37:41We brought Sonny back
37:42for his second
37:43knee replacement.
37:45He's just not as happy
37:46as he was
37:47a few months ago
37:48so we've literally
37:49been counting down
37:49the days.
37:51Good morning.
37:53Hello.
37:54So, are things
37:55much the same
37:56or is there anything
37:57else new
37:58you need to tell me?
37:59I'm concerned
38:00with his front
38:00right as well.
38:02It sometimes
38:02looks as if
38:03he's stumbling.
38:05Okay, hold tight.
38:08All right, baby.
38:10Baby.
38:12Yeah, he's sore there,
38:13isn't he?
38:14So he might have
38:14a flare of that
38:15IMPA.
38:16Okay.
38:19Okay.
38:23Sorry, mate.
38:23Okay, so we're going
38:25to need to check that
38:26out.
38:27It does appear
38:28he's got a flare of
38:29inflammatory arthritis.
38:31Mm-hmm.
38:33Elbow's pretty bad.
38:34Mm-hmm.
38:35So I think
38:36what we'll do today
38:37is CT scans
38:38of both front legs.
38:40If there's no
38:41structural damage,
38:42then we proceed
38:43as planned.
38:44Okay.
38:44And within one week
38:46we start steroid.
38:47Again, because...
38:49I've known
38:49he's been deteriorating,
38:50but until that knee
38:52was ready,
38:53what more could I have done?
38:54You couldn't do anything.
38:56Right, big cuddles then.
38:57Sonny will have scans
39:00taken to determine
39:01the damage
39:02to his elbows.
39:04He wasn't pain
39:05on those fronts.
39:06After months
39:07under control
39:08with medication,
39:09this sudden flare-up
39:10of immune joint disease
39:12has put his future
39:13in doubt
39:14once more.
39:27Loyal Sonny
39:28is awaiting surgery
39:30to replace
39:30his painful
39:31arthritic knee joint.
39:33Sorry, let's pick up
39:34the imaging.
39:35But a flare-up
39:35of inflammatory arthritis
39:37in his front legs
39:38has put the operation
39:39in jeopardy.
39:41So these are Sonny's
39:42CT scans
39:43of the elbows
39:44and wrists.
39:46We can clearly see
39:47that there are changes.
39:49There's a small erosion
39:51there in the head
39:51of the radius.
39:53There's a hole
39:53in the radial carpal bone
39:55there.
39:55Those holes
39:57are representative
40:00of inflammation
40:03that is destroying
40:05that bone.
40:06And as well as that,
40:07both elbows
40:08are also affected
40:09by developmental
40:10elbow disease
40:10whereby they don't
40:11fit together properly.
40:13We'll try and treat
40:14the knees
40:15to give him
40:15a quality of life
40:16that he can walk
40:17and stand
40:17and be happy
40:18because without
40:20the knee operations
40:21he could do
40:22none of those things.
40:23But it would be wrong
40:24to think that
40:25we can address
40:27his quality
40:29of life
40:29by knee replacement
40:30along
40:31because we can't.
40:32So Sonny is going
40:35to be on some kind
40:36of steroid therapy
40:36or immunosuppressives
40:38for life.
40:38Oh, look at you go, Edith.
40:52That's fantastic.
40:54Well done.
40:56Spaniel Edith
40:57may be in recovery
40:58from major spinal surgery.
41:00Well done, sweetheart.
41:02Well done.
41:03Wow.
41:04But the lively
41:05four-year-old
41:06already has a spring
41:07in her step.
41:08So this is
41:09a fantastic result.
41:11We only came out
41:12of theatre
41:1218 hours ago
41:13and she's already
41:15walking really well.
41:17So that's
41:18very, very encouraging.
41:20The fact that the family
41:21came so close
41:22to a decision
41:23for euthanasia
41:24is extraordinary, really.
41:27Hopefully the outcome
41:28will be good
41:29and then they'll be delighted
41:31they gave her a chance.
41:31Edith has made
41:33such good progress
41:34Val and Tara
41:36are allowed
41:36to take her home.
41:38It's been really quiet
41:39actually.
41:40Yeah, yeah.
41:40We've realised actually
41:41how much of a massive
41:42part of her life she is.
41:44She permanently
41:45does naughty things.
41:47She's just crazy
41:48and not having
41:50their there doing that
41:51is just weird.
41:53Look who's here
41:53sweetie pie.
41:54Stinky.
41:54Hello.
41:56Hello.
41:57Hello.
41:58So it's just
41:59walking is simply
42:01that, the harness
42:02and the lead.
42:03Okay.
42:04Well I hope
42:05you're very pleased
42:05with how she's walking.
42:06Oh definitely
42:07I'm quite amazed.
42:08I see she's so strong.
42:09Well done Edith, good.
42:12We've missed your
42:12big nose, look at that.
42:15The cats have missed you
42:17if not.
42:18They've already
42:19stolen your bed Edith.
42:21You're right.
42:23She's looking a bit
42:24pathetic but then
42:25she's got that face
42:26but yeah
42:28it's nice
42:28it's nice to see her.
42:30Looking forward to
42:30getting you back
42:31into old Edith
42:33fingers crossed.
42:34Yeah.
42:35She's a young dog
42:36so I think we've
42:37made the right decision.
42:41Three months later.
42:46Edith, come.
42:49Yeah, is that good?
42:50So this is the first
42:52proper off-lead
42:53she's had.
42:55Seeing the difference
42:56in her has just
42:56been fantastic.
42:58I've got to see
42:58tell her.
42:59Good girl.
43:00She's getting a
43:01spring back
43:02and a wagging tail
43:04and all that
43:05sort of stuff.
43:06The tail's going mad
43:07isn't it?
43:07Oh.
43:09We've been to many
43:10different vets
43:10that I feel
43:12hadn't really
43:12taken our
43:13problems seriously
43:14and it's just
43:16so nice
43:17we've managed
43:17to get it fixed.
43:18You're out of breath
43:19now aren't you?
43:20We're definitely
43:22pleased to have
43:23taken that chance
43:24and gone down
43:24the route of surgery
43:25and just having
43:26a happy household
43:27and having pets
43:29that actually get
43:30along with each other
43:31the future does
43:32look bright.
43:40Ready?
43:41On we go.
43:43Is that nice?
43:44Do you like the water?
43:45It's been a difficult
43:46couple of years
43:47for Sunny and his family.
43:49Good boy, Sun Sun.
43:50But finally
43:51the clouds are lifting.
43:54He's so much more
43:55himself than a year ago.
43:57He has his spirit back
43:58and he wants to
43:59be around
44:00and be involved.
44:01Whoa, steady.
44:02He has no issues
44:04with his knees at all.
44:05He's able to walk
44:06down to the village
44:07around the woods.
44:09There he is.
44:10It's a bit of a physio.
44:12Lots of people call him
44:13the bionic dog
44:13around our village.
44:14Yeah.
44:15It's only when
44:16say I'm giving him
44:16a rub that I think
44:17gosh, he's got
44:19metal knees
44:20especially made for him
44:22in there.
44:22It's quite amazing.
44:25Yes, he does have
44:26some issues on the front.
44:27He will need
44:28medication for life
44:29but I'm going to try
44:30and get some weight
44:31off him.
44:31He's not going to have
44:32any second dinners
44:33with his dad.
44:33I'm going to try
44:35my hardest
44:35to keep him well.
44:38It's nice just to think
44:39that he is not
44:40in pain anymore.
44:41He's the bestest boy.
44:43Ten years I've had him
44:45and he gives me
44:47so much love
44:48and companionship
44:49every day
44:50that it's no effort
44:51to help him in return.
44:53Hopefully he should
44:54be able to live
44:55comfortably
44:55for the rest of his life.
44:58Yes.
45:03It's definitely
45:10going to be
45:10a natural swimmer
45:11isn't it?
45:13Quirky Bertie
45:14has been having
45:15hydrotherapy
45:15to strengthen
45:16his weak leg muscles.
45:19Bertie's loving hydro.
45:20He loves water.
45:22Careful, Bert!
45:24True retriever.
45:25And the boys
45:26are loving
45:27being back together.
45:29I'm ecstatic
45:30with the results.
45:31Bertie!
45:32Absolutely over the moon.
45:36This is a good boy.
45:38You can see
45:39that he runs
45:39a lot straighter.
45:41He's just Bert back.
45:42You know what I mean?
45:43He's just Bertie back.
45:44Good boy!
45:47Noel, I call him
45:48the dog god.
45:49I do call him
45:50the dog god.
45:50Careful!
45:51He doesn't like that
45:52but he is the dog god.
45:53He is
45:54because without
45:55his expertise
45:56yeah, I'm fairly certain
45:58Bert would have
45:59ended up being put down.
46:01Oh.
46:01Yeah, they do like
46:02to do this.
46:04He'll never be
46:04as big as his brother
46:05but nobody's perfect
46:07in the world, aren't they?
46:08Come on!
46:10This way!
46:11He's my boy.
46:12They're both my boys.
46:14They come above
46:15most humans.
46:17Kids are gonna love
46:18that one.
46:19Good boy!
46:26Good boy!
46:26Good boy!
46:28Good boy!
46:40Good boy!
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