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00:00Hello, mate. You understand Irish?
00:02Animals from all over the world
00:04Ah, bonjour!
00:06Come to see one extraordinary man
00:08who's known as the Bionic Vet.
00:10High five!
00:12Yes!
00:14Professor Noel Fitzpatrick
00:16We only get one shot at this. Here we go.
00:18Noel and his team offer
00:20some of the most advanced treatments available
00:22anywhere. The perfect marriage
00:24of mechanics and biology.
00:26This is what we have now. A brand new knee.
00:28Oh, wow!
00:30For some, it's a
00:32last chance. It is a life or
00:34death situation because we cannot leave him
00:36like he is. I just want you to do
00:38anything you can for him, really.
00:40Sorry. As Noel
00:42continues to devise new ways of
00:44healing... You're going to be my own.
00:46Thank you so much. All good. All good.
00:48...he transforms the lives of his patients.
00:50Oh, that is just unbelievable.
00:52He's raring to go.
00:54...against all the odds. Boom!
00:56One small step for a dog, one giant leap
00:58from mankind. Well done.
01:08It's mid-morning at
01:10Fitzpatrick Referrals' sister
01:12clinic in Guildford.
01:14Hello, kitty.
01:16One year old Persian cat has been brought in
01:18after being hit by a car.
01:20He's a nice cat.
01:22He's a super nice cat. Simba.
01:24Do you reckon he was named after the Lion King?
01:26Hello.
01:28One of Noel's team,
01:30reconstructive surgical specialist Dr Jonathan Bray,
01:32is assessing his injuries.
01:34So Simba was hit by a car two days ago.
01:38Quite bad injuries to both front legs.
01:40He's lost most of the skin and there's some fractures.
01:46We are worried about blood supply to the foot.
01:48So before we anaesthetise,
01:50I'm trying to get access to her toes
01:52so that I can check her sensation.
01:58Good kitty.
02:00Do you want to come and get hot chocolate?
02:02Do you want to get hot chocolate with me?
02:04Come on, help me.
02:06Come on.
02:08The cat is a therapy cat for 11-year-old Kian,
02:10who is autistic.
02:12If Kian's having a really, really bad day
02:14with his autism and a meltdown
02:16quite badly,
02:18Simba will lay on his head
02:20or if Kian's hurting himself,
02:22Simba puts his paws on his hands
02:24and he just goes everywhere with him.
02:26And Kian won't allow us anywhere near him some days.
02:32But who are you now near you?
02:34Simba.
02:36What does Simba do for you?
02:38It makes you feel happy.
02:40After the accident,
02:42Simba was taken to his local vet
02:44for emergency treatment.
02:46It became apparent that actually
02:48with the injuries to both legs
02:50that they didn't think
02:52that they'd be able to save him.
02:54And they brought Simba in to say goodbye.
02:58At which point Kian
03:00obviously got very, very upset.
03:02Simba has substantial fractures in his right foot
03:06and the skin has been ripped off his left leg.
03:10We'll just see what's going on.
03:12The family have brought Simba to Fitzpatrick's
03:16as their last hope.
03:18He has got a chance here.
03:20Even if he loses a leg and a foot,
03:22he has still got a chance.
03:24And that's huge.
03:26So grab a seat.
03:28So we've got some injuries,
03:30but time will tell.
03:32OK.
03:34Left side is the worst
03:36from a skin damage point of view.
03:38Yeah.
03:39This side,
03:40I honestly don't know.
03:42At worst,
03:44we might loosen toes.
03:46OK.
03:47OK.
03:48I get a sense that the leg is intact
03:50and moving freely.
03:51Again, we'll assess that as he's up and about
03:53and moving around.
03:54But no, amputation's not on the list at the moment.
03:56OK.
03:58That's incredible.
03:59So we'll see.
04:00All right.
04:01I'll leave you to go home.
04:02OK.
04:03Talk to you, Mike.
04:04See you.
04:05The news comes as a huge relief for the family.
04:09Simba will be closely monitored over the next few days
04:12to see if the wound can support a skin graft
04:15and whether it's possible to reconstruct his crushed foot.
04:21I'm being told he's going to have no legs to this.
04:24So he's definitely going to live?
04:27Yes, darling.
04:28I might even keep both legs.
04:30It's an unusually quiet reception this morning
04:42at Fitzpatrick Referrals' main headquarters.
04:45But even in a crowd,
04:47there's something about Noel's next patient
04:49that stands out.
04:51He definitely has a bit of a large tongue.
04:54He sticks out all the time, constantly.
04:57He's not being rude.
04:58His tongue is too big for his mouth, basically.
05:01It doesn't do any harm whatsoever, but he looks cute.
05:04100% of the time.
05:06Where's your tongue gone?
05:08He's not being rude.
05:09He's not being rude.
05:11He's not being rude.
05:12He's not being rude.
05:13My name's Melissa, and I have an addiction.
05:15Do you all right, Snora?
05:17Good boy Tiny.
05:19Two-year-old Staffy Cross Tiny lives with Melissa and her family.
05:23Come on, then. Presents. Sit.
05:26My addiction is I rescue dogs and rehome them, rehabilitate them with behavioural problems.
05:32Will you get down, please? We don't get anything if we jump up, do we?
05:36And send them packing, hopefully, to a really lovely forever home.
05:40Right, one more, no more.
05:42The most amount of dogs that I've had in one go was 21 dogs.
05:49And it was hellish.
05:51Melissa began fostering dogs four years ago after suffering a brutal attack while on holiday in Spain.
05:57When I came home, it was quite a horrible recovery.
06:02And I was giving up a little bit, to be honest with you.
06:06And then Tiny's litter turned up on the doorstep.
06:11He was the ugliest puppy I've ever seen in all my days.
06:15He had a forehead that we didn't think he'd ever grow into.
06:19Thankfully, he's grown into a swan.
06:22Tiny.
06:24He brought me back from despair.
06:29I'd given up.
06:30I was able to care for somebody else.
06:33That gave me strength.
06:35He reminded me who I was when I couldn't remember.
06:38And, um, that's a really special gift to give.
06:45Sadly, Tiny has started suffering from problems of his own.
06:49We'd go out on walks, and then he'd have a bit of a limp when he came home.
06:53The vet suggested that it was elbow dysplasia.
06:55I hope that I can do for him, as he's done for me, because I don't want my boy in pain anymore.
07:06Now, Tiny, please, Tiny.
07:08Tiny.
07:11What do you know about elbow disease already?
07:13Um, absolutely nothing.
07:15Okay.
07:15Well, that makes it easy.
07:16We can start at the beginning.
07:18That should be a nice fit.
07:19So if that's an arse, and that's a saddle, basically the arse doesn't fit the saddle.
07:23Yeah.
07:24In layman's terms.
07:26So there's too much pressure going down through there, and that cracks and rubs away.
07:32So almost certainly, if we stuck the camera in there, we would see that there's no cartilage between there and there.
07:39What's the plan?
07:40So the plan is we take a CT scan to see how much bone is rubbed, and then we do an arthroscopy to see how much cartilage is gone.
07:50Right.
07:50Depending on what the camera inserted in the elbow shows, Tiny could have painkillers or injections,
07:57but it's possible that surgery may give him a more lasting relief from pain.
08:02Option one is osteotomy, which is to unload it and shift weight to the other side.
08:07Yeah.
08:08Option two is partial, complete joint replacement. In this case, probably partial.
08:12Righto. And would that be both of them?
08:15I suspect both of them, yeah.
08:17Right.
08:18Every surgery has risk.
08:20He could have an infection. The bone might not heal right.
08:23Yeah.
08:23But at the end of the day, you're trying to do the right thing and get your dog out of pain.
08:26Yeah.
08:27He means the world to me.
08:28So whatever you need to do to make him as happy as he can possibly be is what I'd like you to do.
08:34Understood. Okay.
08:36Do you know how much trouble you're worth?
08:39All he's concerned is whether mommy gives him a big cuddle or not.
08:41Yeah.
08:42Yeah.
08:42Yeah.
08:42Thanks.
08:46Okay, my love.
08:50Oh, his elbows are screwed.
08:53Oh, to put it bluntly.
08:55We're in good hands.
08:57Yeah.
08:57Yeah.
09:01It'll be the first night I've been away from him.
09:03But, you know, he's a good boy.
09:05He'll be all right.
09:06He's a bruiser.
09:07He's brave.
09:09But I'm looking forward to getting him home whenever that is.
09:12The arthroscopy will help Noel decide the best course of action for Tiny's elbows.
09:21As we move the joints, you can see where the humerus is rubbing against the ulna all of the time.
09:27And that's what causes the erosion.
09:29You can see here there's some raw bone.
09:31Cartilage is completely gone.
09:34And if we stick a needle into it just to show how hard it is, because it's rock hard.
09:42The inside of the joint is trashed, but the outside of the joint actually still seems to have cartilage on it.
09:49So that's a little beacon of light, all that there.
09:53So it's a difficult situation because he's badly affected on both sides.
09:59The thing is that Tiny is only two years of age.
10:03I'm a little worried how an artificial joint's going to hold up over time.
10:09It's difficult.
10:10This is a difficult challenge.
10:12So at the moment, what's going on in my head is that if I did an unloading osteotomy,
10:22then the body weight will go down through the outside of the joint, which is still okay,
10:26giving the inside of the joint a chance to recover and to not get bad as quickly.
10:33Tiny will have surgery to give him a chance of a future that's pain-free.
10:38All right, mate.
10:40We'll come back another day and try and fix you.
10:55Hey, buddy.
10:56How you doing?
10:58Hi, mate.
10:59How are you today?
11:00Ten days ago, Simba the therapy cat was hit by a car, badly injuring both of his front legs.
11:07So it looks rather angry, don't you think?
11:09Surgeon Jonathan has been checking his skin regularly, and Noel has come to assess the damage to his front right paw.
11:18John is going to do some skin grafting on one front leg to try and get that healing.
11:25And he wants me to try and fix the fractured fingers on the other front leg.
11:33It's going to be challenging.
11:34You all right, buddy?
11:36Oh, yeah.
11:38Now you want cuddles.
11:40Oh, yeah.
11:41Now you want cuddles.
11:42This is the first time 11-year-old Kian has spent any time apart from Simba, who helps him cope with his autism.
11:51You wait till he sees you.
11:52He'll be climbing out of that basket.
11:56Hey, guys.
11:57Hello.
11:58How are you?
11:59Today, the family are meeting Noel to discuss surgery for Simba.
12:03I'm Annette.
12:04Annette.
12:04My mum.
12:05Hi, Becky.
12:05Hello, mate.
12:06How are you?
12:07Nice shirt.
12:07I've got a shirt like that, too.
12:09What's your name?
12:10Kian, and this is your friend, I believe, to help you through the difficult patches.
12:14Is that right?
12:15It's actually, we've never, I've never come across a cat that does what he does.
12:19And what does he do then?
12:20So when Kian was little, his lungs didn't work, and he would just stop breathing out.
12:25He could be eating, sleeping, and just his lungs would just stop, and we'd just flatline.
12:29But Simba learned that when it was going to happen.
12:31So he would tell mum when your lungs were going to stop.
12:34That's amazing.
12:35How old is Simba now?
12:36Seven.
12:36Seven.
12:37But he does different things for you now, doesn't he?
12:40What does he do now when you're poorly?
12:42He just comes up and starts rubbing his head on me.
12:45Oh, wow.
12:46Well, I'm sorry to hear you have such tough patches, but it's wonderful that you found
12:50a little companion to help you, and I just hope that we can get Simba through this.
12:54I'm going to sit with you, actually, because I want you to be strong for him.
12:57Now, he needs you as much as you've needed him.
13:01Now, have you ever seen the movie character Wolverine?
13:04Yeah.
13:05Ah, there you go.
13:06Did you see that boom of light?
13:08Boom.
13:09Boom.
13:10That's right.
13:11That's it.
13:12Yes.
13:13So what does he have coming out of there?
13:15Um, um, um...
13:17Adamantium.
13:18Exactly, my friend.
13:20He's all over this.
13:21You and me are going to be best friends.
13:23He has Adamantium pegs coming out of here.
13:26So I saw that movie years ago, the very first one, long before you were born, and I was
13:32captivated by that.
13:33Couldn't find Adamantium anywhere on planet Earth, so I had to go to a different...
13:37It's only a fictional metal.
13:38It's actually real.
13:40Sorry.
13:41I love that.
13:44You're absolutely right.
13:45It's only a fictional metal.
13:46It's not actually real.
13:47So we're going to have to make do with what we've got for now, which is stainless steel
13:50pegs.
13:51If, if we were able to put Wolverine's pegs up along the bones, then even if this bit
14:00was tiny and short, we could potentially skewer it in position like so, couldn't we?
14:06How long have you been doing this for?
14:08Me?
14:08Oh, good.
14:09Now we're getting the grilling on qualifications.
14:12A long time.
14:13I'm actually not particularly bright.
14:15I found exams very difficult.
14:17I'm not particularly good at anything, except trying to think of a way around problems.
14:24And when I see a frustrating problem, like the problem that Simba has now, I always think,
14:29well, why can't we do better than that?
14:31What do you say to Noel for accepting him?
14:32Oh, no, no.
14:33You're very, listen, mate, it's my, it's my entire pleasure.
14:36Can we have a hug?
14:37Well done, mate.
14:38Oh, you're such a good boy.
14:39You're such a good boy.
14:41Thank you so much.
14:42I'll get him for you.
14:43All right.
14:44And keep the faith.
14:45You're a good kid.
14:46You really are.
14:47Have I got a key fob?
14:48Have you got a key fob?
14:49Has anyone got a key fob?
14:51Are we locked in forever?
14:52We just have to consider what the implications of inventing stuff here forever is.
14:58Oh, we might go out this way.
15:00Okay.
15:03Hello, gorgeous boy.
15:05Sam's been looking after Simba.
15:07Now, mate, look who's here.
15:09All right, buddy.
15:10If you stand up, Cian, and just hold it, lift us.
15:14There you go.
15:15Now, there you are.
15:17Look who's here, Simbas.
15:18There you go.
15:20Good.
15:20The family have decided Simba will undergo surgery in about a week.
15:30But for now, they can spend some precious time with him.
15:33Hello.
15:35He says the attention.
15:36You're a little star, aren't you?
15:38That's what it is.
15:40So cute.
15:50Whilst Noel's Cancer and Soft Tissue Centre is on a separate site from his orthopedics and neurosurgery practice,
15:58the clinicians work together closely every day.
16:03Gone are the days where an individual vet can do everything.
16:06So treat the belly as well as the brain, as well as a fracture.
16:10That's no longer the case.
16:12That is why I've built a team of people that can do what I can't do.
16:16In other words, individuals who are extraordinarily good at the specific area they work in.
16:24Every week, the entire team assembles to discuss cases.
16:29It allows us to bring our specialists in soft tissue surgery,
16:32together with our specialists in orthopedics,
16:35to try and make the best decisions possible for our patients.
16:39OK, next up.
16:41Today, they are considering treatment for a four-year-old lurcher called Cato,
16:46who has a cancerous tumour in his jaw.
16:49The dog is bright and happy, unbothered by the mass,
16:52but he's got a small cocktail sausage-sized mass,
16:57just the base of the mandible.
16:59Cato's local vet attempted to remove the tumour, but it returned.
17:05His remaining option now is to have half his lower jaw cut away,
17:09unless the team can come up with another solution.
17:12So I talked about options,
17:14and said we need to know just how extensive this tumour is.
17:19Well, the other two options,
17:21you just chop the entire mandible out,
17:23or replace it.
17:24Yeah.
17:26We talked about an implant,
17:27and explained that that's reasonably new technology,
17:32but they were interested in trying.
17:34The dog is young,
17:35so I think it would be a perfect candidate for an implant.
17:38A 3D-printed jaw implant could offer Cato a chance of a normal life.
17:46One week later,
17:48and Cato is back with Beverley and John to discuss the surgery.
17:53The family rescued Cato three years ago.
17:56When we first got him,
17:57he was very, very nervous.
17:58I think he'd been mistreated.
18:00He was a stray,
18:01so he was quite thin,
18:02and he looked like he'd been fending for himself.
18:06We called him a dustbin dog.
18:07He'd eat anything and everything.
18:09He's a little more discerning palate now, but...
18:12The really funny thing is he absolutely loves bin men.
18:16He gets really excited,
18:18and our bin men come and fuss him on Friday,
18:20and I just wonder whether when he was a stray,
18:23perhaps the bin men fed him or something.
18:26I don't know,
18:26but he's just got a real affinity to bin men,
18:29so...
18:30Are you going to be brave?
18:33We understand that if they have the jaw removed,
18:36you may have to hand-feed them,
18:38because obviously they don't have the same function.
18:41And Cato loves playing with a stick and a ball
18:44and playing with his toys,
18:45so the option of having an implant
18:48would mean he'll still be able to do those things.
18:51But before the implant surgery can go ahead,
18:54Noel needs to address a concern.
18:56So there's a possibility
18:58that the tumour comes from a nerve.
19:00The jawbone, the mandible,
19:01has a hole in it here
19:02through which a big nerve and some blood vessels go.
19:06It may be possible
19:07to actually get rid of the tumour forever,
19:09but if the tumour tracks along the nerve
19:13and is going further up from here
19:16towards the back of the mouth,
19:18that's not possible.
19:22Cato will need an MRI scan
19:25to determine the extent of the tumour's spread.
19:27Right, what have we got?
19:36Wow.
19:37I'm worried now because
19:38that tumour is growing towards the other side.
19:41That's not good.
19:43OK, thanks.
19:46There's good and bad news.
19:48The good news is it's still very localised
19:50and we cannot see it tracking up the nerve.
19:53Great.
19:54The bad news is it's touching the other mandible.
19:56OK.
19:57Which you can see there.
20:00There's a small line of grey
20:02between it and the other jaw.
20:04So I'm going to need to consult with John
20:06and the radiologist
20:07to determine whether he thinks
20:09that's enough margin.
20:11Couldn't that just be touching?
20:14Yes.
20:14And when you take it away
20:15it just peels away.
20:16But I want John to say
20:18because it's just touching
20:21will it leave cells on that
20:23that could come back?
20:25We have to be as confident
20:26as humanly possible
20:27that we get all this humour out.
20:29Otherwise it's all for nothing.
20:35I'm going to go back.
20:39I'm going to go back.
20:40For now
20:43Kato must return home
20:45I've got something nice for you.
20:47I want some fish skin.
20:48To wait and see
20:49if he can have the operation.
21:01Tiny and his overlong tongue
21:03are back at Fitzpatrick's.
21:07Melissa has asked Noel
21:08to go ahead and perform the surgery.
21:10which will hopefully treat
21:12his painful elbows.
21:14Today we're in for him
21:15to have his elbow done.
21:17His left elbow.
21:18And they're going to break
21:19his poor little leg.
21:21And then they're going to put a plate in
21:24which will reposition the weight
21:25and put the pressure on his good side
21:28rather than his bad side.
21:30And stage two
21:31will be the other leg
21:32in four weeks' time.
21:41Tiny is aptly named
21:42because he has tiny bones
21:44relative to his body size.
21:46So we've got a specifically made plate
21:48which should accurately fit
21:51the contours of the bone
21:53when we go in here.
21:54A lot depends on what this fella here does.
21:57He supports the leg
21:58so it doesn't rotate downwards and upwards.
22:01So basically if this goes wrong
22:03it's entirely your fault.
22:06No, I'm joking.
22:09Primary surgeon always takes the blame, man.
22:10If you've got the implant for me, please.
22:15This is the plate
22:16shaped like a hockey stick
22:18as you can see
22:18with a step in the middle there.
22:20The underside is flat
22:21so we have to be very careful
22:22how we position it.
22:23If you get that wrong
22:24you get everything wrong.
22:29Just hold on.
22:30Noel needs to screw
22:32the top section of the plate
22:33into position on the humerus
22:35before he can cut through the bone.
22:40I'm not happy with that.
22:44It's going to have to rotate a bit more.
22:47Wow.
22:48It's proving very difficult
22:49to get this centred
22:50on this short stubby bone.
22:53Okay.
22:54Hold that again.
22:56Normally the humerus
22:56is like an oval in cross section.
22:58This one's triangular
22:59and the apex of the triangle
23:02is right under the plate.
23:05Don't go down.
23:06Don't go down.
23:07Pull.
23:08Let me treble check that.
23:09Relax.
23:10Still not happy.
23:14It's very annoying.
23:22Okay.
23:23So it's in the right position.
23:25We've locked the top part
23:26of the plate down onto the bone.
23:28We're now going to saw the bone in half.
23:29So as we tighten these screws
23:38the bottom segment
23:40let go, let go.
23:41The bottom segment
23:42should just slide up
23:43towards the plate
23:44creating a step
23:47so the body weight
23:48is going to go down
23:49through the outside.
23:51Noel packs in
23:52donor bone graft
23:54to form a scaffolding
23:55into which he hopes
23:57new bone will grow.
23:58And this bone graft
23:59was donated
24:00from a deceased dog
24:01the same as you or me
24:02can donate parts
24:03of our body
24:04when we die.
24:04I think it's a good thing
24:07I think that every dog
24:08should carry a donor card
24:09when I'm dead
24:10certainly
24:11the living are very welcome
24:12to parts of my body
24:13that's for sure.
24:15Alright
24:16let's go to x-ray.
24:20Hello?
24:20Hey Melissa
24:21it's Noel
24:21how are you doing?
24:22Hiya Noel
24:23how are you doing?
24:23Good thank you
24:24everything went fine
24:25with Tiny
24:25Oh superb
24:27A bit tricky in the middle
24:28but the plate
24:29on the post-op x-ray
24:30picture looks good
24:31Done me proud
24:32Well
24:33we don't know yet
24:34we've got still
24:35another leg to go
24:37but hopefully
24:38this one will heal well
24:39Okay darling
24:40thank you so much
24:41My pleasure
24:42Have a good night's sleep
24:44and thank you so much
24:46for looking after my boy
24:47You're a nice girl
24:48not many people
24:49thank me as effusively
24:50so thank you very much
24:51Okay
24:52Take care
24:53Talk to you tomorrow
24:54Alright bye
24:55Okay bye
24:56What a lovely girl
24:58Good boy
25:04Three weeks ago
25:07a car accident
25:08ripped off most of the skin
25:10from Simba's left front leg
25:11leaving him in too much pain
25:14to walk
25:14Finally got Simba's wound
25:17to a point where I'm happy
25:18with how the surface
25:20is to support a skin graft
25:22so we're going to put a
25:24what we call a free skin graft
25:25on the area today
25:27so that involves
25:29lifting off some skin
25:30on the chest wall
25:31dissecting free all of the fat
25:35and all of the non-skin tissue
25:41so we're really just left
25:44so we're really just left
25:44with a thin wafer of skin
25:45Jonathan then makes holes in the skin
25:48like a pie crust
25:49to allow moisture out
25:51and to give it the flexibility
25:52to wrap to the contours of the leg
25:55We'll put quite a series of stitches
25:58all the way around the outside
25:59movement is what kills us
26:02The graft is secured in place
26:04making sure the hair follicles
26:06will grow in the right direction
26:08and then it's up to nature
26:10to take its course
26:11Fluid and plasma literally moves
26:14from the body
26:15into the skin
26:16and that's how the skin cells
26:19get their nutrients
26:19over the next two or three days
26:21and as long as that's allowed to happen
26:24and it doesn't move
26:26it doesn't get disturbed
26:27then the skin cells will survive
26:29they'll make a happy home for themselves
26:31and it just becomes integrated
26:32That looks lovely
26:36Okay, rest is down to you little Simba
26:41Yeah, there you go
26:44Oh, sweet
26:50Good boy
26:56Bye-bye
27:01Sit
27:03Right, don't have my fingers
27:04thank you
27:05Oi, oi, oi, oi, oi
27:08Don't get all worked up sunshine
27:10Kato, the ever-hungry lurcher
27:13has arrived for the surgery on his jaw
27:15Because he's under the anaesthetic
27:18he couldn't have any breakfast
27:19so we treed him to a late supper last night
27:23he had some roast beef
27:24which didn't last very long, did it, Kato?
27:28After examining Kato's MRI scan
27:30Jonathan and Noel feel they have a good chance
27:33of completely removing the cancerous tumour
27:35You're going to get rid of that nasty lump
27:38You are
27:38A unique, custom-designed implant
27:41created from Kato's CT scans
27:44will replace one side of his jaw
27:46We've tried to tell him
27:49but I don't know whether he's understood
27:52but we've told you that it's a necessary thing, isn't it
27:56that we have been done
27:57Now, this is your present
27:59This is as close to state-of-the-art as we can get
28:03This 69 millimetres of metal
28:06is specifically designed to recapitulate bone
28:10It's the first time this specific kind of reinforced honeycomb titanium implant has been used
28:17So this goes on to the back of the jawbone there
28:20and because this is three-dimensionally printed
28:24to fit this jaw exactly
28:26when that slot's in there
28:28it isn't going to wobble
28:29Please God, everything will go fine
28:30You know what the risks are
28:31Primarily infection
28:32The secondary risk is mechanical
28:34but I think we've done all we can
28:36to avoid a mechanical problem
28:38OK, big guy?
28:40Good
28:41You're going to be bionic?
28:42Yeah
28:43You're going to be bionic?
28:45Kato?
28:48Roisin, this is Kato
28:50Lovely, lovely Kato
28:52Kato
28:53You're going to be beardless
28:55Noel and soft tissue specialist Jonathan
28:58will be performing the complicated surgery together
29:01The main thing for me is that you can get the tumour out to your satisfaction
29:05Yep
29:06I'm confident we can get the implant done
29:08OK
29:09Jonathan begins carefully prizing the tumour away from the healthy side of the jaw
29:15The big question is
29:17are we going to be able to get all the tumour out without actually damaging the opposite side
29:23because it's got a lot bigger since the last time we saw it
29:26So we're just going to put some local anaesthetic around the main nerve that feeds that lower jaw
29:33It's very similar to having a nerve block at your dentist
29:36If this is what your dentist normally does to you, I'd go to a different dentist
29:43So what John has done here is he's separated the tumour from the other jaw bone
29:47I'm going to cut right between these teeth here which are called the incisors
29:51Noel will remove the entire left-hand section of jaw bone that contains the tumour
29:58The anatomically contoured 3D implant can then be fixed into place using special locking screws
30:06Packed on either end with bone graft and sprayed with stem cells
30:10to encourage bone to grow into the titanium mesh of this new half jaw bone
30:17So that's the jaw bone with the tumour growing in it
30:20So hopefully we've got all the tumour out
30:22There's a little muscle and tissue on the side there
30:25which hopefully will act as a buffer between the other bone
30:28so the tumour has not spread
30:31With one side of the jaw bone removed, the implant can now be put in place
30:36It's a sculpture of rare beauty
30:39Bone marrow extracted from near Cato's shoulder is then packed around the ends of the implant
30:47Finally, Noel sprays on stem cells from Cato's bone marrow
30:51mixed with platelets and clotting factors from blood
30:54and a man-made catalyst glue that will help the mixture to set
30:58So this is the future, a three-dimensionally printed implant that exactly fits the body
31:03plus the body's own natural healing system propagates it
31:08to get the perfect marriage of mechanics and biology
31:11That's our goal
31:12Thanks very much everybody, well done
31:17The cutting edge surgery has taken two and a half hours
31:22The 3D CT looks really good
31:25You can see how the implant contours onto the mandible
31:30It's very nice
31:31Well, so far so good
31:33Now we've got to hope that the cells really help the tissue to grow on
31:36Because I think mechanically that sound looks good
31:39Super cat Simba is being transferred to Noel's Orthopaedic Centre
31:51to undergo the Wolverine-inspired surgery on his fractured foot
31:58But before the operation, Jonathan needs to uncover the skin graft he performed four days ago
32:05The moment of truth, my friend, the moment of truth
32:10And either the graft will come off on the bandage
32:12Or the bandage will come off and the graft will stay on the leg
32:21Pretty good all round?
32:23I would be happy with that
32:25Yeah, that's all good
32:27That's a huge relief
32:29Well done, mate
32:30Good
32:31It's all up there
32:32It's down to you now
32:34My bit's done
32:37My bit is done
32:38No pressure
32:39No pressure then
32:41Alright, let's get the kit rocking and rolling
32:42Well done
32:43Okay, thanks Noel
32:47Simba's metacarpal bones have fractured into tiny pieces
32:51Very close to the joints
32:53Noel needs to realign these bone segments
32:56So he can pin them into place
32:58I'll try and find the bottom part here
33:01Give me a 0.9mm drill bit
33:05So as you can see this is tiny
33:08Noel inserts metal pins through the minuscule pieces of bone
33:15Dealing with these bones is like trying to put matchsticks back together really
33:24Oh my lord
33:25Is this a pussycat or a hamster?
33:28And so wolverine begins to emerge
33:37So this isn't in any textbook
33:39I don't think there's any other technique out there
33:42That will be superior to what we're doing now
33:44But yet it's not widespread in terms of acceptance
33:48And I think that that's a real shame
33:53Okay, so we're just going to put a little bit of this bionic glue
33:56On each of the fracture sites
33:58Hold that
33:59Hold that
34:01The team are pioneering another technique today
34:04A newly developed gel with a bone protein suspended in it
34:08That should slowly help to heal the fracture
34:11Oh man, I love bionic juice
34:14Finally, Noel builds a frame to take Simba's weight off the foot while it heals
34:24So these are the pins that have gone up like the wolverine pegs into the metacarpal bones
34:31Meanwhile, we've held everything stable from the wrist down using this rod attached to this walking frame
34:38So that Simba can put this on the ground without affecting the foot
34:44Having had two major operations in four days
34:47It will be some time before Noel knows if Simba's legs will make a full recovery
34:52I see you're missing your little friend as well, aren't you?
35:02Two days ago, two-year-old Staffy Tiny had the first operation to treat the painful erosion affecting his elbows
35:09Come on, Noel
35:13Stop being a superhero and bring us Tiny
35:16Melissa and husband, Saj, have come to take him home
35:20I've been desperate to get here
35:21I've been pacing around for over an hour
35:24And he was late home from work as well
35:27So I was literally clock watching
35:29And yeah, I was running to the car almost really, wasn't I?
35:33Yeah
35:34To get here, I couldn't wait to get here to pick up my boy
35:40Get myself prepared
35:43Now, buddy
35:45Who's in here?
35:47Who's in here?
35:48Go down to his level now
35:50There we go
35:51No excitement, mate
35:52No excitement
35:53You've got to be careful
35:54Let me come in there with you
35:56Happy to see you
35:58Happy to see you
35:59Let's go into reception because he's quite boisterous
36:01Now, as you can see, he's using it reasonably well
36:04We're going on the carpet there
36:06Now, remember, although he feels full of beans
36:10The reality is different
36:12Yeah
36:13The reality is he could break all those screws
36:15Yeah
36:16And believe you me, you don't want that
36:17Oh, God, sorry
36:18Yeah, do you want to get the car and just bring it up to the door?
36:21I think I'll get some sedatives for him
36:23For you to go home with
36:25Just in case
36:28Do you know what? I've never known him to be like it at all
36:32Oh, tiny
36:34Shhh
36:36Calm down now, chap
36:38So these are sedative tablets not to be taking yourself no matter how stressed you get
36:42Okay?
36:43Damn it
36:44I honestly think that once we get him home
36:46Yeah
36:47He's just going to be totally zonked
36:49Yeah, I'll tell you what, after what I've done to secure him at home
36:52I'm either going to make a great dominatrix or a fab sailor
36:55Oh, great, okay
36:56I'm going with sailing
36:57But I'm going to leave Saj with the other aspect of that
37:02Good lad
37:03Thank you, I'll take that
37:05Thank you so much
37:06Mate, look out for yourself and keep that tongue in
37:16Simba the therapy cat has been at Fitzpatrick's for four weeks now
37:19Like many regular visitors, the staff can't help but become attached
37:24It's the patients you see back week in, week out that you get to know really well
37:29Hey baby
37:31They kind of become a little bit part of the family
37:33Come on sausage, you need to get waking up
37:35You've nursed this animal back to health
37:40You kind of develop like this love for them
37:45I honestly could fall asleep so easy right now
37:49I have no favourites
37:52No favourites? Some favourites
37:54I have favourites, you can't help it
37:56I do have favourites
37:58But that's not a lie
38:02Do you have favourites? Favourite animals?
38:05I like pandas
38:07I mean in the best
38:13Hey, do I get a hug?
38:15Ah, yeah buddy, yeah, well done mate
38:19For Kian, being away from Simba is proving challenging
38:23So he and mum Becky have come for a visit
38:26Alrighty, do you want to see where he stays?
38:28Now I don't normally do this
38:30In fact I'm not going to bring mummy through
38:32Because normally I don't
38:34So you have to stay by my side, come on
38:36Here we go
38:38Come this way
38:45Simba, look who's here
38:47Hey mate
38:49Look who's here buddy
38:51There you go now
38:53Shall we lift him out a little bit?
38:55There we go
38:59There we go
39:01Hello beauty
39:03Steady, steady, steady, steady
39:05As you can see he's very lively
39:07He wants to walk on it, good boy
39:09So why don't you chill out with him for a little while
39:11Just hang and I'll come back and see you
39:12And I'll come back and see you
39:13Alright buddy?
39:15You okay? You're very welcome
39:20How do you feel to be with him?
39:22Happy
39:24Oh that's what you wanted to lay down
39:25There's a good boy
39:27There
39:29Although Simba is gradually improving
39:31He's not yet ready to go home
39:39Alright
39:40I know
39:41I know
39:43I know, I know
39:45It's all
40:01It's five days since Kato received his bionic jaw implant
40:05It may not be roast beef on the menu
40:07But he certainly doesn't seem to have lost his appetite
40:09We bought him all soft food in
40:11We've not got any hard food
40:13All soft treats for him as well
40:14To try and make it as easy as possible
40:16He does have a really clever way
40:18That we've been able to inhale a piece of ham
40:20Without actually chewing it
40:22If you hold up a piece of ham he just goes
40:24And it's just gone
40:25So
40:27I think he'll be okay
40:29Imagine what it's looked like without his beard
40:31Thank you
40:33Alrighty Kato's Mummy and Daddy, how are you?
40:35Nice to see you smile, nice to see you smile, come on in
40:36Oh you've got a white box, that's super kind, wow
40:37Look at that, look at that, oh look at that, oh that's amazing, did somebody make that from his picture?
40:41It was a photo
40:42That's brilliant
40:43That's brilliant
40:44And then I've iced it
40:45You iced it
40:46Hidden talent
40:48Did she make one of those for your birthday ever?
40:49That's pretty impressive
40:50Thank you so much, that's super kind
40:51Thank you so much, that's super kind
40:52All righty Kato's Mummy and Daddy, how are you?
40:53Nice to see you smile, nice to see you smile, nice to see you smile, come on in
40:56Oh you've got a white box, that's super kind, wow
40:58Look at that, look at that, oh look at that, oh look at that
41:01Oh that's amazing
41:03Did somebody make that from his picture?
41:04Hidden talent
41:05Did she make one of those for your birthday ever?
41:08That's pretty impressive
41:09Thank you so much, that's super kind
41:11And I will go and get him for you, thanks
41:16You're not going to cry are you?
41:17No
41:20Now, who's in here?
41:23Oh no
41:24Hello family
41:25Hello
41:26Hello family
41:27How are you doing?
41:28Good, so as you can see he looks fit
41:31I mean you wouldn't know really
41:32Apart from he's lost his beard
41:34Apart from he's lost his beard
41:35I had to shave his beard off
41:36But that'll grow back won't he Kato?
41:39It was great to see him
41:40And I think it was great for him to see us as well
41:44He seemed excited
41:46Can I have a kiss kiss?
41:47Are you going to forgive us for what we've done to you?
41:50There's a few little worries that we have
41:53Whether the skin heals back to the implant
41:57And whether he gets an infection
41:58But we're keeping our fingers crossed
42:00And hopefully it will all go well
42:02We're going home now
42:04We are
42:08Come on then
42:10Four months ago Tiny had the second of his elbow surgeries
42:15So we are absolutely ecstatic
42:18He's made great recovery
42:20And we can have him off the lead now
42:22Go on then
42:23Go on
42:24Go on then
42:25Go on
42:26It's a little bit sad
42:27Because I was almost hoping he'd run off into the sunset
42:30And because he's such a mummy's boy
42:33He's sort of stuck to my side anyway
42:35Come on
42:37Come on
42:39Go on then
42:40He absolutely loves
42:42Loves his life now
42:44You can see it in his face
42:45Totally different dog
42:46Are you good boys?
42:47He's so hard
42:48Come on then
42:49Come on then
42:50Well no, he's just brilliant isn't he?
42:53Come on
42:54He's got my dog who I adore out of pain
42:57Go on
42:58You can't get better than that
42:59Come on
43:11Right Simba
43:12It's time to go home
43:13Hey
43:14Therapy cat Simba has spent two months at Fitzpatrick's
43:18After the car accident that devastated his front legs
43:22Here he is
43:26Hey Simba
43:28Look who it is
43:29It's finally time to go home
43:31To continue his recovery with best friend Kian and the family
43:35I don't think any of us ever ever ever dreamed he could survive this
43:39He could survive this
43:42And here he is happy and smiling and purring and
43:46Coming home darling
43:52Simba will need to return for a check-up
43:54To see if his paw, held together with Noel's Wolverine pins
43:59Has fully healed
44:00It's five months since Kato had the tumour removed from his jaw
44:11What's that?
44:12What have you got to do?
44:13Good boy
44:14Do you like it?
44:15You don't like ham do you?
44:17The insatiable lurcher's new bionic implant is making fast work of anything that comes his way
44:23He is a bit more messy now
44:26He tends to drop it all over the kitchen and bits fall out of the side where he hasn't got any teeth
44:32Oh you've got it all down the side of your mouth
44:36And that's when he shakes his tongue comes out and sometimes showers us a little bit
44:41But we don't mind that do we?
44:43We don't mind a little bit of dog spit
44:45That's very cute
44:47For a while I think we sort of thought what have we done and should we have, you know, should we have done it?
44:52I think him coping with it helped us cope with it really
44:55Kato, what about football?
44:58I don't even think now he's aware that anything's different
45:01He's just a completely happy bonkers dog
45:06Yeah we're at the forefront of veterinary medicine
45:09But at the end of the day we've got our dog and he's going to live for as long as he should live
45:13So that's what really matters
45:15The good boy
45:16It's been seven months since Simba the super cat was hit by a car
45:26Simba, come on
45:28Simba's doing really well now, he's running around
45:31He's taking Kean to bed as he used to
45:33His hair's all grown back
45:35There's no scars anywhere
45:37Simba
45:38And it's so nice to see Kean and Simba back together because the difference Simba makes in Kean's life is huge
45:49It was very difficult without him
45:53It just didn't feel safe
45:57It's probably the best feeling ever having him home
46:02Other cats would have given up
46:05But Simba just has patience and the will to live
46:09And I never lost faith in him
46:14He's my bestest friend, no one could replace him as a best friend
46:17He's the best cat in the world
46:18He's the best cat ever in the world
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