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00:01Professor Noel Fitzpatrick
00:03All right, Mrs. Cuddlemonster incoming
00:06is the super vet.
00:08We have issues.
00:09I knew I should have got chihuahuas.
00:11At his unique vet practice, he merges mechanics and biology.
00:16We're past the point of no return now.
00:19Don't be pulling apart my repair, Mrs.
00:21to heal the nation's pets.
00:23Sorry about coronavirus.
00:25Oh, because you're responsible?
00:26I'm responsible for almost everything else.
00:30Even in the darkest days...
00:32I'm so sorry this has happened to you.
00:33...Noel imagines the impossible.
00:36Oh, my little baby girlfriend.
00:38Oh, my God.
00:39Let's go.
00:41Sometimes you have to bend the rules of mechanics
00:43to fit the biology.
00:45...and offers hope...
00:47We've definitely made the right decision.
00:49Good boy!
00:50We've got my boy back.
00:52...for families and their friends.
00:55Look at you!
00:56Why are these doggoes?
00:58Yes, mate, I love you too.
01:05This way.
01:06Good girl.
01:07Oh, I love it when she does that.
01:10If I could pick a dog nose, I'd pick yours.
01:13The bond between humans and animals
01:15is at the heart of Fitzpatrick referrals.
01:18They're just your best friend, aren't they?
01:20Like, they are constantly giving you an unconditional love
01:24which you don't necessarily get from people.
01:26You've been a good boy.
01:28I think it's like the air of innocence that they carry
01:31just really makes you want to make life better for them.
01:34I can't believe you brought the dirtiest toy in.
01:36Devote your life to giving something back to them.
01:39You love your Ellie, don't you?
01:41They always have that love and patience with you
01:44and even when they're in so much pain,
01:46they'll still wag their tails and want to lick your face.
01:49If you'll be back soon, don't worry, puppy, don't worry.
01:52Unconditional love is the reason I became a vet.
01:55Oh, you little cute scruffs.
01:59Looking after that bond of friendship
02:01that exists between an animal and their family
02:04is the greatest reward you could ever wish for.
02:10Stop chewing him. Stop chewing him.
02:14Golden Retriever brothers Bertie and Buddy...
02:17No, it's not food. It's not food.
02:19..have a special relationship with each other...
02:22Gently, gently, gently, gently Bertie.
02:24..and their mum, Rachel.
02:27Come on. Come on.
02:29Look at you, look.
02:31One-year-old Bertie was born with a growth deformity.
02:35I know. Yes.
02:37I walked into this crate of 11 puppies and there was Bertie.
02:41Jazz, look at his little tail, look.
02:43With a little kink in his tail that went round like a little propeller.
02:47Bertie!
02:48Good boy, there you go.
02:50Bertie is the calm dog.
02:52Bertie is the nutcase and he just makes me smile.
02:57At ten weeks he went for his normal check-up and the vet said,
03:01I think he's got dislocated hips and curvature of the spine.
03:05I believe he's also got missing vertebrae as well,
03:08which makes him shorter.
03:11This is why they can't play together.
03:13He's just such a fun pup.
03:15Idiot.
03:17He loves life.
03:20In the last few months, Bertie has begun to limp
03:24because his hip is dislocated due to his genetic deformities.
03:28What's this?
03:29It's a good pup.
03:31Rachel is desperate to help the unique pup,
03:34as he and his brother Buddy have brought her back from the brink.
03:38I lost my partner three and a half years ago.
03:40It's a brain tumour.
03:41I went and got Buddy eight months after.
03:47And I know it sounds stupid, but I think he was sent to me from Stu.
03:53Because I begged Stu to send me somebody.
03:55And when I picked him up in my arms, I just had this heat that went all the way through me.
04:02And it was Stu saying, here you go, here's your mate.
04:05They're everything.
04:06Without them, I'm not sure I'd be in such a good place, to be honest.
04:10And they get the best of everything.
04:12And Noel's the best.
04:14You know what I mean?
04:15If he can't fix him, nobody can fix him.
04:18Bertie has had previous consults at Fitzpatrick's,
04:21but as complex surgery may be indicated, he's now been referred to Noel.
04:26Hello.
04:27Hello.
04:28How are you?
04:29Good morning.
04:30Good morning.
04:31Nice to see you.
04:32Grab a seat.
04:33Oh, you get snuggles for all day.
04:34All day.
04:35Can't get enough of it.
04:36All day snuggles.
04:37Now, so you knew that he had a deformity since birth then, did you?
04:41About ten weeks he went for his injections.
04:44And then said he's got curvature of the spine.
04:46And then I started to know if he was limping.
04:49And I asked them to refer you to you.
04:51By your own request, was it?
04:53Yeah, absolutely.
04:54Because you're our dog bod in our house.
04:55Oh, I see.
04:56OK.
04:57We watch her.
04:58Oh, I see.
04:59Do you watch the telly, mate?
05:00We all watch.
05:01OK.
05:02I'm just going to feel the hip now.
05:04Oh, good boy.
05:05Yeah, that really is painful, isn't it?
05:08See, you've got a completely luxated hip.
05:11All right, mate.
05:12Well done.
05:13All right.
05:14I've had a three-dimensional reconstruction of what his spine looks like.
05:18Wow.
05:19That's mad, isn't it?
05:21So that's extremely deformed.
05:23Yeah.
05:24And...
05:25Sorry about that.
05:27Sorry.
05:28I mean, clearly, you have to understand what the nature of this deformity is.
05:32Now, that isn't fixable.
05:34No.
05:35But that is not Bertie's problem.
05:38Bertie's problem is pain coming from the right hip joint here.
05:42And the pelvis is significantly twisted.
05:45So there's two big issues.
05:47One is the mechanics of getting an implant that actually would work for him and keep that hip in,
05:54because it is dislocating all the time.
05:56Yeah.
05:57And the second issue is what is going to be the effect of the spinal deformity over time,
06:02and he's a hip replacement here in the patient's best interest or not.
06:09Whatever it is, it's got to be right for him.
06:11Yeah.
06:12Yeah.
06:13It's not about me, it's about him.
06:14Absolutely.
06:15Sorry to make you upset, but...
06:20There you go.
06:21I'm not going to do this.
06:22OK.
06:27If he's going to be struggling, and he's going to be in pain,
06:30and he can't run around after him, then it's not life.
06:35Right.
06:36It's not life.
06:39Devastate me, but it is what it is.
06:41It's not about me.
06:42Yeah.
06:43If a hip replacement were to work for him, his function could be pain-free.
06:48So what I would suggest that we do is get an ethics review done.
06:53And that will take a few weeks.
06:55OK.
06:56OK?
06:57You're a beauty, aren't you?
06:59He's a beauty.
07:00Oh, well done.
07:01Well done.
07:04Talk about emotional.
07:05That is me thinking he was coming for his operation today.
07:08And it turns out he's got to be put in front of an ethics board.
07:13And I suppose if I'm honest, it's me to think about what to do as well.
07:17You know...
07:18It's about being selfless, not selfish.
07:35It's about his life, you know what I mean?
07:38If he's going to suffer, will I know when he's suffering?
07:41Because dogs don't show it, he doesn't show it.
07:43It's just what's right for him at the end of the day.
07:58You're part of the family, aren't you?
08:00And you are.
08:01When it comes to the bond with man's best friend...
08:04Come on.
08:05Good boy.
08:07...there's no more shining example than nine-year-old Tibetan terrier Sonny and his family.
08:13Imagine though, this is literally as heaven, just smelling all these doggies.
08:17After a year desperately seeking help for an unusual condition, today they've arrived for long-awaited surgery.
08:24I don't think I've ever been more nervous than when I gave birth, to be honest.
08:32I've had a Tibetan terrier before, so I knew exactly what I was going in for.
08:36Two.
08:37Two.
08:38They partner with monks in Tibet and they will stay by your side because that's where they're happiest.
08:46Right from the beginning, he did not want to be left alone.
08:49I used to tie him to a tree when my daughter was at school and he chewed through nine leads.
08:54And up!
08:55Because he just couldn't bear the thought of a few minutes of us being gone.
09:00I see him as one of my children.
09:03I'm willing to do anything for him.
09:05Over the last year, the family noticed a change in their usually contented dog.
09:12He wouldn't want to go up the stairs.
09:17He wouldn't want to come out of the car.
09:19And for the first time ever, he would snap.
09:24It was said that he had arthritis throughout his body.
09:29The arthritis had badly damaged Sunny's right knee.
09:33But a surgical procedure failed.
09:35And despite seeing several vets, Sunny was still in pain.
09:39He lost five kilos.
09:41That was a third of his body weight.
09:44I was watching him die.
09:46And no one...
09:47I felt like no one would help at all.
09:52I always thought there's something else that can be done.
09:55We don't give up on humans when they can't move around.
10:00We've all just adjusted our lives to cater for his needs.
10:04OK, you got it. Down you go.
10:06I think I'm probably the mad dog woman.
10:10A month ago, Sunny was referred to Fitzpatrick's,
10:13where Noel identified problems affecting many of his joints.
10:17I feel like someone else is caring now and wants to get to the bottom of it.
10:22Good boy.
10:23Fixing my dog, it would be like winning the lottery to me.
10:27There's nothing more.
10:29There's nothing more.
10:30There's nothing more.
10:31Okay, so Sunny's in real trouble because his joint problem is due to an immune-mediated condition,
10:37whereby his immune system is effectively attacking his joint structures.
10:42The connective tissue around his joints and within his joints is being destroyed.
10:48There are those that would say he should be put to sleep and there are also those that would say give him a chance.
10:55We're going to replace his right knee today, but he's got severe arthritis in his left knee as well.
11:02So his overall situation is still very worrying.
11:08Sunny's knees are the most damaged by the disease, but if his other joints decline, he may need long-term medication,
11:16or worse still, his family may need to consider euthanasia.
11:21All right, so I've been through a vast ethics approval process.
11:28So four different vets have looked at this and they're supportive of this surgery to try and save the right hind leg.
11:38Okay.
11:39All of us are aware that the left hind leg is going to need surgery.
11:44So, of course, the big decision that will need to be made for the left knee is what we're going to do in due course.
11:50Oh, there's a lucky spider.
11:52A lucky spider.
11:54That's very lucky.
11:55Very lucky.
11:56I'm going to bring him outside for good luck.
11:58Good boy.
12:00Saving a spider.
12:02A lucky spider.
12:04Just going to give him a new home right there.
12:07Now, that's good.
12:10We had the lucky spider come from the universe, so it's all good.
12:13Right, Sunny.
12:15Big hugs for the family.
12:16And we're going to take you through now, buddy.
12:18Good boy.
12:19All right.
12:20All right.
12:21We'll see you later, mate.
12:22Off you go.
12:23Try and stay calm.
12:24I'll ring you tonight.
12:25You've had a lucky spider, so I'm hoping that it's all going to be fine.
12:30Sunny's right knee will be replaced this afternoon because it's collapsed and been worn down by the inflammatory disease.
12:37He's shaking in.
12:39Yeah.
12:40His left knee will hopefully be operated on in the future to try to improve the loyal boy's quality of life.
12:46Euthanasia would really be the only option if this doesn't work because all his joints are failing.
13:03I don't know if I can deal with that.
13:04Good boy.
13:05You're okay.
13:06Before surgery, the team checks the cells in Sunny's other joints for signs of IMPA, immune-mediated polyarthritis.
13:22All of these joint smears here will tell us whether we've still got an active inflammatory disease that could attack all of Sunny's joints.
13:37Even if Sunny's knee surgery is successful, if his other joints deteriorate too quickly, it may affect plans for future treatment.
13:50So we can see what an immune-mediated disease does.
13:54It destroys the connective tissue around as well as within the joint.
14:01Where's the 2.7 screws, please?
14:04To replace Sunny's knee joint, Noel will use a 3D-printed guide to remove the bottom of the femur and excavate the marrow cavity.
14:15He will then repeat the process with the tibia.
14:18After pumping in cement, the femoral and tibial components are fixed in place.
14:23Finally, Noel will insert a hinge he's invented, which will allow the knee to flex, extend and rotate, but avoid it dislocating.
14:41Noel's first job is to prepare the femur and the tibia ready for the implant.
14:45You've got to be super careful here because the bone is incredibly thin and it's very easy to perforate.
14:54All right, give me some cement, please.
14:57Then he can cement in the first part of the implant.
15:01Get ready to rumble.
15:02OK, so we've got the femoral component in now and that's looking good.
15:14Happy with the placement, he inserts the tibial component.
15:18OK, we've got bone graft here that we've harvested from the bottom part of the femur so that we get dual fixation, immediate stability from the cement and ongoing stability from bone growing in.
15:34Finally, Noel connects the two components with a plastic bushing to form a rotating hinge.
15:39We push it in and we lock it into position.
15:46In a week, the results of the other joint fluid tests will determine what's next.
15:52All right, let's go as quick as we can to x-ray.
15:55But it's the first step on the road to recovery for the devoted dog and his family.
16:02Hello, good evening.
16:04Hi, good evening, it's Noel here, the vet.
16:06Yeah, hi, I'm just going to put you on loudspeaker if that's OK.
16:08Sure thing.
16:09I've done the operation, it went fine.
16:12Great.
16:14My hope is that within a week, we'll get to a point where he's more comfortable.
16:20That's the first news from a vet that we've spoke to, Noel, in the last year, who's done what they said they were going to do.
16:27So thank you for that.
16:29If you can just keep doing what you said you were going to do, we're going to have a very happy family.
16:33Excellent. Well, I shall intend to do exactly that.
16:38It's boring, isn't it? Oh, it's so boring.
16:52Yes, me just...
16:54Good girl.
16:56Come here.
16:57You see all these dogs struggling to walk, and then Edith's jumping around like a bloody lunatic.
17:05It's not every day that a dog is jumping for joy at a visit to the vets.
17:09It's quite funny.
17:10She's quite funny, yeah.
17:12But for four-year-old Edith, her enthusiastic Springer Spaniel personality...
17:17Stop there.
17:19...may be hiding a serious problem.
17:22Sit.
17:23Edith, about two years ago, hurt her back. She started acting a little bit aggressive towards the cats, who she'd previously been best friends with.
17:32The other vets have examined her and said, we can't find anything wrong, but we know that there's something not right.
17:38Edith lives with Val and Tara and their two cats on the edge of the Peak District.
17:48Edith is crazy, nuts, loopy, energetic.
17:52Wait, wait, wait, wait, wait, wait, wait, wait, wait.
17:56She's hilarious. She'll steal things, like your phone or shoes. Her favourite thing ever is socks.
18:04Are you going to give it back?
18:06Good girl.
18:08There's never a dull moment when Edith's around.
18:13The couple believe that Edith's recent aggressive behaviour could be caused by pain from a disc problem in her back.
18:18But they've been unable to get a definite diagnosis.
18:23When you come into the vets and you've got a bouncing dog running around, you do kind of see their point of view that there is nothing wrong with the dog.
18:33But when you know them well, you know that that dog isn't right.
18:38We can't take her on long walks. The cats are too scared to come down the stairs almost. We're stressed.
18:45She's just not right and we came to so many dead ends at the moment that we just hope that, at the very least, we'll get an answer to what is actually wrong with her dog.
18:58Oh, hi there, guys.
19:00Hiya.
19:01Please grab a seat. How are you doing?
19:03Cheers.
19:04Now I see you've been through the wars. I have 12 reports here, which I've just been looking through.
19:10Tell me what happened.
19:12We went for an MRI and in a way I kind of got the impression that they thought we were kind of overreacting.
19:19Because she just doesn't give anything away.
19:23He decided to do steroid injections.
19:26Did that help?
19:27And then about six months or so after that, she started showing signs again.
19:34But what we're noticing this time is she is starting to self-mutilate herself.
19:40We're just in that stage now where...
19:43What's wrong with her and is there something that...
19:46Because I don't think the meds are helping.
19:48Sorry that you've been through all of that.
19:51It's obviously very emotional for you. Yeah.
19:54So you're worried about her that she's in pain all the time?
19:58Yeah, I get that.
20:00And it's very tough when you see your friend going through significant pain.
20:05So, I'm going to do a physical examination of the lumbar sacral spine.
20:10Hold tight.
20:14Hold tight.
20:15Hold tight.
20:18Okay.
20:20It's okay. It's okay.
20:22Right. So, that subjectively would suggest to me that there is sciatic pain.
20:29But this is intermittent.
20:31Yeah.
20:33And the reason for that is that the disc will bulge in a different way depending on what position the dog's in.
20:39So, when we look at your MRI scan from before,
20:42what we can see is there is a relatively mild disc bulge.
20:46Yep.
20:48However, I would bet a million dollars that if we put the spine in that position that disc would bulge more.
20:53Right. Okay. Yep. Makes total sense.
20:57Sometimes you can have a bulging disc that won't show up in neutral positioning on an MRI scan.
21:04Right. Give her a big cuddle.
21:05And it can be quite challenging to get a correct diagnosis.
21:11We have developed a technique known as dynamic MRI whereby we place the dog inside the scanner in the jumping position.
21:20Only then can you see the true extent of compression of the nerve roots that causes the severe sciatic pain.
21:27Now, Edith's folks. Hi guys. Sorry about the delay.
21:40So, what you will see if we look at the hyperextended view is this disc at the lumbar-sacral junction.
21:46It's significantly bulging, causing an hourglass compression of the nerves.
21:53So, that is the normal diameter of the neuroforamen.
21:57By comparison with this one, that disc is bulging right up into that hole through which the nerve should come.
22:05Oh God, that looks painful.
22:08I know she has her moments of pain, but you think that must be...
22:11She's in pain all the time.
22:13Oh, God, yeah.
22:18And it just gets worse, depending on motion.
22:23So, unequivocally, girls, you've got a bad situation.
22:27Yeah.
22:30So, it needs to be operated on?
22:33No dog ever needs anything, because any dog can be put to sleep.
22:37Hmm.
22:38And currently, euthanasia is still considered a treatment.
22:42Mm-hmm.
22:43So, at least you know the situation definitively.
22:46Yeah.
22:47Sorry that it's so tough, but...
22:48I think it says it all, doesn't it really?
22:51That is...
22:52Yeah.
22:53Yeah.
22:54Yeah.
22:55With spinal surgery, there are many considerations.
22:58And when the ethics and risks are discussed with different families,
23:01they may make different decisions based on what they perceive their friend may go through,
23:07and what the prognosis for a good quality of life may be.
23:11No worries.
23:12Now we know why she's sore, having seen a better quality MRI.
23:17I suppose there's only two decisions.
23:19It's whether we go through the operating or it's whether we get to put to sleep.
23:24I'm sounding blasey at the moment, but I probably...
23:27I just want to burst into tears like I did, but I'm not going to.
23:30I'm going to hold it together, so, yeah.
23:32Yeah.
23:46Bless him.
23:48Three months have passed since Bertie the pup with Twisted Anatomy was last at Fitzpatrick's.
23:54Last time it was quite upsetting, to the point that I got on the M25
23:58and had to pull off to service station because I was that upset.
24:01And then when I got home, he did something a bit mad that he's never done before.
24:05He jumps up on the bed, he shoves his head underneath my arm as if to say,
24:09I'm not done yet.
24:11The golden retriever isn't ready to throw in the towel,
24:14and thankfully his hip replacement surgery has been approved by the ethics panel.
24:20Oh!
24:22Sorry.
24:23Sorry, didn't mean to scare you.
24:24It's all right, I'm sorry.
24:26Bertie's deformed spine and pelvis mean an off-the-shelf impression
24:30off-the-shelf implant won't work.
24:32This is a little nutcase.
24:33Hi, nice to meet you.
24:34You're adorable.
24:36So Noel has created a custom-made hip socket to fit the pup's unusual shape.
24:42OK, so a lot of planning has gone into this.
24:46And what I want to emphasise is a few things before the surgery.
24:50I'm going to have to get the hip from an abnormal orientation up here somewhere.
24:55Yeah.
24:56Down into where it needs to be.
24:57Right.
24:58So I may have serious complications inside the operation, which is my next point.
25:04Because if I do have serious complications, the ethics committee have said that the only route that they would conscience, if it failed, was euthanasia.
25:16I don't have any choice in that matter.
25:22No, I know.
25:25Sorry, big guy.
25:26Good boy.
25:27OK, thank you.
25:30See you later.
25:31Bye.
25:35Rachel will head home to wait for news.
25:38This is Bertie.
25:39He is the right length, but it's just all bent.
25:41It's bent.
25:42Wow.
25:44There's a lot riding on the operation being a success.
26:01OK, let's go.
26:03Golden retriever Bertie has had a dislocated hip since birth.
26:06Noel plans to replace his malformed joint using a custom-made implant called an ace fits, built to fit his unusual anatomy.
26:16Because the pelvis is markedly deformed, it's like trying to take a very long journey with the wrong roadmap.
26:24The old head of the femur is cut off.
26:29Go.
26:30We use this disco ball with cutting edges on it to open up the socket.
26:42Give me the implant, please.
26:44This implant is designed based on an ice cream scoop.
26:48It's coated in trabecular metal into which the bone should grow.
26:52Noel packs bone graft from Bertie's old joint into the enlarged hole.
26:57Once the bone grows into it, it should become a permanent part of the body.
27:09Once locked in place with screws, a plastic cup is cemented into the metal socket.
27:14Then Noel can insert the new hip stem.
27:28Open a 6DFX with a lateral stem.
27:32Which is secured with a bolt before the head is attached.
27:35So we can see the head is now in position inside the new cup.
27:46When I grab the top of the femur like this and pull on it, the hip doesn't dislocate.
27:53So what we've managed to do here hopefully is use mechanics to overcome the limitations of the biology.
28:00Right, good job everybody.
28:04After two and a half hours, Bertie can leave theatre.
28:12Hi Noel.
28:13Hey Rachel, I'm sure you're sitting on the phone like a hot call.
28:16Oh, I felt sick all day.
28:19Yeah, I can imagine.
28:20So I've done the operation and so far, so good.
28:25Oh.
28:27So things went according to plan.
28:29It was tough, it was a tough op.
28:33You okay?
28:37Yeah.
28:38I was widowed three and a half years ago.
28:43And without these dogs, I wouldn't be in the place, as good a place as I am now.
28:47And that's not being melodramatic.
28:49These dogs make me move.
28:52Yeah, of course they do.
28:54Of course they do.
28:55And I know it sounds really stupid, and I don't care what anybody says, but they were gifted to me.
29:00From above.
29:01These dogs were sent from above.
29:03They absolutely 100%.
29:04Oh, God.
29:06Well, I'm glad you feel that way.
29:08No, no, listen.
29:09Let it all out.
29:10Let it all out.
29:11It's good.
29:12It's all good.
29:13It's all good emotion.
29:14Oh, shaking.
29:15Noel.
29:16Wow.
29:17You are a dog god.
29:19I'm just glad to be able to help.
29:20I'll let you crack on, because you must be shattered.
29:22I am pretty tired.
29:23Thank you very much.
29:24God bless.
29:25We'll give you a call tomorrow.
29:26God bless.
29:27Lovely.
29:29Bye-bye.
29:34In Somerset, Steadfast Sonny is making good progress after his knee replacement surgery.
29:55Up, son.
29:56Ready?
29:57Good boy.
29:58Good boy.
29:59Good boy.
30:00And his family are fully committed to their Tibetan friend's recovery.
30:04He's coping very well with a new routine.
30:07We stay in this room practically all day.
30:10He has his physio.
30:12He eats and drinks in here.
30:14He sleeps in here.
30:16It is getting a bit boring, to be honest.
30:21This was the one I was scared of doing, but it's not too bad.
30:27His right leg is definitely getting stronger and he's on the least medication he's been
30:32on in a year.
30:33So something's definitely worked.
30:35I'm hoping that they would say yes to do the left knee.
30:39But I'm scared if his IMPA, this arthritis, will go to other joints.
30:46That's what I'm scared of.
30:48Good boy.
30:49Good boy.
30:50I'd love to take him to the beach.
30:53I can't even remember what he looks like to run.
30:56Good boy.
30:57Good boy.
30:58But to be able to watch him do that, it would be amazing.
31:03Absolutely amazing.
31:05Wanna pee?
31:08Not a number two.
31:09Good boy.
31:10Look at that.
31:11Look at him go.
31:13Five days after hip surgery, Quirky Bertie, the golden retriever with a twisted spine
31:29and pelvis, is on the move.
31:31Bertie Bertie Bertie Bertie.
31:33Bertie is so pretty.
31:34And Rachel and big brother Buddy.
31:36But, but, but, but, but, come back.
31:39Now sit, sit.
31:40Can't wait to get him home.
31:42He's been a bit down in the dumps.
31:44It's been very quiet.
31:47Does he bark?
31:48Not close.
31:49Oh, that's so nice.
31:52The next bit's down to me.
31:54Noel's done his bit, so it's going to be a long 12 weeks, but it's well worth it.
31:59Morning.
32:00How are you?
32:01Happy, happy.
32:02Grab a seat.
32:03You are hilarious.
32:04Why?
32:05Oh, I've been listening to your book all the way down.
32:07You're so funny.
32:08Well, I didn't think it was that funny.
32:10It's made me laugh.
32:11It's made me smile.
32:12It's made me cry.
32:13It's made me gag.
32:16So thanks for coming down.
32:18How are you feeling today?
32:19Excited.
32:21Well, that's good.
32:23Let's season that with just realism.
32:25Yes, of course.
32:26Obviously.
32:27I'm very realistic.
32:28Obviously we still have a way to go.
32:30Absolutely.
32:31I understand that fully.
32:32But I wouldn't be sending him home now if he wasn't comfortable and able to walk.
32:37Yeah.
32:38It's just been weird not having him on the back of my ankles 24-7.
32:41Of course.
32:42Because that's what he does.
32:44He also talks a lot as well.
32:46A bit like me, I suppose.
32:47Runs in the family.
32:48Yeah.
32:49HE LAUGHS
32:50He does.
32:51Let me get him.
32:58Who's here?
32:59Bertie!
33:00There we go.
33:01There we go.
33:02There we go.
33:03There we go.
33:04Hello, baby.
33:05Hello, baby.
33:06There we go.
33:07Hello.
33:08Oh, look at you, skinhead.
33:09Let's go in reception.
33:10We'll just show you how to do that walking.
33:11OK.
33:12So you can see that he's walking pretty good.
33:15Yeah.
33:16His little turkey tail is wagging, so he's happy.
33:18His little cute tail, yeah.
33:19I'm pretty happy with that.
33:21Are you happy?
33:22Yeah.
33:23Definitely.
33:24Looks good, doesn't he?
33:25Considering what the other outcome was.
33:26He looks lovely, bless him.
33:27He's a little star.
33:28He is a little star.
33:29All right?
33:30You're a star.
33:31You're a star, guys.
33:32We want our best.
33:33I really appreciate it.
33:34God bless you.
33:35Come on then, Bert.
33:36Bertie will need six weeks of cage rest, followed by rehab.
33:40Come on, mate.
33:41Well done, little man.
33:42Look.
33:43There's your brother.
33:45Only then will he be able to rough and tumble with his best buddy again.
33:49The boys are back in town.
33:50The boys are back.
33:51We're a team.
33:52The three of us.
33:53So, yeah, great.
33:54Great.
33:55We've got a long way to go, but can't wait to see him running around together again.
34:06You all right, Weasel?
34:11It's been a month since Noel confirmed that spirited springer spaniel Edith has a bulging disc in her lower back, causing her significant pain.
34:21So, we've came back down with Edith because we had to make a difficult decision as to whether we were going to put her to sleep because she was in so much pain or whether we were going to go ahead and get surgery.
34:32So, we had a good think about it and we had a good chat with Noel and we made the decision that we were going to go ahead with the surgery.
34:39So, if we hadn't up to do the op, we'd always be thinking we could have maybe fixed her, you know, and we never gave it a good shot, so.
34:49Edith's bulging disc is pressing on the roots of her sciatic nerves.
35:03To access the disc, Noel would need to negotiate other vital nerves leading to the tail, bowel and bladder.
35:10Edith has a deceptively small skeleton.
35:14It makes my job more difficult.
35:17Suction, please.
35:25Noel's first job is to remove the roof of the vertebrae.
35:28It's very tight here.
35:31So, there's a big blood vessel here.
35:34We've got to dissect very carefully between that and these nerves.
35:38And the nerves are like small threads in a patient of this size.
35:43Treading a tightrope between the nerves and the blood vessel, Noel carefully scrapes out the centre of the bulging disc.
35:50So, this is all the disc material we've taken out of the centre of the disc.
35:55With the disc bulge and nucleus removed, Noel inserts one of his most successful inventions.
36:01A Christmas tree-shaped spacer screw that will open up the disc space between the vertebrae.
36:07Okay, so we put a screw through the centre of the spacer device to stop it backing out.
36:14Then, nerves come back over the spacer.
36:18The next part of the process is to fuse the lumbosacral junction,
36:23so that even dynamic movement like jumping cannot compress the nerves.
36:28We've put a screw and a clamp into either side of the L7 vertebral body now.
36:33And what we're going to do next is we're going to put a screw on either side of the sacrum.
36:40Dumbbell-shaped rods connect the clamps and stabilise the area.
36:46If I move these vertebrae now, they move together.
36:49Rock solid.
36:51Rock solid.
36:52They, like me, hopefully what I've done here is enough, to get Edith out of pain.
36:59Despite its risks, neurosurgery can deliver fast results.
37:05The next few days will determine if Val and Tara will be happy with their decision for Edith.
37:11Good girl!
37:13it's been three months since trusty tibetan terrier sunny was last at fitzpatrick's
37:28finally he's been given the go-ahead for surgery we brought sunny back for his second knee
37:39replacement he's just not as happy as he was a few months ago so we've literally been counting
37:44down the days good morning so are things much the same or is there anything else new you know
37:53I'm concerned with his front right as well it sometimes looks as if he's stumbling okay hold
38:01tight all right baby baby yeah he's sore there isn't he so he might have a flare of that impa okay
38:11okay sorry mate okay so we're gonna need to check that out it does appear he's got a flare of
38:24inflammatory arthritis elbow's pretty bad so I think what we'll do today is CT scans of both
38:34front legs if there's no structural damage then we proceed as planned and within one week we start
38:42steroid again because I've known he's been deteriorating but yes there it until that knee
38:47was ready that what more could I have done you couldn't do anything right big cuddles then Sonny
38:54will have scans taken to determine the damage to his elbows he wasn't paying on those fronts after
39:02months under control with medication this sudden flare-up of immune joint disease has put his future
39:08in doubt once more loyal Sonny is awaiting surgery to replace his painful arthritic knee joint sorry
39:28let's pick up the imaging but a flare-up of inflammatory arthritis in his front legs has put the operation in
39:34in jeopardy so these are Sonny's CT scans of the elbows and wrists we can clearly see that there are
39:43changes there's a small erosion there in the head of the radius there's a hole in the radial carpal bone
39:50there those holes are representative of inflammation that is destroying that bone and as well as that both
40:03elbows are also affected by developmental elbow disease whereby they don't fit together properly
40:07we'll try and treat the knees to give him a quality of life that he can walk and stand and be happy
40:13because without the knee operations he could do none of those things but it will be wrong to think that
40:20we can address his quality of life by knee replacement alone because we can't so Sonny is gonna be on some
40:30kind of steroid therapy or immunosuppressives for life oh look at you go Edith that's fantastic well done
40:50well done sweetheart well done wow but the lively four-year-old already has a spring in her step so
41:04this is a fantastic result we only came out of theater 18 hours ago and she's already walking
41:11really well so that's very very encouraging the fact that the family came so close to a decision
41:18for euthanasia is extraordinary really hopefully the outcome will be good and then they'll be
41:25delighted they gave her a chance Edith has made such good progress Val and Tara are allowed to take her
41:32home it's been really quiet actually yeah yeah we've realized actually how much of a massive part of
41:38her life she is she permanently does naughty things she's just crazy and not having the they're there
41:45doing that it's just it's just weird look who's here sweetie pie so it's just walking is simply that
41:56harness and the lead okay well I hope you're very pleased with how she's walking oh definitely I'm
42:02quite amazing she's so strong well done Edith good we've missed your big nose look at that
42:08the cats have missed you not they've already stolen your bed Edith
42:15she's looking a bit pathetic but then she's got that face and but yeah it's nice it's nice to see
42:24her looking forward to getting you back into into old Edith fingers crossed yeah she's a young dog so
42:31I think we've made the right decision so this is a the first proper off lead she's had seeing the
42:50difference in her has just been fantastic good yeah she's getting a spring back and a wagging tail and all
43:00that sort of stuff the tail's going mad isn't it we've been to many different vets that I feel we
43:07hadn't really sort of taken our problem seriously and it's just so nice we've managed to get it fixed
43:13yeah you're out of breath now aren't you we're definitely pleased to have taken that chance and
43:19gone down the route of surgery just having a happy household and having pets that actually get along with
43:25each other future does look bright it's been a difficult couple of years for Sonny and his family
43:44good boy son son but finally the clouds are lifting he's so much more himself than a year ago he has his
43:53spirit back and he wants to be around and be involved whoa steady he has no issues with his knees at all
44:00he's able to walk down to the village around the woods there he is a bit of physio lots of people call
44:08him the bionic dog around our village yeah it's only one say I'm giving him a rub that I think gosh
44:13he's got metal knees especially made for him in there it's quite amazing yes he does have some
44:21issues on the front he will need medication for life but I'm gonna try and get some weight off him
44:26he's not gonna have any second dinners with his dad I'm gonna try my hardest to keep to keep him well
44:32it's nice just to think that he is not in pain anymore he's the bestest boy ten years I've had
44:40him and he gives me so much love and companionship every day that it's no effort to help him in return
44:47hopefully he should be able to live comfortably for the rest of his life yes
45:02he's definitely gonna be a natural swimmer isn't it quirky Bertie has been having hydrotherapy to
45:11strengthen his weak leg muscles Bertie's loving hydro he loves water true retriever and the boys are
45:22loving being back together I'm ecstatic with the results absolutely over the moon
45:29you can see that he runs a lot straighter he's just Bert back you know I mean he's just Bertie back
45:39good boy no I call him the dog God I do call him the dog God he doesn't like that but he is the dog
45:48God he is because without his expertise yeah I'm fairly certain Bert would have ended up being put down
45:55oh yeah they do like to do this he'll never be as big as his brother but nobody's perfect in the world
46:02are they come on this way he's my boy they're both my boys they come above most humans kids are gonna love
46:13that one good boy
46:21good boy
46:43good boy
46:44good boy
46:45good boy
46:46good boy
46:47good boy
46:48good boy
46:49good boy
46:50good boy
46:51good boy
46:52good boy
46:53good boy
46:54good boy
46:55good boy
46:56good boy
46:57good boy
46:58good boy
46:59good boy
47:00good boy
47:01good boy
47:02good boy
47:03good boy
47:04good boy
47:05good boy
47:06good boy
47:07good boy
47:08good boy
47:09good boy
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