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00:00Hello mate, do 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
00:11High five! Yes!
00:13Professor Noel Fitzpatrick
00:15We only get one shot at this, here we go
00:18Noel and his team offer some of the most advanced treatments available anywhere
00:23The perfect marriage of mechanics and biology
00:25This is what we have now, a brand new knee
00:28Oh wow!
00:30For some, it's a last chance
00:33It is a life or death situation because we cannot leave him like he is
00:37I just want you to do anything you can for him really
00:40Sorry
00:41As Noel continues to devise new ways of healing
00:44You're going to be Bionic, thank you so much
00:47He transforms the lives of his patients
00:50Oh that is just unbelievable
00:52He's raring to go
00:53Against all the odds
00:55Boom!
00:56One small step for a dog, one giant leap for mankind
00:59Well done
01:06Fitzpatrick Referrals is open 24 hours a day, seven days a week
01:13It's the weekend and an emergency referral has just arrived
01:17A little Spaniel puppy called Albie
01:20It's just been hit by a car this morning
01:23Sounds pretty bad
01:25The referring vet says there's a broken back
01:27Now, Mr Gorman, hi, I'm Noel
01:30How are you doing? Nice to see you
01:31Hi, nice to meet you
01:32Susan tells me you're Irish
01:33Yeah
01:34Where are you from?
01:35Dublin
01:36Oh, nice to see you
01:37And this is your friend Albie, please
01:38Yeah
01:39Tell me what happened
01:40We're staying on a campsite
01:41And he went behind the bush on the other side of the road
01:44The next our friend knew there was a bang
01:47They ran around
01:48And Albie had been hit by a car
01:50But the car didn't stop
01:51Okay, let's carry him in
01:52All right, okay big fella
01:54That's fine
01:55Okay
01:56Now Albie, how old is he?
01:58He's ten months tomorrow
02:00Oh dear
02:01Oh, poor fella, okay
02:02Hello
02:04Albie has been given pain relief
02:07And has been x-rayed by a local vet
02:09The x-ray picture I've had through Gareth
02:12Have you seen this?
02:13No
02:14Okay, so that's really bad
02:16That's a broken back right down at the base of the spine
02:19And now my worry is
02:20It's entirely possible that the nerves to the bladder are in fact severed
02:25And we wouldn't know that at this point
02:27Because it's only been a few hours since the injury
02:29Yeah, yeah, yeah
02:30And also I'm concerned about the nerves that are coming out of this region here
02:34And that's the L7 nerve root
02:35And that goes down there to form the sciatic nerve down here
02:38Okay
02:39So we're going to have to check if he can feel his back legs
02:42Yeah
02:43Okay
02:44All right big guy
02:45That's it
02:46That's it
02:47Okay, okay, okay
02:48Just put that underneath
02:50Okay big fella
02:51I'm going to lift him up very gently
02:52I'm going to squeeze this foot now
02:54Which is very important to see whether he can feel it
02:56Yeah
02:57Yeah
02:58There is a bit of movement there
03:01All right
03:02You can pop him back down please
03:04Okay, so
03:05It is a life or death situation
03:07Because we cannot leave him like he is
03:08Yeah
03:09He's got a broken back
03:10Okay
03:11He's a young dog
03:12And it would be a very difficult decision to make to put him to sleep at this point without trying
03:19Yeah
03:20I would obviously have to warn you though that even if I can get that vertebra pushed back down and realigned
03:27That there are risks
03:29He may never walk again if his back legs don't work but on the other hand if we don't
03:34Have a look
03:35Have a look
03:36Well if we don't try then we are going to have to put him to sleep because we can't leave him like that
03:41Okay
03:42Please go for it
03:43You know this whole family are hoping that
03:45So you've got a couple of young kids have you?
03:46We've got three young kids
03:47Three young kids
03:48Yeah
03:49Yeah
03:50So they are waiting on news no doubt
03:51Yeah
03:52My wife in particular would be devastated
03:53Okay
03:54Come on
03:55Albi is taken through for detailed imaging of his injuries
04:00Okay
04:01All right
04:02You just check him out
04:03Yep
04:04Do the necessary
04:05Yep
04:06Back at the campsite the family are desperate for news
04:09I've seen the x-ray and it's a very bad break
04:14So it may be wise to prepare yourself and the kids
04:24All right
04:26Sorry sweetie
04:28I just remember just sitting there dumbstruck really
04:33And the children were constantly asking me
04:35Have you heard from them?
04:36Have you heard from daddy?
04:37Have you heard from daddy?
04:38We knew that his spine was broken
04:41We just started preparing ourselves for the worst
04:46It's not just Albi's back that's broken
04:49His ankle is also badly damaged
04:52The car has ripped a hole in the skin
04:54Infection's probably already in there from the side of the road
04:57That's another complication we don't need
04:59And secondly
05:00The ankle ligaments have been severely damaged
05:03So the ankle itself is loose
05:05This is a very bad situation
05:07And Gareth's going to have to make some decisions
05:10Gareth can you come in please?
05:13Thank you
05:16So if we look at this you can see that there's
05:19Probably a dozen or so fragments
05:21All crushed up into the spinal canal
05:25The only way to fix this
05:27Will be to pull that apart
05:29And push those fragments down
05:32Hold that segment apart
05:34And then this hopefully will congeal together
05:38But as you know the function of those nerves
05:40I don't know
05:41They've been really badly garrotted
05:43Okay
05:44The ankle is also disrupted
05:48The ligaments they're damaged
05:50If they're completely ruptured
05:52I may have to go back in at a later date
05:54And fix them
05:55And secondly there's a hole through which grit
05:57From the road has got here
05:59So I'm going to have to flush it out
06:01Hope it doesn't get infected
06:03But in your worst case scenario
06:06I guess you could lose the leg
06:08We should go to surgery now
06:10Or call it a day
06:12Okay
06:14Alright
06:15Let's do that then
06:16And then I guess you can go home
06:19And I'll ring you
06:20Okay
06:21Look after yourself
06:22Thank you
06:23I'll do my best
06:24Okay
06:25Noel will operate to try and save Alvi straight away
06:28So this is a life or death situation
06:30And the problem is that we can't be 100% sure
06:32That the nerves are going to make it
06:34We'll have a look at them
06:35If they're visibly torn then we should not proceed
06:39In this complex operation
06:41Noel plans to drill the roof off the spinal canal
06:44Pull the vertebrae apart
06:46And push the broken bits of bone from the vertebral body
06:50Back down into place
06:51Using tissue glue to temporarily hold them
06:54Then he'll realign the vertebrae
06:57And stabilise them with a combination of metal pins and cement
07:03So this is very very difficult
07:05I'm trying to push the bits of bone down into the base of the vertebrae
07:09Underneath the nerves
07:10While simultaneously pushing this vertebrae back down into position
07:15And it's really tricky
07:16Because that big spiky piece of bone in there
07:18It's just been garrotting that nerve
07:20And I'm just trying to push it down without damaging the nerve
07:29There it goes
07:30The nerves here that go to the bladder
07:32They're actually still intact
07:34So we're in with a chance
07:36Noel uses tissue glue to temporarily hold the loose fragments of bone in place
07:42Now he can stabilise the vertebrae
07:45I'm putting multiple pins here in the vertebrae in front
07:49And some more in the vertebrae behind
07:51And then I'm going to link all these pins together using cement
07:53So that everything is solid
07:55And hopefully this will heal
07:56This bolus of cement will stay in there forever
08:05Because we won't need to take it out
08:07But it will be redundant as soon as the bone heals
08:09Right, our work here is done
08:11We're just going to close up now
08:13But Noel still has work to do on Alby's ankle
08:17We're going to have to treat this hole as an open wound
08:20And just let it drain
08:22And see whether infection takes hold or not
08:25The ankle is unstable
08:27It's likely these ligaments here are badly damaged
08:30Whilst there is a risk of infection
08:33Noel can't fix the ankle
08:35So he temporarily stabilises it
08:37With a frame of pins, clamps and carbon fibre rods
08:41You'll be able to cope very well with having this frame in place
08:44It will hold the ankle solid
08:46Allow the tissue to potentially recover here
08:48And also allow us to dress this wound
08:51He fills the wound with medical grade Manuka honey
08:54It's a natural antiseptic
08:56The honey will help treat the infection
08:58Help the wound to heal
08:59And the frame will hold the bandage in position
09:01And will change it daily
09:04After three and a half hours of surgery
09:07Noel has done everything he can for Alby
09:10Hello Garrett, it's Noel
09:13I'm okay, thank you
09:15We've been operating for quite a while
09:17It was a very challenging surgery
09:19But we've managed to get it done
09:21As far as I could see
09:22The nerves I saw were not severed
09:25We pulled everything back together
09:27The spinal canal now looks pretty good
09:30And I would be reasonably optimistic actually
09:33Although the jury's still out
09:35Alright, please reassure your wife
09:37Thank you, take care, bye-bye
09:39Bye-bye
09:41Bye-bye
09:42Alby will be monitored throughout the night
09:45The next 24 hours will be critical
09:49It's ten o'clock in the morning
09:59Rush hour at the practice
10:01Lovely, you're all booked in
10:02Take a seat
10:03Help us out to see your coffee
10:04Low strike down on the left
10:07Waiting to see Noel is a Scottish Terrier
10:10So this is Flora, the Monopoly dog
10:14She's got a bit of a poorly back leg unfortunately
10:18Flora has been seen by several different vets
10:21But so far no one can work out what's wrong with her
10:24Occasionally she'll just start sort of whining and shaking
10:28And we can't really figure out why
10:30Hence we've brought a scene in the hole
10:32To see if we can figure out what the problem is
10:34At home in West London
10:36James and his wife Alexis
10:38Have had Flora for the past two years
10:40She just makes you smile
10:42No matter what's going on in your day
10:44You come home, whatever mood you're in
10:45She just makes you smile
10:46Flora grew up with Alexis' parents
10:49But when her mother died unexpectedly
10:52The couple decided to adopt her
10:54She's just full of so much love isn't she
10:57And she always wants to be near you or sat on you
11:00We're not going to have children
11:03So to us Flora is like a little child to us
11:09It's been over the past year
11:11That Flora has developed her problems
11:13The vets that we take Flora to
11:15Are trying to help us figure out what was wrong
11:17We thought it was something
11:18Did scans
11:19And then it turned out not to be
11:20Then thought it might be something else
11:22Did more scans, more tests
11:23And it wasn't that
11:24It gets very demoralising
11:26All in all Flora's problems are a bit of a mystery
11:30James hopes that Noel can solve the case
11:34Now Flora please
11:36Hello buddy
11:37Hi there
11:38Come on in
11:39Come on Flora
11:40No, no unfortunately
11:41Unfortunately it's this way
11:43Good morning
11:44How are you doing?
11:45Good morning, I'm good thank you
11:46Hello Flora, please take a seat
11:47Hello
11:48Now then, what's your name sir?
11:49It's James
11:50James
11:51She's seven now
11:52She's seven
11:53When did you first notice any issue at all?
11:55Probably about February time
11:57What did you notice?
11:58So we noticed that she started limping around
12:00Particularly when she's exercising
12:02And then she started hiding in the bathroom
12:04Sort of hiding away and sort of shaking and shivering
12:06We couldn't get her out
12:07That's when we took her to the vet to see her
12:10And what did they think was the problem at that point?
12:12Well they thought that she might have got sort of cruciate ligament damage
12:15Mm-hmm
12:16So tell me about the shivering
12:17When does that happen?
12:18It's pretty intermittent
12:19She just sort of starts shaking
12:21And she sort of can be calmed down
12:23She'll say she'll go and hide away
12:25What does she do?
12:26Hide under a chair or?
12:27Well she'll run into the bathroom
12:28Which is like the farthest room in the house
12:31Sort of farthest away from everyone
12:33Interesting scenario
12:35I'll just get my colleague in
12:36We'll do a physical exam
12:38Okay, so you just talk to her buddy
12:41Good girl
12:42That's it
12:43There we go
12:44I'm gonna check everything over
12:45Good girl
12:47Densely packed is a good word for her
12:51Yeah
12:52She is chunky
12:53She's dark matter
12:54Yes
12:55She is
12:56That's a brilliant phrase
12:58All right Flora, good girl
13:00So she is challenging
13:02I'll give you that
13:03I don't think it's the hips
13:05I don't think it's the ankles
13:07I think it's either the knees
13:09Or the lower back
13:11But my gut feel is that
13:16Let me just check something else
13:18Something's just occurred to me
13:20Pop her back up on the table
13:21Sorry, sweetie
13:23There you go
13:24Hold the chest for me, please
13:26I'm just gonna do something
13:27Good girl
13:28Good girl, Flora
13:31She doesn't like that, does she?
13:33I just wonder if she's got
13:34What we call a dynamic disc
13:36Meaning in certain positions
13:38It bulges
13:39This condition would not necessarily show up on a standard MRI scan
13:43Noel needs to test his suspicion
13:46I'm gonna try a static nerve test
13:48Good girl
13:49Good girl
13:50Oh, oh, did not like that
13:52Doesn't like that
13:53Doesn't like that
13:54That's a positive test
13:55There's a third test
13:57I lovingly call it the Fitz finger test
13:59It's terrible
14:00It's my finger
14:01Up her bottom
14:02Touching her nerve
14:03Right
14:04Sorry
14:05I'm gonna do it
14:06I'm sorry, sweetheart
14:07This is very embarrassing
14:08Very embarrassing
14:09Very embarrassing
14:10Very embarrassing
14:11Good girl
14:12Good girl
14:13This literally is a black hole
14:15Good girl
14:16Okay, hold tight
14:17I'll tell you when I'm on the nerve
14:18Good girl
14:19Okay, so I'm on the nerve now
14:20And I apologize if this hurts
14:21But this is an important test
14:22Go
14:23Good girl
14:27Oh
14:28Doesn't like that
14:29Looks like we're onto something here
14:30Stand at his knee there
14:31Yeah
14:32Oh, I got you
14:33Thank you
14:34Alright, look in my mind
14:35I think that it's more likely
14:37That you've got
14:38What we call an intermittent dynamic claudication
14:41Of the L7 nerve root
14:42What that means is
14:44That in certain positions of her lower back
14:46I think
14:48She's squishing a nerve
14:50Right
14:51There's three things we can do
14:52Just give medicine
14:53Like you have been doing
14:54Second thing we can do
14:55Is do a dynamic MRI
14:57Okay
14:58The other option
14:59Is do what's called
15:00A therapeutic trial
15:01Inject steroid
15:03Around those nerves
15:05With an epidural needle
15:07And that steroid goes down
15:08Around those nerves
15:09And then would numb
15:11The pain
15:12There
15:13Right
15:14Or in fact both
15:15Which is in fact
15:16At this point
15:17My recommendation
15:18Right
15:19Because
15:20That was reasonably positive
15:23I would say
15:24So it's up to you matey
15:26That does make sense
15:27That's certainly what my wife would
15:29Would say as well
15:30Alrighty
15:31Pick her up
15:32Give her a cuddle
15:33Cause we're gonna take her through
15:34Come on Flora
15:35Come on Flora
15:36Alright guys
15:37It was awful
15:38It was awful
15:39It was awful
15:40It was awful
15:41I've never seen a react like that
15:42To anything
15:43Erm
15:44I'm actually quite glad my wife isn't here today
15:45Cause I don't think she would have
15:46Responded to that very well at all
15:47But if we can get some sort of resolution out of it
15:49Say this is the problem
15:50This is how we solve it
15:51Then it's all worth it
15:52It's all worth it
15:53It's the day after Albie had spinal surgery after being hit by a car
16:09Oh
16:11It's a puppy
16:12The family were on a camping weekend
16:14And are now on their way home
16:16We live quite a long way away
16:17He's probably gonna be here at least a week
16:19So we wanted to see him before we went
16:21We don't know when we'll next get to see him
16:23Do we?
16:24Do we?
16:27Now come on in guys
16:28There we go
16:29Dog treats
16:30No hopes that seeing the family will give Albie a boost
16:34Well listen thank you for coming in guys
16:36I'll get a rug
16:37And I'm gonna put it on the floor here
16:39And we'll bring him in and see how he gets on
16:44The more rest he has the better
16:45It'll be here for a while we're covering anyway won't it?
16:50Now here we go
16:51Who's here Al?
16:52Who's here Albie?
16:53Good boy
16:54Here we'll get down with him
16:55You can get down with him
16:56You can get down with him
16:57You can get down with him
16:58You can get down
16:59Keep down at his level
17:00Okay
17:01Okay buddy
17:02It's lovely to see him respond like that
17:03Lovely
17:04And the fact that he can move both back legs
17:06Is a wonderful thing
17:08Because if he had been paralysed at this point
17:10We'd be obviously very very worried
17:12Oh look at that
17:13He's having an on your nose lick
17:16You've missed that haven't you?
17:18He likes to lick the tingle
17:19There you go
17:20He loves a bit of face licking
17:21They don't seem to mind
17:22No
17:23It's all good
17:24All good
17:25My gut feel at the moment is very positive about the spine
17:27I think he's very comfortable
17:29I think that he's getting to a point that he wants to stand up
17:32In terms of the ankle
17:34I think we'll dress it for a week
17:36And see the ligaments form a scar
17:39If not then I'll probably need to go back in and put synthetic ligaments in
17:43So there's still a risk with that
17:45But you know what?
17:46He's come a long way already
17:48I think it's very very good that you all came
17:51Because it's perked him up as well
17:53We've just got to be careful over the next few weeks
17:55So shall I bring him back to his ward now?
17:57Yeah
17:58Yeah
17:59Alright guys big kisses then we're going to go
18:02I'll see you very soon guys
18:04God bless
18:05Bye bye
18:06He looks adorable
18:07Adorable
18:0824 hours ago we thought we were going to lose him
18:11And so to be where we are now is just amazing
18:17Albie will stay in the wards to continue his recovery
18:21And so the risk of infection in his ankle can be monitored
18:25In the MRI room Flora the Scotty dog has been having a series of dynamic scans on her lower back
18:41The images confirm it is a bulging disc
18:44So whilst she's under anaesthetic
18:46Noel's giving her the first of three epidural steroid injections
18:51Alright wake up
18:52Hey James
18:55Sorry about the delay
18:56Come on in
18:59Grab a seat there
19:00Thank you
19:01Okay
19:02I think I have a diagnosis for you my friend
19:04Oh excellent that's great news
19:05Yeah
19:06So at least we've got something to work with
19:07I want to show you this
19:08Because this is quite startling when you actually see it in real life
19:11So this is the kicker image that I was looking for
19:14And that I suspected this morning
19:16Look at the way those facets come down
19:19They are squishing those nerves
19:21So that's a disc bulge
19:23And unusually
19:24Well I say unusually
19:25But I have seen this before
19:27You won't see it on a neutral view
19:29Because it isn't bulging centrally
19:30It's dead flat
19:31It's bulging towards the sides
19:33In every detective story there's one vital clue
19:38When you said to me she's hiding in the bathroom
19:41You probably saw a little bling go on in my eyes
19:44Because that was a trigger for me
19:45You know what?
19:46I was a big fan of Columbo
19:48Oh I love Columbo
19:49Boom
19:50Boom
19:51Just one more thing
19:52Yeah
19:53That's right
19:54My wife she loved this
19:55Yes
19:56That's it
19:57Just one more thing
19:58And he always did that
19:59He would walk towards the door
20:01Just one more thing
20:02And I felt like that this morning
20:04You gave it to me
20:05And it's like putting those clues together
20:06What you actually said was
20:08She goes to the furthest away room in the house
20:11From where anybody is
20:13And that's not typical of a lameness
20:15As a result of knee pain
20:17That's typical of a lameness
20:18As a result from nerve pain
20:20I've done the epidural steroid
20:21But that's the first of three
20:23Meanwhile that's it
20:24That's the only medicine we're giving
20:26Because we won't know if it's working
20:27If we give anything else
20:28And it either works or it doesn't work
20:30Let's say worst case scenario
20:31It only lasted a few months
20:32Or you didn't get a response
20:34Then you can do surgery on that
20:36To stabilize it
20:37And hold it solid
20:38But it's a last resort
20:40Ah you're awake
20:41Brilliant
20:42Come on then
20:43Well done
20:44You are awake
20:45Well done whisker head
20:46Hello baby
20:47So
20:48You can pick her up in your arms
20:49She is still a little bit groggy
20:52Big hug
20:53Thank you very much
20:54See you Flora
20:55Good girl
20:56Well done
20:57I'm glad I could help
20:58I think
20:59Hopefully
21:00Yeah
21:01Came in this morning
21:02We had no idea
21:03What was wrong
21:04We thought of something in a leg
21:05And through some detective wizardry
21:07He's just come up with a decision
21:08That it's her back
21:09Hopefully his Columbo inspired moment
21:12Will lead to a much happier life for Flora
21:17Flora will have two more epidural steroid injections
21:20Over the next six weeks
21:22Cheers to a good guy
21:35In reception Sarah and Jason have brought in their young spaniel Parker
21:40He's only 16 months old but already he's got severe arthritis in both hips
21:53I probably noticed it about last February March time that he just used to be a little bit limpy after a walk
21:57He can't jump up on the sofa like his brother can
22:00He wants to do it but obviously he hasn't got the spring in his legs to push him off
22:04He can't support himself so you can tell that he was in pain
22:08It's quite sad really
22:13At home in Kent, Parker lives with his brother Cooper
22:17The family got them as puppies
22:19They're such a bonded pair, they're so cute with one another
22:22Can you give me cuddles?
22:24Like boys we ain't got
22:25We haven't got because we've got two girls
22:27They're everything to us
22:29Wait
22:30I'm done
22:31Parker has been a foodie right from the beginning
22:34First thing in the morning you could get up at 4 o'clock, 5 o'clock, 6 o'clock
22:38He thinks he's getting up for dinner
22:39Okay, good boys
22:41You come down, you give him his breakfast
22:44He eats that in about 10 seconds
22:46What's Mummy got?
22:48But now his hip problems are affecting his quality of life
22:52He was a fat puppy and he's become a fat, podgy young man
23:01I want to see him be able to chase the ball
23:03I want to see him play with his brother like he should do
23:06He just needs to be pain free doesn't he?
23:09Yeah
23:10Parker has already been seen by Noel's colleague Miguel
23:14He's asked Noel to consider him for total hip replacement surgery
23:18Hi, how are you?
23:19Nice to see you
23:20What's your first name?
23:21Sarah
23:22Hi, how are you doing?
23:23Jason
23:24Hello mate
23:25He's a cutie pie isn't he?
23:27Yeah, he's a big softie
23:28He's very fluffy
23:29And I guess he can't really exercise so he could get a bit tubby
23:32He's a bit tubby
23:33He's convinced whilst we've had his hair cut he'll look colossally
23:35His hair makes you look...
23:36How many times have I heard that?
23:40Cool
23:41I think even if we clipped your hair she'd still have a little bit of love handle action going on there
23:47I may be sounding facetious about that but the lighter we can keep a patient with arthritis
23:52The better they'll be
23:53I cut out all his treats and he has things like carrots and...
23:56Good
23:57Good
23:58But he does have a digestive biscuit in the morning, just one
24:01And he loves his digestive biscuit
24:04I'll bet you do
24:05Can I just check him please?
24:07Come on bubs, head towards you, bump towards me
24:09That's it, there we go
24:11Tight
24:12Tight
24:13Alright
24:14Okay
24:15Okay
24:16Okay
24:17Oh
24:18He's quite sore on both of them
24:19Alright, so they're both as bad as each other
24:21I guess the left one's a little bit worse
24:23I think it's likely rather than unlikely that both hips will need doing in this dog's lifetime
24:28Yeah
24:29The things that can go wrong are fracture or some problem putting in the implants
24:33I've never had one where I'm in the op and I get a fissure or a fracture that I can't fix
24:37You just need to be super careful in the post-op period
24:40We'll be like Sergeant Majors
24:41Yeah
24:42Good
24:43Alright big fella
24:44Come on
24:45He's heavy
24:46Oh, oh, oh, oh
24:47Hey Munchie, how are you?
24:48Alright guys, God bless
24:49Alright, thanks a lot
24:50I'll see you later, bye bye
24:54I'm sad, trying to be brave, trying not to cry
24:58Because I know he's in good hands and I know he'll be fine
25:01Total hip replacement left side
25:02Yep
25:03I've been really apprehensive
25:05Because it's such a big operation for a baby to have
25:09To get Parker out of pain, he is likely to need two major surgeries
25:15Total hip replacements on both sides
25:18Two weeks after life-saving surgery to fix his broken back, Albie is in theatre again
25:35The family want to save his damaged ankle, so after discussing the risks of infection and failure, Noel is going to try using custom-made implants with new synthetic ligaments
25:48Okay
25:49You can see there, that's the remnants of the wound that was wide open
25:52There's still a risk of infection though, because bugs got in here from the road, so we've got to be very careful
25:58In the accident
25:59In the accident, Albie's ankle was dragged along the road, shearing off some of the bone, so Noel is putting in implants to anchor the new ligaments
26:08Okay, these are our implants
26:15The objectives of putting in the artificial ligament are to hold the ankle solid while the scar occurs in the original ligament structure that was there
26:25Okay, so that looks reasonably good, I'm going to ping in the first screws now
26:31Albie's a very young dog, it would be best if we could try and save this joint for the rest of his life
26:38This is the artificial ligament here, that we're going to thread between the two loops
26:45Tighten it down
26:49We're just going to hide this knot down in the tissue here
26:52Now you can see as I move the joint, there's a nice tight man-made ligament here that's running smoothly on the two loops
26:59It's in a pretty good sight, and it rocks backwards and forwards pretty good, so I'm happy with that
27:06Noel reattaches the temporary frame to support the ankle as it heals
27:11Alright, let's go to x-ray
27:12Let's go to x-ray
27:20Four days later
27:22Albie's back on his feet
27:24And ready to continue recovering at home
27:27Now, here we go
27:29Hello, oh wow
27:31Hello, hello
27:33He's raring to go
27:35Calm down
27:36So you should be all set, providing we don't get infection at the moment there's no evidence of infection
27:41Alright mate, well done
27:43Now let's go
27:45He's looking good isn't he?
27:46He's raring to go
27:48Come on mate, there we go
27:50As you can see he's looking amazing, he's putting weight on it
27:54And I think he's even better now with that ligament done
27:57So yeah, amazing
27:59There are seven operating theatres at the practice, with almost a hundred surgeries performed each week
28:17Next in theatre is Parker, for his first total hip replacement
28:22These days it's a fairly routine operation, Noel performs more than a hundred and twenty each year
28:29Each one usually takes about fifty minutes
28:33Hopefully this will be straight forward, but you never can tell
28:37Alright, here we go, this muscle's very very flabby
28:40He's also carrying some fat there, cutting through about an inch of fat to get into his leg
28:46So this is the arthritic socket, and I'm just going to drill it out now
28:59I've just drilled into the bone and it's really soft and already you can see
29:04A wafer thin shell and the pelvic canal inside there
29:08This is a really bad situation now because I think we're in serious danger of fracturing this pelvis
29:13Parker is a young dog, so Noel was hoping to put a metal cup into the pelvis
29:20Around which new bone would grow
29:22Now he needs to change his plan
29:25I'm going to have to put a cemented cup in here
29:28I think this pelvis is so small and so soft that if I hammer it, it'll probably fracture
29:34Noel puts two screws into Parker's pelvis to help anchor the cement
29:39Try and inject the cement around the screws
29:43Okay, so the cups going in now
29:50Damn, it's not working
29:53Right, clean the cement off as quick as you can, I'm going to have to go again
29:57Some of the cement is leaking into the pelvic canal through a small hole in the pelvis
30:01Can I have a kid person in here, please? Quick as you can
30:06A meniscus probe, please
30:08The cement hardens in about four minutes
30:11As it sets, it releases heat, which could cause damage to the nerve structures below
30:16Give me a smaller tip on this, quick, please
30:19Noel must work fast
30:20All right, so this is a major crisis
30:24As the cup was being pushed into the cement
30:26The inner wall that was wafer thin cracked open
30:29And allowed a pile of cement to leak into the pelvic canal
30:32I'm now trying to retrieve that cement and I'm going to have to block the hole
30:36Unfortunately, the cement is more hard than the actual bone
30:41Ah!
30:45That's nasty
30:46If I encounter a complex situation like this, I need to have some kind of solution that I can reach for
30:54So I'm going to cut a piece of titanium mesh and fill that hole
30:59We will not get a third chance of this
31:02This is like bone china
31:04Noel folds the mesh to form a barrier over the hole
31:08So here's the mesh and these are the screws that I'm going to put the cement around and then the cup
31:16Don't move anybody, it's very, very, very fragile here
31:20Don't move, don't move
31:25So the socket's in place now
31:27Now he can cement the stem into the top of the femur
31:31Keep the ankle down
31:33Okay, so we've got the head on now
31:35I'm going to relocate it into the plastic cup
31:38Okay, we're in
31:42Feel stable
31:44So certainly a challenging hip replacement, not at all of what I expected
31:48No matter how many you do, you're always going to get one that's going to give you trouble every now and then
31:52You better be ready
32:03Good morning
32:04Hello sweetheart, did you just come in before your mummy?
32:06Out in the prep area, Flora the Scotty dog is back for her final epidural steroid injection
32:16Twist that way, that's it
32:20Thanks
32:22Okay, alright, wake up
32:24Alright, wake up
32:27James and Alexis are hoping that this particular detective case is now closed
32:32The thing I wanted to emphasise to you today is that this is a treatable but not curable condition
32:39And the majority of dogs with this degree of disease will be fine for X period of time
32:44And then X number of months or years later, you go, oh, things are not too good right now
32:50That is going to happen
32:52If this problem comes back within six months
32:56Then I would probably be saying in a seven-year-old dog, let's just fuse it
33:01Solid, surgically
33:03But I would only do that if I had to
33:06Hopefully the mystery can be solved
33:09Please God, you'll be okay
33:11Hopefully
33:13Okay guys, God bless
33:14Thank you
33:15Thank you for everything
33:17Thank you for believing in the power of deduction
33:19Thank you so much
33:21Go for it
33:23Oh, just one more thing
33:25I thought I got away with it
33:27See ya, bye
33:29That's the gift that keeps on giving
33:33Just one more thing for us to do
33:35Just one more thing
33:37Seriously
33:38I will never, ever, ever hear the end of this now
33:40My wife, she hates it
33:42She hates it
33:43I'll sedate you in a minute, I think
33:45In reception, Sharon is waiting to see Noel
34:00Albie is back
34:02After weeks at home recovering from surgery, he's had a major setback
34:07Unfortunately, Albie has a complication
34:11When he had the original road traffic accident, there was bugs inside his ankle, which we knew about
34:17We gave antibiotics for those bugs
34:19Unfortunately, I think the bacteria has come back
34:22So we've got a blister right here, which has just come up
34:26And I think it's likely that that blister there is infection
34:29And if it is infection, we're going to hope to get it under control
34:31But frankly, if the infection has seeded on the metal or the mesh, it may come back forever anyway
34:38So, this is last chance saloon
34:41I know that the family will not want to put him through an ankle fusion
34:44Given that the bugs can come back again on that
34:47Albie's taken through to theatre, so Noel can flush the wound
34:51This is not good, this is infected
34:57And I don't think this is going to work
34:59So, almost certainly this leg is coming off
35:02I'll just have to have a very frank conversation
35:06I'm so disappointed
35:07At the time, the thing we worried about was his spine, but actually that's all been absolutely fine
35:20Ironically, it's the leg injury that seemed less serious that causes all the problems
35:26Today, I need to sort of decide really whether we just wait and see whether the infection comes back
35:31And hope for a miracle
35:34Or whether we just get it over with and go for amputation
35:38So, trying to be positive, you know
35:41Sorry
35:46Now, Albie's mummy, please
35:51Now, here he is
35:53Hello mum
35:54Hello sweetie
35:56Hello mum
35:57How are you doing there mum?
35:59So, he's doing good
36:00Oh sweetheart
36:01As you would expect, the blister was full of gunge
36:05Yes
36:06I've sent it away to the lab
36:08I'm not hopeful
36:10No, I know, I know
36:12Look, you might get a miracle
36:14I think that's what I wanted to talk to you about really
36:16Because, you know, we are thinking of just, if it is almost inevitable
36:20Well, we haven't got a definitive culture back yet
36:23Right
36:24I definitely wouldn't make the decision today
36:25Oh no, I'm not, I'm not
36:26Yeah
36:27I'm just wanting to discuss it really
36:29Yeah, yeah, well
36:30Because, you know, if it is almost inevitable
36:32This is the dilemma, isn't it?
36:33But, it is the dilemma
36:34Okay
36:35There is a chance this could work
36:37Right, okay
36:38But I think there's a more chance that it won't work than it will work
36:41Okay
36:42My only downside of the leg coming off is he's had spinal surgery
36:46And he has one leg to stand on at the back end
36:48It would be better if we could leave him at four
36:50But he can lead a perfectly happy life on three
36:53Okay
36:54All right mate
36:55Well done buddy
36:56For now, Albie can go home to be with the family
36:59Thank you
37:00And the decision is entirely yours
37:01Whilst they wait for the test results
37:04He'll be treated with a new course of antibiotics
37:08If somebody tells me there's a small chance then I'll give it a go
37:11We'll just see now really
37:13Just hope and pray
37:14The only blessing is that he's happy
37:16We'll get through won't we Albs?
37:17We'll get through won't we
37:18Yeah
37:19Good boy
37:20It's been a week now since Parker had his first total hip replacement
37:36Noel has told the family about the complications he faced in surgery
37:41But now he's ready to go home
37:43It's been nice to get him back
37:44It's been weird without him
37:46It hasn't been a good week
37:50Mother-in-law passed away at the beginning of the week
37:53So now we've got her dog as well
37:56Parker's folks
37:58Hi guys
37:59Hello
38:00I'm so sorry for your trouble I heard
38:03Yeah
38:04I'm sorry about that
38:05Thank you
38:06I'm sorry
38:07Please take a seat
38:09He is getting better
38:10Yeah
38:11All the time
38:12But there's one complication I need to tell you about
38:13And that is the nerve that goes down the back here
38:16Okay
38:17Now the amount that we had to pull everything about
38:20To get the implants in
38:23Causes squishing of that nerve sometimes
38:26That nerve will be weak
38:27For a while
38:28Oh I've been so worried about it
38:29Yeah
38:30I know you have
38:31Yeah
38:32Well I'm going to reunite you now
38:33And I'm going to show you what to do
38:34Okay
38:35So if you push your chairs back a little bit
38:37Alright Mike
38:38Gotta get him on a diet
38:40No
38:42Hey baby
38:44Hey baby
38:45Hello mum
38:46Hey baby
38:47Oh look at his little leg
38:49Come baby
38:50Come
38:52With his temporary nerve palsy
38:54Parker is still not walking properly
38:55So the team have fitted a sling between his ankle and toes
38:59To help him
39:00Whilst the sciatic nerve recovers
39:02Oh
39:04You see he's working fine right
39:06So that should bring at least a little joy to you
39:08Yeah
39:09So he's alright
39:10Yeah
39:11It's alright
39:12As long as you're happy with him
39:13I'm fine with him
39:14So mate
39:15It's not all fluff
39:16It is a bit of fat
39:17It is
39:18We'll get that off you
39:19I knew he was overweight
39:20I just
39:21We'll get the clay off your collar as well
39:22Right I'm going to bid you farewell
39:23Look after yourself
39:24Okay thank you Noel
39:25I'm sorry you're having such a tough time in life
39:26But you'll be alright
39:27And we're here for you
39:28Thank you
39:29We're here for you
39:30Okay
39:31Thanks Noel
39:32It's the same as you know myself
39:33Hopefully
39:34He and Tommy will be able to run about
39:35Like a new dog again
39:37It should be good
39:39Parker's going home
39:40But he still faces another operation on his other hip
39:43It's been a month since Albie had his wound flushed to try and clear the infection from his ankle
39:58Good boy
39:59Good boy
40:00But despite everyone's best efforts nothing has worked
40:04Albie's in big trouble
40:06He's had the risk of infection in his ankle from the very beginning
40:11The ankle was rubbed along the road so a lot of bugs got in at the time
40:15We had hoped that we had conquered those bugs but unfortunately some of them lived on
40:20We can't just give him more antibiotics because the bugs have seeded on the implants
40:24If the implants come out we would have to fuse the ankle solid
40:28The family have decided that they feel the best option for Albie is to have his leg taken off completely
40:36Such a shame because he's using the leg great
40:38And I absolutely would love to save this leg but
40:41In these circumstances I can't
40:43Because it's just not the right thing to do for him and for the family
40:47So
40:48Come on mate
40:49We gotta go
40:51Despite long courses of targeted antibiotics
40:54Albie has been beaten by biology
40:57Amputation is now the safest option for him
41:01In the hydrotherapy centre, Parker has been having a course of underwater treadmill sessions
41:16I know you like a bit of cheese
41:18It's been two months since he had his second total hip replacement
41:22This one had no complications
41:29Come on mate
41:30Now he's been signed off
41:31And he and his brother Cooper are bringing a splash of colour to their daily walks
41:37Go, go, go, go, go
41:40Good boy
41:41We go to the pub
41:44We do two miles
41:45And he'll play
41:46And chase the ball
41:47Rolls in anything that smells nice to him
41:50Yay
41:51I have a trophy
41:52Come on
41:53Good boy
41:54I think he's none the wiser now
41:55What's happened?
41:56No
41:57He just thinks where I can run about now
41:58So he's our bionic boy
41:59He's fab
42:00Go get it
42:01He's over there
42:02Go get it
42:03See like before
42:04He couldn't do this
42:05He couldn't run around with the other dogs
42:07Could you?
42:08Hello
42:09Hey
42:10And Sarah's been watching his weight
42:13I'm so strict
42:15We don't give him any dog treats
42:17He'll eat a carrot
42:18And he has a rye-vita biscuit in the morning now
42:22I think he'd lost two kilos
42:24And it's better
42:25Because we can exercise him so much more now
42:27And that really helps
42:28Come on then Parky
42:30Good boy
42:31It's a huge difference I think
42:33I'm really pleased
42:34I'm really really pleased
42:38Back at the practice
42:43There's been some disappointing news for Flora the Scottish Terrier
42:49Poor Flora
42:51The detective mystery continued
42:54The effect of the steroids that we injected into her spine
42:57Only lasted less than a month in the end
43:00Generally we will try the low risk medical option
43:03Before we will go into surgery for this kind of problem
43:05But unfortunately in the end surgery proved necessary
43:09So six weeks ago we operated on the lower back
43:13And fused it together
43:16Today James and Alexis have brought her in for scans
43:19To check everything is stable
43:22We just hope that the pins and the cement have set
43:24And they've taken
43:25And that yeah now we can resume a normal life with her
43:28And then she can finish her recovery
43:30And soon we'll be running around like an idiot
43:32Without hobbling and being in pain
43:35And have our living room pen free as well
43:37Yes that's going to be a big plus
43:39Hello guys
43:40Hello you alright
43:41Hello hello hello hello
43:42Okay so this looks good
43:43The pins look good
43:44The cement looks good
43:45Nothing's shifted
43:46Nothing has shifted
43:47And there's no reason to suspect that this won't last a lifetime
43:49It should
43:50Yes
43:51Please God
43:52How wonderful for us to share this Columbo journey together
43:54I thought so
43:55Oh brilliant
43:56I am loving it
43:57This is great
43:58This is just going to fuel my obsession
43:59Demand the legend
44:00Thank you so much
44:01No seriously
44:02Thank you so much
44:03Ah there you are
44:04There you are
44:05Hello Flora
44:06And that sort gives woo
44:07Alright bubba
44:08Good
44:19So listen
44:20Just gradually build up the walks
44:22At 12 weeks you can run around the field
44:24I do not need to see you again
44:25Except to share t-shirts at some social function
44:28Okay listen guys
44:29It's been an absolute
44:30Seriously been an absolute pleasure
44:31Thank you so much
44:32God bless
44:33Flora have a great life
44:34Thanks mate
44:35Have a good one
44:36Take care
44:37Take care
44:38Everything's fused properly
44:40So that's great news
44:41We did try the steroid injections
44:42Because we wanted that to be the non-surgical answer
44:45But we were aware that there was a 50-50 chance it wouldn't be
44:48But you have to try it first
44:50It's a massive relief isn't it
44:51I was very nervous that he wouldn't like the t-shirt
44:53But he loved it so it was great
44:56This is it
44:57This is set for life
44:58I will never hear the end of this now
44:59Because it's always going to be super vet approved
45:01So yeah I've got no chance
45:04This is it
45:05Stuck with it now for the rest of our lives together
45:07Pretty much
45:08Great
45:14Down on the south coast near Dover
45:16An old railway track is a favourite walk for the Gorman family
45:20And for Albie
45:22Good boy
45:24Good boy
45:25It's been eight weeks since he had his leg amputated
45:28And seven months since his back was broken in a car accident
45:32Okay go
45:36He's just been absolutely amazing and I think if anything he was just so happy to get rid of that leg in a way that was obviously causing him the pain
45:44Because he's just been happier than ever really
45:47You just can't stop him
45:48He just wants to go from the moment he wakes up to the moment he goes to bed and he's a lot of fun now
45:55He can move fast and he can manoeuvre around incredibly and he could right from the start really
46:02He just amazed me
46:03When he's running you can't even tell that he's got three legs
46:07The kids are just so happy that they've got their dog back
46:11Obviously it would have been nicer if he ended up with four legs
46:15But it's a good second best
46:17I mean he's just enjoying life again and that's all that really matters
46:37You
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