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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.
00:34Noel imagines the impossible.
00:36Oh, my little baby killed the leg.
00:39Let's go.
00:41Sometimes you have to bend the rules of mechanics
00:43to fit the biology.
00:45And offers hope.
00:47We've definitely made the right decision.
00:49Good boy.
00:50We've got my boy back.
00:52For families and their friends.
00:55Look at you!
00:56Bionic doggos!
01:00You'll be walking again in no time.
01:03Properly.
01:04Not hopping about.
01:05No bunny hops.
01:06No bunny hops.
01:07Animals, like humans, often have problems with arthritic joints.
01:09Looking to get a new hip.
01:10Sure, one's broken.
01:11For some, one option for getting back their bounce
01:13is replacing the joint entirely.
01:15Oh, oh, oh, oh, oh, stop, stop, stop, stop, stop, stop.
01:30Noel has developed joint replacement treatments for over a decade.
01:34One of the things that's really important to me in my life
01:36is to give animals a fair deal.
01:38Joint replacements have been around since the early 1900s for humans.
01:43Come on, lovely boy.
01:45Little leg.
01:46Technology has moved on apace.
01:48And why should we not offer our dog and cat friends
01:52the same level of care as we get ourselves?
01:54It's always what is in the best interest of the patient.
01:57This morning, Rob and Mark have brought in seven-year-old chocolate Labrador, Inca.
02:06They've already discussed the implications of surgery
02:09and decided to go ahead with one of the most complex procedures Noel performs,
02:14total elbow replacement.
02:16When she was six months old, Inca unfortunately jumped out of the boot of a car
02:20and we thought that she'd just, like, sprained her muscle or an ankle or something.
02:24Unfortunately, that wasn't actually the case.
02:27That was the start of all of the issues that she's been having.
02:30Both elbow joints on both of her front legs are actually quite faulty.
02:34She's had a number of operations, but on one of the legs that hasn't worked.
02:37And that's why we want to go down this route of having the joint completely changed
02:41and the old one removed.
02:46Rob and Mark live in Hampshire.
02:49Good girl.
02:50Inca has been part of the family since she was a few months old.
02:53When Inca was a puppy, she was so playful, she was so energetic.
02:57She looked like a guinea pig, a brown guinea pig.
03:00Mark and I have always wanted to walk the Inca trail,
03:03so kind of like, you know, ah, Inca.
03:05We don't yet have children, so she is our child.
03:09She means the world to us.
03:10She's our fur baby.
03:11Yeah, she's our fur baby, yeah, definitely.
03:13Like most Labradors, Inca loves her food.
03:16But that's not her only obsession.
03:19She's also partial to a bit of petty theft.
03:22What are you doing, madam?
03:24She's mischievous.
03:26If you're wearing socks, she'll take the socks off your feet and then run away with them.
03:30Yeah.
03:31Usually under the dining room table or somewhere that you can't get to.
03:34But ever since she was two, Inca's sock-stealing antics and her lust for life have been marred by terrible pain.
03:45The original diagnosis was arthritis to start with.
03:49And then unfortunately, as it's a degenerative disease, things got worse and worse.
03:54She's really bad at the moment and can hardly walk.
03:57And I suppose you've always got in the back of your mind, well, you know, the what-if scenario.
04:01Despite being in pain herself, Inca has helped Rob through his own illness.
04:06A couple of years ago, I was actually diagnosed with a neurological condition that causes really severe pain.
04:11There are some days that I'm not physically able to move and she will stay with me all the time.
04:16She just knows that there's something wrong.
04:19It's helped me really think about what she was going through.
04:22It's been a learning curve for both of us, but certainly, you know, I think we've both learned from each other.
04:31Right this way Inca. Good girl.
04:36Yeah, poor girl. Poor girl. Poor girl.
04:39Noel has treated Inca's front legs before, but despite medicine and surgery, her osteoarthritis has worsened.
04:47And the implants haven't worked long term.
04:50Osteoarthritis is impossible to cure.
04:54And as with human patients, treatments to unload the painful areas of the joint can work for a period of time.
05:02We hope that a total elbow replacement will give her a good quality of life.
05:07Hello, mate. How are you?
05:09Soaring and pain.
05:10Noel has used commercially available elbow replacements, but with a high failure rate in the past, he's now developed a new custom-made implant system.
05:20We use plastic guides which are specifically made for her humerus and her radius and ulna.
05:27Oh, wow.
05:28Since I met with you last, we have now done three of these total elbow replacements.
05:35Three so far have been successful.
05:38She's patient number four.
05:39Okay.
05:40I'll do a quick sketch for you.
05:41So that's the humerus.
05:44That's the radius.
05:45What we're going to do is we're going to replace that whole surface with plastic.
05:50Two pegs.
05:52We go into the bone there.
05:54And this component here will be metal.
05:57And then there's a plate down the back here to support it.
06:02That is a state-of-the-art total elbow replacement.
06:06Thank you, Noel.
06:07It shouldn't go on the five legs.
06:10So what happens if we put that in and it fails subsequently, then the implant has to come out and you go back and do a fusion.
06:21Or you lose the limb, in which case, in her particular instance, you could lose her life.
06:26Yeah.
06:27Because the other leg is so bad.
06:29Already, I'm very worried about that carpal collapse on the left forearm, which I'm hoping will get better when the right elbow's done.
06:38I know it's very upsetting for people to have to face this.
06:41No, it's all right.
06:42So we could lose her life if we're in risk of losing her limb.
06:46Okay.
06:47I'm sorry.
06:48It's all right.
06:49But we do need to, you know, face that possibility.
06:52Despite the risks, Rob and Mark have decided to proceed with Inca surgery later today.
06:58Aw.
06:59Come here.
07:00Well done.
07:01Now, sweetie pie.
07:02All right, boys.
07:03Yeah.
07:04Look after yourselves.
07:05Thanks, Noel.
07:06See you later, Noel.
07:07Thanks, Noel.
07:09Good luck.
07:10See you both later.
07:11Bye, Inca.
07:12Bye-bye.
07:13Bye.
07:14Are you okay?
07:15I'll try.
07:18I'm okay.
07:19I'm a little bit upset, obviously.
07:21I know.
07:22She's in the best car.
07:23Yeah, she is.
07:24Yeah.
07:25Hello, love me.
07:26I'm a bag of nerves at the moment because she's obviously, you know, center of our life.
07:30You know, she's our baby and we've got to do this to make sure we've done everything
07:33we can to obviously help her have a normal, happy dog life.
07:37Of course, it's a huge operation for her to go through.
07:40And, you know, fingers crossed it works.
07:43Good girl, Inca.
07:44Do you like the thing?
07:49You're a very brave sausage.
07:51Very brave.
07:53With over 200 procedures performed every month at Fitzpatrick's, most surgeries are routine
07:59for the staff.
08:02When you've worked for Fitzpatrick referrals for so long, it's just like, oh, what is it
08:06today?
08:07Is it hips or elbows?
08:08We could just be a walking x-ray machine because we know what's going to be the problem.
08:13But for patients and their families, it can be a tense time.
08:17Do you think Tilly will walk in?
08:18No.
08:19Do you think she does know the word fat?
08:21That's not sad, just in case.
08:22A bit nervous.
08:23Noel's next patient is an anxious two-year-old Cavapoo called Nala, who's also in need of
08:35a new joint.
08:36She's travelled down from rugby with Ina and Paul after being referred by her local vet.
08:42We've come for Nala to have a total hip replacement.
08:46That's the plan, hopefully.
08:49Back in October, she started limping.
08:52We took her to our own vets and we found it was hip dysplasia.
08:57She struggles such a lot.
08:59We wanted to have a good life and be able to play.
09:03You can't keep living like that, can you?
09:05No.
09:06Good girl.
09:08She's daddy's girl.
09:09She's obsessed with me.
09:10She's absolutely obsessed with him.
09:12Nala's not the only one who's obsessed.
09:19Paul has had her face tattooed on his arm.
09:22She's sort of like my baby, so I thought I'd have a tattoo of her.
09:25Yeah, like a special bond.
09:27Nala, as a puppy, she was just a little fluffball.
09:32She just wanted to play constantly and made us happy.
09:37We had to find a name that Paul would be happy to call in the park and not sound silly.
09:44It's from The Lion King.
09:45I mean, I love The Lion King.
09:47She gets lots of walks, lots of cuddles, lots of treats.
09:53She goes on caravan holidays.
09:56She can be moody.
09:58If you do something she doesn't like, she'll go in a massive mood, won't she?
10:02She won't eat.
10:03She won't look at you.
10:04She's a little diva, a little princess.
10:07Oh, and she's very anxious as well.
10:13We first noticed a problem, she was ten months old.
10:16She had a slight limp on her right leg, but it got worse.
10:22She can't walk very far at all.
10:24She's really stiff when she gets up.
10:27She squeals with pain.
10:30It's got to the point where we've bought a little dog pram and we put her in that.
10:35She does quite like it because she's high up, she can see everything.
10:39I never thought I'd get one of them, but needs must.
10:43I'm hoping Noel can perform his miracles and make her better.
10:48That's what we're hoping for.
10:49We wanted to have our life back.
10:54Are you nervous?
10:56She's absolutely terrified.
10:57Are you nervous?
10:58Yeah.
10:59I'm going to check the right hip first because this is the worst one, isn't it?
11:01Yeah.
11:02Good girl.
11:03Okay.
11:04Good girl.
11:05Hold tight, Daddy.
11:07Good girl.
11:08Good girl.
11:09I'm sorry she might cry.
11:10Okay.
11:11I'm going to check the left hip now.
11:12Stay where you are.
11:13Okay.
11:14Okay.
11:15Okay.
11:16You might or might not get away with the left hip.
11:18I'm going to double check it when she's knocked out.
11:20Okay.
11:21Okay.
11:22Clearly the right hip is very painful at the moment.
11:23Yeah.
11:24Yeah.
11:25Right.
11:26So let me have a little discussion with you.
11:27Okay.
11:28Right.
11:29Hip dysplasia.
11:30This is a hip.
11:31The hip is comprised of the head of the femur and the socket of the ileum.
11:36Socket is called the acetabulum.
11:38So in layman's terms, a head and a socket.
11:41Yeah.
11:42The head is held inside the socket by three things.
11:45A ligament, a joint capsule, and muscles that go from here to here, which are the gluteal muscles, which are your glutes.
11:53Okay?
11:54Mm-hmm.
11:55In hip dysplasia, those three things don't hold the hip in enough.
12:00As a result, you've got a loose hip, which rubs.
12:04Right.
12:05And that causes inflammation.
12:08The pain is as a result of that inflammation and rubbing.
12:12Hip replacement remains the gold standard.
12:14Mm-hmm.
12:15And the objective of a hip replacement is to achieve a new socket and a new head, which perfectly articulates with no pain.
12:22So from that perspective, it's a wonderful op, but it can go wrong.
12:27Mm-hmm.
12:28There's three primary risks.
12:29Mm-hmm.
12:30One is that something could go wrong during the surgery.
12:32Right.
12:33The second thing that can go wrong is sciatic neuropraxia.
12:36When you put the head back in, you stretch the sciatic nerve sometimes.
12:39Mm-hmm.
12:40And that can get palsy, so the leg can be weak.
12:43Weak.
12:44The third thing that can happen is dislocation.
12:46Yeah.
12:47Now, we have...
12:48Noel has discussed other treatment options, but Ina and Paul are determined to go ahead with hip replacement.
12:53All right.
12:54So I will be putting a cemented hip in your friend today.
12:58Yeah.
12:59She's daddy's parrot, isn't she?
13:00Yeah.
13:01Bye-bye.
13:02Bye-bye.
13:03Bye-bye.
13:04Bye-bye.
13:05Bye-bye.
13:06Bye-bye.
13:07Thank you very much.
13:08Right.
13:09Don't worry.
13:10God bless, guys.
13:11Thank you very much.
13:12Thank you very much.
13:13Cheers.
13:14Bye-bye.
13:15Bye-bye.
13:16Bye-bye.
13:17Nervous Nala needs to be sedated for x-ray pictures before her surgery.
13:22Big and brave.
13:23Good girl.
13:24It's okay.
13:25Good girl.
13:26Stay.
13:27Stay, stay, stay.
13:28It's what we wanted, really.
13:30So...
13:31So we're happy with that.
13:32We're happy with that.
13:33I don't think Nala is.
13:35I'm sorry.
13:36You're just not the most compliant of little persons, are you?
13:40Ha-ha-ha.
13:47I love her name as well.
13:49Yeah.
13:50Inca.
13:51At Fitzpatrick referrals, the team are getting ready for one of the most complex operations
13:55Noel performs.
13:58Loyal Labrador Inca is having a total elbow replacement implant fitted to try to alleviate
14:03the chronic pain in her joint.
14:06We're going to try and put a total elbow replacement in Inca's joint now.
14:11We can't take her leg off because her other elbow is really bad as well.
14:15We can only do our best and if she's not improving in the next two or three weeks then
14:20her family is very much aware that we'll either fuse this elbow solid or sadly she'll
14:25end up being put to sleep.
14:27Medicine has failed so far and her surgical procedures that she has had are not working
14:32anymore.
14:33Right, here we go, incision.
14:36Noel and his engineering team invented the implants he's about to put in and an independent
14:42ethics review have green-lit their use for surgery.
14:46Fitting the implants accurately relies on the use of a series of cutting guides made to fit
14:51Inca's anatomy.
14:54The elbow is dislocated and with a guide Noel drills a pin through the humerus.
14:59Using another guide he places three pins in the ulna.
15:03The elbow is dislocated again so the ulna and radius joint surfaces can be removed.
15:10With more guides he drills peg holes and reshapes the joint surface of the humerus.
15:16The components are then secured with a plate, pegs and screws.
15:22Finally, the joint is re-articulated.
15:29Put your finger there.
15:31But before the new implants can be fitted, Noel needs to carefully remove the old implants
15:35from Inca's last surgery.
15:37We can see here where the joint has collapsed down unfortunately and the plastic in here is
15:41worn away.
15:42So this commercially available implant has not worked in the longer term.
15:46This metal has rubbed away the plastic.
15:49With the old implants taken out, Inca's custom made guides can be put to work.
15:59Noel first uses a carefully positioned guide to cut off Inca's radial head, ulna and finally
16:07humerus joint surfaces.
16:10From the outside it's hard for people to appreciate but replacing an elbow joint is far more difficult
16:17than replacing a hip joint for example because the hip is a simple ball and socket but the elbow
16:22is a very complex joint involving three bones that flex, extend and rotate.
16:28A whole different ball game.
16:32With the painstaking preparation done, Noel is now ready to fit the implants.
16:38This is the radius in the ulna component.
16:44The two pegs goes into two holes that we have already prepared.
16:49There's a mesh on the backing here which is coated with hydroxyapatite for bone on growth.
16:55We put that into the two pegs and we just fit it in like so.
16:59We screw it in place.
17:08Then we pop the humeral component on.
17:13We pre-articulate and we got a new elbow.
17:18Finally, Noel attaches the plate to protect the narrow part of the ulna from fracturing
17:24and to fuse the ulna to the radius, effectively making one bone out of two.
17:30Looks pretty good.
17:33Stitch up.
17:35Okay my friend.
17:37Hopefully she'll be running around on the Inca trail before long.
17:44Well done Inca, good girl.
17:47Alright sweetie pie.
17:49Okay, let's go to x-ray please, thank you.
18:01He's a big one.
18:03The variation is wild.
18:06It's one extreme to the other here.
18:08Oh bless his heart.
18:10Animals of all different shapes and sizes come to Fitzpatrick's
18:13for transformative treatments.
18:16One minute we may have a cat that weighs two kilos
18:18and then we can have a dog that weighs 80 kilos come in immediately afterwards.
18:23Great Danes are one of the largest dog breeds.
18:26At six foot on his hind legs, two year old Charles is an impressive visitor.
18:31We're not going in yet Charles.
18:34This morning Steve and Vicky have driven over 200 miles from Manchester
18:38to discuss surgery with Noel.
18:40I've decided on the name Charles because they're quite statuesque.
18:44Very regal and I just thought, yeah it needs to be a posh name.
18:47So we decided on Charles.
18:49We noticed there was a problem about January.
18:52He was sniffing while he was walking along and he'd just fall flat on his face.
18:57And I noticed he wasn't picking his paws up properly.
19:00He'd sort of step on them like that instead of like that.
19:02So it's getting quite bad now, isn't it?
19:08Like all Great Danes, Charles takes up a lot of space.
19:12He's also a bit of a character.
19:15He is loud. He's got a loud personality.
19:18I think I like that about him.
19:21Playful though.
19:23He is playful and he's very demanding.
19:26He'll grab you when he wants to play.
19:29One of Charles' funny habits is he likes to drink from the tap.
19:34It did become a bit of an issue because an hour later I'd realised the tap's been running.
19:40I think we're on a martin-eater.
19:42The water is just going.
19:47Charles first started falling over six months ago.
19:50Their local vet diagnosed a disease of the spine called Wobblers Syndrome.
19:56We had him scanned and everything and they didn't really think there was much that they could do.
19:59No.
20:00It was just medication.
20:01And then if it got worse then it was going to be euthanasia, wasn't it?
20:05Yeah.
20:06They couldn't have done anything for it.
20:07Steve and Vicky are now pinning their hopes on spinal surgery at Fitzpatrick's.
20:13But Steve knows how serious major surgery can be.
20:16I had a very bad bike accident a good ten years ago.
20:20I went through about 33 hours of surgery on my right shoulder and my right pelvis.
20:24So I know what it's like to have titanium plates, pins, screws, you name it, in your body.
20:31Hello Charles.
20:32Hello mate.
20:33Charles was seen by a colleague of Noel's four months ago.
20:36But this is the first time that Noel has examined him.
20:39OK guys, right.
20:45Yeah, that's slow isn't it?
20:47And he's not, he's tentative about putting it back.
20:50That's called conscious proprioception, which is the medical term for perception of position.
20:54So his perception of position of where his foot is, is disrupted.
20:59Now, I apologize if this hurts him.
21:01I'm just going to check each vertebra in turn.
21:03OK?
21:04Head up, Charles, head up.
21:05Good boy.
21:09Good boy.
21:12OK, all right.
21:13We're going to go inside.
21:15OK.
21:16It's obvious he has the problem, the medical term being osseous associated, cervical spondylomyelopathy.
21:25So in layman's terms, bone associated wobblers because they wobble.
21:29The vertebrae are malformed.
21:32Right.
21:33And the facets, which are the top of the vertebrae, squished down on the spinal cord.
21:39On the spinal cord, yeah.
21:40So the spinal cord is like a passenger in a train.
21:43So it goes through.
21:44So it goes right through all these carriages of the train.
21:47And the walls and roof of the train are squishing down on the passenger.
21:53And if we look at that on the CT scan, which was taken in March, we'll see exactly that.
22:00That the bone is squishing down on the spinal cord.
22:04Wobblers usually causes pressure on just two or three spinal cord sites.
22:09But in Charles' case, the disease is affecting six sites in his neck.
22:13There's only three treatments available for this.
22:17One is medicine.
22:18The second treatment is called decompressive surgery, whereby you cut bone away.
22:24The problem is that the spinal column becomes unstable.
22:28We have had dogs that never get up again.
22:31So what we have changed to is fusion at continual sites.
22:37Charles' surgery would involve fusing his entire neck, which carries major risks.
22:42A series of implant components have been made for each site that is affected.
22:47So these saddles have been made for this dog.
22:52So they're all different sizes so that they can fit at different sites.
22:59Vicky and Steve are aware of the risks and the ethical implications of surgery.
23:05But having examined Charles today, Noel is cautious.
23:10But look, I'm worried about doing it now. I am.
23:13I'm not convinced that we should intervene at this point.
23:17He's not as bad as I thought he would be.
23:20Yeah.
23:21So I'm now worried about doing this because I normally only do this on dogs that can barely walk.
23:30Right.
23:31This is such massive surgery, it would need to be a life or death procedure, but actually it isn't.
23:37Yeah.
23:38Although he's got worse in the last few weeks, we don't know if he's going to consistently get worse.
23:45This situation may stay static for three, four, five years.
23:49Right.
23:50He's not in dramatic pain today and he's happy enough and he's walking enough.
23:58Yeah.
23:59If it gets worse and if he's falling on his chin all the time.
24:04Yeah.
24:05And he can't have a quality of life, then that's a different thing.
24:09And I know you've psychologically prepared yourself for surgery and I also know that we have planned for three months to do this surgery.
24:18And we've made all the bids, but I'm not sure it's morally right.
24:22It's fair.
24:23Sorry, guys.
24:24For now, Charles's implants will be set aside, in case he needs them in the future.
24:32Well, I was quite shocked.
24:34The way he's been falling and been closed, we thought he was really bad.
24:37I'm disappointed he's not going to be fully fit, but I'm glad I've not got to put him through it yet.
24:43We've just got to wait now, haven't we, until we see if it gets any worse.
24:48And if it does, then he'll be ready with the parts.
24:51The prep room is one of the busiest areas at the practice, and it can be unsettling for some patients.
25:06When the patients come through to prep, there is always a lot going on.
25:10What's wrong with you?
25:13Oh, no!
25:14There's a lot of strange noises. There's a lot of strange smells.
25:17It can be a bit of a nerve-wracking environment.
25:20Sometimes when patients here don't really relax, then we do tend to sort of give them little things that they get at home.
25:26Like, you'll often find, you know, dogs being covered up with little blankies.
25:31We give them some extra toys to play with.
25:33We'll give them a really good groom.
25:35You just treat them like your own dog, really.
25:38Do we have any, like, little socks or something over here?
25:41I just think she's going to get quite cold.
25:43Nervous Cavapu Nala is being fussed over after being sedated for her hip surgery.
25:49Oh, look!
25:54Look, little tiger.
25:55Oh, I love it!
25:57And then we have me.
25:59Oh!
26:01Great selection!
26:04So I'm going to put a new hip in Nala now.
26:07She's Simba's queen, so we need to allow her to run around again happily.
26:14Concision.
26:15Thanks.
26:16Noel's first task is to remove the upper part of Nala's thigh bone, the femoral head and neck.
26:26You see the arthritic femoral head here where it's been rubbing on the top of the socket, cartilage is worn away.
26:33Right, relax everybody, move out.
26:36He then drills out Nala's arthritic hip socket.
26:42OK, so that was a little more challenging than we had hoped because the bone is very, very dense and sclerotic, meaning it's hardened by rubbing and by disease.
26:59Noel then creates a new socket using a tiny cup-shaped implant made of a special plastic.
27:05It will be held in place with surgical cement.
27:08This is the cup.
27:09It's got a corrugated outer centre into which the cement can go.
27:16I don't like this cement.
27:18It's not sticking to this thorotic bone.
27:20Nala's bone is so dense it doesn't have enough marrow for grip, so there's a risk the cup may loosen from the eggshell-like bone.
27:28Get me the 2mm screws, please.
27:31To try and secure the cup, Noel places small screws like pylons for the cement to grip onto.
27:37We've put these 3 screws here, here and here to hold the cement more solid.
27:46It gives it some grip, like a grappling hook for the cement to attach onto.
27:54And now this cup should be solid, so it should be able to press on it, it doesn't move anywhere.
28:00Finally, Noel has to fit a stem into Nala's femur.
28:08Nala's femur is a difficult size.
28:11It's too big for a size 2 stem and it's too small for a size 3 stem.
28:20He decides to use a size 3.
28:23I've had to be very, very careful filing it out.
28:26Very careful, because it's easy to fracture a femur when you're drilling it, if the bone is dense.
28:37Looks like that fits.
28:41Can we just pop a little head on there?
28:43Can we just pop the new head into the new socket?
28:54Hopefully we're okay, but that size 3 just barely fits in there.
28:59Hello?
29:12Hi, Ena Noel here.
29:13Hi, Noel.
29:14So I've done the operation.
29:16It went fine in the end, but it was a lot more challenging than I thought it would be,
29:21because the bone was very, very dense as a result of rubbing for quite a long time.
29:26Nala actually has had the size of implants I would put in a medium-sized cat.
29:33Oh, really?
29:34Yeah.
29:35Is she okay?
29:36She's fine.
29:37She's awake now.
29:39Okay?
29:40Yeah, lovely.
29:41Thank you for calling me.
29:42No problems.
29:43Have a good evening.
29:45Bye-bye.
29:56It's been six days since Chocolate Labrador Inca had her total elbow replacement surgery.
30:07Well done, sweetheart.
30:09Good girl.
30:10And Noel is encouraging her to take small steps on her long road to recovery.
30:15She's making valiant attempts to move the leg.
30:18It'll take quite a long time before the muscles rehabilitate to the point that they're moving
30:24the elbow well.
30:25But so far, so good.
30:28Every implant is dependent on biology for healing, and hopefully we'll get rid of her pain completely.
30:37Two days later, an Inca is ready to go home.
30:41Do you want to get everything ready for her?
30:44Did you bring some water for her?
30:47Oh, okay.
30:48Very excited, yeah.
30:50Yeah, I mean, it's kind of like, I was like, come on, come on, we're going to be late.
30:52No, we need to leave.
30:53And he's like, no, we'll be on time.
30:55Been a pretty apprehensive few hours this morning getting ready, that's for sure.
31:01So Inca is hopefully getting better and better.
31:04It's going to take a while.
31:06Okay.
31:07So these are the x-ray pictures of what we're dealing with now.
31:11Okay.
31:12The implant should bond solidly to the bone.
31:15The structures around the joint will take a long time to recover.
31:18It's amazing, isn't it?
31:19Yes.
31:20Inca's going to find it difficult for the next couple of weeks.
31:23And it's best I reunite you on some solid ground, because it's a little slippy.
31:33Hello, Inca.
31:35Hello.
31:36Oh, hello you.
31:39Hello.
31:40Are you Inca?
31:41So lead in one hand, harness in the other.
31:44That's it.
31:45Exactly that.
31:46Keep going.
31:48Rob and Mark will have to walk her on a harness for the next few weeks.
31:53Okay, very good.
31:54You've got the hang of it.
31:55That's right.
31:56Just exactly that.
31:57Exactly that way.
31:58But I think she's doing really rather well.
32:00The alignment looks really good.
32:01And I'm happy with how she's feeling.
32:03Yeah.
32:04Yeah, definitely.
32:05She looks happy.
32:06She looks happy.
32:07Right, guys.
32:08Well done.
32:09Look after yourself.
32:10Good girl.
32:11I'm so pleased with how it's gone.
32:12Yeah.
32:13Amazing.
32:14Really, really impressed.
32:15You kind of get to that point, you think, oh goodness, you know, have I done the best thing
32:18for them?
32:19But I look at her and see her today, and you know, I don't even have to answer that question
32:22anymore, because she's just, she's a change dog already, you know, and it's only sort of,
32:26you know, six days since the operation.
32:28It's been three months since Great Dane Charles came to see Noel.
32:41Charles's family have just sent me an email.
32:45Vicky and Steve have sent in videos showing a dramatic deterioration in Charles's condition.
32:51He's got much worse.
33:00That's not good.
33:05When I saw Charles originally, his neurological condition was manageable and his quality of
33:12life was reasonably good without surgery.
33:15Unfortunately, Charles is deteriorating.
33:18He's clearly going off all four of his legs all of the time, falling on his face.
33:25That's not a good quality of life.
33:28Vicky and Steve have brought Charles back to discuss if now is the time to perform surgery.
33:35Come here, sweetheart.
33:36Come here.
33:37It's not nice to see.
33:38I can't take him out, because I can't see it.
33:40I can't wait to see it.
33:41You know, he just falls.
33:42You walk with him, and if you look round, he's on the floor.
33:45Hi, guys.
33:46Hiya.
33:47So I've seen these horrendous videos.
33:50Oh.
33:51Scary.
33:52Very scary.
33:53Clearly, neurologically, he's a disaster zone right now.
33:56Yeah.
33:57Yeah.
33:58The reason that we have been so reticent to do this is he could die.
34:01Yeah.
34:02That's the bottom line.
34:04Something could go wrong, such as bleeding or a sudden nerve discharge or something we
34:08don't know about.
34:09He said, it's a big deal.
34:10Oh, yeah, yeah.
34:11This is not small surgery.
34:12Oh, yeah, yeah.
34:13No, no, no.
34:14And you could lose him, is basically, I have to tell you that.
34:18Yeah.
34:19If there was any way to avoid this surgery, we'd love to avoid it, because we wouldn't
34:22want to put him through it.
34:23But I think you are in a situation where you're between a rock and a hard place now.
34:27Give him a big cuddle.
34:30Noel has successfully fused multiple sites before, so despite the risks, Vicky and Steve have
34:36decided to go ahead with surgery.
34:38Sorry, mate.
34:39I know it's a tough one.
34:40Yeah.
34:41All right.
34:42Take a seat in reception.
34:43Sorry, buddy.
34:44Take a moment.
34:45Take a moment.
34:46Take a moment.
34:47All right.
34:48Okay.
34:49Come on, big guy.
34:50Come on, big guy.
34:51Here we go.
35:08He'll be all right.
35:09He's going to be fine.
35:11Panicking, really, for him, because I know what it's like to go under a knife, and it's
35:14not nice.
35:15You know, you've always got the chance you might not wake up, you know, so he could not
35:18wake up from this.
35:20It's got to be done.
35:21No other way.
35:22Otherwise, it's putting him to sleep, and I don't want to do that.
35:26He's only two.
35:27I don't want to put him to sleep at two years of age.
35:30At least we're trying now.
35:31At least we're trying, you know.
35:33That's all we can do, isn't it?
35:38Noel will operate on Charles straight away.
35:45Over the next six hours, he'll attempt to relieve the pressure on his spinal cord by pushing
35:50his vertebrae apart and fusing his entire neck.
35:55The surgery carries significant risks, but the technique has been independently reviewed
36:01and given the go-ahead.
36:03Right, here we go.
36:04Incision.
36:05The first disc we're going to drill here is between thoracic vertebra number one and
36:14cervical vertebra number seven.
36:16At every single disc, it's the same procedure.
36:18Step one, cut the disc out.
36:20Having removed the disc, Noel creates pathways for the spacer devices, which will push Charles's
36:37vertebrae apart, making more room for his spinal cord.
36:41As we can see now, we've got two spacers between C6 and C7 and two spacers between C7 and C1.
36:48Then we simply screw the saddle down onto the two spacers at every side.
36:54Noel then harvests bone marrow from the front of Charles's breastbone and from the top of his humerus bones, and packs it in around the vertebrae to help fuse his neck solid.
37:06He then repeats the procedure on all six discs and seven vertebrae in his neck.
37:13Wipe my head, please, Lottie.
37:15Thanks, Lottie.
37:16Thanks.
37:17Putting the spacers in the sixth and final disc space now.
37:28So we have all the spacers in and all the plates on now.
37:40We're going to link them together with rods.
37:42So we just put little inlay trays into each of the plates, and then we pop the rods in and clamp them down.
37:57So now we stitch up.
38:03All right, let's go to x-ray, please.
38:05Thank you, everybody.
38:06Well done.
38:10It's always a scary moment when the CT scans come through because you're worried that all the implants are in the right spot and all the screws are the right length.
38:31And given that there's 28 screws and 12 spacers, there's a lot of potential for going wrong.
38:42Big, big, big deal for Charles to go through that.
38:46Hopefully his wobbling will gradually get better.
38:49I don't think he'll ever be normal because his cords are really damaged, but hopefully he'll get somewhat better over time.
38:56Well done, buddy.
39:10Good boy, Charles.
39:12You're such a good boy, Charles.
39:14Man, well done, buddy.
39:16Well done.
39:17At Fitzpatrick Referrals, Great Dane Charles is taking some tentative evening exercise.
39:24So we're on day six after surgery now.
39:27Charles got up after day three, and he's getting stronger each day, aren't you, mate?
39:33He's a good boy.
39:34So his entire neck is fused from here right down to here.
39:40Nevertheless, he is able to walk pretty good, aren't you, Charles?
39:44The magnitude of this surgical procedure is just an awful lot for him to go through.
39:49And I'm just thrilled for him that he's this strong on day six.
39:53Come on, big guy.
39:54Hello, guys.
40:02Hello.
40:03How are you today?
40:04We got here, finally.
40:06The next morning, Steve and Vicky arrive from Manchester to take Charles home.
40:12OK.
40:13You see that?
40:14Yeah.
40:15That's a pretty big deal, isn't it?
40:16Yeah.
40:17Wow.
40:18This is a massive construct, and the bone marrow should fuse that, which we will check again
40:25in six weeks.
40:26We have to make sure he doesn't do a bambi.
40:29Yeah.
40:30Do the splits and go down on his chin, because if he jars that, he'll break it.
40:33I know.
40:34Yeah.
40:35Until the bone is solid, if he bashes it, he breaks it.
40:39Yeah.
40:44Oh, look at his tail going.
40:45No.
40:46Look at that tail.
40:47No.
40:48Look at that tail.
40:49No.
40:50No.
40:51That's nice, isn't it?
40:53I'm just worried till he's fully healed, till he gets that final, yeah, he can go off the
40:57lead.
40:58I'm just going to be panicking that he doesn't, I don't know, knock it or fall or something
41:02like that.
41:03Yeah, yeah.
41:04But I just have to be careful.
41:12Would you like some chicken?
41:13What's that?
41:14No?
41:15Don't tell me you've gone off your chicken as well.
41:16You don't know if you want any other food.
41:17Are you a picky doggo?
41:18In kennels, sensitive Cavapu Nala has been recovering from her hip surgery.
41:28But today, she can go home.
41:30The house feels so empty without her, really empty.
41:34Yeah, when you go out and come in, she's not there to greet you, it's weird.
41:37Okay, so Nala is fine, but it's going to take a while with the rehab.
41:42Okay.
41:43In we go, in we go, in we go.
41:44The leg is very sticky-outy at the moment, as you can see.
41:48Over time, what we're going to do gradually is we're going to try and get some flexion into
41:53the knee, but we're not going to work on a flexion of the hip yet because I need those
41:59stitches to heal for another two weeks.
42:02She is using it, but she's swinging it around.
42:05Nala will come back to the practice for physio every week for the next month.
42:11But in the meantime, she can enjoy her creature comforts.
42:15I think once she's home, like anybody, you feel better at home, don't you?
42:20And you recover better at home.
42:23And I brought one of her favourite foods as well.
42:26Pigs in blankets.
42:29Good girl, Inca, good girl.
42:39It's been six weeks since Inca's elbow replacement surgery, and she's been having weekly hydrotherapy
42:45sessions to help build up her muscles.
42:48You're such a good girl.
42:49She's loving it, isn't she?
42:50She does love it.
42:51Good girl.
42:52And how many laps does she do?
42:53She did six last night, so she's been able to do eight today.
42:57Great.
42:58And what with the range of motion of the elbow?
43:00It's slightly limited.
43:02Well, it's never going to be normal inflection, ever.
43:05When she's moving it under the water, put some resistance against it, so she has to pull
43:09on her triceps.
43:10You're a good girl, Inca, aren't you?
43:12Well done.
43:14A CT scan and x-ray pictures will reveal whether bone is beginning to integrate around Inca's
43:21implants.
43:22So what I'm looking for on the scan today and on the x-ray picture today is I'm looking for
43:28what's happening between the bone and the metal.
43:31Okay.
43:32Specifically, that is called the bone implant interface.
43:35That bone is physically growing onto the mesh.
43:38To see that growing in around the mesh and everything looking solid and the bone graft that I put up
43:45here looking really nice is just a joy for me to see, particularly as she's doing so well.
43:53Yeah.
43:54The positioning and integrity of the implants is really good.
43:58Reluctant to jump up and down with joy yet, but very happy that things are going well.
44:02Brilliant.
44:03Yep.
44:04She's right here.
44:05Ah, brilliant.
44:06Okay, we're ready.
44:07Right, sweetie play.
44:08Hello, Inca.
44:09Hello.
44:11Hello.
44:12Hello.
44:13So I'm thrilled at the moment, lads.
44:14Great.
44:15It's a triumph for her at the moment.
44:16Look at waggy tail.
44:17Yeah.
44:18I like it.
44:19Well done, boys.
44:20It's like a walk.
44:21Come on, men.
44:22Eight weeks later, an Inca is adjusting to life with a new elbow joint.
44:27Inca's a lot happier in herself and she absolutely loves going back on walks again.
44:32She's as happy as she was when she was a puppy and she didn't have any problems.
44:36Noel said that Inca will always have a limp.
44:38As long as she's not in pain, that's obviously the main thing.
44:42We don't know how long that joint will last, but any time that we've got with Inca is more
44:47time than we thought we were going to have, you know, this time last year.
44:50It's just a case of seeing how it goes.
44:53Hello.
44:54She's smiling again.
45:02In rugby, Nala's new hip joint has also given her a new lease of life.
45:07It's been 12 weeks since her surgery.
45:12Everything's changed.
45:13She looked like an old lady.
45:14And now she's a puppy again.
45:16Yeah.
45:17And it's great.
45:18Yeah.
45:19Come on then, bring it back.
45:20So far, the left hip is okay.
45:22If we had to, we'd do it again.
45:24Best thing.
45:25Yeah, it's the best thing we've done for her.
45:27Yeah.
45:28She's got her life back.
45:29The one thing that hasn't changed are Nala's feelings for Paul.
45:33She's definitely his dog.
45:35She does love me.
45:36She sits with me, but she prefers to be with him.
45:40I don't think she'd miss me if I wasn't there.
45:4212 weeks after major spinal surgery, and Charles has also come on leaps and bounds.
45:54Charles is doing really well.
45:55He's running.
45:56He can bend down and sniff at things without falling over now.
45:59He's doing great.
46:00The balance is so much better.
46:02That's crazy, isn't it?
46:03He's back to drinking out the tap.
46:05Yeah, on the sink.
46:07He turns the tap on now.
46:09Has he stopped doing that for a while, didn't he?
46:11Because I think, I don't know, maybe it was the stretch.
46:13With his neck, yeah.
46:14So I've got to make sure I shut the doors to the bathroom now.
46:17I need to teach him how to turn it off now.
46:18Yeah, that's the next plan.
46:21I'm hoping over time that he'll just get more used to the stiffness.
46:24Just have his normal length of life, really.
46:27That's all we wanted, wasn't it?
46:28Yeah.
46:29Runs like a horse, doesn't it?
46:31Look at him go there.
46:41Yeah, that's fine.
46:42He forgot to touch him.
46:44He's coming!
46:46Oh richtig!
46:47See you!
46:48Hi family!
46:49Yeah!
46:50Right.
46:51Isn't mine?
46:53Oh, you show in life.
46:58What this is, mine?
47:00I will avoid having one but not one before.
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