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00:00Hello, mate. You understand Irish?
00:02Animals from all over the world
00:04Ah, bonjour!
00:06Come to see one extraordinary man
00:08who's known as the Bionic Vet.
00:10High five!
00:12Yes!
00:14Professor Noel Fitzpatrick
00:16I'm gonna get one shot at this. Here we go.
00:18Noel and his team offer
00:20some of the most advanced treatments available
00:22anywhere. The perfect marriage
00:24in mechanics and biology.
00:26This is what we have now. A brand new me.
00:28Oh, wow!
00:30For some, it's a
00:32last chance. It is a life or
00:34death situation because we cannot leave him
00:36like he is. I just want you to do
00:38anything you can for him, really.
00:40Sorry. As Noel
00:42continues to devise new ways
00:44of healing. You're going to be Bionic.
00:46Thank you so much. All good. All good.
00:48He transforms the lives of his patients.
00:50Oh, that is just unbelievable.
00:52He's raring to go.
00:54Against all the odds. Boom!
00:56One small step for a dog, one giant leap for mankind.
00:58Well done.
01:04Hello, Ms. Patrick.
01:06Averro's orthopaedic and neurology.
01:08This week, I'm not going to help.
01:10There's a buzz of excitement in the air
01:14at Fitzpatrick Referrals this morning
01:16as a very unusual patient arrives.
01:18Oh, my God.
01:20Oh, my God.
01:24Oh, my God.
01:26Hello.
01:28Five-year-old Hermes is a
01:30one-legged Herman tortoise.
01:32I want to take him home.
01:34He's got a very good personality.
01:36When I first introduced him to the other tortoises,
01:38he chased them. He chases the cat.
01:40You talk to him when you come in.
01:42If he's asleep, he'll wake up and put his head up.
01:44Full of guts, I think you could say.
01:46Very gutsy tortoise.
01:47Hermes got his two front legs amputated to the elbow
01:51and, at the moment, one back leg amputated to the toes.
01:55So he's just come here to see if they can work out a way
01:58we can get him walking because, at the moment, he can't walk.
02:01Self-confessed tortoise lover, Helen,
02:04adopted Hermes from another family two years ago.
02:07I've got two tortoises.
02:09This is Thomasina.
02:11This is what a tortoise should look like with their four legs.
02:15She's 11 now.
02:17So this is Hermes.
02:19There's a good boy.
02:21How's that good?
02:23Hermes, he's only little.
02:25He's a baby, so he needs looking after.
02:28Following a vicious attack,
02:30Hermes has been left with multiple injuries
02:32and sometimes needs the help of a tube to feed.
02:37I mean, he's a cute little fella.
02:39I've never been able to explain why I like tortoises.
02:41I just do.
02:43They've got funny little faces.
02:45I've had them since I was about nine, I think, on and off.
02:49This is where it happened.
02:51There was a fence along here.
02:53He was just about here
02:55and he was kind of on his side, propped up against the fence.
02:59As soon as I got up to here, I could see immediately that he was hurt.
03:04And I guessed straight away that he'd been attacked by rats.
03:10OK, Hermes, please.
03:12Hermes.
03:13Helen has come to see Noel to see if there might be a way to make Hermes mobile again.
03:18Now, what have we got here?
03:20Hello.
03:21Hello, I'm Noel.
03:22I'm Helen.
03:23Helen, grab a seat there for me.
03:25You've got a little friend in here.
03:26We have, yes.
03:27Unusual for a Monday morning for me.
03:29Yes.
03:30Hello, mate.
03:31Do you understand Irish?
03:33Oh, look at you.
03:36You're so cute.
03:37Oh, look at that.
03:39Gosh, what happened?
03:42He was attacked by rats and he ended up having his front legs amputated,
03:48but his back leg looks better.
03:51OK.
03:52And did all of the injuries happen at the same time?
03:54Yes.
03:55They're very slow healing.
03:57Oh.
03:58So, yeah.
03:59They've got very slow metabolism.
04:00Yeah, yeah, yeah.
04:01No, I get it.
04:02Oh, dearie me.
04:04Look at that.
04:06Oh, that's horrible.
04:08Oh, dear.
04:11That's still infected, isn't it?
04:14No, that tip's going to go.
04:16Yeah.
04:17It's definitely going to fall off.
04:20Or be taken off because it's necrotic.
04:23I have to say, it looks a bit worse than it did the last...
04:25It looks horrendous.
04:26..time they did the dressing.
04:28And I would, well, at the moment,
04:31I would almost certainly get an infection in that if I did anything.
04:35He's very forthcoming, isn't he?
04:37With his head.
04:38Yeah.
04:39I mean, he's very outgoing.
04:40Yeah.
04:41Of everything else, he's doing so well.
04:44Well, you're certainly setting me an unusual challenge.
04:48I've done wheels.
04:49Yeah.
04:50On tortoises.
04:51His problem is propulsion, though.
04:52That's right.
04:53That's right.
04:54If he had two back legs that worked.
04:55Yes.
04:56That's right.
04:57Then I could put a wheel here.
04:58Yes.
04:59And he'd be fine.
05:00But the fact that he's missing one back leg is deeply disappointing.
05:02Yes.
05:03You are aware that nobody's ever done a limb amputation prosthesis on a tortoise?
05:07Yes.
05:08Yes.
05:09I don't know what to tell you at the moment.
05:11No.
05:12Because I don't know if it's possible.
05:15It's a very difficult moral dilemma, isn't it?
05:18Because it's easy to put to sleep.
05:21Hmm.
05:22It's just about whether it's morally right.
05:25Hmm.
05:26What do you think, mate?
05:28He's very cute, isn't he?
05:30Very cute.
05:33Okay.
05:34Right.
05:35I'll tell you what I'm going to do.
05:36We only have two options here.
05:37Either I investigate what's possible or we put him to sleep.
05:39Mm-hmm.
05:40Because we can't leave him as he is.
05:41Because he's going to have no quality of life at all.
05:43No.
05:44In order for us to do anything at all, I'm going to have to do a CT scan.
05:47Mm-hmm.
05:48Some of that right hind leg will have to be amputated anyway
05:50if we're going to keep him alive.
05:52Yeah.
05:53Do you want to say bye-bye for now?
05:55Yeah.
05:56Aww.
05:57He'd be a good boy, eh?
05:59Try and get better.
06:01I know you love him.
06:02And I know it would be heartbreaking for you to say goodbye,
06:04but we've got to do the right thing, don't we?
06:06Yeah, yeah.
06:07Okay, thank you.
06:08That's all I can say.
06:09It's an absolute pleasure to see you.
06:10Thank you very much.
06:11All right, God bless.
06:12Leave him with me.
06:13Yeah.
06:17He's not as hopeful as I thought.
06:19I think I'll be saying goodbye to him.
06:24Sorry.
06:25Yeah, I think he'll have to be either.
06:30I don't think they'll be able to do anything for him.
06:32But keep my fingers crossed.
06:34Keep my fingers crossed.
06:39For Hermes to have any chance of survival,
06:41Noel must act quickly to curtail the infection.
06:47He removes the necrotic tibia from his right hind leg.
06:57All right, let's go to CT and see what you've got. Thanks.
06:59Hermes is having a CT scan to establish how much bone stock he has left.
07:09To enable Hermes to walk,
07:10Noel is considering attaching prosthetic limbs to his three damaged legs.
07:16This is an X-ray picture of Hermes.
07:19We can see that the left back leg is fine.
07:23There's only the femur left of the right back leg.
07:26And there's only the humerus left on the two front legs.
07:30And the CT scan allows us to actually take the pelvis out of the body.
07:36And you can see where one leg only has a femur bone and we've amputated at the knee.
07:42But you can also see that that femur is not normally in the socket.
07:46Tortoises can live with a dislocated hip.
07:47The big problem is that every amputation prosthesis that I've ever done has been below elbow or below knee.
07:57So he's unlike any other amputation prosthesis that's ever been done in the world, ever.
08:01I mean, I often say everything is possible, but...
08:06This may in fact be pushing things too far.
08:12Hey Helen, it's Noel, how are you?
08:16Oh, hello. It's fine, thank you, yes.
08:18Now then, so most of the weekend myself and the engineering department have been thinking about Hermes
08:27and what we might or might not be able to do.
08:31The engineers and I have calculated implants that in theory could work.
08:37Yeah.
08:38But it would require a gigantic leap of faith.
08:43Mm-hm.
08:44And there is considerably more risk than normal of failing.
08:50So, do you think it would be better off than just to, um, to let him go now?
09:02Um, I think we, we need to think about it.
09:07We are willing to try, because...
09:10Well, it's a great fit to have tried and failed and never tried at all.
09:14It's a very difficult one.
09:17I think you need to sleep on this.
09:20I guess, uh, the bottom line, Helen, is we, we would be closer than we have ever been
09:26to committing to a procedure with as much chance of failure as success.
09:34It's a lively morning at Fitzpatrick Referrals, and six-year-old Rottweiler Dave has come to see
09:54Knoll after experiencing problems with his right hip.
09:58Dave.
10:00Lovely.
10:01We've come with our Rottweiler Dave today.
10:04He's had two hip replacements.
10:08The one on his right side is failing, and all the bones deteriorating,
10:11so what we're having to do is look at alternative solutions to how to fix it, really.
10:16Every now and again, he has a strain if he runs into the garden.
10:20But he would never let the kids, though, would he?
10:21No, he's all right, he still plays, but when he's, you know, when he's in pain, he's in a lot of pain.
10:26At home in Kent, despite the hustle and bustle of family life, Dave is always in demand.
10:38Dave, give me a kiss.
10:42We've got six children.
10:44Taylor, Sean, Sasha, Charlotte, May and Riley.
10:48Ranging from 22 to six.
10:51And two dogs, two Rottweilers, Dave and Tony.
10:55Dave is six, and we've had him since he was 12 weeks old.
10:59But since the failure of one of his previous hip implants, Dave's quality of life has deteriorated significantly.
11:07Every time he moves, he cries.
11:09It's really scary when he falls, and he is screaming in agony.
11:15The kids are scared.
11:16And the kids are crying, and it's awful.
11:18We're not prepared to just replace Dave's implant with exactly the same implant, and hope that this one works.
11:27Our biggest fear was it would then result in possible amputation.
11:33And because he's such a big dog, I just didn't think that was very fair on him.
11:37But he's a young dog, he should be enjoying his life, and he's not.
11:39He's in constant agony, and it's not fair.
11:41A veteran of two surgeries, Dave can be a little wary of vets.
11:54How are you, Matt?
11:55Matt, nice to see you.
11:56Hello, mate. How you doing?
11:57Hey, mate. How are you?
11:58Good boy. Good boy.
11:59This is Dave.
12:00Yeah. Hi, Dave. How are you?
12:01How old is he?
12:02Six.
12:03Okay, good boy.
12:04You kept him in pretty good shape.
12:06Yeah.
12:07Try to.
12:08Okay, so I've read your history.
12:09Yeah.
12:10You had the first hip replacement in 2011, was it?
12:12Yeah.
12:13And then the second one in 2013?
12:15Yeah.
12:16Okay.
12:17And which is it that has failed?
12:19That's the first one.
12:20So initially, was it okay?
12:23Absolutely no problems at all.
12:25And then we just noticed that he started limping.
12:28But it's not all the time.
12:29The only other thing I wanted to add, ever since he had the second op,
12:34as he's going to the toilet, he's panicking and he takes off like a, like a scalded cat, four years.
12:41We spoke to the vet and they said they thought to be psychological, but it never happened until we had the operation.
12:45And literally, as he goes to the toilet, it'll be three or four droplets as he's running off.
12:50You know, the toilet is never in one heat.
12:52Well, I don't have enough information yet.
12:54I'll need to watch him walk and we will need a CT scan.
12:58Let's go outside.
12:59Okay.
13:03That's great.
13:04Slowly, please.
13:05Keep him away from me.
13:12Okay, stop there.
13:15Come over here, please.
13:20Hold tight, hold tight, hold tight.
13:22This muscle mass is very poor.
13:24Hold tight, hold tight.
13:26Hold tight, darling.
13:27Okay.
13:28All right, that's enough.
13:29I'm not going to push it.
13:30Okay, come on, mate.
13:31Let me go straight in there.
13:34I note on your clinical history that three options have been given to you.
13:39One is revision of the total hip replacement.
13:41Yeah.
13:42One is ephemeral head and neck excision, where you excise the hip replacement and leave him with no head.
13:46Yeah.
13:47And the third one is full limb amputation.
13:49Yeah.
13:50Full limb amputation generally isn't something that we would consider off the get-go.
13:54Brilliant.
13:55Ephemeral head and neck excision is an option, but it would not be as good as a revision total hip replacement.
14:00Yeah.
14:01But bear in mind, I would have to take all of those implants out.
14:05These are big potential problems.
14:07Yeah.
14:08Take off your beautiful collar.
14:09There we go.
14:10Yeah.
14:11He's a lovely dog.
14:12See ya.
14:13All right, bye.
14:15Bye.
14:16All right.
14:17Bye.
14:18Here we go.
14:19He's going to be pretty out of here.
14:24Normally it takes you a couple of days to come down from there.
14:27Yes, he's going to be even soppier than normal.
14:34Noel needs to establish just how severely the existing hip replacement has deteriorated and how much bone stock remains.
14:42Right, so this is a three-dimensional CT scan of the limb.
14:46And you can see that this stem is loose.
14:48Now if you look at this...
14:50How do you...
14:51No.
14:52How do you see that this one's loose?
14:53So this is a cross-sectional view.
14:55So you can see here...
14:56Oh, yeah.
14:57Right, yeah.
14:58Okay.
14:59Black shadow.
15:00That's the void.
15:01Is the void, yeah.
15:02Yeah.
15:03So that shaft is windshield wipering.
15:05Yeah.
15:06Like so.
15:07Yeah.
15:08So when you rock the leg, that goes like that.
15:10Right.
15:11So you know that stem has to come out.
15:12Yeah.
15:13Right.
15:14This piece of the bone here would almost certainly fracture off once you take the stem off.
15:20Mm-hmm.
15:21Therefore, my plan would be to make a plate that goes up over here, goes all the way down here, and then that's secure.
15:27Blimey.
15:28Yeah.
15:29It's all doable.
15:31Good.
15:32The risks are we could get a fracture on the table.
15:35Usually I can mend that.
15:36Yeah.
15:37Infection, because you're going in a second time, that's a risk.
15:40Okay.
15:41Sciatic nerve trauma, meaning that they sometimes drag their leg.
15:45Okay.
15:46And it can take them a few weeks to recover.
15:48Oh, that's fine.
15:49It will be unlikely it doesn't come back, but it's possible.
15:52All right.
15:53Let me go get him for you.
15:54Okay.
15:55All right, guys.
15:56Cheers.
15:57Okay.
15:58Different size.
15:59Uh.
16:00It's going to be really hard to wake up.
16:04Shall we go?
16:05You ready?
16:06Shall we go?
16:07Shall we go?
16:08Come on, then.
16:09Come on.
16:10Come on, mate.
16:11You can do it.
16:12Come on.
16:13Come on.
16:14Oh, you're not going to get up from me, mate.
16:16You're not going to get up.
16:18Oh, come on, let me say.
16:20All right.
16:21I'm bringing mom and dad in.
16:23If you just stand back, please, we're all good.
16:27Now.
16:28Okay, big guy.
16:29Mom and dad are here.
16:30There we go.
16:31Okay.
16:32There we go.
16:33You ready?
16:34Come this way.
16:35Come on, darling.
16:36Come on, mate.
16:37Come on.
16:38Come on, buddy.
16:39You're getting grumpy of everybody.
16:41There we go.
16:42That's fine.
16:43I think he just, he's nervous on his hip.
16:45Oh, thank you.
16:46Okay.
16:47Great to see you.
16:48I can't wait.
16:49Yeah, and thank you for that.
16:50Really appreciate everything.
16:51Okay.
16:52All right, mate.
16:53Hang on.
16:54All right.
16:55We're going.
16:56We'll do it.
16:57Bye.
16:58Bye.
17:00Bye.
17:01It's been nine days since Hermey's tibia amputation, and Helen is ready to pick him up.
17:08A bit nervous, a bit worried.
17:11Originally, we were hoping we could save his one rear leg that's injured
17:15so that he would just have wheels for the front.
17:18But Noel phoned me and said a viable option could be three prosthetic legs.
17:24As Hermes has a dislocated hip and has lost one of his knee joints...
17:28Right, Hermes, mum, please, Hermes.
17:31Placing just one back leg prosthetic is unlikely to be enough to get him walking again.
17:38Hello, mate.
17:39Oh, hello, darling.
17:41OK.
17:42Now...
17:43Oh, dear, oh, dear.
17:45OK, so I've removed the infected tibia.
17:50It's extremely important, given all the anaesthetics that he has,
17:54hydration, because otherwise his toxic excretion will be a problem.
18:00Obviously, eating is an issue, and make sure he's well fed up.
18:05But in his case, other than the fact that he's got three stumpies, he's fine.
18:12The problem that we've got is that we only have a femur and we only have a humerus.
18:17That's all you've got left on the front legs, which is two very curved bones,
18:21really difficult architecture.
18:23It's three millimetres across, and it's approximately 14 millimetres in length.
18:29So we've done a lot of sums on this, and this is what we've come up with.
18:33So that's the front leg.
18:35Yeah.
18:36That's the back leg.
18:37Mm-hm.
18:38And that small implant has two plates on it and a tiny peg.
18:42Yeah.
18:42The titanium implants will need to be attached to the remaining bone in the legs,
18:50the humerus in the front two legs, and the femur in the hind leg.
18:56Noel hopes that within six months, when the implants have bonded to the bone,
19:00specially designed flipper-like feet can be attached.
19:03Nobody knows if this is even theoretically possible.
19:09No.
19:10In terms of the computer modelling, it is possible,
19:14but the risks are the bone fractures during the op,
19:18the bone fractures after the op,
19:20infection, skin breakdown, anything could go wrong.
19:24And unfortunately, with him, I would say it's 50-50 at best.
19:27I very rarely go into surgery with 50-50 odds, almost never.
19:36And if we fail, then we have to put him to sleep.
19:42Well, yeah, I've been thinking about whether we need to,
19:46whether I should put him through it.
19:49And I think that because he's so well,
19:54we should give it a go.
19:57Well, I'm willing to try.
19:59OK.
20:00I think it's probably going to weigh heavily on our consciences if we don't try.
20:05And that animal can live longer than me and you.
20:07Mm-hm.
20:08If this works.
20:10But no matter what, we cannot operate at the moment
20:14until the back leg heals over.
20:15Mm-hm.
20:16I do love him.
20:17He's great.
20:19All right, mate.
20:20He loves a little head stroke.
20:22He does, yeah.
20:23Loving it, loving it.
20:27Listen, we'll talk.
20:30My pleasure.
20:32Bye-bye.
20:35There's a big challenge ahead for Helen
20:37if she's to help Hermes' wounds heal.
20:40I'm a bit worried that I'm asking too much
20:42of Noel and Hermes to do it.
20:45But he's done so well so far
20:47and fingers crossed that he just carries on.
20:52Hi, Hermes.
20:54Of course, this is a very difficult ethical dilemma.
20:57Hermes is a fighter.
20:59He has a lot of life left in him.
21:01He could live up to 80 years of age.
21:03And just because he's a tortoise,
21:05why should he be precluded from the same technology
21:08that's being deployed in dogs
21:09and soon even in humans.
21:12At the end of the day,
21:13to a vet, all life matters.
21:16And Hermes has very few options.
21:26It's a tense day for big, softy Dave the Rottweiler,
21:30who needs a revision to a hip replacement that has failed.
21:34And with the pain worsening,
21:35it couldn't have come a day sooner.
21:38He's really deteriorated recently,
21:41so I'm glad this...
21:42Perfect timing.
21:42It's perfect timing.
21:44So we're all a bit anxious.
21:45Kids are a bit anxious.
21:46Everybody, all the kids are up this morning
21:48giving him extra cuddles,
21:50lying all over him,
21:51hugging him, kissing him.
21:53Oh, no, he's not a tough dog.
21:55No, he's a baby.
21:58Now then, Dave, please, Dave.
22:00Hi, guys.
22:01Hi.
22:02How are you?
22:02Come on.
22:04Hey, mate.
22:05How are you?
22:06What's this, then?
22:07Oh, a double marathon.
22:09Did you run that?
22:09Yeah, yesterday, yeah.
22:10Not him?
22:11No.
22:11Oh, well done.
22:12Was it good?
22:14Hilly.
22:14We've got to get him to run a marathon now.
22:16Yeah.
22:17So I've got a custom-made plate,
22:19which is this,
22:20which is specifically built for his bone.
22:25So this will follow the curve at the top of the femur,
22:27like a hook,
22:28to put small screws in the top.
22:31Yeah.
22:31And I've made two new heads
22:34to go on my stem,
22:38which will look something like that.
22:40Okay.
22:41So if I can get the angle on this right
22:43to fit the existing cup,
22:44that's my preference.
22:45Yeah.
22:46If I have to fracture that cup,
22:49which is plan B,
22:50my plan then is to put this fella
22:54on there,
22:55bolted to the side of the ileum.
22:57All right.
22:57But your first preference
22:58is to get it in the existing cup, yeah?
23:00That's right.
23:01If there's an 80% chance it's going to work,
23:04I'm going to leave it.
23:04Yeah.
23:05If there's a 50% chance,
23:07swap it.
23:07That's right.
23:08Okay.
23:08All right, friends,
23:10that's it.
23:11Sorry, mate.
23:12Oh, baby.
23:14All right, big guy.
23:16Congratulations again.
23:17I totally need to get back running myself.
23:19Well, it's difficult to get in the time
23:21when you're running at midnight.
23:23Yeah.
23:23I mean, I have three businesses,
23:25six children,
23:27the wife,
23:28and I still manage,
23:29so there's no excuses.
23:30No, there is no excuses.
23:32Oh, my God.
23:33I'm just going to go ahead
23:33and feel inadequate.
23:35See you later.
23:36Get some time running, yeah?
23:37See you later.
23:37Bye.
23:41Joking aside,
23:42Noel has a tough job ahead.
23:44Thanks, Mike.
23:44Both he and the family
23:45hope that he will not have to replace
23:47the cup of the original implant
23:49during surgery.
23:50He's in the best,
23:52he's in the best,
23:53best hands possible.
23:56If he can't fix it,
23:57no one can fix it.
23:58Noel seems to know
23:59what he's talking about.
24:00I'm confident.
24:02I think he'd see.
24:04He does, doesn't he?
24:04Yeah.
24:07Dave will be operated on tonight.
24:20Dave, the Rottweiler,
24:24has been anesthetized
24:25for his surgery
24:26to revise a previous
24:28hip replacement
24:29that has failed.
24:34Noel first needs to see
24:36whether he will be able
24:37to salvage the original cup.
24:40Okay, so it looks like
24:41the cup that is in there
24:42might work.
24:43The poly,
24:44which is the plastic liner,
24:46is still intact.
24:49I'd like to keep it in
24:50if we can
24:51because if we have
24:52to take it out
24:53then I'll have to fracture
24:54here and here
24:55to get it out.
24:57The remainder of the implant
24:58needs to be removed
24:59without causing
25:00further trauma.
25:02There's a lot of debris
25:04coming out now.
25:05It's just bone debris
25:06from the metal rocking
25:08around in the bone.
25:09So I've made a custom plate
25:12that's going to go down
25:13along the femur here
25:14because I'm worried
25:17that the top part
25:17of the femur
25:18might fracture off
25:19because of that big hole.
25:22Slide it down there
25:23and it should hook
25:25over the top
25:26nice and neatly
25:27because it's made
25:27specifically for this bone.
25:36Should be rock solid.
25:37Noel closes off
25:40the old hole
25:40with titanium mesh.
25:44Then he's ready
25:45to begin inserting
25:46the new implant.
25:49All right, here we go.
25:51It is time.
25:54Noel fills the canal
25:55of the femur
25:56with quick-drying
25:57surgical cement
25:58ready for the stem.
26:00I need another cement
26:01on standby
26:01in case I don't have enough.
26:07Next, it's the challenging task
26:10of trying to place
26:11the new head
26:11on the stem
26:12at the best possible angle
26:14for the existing cup.
26:17So I'm setting
26:18the angle of version
26:19of the neck right now.
26:22I've got to get that right
26:24so that it hits the cup
26:25exactly right.
26:27If we get that wrong,
26:30that's game over really.
26:31Okay, so now we're going to
26:36try and put the custom-engineered
26:37head back into this cup.
26:40I say a little prayer
26:42that it fits well
26:43and that we do not need
26:44to take the cup out.
26:47One thing is for sure,
26:48if I have to take this cup
26:49out of the bone,
26:50I am going to have
26:51to break the pelvis
26:51to get it out.
26:58Hold on.
26:59As you can see,
27:01it's not hitting the cup
27:03exactly straight.
27:04I mean, it's pretty solid.
27:06I'm lifting it now
27:06and it's not pulling
27:08the hip out of the socket.
27:10I think it's much better
27:11than 50-50 that it'll stay in,
27:13but I could be wrong.
27:17With the existing cup
27:18still in place,
27:20Dave is sewn up.
27:21All right, let's go get
27:23some radiographs, please.
27:24And rushed straight off
27:26to radiography
27:27to ensure Noel
27:28has made the right decision
27:30and that the revision hip surgery
27:32has the best chance of success.
27:37Hello?
27:38Hey, it's Noel.
27:39Oh, hi, Noel.
27:41So, all went fine.
27:42Yeah.
27:43I took the original stem out
27:45and then I put my new stem in there
27:48and my new head
27:49in the existing cup.
27:51So, we went with plan A.
27:53Oh, brilliant.
27:55I was happy
27:55that there was a much better
27:56than 50-50 chance
27:58that it was not going to dislocate.
28:01Have a good evening.
28:01My entire pleasure.
28:02Take care now.
28:03Bye-bye.
28:03All right, bye-bye.
28:04Bye-bye.
28:04Bye.
28:06Lovely people.
28:07I cannot believe
28:08that guy has six kids.
28:09What have I been doing?
28:20Dave will be under the care
28:22of Fitzpatrick's night shift
28:23who've taken over
28:24from the three daytime shifts
28:26and are doing their rounds.
28:27This is S.G. Bruce.
28:30He had CT and x-rays
28:31and a work-up today.
28:32He's been eating,
28:34he's urinating
28:35and he's going to go for surgery tomorrow.
28:39The night team work really hard.
28:41They have to give all the treatments,
28:42all the painkillers.
28:43They have to check bandages.
28:48They have to feed.
28:49They have to walk.
28:50Hi, Lola.
28:51They have to do a lot.
28:52You can go for a walk.
28:54It takes a very special person
28:56to come in
28:56and be able to give the dogs
28:58off to TLC
28:59in between all the treatments.
29:00You just had a nice clean.
29:02He's a lovely.
29:03He's a good boy.
29:06Sometimes you'll get a dog
29:07who can be aggressive
29:08or who won't settle
29:10and in the meantime
29:12they have to keep really quiet
29:13so the dogs can keep asleep.
29:16They really have to work
29:17on their tiptoes
29:17like little fairies.
29:24Hi, Dave.
29:26It's OK.
29:27Hey, hey, hey, hey.
29:28It's all right.
29:29Good boy.
29:31Next morning,
29:32Dave is still recovering
29:33from his anaesthetic
29:34but overnight
29:35he's been feeling confused
29:37and uneasy
29:37away from his family
29:39and Noel has called them in.
29:43We got a call
29:44about an hour ago
29:47from Noel
29:49saying that Dave's not happy
29:51although he's doing well
29:54he's better off at home.
29:56He gets a bit scared, doesn't he?
29:57When he goes to the vets
29:58so he can come across
30:01a little bit grumpy
30:02so I think it's better
30:03for him to be at home.
30:05All right, buddy.
30:06You're a good boy.
30:07You're a good boy.
30:08I would not normally
30:09send a patient
30:10with this degree of surgery
30:11home at this point
30:13post-operatively
30:14but I think that's
30:15in his best interest.
30:17He's not an intrinsically
30:18aggressive dog.
30:19He's just a little bit afraid.
30:21OK, one, two, three.
30:22There we go.
30:23All right, big fella.
30:24Dave is sedated again
30:26so that the team
30:27can move him safely
30:28without causing him
30:29any distress.
30:30Good boy.
30:32Good boy.
30:33Well done.
30:36OK, so.
30:38OK, big fella.
30:39There you go.
30:40Good boy.
30:40It's fine.
30:41It's OK, buddy.
30:42It's all right, mate.
30:44Right, my friends.
30:45We're ready.
30:45Oh, baby.
30:48It's all right.
30:49It's all right.
30:51We weren't able to wipe out
30:52the inside of his dribble
30:53because he wouldn't let us.
30:55How long will that cone need to stay on
30:56until the stitches are two weeks?
30:58Two weeks.
30:58This is now what he has, friends.
31:02I took that implant out completely.
31:05Yeah.
31:06The problem is
31:07that the head is not hitting the cup
31:10at the angle it should be,
31:11but I can't make it that way
31:12unless I take the cup out.
31:13So does that mean
31:14it's going to pop out easy?
31:15Not necessarily.
31:17It might do,
31:17but it's unlikely.
31:18OK, that's good.
31:19And if it comes out,
31:20we've got to replace that cup.
31:22Yeah, OK.
31:23Yeah.
31:23How confident you are
31:24you're not going to have to see me again
31:25with...
31:26Um...
31:28I would say I'm confident.
31:31I'm not 100%.
31:32There we go.
31:35Up we go.
31:35One, two, three.
31:36Up we go.
31:37Up we go.
31:37There we go.
31:38Now.
31:39Now we're set.
31:40Yeah, yeah.
31:40You take that.
31:41Good boy.
31:42Oh, we're going home.
31:44It's your favourite.
31:45This is the dog walking guy.
31:46It's his favourite cup.
31:46All right, mate.
31:47You lift the front.
31:47I lift the back.
31:48You got him?
31:49We want him to lie on the good side.
31:52That's it.
31:53And he's all set.
31:54Well done.
31:55See you soon.
31:56All right.
31:56Good.
31:56Thanks, Noel.
31:58It sounds as if it's all gone well.
32:01But I think he just wants to be at home.
32:03Yeah.
32:04Everyone wants him at home,
32:05so we're getting back now.
32:06Back in Worthing, intensive care nurse Helen has been looking after Hermes the tortoise.
32:30It's taken him 11 months to fully recover from his infected leg.
32:39They have very slow metabolism, so it's taken a long time for his back leg to heal.
32:44There we go.
32:45There we are.
32:46There we are.
32:47How's that?
32:48This is Hermes' special feed with all the nutrients he needs to help him grow and stay strong and
32:55ensure he gets all the calcium and different vitamins and things that he needs.
33:01Hermes has got a feeding tube, mainly it was to build him up to make him strong enough to get through the surgery, to make sure his bones are strong enough to take the prostheses.
33:16There we go.
33:17How's that?
33:18Yes.
33:19Hello.
33:20Yes, hello.
33:21I'm hoping that this operation will be a good success and it's Hermes' last chance, I think.
33:40Finally, Hermes is well enough to come in for surgery and Helen's husband Robert has come along as moral support.
33:47Hiya.
33:48Hello.
33:49I've got Hermes the tortoise.
33:50I'm a bit early on the plane.
33:51Oh, Hermes.
33:52The tortoise?
33:53How's he doing?
33:54Very well.
33:55Oh, can I see?
33:56No.
33:57I love tortoises.
33:59Today, Noel will fit Hermes with his three prosthetic limbs to try to give him a chance of walking again.
34:06Hello, sweetheart.
34:08Oh my God, he's gorgeous.
34:11How is Hermes doing?
34:12Let me have a look.
34:13I'm doing fine.
34:14Let me have a look at the legs.
34:16Hi, mate.
34:17How are you doing in there hiding?
34:19How's his tube?
34:20Yes, that's fine.
34:21Okay, so the stumps are all healed more or less?
34:24Yeah.
34:25Right.
34:26Well, there's a very good reason why this is never done before and that's because number one, it's very hard and number two, there's a very high chance of failure.
34:34So, I've designed this implant.
34:37That's the size of him.
34:39Oh, gosh.
34:40So, this is going to be incredibly difficult, incredibly difficult.
34:47We've designed feet, which we'll consider in due course, but my main worry to be perfectly
34:54frank with you is that he may not make it through.
34:58Yeah, yeah.
34:59I know that.
35:00Yeah.
35:01But, you know, if it works, it'd be much better for him than the life he's got now.
35:06Yeah.
35:07So, you've got to try something.
35:09Yes.
35:10Okay.
35:11So, I'll do my very best.
35:13Okay.
35:14All right, big fella.
35:15Okay.
35:16Lovely.
35:17All right.
35:18Lovely.
35:20Thanks.
35:21All right.
35:22Sir, look after yourself.
35:23I'll do my very best.
35:24Bye, homies.
35:25I'll talk to you tonight.
35:26Okay, lovely.
35:27Thank you very much.
35:28You're welcome.
35:29Bye.
35:31I was quite calm before.
35:37I got a slight finger of doubt has now raised itself and I'm, you know, so I'm very worried.
35:48Hopeful, but worried.
35:52After almost a year of dedicated nursing from Helen, the stakes couldn't be higher for Hermes.
36:00So, this is high risk, high reward stuff.
36:03Basically, it's life or death.
36:05Either I'll be able to replace all three legs and allow him to walk again, or I won't.
36:12And if I can't, he's going to have to be put to sleep.
36:16Can I meet Hermes?
36:18Assisting Noel with the surgery is exotic animal expert, Neil Forbes.
36:23With reptiles in particular, when we give anaesthetic injections, we want to put it in the front of the body.
36:29You put it in the back and it goes out through the kidney before it gets around the body.
36:33It's really important to have an expert in exotic species by your side when you're doing a long procedure on an animal like a tortoise.
36:42Because their metabolic rate and their demands under anaesthesia are very different to cats and dogs.
36:48As you can't see, it's a very good morning.
36:51It's a very good night.
36:52It's a very good night.
36:54Good morning, everybody.
36:56Hello, hello.
36:57Okay.
36:58Right hind implant, please.
37:03It's mine.
37:04So the bone is exposed here, I'm going to drill a tiny hole down into its centre to
37:11take the peg of the implant now.
37:14Right, be careful I don't fracture this, it's a very, very, very delicate bone.
37:33Very poor bone holding power for these screws, they're not all as tight as I would like them
37:38to be.
37:39Okay, so we've got five little screws, of course all of this depends on biology smiling on
37:46us a little bit, it could fail, but so far so good, this implant's in.
37:53Alright, number one done, two to go.
37:57Give me the right front implant please, got it, thanks.
38:18Bone stock's much better in this bond than it was in the other one, much better.
38:23These screws have fantastic purchase.
38:28The third implant is finally in, and Hermes happily has remained stable throughout.
38:35It'll be brilliant if this works Neil, won't it?
38:38It'll be absolutely fantastic.
38:40Okay, so that's as good as I can achieve, it's in the lap of nature now, we've done our best.
38:46Off we go, yep.
38:47Go, go, go.
38:48Noel is keen to get Hermes into radiography and recovery as quickly as possible.
38:53Hello Helen, it's Noel.
38:54Oh hello.
38:55Well, that was a Herculean task.
38:56Right.
38:57We did manage to achieve it, but of course we're by no means out of the woods yet.
39:08No, no.
39:09Now it depends of course on biology, which means the bone needs to grow in and the skin needs
39:15to grow in and of course that's a six million dollar question.
39:20Yeah.
39:21We don't know, but we've built a very nice home for Hermes here.
39:25Lovely, thank you very much.
39:26Thank you so much.
39:27Take care Helen.
39:28You're welcome.
39:29Bye bye.
39:31Bye.
39:32I really hope we get a result.
39:34Long road ahead though, long road ahead.
39:36Noel's Orthopaedic Referral Centre carries out an average of 20 surgeries a day.
39:56With most requiring sedation or anaesthesia, the sight of sleepy patients is commonplace.
40:03Today it's pretty dreary outside.
40:11Alright, off we go.
40:13But six year old Rottweiler Dave's family are looking on the brighter side.
40:18Keep going, straight line.
40:20Great, excellent.
40:22Good, that's what I need.
40:24Let's come back in.
40:25Dave's six week radiographs show the implants are stable and pleased with his obvious improvements
40:31since his surgery three months ago.
40:33There we go.
40:34Matt and Teresa are hopeful that Noel will sign him off today.
40:37Alright, great.
40:38And I will have a little look.
40:39Alright big fella.
40:40Good boy.
40:41Good boy.
40:42It's alright, it's alright.
40:43Well it's still in.
40:44Yeah.
40:45Erm, and the tissue's healing very well.
40:48Muscle mass is actually remarkably good.
40:50He is doing so well.
40:52I don't have any concerns at the moment.
40:54That's fine.
40:55Honestly, he's brand new again.
40:57When he takes off down the garden, when he is something.
40:59Oh, so he's already done that.
41:00Yeah.
41:01I was just going to talk to you about going off lead, but I guess that's already happened.
41:04Yeah.
41:05Yeah.
41:06Sorry.
41:07How many weeks did he actually follow the plan?
41:09Zero weeks?
41:10The thing to hear me is, remember we said he'd go to the toilet and run?
41:13Not done that at all since.
41:14Oh good.
41:15Excellent.
41:16You're not afraid of your poo anymore mate.
41:17No.
41:18That's a triumph.
41:19My job is simply just to sign you off and to give you the okay to crack on.
41:22We've got our dog back.
41:23Undelighted?
41:24Yeah.
41:25100%.
41:26That's great.
41:27Look after yourself mate.
41:28Take care.
41:29Thanks for everything you've done.
41:30Thanks so much.
41:31Thanks very much.
41:32Undelighted.
41:34Come on in baby.
41:39Just so relieved.
41:40Unreal.
41:41To know now that he can live the rest of his life as a normal dog, run around with children.
41:46Just, we couldn't have asked for anything better.
41:48We've got our dog back really, haven't we?
41:50So.
41:51Yeah.
42:04Hermes the tortoise now has his three prosthetic leg implants.
42:08But before Noel can fit his feet, he needs to go home and recover.
42:12Hello.
42:13Hello.
42:14Helen, come to pick up Hermes.
42:16Special tortoise he is.
42:18I'm feeling really excited to come to pick up Hermes today.
42:21I'm a bit nervous about having to continue his care at home.
42:25I don't want anything to go wrong.
42:27So a big day today folks, big day.
42:30Let me get that and let me give this to the girls out here.
42:33Girls, here you go.
42:35Good God.
42:36So this, my friends, is what we've got.
42:41It looks very strange.
42:44Now, clearly we can't put the feet on yet because we need the bone to grow on and we need to make sure that it doesn't get infected.
42:54So I'll bring him in.
42:55Now, mate.
42:56There we go.
42:57There we go, Mummy.
42:58Hello, baby.
42:59Hello.
43:00Oh, gosh.
43:01I have to call you Peggy.
43:04Hello.
43:05Oh, hiya, handsome.
43:07Hello.
43:08Yes.
43:09So as you can see the little stumps are quite neat.
43:12Yes, yeah.
43:13And the same on the backbone.
43:14Yeah.
43:15So at the moment I'm very happy with him.
43:18I will not be going near him with prosthetic feet until well into next year.
43:24Okay.
43:25Thank you for looking after me.
43:26Thank you for looking, doing everything you did.
43:27It's my pleasure.
43:28It's my pleasure.
43:29So pleased.
43:30In Kent, Dave the Rottweiler is back enjoying life.
43:41So get off.
43:42Tony.
43:43With Tony and the family.
43:45Since he's recovered really well, it's nice for him to have a bit of companion.
43:51They sleep together.
43:52They do enjoy each other's company.
43:54It seems to have brought the puppy back out in him and Dave.
43:59And the kids enjoy them both.
44:03He's probably 100% improved from what he was or certainly from what he was going to be.
44:08The biggest improvement is just his everything.
44:10You know, he's a different dog.
44:12He's happier.
44:13He can do everything a normal dog should be able to do.
44:16Yeah, he's a lot happier in himself, you can tell.
44:18Well, look at him there.
44:19You know, he's running.
44:20He walks around, no problem, plays.
44:22He's just thoroughly enjoying his life again.
44:24Yeah.
44:27Dave!
44:29Good boy.
44:30Good boy.
44:31Good boy.
44:32Good boy.
44:33Good boy.
44:34Good boy.
44:36Every so often, Noel is confronted with a case where the odds are simply stacked against
44:45him.
44:46The wounds on his leg, his leg wounds were still fantastic and healing.
44:52The last three or four days, he just suddenly looked a bit sorry for himself.
44:56So I took him to the local exotic vet and they kept him in for two days.
45:05And when I left him, I just thought, no, I think this is it.
45:09Just something about him made me think I wasn't going to see him again.
45:15I got a phone call at half past eight in the morning and he died in the night.
45:19It's difficult when we lose any patient, but myself and the team are devastated that Hermes
45:26didn't make it.
45:28His legs were doing great, but at the end of the day, he had internal organ failure and
45:34he passed away.
45:36So this is where we've buried Hermes.
45:48A little memorial for him.
45:51He was always quite a fighter and there we are.
45:58He couldn't fight anymore, I don't think.
46:01He fought for two years, about 18 months.
46:05Yeah.
46:06Yeah.
46:07Yeah.
46:35Yeah.
46:36Yeah.
46:37Yeah.
46:38Yeah.
46:39Yeah.
46:40Yeah.
46:41Yeah.
46:42Yeah.
46:43Yeah.
46:44Yeah.
46:45Yeah.
46:46Yeah.
46:47Yeah.
46:48Yeah.
46:49Yeah.
46:50Yeah.
46:51Yeah.
46:52Yeah.
46:53Yeah.
46:54Yeah.
46:55Yeah.
46:56Yeah.
46:57Yeah.
46:58Yeah.
46:59Yeah.
47:00Yeah.
47:01Yeah.
47:02Yeah.
47:03Yeah.
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