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00:00Fitzpatrick referrals orthopedics and neurology how can I help it's late July
00:06and Noel is preparing to leave the practice as you can see I've ironed not so good at the ironing
00:14front he's traveling 6,000 miles across the world to South Africa so I've been contacted by a few
00:24vets in South Africa they have incredible animals that they look after every day and that have similar
00:32problems to the animals I see osteoarthritis and all kinds of other issues but they're endangered
00:38they're in danger of extinction Noel has spent the last 30 years developing groundbreaking techniques
00:48to fix thousands of pets now he's hoping to transfer his skills to the treatment of wild
00:55animals to help transform their lives too I'm really well I'm very excited to go but I'm also
01:04a little bit afraid because it's something I've never done before I'm not sure what I'm gonna see
01:10I'm not sure what challenges are gonna meet me I mean there are techniques that I use here that I
01:15simply can't use in South Africa because it's is either not practical or not ethical so I know
01:22that I'm gonna have some intrinsic limitations but all I can do is my best and hope that my best is good
01:29we're here I'm in South Africa slightly different horizon to the hedge road country lanes of Surrey
01:52I've come to Gondwana game reserve which is a reserve for all five big species in South Africa and their
02:05model is sustainable tourism Gondwana is home to several at-risk species Wow as well as the first wild
02:15elephants born in the southern Cape in 200 years it's just extraordinary to get outside the
02:22practice where I spend so much time looking after animals in people's living rooms and backyards to
02:30the great living room backyard of nature Wow that's just incredible first rhino I've ever seen in the
02:40wild absolutely incredible I'm going to meet a vet here called dr. Brendan he's one of the best known
02:50wildlife vets in South Africa and I'm really hoping to learn a lot from him and share anything I might
02:57know which is gonna be a lot less than he knows Brendan has invited no to help with one of Gondwana's key
03:03conservation initiatives Brendan how are you which protects one of Africa's most iconic animals thank
03:13thank you so much thank you so much for having me here I already saw Rhino outside the first time in
03:19my life incredible yeah they're prehistoric with their gentle giants the rhinoceros is one of the most
03:27endangered species on the planet numbers have dropped over 95 percent in the last century and poaching is
03:35often the cause rhino horn sells for more than the price of gold on the illegal market for its mythical
03:45healing properties to deter poachers many reserves remove the horns but not here we made the conscious
03:53decision that we weren't going to dehorn our rhino and we believe that rhino need their horns with
03:57regards to foraging feeding social behavior dominance and we took the the stance that we would protect these
04:04rhinos and develop an anti-poaching unit to be able to do so Gondwana tried to keep the rhinos safe with 24
04:12hours surveillance using tracking bracelets around their legs but one of their oldest males has been
04:19giving the Rangers the runaround fondly known as Bruno he has been a dominant bull on the reserve for
04:27a number of years he really has been part of Gondwana's journey because every youngster that's actually
04:31young Gondwana at the moment has been fathered by Bruno he is very sexually mature so he's often out
04:39and about looking for ladies and he's lost his bracelet a few times so we've decided that we're going to be
04:44doing an implant into the horn of the rhino from a visual point of view you can't see it and the animal
04:50doesn't even know that it's there this is a brand new procedure for the reserve the lines are around
04:59we've got the cheetahs here so we don't want people wandering off Noel will be working alongside Brendan
05:05and the team this will be the first one on Gondwana transmits a signal 24 hours a day and that signal it
05:12can be used to track the rhino can't believe I'm going on a chopper but we are and we're going to go
05:19out and find a rhino this is a unique opportunity for Noel so show me the swinge pretty long yeah
05:31two and a half inch little bit right and what are you aiming for a shoulder no no no brum bruno is
05:40somewhere on the 11,000 acre reserve a male rhino's territorial range is between four and five
05:47kilometers but without his tracker bracelet he's going to be hard to find are we looking for a single
05:53bull the ground team are also on the lookout below there's a bull there there's a runner
06:11they're on your proper clock right now looks like him no color only one small one the ground team confirm
06:22it's Bruno by the marking on his ear okay now it's down to Brendan to dart the 25 miles per hour moving
06:35target
06:38very nice
06:40down here
06:42okay Noel just remember to move forward from the helicopter
06:46these southern white rhino balls weigh around two and a half tons
06:54yeah he's a big boy
06:58wow he's unbelievably beautiful no you want to pop a cap it in sure this is pretty thick
07:08any place you can catheterize is on the ear veins we complain about trying to get a van in
07:12yeah
07:13Bruno's hide is up to five centimeters thick so Noel pierces the thinner skin on his ear flap
07:19to insert an IV line to top up the anesthetic in first time good thank you
07:25thank you didn't look like a total pillock thank you so much might be better to put it in slightly
07:33higher yeah thank you so much Brendan drills into the side of Bruno's horn to insert the tracker
07:45there's no nerve endings in here so there's no feeling it's keratin like my fingernail
07:53you can tidy it up for me no that'd be great
08:00despite the horn being made of the same material as nail or hair
08:04it's so valuable on the illegal market that every shaving has to be weighed and accounted for
08:10so you can see the grain in this like hair fibers growing side by side
08:15it's absolutely and utterly absurd that human beings are chasing this and killing these beautiful animals
08:26unbelievable
08:27the tracker is sealed into the horn using dental acrylic
08:32and that's on all the time as soon as you turn it on you turn on that frequency you'll pick it up
08:39and Bruno is none the wiser
08:42alright sweetheart
08:45you've got your tractor in
08:47to try and keep you safe you gotta stay safe too
08:51bye
08:52bye
08:53it's unbelievable when you're up close with that majesty
09:08It's unbelievable when you're up close with that majesty.
09:21I mean, what a glorious, glorious animal.
09:24Today, there are less than 30,000 rhino left in the wild.
09:41It's actually devastating on a daily basis to see how many rhinos we're losing in a couple
09:46a day.
09:47If you look at the overall numbers of rhinos left, we can't sustain that.
09:51So something has to change, and a lot of big effort that's been put in to try and change
09:55it.
09:56But it's a tough battle that we're fighting.
09:59We shouldn't really be praising the keratin from the nose of a rhino as a treasure.
10:04We should be praising the rhino as a treasure.
10:07Absolutely.
10:08The thing is, if we give up the fight on one species, what does that mean about the rest?
10:12And so it goes way beyond just the rhino.
10:15It's a much bigger picture.
10:18Noel has witnessed the struggle to protect Africa's endangered wildlife.
10:22Tomorrow, he will have the chance to share his skills to help preserve these precious
10:28animals.
10:29I can't help but think of the battles that these people are facing every single day to
10:34conserve species.
10:36And my job back home is to look after the welfare of a cat or a dog.
10:41Their job is to look after a species on the edge of extinction.
10:45And I really hope that I can make some kind of difference.
10:49We'll see.
10:50It's Patrick O'Farrell's orthopaedic and neurology, Kate speaking.
11:06How can I help?
11:07Oh, I know.
11:08Sorry.
11:09Noel's in Africa at the moment.
11:11What we're going to look at is a prosthetic for a rhino's foot.
11:29It's going to be very different than what I'm used to, for sure.
11:33Noel has spent the last 15 years pioneering bionic limbs for cats and dogs.
11:38Where I grew up in Ireland, my father made the very first splints that I've ever seen
11:46out of twigs from the hedgerows to support fractures in the legs of lambs or calves.
11:53So improvisation is the culture from which I've come.
12:01Vernis Smit is an animal prosthetist.
12:04He's heard of Noel by reputation and asked if he can help with his unique
12:08super-sized project.
12:09How are you Noel?
12:10Nice to see you.
12:11Nice to meet you.
12:12Nice to see you.
12:13That isn't a human foot.
12:15That is not a human foot.
12:18This is actually Khaleesi's prosthetic that we are working with at the moment.
12:28Three-year-old Khaleesi lives at the world's first rhino orphanage.
12:32He was just a few months old when a pack of hyenas attacked him and his mother.
12:38Khaleesi is such a brilliant rhino.
12:40He's got such a good character.
12:42He's been here for three years.
12:44He was mauled by hyenas.
12:47They grabbed him by the hind foot and pulled him everywhere.
12:51Dr Pierre treated Khaleesi's wounds, but part of his foot bones had been eaten away.
12:57Every male rhino is a precious hope for the future of the species, so the team reached
13:02out for help.
13:04And Werner answered their call, designing and building the world's first prosthetic foot
13:10for a rhino.
13:11We had a few issues, definitely.
13:14It is the first in the world, so you have to come up with solutions yourself.
13:23Werner has had to adapt the prosthetic as Khaleesi has grown.
13:28He is currently working on a new version strong enough to support Khaleesi's growing weight.
13:34I really have challenges, so I would really like to hear Noel's input and I believe that
13:43he can give us some good advice so that we can improve the prosthetic for Khaleesi.
13:49So, tell me what you're doing here now.
13:54Yeah, so Hyenas caught him and they damaged Khaleesi's growth place.
13:59So, one paw is now six centimetres shorter than the other side.
14:04And that's causing back pain and he's starting to develop scoliosis.
14:09So, we want to add six centimetres at the bottom to take the strain off the other side.
14:16I'm absolutely intrigued by the shortness of that tibia.
14:20Look at the fibula, amazing.
14:22Yeah.
14:23Werner has been hunting for the right material to help increase the height of the boot,
14:28to even out the length of Khaleesi's hind limbs.
14:31If we make a four centimetre recess here, we effectively make a silicone pad
14:39so that there is some comfort for that bulging tissue.
14:43Definitely.
14:44But not hardening like foam would.
14:46Yeah.
14:47Yeah?
14:48And a bit of stroke absorption.
14:49Yeah, well exactly.
14:50Noel and Werner's joint effort should help spread Khaleesi's weight across his hind legs
14:55and realign his spine.
14:57So, there is going to be a gap to work in here, but we're going to have to work from the inside
15:01because the outside must be as strong as possible.
15:05Yes.
15:06I mean, it's not going to be easy, that's for sure.
15:09Werner has a few days to make changes to Khaleesi's boot
15:13before he and Noel test it out at the rhino orphanage.
15:17To work with Dr. Noel is really a big privilege.
15:22The way he's thinking is completely different to the normal.
15:27It makes you think, and I like that.
15:30200 miles away, the team at Lions Rock Big Cat Sanctuary are also preparing for a visit from Noel.
15:45So everything's in, yeah.
15:47Over a hundred big cats live at Lions Rock, rescued from all over the world.
15:53Noel has been asked to see if his experience in the UK can help these wild cats,
15:58many of whom are suffering with limb deformities and osteoarthritis
16:02due to mistreatment and captive breeding.
16:05All the big cats which were rescued from really bad circumstances, in circuses or in private keeping
16:14or entertainment, it's very hard to believe that people would use such beautiful creatures
16:20and treat them in that way.
16:23At Lions Rock, the big cats live in huge enclosures on the 1,200 hectare reserve.
16:30And he's a little crocodile, sometimes he takes my forceps.
16:35All these animals, they feel like my animals.
16:39Good boy!
16:41They mean the world to me.
16:43I want to improve their lives as best as we can.
16:48It's very rewarding to see them rehabilitate and to give them that second chance which they deserve.
16:58Hi guys, how are you?
16:59We're fine, thank you.
17:02So when I come and see you, tell me how I can best help you.
17:06Yeah, so we were thinking about two animals.
17:10One is Lazis, he's a tiger and he's been lame for quite some time.
17:15And my understanding is that you have a lion that has deformity of the limbs as a result of some nutritional issues.
17:22Is that right?
17:24Yes, that would be Ricky.
17:26It was kept as a private pet.
17:29I have some equipment arriving that will allow me not only to see inside the joint, but also to check the level of cartilage wear.
17:36What we're really hoping to do is treat the pain in the joint with some anti-inflammatory of natural origin.
17:43Yeah, that sounds great. We are excited about it.
17:46Hopefully all the stars align and the different pieces of cape.
17:52Yeah, there's no point in Batman turning up without his cape.
17:56And this is South Africa, just saying.
18:01I know, we're going to do our best and we're going to cross our paws and everything will be fine.
18:07I'm excited to come and see you guys.
18:10Thank you so much.
18:11See you soon.
18:12See you soon.
18:13See you soon.
18:14Are all those rhino?
18:15Yeah.
18:16Quite a large population.
18:17Before Noel heads to Lions Rock, he has arranged to meet prosthetist Werner at Khaleesi's home, the Rhino Orphanage, to test out the new problem.
18:35It's an amazing spot, surrounded by forests and mountains. But I'm not allowed to tell you where it is, because if the wrong people were to find out, that would be very bad news for the rhino.
19:05The rhino orphanage is a vital sanctuary for rhino calves, who've been orphaned through poaching.
19:12We just try and save as many babies as we possibly can, so that they can contribute to saving iconic species.
19:23The orphanage looks after the young rhinos until they are old enough to be released back into the wild.
19:30Oh, hi gentlemen. How are you?
19:32Hi.
19:33You must be Ari. Lovely to see you.
19:34Nice meeting you.
19:35Thank you so much for having me here.
19:36Welcome, Pierre.
19:37Today, Noel will help fit three-year-old rhino Khaleesi with his new prosthetic foot.
19:43I'm very excited about learning about rhino orthopaedics. It's an extraordinary privilege and honour to be able to deal with a different species.
19:54Werner and Noel agreed to redesign the boot with a four centimetre padding.
19:58My God, the Paris fashion lines have nothing by comparison to this.
20:05It is one of the strongest boots I've ever made, so it should be very comfortable for Khaleesi to walk in it.
20:11Okay, okay, okay, okay, okay, okay, okay.
20:16But sedating Khaleesi for his fitting...
20:21Come, come.
20:23...is a delicate dance of man versus rhino.
20:26He's having a pop.
20:27Right, let's walk him through the shade or...
20:29Come on.
20:30Come on, mate.
20:32I enjoy to see them struggling a bit.
20:47Wrestling and rhino, look at that.
20:49Look at that.
20:50We're going towards you.
20:51Towards you.
20:53Yeah.
20:54Sitting on his...
21:04All right, big guy.
21:05You rest for a minute.
21:06Good boy.
21:07Good boy.
21:08Let's look at the foot.
21:09Some of the tendons in Khaleesi's right hind leg were severed in the hyena attack and part of his foot bones were eaten away.
21:17Noel has studied x-ray pictures of the damage.
21:21As the foot hits the ground, it's supposed to roll over and the three digits spread out like so.
21:26But because the tendons have been ripped, flexor tendons here are not pulling this toe down into the appropriate posture for walking.
21:35So the purpose of the prosthesis is, number one, to take the pressure from here and load it more favourably.
21:42And number two, to add some limb length.
21:46Let's get it on.
21:47Khaleesi's new boot is made from carbon fibre with leather straps buckled tight around his leg.
21:53Push.
21:54That's the one.
21:57That's the one.
22:01Last one.
22:04I love my job.
22:08I love your job too.
22:11Well done, matey.
22:13The new design needs to support nearly one tonne of rhino.
22:18Just about to wake up now.
22:21Here we go.
22:22And we're out.
22:23Well done, mate.
22:24Okay.
22:25Khaleesi.
22:26Good boy.
22:27Well done, Khaleesi.
22:28So far it looks good.
22:29His spine looks straighter, doesn't it?
22:30Yeah.
22:31It'll take more or less a day or two to get used to it and walk properly again.
22:35Walk normally.
22:36Look, he's meeting his friend.
22:37Yeah.
22:38Yeah.
22:39The feeling it brings for when fitting and prosthetic on a wild animal is really indescribable.
22:44It makes you feel like you're doing something to better the world.
22:45Yeah.
22:46Yeah.
22:47Running.
22:48Running.
22:49Running.
22:50Running.
22:51Look.
22:52Running.
22:53Look.
22:54Look, look, look, look, look, look, look, look.
22:55Running.
22:56Oh my goodness.
22:57Oh my goodness.
22:58Wowzers.
22:59Amazing.
23:00Yeah.
23:01Oh, hang on.
23:02Oh, hang on.
23:03Oh man.
23:04Might have come off.
23:05Yeah, that's a bit of a don.
23:06Yeah.
23:07That's a lot of fun.
23:08I mean, I can't get a lot of fun.
23:09It's just that.
23:10The feeling he's got is the feeling of a prosthetic on a wild animal, it makes you feel
23:14like you are doing something to better the world.
23:16Running.
23:17Running.
23:18Look, look, look, look.
23:20Running.
23:22Oh my goodness.
23:24Oh my goodness.
23:28Wowzers.
23:29Amazing.
23:30Yeah, that's everything the straps have broke.
23:33The straps broke?
23:34Yeah.
23:35Yeah.
23:36Despite Werner and Noel's best efforts, Khaleesi's new boot has come apart.
23:45It actually worked too well.
23:48Because he started running, he was comfortable running with that thing.
23:53And imagine the forces going into while he's running.
23:57I think we should think of a better way to keep it on, because the fitting is definitely good.
24:04You can see the spine is not curving anymore, but the strapping was obviously not strong enough.
24:14Snapped.
24:16Just the power going into it.
24:19Yeah.
24:20Oh man, I feel so sorry for you, all the artisan craftsmanship that went into that and then it just blows.
24:26I think we're going to need to get wider straps and you know those tent straps that hold up tents?
24:31Yeah.
24:32If we had a ratchet on it, tighten, tighten, tighten.
24:35Yeah.
24:36And then buckle down at the side, three or four of those.
24:39It definitely is part of working with wildlife.
24:42Everything is more or less a first.
24:44There's no reference you can go back to.
24:46Dr. Pia says it's also the first time he ran, so that is a real good point and we're not giving up now.
24:53You know what, it's actually more familiar to the territory that I normally walk in than I thought it would be.
25:07Because success and failure are part and parcel of trying to do difficult things.
25:14And every success stands on the shoulders of failure.
25:19And I've spent the last 25 years disproving lots of things that were cast in stone as truth.
25:27Everything is impossible until it happens.
25:32The worst thing will be not to try.
25:34So we're here.
26:00Lion's Rock.
26:02It's with equal measure of intrigue and trepidation that I come in because, of course, I've never dealt with surgery on big cats before.
26:11The biggest cat I've ever operated on is a Maine Cone.
26:13So it'll be an extraordinary privilege, I think, to be in the presence of these magnificent animals.
26:21Noel will be examining two big cats with the team at Lion's Rock.
26:25Hello, how are you?
26:26Working alongside orthopaedic wildlife specialist, Peter.
26:30Peter, nice to see you.
26:31The kit has arrived from the UK.
26:35So we're going to see Laziz and Ricky today?
26:38Yes.
26:39Good.
26:40And Noel's first patient is 15-year-old Bengal tiger Laziz.
26:44He's limping quite badly, isn't he?
26:47There are just 2,000 Bengal tigers left in the wild.
26:51Many hunted for the illegal trade in body parts.
26:54If you don't mind, I'm going to video while I can to see his gate.
26:58Laziz has lived at Lion's Rock since he was rescued six years ago.
27:02Laziz came from the Gaza Strip in a private zoo.
27:12It became publicly known in the media as the worst zoo in the world.
27:17The animals were starving and died.
27:20And Laziz was the only big cat left.
27:24Laziz and the other tigers were confined to tiny, concrete-floored cages in the war-torn city for nearly a decade.
27:32But in 2016, Laziz was brought to Lion's Rock.
27:42But the conditions in Gaza had left him with more than just mental scars.
27:47He's been lame for about almost two years, coming and going, much worse in the wintertime.
28:00Laziz is suffering with severe elbow osteoarthritis associated with growth deformities.
28:07The team are hoping Noel can help.
28:10The hope is that he will have less pain, a better mobility,
28:14and we're really hopeful that he has another good five years with us.
28:20Hello Laziz.
28:22Good boy.
28:23Good boy.
28:25Yes, I know.
28:26I know it's tough, isn't it?
28:27I'm just here to help, buddy.
28:29So what I'm doing right now is just looking at his gate,
28:32much as I would with a dog or a cat,
28:34trying to establish what's going on.
28:37He's got a significant limb deformity on both sides,
28:40but especially on the right side.
28:42Do you think that his osteoarthritis is in any way related to a developmental elbow disease,
28:49akin to what we get in dogs?
28:51What I mean by that is the fit between the ulna and the humerus,
28:55in terms of how that articulation works.
29:00Absolutely.
29:01100% spot on.
29:02That's what I've seen a lot in these bigger animals.
29:05Really?
29:06Really.
29:07Really.
29:11Ricky is the one which is in the feeding enclosure.
29:14Hello, boy.
29:15Hi, boy.
29:16I brought you visitors.
29:19Noel has also seen radiographs of Ricky.
29:22Hi, bud.
29:23A 13-year-old lion from Romania who was kept as a pet.
29:27You can see him walking and you can see his paws.
29:32When he arrived at the sanctuary, he had stunted growth and deformed front legs.
29:37He was mechanically unstable, but now he's showing a slight lump in the left leg.
29:44With lions, they've got an extremely high pain threshold.
29:47So, the moment they start showing pain, you know that they've got an advanced situation happening.
29:55They're all calling each other now.
29:58They're having a conversation.
29:59Yeah, that's usually this time of the day.
30:01They're talking to each other?
30:03Yeah.
30:04I'm a lion.
30:05I'm a lion.
30:06I'm a lion.
30:07I'm also here.
30:08Yeah.
30:09That's very normal.
30:11Tomorrow, Noel will take his first ever x-ray pictures of a lion to see if he can help Ricky.
30:17And he'll perform an arthroscopy on Laziz, an extremely rare procedure for a tiger, only ever attempted a few times worldwide.
30:27It's humbling just to be in their presence, let alone operate on them.
30:33Every day is a school day for me, so the fact that we get to share knowledge is just an incredible thing for me.
30:38If I can contribute in some small way, then I can only be a good thing.
31:08It's the morning of the big cat surgery.
31:21This is a safety zone.
31:24There's two gates for safety.
31:26Both gates will get closed, then we're in the compound.
31:32First up is Tiger Laziz.
31:34Have you pre-prepped both syringes?
31:37I'm going to load a dart now.
31:38Right.
31:39Okay, fine.
31:41Noel will perform an arthroscopy on Laziz's elbows to investigate his lameness.
31:47He then plans to use a cutting edge anti-inflammatory treatment to ease his pain.
31:52This has never been used in big cats before, so Noel and the team don't know how successful it may be.
31:57There's a little bit of worry always with new procedures, because obviously we haven't done this, so this is Noel's baby, but not ours.
32:08So yeah, we just hope everything works well and the animals are better afterwards.
32:13Six milligrams is 0.3 milligrams.
32:17Well, dealing with the big cats with anesthetic is always a little bit complicated, because you have to estimate the weight of the animal, because you can't just weigh him.
32:26You've got to estimate what kind of metabolism it has or she has.
32:29Right, shall we go?
32:45Once you've immobilized them, you start your stopwatch, you're under time pressure.
32:50We'll see how he responds now when I go there.
32:52Yeah.
32:53You're welcome to come with me, just stick on my right side, okay?
32:56Understood.
32:58I'm your right-hand man.
33:00Yeah.
33:01It means I'll be eaten first.
33:05All right, let's sneak in slowly and quietly.
33:14They are dangerous animals.
33:16You've got to be vigilant of it all the time.
33:21Because sometimes they can just jump up and be dangerous to all the surrounding people.
33:27Okay.
33:28I just want to give him something.
33:30Okay.
33:31Bring the stretcher.
33:32Quite extraordinary to see such a large animal incapacitated like this.
33:47Sedation is time limited in big cats, so the team must work fast.
33:53You need the head pulled back that way.
33:58I expected to feel completely out of my comfort zone, but because I was in the presence of a cat, albeit a bigger, bigger cat, I felt a strange sense of familiarity in spite of the wildness.
34:11Someone grab the drip for Ivy.
34:14One, two, three.
34:16This will be Noel's first ever arthroscopic procedure on a tiger.
34:21Not very different to scrubbing for any of the operations back home.
34:24We just had a larger patient.
34:27It's not a chihuahua.
34:28It should be relatively easy to get in the joint.
34:31But then famous last words.
34:35You ready?
34:37You happy?
34:39You ready?
34:41Noelle is suffering from inflammation and cartilage wear, caused by a poor fit of his elbow joint, which results in osteoarthritis.
34:51Noel will insert a large needle called a trocard, down which he will place an arthroscopy camera to examine the joint.
34:57the joint. Then he will inject anti-inflammatory, platelet-rich plasma, followed by a viscoelastic
35:05cushioning agent, which will hopefully relieve the symptoms of the arthritis.
35:10Scope going in. So this is very, very similar to the anatomy of a dog. Actually, there's
35:21really not much difference at all. It's like home from home. I just feel like I'm in a
35:25different house with a different wallpaper. Using the camera, Noel can see how much damage
35:32has been done to the cartilage inside Lazizi's elbow.
35:36Okay, this is really bad. Is this the erosive cartilage done?
35:40Yes, so that's raw bone on raw bone. That's raw bone on raw bone, I see, yeah.
35:45No cartilage at all. Nothing, yeah. So this is typically what I will see in dogs
35:49that have medial compartment disease, where the humerus wears away against the ulna because
35:54of poor fit. And this is particularly severe. If this was a medium-aged dog, for example,
36:01six, I would consider an unloading osteotomy, which is to cut the humerus in half and transfer
36:06the load to the outer part of the joint. And whilst we could do that in a tiger, he's exerting
36:11such extreme load on it that it is likely he would simply blow it apart. This is extreme.
36:18However, our objective is to gain a few years of function for Lazizi, so that's what we're
36:23going to do.
36:25Noel makes small holes in the worn away joint surface to release stem cells in an effort
36:30to reduce inflammation.
36:33We're running long and aesthetic. OK, we're good. Yeah, we're good. So give me the PRP,
36:38give me the lubricant.
36:40Platelet-rich plasma, derived from Lazizi's own blood, is injected into his elbow.
36:45That's it.
36:48He then adds the lubricating hydroelastic gel that suspends the platelets in the joint for
36:55longer.
36:56Look at that gel going in. Pushes it back. Do you see the volume effect there? We're creating
37:01an artificial cushion that will hopefully treat the inflammation and pain inside the joint.
37:06I'm super excited about this. As far as I know, this procedure has never been done in
37:11wild, big cats before. So I'm excited and elated and can't wait to see what the results are.
37:18Scope out. So we just put two tiny stitches in and our job here is done.
37:24All right, ladies and gentlemen, that's it. It's good. We're out of here.
37:29Quickly, because he's going to wake up quickly, yeah?
37:32OK, let's go.
37:33Laziz is taken back to recover in an enclosure.
37:39Whoa!
37:44It's incredible to see him waking up, because you genuinely feel like you've made a difference.
37:49And I can't tell you how special that feeling is. All of this technology is the same for
37:55a human, the same for a dog, the same for a tiger. We are all one. If people could only
38:00realise that for a moment, wouldn't the world be such a better place?
38:04Noel's first ever procedure on a tiger is complete. Now it's the turn of the king of the beasts.
38:19Right, we're going to dart.
38:22Ricky has deformed front legs due to inbreeding and a life in captivity.
38:29Got it, thank you.
38:33Noel is going to do a radiographic work-up to see if anything can be done to ease his pain.
38:42It's an extraordinary thing to touch such a magnificent animal up close. He is truly mind-blowingly gorgeous.
38:50I mean, before I came here, I'd never seen a male lion in the wild, and now I'm hunched beside one as he goes asleep.
38:59An extraordinarily humbling experience. It makes me wonder how we take so much for granted until it's gone.
39:06And, my goodness, do we have a moral responsibility to look after this guy.
39:12Get an IV guy.
39:18Okay, we're going to do a flex natural because we're interested in the growth deformity as well as the elbow.
39:24What I found the most interesting is how to position for your x-rays correctly, how to get the most out of it.
39:32Pull. Pull.
39:34So remember, it does not matter where the wrist ends up on an antebrachial growth deformity.
39:38You're referencing off the elbow in every single case.
39:41It's a lot for my brain to process, but yeah, he's a brilliant man.
39:49Ricky's radius and ulnar bones have grown at different rates, causing his forearms to twist and splay outwards.
39:56If I was straightening this, I would take a wedge out there and straighten it back and I would rotate the paw relative to the elbow to make it into a normal orientation.
40:06At the end of the day, the job of a veterinarian is to care desperately and to act within the confines of what's available.
40:14We're going to do a similar treatment to what we did with Laziz.
40:18We're going to spin down the platelets from the blood, mix it with the lubricant and then inject into both elbow joints.
40:25Noel hopes that this new treatment may alleviate Ricky's pain and also reduce the need for oral drugs, which can cause stomach and kidney problems in big cats.
40:35You ready with the PRP?
40:37I am, yeah.
40:38Thank you. Got it.
40:43Using the PRP in the joint is a totally different procedure that I was not aware of that existed.
40:49I'm excited about the prospect of not giving oral medication.
40:54It could be revolutionary for multiple of my clients.
40:58And we're out of here.
41:01Okay, well done everybody.
41:06As a team, us veterinarians work extremely well together.
41:11You're involved with Wildlife Veterinary Science now.
41:14Congratulations.
41:15I have arrived.
41:18Obviously, because it's a new procedure, we don't know how it's going to affect them.
41:22We'll be monitoring it together, seeing how well they recover.
41:27The bottom line with any first time effort to transfer technology between species is that it may not work in the way we hope.
41:36But this isn't documented anywhere.
41:38There's no book you can open and rewrite in the book now.
41:45It's been an absolute honor, truly.
41:48To be able to contribute to his quality of life is an extraordinary privilege.
41:53Yeah, absolutely. For me too.
41:55Yeah. Thank you.
41:56It's rewarding.
41:57Oh, very.
42:00You're going to be okay.
42:01Love you, mate.
42:02You're a good boy.
42:15It's November, and three months since Laziz and Ricky became the first ever wild big cats to have anti-inflammatory PRP and viscoelastic lubricant treatment for osteoarthritis.
42:36Since Noel was here, as you can see, even the environment has changed a lot. It's very green now. It was a great experience. It was great to work with Noel. He has so much knowledge to share.
42:49With Ricky and Laziz, it hasn't been as successful as we were hoping for. It doesn't mean that we're going to give up.
42:58We know now exactly what the joint, for example, who Laziz looks like. We can maybe use the next type of more gel or think about, you know, including stem cells. There's a lot more options. This is why this collaboration is so great.
43:15Biology is infinitely variable, and we are at the mercy of biology. But the important thing is we have to keep trying. I'm working with Christine, Peter, and the other vets to do the very best we can because we must progress to provide quality of life.
43:34In Pretoria, Werner has been working to improve Khaleesi's prosthetic boot and has added Noel's suggestion of ratchet straps.
43:46We adapted the straps, as Dr. Noel said. So each strap can take up to a ton. So it should hold this time.
43:55This time.
43:56Three months after the last boot failed, Khaleesi is fitted with his new super strapped boot.
44:04Come, Khaleesi.
44:06Come, Khaleesi.
44:08Come, hop, hop, hop, hop, hop, hop.
44:11Khaleesi.
44:12Here we go.
44:14We fit the boot two weeks ago, and he's actually quite comfortable on it. Checked it two weeks after the fitting,
44:23and he runs easily, walks easily.
44:32Meeting Dr. Noel was really a great privilege. I learned a lot.
44:36He really thinks out of the box using anything and everything that is available in the world.
44:44He's inquisitive. He's bloody hard working. He's got passion doing the right thing.
44:53I can't think of anything more precious in the world than being in the presence of the giants of nature telling us,
45:02come on, guys. Up your game. Look after the world a bit better.
45:07And if I could, for one moment, transfer the love that somebody feels for their dog or their cat in the United Kingdom
45:16to these animals and make us realize that this is our home too, then that would be enough.
45:22Truly, I have felt more at ease and welcomed by this environment than any place I've ever been in my life.
45:34It's quite... It's... It's overwhelmingly beautiful.
45:47It's going to be hard to go back to the real world after this.
45:49Can I just stay here? Can you guys just go home? Can I just live here?
46:04Have a great Job.
46:19.
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