- 6 days ago
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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.
00:16Past 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 gives leg.
00:39Let's go.
00:41Sometimes you have to bend the rules of mechanics to 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, bionic doggos.
01:00I'd love to work here, but I think it would be such a hard job.
01:15You'd just want to take them all home.
01:17I would.
01:18It's late afternoon at Fitzpatrick Referrals.
01:23I read that at Fitzpatrick Ferals.
01:25I was thinking they've got a whole part for feral dogs.
01:29Sick and injured animals are waiting to check in to this one-of-a-kind animal hospital.
01:35I'm Lauren.
01:36I'll be your anesthesia nurse today.
01:38And whilst a visit to the vets may not be everyone's idea of a fun day out.
01:43Oh, look at them what's going on.
01:49For nine-month-old cockapoo Betsy.
01:52Yes.
01:53It's become part of everyday life.
01:55What's going on?
01:57This is probably our tenth time down here or something like that.
02:02We've been coming since Betsy.
02:05Our dog was unfortunately hit by a van.
02:07Yes!
02:09Yes!
02:10You'd think that she'd be scared of the vets now after everything, but nope.
02:14She's amazing.
02:15Yeah, she's full of energy.
02:16I think everyone here loves her.
02:17Everyone loves Betsy.
02:23Betsy, wait.
02:24Good girl.
02:27Good girl.
02:30Silly poof.
02:35Betsy was just four months old when she was hit by a van.
02:41I was taking her out for a walk.
02:43I was trying to put her back on the lead
02:45and Betsy spotted it must have been a bird or something.
02:51And she just ran out straight across the road
02:53and a big van went right over the top of her.
02:56She had fractures all the way down her spine
02:59and she'd also torn nerves in her armpit,
03:03which meant that she lost feeling in her front right paw.
03:06Here we go.
03:07Here we go.
03:09I can't imagine the pain she must have been in.
03:11She was wagging her tail after.
03:14No!
03:17She's unbelievable.
03:20Betsy was so ill.
03:22There was multiple times that we thought that we had to let her go
03:25and she was always the most bouncy, happy puppy that you'll ever, ever see.
03:31Unable to feel her front paw, Betsy drags and tears her skin.
03:36Yeah!
03:38There's no treatment for the nerve damage.
03:40So Sophie and Dan are considering amputation
03:43but want to know if Betsy could have a custom-made prosthesis called a perfits.
03:50We're hoping this bionic foot will allow her to move around much more naturally.
03:55She's got a long life ahead of her
03:58and if we can give her the opportunity to live that on four legs instead of three,
04:02I think that's the best thing to try for.
04:04The couple are also expecting a baby in five weeks' time.
04:13We've had a big course in adulting this year, I think it's fair to say.
04:17Yeah.
04:21Until now, the cheerful cockapoo has been under the care of Fitzpatrick's neurology team.
04:27Hi guys!
04:29But as the only vet in the world performing perfit surgery,
04:32today Betsy will be meeting Noel.
04:36Hello, hello, hello, hello.
04:37You're about to pop any minute.
04:39Almost.
04:40Technically in five weeks.
04:41Alright, well listen, if it happens in here, you're in good hands.
04:43I'm all over it.
04:45What an adorable doggy.
04:46Come on, missus.
04:48Here we go.
04:49Now, so you know that what Joanna's been investigating is whether the radial nerve is working,
04:54whether the ulnar nerve is working.
04:57And what I was particularly interested to see when we were outside in the yard earlier,
05:02she can retract the limb.
05:04Now, that's critical to function.
05:06Yeah.
05:07Because if she couldn't pull that leg forward and pull it backwards from there up...
05:12It would be an easy decision, wouldn't it, really?
05:14Yes.
05:15Then we would be recommending a full limb amputation.
05:17Yeah.
05:18And this far out from the injury, if she has bicep function and if she has tricep function,
05:26I can see why it's a difficult decision for you to chop her leg off.
05:30Yeah.
05:31So, then we come to the ethical dilemma.
05:36Yeah.
05:37With a dog this size, nine out of ten people would choose to chop the leg off
05:42because this is a very light dog and can run around happily on three legs.
05:48Hmm.
05:49So, you need to understand from the get-go, of course I can do this surgery,
05:54but is it ethically right to do it?
05:56Yeah.
05:57So, my job today is to simply tell you the pros and cons.
06:01Yeah.
06:02And send you away to have a think.
06:03Yeah.
06:04The implant comprises two metal plates and one or two pegs that goes up into the bone.
06:11Yeah.
06:12The challenge is what the bit that comes through the skin.
06:14Yeah.
06:15And the reason that's a challenge is infection.
06:18Yeah.
06:19If you get a firm seal around the spigot by 21 days, you're good to go.
06:24We would generally say to people that if it's not working out by one month post-op,
06:29to take the leg off.
06:31Right.
06:32Joe's going to go and change the dressing and we'll have a look at it now.
06:34Yeah.
06:35I'll have a look at the wounds, okay?
06:36Yeah.
06:37Yeah.
06:38So, you have the facts now anyways.
06:39Yeah.
06:40Betsy's treatment will have to be reviewed by an independent ethics panel before it's
06:53given the go ahead.
06:55Every surgical procedure should be subject to appropriate ethics.
07:00And there's no blanket answer.
07:02Every patient is an individual.
07:04I know.
07:05We'll be finished.
07:06We'll be finished.
07:07Okay.
07:08As a result, we have an ethics review panel to get a consensus of opinion if the family
07:14do choose a more advanced surgical option.
07:17So, even if they get the green light, there's a lot for Sophie and Dan to consider.
07:24Well, objectively, I think based on that discussion, the...
07:30I'm trying to figure out, say the...
07:34On a probability-weighted basis.
07:37And then there's the overlap of it with...
07:41Baby Adams.
07:43Yeah.
07:44Hello.
07:45Hello.
07:46Hi.
07:47No, Betsy.
07:48She's my best friend.
07:49I love you to millions of millions of millions of millions.
07:53If she has the perfect, she'll be here for a lot, won't she?
07:55Oh, my God, I'll have a meltdown.
07:56I'm not going to work.
07:58Yes.
07:59It's not straightforward.
08:00Lots of pros and cons to weigh up, and Noel's explained all those to us, so...
08:05We've got some thinking to do.
08:06Yeah.
08:07What do you think, Betsy?
08:08Birds.
08:09Yes.
08:10Hello, puppy.
08:11Hello, puppy.
08:20Hello, puppy.
08:34Hello, puppy.
08:38I think everyone loves puppies.
08:45It's impossible not to love them.
08:48Oh, my goodness.
08:50Oh, so cute.
08:52When I see a puppy, I just need to cuddle him and kiss him.
08:55She's just amazing, right?
08:59Everyone drops what they're doing to just cuddle the puppies.
09:03It's a baby, aren't you?
09:06You see this little ball of fluff?
09:08And it's like your ovaries just start to flutter.
09:13Hi.
09:17They are so vulnerable and they need our care even more than an adult dog.
09:24Oh, my God, he is so cute.
09:26I think I need to get another puppy.
09:33Very cute.
09:38There's another puppy stealing hearts at Fitzpatrick's.
09:43I don't think she knows what to think of today at the minute.
09:49But unlike Betsy, who's a regular at the practice.
09:52Hey, Angel, Angel, don't say hello.
09:56It's nine-month-old puppy Angel's first visit.
10:00She's crumb.
10:02No, she's full.
10:03She's full.
10:04She's nine-month-old, but she's tiny.
10:07Angel was the smallest of the litter.
10:12So the other dogs, I would say, are sort of up here.
10:15So she can actually walk under there.
10:17Although dog de Bordeaux Angel is half the size she should be,
10:22it's not her pint-sized proportions that has brought her to Fitzpatrick's.
10:27So Angel got a problem with her two front legs.
10:31We have taken her to the vets and they said they hadn't come across it before.
10:36We were told that surgery may be successful.
10:40We were also told that it might not help at all.
10:44We came down for a second opinion just to see what Noel's thoughts were.
10:49Kirsty and her family have always loved dog de Bordeaux's.
10:55It started with their first dog, Bella.
10:58I had Bella from when she was nine months old and my partner wanted to breed Bella.
11:04So we did and then we had six beautiful dog de Bordeaux puppies.
11:10They were very, very noisy.
11:15I named Angel because she was really good.
11:19Angel was definitely the cutest puppy.
11:23Angel stood out right from the beginning.
11:28Because she was a bit of the runt of the litter.
11:30She wasn't getting fed as much.
11:33I had to step up and start bottle feeding her myself.
11:36In your arms, like a baby actually, yeah.
11:39So I just naturally had that bond with her from day one.
11:43I think it's safe to say she likes that.
11:48Angel!
11:49As the puppies grew, it became obvious that Angel wasn't just smaller.
11:53Sadly, like many short-nosed breeds, she had genetic problems.
11:58When we go out for a walk, her brothers and sisters run and Angel just models.
12:04We always thought, oh, she's small, she's just compensating.
12:07Maybe she's just not walking as right.
12:10But we started to notice with her front legs that they were sort of not growing
12:14as we think that they should have, sort of more as a bow defect.
12:18I'm really concerned about Angel.
12:21I just want to make sure that she gets the best treatment that she can get,
12:25get the best possible outcome.
12:27I want Angel to get better so she can be happy and healthy and run around.
12:38Hello, hello, hello, lovely people.
12:40Come on in here.
12:41Hello, mate.
12:42You're a beauty, aren't you?
12:43Oh, look at those lovely eyes.
12:45Yes.
12:46So I read the imaging report from the last place.
12:49Yeah.
12:50Why did you want a second opinion in the first place?
12:52They suggested sort of surgery to cut the top and the bottom bones.
12:56Yes.
12:57To have two external frames on each leg.
13:00But they weren't sure if it was going to be successful.
13:04So let's begin at the beginning.
13:07There's three bones.
13:08Humerus, radius, ulna.
13:11Sometimes there's an asynchronous growth between the radius and the ulna.
13:16In other words, the two bones don't grow at the same rate,
13:18the origin of which is genetic.
13:21And as a result, this acts like a bow string and this acts like a bow.
13:27Growth deformity occurs because of premature closure of the growth plate in the ulna.
13:34So that's keeping growing and that one isn't.
13:37You with me?
13:38Yeah.
13:39It subluxates the radial head.
13:42It pushes it out of the joint.
13:44Because it's in a finite space and it wants to keep growing.
13:47Pushing it that way.
13:49So the question is, is she actually going to get worse?
13:53So it looks to me like on this CT scan that that growth plate in the radius is still wide open.
14:00Which means the leg's going to bend more.
14:03So I, my opinion is we should take a chunk out of the ulna here and allow the radius,
14:11the breathing space it needs to complete its growth.
14:14I do not think that we should go down the route of a major and expensive surgery
14:19because I think that she'll probably cope without it.
14:22Yeah, that's great.
14:23That's, yeah.
14:24Okay?
14:25Yeah.
14:26Do you want me to proceed?
14:27Yeah.
14:28Right, missus.
14:30You're going to come and meet all the girls and they'll all fall in love with you.
14:35Oh, I didn't expect that.
14:37Oh, you didn't?
14:39No.
14:40You happy enough to leave her?
14:42Yeah, yeah.
14:43Yeah, time is of the essence, I think.
14:45Aw, I love you so much.
14:49All right, missus.
14:51Good girl.
14:52All right, cuddle monster incoming.
14:56Sometimes the patients presented to me warrant complex surgical intervention, but simple
15:03solutions should always be considered.
15:05And for me, it is what is in the best interest of this individual patient.
15:11For Angel, an age old technique may provide a very satisfactory solution.
15:16I feel much more positive than I did this morning, that it's, you know, a simpler surgery.
15:23Hello, lovely girl.
15:24How are you?
15:25I just feel a bit sad because I've just had to say goodbye to her and wasn't really expecting
15:30that today, but I know she's in the best hands, so she'll be just fine.
15:35Very good girl.
15:37You're ridiculously cute.
15:48You're nice too.
15:50Aw, okay, okay.
15:51I'm going to be in the middle.
15:52Right, that's fine.
15:53That's all right.
15:54Stay, but don't get too excited.
15:56I mean.
16:02Good girl.
16:04All right, okay.
16:05Cockapoo Betsy wasn't due back at Fitzpatrick's for another week.
16:09Oh man.
16:10That's, that's, that's really horrendous.
16:16But this afternoon, the nine months old puppy has been rushed in with a badly infected foot.
16:27Just can't unsee that gruesome, rotting core.
16:31Yeah, it was bad.
16:35We've got an acutely critical situation.
16:38And I'm going to need to have a very serious chat with mum and dad.
16:41All right, sweetie pie.
16:45We've been to the local animal hospital today, and they described it as her toes are actually falling off.
16:52The next level of concern, I think, is that the operation that we thought she was going to have is not going to be possible now because of the level of infection in her leg.
17:02So we might be, I feel like we've come here to have a conversation with Noel about a full amputation today.
17:07Which is not what we were hoping for, but we had in mind as an outcome.
17:14Betsy is still waiting for a decision from the ethics review about her perfits, but this infection may change everything.
17:26I just feel, like, I don't know, like, guilty or something.
17:34Guilty?
17:35Well, yeah, because, like, we'd been the ones doing the bandages and stuff.
17:42Hi, guys.
17:43I'm just going to chat to you where you are, if that's OK.
17:45Yeah.
17:46Got to maintain social distancing, so we're all set.
17:49It's bad.
17:50Yeah.
17:51Did the one just get worse and worse?
17:53Actually, on Wednesday night, it looked fine.
17:55And then it started smelling really badly, and we realised it was the dressing, and we took it off this morning, and it was just like, holy shit.
18:02It's the worst thing I've ever smelled.
18:05I just don't know, I don't understand what happened in the course of a week.
18:08I think that you've got a combination of abnormal sensation, sweating and impairment of blood supply, and necrosis has ensued.
18:23Is it normal for it to progress that quickly?
18:25There's nothing about this is normal.
18:29This does change the ball game in terms of what we do next, because I have to take the foot off.
18:34Yeah.
18:35We truly can't know if bacteria from that lesion gives rise to bacteria elsewhere, which can affect a stump.
18:48Yeah.
18:49So the infection could come back.
18:51So it could be quiescent there that we don't know about.
18:54And right now, we only have two options.
18:59So option one is to do a partial amputation above that site and see how that heals, and then consider a limb amputation prosthesis into that stump at a later date.
19:09Right.
19:11And option two is to take the full limb off.
19:15So, you don't need to make a decision right now.
19:21We will take care of her here.
19:23She needs to stay here now.
19:24Yeah, yeah.
19:25Last thing I want to stress for you.
19:26Don't, don't, I don't want that on my conscience, and I don't want it on your conscience.
19:30Don't get stressed.
19:31No, it's, it's...
19:32Leave the stress of your other baby to me.
19:34Okay.
19:35Okay.
19:36We, uh, need to decide whether we do a full amputation now or have a partial amputation.
19:45Um, and then in a month's time, try and do the implant operation.
19:49But if there's any sign of infection, you can't go on and put an implant into her bone.
19:55I mean, that's just too risky.
19:58So we'll see.
19:59I'm sure it'll, it'll work out in the end.
20:01That's our attitude to everything in life.
20:03So, be fine.
20:22There's too many lunches.
20:24Can people just not need lunch?
20:26Then life would be a lot easier.
20:28Angel, darling.
20:30Sleepy.
20:31Sleepy sleeps.
20:33Angel, the bijou dog de Bordeaux, is being prepped for surgery.
20:39Good.
20:40That hit the spot, didn't it, Angel?
20:44The puppy's radius bones have grown more than her ulnar bones, bending her front legs out of shape.
20:50Right, let's go.
20:51Noel is going to attempt to address the deformity and give her a better quality of life.
20:59This is the joint surface here.
21:01This is the growth plate here.
21:03I'm putting a screw below the growth plate and above the growth plate and I'm going to bridge it on the inside here.
21:12To prevent Angel's still growing bones from distorting any further, Noel puts wire, in a figure of eight, between the screws to act as a bridge and halt the growth on that side.
21:24This bridge will mean that the growth plate is going to stop growing as long as the bridge is in there.
21:29So this side won't grow.
21:30That side will grow a bit more.
21:32And it will push the paw, hopefully, a bit more towards here.
21:37Two metric ethylon, please.
21:39Right, we're going to do a second part of the procedure now, which is to chop out a segment of the ulna on both sides.
21:48Removing a section of the ulna will relieve the bowstring effect and stop the leg bending any further.
21:55I'm just going to pack it with collagen now.
22:11That stops the bleeding.
22:20Noel then performs the same surgery on Angel's left forearm.
22:25If the bridge I've put in there across the growth plate is causing too much ceasing of growth, then the foot could turn the opposite way.
22:35I may need to take this bridge out at a later date, depending on how things go.
22:40Hopefully this will get a good result for Angel.
22:44Alright, drop her slowly, move her back.
22:47There we go now, Angel. Well done. That's much better, isn't it? Good girl.
22:51It will be several weeks before Angel's legs stop growing.
22:56Only then will Noel know if the life-changing surgery has been a success.
23:01Come on, Angel. Angel.
23:02You've got to wake up. Come on. Make you wake me.
23:13In theatre two, Cockapoo Betsy's infected foot is about to be removed.
23:25Tail clip.
23:26After consulting with Noel and much deliberation, Sophie and Dan decided against amputating the whole leg.
23:35Jack the table up, please.
23:37In the hope that if they get the green light from the ethics review, they may be able to proceed with the perfits if the infection clears up.
23:44I'm placing a tourniquet around the leg.
23:49And that stops it bleeding while I chop the foot off.
23:55Takes about 60 seconds.
24:00OK, so now we've got a stump and we've removed the infected foot.
24:05Betsy will have a course of antibiotics.
24:08Well done, Betsy. Good girl.
24:10Good girl.
24:11And there's a chance that in a few weeks' time she may finally get her bionic foot.
24:35Oh, babe.
24:36Mwah.
24:38Carefree Cockapoo Betsy is back at Fitzpatrick's.
24:43Do you want this?
24:45But this time, she's not alone.
24:48Good boy, Hugo.
24:50You're trying.
24:53The happy-go-lucky pup has been as accepting of new baby brother Hugo as she is of everything else in her life.
25:00We were surprised that she's not that bothered, but she seems to recognise that this is a small person, not an animal.
25:06Don't you?
25:07Not a cat.
25:09We'll wait until he starts trying to ride her around the place or feeding her all her treats out of the cupboard.
25:15You're going to be in cahoots, aren't you?
25:18Yes.
25:19She's going to be in cahoots and crying, yeah.
25:21Since Betsy's gangrenous paw was removed, there's been no sign of infection.
25:28And after being given the go-ahead from the ethics review…
25:32Right.
25:33…a little scamp.
25:35Sophie and Anne have decided to proceed with the perfect surgery.
25:39Oh, look at that waggy tail.
25:41Always wagging.
25:43Betsy may be facing another operation…
25:46Yay, Betsy!
25:49Yay!
25:51…but she's delighted to see her Fitzpatrick's family.
25:54Betsy is happiness in a little fluffy black ball.
26:00Yay!
26:01Yay!
26:05She is always just so happy to see everyone.
26:08Yeah, look at me!
26:10Look at me!
26:12She basically grew up with us, and I think she feels like a part of this family.
26:19Betsy-boop!
26:21Betsy-boop, Betsy-boop, Betsy-boop, Betsy-boop!
26:23I think that she knows that we saved her life.
26:27I miss you, Betsy.
26:28She's very grateful.
26:30She really deserves to have the best that life can give her.
26:38Life and us can give her.
26:41Can you have a new foot?
26:43Can you have a new foot?
26:45Yes!
26:46Betsy-boop.
26:47She's just the best dog.
26:50We're going to put the Perfids device inside Betsy's leg now.
26:55A lot of people think that a bionic limb is any limb that just fits on a human or an animal.
27:01That's not true.
27:02The vast majority of so-called bionic limbs are just a socket that fits on the stump and does not directly link onto the skeleton.
27:10Perfids are a permanent part of the body, but of course their success depends on mechanical and biological factors.
27:19And if infection gets in, that's a massive problem.
27:29Table up, please.
27:31To give Betsy her bionic foot, Noel begins by removing the lower part of her remaining limb.
27:36We've taken the carpal bones away now. The wrist is gone.
27:45Then he uses 3D printed cutting guides
27:52to shape the radius and ulnar bones ready for the implant.
27:55We'll leave as much of the skin as we can at this stage.
28:13Betsy's endoprosthesis consists of five elements.
28:17A peg is inserted into the radius.
28:20The radius and ulnar bones sit on a platform.
28:23Two plates are secured to the bones with overlapping locking screws.
28:28Bone graft from the amputated bone is packed between the radius and ulnar.
28:34Then the muscle is stitched onto one half of a mesh dome and the skin onto the other.
28:40Finally, an external prosthesis is attached to the spigot of the implant using a clamp.
28:45After drilling a hole inside the radius, Noel pops the implant into position.
28:58It should fit like a glove because we've measured it like so.
29:01Okay, so now we screw the plates onto the bone.
29:10After packing in the bone graft, Noel can stitch up.
29:16So the skin will gradually shrink onto the dome in coming days and hopefully it would form a permanent seal around the end of the metal so that the infection can't get in.
29:31And if infection gets in, that's a massive problem.
29:34Give me the foot, please.
29:38Finally, the exoprosthesis, which is Betsy's new foot, is screwed into place.
29:43An hour can be the difference between having a leg and not having a leg.
29:48Right, Betsy, there you go. You've got a new bionic paw, sweetheart.
29:59With the mechanics in place, it's now down to biology.
30:03Only if the skin seals and Betsy avoids infection will the surgery be a success.
30:09In the wards, nine-month-old Angel is recovering from the operation to treat her bowed front limbs.
30:30I can't believe we're going to see her.
30:32Now three days since the surgery, Kirstie and daughter Freya have arrived to take the puppy home.
30:40It's been horrible, hasn't it? It's been, oh, it's been emotional.
30:45We've got three days' worth of kiddles and snuggles to give her, so she's going to get loads of attention.
30:50She's your doggie, isn't she? So you picked her, yeah.
30:54And she's little like us, too.
30:57Hiya.
30:58Hello. I don't think we've met before, have we?
31:01No.
31:02What's your name? Freya.
31:04And who's that friend you've got there? What's this one's name?
31:07Mini Angel.
31:08Mini Angel.
31:10Oh, I see. So that's Mini Angel, and I've been looking after Maxi Angel.
31:15Have I? Yeah.
31:16Yeah.
31:17All right, well, Maxi Angel is doing very well.
31:19Oh, brilliant.
31:20So, Mummy, what I've done is I've taken a bit out of the ulna and I've put a bridge across here.
31:26Yeah.
31:27And what this bridge does is it stops that bit growing.
31:30Yeah.
31:31This bit may grow more and push the foot back in.
31:34Perfect, yeah.
31:35I may have to take that out.
31:36Yeah.
31:37In a few weeks' time, depending on how things go.
31:40Yeah.
31:41Are we ready for little Angel to see big Angel?
31:43Yeah.
31:44Okay.
31:45Here we go.
31:48Now, who've we got here, Angel?
31:50Angel!
31:51Now, there we go.
31:53Angel!
31:54There we go.
31:55Look at that.
31:56Oh, baby!
31:57Look at that.
31:58Wow.
31:59Doesn't she look well?
32:00Oh, thanks so much.
32:01Yeah, perfect.
32:02Well done, Angel.
32:03Thanks ever so much.
32:04No problem.
32:05Oh, amazing.
32:06I've missed her so much.
32:07So, oh, I can't even explain how happy I am to have her back.
32:14Yeah, as you can see, she's quite energetic.
32:17So, it's going to be, I think, quite difficult.
32:20But, I mean, it's got to be done.
32:22So, we'll find a way.
32:23Hey, we'll find a way.
32:25We'll find a way.
32:42Oh, you look good, yes.
32:44Yes, she's very good.
32:46Oh, she's so good.
32:48Look at her.
32:49Good.
32:52Since her bionic limb surgery last week,
32:54Kisses everywhere.
32:55Kisses everywhere.
32:56Hello, mammon.
32:57Eager to please puppy, Betsy, has been having daily bandage changes.
33:02Good girl.
33:03To check if the skin is sealing.
33:06So far, so good.
33:07Good girl, Betsy.
33:09And to make sure there's no sign of infection.
33:13Scratching my head, because with a faster collar, you cannot.
33:16Can you?
33:17Yeah.
33:18Hi, mate.
33:19Hi.
33:20Hi.
33:21Hi, buddy.
33:22Please don't bless anyone.
33:23Betsy's doing pretty good.
33:25She's now five days post-op, and she is standing on the leg.
33:32That's not good.
33:33All right.
33:34Hmm.
33:35Right.
33:36I need to ring mom.
33:37I'm going to need to open it up.
33:38Can you get Lisa to get the Allen keys so I can take the foot off, please?
33:47This dog's now going to have to go to ISO.
33:52Oh, Betsy.
33:53Hello.
33:54Oh, hi, Dan.
33:55It's Noel here.
33:56So as you know, we're changing the dressing daily on Betsy.
33:59Unfortunately, there is discharge from the wound tonight of probably the same bacteria
34:19that was in the foot originally.
34:22And that leaves us with only two options, trying to treat the infection or taking the
34:27leg off entirely.
34:28What's the option then in terms of trying to treat it?
34:33The option is open up all the skin around the dome, flush it, and then try and re-suture
34:39at a later date.
34:41But of course, there's the ethical issues of putting her through all of that.
34:45And we either go down that route for a few days and see, or we go for fully amputation
34:52in the next 24, 48 hours.
34:54Yeah.
34:55And there's no guarantee that if you manage to clear this infection, she wouldn't get
35:00another one, right?
35:02That's right.
35:04She's in good spirits.
35:06It's not affecting her in terms of her demeanor.
35:10But clearly, we could fail no matter what we do now.
35:18One of the reasons why limb amputation prosthesis surgery is not more widely adopted is failure.
35:25When you've put more than a decade of effort into the evolution of the prosthesis and the engineering
35:32and surgery have all gone to plan, but yet biology doesn't smile, it's utterly devastating.
35:41Can I have the key, please?
35:44Most people do opt for full limb amputation, which is entirely reasonable.
35:50But at every stage, you discuss the ethics with the family, and if they choose to fight
35:56on, then decisive and definitive action is required because you're fighting a war, and
36:02you've got one week to win that war, or that limb is lost.
36:07Any further treatment must be ethically in Betsy's best interest, but action cannot be delayed.
36:15Tonight, I'm going to treat the infection, and overnight, Sophie and Dan are going to
36:20decide if they want me to take the limb off completely.
36:25The area is flushed with saline.
36:28Be conscious that everything you touch has bugs on it.
36:32Then Noel makes an attack on the bacteria, causing the infection.
36:36We will only do this for a very limited time period because otherwise it's not in Betsy's best interest.
36:49We're seeking to decolonize the area, then we're going to give antibiotics, and we're going to pray.
37:06It's been six weeks now since Angel the puppy with little limbs had surgery on her bowed front legs.
37:19Angel!
37:21She's been on cage rest at home.
37:25It's definitely like having a baby, full-time work, but to be fair, she hasn't cried one, she hasn't wimpered.
37:31She's been excellent, yeah.
37:34Angel!
37:35Noel wants to check if he needs to remove the screw and wire bridges he put into Angel's legs.
37:41Oh, it's Angel!
37:44If the scan shows the bones are twisting in the other direction,
37:47Angel could face further surgery.
37:53Hi guys, come on in.
38:10So, what you will notice is that that growth plate is now closed.
38:20There's going to be no more growth there.
38:23Yeah.
38:24Which is good.
38:25Also, what you'll notice is that the wrist straightened up a bit because the growth continued a bit on the outside for a few more weeks.
38:33And the ulna is filling in with fibrous tissue which is becoming bone.
38:37So, I'm happy to say that we do not need to take the implants out and that, in fact, her legs are perfectly functional and happy.
38:45In terms of, like, exercise...
38:48In terms of exercise now, my strong advice to you is get her fit and don't let her get fat.
38:53Yeah.
38:54Because she'll have a big body and short legs and there's nothing you can do about that.
38:58Right.
38:59At least you've saved her from significant joint incongruity, significant osteoarthritis.
39:05And that is a massive thing you've done for her.
39:11Cheers!
39:12Oh, my God.
39:13I am absolutely over the moon.
39:16We've got to make sure that she stays fit and healthy because we don't want to put any pressure on her bones, really.
39:21And, erm, he doesn't have to do any more operations at all.
39:25So, that was the best result that we could have got today.
39:28Good girl. Come on, then.
39:38Well done, Betsy. Good girl.
39:41In the isolation ward...
39:43You're such a good girl. Well done.
39:45It's been a tense few weeks.
39:48Betsy's been in isolation now for the last couple of weeks because of the infection in her leg.
39:54Now the skin looks good.
39:57The plucky pup has overcome infection again.
40:01And she's got the all clear to go home.
40:07We've been really looking forward to bringing her home.
40:10We weren't sure if we'd get to bring her home this soon.
40:13So, I'm very excited.
40:15Hugo's very excited.
40:17He looks really excited.
40:24How are you today and how's Hugo?
40:26He's good.
40:27He's doing well today.
40:28He was having a bit of a wear.
40:29I heard it.
40:30I heard it.
40:31Erm, so far you've been incredibly unlucky and incredibly lucky.
40:35Yep.
40:36You've been incredibly unlucky that the infection from the gangrene foot came back.
40:40You've been incredibly lucky that so far the revision surgery has worked.
40:46Most people opt for amputation at that point.
40:50One of your interns can write a nice case report.
40:52Yes.
40:53Yes.
40:54Well, everything in science is going to be based on evidence.
40:57Any questions before the missile comes through the door?
40:59The missile of love.
41:01To what extent do we need to keep her limb kind of protected?
41:05You don't need to protect her limb.
41:06You don't need to protect her limb.
41:07You need to protect yourself from her knocking you out with her limb.
41:10Right.
41:11Because this is like a pogo stick of pudge.
41:14Yeah.
41:15I'll get her.
41:16Oh.
41:17No, missus.
41:18Come on.
41:19There we go.
41:20Look at you.
41:21Hi.
41:22Look at you.
41:23Bionic doggo.
41:24Bionic doggo.
41:25Oh, I can see you could do some damage with that.
41:27Wow.
41:28Yeah, she would definitely bash you with that foot.
41:30Yeah.
41:31Yeah.
41:32Yes.
41:33Well done.
41:34Shall we walk outside a little bit and just show you the walk?
41:41Come on then.
41:43At last, Betsy has her bionic foot.
41:47But she's still got some practicing to do.
41:49Yeah, that's it.
41:50Perfect.
41:51Just a one foot rope.
41:52A little shorter.
41:53A little shorter, please.
41:54That's it.
41:55That's it.
41:56And she'll get the hang of it over time.
41:57She just, when she calms down, she uses it much better.
42:00Yeah.
42:01All right.
42:02Well done, missus.
42:03Well done.
42:04We love you.
42:05And we shall miss you.
42:06Seven months since the accident.
42:08Thanks dog.
42:09Okay.
42:10God bless.
42:11It's a moment the family thought they'd never see.
42:15It's been such a long journey.
42:17It's a huge relief.
42:18Just amazing.
42:20So happy.
42:21It was the right decision to have one last try at saving it.
42:27Look at your silly cone head.
42:29Good girl.
42:36Angel!
42:37As part of Angel's recovery, Noel recommended that we took her to some hosier therapy sessions, just to help age with her recovery and to build her strength back up.
42:56Yeah.
42:57It's ten weeks since she had the surgery on both her front legs.
43:02Yeah.
43:03She's going really well.
43:04We've had to keep her on strict bed rest.
43:06I think it's been harder because she's a puppy.
43:09But obviously, we've had to make sure that we've quite strict with her.
43:12Angel!
43:13Well done.
43:14Now, she's allowed out with one of her brothers.
43:20Oh, it's brilliant.
43:21It's so nice to see her out and about and playing.
43:24That's all we could have ever hoped for, really.
43:26And as you can see, she's loving it.
43:28No pain at all.
43:29So, yeah, it's absolutely fantastic.
43:31Let's go!
43:32It makes me feel happy that Angel actually gets to run around with her brother for the first time in ages.
43:47It's like she's got a new lease of life, just wants to get out for a walk, so she's absolutely loving life.
43:53Yeah, she's loving life.
43:55Come on, baby.
43:56Come on, you can do it.
43:59Absolutely over the moon, yeah.
44:01Yeah.
44:10Good girl, Betsy.
44:11Show us your foot.
44:12Come on.
44:13Yeah.
44:15It's been nearly a year since the accident that left puppy Betsy in a critical condition and unable to use her right front paw.
44:25Good girl.
44:28Betsy's doing really well.
44:29She's taken to this new foot and she's just so happy.
44:32She's amazingly quick on it, especially when running after the cat in the house.
44:37She's running so well.
44:39She's like a normal dog.
44:41Wait until she finds out how to use it to dig.
44:44It did at times feel like everything was against Betsy.
44:51And she's off again.
44:53The second infection was really a blow.
44:56I mean, I thought after everything that we'd done, we were going to have to amputate her leg.
45:01And it was, yeah, it was really hard.
45:04Good girl.
45:05Good girl.
45:07So then when Noel managed to save it, it was amazing.
45:12I feel like Betsy is the reason why we are here.
45:17You know, because it would have been so easy to have given up on Betsy from day one.
45:23Snow.
45:24You've never seen snow before.
45:25And I think Betsy just represents what teamwork and family can achieve when we actually believe that the outcome can be successful.
45:36I think we're very glad that we possessed it through all the complications she had.
45:40You know, we had to take some risks along the way, but we're very lucky in that it's all paid off.
45:45We're here today with Betsy on her, all four balls.
45:53Good girl.
46:15Good girl.
46:16Good girl.
46:17Guess what she made it through with Theini's Program?
46:18Good girl.
46:20Good girl.
46:22ожал intelligence.
46:23Welcome to Natalie影 we had 16 months after дум when you had a fever.
46:27You were already there.
46:30Sometimes we couldn't.
46:32It was just, you know, when you asked her, what she did and cannot live.
46:36Hurting.
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