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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
09:02you
09:04you
09:08you
09:10you
09:14It's unbelievable when you're up close with that majesty, I mean what a glorious, glorious
09:24animal.
09:27Today, 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
09:46of days.
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, but 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
10:11rest?
10:12And so it goes way beyond just the rhino, it'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 animals.
10:28I can't help but think of the battles that these people are facing every single day to conserve
10:35species.
10:36You know, my job back home is to look after the welfare of a cat or a dog.
10:42Their job is to look after a species on the edge of extinction.
10:46I really hope that I can make some kind of difference.
10:48It's Patrick O'Farrell's orthopaedic and neurology, Kate speaking, how can I help?
11:08I know, sorry, Noel's in Africa at the moment.
11:14Noel is a long way from leafy godalming.
11:19The fight for the rhino has brought him to South Africa's capital.
11:23What 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.
11:34Noel has spent the last 15 years pioneering bionic limbs for cats and dogs.
11:40Where 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, super-sized
12:09project.
12:10How are you, Noel?
12:11Nice to see you.
12:12Nice to meet you.
12:13I'm very nice.
12:14That isn't a human foot.
12:15That is not a human foot.
12:17This is actually Khaleesi's prosthetic that we...
12:20Oh, this is Khaleesi's cast.
12:22...are working with at the moment.
12:26Three-year-old Khaleesi lives at the world's first rhino orphanage.
12:33He was just a few months old when a pack of hyenas attacked him and his mother.
12:38Khaleesi is such a brilliant rhino.
12:41He's got such a good character.
12:42He's been here for three years.
12:45Khaleesi's was molded by hyenas.
12:47They grabbed him by the hand foot and pulled him everywhere.
12:51Dr. Pierre treated Khaleesi's wounds, but part of his foot bones had been eaten away.
12:58Every male rhino is a precious hope for the future of the species.
13:01So the team reached out for help.
13:04And Werner answered their call.
13:07Designing and building the world's first prosthetic foot for 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.
13:21Werner has had to adapt the prosthetic as Khaleesi has grown.
13:29He is currently working on a new version strong enough to support Khaleesi's growing weight.
13:36I 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.
13:48So tell me what you're doing here now.
13:53Yeah, so hyenas caught him and they damaged Khaleesi's growth place.
13:59So one paw is now six centimeters shorter than the other side.
14:03And that's causing back pain and he's starting to develop scoliosis.
14:08So we want to add six centimeters at the bottom to take the strain off the other side.
14:13I'm absolutely intrigued by the shortness of that tibia.
14:19Look at the fibula. Amazing.
14:21Yeah.
14:22Werner has been hunting for the right material to help increase the height of the boot,
14:27to even out the length of Khaleesi's hind limbs.
14:30If we make a four centimeter recess here, we effectively make a silicone pad so 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 and realign his spine.
14:56So there is going to be a gap to work in here, but we're going to have to work from the inside because the outside must be as strong as possible.
15:04Yes.
15:05I mean, it's not going to be easy, that's for sure.
15:08Werner has a few days to make changes to Khaleesi's boot before 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.
15:30Two hundred miles away the team at Lions Rock Big Cat Sanctuary are also preparing for a visit from Noel.
15:44So everything's in, yeah.
15:47Over a hundred big cats live at Lions Rock, rescued from all over the world.
15:52Noel has been asked to see if his experience in the UK can help these wild cats, many of whom are suffering with limb deformities.
15:58Many of whom are suffering with limb deformities and osteoarthritis due to mistreatment and
16:04captive breeding.
16:07All the big cats which were rescued from really bad circumstances, in circuses or in private
16:14keeping or entertainment, it's very hard to believe that people would use such beautiful
16:20creatures and treat them in that way.
16:24At Lions Rock, the big cats live in huge enclosures on the 1,200 hectare reserve.
16:32And he's a little crocodile, sometimes he takes my forceps.
16:35All these animals, they feel like my animals.
16:38Good boy!
16:41They mean the world to me.
16:43I want to improve their lives as best as we can.
16:49It's very rewarding to see them rehabilitate and to give them that second chance.
16:54Which they deserve.
16:56Hi 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.
17:15My understanding is that you have a lion that has deformity of the limbs as a result of some
17:22nutritional issues.
17:23Is 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
17:34to check the level of cartilage where what we're really hoping to do is treat the pain
17:39in the joint with some anti-inflammatory of natural origin.
17:43Yeah, that sounds great.
17:44We are excited about it.
17:47Hopefully 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
18:06be fine.
18:07I'm excited to come and see you guys.
18:10I'm here.
18:11Thank you so much.
18:12See you soon.
18:14Are all those rhino?
18:35Yeah.
18:36Quite a large population.
18:39Before Noel heads to Lions Rock, he has arranged to meet prosthetist Werner at
18:43Khaleesi's home, the rhino orphanage, to test out the new prosthetic boot.
18:49It's an amazing spot, surrounded by forests and mountains, but I'm not allowed to tell
18:55you where it is because if the wrong people were to find out, that would be very bad news
19:00for 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
19:22species.
19:24The orphanage looks after the young rhinos until they are old enough to be released back
19:28into the wild.
19:29Hi, gentlemen.
19:30How are you?
19:31Hi.
19:32How are you?
19:33You must be Ari.
19:34Lovely to see you.
19:35Nice meeting you.
19:36Thank you so much.
19:37Welcome.
19:38Today, Noel will help fit three-year-old rhino Khaleesi with his new prosthetic foot.
19:43I'm very excited about learning about rhino orthopaedics.
19:47It'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.
19:59My God, the Paris fashion lines have nothing by comparison to this.
20:05It is one of the strongest boots I've ever made.
20:09So it should be very comfortable for Khaleesi to walk in it.
20:12OK, OK, OK, OK, OK.
20:15OK.
20:16But sedating Khaleesi for his fittingā¦
20:21Come on.
20:23ā¦is a delicate dance of man versus rhino.
20:26He's having a pop.
20:31Right, let's walk him to the shade orā¦
20:41Come on.
20:42Come on, mate.
20:46I enjoy to see them struggling a bit.
20:48Wrestling and rhino.
20:49Look at that.
20:50We're going towards you.
20:51Towards you.
20:52Yeah.
20:53Here.
20:54Sit on hisā¦
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
21:14and part of his foot bones were eaten away.
21:17Noel has studied x-ray pictures of the damage.
21:20As the foot hits the ground, it's supposed to roll over and the three digits spread out like so.
21:27But 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.
21:41And number two, to add some limb length.
21:44Let's get it on.
21:47Khaleesi's new boot is made from carbon fibre with leather straps buckled tight around his leg.
21:53Push.
21:56That's the one.
21:57Last one.
22:01I love my job.
22:05I love your job too.
22:11Well done matey.
22:13The new design needs to support nearly one ton 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.
22:26So far it looks good.
22:40His spine looks straighter doesn't it?
22:45Yeah.
22:46It'll take more or less a day or two to get used to it and walk properly again.
22:52Walk normally.
22:53Look he's meeting his friend.
22:55Yeah.
22:59The feeling it brings for when fitting and prosthetic on a wild animal is really indescribable.
23:04It makes you feel like you are doing something to better the world.
23:08Yeah.
23:11Running.
23:12Look.
23:13Look, look, look, look, look.
23:14Running.
23:15Oh my goodness.
23:16Oh my goodness.
23:17Wowzers.
23:19Amazing.
23:20Yeah.
23:24Oh hang on.
23:26Oh man.
23:28Might have come off.
23:30Yeah.
23:31That's everything the straps have broke.
23:33The straps broke?
23:34Yeah.
23:36Yeah.
23:37Despite Werner and Noel's best efforts, Khaleesi's new boot has come apart.
23:42It actually worked too well because he started running.
23:50He was comfortable running with that thing and imagine the forces going into while he's
23:56running.
23:57I think we should think of a better way to keep it on because the fitting is definitely good.
24:03You can see the spine is not curving anymore but the strapping was obviously not strong enough.
24:13Snapped.
24:16Just the power going into it.
24:18Yeah.
24:19Yeah.
24:20Oh man, I feel so sorry for you.
24:21All 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.
24:49So that is a real good point and we're not giving up now.
24:57You know what?
24:58It'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.
25:15And 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.
25:28Everything's impossible until it happens.
25:32The worst thing would be not to try.
25:37So we're here.
25:38Lion's Rock.
25:39It's with equal measure of intrigue and trepidation that I come in.
25:40Because, of course, I've never dealt with surgery on big j Cars.
25:41So we're here, Lion's Rock.
26:02It's with equal measure of intrigue and trepidation that I come in because of course I've never
26:08dealt with surgery on big cats before.
26:11The biggest cat I've ever operated on is a mane cone so it'll be an extraordinary privilege
26:16I think to be in the presence of these magnificent animals.
26:22Noel will be examining two big cats with the team at Lion's Rock.
26:27Working alongside orthopaedic wildlife specialist Peter.
26:33The kit has arrived from the UK.
26:36So we're going to see Laziz and Ricky today?
26:39Yes.
26:40Good.
26:41And Noel's first patient is 15 year old Bengal tiger Laziz.
26:45He's limping quite badly isn't he?
26:48There are just 2,000 Bengal tigers left in the wild.
26:52Many hunted for the illegal trade in body parts.
26:55If you don't mind I'm going to video while I can to see his gait.
26:59Laziz has lived at Lion's Rock since he was rescued six years ago.
27:03Laziz came from the Gaza Strip in a private zoo.
27:12It became publicly known in the media as the worst zoo in the world.
27:17Animals were starving and died.
27:21And 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
27:31for nearly a decade.
27:34But in 2016 Laziz was brought to Lion's Rock.
27:43But the conditions in Gaza had left him with more than just mental scars.
27:47He's been lame for about almost two years.
27:57Coming and going, much worse in the winter time.
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, and we're really hopeful
28:16that he has another good five years with us.
28:19Hello Laziz.
28:21Good boy.
28:22Good boy.
28:23Yes.
28:24I know.
28:25I 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 gait as much as I would with a dog or
28:33a cat.
28:34I'm trying to establish what's going on.
28:37He's got a significant limb deformity on both sides, but especially on the right side.
28:43Do you think that his osteoarthritis is in any way related to a developmental elbow disease
28:49akin to what we get in dogs?
28:52What I mean by that is the fit between the ulna and the humerus in terms of how that articulation
28:59works.
29:00Absolutely.
29:01100% spot on.
29:02That's what I've seen a lot in these bigger animals.
29:05Yeah.
29:06Really?
29:07Really.
29:08Rikki is the one which is in a feeding enclosure.
29:14Hello boy.
29:15Hi boy.
29:16I brought you visitors.
29:19Noel has also seen radiographs of Rikki.
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.
29:31When he arrived at the sanctuary, he had stunted growth and deformed front legs.
29:36He 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
29:52happening.
29:53They're all calling each other now.
29:57They're having a conversation.
29:59Yeah, that's usually this time of the day.
30:01They're talking to each other.
30:02Yeah.
30:03I'm a lion.
30:04I'm a lion.
30:05I'm a lion.
30:06I'm also here.
30:07I'm a lion.
30:08Yeah.
30:09That's very normal.
30:10Tomorrow, Noel will take his first ever x-ray pictures of a lion to see if he can help
30:16Ricky.
30:17And he'll perform an arthroscopy on Laziz, an extremely rare procedure for a tiger, only
30:23ever attempted a few times worldwide.
30:26It's humbling just to be in their presence, let alone operate on them.
30:32Every day is a school day for me.
30:34So 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 that can only be a good thing.
30:56It's the morning of the big cat surgery.
31:19This is a safety zone.
31:23There's two gates for safety.
31:25Both gates will get closed.
31:27Then we're in the compound.
31:32First up is Tiger Laziz.
31:34Have you pre-prepped with syringes?
31:36I'm going to load a dot now.
31:38Right.
31:39Okay, fine.
31:40Noel will perform an arthroscopy on Laziz's elbows to investigate his lameness.
31:46He then plans to use a cutting edge anti-inflammatory treatment to ease his pain.
31:51This has never been used in big cats before.
31:54So Noel and the team don't know how successful it may be.
31:58It is a little bit worried always with, you know, new procedures because obviously we haven't
32:03done this.
32:04So this is Noel's baby, but not ours.
32:07So, yeah, we just hope everything works well and, you know, 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
32:22have 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.
32:30Right, here we go.
32:31Once you've immobilized them, you start your stopwatch.
32:48You're under time pressure.
32:49We'll see how he responds now when I go there.
32:51Yeah.
32:52You're welcome to come with me.
32:53Just stick on my right side, okay?
32:55Understood.
32:56I'm your right hand man.
32:59Yeah.
33:00It means I'll be eaten first.
33:02All right, let's sneak in slowly and quietly.
33:07Thanks.
33:12Thanks.
33:13They are dangerous animals.
33:15You've got to be vigilant of it all the time.
33:20Because sometimes they can just jump up and be dangerous to all the surrounding people.
33:29Okay, I just want to give him something.
33:37Okay, bring the stretcher.
33:39Quite extraordinary to see such a large animal incapacitated like this.
33:46Sedation is time limited in big cats, so the team must work fast.
33:53Need the head pulled back that way.
33:57I expected to feel completely out of my comfort zone.
34:02But because I was in the presence of a cat, albeit a bigger, bigger cat,
34:06I felt a strange sense of familiarity in spite of the wildness.
34:12Someone grab the drip, the IV.
34:15One, 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 have a larger patient.
34:26It's not a chihuahua.
34:27Should be relatively easy to get in the joint.
34:29But then famous last words.
34:32Are you ready?
34:35Are you happy?
34:36Are you happy?
34:37The posterior patient is doing the fracture.
34:38Thele's early on.
34:39The Technician.
34:40The
34:42Lezyz is suffering from inflammation and cartilage wear,
34:45caused by a poor fit of his elbow joint, which results in osteoarthritis.
34:49Noel will insert a large needle called a trocar, down which he will place an arthroscopy camera to examine the joint.
34:56to examine the joint.
34:58Then he will inject anti-inflammatory,
35:01platelet-rich plasma,
35:03followed by a viscoelastic cushioning agent,
35:06which will hopefully relieve the symptoms of the arthritis.
35:12Scope going in.
35:16So this is very, very similar to the anatomy of a dog.
35:20Actually, there's really not much difference at all.
35:23It's like home from home.
35:24I just feel like I'm in a different house
35:26with a different wallpaper.
35:29Using 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.
35:38Is this the erosive cartilage down here?
35:40Yes, so that's raw bone on raw bone.
35:42That's raw bone on raw bone, I see, yeah.
35:45No cartilage at all?
35:46Nothing, yeah?
35:47So this is typically what I will see in dogs
35:49that have medial compartment disease,
35:52where the humerus wears away against the ulna
35:54because of poor fit.
35:55And this is particularly severe.
35:57If this was a medium-aged dog, for example, six,
36:01I would consider an unloading osteotomy,
36:04which is to cut the humerus in half
36:05and transfer the load to the outer part of the joint.
36:07And whilst we could do that in a tiger,
36:10he's exerting such extreme load on it
36:12that it is likely he would simply blow it apart.
36:17This is extreme.
36:18However, our objective is to gain a few years of function
36:22for the disease, so that's what we're going to do.
36:25Noel makes small holes in the worn-away joint surface
36:28to release stem cells in an effort to reduce inflammation.
36:33We're running long on anaesthetic.
36:35Okay, we're good, yeah, we're good.
36:37So give me the PRP, give me the lubricant.
36:39Claytlet-rich plasma, derived from Laziz's own blood,
36:43is injected into his elbow.
36:47That's it.
36:50He then adds the lubricating hydroelastic gel
36:53that suspends the platelets in the joint for longer.
36:56Look at that gel going in, pushes it back.
36:58Do you see the volume effect there?
37:00We're creating an artificial cushion
37:03that will hopefully treat the inflammation
37:04and pan inside the joint.
37:06I'm super excited about this.
37:08As far as I know, this procedure's never been done
37:10in wild, big cats before.
37:13So I'm excited and elated,
37:15and can't wait to see what the results are.
37:18Corp out.
37:20So we just put two tiny stitches in,
37:22and our job here is done.
37:24All right, ladies and gentlemen, that's it, it's good.
37:26We're out of here.
37:29Quickly, because he's going to wake up quickly, yeah?
37:32Okay, let's go.
37:33Laziz is taken back to recover in an enclosure.
37:38It's incredible to see him waking up,
37:40because you genuinely feel like you've made a difference,
37:42and I can't tell you how special that feeling is.
37:45All of this technology is the same for a human,
37:47the same for a dog, the same for a tiger.
37:49We are all one.
37:50If people could only realize that for a moment,
37:52wouldn't the world be such a better place?
37:54Noel's first-ever procedure
37:56on the ground,
37:57the same for a tiger.
37:58We are all one.
37:59If people could only realize that for a moment,
38:01wouldn't the world be such a better place?
38:04Noel's first-ever procedure
38:07on a tiger is complete.
38:14Now it's the turn of the king of the beasts.
38:19Right, we're going to dart.
38:23Ricky has deformed front legs
38:25due to inbreeding and a life in captivity.
38:28Noel 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.
38:46He is truly mind-blowingly gorgeous.
38:50I mean, before I came here, I'd never seen a male lion in the wild.
38:56And now I'm hunched beside one as he goes to sleep.
38:59An extraordinarily humbling experience.
39:02It makes me wonder how we take so much for granted until it's gone.
39:05And my goodness, do we have a moral responsibility to look after this guy.
39:15Get an IV guy.
39:18Okay, we're going to do a flex natural
39:20because we're interested in the growth deformity as well as the elbow.
39:23What I found the most interesting is how to position for your x-rays correctly,
39:30how 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,
39:52causing his forearms to twist and splay outwards.
39:56If I was straightening this, I would take a wedge out there and straighten it back
40:00and 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
40:11and 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,
40:20mix it with the lubricant and inject into both elbow joints.
40:25Noel hopes that this new treatment may alleviate Ricky's pain
40:29and also reduce the need for oral drugs,
40:32which can cause stomach and kidney problems in big cats.
40:36You ready with the PRP?
40:37I am, yeah.
40:38Thank you, got it.
40:39Using 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.
41:00Okay, well done everybody.
41:03As a team, us veterinarians work extremely well together.
41:11You're involved with wildlife veterinary science now.
41:14Congratulations!
41:16I have arrived!
41:18Obviously, because it's a new procedure, we don't know how it's going to affect them.
41:21We'll be monitoring it together, seeing how well they recover.
41:26The 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.
41:41It's been an absolute honor, truly, to 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 gonna be okay.
42:01Love you, May.
42:02You're a good boy.
42:10It'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.
42:38Since Noel was here, as you can see, even the environment has changed a lot.
42:42It's very green now.
42:44It was a great experience.
42:45It was great to work with Noel.
42:47He has so much knowledge to share.
42:50With Ricky and Laziz, it hasn't been as successful as we were hoping for.
42:56It doesn't mean that we're going to give up.
42:59We know now exactly what the joint, for example, all of this looks like.
43:03We can maybe use the next type of more gel, or think about, you know, including stem cells.
43:10There's a lot more options.
43:12This is why this, you know, collaboration is so great.
43:18Biology is infinitely variable, and we are at the mercy of biology.
43:23But the important thing is we have to keep trying.
43:25I'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.
43:35In Pretoria, Werner has been working to improve Khaleesi's prosthetic boot, and has added Noel's suggestion of ratchet straps.
43:47We adapted the straps, as Dr. Noel said, so each strap can take up to a tonne, 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, hop, hop, hop, hop.
44:10Come, please.
44:12Here we go.
44:14We fit the boot two weeks ago, and he's actually quite comfortable on it.
44:20Checked it two weeks after the fitting, and he runs easily, walks easily.
44:32Meeting Dr. Noel was really a great privilege.
44:35I learned a lot.
44:37He really thinks out of the box, using anything and everything that is available in the world.
44:42He's inquisitive, he's bloody hard-working, he's got passion doing the right thing.
44:57I can't think of anything more precious in the world than being in the presence of the giants of nature telling us,
45:03come on guys, up your game.
45:05Look after the world a bit better.
45:06If 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,
45:20then that would be enough.
45:23Truly, I have felt more at ease and welcomed by this environment than any place I've ever been in my life.
45:33It's quite...
45:38It's...
45:42It's overwhelmingly beautiful.
45:47It's going to be hard to go back to the real world after this.
45:55Can I just stay here? Can you guys just go home?
45:58Can I just live here?
45:59Can I just live here?
46:00Can I just live here?
46:29Can I just live here?
46:31Can I just stay here?
46:35...
46:48Can I justŠ»Š¾Š½isten...
46:50Can I just play your game like that?
46:52There's maybe no room for everyone that is that day or day.
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