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00:00Go and see Uncle Noel.
00:02Superheroes don't always wear capes.
00:05So cute! Oh my god!
00:07I've got a new friend. He's beautiful.
00:09Professor Noel Fitzpatrick and his team
00:12Did you have some nice eggs for me?
00:14Offer cutting-edge solutions.
00:17Would you like to be to dream these things up?
00:20I dream a very little else.
00:22To help save the nation's pets.
00:24This has to be done within the next 48 hours.
00:26Coming through.
00:27Please be okay. Please be fixable.
00:30If you only get one chance at this,
00:31I just have to hope my best is good enough.
00:34Come on. You're a trooper. You'll be okay.
00:36Transforming the world for families.
00:39What have we got here?
00:41One animal at a time.
00:43That's crazy.
00:45He is just back to living his best life.
00:48You've got Superdog.
00:49He told me modestly that it was technology
00:51but it was so much more than that.
00:53You're cute.
00:54He'd worked a miracle.
00:55Now, it's me. Yeah?
00:57It's going to be all right.
01:05Morning.
01:06If you want to grab a seat, they'll be with you shortly.
01:08Families come to Fitzpatrick referrals in Surrey from all over.
01:12We've travelled from Glasgow, travelled down last night.
01:17Now I've got to go to Portsmouth and then we've got a 12 and a half hour boat trip.
01:22Where are you guys going?
01:23Guernsey.
01:24Oh, Guernsey.
01:25And some really go the extra mile for the animals they love.
01:28I think you're the only person ever that has just turned up from Germany.
01:33I said, okay, we go. We drive through England to Fitzpatrick.
01:38We've treated patients from many different countries, including North America and all over Europe.
01:43If families can't find solutions elsewhere, then we'll do our very best for their animal friends no matter where they come from.
01:55Just got the jet, flew both dogs over.
01:58Seven-month-old French bulldog Milo has also come a long way.
02:02We flew here yesterday from Spain.
02:05I'd heard of Noel and thought, well, let's try and see if we can get here.
02:09The high-flying Frenchie arrived by private jet after his own crash landing back home in Marbella.
02:16He jumped off a bed about six and a half weeks ago.
02:19He's had various operations in Spain which haven't worked out
02:23and his poor life at the moment is us holding him.
02:26He's only a puppy. Look at that little face.
02:29Milo arrived in the lives of ex-pats Paul and Sandra after a chance encounter at the hairdressers.
02:45I've heard the two girls talking at reception going, look at this little French bulldog.
02:49Someone wants to find it at home.
02:51I sent the picture to Paul and that was it really because as soon as we saw Milo we all went, awww.
02:56Most expensive haircut in the world.
02:59You want some?
03:00Boy, he'd like that.
03:01Milo soon struck up a bromance with the family's other Frenchie, Buddy.
03:06They played together, rolling around on the floor.
03:09Milo was just a bundle of joy.
03:11Buddy loved having a friend and we've got a big enough guard and they can run round.
03:16We go to the beach, we walk them, you know, on a lead and they're French bulldogs.
03:23They don't really like anything over 23 degrees anyway.
03:26But it's not siestas for everyone.
03:29Well we have a real estate company, we have an interior design company, we have a construction company,
03:37we have a property development company, we have a wine company.
03:41Have I left anything out?
03:43No, that's enough work.
03:45We have to keep working to pay the bills for Milo.
03:48And it was while Paul was working in Provence that disaster struck at home.
03:55Milo must have got on the bed because the next thing I heard was the cry.
03:59And he's off the bed by the wardrobe holding his leg and he'd broken his elbow.
04:05So I took him to have it pinned and you flew back that day, didn't you?
04:09Within a few days we noticed the joint wasn't right.
04:13Like Frankenstein, there was a bolt coming out, not out of his neck but out of his leg.
04:17And they re-operated and then after about a week the same thing has happened.
04:23Third time we took him back, it all went wrong again.
04:26We took him to another specialist, he put his hands like that, his head like that and he went,
04:30it's a complete disaster.
04:32I don't even, I do this for a living and I don't actually know what I can do for your dog.
04:37I said, look, just tell me who is the best surgeon for this in the world.
04:43He went, Noel Fitzpatrick.
04:48Hello, would you like to come in?
04:50Please. Thanks.
04:53It's very cute.
04:54Hello, sir. Hi Noel, how are you?
04:56Good morning, grab a seat there for me.
04:58Lovely to meet you, I'm sorry you've been through all of this.
05:00Beautiful dog.
05:02Hello sweetheart.
05:03So I hear that and I've looked at the radiographs.
05:05Three surgeries, is that right?
05:06Yeah.
05:07Okay, hello mate.
05:08He's gorgeous but unfortunately, Frenchies are gorgeous but they get elbow fractures a lot.
05:13Right.
05:14The elbow is comprised of three bones, the humerus, the radius and the ulna.
05:20I always refer to the bottom of the humerus as an arse in a saddle.
05:25Right.
05:26Because everybody gets that.
05:27That's an arse, that's a saddle.
05:28Okay.
05:29There may be a genetic predisposition in this dog to a slightly poor fit between the saddle and the arse.
05:36Yeah.
05:37That makes the ulna act like an axe in a block of wood.
05:40Okay.
05:41That causes micro cracks and I suspect that the fracture was caused by minimal trauma but I can't remember what happened.
05:49It just jumped off the bed.
05:51Well, there you go.
05:52That's all.
05:53Well, that's not a road traffic accident.
05:54No.
05:55No.
05:56So your first surgery was a screw across between the two butt cheeks.
05:59Yeah.
06:00And a pin up the side.
06:01Yes.
06:02The pin got loose, the screw loosened.
06:04Your second up was a bigger screw and a plate and your third up was a bigger screw and a washer and a plate.
06:11Yeah.
06:12None of that worked.
06:13No.
06:14It's a complete disaster.
06:15Any surgeon can fail, any surgery can fail.
06:19This gentleman has done his best.
06:21No, no, we appreciate that.
06:22But it has all done tits off.
06:24Yeah.
06:25I'm not an expert, obviously, but it's like the bolts come out inside his leg.
06:29I'm going to have a little feel.
06:31You're quite right.
06:32That is the screw poking out on the inside.
06:34Yeah, makes me feel sick.
06:35And that is bone sticking out as well.
06:38There's only going to be three options here.
06:40Yeah.
06:41Option number one, can we do a primary repair?
06:43Option number two, can we fuse the elbow solid because this fragment is too kaput, too exploded?
06:50And option number three, full limb amputation.
06:53So, we can't do anything until we get the CT.
06:56Okay.
06:57Right.
06:58We're going to see if this bone is still viable.
07:00Because if it's mush, I can't do a whole lot.
07:04Because it may already be too far gone.
07:07What happens after that if it is mush?
07:09If it is mush, then you're probably talking about an elbow fusion.
07:12Okay.
07:13Which is fusing the elbow solid.
07:15So then he doesn't have a movement.
07:18He walks like that.
07:20Right.
07:21Cool.
07:22Squat.
07:23Yeah.
07:24Right.
07:25Now, I know that it's been a big journey for you to get here.
07:29So I appreciate that.
07:31If I could have known who you were to start with, he would have been here.
07:35Sorry, sorry, mate.
07:36Sorry, sorry, sorry.
07:37I will have some idea after the CT.
07:41X-ray pictures and a CT scan will help assess the scale of damage to Milo's elbow.
07:52God, I'm really nervous.
07:55And what, if anything, Noel can do.
07:58Now, Milo's family.
07:59Yes.
08:00Come on in.
08:02You can clearly see there's a lucent line around that screw where it's been windshield wipering.
08:11Right.
08:12So it's been going like a windshield wiper and it's destroyed the bone around the periphery by rocking.
08:17This is a CT.
08:18Yeah.
08:19And you can see the nut is now floating up here.
08:23That's the plastic nut.
08:24Oh.
08:25That's shadow.
08:26Is this what's causing that big lump in the inside?
08:28Yes.
08:29So that's a seroma, which is a fluid pocket built up around the nut.
08:32That nut has come off the end of this.
08:34That has wobbled and this thickness is now twice the width of the screw.
08:38Jesus.
08:39I don't want to burst into tears or scream.
08:41Right.
08:42Yeah.
08:43So that bit is rocking like that.
08:44Yeah.
08:45This is wearing away like a file.
08:46Exactly that.
08:47There might be enough bone to hold it together, but I think the odds are against it.
08:54Even if you could fix it, the joint would remain painful and therefore one would, from an ethical point of view, prefer to consider fusion.
09:02So he'd run like that?
09:03Yeah.
09:04He won't know the difference.
09:05Would he be in pain?
09:06No.
09:07Is he in pain now?
09:08Yes.
09:09The case will be sent for ethical review to get another perspective on what may be best for Milo.
09:14Not 100% bad news, but it's close.
09:19In the meantime, Noel and his engineering colleagues will plan a custom plate system to fuse his severely damaged elbow.
09:27He's called Milo.
09:28Yeah.
09:29Yeah.
09:30Yeah.
09:31Yeah.
09:32Yeah.
09:33This is a Spanish French tree.
09:34He's got particularly lovely ears.
09:36Can you in Bramble?
09:37No.
09:38Morning.
09:39If you want to grab a seat, they'll be with you.
09:52Waiting for their consultation with Noel are 11-year-old brimble boxer Bramble and inseparable mum, Paula.
10:00She's like a shadow really.
10:02She follows me around everywhere I go.
10:05Paula's shadow no longer keeps up.
10:08Bramble has a lame hind leg.
10:11The main priority is to make sure she's okay.
10:18Paula took a gamble on Bramble eight years ago, taking her in as a rescue without meeting her first.
10:25I knew before I even met Bramble that she wasn't going to go anywhere.
10:30Once she was through that door, she was staying.
10:33So even if she was the worst dog in the world, she was going to stay with me.
10:38And she's been lovely.
10:40I'm coming over to join us, Bram.
10:43Bramble's my fourth boxer.
10:45I've just loved the breed and they've all got such character.
10:49Boxers, to me, are pretty special.
10:52We both love each other.
10:55And, you know, completely.
10:58We'd spend quite a lot of time in the garden when it's nice weather at the weekend.
11:03We love going to the woods together.
11:06You're a bit slow, aren't you, Bram?
11:09As Bramble has grown older, walks have become shorter.
11:13But, you know, she is getting on.
11:15And in recent months, trips to the woods have been put on hold because of Bramble's lame leg.
11:22We can't go anywhere.
11:24She can't walk at all.
11:26We're housebound, basically.
11:29I went to get an opinion from my local vet.
11:34And this guy took one look at her and said,
11:36she's got a massive bone tumour and she should be put down.
11:39Oh, life without Bramble would be so empty.
11:45I don't want to think about it.
11:49Paula didn't give up on her old companion.
11:54So I said, look, I want a referral.
11:56I want a second opinion here.
11:58And that's when we got referred to Noel.
12:02Um, no.
12:06Paula?
12:07Noel's colleagues have already seen Bramble and taken both x-ray pictures and a CT scan of her knee.
12:14Here we go.
12:15How are you?
12:16Hello, mate.
12:17And the results are not good.
12:19When we took a CT scan of the right knee that is particularly badly inflamed, this one.
12:26We've got poles.
12:28Here.
12:31There.
12:32Yeah.
12:33What's caused that?
12:35Either aggressive synovial inflammation that has got so inflamed that chemicals inside the joint are eating the bone like acid.
12:44Either that or a tumour.
12:48Something is eating the bone away.
12:51So the next question is what to do.
12:53We only have the following options.
12:55Option one.
12:56Do nothing.
12:57Just give tablets.
12:58To try and dull the pain.
13:00Option two is full limb amputation.
13:02You ruled that out.
13:03I thought if she's got arthritis in three of her legs and the other back leg's not great either.
13:08Really don't want to go down that route.
13:10Option three is fuse the knee solid.
13:13Chop that out.
13:14Chop that out.
13:15Put a plate across.
13:16It fuses solid.
13:17Last option is a knee replacement.
13:18We've done more than 30.
13:21We've had one fail because of loosening of the implant in the cement that holds it in the bone.
13:29And therefore we've redesigned it to be un-cemented meaning that we don't use cement and instead we use plates and screws to anchor it to the bone.
13:38So it's just a progression of technology.
13:40Downside of this is twofold.
13:42One putting the dog through it and two putting you through it.
13:45Yes.
13:46What I would recommend is that we take a biopsy and if this is not cancer this should work fine because you're cutting the entire joint out.
13:54If it is cancer there's a risk that even if I cut the bottom off the femur and the top off the tibia there is a risk that that chumel could still come back.
14:03Yeah.
14:04In the rest of the bone.
14:06In the rest of the bone.
14:07Yeah.
14:08I've got some big decisions to make.
14:09Let me know when you know.
14:11Right.
14:12What do you think Brim?
14:13I wish I had a crystal ball.
14:15All of us do.
14:18Paula faces a huge dilemma.
14:21I've got to decide now whether to just do nothing and do the pain management or have the knee operation.
14:29Big decision to make really.
14:41Milo the Spanish Frenchie is back for surgery with Noel.
14:45We're here today because Noel's going to take the old bolts out of his legs.
14:51We're trying to see if we can relieve some of the pain he's in because you can see he can't never get comfortable.
14:56But it's been quite stressful.
14:58I can't actually think of 11 weeks of absolute heartache and trying to sort him out.
15:05The ethics review has recommended that Noel remove the existing implants and wait to see if Milo forms a false joint.
15:12Instead of fusing the elbow straight away.
15:15See you boy.
15:21Table up please.
15:22Okay so we're just going to cut in here.
15:25Noel removes the screw which is protruding from Milo's elbow.
15:30So we can see this is just totally loose.
15:33Then the plate and other screws.
15:36Yeah we're done.
15:38So we're leaving the piece of bone on the end of the humerus rubbing on the radius.
15:43And we're leaving the piece of bone on the other side rubbing on the ulna.
15:48It is my belief that Milo will stay in pain.
15:51But that is not the belief of the ethics review and therefore I must do as I'm told and leave it as it is.
15:59I genuinely hope that I am wrong because that will be the best possible outcome.
16:04It's all about the patient.
16:05It's not about my ego.
16:07Thank you very much.
16:21Good morning Lolly.
16:22The team at Fitzpatrick's are more than just colleagues.
16:25Come on Roggie.
16:26Good boy.
16:27Aw he's got a lovely face.
16:30The relationship we all have at work, I don't think I've had it in any other job.
16:35We're all so close knitted.
16:37Is there still Kate Clare?
16:38Yeah.
16:39I need to get some of that today.
16:40Everybody helps everybody and we're always there for each other.
16:45And this is all North Holland.
16:48This is where I'm from, Amersford.
16:50We are a huge family.
16:52We're the Fitz fam.
16:53We love each other dearly.
16:54Hello.
16:55Hi.
16:56You're very beautiful aren't you?
17:01And waiting in reception are the loved ones of a former member of the Fitz fam.
17:06My wife used to work here so it's the right choice for Digby.
17:13Digby is a ten month old Maine Coon who's here with Dad Ben.
17:19We noticed he was struggling to get up on the bed.
17:22We took him in for x-ray and discovered that he had hip dysplasia.
17:27He's on medication to manage the pain and that will only get worse.
17:36Ben and wife Indy moved to the UK ten years ago when Indy landed her dream job.
17:43I was at the time watching Noel on telly from Australia and thought that looked amazing.
17:49So I applied for the job from Australia.
17:52The week we arrived here I had an interview and I'd started within a couple of days.
17:56Three furry companions travelled with a couple from the other side of the world.
18:01We moved to the UK with our dog Neela and with our two cats Ty and Lottie.
18:08They were with us up until two years ago and then all three of them died within a few months of each other.
18:15And then we got Digby and Delilah to create the new family.
18:24He's three days older than her but they have played together since the day she was born.
18:34Digby was a lot less ginger than he is now but just adorable.
18:39Digby is the silliest, the sweetest, the chattiest cat I've ever met and I've worked with a lot of cats.
18:52I was at Fitzpatrick's for about six months and would have stayed there for a lot longer.
18:59Fitzpatrick's was amazing, eye-opening.
19:02It taught me a huge amount in a really short space of time but it was a long way to drive.
19:08It looked like a really short distance on a map when you're in Australia.
19:11So I started a local clinic to us and was there for another ten years.
19:17With all her experience Indy knew the significance of Digby struggling to keep up with his sister.
19:24Towards the end of last year we both noticed that he was just not walking quite right.
19:29He had a very very subtle limp but more that his back legs were touching when he was standing.
19:35So he wasn't holding his own weight, he was trying to support his weight.
19:40Delilah was jumping, she was getting up onto the counter.
19:43He would definitely be right on her toe but he wouldn't do the jumping.
19:47Mancoons are prone to hip dysplasia.
19:50Didn't think for a second it would be as bad as it was and certainly didn't think it would be both legs.
19:57My blessing is pure ignorance.
20:01Whereas from Indy's point of view, almost knows too much.
20:06She knows the risks associated, she knows what the animal's going to go under.
20:10Indy also knows what's best for Digby, so the couple turned to Maine Coon devotee Noel and the Fitzfam.
20:18Knowing first hand the level of care that Fitzpatrick's has delivered,
20:23that level of expertise made the decision a whole lot easier.
20:27Hello, how are you?
20:29Sorry about the delay.
20:30Nice to meet you, my mum.
20:31Hello, mate.
20:32You probably know I have two Maine Coons, so I'm very partial.
20:37Now, big fluff monster.
20:39Hello, mate.
20:40How are you doing?
20:41Is he shaking?
20:42No.
20:43I'm the king of Maine Coons.
20:45Oh, mate.
20:46Gee, I would just have a whole army of them, wouldn't I?
20:49I'm going to end up that old cat guy.
20:51Yeah.
20:52I'm going to end up in a cottage in the middle of nowhere with 17 Maine Coons.
20:55Yes.
20:56Hip dysplasia, what do you know about it?
20:58Quite a bit.
20:59My wife used to work for you.
21:00Yeah, I heard.
21:01Yeah.
21:02I heard.
21:03So, loose hip.
21:04And it happens because the tissue around the hip doesn't hold it in place.
21:08Yes.
21:09So it's not a primary shallow socket.
21:11The socket gets shallow because the head isn't held in.
21:13Right.
21:14So it's kind of worn out as opposed to...
21:16It gets loose and then it's worn out.
21:18Yeah.
21:19And you've got it both sides.
21:20Which is worse?
21:21His right hand side, I believe.
21:24Yeah.
21:25Okay.
21:26All right.
21:27Now, mate.
21:28Well done.
21:29Yeah.
21:30I love you, but I've got to do this.
21:36That hurts.
21:37He's a very good cat.
21:38That hurts a lot more than he's letting on.
21:41Oh, you're such a good boy.
21:42Well done, mate.
21:43Okay.
21:44Yeah.
21:45So, let's get the imaging.
21:47Yes, sir.
21:48You chill out, have coffee, have tea.
21:50Yeah.
21:51Okay.
21:52Thank you very much.
21:53Thanks.
21:54Digby's made quite an impression on the king of Maine Coons and he gets in an extra cuddle before sending him off for scans.
22:07He's great.
22:08He's fabulous.
22:09He's gorgeous.
22:10He's quite the fan of Maine Coons and has taken quite the shine to Digby.
22:15Hands off Noel.
22:16He's mine.
22:17Digby may be a cool customer when being examined, but Noel will get X-ray pictures and CT scans to establish just how much pain his new friend is in.
22:30Both hips are very painful.
22:37This is a very patient cat.
22:38Yes.
22:39Extraordinary, actually.
22:40Yes.
22:41Both hips are dramatically loose.
22:42Yes.
22:43Meaning that the head was never held properly in that socket.
22:50Yes.
22:51And as a result, as the head came out of the socket, not being held in by the muscles, the ligament and the capsule, the way it should be, the head begins to tug on the capsule and produce new bone.
23:05Yes.
23:06And also begins to rub.
23:08Yes.
23:09Eroding the cartilage here and here.
23:11Option number one is medicine, but medicine will only ever be palliative.
23:16Surgically, there are two options, femoral head and neck excision and total hip replacement.
23:21Femoral head and neck excision involves cutting the head off and the neck off and leaving a false joint.
23:26Yes.
23:27Total hip replacement is accepted universally scientifically as the gold standard, whereby we put in a tiny socket, a tiny stem, a tiny head.
23:36The risks are dislocation, i.e. if the muscle loosens further, further after the surgery, it can dislocate.
23:46Implant loosening is a risk over time and infection is a risk.
23:51Whether you want it done or not, if you do, I'm going into a spinal now and we'll do it after that.
23:55Yes.
23:56If you don't, we can reschedule for another time.
23:58No, we're here to do this.
24:00Okay.
24:01Thanks very much.
24:03The next time Ben and Indy see their beloved Digby will be after his surgery.
24:13Shutting the door was pretty tough.
24:17Pretty tough having the conversation with Indy.
24:20But it's the right thing to do and he's going to be fine.
24:25He's going to be fine.
24:27He's a handsome man.
24:37Bramble, the arthritic boxer with a mystery disease affecting her knee, is back at Fitzpatrick's.
24:44Results of her biopsy were inconclusive.
24:47And after much soul searching, Mum Paula is going ahead with a next generation knee replacement.
24:54Yeah.
24:55Good morning.
24:56Hi.
24:57Can we come through?
24:58Yes.
24:59Bramble's quite old now, she's 11 and it's a major operation and I'm terrified.
25:05I know she's in the best hands possible but it still doesn't stop you from worrying.
25:10Right, let's go.
25:12Noel will use 3D printed guides to make cuts in two bones, the tibia and the femur.
25:20He will implant custom components in both, first the tibia and then the femur.
25:26Anchoring them with a combination of rods inside and plates outside the bones which interlock with screws.
25:33Then he'll loop the tibial and femoral components together with a plastic bushing and an axle through a spigot,
25:40which prevents the prosthetic knee joint from dislocating.
25:43So we're just chopping into the diseased knee now.
25:46But first, he investigates the tissue in Bramble's knee.
25:50So far it does not look like a tumour.
25:52This really raw stuff here, that's proliferative synovium and it's got tendrils like a sea anemone.
25:59It attaches to the bone and then a specific kind of immune reaction eats the bone away.
26:05It's a really complex inflammatory process which can look like a tumour.
26:10Having established the best possible news, Noel starts the pioneering operation.
26:16He cuts the top of the tibia and bottom of the femur, then implants the first component with a titanium rod.
26:30The tibial component is now in situ.
26:33He then screws a support plate onto the outside of the tibia.
26:37The torsional alignment of the tibial component is now correct.
26:42Before implanting the second component in the femur.
26:45Noel fits a plastic bushing and an axle between the two components.
26:52And now he can't dislocate the knee.
26:55And slides a support plate along the femur.
26:59Lock it down into that hole there.
27:01And we put a longer locking nut down the centre here.
27:04Before tightly securing the axle that links the tibial and femoral components together.
27:09So when the foot places, it can flex and extend.
27:14And it can also twist in and out.
27:18So the bramble should be pretty comfortable.
27:21With surgery complete, the question now is how well will bramble recover?
27:27We are finished here.
27:29It's mid-afternoon.
27:46Good boy.
27:47Noel is assessing Milo, 19 days after he removed the failed implants from his elbow.
27:53Unfortunately, he's still in pain.
27:56You can see that the leg is wobbling here because the forearm isn't properly attached to the upper arm.
28:02So when I push the forearm in, there's nothing holding it together.
28:08It's just really hard for us to see him in this amount of pain.
28:11You're such a good boy.
28:14In spite of all of that, you still love Uncle Noel?
28:16I love you too.
28:17I love you too.
28:22Play party hat off with you on.
28:24Milo's elbow remains painful despite removing the old implants and hoping for a false joint,
28:30as had been recommended by the Ethics Review.
28:33So today, Noel will go ahead and re-operate to fuse the joint, according to his original plan,
28:39using a custom plate construct.
28:41Finally, I am going to endeavour to fix Milo later than I would have liked to.
28:48Right, can we please?
28:50So let's go the next mile from Milo.
28:52Noel starts by harvesting bone marrow from Milo's pelvis, which he will graft into the elbow to encourage fusion.
29:00So this is the moth-eaten piece of bone.
29:07He drills out the remaining cartilage from the damaged humerus, ulna and radius bones.
29:13So we're taking the bone graft now and popping it in, filling the holes.
29:19Next, Noel applies two custom titanium plates, which are linked together by a bolt.
29:26This is a very, very strong plate.
29:28Because it's custom made, it's exactly going to fit Milo's bone curvature.
29:32He attaches the top plate to Milo's humerus and the bottom plate across the ulna and radius with temporary screws.
29:41Satisfied with the alignment, he secures both plates in position with permanent locking screws.
29:47I think that that's a win.
29:49Just tightening the nut in between the two plates now.
29:54That's nice and tight. Good.
29:57So now you can see the humerus up here is locked rigidly relative to the radius nana down here.
30:04The elbows fuse solid.
30:06Alright, let's ditch up three metric PDS.
30:09If the operation is a success, Milo could be back on Spanish soil within weeks.
30:14Everything rests on the rate of his recovery.
30:17There's no trick for us off the Phoenix Enology, Sam speaking, how can I help?
30:30Do you want a booty for the bandage?
30:31I would love a bandage.
30:32Do you think a green or a purple?
30:34Yeah, maybe green with a purple.
30:36Oh, yeah.
30:40Here we go. Sit down there.
30:42Grand old boxer Bramble is now four weeks into a 12 week recovery, following her full knee replacement.
30:51Her most recent x-ray pictures, taken a fortnight ago, showed a dream recovery.
30:57Bramble was doing really well and then Monday morning she woke up and she was not wanting to put any pressure on her leg at all.
31:04I was hoping it might have got better, if it was just a bit of muscle strain or something, but it's...
31:12No.
31:14This is no good.
31:18Fresh x-ray pictures reveal the reason Bramble's recovery has stalled.
31:23OK, so if we look at the x-ray picture from the 13th of June, it looks completely normal.
31:31Yeah.
31:32And if we look at the x-ray picture two weeks later, today...
31:38Oh, God.
31:40That's what we have.
31:41Oh, my God.
31:45Clearly it's fractured through here.
31:46Yeah.
31:49Bramble has a broken femur above her knee replacement.
31:53Now, you might well ask, why does that happen?
31:56It happens because of a stress riser, where very strong metal goes into lesser strong bone.
32:04Right.
32:06We aim to try and mitigate the stress fracture effect by running a peg down a certain length and then a plate down another length.
32:15Yeah.
32:16To try and spread the load.
32:17And the bone needs to thicken up around the metal and heal.
32:20Well, what happens in biology over time is the bone thickens up.
32:24It gets stronger.
32:26As it takes the load.
32:28But unfortunately in this case, it didn't have time to thicken up before it broke.
32:32Yeah.
32:33So the most logical thing to do is to extend that plate up to the top of the femur.
32:41Where the bones are strong.
32:43Where the bone needs the strongest, yeah.
32:46So imagine that I detach this plate, make another plate that's longer and goes up to there and hooks over the top.
32:53Put that back on there.
32:55Wire it.
32:56Yeah.
32:58Put more screws in.
32:59Mm-hmm.
33:00That should do the trick.
33:01My colleague Jay is working on engineering drawings based on the CT scans of Bramble that we took immediately post-op.
33:08Mm-hmm.
33:09And the x-ray pictures we took today.
33:10Yeah.
33:11And he's designing a plate to go on the side of the femur.
33:16He should have a rough design by tonight.
33:18Mm-hmm.
33:19And I will ring you tonight.
33:22I'm sorry.
33:23I know that brings tears to your eyes.
33:24I am sorry about that.
33:25I'm sorry.
33:27Paula needs to wait a little longer to go walking with Bramble.
33:37Are you grappling?
33:40Oh, fierce Colin.
33:42You're very fierce.
33:45Digby, the laid-back Maine coon who was brought in by one of Noel's former colleagues, is being prepped for the first of two hip replacements to treat painful hip dysplasia.
33:54Right, are we ready?
33:57Noel aims to replace the damaged femoral head and neck in Digby's hip joint with metal components and the socket with a plastic cup.
34:08All right, let's go.
34:11He removes the existing femoral head and neck and drills out the hip socket.
34:17We have drilled out the arthritic socket, creating a recess for cement.
34:21Then seats a plastic cup in the socket on a bed of bone cement.
34:26I have sequentially enlarged the femoral canal by drilling, reaming and filing.
34:31Noel inserts a metal stem into the femur and attaches a metal ball which acts as the new head.
34:40Then we simply pop the head into the socket, like so.
34:45Then we just stitch up and Digby has a new hip.
34:48The aim is to repeat the procedure on Digby's opposite hip in four weeks.
34:53And hopefully he's done for life.
34:55But only if he makes a full recovery.
34:58Good boy, Digby.
34:59It's two weeks since Spanish Frenchy Milo had his elbow fused.
35:09And he's boarding at Fitzpatrick's until he recovers enough to go home.
35:14All right mate, good boy.
35:17Go lower, lower, lower with hand.
35:20That's it, that's it, that's it. Now you've got it.
35:23Part of that recovery includes hydrotherapy.
35:25This improves muscle motion without stressing the fused joint.
35:30And calls for an underwater treadmill and squeezy cheese.
35:34But Milo's more use to walks on the beach.
35:38Travelling by treadmill isn't his style.
35:41Sweat trousers coming up.
35:43Right mister, look at what you're making me do.
35:46Oh my God.
35:48You're really pushing me now.
35:50So, he's the first dog that I've been barefooted for for a while.
35:53The objective of the exercise is to move this leg forward with his body weight borne by the water.
36:00Let his back legs move himself.
36:02Good boy.
36:04Good boy, that's excellent. That's much better.
36:06Looks like knowing I was getting into there, I would have done my toenails.
36:09We have to stretch that triceps.
36:12Yeah.
36:13But the underwater treadmill is really excellent for that.
36:16He quite enjoys it, I think, because he gets cheese.
36:18He's made quite good off it.
36:19Could you imagine?
36:20Grand old boxer Bramble is being prepped for theatre to repair a broken femur, a complication after knee replacement surgery.
36:34Not 0.44, yeah.
36:39Noel aims to replace the plate on Bramble's femur with a new, longer custom plate.
36:45Come on Brambley.
36:47That will spread the load up to the top of the femur.
36:50We do one's very best to avoid complications, but at the end of the day, biology is biology.
36:55Noel first removes the plate that was fitted to the femur during Bramble's knee replacement.
37:01We take this short plate off.
37:03Then secures the fractured femur with wire.
37:07Now putting the plate on on top of those wires.
37:10The new plate has been custom made for Bramble.
37:13It's called a FITS-FAR plate, which stands for femoral augmentation reconstruction plate.
37:17I invented this plate eight years ago to treat fractures of the femur associated with hip replacement.
37:25Noel screws the bottom part of the FITS-FAR plate to the femur.
37:29Then prepares to attach the upper part of the plate to the top part of the femur.
37:34The plate is shaped exactly like a femur.
37:37You can see the bottom part here is straight.
37:39The top part has a hook on it, which goes on to the top of the femur.
37:43Using wire and temporary screws, Noel pulls the plate down onto the bone until he's happy with its alignment.
37:51Then we take out the temporary screws and put permanent screws in.
37:55The permanent screws lock into the plate with this threaded part of the head right here.
37:59Right, we are finished here.
38:02All right, Bramble, well done.
38:04Hopefully, this repair will get Bramble back walking with Paula within days.
38:09Brambley-lambly. Time to wake up, girl.
38:12Brambley-lambly. Time to wake up, girl.
38:13Let's go, girl.
38:16The Mane Coon
38:19Since his second hip replacement two days ago, Digby the main coon has had a bit of a love in at Fitzpatrick's.
38:35Yes, you're such a good boy.
38:37From the man himself...
38:38He's such a lovely boy.
38:40...and his team.
38:41team now parents Indian Ben are here to take Dickby home hi guys how are you doing before
38:53someone else does so you'll be lucky to get digby home because he's gorgeous I'll be having three
39:00men cones it gives me loads of kisses every time we come in the nurses everybody's like oh my god
39:04your cat I know they love digby don't they they do so no no I would get out of cage cuddles we go in
39:13it's big enough it's a greyhound cage the chilled Maine Coon is going home for four weeks of cage
39:21rest if Noel can part with him oh yeah he loves everybody don't you make
39:34he's so good I love it when he rubs my nose he gets up and you cannot keep him rubs his nose
39:39against me up there like that time for a sharp exit no I was a little disappointed that it
39:45didn't let this go but hands-off now
39:48high-flying Spanish Frenchie Milo has spent five weeks at Fitzpatrick's recovering from elbow
40:05surgery and charming the nurses Milo is actually a real delight to to nurse because he you get so much
40:14from him probably the most at ease relaxed patient I've ever seen in a kind of environment oh my nice
40:23gorgeous the doggy Don Juan has been improving steadily but today the team have noticed a
40:31problem with my nose leg so Milo has got a crack in his humerus unfortunately there is no surgery that
40:40does not have potential complications and this is a recognized complication of elbow fusion as the
40:48elbow remodels in a fused position all the stress goes further up the arm and in this particular case
40:56has caused a fissure before it remodeled enough it's bad but it's not that bad no will operate before
41:07the fissure can fracture right jack up please so we're just putting an extra plate on here in
41:14addition to the plates that are there already to support the fissure Noel chooses a plate of
41:21appropriate size lever small plate benders and the synthies plate benders please which he bends to fit
41:28Milo's humerus thankfully it hasn't yet completely fractured we caught it just in time and secures
41:35with locking screws so we've now put the plate in and it's really important that we did that today
41:41because otherwise we may well have a fracture tomorrow okay Milo let's go to x-ray good boy
41:47four months ago Bramble the venerable boxer had next generation knee surgery in the hope she would
42:00one day join Paula in the woods again well let me go there you go it's lovely to get out again and
42:14let Bramble off the lead it was such a relief to be able to let her off from some freedom it works out
42:21fine Paula has her shadow back and the sprightly 11-year-old is doing more than walking the steps
42:31are good for her and also to stretch the leg back the step exercises I think one of the best she can
42:40do the first time I took her over here we we walked up in the steps and then I counted them it was 150
42:47though sometimes Bramble takes the odd shortcut cheating again rebel Bramble's so much happier
42:55now because she's out of pain and she can get around and she's independent you know I don't have
43:02to support her any longer was definitely the right choice having surgery back to be normal again it's
43:12really delightful 12 weeks after his second hip replacement Maine Coon Digby is also recovering
43:29following strict cage rest overseen by mum veterinary nurse Indy he's demanded attention constantly he has a
43:39very loud voice but the cool cat is out of the cage and finding his feet again Digby is amazing
43:47now he came out of the cage four weeks ago he you know wants to be around us or outside he's totally
43:57back to where he was he is so full of energy nowadays post-surgery he's more kitten like now I think he was
44:04yeah when he was a kitten it has been an absolute joy watching he and Delilah would play again it's
44:12just really brought life and happiness back into the home and Indy knows better than anyone who to
44:20thank for the future of this laid-back bundle of fur we are totally in the debt of Noel and all the
44:29nameless people who put their love and care and kindness into getting him to being who he is now now
44:36at the age of 15 16 months he's gonna have a wonderful beautiful pain-free medication free life there's
44:45nothing holding him back nine long months after breaking his elbow leaping off the bed Milo the
44:58flying Frenchie is back on four feet in Marbella hey hey slowly slowly slowly hey come here but here but
45:07come on here he comes here he comes he's running around he runs as fast as Buddy he can trot as fast
45:13as Buddy plays with him all day long you know if we put Milo inside to cool off for 10 minutes
45:19Buddy's at the door scratching to get in there they literally play all day long until they go to sleep
45:23Milo! Bud! Ah it's unbelievable the weight that's been lifted off us
45:29good boy to now be back in Marbella on a beach with the dogs you know it's just it's a miracle to be
45:37honest Noel's 100% the best pet in the world and if anybody doesn't believe that I have the walking
45:43proof of it we have a dog with four legs running on a beach what more can we ask what he's gone
45:50through to be still the character he is he's got to be a little bit insane I think but he fits into the
45:56family well because that takes after someone else but even mad dogs and Englishmen need siestas
46:05I think they're very tired actually now they just need to go home and go to sleep
46:26Oh
46:35I love You
46:37Oh
46:39Oh
46:41Oh
46:43Oh
46:44Oh
46:45Oh
46:47Oh
46:49Oh
46:49Oh
46:51Oh
46:53Oh
46:55Oh
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