Episode 3 Operation Wild


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Episode 3

Veterinary science series. Vets use keyhole brain surgery deep in the jungle, remove an elephant's tusk and fit a prosthetic tail to a dolphin.


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'We share our world with some amazing animals,

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'and sometimes they need our help.'

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When wild animals get sick, it takes radical thinking, extraordinary

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medical skills and great bravery to treat them and save lives.

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What are you doing?

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'In this programme, I'll be finding out how vets are using

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'ingenuity and dedication to save animals across the globe.'

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Good girl, now let's see you swim.

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'And vet Steve Leonard will be seeing how human medicine

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'can be adapted to transform animals' lives.'

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This is real bionic stuff, it's amazing.

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'From keyhole brain surgery for a moon bear

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'to extreme elephant dentistry...

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'This is big animal medicine as you've never seen it before.'

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'I'm off the coast of Okinawa, the largest in a chain of

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'tropical islands that stretches south from mainland Japan to Taiwan.

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'I'm with Dr Keiichi Ueda, who today is going to try out

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'an extraordinary invention that's been over a decade in the making.

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'It could transform the life of Fuji, a dolphin with no tail.

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'Keiichi is a vet here at the Churaumi Aquarium.'

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So, this is breakfast?

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This is breakfast, yes.

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Hello. Hi, darling.

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Good girl.

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FUJI CLICKS

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And you sound like you're laughing. Are you laughing, Fuji?

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Yeah.

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'Fuji's tail was destroyed by a bacterial infection

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'that almost killed her.'

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Oh, I see.

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-75% of it's gone?

-Yeah.

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So she can't balance, and you can see it compared to the other dolphins,

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she can't stand up like they do, cos she hasn't got the balancing power.

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She can't jump, uh-huh.

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'Fuji is missing the end of her tail, which should split into two flukes.

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'These propel dolphins through the water...

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'..and help them leap into the air.

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'They even use their flukes to communicate with each other.

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'Losing her tail radically changed Fuji's life.

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'The mother of three could barely swim,

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'and stopped socialising with the other dolphins.

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'For the last 12 years, Keiichi has been trying to find a solution.

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'He's been developing prosthetic tails for Fuji,

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'and today he's going to try out the latest one.'

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This one is the first type.

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This is the original.

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The last type.

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When you first came up with the idea, what did everybody say?

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Trial and error, uh-huh - and this is the most recent?

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Yes.

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And is this actually cast on her tail, so it's made...

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-Yes.

-Precision fitting, as it were?

-Yes.

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Have you tried this on Fuji?

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No, it's the first time.

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And do you think she'll be able to swim fast?

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I hope.

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And will she be able to jump?

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-Er, maybe.

-OK.

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I hope.

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'If this tail works, it could transform Fuji's life.

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'The flukes have been modelled on those of one of Fuji's daughters.

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'The inside of the prosthetic fits snugly around Fuji's tail stump,

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'and is held in place by a brace.

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'It needs to be just as strong as the real thing.'

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So we'll find out first of all

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whether she can swim properly with this, and also whether

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she can jump out of the water, cos that will be a really good sign.

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Go, Fuji, go.

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'The tail seems to fit perfectly...

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'..but Fuji isn't swimming any better than before.'

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She is nervous.

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Come on, Fuji.

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Let's see you swim.

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Good girl, away you go.

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'Keiichi can only hope that Fuji just needs some time to get used

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'to her new prosthetic,

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'and remember what she's capable of with a fully functioning tail.'

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Good girl.

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She's warming up.

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She's warming up, is she?

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-I think she likes it.

-Yes.

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She seems really proud of it,

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so she's waving it around and she's swimming really strongly.

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Good girl, good girl!

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Good girl.

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Look at her, she's going straight off on her back

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and flapping her tail - she's excited, isn't she?

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'But the ultimate test is if Fuji can jump out of the water.'

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She make a jump.

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She's going to try now?

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Come on, Fuji.

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Ah! Ha-ha!

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'At her first attempt, she manages a three-metre jump,

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'propelling her whole body out of the water.'

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Build up the power.

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She's going so much faster with the tail. Oh, yeah!

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'Keiichi's determination has paid off.

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'Her tail has given Fuji back her strength and speed.

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'It means she can leap and play with the other dolphins again.

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'It's given her a new lease of life.'

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Yeah!

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'There's always a chance that innovative techniques won't work...

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'..but the risks are even greater

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'when you're trying something new out in the jungle.

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'I'm in Laos, where vets are going to attempt

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'ground-breaking brain surgery.

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'These rainforests are home to a species of bear

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'that's only found here in Asia.'

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These are Asiatic black bears, or they're also called moon bears,

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cos they've got this moon shape across their chest.

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Unfortunately they're threatened, because their bile is used

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in traditional Chinese and Korean medicine.

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'The Tat Kuang Si Bear Rescue Centre..'

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Hey, Didi, there you go.

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'..is run by animal lover Mike Brocklehurst.'

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Come on, Mi-Mi.

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'Mike and his team currently look after 24 moon bears.

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'Four years ago, Mike took in a three-month-old cub called Champa

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'who'd been found in a nearby village.'

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When she came, she was in a, you know, a very bad way.

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She weighed 1.7 kilo, she was all legs and belly.

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She was obviously suffering with malnutrition,

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she had a big domed head with a pointy noise,

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her eyes were bulging out, all her teeth were going brown.

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I didn't think she'd survive,

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so I used to take her home every day, bring her with me

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to the sanctuary, feed her throughout the day and night.

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So you were her surrogate dad at the time.

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At the time, surrogate mum and dad.

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Come on, Champs, come on, Champs.

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'Champa never fully recovered.'

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Come on, Champs.

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At what point did you realise that,

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you know, there was something wrong there?

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Well, within a month or so she actually stabilised her condition,

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and I thought, well, she's going to be a good, healthy little bear,

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but I started realising that she wasn't developing

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as well as the other bears and she was perhaps losing her sight.

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Yeah, and over the last six months she's started to decline.

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Yeah, she has - she weighs probably about 20% less

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than the other bears of her age.

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Some days she'll just want to stay in the hammock all day,

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she won't come outside. She doesn't do a lot.

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'The sanctuary's medical team think Champa was born with hydrocephalus,

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'which means excess fluid builds up in her brain.

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'The condition, which can also affect people,

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'means her brain hasn't properly developed.

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'She has poor vision, and they think the pressure in her head

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'could be giving her excruciating headaches.'

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It's so hard just to watch her move.

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I get migraines, so I know what brain pain feels like,

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and she just looks like I feel when I've got a really bad head.

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This swinging motion, this dropping of her nose, and really slow,

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exaggerated movements, and then the loss of her sight

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and having to feel her way around.

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She's obviously a really sick bear.

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'The Buddhist tradition here in Laos and complex laws surrounding

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'endangered animals means putting Champa to sleep isn't an option.'

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Good girl.

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'Mike is determined that, even if she won't ever have the same life

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'as the other bears, she should at least live without pain.'

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Good girl, good girl, eh?

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-Do you want to give me a hand with this?

-No worries.

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'He's called in vet Romain Pizzi.'

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Right, can you just grab that?

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'Based at Edinburgh Zoo,

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'Romain is a pioneer of keyhole surgery for animals...

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'..and he thinks he'll be able to relieve

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'the pressure on Champa's brain.'

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You've brought enough gear with you.

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-Well, we are doing brain surgery.

-That is true.

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'Romain is going to try to implant a tube into Champa's brain,

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'which will drain out the excess fluid as it builds up.'

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So, it's a matter of placing the tube into the brain,

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then running it into the abdomen, so you can allow that fluid to run.

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To drain, yes. There's a little valve that,

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when the pressure gets above a normal pressure,

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then the fluid flows through that, so we've got

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to bury this little tube underneath the skin so she can't chew it out

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and then put it in the abdomen where this extra fluid can be absorbed.

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'It's a risky operation that was originally devised for people.

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'It's the first time anyone's attempted it on a bear.'

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Come on.

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'But Mike is hoping that, from tomorrow,

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'Champa could have a pain-free life.'

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What's here, what's here? Come on, it's good stuff.

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'Some animals are so well-adapted for the environment they live in,

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'there's no way vets can borrow human medical techniques

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'to look after them.

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'Elephants' tusks are elongated front teeth...

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'..used for fighting...

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'..digging and moving trees.

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'Treating them takes expertise and highly specialised equipment.'

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This is a domestic saw.

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You have to realise that you don't go and buy

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equipment for elephant dentistry,

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there is just nothing available, so we have to cope with

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what we've got, and all of the other instruments here were purpose made.

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My friend is a mechanical engineer and this is their handiwork.

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'Big-animal dentist Gerhard Steenkamp and vet Adrian Tordiff

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'have been flown in from South Africa to try

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'and remove the tusk of a five-tonne elephant.'

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I'm going to need most of that.

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'Ninio is a 13-year-old African elephant

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'who lives at Poznan Zoo in Poland.

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'He's cracked his left tusk, and it's become badly infected.

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'The team here has tried to treat Ninio...

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'..but the infection won't go away,

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'and they're worried it could be spreading into his head.'

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Ninio is experiencing pain and major infection in the tusk

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and he has this big hole in the tusk and it is really

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unpleasant for him, so we must help him and we will do this.

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'The vets think the only way to get the infection under control

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'is to completely remove Ninio's tusk.

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'Before they can operate, Adrian has to anaesthetise him.'

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This stuff is incredibly potent,

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so one drop will probably pretty much knock down

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everyone in this room, you know, and stop them breathing.

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Ready to go.

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'Adrian doesn't want Ninio to get stressed at the sight

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'of the gun, as that would cause him to release adrenaline

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'and make it harder for him to go to sleep.

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'If Ninio lies down in the wrong position or for too long,

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'he could crush his internal organs under his own weight,

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'so they're up against the clock.

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'Once Ninio is settled,

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'Gerhard quickly removes the outer part of the infected tusk.'

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Endoscope.

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'Now, using a specially-designed endoscope,

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'he's able to see what's causing Ninio so much trouble.'

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So, that is the pulp, still a little bit alive, so inflamed and infected.

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'To clear the infection, Gerhard needs to remove the entire

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'root of the tusk...

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'..which goes half a metre into Ninio's skull.

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'He discovers the infection is so severe,

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'it's made the tusk grow in a completely abnormal way.'

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The ivory has closed off, there's a wall right here

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and I cannot get beyond it.

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Give him another two milligrams, OK?

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'Ninio's already been asleep for longer than they'd hoped.

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'They can't afford to give him any more anaesthetic.

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'All Gerhard manages to do is break a small hole

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'into the wall of ivory, which he hopes will relieve some pressure

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'from the infection.'

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So it's not coming out today?

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Not today.

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So I think we need to wake him up.

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It is the first tooth in my life that I cannot get out,

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so that is really disappointing.

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The operation will allow the infection to drain,

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and so Ninio should start feeling better.

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I'm just relieved that he's standing and looking OK.

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But Gerhard and his team will have to find a way to get that tusk out.

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If the infection takes hold again, Ninio might not survive.

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The hardest part of helping an animal can be making a diagnosis.

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You guys want to jump up there and pull her in?

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In Chicago, vets need to find out what's wrong with Tiara.

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She's an Amur tiger, one of just 500 left in the world.

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Tiara's had a nose bleed and the team here at Brookfield Zoo

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are worried that it's a sign of something more serious.

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One of the bigger concerns is that we potentially could have a tumour

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or a mass or something else in there that's causing the bleeding.

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So the main thing we're all going to be very careful about

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is not getting our hands in her mouth at all.

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It's been impossible for head vet Mike Adkesson to do a check-up with Tiara awake.

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There, under her chin.

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She's a little on the thin side which is not a bad thing.

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We like to see our animals a little bit on the lean side

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so that we don't run into issues with them becoming overweight.

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He's going to examine her with a CT scanner,

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just like you'd find in a hospital.

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-Got it. Do you want it back?

-OK. Let's go forward.

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This machine's been adapted for animals,

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although not all of them are as big as Tiara.

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If I could try and wedge her mouth a little bit, to get her jaws open.

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The scanner will create a 3D image of inside Tiara's head.

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Slide that forward.

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So it's basically a giant X-ray machine

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that takes sort of cross-sectional images,

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so if you think of a loaf of bread being sliced into a bunch of slices,

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that's basically the set of images we get out.

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Are we set with the anaesthesia?

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We're scanning basically from the tip of her nose

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all the way to the back of the skull, er, which is going to

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give us a look inside the nasal passages, the sinuses.

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We're looking for any irregularity or asymmetry between the two sides.

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With virtually none of the risks of surgery,

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this is the safest way to examine Tiara.

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As she begins to come round, timing is everything.

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It's too dangerous to be in the same room as her awake,

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but they must wait for signs that she's breathing properly on her own.

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As she starts coming up, the first thing she'll start doing

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is sort of biting this airway tube a little bit

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and then in the process of coughing it out,

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we'll know she's getting ready to wake up.

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It will take Mike and the team the rest of the day to examine

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the results of the scan and find out what's behind Tiara's nose bleed.

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At the Moon Bear Sanctuary in Laos,

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Champa is about to have ground-breaking surgery

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to try and relieve the pressure on her brain, caused by hydrocephalus.

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Come on.

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Mike, who rescued Champa as a tiny cub,

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is hoping it's going to be a whole new start for her.

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I don't think I slept at all last night.

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I went to bed early, hoping to be rested this morning,

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but, yeah, I just, er, kept thinking all night, what, you know,

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what does the day hold for us today?

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Vet Jonathan Cracknell needs to anaesthetise Champa.

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That's great. Very wobbly.

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But before they even get her to surgery,

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Jonathan realises something is not right.

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Can you get me the ambu bag and the tubes...

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cos you're not breathing.

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-She's stopped breathing?

-Yeah.

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Jonathan has just moments to clear her airway.

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You in? Her colour's gone very bad.

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She's breathing now.

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-Yeah.

-Yeah, there you go.

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That was a bit tense.

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That was a bit tense. She went down quicker than we expected.

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Only once they're happy Champa's breathing properly

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can the team take her to the sanctuary's on-site clinic.

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It's a bit of a steep climb,

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but thankfully she's stayed nice and stable.

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Romain is going to try and implant a tube

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that will run from Champa's brain down to her abdomen.

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It will drain away excess fluid as it builds up in her brain.

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I'm cutting.

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Romain has to drill a tiny hole into Champa's skull.

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Let's try and see which...

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It's got to be really millimetre by millimetre

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and just very, very gently make their way through the skull.

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This is the really critical bit because one slip,

0:26:470:26:50

one tiny probe too far, and we could do some real damage.

0:26:500:26:54

If the drill even touches Champa's brain, she could die on the table.

0:26:550:27:00

This bit I'm not going to watch. They're the experts.

0:27:040:27:07

I'm going to leave... I really don't want to see the next bit.

0:27:070:27:09

Romain is about to implant one end of the tube

0:27:090:27:13

into a cavity in her brain where the fluid builds up.

0:27:130:27:17

Yeah, definitely in.

0:27:170:27:19

He feeds the other end of the tube down towards her abdomen.

0:27:200:27:24

He's going to insert an endoscopic camera to find it

0:27:300:27:33

and bring it down into position.

0:27:330:27:35

To see his way round with the camera,

0:27:390:27:41

Romain needs to inflate Champa's abdomen.

0:27:410:27:44

Would you switch on the insufflation?

0:27:440:27:46

But something's not right.

0:27:500:27:53

-I think it's shortening out.

-I think it is, yeah.

-I think it's just the power supply.

0:27:530:27:57

There's not enough electricity to power the vital equipment.

0:27:570:28:00

The other thing you can do

0:28:000:28:02

is see if you can plug it directly into something, Nick.

0:28:020:28:05

If they can't get the machine working,

0:28:110:28:13

Romain has no chance of finding the end of the tube.

0:28:130:28:16

Oh...just keep...any luck?

0:28:200:28:23

No, it's still not, um...

0:28:230:28:25

He's going to have to improvise.

0:28:280:28:30

Get the mattress pump, remember that one.

0:28:300:28:35

What we'll do is, er, use this - which is a mattress inflator pump.

0:28:350:28:38

It's like for air beds, basically.

0:28:380:28:40

It's not ideal but needs must

0:28:400:28:42

and, er, when you're in the middle of nowhere,

0:28:420:28:44

sometimes you just have to adapt.

0:28:440:28:46

OK, can you just all keep quiet for a second?

0:28:460:28:49

-Are you happy on the generator?

-Yeah.

0:28:490:28:51

-You're happy.

-She's got enough oxygen and she's breathing on 100% 02.

0:28:510:28:56

If you put on the light for the room, please.

0:28:560:28:58

-Do you want to put the mattress pump on for a short burst?

-Yeah.

0:28:580:29:01

Cuff her up again.

0:29:030:29:04

His plan works.

0:29:090:29:12

There comes the tube, see, there's our stent coming out there.

0:29:120:29:16

With her abdomen inflated, Romain can see what he's doing.

0:29:160:29:21

That's the other end of the tube

0:29:220:29:24

so that's where the fluid will now drain to.

0:29:240:29:27

It will disappear in between the liver and the diaphragm

0:29:270:29:31

and just be absorbed there.

0:29:310:29:32

It's quite a long way to go, from the brain to the belly.

0:29:350:29:39

He guides the tube into position.

0:29:390:29:41

And a last quick look and reposition.

0:29:440:29:47

It will stay inside Champa for the rest of her life.

0:29:470:29:51

We'll do the external bits quickly.

0:29:510:29:54

Almost done. Almost done. Almost done.

0:29:540:29:56

Against all the odds, the surgery's complete.

0:29:580:30:01

One of the things that we like to do is let them

0:30:090:30:11

come round at their own pace, so we're not going to push her.

0:30:110:30:13

She's had a six-hour anaesthetic

0:30:130:30:15

and we just want her to come around at her own steady rate.

0:30:150:30:18

Hello. All right, darling?

0:30:290:30:32

OK, you're pretty good, aren't you?

0:30:330:30:35

The next morning, Champa's back on her feet.

0:30:430:30:46

But it will be a few weeks before Mike and the team know

0:30:520:30:55

if the operation's been a success and Champa's no longer in pain.

0:30:550:30:59

Good girl.

0:31:000:31:02

Good girl.

0:31:030:31:04

Good girl.

0:31:050:31:06

It's been five months since Ninio had his last dental operation.

0:31:180:31:22

Vets Adrian Tordiff and Gerhard Steenkamp have come back to Poland

0:31:230:31:28

to try and remove the infected tusk that last time defeated them.

0:31:280:31:33

Hello, boy. There we go.

0:31:330:31:36

Ninio's tusk was so deformed that Gerhard has spent the last few months

0:31:360:31:40

developing special tools to try and get it out.

0:31:400:31:43

These are the cutters that I've had made.

0:31:450:31:48

They made me a very nice chisel.

0:31:490:31:52

-Oh, yes.

-In Poland.

-To try and split the bone apart.

0:31:520:31:55

With Ninio asleep under a general anaesthetic,

0:31:570:32:00

Gerhard gets a chance to have a look at the tusk.

0:32:000:32:03

There's still a lot of pus coming out of it,

0:32:050:32:07

but it's clean in terms of no parasites,

0:32:070:32:09

no maggots or anything like that.

0:32:090:32:12

There's little bits of movement on some of these tusk pieces

0:32:120:32:17

which could be positive.

0:32:170:32:20

Gerhard hopes that if he starts by hollowing out the centre

0:32:220:32:25

of the tusk, he'll then be able to remove the outer pieces more easily.

0:32:250:32:29

But the ivory is too tough, even for the new tools.

0:32:480:32:52

Gerhard decides his only option is to try

0:32:520:32:54

and pull the tusk out with a winch.

0:32:540:32:57

Yes!

0:33:190:33:21

Relieved. Absolutely relieved!

0:33:210:33:25

It's feeling nice and smooth in there,

0:33:260:33:28

no bone fragments, which is great.

0:33:280:33:31

There's no more ivory left

0:33:310:33:33

and things are looking really good.

0:33:330:33:38

Now Gerhard can clean away the mass of infection

0:33:430:33:46

that was trapped behind the tusk.

0:33:460:33:47

And after three hours, the operation's over.

0:33:520:33:55

The next day, the vets check in on Ninio.

0:34:090:34:12

Actually quite remarkable, and now that his trunk is up,

0:34:150:34:19

I can look into his empty alveolus and there's just about nothing...

0:34:190:34:23

-Coming out.

-..coming out of it.

0:34:230:34:25

Nice and clean.

0:34:250:34:27

He's eating quite well and moving around well.

0:34:270:34:29

The infection has gone,

0:34:370:34:38

which means Ninio will soon be out of pain

0:34:380:34:41

and can rejoin the other elephants.

0:34:410:34:44

In Chicago, Mike has been going through the images

0:34:570:35:00

produced by the scan of Tiara's head...

0:35:000:35:03

..to see if her nose bleed was the sign of anything more serious.

0:35:060:35:10

We're seeing the front teeth come into view,

0:35:120:35:14

canine teeth coming into view here.

0:35:140:35:16

Now we're getting into some of the nasal passageways.

0:35:160:35:19

If we were to see a mass or anything in this area,

0:35:190:35:22

we'd lose a lot of this and we'd just have a solid structure

0:35:220:35:26

with none of these little fine folds of tissue in there.

0:35:260:35:29

It's good news for Tiara.

0:35:300:35:32

I think we're really good shape here.

0:35:330:35:35

There's really nothing that we're seeing out of the ordinary.

0:35:350:35:38

Though the blood we were seeing from the nose was probably

0:35:380:35:42

just a, you know, an incidental finding, so to say that, you know,

0:35:420:35:46

she had some sort of traumatic event or bumped her nose or just

0:35:460:35:48

had a nose bleed for kind of an unknown reason even, but it doesn't

0:35:480:35:52

seem to be anything concerning as a long-term problem here.

0:35:520:35:56

With the population of Amur tigers critically low,

0:35:570:36:00

it's a relief for everyone.

0:36:000:36:02

Tiara's been given the all-clear,

0:36:040:36:08

without having to undergo invasive surgery.

0:36:080:36:11

For big-animal vets, every patient comes with unique challenges.

0:36:190:36:23

Galapagos tortoises move so slowly

0:36:270:36:30

that their main protection against predators is their shell.

0:36:300:36:34

It's the perfect suit of armour,

0:36:360:36:38

but it makes them incredibly difficult to treat.

0:36:380:36:41

Hello, girls.

0:36:440:36:45

Ha-ha! Losing my nerve.

0:36:480:36:52

They must have quite sharp teeth, cos they go crunching through those.

0:36:520:36:55

It really is quite a powerful bite for a vegetarian.

0:36:550:36:59

As part of a programme to save this endangered species,

0:37:040:37:07

London Zoo is currently home to five Galapagos tortoises.

0:37:070:37:11

And there's one tortoise missing from that group

0:37:150:37:18

and she's called Priscilla and the reason

0:37:180:37:20

she's not with them is she's been very sick, so they've taken her

0:37:200:37:23

to the zoo hospital so that the staff can keep a close eye on her.

0:37:230:37:26

Priscilla is being looked after by veterinary nurse Matt Rendell.

0:37:290:37:32

So this is Priscilla.

0:37:330:37:35

Good girl.

0:37:350:37:37

She's so unwell, she's been unable to eat for several weeks.

0:37:370:37:41

How did you first know that she was... Oh, darling!

0:37:420:37:46

How did you first know that she wasn't well?

0:37:470:37:49

Well, normally, tortoises graze all the time

0:37:490:37:52

and it was something that she stopped doing

0:37:520:37:54

and it was obvious from her weight loss

0:37:540:37:55

and the fact she was really kind of down in the dumps

0:37:550:37:58

that she really wasn't well at all.

0:37:580:38:00

The only thing keeping her alive is a feeding tube

0:38:000:38:03

inserted into her neck.

0:38:030:38:05

They're worried that not eating is a sign that Priscilla's liver

0:38:050:38:10

isn't working properly.

0:38:100:38:11

But the problem is getting to it beneath her protective shell

0:38:140:38:17

to find out what's wrong.

0:38:170:38:19

They've called in keyhole surgery specialist

0:38:220:38:25

Romain Pizzi to see if he can help.

0:38:250:38:28

This tortoise has been ill but it's difficult to piece everything together

0:38:280:38:32

and know what's going on so the easiest way is to look at the organs, so...

0:38:320:38:36

The tortoise is in a big box - that makes getting inside very difficult.

0:38:360:38:40

Romain hopes that with an endoscopic camera and extra-long instruments,

0:38:440:38:49

he might be able to reach Priscilla's liver to take a sample.

0:38:490:38:52

Lift, lift, lift, perfect.

0:38:540:38:55

The easiest window and the safest place is in front of the back leg,

0:38:550:38:58

so there's a little gap there where there's some soft tissue there

0:38:580:39:01

that we can make a little cut and we can actually stick the telescope in.

0:39:010:39:05

In a person, or most animals, we'd actually puff them up

0:39:050:39:08

with carbon dioxide and that makes like a tent so you can see

0:39:080:39:12

what's going on, but the tortoise has got a rigid tent, so it's

0:39:120:39:16

quite difficult to navigate our way around and see what we need to see.

0:39:160:39:19

Romain hasn't tried this on a tortoise Priscilla's size before.

0:39:220:39:25

Just be very careful. You're not going to be able to do that.

0:39:270:39:31

But his plan to get the biopsy of her liver falls through

0:39:310:39:34

before he can even begin.

0:39:340:39:37

An ultrasound reveals her bladder is completely full,

0:39:380:39:42

blocking his path.

0:39:420:39:45

My main risk is sticking the endoscope in,

0:39:450:39:49

going into the body and actually puncturing the bladder.

0:39:490:39:53

That's what we really don't want to do.

0:39:530:39:55

Romain decides that the only way to get to the liver

0:39:550:39:58

without damaging her bladder is to tip her onto her side.

0:39:580:40:02

I'm hoping what we'll do is, once you tilt it, we may connect,

0:40:040:40:07

things will fall down and so you'll have a safe space to go in.

0:40:070:40:11

Get us two more chairs and tie them together.

0:40:110:40:13

But getting Priscilla into position isn't easy.

0:40:160:40:20

Right, so... so the chairs - turn her lateral

0:40:230:40:26

and that is, in essence, a cradle.

0:40:260:40:28

One, two, three.

0:40:280:40:30

I'll get the legs.

0:40:320:40:34

If they crack or damage her shell, it will take years to heal.

0:40:340:40:38

OK, watch that leg.

0:40:380:40:40

That's the best we can do.

0:40:410:40:43

So the team have been pretty inventive and creative.

0:40:430:40:46

They've put two chairs together to create a cradle,

0:40:460:40:48

so Priscilla can now be sideways and it means that Romain can

0:40:480:40:52

get in through that soft bit at the top of the leg.

0:40:520:40:56

She's been anaesthetised for an hour and ten minutes now, guys.

0:40:560:41:00

Romain makes two incisions - one for the endoscopic camera

0:41:000:41:05

and one for the instrument that he'll take the sample with.

0:41:050:41:09

He has to make his way carefully towards her liver.

0:41:130:41:16

That bladder is absolutely huge.

0:41:180:41:20

What is interesting is the length of instruments you are using.

0:41:220:41:26

It is what they call bariatric instruments, which is what

0:41:260:41:29

they use in very fat people so they are extra length

0:41:290:41:31

and that whole length of the instrument is disappearing

0:41:310:41:34

inside the tortoise and it's still not...still not getting far enough.

0:41:340:41:38

Priscilla's shell means there's very little room for him to manoeuvre.

0:41:410:41:46

If you look, it's like fighting with chopsticks inside this tortoise.

0:41:470:41:51

Finally, he makes it.

0:41:550:41:56

This is the liver - this whole structure here is liver.

0:41:580:42:00

We're only just seeing the edge.

0:42:000:42:03

The liver is not pretty.

0:42:060:42:07

I would say - to me, that doesn't look normal for most reptiles.

0:42:070:42:12

Priscilla's liver is a much lighter colour than it should be,

0:42:120:42:16

confirming their suspicions.

0:42:160:42:18

Quite a reasonable piece there. We'll take a couple from that tip.

0:42:200:42:24

He snips a tiny sample,

0:42:240:42:25

which will now be sent to the zoo's laboratory to be analysed.

0:42:250:42:30

You don't want that in any more, do you?

0:42:330:42:36

An hour later, Priscilla's awake.

0:42:360:42:39

Everyone's delighted and relieved that Priscilla's come through the procedure so well.

0:42:440:42:48

She's come round from the anaesthetic but we've got to wait for the results

0:42:480:42:51

from the biopsy tests and then see what happens next.

0:42:510:42:55

A week later, the results of the biopsy reveal that Priscilla

0:43:060:43:10

has a chronic liver condition called fatty liver.

0:43:100:43:15

It's triggered by not eating and means the liver starts

0:43:150:43:18

processing fat abnormally, which can be fatal.

0:43:180:43:22

Good girl.

0:43:220:43:25

In Priscilla, they caught it just in time

0:43:250:43:28

and through an intensive feeding programme,

0:43:280:43:31

Matt and the team have managed to reverse the damage.

0:43:310:43:34

And now Priscilla's back eating on her own.

0:43:360:43:39

She's interacting with us much more. She's just pleased to see us now

0:43:400:43:43

and comes over and enjoys a fuss

0:43:430:43:45

and physically she's much, much stronger now.

0:43:450:43:48

She can stand up now. We're really pleased with her progress.

0:43:480:43:51

It's been a very rewarding nursing case.

0:43:510:43:53

Priscilla's protective shell

0:43:560:43:58

made her a more challenging patient than many,

0:43:580:44:01

but a few weeks later,

0:44:010:44:03

she's well enough to be returned to her enclosure.

0:44:030:44:06

21st-century medicine is coming to the rescue of animals

0:44:290:44:32

right around the globe - even prehistoric ones.

0:44:320:44:36

I'm in the Everglades National Park in Florida.

0:44:410:44:44

Alligators and crocodiles have been living in swamps like these

0:45:020:45:05

for millions of years and they've changed very little since then.

0:45:050:45:10

It's obviously a body shape that works really well.

0:45:110:45:14

Although they sit here motionless most of the time,

0:45:210:45:25

when they get close enough to grab something,

0:45:250:45:27

they can move at amazing speeds.

0:45:270:45:29

These opportunistic predators have a fearsome reputation

0:45:330:45:37

for most people here in Florida.

0:45:370:45:40

But not Bob Freer.

0:45:430:45:45

He's been rescuing gators in need of help for over 20 years.

0:45:460:45:51

I actually got my first alligator back in 1956.

0:45:530:45:57

My father actually went into a gas station, came out and just threw

0:45:570:46:01

a little alligator hatchling in the back seat with me.

0:46:010:46:05

Er, and when I went to grab it, it actually grabbed me by the finger

0:46:050:46:08

and that kind of started the love relationship

0:46:080:46:11

that I have with alligators.

0:46:110:46:12

Bob's most recent arrival is Martha, who he found suffering

0:46:170:46:21

from what looks like a chronic blockage in her guts.

0:46:210:46:24

She really isn't right. She's sitting really strangely.

0:46:260:46:29

That's the first thing we noticed,

0:46:290:46:31

and this little tilting back and forth, you know,

0:46:310:46:33

like she's bobbing. She just doesn't have control.

0:46:330:46:35

Yeah. So she can't sink at all at the moment, then?

0:46:350:46:38

No. She tries to go under to get away,

0:46:380:46:41

she just bobs right back to the top again.

0:46:410:46:44

-To see an animal suffer, you know, it's a little heart-breaking.

-Hmm.

0:46:480:46:52

You can really see the difference between a normal gator

0:46:580:47:01

and Martha here - you know, with the sleek aqua-dynamic shape,

0:47:010:47:05

this really good swimming position, and then poor Martha

0:47:050:47:09

looking like some kiddie's inflatable toy. It's dreadful.

0:47:090:47:14

They don't know what's causing Martha's blockage.

0:47:180:47:22

But it's so severe, her gut could rupture at any moment.

0:47:260:47:29

They need to get her to a vet.

0:47:320:47:33

The amazing thing about gators is that although they have

0:47:420:47:45

one of the strongest bite pressures in the animal kingdom,

0:47:450:47:49

actually the muscles to open the jaw you can hold with just two fingers.

0:47:490:47:54

That's why the insulation tape that's going on now

0:47:540:47:57

is just enough to keep that jaw from opening up.

0:47:570:48:00

Martha is going to be examined by Doug Mader.

0:48:060:48:09

-Meow!

-Hello!

0:48:090:48:12

As well as being a small-animal vet,

0:48:120:48:15

he's a world renowned reptile specialist.

0:48:150:48:18

Hey, Bob, what have you got here?

0:48:190:48:21

Er, well, we've named her Martha,

0:48:210:48:24

and basically you can tell from its stomach there

0:48:240:48:27

she's not feeling very good.

0:48:270:48:29

She's not feeling good. She's really bloated.

0:48:290:48:31

All right, kiddo, you're in the right place.

0:48:310:48:34

So what we're going to do is try and give her a look-over.

0:48:340:48:37

She is packed.

0:48:370:48:39

Most likely she's probably swallowed something she's not supposed to.

0:48:390:48:43

Can you actually feel anything in there?

0:48:430:48:45

-You can. Want to feel it?

-Yeah, I'll have a quick feel.

0:48:450:48:47

-She feels like she's got a brick in there.

-Oh, my God, that is solid.

0:48:470:48:51

-So we'll take her in and let the nurses get the X-rays.

-OK.

0:48:510:48:56

The X-rays reveal just how unwell Martha is.

0:48:580:49:02

-Her head is up here.

-Yeah.

-OK. This is her lungs.

0:49:030:49:05

This is her stomach here

0:49:050:49:07

and these large masses are not supposed to be there.

0:49:070:49:10

-She can't go on, can she?

-No.

-This is enormous.

0:49:100:49:13

-No, and you can see, the pelvis is here.

-Yeah.

0:49:130:49:15

And even the smaller masses, they'd never fit through the pelvis.

0:49:150:49:18

They're not coming out the normal route, no.

0:49:180:49:21

Martha's only hope is surgery to remove these blockages.

0:49:230:49:27

We're using a 21st-century technology to save an animal

0:49:290:49:31

that's been around since the dinosaurs.

0:49:310:49:33

-Are we ready?

-That's it.

-OK, here we go.

0:49:390:49:42

At last Doug can find out what's causing Martha's blocked gut.

0:49:440:49:49

-She may jump, she's not awake.

-She's not feeling it?

0:49:540:49:57

That's normal twitch of the abdominal muscles.

0:49:570:49:59

He sees immediately that things are much worse than he was expecting.

0:50:040:50:09

What I need to do is figure out what I'm looking at.

0:50:090:50:12

-So you're just trying to tease in between those areas.

-Yeah.

0:50:120:50:15

-Obviously you can't even see what to cut, so you're just...

-Not yet.

0:50:150:50:19

There's been so much trauma inside the abdomen,

0:50:190:50:22

so much inflammation that's caused the actual guts themselves

0:50:220:50:27

to start to stick and scar together

0:50:270:50:30

and scar to the abdominal wall

0:50:300:50:31

and everything is just a big, sticky, horrible mess.

0:50:310:50:35

Doug manages to separate out one of the huge lumps he saw on the X-ray.

0:50:360:50:41

Oh, yuck.

0:50:430:50:45

We wouldn't see this degree of change

0:50:450:50:48

in a patient of mine.

0:50:480:50:50

There's no way that, you know,

0:50:500:50:52

a dog or cat could tolerate this degree of abdominal mess.

0:50:520:50:57

It would be dead long before it could get to this stage.

0:50:570:51:00

Doug can clear out Martha's intestines

0:51:010:51:04

but he discovers they've become completely sealed off.

0:51:040:51:08

Bob, come over on my left shoulder so you can see, this is your animal.

0:51:090:51:13

Hmm.

0:51:130:51:14

Look, the whole pelvis is scarred over.

0:51:140:51:17

There's no connection between the colon, where the faeces were,

0:51:170:51:23

-and the outside.

-Yeah.

0:51:230:51:25

-Bob...

-Yeah.

0:51:250:51:27

I hate to say this, but I think we made a try.

0:51:270:51:30

No amount of surgery can help Martha.

0:51:330:51:35

We'll put her to sleep. We'll euthanise her before she wakes up.

0:51:370:51:42

Not the way we want it to end,

0:51:420:51:43

but it's part of our job as veterinarians.

0:51:430:51:45

-Sorry, Bob.

-Yeah.

0:51:550:51:58

I know you care about your animals.

0:51:580:52:01

I wouldn't have been able not to try.

0:52:040:52:06

We had to give it a try.

0:52:070:52:09

And I was hoping for better results than this.

0:52:100:52:13

Martha was just too unwell for Doug and Bob to save her.

0:52:190:52:24

But their efforts have at least put an end to her suffering.

0:52:260:52:31

BIRDS CALL

0:52:360:52:38

In Laos, it's been six months

0:52:430:52:45

since Champa the moon bear had keyhole brain surgery.

0:52:450:52:48

I'm just putting in a few branches for Champa.

0:52:500:52:53

She likes anything new that comes into her enclosure, to check it out.

0:52:530:52:56

She particularly likes the banana tree

0:52:560:52:59

or anything with leafy branches, cos they're quite destructive.

0:52:590:53:02

She loves to just sit there and break it up.

0:53:020:53:04

Champa! Champa! Come on, girl.

0:53:050:53:08

The tube which runs from Champa's brain down to her abdomen

0:53:100:53:13

means excess fluid is no longer building up in her brain.

0:53:130:53:18

Having this operation has, you know, transformed her whole life.

0:53:180:53:21

She's gone from a bear which was virtually 24 hours a day

0:53:210:53:25

in terrible pain...

0:53:250:53:27

She had no quality of life, she...

0:53:270:53:30

she could hardly eat, she was in so much pain.

0:53:300:53:33

But since then, she's a different bear.

0:53:330:53:37

She'd never do this before.

0:53:370:53:39

She'd never even have her head up.

0:53:390:53:41

While Champa will never be able to live with the other bears,

0:53:410:53:44

Mike's seen a huge change in her behaviour.

0:53:440:53:47

Yeah, what is that?

0:53:470:53:49

Oh, you cheeky bear, you cheeky bear.

0:53:490:53:52

This is how bears play with each other.

0:53:520:53:54

They like to mouth each other and swipe each other.

0:53:540:53:57

You, you're a bad girl!

0:53:570:53:58

What are you doing?

0:53:580:54:00

HE MAKES CLUCKING SOUND

0:54:000:54:02

He hopes Champa will go on to lead a full life,

0:54:020:54:05

free from the pain that tormented her for so long.

0:54:050:54:09

You're a funny bear.

0:54:100:54:12

You're a funny bear, aren't you?

0:54:120:54:14

You're a good bear, though.

0:54:140:54:15

You! You!

0:54:150:54:17

CLARE: In this series we've seen how life for many animals is changing

0:54:230:54:27

and how they face great challenges to their survival.

0:54:270:54:30

But advanced diagnostics, innovative surgery

0:54:350:54:40

and the dedication of vets around the world,

0:54:400:54:43

mean we can now look after them in ways we never could before.

0:54:430:54:47

Clare Balding and vet Steve Leonard join vets around the world whose ingenuity and dedication is transforming animals' lives. For the first time ever, a vet attempts to treat a moonbear using keyhole brain surgery deep in the jungle. Vets try to remove an elephant's massive tusk after he develops an infection, and will a prosthetic tail help a dolphin called Fuji swim again?