Episode 4 Young Vets

Britain is a nation in love with its animals.

How are you doing?!

We own 27 million pets...

..and 900 million farm animals.

Very frisky one.

All of them...

DOG WHINES

..need vets.

Over the course of their final year,

ten students at the prestigious Royal Veterinary College

in Hertfordshire are taking what they've learned in the classroom...

Do it.

..and putting it to the test in practices...

..farms...

This is all new territory for me.

..and state-of-the-art animal hospitals.

It's a whirlwind of back-to-back work placements...

MONKEY SCREECHES Sounds like an unhappy monkey!

Nice and quick, good.

..and they can't afford to fail a single one.

'I need to do my job properly.'

I need to do better.

It's the most challenging stretch...

Whoa!

..of a very long journey...

I have a serious problem with my hand shaking.

..to become...

-Well done.

-Gassy!

..fully qualified young vets.

Saved a life today, which is good!

In just nine months' time, fifth-year students

at the Royal Veterinary College face their dreaded final exams.

So far, in this final year, there've been plenty of highs...

Bit overwhelmed. Incredible.

..and lows.

Oh, my God. Fluids. I didn't write that down, either.

But their confidence is growing.

-Enter.

-Enter, student.

Yeah, she's...she's passed.

For vet student Elly Berry,

the next fortnight is going to be a huge challenge.

I'm always nervous. I never seem to be able to fight the nerves

of doing a new thing.

I definitely... You know, ask me what a horse is right now

and I'd be, like, "Oh, it's got legs."

I can't remember much and until challenged,

I don't know what I know...which is scary.

Elly's on her way

to the college's state-of-the-art Equine Referral Hospital...

Hello, team.

..where she's starting a notoriously scary two weeks on equine surgery...

which she has to pass.

You need to still do your checks and look after your patients.

It's your responsibility to keep an eye on them,

so make sure that they get done. Keep on top of your patients,

because they are your responsibility.

When they come and work in the hospitals,

this is where they get to apply all of the knowledge and information

that they have acquired over the previous four years,

becoming properly part of the clinical teams

and playing a real role in patient care -

talking to clients and so on -

is really what pulls all of their experiences together,

so it's pretty tough. We expect a lot of them.

What does "double-barrelling" mean?

Double barrel, as in kick with both back legs.

-Oh,

-BLEEP.

I'm always a bit nervous with equine,

just because it's out of my comfort zone

and, you know, right now, trying to think about anything equine...

Oh! Nothing. Nothing comes to me. It's just...

It's always a bit nerve-racking.

The first test of Elly's equine knowledge is two-year-old Vinnie.

Luckily for Elly,

her patient is a much-loved and extremely docile rescue pony.

He's been brought in by his owner, Emma.

I have two young children that were showing great interest in riding

and we thought it'd be a nice idea to adopt one from the RSPCA.

He's only tiny, he's only 12 hands high.

But he's got a great personality to make up for the size of him.

Hello, friend.

-Where's the lump?

-Erm...

-..all of that.

-Oh! All of that! The big lump on his face!

But the angry-looking lump on Vinnie's face

has got the whole team very worried.

In veterinary medicine, you are kidding yourself

if you see a lump and you don't think,

even in the back of your mind, that that could be cancerous.

That could be fairly sinister

and I think everyone's heart sank at that point.

When we picked him up, he was...he was well.

They'd sort of built him back up from being underweight.

The other pony that he was brought in with didn't make it.

I think he had to be put down, unfortunately.

We're just taking it slowly with him, though,

since he's not had a great start in life.

You've got a tiny moustache!

My biggest worry is he could have cancer...

Fingers crossed, that's not going to be a possibility.

We have to wait and see what happens.

Vinnie needs to have a CT scan

so the team can see if the lump is cancerous.

Ready? Come on, then.

But there's a problem -

pint-sized Vinnie is a lot smaller than the average patient.

It would transpire that Vinnie is, in his tininess, too small for the CT,

cos he has to be tall enough to get his head on a ledge

and it's...shall we say, regular horse sized, not Vinnie sized.

So they have sourced some blocks and I believe

they're raising the platform so that it is now Vinnie sized.

Vinnie's sedated so he doesn't move while he's in the scanner.

Elly and the team are anticipating the worst,

so it's a nervous wait to see the scan results.

Vet Ben Jacklin is leading Vinnie's diagnostic team.

When we use the CT machine,

we're able to image the whole of the horse's head.

And we can look for all sorts of things.

We can look for traumatic injuries, fractures of the skull.

We can look for masses inside the nasal cavities and the sinuses

and we can look for problems with the teeth, as well -

fractures of the teeth, tooth-root infections of the teeth

and we're able to see all of these things very clearly

using a CT machine. Far more so than if we're using radiographs.

'I'm just hoping it's going to be good news.

'I've been dreading it for a week.'

It's like having one of your children going in

and having a procedure done.

The scan results are in and Ben and Elly anxiously scrutinise

the pictures to see if there's a tumour there.

And we can slide forward

and we start to get onto the first sign of the soft tissue swelling

on the side of the face.

Vinnie's lump is clearly visible on the scan

and they can see that he must be in a lot of pain.

So, yeah, we've got a little bit of gas here,

which is consistent with an enamel breach.

But it's a huge relief,

because it turns out that Vinnie's problem isn't life threatening.

The cause of the tooth infection...

This is probably an abscess here.

The good news was that it wasn't cancer at all

and it was a tooth-root abscess,

which would have been causing him a lot of pain and this big lump,

but, luckily, with an abscess, we can definitely solve that

as opposed to cancer, which is always a bit of a tricky affair.

Elly will be helping to treat Vinnie,

so Ben needs to make sure her knowledge is up to scratch.

And the treatment would be?

Surgery and the removal of the tooth.

Yeah, and how can we remove the tooth? What's the best way to remove the tooth?

Well, you can't go into the sinus, cos it doesn't communicate.

-So we don't have that option.

-No.

-Cos you can usually tap them down, can't you?

-So bash them out.

Yeah, you certainly can do. Why might we try not to do that?

Erm, damage to a young skull?

Yeah, so what's the difference between true love and sinusitis?

True love and sinusitis?! I don't know. Tell me, please.

Sinusitis lasts for ever.

So if we disrupt the sinus,

by opening it up and banging the tooth ridge,

then the horse will have a low-grade sinusitis for ever and ever.

Essentially, what we would always try and do first of all

is orally extract these teeth.

-So we've got some wiggling to do.

-Brilliant.

Meanwhile, Vinnie's owner Emma has heard the good news

and has come to visit him before his operation.

Little baby! Are you going to assist?

I'll be there. Yes, I doubt... I don't know what I'll get to do...

-Will you do suction?

-..but I will definitely...

I'll definitely be there to stroke him and make sure he's got comfortable.

Plan now - Vinnie is staying in overnight

and then tomorrow we'll go into surgery to have that tooth extracted,

really, so they'll just tug on it.

It looks like tomorrow will be a big day for little Vinnie.

When I first started rotations and you're doing your physical exam on animals,

particularly abdominal palpation, "I'm just feeling the dog's belly!

"I have absolutely no idea if this is a liver or..."

-That is so true!

-"That feels a little bit lumpy. What could that be?"

-"I know what should be in here but..."

-You're running stuff through your fingers,

"Yeah, so if nothing's normal in here, I won't know."

It makes you looks more professional if you do the palpation.

-That is a bit... Seriously, is it just me or does that actually make you feel like a vet?

-Yes.

Yeah, when're you're doing the palpation, you're just like...

-"Yes, I do have eyes on the end of my fingers! Yes."

-Yeah!

By the time they graduate, our vets must have learned all the skills

they need to go straight into practice.

This includes being able to give a good basic anaesthetic.

And this week Jo Hardy is at the college's Queen Mother Hospital

learning how to do it.

You have absolutely no idea what you're going to get.

It could be anything that walks through the door

and the team just kind of goes, "You're doing this case now."

Because of that, it's really quite stressful,

cos you just don't know what's going to happen.

Jo's patient today is a nine-year-old Chihuahua called Rex.

It really is make or break for little Rex.

He's swallowed a fish-hook and if the medical team can't get it out,

he will almost certainly die from blood poisoning.

We're going to go to endoscopy and hopefully put a camera

down his throat and retrieve the fish-hook.

But the risky procedure to get the fish-hook out

is even more challenging, because Rex has a serious heart murmur.

My job is to keep him asleep.

I think he'll be quite a challenging one,

he's got a few heart issues and so we've got to make sure

we use the right drugs and keep him nice and quiet and asleep.

Anaesthetist Jaime Viscasillas is supervising Jo today.

He expects her to come up with a plan for anaesthetising Rex,

including which drugs to use.

-What's your plan?

-Maybe a propofol midazolam induction?

-OK.

-And then maintenance.

-Why midazolam?

-Well, it's a muscle relaxant.

-OK.

And so I suppose it will help relax the muscles in the oesophagus.

We'll do it as you're doing the endoscopy.

-OK.

-Good. Shall I calculate some doses?

-Yeah.

Right, come on, then.

First of all, Jo needs to give Rex a sedative.

Very small.

Then comes the difficult task of getting the anaesthetic tube

into Rex's tiny throat.

Push gently and twist.

-Push a little bit harder.

-OK.

-Yeah. Oh, there we are.

-Good. Very good.

Good pulse.

Once little Rex is fully under,

there's no time to lose getting him to the endoscopy suite,

where vet Chris Scudder is waiting for him.

So what we hope to be able to do is

we're going to use one of our fibre-optic cameras

and we're going to pass that through the dog's mouth

and into the dog's gullet, the oesophagus,

which is currently where the fish-hook is situated.

It wasn't a healthy dog, even minus the fish-hook incident.

He had this whopping, great, big heart murmur which is an awful thing

to have playing on your mind when you're doing anaesthetic,

because that really affects how the drugs work.

'It was really difficult to keep stable.

'Because of that, it was so stressful.'

There it is.

We're going to retrieve the hook

and then implant the hook into the tube and then pull the tube out,

so that the hook then doesn't get reattached back inside the dog.

But what they thought would be a tricky procedure

is turning out to be extremely dangerous for Rex,

because Chris has spotted a problem with the position of the hook.

It didn't look like it, no, no.

But it looks like it might be through.

It looks well and truly through.

It's not in his oesophagus...

..it's through his oesophagus.

It was really well wedged

and so everybody was just so emotionally involved

in what was going on and was willing them to try and get it out.

We have to attempt to try.

With his heart murmur,

it's dangerous for Rex to be under general anaesthetic for long.

But pulling the hook out too fast could tear Rex's oesophagus,

which would be fatal.

Above all, the team need to stay calm.

Yeah. We've not got hold of it at the moment.

Grab it here and push, rather than pull.

You had to get it out without the hook grating on the side

of the oesophagus or damaging the oesophagus further,

so we had to take it out super slowly, but without dropping it.

With one last tug, Chris manages to pull the hook into the tube

and out of Rex's oesophagus.

CLAPPING

Right, fish it out.

All right, let's go back.

Fantastic that we've got the fish-hook out.

It's quite big for a little dog.

Anaesthetically, we still haven't finished yet.

We'll soon see how he does waking up and how he progresses.

It could have been really bad,

because he's not a surgical candidate.

And so, yeah, saved a life today.

Even though they're well into their final year,

the students are still tackling a lot of procedures

for the very first time.

And Elly's no exception.

At the college, she's about to perform her first dental surgery

on a horse.

I feel like he's the equivalent of sort of a little toddler

that's not quite sure what's going on, but he's been very brave.

You are beginning to feel very sleepy.

Vinnie the rescue pony has a painful abscess

and needs to have a tooth removed.

He's given a local anaesthetic and a sedative ready for the operation.

Just did an IV.

Just, you know, just put some sedation in a horse.

Haven't done that before!

Elly is working today under the scrutiny

of senior surgeon Tom Witte.

So we have to take the tooth out.

That's where the swelling's coming from.

We'll be opening his mouth up and putting in various instruments

to try and loosen that tooth up slowly over the next...

Probably 45 minutes or an hour, it'll take us.

It's a square tooth in a square socket with two square teeth

on either side of it.

Very tightly opposed to each other,

so the process of extracting that is fairly tricky.

We can, if possible, bring that trolley in, as well,

a little bit closer?

Couple of minutes' time, Tom.

-Adequately abducted?

-Yeah. Looks good.

-Not too abducted?

No, no, that's good.

First step in loosening the tooth...

is to place the separator.

Might be able to see those spreaders in place.

-Oh, yeah!

-And so we can now start loosening, start wiggling the tooth

-a little bit from side to side. So like this.

-Yes.

A little bit of stabilisation on here now

and then you're going against the end stops, essentially.

'They're quite... What's the word? Brutal.'

Yeah, they're quite brutal operations.

Although this looks painful,

Vinnie's still heavily sedated and can't feel a thing.

It's very much just a matter of yanking this here,

pulling that there, pulling it out!

And it was...

Every so often, we just give this just a little squeeze

to make sure we're still tightly gripped on the tooth.

Yeah. My bicep feels, you know, like, top notch.

It won't be long now before we've got this out of there.

This tooth is getting pretty loose within the socket.

You can see that tooth is getting loose

in a lot of different directions.

Tooth fairy's on its way!

Over an hour of non-stop wiggling may finally be paying off.

But anyone scared of the dentist, look away now.

-SQUELCHING

-Oh, you hear that?

-Heard that.

Elly, why don't you try and get that tooth out of there?

-I can't feel it, either.

-Really?

-Yeah. Where is it?

Oh, ha-ha!

She's managed to rotate it towards the...

ALL: Yeah!

-Is that all right? Bloody hell.

-Very good.

So, got an intact tooth.

Let's give it a rinse.

All Vinnie needs now are some antibiotics

to get rid of the abscess.

And it was awesome just, like, reaching in and being, like...

"Look at this!"

The key is to check that all the... that the tooth is intact -

that you haven't left any fragments behind.

(It's awesome!)

It's really, really cool. I didn't expect that. That was...

'Nice to be challenged and to get it right'

and that was...that was good. Yeah, good.

Quite proud of myself.

'Come on, Vinnie. Good lad.

'Little Vinnie.'

Little Vincent.

No, he was...he was tops. He was sort of the perfect patient for me.

'He was great. He was a little...little soul.'

Little Vinnie's feeling much better for his visit to equine surgery

and, as it turns out, so is Elly.

I've come away from all my equine experience at RVC

feeling a lot more positive about horses

and not that I would necessarily go into equine practise per se,

but if I was to come across a horse, I wouldn't be terrified any more,

whereas it definitely would have been before.

-Hi.

-Oh, hello. Morning.

This week, Judy Puddifoot is at a small animal practice in Luton.

Every final year placement counts, but for Judy,

this one counts more than most.

If I was to become a vet, then I would be a small animal vet.

I like the idea of the romanticism of driving across the moors

in the sun and going to a calving,

and you know, everybody thinks that's great, everybody's got that image.

It's brilliant.

But when it comes down to it, the reality is I kind of like cats

and dogs more than large animals, so that's the area I want to go into.

Today, Judy's doing consults and her first patient is spaniel Harry.

-He's got a nasty...

-Skin problem.

-Skin problem on his leg.

And it's gradually got worse and worse.

I think it's time a vet had a look at it, basically.

-He's ten years old now, the light of our life.

-Yeah.

He's been through a serious accident before and nearly lost a leg

-and he does mean the world to us.

-Yeah.

-Absolutely.

Hi, would you like to come through?

My name's Judy, I'm a final year vet student

and Katy's kindly asked me to start this consult.

She's going to be there anyway,

but if you want to bring Harry on through.

-Come on, Harry.

-This way. No, this way.

Supervising vet Katy Wragg is expecting a lot more from Judy

than just sound clinical reasoning.

The job is probably 10% knowledge when you actually get in there

and 90% actually how you deal with clients

and how you use that knowledge to then be able to sort out

the animals and some people are very good at that stage

and some people will be more academic.

The rotation bit of that is the bit where you figure out

whether you're good at that or not.

-So, it's this lump that we've come about today, isn't it?

-Yes.

When did you first notice this?

Back in the summer, he come running in the back door

with his tail between his legs and we thought something had bit him.

-What would you do?

-What would I do? Um...

-What would you do?

-What do you think it is?

-I think...

I wonder if maybe he's got something in there

-and it might have got infected.

-A foreign object?

-Yeah. Something.

A thorn or a little piece of something in there.

-So, what do you think all of this around here is?

-I'm wondering...

This is all saliva staining, I'm guessing.

And I wonder if the little bits that are sore around it are

-because of that.

-Yes.

-Give him some antibiotics to cover...

Cos if it's pussy, it's not nice. That's infected.

-He needs to be covered with antibiotics.

-Perfect.

Sounds like a good plan. Sounds like a good idea.

-OK, thanks very much.

-Nothing serious, that was the main thing.

-Thank you.

-Thanks very much. Bye.

'Sometimes people feel a little bit maybe scared to go to the vet.

'It's important they come and feel comfortable'

when they're talking to us and I do pride myself on that, actually.

It's something that I think I do quite well.

It's a natural talent,

I suppose, being able to talk the hind leg off a donkey!

Judy's well aware that in a practice like this one,

vets have to be surgeons, as well as GPs.

A huge list of things that we have to know on the day we graduate,

so we all work towards ticking all these things off of our list.

And being able to do routine neutering, which is

castrating cats or spaying dogs, or female cats, is a day one skill, so

there is a lot of pressure to do them right and to do them

and be confident with them by the time you graduate.

And today, Judy gets the chance to prove herself.

We are going to castrate a cat.

-We...

-You are.

-I am.

I'm going to castrate a cat.

-Under my supervision.

-Direct supervision.

The unlucky patient is Bobek, the ginger Tom.

Are you going to be naughty?

This is bread and butter.

Got to be able to do these in your sleep, hopefully.

Vet Jennifer Posey is supervising Judy.

-Yeah.

-OK? Any questions before start? You happy?

This is definitely the right cat that's definitely being castrated?

-Yes.

-That's my only question.

-How many would you say you've done?

-Oh... I don't know if I can say.

Probably... I don't know. 200? 300, maybe?

But for Judy, this is number one.

'It's probably the first time that I got to do a castrate by myself,'

without having somebody else scrubbed in, as it were, ready to take over.

-This is always the hard bit.

-Yes.

-Make sure you keep your hands protected.

-Yeah.

That is really just to protect him from anything on the outside.

God, I hate it. Cack-handed student, can't you?

I'll get there eventually.

-You're doing fine, absolutely fine.

-God, get out of the way!

Jesus!

Depends on the size of the, um...items you're working with,

as to how fiddly exactly they are.

Smaller equals more fiddly. Bigger equals slightly less fiddly.

But fiddly, nonetheless.

Don't get flustered. You're fine.

Lovely.

-Happy with that?

-Yeah. Looks perfect.

-Lovely.

-Lovely.

Very nice.

Right. You don't need those any more, Mister.

Lovely Pat Butcher earrings!

Cat castration. Tick.

So when we finish doing a cat castrate,

we put the testicles in a little plastic bag and the owners like to

'take them home, like a little doggy bag, but it's a little catty bag.'

That's a deposit for the ball bank.

I'm joking. That's not true. I'm joking! Sorry!

And with her first solo castrate successfully in the bag,

Judy's another step closer to that perfect job.

Yeah.

No, I really enjoy it cos ever since I was a kid,

this was my image of being a vet, doing...

People coming in, sorting out their cats and dogs and rabbits

and guinea pigs and...the odd ferret.

So, living the dream!

DOG BARKS

Student Hannah Nevin is about to start her next placement and the

reality is dawning that qualifying as a vet is only months away.

I'm really afraid.

I'm so excited to graduate, fingers crossed it all goes well.

I can't wait to not be referred to as the student any more,

but it's still really daunting,

the fact that we're going to have to make our own decisions.

You don't have the safety net.

Oh, well, I didn't know that because I'm a student.

This week, she's working on the veterinary

front-line at a busy charity practice in Plymouth.

-Morning. How's it going?

-How are you?

-Good, thanks.

Head vet Robert Newcombe is supervising Hannah and today,

for the first time in her training,

she's going to be seeing some patients on her own.

-Hannah. Hiya there. OK?

-Good.

-The nurse consults, can you do those this morning?

-Yeah. That's fine.

-OK.

And follow some of those through

and if there are some extras that come in, we might be able to

pass some of those onto you as well, if you're a bit quick.

You are very good on some of them, but one or two of them

are just stitches out or weight checks, they may not take that long.

-Ok?

-Yeah. Yeah, sounds good. I'll have a look to see what there is.

'I seem more confident than I am.

'I always, whenever I'm in a sticky situation,

'I do try and look confident.'

Whenever you do get asked to do something by a vet, you don't

want to be like, "Oh, no. I'm not sure about that," you know?

You want to be like, "Oh, yeah. Sure, I'll give that a go!"

Otherwise you look like a bit of an idiot.

Right, I'll just ask.

The PDSA provides free pet care for people on low incomes,

so here, the vets are always busy.

Where is his hernia?

-There.

-Sorry, buddy. This is not very dignified.

And the pressure's on Hannah to work accurately and fast.

Um... I don't think so.

They'll see about sort of 30-40 clients a day, roughly.

Some days, though, they can make it up to 50.

Just keep an eye on it and if you have any concerns, just let us know.

I don't know what this one is.

Does put you a bit on the spot,

dealing with the general public cos you don't really know what's

going to come next and if anything's a bit tricky,

I try to take them round the back and I'll get someone else to see it.

And Hannah's next patient is about to test her confidence.

Shih-Tzu Ruby is recovering from spinal surgery.

-How is she?

-I think she's expressed loads this morning.

-Has she, really?

Yeah, loads.

-Was that when you were taking her out for a walk?

-Yeah.

Right, I'll take her round the back.

Hannah's about to discover that students get all the glamorous jobs.

Because she has spinal problems, she gets a really full bladder

and isn't able to express it.

Cheers.

All right, darling?

Ruby hasn't done a wee in a while, so there should be

plenty in there, but finding Ruby's bladder is no easy task.

So, I have to try and put pressure on it, but gentle pressure,

cos you don't want the bladder to rupture or bruise the bladder.

Feels really empty.

Sorry, darling.

Can't really feel her bladder.

So, I might just get Robert to have a...

That's the easy option, isn't it?

Definitely. Let's go.

It's time to ask an expert.

OK, let's just pop you up and feel your little bladder.

There is a bit of just knowing how the bladder feels

and how much you can push on the bladder. And just gently...

You have to know what limit you can actually apply to the bladder.

TRICKLING

There we are, all done.

That's everything.

-A tiny few dribbles to finish with.

-'I found it very tricky.'

But obviously, Robert was very good at it.

He did it straightaway!

-There we are. All done.

-That's perfect.

-OK?

-Lovely job.

There she is.

That's grand. She had a wee bit in there.

I just need to work out how to get her tablets up.

Hannah needs to get the experience and I often say,

doing it is the best way to get it.

She still has a little way to go.

She's still got a little bit of confidence to build in all

the cases that she sees.

-All right?

-OK, brilliant. Thank you.

-No problem at all.

DOG WHINES

CAT PURRS

DOG PANTS

You are always going to forget things to start with but it's just

getting into the swing of things and just getting your own style.

Always forgotten something obvious, like "Aw..."

I hate feeling like that.

-Is your dog still eating, mate?

-Yeah! Exactly!

There's a lot of popping your head back through the door,

"Sorry, just one more question..."

I have done that so many times.

It's hard work being a final year vet student,

and free time is scarce.

But twice a week Dru Shearn takes time out to unwind

with a gentle game of rugby.

I've got to have outside interests otherwise I'd go mad.

I've got to just kind of get away from it a bit

and spend time doing something completely

unrelated to final year stuff.

So really important to have a

bit of time out from it and get some exercise and get some fresh air.

THEY CHANT

But every Monday morning it's back to the veterinary grindstone,

and this week Dru's chosen a tough assignment.

He's opted to do a placement in the specialist orthopaedics

unit at the Queen Mother Hospital.

Every day here the expert clinicians

perform complex surgery on bones and joints.

Bonnie? Hello. Hi. Hello, I am Dru,

one of the orthopaedic students. Nice to meet you.

Dru's first patient is black Labrador Bonnie,

who's been referred here by her local vet because she's limping.

They've treated her for suspected arthritis

but she's not improving, so the problem might be more serious.

What's the main reason you've brought her here today?

Initially, she's been limping.

She was X-rayed as well,

and she was found to have had some arthritic bits in the joints.

And he assumed it would be same with the right as well.

And when did you first kind of notice?

Was it after a walk? Was it just as she was getting up?

-In the evenings.

-In the evenings.

From your point of view, in terms of just

like around the house and exercises, how do you think she's changed?

She would play ball indoors.

Now she would do it, but after a couple of more times,

she doesn't want to do it.

I'll go to speak to Vincent and he'll come in

and have a chat with you as well and discuss the plan.

Dru is under the supervision of vet Vincent Guerin.

-VINCENT:

-What I want to find out is which joint is the problem?

Vincent has a hunch that Bonnie's limp is caused by a small

fragment of bone lodged in her elbow.

But first he needs to examine her

joints to see exactly where it hurts.

-VINCENT:

-At the shoulder a bit there, a disturbance, well almost.

Not completely. I just have the feelings in the tips.

DRU: 'Examining her, Vincent obviously had to try

'and manipulate all her limps and try and find out where she was painful.'

And he had to almost push her kind of past her limit to be able

to find out where she was painful, cos she just wasn't telling us.

And she did wince a little bit when he then got to that limit

and you really feel for her because she is obviously hiding it so well.

So affects the legs in rotation. You've been very good!

Vincent's able to show Bonnie's owners exactly where

he thinks the fragment might be.

So if there is a fragment in there,

or if the shape is abnormal, then it can be painful.

OK. Best way to know what is going on

is to do 3D radiographs so a CT scan.

-Is it OK with you?

-BOTH:

-Yeah.

Bonnie, this way. Good girl.

The decision's made for Bonnie to be admitted to the

hospital for a CT scan because this is the only way of knowing

if there really is a fragment there.

If there is, Bonnie will need surgery.

Come on. This way.

But she's reluctant to be parted from her owners.

It's fine. Come on.

She wasn't particularly happy to be going with me into the hospital,

which I was a little bit offended by.

I was happy to be taking her

but she obviously didn't want to spend the day with me.

Good girl.

Come on. Good girl.

Just dragging them away from what is essentially their mum and dad

is quite sad.

This way. Good girl.

Have you done a saphenous before?

-FEMALE VET:

-I can see a bit of a fine line in there.

It could be consistent with a fragment.

The CT scan results have Vincent's hunch -

that the problem is in Bonnie's elbow.

If this is the left leg here and this is the right leg,

it's kind of a view as if you chop your arm in half

and looked down the end of it.

You can see on the right that, as you move backwards,

there is this little kind of fragment here - just there.

And they think there might be a little fragment in there as well.

So there's a little line where that's probably a fragment.

Anything that is going to be

within your joint that is hard and solid,

it's going to cause a hell of a lot of pain,

even the tiny, tiny things that you think, "What is that going to do?"

really can be massive problems.

The following morning, Bonnie's getting a short back and sides.

Quite a lot of these instruments I've never used before.

So we just had a quick run through then, of what they are

and what their names are so hopefully I won't forget.

She's having keyhole surgery on her

elbow using the latest camera technology.

If you aren't straight...

you don't see straight, you see with an angle.

OK. See if you turn the scope, you can see 180 or even 360.

It was amazing to be able to just like get

involved in something that advanced.

It's a really advanced surgery

and to be able to be part of it was amazing.

Dru's job is to hold Bonnie's leg absolutely still

while Vincent operates the tiny camera inside the joint.

-VINCENT:

-So we have fragmentation in situ.

-FEMALE VET:

-That is the fragment. It just popped out.

So the game is to detach this fragment without detaching

too much and lose it and never be able to remove it.

'There was a few hairy moments during the surgery when...

'there's a possibility of just losing it and it will...'

It's gone, and once it's gone, you can't get it back and it's

still floating round in there. So it was a really difficult surgery.

Look at that.

So I need to detach it a little bit so I can grab it.

Just pull the camera a little bit out.

Wow, you have a piece.

No, no, it's here.

Oh, yeah. Two millimetres, but that was cool.

It was really cool to be able to see the little fragment afterwards.

You don't often get to remove something and actually see it

afterwards and appreciate what the problem was.

With the tiny bone fragments successfully removed

from Bonnie's elbow...

-OK? Happy?

-Yep.

-OK. I'm happy.

..it's time to close up the wound,

and Dru gets a chance to test his suturing skills.

Yes, please.

'I wasn't expecting to be asked to close up.

'Here obviously we are offering such a high level of care that they

'have to trust your ability to do that.'

It's the only thing that the person who the dog is going home to

is going to see, so doing it on live animal is a little bit different -

with everyone watching you as well there is quite a lot of pressure.

-Great!

-Same again?

-Yes!

In this pot, you can see a couple of fragments

we've taken out from the right elbow.

And you can see there's

a tiny little kind of alligator teeth, a grabber on the end,

and we've just got behind the fragment and pulled it out.

Although the team are pleased they got the fragments out,

there isn't a 100% success rate with this kind of surgery.

So only time will tell if Bonnie will make a full recovery.

At the charity practice in Plymouth, the ever-cheerful Hannah is

spending the day seeing surgical cases with vet Erin Beale.

We are as busy I think as we've ever been,

so that means we have an enormous number of cases come

through the door every day,

-so for students, that is absolutely brilliant.

-Sorry, Erin.

Hannah's first procedure today is, surprisingly,

even more unpleasant than expressing urine from a Shi-Tzu.

This is Freddie. He's just come in to

empty his anal gland, which is one of the perks of the job in veterinary.

Whenever they get full, they get like really irritating, erm...

So every so often, they need to get emptied

so it's just like two little glands round the back

and sometimes they can be really filled with unpleasant stuff.

Good boy. So, put some gloves on.

Right. Being a vet is by no means a glamorous job.

If you want to look lovely at your job

and have your nails painted and wear pencil skirts,

this is not the right thing to do.

Insert a finger. You imagine about here and here.

If I give you some tissue, you can milk it into the tissue,

not into your face and then milk it out for me from the other direction.

-Right.

-OK. That looks like it's the right one that is going to explode.

Right. OK.

I'm sorry, man.

Good boy, Freddie.

Can you feel it?

-It might be very empty already.

-I have to say...it's not very...

It smells pretty bad.

The smell of anal glands is a really weird one.

It does smell like poo but like worse - like much, much worse!

It's not just very nice at all.

Sorry, darling.

I think that's gone.

So if you give it a really good clean and I'll give you some...

Yeah.

-OFF-CAMERA:

-How do you cope with those sort of things?

To be honest, I am not overly squeamish.

I think if you go into veterinary you can't really be.

There are so many gross things that you have to do

and I think you just have to...

It does help if you've not got a very good sense of smell.

It was a smelly job, but at least it was simple.

I'm awake. Good boy.

Now it's time for Hannah to step up a gear.

Erin's going to watch her wield a scalpel on Marley the staffy,

in a procedure she's never tackled before.

We've got a dog in that's just got a few lumps to get removed.

It has actually quite a few - it's got

a couple around his eye and then a couple...I think he's got

one around his shoulder so just going to be removing those.

The lumps on Marley's face might develop into cancer,

so Hannah's going to cut them out.

But she's going to need a steady hand to impress Erin.

Any time I do anything surgical, at the minute,

I still get nervous doing it and you know you still feel a bit shaky

whenever you are doing things like that.

So just like...round?

Ellipse probably in that kind of direction.

Like an eye?

-Yes.

-OK. Right.

The fact that it was more cosmetic kind of surgery was

definitely a bit more worrying, because you knew

these sutures are going to be seen by

the owners and these were wounds that were going to be on the dog's face.

You didn't want to make a mess of it.

-About there?

-A bit closer.

-A bit closer?

-Yeah.

Have a problem with my hands shaking as well.

-No matter how nervous I feel.

-That's OK.

-They always shake so much.

-The more you do...

Do you think it will go eventually?

Should we attach it to her hands and see how nervous she is?

Erin and Paula were kind of having a giggle to themselves.

I think they could tell I was pretty nervous with the anaesthetic machine.

They were saying, "If we put the

"heart monitor on Hannah, it would be through the roof."

Which it probably would have been.

Some of the needles are less sharp than the others, so

if you're not happy we can...

It's just they've got really tough skin.

Looking good. Right.

She did very well. She'd make a great surgeon.

She is nice and confident. She is good with the clients.

She has lots of initiative.

Encouraged to see vet students like that.

We are more likely to give them more stuff to do. She is really good.

The people that you see and the animals that you see,

the pace of it - I actually I think is definitely stressful,

but I really, really like it.

And I like that you see such a variety of things as well.

I've decided myself that this is something I'd really want to

do in the future - I really see myself working there.

In Essex a few weeks later,

it's clear that Dru's patient Bonnie has been given a new lease

of life following elbow surgery at the Queen Mother Hospital.

She's pain-free and her owners are thrilled.

She is walking so much better.

The recovery is remarkable. Absolutely remarkable.

I only get to see Bonnie go home

when she is actually worse than when she came in.

So it's really nice to know now that she's a happy, healthy dog,

and she's not painful any more and we've done our job.

Oooh, there we go. Yeeeey! Good boy, Teera.

In Luton, Judy's coming to the end of her

placement at the general vet practice.

Lots and lots of distraction.

Nice rough stroking down there to distract him there for me.

And she's about to discover that students can sometimes

come in very handy when an unusual patient comes into the surgery.

When we got the call to say there was a hedgehog

on its way down, immediately all fingers pointed towards me.

"Judy, you can go and see the hedgehog." OK!

Found this little hedgehog on the school playground -

I work in the school, and he clearly needed looking at

so I just went and scooped him up into the box with my jumper.

Hello. Brought a hedgehog in for us?

Right, do you want to bring him through and we'll have a look.

Come on in. So where did you find this little one then?

In one of our school playgrounds...

But I noticed when I went to bring him

home one of his back legs was sticking out.

He can't walk on his back legs, they are dragging behind.

OK. Let's have a look at you.

Do you want to put that box on the floor?

All right. All right, Mr or Mrs? Oh, no, don't do that to me.

He wasn't a willing patient that day unfortunately.

OK. There's apparently a trick.

Pull your hands back and...

Yeah. Well, I wouldn't pull him open.

Look, see how he's just put his spines right up?

You little moo!

It turns out that examining a reluctant hedgehog is

a difficult business.

I fear that as soon as I start touching him, he's going

to curl himself back up.

So let's see what you do, Mister.

Do you want to open for us?

I tried.

I tried my best and, if the hedgehog doesn't want to be unrolled,

then he's not going to be unrolled.

Not for me or anybody.

So you can't fight it.

Bye.

But all that's needed is some expert assistance.

-OFF-CAMERA:

-Oh, you've managed to open him up?

Yeah, we put him in a little bit of water

and he's not keen on it so he's just trying to walk out of it,

but he can't use either of his back legs properly.

All right, mate? And he's covered in ticks and fleas.

Are you going to walk on here now?

His front legs doesn't look too good either.

Are you going to walk? No?

Some we can fix and treat and get them

back on the road to recovery and others we can't.

It really depends on what sort of injuries and illnesses they've got.

So what is your assessment of the situation?

Well, my assessment is that he's in quite bad way actually.

He is very thin, this leg I think is broken.

Looks quite swollen and possibly infected. He's got toes missing.

I think he's probably been attacked by a fox or something.

Yeah, you're right, that is broken by the hook.

He has a wound on the inside as well.

He'd be cold, very thin so what would you do?

Well, unfortunately I think the kindest thing for him

probably is to put him out of his misery,

because we couldn't release him back to the wild with three legs -

-it wouldn't be fair.

-No.

-And he's not really using his other hind leg.

-Yep.

I agree. OK. Bless him.

There's nothing they can do for him,

so they make the kindest decision they can -

to put the hedgehog to sleep.

So the way we euthanize small animals,

because we can't get a vein in them generally,

is we do the kind thing and give

them a bit of gas burst to put them to sleep.

So just curl up in there, sweetness.

And it's a bit nicer to be injected in the tummy rather

when you are already asleep.

You know as a profession,

veterinary medicine actually is very lucky that we have euthanasia as an

option for animals.

And it's usually not as bad as people are expecting.

I think he's gone. OK.

It's probably nicer just to have a little

bit of gas, go to sleep.

Yeah. bye-bye, hedgehog.

SNAKE HISSES

DOG BARKS

HORSE WHINNIES

Charlie Tewson is in unfamiliar territory this week -

working with horses on his equine surgery placement.

A lot of the time with the sort of equine things,

I am just not as comfortable as I imagined if it was a dog,

I'd...understand it a lot better.

My equine knowledge isn't quite as good, in my opinion,

but I think if you are enthusiastic, you can get by.

Here at the college's referral hospital

a lot of the patients are high-value performance animals,

which means students are under extra pressure not to make mistakes.

Charlie must do his first consult of the day under the watchful

eye of vet Rachel Tucker.

I'm just going to ask him

to have a little bit of a chat with you, get a bit of history.

His patient is a young horse called Nanne who's in to be castrated.

And Charlie - who's never castrated a horse in his life -

will be performing the op.

-OK. What is your horse's name?

-Nanne.

It's spelt strange. It's Dutch. OK.

-N-A-N-N-E.

-And what do you mainly use Nanne for?

-Pardon?

-What do you mainly use Nanne for?

I've only had him since Sunday so...

OK. Brilliant. Do you know whether his testicles have descended yet?

Yeah. In the vet, they said it had.

Hello.

Yeah, poor guy is going to have his balls chopped off.

Hopefully he won't know what he's missing.

HORSE WHINNIES

In terms of confidence,

yes, I can sort of pretend to be confident.

But occasionally the horses can see it.

Occasionally I don't quite know what they are going to do.

HORSE WHINNIES

Before Nanne can be castrated, he needs to be anaesthetised.

HORSE WHINNIES

So Charlie's first big challenge is to fit a jugular catheter.

But only if Nanne will let him.

-OFF-CAMERA:

-How's it going, Charlie?

Obviously not ideal.

Nanne here is only 18 months old. He is only a baby.

He doesn't understand the prospect of standing still

and that makes a little bit of a moving target for us and that

makes it more and more difficult for us get a catheter into him.

Good boy. Good boy.

Well done.

He has now got a catheter - it's taken a couple of attempts.

He was a little bit of a monkey, but, yes, we've got that in place.

As the team anaesthetise Nanne in the knock down box, vet

Rachel is talking Charlie through his first ever horse castration.

So I need you to talk me

through what you are going to do before you do it.

OK? OK.

You always look forward to the opportunity to actually

get your hands on some practical task that is a genuine clinical

task that you will be potentially doing once you are a qualified vet.

You are raring to go really and it just reminds you of what you

are here for and what you are going to be doing once you've qualified.

The operation itself - I was only nervous because I hadn't seen one

done before and I haven't had a huge amount of time to read about what it

is, and so it was kind of working on a step-by-step basis.

-Just kind of doing what I was told basically.

-One, two, three. Lovely!

If you'd like to talk me through it. OK.

If you talk to me throughout, that's easy for me. OK.

Is it the whole 20ml or do I get 10ml in each ball?

For this - yeah, 20ml.

As a vet student basically, you don't

get to do a huge amount of procedures on horses.

There's just so many people in the room,

kind of, not necessarily watching you, but that are working

together to let you do this thing - means that is an added pressure.

-Which one are you going to start with?

-Errrm, top...bottom.

THEY LAUGH

I am just going to hold the testicle for you

-and let you organise yourself with the emasculators.

-Thank you.

That is the first time I've used emasculators.

Have used elastrators on newborn lambs,

which are the rubber ring ones, but they are not quite as slicy.

Whereas those ones had quite a satisfying crunch to them.

CRUNCH

HE LAUGHS

You can't put that in.

Come on, Charlie.

-That's embarrassing!

-Did you not have your Weetabix this morning?

OK. That's all done.

Just hold on there for three minutes, please?

Once the emasculator's on,

the team have to wait for the blood supply to stop.

Surgery has kind of come to a standstill

and you've just got to wait in that time,

just hold the emasculator...

It can be a little bit awkward to begin with.

Told them about my weekend and just see how people are.

-How was your weekend?

-Great, thanks. How was yours?

Really good. I went to see the

wildlife photography thing at the Natural History Museum.

It was lovely.

-MAN:

-How is he doing, Rachel? Is he doing OK?

Doing a good job, yep.

-Must be a good feeling?

-Um...

THEY LAUGH

I feel a bit bad for the horse.

That's great. OK? Yep. Go for it.

-Can we have two minutes' time, please?

-One down.

We can't stop now.

Emasculators - they do exactly what they say on the tin.

OK. Good.

I was impressed - he didn't get too carried away.

He listened to direction, was very in control and very slick,

so I'm very pleased with his practical skills at this

level of his training. Definitely.

You've known me two days and you've done this to me already!

And Charlie is really nice so he's done a good job.

He looked after my horse.

Prospect of castration is something that

you come to terms with very quickly as a vet.

Yes, it causes some discomfort

and takes away some of the pleasures of life.

It's a necessary evil.

"Some of the pleasures of life!" HE LAUGHS