Episode 5 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...

..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...

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.

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.

-You're going in.

-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!

It's late Autumn and our young vets are growing in confidence,

and learning essential new skills every week.

But there's still a long journey ahead of them before they qualify.

I've got big hurdles to jump before I graduate,

but I am getting to the point where I feel like I want to...

I want to get out there and start doing the job

that I've been training to do.

On this chilly Monday morning,

Matt Wilkinson is heading to the Queen Mother Hospital for Animals

for yet another practical placement.

This week he's working in the specialist neurology department

where they treat serious brain and spinal injuries.

We're basically just divvying up who gets what,

sorting out the new cases and stuff

and then we'll just get on with stuff, I think.

Just crack on and start doing things.

But I have a feeling it's going to be quite a busy day.

Within an hour, Matt's prediction comes true

as he's suddenly called to the emergency room.

A Rhodesian Ridgeback dog called Blue has been rushed here

because he's had a series of seizures,

which left untreated could prove fatal.

This is Blue. Blue is, I think, ten years old.

Matt's supervisor on the case is vet Johnny Plessas.

He presented with acute onset of seizures in the last 24 hours.

He had a previous seizure about six months ago.

Six months ago, yeah.

Blue's been given anti-seizure medication by his local vet,

but what's causing the seizures is still a mystery.

Yesterday they gave some diazepam

and they did some emergency bloods, which were relatively unremarkable.

Blue was brought in by James and his friend Max.

Terrific dog, I've had him since he was a pup.

And I remember, I had this picture of him,

and his head and his paws were bigger than his body,

so he'd always walk about like that with his head down

and just, he does mean the world to me, he does.

-You've got him?

-Mm-hm.

-All right.

Johnny and Matt need to do a full neurological examination on Blue

to see if his brain and spinal cord are functioning normally.

But for this, they need Blue to stand up...

and he can't.

-I don't think he's going to stand.

-No, I'm supporting him mostly.

-OK. All right.

-Good boy.

OK. All right, all right.

I don't know if he's like that

because he has a significant neurological problem

which is causing him to be quite daunted and sedated,

or if it's just the seizures.

Meanwhile, James is hoping that there's a simple explanation

for Blue's seizures.

Blue will just eat absolutely anything he can get his hands on.

Cos he did actually eat some insulation.

You know, loft insulation with fibre glass and stuff like that.

Yeah, he ate some of that.

And that's what hopefully is the problem.

But it's dawning on Johnny and Matt

that the problem could be a lot more serious.

-He's not really responding.

-No.

-Is this dog neurologically normal or abnormal?

-Abnormal, yeah.

He's abnormal. He's quite obviously abnormal.

The fact that he was missing some reflexes on his face

was a bit worrying to us because that can be fairly indicative

of a fairly serious neurological condition.

What are your top differentials for this dog?

He could have a full brain lesion of some kind.

Neoplasia is definitely quite high on the list.

Unfortunately, one of the things that's quite high up on our list

at the moment due to his age and the signs that he's having is...

One of them is a brain tumour...

..which obviously is not ideal.

Would you like to come through, please, and we can have a chat.

James' parents are out of the country,

so it falls to him to tell Johnny more about Blue's seizures.

So I'm going to start with a few questions first,

just to see exactly what happened with Blue.

You said also that he has eaten something.

Yeah, the fibreglass insulation.

I must admit, I'm not 100% sure if that can cause seizures,

I need to investigate that a little bit.

You mentioned that he had a seizure, but I didn't actually ask you

to describe a little bit exactly what you saw there.

Yesterday, he was, like, dribbling from his mouth,

and then he just sort of collapsed, didn't he?

Yeah, you could see, it looked like he was getting weak.

It must have lasted about two or three minutes,

and then it was about...

-Another five or ten minutes after...

-He had another one.

-Did you see the sort of seizure?

-Yeah, I did.

-OK.

-Are you OK?

-Right.

It's all right, mate.

I know it's all a bit upsetting, but at least he's stable at the minute.

Are you sure you don't want to go out

just to get some fresh air or something like that?

Do you want to go out for two minutes?

-No, I'll be all right.

-OK.

So I guess the first thing will be to just figure out

if there's something outside his head causing the problems.

If we don't find anything there, we need to look into his brain

to make sure he doesn't have any problems there.

If there is a problem inside the head, I think the number one is...

I don't want to give you bad news, but I think the number one I've got,

considering his age, there is the possibility of a brain tumour.

Do you like to ask me anything? Is everything clear so far?

-Can I see him before I go?

-Yes, sure.

He's just behind the door anyway, so let me see if we can move him.

You never know if an owner is going to be tearful or really upset,

or angry.

It's not just dealing with animals, you have to deal with clients.

You've just got to be comforting

and appreciate that they're seeing their animal in such a state

that they're not used to and they might think the worst.

He's just a little bit sleepy but he's stable, he's OK,

and we expect him to be sleepy anyway.

We're going to keep him in the intensive care department for now,

just to be closely monitored

especially because he's quite sedated.

For James it means leaving his beloved Blue at the hospital.

I was hoping they would say it's just, like, the fibreglass.

-He's just had like...

-Too much of that.

Or, I don't know, poison or something like that.

But I never thought it'd come to, like, a brain tumour

or something to do with his heart or something like that.

For Blue, the future is uncertain.

It's surprisingly difficult to catch a dog as they're moving

when they're peeing.

You're trying to get right in there with the bowl,

but then they can't move their legs,

so then they end up peeing all over your hand.

But that's when you catch it in your glove.

When it runs down your arm, you catch it in the glove

and then take the glove off carefully.

-You never done that?

-Judy!

Just me on that, then?

Student Judy Puddifoot knows exactly what kind of vet she wants to be.

Yeah, I prefer companion animals. Yeah, cats, dogs, guinea pigs,

ferrets even at a push, yep.

I prefer those. Small animals.

If you can pick it up, and not ride it or eat it,

they're my favourite animals.

-Morning, Judy!

-Morning.

-Fit and fresh?

-Oh, yes.

But this week she's on less familiar territory,

working at a large animal practice near Luton.

Her first challenge is at a local dairy farm

to do one of a vet's key jobs -

checking to see if the cows are pregnant.

This is a unique outfit, especially for farms.

Judy, would you nip round over to the far side of the scanner

and plug it in for me, please?

She's working under the scrutiny of the senior vet, James McFarland.

This is entirely to try and bring on the next generation

of the veterinary profession, so that they're capable,

comfortable that they can look after our farming folks as best they can.

And it's time for Judy to get stuck in.

I'm getting lube.

This is one of the most important things

in farm veterinary life - lubrication.

Very important.

I'm just setting up the ultrasound scanner

to allow me to do rectal examinations on the cows.

We'll just work through them one by one.

Each one will have its own situation

and I don't know what they are yet until we get started.

But first, she's got to catch herself a cow.

And this lot are giving Judy the run-around.

They know when there's a rookie in the...in the yard, I think.

Go on, one of you. Any volunteer?

These wild cows!

Straight off the moors, these, ain't they?

Go on, go.

That's the way to do it!

These are made for people with ridiculously big hands,

can I just say that?

Look, it's ridiculous.

If I was having a calf, I wouldn't want a hand that size inside me.

Full of dung.

Yes, if you can just clear all that out for when I have a go.

You want me to get rid of that? Thank you very much.

Before a dairy cow can produce milk,

she needs to get pregnant and produce a calf.

And it's the farm vet's job to pregnancy test the whole herd,

one by one.

-OK, there we go.

-Hey!

-There's the embryo.

And with the help of his ultrasound scanner,

James can see that it's good news for cow number one.

This is an eight-weeker.

You can see the little bits of the embryo skeleton in the black.

The black is fluid,

but the bit in the middle is little skeleton that's...

Oh, jumping around! Did you see him move? That's him not me.

Mm, lively.

It's not glorious technicolour, but there's little legs.

See the two little legs coming down to the end?

Here there's little feet at the bottom.

-So this is definitely pregnant.

-She's definitely lively.

She's done the job and I'm going to leave her alone

-and not jeopardise the pregnancy.

-Yup.

But as a crucial part of her training,

Judy needs to learn how to feel for a pregnancy without ultrasound.

It's time for James to put her to the test.

If you want to put some lube on your hand,

see if you can find that left ovary.

Thank you.

When people find out you're at vet school,

first thing they ask you is, "Have you put your arm up a cow's bum?"

Yes, I have done that. "What does it feel like?"

Imagine what it feels like. It pretty much feels like that!

Just found the cervix, so I'm sweeping along the pelvis

until I can find the cervix below my hand.

Then I'll follow that along,

then that should branch off into left and right horns of the uterus.

I managed to feel an ovary, actually.

I think it was an ovary.

You just go on what it feels like.

And he says, "Well, is it firm? Is it walnut sized?"

Yes, yes. And it sounds like it's in the right place. So...

If it walks like a duck and sounds like a duck,

it must be an ovary, I guess.

That was fine, managing animals that weigh 650, 700kg.

These are not pussycats. These are big guys,

and you need to be able to handle them safely,

properly, comfortably and well.

She's coming on fine. She's made steady progress

and whether she ever sees a cow in anger, I don't know,

but the experience of managing and working around

has got to be good for students.

COW FARTS

Gassy! It doesn't bother me. It really doesn't bother me.

If you don't like poop, don't become a vet.

That's my advice cos there's a lot of poop!

At the Queen Mother Hospital, Matt is helping vet Johnny

with Blue, the Rhodesian Ridgeback, who's been having seizures.

The neurology team are worried that Blue might have a brain tumour.

To find out whether or not their hunch is correct,

Blue needs to have an MRI scan.

For this, he'll need to be anaesthetised.

-And this...this murmur, a recent finding?

-They're not sure.

But Blue also has a heart murmur, which means a general anaesthetic

could be extremely dangerous for him.

So, first of all, the team need to check

that his heart is strong enough.

And it's up to cardiologist Adrian Boswood to make the decision.

-Can we grab the lights?

-Yeah.

What we needed to do was do an ultrasound of his heart.

You know, with the question, is he safe to anaesthetise?

You're waiting for a yes or no answer, you know?

"Yes, Blue is safe to anaesthetise"

or "No, Blue is not safe to anaesthetise."

And you really want the yes answer, because you need to go ahead

and you need to go ahead and do that MRI and see if there's a problem.

It looks like probably he's got a quiet valvular disease,

and it's not particularly significant.

It doesn't seem to be causing his heart to be enlarged.

Is he safe to anaesthetise? The answer is yes.

Yeah? Cool, excellent.

Blue gets the green light for his MRI scan,

but the team are anxious about what they'll find.

We're all just stood there, watching the screen intently.

All of us secretly hoping that he wasn't going to have something nasty

like a brain tumour.

It's a very tense moment really, just waiting

to see whether you were wrong

or whether your suspicions will be proved right.

I think everyone is just standing there thinking,

"Please don't have a brain tumour, please don't have a brain tumour."

There is definitely something there

and you can see how it's pushing the cerebellum down.

Yeah, it's really squished.

So...

Hmm, let's see. Let's see what we can find.

Blue has a mass in his brain,

which is causing a bit of compression

on various parts of the brain,

which would explain why he's had the seizures.

Not really what we wanted to hear.

With their worst fears confirmed, they need to work out

whether surgery is a viable option for Blue.

If we were to operate on this mass, we'd have to go underneath

the occipital lobes and try to then scoop this mass out,

which is quite tricky. It's not easy.

And obviously it's not without significant risk of haemorrhage.

It's definitely a quite significant condition.

If we don't treat him,

I think it's definitely a quite serious condition,

that potentially he can pass away. He can die because of it.

We might just then lose him suddenly because of what we call herniation.

So, unfortunately, that's what we're going to have a discussion

afterwards with the owners. Sudden death is a possibility.

-Hello. I'm Johnny.

-Hi, nice to meet you. I'm Matt.

The following day, Johnny and Matt have the difficult job

of breaking the news to James's parents,

who cut short their holiday in America

when they heard that Blue was ill.

First of all, I want to let you know that he's stable,

and that he's brighter compared to what he was the previous days.

However, I had an idea that there is a possibility

that we might be dealing with a tumour.

Unfortunately, we did find that with MRI scan.

With their beloved dog in such a serious condition,

Blue's family are faced with a difficult decision.

If we should consider the possibility of surgery,

it's a very risky procedure to perform,

to try to remove the tumour.

The second one is what I would probably recommend to you

is radiation therapy.

I think it's very unlikely that the tumour will go away completely,

but if we can make it to shrink as much as we can,

and we can prolong Blue's life for as much as we can.

That might be one year, that would be great.

If we can prolong it even a little bit longer,

I think would be even better.

That's going to be the best way to go, then?

I think so. I think, if he was my dog,

of course, you have all the options

and, of course, you have the option of not giving any treatment

and you would like to consider the possibility of euthanasia

to put him to sleep at this stage,

if, you know, you cannot accept treating a dog

with this kind of clinical science. I think this is an option for you.

I think the radio treatment sounds the best way to go.

-Yeah.

-Yeah.

With the decision made to go ahead with radiotherapy,

Blue is reunited with his family.

Look who is there!

Aw. There we go.

That's better, yeah.

I think he recognised you now.

Yes, he's like "Oh, hi!"

He was a little bit slow, but he got there.

They're discussing a brain tumour.

A brain tumour is not a nice thing to have to talk about.

But I think what's nice about that conversation was

that it wasn't about negatives.

It was about positives of what you can do for this dog...

what you can do for Blue.

What are the possible options?

And how can we prolong his life and make him feel better?

QUIET CHATTER

Good. I mean, I was hoping that they would go

towards the radiotherapy route,

because I think that's probably the more appropriate choice for him

and they have opted for that, so that's really good,

which means, I mean, it could potentially give him

s..., you know, up to a year plus potentially of extra life,

which is really good. So I'm glad they've opted for that, yeah.

Blue's radiotherapy will take place at a specialist unit in Essex.

And although it's not going to completely cure Blue,

it will at least give him and his friend James

a bit more precious time together.

When he comes home, I will not let him out of my sight.

Will I? No.

I'm not going to let you out of my sight.

No. No, I'm just going to be there every day,

feed him, take him for some walks,

and just smother him with kisses and cuddles. That's what I'm going to do.

That's my plan of action.

I think the main problem with cats is that they're so unpredictable.

-Yeah.

-Kind of they'll be, one minute they'll be fine

and then the next, they'll just be like, "Grr." Just go for you.

-Yeah, literally!

-And so sharp.

-Cat... Yeah, so sharp.

CAT MEOWS

There are some really lovely cats and then there are some

which are just a bit crazy, but...

aren't we all?

-Aren't we all.

-Indeed.

With just months to go before she graduates,

Catherine Needham is pleased with the way things are going.

I definitely feel that I've come a long way through rotations already.

There's a lot that I am a lot more confident with now than...

I thought I would be at this stage,

but there definitely is a lot that I still feel I need to work on

or that I wouldn't be confident doing.

But today Catherine's taking a leap into the unknown.

I'm at the Beaumont Small Animal Hospital in Camden today,

which is the first opinion hospital that the RVC have.

A lot of people aren't as knowledgeable on exotic animals,

and there's a couple of vets at the Beaumont who specialise in exotics,

so this is one of the days that the exotic vet is in.

At the moment, I've got very little experience of looking at reptiles

and tortoises and things,

so I hope that I'll learn a bit about them today.

I'm Catherine, and I'm one of the final year vet students.

His name's Julian and he's about 2.

And he's from Macedonia.

He's about this big. He's really cute.

Oh, he's tiny!

He's going to be a bit sleepy cos he's cold.

I didn't realise he was going to be quite this tiny,

so I'm just going to have to go and get the smaller scales for him.

-I didn't realise he was quite that small.

-Sure.

So, I'll just leave you and run out for a bit.

Julian's in for one of his regular worming treatments.

Do you want to pop him back in the box

that might be the easiest way to weigh him.

If the worming is working,

he'll have gained weight since his last visit.

One gram more than last time.

Good.

I'll leave you with him for a minute.

I'll just go and speak to Nadine

and then we'll come back and we'll worm him.

The exotics specialist at the Beaumont is vet Nadene Stapleton.

-All right. What was his weight today?

-92 grams.

Whoo! That's one more gram than last time.

Worming has obviously done the trick.

Let's give him his wormer.

So, this can be a bit of a spectator sport.

I usually just grab the head.

They're really strong, so you can't...

You'll injure them if you're trying to pull the head out

and they're trying to pull against that.

So, what you're wanting to do is basically fatigue their muscles.

You just hold on. You don't try and pull out.

You just hold on to the head until they kind of go...

-SHE SIGHS

-..and relax.

Then you pull the head out a little bit. Any questions?

Nope, that's fine.

-Right, let's try and make you look like a fool!

-Thanks!

Very hard, but you're basically just popping fingers in,

knuckles just to stop him from putting his head back in.

But you have to be quick!

Worming little Julian means getting the end of the syringe

right inside his mouth.

It's almost working. It's not a lot.

Not surprisingly, Julian doesn't fancy this at all.

He was a very small tortoise, which makes handling harder

than with a bigger tortoise,

just because there's kind of less of them to actually hold on to

while you're trying to worm them,

so that was definitely an experience that I'd not had before.

Trying to persuade a tortoise to keep its head out of its shell,

so that we could worm it, was definitely a new one for me.

Yeah, he's particularly difficult.

I think we had a lot of trouble with him last time, didn't we guys?

If you're at the stage now

where he's pulling his head all the way back in

and there's just not a chance

you can wiggle your fingers in behind it, then just let him go,

pop him back on the table and he'll start walking around again.

He'll usually pull it back out again. So, pop him down.

Yeah, I don't think it's... Not happening.

He's like, "Phew, glad that's over!"

You'll get another go in a minute.

All right. So, this time, same thing,

but what I want you to do is just be a little bit faster

at getting your fingers and knuckles in behind the jawbone,

is what you're trying to achieve.

So, let's see how you go.

Oh, I think he's gotten a little bit cagier, what do you think?

I think he's a little bit faster than last time.

Let's see whether I can have any more luck.

I think someone needs to invent a lettuce-flavoured tortoise wormer.

In the end, Nadine took over and she did that bit

and I actually did the worming rather than holding its head out.

Just because you can't really argue with a tortoise.

Yeah, it's got to get all the way down.

Perfect.

THEY LAUGH

Oh, sorted.

-How did Catherine do?

-Oh, fantastic.

I couldn't have done it without her.

I would have just been standing there holding his mouth open!

In your pod, little man.

DOG WHINES

Student Charlie Tewson is also having a new experience this week.

He's experimenting...

with facial hair.

I quite like the look actually.

I don't think I'm going to carry it on after November,

but I think the '80s is coming back.

He may be putting on a brave face this morning,

but he's not looking forward to his next placement

at the Queen Mother Hospital.

I've been trying to read up a little bit over the weekend,

but it turns out that small animal medicine

maybe covers about half the material we've ever learnt,

which means trying to revise it in a weekend is pretty difficult.

Mustn't forget your lunch!

DOG YELPS AND BARKS

-Morning.

-Morning, guys!

There's a lot of rumours you hear from other students

how bad it is or how intense they grill you.

Some of it's hearsay.

Some of it's completely true, I've learnt in hindsight,

but, yeah, I think everyone does work themselves up a bit

before going into it.

DOG BARKS

Small Animal Medicine is a really crucial placement

for final year students.

It starts with a pep talk

from one of the hospital's leading specialists, Professor Hattie Syme.

The best way to understand what's going on with your cases

is to be with them right from the very beginning.

Diagnosing illness is the basis for all veterinary work,

and every one of our students must develop the skills

that will help them crack the mysteries

they'll face every day once they qualify.

It's all about the diagnosis

and that's what's so fun about it and what can be so frustrating about it.

Hattie's preparing the students for a tough fortnight

discovering their inner Sherlock Holmes.

It's an intellectual process,

so there's no reason why the student on the case

can't be every bit as much the detective as we are,

just less experienced detectives.

OK that might be it. Oh, good, nice, thick file.

Charlie picks up a patient straightaway,

a Jack Russell called Jack.

He's having treatment at the hospital

for a potentially life-threatening problem with his immune system,

and he's back in today because he's become worryingly lethargic.

He's a dog that's had ongoing anaemia for quite some time,

and we don't quite know the exact underlying cause.

At the moment our presumptive diagnosis is his immune system

is attacking his red blood cells,

but unfortunately he's not really having a very good response

to treatment at the moment.

So, have you managed to have a chance to...

I've had a very quick brief glance at the first half...

Vet Anna Threlfall will be putting Charlie to the test

on this challenging case.

He came in last week on the 11th, I think, he was back in.

And he was doing reasonably well at home,

so have you taken histories and stuff yet?

-I've done a few, yeah.

-OK, Jack's lovely.

-OK.

Just need to go a bit slow with him. He's a Jack Russell.

-Hi, guys.

-This is Charlie. Charlie's one of our final years as you know.

Hi, how're you doing?

Before Jack had come in, he had already had one

or two blood transfusions before because of this condition,

and it was trying to kind of support him

while his body could mount an appropriate response

to the drugs we were giving him,

so that he could then start producing his own red blood cells.

Have you noticed any days when he's been particularly lethargic

or he's been about the same?

I'd like to say Saturday I was very, very concerned.

He was very lethargic the whole day.

He'd get sort of like 30 or 40 yards and stop.

And I'm just like, I'd go, "Come, Jack, come for a walk now." No.

Just didn't want to walk, you know what I mean?

-Brilliant. Thanks for this.

-Thank you.

Jack was worse than I thought he was going to be.

Looking quite slow, quite under the weather,

essentially which we now know

because he didn't have enough oxygen going round his body.

We've had him since he was eight weeks old and he's 10 now.

You do become rather attached to them.

I mean, no matter what you do to him...

You can have a row with him on the night before

and in the morning he'll come running up to you.

He's your best mate, you know what I mean?

Never answers you back.

When we first brought him in here, it was like...

-HE SIGHS

-We thought he was a goner.

Like a week and a half ago.

The emotional attachment of owners to their pets

is something that really gets to you,

I mean you could clearly see that in Jack's case,

where they'd already put him though two transfusions,

but were just desperately trying to give his the chance

for his body to respond.

Anna's determined to get to the bottom of Jack's illness.

I think we should take him in today and do the blood work

and keep hold of him until we get all the results back,

so we're a little bit happier with him

cos then we can decide what we need to do from here on.

Good boy. Good boy.

It's time for Jack's owners to leave him

and for Charlie to take a blood sample

to test Jack's red blood cell count.

Come on, then. OK, good boy.

If it's low, it means the drugs and the transfusions aren't working

and Jack's treatment options are running out.

JACK WHINES

He's just very scared. I think he doesn't quite know

what to make of it. I can see...

He's got that look about him of just...

definitely doesn't want to be here.

Hopefully, we'll get to the bottom of it.

Charlie's not the only student being put to the test

in Small Animal Medicine this week.

It's the big one, really. It's always been the big one in my mind.

It's the one to do well in,

and it's the one that's been the most terrifying because of that.

It's all gone a bit...

There's a lot of client and patient responsibility,

which is something we haven't actually had that much of.

Elly Berry's first patient, ten-year-old Labrador, Xander,

was admitted overnight to the intensive care unit

with some very serious symptoms.

He'd collapsed. He was hypothermia...

So, he was hypothermic with cold,

Erm, vomiting, and now he's got lots and lots of diarrhoea.

Oh! It's everywhere.

Picking him up as a case, you knew he was pretty ill

and just to look at him, his little face,

he wasn't... You know, he's a yellow lab.

You'd imagine him to be bouncing all over the place, but he just wasn't.

Xander's really poorly,

but they don't know what's causing his symptoms,

so he's going to need to have a lot of tests.

Elly's being supervised by vet Myfanwy Hill.

Got a lot of diarrhoea. I've managed to avoid it, so far,

but I wouldn't be surprised if I get covered in it later.

Elly's first job is to take Xander's blood.

But choosing the right equipment is more complicated than it looks...

apparently.

-One of these?

-Yeah, how much blood do you want?

-Not very much at all.

-No.

-So, tiny. Erm, blue needle?

-Green needle, orange needle?

-Which needle do you think?

Erm, needle-wise...

-Not the biggest one.

-Orange one?

-He's not a cow.

Put them on the table for me in order of size.

How big do you think they are in terms of how wide they are.

Oh, dear. That's the biggest,

then that one and that one and that one.

-So, you think that's the biggest?

-No, smallest! And that's biggest.

Smallest, next smallest, yeah?

There we go. If I was bleeding him, that's the length I'd choose.

Oh is it?! Ah!

Sweating, sweating from the pressure!

I've seen blood taken so many times. You just... I don't know.

I just couldn't remember at that point what size needle,

And, erm, I mean, I know now!

So, that's the main thing.

So, if you've got your thumb on the end,

is it going to be able to go in if you've got your thumb on the end?

-It's all going so wrong.

-There we go, perfect. That's enough.

I was fingers and thumbs all over the place.

I just ended up having my thumb over the end,

so obviously the pressure meant that... I just...

Yeah!

A really fun week with me. You're going to have all the LOLs!

So, we're checking how much red blood cells are in the blood,

in comparison to how much other fluid there is in the blood.

Wait 23 minutes on...

So, it's a measure of how dehydrated the dog is.

I think it's 56.

And what do you think of 56?

-I think that's quite high.

-Mm-hm, yep. I'd agree.

The blood results show that Xander is severely dehydrated,

so he'll be put on a drip in intensive care overnight.

But perfectionist Elly isn't happy with her morning's work.

That was, erm, chronic. That was really, really, really bad.

Tomorrow can only be better.

The next morning, Xander's no better,

and the decision is made to do more tests.

This time to see if there's something seriously wrong with him.

He will be having the FNAs, the fine needle aspirates,

is where you stick a needle into...

He's having it in his liver and his spleen

to get a sample of the cells to see if any of them are cancerous.

Xander lies patiently on the table

while the team work as fast as they can.

Are you ready?

Using ultrasound guidance,

you can actually insert the needle into the dog

and you can then see your needle with your ultrasound probe

and you know you're in the right place.

And you can actually take a sample of the cells from that organ,

and then you can examine them to see

if they have any signs of being cancerous or not.

They're incredibly sharp.

It's like us having a jab for flu or something, I think.

Come on, dude. Thank you very much!

It's time for Xander to go back to intensive care.

And it's an anxious wait to see

if his tests come back positive for cancer.

The day someone brings a snake in to me...

Like I don't think I've ever held a snake!

THEY LAUGH

Don't let it go around here.

Top tip!

In Luton, Judy's placement at the large animal practice

is coming to an end.

But there's still one big challenge left

and it's one Judy's never faced before.

On the menu today,

we have a ram coming in first thing to be castrated.

Be interesting.

I'm a ram castration virgin, so this will be the first one,

but anyway we'll see what they can...what they can throw at us.

Morning!

-OK, you're all set, Barry, with her?

-Yep, yep, ready to go.

All right, let's go get our patient.

It turns out that castrating a ram

is not something even vet James does every day.

This patient is a rare breed sheep, and the owner, sadly for him,

she's decided he's not good enough to breed for them,

and therefore he needs to be neutered. It's quite uncommon

because the vast majority of sheep would be in a commercial situation

and therefore if they're not needed for breeding, then why keep them?

But this owner has an interest in each individual,

so she would prefer to have him neutered,

and she'll keep them, I suppose, as pets,

but from the ram's point of view that's probably a good thing!

-All present and correct?

-All present and correct. One, two and no hernias.

Everything's normal. That's fine. He's quite a big lad!

Oh, yeah.

-That's a good lad.

-Good boy.

Normally, when animals are anaesthetised,

they should have an empty stomach.

-You can stop him reversing, yeah?

-Yep. On stop.

With a cat or dog you can starve them overnight,

and therefore their tummy is empty

whenever you go to do the anaesthetic.

But with a sheep, we don't have that option.

They have a multi-chambered stomach, which holds enough grass in there

to be able to give grass time to be digested.

The rumen would take three days at least to empty

and you can't do that,

so it's just another hazard that you've got to factor in.

To reduce the risk of Pierre the sheep choking during the procedure,

it's essential they operate as quickly as possible.

Get the skin away from the testes themselves.

Go straight across the bottom. Erm, just take that away.

After that, the technique is really very similar

to what you would do with a dog. You'll get those on

-to crimp your site where you'll put your ligature on.

-Yep.

-There.

That's your ligature. Can you see how that is nipped...

-nipped a nice waist in the cord?

-Yeah.

That's really got a good grip on it.

'See one, do one, teach one', is the theory of veterinary medicine,

so I watched James remove one

and then, all of a sudden he turns round and says,

"Right, you can take the next one off!" and I'm like, "OK."

And, erm, it was a handful.

-Make sure it's firm. Is it firm? Is it right on the cord?

-Yeah.

You have only one chance to get this ligature done

and now's the time.

And you need to take the testis off itself, go distal to the forceps.

-Can you take the testis?

-Got it.

-Got it? Good. I've got the forceps.

-Sure.

Thank you very much, well done.

Grasp it with both hands, I say.

And I did!

You've got a nice waist where your ligature went

and you've got a good enough gap where the ligature is placed.

How was that?

Fast! It's brilliant!

That was great. I didn't realise I was going to get to actually

do one testicle, so that's good.

Don't want any anti-toxin, no?

-No, I'm too old for that now.

-OK.

She wasn't expecting to actually have hands on in the op,

but I watched her tie the ligature.

She's quite dextrous with her fingers.

The ligatures were good and it's good to let Judy at least have one

ticked away, under her belt.

Not quite ready to run off just yet!

-Ah, boy.

-He was a nice little ram, yeah.

In the back of the van, and it was...

Ah, that day reminded me of All Creatures Great And Small

and out he came, out his balls came!

Done.

Don't stand still too long cos I'll have them off!

Just like that!

In the hospital's Small Animal Medicine Unit,

the detective work continues.

Elly's patient Xander is still seriously unwell

after collapsing three nights ago with a mystery illness.

His liver and spleen have been tested for cancer,

and this morning Elly's heard some good news.

So, when we did the sticky needle thing into the liver

and the spleen and the peritoneum,

all those cell samples came back as negative for cancer,

so that's really, really good.

But Xander's not out of the woods yet.

The next step is to do a CT scan to check for cancer

in other parts of his abdomen.

For this test, he's been anaesthetised.

-Is that the beginning of the stomach?

-Yes.

We're looking over those CTs of his abdomen.

It's that worrying time when you just don't know what's going on

and you don't want to find something that's big and nasty and malignant,

but you never know, really.

CT's done and nothing has been found,

so that is a good thing in the light that it's not cancer.

But even though there's no cancer, Xander's still a medical mystery.

And a frustrating case for Detective Hattie.

We've been searching very hard basically,

for different types of cancer,

but so far we've not found them.

And the frustrating thing is that

it can seem really good for the dog that we haven't found cancer,

but actually if we haven't got a firm diagnosis,

then we don't have a way to treat.

DOG BARKS

Meanwhile, Charlie's patient is proving just as much of a challenge.

Jack, the Jack Russell, has a serious auto immune disease,

which is making him severely anaemic.

Overnight, Jack's had another blood transfusion

to boost his low red blood cell count.

But although it's made him feel better, it's not a cure.

The transfusion is just a temporary measure.

You're just buying them some time until their body can respond.

The team think Jack's bone marrow isn't forming new red blood cells.

But they need to find out why.

He's going to have a bone marrow biopsy,

so we're trying to get down to the underlying cause

for his immune-mediated haemolytic anaemia.

Though, we always try to get both an aspirate and also a core.

So, the core will be, hopefully,

an actual a little piece of the bone marrow.

Vet Roseanne Jepson is overseeing this complicated procedure.

There can be difficulties getting the sample

depending on what's going on in the marrow,

so sometimes it's easier than others.

There are some risks. We've given some local into the site

to try and make sure the dog's comfortable

after we've done the procedure.

First, Anna gets a sample of fluid from the bone marrow in Jack's leg.

Then comes the really tricky part.

There is a slightly more violent period

where we have to try and ensure

that we have a tube of marrow within our needle,

so there will be a bit of moving the needle around within the leg.

You don't have to work out at the gym

after having done one of these sometimes.

The red blood cells are produced in the bone marrow,

so, essentially, what we'd like to do

is take a sample of the bone marrow

and check whether in the bone marrow,

it's producing red blood cells appropriately.

It looked pretty brutal, but they're asleep,

so I mean, you do worse things and we needed to know.

Yeah! Perfect, good job!

Perfect, close it up.

We're done, yes.

While Charlie bottles up the tiny bone marrow sample,

Jack's beginning to come round from his anaesthetic.

And he seems none the worse for wear.

Do you want to have a run around, sweetheart?

Aw, he does!

-Go on, then, launch the dog.

-Be free!

It's sometimes quite nice to let them wander round recovery

and just have some attention, some TLC.

Even though, as he was wandering around he was a bit wobbly.

-Aw!

-Oh, Jack.

Essentially, Jack was a little bit drunk, or to that effect.

THEY LAUGH

Good work, anaesthesia team. Good work, biopsy team.

The results of the biopsy show signs

that Jack's bone marrow is making some new red blood cells.

But they also show a worrying new development.

It's OK. Hello.

Unfortunately, we've identified some fibrosis,

which is like a type of scar tissue,

which can form in the bone marrow.

We are concerned that his prognosis is a little bit worse.

But animals can recover from it

and we'd probably give him a 50% chance

of actually responding to the steroid treatment that he's on.

When you've had a patient in for a good few days,

then, yes, of course, you build up a bit of a relationship.

Jack's been a lovely dog,

but there are some things that are just outside our control.

Jack will be going home for now.

All the team can do is hope that this time

he responds to his treatment.

It's now five days since Xander the Labrador

was admitted to the emergency room,

severely dehydrated and close to death.

He's undergone a barrage of tests,

but his condition is still a mystery.

But student Elly has come in this morning

to find Xander looking much more cheerful.

He's basically just lots better. He's eating loads.

He's pooing again, bit watery, but better than nothing!

And, erm, he's had his ECG that he's had strapped to him,

that's taken off as well

cos they're not so worried about his heart as much.

And he's going back to normal wards, so he's doing all right, really.

And he should be going home either tomorrow or Sunday.

There's still no diagnosis for Xander's mysterious illness,

but vet Katarina has her own theory.

I think my hypothesis at the moment

is that he just had some allergic reaction probably.

He has some skin allergy, some skin allergic disease,

so, maybe, whatever happened

because, you know, actually, we didn't put him

on any specific treatment.

He was not on antibiotics, he wasn't on steroids.

He just...I think, he just improved by himself, so...

But it's good!

I came to realise that Xander, with all his twists and turns

and his unanswered questions,

that that is what medicine is mostly about.

Just a lot of leads and sometimes mostly not a lot of answers.

But the fact that he got better was fantastic. Was really good.

In downtown Potters Bar,

it's an early start this morning for student Dru Shearn,

who's anxious to at least look like he knows what he's doing.

I think if you wear shirt, tie trousers, I think

people take you more seriously

and they treat you more like a professional.

If you just turn up, kind of T-shirt, jeans,

people aren't going to take you seriously.

Today he starts a surgery placement in the College's Equine

Referral Hospital, which brings with it some extra responsibilities.

Most of them are performance animals,

and people pay a lot of money to keep them that way or to get them

to that point, so you have to take extra care with them.

I think the owner seems to have a little bit more of a say in

treatment options and how they're treated care-wise while they're here.

Oh! Have we got caught in the tail!

THEY LAUGH

Dru's first case is Darcey Bussell,

a foal bred specifically for a career as a dressage horse.

Darcey has suddenly become lame.

This could mean her dressage career is over before it even starts.

Dru needs to get up to speed by reading through her case notes.

So how long have we got to read up on the case?

Ten minutes.

About ten, 15 minutes, which doesn't really help

when I can't read this person's writing.

At just five-and-a-half months, little Darcey is already a handful.

Still feisty. Good, good to hear!

Feisty is not a word you want to hear

when you're looking at an animal's history!

Along with needy, dribbly, or aggressive.

Those are probably like, the top four that you don't want to hear!

But to help her overcome the extra stress of being at the hospital,

her mum is always kept close by -

even when she's taken in to have her shoulder X-rayed.

Cos this is the pouch right, down here?

This is the end of the glenoid here?

In the X-rays, surgeon Andy Fiske-Jackson can spot

a thickening of cartilage and bone within Darcey's shoulder joint.

Right, guys, the picture looks like certainly it is

supportive of an OCD lesion. So yep, just that line down there,

around here there looks to be some disruption.

OCD is osteochondrosis dissecans. In basic terms,

it's sort of a degeneration or problem with the cartilage.

It can be a really big problem,

especially in your sort of high performance animals,

it can be the thing that makes or breaks them. If they get this

disease and it's not treated, that can be the end of their usefulness.

But the team won't know whether Darcey's lameness can be corrected

until they open up her shoulder and take a look inside the joint.

So she's prepped for surgery.

We've isolated this lameness to the shoulder joint of the foal.

The aim now is to put a camera into that shoulder joint

to evaluate the whole joint, and evaluate with

the amount of damage we have just the prognosis for the foal.

Dru has been given a crucial role.

I'm going to be trolley dolly today, which I guess involves

passing instruments, light refreshments, snacks,

scratch cards, that kind of thing.

But he soon realises that it's a lot more complicated than he thought.

It's hard to be shown 20 instruments

and then five minutes later be expected to pass the right ones,

when they look the same and have got similar names.

So...

But Dru isn't just getting surgical experience today.

He's also getting a lesson in the harsh realities of treating

performance horses.

Because if the team don't think it's possible to correct little Darcey's

lameness here and now, she'll be put to sleep on the operating table.

When Darcey was under anaesthesia and covered in green sheets,

and you just see a leg sticking out and you're doing something,

you're concentrating on instruments and passing things

and that kind of thing, you don't

necessarily think about what the decision making process is.

These are, like we say, they are performance animals

so the decision on whether they're going to live or die

sometimes is down to, are they going to be a good competitor?

Which is...

it's quite difficult to accept, really.

Pick the leg up a little bit, just pick the leg up a little bit.

It's not long before the team, led by orthopaedics specialist

Roger Smith, locate the source of Darcey's lameness.

There's an area of damage in the cartilage.

The cartilage is very thickened

because it hasn't developed properly.

That's very granular abnormal bone,

the question is how far down it goes.

Piece by piece, the team painstakingly extract

the thickened cartilage.

OK, so I'm going to close it.

All we've done is we've removed all that damaged cartilage,

and also the defective bone underneath.

Yes, we're pleased with what we've achieved.

As Dru and the team suture Darcey's shoulder,

it's clear that the surgery is a success,

and her future's no longer hanging in the balance.

And trolley-dolly Dru gets the thumbs up from surgeon Andy.

Dru did very well. He was very diligent.

And it's something we don't expect to get bang on right the first time.

I think what we want is someone who's paying attention,

understands, and starts to learn a pattern, you know.

That's what we look for in learning and he certainly did that.

So, very happy with it.

Three days later, Darcey's recovering well,

and her owner Julie has come to take her home.

Our biggest concern was that they were going to get into the joint and

find that, actually, even with the surgery, and even with a long amount

of rehabilitation, she would still be lame, even as a pasture animal.

If it's successful,

you will pay any amount of money to have it successful.

But if we run out of money looking after this one,

we're going into the winter, we've got

all these others to pay for, what do you do about feeding them?

So it does make it really hard, it does make it hard.

I mean, money isn't everything, but it really, really helps

when you've got horses.

I'm glad to have her home.

-Charlie?

-Yep.

I've just written her for bloods and CPLI?

Charlie's in the second week of his Small Animal Medicine placement

and his patient Jack has come in for a check up.

Jack's being treated for a very serious auto immune condition.

Hello, Charlie. All right?

How you doing? Nice to see you again. Aw, hello! Oh, Jack.

A week since a bone marrow biopsy and blood transfusion,

it's time to see if Jack's finally responding to treatment.

Essentially, Jack looks very well. OK, so we think better.

Any other sort of problems that you've noted?

No, nothing really.

He'll eat and then two minutes later he's asking for more food.

Yeah, that's what steroids do to you, basically.

What have you been doing for exercise for him?

I've just been taking him for walks and that...

And how long do you think the walks are?

Probably 15-20 minutes or so, he's back to pulling,

like how he used to be kind of thing.

Yep, so Jack's demeanour obviously is well.

We still have to take every day at a time, and it might be that the

transfusion is still what's really supporting him,

and it's definitely a good sign.

Fantastic to see Jack so lively and happy and bubbly,

and so much improved from when he was here.

How's Jack doing?

Really well, owner has absolutely no problems to...

Oh, fantastic. I'm relieved.

He says, even better than when he took him home,

thinks he's got better.

They're so pink.

I think he's quite good.

-He's all good, isn't he!

-Yeah.

OK. Good, well done, Jack.

We're crossing our fingers and just hoping that everything...

that it's going to show that his bone marrow is regenerating.

At this stage, we can't really say.

LAUGHING: Slow down, Jack!

-For now, signs are looking good.

-He's good.

-Yeah, it's really nice to see.

-LAUGHING: Thanks for everything. Really nice to see you.

-Cheers.

They're still saying 50-50,

but you wouldn't think it looking at him, would you?

It's one of those ones where you as well are just really

rooting for it because he's showing positive signs.

But you try not to get too excited about it,

just because, at this point, you don't quite know.

The signs are looking good,

but it can always take a turn for the worse.

It's just one of those wait and see, and keep your fingers crossed.

It's now springtime, and in Essex, Jack's owners, Lynn and Dan,

are reflecting on the months

since Charlie helped to treat their much-loved dog.

Last time you saw him he'd just had another blood transfusion,

so his levels were pretty high.

And then what happened in the weeks following that,

his levels dropped again quite low.

We had a number of blood tests, but he didn't

regenerate any new cells so he was just getting weaker and weaker.

Talking to Anna and our vets, and amongst ourselves,

we just thought, "He's suffered enough and..."

Don't let him lose his dignity. It's never going to happen.

But don't let it go too far downhill

before you take him to the vet and basically put him to sleep.

So that's what happened. That was...

-19th December.

-Yeah, 19th December.

Four months on, the loss of their beloved Jack has become

a little more bearable - thanks to a new addition to the family...

THEY LAUGH

That's Alfie!

16-week-old Alfie.

And here we go again!

-It feels like a home again.

-I come in from work and he comes running up.

He does, doesn't he? Comes running up,

pleased to see you, his little tail going.

And it is, yeah, it's a home again.