Episode 9 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...

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.

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 it better.

-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 early March, and there's only a month to go till the students

start their final exams.

Our young vets are near the end of their practical placements,

and running out of time to learn the vital skills

they need to get out there and practise.

This next month really is make or break.

When they graduate, the support network is going to be taken

away, and it's very important to give them increasing

amounts of responsibility, then it won't be such a shock

when they have to make some big decisions out in the outside world.

Good God alive! Never again.

Final year student Dru Shearn already has a job lined up

at a mixed practice in Somerset.

120.

But he won't be working anywhere if he doesn't graduate,

and he's got one more placement he must pass - working

in the Intensive Care Unit at the Queen Mother Hospital for Animals.

Hello...

Dru's first patient is an 11-month-old Labrador called Alba,

who's critically ill.

The vets think she has New Forest Syndrome -

an extremely rare condition which causes rapid kidney failure.

Some dogs with this disease have been seen at the hospital before,

but not one of them survived.

This is Alba - she came into the emergency

and critical care service last night.

She has this kind of strange mystery illness that

I actually really know nothing about.

I've kind of heard whisperings of it, and heard of a few cases,

but I don't actually know what it is.

It's basically some sort of illness that causes skin lesions

and skin problems, and then they get acute kidney failure,

so basically their kidneys, they stop working.

She has quite a lot of bruising around her, like, belly area.

There's been so few of them at the moment that we don't

really know what the exact...what the exact picture is.

Normally, you can refer to a textbook

when you're confused or, you know, speak to someone about it,

and there's just no information about what causes the disease,

cos we're not really sure.

Most of the information I found were news articles saying,

"This mystery disease is just killing dogs

"and there's nothing we can do to cure them once they've got it."

They are, you know, they're all unfortunately dying.

What's the plan for the blood work now?

Dru's supervisor is Dan Chan, a leading expert in critical care.

But even he's seen few cases like Alba's.

18 months ago it started with dogs who were around the area or

were walking around the New Forest.

And it seems that no longer that's the case,

because now there's about 30 or 40 cases that are possibly

involved, and they're not just restricted to New Forest.

That's where we are right now.

These are very early stages of understanding

what the disease process is.

It's possible that this is our sixth case.

The thing we know is, once you start damaging the kidney,

it's very hard to stop.

Resident Kerry Doolin knows only too well that Alba's

chances are almost non-existent.

Have you had any that have, like, presented like this and survived?

-No.

-So no survivors.

-Nowhere has really.

So all the actual confirmed cases at the moment have been at post-mortem?

-Yeah, yeah...

-OK.

And it's so new for us... It's changing the whole time

what we do about it, so...

So, um, you can see...

Oh, God, it really smells as well.

You can see that she's having bad diarrhoea,

but it also looks like it's got a bit of blood in it, digested blood,

so, um, she just doesn't look like a happy dog at the moment.

Personally, I've not seen a dog much sicker than that

and still really be conscious or not be about to...you know, to die.

You know, Labradors are happy, go lucky sort of dogs,

and to see one with her head down like this,

and just not interested in anything is pretty unusual.

So it kind of shows the severity of how ill she's feeling

really at the moment. It's really hard to see them like that

and know that there's nothing you can immediately do to help them,

make them feel better.

God it smells. Phew.

With so little known about Alba's condition,

the vets don't know how to treat her.

The senior clinicians are going to discuss the case, so we're just

sitting in to, um, see what the plan is and where we're at at the moment.

The team must call on all their experience to work out

the cause of Alba's symptoms and find a cure before it's too late.

Cos I was thinking, this could just be a dog with

Necrotising Hepatitis AKI.

These are incredibly intelligent people and they're very qualified,

they're really good at what they do.

For me, it was slightly reassuring to see that sometimes they're

stumped as well, and they have to take a step back

and work through it, like maybe I would for something more simple.

You know, you don't qualify and know everything, so there's always

going to be stuff out there that you have to think about.

Any treatment they come up with will be experimental,

but they have to make a decision, as time is running out for Alba.

If there was a dog that we should intervene, this might be it,

it hasn't jumped off the cliff yet.

It could...there could be a shot.

With nothing to lose, the team recommend a radical treatment -

a special type of blood transfusion called plasmapheresis.

It's Alba's last chance of surviving this killer disease.

She's going to have, like, a big catheter put in

and she's going to have her own plasma, which is like a portion

of the blood that contains things like proteins and clotting factors

and things like that, taken out and kind of almost, like, filtered

and then put back into her body,

in the hope that we can get rid of anything bad that's in there.

That in itself has got risks, because you're taking things

like clotting factors out of the body, so she might bleed

even more, so then you have to try and counteract that.

So there's loads of things that are quite complicated.

But basically, we're going to try

and filter out anything bad that might be in her blood.

Yeah, it's pretty cool actually, from my point of view,

but probably not for hers.

Without this treatment, Alba will almost certainly die.

But it's completely untested, and her owners must make the difficult

decision whether to take the risk and go ahead with the procedure.

Are you going to then speak to the client?

I've spoken to her already this morning and, from her standpoint,

she's keen to do whatever is possible for the dog.

How much does she know about this potential problem?

I said there's a lot we don't know about it,

and what we do know is not great.

It does have quite a terrible prognosis if it truly is that.

So I left that day finishing my shift,

she just looked like she was going to die.

You always hope that your patient is going to survive,

but the odds are massively stacked against her.

We've not had a case like that survive.

Lay down, sugar.

-What colour are you guys' stethoscopes?

-Black.

-What have you got then?

-I was an ocean blue.

I was an ocean blue!

But no, it stained something horrid, quite a lot of poo stains.

Yeah, that's...

What were you doing with your stethoscope?!

That's why I went for black.

-It's very - exactly!

-Yeah, it's practical.

I'm all about the practical.

The practical ugly shoes, the practical stethoscope.

Just don't get poo on your stethoscope!

This week Elly Berry is out in the wild west,

on a placement with farm vets in Devon.

She wants to work in a mixed practice, and she's running out of

time to learn all the skills she'll need for her first day on the job.

At the moment, I'm just trying to put myself in the shoes of a real vet,

cos it's not long till actually we are real vets,

and these scenarios that we're going out to see, that's going to be us.

I need to make the most of that opportunity now,

cos this is sort of one of the last times I'm going to

be in this environment, and not ultimately responsible.

I'd really like to practise things that I'll be doing in real life,

so getting used to what's expected of me.

I'd love to get good at sewing up cows.

It all needs practice.

I'm going, Elly, go on down.

Fortunately for Elly, her supervisor, Rupert Kirkwood,

is expecting her to do a lot more than just watch and learn.

Today, he needs her to help him do life saving surgery on a cow.

So we're going to get the cow in the crush, anaesthetise her up,

and we'll do the job when she's standing, obviously.

We're going to cut a hole in her flank, or you are hopefully.

Don't worry, I will supervise you closely.

We're going to have a look at the cow to make sure her stomach

is still displaced.

One of the cow's stomachs, the abomasum,

has shifted to the wrong side of her body.

If it's not fixed back into the correct position

as soon as possible, she'll die.

The first step is to give the cow a local anaesthetic.

The nerves come out of the spine and run down the side like that,

so I'm blocking off the nerves as they come out of the spine,

with a line of anaesthetic there and there.

So that makes that part of the flank go numb, so that's the target.

Cut a hole in the flank, right through into the abdomen.

We can then reach in with our hand right over to the displaced stomach,

which is trapped on the abdomen between the rumen and the body wall

on the other side, and then deflate it and then drag it right underneath

her abdomen, right underneath her gut, pull it up to the exit hole

here, and stitch it in place, which is where it should be living anyway.

I think I know the process, but they're still fairly big

surgeries, they're never not going to be impressive.

Elly has seen this procedure once before -

but Rupert's a firm believer in letting vet students get

stuck in, so he's letting Elly start the surgery off.

I'll take over if you want, you can get yourself scrubbed up, I'll

just check to see how my anaesthetic is getting on and you can cut in.

And this is high pressure stuff.

Cutting through the abdominal wall is straightforward,

but what you don't want to do, the big danger is

when you get through, into the abdomen itself, you don't want

to nick a hole in any of the guts, then you really are in trouble.

So there's a little bit dangerous when you actually go through

the full thickness of the abdominal wall.

And once we do that, then we're away.

Cutting a cow open in a muddy barn is a far cry from

the state-of-the-art operating theatres

at the Queen Mother Hospital.

So she's got to go through the skin, which she has done already,

good. There's quite a lot of fat there. That's it,

that's perfect. Just keep going gently. Try and identify

the peritoneum, which is the lining to the abdominal cavity.

Amazingly, the cow is completely awake throughout the operation.

At no point was I worried that the cow could feel anything.

I know it's ridiculous - at one end, they're chewing

and at the other end, you are slicing into their stomach,

but, no, it's not a problem at all.

Are you through it or not quite?

I think that's it. Just nick a tiny hole in that, just gently.

Right, shove your arm in, right around so... Left arm!

And head around the back of the rumen,

head off in that direction, go round the back, see if you can feel it.

Yeah it's there.

Is it really big and bloated or not?

Yeah, no, it is actually. Yeah, it's really big and bloated.

Right, we're going to deflate that.

It feels like one of those balloons, you know, like, the really good ones

you get at your birthday that often have things inside it.

They're like really firm, like thick rubber. It feels like that.

We've got to drag it right down and up, across the abdomen,

and stitch it in place here.

It's still there. Sorry, cow.

This is the kind of thing that Rupert makes look really easy.

-This, I've been told, is not easy.

-It took me a while to...

There we go, that's what we want.

That, that is the pylorus, the exit muscle to the stomach.

Right, stitch in there, go on! Whack it through.

Right the way through? Yep. Through like...that.

You want to just tie that bit of stomach to the wall

of the abdomen, just so that stomach is firmly in place

and it's not going to start drifting off and filling with air,

so this basically can't happen again in that cow.

That's it, perfect. Once more and then we know we've got it.

I've never done this before, but he sort of handed me the stitch

and I got to suture it to the stomach wall, so that was good, too.

There's nothing genteel about this surgery, is there?

No. Well, no, it's pretty...pretty basic stuff.

Well they probably do the same with you when you're in hospital,

-you just wouldn't know about it!

-You just wouldn't know about it.

That's it!

You know, I'd be very surprised if she wasn't fine.

I'd be very disappointed if she wasn't fine, actually.

Good enough, go on.

Lovely!

That's it! Well done, good job.

I mean, there's a moment there when you're like,

"Hmm, that looks like steak," and then you're like "Meh, sew it up."

Eurgh, you!

After a thrilling day performing life saving surgery,

Elly gets to share the excitement with one of her biggest fans.

She's staying nearby with her grandmother, Jean.

-You all right, Grandma?

-I want to get the water.

-Right, Grandma.

-That's why.

-Oh you're amazing.

How much would you like?

-Not too much.

-Not too much? Oh, Grandma!

You're a growing girl(!)

That's the trouble!

Very proud of her, always have been.

She's a joy, absolute joy.

You always said, when you were down here last time, you really

were more interested in being a vet with large animals.

Yeah. If I could find one that did dogs and cats,

and then a cow in the afternoon, that would be wonderful.

But I think I'm probably wishing for too much here.

I'm sure she'll be an absolutely wonderful vet.

And she's very down to earth,

and good with people from all walks of life -

she even puts up with me, so...

Thank you for having me!

Aww! It's my pleasure.

While Elly's brushing up her skills on the farm,

mature student Judy Puddifoot is hoping to get lots of hands-on

experience with small animals...

Morning!

..at a large general practice in Watford.

Hello, Lola. Hello!

I affectionately call it the bucket list,

but every vet student across the country will be very familiar

with what is officially called the day-one skills.

This is a huge, never-ending list

of practical skills, knowledge, etc.

that every vet student should know on day one.

Judy may be desperate to learn, but she's still only a student,

so there's a limit to what the vets can let her do.

And today she isn't exactly being stretched.

Whew, it went in the pot!

Perhaps she'll have better luck with her next patient,

a Jack Russell called Suki.

She's my granddaughter's dog. She's living with us for three years

while she's at university.

I take her for a walk with my dog de Bordeaux every morning.

And today we came across a Staffordshire terrier,

which, unfortunately, bit her on the leg.

My granddaughter doesn't actually know we're here

cos I'd rather she didn't know.

We'll break the news to her when she comes back.

-Hello, Suki, please?

-Yes!

Judy's being closely supervised by one of the practice partners,

Raquel Amils.

Come on, this way. When did this happen?

This morning, about an hour and a half ago, I suppose.

Hour and a half ago, OK.

Is she up to date with vaccinations, worming and all that?

-I don't know, I very much doubt it, though.

-OK.

My granddaughter's a student and times are hard...

You know, a wound can look very superficial and not really

a lot to worry about on the surface, but if the joint's involved,

you do not want an infection in a joint, that's very bad.

You can see, much better now.

The big swelling that is in that area is quite amazing.

Ten percent of all wounds treated by vets are dog bites.

And let's face it,

dogs are notoriously unfussy about where they stick their mouths.

Without prompt action to treat her leg,

Suki's wound could become dangerously infected.

You can see, there is a lot of reddish in the area.

The wound looks small, but I've put a probe inside it,

and inside, underneath the skin, it extends almost to 1cm, 1cm and 2mm.

It's quite a big extension, I would say.

I would not close completely the wound, cos it's a bad wound.

So what we will do is we will put a drain in the wound.

Luckily for Suki, she's been seen before infection has had

a chance to set in. But Grandad Peter is about to discover

that treating dog bites doesn't come cheap.

The estimate is more or less about... £800.

-Sure, OK.

-Is that OK?

-Yeah, that's fine.

It comes as a shock -

and I hear it all the time - that vets bills cost so much money.

And they do, but they only sound like a lot of money because

when you go to hospital,

you don't get slapped with a bill at the end of it.

People in this country are very lucky that we have the NHS.

There isn't an NHS for animals, so it has to be paid for by the owners.

I wish she'd had insurance. It's very expensive,

but probably worth it.

They talk about Bank of Mum and Dad,

but this is Bank of Grandad and Grandma, or Nanny.

That's what families are for, aren't they?

Bless you. So much money!

It's all right, I'm going to cry when I get in the car!

Meanwhile, Judy scrubs in for surgery

to put the drain in Suki's wound.

I'm hounding them to get us to let me do stuff,

because I've only got two more weeks of going out to see practice left.

After that, I'll lose all my opportunities to learn

any more practical skills.

So anything I've not done, I'm trying to get done now.

And, yeah, putting drains in is on my bucket list, so I need to do that!

So that end's going to go under the skin, and then put one suture

-right through it.

-Yeah. So you go up here.

-Right.

-OK, your turn.

Here goes...

A drain will enable any infected pus to escape while the wound heals.

But as Judy's discovering, it's a really fiddly business.

That's where 20-20 vision is coming in. Look at that, jeez!

You've got to have good eyesight.

I did put the drain in Suki's leg,

that's the first drain I've ever put in, actually.

-So go via the wound and out?

-Yeah. yeah.

-Oh, you're kidding me.

-Up there,

and aim to come out sort of about four or five millimetres above this.

-Through there, come out there.

-Exactly.

-Got ya.

Four weeks from the end of rotations, and I'm still getting

-to do new things!

-Well done, drain placer!

First of many?

First of many, yeah.

Another thing ticked off the bucket list.

Ooooh, good girl. Suki, Suki! Good girl.

With the drain successfully, and expertly, sewn in,

Suki is almost as good as new.

Fantastically put in drain, I think.

And she's sent home to recover with a slightly poorer Grandad.

When you get a case what, what do you hate

being on the top of that folder?

Disease of unknown origin.

You can't read anything about that.

A disease that another qualified, experienced vet cannot solve,

-you have to.

-So they send them to you.

With all my experience, yeah.

And as a student, you have to look at them.

In the Queen Mother Hospital's Intensive Care Unit, Dru's

patient Alba is still fighting for her life.

The vets think she may have a deadly condition

known as New Forest Syndrome, which causes catastrophic kidney failure.

These are some sort of up-to-date blood results, just like basic

parameters, and some of her kidney values seem to be increasing,

which would suggest that her kidneys are not working as they should.

Overnight, Alba's owners have made the difficult decision to try

a radical treatment - a special kind of dialysis called plasmapheresis.

Her blood will be passed through a machine to try

and remove some of the pathogens which are making her so ill.

It's her only hope of survival.

We're going to take her down, get her under an anaesthetic,

and then place a catheter in her jugular vein,

and then she'll start the whole process of filtering out

her plasma.

With Alba in a critical state,

the team get to work without delay, to fit her jugular catheter.

This needs to be done in conditions which are as sterile as possible.

So we're out in the corridor instead of being in the room this time,

just because she's...she needs to be barrier-nursed.

So we're obviously worried about either contaminating her or

her contaminating us, and us passing on to other patients.

But this part of the procedure is very risky.

The worst thing that could happen now is that she starts bleeding

and we can't stop her from bleeding. And that's fairly... You know,

that's a big place to be bleeding from, your jugular.

It may make her worse as well, that's the problem. It may

make her worse, it may do nothing, it may make her better. So we're

hedging our bets on the fact that we're making her better, because

there's no real other options at the moment. So we have to do something.

While Alba's sedated, the team take vital tissue samples

and photograph Alba's symptoms.

And clinician Dan quickly collects blood for analysis.

We're just getting the, uh, blood samples, to test for various

things that might give us a clue of what might be going on.

So if we identify what's triggering this disease, then, you know,

the answers might be in these tubes.

The team waste no time hooking Alba up to the dialysis machine.

We're taking blood in, circulating,

and it's already starting to return back to the patient.

It will take eight hours to filter Alba's entire blood supply.

Now, I showed you that the blood is being circulated here

and filtered there, but one of the things that's happening is....

This is the waste bag.

So this is what's been washed out of Alba's blood.

So you're just noticing the different colour,

and that's because her red blood cells are being returned to

Alba, but this is the leftover.

So we're hoping that in this bag,

are the things we're trying to get rid of.

Prognosis is still pretty guarded to poor, given the fact that this

disease has caused a very young dog to have kidney failure.

Although Dru's shift is ending,

Alba's treatment will continue into the night.

But the team's efforts could all be in vain.

Even with the treatment, Alba's chances of surviving this dreadful

disease are very slim.

I heard of a story, it wasn't actually me that saw it,

but it was a vet I was with on EMS,

and he said he had a dog come in once that had eaten

seven golf balls.

And when it walked into the room...

-Was it jangling?

-..you could hear them

-clunking around in its stomach!

-No! Brilliant!

Which was amazing. Just amazing.

Today, student Dani Willey is starting a placement

at a charity practice in South East London.

Do you want me to get the door for you?

After almost a year of honing her vet skills, she's raring to qualify.

I think you could just be a student forever

because there's always things to learn,

but it's not what we want, we want to get actually out there,

and actually be vets, because that's what we've wanted to do for so long.

For Dani, the next two weeks are her last chance to work with

small animals, and the next time she enters a general practice

like this one, she will BE the vet.

Would you like to come through?

Sometimes I do feel like a vet, other times I'm like,

nah, definitely not.

I think sometimes I still think I'm at school.

Grey's going to draw you a picture to say thank you very much,

and we're going to bring it in.

That's a very good picture.

Sorry!

It's lovely.

Fortunately, this particular practice in New Cross is

one of the PDSA's busiest, so Dani will have ample opportunity

to show her supervising vet, Vincent Tsui, whether she's up to the mark.

Sorry.

Check, he's also got a great trick, he can lick his eyeball.

And it's not long before Vincent's piling on the pressure.

What sort of pain relief would you go for?

Metacam?

So Metacam is sort of like

the equivalent of taking a couple of Panadols.

Do you reckon after having

-your butt ripped in two...

-Probably not.

Yeah, I reckon you'd go for maybe something a bit stronger...

These are skills that she really needs to be on top of from day

one. There will be an expectation from anywhere she works at,

she will at least know how to do these things.

But the key really for her is to get as much

experience of that as possible.

But if Dani's hoping to brush up her skills on routine cases,

today is not going to be the day.

Bentley, the Shar-Pei, is recovering from cosmetic surgery -

South East London style.

Erm, we're here so that he can come and get a check up on his face,

cos he had to have a face-lift last week.

Obviously in Shar-Peis,

when they're puppies, they're meant to have their eyes tacked,

and the people that had him before, they didn't do it when he was young.

So I brought him down here, cos he had puss coming out of his eyes,

and bumping into things. And they said he had to have an operation,

cos he couldn't see out of his eyes properly.

So the main thing today, we don't have to do a great deal,

but we just want to clean up the wound areas, so we're probably

going to be taking these rubber drains out. And I can see there's

just a little section here which we might need to sort of re-stitch.

I thought so, yeah.

It actually looks like it's healing really, really well,

and we can actually see Bentley's eyes.

Has Bentley changed at all behaviourally since this happened,

apart from having a big cone of shame on his front?

He's just been getting all the attention.

You be good. Good boy!

This way, good boy.

I've never seen a facelift on a dog before, so it's quite interesting.

A doggy facelift might seem a bit fanciful,

but for Bentley, this was a much needed operation.

I wish we had a before photo, but this was...

You can sort of see where Bentley's muzzle is.

The forehead area was pretty much, you know, double that size,

and it was just like a giant beanbag sitting on top of his head, really.

I guess the thing that attracts people to this breed is

when they're puppies, they're very, very cute,

but this surgery alone probably cost the PDSA somewhat north of £750.

And a lot of the time they need multiple procedures like that

to just ensure they can see properly and be comfortable.

Drains removed and all spruced up, Bentley is ready to go home.

Hello!

But before he leaves,

Dani must conquer her most challenging procedure yet.

For some reason, they're so difficult

to get your head around how to put them together.

...fitting Bentley with a new Buster collar.

Got quite a big, thick head, hasn't he?

It's one of those things that you think, it must be easy to put

together, but anyone that's had to put one together

for their animal probably realises that it isn't actually that simple.

-Right, is that going to go over two times?

-We'll see.

Oh, good boy.

That will stay on, right? Like won't it?

Yeah, it should be OK. Or you could tie it on to the actual collar.

Er, yeah, yeah. That'd be better.

So that's secure enough?

But Dani's victory is short-lived.

It's too loose.

We'll have to be going back in there. Can't be having that,

that's way loose.

Oh, dear...

Up! Oh, that was rubbish!

Good girl! Good girl.

Jo Hardy may be coming to the end of her clinical placements,

but the pressure isn't likely to ease up any time soon.

My first of the long, long course of exams, is in three weeks' time,

so alongside trying to keep up with all my many cases in the

hospital and revising neurology, I'm also trying to revise for my exams.

So it's a busy and quite stressful time for me at the moment.

This week, she's in the neurology department

of the Queen Mother Hospital,

where patients are referred with serious brain and spinal problems.

Her supervisor is resident Joe Fenn.

-I would speak to his owners now.

-OK, sure.

-Forms are in for MRI.

-Great.

Obviously, it's a really difficult rotation because it's

so complicated, all the parts that you're trying to learn,

all the brain and the spinal cord and things.

But the biggest challenge is a physical one, cos loads

of animals are off of their legs, so you have to carry them round,

or at least, um, put a sling under them and sling their back legs.

And from a physical point of view,

Jo's first patient is about as challenging as they get.

He's a 3-year-old Great Dane called Luca,

and he weighs in at 80 kilos, which is a whopping 12 and a half stone.

Luca was a massive dog. He was so huge.

Not much of a dog, more of a horse, a mini horse.

Look at his face! Isn't he gorgeous?

Luca's been referred here with a problem that can affect large

breed dogs - his back legs have suddenly become too weak to

hold his considerable weight.

He came in as an emergency last night.

Since Saturday, he's been very wobbly on his back legs.

We've got a few working diagnoses.

It could be a problem with one of the discs in the spine.

It could be some sort of vascular problem.

Or worst case scenario, it could be a neoplasia,

so a cancer, pressing against his spine.

Luca needs to have scans to locate the cause of his paralysis.

But getting him there requires the combined strength

of the entire neurology nursing staff.

He just couldn't support himself. We had to have four people

carrying him, and then he was leaking from behind as well.

Unfortunately, poor Luca's spinal problem

has also made him incontinent.

He appears to be urinating. Do you want to follow us with a mop?

So we had another clinician behind us just mopping up the whole way.

Well, his friend here's forgotten how to work now.

After a mammoth effort from a huge team,

Luca's finally sedated for his scans.

Luca was in a whole other realm, he was in his own little category.

Obviously, he needs massive doses of all his drugs that he was on.

The scanner produces an image which is basically really

good for seeing soft tissue, so we can see the spinal cord

really well. He's going to have all of his spine looked at.

Next stop is the CT scanner - but it's a tight fit.

He was just physically too big. They don't make scanners for things

the size of a small horse. So we had quite a bit of difficulty

just repositioning him so we could just squish him through.

From the results, clinician Joe can see exactly what the problem is.

Thankfully, it's not cancer.

But part of Luca's spine is pressing on his spinal cord.

His spine, lower spine, and his pelvis,

there are nerve roots at that level

being squashed by chronic compression over a while,

which then got suddenly worse due to a slipped disk

at that level as well.

Quite an uncomfortable condition to have,

similar to sciatica sort of pain in people.

If Luca is ever to walk again,

he needs a major operation on his spine.

To treat this, we remove the bone overlying that area,

which is causing this compression.

We don't want him to move during surgery.

The last thing we'd want is for him to wobble.

And since he's so big and the table is a little bit too small for him,

we're taping him down so that he doesn't move at all.

You just don't want to hit the wrong part in a spinal operation.

-Let's go.

-Sure!

It's the first time Jo has ever assisted on spinal surgery,

and this is a massively complex operation.

Luca had a dorsal laminectomy, they do quite a lot at the QMH.

It's a really specialist surgery,

you have to be a neurologist to be able to do it, and it's hard.

So, first incision.

It was absolutely incredible how deep we had to go to be able

to get to his spinal cord.

It doesn't run straight over his back like you expect it to.

There was this point in the surgery where I just paused for a moment,

looked at him and thought, "It looks like we've cut this dog in two!"

To actually see the spinal cord is crazy!

I doubt I'll ever be able to do that again.

Two of the vertebrae have telescoped into each other like that,

and so that was causing a compression of the spinal cord.

So the top has been taken off so there's no compression there.

OK, done.

After four and a half hours in surgery,

neurologist Joe is quietly pleased with how it went.

Everything looks to be, yeah, in order. So, happy.

The following morning is Jo's last in neurology, and she's

popped in to see Luca, who's feeling a bit sorry for himself.

You're being silly, come on. It's OK.

HE WHINES

Good boy.

I'm revising while I'm keeping him company.

Umm, I thought he might appreciate some attention.

There's no time for either of them to relax.

12-and-a-half stone Luca needs to get his back legs moving.

The only way to do that is with some heavy lifting gear.

Good boy.

Come on, you can army crawl just to there.

Good boy!

Luca made such an incredible recovery and so very, very quickly.

Even the next day, he was able to move his back legs.

We were just so relieved by this.

It just meant he was going to make a really great recovery,

and we had all our hope in that.

Aww, and he's down. Ey, good boy!

Luca's well on the road to recovery, but it's clear that he

thinks he's had quite enough exercise for one day.

It is really impressive that he's actually trying to get up

and move his legs after such major surgery.

Cases come and go and not all of them are happy stories.

I'll always be emotionally invested in them,

but I never want to get really, really close and attached,

but Luca was just one of those that you couldn't help.

He was so cuddly and he was such a big character.

I just, yeah, I got really attached to him. He was a lovely dog.

I really enjoyed having him in my care.

HE HOWLS

At the high street vet practice in Watford, Judy's keen to get

stuck in to her next challenge.

Another day.

Another day saving lives!

But today she's doing something vets don't normally do.

This word kept being banded around by the nurses followed by a giggle.

And I couldn't understand what they were all going on about.

What's this? "Oh, yeah, you're going to assist Raquel, you're going to be

"the hooker."

Sorry? I'm going to be the what?

Elsa! Oh, hello.

Her patient, Elsa,

is about to be neutered using state-of-the-art technology.

Oh, well done, Elsa. Didn't know we did lionesses.

So, this afternoon what we're going to do is what's called

a laparoscopic spay,

which basically is we're going to spay a dog via keyhole surgery.

Right. Good girl, Elsa.

I've never done one, I've never even seen one hands on,

I've only ever seen it on TV,

and to actually scrub in and be involved, was very exciting.

But equally, nervous because... What am I going to have to do?

And what do I have to do not to balls this up?

Under a little bit of pressure not to drop the ovary.

Um, it'll be fine.

Looking forward to it. I'm very excited, but again, internalised.

And it's time for Judy to find out what being a hooker really means.

This is a hook, you'll be in charge of this bit.

Oh, right, that's mine, OK.

So, I was scrubbed in as chief hooker.

You don't go and stand on a street corner,

you actually get involved in a surgery.

Surgeon Raquel uses a tiny camera to locate the first ovary.

Here. Big. You can see the ovary?

Now is the part of the hook.

Oh, God, that's me.

-This is a hook.

-OK.

The tip of the hook has to go parallel to the tip of my forceps,

and you'll have to make the rest of the hook through the skin.

I'm going straight in through the skin with the hook?

Straight through the skin, and then you'll have to...

Oh, Lord. Right, I see. OK.

Chief hooker, this is the most important part of the surgery, OK?

Don't underestimate how important my bit was.

Get the hook, pop that through, grab the ovary and hold that in position.

-There, you see?

-Wow.

And then the surgeon can grab that, cauterise it,

and pull it out of one of the holes.

-There it is!

-Perfect.

-Wow.

What we do is we check that all the ovary is there.

It could be quite a struggle, but it's kind of like...

Out it comes.

It's fantastic!

Whoop, there we go.

-Perfect.

-Beautiful.

-Done!

That's my memory of laparoscopic. Hooking...the ovary. That's it.

There we go, there we go. Back in the room.

Elsa's keen to get moving,

and Judy's first keyhole surgery has been a big success.

For first time for her to do a laparoscopic surgery,

I know that she was only doing the hook,

but that was a key point for any type of surgery like this.

She did well, I must say. No, I lie.

She did great!

Lovely jubbly. Thanks, Andrew!

I've not seen on my bucket list that it says being a hooker

is a day-one skill. Um...

I'll have to look into that.

Not sure it is, but if it is... tick!

At the Queen Mother Hospital,

Dru has come in to visit his patient, Alba.

She was admitted five days ago to Intensive Care with

a suspected case of New Forest Syndrome - a mysterious new

illness which has been killing dogs all over the country.

I thought I'd pop back and see how Alba's doing.

Hopefully, she's better than she was when I last left her.

She was really flat and she just looked still really, really ill.

She was just getting her treatment.

Alba's entire blood supply was filtered through a dialysis

machine for eight hours.

And since then, the team have been waiting to see if she can defy

the odds and become the first dog to survive the disease.

Hello! Aww, hello, you.

You look better, don't you? She looks amazing.

She's like a diff...like a completely different dog!

Although she's still bruised, she's a lot less sore and it's gone down.

It's gone down a heck of a lot.

She's actually playing with her toys.

She just looks...she looks her normal...

The prognosis really wasn't very good at all.

Most of them have, unfortunately, not survived.

If she was my dog, I'd be over the moon.

She's still got a little way to go,

but she just looks so much better. She's such a lovely dog,

it would've been quite depressing if that's the way it'd finished.

Just two days later, the news is even better.

Alba is making a truly amazing recovery.

Specialist Dan Chan is thrilled.

She looks fantastic, and she's made a dramatic recovery.

I think that, you know, we have a lot of unanswered questions -

whether it's truly the same disease.

But if it is, then it's a small breakthrough.

The team really felt good about doing something that everyone

thought was a really slim hope of getting her to recover,

so it is a huge boost. So I think it's really gratifying

to see a patient that walks out of here.

Alba's become a celebrity in the ICU.

Oh, what's this?

But now it's time for her to be reunited with her family.

Today, Alba's going home. She just looks like a different dog

to when she came in, you wouldn't even recognise her.

She's just like a normal labrador.

Hopefully, she's going to carry on being sort of just a healthy,

happy, young dog.

Hi there, nice to meet you!

She was going to die with no intervention, no doubt about it.

And then to be able to see it through completely to the end

and see the resolution - she's completely healthy, she's been cured.

My last case in the QMH,

it's really nice to finish on something like that.

You don't get that very often, where no-one really knows how to

deal with the case and they're not really sure about the disease

and how to treat it, and it's the first one that's gone home healthy.

So, um, that's really cool.

At the charity practice in South East London,

Dani's hoping to impress vet Vincent on her last-ever

placement with small animals.

Thankfully, her next case - Prof, the kitten -

doesn't need a facelift.

But she does have a problem at the other end.

Has she actually passed any faeces at all?

No, she was trying gainfully, but she couldn't.

She's been able to eat, but I haven't fed her this morning

because I thought if she's constipated, I don't want to give

-her any more to make her worse.

-Yeah, quite right.

Let's pop her out and have a little feel of her back end.

Come on, girl. Come on, sweetheart.

Yeah, she's definitely constipated again.

I think what we all might need to do today is actually bring her through

again, and she'll most likely need an anaesthetic.

Prof has recently been spayed, and a common complication

of the operation is scar tissue building up around the bowel.

Vincent thinks this might be the cause of her problem.

There's obviously something at her back end that's stopping

her from going to the toilet. Like she was fine before everything,

and there's something that's either too narrow for the poo to come

through or something actually blocking that to come through.

-Hopefully we should find an answer.

-Thank you, I'd appreciate that.

When Prof came in, she did look pretty sick and unhappy,

so it was definitely something that needed to be investigated.

It sounds to me like there is some sort of physical problem stopping

her from going to the toilet.

That's not a normal sort of noise for a young, healthy kitten to

be making. She's obviously very uncomfortable,

which is why I think we need to do something about that straightaway.

The first step is to X-ray Prof to see where the blockage is -

and it's very obvious.

You shouldn't really be able to see this much faeces.

That is just a constipated cat.

What's quite interesting about it is it's not just constipation,

it goes into this gigantic sort of nugget here,

and then there's a really narrow section after that,

which means that there's an area where poo just can't get through.

Without intervention, little Prof could become very ill indeed,

so Vincent and Dani opt for surgery.

So we're going to do an exploratory laparotomy, just to go into the

abdomen and kind of get a visual, like proper look at what's going on.

X-rays are useful, but there's only so much they can show you.

Is this something you've done before?

Err... Yeah, I've seen some ex-laps before,

but I've not seen any that've been for constipated cats!

-So we're going to be having to go into this particular area.

-OK.

And you can actually feel, that's where the lump of poo is.

Within minutes, Vincent has located the exact problem -

and it's just as he suspected, scar tissue constricting Prof's colon.

I think maybe what's happened is, it's not the colon that's

stuck to the side, but there's a bit of mesentery or fat that's

been stitched to the side, and it's actually coming across the colon

and almost strangling it in the process.

One snip, and it's sorted!

So far, Dani's managed to avoid getting her hands

dirty on this case.

But her luck's about to change.

What I might need you to do is pop on some gloves

and occasionally rectal the cat.

The final year of vet school is full of new experiences,

but rectalling a cat whilst it was having abdominal surgery

and feeling the surgeon's finger touch my finger...

Oh, there it is, hello!

Oh, yeah, hi.

It was quite surreal, um...

This is really weird.

Once the blockage has been successfully removed,

Prof is moved to recovery, where Vincent and Dani are hoping

for a very important delivery.

I'm hoping that we see this little nugget of joy coming out

over the next 24 hours, really.

I don't know how else to put that.

But I would literally be jumping for joy when Prof

actually finally goes to the toilet.

-It just did then?

-Yes.

-Oh, fantastic.

Nuggets of joy!

Shall we go and look at it?

Nugget of joy, yeah.

I mean, that's kind of the proof that the operation was a success.

Vincent and Dani are delighted with the results.

I'm so happy!

But their pleasure's nothing compared to little Prof's.

Hopefully this is the first of many great things to come from you.

My job is so weird!

In rural Devon, Elly is honing her farm vet skills.

The weather may be terrible, but animals still need to be treated.

Basically, there's just another storm coming in.

More rain, more wind...

The weather doesn't necessarily put me off doing farm work.

Half the year, you're going out in all right weather.

But it's the stuff you're doing, I wouldn't want to stay

cooped up inside all day, I chose to be a vet so I'd have this

variety of lifestyle, and that's what I'm after.

And the weather just happens to be part of that.

It's never bothered me too much.

As soon as she gets to work,

it's straight out on an emergency with senior vet Rupert Kirkwood.

OK, so now we've had a call to a ewe having a difficult lambing.

The farmer thinks she's got twins in there all muddled up,

so it's quite an emergency job.

The sooner we get there, the more likely we are to get live lambs out.

Lambing season is a really busy time for farmers,

who have to cope with most births without assistance.

The vet's only called in when there are serious complications.

Are you going to get up?

-Look, I'll whack my hand in there...

-Sure, sure, sure.

The ewe has been in labour for several hours,

but her twins are stuck fast.

We have a foot.

We have another foot.

Front feets, back feets?

Without Rupert and Elly's intervention,

she and her lambs will die.

We have a head, twisted round.

-It's a bit muddled up, isn't it?

-Yeah.

And it's quite tight as well, isn't it?

Ideally, Rupert would untangle the twin lambs inside the sheep

and deliver them normally, through the birth canal.

With lambs, their head's up and can get caught back - so you're

pulling on the legs but the head's caught back in the pelvis.

-So if you have...

-The only other option here is a caesarean,

of course, but just if I can't sort it out.

But it's a lot easier if we could do it this way.

This is just... It is a difficult job and the lambs are well

and truly twisted up.

I mean, it just is very, very tricky.

I just might not be able to do this. Could you give Ashley a buzz,

tell him to bring the Caesar kit out?

I'm just... Ross, it's just possible I can't do this if it's

so tight and twisted up.

In which case, we'll have a Caesar,

and I'll get... There's another vet free who can bring the kit out.

Hi Candy, it's Elly.

Hi, just wondered - would you be able to ask Ash

if he could bring a Caesar kit out to this lambing?

No, it's just not going to come.

I'm going to kill... I don't know what state the lambs are in,

but it's not going to do anyone any good them coming out of there.

Sorry, it's just not going to happen.

Let's have two of those, Elly.

The time has come for Elly to improvise an operating table.

Um, Elly, clip her up, get her on there.

Make yourself comfortable. And start clipping her up there, Elly.

I hope the lambs are alive, but the sooner they come out,

the greater chance they have of, uh, being alive.

Is that about the right size?

-Bit bigger.

-Yeah?

Rupert injects a local anaesthetic

and Elly makes the operation site as clean as possible.

The missing Caesarean kit is on its way,

but vital time is ticking away and the ewe is in serious danger.

I'm just thinking, priority is to get the lambs out.

And if we have to wait for an extra minute or two before we can

stitch the ewe up, well, so be it.

You've just got to be a bit careful when you're used to cutting

holes in cow's sides that you don't go marching right through.

-Oh, here you are, Ash. You OK?

-Yep.

Thankfully, within minutes, the kit arrives.

But even with their prompt action, it's touch and go

whether the lambs will be born alive.

Let's have a pair of scissors, folks, can we?

There's a lot of lambs in here, a lot of lamb.

They're fairly packed in.

Go on, come here.

Your job, Elly, when lambs come out, is absolutely, hopefully...

Hang on a minute.

It's all a bit bloomin' tight in here.

That is a lamb's leg.

The operation has reached a critical stage.

This really doesn't want to appear.

They're about to find out whether the lambs are OK.

Either way, Rupert needs Elly's help to get them out.

Cut in there, go up that way.

Keep going. Full depth of uterus.

Go on, just keep slicing.

Go on, go on in there, stick it right into the...

-That's it, go on.

-That's leg.

-That's lamby leg!

-Yes, go on, keep going up there.

-I don't want to cut you!

-Don't worry about me.

Lamb comes first, now go on a bit more.

Important to try and get the hole in the uterus big enough first off.

Right, lamb and a half!

Elly grab on this here.

It's a boy!

Hang on, I just want to make sure I've got the uterus,

I don't want to lose that uterus.

-I've got lamb.

-I haven't got the uterus...

Go, go on, out.

Good grief!

That wasn't going to come out the back end in a month of Sundays!

You look after lamb, OK? Do everything you can, is he...?

He's alive! He's alive.

I'm just trying to keep lamby as alive as possible.

But he's taken a breath!

Cracking.

Cracking lamb, look at the size of that!

-Well there's another one, Elly.

-Oh, coming. Hang on.

Go, go, go... Go on.

Hopefully, that's it. Is it?

-He's alive as well! They're both alive.

-What's your gut feeling,

-that there was two in there?

-Cracking! I know!

I know!

It's a good outcome, that.

Yeah.

I think this is the one, that was coming out first

and had all the tugging and the pushing.

I mean, it's incredible, they're both doing well.

It's a funny job as a vet, you know.

You'd think after 30 years in the business, you'd get used to

the sound of little baby lambs calling out, but it's, um,

you know, it's a very satisfying job,

there's a lot of people who'd give an arm and a leg to do the job

that we're...what we're doing now.

Um, you know, it's a real basic, core, real life job.

You know you're in the right job when, it might be tough at times,

but if you still feel that after 30 years,

that then...that's great.

That's something to aspire to, isn't it?

Can you imagine? Aw!

But, you know, you're operating under farm conditions.

Actually, the results we get are, you'd say, astonishingly good.

I think if you were a medical doctor, you'd be horrified at what

we do on the farm.

Both mother and lambs are alive and doing well.

Top job, I reckon.

That's brilliant!

It's a bit naff to say good team work, but on that occasion, it was.

For Elly, it's been a baptism of fire.

But she's proved herself today.

That was brilliant!

I mean, it was quite touch and go, and out came two lambs!

I really didn't think they'd be alive.

But I love that bit when you're just trying to resuscitate them

and they do a little "Meeeeeh".

I want to do that. I want to do this! All of the time!

Hee-hee!