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These are the user uploaded subtitles that are being translated: 1 00:00:00,000 --> 00:00:03,540 Mac, a dog rushed in suffering from fits, is faring better. 2 00:00:04,700 --> 00:00:07,680 The anti -seizure drugs given to him by Annette worked. 3 00:00:08,420 --> 00:00:12,640 They won't have cured his meningitis, but the immediate danger has passed. 4 00:00:15,180 --> 00:00:16,360 Sorry, he's a bit tired. 5 00:00:17,380 --> 00:00:19,300 I'm very pleased there were no seizures overnight. 6 00:00:21,800 --> 00:00:23,420 So he's doing actually quite well. 7 00:00:24,720 --> 00:00:28,920 The fits may have stopped, but Mac has been behaving somewhat strangely. 8 00:00:45,360 --> 00:00:49,340 Max circling may just be a temporary after -effect of the seizures. 9 00:00:59,660 --> 00:01:00,800 I just closed the door. 10 00:01:03,940 --> 00:01:04,940 Hello, my dear. 11 00:01:06,240 --> 00:01:10,760 Annette calls to update Mac's owner, Alan, who's been desperately worried 12 00:01:10,760 --> 00:01:11,760 his beloved pet. 13 00:01:13,220 --> 00:01:16,400 Hello. Hello, good morning. This is Annette Westman speaking from the 14 00:01:16,400 --> 00:01:17,079 Vet School. 15 00:01:17,080 --> 00:01:18,880 Hi there. Really quite good news for Mac. 16 00:01:19,100 --> 00:01:20,500 There were no more seizures overnight. 17 00:01:21,140 --> 00:01:22,720 So I'm really pleased with that. 18 00:01:23,200 --> 00:01:25,300 So he responded well to the given treatment. 19 00:01:25,640 --> 00:01:27,860 And at the moment, he's circling to the right. 20 00:01:28,510 --> 00:01:29,970 And a bit spaced out as well. 21 00:01:30,930 --> 00:01:34,230 But in general, I'm really happy that there were no more seizures for now. 22 00:01:34,750 --> 00:01:37,850 Okay. How are you this morning, after the night? 23 00:01:38,650 --> 00:01:40,090 Well, it was great. 24 00:01:42,050 --> 00:01:43,770 My wife was quite upset, obviously. 25 00:01:44,190 --> 00:01:46,630 I imagine it's difficult, those things. 26 00:01:48,790 --> 00:01:51,910 Alan can come in to pick up Mac later on today. 27 00:01:55,440 --> 00:02:00,860 In the equine centre, David's about to start a gastroscopy on Timmy, a horse 28 00:02:00,860 --> 00:02:02,880 who's been causing concern for a year. 29 00:02:04,200 --> 00:02:07,160 Timmy's been lightly sedated in advance of the procedure. 30 00:02:08,460 --> 00:02:13,980 We're about to pass the tube all the way up his nose, and then we're going to 31 00:02:13,980 --> 00:02:16,500 swallow the tube, so it's a camera, so it's an endoscope, and then all the way 32 00:02:16,500 --> 00:02:17,500 down his gullet. 33 00:02:17,680 --> 00:02:21,700 We'll go through his thorax and then into his stomach. So his stomach sits a 34 00:02:21,700 --> 00:02:24,000 long way back, so on the left -hand side of his tear. 35 00:02:31,700 --> 00:02:35,960 David will be looking for something that could be causing Timmy pain and making 36 00:02:35,960 --> 00:02:37,000 him hard to ride. 37 00:02:38,360 --> 00:02:42,440 Timmy's discomfort has been a mystery to riders Vivian and Alexandra. 38 00:02:51,180 --> 00:02:53,580 And I suppose that's one of the things, when an empty stomach, the bile mixes 39 00:02:53,580 --> 00:02:58,040 with the acid, and together they're even a bit more light towards the damage, as 40 00:02:58,040 --> 00:02:59,620 they've got empty stomachs for a long time. 41 00:03:00,100 --> 00:03:01,920 This is last meal with a little bit of grain. 42 00:03:03,680 --> 00:03:07,180 Natural contractions help to push the camera up Timmy's intestine. 43 00:03:09,060 --> 00:03:12,720 He's finally gone through his drink today. We're coming to his small 44 00:03:12,960 --> 00:03:18,120 and all that bile, that poppy -coloured substance, the bile that gets squirted 45 00:03:18,120 --> 00:03:19,120 into his stomach. 46 00:03:28,270 --> 00:03:31,210 It looks like David's found a source of Timmy's problems. 47 00:03:32,170 --> 00:03:36,470 He's just got two ulcers damaged to the edge of the sphincter. 48 00:03:36,950 --> 00:03:41,810 It's likely that they are a little bit painful when he's moving forward. Think 49 00:03:41,810 --> 00:03:44,270 about it, it's a really, really strong muscle, the pelvic sphincter. It's 50 00:03:44,270 --> 00:03:50,110 contracting very frequently, so any small ulcer or inflammation there is 51 00:03:50,110 --> 00:03:51,790 significant as a source of pain. 52 00:03:52,150 --> 00:03:56,170 The sphincter is the muscle which releases food from the stomach into the 53 00:03:56,170 --> 00:03:57,170 intestine. 54 00:03:57,320 --> 00:04:00,240 Probably the worst bit of your stomach to have affected. 55 00:04:01,140 --> 00:04:04,260 Because that's where the acid is also very strong, that's what makes it 56 00:04:04,260 --> 00:04:05,260 for them. 57 00:04:05,700 --> 00:04:09,520 Timmy's ulcers will have caused him pain, explaining his behaviour. 58 00:04:10,340 --> 00:04:13,120 Now, David needs to think of ways to treat them. 59 00:04:15,640 --> 00:04:19,920 Catherine's about to operate on Panther, a dog who's in danger of choking to 60 00:04:19,920 --> 00:04:22,460 death because her larynx keeps blocking her airway. 61 00:04:25,250 --> 00:04:27,510 Catherine's going to stitch the larynx to one side. 62 00:04:29,050 --> 00:04:33,210 It can be quite challenging, and particularly if you get a dog that has 63 00:04:33,210 --> 00:04:37,650 lot of fat laid down around its neck, it can make it very difficult to get at 64 00:04:37,650 --> 00:04:38,950 the larynx in the first place. 65 00:04:40,050 --> 00:04:44,010 And because you're working through a relatively limited approach, a 66 00:04:44,010 --> 00:04:48,450 small incision, it can then just make it physically more difficult to get the 67 00:04:48,450 --> 00:04:49,450 sutures in place. 68 00:04:50,000 --> 00:04:52,740 Probably the single biggest problem with this procedure is people 69 00:04:52,740 --> 00:04:55,080 underestimating how difficult it's going to be. 70 00:04:57,060 --> 00:04:59,940 It's also a challenge for Adam, the anaesthetist. 71 00:05:00,460 --> 00:05:04,540 From his point of view, an animal with breathing problems is about as tough as 72 00:05:04,540 --> 00:05:05,540 it gets. 73 00:05:07,380 --> 00:05:10,260 OK, so you can see at the moment she's not really breathing properly. 74 00:05:11,140 --> 00:05:16,500 And that's partly because she was panting beforehand and partly because 75 00:05:17,480 --> 00:05:22,180 just induced anesthesia. So what I might need to do is just help her breathe to 76 00:05:22,180 --> 00:05:23,180 begin with. 77 00:05:24,440 --> 00:05:25,960 So we'll give her a breath. 78 00:05:34,640 --> 00:05:37,600 It's not just Panther's breathing Adam needs to think about. 79 00:05:39,200 --> 00:05:42,920 Animals' eyes will tend to dry out a little bit during anaesthesia because 80 00:05:42,920 --> 00:05:45,180 they're not producing tears and they're not blinking. 81 00:05:45,720 --> 00:05:50,800 So we need to protect their corneas with some artificial lubricant. So any 82 00:05:50,800 --> 00:05:54,940 animal that's being anaesthetised here will get their eyes lubricated. 83 00:05:55,500 --> 00:05:57,800 So you can see how we need to multitask. 84 00:05:58,860 --> 00:06:00,380 Lots of things all at once. 85 00:06:01,500 --> 00:06:06,100 When Panther's owner Angie brought her in, she had no idea Panther would be 86 00:06:06,100 --> 00:06:07,100 rushed into surgery. 87 00:06:08,460 --> 00:06:13,200 A bit worried, anxious, but hopefully we're in the right place to get a good 88 00:06:13,200 --> 00:06:14,200 result. 89 00:06:15,460 --> 00:06:20,780 Catherine's first task is to get access to Panther's larynx and give some tips 90 00:06:20,780 --> 00:06:24,440 to the trainee surgeons watching this procedure for the first time. 91 00:06:26,160 --> 00:06:27,160 She's a bit overweight. 92 00:06:31,620 --> 00:06:37,560 Catherine needs to feel or palpate. 93 00:06:37,960 --> 00:06:39,220 her way to the larynx. 94 00:06:39,880 --> 00:06:42,940 You can feel the wing of her thyroid right in here. 95 00:06:43,900 --> 00:06:46,920 A lot of this surgery is done by palpation rather than by seeing. 96 00:06:47,920 --> 00:06:51,920 This is the point where in the books they talk about being careful not to 97 00:06:51,920 --> 00:06:54,860 off the articular process. This is the point where they're talking about when 98 00:06:54,860 --> 00:06:55,860 you're dissecting it. 99 00:06:57,500 --> 00:07:02,400 So particularly if you try to pull upwards too much while you're 100 00:07:02,400 --> 00:07:05,100 you kind of have to work within the space that's there. If you keep trying 101 00:07:05,100 --> 00:07:07,160 lift things up towards yourself where you're... 102 00:07:07,760 --> 00:07:11,760 You're kind of bending it backwards and that's where you start running the risk 103 00:07:11,760 --> 00:07:12,760 of snapping things. 104 00:07:13,300 --> 00:07:16,460 They're not the easiest procedure to do. 105 00:07:17,400 --> 00:07:22,720 I think they're a real example of why you need to know your anatomy and how 106 00:07:22,720 --> 00:07:24,300 important it is to know your anatomy. 107 00:07:25,780 --> 00:07:28,640 This is one of your classic deep dark hole surgeries. 108 00:07:32,900 --> 00:07:36,600 While Catherine carefully dissects her way to Panther's larynx. 109 00:07:39,170 --> 00:07:42,050 In the hospital kennels, Max sleeps soundly. 110 00:07:42,410 --> 00:07:44,990 The vets are delighted there have been no more seizures. 111 00:07:47,110 --> 00:07:51,670 Neurology resident Rodrigo comes to tell Max's owner, Alan, that Max is ready to 112 00:07:51,670 --> 00:07:52,429 go home. 113 00:07:52,430 --> 00:07:55,970 If you want to come with me, I will explain everything and then I will bring 114 00:07:55,970 --> 00:08:01,010 Max. The staff here have been wonderful, trying to help him as best they can. 115 00:08:01,350 --> 00:08:05,630 But at this moment in time, we're not sure what's going to happen with him 116 00:08:05,630 --> 00:08:07,570 than the fact that I'm taking him home today. 117 00:08:08,350 --> 00:08:14,550 and hopefully we'll get an idea of how he is as a dog and what his quality of 118 00:08:14,550 --> 00:08:15,550 life is going to be like. 119 00:08:20,630 --> 00:08:26,470 Mac doesn't give Alan his usual welcome because he's still affected by the 120 00:08:26,470 --> 00:08:27,470 drugs. 121 00:08:27,770 --> 00:08:31,770 So the thing is he tends to be walking in circles to the right. 122 00:08:34,789 --> 00:08:38,710 Hopefully, if it's only the side effect of having a lot of seizures, this will 123 00:08:38,710 --> 00:08:40,770 start stopping during the next days. 124 00:08:41,190 --> 00:08:43,470 That's OK. Come on. 125 00:08:45,110 --> 00:08:46,110 That's my boy. 126 00:08:47,410 --> 00:08:48,730 Oh, I don't want to stare at him. 127 00:08:50,450 --> 00:08:51,450 He's a good boy. 128 00:08:52,510 --> 00:08:53,510 Shall we go home? 129 00:08:54,650 --> 00:08:55,650 Shall we? 130 00:08:56,450 --> 00:08:57,450 Come on, pal. 131 00:08:58,330 --> 00:08:59,330 Thank you. 132 00:09:00,070 --> 00:09:03,870 Alan will continue to give Mac his meningitis medication at home. 133 00:09:06,570 --> 00:09:10,950 In the operating theatre, Adam's had to move quickly. A few moments ago, 134 00:09:11,070 --> 00:09:13,570 Panther's haemoglobin levels dropped without warning. 135 00:09:14,710 --> 00:09:18,930 She wasn't the most straightforward of cases in the world, it has to be said. 136 00:09:19,030 --> 00:09:24,230 She had a few issues with her blood pressure ending up on a dopamine 137 00:09:24,250 --> 00:09:25,330 which seemed to do the trick. 138 00:09:27,370 --> 00:09:32,350 While Adam monitors Panther's blood pressure, on the operating table, 139 00:09:32,350 --> 00:09:33,750 has reached her larynx. 140 00:09:34,040 --> 00:09:36,600 and is now stitching it to the side of her airway. 141 00:09:37,180 --> 00:09:39,500 This is the other awkward bit of the surgery. 142 00:09:39,900 --> 00:09:45,180 There's no decent guidelines as to what is the right tightness for these. 143 00:09:45,900 --> 00:09:50,700 So it's sort of something you build up, an awareness of sort of what is the 144 00:09:50,700 --> 00:09:52,080 right, how tight is the right tight. 145 00:09:54,280 --> 00:09:57,660 We're not aiming to get it cranked right open. We just want to have a decent 146 00:09:57,660 --> 00:10:01,960 airway for her to breathe through. Sure. So what we're going to do is just snug 147 00:10:01,960 --> 00:10:03,440 it down but not overdo it. 148 00:10:04,020 --> 00:10:07,080 And because we're kind of working against tension in the cartilage, once 149 00:10:07,080 --> 00:10:10,700 got it to the point where I'm happy with, we'll just clamp it lightly so 150 00:10:10,700 --> 00:10:12,200 doesn't come undone. 151 00:10:12,460 --> 00:10:13,460 Okay. 152 00:10:13,620 --> 00:10:18,340 And then get the subsequent knots snugged down onto that. Cool. 153 00:10:20,360 --> 00:10:25,420 If Catherine left the airway too wide open, Panther could inhale food or water 154 00:10:25,420 --> 00:10:26,420 into her lungs. 155 00:10:28,200 --> 00:10:34,820 What we want is to get a comfortable airway that they can exercise and have a 156 00:10:34,820 --> 00:10:36,520 happy life with, but not overdoing it. 157 00:10:36,780 --> 00:10:37,780 OK, 158 00:10:39,260 --> 00:10:40,260 so that's us done. 159 00:10:42,660 --> 00:10:44,840 Right, so let's get all those towel clamps off. 160 00:10:46,700 --> 00:10:50,820 The 45 -minute operation has been a masterclass for the trainee surgeons. 161 00:10:52,440 --> 00:10:54,080 Avoid poking your eye out with that. 162 00:10:54,900 --> 00:10:59,900 OK, so are you looking there? Can you see how that's fixed partially open? So 163 00:10:59,900 --> 00:11:02,660 we've lifted and rotated, so she's now got a nice airway to breathe through. So 164 00:11:02,660 --> 00:11:03,660 that's about what you want to see. 165 00:11:04,760 --> 00:11:10,740 The surgery may be finished, but Adam's care of Panther isn't over yet. 166 00:11:12,180 --> 00:11:13,180 She is being... 167 00:11:13,480 --> 00:11:18,960 sedated in ICU because she's quite an anxious dog and the last thing you want 168 00:11:18,960 --> 00:11:24,600 for these types of patients to be anxious because they get themselves all 169 00:11:24,600 --> 00:11:29,780 up and have major problems with their airways so she's being sedated and the 170 00:11:29,780 --> 00:11:34,860 sedative that I'm using should help her blood pressure a little bit as well so 171 00:11:34,860 --> 00:11:38,780 we'll see what happens when we go through she's not far off coming round 172 00:11:38,780 --> 00:11:39,780 actually 173 00:11:41,079 --> 00:11:45,300 Panther's not out of the woods yet, but her surgery has gone well. 174 00:11:45,740 --> 00:11:49,600 It's a procedure that can be very satisfying to do because there's a lot 175 00:11:49,600 --> 00:11:52,800 distress for owners as the condition gets worse because they're watching 176 00:11:52,800 --> 00:11:58,380 sometimes increasingly frequent episodes where their dog is really struggling to 177 00:11:58,380 --> 00:12:03,260 breathe or possibly even collapsing and semi -choking. So I think it's nice, 178 00:12:03,380 --> 00:12:07,660 even though it's not the perfect treatment because we're not reversing 179 00:12:07,660 --> 00:12:08,960 gone wrong, we're kind of... 180 00:12:09,560 --> 00:12:13,120 We're managing the signs as best we can, so you kind of know you're not doing 181 00:12:13,120 --> 00:12:15,720 something that's perfect, but it makes a really big difference to quality of 182 00:12:15,720 --> 00:12:17,200 life, and that's the most important thing. 183 00:12:21,240 --> 00:12:24,260 Chico's owners, Gus and Liz, have come to the vet hospital. 184 00:12:24,940 --> 00:12:26,960 They've made their decision about Chico. 185 00:12:29,120 --> 00:12:34,780 There could be procedures we could carry out, but we feel the cats have come to 186 00:12:34,780 --> 00:12:37,860 the end of the road. These procedures would be terribly invasive. 187 00:12:38,600 --> 00:12:40,840 and might not give her very much longer anyway. 188 00:12:41,200 --> 00:12:46,860 So we're back today to say cheerio to Chico and have her food to sleep. 189 00:12:47,260 --> 00:12:52,500 She's so thin now and so slim, and she's worn out, so I think it's time just to 190 00:12:52,500 --> 00:12:53,500 let her go. 191 00:12:55,720 --> 00:13:00,500 Ian collects Chico so Gus and Liz can say their private goodbyes. 192 00:13:02,600 --> 00:13:03,880 We'll miss her terribly. 193 00:13:04,680 --> 00:13:06,840 The big gap in her life, definitely, yes. 194 00:13:07,140 --> 00:13:12,280 And she's 17 and a half now, so it's had a good innings. 16926

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