The practice is now accepting dental referrals, including for dental, oral and maxillofacial surgery.
Hannah said: “I am proud to join the Fitzpatrick Referrals team to extend their referral offering to include this very important aspect of small animal veterinary treatment.
"Working alongside a world-class team with state-of-the-art facilities is a fantastic opportunity.”
https://www.fitzpatrickreferrals.co.uk/services/dentistry/
The scheme will allow regular referrers to gift free treatment worth up to £5000 to clients in need of financial assistance
Hospital Director Nicola Bromley said: “We recognise the challenge it is for families who may need specialist care for their animal friend but are unable to find the necessary funds.
"We highly value the relationship we have with our referring vets in providing options to their clients, and we hope this scheme will empower them to give hope to those who need it most.
"We are committed to supporting our referring primary care vets through collaboration, to make the whole sector as good as it can be for every animal.”
The new scheme will be activated immediately and apply to referrals made from January 2024, meaning practices and primary care vets who already refer to Fitzpatrick Referrals can refer pro bono cases immediately.
https://www.fitzpatrickreferrals.co.uk
DISCUSSION
Lead author Professor Clare Rusbridge, Chief of Neurology at Fitzpartick Referrals, conducted the study because of a lack of clarity on the recognition and diagnosis of the clinical signs associated with CM as opposed to syringomyelia (SM).
CM is an abnormality in the skull, making it smaller, and impacting on the brain to alter the flow of cerebrospinal fluid; this results in pain and a collection of fluid pockets within the spinal cord. These fluid pockets are commonly known as SM and over time can cause irreversible damage to a dog’s spinal cord. However it is not clear whether signs of pain in affected dogs are due to CM or SM or both.
To try to rectify this, Clare studied the medical records of all the cavalier King Charles spaniels diagnosed with CM-associated clinical signs presenting to her at Fitzpatrick Referrals over a five year period. She documented the historical and examination findings and related them to the MRI findings, including presence and size of the SM.
She found common signs in all dogs were vocalisation, spinal pain (neck, middle or lower back), reduced activity, reduced stairs or jumping ability, aversion to being touched or groomed, altered emotional state (described as being more timid, anxious, withdrawn or aggressive) and sleep disturbance.
A tendency to rub or scratch at the head or ears was common but was more likely in dogs with small or no SM suggesting that this may be a sign of head discomfort associated with CM. Head and ear rubbing was not associated with the presence of material within the middle ear (a condition which is also common in this breed and often given the acronym PSOM).
The only signs that were specific to SM were phantom scratching, scoliosis (twisted spine) and weakness and these were only present when the SM was large (at least 4mm wide).
Clare says this study is important because it suggests that CM alone is a cause of pain in many dogs. The aim now is to use the information gained in this study to develop a questionnaire to determine risk of CM and monitor the response to clinical signs.
Reference
Photo: Charlie on a bad day
Fitzpatrick says that the initial results from a study at the University of California Davis has shown a reduction of up to 40% in the volume of prostatic tumours following embolisation, along with significant improvements in the patient's quality of life (the ability to pass urine and faeces in particular)1. However, prostatic embolisation in veterinary patients has only been performed in a small numbers of centres globally and not previously in Europe.
Gerard McLauchlan (European and RCVS Specialist in Small Animal Internal Medicine, Fitzpatrick Referrals Oncology and Soft Tissue) first carried out the procedure in December 2018 and has since performed it on two more patients.
Fitzpatrick is now offering prostatic embolisation alongside targeted intra-arterial (IA) chemotherapy, a treatment which it has now given to over forty patients with urinary tract tumours in the past 24 months, leading to a reduction in tumour size of up to 30% and an improvement in clinical signs.
Gerard said: "We have been developing and refining new techniques for treating various cancers over the past two years at our oncology and soft tissue centre. Really excellent results have been seen so far in cases with prostate cancer treated with intra-arterial chemotherapy and embolisation is the next logical step for managing this condition.
"Prostatic embolisation has only been performed at two centres in the United States and has shown very promising results in terms of patients quality of life and overall survival.
"With a recent study documenting the mean survival of patient with prostate cancer receiving standard intravenous chemotherapy as being only 101 days these new techniques offer an amazing opportunity to truly change how we view and manage this condition."
Teddy had initially been examined at another specialist centre where life-long medical management was recommended due to the complexity of his vascular abnormality.
His primary care veterinary surgeon, Dr Rachel Lang, then referred the case to Gerard.
The first step was a contrast CT scan of Teddy's liver to highlight the vascular abnormalities and take accurate measurements.
Teddy then underwent a transjugular coil embolisation of his shunts using fluoroscopic guidance.
This involved placing a stent in his caudal vena cava that spanned both abnormal communications, and then deploying multiple platinum coils into the shunts to occlude the vascular flow while ensuring portal hypertension did not develop. The entire procedure was completed in less than 60 minutes and was performed via a 2cm skin incision over his jugular vein.
Teddy made an excellent recovery from the procedure and is currently free of clinical signs and receiving no medication at home.
Rachel said: "I was really struggling to find a referral centre willing to take on Teddy's case as it was so unusual and had spent weeks contacting every local referral centre I had referred to in the past. I contacted Fitzpatrick's about his case and within an hour Gerard McLauchlan had rung back and actually sounded keen to see Teddy which was a delight after weeks of frustration. The referral process was very easy from my side and I've been kept well informed throughout. I wouldn't hesitate to refer a case again and only wish we were closer!”
Gerard said: “Teddy is a wonderful patient with an amazing family. We were delighted to be able to offer a solution to his problem that had been previously thought not possible. Teddy should now be able to enjoy an excellent quality of life without the need for long term medications or diet. Interventional Radiology provided new and minimally invasive options for many conditions including vascular abnormalities, urinary tract problems and various cancers.”
You can view the CTs in the VetSurgeon Clinical Reference Library here.
Michael qualified from the University of Glasgow in 2009 and then worked in first opinion practice in Buckinghamshire and Northern Ireland. He then returned to the University of Glasgow in 2012 to further his training and experience in oncology by completing four years of additional training. He completed an ECVIM residency in oncology in 2016 and became a Diplomate of the European College of Veterinary Internal Medicine and a European Specialist in Oncology in 2017. Michael worked at a private referral practice in Surrey prior to joining Fitzpatrick Referrals. Earlier this year, Michael was awarded a Masters degree in Veterinary Medicine. This additional qualification researched canine mast cell tumours.
Michael said: "I am absolutely delighted to have joined Fitzpatrick Referrals Oncology and Soft Tissue hospital. I have had a long-standing ambition to work as part of the fantastic team here since visiting the hospital during my specialist training in 2015. At this visit, I immediately felt at home in a group of people driven to deliver the very best compassionate care for dogs and cats.
"My ambition is to develop the very best ways to minimise the impact that cancer has on animals. I know that Fitzpatrick Referrals is the best environment for me to be able to achieve this. Throughout the hospital, there is an amazing positive attitude and a collective drive to improve the overall care we can give to pets with cancer. I am also excited by the opportunity to be able to help others to achieve their goals in improving cancer care for pets."
Having had a three-month sabbatical working at Fitzpatrick, Jonathan decided to relocate from New Zealand where most recently he'd been Head of the Companion Animal Group at Massey University.
Jonathan said: "My prime passion is working directly with animals and their families in a supportive and exceptional clinical setting. I enjoy pushing boundaries and not accepting the status quo. I want to identify better ways of improving outcomes for patients, and minimising the impact of the disease (or its treatment) on an animal’s quality of life. My sabbatical at Fitzpatrick Referrals exposed me to their tremendous energy and real passion for patient and client care. From the moment the clients walk in the door, I feel there is an embrace that lets people know we truly care and want to do the best for their animal friend. I am looking forward to discovering what we can achieve together. Cancer management is such an important opportunity, with the power to change both animal and human lives positively. The direction and focus of Fitzpatrick Referrals in this area is already incredibly exciting.”
Clinical Director of Oncology and Soft Tissue, Professor Nick Bacon said: "On Jon’s first day of his sabbatical, he jumped right into the team and made an immediate positive impact. He hasn’t looked back. He carries with him such a good energy, which we all absorb and hopefully reflect back. His knowledge of implant design for dealing with defects in the mandible and elsewhere is exceptional and I am looking forward to watching that develop. I am also very pleased that Jon’s wife Sharyn is able to join the team; she is very experienced in the field of advanced imaging in humans, including Fluoroscopy and PET-CT. This is already benefitting our patients as we improve our diagnostic and treatment abilities, and get ready for the future."
Jonathan has active research interests in several clinical areas including soft tissue sarcoma, injection-site sarcoma, endoprosthetics and haemangiosarcoma. He also supports the concept of One Medicine as his PhD research into soft tissue sarcoma, haemangiosarcoma and endoprosthetics has a potential relevance in improving the understanding of treatment paradigms for humans and animals.
Prior to joining Fitzpatrick Referrals, Gerard was a Senior Lecturer in Internal Medicine at the University of Glasgow as well as Head of the Emergency Service and Director of both the Internship and ECVIM Residency Programmes. He is also a European and Royal College Recognised Specialist in Internal Medicine, and recently became one of few specialists in the world to have completed a 12 month Fellowship in Interventional Radiology at the Animal Medical Center in New York.
Gerard said: "When I returned to the UK, it was a natural fit for me to join Fitzpatrick Referrals. The team all share the same ethos and together I know we will be able to offer a truly world-class service to our patients and their family. I genuinely believe we will be able to change what is accepted as the gold standard of care for animals in the UK."
Fitzpatrick Referrals says its interventional radiology service performs minimally invasive procedures that are often considered the standard of care in human medicine, providing options for veterinary patients where conventional therapies are not associated with the best outcome.
Clinical Director of Oncology and Soft Tissue, Professor Nick Bacon said: "Gerard joining the team in Guildford opens new doors for our patients but more importantly we hope the disciplines of veterinary oncology and soft tissue surgery as a whole. He brings huge experience in interventional radiology solutions for portosystemic shunts, tracheal collapse and urinary calculi obstruction. Gerard is also key to developing our cancer care. Progress is not about ever bigger treatments chasing a cure; it can just as easily mean delivering palliative or curative-intent treatments in smarter ways, with less side-effects and lower morbidity. I am looking forward to watching our treatments evolve for a variety of tumours including urinary, liver, lung and head and neck. No cancer treatment is perfect, but we are striving for the best we can for the patient in front of us."
Noel Fitzpatrick said: "It remains my objective to build the greatest team of super-specialists on planet earth where we can offer all of the options to all of the animals and the families that love them all of the time. Gerard has a unique skill set that will not only complement our growing team, but will enhance the spectrum of treatments we can offer and which the families of animals throughout the UK and beyond really want. Increasingly people want the same level of care for their dogs and cats as we have for ourselves and our goal is to deliver exactly that with the very best team and facilities in the world today."
Fitzpatrick Referrals will be holding a Partners in Care CPD session on 25th May inviting vets to meet Dr Gerard McLauchlan and discover more about the interventional radiology service. To register your interest, contact Sarah on SarahC@fitzpatrickreferrals.co.uk.
Fitzpatrick Referrals has announced the launch of a new cancer and soft tissue surgery referral service headed by Professor Nick Bacon (pictured right) and Dr Laurent Findji.
Professor Bacon and Dr Findji are American and European Board-Certified Surgeons respectively, with extensive experience in cancer care and soft tissue surgery innovation.
Professor Bacon joins the service directly from his post as Head of Oncology at the University of Florida, College of Veterinary Medicine. He will also take up the position of part-time Chair of Oncology at the new University of Surrey School of Veterinary Medicine.
Dr Findji joins the team from his prior role as director of the VRCC in Essex, bringing his expertise in cancer and soft tissue surgery advancements.
Professor Noel Fitzpatrick, founder of Fitzpatrick Referrals, said: "With these two eminent and globally recognised Specialists leading the new service, the UK will now be able to provide an innovative approach and comprehensive diagnosis, treatment, management and prognosis for all cancer and soft-tissue patients. The service will also be able to use the additional expertise available through the University of Surrey and both Specialists will be available for referring vets to discuss cases and to offer advice on the innovative treatment options available."
Professor Stuart Carmichael, the new service's director, said: "We would only introduce a service like this when we know it can provide the best options, the most comprehensive care and the highest level of expertise available. This is a referral service which will change the way that cancer patients are dealt with in the UK."
Noel added: "It's a testament to the reputation of Fitzpatrick Referrals and the University of Surrey, our partner in education, that we have been able to attract talents as great as Nick and Laurent. This is an exciting time not only for the hospital, but also for first-opinion practices throughout the UK who can avail of this world-class opportunity to offer a potentially life-saving service to their clients for their patients."
The service will operate initially from a self-contained clinic at the existing Fitzpatrick Referrals Orthopaedic + Neurology Hospital in Surrey and will be accepting patients from 1st October.
Fitzpatrick Referrals has launched a new sports medicine and rehabilitation centre for dogs at its referral centre in Surrey.
Fitzpatrick Referrals has been running a dedicated rehabilitation centre since the practice opened at Eashing in 2007. It has now extended the offering to include sports medicine clinics and osteoarthritis clinics, creating what it claims is the largest centre of its kind in the country.
Building work has now been completed at the centre and Fitzpatrick Referrals has appointed David Prydie MRCVS, a small animal rehabilitation expert, to head up the centre.
Speaking about the launch of the new service, Noel Fitzpatrick, Managing Director of Fitzpatrick Referrals said: "At Fitzpatrick Referrals, we believe that appropriate rehabilitation is integral to the success of orthopaedic and neuro-surgical intervention and fundamental in promoting pain free functional quality of life.
"Traditionally, the rehabilitation centre has been geared towards treating post-op patients. While the new centre will continue to treat animals which have been referred to Fitzpatrick Referrals for surgical procedures, helping to restore function, reduce pain and speed up the recovery process, we will now offer new dedicated Sports Medicine and Osteoarthritis clinics, of which there are currently only a handful in the UK. This will provide referring practitioners and clients with a new range of options for dealing with sports injuries and the on-going management of Osteoarthritis.
"For the first time, minimally invasive arthroscopic investigation and advanced diagnostic imaging with MRI and CT will be available side-by-side with a team of clinicians who truly understand the unique anatomy, physiology and exercise demands of working and sports dogs and who adopt an integrated approach to achieving maximum mobility for dogs of all ages. We intend that the new centre will create a new standard of integrated care for the active performance or pet dog because we will match function with form and intention with action. Every plan will be tailor made for the individual with sincere attention to the very special environment and demands of the sporting dog. I'm extraordinarily excited about this new horizon."
David Prydie added: "We expect to see cases where there are specific injuries which the canine athlete is prone to and which require specialist knowledge to identify and treat. Our goal is to help the dogs return to their performance event as soon as possible. We will also be offering advice on training regimes for the various activities. The centre will offer a new osteoarthritis clinic, treating osteoarthritis in all ages of dog using a multimodal approach such as weight management, exercise regimes, physiotherapy techniques and use of tools such as the therapeutic laser. There is a wealth of experience already present within the practice and I will be working with Noel and the other surgeons to develop our offering in sports injury management and also with Professor Stuart Carmichael in the development of osteoarthritis management schemes."
The practice will celebrate the launch of the new centre with its first festival for pets, 'Dogfest', built around the theme of the 'Active Dog'. The festival will take place on 10th and 11th of August and will feature a number of agility and flyball events, canine sports medicine lectures delivered by world experts, a range of tents and stalls, 'Have a Go' agility sessions, an agility display by former Fitzpatrick patients who have returned to compete in the agility circuit, a 'Meet the Fitzpatrick Heroes' display and a special '999' display by the Sussex Police Dogs on both days.
For information on the new Fitzpatrick Sports Medicine and Rehabilitation Centre services and to discuss referrals, contact the reception team on 01483 423 761.
Fitzpatrick Referrals has unveiled details of its new joint replacement program, which includes solutions for replacing badly injured and arthritic knees, shoulders, and hocks in addition to the more commonly replaced hip and elbow joints.
According to the practice, this is a dramatic breakthrough which brings new hope to veterinary surgeons and pet owners in otherwise hopeless cases.
Fitpatrick Referrals says the procedures have been developed as a solution for joints with traumatic global joint disruptions involving significant soft tissue damage and for joints with painful end-stage arthritis, with the objective of providing functional, pain free quality of life.
Noel Fitzpatrick said: "As we understand and try to deal with the problem of painful osteoarthritis in our pet animals it seems likely that there will be a larger role for joint replacement. Already hip replacement is used to great benefit in the majority of patients that receive it. Other damaged joints could be treated in the same way - but until now the technology to replace knee, hock, shoulder and elbow joints with custom designed prostheses to exactly fit each and every patient did not exist. At Fitzpatrick Referrals this is now a reality for both cats and dogs."
He added: "Joint replacement is particularly useful when a multi-modal approach is used to try and manage osteoarthritis through-out the life of the animal, an area where The Fitzpatrick Group has an increased interest and a variety of publications in peer-reviewed journals. It also offers a realistic alternative to either fusion or amputation in traumatically injured joints."
Fitzpatrick Referrals scooped two awards at last week's Vet Marketing Awards, held at the London Vet Show.
The practice picked up the Training Initiatives Award, in recognition of its CPD, Internship and Residency programmes, the launch of Fitzpatrick Learning Academy and the commitment of Fitzpatrick Referrals to pushing the boundaries to advance the veterinary profession.
Noel Fitzpatrick was also awarded the 2011 Science prize for his dedication and commitment to moving the profession forward through scientific and technological development, his research, philosophy and practice.
Organised by Grove House Publishing, who produce OvertheCounter magazine,Vet Marketing and Farm Business, the Vet Marketing Awards are designed to award best practice companies and individuals who are driving innovation in branding, communications and product development, in a way that promotes health and wellbeing for the good of practice, customer, and animals in their care.
Commenting on the Training Initiatives Award, the judges said: "The mission of Fitzpatrick Referrals is to deliver 'the best level of surgical, medical and compassionate care for small animals,' and they have certainly achieved this since the opening of their state-of-the-art practice in 2008. To offer their unparalleled level of care means a high level of training for their staff, and for vets and trainees from across the country. The judges were impressed that they offer more residencies, internships and fellowships than any other private practice in Europe, their commitment to CPD and the in-depth nature of their entry."
Presenting Noel Fitzpatrick with his Science Award, host of the awards ceremony, Alan Whibley, publisher of Vet Marketing said: "For the judges, this is was by far the winner in this category. Noel Fitzpatrick advances scientific and technological development in the veterinary profession, based on the moral and ethical obligation to adopt these new techniques responsibly. He pushes the boundaries, through technology, and also his support for his fellow veterinarians, through internships, CPD lectures and key note speeches, such as the one earlier today. He promulgates the moral imperative to ensure that whilst the client is fully aware of every procedure possible, that a pet is a member of the family and should be treated as such."
The entertainer Michael Ball yesterday opened the final phase of Fitzpatrick Referrals' new ultra-hi-tech patient ward, which, according to the practice, will elevate animal care to a whole new level in the UK.
The ward boasts bacterial-resistant wipe-down wall coverings and floor surfaces with underground heating, and air conditioning optimised for high efficiency particulate air to minimise the possibility of infection.
Instead of gates or bars, the kennels have reinforced glass doors which permit a wide field of view for the animals and allow them to feel as much at home as possible. Each kennel has a space for medication and notes, and a "quick reference" daily guide is written on the glass door each morning to ensure continuity of care and ease of visibility for all. Each kennel has a radio and many are equipped with televisions to provide auditory and visual stimulation - creating a home from home experience for patients.
The practice says light is an important part of the "care package" offered in the luxury wards, and numerous windows and night time dimmers provide a diurnal rhythm to help comfort anxious animals and help those with separation anxiety to settle. Webcams are easily connected for remote viewing, and each and every patient is checked hourly by the 24 hour care team of ward assistants, fully qualified veterinary nurses, surgical interns, residents and senior clinicians.
Noel Fitzpatrick said: "I've always felt that people who love animals are generally great people, and they absolutely want to know that when their animal friend is away from home, especially if severely ill, that they are receiving round-the-clock care in the best facility imaginable. This in my head does not involve bars, so I have a "no bars" policy. I want the patient to be super-comfortable and not to feel threatened or "in prison", especially when some of them will have severe physical disability."
Michael Ball said: "I saw the Bionic Vet on television but I never thought I would find myself here. Noel has an extraordinary talent for healing and has built an amazing team who truly do care deeply about each and every one of these patients as if they were their own pets. They really do provide an unparalleled level of care. What Fitzpatrick Referrals has managed to do is truly remarkable. When I look at the level of hands-on care and compassion shown by all of team, I'm overwhelmed. I am hugely honoured to be associated with Fitzpatrick Referrals and what this practice stands for. The work which is happening here is benefitting the veterinary world and the human world - it's incredible."
After cutting the ribbon and declaring the new facility officially open, Michael Ball met with Dr Fitzpatrick for the 'see out consultation' for his dog, Freddie, who has been recovering after a major hip operation at the practice.
A three and a half year old white German shepherd dog from Dorchester, Dorset, has become the first in the world to have an ankle amputation prosthesis.
Mitzi Davis was trampled by a horse which crushed her foot, tearing off all blood and nerve supply, back in October 2010.
In a pioneering procedure, Dr. Noel Fitzpatrick from Fitzpatrick Referrals fitted a titanium implant to the bone below her joint - the first time a prosthesis has been put in a fully articulating bone of a dog.
The ITAP implant (which stands for Intraosseous Transcutaneous Amputation Prosthesis) is a new way of attaching prosthetic limbs. It involves implanting a titanium rod in the bone, onto which skin can attach just like a deer's antler, leaving a "peg" sticking out of the skin which can't get infected because of the resilient seal. The technology was developed for dogs by Professor Gordon Blunn at University College London (UCL) in association with Dr. Fitzpatrick.
The "exo-prosthesis" or foot is then screwed onto the peg and can be changed and modified as necessary. First Mitzi's gait had to be modelled on a computer, much like in a CGI movie. Then a foot was made using computer finite element analysis, designed so that the material of the foot would absorb shock from the ground and, most importantly, snap and break before the implant in the bone or the bone itself.
Dr. Noel Fitzpatrick said: "Today of course has implications not only for animals but for human amputees in the future and I will continue to work closely with Professor Blunn and the Stanmore Implants team to advance this technology to improve the quality of life for animals and eventually, for humans."
The ITAP technology is being tested in humans and has already been used to create a prosthetic for a woman who lost her arm in the July 2005 London bombings.
Professor Blunn said: "Humans and other animals share a large number of degenerative musculo-skeletal conditions. The repair process of the musculoskeletal system is essentially the same whether in a dog, cat or human being. Reconstruction of the musculoskeletal system share common problems and the interchange of information between both veterinary and human orthopaedics is very important. Therefore treating animals is not only ethical in its own right but is a useful paradigm for human orthopaedics.
"Treating Mitzi with an ITAP device has proved to be beneficial and the information learned from this case has been directly applied to human surgery. Mitzi's ITAP is made from titanium alloy which is attached to the residual bone. The surface of the implant is coated with hydroxyapatite which enhances bone attachment, securing the implant in place. Part of the implant just underlying the skin has a surface which encourages dermal and epidermal attachment. This ties the skin into the implant and produces a seal preventing infection. This implant has been adopted for human use."
Fitzpatrick Referrals has announced the launch of a new outpatients diagnostic imaging service, available to all primary care veterinary surgeons.
According to the practice, its Siemens CT and closed field MRI scanners are among the most advanced in small animal practice in the world, and enable more accurate and timely diagnosis of both routine and potentially life-threatening conditions, including tumours. The practice is now making these scanners available to outpatients from primary care practices.
The service will be available 7 days a week, from 09:00hrs to 21:00hrs. Primary care vets can access the service directly and schedule an appointment at a time convenient to them and their patient, without the need of referral. The qualified team of radiographers at Fitzpatrick will operate the scanners and all scans will be complemented by detailed imaging reports created and sent electronically by Vet CT Specialists, a teleradiology company headed by radiology specialist Victoria Johnson BVSc DVR DipECVDI MRCVS.
Fitzpatrick Referrals says it acknowledges that many primary care veterinary surgeons do not have the resources to provide advanced diagnostic imaging on site, so it is very pleased to be able to offer its CT and MRI suite to help expedite diagnosis, whilst the patient remains under direct supervision by the referring practice and the patient is immediately returned to their care thereafter. This can be an extension of the service offered by the primary care clinician to the client, hopefully resulting in rapid and appropriate treatment for the patient and expanding the range of services offered by practices to their clients.
Dr Noel Fitzpatrick, Director said: "It's as if the MRI and CT were actually in your own practice, because our facility is just an extension of your care package and you can advertise it as such. This improves the profile of your practice and enhances the bond of the client with the referring practice whilst facilitating appropriate intervention in a timely fashion. All types of scanning, soft tissue, orthopaedic and neurologic, can be catered for and all patients will be cared for and monitored by qualified veterinary nurses at a time to suit the owner. I see this as a win-win situation. If the primary care clinician needs any further help with the case, they can just ask on the day. Seven-day week advanced diagnostic imaging is now within the grasp of each and every practice, marking a new era of an integrated team approach to efficient cost-effective diagnosis and treatment."
To book an appointment, call Fitzpatrick Referrals on 01483 423761 and in due course there will be an online booking facility. For more information on the Outpatients Diagnostic Imaging Service, call Simon Hester on 07802 584133 or visit www.fitzpatrickreferrals.co.uk.
Neuro orthopaedic veterinary surgeon Noel Fitzpatrick has been having a busy old time: hot on the heels of his world-first procedure to implant a prosthetic hip and femur in an American Bulldog comes the news that he has now fitted a cat with titanium prosthetic paws in another world-first.
Oscar the cat was minding his own business, basking in the late summer sun, when a passing combine harvester chopped off his hind paws.
Unlucky.
However, Oscar's luck turned when his veterinary surgeon, Peter Howarth from St Saviour in Jersey, referred owners Kate and Mike Nolan to Fitzpatrick Referrals to investigate the possibility of giving Oscar a pair of prosthetic paws.
Kate said: "We had to do a lot of soul-searching and our main concern has always been whether this operation would be in Oscar's best interests and would give him a better quality of life". Having decided it would, the Nolans asked Noel to go ahead. And so he came to give the two-year-old cat a pair of new artificial feet in a single, three-hour surgical procedure - something he says has never been done before by any team anywhere in the world.
The revolutionary design of the feet uses custom-made implants to 'peg' the ankle to the foot and mimics the way in which deer antler bone grows through skin. These pegs, or ITAPs (intraosseous transcutaneous amputation prosthetics), were first developed by a team from University College London led by Professor Gordon Blunn, Head of the Centre for Bio-Medical Engineering at UCL's Institute of Orthopaedics and Musculoskeletal Science. Working in partnership with UCL, Fitzpatrick has pioneered the use of these weight-bearing prosthetic implants.
During the operation, the veterinary surgical team had to insert the ITAPs by drilling into one of the ankle bones in each of the back legs - an extremely delicate feat, which could have fractured the ankle joint before the procedure had even begun, and even more challenging because it had to be performed twice. These artificial implants which are attached to the bone at an amputation site are coated with hydroxyapatite, which encourages bone cells to grow onto the metal. The skin then grows over the special umbrella at the end of the ITAP to form a resilient seal against bacteria and potentially fatal infections. The ITAP itself protrudes through the bone and skin, allowing the custom-built artifical paws to be attached securely. Click here to see x-rays and other case photos in the VetSurgeon media gallery.
Following successful surgery in November last year, the focus of the veterinary team has turned to the slow process of rehabilitation and helping Oscar to learn to walk again - firstly using external scaffolding anchored to the tibia to protect the new implants until the ITAPs integrated into the bone and the skin grew onto the ITAP. Remarkably Oscar was trying to stand within a day of the operation and despite some problems with infection that had to be overcome, in less than four months Oscar could stand and bear weight equally on all four limbs. He has since been fitted with a series of prototype new paws to ensure the best possible long term fit.
What makes this procedure so complicated is that Oscar's feet were severed at the junction of the tarsus and metatarsus. Noel said: "The real revolution with Oscar is because we have put a piece of metal and a flange into which skin grows into an extremely tight bone, with very narrow tolerances in the region of nanometres, rather than millimetres. We have then successfully managed to get the bone and skin to grow into the implant and we have developed an exoprosthesis that allows this implant to work as a see-saw on the bottom of an animal's limbs to give him effectively normal gait. Oscar can now run and jump about as cats should do.
Noel Fitzpatrick and the team at Fitzpatrick Referrals are the focus of a new six part documentary series: The Bionic Vet to be broadcast on BBC 1 at 10.45 pm every Wednesday starting on 30 June 2010. The programmes will focus on the multi million pound state-of-the-art vet practice in Surrey as well as the ways in which Noel is pioneering revolutionary new surgical techniques.
Fitzpatrick Referrals has carried out a world-first procedure in which an American Bulldog was fitted with a prosthetic hip and femur with a special in-growth attachment which effectively re-attaches the tendons and muscles to the artificial limb.
The procedure took place after 8 year old Roly was diagnosed with cancer in his rear hind leg earlier this year. It involved a highly complex two-hour operation, during which Dr Noel Fitzpatrick, a neuro-orthopaedic veterinary surgeon, replaced the cancerous femur bone and hip joint with a specially constructed artificial prosthesis, while re-attaching the musculature and realigning the relative position of the joint to restore perfect movement to the dog.
The prosthesis was designed through a collaboration between Professor Gordon Blunn, Head of the Centre for Bio-Medical Engineering at UCL's Institute of Orthopaedics and Musculoskeletal Science; veterinary surgeon Noel Fitzpatrick and Jay Meswania from specialist implant manufacturer OrthoFitz.
Professor Blunn said: "What is significant about the design is the way in which it sandwiches tissue and metal together overlaying the gluteal muscles onto the top of the endoprosthetic femur - alternating tendon, synthetic Dacron mesh, tendon, synthetic Dacron mesh, tendon and finally trabecular metal - which has a honeycomb surface resembling a series of small chambers. In this way, the hope is that the Sharpeys fibres which attach tendons of muscles to the bone will grow into the trabecular metal surface and permanently adhere to it."
"This truly remarkable achievement was made possible through the convergence of biomechanics, biology and surgical innovation," said Noel Fitzpatrick. "We tapped into the evidence provided by the CT and MRI scanners we have in place at the practice, so that the data collected about Roly during clinical diagnosis was used to design and construct an artificial femur which exactly mirrored his original limb. It has been constructed rather like a telescope - one section fitting inside the adjoining section, so that we get maximum flexibility and traction during motion."
Noel added: "Hip replacement is common here. We do more than 50 a year, on animals as small as a cat or a Chihuahua. But this hip replacement was special, and to my knowledge, the first of its kind in the world. It's important though to emphasise that this technology must only be employed when it is in the best interests of the individual patient. It's not enough to be able to do something; it must be done for the right reason in every case without exception. It must be ethically right. It's also important to emphasise that Roly will probably not live for a normal lifetime because bone cancer generally spreads to the lungs over time in spite of chemotherapy. However, this technology is equally applicable for dogs and cats affected by trauma who will likely live longer. My job is to look after my patients as best I can and to be honest with their guardians and give them options. What I do is provide pain free functional quality of life for as long as my patient is alive. That's important and that's special, but the decision must remain with each and every individual animal owner".
According to the team, this development also has potentialy life-changing implications for human patients such as motorcycle accident victims, where a key challenge to recovery may be successfully re-attaching the kneecap tendon onto the top of the tibia in the lower leg, and injured sports players with ruptured repairing ruptured tendons.
Click here to view the x-rays of this case in the VetSurgeon Gallery.
Veterinary surgeon Noel Fitzpatrick, a pioneer of prosthetic implants, has launched what is being billed as Europe's most advanced neuro-orthopaedic centre for dogs and cats.
Fitzpatrick Referrals' £10m facilities at Eashing, near Godalming, Surrey, have been set up to offer a world-class "centre of excellence" in diagnosis, surgery and rehabilitation.
Facilities at the centre include:
Noel was the first veterinary surgeon to successfully apply a prosthetic limb to a dog where both bone and skin can grow into metal - a technique with far-reaching cross-over potential for human surgery. He believes in "pushing the boundaries" and creating solutions for conditions that may never have previously been treatable, and says the work being done at Eashing also provides valuable experience for medical science as a whole. Examples include cartilage resurfacing, limb-sparing cancer surgery and spinal vertebral fusion.
Professor Gordon Blunn of the Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science at University College London said: "Orthopaedic conditions and diseases are common to both human beings and to animals. For example osteoarthritis is debilitating condition seen in humans, cats and dogs. Bone cancer which can lead to loss of life in humans and is usually associated with the peripheral skeleton is also seen in the peripheral skeleton of large dog breeds. Translation of ideas, orthopaedic practice and treatments, from humans to the veterinary field and visa versa has considerable advantages to all animals including dogs, cats and man. Noel Fitzpatrick is pioneering this concept and his work in limb reconstruction for dogs and cats has already had benefits in both veterinary and human orthopaedic practice."
DJ Chris Evans is one satisfied client. His dog, Enzo, a German Shepherd, was "written off" by other vets after becoming paralysed with two herniated discs. Noel fitted Enzo with two bolts to replace the collapsed disc and keep the vertebrae apart. The surgery was followed by extensive physiotherapy and hydrotherapy to enable Enzo to learn to walk again.
Chris said: "Noel lives out his dreams with boundless curiosity, ambition and genius, the product of which is hundreds, soon to be thousands, of fixed pets and happy owners - like me. I have huge respect for his endeavour, his integrity and his compassion and to me he's a superhero-vetman who will leave no stone unturned in his quest to heal, to create and to comfort. He thinks of solutions to medical problems that I'm sure no-one else could even dream of, let alone think of. Actually - I don't think he ever sleeps!"