Plus-Hex CLINICAL
physiotherapy is instigated earlier following surgery of slipped capital femoral epiphyses .
Although thermotherapy could have been carried out on Max while he was in hospital , there is a difficulty with this approach in small mammals after anaesthesia , as it is more important to maintain normothermia . In addition , thermotherapy can be particularly difficult in conscious ferrets as they are well known for their inability to stay still . Laser therapy and other woundhealing techniques could have been beneficial [ 27 ] .
Figure 23 . Max enjoying some exercise on a lead . Photo permission from Michelle Howe .
Discussion
Capital physeal dysplasia is a broad term that describes an abnormality of the growth plates at the end of the femur . This can include fractures or slipped capital femoral epiphyses . It is known to also occur in humans .
Young , obese , male , neutered cats are at risk of developing capital physeal fractures [ 34 ] . Obesity and delayed physeal closure may develop secondary to neutering . In humans , slipped capital femoral epiphyses also appear to be more frequent in obese adolescent males . In both cats and humans there is some evidence of this condition being inherited [ 35 ] . Max ' s siblings showed similar clinical signs , but a diagnosis was not confirmed .
Physeal closure occurs in ferrets between 4 and 7 months of age [ 36 ] . As Max was 6 months old when his lameness started , it is likely that the combination of his unfinished growth plates and increased joint loading from obesity contributed to this condition . It is well known that obesity is a factor in many disease processes , including musculoskeletal disorders , and excess adipose tissue has been associated with inflammation [ 37 ] .
In cats that have undergone FHNE surgery , opioids and NSAIDs are essential for providing analgesia and encouraging early use of the operated limb [ 38 ] . Cold packs are recommended for the first 48 hours , followed by warm packs and gentle passive range-ofmotion exercises several times a day . Exercise should be controlled , and it is advised that cats should be restricted to a small room for 2 weeks [ 38 ] . However , early weight-bearing following FHNE surgery is important [ 38 , 39 ] . In a study by Yap et al . [ 39 ] , 18 cats underwent either a unilateral or bilateral FHNE and the majority of cats took between 1 and 2 months to resume normal activity . A combination of active and passive range-of-motion exercises is advised ; sit – stand exercises using treat rewards , and hip extension using a ball or roll are advocated [ 40 ] . In humans ,
The delay in Max ' s return to normal hindlimb function was thought to be due to his excess weight , delayed rehabilitation and postoperative complications [ 32 ] . Once rehabilitation was regularly instigated , alongside weight loss , his hindlimb use improved greatly .
The owner reported that it was difficult to keep Max rested after surgery because he was very active and excitable . They also reported it was difficult to assess his levels of pain . His clinical notes suggested that he would react adversely when palpated over a painful area , but he would also react when palpated elsewhere .
The owner reported a decrease in Max ' s hindlimb use when the lump developed over his left hip ( palpation of which he reacted adversely to ), along with decreased appetite and a level of ‘ apathy ’ (‘ just coming out to eat , then going back under his towel ’). However , this behaviour coincided with his watery eyes and swollen lymph nodes , so it was difficult to know if this behaviour was related to illness or pain , or both .
This case study highlights the difficulty in assessing pain in ferrets . However , there are behaviours identified in this case that could be used as a baseline to further investigate and refine pain assessment , such as apathy , lethargy , reduced hindlimb use , reduced appetite , lameness , self-mutilation and reacting on palpation of a painful area .
This case study shows that rehabilitation is an essential part of pain management and wellbeing in a ferret following orthopaedic surgery . The authors hope that more species-specific and condition-specific pain assessment and rehabilitation techniques will become commonplace in the future .
Acknowledgements
The authors would like to thank Cathy Johnson-Delaney , Anna Mercer ( Anna the Ferret Nurse ), Pam Weaver ( Fluffy Retreat Ferret Rescue ), Mary Ellen Goldberg , Michelle Howe ( owner of Max ), Mitsie Vargas , Abigail Edis , Nadene Stapleton and the exotics team at the Royal Veterinary College , Claire Grozier , Leanne Lowes , Sarah Keefer from Ferrets Unlimited Rescue Services , and the owners of all the ferrets photographed for educational purposes .
Volume 40 ( 2 ) • April 2025
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