Hybrid/combo ich/velvet treatment discussion

mnreefster

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Hi all,

I'll try to make this as quick as possible. I had an ich or velvet outbreak when I was on vacation recently. Was gone for 4 days but when I came back 3 had died that night (powder brown, royal gramma and starry blenny). It came out of nowhere and I was only gone for 4 days. You can see the pic of the purple tang. I know I had ich in the tank but they were doing relatively fine for over a year - growing and really not showing signs of it for well over 9 months after initially having signs for a few weeks. If it wasn't ich then velvet is likely due to the aggressive nature of their demise (coral was purchased the week prior and put in the DT). To save the explanation of what I drew a pic of the timeline. Basically I treated the 8 remaining fish with copper power (level between 2.3 and 2.6 for 15 days) with additional treatments of prazipro, kenamycin, and general cure (wrasse had developed an infection - source unclear).

The "hybrid" or combo part was really in response to so many failed attempts documented on this webpage. The general theme over and over seems to be "I had my tank fallow for 70+ days and treated them and as soon as they go back in they get ich again". I'll save the debates about proper treatment, cross-contamination, etc. Jay had posited that perhaps ich lays dormant in an anaerobic environment so the rationale is that it had not cleared the DT. The stories over and over seem to point to the DT as the issue, especially when fish are showing no symptoms at all in their QT. I am a pharmacist by trade and I lean heavily on evidence-based approaches but there just aren't a lot of good studies (as Jay and others have established exhaustively) to identify the cause - other than human error. But I do believe there may be something there, people do make mistakes but again, there seems to be a consistent story with these failed attempts.

That leads me to what I have tried to do here. It consists of doing all of the following:

1) Copper treatment (with FW dip prior)
2) Tank Transfer
3) Prazipro
4) 90 - 100% water change in DT
5) UV Sterilizer
6) Rip cleaning the sand with tap water and rinse with RODI
7) Clean (as best you can) the DT and sump

This also assumes that everything listed above is done correctly, i.e., coper levels appropriate, other med dosing appropriate, duration of treatment appropriate, no cross-contamination, proper UV sterilizer size and pump settings for tank size, etc.

I am not going into detail on each of these other than to say all the information and process for each is on this website. For the most part this has gone well so far. I have eight fish in 30 gallon QT - purple tang - blue jaw trigger - YWG - blueside fairy wrasse - blue star leopard wrasse - clownfish - 2 cardinalfish. Clownfish did get air bubble trapped in his eye but he recovered. The blueside fairy wrasse somehow got an infection (hence the kenamycin and general cure). But he does seem to be improving (two pics below). I know they need to get out of there as soon as possible though and eventually I think the stress may get to them.

Finally, you can see the timeline posted in the pic - but I wanted to get thoughts on how to finish this out. I plan on waiting 75 days but I am considering another copper treatment at day 61 and then having them go right into the DT at day 75 (provided they are tolerating things well). Also considering another tank transfer closer to the end? I don't want to overdo it but they took to the first treatment well. Also curious if others have rip cleaned the sand as part of their QT treatments and if it was successful?

IMG_8793.jpg

Before kenamycin and General Cure
IMG_8737.jpg
After - taken today
IMG_8795.jpg
Last day in the DT back in August
IMG_8506.jpg
 
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I know a lot of people do 30 days of copper powder. I haven't had ich in 3 years in 2 tanks after going fallow for 9 weeks. I used cupramine for 30 days and I always have 3 containers to move fish when moving to display tank. one to hold another to switch nets and last to dunk clean net. I think the biggest failure is not qt everything and not treating all new fish with copper.

I qt all coral and inverts for 5-6 weeks in 80 degree water. Someone buys new coral 2 weeks before adding fish and catches ich from it blames the original ich strain. I think people have trouble reading the level of copper and it also drops below desired levels with WC by not mixing copper with newly added water. If in doubt dose with copper again. Otherwise just enjoy hobby and prevention is easier then treating DT. Stir up sand bed if it gives you peace of mind. I didn't and can say with 99% certain I don't have ich.
 

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Hi all,

I'll try to make this as quick as possible. I had an ich or velvet outbreak when I was on vacation recently. Was gone for 4 days but when I came back 3 had died that night (powder brown, royal gramma and starry blenny). It came out of nowhere and I was only gone for 4 days. You can see the pic of the purple tang. I know I had ich in the tank but they were doing relatively fine for over a year - growing and really not showing signs of it for well over 9 months after initially having signs for a few weeks. If it wasn't ich then velvet is likely due to the aggressive nature of their demise (coral was purchased the week prior and put in the DT). To save the explanation of what I drew a pic of the timeline. Basically I treated the 8 remaining fish with copper power (level between 2.3 and 2.6 for 15 days) with additional treatments of prazipro, kenamycin, and general cure (wrasse had developed an infection - source unclear).

The "hybrid" or combo part was really in response to so many failed attempts documented on this webpage. The general theme over and over seems to be "I had my tank fallow for 70+ days and treated them and as soon as they go back in they get ich again". I'll save the debates about proper treatment, cross-contamination, etc. Jay had posited that perhaps ich lays dormant in an anaerobic environment so the rationale is that it had not cleared the DT. The stories over and over seem to point to the DT as the issue, especially when fish are showing no symptoms at all in their QT. I am a pharmacist by trade and I lean heavily on evidence-based approaches but there just aren't a lot of good studies (as Jay and others have established exhaustively) to identify the cause - other than human error. But I do believe there may be something there, people do make mistakes but again, there seems to be a consistent story with these failed attempts.

That leads me to what I have tried to do here. It consists of doing all of the following:

1) Copper treatment (with FW dip prior)
2) Tank Transfer
3) Prazipro
4) 90 - 100% water change in DT
5) UV Sterilizer
6) Rip cleaning the sand with tap water and rinse with RODI
7) Clean (as best you can) the DT and sump

This also assumes that everything listed above is done correctly, i.e., coper levels appropriate, other med dosing appropriate, duration of treatment appropriate, no cross-contamination, proper UV sterilizer size and pump settings for tank size, etc.

I am not going into detail on each of these other than to say all the information and process for each is on this website. For the most part this has gone well so far. I have eight fish in 30 gallon QT - purple tang - blue jaw trigger - YWG - blueside fairy wrasse - blue star leopard wrasse - clownfish - 2 cardinalfish. Clownfish did get air bubble trapped in his eye but he recovered. The blueside fairy wrasse somehow got an infection (hence the kenamycin and general cure). But he does seem to be improving (two pics below). I know they need to get out of there as soon as possible though and eventually I think the stress may get to them.

Finally, you can see the timeline posted in the pic - but I wanted to get thoughts on how to finish this out. I plan on waiting 75 days but I am considering another copper treatment at day 61 and then having them go right into the DT at day 75 (provided they are tolerating things well). Also considering another tank transfer closer to the end? I don't want to overdo it but they took to the first treatment well. Also curious if others have rip cleaned the sand as part of their QT treatments and if it was successful?

IMG_8793.jpg

Before kenamycin and General Cure
IMG_8737.jpg
After - taken today
IMG_8795.jpg
Last day in the DT back in August
IMG_8506.jpg
These fish appear to have flukes which are Monogean flatworms which are white to almost translucent spots on the fish that look almost like the ick virus, but are larger and not as close together. If flukes, gills will be red or swollen with rapid breathing, fish acting lethargic or swimming near the water surface, hiding in the corner of tank or behind rocks, loss of appetite, shaking its head, flashing/darting, develop clamped fins, , or scratching against objects. They may also exhibit what looks like yawning from gill irritation develop, cloudy eyes and loss of color .
 
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mnreefster

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These fish appear to have flukes which are Monogean flatworms which are white to almost translucent spots on the fish that look almost like the ick virus, but are larger and not as close together. If flukes, gills will be red or swollen with rapid breathing, fish acting lethargic or swimming near the water surface, hiding in the corner of tank or behind rocks, loss of appetite, shaking its head, flashing/darting, develop clamped fins, , or scratching against objects. They may also exhibit what looks like yawning from gill irritation develop, cloudy eyes and loss of color .
Hard to tell in the pic but it does seem like something on the gills. A couple of things going against that though - freshwater dip revealed nothing in the bucket after 5+ minutes. It went through two courses of prazipro already. Just to clarify there is the purple tang but the other pics- that’s the same fish two weeks apart (after the first treatment and then again after the second treatment). Also no other fish showing any signs of disease which makes me think it’s not communicable. He’s had this for over two weeks but it is getting better.
 

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I feel for you. I've been lucky with my fish by following the standard QT protocols, but I can't figure coral out no matter what I try.

One comment, you never see someone initiate a thread when everything works perfectly. And, when someone starts a thread because of problems, the responders are quick to share personal experiences which are similar to the original poster. That's both the good and the bad of message boards.

I believe too often the OP fails to look at the stickies which usually provide a consistent message and instead wades thru all of the responses looking for a solution with which he is comfortable. .

I also believe that online diagnosis is an art that is difficult to master.

Hope your 75 day fallow is successful and you are able to get back on track
 

vetteguy53081

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Hard to tell in the pic but it does seem like something on the gills. A couple of things going against that though - freshwater dip revealed nothing in the bucket after 5+ minutes. It went through two courses of prazipro already. Just to clarify there is the purple tang but the other pics- that’s the same fish two weeks apart (after the first treatment and then again after the second treatment). Also no other fish showing any signs of disease which makes me think it’s not communicable. He’s had this for over two weeks but it is getting better.
The eyes show on purple tang what also looks like flukes. You may have to add another 8 day interval as Monogean flukes can be stubborn to praziquantel
 
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The eyes show on purple tang what also looks like flukes. You may have to add another 8 day interval as Monogean flukes can be stubborn to praziquantel
Thanks Vetteguy - I'll try that out. They tolerate it pretty well so that would be an easy thing to try.
 

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Hi all,

I'll try to make this as quick as possible. I had an ich or velvet outbreak when I was on vacation recently. Was gone for 4 days but when I came back 3 had died that night (powder brown, royal gramma and starry blenny). It came out of nowhere and I was only gone for 4 days. You can see the pic of the purple tang. I know I had ich in the tank but they were doing relatively fine for over a year - growing and really not showing signs of it for well over 9 months after initially having signs for a few weeks. If it wasn't ich then velvet is likely due to the aggressive nature of their demise (coral was purchased the week prior and put in the DT). To save the explanation of what I drew a pic of the timeline. Basically I treated the 8 remaining fish with copper power (level between 2.3 and 2.6 for 15 days) with additional treatments of prazipro, kenamycin, and general cure (wrasse had developed an infection - source unclear).

The "hybrid" or combo part was really in response to so many failed attempts documented on this webpage. The general theme over and over seems to be "I had my tank fallow for 70+ days and treated them and as soon as they go back in they get ich again". I'll save the debates about proper treatment, cross-contamination, etc. Jay had posited that perhaps ich lays dormant in an anaerobic environment so the rationale is that it had not cleared the DT. The stories over and over seem to point to the DT as the issue, especially when fish are showing no symptoms at all in their QT. I am a pharmacist by trade and I lean heavily on evidence-based approaches but there just aren't a lot of good studies (as Jay and others have established exhaustively) to identify the cause - other than human error. But I do believe there may be something there, people do make mistakes but again, there seems to be a consistent story with these failed attempts.

That leads me to what I have tried to do here. It consists of doing all of the following:

1) Copper treatment (with FW dip prior)
2) Tank Transfer
3) Prazipro
4) 90 - 100% water change in DT
5) UV Sterilizer
6) Rip cleaning the sand with tap water and rinse with RODI
7) Clean (as best you can) the DT and sump

This also assumes that everything listed above is done correctly, i.e., coper levels appropriate, other med dosing appropriate, duration of treatment appropriate, no cross-contamination, proper UV sterilizer size and pump settings for tank size, etc.

I am not going into detail on each of these other than to say all the information and process for each is on this website. For the most part this has gone well so far. I have eight fish in 30 gallon QT - purple tang - blue jaw trigger - YWG - blueside fairy wrasse - blue star leopard wrasse - clownfish - 2 cardinalfish. Clownfish did get air bubble trapped in his eye but he recovered. The blueside fairy wrasse somehow got an infection (hence the kenamycin and general cure). But he does seem to be improving (two pics below). I know they need to get out of there as soon as possible though and eventually I think the stress may get to them.

Finally, you can see the timeline posted in the pic - but I wanted to get thoughts on how to finish this out. I plan on waiting 75 days but I am considering another copper treatment at day 61 and then having them go right into the DT at day 75 (provided they are tolerating things well). Also considering another tank transfer closer to the end? I don't want to overdo it but they took to the first treatment well. Also curious if others have rip cleaned the sand as part of their QT treatments and if it was successful?

IMG_8793.jpg

Before kenamycin and General Cure
IMG_8737.jpg
After - taken today
IMG_8795.jpg
Last day in the DT back in August
IMG_8506.jpg

First, I applaud your systematic approach to this issue!

I presume the invertebrates are all fine (I use that to rule out environmental issues)
Did you see rapid breathing in the fish before they passed?

Failure of fish disease treatments typically boil down to three main issues:

1) Misidentification of the disease.
2) Improper medication
3) Biosecurity failure

Regarding this statement "Jay had posited that perhaps ich lays dormant in an anaerobic environment". Actually, that is something that has been noted in the lab, but I find it difficult to reconcile how that can happen in an aquarium. For an area in the aquarium to be anaerobic, there has to be no water flow. This is typically caused by very small pores in rock, where oxygen cannot diffuse down into. Ich tomonts are pretty large, the chance of them fitting into such a tiny crevice seems impossible to me.

Jay
 
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First, I applaud your systematic approach to this issue!

I presume the invertebrates are all fine (I use that to rule out environmental issues)
Did you see rapid breathing in the fish before they passed?

Failure of fish disease treatments typically boil down to three main issues:

1) Misidentification of the disease.
2) Improper medication
3) Biosecurity failure

Regarding this statement "Jay had posited that perhaps ich lays dormant in an anaerobic environment". Actually, that is something that has been noted in the lab, but I find it difficult to reconcile how that can happen in an aquarium. For an area in the aquarium to be anaerobic, there has to be no water flow. This is typically caused by very small pores in rock, where oxygen cannot diffuse down into. Ich tomonts are pretty large, the chance of them fitting into such a tiny crevice seems impossible to me.

Jay
First off - sorry about the misquote - I had it backwards!

Inverts are all doing fine and I believe the powder brown tang was breathing fast from what I recall but when I got home late at night only he was out - the other two were in hiding and I found them the next morning perished. Here is another pic of the the PT before he was put in QT. The identification piece is what I never really nailed down. I've really just been treating empirically this whole time (we do it in hospitals in similar fashion). I suppose it could be multiple things as well, e.g., flukes causing the fish to be immunocompromised resulting in the previously managed ich to run amok or at least start showing signs again. I wish I had taken more pics but the others really weren't showing too many signs.

I'm really just trying to layer as many things as I can in order to prevent these three things from occurring that you lay out in a very simplistic way. I just don't want to put the fish through the ringer so I am trying as much as I can with the DT while trying not to do too much to the fish. But if I need to treat them again I'll do what's best for them.
purple tang.jpg
 
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Sorry - your post from yesterday scrolled off my list and I missed it!

The white spots above the anal fin on that purple tang are likely not ich (too localized). Could be some ich mixed in with scrapes or mucus. If it was ich, this fish could go for quite some time from this point before dying - certainly more than a week.

You wrote: "considering another copper treatment at day 61 and then having them go right into the DT at day 75 (provided they are tolerating things well). " - I would do that. Many public aquariums do that now. Basically, you treat the fish for protozoans for 30 days, then two weeks (or longer) for flukes, then put the fish back into full copper for 72 hours to two weeks (depending on your opinion) and then move the fish to the DT. Skip the transfer method at the end - too stressful and of dubious value except for ich.

Jay
 
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Sorry - your post from yesterday scrolled off my list and I missed it!

The white spots above the anal fin on that purple tang are likely not ich (too localized). Could be some ich mixed in with scrapes or mucus. If it was ich, this fish could go for quite some time from this point before dying - certainly more than a week.

You wrote: "considering another copper treatment at day 61 and then having them go right into the DT at day 75 (provided they are tolerating things well). " - I would do that. Many public aquariums do that now. Basically, you treat the fish for protozoans for 30 days, then two weeks (or longer) for flukes, then put the fish back into full copper for 72 hours to two weeks (depending on your opinion) and then move the fish to the DT. Skip the transfer method at the end - too stressful and of dubious value except for ich.

Jay
Thanks Jay. As for an update, the wrasse is going downhill. Breathing heavily for the past 24 hours and now on its side. I started the prazipro again yesterday but not sure if he’s too far gone at this point. I’ll continue to monitor him but he seems to be struggling with this infection. Just not sure what to treat with at this point - keep him in the prazipro water or put him in his own tank and start kena or someth else. Any suggestions based on the pics?


taken today
DD8C2410-E1C8-40CD-B201-7F8FDAB47DFC.jpeg


taken 4 days ago

CBDF3B60-ADC4-4F4E-B9A1-7B35872F2293.jpeg


taken 12 days ago
8E392DE7-9CB1-4CE5-87E3-12BB0A12FE97.jpeg
 

Jay Hemdal

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That is a tough issue - not ich or flukes. Most likely bacterial, and could be arising from inside the fish (so a systemic disease, causing the heavy breathing). I hadn't given that any thought because the second picture above looked so much improved. How long did you treat with the Kanamycin? This may be a relapse issue. Typically, you need to dose that every other day for 3 doses (so 6 days total).

Jay
 
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That is a tough issue - not ich or flukes. Most likely bacterial, and could be arising from inside the fish (so a systemic disease, causing the heavy breathing). I hadn't given that any thought because the second picture above looked so much improved. How long did you treat with the Kanamycin? This may be a relapse issue. Typically, you need to dose that every other day for 3 doses (so 6 days total).

Jay
Yeah Jay I actually have been wondering the same thing. So, I didn’t include this before as to not put too much info in the original post but I actually cut the kena tx short because it made the water quality so terrible. I dosed it twice but basically did a 100% water change on day 3. I do have a 10 gallon I could put him in there. at this point not sure there is much to lose?
 

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Yeah Jay I actually have been wondering the same thing. So, I didn’t include this before as to not put too much info in the original post but I actually cut the kena tx short because it made the water quality so terrible. I dosed it twice but basically did a 100% water change on day 3. I do have a 10 gallon I could put him in there. at this point not sure there is much to lose?
I would try that, but relapses are tough because the fish’s resistance is already compromised.
Jay
 
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Update - day 6 or tx with kenamycin. So he definitely turned around after starting the treatment. He was on deaths doorstep and is now breathing normally, swimming around, essentially behaving normally from what I can tell. The thing is that he still shows signs of something going on, but I just don’t know if that’s actually signs of recovery. So the kena definitely was the way to go. I’m just wondering about duration of tx. Any thoughts?
7D3F7DD0-6253-4D1A-A450-884CE8ABD214.jpeg
F2BDDCE0-0181-42B1-836F-9648C3F8F280.jpeg
1E254652-0D81-413A-857D-7CB876066730.jpeg
EE8C511E-A168-4899-BA20-E2F331BA9221.jpeg
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Do you think the head lesions have improved?

I wouldn't extend the Kanamycin any further. Maybe switch to another type? You could try a combo of Maracyn 1 and Maracyn 2

Jay
 
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Do you think the head lesions have improved?

I wouldn't extend the Kanamycin any further. Maybe switch to another type? You could try a combo of Maracyn 1 and Maracyn 2

Jay
I think the spots have improved but it seems they have migrated. Used to be just on the right side but now on the middle and left. I think I may just wait a few days and monitor without doing anything. See if he improves. I went through an anti microbial stewardship program back in college and an infectious disease attending physician had 10 rules for treating. #4 was if the patient is improving, consider no changes. I’ll keep you updated but if I have to intervene I’ll take your advice.
 
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