Oxygen while using meds

[TCFletch]

Oh no! I'm so sorry to hear what happened. If it wasn't flukes do you think it was from all the medications? I certainly hope the butterfly makes it.

Also just to let you know, my tangs have velvet and a bacterial infection, but because I've been following this thread and copying your steps almost exactly, my fish are doing great. They're eating and they look 100% better.

If something should go wrong during the last freshwater dip, I know to put them back in QT.

We learn from each other's mistakes. Great teamwork. Do another thread like this one and many reefers will follow. [emoji4]

 

[Humblefish]

If it wasn't flukes do you think it was from all the medications?

I think I probably dumped too many meds on them; in my effort to treat velvet, flukes and a bacterial infection all at once in just 12 days. Their appetites really diminished over the last 4-5 days as I kept adding more praziquantel, metronidazole and kanamycin. The tangs were weak at this point, but my mindset was to just reach the "finish line" i.e. Day 12 so I could get them out of that toxic soup. Doing a FW dip before transferring was probably too much and that's on me for not knowing better. I should have skipped the FW dip, placed them in another non-medicated QT, and then checked for flukes after they had been eating for a week solid. But I am going to New Orleans this week, so I was trying to get everything setup for my wife to care for them while I was away.

The YT should have been isolated in his own QT and treated separately. Since he had the most dangerous issue (a bacterial infection that kills within a week.) The other two fish should have never been needlessly exposed to the antibiotic, which I feel was the game changer. Because it's not something I normally dose. I'm also gonna rethink how I dose/administer praziquantel & metronidazole. According to Jay Hemdal, one dose of prazi @2ppm for 24 hours should be sufficient to eradicate flukes. Of course, you have to administer a second dose, one week later, to kill any hatchlings. Prazipro's dosage is 2.5ppm, which might explain why some fish die in it (overdose). So, I'm gonna ratchet my prazi dosage down to 2ppm, and only do two doses (instead of 4) over the 10 day period. I also see no reason to dose metro with CP unless a bacterial infection is in play. So long as the fish is eating, it would be safer (and more effective) to feed metro (and prazi) laced food in order to clear out intestinal worms.

I'm also gonna experiment with different antibiotics to see which are safer to use in conjunction with CP, if necessary. Kanamycin is, in general, less harsh; but nitrofurazone seems to be the better option for mixing with CP. I just :mad: how it turns the water yellow. I also might go back to erythromycin & minocycline (old school Maracyn 1 & 2) for prophylaxis with CP.

 

[DLHDesign]

I love that I can actually follow most of that post, now! Awesome stuff.

 

[CJBuckeyes]

@Humblefish , very sorry about your bad luck with this round of treatment. I echo the comments above, you've saved more fish than you know through your advice.

I'm going to provide a summary of my ongoing treatment, as it was very similar to yours. Hopefully this will help. I'm going to provide as much detail as possible, sorry if it's a long post!

Setting the stage: I had 6 fish in my tank, most of which had been with me for years. In the past I haven't properly QT'd, but the worst I ever saw was an occasion spot or two on my extremely skittish Foxface. About 2.5 months ago I purchased a juvenile kole tang. I was about two weeks into passively QT'ing him (no meds) and he looked super healthy and was eating well. Then a work trip came up, I had to leave in two weeks. I had to make a decision to either teach my lady how to feed, observe, monitor ammonia, mix/change water, etc.. or put a healthy looking fish into the DT. It was a tough decision. I decided to put the kole in immediately, giving me two weeks to observe before leaving. He looked fine the entire time, until the morning I left. He was covered in white spots and swimming rapidly:-( Had to leave for the airport..

Speeding things up: When I got home the kole tang had vanished. Adding to the chaos, my apex auto feeder didn't feed while I was gone. The fish looked horrible. I started feeding heavily, hoping they would turn around. My two anthias had ragged fins. Within a few days one was lying on the sand breathing rapidly. That was the last I saw of him. Started planning for treatment. Then my ORA orchid dotty back showed ragged fins and a huge gut. Found him dead the next day. My fox face had huge black spots on his side, this clearly looked like black ich. I also noticed what looked like powdered sugar down his back at certain angles. I assumed this was velvet. As I was pulling my two clowns out, I noticed sloughing skin/mucas on their foreheads. Brook? The first day in QT I noticed white stringy poop from one of the clowns. Internal parasite? It seemed like they had everything! I decided to start treatment for velvet as it seemed the most serious, and black ick as I was the most certain about it. Here's how the treatment went.

Day 1: CP* dose and prazipro as per instructions. Fox face breathing very heavily (w/ proper aeration), skiddish, not eating. *Important to mention that I used NLS Ick Shield. Couldn't get pure CP quickly, but all reviews I could find said Ick Shield worked well.

Day 2: No dose. The black spots were gone as was the "powdered sugar" on the back of the FF, leaving raw patches in the areas where the large black spots were. Fish still looked "sickly", though. Clowns and anthias eating, FF would not.

Day 3: No dose

Day 4: Fish still look sickly. Ruby reef rally arrived, did a bath.

Day 5: All fish looked remarkably better. From this point on, no spots, sloughing skin, or any external marks. FF still breathing heavily, skittish, and occasionally swimming erratically.

Day 6: Kanaplex and metroplex arrived. Dosed both. Kana to prevent secondary infection, metro b/c of white stringy poop noticed on first day.

Day 7: Very cloudy water, no other changes.

Day 8: Clowns and anthias eating, but barely. Make a decision to skip kana and metro.

Day 9: Anthias stops eating.

Day 10: Foxface still not eating. Anthias suddenly found dead. Started to rethink treatment.

Day 11: Resumed ruby reef rally bath as all fish seemed to look much better after the first bath. Also started metro as I was starting to suspect internal parasites as the cause of the anthias death.

Day 12: Looking better. FF still hasn't eaten.

Day 13: Dosed metro.

Day 14: 12 hour bath in bucket with ruby reef rally as I sterilized the QT and all equipment with vinegar and let dry in the sun. As I was removing the FF from the bucket with a colander, he jumped out onto the floor. I put the colander next to him and he flopped halfway back in. I reactively reached down, and yeah.. ouch! Felt like a bee sting for about 5 mins. Haven't noticed any damage to the fish yet.

Day 15: Back in the QT, no meds. ALL FISH EATING VORACIOUSLY!

My plan going forward is to just feed and observe. One thing that I'm pretty excited about is the ability to use ampule now. The 50% water changes every other day were a huge chore.

The big questions I have:
1. **What diseases did I actually have?** Based on the reactions to treatment, I think it was brook and not velvet. More confident on the black ick and internal parasites.
2. **Did I eliminate them?** (i.e. should I continue metro for internal worms? Should I continue ruby dips? Going to wait and observe for now)
2. What killed the anthias? Disease or meds?
3. Did NLS Ick Shield work? I think so...

Sorry this is so long, but hopefully it provides one more data point regarding treatment.

 

[Humblefish]

@CJBuckeyes I would just continue to observe for now and keep feeding. It sounds like you might have had 2 or 3 different diseases in play. Hopefully the NLS Ick Shield works as advertised.

 

[melypr1985]

IT'S BEEN A DEVASTATING DAY - haven't had something like what I'm about to describe happen to me in a long time.

So, I'm getting the FW dip water ready (temperature/aeration). I decide I'm gonna dip them all together in a 5 gal bucket (I usually dip one at a time), and this was probably my first mistake. I get all the fish in there and remember I forgot to set the timer. So I run into the kitchen to set the oven timer, but when I get back I find the Clown Tang has jumped out of the bucket and hit the hard floor. What makes this even worse is I had the bucket resting on a step stool so he had farther to fall. So, I scoop him up and place him into the conditioning tank. In retrospect, I should have just put him back in QT.

I get back to the bucket and now the Yellow Tang is laying on the bottom. ***?! I try to move him around but he's just looking worse & worse, so I cut his FW dip short and put him in the 150 gal. I'm telling ya, I've probably done hundreds (if not thousands) of FW dips and rarely does something like this ever happen.

The Heniochus (the delicate one) seemed fine the entire time, showed no flukes and even ate before I turned the lights off (after being put into the 150.) But when I get back to the conditioning tank, the Clown Tang is now stuck to the MP40 (I even turned it down to low) so I'm sure that didn't help matters either. I put him in an acclimation box, but he never could swim right after hitting the floor and died tonight.

The Yellow Tang is just more bad news. Initially he seemed fine in the conditioning tank, but then started looking worse & worse. He then started developing these red marks (photos below) behind his pectoral fins (both sides). Similar to how the infection looked (but had cleared) near his eyes. All environmental factors (i.e. pH, ammonia) check out fine.

This photo was taken in QT just 30 mins before all the mayhem started.



This is postmortem (6 hrs later). This "red cut" appears on both sides of the fish.



According to the anatomy of a Zebrasoma Tang (below) these red marks look very close to where the liver is. I will do an autopsy tomorrow, right now I'm too exhausted.

The butterfly seems fine. Hopefully it stays that way. I was able to do a full FW dip postmortem on both tangs, no flukes showed...

Oh man! I'm so sorry this happened. Keep your head up, you know that this thread alone will have a big impact on fishy lives world wide. They were not lost for nothing and you absolutely gave them your all. You know what we always say "if you lose a life, learn from it" and I know you did. Me too in fact!

 

[Valkyrie]

Unfortunately, we can only do our very best and learn from it when we come up short. When we stop learning, we die. You provided a chance these fish didn't have before, a worthy endeavor. They've given their life so others may live.

I've learned an amazing amount in just the last 24 hours of reading this saga. It set me on the quest to learn more, read more, spend more time in the stickies gleaning as much information as I can. I have a shopping list of medications and equipment, 2 books on my Amazon wishlist and I'm getting googly eyed staring at the computer and my own tank to make sure my fish are ok (obsess much? not me!).

I want to help. It's in my blood and I must.

 

[Humblefish]

So I think the Heniochus is gonna be OK (video below). But I'm still really bothered about what happened to the Clown Tang; I can't stop thinking about it. Such a stupid way for something to die. The YT I can accept because I knew it had an infection I wasn't sure I would be able to cure.

At least from this experience I am revamping my CP QT protocol. I'm pretty sure I can use less dosages of prazi & metro next time in order to still effectively deworm. Just gotta figure out what went wrong with the antibiotics.

 

[Valkyrie]

I'm lost, why do you say something went wrong with the antibiotics? Because of the yellow tang?

 

[Humblefish]

I'm lost, why do you say something went wrong with the antibiotics? Because of the yellow tang?

My pet theory is the YT's liver got damaged from dosing too many meds all at once. Getting hit with 5 consecutive doses of antibiotics might have proved to be too much, when combined with CP + prazi + metro.

 

[TCFletch]

So the butterfly is in an observation tank? What's the salinity and temperature? No meds? Eating ok? No signs of anything? He looks good in the video. If all goes well, how long do you expect to keep him in this tank? You'll be in New Orleans?

You may have noticed by now, I like to ask lots of questions. [emoji4]

 

[Humblefish]

So the butterfly is in an observation tank? What's the salinity and temperature? No meds? Eating ok? No signs of anything? He looks good in the video. If all goes well, how long do you expect to keep him in this tank? You'll be in New Orleans?

Yes, "Liquorice Stick" is in a 150 gal conditioning tank with no meds. He's eating fine and looks clear of any ailments. SG 1.026, Temp 77.

I will keep him here for a couple of months to be sure he is clear of all diseases and also to look for a good home. He's not a reef safe Heniochus so it might be difficult.

 

[TCFletch]

This is awesome news and I'm sure Liquorice will find his forever home and a family that will take good care of him. If he could talk he would say "Thank you, Humblefish for saving my life." [emoji7]

 

[Valkyrie]

Pardon my questions, please remember they're coming from a place of mammal knowledge and fish ignorance (except koi).
Please do not think that I am questioning YOU, I don't know you or your qualifications, but I highly respect your experience and the knowledge you share. I also ask these questions because I don't know the algorithms for treatment.

What kind of bacterial infection did the tang have? Infectious agent? Gram neg or point of sale? Could he have already gone septic by the time you got him?
Do you have a microscope so you can take samples and make cytology slides? I'm seriously considering it again. I had a small one but I need 100x, at least, to id bacteria. The small one worked ok for parasites. Do you have access to a lab that could culture these bacterial infections so that we don't have throw everything at a fish to see what sticks?
Would he have been better off in a tank by himself to reduce stress and to better manage the dosing? Did he need the praziquantel? I understood that it was only bacterial. I've been reading the dosing schedule over and over as well as our initial introduction to the fish. But that doesn't mean I didn't miss something.
I'm trying to find what I can about kanamycin, but I seem to have misplaced my Plumb and I found online that it's been discontinued in human use. I hope that isn't going to affect the availability eventually. Is it also metabolized by the liver?
The metronidazole is great with the internal parasites so again, why do we use it to treat bacterial when already using kanamycin.
I'm not sure just how delicate the systems of marine fishes are and I know that with mammals we tend to go in with guns blazing, especially when death appears to be imminent. Is that how we should treat fish, too? At least with mammals we can run blood tests to insure that the liver & kidneys are healthy enough to metabolize drugs safely, we don't have that luxury with fish.
Can enrofloxacin or any of the floxacins be used in marine fish? It's amazing in koi, but I've not found anything that says it can be used in marine fish. I imagine that as an injectible it would likely have to be highly dilute and the amount minuscule, but being broad spectrum it would be awesome if we could use it. Even Merck only mentions it being used in koi.

 

[Humblefish]

What kind of bacterial infection did the tang have? Infectious agent? Gram neg or point of sale? Could he have already gone septic by the time you got him?

I didn't do a skin scrape because of the location (face/near the eyes). Also, the redness appeared to be too deeply embedded; it wasn't on the surface of the skin. The postmortem scrape I took (red on the skin above the liver) didn't yield anything useful. Also, the liver looked normal to me. So I'm pretty much stumped.

Do you have a microscope so you can take samples and make cytology slides?

I do, but I seriously need to buy a new one.

Do you have access to a lab that could culture these bacterial infections so that we don't have throw everything at a fish to see what sticks?

I do, but its not always at my disposal.

Would he have been better off in a tank by himself to reduce stress and to better manage the dosing? Did he need the praziquantel? I understood that it was only bacterial. I've been reading the dosing schedule over and over as well as our initial introduction to the fish. But that doesn't mean I didn't miss something.

All 3 fish came from the same tank. The other tang had flukes (confirmed via FW dip) and the Heniochus had velvet. So, being both are waterborne transmissible diseases the YT had to be treated for both in addition to his (perceived) infection.

I'm trying to find what I can about kanamycin, but I seem to have misplaced my Plumb and I found online that it's been discontinued in human use. I hope that isn't going to affect the availability eventually. Is it also metabolized by the liver?

It's a good antibiotic to use on fish because it is readily absorbed by their skin.

The metronidazole is great with the internal parasites so again, why do we use it to treat bacterial when already using kanamycin.
I'm not sure just how delicate the systems of marine fishes are and I know that with mammals we tend to go in with guns blazing, especially when death appears to be imminent. Is that how we should treat fish, too? At least with mammals we can run blood tests to insure that the liver & kidneys are healthy enough to metabolize drugs safely, we don't have that luxury with fish.

Metro also targets anaerobic bacterial fish diseases. For severe infections, I advocate combining kanamycin, nitrofurazone and metronidazole. This combination provides the widest spectrum of treatment I've found, in the hopes one of the antibiotics will successfully target the offending bacterium. I do this because doing a skin scrape/scope ID just isn't practical for most hobbyists, and a gram negative bacterial infection can kill a fish in a matter of days.

Can enrofloxacin or any of the floxacins be used in marine fish? It's amazing in koi, but I've not found anything that says it can be used in marine fish. I imagine that as an injectible it would likely have to be highly dilute and the amount minuscule, but being broad spectrum it would be awesome if we could use it. Even Merck only mentions it being used in koi.

I've never used those, but that's not to say they wouldn't prove useful.

 

[CJBuckeyes]

Glad to hear that the butterfly is still doing well.

@CJBuckeyes I would just continue to observe for now and keep feeding. It sounds like you might have had 2 or 3 different diseases in play. Hopefully the NLS Ick Shield works as advertised.

2 days post treatment in the QT (no meds) and my fox face is breathing faster than normal and sitting in front of the HOB filter. Sigh. A few reasons it might have not worked: No FW bath, no ruby bath until day 4, or NLS ick shield doesn't work.

Option 1: FW + ruby + NLS ich shield. Same as last time but adding fw dip and doing ruby dip up front. Fox face may stop eating again, although less meds that last time so he may not.
Option 2: FW + ruby + copper. Would take out NLS effectiveness as an unknown, and maybe the Foxface won't suffer appetite suppression.

Any thoughts? Thanks!

 

[Humblefish]

Option 2: FW + ruby + copper. Would take out NLS effectiveness as an unknown, and maybe the Foxface won't suffer appetite suppression.

^^This, although appetite suppression is still very possible with copper. However, we know copper treats velvet. We don't even know for sure what is in NLS Ich Shield. I recommend using a chelated copper product such as Coppersafe or Copper Power. You'll also need an API copper test kit.

 

[Valkyrie]

Fascinating. Thanks for your responses @Humblefish. Very helpful. I wish I had some insight to offer re: the yellow tang. Quite perplexing.
I'm studying for my VT specialty in clinical pathology. I won't be submitting any case studies for fish, though.

 

[TCFletch]

To Humble, is it ok to use the same filter sponge/HOB that I used in my QT for my observation tank? It should be clear of any trophants since I'm using Cu. I'll be transferring my fish to observation tank in about 2 weeks and want to use the same filter. Can I do that? Thanks in advance.

 

[Humblefish]

To Humble, is it ok to use the same filter sponge/HOB that I used in my QT for my observation tank? It should be clear of any trophants since I'm using Cu. I'll be transferring my fish to observation tank in about 2 weeks and want to use the same filter. Can I do that? Thanks in advance.

I would not. I use all new water, equipment, sponges, etc. in the observation tank. Copper only eradicates the free swimming stage of ich & velvet and that only shields your fish from reinfection. Copper does not kill tomonts which could be encysted inside the sponge (or on other equipment.)