# HITH in an oscar- running out of ideas



## ahicks51 (May 9, 2021)

I have a single oscar, by himself in a 120 gallon tank, no other fish. I've kept oscars on and off for decades, never had HITH, but I've been fighting it since November. At the time, I was using RO water (the tap water here is insanely hard, about 500 ppmTDS right out of the tap), and using HOB filters.

After figuring out the filtration wasn't sufficient, I installed a fluidized bed sump (29 gallon capacity) and a surface skimmer packed with floss. I ran two courses of medicated food (Hex Shield, active ingredients being magnesium sulfate and metronidazole) for three days, to little effect.

Since then, the disease has waxed and waned: it started with small round lesions on the head, and eventually got larger lesions on the cheeks (the more characteristic "HITH" lesions), which quickly healed up and went away with no scarring. The forehead lesions remain.

A few weeks ago, I ran a two-week course of Seachem Metroplex (metronidazole as the active ingredient), and the lesions seemed to stop coming and going; after two weeks, I gave three more days' worth of Hex Shield medicated food, just as an additional measure.

Alas, it's coming back again.

The forum info asks I give all the following info: approximately three weeks of age, tank has been running for about 8-9 months now; water parameters are 0/0/60-ish, and I do 25% water changes every three days. We have ~20 ppm nitrate in the tap water, so getting those nitrates down has been difficult. Again, ONE oscar (medium-sized, under 12") in a 120 gallon tank, more like 130 gallons once hardscape and sump are figured in. Water is dechlorinated with ascorbic acid (vitamin C) as per FWS:

https://www.fs.fed.us/t-d/pubs/html/052 ... 31301.html

Temps run mid 70s to very low 80F, pH is 7.8-ish. Hardness is somewhere in the 800 ppm TDS, I'm still changing out the salt; I was adding 1 tablespoon of sea salt per 7-8 gallons up until recently. It seems to have no benefit. Again, tap water here runs 500 ppm TDS, and this disease first showed up when it was ~150 and I was using RO water.

Food has been Hikari cichlid chow, occasionally with live mealworm beetles, live bladder snails from the guppy tank, cooked frozen peas, and (most recently) red wrigglers, as per the webpage on Spironucleus. I have tried fortifying the Hikari pellets with both vitamin D and vitamin C to no apparent effect. No live fish have ever been fed.

Pic from above:










Better pic:










The lesions are deeper than they look in these pics. The white coloration comes and goes: the erosions get worse with the white, and then they lessen when the white disappears.

I'm all out of ideas. If anyone has any suggestions, I'm all ears as to what to try for this guy. Water quality went from "poor" to "excellent"- I can view the tank through 6' of water as if it were air now.

The webpage on Spironucleus says the pH tolerance of the organism that may be responsible is 5.5 to 8.5; seems that denitrifying bacteria die (or stop working) below 6 or so. And the pKa of ammonia/ammonium is around 9.26, but starts creeping up around 8.2-ish... so I suppose if it *is* caused by Spironucleus or another diplomonad, perhaps if I could keep nitrogen under control (drop the temperature a hair, increase the flow through the sump, cut way back on the food)... *maybe* that might kill the critter if I were super careful about the pH?

I'm an analytical chemist by trade, I could probably pull it off with a carefully calibrated pH meter, but I don't know how well oscars can tolerate pH 8.5.

Any thoughts on the pH thing, or anything else to try? Do the red wrigglers work "miracles", or is this poor guy doomed to have HITH forever? I've kept oscars for so many years and never dealt with this before.


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## Auballagh (Jan 29, 2003)

Okay, well..... you are _PRETTY MUCH_ doing everything right. The steps you are taking with this I believe, are the right ones.
However.... to be blunt?
I think you're half-*ssing this thing. And, the follow-through just isn't/hasn't been enough to rid your Oscar of this problem.
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WHERE are you getting this water with a measured 20 PPM Nitrate in it? The maximum allowable limit for municipal provided tap water in the U.S. is 10 PPM. 20 PPM is too high of a starting Nitrate level to keep Oscars in.
- Change your supply water to a source that measures out in Nitrates lower than 10 PPM.
- or - 
- Set up a plant refugium with Pothos, floating plant species or other plant types that will naturally consume the Nitrates out of your water source.
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The Metronidazole medication is the 'gold standard' in treating a runaway Spironucleus vortens infestation in Cichlids. And, you have a huge advantage in treating your Oscar with this medication since he seems to be eating normally (just about everything offered?!!). However, your treatment regimen with the Metronizadole ended after only 3 days. My own experience and all sources I have found, is to provide medicated food for a minimum of 10 consecutive days. Noticeable (visual/beneficial) effects of medication application do not indicate suspension of the treatment protocol. The treatment regimen must proceed for a minimum of 10 consecutive days to be effective against the Spironucleus vortens infestation.
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I've heard (and seen) just how adaptable Oscars can be in regards to water parameters. By jeeeeze man, 500 PPM TDS is really 'beyond the pale'! African Mbuna would have to be carefully acclimated to water that hard! Let alone a New World Cichlid that originates naturally from a Black Water environment... Your application of RO water is useful, but will it be sustainable in the long run with a water supply that is fighting you this hard?
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Your Hexamita treatment with Seachem Metroplex and Hex Shield may be distracting from the real problem. Does your Oscar have HITH symptoms caused by a runaway Spironucleus vortens infestation? Or, is he battling a Hexamita outbreak informed by HLLE symptoms? If the lesions have been confined almost completely to the head region, I'm inclined to go with HITH.
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Salt treatment/addition to the water. Salt by itself is used purely as a supportive measure, for the sick fish. It will not cure your Oscar of HLLE or HITH. Salt WILL however, help a lot to prevent secondary infections in the HITH wound sites caused by opportunistic fungus or bacteria. Healing wounds freed of attack by the Spironucleus will heal much quicker with salt added to the aquarium water.
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Food. Your multiple food sources are very good. I would recommend adding frozen/thawed/pealed shrimp bits and semi-chopped night crawlers (Big Earthworms) to the mix. Soak all foods in the Metronidazole medication, and continue to supplement with those D and C vitamins. Adding a bit of fresh garlic paste to the food soaking process may promote a stronger appetite, and will help to boost your Oscar's immune system.
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Is your tank being filtered with chemical filtration things? Activated Carbon has been positively linked to HITH outbreak in Cichlids, and use of any other chemical filtration may partially inhibit the effectiveness of your medication (even though you are treating your Oscar by feeding with pre-soaked food).
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Well, that's a bit for you to unpack. Hopefully, this information will help, as I see you have a lot of challenges to overcome in keeping this Oscar. The worst of which I believe is in the water source you are using for this aquarium.


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## Oscar6 (Aug 4, 2017)

Something to be aware of.. once hith is contracted, it is very difficult to cure, and the fish will be more susceptible to a recurrence. You are in a jam with your water. It is critical that nitrate be at maximum 10ppm. Not just to ease the hith, but to make meds effective. At 60ppm, meds, even ones that are sure fire effective are rendered useless. All that aside, your fish is not in terrible condition. I have completely cured Oscars with far worse afflictions than that. In my experience it's clean, pristine water that wins the battle. As suggested, you need to find a better source of water.


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## ahicks51 (May 9, 2021)

I live in a major metro area (population about 4.7 million), and- well, I'm an instrumental chemist who doesn't give much credence to these silly droplet tests, but this is what I get when I run our tap water using the API test as performed to the very letter:










Normally I'd run this on an ion chromatograph to get a much better idea of what the number really is, but I don't have an IC right now. I'm thinking I can use the droplet tests in a UV/Vis spectrophotometer, just duplicating the EPA's method, so I'm going to try that.

But this whole trail of tears started in the first place when he was supplied with nothing but RO water. As for the medicated food, the instructions with Hex Shield are to use it for no more than three consecutive days. After that proved ineffective, I went with a two week bathing treatment with Metroplex, and capped that off with another 3 days of Hex Shield medicated food.

For a 10-day course of medicated food, is there a recommended feed product, or it a matter of making my own? The only Hex Shield I could buy was far too small, so I wetted it, mashed it into larger pieces, and tossed those in the dehydrator so they wouldn't fall apart.

As for chemical filtration: no. I've never used a/c with this fish. Used a/c for years back in Pennsylvania, when I was young and very stupid and there was no Internet and the water quality wasn't good and I never saw HITH.


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## Auballagh (Jan 29, 2003)

The water you are using exceeds the U.S. EPA standard for municipal tap water....

The maximum contaminant level (MCL) for nitrate in public drinking water supplies in the United States (U.S.) is 10 mg/L as nitrate-nitrogen (NO3-N). This concentration is approximately equivalent to the World Health Organization (WHO) guideline of 50 mg/L as NO3 or 11.3 mg/L NO3-N (multiply NO3 mg/L by 0.2258).

Well water, or so-called 'self-supply' water is not regulated by those EPA requirements, and may present a significantly higher risk for human consumption. Arizona is a state with a large percentage of land that no longer has safe, self-supplied drinking water due to agricultural runoff and other causes. 
I would not recommend drinking the water out of your tap.
As in dedicated black water bio-tope aquariums, the use of Reverse Osmosis filtration may be an aquarium water supply requirement for safely keeping your Oscar (or other fishes known to be sensitive to HITH). To strip out the excessive levels of dissolved solids and Nitrate contamination from your water supply, a measured, premixed 'cocktail' of RO filtered source water using an installed reservoir system to service the aquarium, may be the only way to provide the water quality you need to keep this fish healthy. This water supply, pre-treatment regimen could be a bit similar to what some aquarists do in keeping saltwater reef tank, home aquariums. 
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This posting thread will inform what serious cases of HITH can look like in an Oscar. And specifically, one 'recipe' for preparing pre-soaked food with Metronidazole medication,

https://www.cichlid-forum.com/phpBB/vie ... 3&t=454563
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And lastly, if the use of Seachem Metroplex and Hex Shield has shown some effectiveness and benefit in treating your Oscar, you should definitely run through a full series of treatment over 14 days with those products. However, if after treatment with the Metroplex and Hex Shield the fish still shows signs of an active (non-healing) case of HITH, you should initiate food medication treatment with Metronidazole over a minimum period of 10 consecutive days.


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## ahicks51 (May 9, 2021)

Just as a follow-up, I tried a few more things, and I think he's on the mend. It's been several weeks since I discontinued the primary treatment, and there's no signs of new erosions, so I think it's fixed.

There were several parts to the treatment. First was the water quality; I've been doing water changes with RO, and dropped the hardness a bit by the time I started chemical treatments. However, it must be noted that the disease showed up originally when the tank water was very low in TDS; it climbed because I was doing water changes in excess of what my RO could produce.

Second was to elevate the temperature; I have reason to be sceptical as to the accuracy of the digital thermometer I've been using, but I ranged the temperature as high as what I think was 88F.

The primary treatment, however, was eSHa's "Hexamita Discus Disease Treatment," an European product that contains copper sulfate, acriflavine, ethacridine lactate, and methylene blue.

Appetite was unaffected, and he was fed red wriggler worms, and some fish pellets (Dainichi Cichlid) that had been treated with a bit of Epsom salts.

The eSHa product instructions are to use it for three days; I extended that to four. There was marked improvement after the first day or two. The small bottle of product was enough to treat a 120-gallon tank + 10-15 gallons of sump for four days with plenty left over.

It's been 3-4 weeks since the treatment ended, and there are no new erosions. Treatment was well-tolerated. I continue to feed food supplemented with Epsom salts, and I have let the temperature come back down. Water changes are now entirely RO water, and the TDS in the tank is right around 200 ppm just right now.

It is my impression the eSHa product is the primary contributor, but mention the other factors here in case it might benefit someone else.


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## Oscar6 (Aug 4, 2017)

Good news and good job! Another simple thing to do for your fish is to get a vitamin supplement into him. I am a long time user of Boyd's Vitachem. Simply saturate a couple of meals per week, same as applying the Epsom salt to his food. Boosts the immune system, helps keep fish strong and vibrant.


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## ahicks51 (May 9, 2021)

OK, this is crazy: now the smaller oscar I have in his own 55 gallon tank has a small lesion, front and center.

He's only maybe 6", in the 55 gallon tank by himself, I'm doing regular water changes- and here's the annoying part: I'm using the same RO unit in the 55 as I was with the 120-gallon when the larger oscar started to come down with HITH.

I'm having trouble parsing this. Is it possible the specific RO unit is responsible for the HITH? I'm mainly using a different RO unit and membrane for the 120 now, although there's some overlap. I'm probably going to stop using the "bad" RO unit entirely.


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## Auballagh (Jan 29, 2003)

Yes, it's possible the RO unit that is primarily supplying your 55G tank with the smaller Oscar in it, is causing the problem.
And, with the water conditions you have coming out of the tap, I would definitely stay on top of maintaining your RO units. Talk about primary life support equipment! Your super hard, high Nitrate tap water source, just isn't suitable for keeping those Oscar's.
Some ideas,
- Pellets: Go with more than one source of pellet food. Store all pellet containers in the freezer, to ensure maximum freshness and nutritional viability.
- Multiple Food Sources: Attempt more sources of natural, or so-called 'treat' food. Chopped up/shelled shrimp bits, menhaden pieces, night-crawlers, even gut-loaded crickets (or, esp. Dubya Roaches) would be appreciated. Don't forgo the finely ground, fresh garlic paste as a pre-soak for all food offerings. 
- Live Plants: Potted, substrate rooting plants used in combination with hardy non-substrate types would (probably) survive in an Oscar-based aquarium,

https://www.cichlid-forum.com/phpbb/vie ... 3&t=453821

And, since you seem like a 'Techie Sort', the challenge of a planted refugium install may be something you would enjoy. I personally recommend the larger/external 'above tank' overflow type refugium, that utilizes the aquarium itself as a sort of sump. I think you would be surprised at just how effective, healthy and strongly growing aquatic plants can be in naturally removing undesirable organic chemicals from the aquarium water.
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And lastly, even though the symptoms are apparently just starting to develop... you may have to treat the small Oscar for a _Spironucleus vortens_ infestation with Metronidazole for 10-14 consecutive days, to ensure that the protozoa causing those early HITH symptoms, are eliminated from his bloodstream.


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## ahicks51 (May 9, 2021)

All right, then:

My tap water: 504 ppm TDS, ~5 ppm nitrate. This is down from the ~11-12 ppm I measured a few weeks ago.

RO #1, which I have no problems with: 27 ppm TDS, 0 ppm nitrate.

RO #2, which I used for producing all that water when the first oscar got sick (and now the second one): 18 ppm TDS, 0 ppm nitrate.

Tank #1, 120 gallons with half-filled 29 gallon sump with Kaldnes K2 media: 180 ppm TDS, nitrate 40-80 ppm as per droplet test. One fully mature oscar, with ~15% weekly water changes, mostly RO#1, rarely RO#2. Some plants.

Tank #2, 55 gallons with HOB filters: 131 ppm TDS, nitrates 20-40 ppm as per droplet test. One young oscar, ~6", with ~20% weekly water changes using RO#2. No plants, he shreds everything in his tank.

What's weird is that neither fish got sick when provided treated tap water, i.e.: several hundred ppm TDS. Tank #1 I started to switch over to RO using RO#2, and- hole in the head, for the first time I've ever been keeping oscars. TDS went up because I couldn't keep up with the water changes using RO, and now I'm pushing it back down.

Tank #2, I started switching over to RO, and all of a sudden- HITH. The water is perfectly clear. Gravel vacuuming barely gets out anything.

It's just weird that I switched to RO#2 right before both of these guys came down with HITH. Same water supply. #1 unit is inside, under the sink, #2 is outside, connected to a hose spigot.

I do need to get those nitrates down in the big tank; is there a shallow-ish refugium I can stick on top of the tank, something I won't have to fabricobble together?


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## Auballagh (Jan 29, 2003)

It's good to see that the Nitrates have come down a good bit to at least a legal, municipal level in your tap water (esp. if you are paying for that water?!!!). Unfortunately, I still believe that the high measured Nitrate levels in your aquarium is causing stress in your Oscars.
- RO Capacity:
Do your RO filtration units have enough capacity to support your aquariums? The water changes are not being conducted in high enough percentages and with enough frequency to off-set the climbing Nitrate levels in your aquariums. Are your water reservoirs large enough in size to permit the RO filtration units to run and fill those collection reservoirs 24/7? 
- Mechanical Filtration:
If you are going to get ahead of these rising Nitrates, you are going to need to optimze filtration efficiency in your aquariums. Removing, solid organic wastes BEFORE they breakdown into toxic organic compounds is one way to do this. Install foam pre-filters on all filter intakes (pre-filter socks work great on sump intakes). Clean all foam pre-filters two to three times per week. When I decided to keep sensitive WC Cichlids, and was forced to revise my own aquarium filtration processes a few (many...) years back, I discovered that mechanical removal of these solid waste products from installed pre-filters, produced impressive results in reducing measured Nitrate levels for the water in the aquarium.
NOTE: Be sure all foam pre-filters are easily accessible. Your own foam pre-filter cleaning process may require the use of multiple filters.
- Refugium (RFG):
The best-looking RFGs are custom-made from black acrylic (???). But really, for an above tank/external RFG, you just need a long, narrow and shallow container. Large/external RFGs are typically mounted up on the back wall of the aquarium they service. To that end, a four foot long 33 gallon 'long' aquarium, would work very well in this application. I would drill out the glass bottom on one end, and fit up a PVC stand-pipe with bulkhead fittings as your overflow. Yet another foam pre-filter could be fitted to the top of that overflow stand-pipe to prevent plant debris from getting swept down in to the aquarium. A (foam pre-filtered, of course!) submersible pump set up inside the aquarium provides inlet water to the RFG via a discharge spray bar. (I've actually seen a canister filter used for that!) Low flow through an RFG is preferable. Plexiglass bulkheads may be installed to prevent floating plants from getting bunched up at the discharge end of the RFG. Suspend high-quality LED, plant grow lights above the RFG and do not cover this container with a lid. Partially immersed, aquatic plants should be allowed to grow freely above and outside the confines of the container. Multiple plant species should be utilized to optimize success and accommodate different growing seasons and natural plant cycles, with a combination of substrate-rooted (potted?) and non-substrate plants employed.
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So, I see you have been fighting some pretty hard challenges in keeping these fish for a while now. And, it does sounds like you are on the right track with it. But unfortunately, this 'bare knuckle fight' you are now in with your water - will definitely be on-going. 
Good luck with it, and keep charging!


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## ahicks51 (May 9, 2021)

OK- just a quick note. Much strangeness: I started feeding food + magnesium sulfate (and red wiggler worms) to the small guy with the lesion front-and-center of his head.... and it went away. I thought it was going to go from the erosive "phase" to the pseudo-recovery phase, which is invariably followed by another erosive phase in which it worsens, but.... it's been several days now, and the head lesion is gone, and there are no signs of new ones. Sensory pits look good, lateral lines look good... it can't be this simple. It's been several days, and- knock on wood- no signs of re-emergence.

I've also started adding small quantities of mag sulfate to the RO water changes. Is it possible there's just not enough magnesium in the RO water? Perhaps this explains the observation that both times I've tried to lower TDS is when HITH seems to flare. The other possibility is that it's a nutrient lockout, where the ratio of calcium to magnesium is too high- they're both divalent cations, related from a nutritional perspective, so if there's too much calcium, not enough magnesium is taken up? I don't even know if that's a thing with fish.

It's interesting to note that one formulation for HITH (New Life Spectrum Hex Shield) contains magnesium sulfate as an active ingredient. Mag sulfate has been shown effective on hexamita, at least internally; there's quite the discussion here:

https://www.monsterfishkeepers.com/forums/threads/treating-hexamita-aka-spironucleus.339362/

Seems to me HITH is a syndrome, not a single disease. Metronidazole may treat the underlying pathogen or parasite under specific circumstances, but- I think we might agree on this- if the prevailing condition that caused it is not handled, it's just kicking the can down the road. For me, it seems magnesium might be pertinent. That HITH shows up when I try to make things better through improved water quality seems counter-intuitive; that it gets better- and quickly- with magnesium supplementation is curious. I wonder if magnesium chloride would also work.

Anyway. A potential data point for anyone who's interested. For now, it's my job to continue care and monitor. TDS down to 111 from 131 ppm, nitrates are probably about where they were. Working on a planted sump for the 120 for nitrates, but I'm stumped on precisely how to plumb it in with the existing system.


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## Auballagh (Jan 29, 2003)

That's good news!
And yes, it's been known for awhile now that Epsom Salts are beneficial when used to promote better nutrition and feeding responses in Cichlids. With your younger Cichlid, the magnesium sulfate may have had a stronger effect than in the older Oscar. Please continue to share what you find. This sounds promising!



Auballagh said:


> - Refugium (RFG):
> The best-looking RFGs are custom-made from black acrylic (???). But really, for an above tank/external RFG, you just need a long, narrow and shallow container. Large/external RFGs are typically mounted up on the back wall of the aquarium they service. To that end, a four foot long 33 gallon 'long' aquarium, would work very well in this application. I would drill out the glass bottom on one end, and fit up a PVC stand-pipe with bulkhead fittings as your overflow. Yet another foam pre-filter could be fitted to the top of that overflow stand-pipe to prevent plant debris from getting swept down in to the aquarium. A (foam pre-filtered, of course!) submersible pump set up inside the aquarium provides inlet water to the RFG via a discharge spray bar. (I've actually seen a canister filter used for that!) Low flow through an RFG is preferable. Plexiglass bulkheads may be installed to prevent floating plants from getting bunched up at the discharge end of the RFG. Suspend high-quality LED, plant grow lights above the RFG and do not cover this container with a lid. Partially immersed, aquatic plants should be allowed to grow freely above and outside the confines of the container. Multiple plant species should be utilized to optimize success and accommodate different growing seasons and natural plant cycles, with a combination of substrate-rooted (potted?) and non-substrate plants employed.


To simplify... The water is pumped up from the aquarium to the refugium. The water overflows from the refugium and returns back down to the aquarium. A cycle! The rest of it just makes the thing work to provide Nitrate-eating plants for your aquarium.


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## Auballagh (Jan 29, 2003)

Oh, I thought there was something in the old DIY archives of C-f about using Pothos plants in the aquarium.
Link shows a somewhat novel method of using immersed plants to get those desirable Nitrate-Eating effects - without the refugium!

https://www.cichlid-forum.com/phpbb/vie ... 0&t=379578

Two Pond Baskets with Pothos plants. Both rigged under the direct discharge flow from two HOB filters. Simple! And most importantly, looks like it probably works.


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