# Hole in the Head



## gplate (Jan 8, 2014)

Hey guys,

I wrote a little while back about my Gold Severum who was swelling and not excreting. I finally got one good load out of her, but her eating was still picky. I changed water several times over the ensuing days, trying to ensure that anything that was water-borne was removed. I changed filter medium and continued treating with Epsom Salts.

Then I noticed holes around her face and disturbances near her lateral line just behind the head. Also she stopped eliminating again. So I read up on HITH and I found an article that mentioned good results with ingested Epsom Salts. She wouldn't even eat peas, so I made a 3% solution (as recommended in the article) and soaked small bits of whole wheat bread in it thinking the fiber might help as well. She ate that with gusto, but I didn't know if bread was good for her and it doesn't have all the nutrition she needs. So after 3 days I tried peas again. She ate them fine and I thought we were out of the woods. Also I started to see the white, ***** stool mentioned for the disease, but at least SOMETHING was coming out. Then she stopped eating the peas.

So I read some more and decided to treat with Fish Zole. I' also found (from getting a mouth infection) that our well water wasn't getting sufficient chlorine to do the job. We have a very good water filtrsation system that removes ALL the chlorine before it's dispensed thru the faucet. Got that taken care of, changed water, cleaned out the filter and began treating with the Fish Zole. I've been treating for 6 days now (today's the 7th) and she doesn't seem to be improving. She's hiding in the back of the tank during the day, although she comes out in the evening and swims around like normal. I'm dosing as per the instructions (one level scoop per 15 gallons). The water has been tested and is good.

I'm really getting concerned again as the bottle says not to treat more than 10 days. She's still got the white, stringy stool and leaves her mouth open all the time (unusual). I tried a little bread again just so she gets SOMETHING to eat. She goes right for it, but then spits it out. It's almost like her mouth is sore or she can't swollow. Any help or suggestion would be GREATLY APPRECIATED. She's my baby. PLEASE HELP!


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## GTZ (Apr 21, 2010)

Any idea how much a scoop is in mg?
Are you filtering or have you been filtering with carbon? Just on the off chance that it's a possible cause for your lateral line erosion as it has been positively linked with HITH or HLLE.
HLLE is best combated by varying the diet of the fish, which in your case is difficult seeing as how it isn't eating and by providing pristine water conditions. I would continue with the epsom dissolved in the water while still attempting to feed shelled peas with epsom crystals.


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## gplate (Jan 8, 2014)

Hi and thanks for responding!

Each scoop contains 300 MG. I've left the filter on the whole time, but just to circulate the water. All carbon has been removed the whole time of treatment. I have left a bag of Fluval Clearmax in the filter as it's supposed to remove nitate, nitrite and phosphate, hopefully keeping the water a little better than having no cleansing at all.

The water has been treated with 1 Tbs. / 10 gal. of epsom salt. It is crystal clear. Every day, I change about 10% of the water and remove all uneaten food. I was feeding frozen shelled peas at first, but when she stopped eating them I tried canned. She ate them for a couple of days, then stopped. Plus they're so mushy they make a real mess of the water. She then ate tiny bits of bread that I soaked in a 3% solution of epsom salt. Now she's stopped that too. She at least tries to eat the bread, but spits it out like she can't swallow it. I mean how much softer or easier to swallow than a bit of wet bread? She also leaves her mouth hanging open, like it's sore. As I mentioned, the water was not great for about a week when both my wife and I got mouth infections and found that the chlorinator on our filtration system was empty. The tank water had been partially changed a couple of times during that time as I have been fighting this ( or some series of ailments) since my first post about a month ago. So that may well be where this infection originated. We have well water, but it's never been a problem since 2008 and our whole house filter system is first class. Since getting the house water straightened out, I changed 1/2 the tank water immediately and 10-20% per day since beginning the fish zole, so hopefully, with all those changes plus all the antibiotics, the infectious critters are gone. But maybe not... I'm really starting to get depressed as I've been fighting this for quite a while. I've done the 10 days maximum that Fish Zole recommends. Should i do a thorough cleaning and try a different antibiotic or whatever kills the HITH bacteria? Is more than 1 Tbs/10 gal of epsom dangerous? I'm running out of ideas. She still has the white stringy poop and no appatite after all my efforts.


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## GTZ (Apr 21, 2010)

Metronidazole when used with fish is primarily an anti protozoan, so if the fish is suffering from something else, then yes, I'd likely try something else. 
The problem with treating HITH is that the root cause of the illness is unknown. There are many theories as to what causes it, from Hexamita (parasite) to carbon useage, but the latest info suggests that it has more to do with less than ideal nutrition. Carbon has also recently been confirmed as affecting lateral line erosion.
For broad spectrum antibiotic treatment, I usually recommend a combination of Kanamycin (Seachem Kanaplex) and nitrofurazone (API Furan-2). You may want to give that a try for 5-7 days.


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## gplate (Jan 8, 2014)

I don't know if the photo will show up as I've never used a photo sharing service. But I just wanted to follow up. I've begun the Kanaplex/Furan-2 medicating. This is day 3. Her mouth is still hanging open, but a new symptom is occuring. The area on the hard section between the gills and the "face" look like they're getting wrinkled, plus on the side shown in the photo (her right side), there seems to be a darkened area, almost like a bruise. Also there's darkening where the pectoral fins connect, a darker, more purple color than the usual blood red of septicemia. There's minor fin damage on the bottom of the pectoral fins and a couple of whitened spots on her dorsal fin spines.

I did a fairly major water change before beginning the treatment as I had been treating with Fish Zole previously and wanted to begin the new treatment as "clean" as possible. I also cleaned all surfaces in the tank and cleaned inside the filter to make everything as sterile as possible. I added 1 Tbs / 10 gal of epsom salt before adding the meds. I just checked the water and all is perfect. My only question is pH which is about 7.6. I think that's OK but not sure. Temp is about 75 degrees.

I just checked the photo and somehow it worked really well. You can see the darkening on the gill plate and the puffiness around the top of her face and near the lateral line. Also if you look just in front of the indentation at the front of the gill plate you can see a whiteish area that looks like dried, peeling skin on a person. And just in front of that, one of the holes in her face as well as on her "nose" and just above the eye. Likewise you can see the damage to the bottom of the pectoral fin. I'll try, do, pay anything just to get her to eat at this point!


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## gplate (Jan 8, 2014)

I have used the excellent article on this site for spironucleus. It recommends 30% water change followed by raising temp to 30 degrees C then treating with Metronidazole 400 mg/10 gal. after 8 hrs. change 25% of water and re-treat with Metronidazole. I have been treating with Kanaplex/Furan-2 combo. I started above recommended treatment yesterday and thought she was going to die . She was laying almost horizontally in the top corner. I was talking and singing to her as I always do so she could go in peace. Suddenly all this *****, slimy stuff started shedding odd in sheets and after an hour or so she was upright, but still in the corner at the top. I did the water change and second Metronidazole treatment, said a prayer and turned off the lights.

This morning she was upright at the bottom of the tank, so I felt a little better. There was a pretty long string of whitish/clear poop clinging to a plant. I did the water change and Metronidazole treatment and left her alone to rest. I did put in a shelled pea if she should want to eat. It's been about 5 or 6 days since she's eaten anything.

About 2 1/2 hrs. later I gave her the final Furan-2 treatment as I didn't want to discontinue an antibiotic part way through the treatment (Dr's always tell you that). Shortly after, she started standing on her head at a full 90 degrees. That was about 5 or 6 hrs ago and she's still ilke that although she actually looks pretty good with that exception. I plan on giving her the water change/ Metronidazole treatment before bed, but she's supposed to get the last Kanaplex today. I think I'm gonna hold off on that until tomorrow. Or should I skip it completely? I just don't want any opportunistic "bugs" she might have picked up in her weakened state to have a chance to make things worse. I'm really torn as to how to proceed.

Is the standing on the head a sign of bugs dying off and giving off gas? Is it a sign of something else? Is there anything I can do to help her correct the problem? Should I givr her the final Kanaplex dose? If so, when. Or maybe I should continue antibiotics for the reason stated above. Any help or insight would be greatly appreciated!


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## GTZ (Apr 21, 2010)

Unfortunately, a vertical swimming position is usually not a very good sign. In these cases, the fish is unable to right itself, usually due to a swim bladder problem. I'm at a loss as to what else to suggest other than finishing the antibiotic treatment, continuing with epsom salt and regular water changes, while keeping the epsom concentration consistent.


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