Urgent: Swim Bladder Disease? Next Steps?

[Troy328]

Today's update:

Symptomatic fish passed away overnight. I finally tracked down a fish store that has Expel-P. Picking it up now. No fish show signs that I have seen yet.

 

 

[Troy328]

Hello everyone, it has been a while, but i have a positive update!!

 

The struggles seem to be finally over (fingers crossed). I can confirm that praziquantel + levamisole worked for my tank!! I ended up with 4 casualties total, but only 1 after I started treatment, and that was early on. Everyone seems to be healthy now. I just wanted to share what worked for me in the event someone comes across similar issues in the future.

 

I mostly followed @Colu's instructions, but with a little bit less medicine and a slightly different schedule.

 

I decided to start with paracleanse initially, because that was what I had on hand. After that ran it's course, I did a water change and did my first dose of expel-p. I turned out my tank lights for the day as well, and then did a big water change the next day, about 50%.

 

I wasn't able to give the next dose of medicine until a week later. I switched from paracleanse to prazipro, which is what two separate local fish stores recommended to me. So I then dosed prazipro a week after the levamisole treatment. I let it sit for about six days (instructions said 5-7), and then did a 30% water change, followed by another expel-p dose the following day. This time, I not only turned the tank lights off, but partially covered the tank as well to sort of black things out and help the medicine work, as my tank also gets a decent amount of natural sunlight and apparently light is detrimental to expel-p's effectiveness. 24 hours later, I did another big water change, a little more than 50%.

 

After that dose, I ended up with some cloudy water, which I think was moreso due to the blacking out of the tank, and had much less to do with expel-p or any side effects. regardless, I stayed the course and it has since cleared up naturally. I did one more dose of prazipro for good measure, which was about a week after that second expel-p treatment, and once again did another 25%-30% water change 5-7 days later. Everyone seemed to be doing really well from the second dose of expel-p onwards, despite the cloudy water, so I have not given any more medicine. I have been closely watching the fish and everyone seems to be doing well, no wasting, high energy, and fish are readily eating without spitting anything back up. I also wanted to add that I had three small fry in the tank that I discovered shortly after the first dose of paracleanse, and they handled the medication perfectly well and are still doing well and growing!

 

I know the original instructions had called for more doses of both medicines, and it also had the medicines working simultaneously as opposed to alternating, but this seems to have worked for me and my fish. I will be keeping both on hand going forward, just in case if the problem does crop back up again or isn't truly resolved, in which case I will attack it more aggressively. I also think I will definitely use both in quarantines going forward, too!

 

Thank you so much for all of the help!!

[Odd Duck]

On 6/2/2023 at 12:14 PM, Troy328 said:

I will be keeping both on hand going forward, just in case if the problem does crop back up again or isn't truly resolved, in which case I will attack it more aggressively. I

Keep in mind that the recommendations are not random, they are based on the parasites life cycle.  If you don’t complete the treatments as recommended you can end up with resistant parasites that need even longer treatment than the “normal” treatment regimen.  Short of running fecal parasite screens we don’t know if all the parasites were cleared.  It’s much like if you have bronchitis then start to take antibiotics.  You start to feel better almost right away, but you aren’t yet clear of infection.  If you stop the antibiotics too soon, you can end up even sicker with now potentially resistant bacteria because the weaker bacteria were killed first and you’re left with only the resistant ones.

 

Deworming

Siphon out debris from the bottom before and after dosing to remove any expelled worms, eggs, debris, etc.  Levamisole is inactivated by organic debris and by light, so dose after lights out and black out the tank for 24 hours, remove organics via water changes and cleaning the bottom of debris as much as possible.

It’s likely that levamisole does what it can do within the first hour, but best to follow directions precisely.  If you have a bare bottom hospital tank available, it might be best and easiest to transfer the fish to that tank for the duration of treatment - up to 5 weeks total treatment time if doing 3 doses of praziquantal.

Levamisole treatment should be weekly for 4 treatments.  Praziquantal treatment should be every other week (at least) for 2-3 treatments and it is left in for a week at a time.  It can be dosed the day after levamisole treatment.  Remove any carbon or Purigen from filters before dosing.

Have enough dechlorinated water to do a 50% water change immediately if any adverse symptoms are seen in the fish.

A typical treatment regimen: 

1. 50% water change with careful siphoning of debris from the bottom of the tank.

2. Dose with levamisole and black out the tank for 24 hours.  Then 50% water change siphoning the entire bottom of the tank.

3. Dose with praziquantal directly after the second 50% WC.

4. One week later, 50% water change siphoning the bottom thoroughly.  Dose with levamisole following directions in step 1-2.

5. One week later (start of week 3 of treatment), repeat all steps 1-4 over another 2 weeks time.

6. Repeat all steps 1-5, then do last WC one week later after third dose of praziquantal.

Not all snails will tolerate treatments, so best to remove any snails in the tank.

Condensed, weekly schedule:

Week 1: siphon debris and do 50% water change, levamisole x 24 hrs, siphon.  Treat with praziquantal and leave in until next week.

Week 2: siphon, levam x 24 hrs, siphon.

Week 3: siphon, levam x 24 hrs, siphon, then prazi.

Week 4: siphon, levam x 24 hrs, siphon.

Week 5: siphon, levam x 24 hrs, siphon, then prazi.

Week 6: siphon.

[Troy328]

On 6/2/2023 at 3:58 PM, Odd Duck said:

Keep in mind that the recommendations are not random, they are based on the parasites life cycle.  If you don’t complete the treatments as recommended you can end up with resistant parasites that need even longer treatment than the “normal” treatment regimen.  Short of running fecal parasite screens we don’t know if all the parasites were cleared.  It’s much like if you have bronchitis then start to take antibiotics.  You start to feel better almost right away, but you aren’t yet clear of infection.  If you stop the antibiotics too soon, you can end up even sicker with now potentially resistant bacteria because the weaker bacteria were killed first and you’re left with only the resistant ones.

 

Deworming

Siphon out debris from the bottom before and after dosing to remove any expelled worms, eggs, debris, etc.  Levamisole is inactivated by organic debris and by light, so dose after lights out and black out the tank for 24 hours, remove organics via water changes and cleaning the bottom of debris as much as possible.

It’s likely that levamisole does what it can do within the first hour, but best to follow directions precisely.  If you have a bare bottom hospital tank available, it might be best and easiest to transfer the fish to that tank for the duration of treatment - up to 5 weeks total treatment time if doing 3 doses of praziquantal.

Levamisole treatment should be weekly for 4 treatments.  Praziquantal treatment should be every other week (at least) for 2-3 treatments and it is left in for a week at a time.  It can be dosed the day after levamisole treatment.  Remove any carbon or Purigen from filters before dosing.

Have enough dechlorinated water to do a 50% water change immediately if any adverse symptoms are seen in the fish.

A typical treatment regimen: 

1. 50% water change with careful siphoning of debris from the bottom of the tank.

2. Dose with levamisole and black out the tank for 24 hours.  Then 50% water change siphoning the entire bottom of the tank.

3. Dose with praziquantal directly after the second 50% WC.

4. One week later, 50% water change siphoning the bottom thoroughly.  Dose with levamisole following directions in step 1-2.

5. One week later (start of week 3 of treatment), repeat all steps 1-4 over another 2 weeks time.

6. Repeat all steps 1-5, then do last WC one week later after third dose of praziquantal.

Not all snails will tolerate treatments, so best to remove any snails in the tank.

Condensed, weekly schedule:

Week 1: siphon debris and do 50% water change, levamisole x 24 hrs, siphon.  Treat with praziquantal and leave in until next week.

Week 2: siphon, levam x 24 hrs, siphon.

Week 3: siphon, levam x 24 hrs, siphon, then prazi.

Week 4: siphon, levam x 24 hrs, siphon.

Week 5: siphon, levam x 24 hrs, siphon, then prazi.

Week 6: siphon.

Thank you for your thoughtful response, and for taking the time to reply.

 

I do not want to come across as sounding argumentative whatsoever, but where does the 4 weeks of treatment recommendation come from? While I found the schedule to be very helpful, I mostly followed the instructions on the package. Expel-P seems to suggest 2 treatments, not 4. Aquarium Co-Op seems to also suggest 2 treatments and then continued weekly treatments until the worms ate killed or fish are regaining weight. I saw significant improvement in my fish, and so I stopped treatment after 2 doses.

 

To your point about fecal parasite screens and the potential of drug resistat parasites, it is true that I technically do not know that all of the parasites are gone. But I never visually saw any parasites in the first place, nor did I see them at any point during treament. I did take extra care to siphon my tank thoroughly, but I never saw any. In other words, without visually confirming the deaths of the parasites, I would technically *never* know if I was successful,  regardless of whether I did 2, 3, 4, or more doses. What I *was* able to see, though, was one symptomatic fish (spitting food, low energy, not yet wasting) completely regain it's appetite and energy, along with none of the other fish developing symptoms.

 

That said, what would you recommend from this point onwards? I am a month removed from the last time I dosed medication. Should I pick back up where I left off? Should I start treatment all over again? Should I simply observe for now?

 

Furthermore, how long would you say I need to wait without seeing any symptoms of parasites to know I'm fully in the clear?

 

Thank you again for your words and patience with me. I understand I am probably coming across as stubborn, but I am legitimately trying to do what's best for my fish. I thought I had done so successfully, but if it turns out I judged incorrectly amd have more work to do, I will accept that. Maybe I just got lucky, in which case I will be more careful in the future.

[Odd Duck]

You may be just fine, especially since your fish all seem to have recovered.

I didn’t feel like you were being stubborn and I hope I didn’t make you feel like you were doing anything “wrong”, I know you were following directions from the package.  I also know that over-the-counter (OTC) meds directions, especially for fish, are not always ideal.  The law in the US is very poor in regards to fish meds with sometime little valid reasoning for the directions and recommendations.  Since I have just a touch of training in animal care and parasites control and prevention 😁 (I’m a veterinarian that sees exotics), I tend to follow recommendations from exotic animal formularies rather than strictly the OTC labels.  ACO could get in trouble for making recommendations that exceed the label directions.  I am not as limited by their constraints since I have considerable training.

If you aren’t seeing any symptoms, I’d probably just watch closely at this point.  There are parasites that will clear with only 2 doses.  You have the meds you need now, you know where to find my recommendation that should clear even the more stubborn of the common fish intestinal parasites if something comes up again, plus you can always PM me if you lose track of it or symptoms come up again.  It’s very difficult to be certain you are clear of any parasites without doing pretty significant testing and good luck collecting a fecal sample sufficient for testing on only a few fish in your tank, so watching for symptoms is probably the best you can do.

Do remember that I have a bit of a wacky schedule since I mostly work ER these days and usually get all my week’s worth of hours in 3 days so I’m not on the forum much, if at all, on those days.  If you don’t hear from me within 24 hours after a PM, post up so @Colu and others can take a shot at helping, since most give very solid advice.

I’m very glad your fish are doing better!