Hole in the Head, Hexemita and Lateral Line Erosion

[Merrilyn]

This is the latest treatment for hole in the head, confirmed by two vets.

Once the fish has been treated with Metro, it's important to add green vegetable matter and vitamins to the diet to aid in the healing of the holes.

It can be transmitted to your other fish, possibly thru contaminated droppings, although little scientific work has been done in this area. It is believed that the pathogen responsible for Hole in the Head (also known by a variety of other names such as Hex, head and lateral line erosion and wasting disease) is Spironucleus Vortens.

An infected fish may show one or several of the following symptoms:-

Skin lesions around the head area.
Turning dark.
Refusing to eat.
White jelly like droppings.
Muscle wasting and pinched appearance above the eyes.

The best drug to use is Metronidazole (Flagyl) which you will need to get from your local vet. Ring first to see if he will prescribe it after seeing a photo of the fish, or if he insists on seeing the fish himself.

1. Move the fish to a clean hospital tank with some of the existing tank water. You'll need a heater and mature sponge filter.

2. Set the temperature to 30 degrees, no higher.


3. Add 250 mg Metro per 10 Litres of water. Crush tablets to fine powder and mix with water to form a paste before adding to the tank.

4. After 48 hours, do a 30% water change and repeat the dose. This should be done for a total of 3 treatments.

5. During treatment the tank lights should be left off. Metro is affected by light. And turn off your UV unit.

6. A variety of good quality, high protein food with added vitamins and minerals should be fed several times daily. Include prepared dry food, beef heart, brine shrimp, green vegetable matter and blood worms in the diet. Remove any uneaten food and keep the water very clean.

DO NOT USE LIQUID METRO. IT CONTAINS SUGAR WHICH WILL CAUSE A BACTERIAL BLOOM IN YOUR TANK AND SUFFOCATE YOUR FISH. ONLY USE METRO IN TABLET FORM.



Further reading can be found in the excellent article from Discus Page Holland

http://article.dphnet.com/cat-02/spironucleus.shtml#1.%20%20Introduction%20–%20Comm on%20Symptoms[/b]

[TW]

Great article, Merrilyn. Thanks for taking the time write it.

Link is great too.

One thing I noticed is that Discus Page Holland's link suggested metro dosage which is more intense. In an average case this link recommends 250mg per 10G, re dosed every 8 hours for 3 days (separated by 25% WC). For severe or reoccurring, dose is 400mg per 10G (same frequency of re dosing).

So our dosages are greater, but they recommend more frequent redosing, based on that metro in IV solutions has a life of 6-8 hours only.

Should we be rethinking our recommended re-dosing schedule?

[waitaki]

TW I followed the recommendations of the Hollands page and didn't get the required results, however following Merrilyn's advice had a result. I showed Dr Loh, the fish vet, Merrilyn's dose which he agreed with.
I guess it depends on the severity of the ailment and how many times you treat the fish and just how much you are willing to put them through.

[RDavies]

One of my new fish appears to have HITH disease. I have had her, an Albino Alenquer for about 10 days and is looking good apart from not eating anything since she arrived, and starting to get small sores around the head. She is also the only one showing string white and jelly like poos.
The other fish, including the others I got with her are eating like pigs and very active. I treated the whole tank with big L a week ago, and Prazi starts tomorrow, just for preventative worming of the whole tank.
Will Hex treat itself once the fish are stabilized and in good water, or is metro a necesity?
Is it very contagious to the others if they are healthy and eating well?

[RDavies]

One of my new fish appears to have HITH disease. I have had her, an Albino Alenquer for about 10 days and is looking good apart from not eating anything since she arrived, and starting to get small sores around the head. She is also the only one showing string white and jelly like poos.
The other fish, including the others I got with her are eating like pigs and very active. I treated the whole tank with big L a week ago, and Prazi starts tomorrow, just for preventative worming of the whole tank.
Will Hex treat itself once the fish are stabilized and in good water, or is metro a necesity?
Is it very contagious to the others if they are healthy and eating well?

[Decapper]

Just for ppl reading this and trying this solution can I please advise to lower your PH to 5.5 if possible. and if you are starting out from 7.0ph then do this over a 3 day period. The bacteria that is responsible for HITH can not live in a culture below 6.0PH

Remember do this slowly as you dont want to stress an ill fish already with a ph shock.

[Decapper]

Wow.. I have dosed my 70L tank with the above spec.. 250 x 7 = 1750 / 200(my tablets) = 8.75 tablets

I only dosed at 6.5 tablets and on my second dose after a 30% water change and 12hrs on my discus started darting round and jumping as in overdose! Have done a complete 100% water change and turned on lights and UV light and now waiting to see if I have any loses

[m.ingram]

They will dart around it is quite normal for that to happen .The tank has no light and when light comes in they freak out and dart all over the place . If i was you i would finish off the treatment as if you only half doing it you run the risk of bacteria becoming resistant to metro .

[Decapper]

Telling you they are not darting because the light. They are darting due to overdose.. Two lying on the bottom. One near the top. Not looking good. I'm sure two will die. Not happy

[Decapper]

Ok after water changes and also transfer to a tank that is well aged all fish (including the two that where on the bottom of the tank gasping) have recovered.

Been doing heaps more research and found that Andrew Soh recommends 1.5gm per 100L.

So my tablets being 200mg I get 13.3L per tablet. That is roughly 5.2 tablets for my 70L tank and not 8.7 tablets as I dosed recommended here. He also says he treats every 4 days for 12 days in total treatment time.

Going to start re-dosing today as I don't want a super bug. Wish me luck!

[Exotic Aquatic]

1 X 400mg tab/40l for 10 days at 30-31deg works a charm!!! lights off and towel over tank- (to keep them from freaking out).

This was advice from someone i completely trust with vast medical experience, and a long time fish keeper/breeder... and he didnt let me down 100% success rate for the customers fish, and the other EIGHT they infected!!! these fish are now the biggest pigs of the lot at feeding time, and already looking fat!

[ILLUSN]

Wow.. I have dosed my 70L tank with the above spec.. 250 x 7 = 1750 / 200(my tablets) = 8.75 tablets

I only dosed at 6.5 tablets and on my second dose after a 30% water change and 12hrs on my discus started darting round and jumping as in overdose! Have done a complete 100% water change and turned on lights and UV light and now waiting to see if I have any loses

ok so lets review you have a 70L tank volume so you need 70x25mg= 1875mg.
at 200mg/ tablet you need ~9 tablets. you used 6
you crushed the tablets disolved in water to make a paste (the metro disolves the binder does not).

48 hrs later you did a 30% water change redosed metro, 12 hours after your redose you had problems (60 hours after your initial treatment) you had problems?

also do you have a 7oL tank or 70L of water in the tank? the correct dose is 25mg/L of water so measure the inside of your tank both length and width and multiply by the height of your water column

[Decapper]

1 X 400mg tab/40l for 10 days at 30-31deg works a charm!!! lights off and towel over tank- (to keep them from freaking out).

This was advice from someone i completely trust with vast medical experience, and a long time fish keeper/breeder... and he didnt let me down 100% success rate for the customers fish, and the other EIGHT they infected!!! these fish are now the biggest pigs of the lot at feeding time, and already looking fat!

Thanks for the advice.. Seems everyone has a view about dosage on metro..

You say 200mg = 20L at 10days
Discusforum 200mg = 8L at 2days
Andrew Soh 200mg = 13.3L at 4days

Well I've tried Discusforum and the results where close to death. Now trying Andrews Soh and hope that is fine. Otherwise I'll go with Yours thanks

[Decapper]

Wow.. I have dosed my 70L tank with the above spec.. 250 x 7 = 1750 / 200(my tablets) = 8.75 tablets

I only dosed at 6.5 tablets and on my second dose after a 30% water change and 12hrs on my discus started darting round and jumping as in overdose! Have done a complete 100% water change and turned on lights and UV light and now waiting to see if I have any loses

ok so lets review you have a 70L tank volume so you need 70x25mg= 1875mg.
at 200mg/ tablet you need ~9 tablets. you used 6
you crushed the tablets dissolved in water to make a paste (the metro dissolves the binder does not).

48 hrs later you did a 30% water change re-dosed metro, 12 hours after your re-dose you had problems (60 hours after your initial treatment) you had problems?

also do you have a 7oL tank or 70L of water in the tank? the correct dose is 25mg/L of water so measure the inside of your tank both length and width and multiply by the height of your water column


I have 70L of water in the tank. I worked it out to the water level
Sorry for the 70L I dosed 8.5 tablets first and second dose 48hrs apart.

Yep that is correct 60hrs and I had darting resulting in large hits to glass. Also backing up. Upside down.. laying on the bottom. Heavy gasping. Overdose signs

Then I don't large water changes which seemed to work at first but I think further stressed the fish. So I transfered to another tank with well aged water housing L numbers. Fish did not recover straight away but looked better even if still laying on bottom of tank gasping. Following morning swimming fine.


P.s
I use a pill crusher which also mixing the metro into the water very effectively. Maybe that is my problem its too effective resulting in a higher dosage absorbed

[ILLUSN]

Did you do a 30% water change between doses ie dose wait 48 hours do a water change then redose.

Interesting the darting I had a fish kill itself doing this a few days ago all I did was feed it. After it smashed into the glass it did just as you describe.

[Decapper]

Yep 30% water change as instructed..

I was very lucky I did not lose any.. (besides 2 L066)

After re-dosing everything seems ok... Thats at Andrew's dosage. Still not 12hrs yet.. Took a chance at putting them through the meds again. I hope their livers are not stuffed. I'm also running a L066 fry in there as a cannery

[lpiasente]

Did you do a 30% water change between doses ie dose wait 48 hours do a water change then redose.

Interesting the darting I had a fish kill itself doing this a few days ago all I did was feed it. After it smashed into the glass it did just as you describe.

My exact thoughts. I have dosed at a way higher dose (under guidance) and never had any fish dart around. I would also think startled. I too had one smash into the glass after my cat jumped on top of the tank. It didn't die for a few days just sat near the top of the tank gasping. Has anyone ever had this with metro????

[ILLUSN]

Not with metro but I have had fish smash into the glass ten gasp for a day or so before dying no idea what causes it I think I had a read somewhere about "crazy swim disease" associated with temps above 28c but I've only ever had 4 fish do it over the last 16 years or so

[Decapper]

This morning they seem to be handling the metro a bit better. Seem to be a little bit skittish, I'll monitor through the day. Interesting that it's only happening to me. I read "Discus Health by Dieter Untergasser"



Although metronisazole has been used successfully for treating aquarium fishes for decades, the possibility of negative side effects should not be overlooked. There have been rare cases where -- due to unknown reactions -- all the fish died during treatment with this substance.

He recommended dosage at 500mg per 100L

You say 200mg = 20L at 10days
Discusforum 200mg = 8L at 2days
Andrew Soh 200mg = 13.3L at 4days
Dieter Untergasser 200mg = 40L

[ILLUSN]

thats the old dose from when i was a kid, dad and i used to use 1 200mg tablet per 40L it seemed too loose effectiveness around 1988-1989 and we uped the dose to 200mg/20L this seemed to work better, around 2006 we had some discus come from malaysia that didn't respond looking around here we tried the 25mg/L dose and it worked very well.

as i said to you before i prefer to dose 10-12.5mg every 12 hours with a water change daily for 10 days, my fish room faces south and it gets a bit of natural light, conmbine that with the short half life of metro and it works better for me but i'm a former microbiologist.

[Decapper]

It went sour even with Andrew's mix. I'm think their too small to take the dose.

I've started force feeding and with good results. All are now eating with out my help. Going to keep feed them 3rd and 5th day.

What I'm concerned about will it return seems I'm not treating the water. In a bit of a bother here as I don't want some super bug. I have read that if the water is kept clean and fish are happy and health they will keep it at bay.

[broadfoot]

How does siphoning waste work with this treatment?

I've put my 7 juvenile discus in ~105 litres of water and dosed them with 13x200mg tablets.

If I feed them and siphon out water, am I meant to replace that water (which will dilute the medication) or do I let the tank run slightly lower and lower for the 48 hours between 30% water changes?

Thanks :)

[broadfoot]

I followed Merrilyn's instructions but after one day my water has gone cloudy and the fish have stopped eating. I used the tablets not the liquid.

Do I just stick to the plan and do 30% WC after 48hrs?

[ILLUSN]

Yeah the metro makes the water taste bad.

Also remember metro is only effective for 4-8 hrs. So if you siphon your tank 8hrs or more after treatment there's no active drug left. Just stick to the plan and redose after 48 hrs

[broadfoot]

Great, the plan has been stuck to :)