Is he doomed?! :(

[tarheel96]

One can use soda bicarbonate or potassium carbonate and slowly raise the ph above 8 for a few days. The fish should not be stressed as it will not alter the conductivity of the water by much. TDS/conductivity is what causes osmotic shock and not pH....for those concerned with my suggestion. People dose carbonates and bi-carbonates all the time in RO water to get some buffering capacity, not much of an issue to fish...It will alter the KH, and in turn the pH but after dosing is stopped, it will slowly go back to the natural tank value as KH is used up in nitrification/by the filter bacs. Soda bi-carbonate or potassium carbonate does not raise the GH.

All of this is 100% true. I raise the carbonate alkalinity of my water using both sodium bicarbonate and potassium bicarbonate. Sodium bicarbonate is the easiest for someone to use because it's easiest to find ... it's just regular baking soda. Arm and Hammer baking soda. NOT baking powder or washing powder!

The only thing is ... sodium bicarbonate (baking soda) and/or potassium bicarbonate will only raise pH to 8.4 - 8.6. According to the paper this is just at the level where spironucleus vortens is killed (pH 8.6).

Also, if it's systemic as RD. suggests, then pH may not make much of a difference.

 

[RD.]

I can't believe that I'm about to post this but ........ in post #3 Brandon said: "Have you ever used a product called clear by czaqua? It's made for flowerhorns but works on all fish. I use it on any fish I have with white poo. Clears it out in days. I think every riv I've ever owned had white poop at one point or another. They are very prone to getting it ".

I am personally not a fan of Asian meds that don't break down the ingredients on the label, but from what I can gather Clear is a combination of something equal or similar to Metronidazole, and ? as well as an antibiotic, which when used together have been very successful in treating Hex/Spiro in many flowerhorn. At this point, considering everything that you have treated this fish with, it might be time for some Thai voodoo medicine. Hopefully there's somewhere in Canada that sells it cheaper than this?

https://www.amazon.ca/FlowerHorn-inflammatory-CZ-Aqua-Products/dp/B01G75EP0W

 

[neutrino]

There's another possibility, which is that whatever it was has cleared, possibly due to your treatment, and has simply left a little divot that's temporarily causing some irritation. The problem here is an isolated small bump or two can be a lot of things, some of them are just something that comes and goes without any serious consequences or ever knowing what they were exactly. If an earlier issue damaged the tissue and created the hole, this may have been an opportunistic organism or pathogen that attacked the weakened tissue until either the meds worked or the fish's own defenses, you don't always know which.

Giving fish illness advice without an obvious indication of a specific condition is a hit and miss proposition, so I'm not advising here, but I'd just say that if it was me at this point I'd simply finish out the kanamycin treatment, keep water very clean-- which would have the benefit of clearing out old meds before beginning something new-- and watch him closely to see if this wasn't the end of it before treating with other meds.

My preference to frequent med use if I had ongoing issues or suspected something in the tank, would be to try a UV sterilizer, but that's a whole other subject. But UV can also be good for redox-- Redox is a big subject, some of it technical, personally I don't get very technical over it, but it's a factor in fish health and there are some aquarium basics involved, clean water, mineral balance, sufficient 02, UV can enhance (including passive UV from sunlight). If you wanted to do some reading as to what redox is and how it relates to aquarium health-- disclaimer: this site also offers products for sale, including UV sterilizers, but the article is still informative and has a number of links to additional reading-- http://www.americanaquariumproducts.com/Redox_Potential.html#aquarium_redox

As someone said earlier, you can get a lot of opinions on health issues, sometimes we're just guessing on health threads, so this is just my opinion of what my own next step would be, not claiming to have the correct answer.

 

[RD.]

I agree about keeping on with the Kanamycin for now, but, we know this fish had worms (and it was successfully dewormed) and we know this fish had Spironucleus vortens, both were identified via feces smears and viewed under a microscope. The last treatment was several weeks ago, and I assume many water changes ago. The new "hole" certainly looks like the beginning stages of HITH, which this fish has exhibited in the past. Right now, everything is pointing back to HITH, and possibly a reinfection of S. vortens. For anyone that closely followed the issues with this fish from the beginning there absolutely was an obvious indication of a specific condition. In fact, two very specific conditions. One was easy to eradicate (worms), the other maybe not so much? I am honestly a bit shocked that this fish is once again having a health issue, the OP has certainly gone above & beyond in treating his fish.

 

[philipraposo1982]

Not sure if this is a red flag or anything but a few days ago I noticed a bit of red or pink in Kai's mouth. Around the back side where his teeth would be. Kind of looks a bit swollen or irritated.

I wonder if it's related.

He often attacks and move my plastic plants in the tank soaybe it's from.that?

Or maybe he tried to.mouth a Clown loach?

 

[neutrino]

I agree about keeping on with the Kanamycin for now, but, we know this fish had worms (and it was successfully dewormed) and we know this fish had Spironucleus vortens, both were identified via feces smears and viewed under a microscope. The last treatment was several weeks ago, and I assume many water changes ago. The new "hole" certainly looks like the beginning stages of HITH, which this fish has exhibited in the past. Right now, everything is pointing back to HITH, and possibly a reinfection of S. vortens. For anyone that closely followed the issues with this fish from the beginning there absolutely was an obvious indication of a specific condition. In fact, two very specific conditions. One was easy to eradicate (worms), the other maybe not so much? I am honestly a bit shocked that this fish is once again having a health issue, the OP has certainly gone above & beyond in treating his fish.

Yup, readily admit I didn't go back and read the 11 links in the original post

My comment about opinions and advice was a qualifier for my own post, not pointed at someone else....but I understood this has been an ongoing saga, a reason that I brought up redox, since it can be an overlooked factor in health issues. It's not always about effort, sometimes it's what's in or what's missing from your water.

I'm also coming from the experience that when issues keep returning after one medication or treatment after another, there are other possibilities besides chalking it up to bad genes or trying more meds. In fact, on more than one occasion, after pointing someone to the possibility, I've seen them finally fix very similar issues and history to this one after addressing mineral balance and/or redox. As I say above, something to consider, not saying I've solved it.

So if the evidence strongly points to HITH/spironucleus, has the Epsom salt treatment been done?

 

[tarheel96]

Large frequent water changes (weekly 50-75%) will replenish minerals, electrolytes, and restore redox. I like the use of UV sterilizers because they kill pathogens. I have a TMC vecton 32 watt hooked up to a 75 gallon JD tank.

 

[tarheel96]

So if the evidence strongly points to HITH/spironucleus, has the Epsom salt treatment been done?

I've followed this case from the beginning and I seem to remember philipraposo1982 having tried the epsom salt treatment if not at least in the form of NLS HEX SHIELD medicated pellets which have magnesium sulfate, garlic, and metronidazole in them. The fish didn't like the taste of epsom salt soaked pellets if I recall correctly and wouldn't eat them without making a mess.

It should be worth mentioning that magnesium sulfate heptahydrate is Epsom Salt. The formula for this is MgSO4.7H20 of which roughly 10% is Magnesium.

Pure Magnesium Sulfate is MgSO4 and has roughly twice the magnesium (just over 20%). This is likely what's in NLS HEX SHIELD.

 

[philipraposo1982]

Yes Epson salt treatment was done in the past before metro feeding started. Tried feeding hex shield.but he wouldn't go for the taste.

I do weekly water changes, never missed one since I have been in the hobby. He get fin level changes each week, nitrates barely hit 5ppm sometimes around 10ppm if I feed more that week. I been focusing on not overfeeding and keeping his gut healthy. Trying to at least.
MY water is high TDs, high pH, high minerals.

If you want to look it up Google Cambridge Ontario water and see. Kitchener and Waterloo region we all share the same or very similar water.

 

[ryansmith83]

I see this in discus a lot. A bump in the forehead ruptures and leaves a crater. A biologist friend of mine theorized this was likely a bacterial infection rupturing. He suggested it could be a secondary infection caused by clogged sensory pits, or sensory pits that are infected with hex/spiro.

This might sound crazy, but what I do for discus is net them, dip a Q-tip in hydrogen peroxide, and swab the wound really well to kill anything in it. Just don’t get it in his eyes. Then return the fish to a clean tank and do frequent water changes to keep things really clean until it heals. Sometimes it takes a few weeks to heal over.

I often recommend doing this in conjunction with a metro treatment. I use pure metronidazole powder at 400mg per 10 gallons which you really need a cheap gram scale for, otherwise it’s hard to know when you’re dosing enough.

I can definitely see the HITH scars on the fish in the picture. The best approach to keeping HITH away is frequent water changes and a good diet (maybe with some added vitamins).