None of the advise is a guarantee. It is good advice but not guaranteed. My oscar has had HITH for 6 months. My water quality has always been awesome. But I stepped in up even more daily water changes, the diet has always been varied, no feeders, raised temp, added salt, Melafix, Pimafix, nothing has worked. He is still eating and very active but it is very frustrating that it has not improved or gone away!