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FAQs on Freshwater Head & Lateral Line Disease, HLLE, HITH (Hole In The Head)... Causes

Related Articles: Head and Lateral Line Disease (HLLE), Freshwater Diseases, FW Disease Troubleshooting, Ich/White Spot Disease, Freshwater Medications,

Poor nutrition (avitaminoses), Poor water quality... mostly Poor environment period... in the most general

POSSIBLE DISEASED GOURAMIS, HLLE – 06/28/08
Hi Team,
I currently have a 35 gallon tropical tank, PH 7.2, Ammonia = 0, Nitrite = 0, Nitrates = 10-20. I have 2 Pearl Gouramis, 1 male and one female and both have small holes around the top half of their head around the eyes and 'nose'. They are not filled with puss etc. They are empty like bore holes.
<Sounds like Head & Lateral Line Erosion disease (HLLE), a syndrome that may, or may not, be related to the Hexamita parasite. I would treat for Hexamita anyway, and also review water chemistry/quality.>
The male is a much paler colour than normal.
<Again, consistent with HLLE/Hexamita.>
The female still looks a normal colour. The holes are only on the Gouramis. All other fish seem unaffected (1 queen arabesque Pleco, 1 Betta, 9 neon tetras, 1 swordtail).
<Hexamita/HLLE doesn't affect all fish species equally strongly. Cichlids are by far the most prone, but Gouramis can develop the symptoms too. I've never heard of Catfish, Livebearers or Characins developing the disease. This isn't to say they don't, but it isn't common.>
I feed them on Tetra Pro flake food/varied sinking pellets and a weekly treat of frozen daphnia or brine shrimp. I would guess that this is hole in the head disease from the info on your site but I change 10-20% water weekly and feed high quality and varied food so I am not sure how this would have happened as this often relates to poor water.
<Indeed this is the case. But the infection can be latent in store-bought fish, only to develop a few weeks or months after purchase. Inbreeding may weaken the immune system of some fish species. Nitrate is likely the triggering factor with cichlids, but 20 mg/l nitrate is "safe", so not really sure what's going on here. Regardless, treat first, worry about the science later.>
Is hole in the head disease infectious??
<Not really, no; Hexamita quite probably sits inside the guts of most fish harmlessly, and only causes problems when their immune systems are otherwise impaired. If it is in your system, then all fish have been exposed, so isolating any one fish won't make a huge difference. Since only certain fish develop the disease (or diseases) there isn't any need to worry about the catfish, tetras, or livebearers. By all means isolate the fish if it makes treatment easier/cheaper, but beyond that there's no overbearing reason to do so.>
Are my other fish likely to catch it from the Gouramis??
<Possibly the Betta.>
Are there any treatments available in the UK that you could recommend??
<Yes. eSHa make something specific for Hexamita/Discus Disease. Not used it myself, but I rate their other medications very highly.
http://www.eshalabs.com/hexamita.htm
>
Or is it maybe too late to save them??
<Fish can, do recover from Hexamita provided they are treated and properly fed/maintained.>
I would like to treat the entire tank anyway if poss. as a precaution.
Thanks
Brian
<Cheers, Neale.>

What type of filter media should I use? (RMF, comments on Hexamita, carbon?) 7/13/08
I have been searching for many answers in your forum for the past few days, and I must say "thank you" for all of this information. I have answered most of my questions using the search. To explain myself, I would like to give a little background.
<Ok.>
A friend of mine moved out of the area and asked me to take his aquarium. There is one very large Oscar in a 35 gallon Hex aquarium with an Marineland Emperor 280 power filter.
<Ah, first problem: the tank is _way_ too small for an Oscar, arguably even for a juvenile, let alone an adult. A tank twice this size would be much more reasonable. All cichlids are sensitive to dissolved metabolites -- that means ammonia, nitrite, and nitrate. So you need both good filtration (to deal with the nitrite and ammonia) and aquarium capacity to dilute the nitrate. Water changes of 25-50% per week are needed to further dilute the nitrate. Without this sort of regimen, cichlids are extremely prone to disease, especially Hexamita and Hole-in-the Head.>
The Oscar started getting HITH disease even though I do weekly water changes and according to my LFS, all tests show very good water quality for this type of fish.
<There you go. Am I good or what? The point here is that the tank is too small. While it is (theoretically) possible to keep cichlids in small tanks by doing massive (e.g., 90%) water changes on a daily basis, the only practical way to keep them as low-maintenance pets is to use a big tank so that water changes can be spaced out.>
I read on your pages about Oscars that HITH may be caused by stress from the aquarium being too small, as well as the use of carbon.
<Both these things have been cited in the past as possible triggers. But the balance of opinion nowadays relates HITH to the protozoan Hexamita, an organism that probably lives harmlessly enough in the digestive tracts of many aquarium fish, including cichlids. But when conditions decline, e.g., nitrate exceeds 20 mg/l, the fish's immune system stops working properly and the Protozoans can spread, causing harm. The precise symptoms depends on where the Protozoans end up, which is why Hexamita and HITH had been considered separate diseases for a long time. Both diseases fall under the category of "easy to prevent, difficult to cure".>
My friend, and now myself, has always used Marineland Diamond Blend Filter Media in the Emperor 280's media basket…which is carbon and ammonia remover combined.
<Not a huge fan of chemical media, either carbon or zeolite, in freshwater tanks. Neither serves much purpose when compared with the much bigger benefits obtained by doing large (50% weekly) water changes instead. Zeolite is doing something your filter bacteria is doing anyway, so is utterly redundant except in tanks (e.g., hospital tanks, sub-pH6 tanks) where it isn't possible to use biological filtration. In the past the theory was carbon removed dissolved organics from the water, letting you minimise water changes. When I started in the hobby, "old water" was recommended for freshwater fish, with aquarium books often suggesting 10-25% water changes a month as reasonable. Over time the dissolved organics made the water more acidic and gave it a yellow colour. If you do big, weekly water changes, none of this happens, so the carbon is redundant. Furthermore, to actually work properly, carbon needs to be replaced at least monthly, something hardly anyone in freshwater fishkeeping does. So all you get is carbon behaving as an (admittedly reasonably good) substrate for filter bacteria. Instead I would recommend using exclusively top-notch biological such as Siporax together with mechanical filter media that can be cleaned/replaced according to your budget. You should also have a filter offering not less than 6 times (and ideally 10 times) the volume of the tank in turnover per hour (irrespective of the "recommended aquarium" size offered by the manufacturer of said filter, as these assume best-case scenarios of tanks with small, clean fish like Neons).>
I purchased a 75 gallon aquarium, and an additional Emperor 280 power filter. I plan to use both of the 280 filters on the 75 gallon.
<These filters offer filtration of 280 gallons per hour each, and for your tank I'd recommend at least 450 gallons per hour total and ideally up to 750 gallons per hour. With big, messy fish -- the more the better. I am not wild about hang-on-the-back filters though because they don't seem to be as flexible as canister filters. I want filters that can have the inlet and outlet put where I want them, not limited by the design. I don't like filters that use proprietary "modules" either -- I want to be able to put whatever media I want in the filter. Hence I'd always recommend a decent canister filter such as the excellent value and highly reliable Eheim 2217. At about 260 gallons per hour, two of these would provide adequate filtration and three would provide excellent filtration. They are basically empty buckets into which you cram in whatever media you want. For an Oscar, a mix of sponges/filter wool for solid waste and then lots of ceramic noodles for biological filtration would be ideal. Eheim filters may be slightly more expensive than generic Chinese brands, but they last forever (or at least 10+ years) and such spare parts as you might need (like the rubber seals that will wear out after a while) are cheap and easy to obtain.>
From the reading on your site, I have used water from the old aquarium in the new aquarium.
<Makes absolutely no difference. The bacteria are not in the water column or even sitting on the gravel (much) but in the filter media. Unplug a mature filter from one tank and connect it to another tank with similar water chemistry, and you it will carry on working perfectly. You can also donate 50% of the media from a mature filter to a new filter to instantly cycle the new filter without causing any harm to the mature filter.>
I also placed the new filter on the old aquarium in order to ready the new filter's bio-wheel.
Since you do not recommend carbon in a freshwater aquarium, and this could be causing the HITH disease, what would you recommend I use in the filter media baskets?
<As stated above.>
Also, the Marineland "Rite-Size E" filter cartridges come packed with activated carbon. Should I slice these open and remove the carbon?
<Nope. Just consider them money down the drain. Or at least that's how I view them. Activated carbon is a posh way of saying "charcoal", and a great way for manufacturers to sell you something at a premium that costs very little to make. These "filter cartridges" are overpriced for what they are anyway, and that just adds insult to injury. Over the long term, a plain vanilla canister filter into which you can add whatever media you choose will work out so much cheaper, as well as working MUCH MUCH better.>
Thank you for all your help,
Jay
<Cheers, Neale.> <<I am in agreement. RMF>>

Re: What type of filter media should I use? - 07/13/08
I understand what you are saying about filtration, but given my budget and what I have already spent, do you think the two Emperor 280's hanging on the back plus one Eheim 2217 (as you suggested as a good canister) would suffice for this 75 gallon with the one large Oscar? The 280s come with empty media chambers and I will pick up Siporax as you suggested to fill these with. The Eheim is 260gph and the two Emperor filters are 280 each. This would bring my turnover to approx 820gph (manufacturer spec).
Thanks again,
Jay
<Hello Jay. What you propose should work. But you'd want to be clever about where you positioned all these filters to that they weren't all pumping water around just one end of the tank. With big aquaria, it's important to make sure the bottom of the tank receives lots of water current. So perhaps you'd arrange the Eheim so the spray bar pushes water downwards rather than forwards. Even better (and not expensively) you could couple the canister filter with an undergravel filter plate to create a "reverse flow undergravel" filter. This works by the filter pushing water into the filter plate via what would ordinarily be the uplift. The water then comes upwards through the gravel, further supporting nitrifying bacteria and incidentally also keep the gravel much cleaner than otherwise. While not much used nowadays, undergravel filters work amazingly well, and provide good water quality at low cost. A 75-gallon tank should work nicely for an Oscar (or a mated pair). Cheers, Neale.>

Re: What type of filter media should I use? - 07/13/08
Thank you for the quick responses and for the great information. I would have never thought about using an undergravel filter to create uplift.
<Used to be very common during the 1980s, and much appreciated in tanks such as Mbuna systems where you want to combine good biological filtration with the chemical buffering provided by a calcareous substrate. Out of fashion nowadays because undergravels generally don't work with plants, and that's the direction advanced freshwater hobbyists tend to go.>
The Emperor 280 filter's water intake tubes have a dual intake. I will have one at each end of the 75g aquarium, so water will be pulled into the filter from the bottom and middle of the tank and at both ends. Should I position the Eheim pickup in the middle of the aquarium near the water surface?
<Without seeing these filters _in situ_ it's difficult to make any pronouncements here! But here's my test. Put individual flakes of food in the aquarium at different positions and depths. Watch the flakes drift around. If they move about constantly wherever you put the flake, then you're fine. If they collect in certain corners, then you have a "dead patch". If you find the flakes drift slower at some points than others, you have inconsistent water flow. In either case, review the position of the inlets/outlets and try again. As always, theory is fine, but actual experimentation is better!>
Maybe even build a skimmer box that the Eheim pickup could pull water from in order to clean the water surface??
<Largely a waste in non-planted tanks. Surface skimmers are great for removing bits of leaves and such that float about. In non-planted tanks this isn't an issue. Rather, your problem is going to be faeces and uneaten food collecting on the substrate. Water changes will help (stir the gravel a bit each time) but my "tip of the day" is to buy a turkey baster. These are great for spot-cleaning waste in large tanks. Cheap and very effective. Also very useful for catching fry and separating eggs from mouthbrooding fish. No aquarist should be without one!>
Your expertise is greatly appreciated. Thank you,
Jay
<Cheers, Neale.>

Cichlid problem, hlth. 8/17/08
Hello again,
My T-bar cichlid has got hole in the head, all my fish are scratching, twitching and have all there fins down.
<Likely caused by Hexamita, and almost always trigger by environmental or dietary deficiencies, i.e., overcrowding, high nitrates, lack of fresh greens. Treatment is only possible via Metronidazole, couple with correction of water quality/diet.
http://www.wetwebmedia.com/metranidazole.htm
>
They are all eating normally except my T-bar with hole in the head and they have been doing this for 3 days now and they have no signs of any spots so it cant be white spot.
<Hexamita is most common when cichlids are overcrowded. Quite possibly latent in all cichlids, when their immune system becomes weakened the Protozoans spread from the digestive tract into the body and out to the lateral line. It's the ones in the lateral line that cause the distinctive pits and lesions.>
What could be wrong with them all?
Thanks
<Review environment, diet, and act accordingly. Cheers, Neale.>

Re: cichlid problem 08/18/2008
Hello,
When you said "review environment" what did you mean? My tank has lots of bogwood and a few plants with fine gravel.
Thanks.
<Simple. Take a look at all the requirements for the fish you have. Look in an aquarium book (or search this web site) to find out more about each species. Note things like water chemistry (pH, hardness), diet, space requirements, compatibility with other fish, etc. Write all these things down. Then compare them to the environment in your aquarium. Any differences between what your fish need and what you are providing will be likely sources of potential problems. Also check nitrite and nitrate; nitrite should be zero at all times, and with cichlids nitrate should be as low as practical, ideally less than 20 mg/l. Cheers, Neale.>

Cichlids With Hole In The Head 1/16/06
I have a problem with four of my Cichlids and I was hoping you might be able to shed some light on it for me. The fish involved are 1 Aurora (3-4 inches), 1 Daktari (3-4 inches), 1 Hajomaylandi (3-4 inches), and 1 Venustus (6-7 inches). All four have developed a kind of indentation on their back, between the eye and beginning of the dorsal fin. It is apparent on both sides of the fish. They are all still eating well but do seem to be swimming somewhat slower. This has appeared since new years day when, unfortunately, we lost eight fish to a temperature spike. The other fish, eight surviving originals and four new ones (purchased after the loss) all seem to be fine. I have searched for an answer but haven't found one as yet, when I found your site I thought you might be able to help. Kind Regards, Michelle. :)
< When cichlids get stressed from bad water , aggression or temperature extremes they sometimes will get a symptom or disease often referred to as Hole-In-The-Head. It is often seen in discus and many larger South American species but actually quite rare in African cichlids. Keep the water around 75-77 F. Make sure that the pH is up around 7.5. Do a 50% water change, vacuum the gravel and clean the filter. Get a fish food with Spirulina algae in it. I would try to treat the tank with Metronidazole. If you can. Try and find a medicated fish food with Metronidazole in it.-Chuck>

Cichlid May be Getting Hole-In-The-Head 10/10/06
Thanks for taking this question, I have a tank of various Cichlids and I noticed a round hole on the surface of the gill on my Brown/Black Cichlid. He seems to act fine and is eating well. Any idea what it might be? The hole looks pretty deep and I worry it may spread to other fish. Thanks for the help. Shaun
< Many cichlids come down with hole-in-the-head disease. It starts as little clear openings around the gills and head. Sometimes the entire head erodes away it not treated. The cause is not clearly defined. Some say water quality while others think it could be nutrition. Cover your bases by doing a 50% water change, vacuum the gravel and clean the filter. Change the diet and try to include more nutritious foods. Try to add more vegetable matter to the diet in the form of veggie flakes or pellets. It starts to get really bad then treat with Metronidazole.-Chuck>

Fresh Water filtration, HLLE questions 1/2/07
Hi Folks.
<<Hello, Jim, and Happy New Year. Tom here.>>
I have two large Blood Red Parrot Fish in a 55 gallon tank and am wondering what I can do to remove dissolved waste from the water like my Berlin airlift skimmer does for my 55 saltwater tank.
The other day I noticed algae growth in the fresh water tank and cleaned out the tank.  Currently I am using two large filters on this tank.  One is a Bio wheel filter (pinquin <<Penguin>> I think)  and the other is an Aqua Clear 500.
My question is what can I do to lower the algae growth and improve the over all water conditions and prevent  hole in the head worms from ever showing up?
<<As with any “problem”, Jim, eliminating the root cause is key to success. In your case, as you most likely realize, excess nitrates and phosphates “feed” the algae but lighting is, of course, another major consideration. In a great many cases, simply reducing light levels or the duration of lighting exposure can greatly reduce algae build-up in the tank. Ensuring that the aquarium isn’t exposed to natural sunlight should go without saying. As for overall water conditions, vacuuming the substrate deeply in conjunction with regular water changes is an absolute must. (When I suggest “deeply” vacuuming the substrate, I mean to the bottom of the tank.) Now, by way of explanation, Hole-in-the-Head disease (HITH) is the degeneration of the sensory organs in the head and/or lateral lines of the fish (you’ll also see reference to HLLE which is Head-and-Lateral-Line-Erosion). Even though the disease has been arguably tied to high nitrates (>40 ppm)/poor water conditions, there aren’t any “worms” involved. In reality, improper diet and lack of appropriate vitamins/minerals are the commonly-held culprits of this illness. In a nutshell, regular water changes and substrate cleaning to keep your fish stress-free along with a varied, high-quality diet will all but guarantee that your Cichlids will never suffer from HITH/HLLE.>>
Would a UV light help?
<<Not worth the money, in my opinion, Jim. You have little to no-cost options available to you – might even save some money if you reduce lighting – that make a UV sterilizer unnecessary. If, on the other hand, you have money burning a hole in your wallet and you find a unit suited exactly to your tank, water conditions, etc., it can help in reducing the “suspended” algae and microorganisms in the water. Worthless for anything that  doesn’t make it to the contact chamber, however.>>
What about a canister filter with a built in UV?
<<A better option but you’ve plenty of filtration now and, again, there are more cost-effective options to exercise here.>>
Would adding sand and live plants help?
<<Now we’re on  to something. The sand, in itself, isn’t really necessary but the plants would be an excellent consideration if your Parrotfish will leave them be. Certainly a natural and inexpensive way to go if you’re looking for something to out-compete the algae for nutrients. I wouldn’t go crazy with this without a little experimentation to see if your fish will keep from tearing them up, though.>>
Jim
<<Well, now you’ve got my two-cents-worth, Jim. Hopefully, I’ve given you something to work with. Good luck with your tank. Tom>>

Angelfish With Hole-In-The-Head – 2/25/07
Hello! I have a freshwater angelfish with HLLE for approximately 8-9 weeks.   I have read over your FAQs, and have begun supplementing her food with  vita-chem.
I don't know if I missed this information, but do you use  iodide as a supplement in freshwater aquariums? Thanks, Lea
< In FW situations the HITH disease is usually associated with poor diet, dirty water and stress. Start by doing a 50% water change, vacuum the gravel and clean the filter. Treat with a combination of Metronidazole and Nitrofuranace. The vitamins can't hurt and try a new high quality food that your fish will eat.-Chuck>

Re: FW Angelfish With HITH II – 2/25/07
Thanks for your response.  I probably should have been more specific  with my original question.  I have kept aquariums for years and I currently  have 5.
My problem lies with my 90 gal fresh water tank.  I do weekly  partial water changes with a python gravel vac.  I have two Emperor 400  filters with 4 cartridges, of which I change only 2 at a time whenever they  become dirty.  My temp stays about 78-80 and my pH stays around 7.2 -  7.4.  I have well water with a very low pH  and I use a couple of  handfuls of crushed coral scattered in the gravel to buffer the pH up.  No  ammonia, nitrites, or nitrates.  My water is crystal clear.  Only  artificial decorations ; no live plants.  The tank has been set up for  about 18 months.
My fish include 4 large angels and a much smaller one (the sick one).   All were purchased at the same time from the same tank at the same size.   The sick one appears to be the only female and she has paired with a male.   She is the most aggressive, and she was laying eggs regularly until about the  time she began to show lesions about two months ago.  The other fish are 5  large rainbowfish, 4 clown loaches, 5 blue Gouramis, 1 Otocinclus (the only one  to survive the angels) 2 Chinese algae eaters, and 6 Corydoras catfish.
All seem healthy and all eat well, including the angelfish with HLLE.   I feed a variety of commercial foods including tetra flakes, tetra crisps,  shrimp pellets, algae wafers, Tubifex and bloodworms.  I recently began supplementing with a beef liver, chicken liver, shrimp, spinach, carrot, green  pea, and garlic mixture which they all seem to love.  However it stinks and  clouds my water (which does clear after about 1-2 hrs).  I have also begun  using vita-chem soaked food as an additional treatment for the HLLE.
When I was reading your FAQs I realized you mentioned iodide as a  supplement for HLLE.  I didn't notice if it was to be used as a supplement  in freshwater tanks.  I saw it in the marine section.  I was  wondering if this was an additional step I needed to take to treat my  fish?
< No documentation of iodine working on HITH in FW.>
I have had all my fish for a long time.  The last fish I added were  the blue Gouramis around last July.  None of my fish seem stressed.   None of them lurk in corners or hang out at the top of the tank nor around the  filters.  The paired angels do like to hang near the magnet algae cleaner  where they usually lay their eggs.  Just thought you might have some  additional information for me if you knew I had already taken care of the  obvious ones.  I like pristine water and my fish actually seem to enjoy the  whole water change process.
The angelfish with lesions has a large one (sort of gray no pink color,  like her skin is just eroding away) around her head on one side, and several smaller places along her lateral line on the other side.  No other fish has  any marks.  Would appreciate any advice you can offer for additional  treatment.  I have not tried any medicines yet. Neither have I  isolated her, as of yet.
Thank you very much for your time, Sarah
< When I responded to your question I said that three things are at work to cause HITH. Your water quality sounds good, although angelfish prefer soft acidic water. The diet sounds good but I would skip the livers. The female has been stressed from spawning and was weak and susceptible to disease. I still would recommend the earlier treatment in a hospital tank.-Chuck>

Re: FW Angelfish With HITH. Nitrofuranace Vs Nitrofurazone – 2/25/07
In addition to my first reply, is Nitrofurazone the same as  Nitrofuranace?
If not, where do I find Nitrofuranace?
< Same stuff.-Chuck>

Oscar, hlth. 2/8/08
Hello. I am beginning to feel concerned about my 6 inch tiger Oscar, Dave. He has been very healthy ever since my husband and I purchased him, that is until about a week ago. It is starting to look like he is missing sections of scales on his head, right above his eyes. Today when I went to feed him I inspected him again, and the top of his head has turned a dull grey, it is usually a nice dark green, brown like the rest of him. It is also starting to look like he may have hole in the head disease. He swims sideways some times, and his head looks terrible. My husband says that he just has a mottled coloration on his head, but it was not like that before. He eats fine, and the levels in his tank are good, he swims around just as actively as always. What should I do? I do not know what to do about it or if it even something to worry about. We cannot afford all kinds of medications for a fish right now, so please tell me what you think, and if it is hole in the head. Thank you so much! Once again, Lena.
<Greetings. I can't begin to answer this without some key bits of information. Please tell me the following:
[a] How big is the tank?
[b] How much water do you change per week? (Be honest!)
[c] What food does he get? Does he ever eat live fish?
[d] What are the pH, hardness, nitrite, and nitrate?
You see, Hole-in-the-Head is very much related to water quality. Cichlids that get Hole-in-the-Head very often live in tanks with a high level of nitrate. It's a lot easier to prevent HITH than it is to cure, though some drugs work (slowly). See here:
http://www.wetwebmedia.com/FWSubWebIndex/fwhllefaqs.htm
Apart from suitable medications that kill the protozoan that causes the disease, there's no other cure, and it doesn't get better by itself.
Cheers, Neale.>

Re: Oscar, hlth. 2/9/08
Hello again, and thank you for your quick response. I looked up some pictures online of Oscars with hole it the head and they look exactly like my fish does. So he does have it.
<Oh dear.>
He is in a 50 gallon tank, eats peas, shrimp and krill, and I do a 20% water change every week. There is carbon ion the filter, so should I remove the carbon and buy some treatment for him?
<Yes; always remove carbon before treating fish. Personally, I consider carbon a waste of money, but some people like to waste money, and who am I to stop them!>
My local PetSmart has a product called "Jungle Labs Hole'n Head guard". Do you know anything about this product, or could you please suggest one?
<Have absolutely no experience of this product. Do read here for suggestions on treatment:
http://www.wetwebmedia.com/FWSubWebIndex/fwhllefaqs.htm
Since these antibiotics aren't (legally) available in the UK, I haven't used them so can't offer any great insights into their use.>
I gave limited sources for aquarium life supplies so I don't know what I will be able to do, or if I will be able to do anything. Thank you again, Lena.
<Cheers, Neale.>

Re: Dave, my Oscar. HLLE remission recounting -02/20/08
Sorry to bother you again, but I thought that I should update you on my Oscars progress. We started treating him for his Hole In The Head about two weeks ago and he looks a million times better.
<Great!>
I started a more frequent water change and gravel cleaning schedule and it really seems to help. The large holes on his head have shrunk considerably and many of the smaller ones have disappeared all together. I was wondering, for how long should I be treating him? Until all of the holes are gone?
<Unless the medication explicitly says otherwise, yes.>
Also, since he has begun healing, we have noticed peculiar horizontal lines going across the length of his body. He has two on one side and one on the other. They look almost like scratches, but there is nothing in his tank that he could have scratched himself on. It looks as though someone took a knife and ran it across his body, creating rifts in his scales. Is this normal?
<No; possibly these are signs the lateral line is damaged. On cichlids, there are two lateral lines on each flank: one arches on the main part of the body from behind the head, and another is lower down the body running in a straight line between halfway along the body to the base of the tail. If that's what you're seeing here, it's "all of a piece" with Hole-in-the-Head, unfortunately. See here:
http://www.wetwebmedia.com/hllefaqs.htm
Alternatively, fish sometimes damage one another, so do check no-one has attacked the Oscar. A photo might help.>
If it is not could you please help me to figure out what it is that he may have? Thank you so much, your site is so helpful! Lena.
<Glad to help, Neale.>

Re: Dave, my Oscar. HLLE -02/20/08
Thank you so much once again for your quick response. According to your description of the lateral line, it sounds like that is the problem with my Oscar. How can I cure him? I am already treating him with medication for Hole In The Head, will that cure the damaged lateral line as well?
<In theory, yes. The two diseases are probably caused by the same pathogen and/or environmental issues. But it *does* take a long time to get better.>
I read that bad water quality and diet cause this, but I do at least a 20% water change once a week, now that he is sick probably more like 50%.
<For big cichlids, 50% water changes are recommended. Nitrate may be the trigger; cichlids are sensitive to nitrate, and when the concentration goes up, the chances of HITH or HLLE increase. Anyway, big water changes help here, especially if your water has pretty high levels of nitrate to start with. Here in England, many cities will get water with 50 mg/l nitrate right out the tap, so you have to do BIG, REGULAR water changes to keep cichlids healthy.>
All he will eat is peas, krill and shrimp.
<Nothing really wrong there, but I'd add some squid, mussel and/or white fish to the mix. Squid is very cheap, most cichlids love it, and it is very protein-rich.>
He still eats fine, and swims around, we have now added a bubbler to aerate the water better and upped the temp up to 86. The holes in his head, like I said, seem to be healing, but will he pull through all of this sickness
<It sounds as if you're doing all the right things. With luck, he'll pull through. Cheers, Neale.>

Re: Dave, my Oscar. HLLE, reading... 3/6/08
Hello again, I know that I have written to you numerous times now, but I really don't know what to do. My tiger Oscar has HITH and does not seem to be improving. We are still treating him, and his water is fine, and for a long time he looked like he was getting better, the holes were shrinking and he ate and swam normally. We are still treating him,
<... need data... treating him with what? Not Metronidazole/Flagyl... ongoing... I hope... is toxic>
his water is fine and I do frequent water changes, but he is no longer eating, he hides almost all of the time and the holes are staying the same size now, it has also attacked his lateral line. Please give me some advice. Thank you, Lena.
<... if the above-mentioned antiprotozoal is used too much/long it will destroy nephro/kidney tissue... Please, read here:
http://wetwebmedia.com/metranidazole.htm
and
http://wetwebmedia.com/hllefaqs.htm
and
http://wetwebmedia.com/FWSubWebIndex/oscardisfaqs.htm
and the linked files above... Bob Fenner>

hemexia hole in the head or something else... Using WWM 2/14/08
Thanks for taking the time to read about my problem. I don't have spell check
<Do look on the Net proper... such programs can be downloaded for free>
and I will do my best. I have a green Severum 4.5 inches and 3 Oscars all are about 10-12 inches long. I have had one of them for about 8 years. The other two I received from someone that didn't have room for them. All these fish have been in my care in this new environment for aprox. 1.5 years.
I have a 220 gal tank upstairs that circulates into a 90 gallon tank in the basement. (overflow type) I also filter with a powerhead. I have a total of 310 gallons of water. I usually fill with a Reverse Osmosis filter
<Mmm... the fishes listed prefer/need the mineral content... in the raw source water>
when I have time but because of recent circumstances, I haven't been using it for my water changes. It takes too long and I am now on a new well that is 550 feet deep. Very good water compared to my last well. That's why I have a Reverse Osmosis filter. My new well is a little high is Iron and magnesium
<How high is high?>
but It has no taste or yellow tint . It passes all water drinking standards and If I would say "almost as good as spring water."
<I would just use this water, w/o the RO for your tanks>
My PH is 8- 8.2 Ammonia is 0, Nitrites 0, Nitrate is 10. ( not so good). I haven't tested for phosphates recently as I can't locate the test. As for my water temperature I don't usually have a heater. I did purchase one today.. My water has been aprox. 68 F now for about 3 months. In the summer it can be as warm as 79. I am raising that slowly to about 72 degrees unless you say otherwise. During my research I read that when a fish is sick that raising the temperature can sicken the fish faster.
<Mmm, can, depending on actual cause...>
Helping the hemexia or bacteria grow faster.
<Hexamita... aka Octomita necatrix?>
I am not so sure how true that is. About once a week I change out about 5 gallons of water and refill. Maybe that was not enough .Just yesterday I emptied the lower 90 gallon tank and cleaned all the rocks etc. and refilled.
I have been treating my fish for Hemixia and now with Melafix..
<The "Fix" is worthless>
I wonder if my fish have Hemexia because I used to feed them live wild shiners.
<Not a good idea>
I kept them in the lower tank for about 6 months. I caught them in my fathers pond.. They appeared to be healthy and I didn't seem to have the issues that goldfish do.( ich) My father has rainbow trout and he feeds them a high protein food.
<This food may be of value to your cichlids>
The shiners eat this for their nutrition so I thought maybe they would be a good food for my fish. The only reason my father has the shiners is because he thought the trout would like them. His trout won't eat them and there are so many it was ruining his water quality. His trout were starving for air etc.. He wanted to get rid of shiners and that is how I started using them for food. ( FYI after a lot
<No such word>
of work removing fish and pond bleaching etc.. my father did get rid of all shiners in his pond and the trout are much happier fish now)
<Ahh!>
My Oscars had a diet of these shiners and pellet food for about 6 months . I haven't fed them any shiners in about 4 months now.. And I wont ever again now that I realize the harm I brought to my fish.. Not all my fish are sick. Mostly just my tiger Oscar.. He has hole in the head recently progressing very fast in the last 2 weeks. Holes are now through his gills. I treated with a jungle Metronidazole treatment for about 2-3 days 2 weeks ago with no major improvement.
<Mmm, you did remove carbon/charcoal... the product was used as directed, at full strength...>
I know that medication is not always the answer and that maintaining my tank is probably the most important for him to get better. Recently I have noticed holes in his fins and possibly loss of scales.
<Not Hexamita here, but water quality...>
When I vacuumed my gravel today I did see fish scales ..Oh no!! I also have small white worms 1/8 - 1/4 inches long in the gravel in my tank.
<These are a third item... unrelated to the others>
In researching they appear to be somewhat harmless. Protozoa I think they were
<Uh, no... Can't see such w/o magnification>
and they are apparently eating debris in the rocks.. Should I remove or kill these small worms?
<I would not>
Another thing I have noticed recently is that my fish used to have brown pellet like stool. Now I have noticed that it is clear and stringy. Somewhat like a small clear intestinal track. More than one Oscar appears to have this symptom.
all have some signs of slight hole in the head. One is really sick with hole in the head and other symptoms that I described earlier. All are still eating at this point. I don't overfeed my fish. I wonder if maybe I underfeed them. I feed usually once every other day. Sometimes I find a bug or moth and they eat that as a treat. They do have a boring diet. They don't like homemade foods or Krill. They spit it out.
I don't want to treat my fish for the wrong thing. I realize that this can be harmful to their health. Hopefully you will have some suggestions for me. Thank you so much for your time it is much appreciated.. Amy L I will wait for your reply. Ty
<I'd return to regular water changes, use the source water straight, and read here: http://wetwebmedia.com/hllefaqs.htm
and the linked files above. See WWM re "feeding feeders", water quality... Much for you to gain there.
Bob Fenner>

I Forgot to tell you... More/less re Hexamita
Hello Again,
I just emailed a few min. ago. So you know... I have had Oscars for about 10 years. They never really got sick on me. Occasionally they did of course ,but they got better too.
I have also been adding Aquarium salt to my tank. I had put salt in the tank a long time ago upon setting up. It wasn't necessarily a large amount. I have not been adding salt as I make my water changes. I never knew that it was important for their health. I am concerned to over salt my fish now. But I am adding the recommended dose, slowly so I don't shock them. Thanks Again for your time in this matter My fish will thank you. I am working on getting you a nice picture in focus. I will send it as soon as I can. Much Thanks Amy L
<Please read where you were referred to... and learn to/use the search tool and indices on WWM. Bob Fenner>

Pictures of my Oscar possible Hemexia
Hello Again,
<Hi there Amy>
Last time tonight. I should have sent this the first time I mailed you. Here are some Pictures of my sick fish.
<Good ones too>
I marked the picture with Yellow arrows. Hopefully you can see the blemishes, scales and the holes in fins.etc.... It really looks much worse in person. It is hard to take the pictures and sending them so small that's another challenge. I hope this helps in your diagnosis. Thanks So Much, AMY
<Some of this is neuromast destruction/HLLE... Read where you were referred to. RMF>

update since yesterday... Reading
Hello guys Amy L here "Sick Oscars" 2/15/08
Thanks again, for helping me with my problems. I think things will get better soon.
My water temp. is now at 72 degrees. Should it be higher?
<I would keep it in the upper 70's F.>
ammonia still 0 and Nitrate still 10 before this water change.
I also changed more water today. I hope I don't change too much and really mess up my balances. I refilled the 90 gal. tank In my basement. The water changes are pretty easy for me to do because I just turn the valve in the bottom of the tank to empty. So I really have no excuse for not changing more than 5 gal a week. Before I circulate the tanks I also emptied another 32 gallons from upstairs tank, by filtering out my rocks. They seem pretty clean on the most part. Some areas are a little dirty. I timed how fast my overflow puts the water back in my upstairs tank. It seems that it pumps about 30 gallons in 5 minutes. So 350-360 gallons per hour. Is that a big enough pump for my tank? 310 gal total tank with 4 fish?
<Mmm, marginal... ten or even twenty times turnover would be better>
I also run a maxi jet 1200 that filters with fiber fabric to mostly get floating debris.
<Oh! This water movement counts as well>
I have not added any medications today. As I am not sure what the best one to add is. I will wait to hear from you. After reading some articles, I'm leaning toward treating with Metronidazole again and maybe a fungal medication for fin rot. What are your thoughts.
<For you to read. I would NOT continuously expose animals to this powerful antiprotozoal>
I'm closely watching my Oscars soars and maybe they are healing. Some are darkening. I think that's good. Thanks again AMY
<Darkening is a bad sign... Again... reading on WWM re Oscar Disease, Flagyl...
http://wetwebmedia.com/metranidazole.htm
http://wetwebmedia.com/FWSubWebIndex/oscardisfaqs.htm
and the linked files above. Bob Fenner>

more information about my well water quality.
Hi Bob, Amy here with the Oscars with "HLLE" 2/15/08
<Howdy>
Thanks so much for your time. I will read where I was referred thanks. I'm starting to understand your sight better now. You asked how high my Iron is in my water. My water test shows that the Sodium is 61 Do I still have to add Aquarium salt?
<... you still have to read>
This isn't the same as city water. So here it is let me know what you think. All these say mg / l is that milligrams per liter?
<Yes, equivalent to ppm>
Iron 0.27
My Manganese is <0.03
Lead <0.005
Chloride <10
Hardness 24
Alkalinity 150
Conductivity 280
Nitrite Nitrogen <0.01
Nitrate Nitrogen <0.5
pH 8.28
Copper < 0.05
Fluoride <0.2
Okay thanks once again. Amy
<Read... RMF>

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