Tank help Cichlids With Hole-In-The-Head 7/1/09 Hello WWM crew, My name is Ryan. I was referred to your site from Brian MacDonald "The Fishman". He came out to look at my tank and get my water chemistry back on track, (my pH and alkalinity were always bottoming out) which we got to a 7.0 for pH and a good rating (120-180) for the alkalinity. My tank is 210 gallons, with 2 Xp4 Filters (added an extra one almost 2 weeks ago now as per Bob's advice to Brian) 2 Power heads, 2 heaters. Water temp is always 80. One of the filters has a snorkel attachment on it which I use on full tank till I get any scum on the surface then I switch it for about 30 min to full skim then put it back, while the other Xp4 has the factory blue downspout. My Fish include: 2 Tiger Oscars, 4 Jack Dempsey (3 female 1 male, which have had eggs 3 times now) 2 Green Terrors, 1 Convict, 1 Green Severum, 1 Parrot, 1 Royal Pleco, and 1 Leopard Sail-fin Pleco. 2 Pictures of my tank with the canopy off are on Brian's site http://www.carefreeam.com/testimonials.html (these pics were taken before I added the 2nd filter) I feed them Hikari Bio Gold Large pellets, Hikari Gold smaller pellets, Tetra Pro Flakes (the ones that don’t break apart) Hikari Blood Worms, Sally's Brand Frozen Krill, and Hikari algae wafers for the Pleco. I feed 2 times a day the pellets (which I switch up day to day to keep them interested) and sometimes instead of pellets the second time of the day I will add one of the frozen food, a few blood worms or some krill. When I turn off the lights I wait for about an hour and then I will throw in some algae wafers, but that is only maybe 2 times a week. Also I feed them live earthworms as a treat when I get them from the gardens, with my worm catcher. My cleaning schedule is 2 times a week Monday and Thursday water change and gravel clean, service the 2 filters every 2 weeks, and change the micro filter pads and the 4 bags of carbon (2 in each filter) every month to a month and a half depending on how dirty they both are in the rinse off process. I was using a lot of Cycle product but after reading on your site I have stopped using it and as well as the Nitra Zorb pouches I was using in the past. (Great info on your site) Now with the stepped up water and gravel clean, those two products are not needed. Thanks for saving me lots of money. OK after all of that back story this is my problem, after keeping the tank nice and clean and doing this scheduled maintenance for about 2 months now, If and when would I notice the fish to recover from Hole in head disease? The 2 Tiger Oscars were given to me around a year ago, and they were kept for about 7-8 months in really poor conditions at the other guy's house, which I rescued them from. They both were in bad condition, but the whole time I have had them they have come back and have grown double in size. They both suffer from Hole in Head disease, and I am worried my other fish will get it or are getting it from them or my water. Brian suggested that I send in some pics and contact you guys direct for some help because he thought with my new schedule of water cleaning, they should have started to heal up. Also I forgot to say but every month I add some API aquarium salt to help them with the electrolytes and healing. I am including 4 pictures of close up night shots so they aren't moving, 1 of the 2 Oscars which you can see there hole in head, 1 of the Severum with a line running down his body I am not happy with, 1 of the female Dempsey with the same line forming as the Severum and 1 of my bigger Green Terror who never seems to heal his 2 Pectoral fins, and he has them always ripped and fluttering. Every time one side seems to heal for him his other is torn. So thanks for letting Brian know I needed better filtration already. I am so glad to have people who know what they are talking about helping me since I was lied to and pretty much screwed by the Big Al's people of Brampton into spending about $2000 in chemicals and Nitra Zorb and Cycle and pretty much anything else they could sell me, and not ever get my tank into proper standing, as your site and Brian's help did. So Please let me know what to do from here, and thanks again. < Check the nitrates regularly. You are feeding lots of different foods which is very good, but these materials create lots of nitrogenous waste. The ammonia and nitrite concentrations should always be zero. The nitrates should always be under 20 ppm. If the levels exceeded this limit you need to do more frequent water changes, change more water when you do your water changes or reduce the bioload by having fewer fish. The alkalinity issue you are having may be a sign of your problem. You fish may not be getting enough calcium in their diet. I have a theory that calcium is not found in soft acidic water. Fish found in these areas need to get the calcium from their diet since there is none to be found in the water. If you water is very soft and you have alkalinity problems then the problem may be that their is not much excess calcium to build and replenish bone structure. The skull is s very large bone on the fish and may be the first sign of a calcium deficiency. Many people who make their own fish food have added calcium to their fish food recipe and have had some success. Many of the foods you are feeding are very high quality but usually have high protein amounts that encourage grow. Growing fish need lots of calcium for growing bones. You could try to add some crushed coral to the tank to increase the calcium content of the water and try to get the alkalinity up to 200-300 and see what happens. This disease is very common on large new world cichlids but seems very rare on African Rift lake cichlids of similar size. The pH of the lakes is well above 7 with alkalinity well above 300. Some treat the fish with Metronidazole. This may he a case of treating the symptoms and not the disease.-Chuck>

African Cichlid problem
Malawi Cichlid With Hole In The Head 6/19/09
You have a great site, I have learned a lot browsing through it.
<Thank yo for your kind words>
Please help me asap!
Background:
55 gallon tank
Inhabitants: One 6-7" female Fossorochromis Rostratus (6.5 years old),
Three
1-inch female Aulonocaras
Filtration: Eheim 2213 canister filter
Nitrates: 5 ppm right before water change
Nitrites: 0
Ammonia 0
pH: 7.5
Water Change Frequency: 40-50% twice a week Food: homemade from internet recipe and Hikari Marine A Temperature: 76 F Symptoms: All inhabitants healthy with absolutely no prior medical problems.
The Fossorochromis recently began showing minor symptoms of hole in the head disease, much to my dismay. I went through a round of Metro+ and added liquid vitamins to her food with no discernible improvement, but no worsening either. Yesterday noticed a reddened area and "pimple" near her mouth and her fins were down. Suspected bacterial infection of some kind.
As I hadn't had time to research the situation fully (gram positive or negative or something else entirely) and haven't had to use antibiotics of any kind in the last 6 years of this hobby, I added the only thing I had on hand, Pimafix. Yes, I am aware that is like giving herbal remedies to an MSRA patient, but I had nothing else and live an hour from the nearest pet store. This morning her fins are back to normal intermittently but she is breathing very hard. I added an air stone and am in the process of changing the water yet again to increase oxygen content. She appears to be breathing easier now, but not back to normal. I own nine freshwater aquariums and fortunately have never seen this before so I don't know what is going on.
All the rest of the inhabitants in her tank are just fine. Any ideas are welcome! Thank you for your time and suggestions. Rebecca < There are ideas about the causes of hole in the head disease without any scientific evidence to back them up to my satisfaction, but you have eliminated some of the theoretical causes. Some people think it is bad water. This is not the case because you water conditions are fine and you are up on your water changes so it is not nitrogenous waste either. This comes down to diet. Usually food with fish meal contains enough calcium for fish to build their bones as they grow. Since you make your own fish food it is hard to tell if your food has enough calcium in it. Larger fish need more calcium to replenish the calcium needed to build their bones. Try Spectrum New Life pellet food for awhile and see if this makes any difference. I have never had a problem with HITH while using this food. If this works then in your situation we may have found a possible cause and cure.-Chuck>

Update on African Cichlid situation... hlth.
Malawi Cichlid With Hole In The Head 6/19/09
Thought I would add an update. After the massive water change, which rid the tank of Pimafix, the Fossorochromis in question returned to breathing and acting normally, so maybe her problem was due to that.
<Possibly>
I don't plan to use that product again.
<I would not>
However she still has the small raised red bump by her mouth and the beginning HITH situation.
<Likely best cured by providing ongoing optimized water quality and nutrition>
I will refrain from adding any more medication, herbal or otherwise, without strong recommendation.
Thanks
for your time.
Rebecca
<Thank you for sharing. Bob Fenner>

Re: African Cichlid problem
Cichlid With HITH 6/21/09
Thank you for your advice. The reddish sore resolved into another small HITH-like hole, but at least no infection. She is acting normally. I am purchasing Spectrum New Life pellet food online as I write this and implementing daily 25% water changes just in case. I will update you on the
results as soon as something changes. Thanks again. Rebecca
< Try to increase the calcium content of the water by adding some crushed coral to the filter. As it dissolves into the water it may be ingested by the fish.-Chuck>

Re: African Cichlid problem
Hole-In-The-Head Treatment 7/1/09
I purchased the recommended New Life Spectrum food. Until the food arrived, I added powdered calcium to the water and a little to her food as well as a big mesh bag of crushed coral. Since following your advice, one hole has gotten so small I have a hard time finding it, the other two don't seem to have changed too much yet (although all redness is gone), and no new holes are forming. She looks and acts normal and I have high hopes that she is recovering. Thank you for sharing your theory and giving a friend back to me! I will update again when something major occurs, such as (hopefully) her complete recovery. Rebecca
< Thank you so much for writing back. It is times like this that makes me glad that your question was asked and that all fellow aquarists and their pet cichlids might benefit from our WWM forum. Hopefully the recovery will continue and this disease will no longer become an issue.-Chuck>

Old Frontosa With Hole In The Head  06/03/09 Hi guys, I have a frontosa. He is about twelve years old. I have medicated him with every thing I can think of, Nitrofuranace and Metronidazole. If I am not mistaken it is hole in the head?, You cannot see it very well in the picture but that is a deep hole on the side of his face not just surface. and he also has transparent grape like clusters by his eye and his face is pitted pretty bad, am I right about the hole in the head? < That is definitely Hole-In-The Head.> He has had this for a about two years, I have been thinking about putting him down with Finquel. I am sending you some pics. If the pics are to big, please let me know and I will try to make them smaller. Thank you Michelle W. < Thanks for the pictures. Your frontosa is very old and may not respond to the medication. First lets start with the water quality. The ammonia and nitrites should be zero. The nitrates should be under 20 ppm. The pH should be as close to 8.0 as possible. The water temp should be around 82 F. The diet should include a high quality pellet with fish meal as a major ingredient. Now that he is sick you should try and feed him some medicated food with Metronidazole in it. Your fish has been sick for a very long time and his age makes recovery a very slow process. You used the right medications, it is just that in hard alkaline water these medications are not as effective.-Chuck>

Hole in the head??
Angelfish with Internal Infection   2/20/09
Hi Folks; I love your website. A goldmine of information I wish I knew about a year ago. My problem- I have an angel fish who started acting lethargic, and would float around the corners of the tank (55 gal) at an angle. I didn't know what to do, so I hoped it would just pass. I waited two days and my wife noticed a red spot near his gills that is now a hole.
Two days after I first noticed his symptoms, I found your site. I immediately setup my old 20 gal as an emergency hospital tank. I couldn't wait for cycling so I transferred him.
< Usually cycling is not needed because if you do medicate the tank, the treatment would affect the bacteria anyway.>
Before I transferred him he had taken to lying on his side in the tank. I have removed the carbon filter from the hush 35 filter I use for that tank and medicated with Jungle Tank Buddies Parasite Clear, as it contains Metronidazole (which you recommend).Since transferring him, I can't say he is any better but he also doesn't seem to be worse. If I tap the tank gently, he gets up and swims around for a couple of minutes and then settles in again. I am unsure of how to proceed, what to watch for. or if he will make it.
He came from my 55gal tank (which I have also medicated the same way. I have noticed some different skin markings on one of my Gouramis and one of my Bala sharks.
History of the 55 gal tank is good. I almost always do a 20% water change every week. I did miss a week just before I noticed my angel fish acting strange. I keep a computer log of all my water readings, observations and treatments and I have a full year of data.
My pH occasionally drops to 6.0 in a week, but usually only drops to 6.3 I try to maintain 6.8 to 7.0 My ammonia is almost always 0, same for nitrites. My nitrates usually climb to 20 or 30 in a week, but the water change seems to correct that. My water is almost always crystal clear. I use a penguin 350 filter with bio-wheels to keep the water clean.
I have a leopard Plec, another Plec I inherited from my daughters tank (pepper Plec I think) a small striped orange and black algae eater, 3 Bala sharks, 2 Gouramis, a red tail shark 2 neon tetras and 3 fish I don't know the names of (sorry). Feeding has always been Nutrafin flake food and occasional freeze dried bloodworms. In the last 2 months, I have twice put zucchini in the tank, and today a small piece of carrot.
< The squash and carrot contain land based plant cell walls that may not be digestible by the angelfish. If the fish cannot digest these things then bacteria in the gut start to work on them. This may cause an infection and
a blockage. This may be the cause of the problem.>
I think that the tank has been well looked after and maintained, and because of that I rarely have to add anything but tap water conditioner and Prime (by Seachem) at water changes. I keep the 55 gal tank at 76 F and my emergency hospital tank has been 78 to 79 F. I am currently raising this to 81 F because I understand that the angel fish will do better in the warmer water.
Can you see anything I have missed? I tried to find Jungle hole in the head treatment, but it is not available in Canada.
Regards Floyd
Abbotsford BC
< I would recommend using Nitrofuranace in addition to the Metronidazole.
The Nitro is a wide spectrum antibiotic that may be absorbed into the fish.-Chuck>

Hole in the head??  FW Angel, dis.   2/20/09
Hi Folks;
<Floyd>
I love your website. A goldmine of information I wish I knew about a year ago.
<Ahh!>
My problem- I have an angel fish who started acting lethargic, and would float around the corners of the tank (55 gal) at an angle.
<Unusual beh.>
I didn't know what to do, so I hoped it would just pass. I waited two days and my wife noticed a red spot near his gills that is now a hole.
Two days after I first noticed his symptoms, I found your site. I immediately setup my old 20 gal as an emergency hospital tank. I couldn't wait for cycling so I transferred him. Before I transferred him he had taken to lying on his side in the tank.
I have removed the carbon filter from the hush 35 filter I use for that tank and medicated with Jungle Tank Buddies Parasite Clear, as it contains Metronidazole (which you recommend).
<Yes>
Since transferring him, I can't say he is any better but he also doesn't seem to be worse. If I tap the tank gently, he gets up and swims around for a couple of minutes and then settles in again.
I am unsure of how to proceed, what to watch for. or if he will make it.
<Mmm... best to wait at this point... Am suspecting something internal... not really/easily treatable>
He came from my 55gal tank (which I have also medicated the same way. I have noticed some different skin markings on one of my Gouramis and one of my Bala sharks.
History of the 55 gal tank is good. I almost always do a 20% water change every week. I did miss a week just before I noticed my angel fish acting strange. I keep a computer log of all my water readings, observations and treatments and I have a full year of data.
My pH occasionally drops to 6.0 in a week,
<Mmm, I'd be bolstering the alkalinity. Please read Neale's excellent piece
here re: http://wetwebmedia.com/FWSubWebIndex/fwsoftness.htm
and the first linked FAQs file at top>
but usually only drops to 6.3 I try to maintain 6.8 to 7.0
<This is a huge variation in a week... Again, I'd avail myself of a simple prep. even just Baking Soda...>
My ammonia is almost always 0, same for nitrites. My nitrates usually climb to 20 or 30 in a week, but the water change seems to correct that. My water is almost always crystal clear. I use a penguin 350 filter with bio-wheels to keep the water clean.
I have a leopard Plec, another Plec I inherited from my daughters tank (pepper Plec I think) a small striped orange and black algae eater, 3 Bala sharks, 2 Gouramis, a red tail shark 2 neon tetras and 3 fish I don't know the names of (sorry). Feeding has always been Nutrafin flake food and occasional freeze dried bloodworms. In the last 2 months, I have twice put zucchini in the tank, and today a small piece of carrot.
<Ah, good>
I think that the tank has been well looked after and maintained, and because of that I rarely have to add anything but tap water conditioner and Prime (by Seachem) at water changes. I keep the 55 gal tank at 76 F and my emergency hospital tank has been 78 to 79 F. I am currently raising this to 81 F because I understand that the angel fish will do better in the warmer water.
<Yes...>
Can you see anything I have missed? I tried to find Jungle hole in the head treatment, but it is not available in Canada.
<Is largely Metronidazole/Flagyl as well... Again... am suspecting that this Angel has other than an Octomita/Hexamita issue. Only time can/will tell here.>
Regards
Floyd
Abbotsford BC
<Thank you for sharing, writing so well. Bob Fenner>

Follow-up to hole in the head?? question   2/22/09
Follow Up Treatment of Angelfish
Thank you for your responses. I went out and bought Furan2, it contains Nitrofurazone (couldn't find a treatment with Nitrofuranace). I medicated with 2 capsules of powder ( the recommended dose on the label). I also bought a general and carbonate water test kit. General hardness was 3.92DH and the KH was 40mg/L as CaCO3. I will stay on top of the situation and hopefully save my little angel fish.
Observation - after the Metronidazole treatment but before Nitrofurazone treatment, I found he had even less energy, but seemed to be gasping a little bit less. Also, his sense of balance seems to have improved slightly. I hope the resolution of this problem helps others as well. I had no idea that the pH swings were caused by poor reserve of alkalinity.
Regards Floyd
Abbotsford, BC Canada
< The medications will take time to work. The Furan II should be as effective against internal bacterial infections. Go back to the WWM page and search alkalinity to give you some idea on where you are.-Chuck>

Help with sick Severum Severum Starting To get Hole-In-The-Head 9/9/08 Hi, I have a 200 litre aquarium which has 5 angels, 1 Oscar, 1 silver shark, 1 bichir, and a breeding pair of Severums. All fish are totally fine expect for the Severum which has been getting strange white bumps around his eyes and on his head for the last few days. I have attached a picture, I wonder if you could advise what is wrong with my fish and how to treat it?? Many thanks Jason Ingold < It looks like you Severum is showing the first signs of Hole-In-The-Head disease. After the pus filled blisters pop a hole is left in its place. The holes continue to grow eating away the skull. There are some ideas to what the cause of this disease could be but no exact pathogen has been identified. The stress of breeding could have weakened your fish and made them vulnerable. If it was my fish I would place it in a hospital tank with clean warm(82 F) water. Treat the tank with Metronidazole and Nitrofuranace. If the fish is still eating then feed a medicated food with Metronidazole in it. Generally I would try to improve the diet with a quality pellet food. If you fish is still eating I would try a little trick I stumbled on a few years ago. I had an south American cichlid like yours that just started to get the disease but was still eating. He especially love black worms. I took the portion of black worms in a little plastic cup with some water and medicated the worms with the dosage of Metronidazole. The worms died right away and I quickly fed them to my fish. The fish were unaware that the worms were dead and ate them all up. The lesions turned black the next day. I did a major water change, cleaned my filters and got some fresh fish food that was high in vegetable matter. I felt that this would provide the minerals my fish may have been missing. Hope this helps.-Chuck>