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

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

Related FAQs: Freshwater HLLE 1, FW HLLE 2, & FAQs on FW HLLE: Causes/Etiology, Non-Cures, FW Case Histories, SW Case Histories, & Marine HLLE: HLLE 1, HLLE 2, HLLE 3, Nutritional Disease, Aquarium Maintenance, Freshwater Medications, Freshwater Infectious Disease, Freshwater Fish Parasites, Ich/White Spot Disease, African Cichlid Disease 1, Cichlid Disease,

Oscars and Hexamita      1/31/17
Hello, i have had so much of a problem with Oscars and i hear they are supposedly hearty fish.
<Sort of. While they're big, they're also notoriously sensitive to water quality. This is true for most big cichlids. Virtually all problems with Oscars come down to poor environment or poor diet. Often a combination of both.>
I used to have 2, 3 inch Oscars one was a black and red tiger Oscar and the other is an albino.
<Used to have...? What happened to them...?>
I have/had them in a large hexagonal tank, when i got the tank i didn't know how many gallons it was cause it was donated to me. So, i took measurements of it and found out its a 20 gallon even though it looks bigger than just 20 gallons.
<Regardless of appearances, 20 gallons is MUCH TOO SMALL even for three inch long Oscars. Once they get past the "fry" stage, Oscars are jumbo fish. I'd be looking at 55 gallons, minimum, for juvenile Oscars; adults
should be provided with at least twice that.>
Last spring i got the Oscars to fill the tank and i love them very much except a couple weeks after i got the Oscars the tiger Oscar (his name was Julius Caesar) developed Hexamita on his left gill that just kept going and going until it ate down his lateral line and completely through his tail.
<Absolutely typical reaction to poor environment. Now, the thing here is that while everyone focuses on ammonia and nitrite (with an "i"), with cichlids, nitrate (with an "a") is the silent killer. Cichlids are extremely sensitive to nitrate. Because Oscars are big, greedy feeders the nitrate level in their tanks can go up very quickly. Anything above 20 mg/l
is stressful, and anything above 40 mg/l will make them sick. A big tank dilutes nitrate, while substantial weekly water changes removes nitrate.>
It infested his jaw so bad that when he died he didn't have a lower jaw left, i felt so bad for that fish. When i went to my very informed fish store owner who has had and sold fish for more than 20 years he recommended to me that i use Metronidazole, it was MetroPlex by SeaChem. a little bit in a bottle for 16 crappy dollars that didn't do anything to help my poor Julius.
<Metronidazole is the correct medication. However, it will not do anything if the environment is wrong
. It's kind of like trying to treat someone for burns without pulling him out of the fire.>
I treated that fish just about the entire time i had him. Up until about two weeks before he died (this went on for 6 months) he had a healthy appetite, had bright colors, wasn't swimming around erratically and bumping into the tank out side of the regular symptom of Hexamita where they will swim backwards or lay on their side and he would only use the one effected gill sometimes.
Some days id wake up and look at him and he wouldn't use it at all and then the next day he would be using it again. I did regular water changes and gravel vacs i tried MelaFix and PimaFix both were completely useless
<In this situation, yes, useless.>
but i ended up using all of it anyway because it seemed to help with their gill flapping a little bit , the store owner recommended to me that i separate the fish because they would contaminate each other, and i used the MetroPlex and Metronidazole treated food except none of it made the one Oscar better. I didn't have the space to separate them so i just kept them together instead of getting rid of the other one because i figured treating them both would help keep the other from getting infected also (i am too attached to these fish) but the albino Oscar never showed any symptoms or
had any problems.
<Oscars are inbred now, and there is variation among strains, some being tougher than others. Luck comes into play too, and being territorial, non-sociable fish, dominant fish will stress other fish kept with them, weakening their immune systems. So one fish getting sick while another stays healthy isn't unusual.>
He wasn't getting the hex his fins were nice he is bright and active all the time never had any Finrot or PopEye or constipation always has a good appetite. Except now he has been alone in the hexagon tank since September
2016 and its now January. I stopped the treatment of Julius two weeks before he died because he stopped eating completely the medicine wasn't helping and i didn't have the stomach to euthanize him myself, i cant handle killing with my own hand.
The week he died i was sick home from school and i remember watching him lay on the bottom and his gills just stopped flapping so i took him outside a buried him with a little gravestone and a small tree.
<Oh dear.>
However now the last day of January 2017 i noticed the albino Oscar has similar Hexamita pits by his but hole on his side and some very small holes on his head, they look different like somebody took a pencil and poked holes clean through my Oscars head, they aren't sores they're holes. He still has a good appetite. And looks/acts well, i removed the common Pleco and all the tank decor a week ago because i though they might be the source of my Oscars wounds, but the wounds haven't gotten better only bigger.
<You should not be keeping Oscars and Plecs together, certainly not in such a small tank. Plecs add substantially to water quality problems, and in some cases they will scrape at the mucous from large cichlids, causing physical damage and stressing the fish.>
Iv been doing small gravel vacs and water changes every couple of days. Not a 30% change but just a jug that i had it take about 5% of the water out and i just fill that with whatever i can get from the gravel every day or two.i feed my Oscars what ever fish food i have, i don't have a scheduled and marked calendar diet for them but they get a variety of food that being frozen brine shrimp, baby brine shrimp, live brine shrimp, krill, very little bloodworms, Hikari cichlid gold pellets, metro soaked pellets, wax worms, crickets, and sometimes flake food, and peas once in a while, I gave them
some cooked tilapia once too but it was a long time ago and im going out today to get him some live black worms and some ghost shrimp. I use test strips to test the water, ammonia and nitrites are always at 0 ph is 7, the water that runs from my tap is hard water but it has no chlorine.
<The fundamentals of the way you're keeping this fish are right, but I fear tank size is the killer here.>
The water is a little more alkaline than it is acidic, its was at 7.6 that last time i tested except i lost my job and have no more test strips so i have no idea where its as of this very moment The nitrates fluctuate a lot sometimes i find they are really high(which i then do a larger water change) and sometimes i find they'll be really low.
<See above why this matters.>
To put it at an average id say about 25-30 ppm. I have a 40 gal filter on it that has carbon filter pads in it (i would remove the carbon when treating my Oscars) and a light, i live in a very warm room and between the light and my room warmth with the sun by my window anytime i put my fingers in the tank the water is comfortably warm.
<Oscars are tropical fish, and exposure to low temperatures is quickly lethal. Anything below 22 C/72 F should be treated as dangerously low.>
I have an air stone that i rotate between my 5 gal my 10 gal my 2, 20 gals and a 75 gal that houses two very large jack Dempseys i have had fish for 4 years now and all of my tanks are established through the filter cycle.
Please help the fish store owner got stumped and told me i should euthanize Julius before he died and now my last Oscar is starting to get sick and i don't know what to do cause iv started using the metro soaked food and the sores on my albino are only getting bigger with every dose just like Julius had and i don't want to lose my Oscar. He is the light of my bedroom i fall asleep every night watching him swim.
<The 75 gallon tank is where the Oscars need to be!>
Could it be something wrong with the tank?
<Yes; it's too small.>
Is it possible Hexamita can be a genetic thing?
<Nope. Nitrate above 20 mg/l is a problem, and unless you're doing daily water changes, it's unlikely you can keep nitrate that low with one or two Oscar juveniles in a 20 gallon tank. Cheers, Neale.>
re: Oscars and Hexamita      2/3/17

Thank you Neale for your advice.
Ill put the Oscar in with the jack Dempseys and see how they get along
<Wouldn't hold out much hope here. Adult JDs can/will pulverise juvenile Oscars if they feel their territory is being encroached. Oscars are not really "fighters" outside of breeding, whereas JDs can be extremely territorial. Not always, but often. I'd be watching these fish very carefully. I'd remove the JDs first, rearrange the tank so territories are
broken up, add the Oscars, turn the lights out, leave it like that for half an hour at least, then re-introduce the JDs. Standard operating practise with territorial cichlids, really.>
and if they don't like each other ill get him a bigger tank
<Do suspect this is on the cards; I'd start looking now! Cheers, Neale.>

Hole In the Head in Goldfish. Furan, Metronidazole f's      4/11/14
I thought I'd share this video with you guys: http://youtu.be/rcpcz5x9XIU
I've learned so much from your website. Thank you for all that you do.
<Ah, I thank you. Bob Fenner>
Kind regards,
*Cynthia | East Coast Ranchu*
646.657.8577 | www.eastcoastranchu.com
Ranchus for Sale: CLICK HERE <http://tinyurl.com/new-ecr-ranchus>
><{{{*> doing good things for the hobby ><{{{*>

Jellybean Parrot has bumps/white spots, please help me identify
Jellybean Parrot Cichlid With HITH 11/21/10

I have a jellybean parrot fish that is about 7 years old. It has recently developed white bumps/spots on its head. My husband thought the change in her appearance was due to age and so he dismissed it. He thinks he first noticed them about a week ago. I've attached two photos. The large bump in the center of her head is actually a cluster of bumps. It is white on the surface and somewhat fluffy in appearance with a red coloring underneath. As I'm hoping you can see in the photo, it is a protruding growth. There is a line of smaller white spots along the back of her head.
The top of the fin on the left side of the second photo also appears to be abnormal in shape/color. The pale areas of the body are her normal coloring. She is eating and behaving normally.
She is in a 55 gal tank with a rainbow, a catfish (I don't remember what breed) and several tetras. The last water change was 5 days ago and may have been a little overdue but not much. We do not have a quality test kit, only the simple strips. The water had not been tested in a long time and when I tested tonight the levels were not good. The nitrate level was 80, nitrite 3, pH 7.2, alkalinity 80 and the water was hard 150. My husband is doing a 25% water change now. The temperature of the tank is 76 degrees.
I've tried to research the problem online but have only become more confused. I do not want to treat her for the wrong thing and cause more problems. I'd greatly appreciate your opinions.
Thank you! Kim
< Your cichlid has Hole-In-The-Head Disease. First get a nitrate test kit.
Get the nitrates down to under 20 ppm with water changes. The lower the nitrates the better your fish will be. In a hospital tank treat with a combination of Metronidazole and Nitrofuranace. If you fish is still eating
then start feeding medicated foods with these medicines in it. I would still treat the water too. The key to a full recovery is an early treatment.-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!
55 gallon tank
Inhabitants: One 6-7" female Fossorochromis Rostratus (6.5 years old),
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.
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.
for your time.
<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>

Re: African Cichlid problem
Hole-In-The-Head Cured on African Cichlid -- 10/3/09

I apologize for taking so long to get back to you and I want to thank you again for your advice. My female Fossorochromis has fully recovered and does not seem to be having any further issues with hole-in-the-head. I am feeding her (and all my African cichlids) New Life Spectrum food along with krill and small shrimp. Once a week I supplement her food with a little calcium and glucosamine (which is apparently derived from shellfish and shrimp shells). I have also added crushed coral to her canister filter media. Everything seems to be going well now and has been for the last few months. Thank you, Rebecca
< Glad to hear everything worked out OK.-Chuck>

Oscar With HITH 02/06/09 I have seen much info. on the site about treating HITH by medicating the food. I purchased General Cure (API) Brand which contains 250mg Metronidazole & 75mg Praziquantel per packet (box of 10). The directions say to treat the water, 1pkt/ 10 gal. He is in a 55 gal tank. I know if I put him in a smaller treatment tank he will be unhappy and fear he will go off food. Since my Oscar is eating well I would rather treat the food. Can this combination of meds be used in treating the food? If so, should I use the same dosage you have recommended for the metronidazole (1/2 t / 4oz.)? < Treating the food as recommended is a big advantage over treating the entire tank. I would also recommend a change in diet to a high quality pellet food and checking the nitrates to keep them under 20 ppm.> Other info: The Oscar does not have white / slimy poo. I received him from a petstore when the previous owner could no longer care for him. At that time he had what appeared to be fin rot as well as a small pin sized hole in his head. He was being kept in a 10 gal tank before I received him. He was lethargic and off food. I treated him w/ Melafix for the sores which have quickly healed. He began to eat about four days after I put him in the 55 gal. tank and treated w/ Melafix. The hole however has grown slightly larger in the last three weeks It started in one sensory pit and has now eroded an entire cluster of pits. I have been taking pictures every few days to monitor its progress. < Treat the food as recommended and keep up with the maintenance. Generally it is believed to be a symptom of a dietary deficiency with a combination of a pathogen feeding on a weakened host.-Chuck>

Hole in the head disease 11/16/08 Only one of my Oscars have hole in the head disease. I have two in the same tank. Should I treat all the fish or remove the sick one and treat him in another tank?? Thank You and I love your web site VERY HELPFULL! ;) <All should be treated. Please read here: http://wetwebmedia.com/HLLESWCauseF.htm and the linked files above. Bob Fenner>

My Frontosa, HLLE tissue damage - 7/1/08 Hi, I wrote you before about my Front, Georgie and his hole-in-the-head problem, and that I treated him with Medizole and Furnace, I then noticed it looked like fungus so I treated him again with just the Furnace, It looked like it went away but his holes didn't look any better, so I then treated him with some medication called Hole-in-the-Head by JUNGLE, and he still looks like this, is there any hope? <To heal the wounds from the neuromast destruction? Mmm, yes... with time, good nutrition, water quality...> ( I sent you a couple pics) I have had him for a long time( we think he is around thirteen years) and he has always been healthy but know I am at a loss, usually when I treat my fish I have good luck if I catch it right away, I am sending you a few pics and see if you can see what you think, Thank you for your time, John Cline <Have seen worse cases remit. Do try feeding Spectrum pellets exclusively, being religious re weekly water changes... Read here: http://wetwebmedia.com/hllefaqs3.htm and the linked FAQs files in this series above. Bob Fenner>

Cichlid With Hole-In-The-Head 4/8/06 I have a 9' red flame cichlid that has developed raw spots on its head (above the eyes and below the dorsal fin, and between his eyes) they developed after his tank mate died about 3 weeks ago. The spots seemed to have blood circulating to them because I see red within the areas. I do 25 -30 % water changes about every 10 days (55 gal whisper 3 filter) I have also been adding aquarium salt (1 tablespoon a day for three days now). I have had the water tested and is within the norm. He is the only fish in the tank and has stopped eating for at least 4 days, spends a lot of time on the bottom. When I turn on the light he comes to the top to eat, if he even bothers to take any Hikari cichlid gold pellets, he just seems to swim backwards any spits them out. These spots are not deep; they seem to be just on the surface. The one above his eyes is approx ½' across and slowly getting bigger. He has had these spots before but this big and not for this long. Any help you can provide would be much appreciated Thank you Dave < Do a 50% water change, vacuum the gravel and clean the filter. Treat with Metronidazole and Nitrofuranace. When he starts to eat , offer some live food live washed earthworms, and watch for ammonia spikes because the medication will affect the biological filtration.-Chuck> Hole in the Head and Eye Problems ... Oscars - 03/27/06 Hi WWM Crew, I have had Oscars since 1980 and never had any problems with them before. I believe that is because I pay such careful attention to water quality and diet. However, just recently one of my two 12" Oscars starting laying on the bottom and gasping for air. This has gone on about a week. The pH, Nitrates and Ammonia are perfect. I feed them Hikari pellets. The one in question has one boated eye and lays on the bottom of the 80 gallon tank. If I reach in and touch him he has good energy and swims strongly across the tank. He can also come up for food but lately I can tell it is getting harder for him. The only other symptom is a slight hole in the head which I treat but can never seem to make go completely away. I have tried Maracyn TC as I thought it was bacterial. Then MarOxy as the Maracyn TC did nothing so maybe it was fungal. This also did nothing. I have tried salt and several water changes but nothing seems to work. Any thoughts? Art <Most eye problems, as well as Hole in the Head, start when too much organic matter starts to build up in a tank. Please re-test the water. After a few rounds of meds you have probably lost your cycle. Also, when doing a water change always use a gravel vac to remove as much waste as possible. Hole in the Head is caused by a protozoa. Metronidazole is the drug of choice. However the wounds caused by the protozoa can become infected by bacteria or fungus. Keeping your system pristine will help greatly. This will also help with his breathing and eye problems. Should the eye begin to swell, add Epsom salt at the rate of one tbls per 5 gallons. Replace the Epsom salt in the new water when doing a change until the swelling goes down. Don>

Gouramis With Hole-In-The-Head - 05/23/2006 Hi there. OK. My eyes hurt. Been reading your FAQ's. Can't find definitive info on what I'm looking for. I seem to have a Hole in Head "outbreak" in my aquarium. I have a 60gal, heavily planted, tank; plenty of lava stone and wood for hiding. Penguin 400 filter, CO2 diffuser, 17 Gouramis, a Pleco and a small Cory. Water changes are every other week, (sometimes weekly if I think it needs it) Filter cartridges rinsed bi-weekly, changed monthly (per advise of LFS). Ammonia 0, Nitrite 0, Nitrates tend to be in the hi 20's, touching 30, but I attribute part of that number to plant fertilizers. Some products tote amazing cures, some say nothing helps Hole in Head. Any suggestions on how to rid the fish of this? Also.. is this contagious like Ick? I do see it on 2 or 3 fish, but not the other tank mates... at least not yet. Thanks. You guys are great John < Usually this is a problem with some New World cichlids and not associated with Gouramis. Do a 50% water change, vacuum the gravel and clean the filter. Treat the tank with Metronidazole and see if that helps. It could just be a bacterial infection and it may respond to antibiotics like Kanamycin. If you do decide to use antibiotics then watch for ammonia spikes because it may affect the biological filtration.-Chuck>

Oscar With Hole-In-The-Head 9/12/06 Hi crew. I have an Oscar which appears to have a hole in the head. I am not sure whether it is HITH disease. It appears to be very dull. Can you help me out with the cure and other things to cure it. Thanking you <Do a 50% water change, clean the filter and vacuum the gravel. Upgrade the diet top include more live and frozen foods. Treat with Metronidazole and keep the lights off.-Chuck.> Gold Severum.........is this hole in the head? Asymmetrical? No 8/14/06 hey guys, first off, great site as always. I have had a 150 gallon(6 foot tank)) setup for quite some time. Currently housing 6 inch gold Severum 7 inch Jack Dempsey 3 inch Oscar 4 inch Red jewel 3 1/2" Green terror (2) 5 inch banded Leporinus 4 inch Gibbiceps Pleco 8 Buenos Aires tetras <Must be fast!> I have 2 Emperor 400's for filtration <And lots of big regular water changes I hope> Recently I had a aggression problem that caused me to have to give away my 6 inch Green Severum, as he was attacking the Gold Severum often, and when he wasn't, he was extremely aggressive going for food. Since then I noticed that what I originally thought was a bite wound on the side of the Gold Severums face has not healed. As i look at it now I am thinking that either the wound is not healing or they may just have been open sores from the beginning. Both are on the left side if the head, behind the eyes, and before the gills. There is no "pitting" as i have seen HITH described, however it does look like the larger sores I have seen in HITH pictures online. <Mmm...> Would treatment of non-healing wounds be much different than a treatment for HITH (if that's what this is?). <Are identical... improved nutrition, and water quality... sometimes coupled with the use of a protozoacide> I will add that i had been lax with maintenance these last 2 months the last 2 months of my wife's pregnancy), however, It had always been top-notch until now. <Oh> Hopefully i can solve with increased maintenance, and frequent water changes for a few weeks. Since i prefer not to have to set up a hospital tank if I can avoid it. <I would not here> Also, one last question. Regarding stocking. Will this tank be able to handle another Oscar without having to displace the current inhabitants? <Not a good gamble, no> I realize that having two fish that will be 12 inches long each may tax even this tank. Thanks in advance for any help you can throw my way! <If the pitting is not "symmetrical... bilaterally", that is, about the same on both sides of the fish, this is not likely HLLE, HITH... but "just" sores or pitting from poor water quality. Bob Fenner>

Experts Asking Experts, Hole-In-The-Head On A Flowerhorn 12/19/06 Good morning, Crew! I hope this day finds you well. Inspired by your example, I have been helping people with their fishy questions by volunteering at AllExperts.com. So far, everything has been very straightforward, but yesterday a gentleman overseas asked me about his Flowerhorn. I hope you don't feel that I am asking you to "do my homework" for me, but before I suggest any other treatment besides salt, I wondered if you wouldn't mind sharing your opinions on what appears to be wrong with this cichlid. Before he sent me the pictures, I told him it was probably Head and Lateral Line Erosion (HLLE). Although the pattern of erosion is not what I expected to see based on his descriptions, I still believe that HLLE is the causative agent here - but I wanted to double check with the real experts! Thank you so much for your assistance, you have always been so reassuring and helpful. There are so few free resources like this on the web at large...what you have here is remarkable. Happy holidays to all of you! I hope that a fab getaway is in your future! Nicole < The exact cause is not known. Generally a 50% water change, vacuuming the gravel and cleaning the filter improves the water quality and slows the progression of the disease. Treatments of a combination Metronidazole and Nitrofurazone have had some success. Some aquarists have also had good luck with Clout. After treatments have arrested the disease, a more nutritious diet with fresh ingredients and high vitamin and mineral contents speed the recovery. Vitamin C seems to be a key vitamin in getting a full recovery. many Flowerhorn breeders are obsessed with color and developing the fatty hump on the males. These high fat diets usually develop into diseases like bloat and the hole in the head that this Flowerhorn seems to have.-Chuck>

Chocolate Cichlid With Hole-In-The-Head Disease 3/27/07 Hello; I thank for the great website. My experiences as an aquarium keeper have been greatly enhanced by what I have learned on your site. I purchased a 4 inch black ghost knife, and a 3 inch chocolate cichlid two days ago. They are both in quarantine in a 30 gallon tank; 79F, 0 ammonia & nitrites, nitrates 10-15. The tank has been running with a Pleco and Synodontis (and a few other temporary 'guests') for about a year an half. The BGK and chocolate cichlid are to eventually move into a 100 gallon Amazon tank. The problem and question: After looking at the chocolate cichlid closely, he appears to have HLLE small lesions behind the eyes on both sides of his head. Three or four holes on each side. If I do a treatment with Metronidazole on this tank will I be endangering the black ghost knife? < The BGK should be unaffected by the treatment.> I've read about their sensitivity to medications. < They are mainly sensitive to dyes.> I plan to treat the tank every two days, after 30% water changes, as the package instructions state, for ten days. Then, follow up with a good diet and added vitamins. Any other suggestions or information greatly appreciated. Thank you very much in advance, Anna < Should like a solid game plan.-Chuck>

Repeated hole in the head disease, Metronidazole Treatment For HITH - 6/1/07 > My T bar Cichlid is suffering from his 3rd bout of hex this time he has a small visible pin sized hole above his eye and the usual white strongly pooh. Last time in September 2006 I treated the tank with Metronidazole 5mg/L and he recovered well. I have done a water exchange today and added metro at 5mg/L. Is this repeated dosage likely to harm my other fish? 2 cat fish 3 rainbows, 2 giant Danios and 1 rosy barb? < If treated as recommended this medication should have no effect on the other fish.> > Also do I need to do 50% water changes in between adding the dosages on the 2nd 4th and 6 days? < Metronidazole is affected by organics in the water. The cleaner the water the better the medication will work. Water changes also reduce organic waste. The tank is getting cleaner. The water is getting better and the medication is getting more effective. Sound pretty good to me.-Chuck> > Many thanks for your help

Treating An Oscar with Hole-In-The-Head -- 1/04/08 I have an Oscar that has hole in the Head Disease. I have treated him on two different occasions over a three month period with Fish-Zole. The places on his head just don't seem to want to heal. He is in a 75 gallon aquarium with a canister filter which gets cleaned once a week. He gets a 25% water change once a week. His water quality is in the good range on everything. He gets a variety of foods (no feeder gold fish). He gets pellets, sticks, krill and a mixture of beef hearts, garlic, spinach, vitamins and other ingredients twice a week. He also gets Vita-Chem added to his pellets 5 times a week. He has a very good appetite and seems to be growing. Should I treat him with the Fish-Zole again or is there something else That I can use to heal the places on his head. I don't want to loose him. Your help will be greatly appreciated. Thanks in advance. Nancy < This disease takes its own sweet time to heal. If the lesions are not getting any bigger then you fish is probably cured. The wounds left behind are typically very slow to heal. They first turn black and then slowly start to close up. Check the nitrates. Try and keep them under 20 ppm. Your treatment methods are very sound and hopefully caught in time.-Chuck>

Treat Oscar With Hole-In-The-Head Part II 1/5/08 I checked the nitrates they are 10 ppm. Some of the places seem to be turning black but he has a few places that seem to be getting deeper. The largest one is about 1/8 across and the others are smaller. They are white in color. I have enclosed a couple of pictures. Maybe you can get a better idea of my problem. Thanks again. Nancy < This infection is pretty severe. Never seen it this wide spread before. Look for a medicated food with Metronidazole in it. Add it to your fishes regular diet. Keep the water clean and the diet nutritious like you have been. Drs FosterSmith.com sell a medicated food called Anti- Parasite. It has Metronidazole in it. Add this to the diet. Keep tract of the disease by taking pictures of your fish once a week. Date them and compare them over time to see if he is getting better.-Chuck>

Oscar With Hole-In-The-Head Gets Treatment 1/7/08 Thank you for your quick response. If you look at the picture that I have attached. The places midway up toward his dorsal fin and midway down his side are not the holes that I am talking about. He did those places on the gravel in the bottom of his tank. The holes are located beneath his gills and to the right of his eye which seem to be healing and the small ones on top of his nose. I have started him on the medicated food and also added some MelaFix to his water. Will see how this does. He really doesn't know what to do with those little pellets of food but I am sure he will find out. Thanks again for your help. Nancy <Don't feed him for a few days and he will be hungry enough to eat the new medicated food. It looks like you are doing everything you can possibly do.-Chuck>

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