Re:Gas Bubble:Problems:HELP

#2769
Pete Giwojna
Guest

Dear protectsme:

I’m sorry to hear about your seahorse’s problem with gas bubble syndrome and positive buoyancy. It sounds like you’re stallion is suffering from recurring pouch emphysema (PE), which is a form of gas bubble syndrome that cannot be relieved simply by evacuating the gas that builds up within the pouch.

You did well to release some of the trapped air from his pouch, but I would not recommend repeating that procedure if it has failed to resolve the problem. Repeatedly "burping" or massaging the pouch can be hard on the delicate marsupium and create new problems. It’s time that you performed a pouch flush and treated the seahorse with Diamox instead. It’s wonderful that Seagazer has so graciously agreed to provide you with the needed medication, which can be difficult to obtain. That’s going to save you a lot of time and trouble, and the sooner you can administer the Diamox, the more likely your seahorse is to recover. (Many thanks for offering to help with the Diamox, Seagazer! That could prove invaluable in a case like this. It may make all the difference.)

The treatment protocol I recommend in cases of suspected pouch emphysema (PE) like yours is as follows:

First Treatment: Manually Evacuating Gas from the Pouch

At the first sign of a bloated pouch accompanied by any indications of positive buoyancy, the pouch should be "burped" or the trapped gas should be evacuated using a fine catheter. That will provide the affected seahorse with immediate relief, and if this simple first-aid measure resolves the issue, all is well and good.

In that case, the problem was no doubt due to simple pouch bloat, a harmless sort of gas build up that is entirely unrelated to chronic pouch emphysema. Pouch bloat can be caused by gas produced by the decay of embryonic material and the remains of placental tissue or other organic matter (possibly even stillborn young) within the brood pouch, if the male is unable to flush it out and cleanse it properly by pumping water in and out during its pouch displays (Cozzi-Schmarr, per. com.). And in some isolated cases, it’s possible that a bacterial infection of the pouch may also be involved (Cozzi-Schmarr, 2003). But it is far more common for pouch bloat to result from air bubbles trapped in the pouch during courtship displays, especially if the male chooses to display in the bubble stream produced by an airstone or bubble wand or bubble curtain (Strawn, 1954).

However, hobbyists should be aware that even a case of simple pouch bloat can contribute to recurring pouch emphysema, a much more serious problem, if it is not handled properly. The simple act of of struggling against the positive buoyancy that results from pouch bloat can alter the seahorse’s blood chemistry, and result in full-blown PE via acidosis of the blood if the problem is not relieved promptly.

The first indication of pouch bloat (or pouch emphysema) is a loss of equilibrium. The seahorse’s center of gravity shifts as the gas accumulates in its pouch, and it will have increasing difficulty swimming and maintaining its normal posture, especially if it encounters any current. It will become apparent that the seahorse has to work hard to stay submerged, as it is forced to abandon its usual upright swimming posture and swim with its body tilted forward or even horizontally in order to use its dorsal fin to counteract the tendency to rise.

The uncharacteristically hard work it must do while swimming means the hard-pressed seahorse builds up an oxygen debt in its muscles, and the lactic acid that builds up as a result of anaerobic metabolism further disrupts its blood chemistry and worsens the situation. It will struggle mightily in a losing battle against its increasing buoyancy until finally it can no longer swim at all, bobbing helplessly at the surface like a cork whenever it releases its grip on its hitching post. At this point, its pouch will be obviously swollen and bloated.

It is imperative that the gas be evacuated and neutral buoyancy restored long before that happens in order to assure that the affected seahorse is subjected to the least possible stress and does not have to overexert itself for an extended period. The longer it must fight against positive buoyancy, the greater the chances its blood will be acidified in the process and the more likely it becomes that a case of basic pouch bloat can progress into recurring pouch emphysema.

Breeding males are often especially susceptible to chronic pouch emphysema and GBS in general because of the placenta-like changes that occur in the lining of the pouch during pregnancy. Spongelike, its tissues expand as the capillaries and blood vessels swell and multiply. A film of tissue then forms around each embedded egg, providing it with a separate compartment (alveolus) of its own. The thickening of the wall of the marsupium and elaboration of pouch structures around the implanted eggs result in a dramatic increase in vascularization, and this increased blood supply (hence increased concentration of carbonic anhydrase) transports more dissolved gases to the pouch, increasing the risk of GBS accordingly.

Ideally, the air should be evacuated from the male’s pouch at the first sign of positive buoyancy. If this simple procedure does not cure the problem, then it is appropriate to move on to stronger measures once the problem recurs, as described below.

Second Treatment: Flushing the Pouch combined with administering Acetazolmide orally.

In my experience, acetazolmide (brand name Diamox) is much more effective in treating PE when it is ingested rather than administered as a pouch flush or a series of baths. Therefore, if pouch gas recurs a second time, I recommend treating it more aggressively with antibiotic/antifungal pouch washes while feeding the affected seahorse Diamox-injected shrimp (or Diamox bioencapsulated in live shrimp, depending on how badly handicapped the buoyant male happens to be when it comes to feeding).

The pouch flush solution I prefer is a combination of nifurpirinol and neomycin sulfate, since that combo works together synergistically to forms a wide spectrum antibiotic with potent antifungal as well as antibacterial properties (Basleer, 2000). Nifurpirinol (Furanase) and neomycin sulfate (Neosulfex) are the active ingredients in two different commercial products designed for aquarium use, and both of them used to be readily available at your local fish store. Neosulfex has since been discontinued, I believe, but neomycin sulfate is still found in many aquarium medications and is also available online from the National Fish Pharmacy.

Because it is so difficult to distinguish chronic pouch emphysema (PE) from ordinary pouch bloat, which has virtually identical symptoms, many seahorse keepers delay treatment too long when their prize ponies are experiencing buoyancy problems. They will often continue to evacuate the air from the pouch repeatedly in the forlorn hope that their stallion has not developed a life-threatening form of GBS but merely trapped a little air during his pouch displays. Very often this is wishful thinking, which only delays the inevitable and subjects the seahorse to ongoing stress needlessly, while making successful treatment more difficult by increasing the risk that gas emboli will form elsewhere and cause more damage in the meantime. In many cases, all you accomplish by waiting and hoping for the best is to allow the PE to become more advanced, more entrenched, and more severe in the interim.

To avoid this sort of needless delay, I suggest flushing the pouch thoroughly with antibiotics at the first sign of pouch gas and positive buoyancy should your initial attempt to evacuate the air fail to cure the problem (Garrick-Maidment, pers. com.). The affected seahorse must be handled in order to "burp" its pouch or evacuate the air via pouch massage anyway, so I recommend administering an antibiotic pouch wash at the same time.

Not only is repeatedly evacuating the air from the male’s pouch counterproductive in most cases, the constant manipulation can be hard on the tissue of the pouch, aggravating the dermal layers of the marsupium and leaving them vulnerable to secondary infections. (The male marsupium is far more complex than most hobbyists realize, consisting of four separate layers of epithelial and connective tissue, with the innermost layers being heavily vascularized.)

The skin or integument of the pouch is of course its first line of defense against disease. It contains mucus glands, and the slime covering the skin acts as a barrier to ectoparasites and infection. The protective slime may even contain antibodies and antibacterial substances (Evans, 1998). Marine fish are always in danger of dehydration because the seawater they live in is saltier than their blood and internal body fluids (Kollman, 1998). As a result, they are constantly losing water by diffusion through their gills and the surface of their skin, as well as in their urine (Kollman, 1998). The mucus layer also acts as a barrier against this, waterproofing the skin and reducing the amount of water that can diffuse through its surface (Kollman, 1998).

Repeatedly burping or massaging the pouch removes this protective barrier, and the shearing pressures that are involved may aggravate the underlying tissue, resulting in secondary infections of the outer marsupium that can further complicate the picture.

Progressing directly to flushing the pouch plus oral Diamox after the first pouch evacuation helps minimize these repeated insults to the delicate marsupium.

Third Treatment:

If all goes well, as it usually does when the proper measures are performed in a timely fashion, a third round of treatments is normally not necessary. In fact, some experts report a 100% cure rate for pouch emphysema when such pouch flushes are properly administered during the early stages of the condition (Garrick-Maidment, per. com.).

However, if the pouch flushes and an oral Diamox should fail to resolve the problem, the recompression-decompression cure would be your next recourse. Paul Groves found pressurization to be an effective cure for pouch emphysema, as well as the other forms of GBS, while he was conducting his extensive series of trials with gas bubble syndrome.

And if they happen to have the necessary equipment already on hand, some hobbyists prefer to treat PE with recompression-decompression as their second form of treatment, skipping over the Diamox and pouch flushes altogether. I have not tried the latter personally, however.

So that’s the rundown on pouch gas and pouch emphysema, protectsme. That is the progression of treatments I normally recommend for this problem. In your case, I would suggest performing a pouch flush on your stallion as soon as you can obtain the necessary apparatus and medications. Since your seahorse is no longer eating, rather than using antibiotic pouch flushes while administering Diamox orally, I would suggest performing the pouch flush using Diamox according to Keith Gentry’s instructions below. Since I’m not sure what materials you’ll be able to obtain for the pouch flush, I will provide you with detailed instructions for several methods of flushing the pouch, including Keith’s recommended procedure:

For starters, here are the instructions for using a pouch kit to perform such a pouch flush:

Pouch Kit Instructions

Click here: Seahorse.com – Seahorse, Sea Life, Marine Life, Aquafarm Sales, Feeds and Accessories – Pouch Wash
http://www.seahorse.com/Aquarium_Life/Care_Sheets/Pouch_Wash/

The antibiotic pouch kit should be like a fire extinguisher in the kitchen and used only in an emergency and NEVER as a prophylactic. Please perform this procedure in a separate vessel so that the antibiotic wash does not flow into the holding tank. You may wish to trim the plastic tip of the syringe attachment to accommodate the orpheus of your seahorse. You can express the air in the pouch by gently inserting this tip into the opening.

PLEASE KEEP REFRIGERATED shake well before using

What you need to do:

First: Find someone to help you!

Second: Keep the head and gill area of the seahorse submerged at all times! You may cut the end of the tip to fit your needs.

Third: The Procedure should be preformed in a separate hospital tank where the antibiotic flush will not harm your biological filter:

*Have one person hold the seahorse upside down with the head in the water and his tail and abdomen out of the water. He may wrap his tail firmly around your finger. Insert the tip of the pipette into the opening in the pouch being careful not to insert it too far. (You may cut the end of the tip to fit your needs.)

*Gently massage out any air bubbles into the pipette.

*Remove the pipette and express the air bubbles from the pipette.

*Rinse the tip of the pipette with alcohol and let dry.

*Withdraw approximately 2 ml’s of pouch wash into the pipette. The quantity will actually vary according to the size of the males pouch. The extra large males can easily use 2 mls of pouch wash and the smaller males less than one.

*Reinsert the tip into the pouch and gently force the liquid into the pouch and then gently suck it out. Do this twice and then release the male into his tank.

*He may seem slightly stunned or shocked. Don’t panic! Simply turn off the lights and allow the male to rest. If you have any red shrimp he may enjoy them at this time.

*You may have to repeat this procedure again the following day.

*Return him to his normal diet of frozen mysis shrimp enriched with Vibrance the day after the procedure.

*You may email ocean rider with questions, or if you are a member of the Ocean Rider Club ask them for assistance.

Flushing the pouch can be a tricky procedure and I know it’s intimidating the first time you perform the procedure, protectsme, so I’ll provide you with some additional instructions by myself and others that explained some of the other approaches to flushing the seahorse’s pouch in greater detail. For starters, here are detailed instructions from Leslie Leddo and myself explaining how to perform a pouch flush:

"Pouch Flush Techniques and Tips"
By Leslie Leddo

You will need:

·A small syringe. I like to use a 1-cc syringe.

·A catheter of some sort. It needs to be something that is plastic, very narrow, cannulated, blunt tipped, semi pliable, but not so soft that it bends from just a bit of pressure, on one end and fits snugly on to the tip of a syringe at the opposite end. Some suggestions would include an a plastic intravenous catheter, with the center introducer needle used to puncture the skin and vein order to introduce the catheter removed, a plastic pipette, or the syringe tips that come inside some of the aquarium test kits. If you have access to an IV catheter any size, between an 18 and 25g will work well.

·A bowl. I like to use something with a wide rim so I have space to move freely and have enough room should I need another pair of hands…i.e., an assistant. The syringe and pipette/catheter are both used to flush the pouch as well as to aspirate the previous days flush from the pouch.

How to prepare the Syringe and Catheter:

Draw about 1cc of the medicated flush solution into the syringe by pulling back on the plunger.

Invert the syringe so the tip is pointed up. With the syringe inverted, gently tap it until all the air bubbles come to the surface just below the syringe tip; with the syringe still inverted depress the plunger until all the air is removed from the syringe and a small amount of the solution is emerging from the syringe tip.

Attach the catheter or pipette to the tip of the syringe, depress the plunger of the syringe to fill (prime) the catheter or pipette with the solution.

Okay, now you are ready to flush the pouch. Proceed as follows:

Gently place the horse in the bowl filled with his own tank water. Very gently and slowly introduce the tip of the catheter through the pouch opening, into the pouch. When you enter the pouch you may meet some resistance. If you encounter resistance when inserting the catheter, I have found that it helps to try different angles, rather than pushing forcefully. I have never dissected a seahorse, but from all the evacuations and flushes I have done it feels to me as if the opening to the pouch is more than a simple opening. It feels like a short tunnel, with folds or pockets of tissue along the walls of the tunnel. I have had to flush/evacuate several different horses. They all seem to be built a bit differently.

I have had success entering the pouch opening straight and then angling the catheter down a bit as well as entering at an angle from the start.

Once you have the catheter tip inside the pouch, depress the plunger of the syringe, flushing the pouch until you see some of the solution coming back out of the pouch. Continue to flush the pouch with about .2 to .3 cc.

Once the pouch has been flushed, you want to leave a small amount of flush inside the pouch. Pulling back on the plunger aspirate the some of the fluid until some of the solution has been removed from the pouch, leaving enough so that the pouch remains softly full, but is not at all taught or tight. Place your horse back in his tank

The next day, prior to the new flush, aspirate the previous days flush from the pouch. Using the syringe with the catheter/pipette attached to the tip, insert it as described above. Pull back on the plunger of the syringe withdrawing the flush from the day before.

Now you are ready to administer the newly mixed flush by repeating the steps described above.

Antibiotic Pouch Washes

If you can obtain a suitable small glass eyedropper with a rubber squeeze bulb, the tip of which you can insert into the pouch orifice, you can use the eyedropper to flush the pouch instead. Otherwise, you’ll have to obtain a small pipette or use a small syringe and catheter for the flushes, as previously described in Leslie Leddo’s pouch flushing tips. You will be flushing the male’s pouch once a day for three consecutive days, using a medicated pouch flush solution.

The first thing you’ll need to do is prepare the pouch flush solution. I recommend using a combination of nifurpirinol and neomycin sulfate for the pouch flushes, since that combo works together synergistically to forms a wide spectrum antibiotic with potent antifungal as well as antibacterial properties (Basleer, 2000). Nifurpirinol and neomycin sulfate are the active ingredients in two different commercial products designed for aquarium use, and both of them should both be readily available at your local fish store. Prepare a 50:50 solution by taking approximately 1/10 teaspoon of nifurpirinol and 1/10 teaspoon of neomycin powder (from a capsule) and mixing them together with about 40 cc (or 2-1/2 tablespoons) of tank water from your seahorse setup. (Nifurpirinol comes in tablet form, so you’ll have to crush a tablet into as fine a powder as possible, using a blender if necessary, and then use 1/10 teaspoon of this nifurpirinol powder for the mixture.) Mix the nifurpirinol powder and neomycin sulfate powder with the tank water very well until the medication is thoroughly dissolved. Avoid any undissolved residue that remains. (You will have to make up a new batch of this solution each day for 3 days.)

If you can’t find both nifurpirinol and neomycin, then you can use either one alone, or substitute kanamycin capsules alone, to make your medicated pouch solution. In that case, just use 1/10 teaspoon of the antibiotic powder and mix it thoroughly with about 20 cc (or 1-1/2 tablespoons) of tank water. Again, make a new batch of pouch-flush solution each day.

And here are instructions from Keith Gentry explaining how to do a pouch-flush directly with Diamox:

Pouch Flush

In cases of recurring pouch emphysema, diamox can be administered as a solution injected into the pouch via an narrow gauge irrigating cannula or plastic 26 or 28 gauge IV catheter sleeve attached to a 0.5 or 1ml syringe (larger syringes should not be used).

Using a blender, mix ½ of a 250mg Diamox tablet with a cup of seawater at the same specific gravity as the tank. Fill the syringe with about .5ml of this solution, avoiding the residue at the bottom of the cup. The seahorse should be held as per the procedure for pouch evacuations.

Insert the catheter sleeve slowly and gently a small way into the pouch opening and inject this solution SLOWLY into the seahorse’s pouch, leaving the solution in the pouch. Make sure you are familiar with the location of the pouch opening.

Never use a metal needle for this procedure.

The procedure may have to be repeated twice to be effective. In stubborn cases, it is recommended to concurrently administer broad spectrum antibiotics. Diamox and antibiotics have been used simultaneously and successfully without appararent side effects.

I believe the dosage of antibiotic is one 250mg tablet of neosulfex per 10 gallons. It’s important you treat the horse in a quarantine tank. Diamox and neosulfex can kill your
biofilter.

For neomycin and sulfa you can use up to 4 times the marine dosage listed on the instruction or are up to 8 times the recommended freshwater dosage. [End quote]

Finally, here are Neil Garrick-Maidment’s instructions for performing his extremely successful pouch flushing procedure:

[open quote]
Hi Pete,

Hope you don’t mind me interjecting on the point about gas bubble in the
pouch but it is important to emphasise a few things.

When I devised and developed this treatment quite a number of years ago, I
was shocked to hear some of the ways people were clearing the bubbles within
the pouch, from cocktail sticks to straws, which caused irreparable damage
to the pouch and the Seahorse. It is vital that great care is taken when
doing this process and the purchase of a fine blunt ended pipette from the
chemist is the best way.

When handling the Seahorse make sure you have a
firm grip with the pouch facing outwards under the water, its best to have
the tail curled around the little finger to add stability. Then insert the
pipette almost vertically, through the pouch opening so the pipette goes
down into the pouch (almost parallel with the body) and not in towards the
body which will cause major internal and secondary problems.

Once the pipette is safely in the pouch then a fine nozzled hand spray (it must be
fine to fit into the end of the pipette) must be used to flush down through
the pipette, you will notice bubbles of gas being vented from the pouch as
you flush the pouch, initially with water from the tank, this stops shock to
the animal and at the same time clears the pouch. This same method (do not
remove the pipette in between stages) should then be used to add medication
etc.

When withdrawing the pipette use a slight twisting motion and remove in
exactly the same direction as it has gone in. The Seahorse will seem a
little shell shocked after this but the immediate release from floating etc
will provide instant relief.

I have had 100% success with this process but
you must be in mind of the Seahorse and its discomfort at all times.
Just before starting make sure you have all your equipment and medication in
place, there is nothing worse than getting part way through and realising
you have forgotten something.

Hope this helps

Best wishes
Neil
Neil Garrick-Maidment [close quote]

One of these techniques should work well for you, depending on what medications and equipment you have on hand or have access to for performing the pouch flushes. If the pouch gas problem recurs, I would suggest alternating Diamox pouch flushes with antibiotic pouch flushes until the problem is resolved.

If the pouch flushes don’t resolve the problem either, let me know as soon as possible and I can provide you with instructions for pressurizing or decompressing the seahorse instead.

Seahorses in good condition can fast for a few days without any ill effects of all, so you should have time to see if a pouch-flush, our series of pouch flushes, can release the trapped gas and restore your seahorse to normal once again. I’m confident that he will resume feeding once the problem with positive buoyancy is eliminated and he can swim and I normally again.

Best of luck treating your gassy male, protectsme!

Respectfully,
Pete Giwojna


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