Pete Giwojna

Dear designs:

Okay, if she is floating, then you are quite correct — acetazolamide (brand name Diamox) is the medication that you will need to resolve this problem. You are doing great to keep hand feeding her to provide her with good nutrition during this crisis — hopefully, that could keep her going long enough for you to obtain the Diamox.

Unfortunately, as you have discovered, Diamox is a prescription medication that can be difficult for the average hobbyist to obtain. If you cannot obtain the Diamox from your family veterinarian or physician, then you have three alternatives at this point:

First of all, you can order the Diamox without a prescription from the online source I mentioned in my previous post. In all probability, the medication will reach you without any problems, although it will take about two weeks to be delivered. Because of this delay, that isn’t much help for a seahorse that is already ailing, but many seahorse keepers find it prudent to order the Diamox from this vendor and then keep it on hand in case it has ever needed.

Secondly, you can appeal to other hobbyists on the various seahorse discussion boards and forums and see if one of them can provide you with some Diamox tablets from their surplus. It usually only takes a handful of the Diamox tablets to treat a case of gas bubble disease and once a hobbyist has attained a supply of Diamox from one source or another, the bulk of the medication is typically left over following a treatment regimen. A sympathetic hobbyist may be willing to make some of his excess Diamox available to you.

Finally, you can consider using the recompression/decompression cure to treat your seahorse for GBD by pressurizing it at a depth of 30 inches or more (the deeper, the better), as explained below. The recompression-decompression cure is a good alternative for treating Gas Bubble Disease (GBD) for hobbyists who are having trouble obtaining Diamox for one reason or another. Anyone can set up a simple homemade decompression chamber and be treating their seahorse as soon as they can mix up a new batch of saltwater. I would be happy to run through those procedures again for anyone who finds themselves in this all-two-familiar familiar Diamox dilemma, ponydesigns:

The Recompression Cure for Gas Bubble Syndrome

Recompression simply involves placing the affected seahorses in a flow-through cage or enclosure and immersing them for a period of days at a depth with sufficient water pressure to cause the emboli to dissolve. The increased hydrostatic pressure causes the gas bubbles that have formed within the tissue and blood of the seahorse to go back into solution where they can be resorbed, relieving the problem. (This is why a decompression chamber is used to treat divers for the "bends," caused by nitrogen gas embolisms within the diver’s tissue and blood.) Afterwards, the seahorses are slowly raised back to normal depth/pressure over a period of hours, allowing the total partial pressures of the dissolved gases in the water and the seahorses’ bloodstream to equalize on the way up.

At present, there is no consensus among the professional aquarists who use this method regarding the exact depth and length of immersion needed to effect a cure. I’ve encountered decompression times ranging from 2 days to 10 days and depths ranging from 10 feet in large aquaria (Paul Groves, pers. com.) to over 35 feet at the bottom of the ocean (Bill Stockly, pers. com.), all of which worked equally well. Interestingly, the shortest immersion time was used successfully at one of the shallowest depths (4 meters) and cured seahorses afflicted with all the different forms of GBS (Paul Groves, pers. com.).

While the exact treatment protocol that will produce the best results remains to be determined, everyone whom has tried the decompression cure agrees as to its remarkable effectiveness. It cures external GBS (subcutaneous emphysema, a.k.a. tail bubbles), chronic pouch emphysema (pouch bloat) and internal GBS equally well. In fact, as long as treatment is begun early enough, before the emboli have caused irreversible damage, decompression has a very high cure rate. It is safe, provides the affected seahorses with immediate relief, and works for all forms of GBS.

Of course, the home hobbyist lacks the resources to apply decompression at the sort of depths employed by the professionals. But I am discussing the recompression-decompression cure in some detail for two reasons. First of all, a number of hobbyists have managed to construct homemade decompression tanks and chambers, and other enterprising hobbyists may wish to follow their lead (Lisa Hovis, pers. com.). Homemade decompression devices range from simple tubes of water 6-12 inches in diameter and 4-12 feet tall capped at one end, designed merely to increase hydrostatic pressure, to pressurized wide-mouth bottles complete with pressure gauges and bleeder valves (Lisa Hovis, pers. com.). Secondly, I suspect that when enough data comes in we will find that a depth considerably less than 10 feet and relatively short immersion times will prove to be adequate to resolve most cases of GBS.

For example, while working with the Hawaiian seahorse (Hippocampus fisheri) at the Waikiki Aquarium, Karen Brittain found that all the specimens kept in smaller, shallower aquaria developed subcutaneous gas bubbles within a matter of months, whereas H. fisheri that were maintained in tanks at least 1 meter deep fared much better (Bull and Mitchell, 2002, p37). The Hawaiian seahorse remains pelagic all its life, typically being found at least a mile offshore in deep water, and Brittain speculates that H. fisheri needs to migrate to depths unachievable under normal aquarium conditions to maintain proper physiological balance (Bull and Mitchell, 2002, p37). I think she is absolutely correct. It seems likely that H. fisheri follows a daily vertical migration pattern, perhaps synchronized with the movements of plankton. Her findings suggest that tanks a minimum of 3 feet deep can provide a measure of protection against GBS, and custom-built aquaria of those dimensions are certainly within the realm of the home hobbyist.

This remains a fertile field for future research. It has been suggested that should there be an outbreak of GBS in one of your aquariums, transferring the seahorses to an aquarium at least 3 times as deep can decompress the patients and prevent a recurrence of such problems (Wooten and Waughman, 2004). This suggestion has a lot of merit. Even upgrading to a tank that’s twice as deep would be quite advantageous in terms of GBS prevention. Much work remains to be done to develop decompression guidelines for seahorses and to determine what sort of depth is needed to confer protection from GBS to different species. But when it comes to GBS, two things are certain: deeper tanks are healthier for seahorses and recompression can achieve remarkable recoveries.

In short, many times your best bet to cure internal GBS may be to try a moderate form of recompression to help your seahorse recover. What I have in mind is confining the affected seahorse in a flow-through enclosure at the bottom of a 50-gallon Rubbermaid enclosure 40 inches deep, or something similar, for a period of about 3 days. Once the seahorse is immersed at the bottom of this homemade "decompression chamber," you cannot raise it to the surface again for daily feedings. Since your decompression chamber will have no biofiltration, I would simply fast your seahorse while it recompresses at depth. It can easily go without eating for a few days and that will help eliminate any ammonia spikes in the meantime.

If you decide to try this, be sure to keep your makeshift decompression chamber well-aerated. A shallow airstone anchored just below the surface — NOT at the bottom of the decompression chamber! — to provide surface agitation and oxygenation should suffice.

When the recompression period is finished, raise the seahorse to the surface (or lower the water level in the hydrostatic chamber) gradually, in a series of stages, over a period of several hours, to assure that the patient decompresses completely and the gas emboli don’t reform.

Lighting your homemade decompression chamber isn’t really necessary. Seahorses have outstanding visual acuity and see very well under low light conditions (a couple of species are even said to have adopted nocturnal behavior in the face of heavy fishing pressure), so your seahorse will be able to see well under the ambient light levels that penetrate and 50-gallon bucket. You won’t be feeding the seahorse while it’s undergoing the decompression cure, so it doesn’t need to be able to see well enough to hunt small prey or anything like that, and the darkened conditions may give the seahorse a sense of security and help it relax, since it won’t be feeling so exposed and vulnerable.

If you want to keep an eye on the seahorse periodically while it’s undergoing pressurization, you can just take a quick peek now and then using a flashlight.

When the recompression period is finished, raise the seahorse to the surface (or lower the water level in the hydrostatic chamber) gradually, in a series of stages, over a period of several hours, to assure that he decompresses completely and the gas emboli don’t reform.

One of our other Club members (Christine) recently used this method to cure her seahorse of internal GBS after Diamox baths had been tried unsuccessfully. Here is how Chris described her experience with GBS, and her treatment method with her homemade decompression chamber, in posts to the group:

Hi — After 3 days of diamox Heidi was still buoyant (the diamox did not
seem to have helped at all), and swimming with the tip of her head
sticking out of the top of the water, clearly frustrated with her
situation. I looked at her with a magnifying class, and can’t see any
external signs of bubbles. I also don’t see any signs of bloating or
eye problems.

I followed Pete’s suggestions, took her off the diamox to restore her
appetite, gave her 1 day of rest in the hospital tank with clean water
and Kanamycin. She ate well yesterday and this morning. I rigged up
an inexpensive way of submersing her to 3 times the depth of my 30
gallon display tank. (I priced building a 6 ft deep tank out of an
acrylic tube attached to a base, or acrylic rectangles
attached to a base, and it came out to be anywhere from $250 to $400.
They wanted to charge $175 per linear foot of the acrylic tube thick
enough to safely support a 5 or 6 ft column of water). I’m going to
try the cheap method first, and will build a deeper aquarium if she
needs a greater water pressure.

So-I have her in a ‘critter keeper’ (small plastic container with a
lid that has slots in it and a viewing window in the center) with 2
soft rubber hitching posts. The lid has 4 large criss-crossed rubber
bands on it just in case the lid comes off. I made sure there weren’t
any bubbles underneath the critter keeper or underneath the little
clear viewing lid on the top. I bought a 50 gallon rubbermaid bucket
which gives a water depth of 3 1/2 ft when filled. The critter keeper
is inside a 5 gallon white bucket weighted down with a signature
coral, with a rope tied to the bucket handle (made it easy to lower
into the big bucket). I lowered her slowly this morning, and she
seems fine (not pinned against the lid of the critter keeper, and she
is able to go between the 2 hitching posts). I have an airstone going
at the surface of the deep bucket, as Pete suggested. I can see her
with a flashlight. Her breathing looks normal.

I filled the 50 gallon bucket yesterday with the shower! and let it
‘degas’ for one day (also to make sure that it didn’t spring a leak.
It is in the bathtub). The water temp is 70 degrees. I matched the
specific gravity and ph of the hospital tank.

Heidi is going to remain there for 2-3 days, as per Pete’s suggestion.
After that, I will bring her up very slowly (or unload the water from
the big bucket very slowly). I hope this works! Our big bathroom has
been completely taken over with buckets, hospital tank, salt mix, etc.
Wish us luck!

And here is Christine’s follow-up message after the recompression-decompression treatment was completed:

Hi Pete and Everybody, Heidi is okay! No more floating. I unloaded
the water from my makeshift compression chamber very slowly, as per
Pete’s suggestion, rather than pulled up the critter keeper from the
bottom (much safer to unload the water). I then transferred the
critter keeper she was in to a 5 gal bucket of clean saltwater,
and she swam out when I opened the lid. I decided to do a water
change in the main tank before putting her back in, and used the water
I pulled out of the main tank (74 degrees) to warm up the water she
had been in (70 degrees) to help re-acclimate her to the main tank.
She is eating and swimming as normal, back to her aggressive self with
the turkey baster and Mysis. She is very happy to be back in the
display tank, and is enjoying swimming all around, once again
neutrally buoyant. She was sooo happy to see her favorite coral
colored fake coral. Her color is going back from being dark brown
(her under stress color) to light brown/gold today. I hope to see
her go back to her coral color soon. Thanks for your help Pete!

I hope I never again have a SH with the floaties!
For the record, she was in a critter keeper inside a 5 gal bucket
weighted down with a fake (Signature) coral at the bottom of 40 inches
of water in a Rubbermaid 50 gallon bucket (on wheels-a new bucket). I
had an airstone at the top as per Pete’s instructions. She was in for
2 1/2 days.

For best results, the decompression sure is often combined with antibiotic therapy. It is a simple matter to administer a regimen of antibiotics while the seahorse is submerged at the bottom of the 50-gallon Rubbermaid bucket. (Just don’t perform any water changes while the seahorse is undergoing recompression-decompression.) This would help prevent any secondary infections which are often associated with GBS or stress, and would also cover all the bases if you suspect the underlying cause of your seahorse’s positive buoyancy may be due to a bacterial infection.

For the antibiotic therapy, kanamycin, neomycin, and nifurpirinol are the antibiotics I prefer. I would recommend using two of them (i.e., kanamycin/neomycin or nifurpinol/neomycin) in combination for even greater efficacy, as described below:


This is a potent broad-spectrum, gram+/gram- antibiotic. It is wonderfully effective for aquarium use because it is one of the few antibiotics that dissolves well in saltwater and that is readily absorbed through the skin of the fish. That makes it the treatment of choice for treating many bacterial infections in seahorses. Kanamycin can be combined safely with neomycin to further increase its efficacy. Like other gram-negative antibiotics, it will destroy your biofiltration and should be used in a hospital tank only.

nifurpirinol (Furanase)

Nifurpirinol is a nitrofuran antibiotic that is the active ingredient in many commercial preparations designed for use in the aquarium. It is stable in saltwater and rapidly absorbed by fish, making it the preferred treatment for fungal infections in seahorses (Burns, 2002). Nifurpirinol is photosensitive and may be inactivated in bright light, so use this medication only in a darkened hospital tank.

Nifurpirinol may be combined with neomycin (see below) to produce a potent broad-spectrum medication that’s effective against both fungus and bacteria. Nifurpirinol/neomycin is therefore a great combination to use when you’re not certain whether the infection you are treating is fungal or bacterial in nature.

neomycin sulfate

Neomycin is a very potent gram-negative antibiotic. Most of infections that plague marine fish are gram-negative, so neomycin sulfate can be a wonder drug for seahorses (Burns, 2002). As mentioned above, it can even be combined with other medications such as kanamycin or nifurpirinol for increased efficacy. For example, kanamycin/neomycin is tremendous for treating bacterial infections, while nifurpirinol/neomycin makes a combination that packs a heckuva wallop for treating mixed bacterial/fungal infections or problems of unknown nature. Keep it on hand at all times.

Neomycin will destroy beneficial bacteria and disrupt your biological filtration, so be sure to administer the drug in a hospital tank.

One other thing to keep in mind is water temperature. Since you’re homemade decompression chamber is unheated, the water temperature will gradually fall over the three-day treatment period. This is fine and to be is expected — and even beneficial in many respects — but it does mean that once the decompression period is over, you may have to acclimate the seahorse for temperature before returning the patient to the main tank.

In short, designs, you might want to consider ordering the Diamox from the outline vendor I suggest and then pressurize the affected stallion in a homemade decompression chamber as described above while you are waiting for the medication to arrive.

The preventative measures were GBD we have discussed on this forum on several occasions can help stabilize future problems with gas bubble disease, but they won’t reverse the damage that has already been done or cure an ongoing problem with GBD.

Best of luck restoring your female to neutral buoyancy again, designs.

Pete Giwojna

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