How do you Treat Bubble Disease in a Sea Horse?

Dear Moon Valley:

Yes, there is a medication that is effective in treating most forms of gas bubble syndrome (GBS). It is acetazolamide (brand name Diamox), which is a type of carbonic anhydrase inhibitor. It is typically available in 250 mg tablets, but it is a prescription drug and it can often be difficult for the home hobbyist to obtain. I will discuss this dilemma in more detail at the end of this e-mail, including recommending the best ways to go about acquiring some of the medication, Moon Valley.

As you know, the acetazolamide (brand name Diamox) can be administered in a number of different ways, and the best method of administration will vary depending on the form of gas bubble syndrome you are treating. Each of these different techniques for administering the Diamox requires a different amount of the medication. For example, chronic pouch emphysema is best treated by administering a Diamox pouch flush, after first evacuating any air bubbles from the seahorse’s marsupium. This method only requires one 250 mg Diamox tablet per pouch flush. Many times one pouch flush is all that is needed to resolve the problem, but stubborn cases may require two or three pouch flushes to be performed before the condition returns to normal.

Likewise, subcutaneous emphysema (commonly known as tail bubbles or external GBS) can be successfully treated by a prolonged immersion in a series of Diamox baths or by administering the Diamox orally via feeder shrimp that have been injected with a solution of the medication. This method requires 5 or more 250 mg Diamox tablets (depending on the size of the hospital tank or treatment tank).

The Diamox can also be administered orally after injecting a solution of it into live feeder shrimp or even large frozen Mysis, and this technique also requires several of the 250 mg Diamox tablets in order to complete the treatment regimen.

I will discuss each of these methods of treatment in more detail below, Moon Valley.

Once you have obtained the acetazolamide (brand name Diamox), it is very effective in treating subcutaneous emphysema or tail bubbles when it is either administered orally by injecting a solution made from Diamox (the tablet form of acetazolamide) into feeder shrimp or when it is administered as a 4-8 day series of baths (and it can also be easily administered as a pouch wash, but that is more appropriate when treating pouch emphysema than tail bubbles), as explained below:

Acetazolamide Baths (prolonged immersion)

The recommended dosage is 250 mg of acetazolamide per 10 gallons (25 mg/gallon) with a 100% water change daily, after which the treatment tank is retreated with the acetazolamide at the dosage indicated above (Dr. Martin Belli, pers. com.). Continue these daily treatments and water changes for a minimum of 4 consecutive days (stubborn cases may need to be continued for twice as long, or up to 8 days) for best results (Dr. Martin Belli, pers. com.).

The acetazolamide baths should be administered in a hospital ward or quarantine tank. Acetazolamide does not appear to adversely affect biofiltration or invertebrates, but it should not be used in the main tank because it could be harmful to inhibit the enzymatic activity of healthy seahorses.

Using the tablet form of acetazolamide (250 mg), crush the required amount to a very fine powder and dissolve it thoroughly in a cup or two of saltwater. There will usually be a slight residue that will not dissolve in saltwater at the normal alkaline pH (8.0-8.4) of seawater (Warland, 2002). That’s perfectly normal. Just add the solution to your hospital tank, minus the residue, of course, at the recommended dosage:

Place the affected seahorse in the treatment tank as soon as first dose of medication has been added. After 24 hours, perform a 100% water change in the hospital tank using premixed water that you’ve carefully aerated and adjusted to be same temperature, pH and salinity. Add a second dose of newly mixed acetazolamide at the same dosage and reintroduce the ailing seahorse to the treatment tank. After a further 24 hours, do another 100% water change and repeat the entire procedure until a total of up to 4-8 treatments have been given. About 24 hours after the final dose of acetazolamide has been added to the newly changed saltwater, the medication will have lost its effectiveness and the patient can be returned directly to the main seahorse tank to speed its recovery along.

One of the side effects of acetazolamide baths is loss of appetite. Try to keep the affected seahorse eating by plying it with its favorite live foods during and after treatment, until it has fully recovered.

The affected seahorse typically show improvement of the tail bubbles within three days, in which case the four-day series of Diamox baths will resolve the situation. Dr. Martin Belli reports they nearly 100% success rate treating subcutaneous emphysema when this treatment regimen is followed for 4-8 days, and most cases clear up in less than a week. For best results, the Diamox should be used in conjunction with a good broad-spectrum antibiotic to help prevent secondary infections. A good aminoglycoside antibiotic such as kanamycin or neomycin would work well for this.

If you prefer, you can also administer the acetazolamide orally, providing your stallion is still eating, which will allow you to treat the affected seahorse in the main tank amidst familiar surroundings and in the company of its tankmates where it is the most comfortable. You get the acetazolamide into the food by preparing a solution of the medication, as described below, and then injecting it into live feeder shrimp or even the large Piscine Energetics frozen Mysis relicta. The medication is deactivated fairly quickly once you prepare the solution for injecting, so you must prepare a new acetazolamide solution each day during the treatment period. Here’s how to proceed:

Administering Acetazolamide Orally

I have found that acetazolamide is often more effective when it’s ingested and administering the medication orally allows you to treat the seahorse in the main tank where he’s most comfortable and relaxed. However, administering an effective dose of the medication orally can sometimes be difficult to accomplish since the seahorses don’t always accept the medicated Mysis (apparently the Diamox is not particularly tasty).

If you can obtain a small syringe with a fine needle, the acetazolamide solution can simply be injected into feeder shrimp or even frozen Mysis. Mic Payne (Seahorse Sanctuary) used this method of administering acetazolamide successfully when he had recurring problems with GBS due to maintaining a population of Hippocampus subelongatus in shallow tanks only 16-inches (40 cm) deep:

“Seahorses maintained in this system are susceptible to gas bubble disease. Specimens with bubbles around the eyes or under the epidermis of the tail are readily treated with acetazolamide (Diamox tablets 250 mg). Mix a very small amount of crushed tablet with water and inject it into several glass shrimp that are then frozen. These are then fed to the target animal at the rate of two per day for four days. Bubbles disappear on the second day.”

Hawaiian volcano shrimp or red feeder shrimp (Halocaridina rubra) work great for this. If a fine enough needle is used, they will survive a short while after being injected — long enough for their twitching and leg movements to attract the interest of the seahorse and trigger a feeding response.

Leslie Leddo reports that a 1/2 cc insulin syringe with a 26-gauge needle was ideal for injecting frozen Mysis or live red feeder shrimp. They plump up when injected and ~1/2 cc is about the most of the solution they can hold. Their bodies will actually swell slightly as they are slowly injected and excess solution may start to leak out. The 26-gauge needle is fine enough that it does not kill the feeder shrimp outright; they survive long enough for the kicking of their legs and twitching to assure that they will be eaten.

Administering the Diamox orally in this way is the least stressful way to medicate the seahorse, so, depending on the form of GBS you are treating, may want to consider trying injecting feeder shrimp with the solution of the medication first before you resort to the Diamox baths or pouch flushes.

Finally, Moon Valley, the acetazolamide can also be administered in the form of pouch flushes, which is the most effective method of treatment when dealing with male seahorses that have developed chronic pouch emphysema.

The amount of the Diamox you will need to use to perform the medicated solution for flushing the pouch depends on the severity of the problem, Moon Valley. In relatively mild cases, you need to dissolve 62.5 mg of Diamox (i.e., 1/4 of a 250 mg Diamox tablet or 1/2 of a 125 mg Diamox tablet) in 1 cup (~237 mL) of clean saltwater to prepare the solution.

However, in severe cases where the chronic pouch emphysema is long-standing, it is appropriate to use twice as much of the Diamox when preparing the pouch flush solution. So in a stubborn case of chronic pouch emphysema, you would need to dissolve 125 mg of Diamox (i.e., 1/2 of a 250 mg Diamox tablet or 1 entire 125 mg Diamox tablet) in a cup of clean saltwater to prepare a pouch flush solution with the proper concentration of the medication.

So if you are dealing with a mild case of pouch emphysema, you will want to prepare the pouch flush solution by dissolving 62.5 mg of Diamox in 1 cup of saltwater. Here’s how to proceed:

If you have the 250 mg Diamox tablets, break one of the tablets in half, and then cut one of the halves into two equal pieces. That will provide you with approximately 1/4 of a 250 mg tablet, which is equivalent to ~62.5 mg of Diamox, Moon Valley.

(Likewise, if you have the 125 mg Diamox tablets, simply break one of the tablets in half, and that will give you approximately 62.5 mg of Diamox with which to prepare the pouch flush solution.)

Next, pulverize the 62.5 mg piece of Diamox, crushing it into a fine power, and mix it thoroughly with 1 cup of clean saltwater taken from your seahorse tank. (Some people like to use a blender to mix the Diamox with the saltwater so that it dissolves better.) I like to use saltwater taken from the seahorse setup when mixing the pouch flush solution, Moon Valley, because that assures that the saltwater will have the same pH, temperature, and specific gravity as the seahorse is accustomed to, so that it will not be a shock to his system when it is injected into his pouch.

Now that you have prepared the Diamox solution for the pouch flush, let it sit for a few minutes before you fill the syringe. You will notice that some fine particles settle out of the liquid onto the bottom of the cup. That’s because the Diamox is not 100% soluble in saltwater, so there is always some undissolved residue.

Once the Diamox solution has had a chance to settle, suck up some the solution in the syringe (avoiding the undissolved residue at the bottom), and then hold the syringe upside down and depress the plunger slightly in order to expel a little of the solution, thereby eliminating any air that may be trapped in the barrel of the syringe. Leave about 0.5 mL of the Diamox solution in the syringe for the pouch flush.

Now you are ready to perform the Diamox pouch flush. First release any air that may be trapped in the male’s pouch using whatever technique is easiest for you, and then insert the cannula into the aperture of the pouch and slowly inject the solution into the pony’s pouch.

To provide you with additional guidance, Moon Valley, here are the instructions from Keith Gentry explaining how to administer a Diamox pouch flush when treating a severe case of chronic pouch emphysema:

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 0.5ml 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 apparent side effects.

And here is another summary of the recommended procedure for administering the Diamox pouch flush when dealing with a mild case of recurring pouch emphysema, Moon Valley:

Diamox Pouch Flush Instructions

ACETAZOLAMIDE (pouch flush) Dosage and Preparation Instructions
Active Ingredient: Acetazolamide
Indication: persistent and recurring pouch emphysema
Brand Name: Diamox
Dose at 0.5mL of a 62.5mg/cup solution
Supplies: narrow gauge irrigating cannula or narrow gauge IV catheter sleeve, 0.5 or 1mL syringe without needle

• Mix 62.5mg of Diamox (1/4 of a 250mg tablet) with 1 cup (approx. 237mL) of marine water with specific gravity, pH, and temperture matching that of the aquarium.
• Let the mixture settle.
• Fill the syringe with about 0.5mL of the solution, avoiding the residue that has settled to the bottom of the container.
• Hold the seahorse according to the procedure for pouch evacuations. Insert the catheter sleeve slowly and gently a small way into the pouch opening.
• Inject the solution slowly into the seahorse’s pouch. Leave the solution in the pouch.

Okay, Moon Valley, that’s the rundown on the recommended Diamox pouch flush procedures. Just remember that you must first evacuate any gas trapped within the pouch before you perform the medicated pouch flush, and everything should go smoothly.

In stubborn cases, you may indeed need to repeat the medicated pouch flush more than once, so if you do not notice any significant improvement in the stallion’s condition in the next two days, don’t hesitate to repeat the procedure.

After you perform the pouch flush, the heavily vascularized lining of the pouch will gradually absorb the medication, so you need to wait at least a couple of days to determine if the Diamox pouch flush will have the desired effect. In severe or long-standing cases of chronic recurring pouch emphysema, it is often recommended that you repeat the Diamox pouch flush three times in succession (waiting two days after the first pouch flush and then performing a second Diamox pouch flush, and then waiting two more days before performing the third and final Diamox pouch flush) in order to resolve the problem once and for all.

For best results, it is customary to administer antibiotics in conjunction with the Diamox pouch flush(es), Moon Valley. This is done as a precaution in order to help prevent any secondary infections resulting from the procedure. As long as the seahorse is still eating, the easiest and most effective way to accomplish this is to administer the antibiotics to the seahorse orally while he remains in the main tank, amid familiar surroundings, where he is the most comfortable.

Since one of the side effects of Diamox is that it sometimes suppresses appetite, some hobbyists like to administer the antibiotics orally by gutloading live adult brine shrimp with Furan2, Moon Valley, since the movements of the adult brine shrimp will normally trigger a strong feeding response from the seahorse.

But if the seahorse continues to eat frozen Mysis well after the Diamox pouch flush, it is simpler to administer neomycin sulfate orally by combining Seachem NeoPlex with Seachem Focus and then adding the resulting mixture to the frozen Mysis in the proper proportions. The Seachem Focus binds to the medication in the NeoPlex (i.e. neomycin sulfate) and then binds strongly to the frozen Mysis, masking the unpleasant taste of the medication in the process, thereby assuring that the seahorses will eat the medicated Mysis readily.

For the sake of thoroughness, I will provide instructions for both methods of administering antibiotics orally following a Diamox pouch flush for you below, Moon Valley. Which method you may want to use will probably depend on whether or not you have a good source from which you can obtain healthy live adult brine shrimp locally.

Gutloading Live Adult Brine Shrimp with Furan2

Administering the antibiotics orally via gut loaded live adult brine shrimp is very helpful because it will allow you to treat the male in the main tank, without isolating him from his tankmates. He can thus day amidst familiar surroundings in the company of his herdmates, so it is a very stress-free method of treating your pony.

I recommend using Furan2 for this purpose, Moon Valley, because it is ideally administered orally via gutloaded adult brine shrimp, and both the live adult brine shrimp and the Furan2 can be readily obtained from well-stocked fish stores.

Here are the instructions for gut loading live adult brine shrimp with the Furan2, Moon Valley, (courtesy of Ann at the org):

FURAN-BASED MEDS (oral) Dosage and Preparation Instructions for a 10g/38L Hospital Tank
Active Ingredients: Nitrofurazone and/or Furazolidone
Indication: bacterial infection
Brand Names: Furan-2, Furanase, Binox, BiFuran+, FuraMS, Furazolidone Powder
Feed adult brine shrimp gut-loaded with medication to the Seahorse 2x per day for 10 days.
• Add a small amount of the medication to one gallon of water and mix thoroughly.
• Place the amount of adult brine shrimp needed for one feeding into the mixture. Leave them in the mixture for at least 2hrs.
• Remove the adult brine shrimp from the mixture and add them to the hospital tank.
• Observe the Seahorse to be certain it is eating the adult brine shrimp.

In my experience, the best way to gutload the adult brine shrimp is to set up a clean plastic pail with 1 gallon of freshly mixed saltwater, add one packet of the Furan 2, add enough live adult brine shrimp for a generous feeding for all of your seahorses to the bucket after you have thoroughly and carefully rinsed them in freshwater to disinfect the shrimp. Leave the adult brine shrimp in the medicated bucket for at least two hours and then feed them directly to the seahorses. Repeat this procedure twice a day for 10 days.

Don’t worry that all the seahorses will be eating the medicated brine shrimp, Moon Valley –it won’t do any harm at all to treat all of the ponies prophylactically.

Finally, here are the instructions for medicating the frozen Mysis with neomycin sulfate so that it can be administered orally, Moon Valley:

Medicating Frozen Mysis Using Seachem NeoPlex + Seachem Focus

As long as the seahorse is still eating frozen Mysis well, Moon Valley, you can also treat him with some oral antibiotics by mixing them with frozen Mysis.

I would like to use Seachem Focus together with Seachem NeoPlex for this purpose, Moon Valley, because the Focus contains a good nitrofuran antibiotic whereas the NeoPlex contains a good aminoglycoside antibiotic (neomycin sulfate). The neomycin can safely be combined with nitrofuran antibiotics to produce a synergistic effect that makes the combination much more potent and effective than either of the medications used alone.

The Seachem Focus and Seachem NeoPlex are readily available from any local fish stores that carry Seachem products and it’s very easy to use them to medicate the frozen Mysis to feed to the affected seahorse so that the medications will be ingested and move efficiently into the bloodstream, where they can be the most effective in preventing secondary infections.

In short, after you have performed a medicated pouch flush, Moon Valley, I recommend that you obtain some Seachem NeoPlex and administer it to the seahorses orally by mixing Seachem Focus and the NeoPlex together with frozen Mysis that you have carefully thawed and prepared. The Focus will bind with the medication in the NeoPlex and then bind to the frozen Mysis in a manner that masks the unpleasant taste of the medication and makes it more palatable to the seahorse. The active ingredient in the NeoPlex is neomycin sulfate, a potent aminoglycoside antibiotic, so when the seahorses subsequently eat the frozen Mysis, they will ingest the antibiotics and get the maximum benefit they can provide.

Here is some additional information on the Focus by Seachem Laboratories, which explains how to use it to combine medication with food:

Seachem Laboratories Focus – 5 Grams Information

Focus ™ is an antibacterial polymer for internal infections of fish. It may be used alone or mixed with other medications to make them palatable to fish and greatly reduce the loss of medications to the water through diffusion. It can deliver any medication internally by binding the medication to its polymer structure. The advantage is that the fish can be medicated without contaminating the entire aquarium with medication. Fish find Focus™ appetizing and it may be fed to fish directly or mixed with frozen foods. Focus™ contains nitrofurantoin for internal bacterial infections. Marine and freshwater use. 5 gram container.

Types of Infections Treated:

Fungal
Bacterial

Focus
DIRECTIONS: Use alone or in combination with medication of your choice in a 5:1 ratio by volume. Feed directly or blend with fresh or frozen food. Feed as usual, but no more than fish will consume. Use at every feeding for at least five days or until symptoms clear up.

Contains polymer bound nitrofurantoin.

Active ingredient: polymer bound nitrofurantoin (0.1%). This product is not a feed and
should not be fed directly. Its intended application is to assist in binding medications to fish food.

And here is an excerpt from an e-mail from another home hobbyist (Ann Marie Spinella) that explains how she uses the NeoPlex together with the Focus for treating her seahorses, Moon Valley:

“When I bought the NeoPlex yesterday I also picked up a tube of Focus. According to the instructions, it says it makes the medication more palatable to fish & reduces the loss of the medication once it’s in the water.

So I followed the dosing instructions exactly. I used regular frozen mysis instead of PE. I figured it was softer & smaller. I was thinking along the lines of more surface area for the medication to adhere to & with the softer shell hopefully it would absorb into the shrimp a little better.

I used 8 cubes which came to just about 1 tablespoon. I thawed & rinsed the shrimp thoroughly in a little colander & let it sit on a paper towel to remove as much water as possible.

Then I put in it in a small dish & added the Focus & NeoPlex in the recommended ratio which is 5:1 (5 scoops Focus / 1 scoop NeoPlex). I mixed it thoroughly & added a few drops of Garlic Power.

Then I measured out 5 – 1/4 tsp. servings & 4 servings I placed on a sheet of Glad Press & Seal, sealed them & put them in the freezer, since it says in the instructions that you can freeze what you don’t use right away, & the remaining 1/4 tsp. I split in half & fed to them this morning. The rest I’ll give to them
this afternoon & I’ll do this every day with the remaining shrimp that I already prepared & froze.

In the video you can see that the seahorses are eating it. Yea!!

Thanks for all of your help & I’ll keep you posted.”
Ann Marie

Okay, Moon Valley, that’s the rundown on the different methods of administering acetazolamide and the proper dosages for each of the procedures. Note that when administering the pouch flush using a solution made from 1/4 of a 250 mg tablet of Diamox, it is customary to use clean saltwater from the seahorse’s tank to make the solution rather than sterile saline or sterile water. In stubborn cases, you may need to repeat the pouch flush twice in order to completely resolve this problem.

Since chronic pouch emphysema resulting in positive buoyancy is the most commonly seen form of gas bubble syndrome, I’m going to provide you with detailed instructions for treating pouch emphysema in three distinct stages, Moon Valley.

The first step in treating chronic pouch emphysema is always to release the gas trapped in your male’s pouch, Moon Valley, which can be accomplished in several different ways, as we will discuss later in this post. And I will also refer you to some video clips that illustrate how to evacuate the gas from your stallion’s pouch in a case like this.

As you know, chronic pouch emphysema is the most common form of gas bubble syndrome (GBS). Sexually mature males that are actively courting and breeding are the most vulnerable to this condition because of the placenta-like changes their heavily vascularized, physiologically dynamic brood pouch undergoes at these times.

I will typically address problems with positive buoyancy due to gas building up within the brood pouch (i.e., pouch emphysema) in three stages, Moon Valley.

The first stage is simply to manually evacuate the gas from the male’s pouch. This can be accomplished in a number of different ways, but manually burping the pouch is probably the most common technique employed by home hobbyists. This will release the trapped gas and provide the affected male with immediate relief from the positive buoyancy so that he can swim normally and eat normally again, but very often it does not resolve the problem because we are merely treating the symptoms of the problem rather than the underlying cause of the pouch emphysema.

So many times the positive buoyancy problems return within a week or two as more gas gradually builds up within the male’s pouch, Moon Valley. When the bloated pouch problems recur (chronic pouch emphysema), it’s appropriate to move on to the second stage of treatment, which involves first releasing the trapped gas as before and then performing a medicated pouch flush.

I usually recommend Furan2 for a medicated pouch flush for stage II, Moon Valley, because it is inexpensive, readily obtained from local fish stores and pet shops so that the home hobbyist can obtain it quickly, and contains an effective combination of two nitrofuran antibiotics (i.e., nitrofurazone and furazolidone). With luck, the medicated pouch flush will sometimes resolve the problem, and no further treatment will be necessary. That will be the result in a little more than half of such cases.

But in a considerable number of cases, the positive buoyancy problems due to gas building up in the brood pouch will eventually recur yet again. When that happens, it is appropriate to perform a medicated pouch flush using acetazolamide (brand name Diamox), but I save that for the last resort because acetazolamide is a prescription drug which is often very difficult for home hobbyist to obtain.

The third stage of treatment again involves releasing the trapped gas via burping the pouch of whatever method works best for you, followed by filling the pouch with a solution made from the Diamox tablets. In my experience, this will almost always resolve the problem for the long term.

I break down the treatment for this condition into three separate, distinct stages because when hobbyists first contact me about such a problem, it’s usually a crisis situation. Their male seahorse is struggling mightily with positive buoyancy (i.e., the tendency to float) due to the buildup of gas within its pouch, and the seahorse is unable to swim or feed normally. Worst of all, the aquarists are typically unprepared to deal with such an emergency and do not have the necessary apparatus (a fine cannula and syringe) or medications (antibiotics and/or acetazolamide) on hand that are necessary to deal with the problem.

It’s important to act quickly in such a situation because a seahorse’s condition can weaken and go downhill quickly when it is unable to feed, so for Stage One, I simply explain how to manually evacuate the gas from the stallion’s pouch, which can be done without any special equipment, and which will provide the seahorse with immediate relief, allowing him to swim normally and feed normally again.

But I also advise the home hobbyists that, even though their seahorse is seemingly back to normal again after they release the gas from its pouch, the problem is likely to return within a week or two, and I advise them to obtain a suitable small catheter or cannula and syringe, along with a good broad-spectrum antibiotic (i.e., Furan2) so they will be prepared to perform a medicated pouch flush to address the chronic pouch emphysema properly, if it recurs (Stage II for treating chronic pouch emphysema).

Likewise, following the second stage treatments (i.e., a medicated pouch flush), I always advise the home hobbyists that there is still a chance that the pouch gas problem and positive buoyancy will reoccur at some point after the medicated pouch flush, and I advise them to begin lining up a source for acetazolamide (brand name Diamox) in the meantime, because it’s a prescription drug that is commonly very difficult for the home aquarist to obtain.

That will assure that the home aquarist will have a good chance to obtain some of the Diamox in the event that the third stage of treatment for chronic pouch emphysema becomes necessary – performing a medicated pouch flush using a solution of the Diamox. In most instances, that will almost always resolve the problem once and for all.

Although Diamox is very effective when it’s administered orally via injected feeder shrimp (or administered as a series of baths) when treating subcutaneous emphysema or tail bubbles (blisterlike bubbles of gas that form just beneath the skin, usually on the tail or head of the seahorse), Moon Valley, I find that the most effective way of administering Diamox in cases of chronic pouch emphysema is to perform a medicated pouch flush with the Diamox solution.

Here are the complete instructions for carrying out all three stages of treatment for chronic pouch emphysema, Moon Valley:

Treatment Protocol for Chronic Pouch Emphysema and Positive Buoyancy

A bloated pouch combined with positive buoyancy (i.e., the tendency to float) is a sure indication that your stallion is suffering due to gas building up within his brood pouch. This is a common problem for male seahorses and it is very treatable.

As we discussed, this problem is almost always due to a buildup of gas within the brood pouch of the male, and, if left untreated, the condition will continue to worsen as more gas builds up until the seahorse is left floating helplessly at the surface. Affected males will be unable to swim in their normal upright position, but rather must swim tilted forward at an angle, or sometimes even upside down, so that their dorsal fin can counteract the tendency to float. This is hard work and the seahorses with positive buoyancy problems often prefer to stay hitched to a convenient perch rather than struggling valiantly against the tendency to rise when they release their hold. When they do attempt to swim, their center of gravity can shift suddenly due to the movement of the gas bubble(s) within their pouch, and this causes them to adopt awkward postures in order to make the necessary adjustments and regain their balance. Because their mobility and ability to swim normally is compromised, this naturally has an adverse impact on their feeding as well.

Stage 1 Treatment for Chronic Pouch Emphysema – releasing the trapped gas

Air or gas can be trapped within the male marsupium for a number of reasons, but the first course of treatment is always to release the gas that is trapped within your male’s pouch. This will provide him with immediate relief and he will be able to swim and eat normally again. If the problem recurs, you may need to take additional measures to treat the condition, but, initially, simply evacuating the air from his pouch should suffice for now.

Aside from burping the pouch, I find the easiest and most effective way to evacuate the gas and deflate the pouch is to carefully insert a small catheter or cannula or tiny pipette into the aperture of the pouch and then apply firm but gentle pressure to the outside of the pouch. This usually causes the air to escape through the catheter or pipette. And a needle aspiration is another very easy way to remove the trapped gas from the pouch, which you should also consider.

So I recommend home hobbyists try “burping” the pouch of the seahorse to release the trapped gas when this problem first appears, as explained later in this e-mail, first and foremost, Moon Valley.

If that is unsuccessful for any reason, the aquarist should next try inserting a small catheter or tiny pipette into the mouth of the pouch and then massaging the marsupium very gently to force the trapped air through the catheter or pipette. If this is successful, you will see a stream of small bubbles rising from the catheter/pipette when you apply gentle pressure to the outside of the pouch.

Failing that, a needle aspiration is also very easy to perform and very effective in removing the excess gas from the pouch of a seahorse. You should be able to obtain a suitable hypodermic syringe and needle quickly from your family doctor or veterinarian or perhaps a friend who works at a hospital or needs to be treated for diabetes. I will explain how to perform a needle aspiration in more detail later in this message.

For now, just let me say that performing a needle aspiration sounds like a very intimidating procedure but that’s really not the case in actual practice. It’s actually much easier on both the seahorse and the aquarist than any other methods for releasing trapped gas, such as burping his pouch or opening of the aperture with the aid of a bobby pin, and it can be more effective in extracting the gas that builds up within the pouch. I can assure you that it’s a perfectly painless procedure for your pony and much less stressful than some of the other techniques.

In addition to aspirating trapped gas, the hypodermic can also be used to flush out the pouch thoroughly either with sterile saline or a medicated solution (an antibiotic or Diamox dissolved in saltwater), for even better results. Here’s how another hobbyist describes this procedure:

dear pete, it was time to give the antibiotics due to recurrent swelling of his pouch and i had small iv catheters but i was unable to intubate the opening. either too small or voluntary tightening by the horse. only choice left was an injection with a needle. i used a 29g insulin syringe and first removed whatever air i could. then reinjected approx .5cc mix of neomycin sulfate plus bifuran until distended then withdrew approx half of that and left the remainder in his pouch. a couple of lethargic days followed with little food intake. then he started eating live brine shrimp then the usual mysis. it is now 5 or 6 weeks later and all seems well. before that a diamox bath didnt do much but i stopped the diamox due to what seemed like unfavorable side effects. hard to believe the antibiotic injection worked so well. i gave only one injection as it seems to have worked. thanks again for all your help. he was certainly a goner without the intervention and we are most grateful. best regards sg

In short, Moon Valley, bloated pouch or pouch emphysema is the most common cause of positive buoyancy problems in male seahorses, and there are a number of options for treating it you may want to consider. But I would suggest that you try burping the pouch first or else evacuating the trapped gas or air from your male’s pouch by inserting a small catheter or pipette through the mouth of its pouch or by performing a needle aspiration and possibly flushing the pouch at the same time, for starters.

Here is a complete discussion of the different methods for evacuating gas from your male’s pouch (Stage I) to provide him with some immediate relief from this problem:

Pouch Massage: Burping the Pouch

Pouch bloat is ordinarily easily resolved by evacuating the gas from the marsupium. This procedure is commonly known as pouch massage or “burping” the pouch and it provides immediate relief for the seahorse when successful. The first attempt or two at performing this procedure can be very intimidating, I know, but it is actually much easier than it sounds.

To expel the trapped air, wet your hands first and hold the seahorse upright in the water with your non-dominant hand, allowing his tail to wrap your little finger or ring finger so he has a good grip and feels secure (Burns, 2001). While the seahorse is thus restrained, use your dominant hand to massage the pouch firmly yet gently between your index finger and thumb, working upward with a circular motion from the bottom of the tail toward the top so as to work the trapped gas upwards toward the opening of the pouch (Burns, 2001). Don’t squeeze the pouch too forcibly, just maintain gentle pressure from below as you massage the pouch, always working from the base of the pouch toward the orifice at the top with your thumb and index finger to force the gas upward.

Hopefully, as your massage moves to the upper half of the pouch and approaches the top, the aperture of the pouch will begin to gape open, allowing a stream of bubbles to escape (Burns, 2001). This is the “burp” you’ve been hoping to produce, and when it happens, you can actually feel the bloated pouch slowly deflate as you gently force the bubbles out (Burns, 2001).

If that does not happen, however, you will have to modify your gas evacuation technique somewhat, this ti. Me using the thumb and index finger of your non-dominant hand to massage the pouch with a gentle back and forth motion, while you use a bobby pin or similar blunt implement in your dominant hand to carefully tease open the aperture of the pouch (Burns, 2001).

You are not trying to insert the bobby pin into the pouch at all (Burns, 2001). The idea is to use the rubber-coated end of the pin to gently manipulate the orifice of the pouch, using a sideways pressure on the mouth of the pouch to tease it open, rather than using a downward pressure to force the bobby pin into the opening (Burns, 2001).

Begin as before, holding the seahorse upright in the water with your non-dominant hand, allowing his tail to wrap your little finger or ring finger so he has a good grip and feels secure, while leaving your thumb and index finger free to perform the massage (Burns, 2001). Begin at the base of the pouch near the tail, and massage the pouch gently but firmly between your thumb and index finger, working upwards with a back and forth motion as though gently squeezing a toothpaste tube from the bottom to the top (Burns, 2001).

Meanwhile, using your dominant hand, position one of rubber coated ends of the booby pin at the mouth of the slitlike aperture, and use sideways pressure to prise the lips of the pouch open without actually inserting the pin into the pouch (Burns, 2001). This may take a surprising amount of pressure, so proceed gently but firmly, making sure you direct the brunt of the pressure sideways rather than downward (Burns, 2001). As your massage progresses to the upward portion of the pouch, a few small bubbles at a time will be expelled, and you can feel the pouch gradually deflate between your fingers.

Continue applying pressure from the bottom of the pouch up while prizing the mouth of the pouch open until the pouch feels flaccid and no more gas escapes (Burns, 2001). You may have to repeat this procedure two or three times to be sure you have evacuated all of the trapped gas (Burns, 2001).

If successful, it’s an instant cure and your seahorse should be back to normal immediately, able to swim freely and feed as usual. Burping the pouch is stressful, but seahorses are very forgiving and often will swim away and start eating immediately afterward as though nothing happened. This type of pouch gas is not a serious problem and poses no threat to the seahorse’s long-term health.

Eyedropper Pouch Evacuations

Rather than burping or massaging the pouch, some hobbyists find it easier to use an ordinary eyedropper to evacuate the air from a large seahorse’s pouch. This technique is fairly self-explanatory. Get a glass eyedropper (the smaller the better) from your drugstore — the glass kind that has a rubber bulb. The glass tip is much smoother than plastic droppers are and the rubber squeeze-bulb allows you to apply suction using the eyedropper with one hand while holding the seahorse with your other hand.

Take the seahorse in your nondominant hand, keeping it underwater, of course, and let it wrap its tail round your baby finger. Then take the eyedropper in your dominant hand, squeeze the rubber bulb and hold the bulb squeezed closed while you very gently insert the glass tip into the aperture of the pouch. Once you are just slightly inside the pouch, slowly release the squeeze bulb and the bubbles of trapped air will often be aspirated.

Remove the eyedropper, expel the bubbles it extracted, and repeat the whole procedure as necessary to remove all the trapped air and restore neutral buoyancy.

Needle Aspirations.

It is also very practical to aspirate air from a bloated pouch using a small hypodermic needle and a syringe. The pouch can easily be penetrated from side and is not harmed by the entrance of the needle. It causes the seahorse surprisingly little discomfort and is often less traumatic that massaging the pouch and other methods for evacuating gas. It is a quick and effective technique and is often easier on the seahorse keeper and his patient than other approaches.

Remember, when you perform a needle aspiration, you are not penetrating the seahorse’s stomach, but rather the brood pouch that is slung beneath its belly at the base of its tail.

You cannot release the gas that has built up in your male’s pouch simply by perforating the side of his pouch with a small needle. That’s not what the term “needle aspiration” means. Rather, you need a hypodermic needle and syringe in order to perform a needle aspiration. You must first depress the plunger on the hypodermic syringe to empty all of the air out of the barrel of the syringe, and then carefully insert the hypodermic needle into the side of the pouch, just far enough to penetrate into the central cavity of the pouch, and then gradually withdraw the plunger again, which will extract the gas from that area of the pouch.

You may need to perform this procedure twice, once from the left-hand side of the pouch and once from the right-hand side of the pouch, since male seahorses in breeding condition develop an septum or internal membrane that divides their pouches roughly into left and right hemispheres. So you may need to aspirate air from the left side of the pouch, and then repeat the procedure with your hypodermic needle on the right side of the pouch in order to remove all of the trapped gas from your stallion’s marsupium. But do not penetrate the pouch of your male with a hypodermic needle more than that; if aspirating the gas once from each side of the pouch is not sufficient to deflate the pouch and eliminate the problem with positive buoyancy, then you will need to flush out his pouch instead or release the gas using one of the other techniques described above.

Whatever method you decide to use to evacuate the male’s pouch, be sure to observe the following precautions when manipulating seahorses:

Handling Seahorses

I do not like to use an aquarium net to transfer or manipulate seahorses, since their delicate fins and snouts can become entangled in the netting all too easily. I much prefer to transfer the seahorses by hand. Simply wet your hand and fingers (to avoid removing any of the seahorse’s protective slime coat) and scoop the seahorses in your hand. Allow them to curl their tail around your fingers and carefully cup their bodies in your hand to support them while you lift them out of the water. When you gently immerse your hand in the destination tank, the seahorse will release its grip and swim away as though nothing out of the ordinary has happened.

Composed of solid muscle and endowed with extraordinary skeletal support, the prehensile tail is amazingly strong. Indeed, large specimens have a grip like an anaconda, and when a 12-inch ingens or abdominalis wraps its tail around your hand and tightens its hold, its vise-like grip is powerful enough to leave you counting your fingers afterwards!

In fact, it can be quite difficult to remove an attached seahorse from its holdfast without injuring it in the process. Never attempt to forcibly detach a seahorse from its hitching post! When it feels threatened, it’s instinct is to clamp down and hold on all the tighter. When you must dislodge a seahorse from its resting place for any reason, it’s best to use the tickle technique instead. Gently tickling the underside of the tail where it’s wrapped around the object will usually induce the seahorse to release its grip (Abbott, 2003). They don’t seem to like that at all, and will quickly let go to move away to another spot. Once they are swimming, they are easy to handle.

Okay, Moon Valley, those are some simple techniques that can be used to release the trapped gas from the stallion’s pouch for the first stage of treatment. In a case like this, the first step is always to try manually releasing the trapped gas from the seahorse’s pouch. I find the easiest way to do that is to carefully insert a small catheter or cannula or tiny pipette into the aperture of the pouch, as previously described, and then apply firm but gentle pressure to the outside of the pouch. This usually causes the air to escape through the catheter or pipette. This method works very well but it’s easier if you have three hands or a helper to assist you.

If the aperture to the pouch is too tight to insert a small catheter or tiny pipette, then the next easiest way to release the gas is by performing a needle aspiration, a technique that will work equally well for administering an antibiotic solution should a pouch flush proved necessary.

Finally, Moon Valley, to provide you with some additional guidance, there are a couple of short video clips on YouTube that show how to release or evacuate the gas from a male seahorse’s pouch. It might be helpful to watch these short videos before attempting this procedure.

The first one is titled “Deflating my male seahorse’s pouch,” Moon Valley, and it demonstrates how to “burp” the stallion’s pouch to release the trapped gas. Just copy the URL on the line below, paste it in their web browser, and press their “Enter” key, and it will take them directly to the right video clip on YouTube:

http://www.youtube.com/watch?v=NadBg2LL7mU&noredirect=1

The second video clip is titled “Male Seahorse pouch evacuation,” Moon Valley, and it shows how to burp the male’s pouch to expel the trapped gas by using the blunt end of a bobby pin to tease open the opening of the pouch. Just copy the URL on the line below, paste it in their web browser, and press their “Enter” key, and it will take them directly to the right video clip on YouTube:

http://www.youtube.com/watch?v=c-ZHWg3YsEQ&noredirect=1

Burping the pouch to release the trapped gas will provide the stallion with immediately relief, Moon Valley, but most of the time the belief is only temporary because more gas will begin accumulating within the pony’s pouch, resulting in positive buoyancy, and the problem will recur.

That happens because burping the pouch does not address the underlying problem that is causing the gas to build up within the pony’s pouch to begin with, so you can expect the problem to be return as more gas gradually accumulates within the stallion’s marsupium, Moon Valley. If that is the case, as I strongly suspect, you cannot simply continue to burp the pouch to deal with the situation. Repeatedly burping the pouch is not a long-term solution for this problem because it will eventually result in serious pouch infections that often prove fatal.

In other words, Moon Valley, burping or manually evacuating the excess gas from a male’s pouch when these having problems with positive buoyancy can certainly provide him with some immediate relief, but when you have to repeat the procedure for manually evacuating gas from a seahorse’s pouch more than once, it becomes increasingly hard on the seahorse and will not resolve the problem once and for all because you are merely treating the symptoms and not the cause of the gas build up.

When that’s the case, Moon Valley, you need to move on to more aggressive forms of treatment in order to resolve the problem with chronic pouch emphysema once and for all. In that scenario, it will be necessary to perform a medicated pouch flush instead, as explained below.

Not only is repeatedly evacuating the air from the male’s pouch counterproductive in most cases, Moon Valley, 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.

In order to prevent that from happening, in addition to burping or manually removing the air from the stallion’s pouch, I strongly recommend that you also round up the required apparatus and equipment to perform a medicated pouch flush, so that you will be prepared and have everything at the ready should it become necessary to do so.

You can obtain the small syringes and cannulas needed to perform pouch flushes at the following website, Moon Valley — just copy the following URL, paste it in your web browser, and press the “Enter” key, and it will take you directly to the right webpage for ordering the syringe and cannula you need for performing pouch flushes:

http://www.seahorsesource.com/cgi-bin/shop/search.cgi?&category=Medications

Furan2 can be purchased inexpensively from most local fish stores and pet shops, and is also available from many online sources.

Stage II Treatment for Chronic Pouch Emphysema – perform a medicated pouch flush with Furan2

The first step in performing this procedure is to release the trapped gas from the seahorses pouch manually, just as before. This can be done by “burping” the pouch, using a blunt-tipped bobby pin to gently prise open the aperture of the pouch while you apply pressure to the sides of the pouch to force out the gas bubbles, inserting a cannula into the mouth of the pouch and then compressing the sides of the pouch to expel the gas bubbles, or any of the other methods explained in the Stage 1 treatment section above.

As you will see in the YouTube video clip listed at the end of this message, you can also use the tip of the syringe to gently and delicately move the sides of the slit-like aperture back and forth, which loosens up the sphincter muscle that holds the mouth of the pouch closed. That will make it easier to insert the cannula into the pouch for releasing the trapped gas initially, and then for filling the pouch with a medicated solution afterwards, Moon Valley.

Once you have accomplished the first step, and successfully released the trapped gas from the seahorse’s pouch using whatever technique is easiest for you, the next step is to mix up a medicated solution that you can suck up in the syringe and then slowly pump into the stallion’s pouch.

I recommend using Furan2 for the medicated pouch flush because it is inexpensive to use, readily available from local pet shops and local fish stores, and contains a mixture of different nitrofuran antibiotics (nitrofurazone and furazolidone) that is effective against both fungal and bacterial infections.

To prepare the medicated solution from the Furan2, Moon Valley, you simply dissolve one packet of the Furan2 powder in one cupful of aquarium water taken from the seahorse tank. (We use the seahorse aquarium water for mixing up the solution of Furan2 because that will assure that the saltwater is at the same temperature, pH, and specific gravity as the water the seahorse is living in, which in turn assures that it will not be a shock to the stallion’s system when we fill his pouch with an antibiotic solution made from the tank water.)

Once the solution of Furan2 and saltwater from the aquarium has been prepared, you simply attach the cannula to the end of the syringe, suck up a few millimeters of the solution into the barrel of the syringe, hold the syringe upside down and depress the plunger slightly to release any air bubbles, and then carefully insert the cannula from the syringe into the seahorse’s pouch and gently depress the plunger to carefully fill his pouch with the medicated solution. The solution of Furan2 is left inside the seahorse’s pouch and the heavily vascularized lining of the pouch will gradually absorb the antibiotics into the stallion’s blood stream over a period of days.

In stubborn cases, you may have to repeat this procedure two or three times to achieve the desired result, but in most cases, performing one medicated pouch flush does the trick.

That’s all there is to it, Moon Valley, but I will go over some more detailed discussions on flushing the pouch with you below to make sure that you are as well prepared as possible for performing this procedure.

Just remember, that the first step is always to release all of the trapped gas from the pony’s pouch, using whatever technique works best for you.

As we have discussed previously, Moon Valley, 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.)

So when problems with pouch gas and positive buoyancy do recur, the best thing to do is to release the trapped gas as usual and then perform a medicated pouch flush.

To provide you with some additional guidance regarding the pouch flush procedure, Moon Valley, here are detailed instructions from Leslie Leddo and other experienced seahorse keepers explaining different ways to perform a pouch flush when you’re ready to proceed:

“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 such considerably doing 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 it in the 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.

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 realizing you have forgotten something.

Hope this helps

Best wishes
Neil
Neil Garrick-Maidment
[close quote]

In addition, Moon Valley, there is a good YouTube video clip that explains how to perform a medicated pouch flush my first releasing the trapped gas from the seahorse’s pouch and then filling the pouch with antibiotic solution. This YouTube video is titled “Episode 1 pt 1, How to remove an air bubble in a male seahorse pouch,” and is fairly self-explanatory.

Just copy the URL on the line below, paste it in their web browser, and press their “Enter” key, and it will take them directly to the right video clip on YouTube that demonstrates how to perform a medicated pouch flush:

http://www.youtube.com/watch?v=-8UP2__taCk&noredirect=1

As you can see, Moon Valley, there are a number of different methods for performing pouch flushes, all of which seem to work equally well. One of these techniques will hopefully work well for you, depending on what medications and equipment you have on hand or have access to for performing the medicated pouch flushes.

In a certain significant percentage of the cases, even flushing the pouch and administering antibiotics within the pouch itself, as explained above, will not resolve stubborn cases of chronic pouch emphysema.

When that’s the case, you should proceed to performing a medicated pouch flush using acetazolamide (brand name Diamox), Moon Valley. In order to be prepared for that eventuality, it’s always best to take the time and effort to line up a good source for the acetazolamide as soon as you complete your antibiotic pouch flush. The reason for this is that the acetazolamide/Diamox is a prescription drug and can sometimes be very challenging for the home hobbyist to obtain, as discussed below:

Unfortunately, the prescription drug acetazolamide (brand name Diamox) has become increasingly difficult for seahorse keepers to obtain these days. . It is a carbonic anhydrase inhibitor — a prescription drug often used for treating glaucoma, hydrocephaly, epilepsy, congestive heart failure, and altitude sickness in humans, so you have to get it from your Vet or perhaps your family doctor. Unfortunately, Veterinarians are often unfamiliar with Diamox — it’s very much a people med and unless you find a Vet that works with fish regularly, he or she will probably never have heard of gas bubble disease or treating it with carbonic anhydrase inhibitors. Many pet owners are on very good terms with their Vets, who are accustomed to prescribing medications for animals, so it’s often best to approach your Vet first about obtaining Diamox despite the fact they may never have heard of it until you brought it to their attention. Your family doctor, of course, will be familiar with such medications and have Diamox on hand but it can sometimes be difficult to get your MD to jump that final hurdle and prescribe it for a pet. Either way, it can be tough to get the medication you need under these circumstances.

However, I would exhaust those possibilities first before I considered an online source for the Diamox. Print out some of the detailed information that’s been posted regarding pouch emphysema and gas bubble syndrome (GBS) on the Ocean Rider “Seahorse Life and Care” discussion forum at http://www.seahorse.com, and how it’s treated using Diamox, and present that to your family veterinarian and/or your family practitioner. Bring photographs of the affected seahorse and be prepared to bring the pony in for a visit, if necessary. (Veterinarians are prohibited by law from prescribing medications to treat an animal they have not personally seen and examined. If you have had a close personal relationship with your vet over a period of years, they are often willing to bend that rule in the case of fish, but you may well have to bring the seahorse in for a quick checkup to get the desired results.)

Unless you have a close, personal relationship with your veterinarian or family physician, Moon Valley, it can be very challenging to get a script from either of those sources. And, when they do provide a prescription for Diamox for the treatment of seahorses, it is not a script for 50 or 100 tablets – it is normally only for 5-10 250 mg Diamox tablets, which is enough to treat one episode of GBS. That means that the fortunate home hobbyists with understanding vets or physicians who are able to obtain the medication through the proper channels usually do not receive an excess amount, which they would then then be free to share with other hobbyists.

As an alternative, not too long ago, it was possible to order the Diamox online without a prescription from a good source in Canada, but that is no longer the case. Nowadays, the vast majority of the online pharmacies are dummy sites that are simply trying to rip people off. Many of them are based in Russia or the other states in the old Soviet Union, or China, even if they purport to be Canadian or some other nationality, and are simply trying to obtain your credit card information for outright fraud. Other oversee drug outlets you can order from online without a prescription will not abuse your credit card, but instead will send worthless sugar pills that contain no medication whatsoever rather than the drug you actually order, which has very serious repercussions for ailing people that are trying to obtain the drugs for their own health problems, rather than for a pet pony. Because of these sorts of abuses, the U.S. Customs people can and will intercept such shipments whenever possible, confiscating the packages they can track down. For these reasons, I no longer suggest that home hobbyists try to obtain the Diamox online without a prescription…

With the good Canadian source that we used to be able to rely on no longer in business, and other online sources of pharmaceuticals becoming increasingly risky and hazardous to use, I no longer suggest that hobbyists consider obtaining the Diamox from such sources.

Rather, if your family physician and family vet should prove to be uncooperative, the next thing I would recommend is ordering the medication from Drs. Foster’s and Smith at the following URL, in which case their Pet Pharmacy may be able to help you to obtain the necessary authorizations from another veterinarian in your area. Just copy the following URL, paste it in your web browser, and press the “Enter” button, and it will take you to the right page on their website for the acetazolamide (brand name Diamox):

http://www.drsfostersmith.com/Product/Prod_Display.cfm?pcatid=16478

Should the antibiotic pouch flush prove to be unsuccessful in resolving the pouch gas problem once and for all, Moon Valley, here are the instructions for performing a medicated pouch flush using a solution of Diamox (Stage III):

Stage III Treatment for Chronic Pouch Emphysema – perform a medicated Diamox pouch flush

The first step in performing a successful Diamox pouch wash is, as always, to release all of the trapped gas from the affected seahorse’s pouch. Feel free to do this in any way that is comfortable for you – burping the pouch, a needle aspiration, inserting a small cannula into the aperture of the pouch and gently compressing the sides of the pouch to force the air out of the cannula and the mouth of the pouch, or whatever else works for you.

Once you have expelled all of the trapped gas from the stallion’s pouch, the next step is to flush the pouch using a solution of Diamox. This is done exactly the same as performing a medicated pouch flush using Furan2, except that you will be using a Diamox solution in place of the antibiotics. As before, the Diamox solution is prepared using clean saltwater obtained from the seahorse’s tank.

With that in mind, 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 (in a hospital tank). 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 (when administering the antibiotics in a hospital tank).
[End quote]

Okay, Moon Valley, that’s the complete rundown on releasing the trapped gas from a stallion’s pouch and performing a medicated pouch flush using a solution of Diamox, should that ultimately become necessary.

Respectfully,
Pete Giwojna, Ocean Rider Tech Support