Seahorse with Tail Problem

Dear seahorsegirl:

Yes, I agree that the symptoms you describe sounds very much like the early stages of tail rot, and the sooner you detect this condition and begin treatment, the better the outcome is likely to be.

You did well to begin treating the affected seahorse with antibiotic therapy in your hospital tank, since this problem does not appear to be related at all to gas bubble syndrome (GBS). Although it’s true that external GBS (i.e., subcutaneous emphysema) often affects the tail of the seahorse and is commonly known as tail bubbles for that reason, it has very different symptoms from tail rot. The telltale sign of subcutaneous emphysema of the tail is the appearance of upraised blisterlike pockets of gas that form just beneath the skin, appearing very much like you would imagine from the nickname “tail bubbles.”

The appearance of the subcutaneous emphysema does not usually affect the grasping ability of the tail are the seahorses ability to use its tail as usual, except when the subcutaneous emphysema become so large or so numerous that they cause the tail of the seahorse to become buoyant.

In this case, the clumsiness and apparent stiffness of the tail, with difficulty in wrapping around her clinging to objects or convenient hitching posts, is very typical of tail rot, which begins with the loss of prehensility in the tail that begins at the tip and gradually spreads upwards.

The antibiotics you are using for treatment are appropriate and make a good starting point, seahorsegirl. The active ingredient in the Seachem NeoPlex is neomycin sulfate, a good aminoglycoside antibiotic, and it is known to be helpful in treating some cases of tail rot, particularly when combined with sulfa drugs, so I think you are off to a good start.

However, for best results, I would also recommend treating your seahorse with a good antiparasitic that is administered orally (by pretreating frozen Mysis with the meds). The reason for this is that tail rot is often the result of a mixed infection involving ciliates (certain protozoan parasites) as well as a bacterial or fungal infection. I recommend Seachem Metronidazole combined with Seachem Focus and Seachem Garlic Guard for this purpose, as explained below:

Medicate your seahorses’ frozen Mysis with a good antiparasitic (Seachem Metronidazole) used together with an antibiotic (Seachem Focus) and then soak the medicated Mysis in Seachem Garlic Guard, which acts as an appetite stimulant. Your seahorses will ingest the medicated frozen Mysis and receive protection from potential bacterial and parasitic infections this way, which are possible contributing factors in any tail rot infection. The following information will explain how to use these products (Seachem Metronidazole, Seachem Focus, and Seachem Garlic Guard) properly to medicate the frozen Mysis, seahorsegirl.

Seachem Metronidazole Aquarium Fish Medication – 100 g

Product Description:
Parasitic and Bacterial infections don’t stand a chance with Metronidazole. When you find your fish infected with such nasty bugs as Ich or Hexamita, grab the Metronidazole and say goodbye to infection. This fast and effective treatment is safe for biological filtration and is easily removed with carbon after treatment. For freshwater or marine fish.

Specifications:
PACKAGE SIZE 100 GRAM
TREATS UP TO 265 TO 530 GALLONS
TYPE OF DISEASE BACTERIA, PARASITE
AQUARIUM TYPE FRESHWATER, SALTWATER
ACTIVE INGREDIENTS METRONIDAZOLE
FORM POWDER
INVERT SAFE WITH CAUTION

Instructions:
Do not use UV, ozone or chemical filtration during use.
Use 1-2 measures (each about 100 mg each) for each 10 gallons. Measurer included. Repeat every 2 days until symptoms disappear.

To feed, blend 1 measure with about 1 tablespoon of frozen food paste.

Okay, seahorsegirl, that’s the rundown on the Seachem Metronidazole, which comes in powder form and includes a little scoop for measuring the doses.

And here is the corresponding information for the Seachem Focus, which also comes in powder form with its own measuring scoop:

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 conSaranating 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:

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 finding medications to fish food.

That’s the rundown on the Seachem Focus, seahorsegirl.

Here is the corresponding information for the Seachem Garlic Guard (pay special attention to the information in bold type, which explains how to use the Garlic Guard together with Seachem Metronidazole and Seachem Focus properly):

Seachem Garlic Guard

* For fresh and saltwater fish, planted and reef aquariums
* Contains allicin, the active ingredient in garlic
* Contains ViSaran C for enhanced health benefits

Whet your fishes’ appetite with the natural healthful properties of garlic. Contains allicin, the active ingredient in garlic with powerful antioxidant properties that can lessen free radical damage to cells – plus ViSaran C for enhanced health benefits. For fresh and saltwater fish, planted and reef aquariums.

Directions for Use: Shake well before use. Soak food in Garlic Guard before feeding. For enhanced effectiveness against Ich and other parasites use Seachem’s Focus and Metronidazole as follows: Add 1 measure of Metronidazole to 1 measure of Focus per tablespoon of frozen food. Completely soak this food mix in Garlic Guard, refrigerate, and feed once or twice daily for 1-2 weeks.

Guaranteed Analysis
Garlic Extract 9900 ppm
Allicin 130 ppm
(active ingredient)
ViSaran C 1000 ppm

Okay, seahorsegirl- as you can see from the information above, it is actually quite easy to medicate the seahorse’s frozen Mysis using these products: You just use one scoop of the Seachem Metronidazole together with one scoop of the Seachem Focus for each tablespoon of the frozen Mysis you will be medicating, and then thoroughly soak the resulting mixture in Seachem Garlic Guard. The medicated frozen Mysis and then be fed directly to the seahorses and any excess can be frozen for later use.

Feed the affected seahorse twice a day in your hospital tank using Mysis that you have medicated as explained above for five straight days, seahorsegirl, and that will help assure that none of them will be affected by the same parasites or pathogens that may have caused Huck’s tail rot infection.

The metronidazole will eliminate any protozoan parasites that may be contributing to this tail problem, while the nitrofuran antibiotic in the Seachem Focus helps to combat infections after being absorbed into the bloodstream from the seahorse’s gut. This will allow you to fight infection internally at the same time the neomycin sulfate and sulfa drugs in the aquarium water are combating the infection externally.

Call around to your local pet shops and fish stores to find one who carries products from Seachem Laboratories, Sara, and they should have all of the products above. If not, they are all readily available online from many different sources.

Here is some additional information tail rot for future notice that you may find helpful:

White Tail Disease or Tail Rot:
Ulcerative Dermatitis of the Tail Tip

Tail rot, a.k.a. white tail disease or ulcerative dermatitis of the tail tip, can result from a number of causes. It can develop when a mechanical injury to the tail, such as a cut or scrape, becomes infected. Certain ciliates and protozoan parasites can attack the skin of seahorses, and when their integument is compromised, secondary bacterial and fungal infections may set in, resulting in tail rot. Likewise, cnidarian stings or the embedded spicules from a bristleworm can become infected and lead to tail rot. Many times an underlying bacterial infection (Vibrio, Pseudomonas or Mycobacterium) may be the primary cause of the tissue erosion and ulceration that’s so characteristic of tail rot. It is often associated with heat stress, particularly in temperate seahorses that have experienced a temperature spike during a summertime heat wave.

The tip of the tail is especially prone to infection because blood-oxygen levels are often deficient in the extremities — oxygen tension is lowest in the most distal part of the tail — and the bacteria that are responsible for tail rot prefer a low oxygen environment. A dirty substrate can be a contributing factor in some cases, and stress is almost always involved. The seahorse’s tail is prone to scrapes and abrasions as well as injuries such as stings from anemones or bristleworm spicules because it is used to grasp objects and often in contact with the substrate.

Disease-causing (pathogenic) bacteria such as the ones that cause tail rot are opportunistic invaders that are normally present in low numbers but don’t cause problems until the fish is injured, stressed, infested with parasites or otherwise weakened (Indiviglio, 2002). They will then take advantage of the overtaxed seahorse’s impaired immune system and reproduce extremely quickly, causing a variety of illnesses and problems (Basleer, 2000). Some of these are specific to seahorses, such as snout rot and white tail disease, and others are common to all fishes (Mycobacteriosis).

A progressive loss of prehensility and increasing discoloration beginning at the tip of the tail are the initial stages of tail rot or white tail disease. As I mentioned, it often affects the most distal portions of the tail first, where the oxygen tension is lowest and the circulation is the poorest, which seems to make the tail tip particularly susceptible to such infections.

Here is an excerpt on tail rot from my new book (Complete Guide to the Greater Seahorses in the Aquarium, unpublished):

White Tail Disease (Tail Rot)

As you might expect, this problem is due to an infection that attacks the tails of seahorses. The tip of the tail typically turns white and, as the infection spreads, the whiteness moves progressively up the tail and ulcers or open sores begin to form where the skin peels away (Giwojna, Oct. 2003).

Hobbyists usually refer to this problem as Tail Rot or White Tail Disease, but the disease is already well advanced by the time whitening or tissue erosion occurs (Giwojna, Oct. 2003). Early detection makes it much easier to get these infections under control. Some of the early indicators of a tail infection to watch for are discussed below.

The disease begins with a loss of prehensility in the very tip of the tail (Giwojna, Oct. 2003). At this stage, the seahorses can grasp large objects just fine, but cannot take hold of slender objects with a small diameter (Leslie Leddo, pers. com.). Next the loss of prehensility spreads further up the tail and the seahorses begin to act as if their tails are very tender and sensitive. They will drape their tails over objects rather than grasping onto them and begin to drag their tails behind themselves, often arching the end of their tail upward in the shape of “U” (rather than the usual “J” or tight coil) as if to lift it off the ground and keep it from touching anything (Leddo, pers. com.).

This is usually when the tip of the tail becomes white and the loss of coloration starts advancing further and further up the tail (Giwojna, Oct. 2003). At this point, the discolored skin begins to flake or lift up and open wounds and ulcers develop on the most distal portions of the tail (Giwojna, Oct. 2003). The infection attacks the underlying tissues, and the tail is gradually eaten away, often all the way to the bone, exposing the vertebrae (hence the name Tail Rot). Survivors may end up missing the last few segments of their tail (Giwojna, Oct. 2003).

White tail disease is highly contagious disease. I have seen it often in temperate seahorse species suffering from heat stress, as well as in crowded nursery tanks where it spreads through the fry like wildfire (Giwojna, Oct. 2003).

Infected seahorses should be treated with antibiotics in isolation at the first sign of a loss of prehensility in the tip of their tails (otherwise the antibiotics may harm the biofilter in your main tank, creating more problems). There are a number of treatment options to consider, and the following antibiotics have proven to be effective in treating tail rot in seahorses in some cases:

Enrofloxin (brand name Baytril) — a potent prescription antibiotic that can be difficult for the home hobbyists to obtain;

Tetracycline or oxytetracycline (but ONLY when administered orally);

Minocycline (e.g., Maracyn-Two Powder Saltwater by Mardel or a combination of MarOxy + Maracyn-Two);

Sulfa 4 TMP (four different sulfas plus trimethoprim) — National Fish Pharmaceuticals;

TMP Sulfa (trimethoprim and sulfathiazole sodium) — Maracyn Plus by Mardel; National Fish Pharmaceuticals;

Neosulfex or Neo3 (neomycin + sulfa antibiotics) — unfortunately, no longer available

Neomycin sulfate + triple sulfa (both available from National Fish Pharmaceuticals)

Kanamycin sulfate + triple sulfa (both available from National Fish Pharmaceuticals)

Furan2

Nitrofuracin Green (equivalent to Furan 2) — National Fish Pharmaceuticals

We’ll discuss each of these medications and how best to administer them to your ponies in some detail below. Hopefully, you will be able to obtain one or more of them in your area:

Enrofloxin (brand name Baytril)

Baytril (Enrofloxacin) is a powerful new broad-spectrum antibiotic that increasingly used to treat infections of the urinary tract, skin, prostate, gastrointestinal system, liver, ears, and lungs in humans. It is affective against both gram-negative and gram-positive bacteria and is widely used in aquaculture to treat marine fish. It belongs to a relatively new class of antibiotics called fluoroquinolones, which are effective against a wide variety of bacteria, and is now being used in the aquaculture industry to treat bacterial infections in valuable fish. Baytril is a more potent antibiotic than aminoglycosides such as kanamycin or neomycin, but you will probably have to obtain it from your veterinarian. In liquid form, enrofloxin (Baytril) can be administered either by injection at around 10mg/kg bodyweight every other day or administered orally.

In order to determine the proper dosage for the intramuscular injections, you need to be able to weigh the seahorses accurately, and you must obtain the injectable form of the medication.

Due to their bony exoskeleton, injections are particularly challenging with seahorses. Seahorses store their limited fat reserves primarily in their tail, which is the most muscular part of their body. The meaty part at the base of the tail is best suited for IM injections. If you attempt the intramuscular injections, I would suggest targeting the base of the tail a short distance below the pouch using a ventral approach with a shallow angle of attack. The needle should be directed between the scutes/plate margins for ease of penetration through the skin. The external area can be rinsed with sterile saline or a drop of a triple antibiotic ophthalmic solution applied prior to needle penetration.

The Baytril can also be administered orally by tube feeding it to the seahorse, which is helpful when the seahorse is not eating, but it is a stressful procedure for the seahorse. Here are the instructions for administering the Baytril orally, courtesy of Ann at the org:

ENROFLOXACIN Oral Dosage and Preparation Instructions
Active Ingredient: Enrofloxacin
Indication: bacterial infection
Brandnames: Baytril
The following information is based on the most commonly available tablet sizes for Enrofloxacin/Baytril
available in the US and abroad and an average sized seahorse of approximately 10 grams.
Tube feed the seahorse 0.1mg of Enrofloxacin once a day for 10 days.
Day 1 – 10 of Treatment
• Crush 1/4 of a 68mg or 50mg tablet into a fine powder.
• Use a mini-blender or small hand-blender to thoroughly mix the powder with marine water. Mix 1/4 of a
68mg tablet with 85mL of marine water. Mix 1/4 of a 50mg tablet with 62.5mL of marine water.
• Fill a small syringe with 0.5mL of the solution.
• Tube feed the seahorse just as if you were force-feeding the pony to provide nutritional support.
• Throw out the unused Enrofloxacin and marine water solution. You will need to make new solution daily because Enrofloxacin breaks down quickly in saltwater causing it to become completely ineffective by the next day.

Important Notes:
Enrofloxacin is available only by prescription from a veterinarian.

Enrofloxacin International Version – Tablets are produced in 15mg, 50gm, 150mg, & a 2.5% injectable solution

Enrofloxacin US Version – Tablets are produced in 22.7mg, 68mg, 136mg, & a 2.27% injectable solution

If you are able to ascertain the exact weight of your seahorse you may want to adjust the dosage as necessary to get the most benefit from the medication. In such an instance you would dose Enrofloxacin at 0.01mg of the medication per gram of body weight.
A veterinarian who works regularly with small exotics will be familiar with the proper way to dilute
injectable Enrofloxacin solution to fit your needs.

Here are the instructions for adding the Baytril directly to the hospital tank, rather than injecting it or giving it orally:

If you obtain the tablet form of Baytril rather than the liquid, just add one 90.7 mg tablet (or the equivalent) per 10 gallons to the filter box on the treatment tank each day for 3-5 consecutive days. The circulation of the water through the filter will dissolve the antibiotic tablet and dispersed throughout the aquarium. If you don’t have an external filter on your hospital tank in which to dissolve the Baytril tablet, then just crush it into a very fine powder and dissolve it in the treatment tank as thoroughly as possible. Repeat the procedure for three consecutive days.

The tablet dosages are recommended by Dr. Peter Hill, DVM for the Newport Aquarium, and were intended for a 10-gallon hospital tank. In other words, the dosage of Baytril he recommends is one 90.7 mg tablet per 10 gallons of water (or ~45 mg Baytril/5 gallons if you are using a five-gallon hospital tank or a 10-gallon tank that’s half filled with water). This dosage should be repeated for 3-5 consecutive days. In short, the treatment regimen for prolonged immersion in your hospital tank would be as follows:

Day 1: Baytril — one 90.7 mg tablet/10 gallons
Day 2: Baytril — one 90.7 mg tablet/10 gallons
Day 3: Baytril — one 90.7 mg tablet/10 gallons

Note: enrofloxin/Baytril is most effective when injected or administered orally; the bath treatments are less effective and typically must be maintained for at least a week or more in order to be helpful in treating tail rot.

Tetracycline Antibiotics

Unlike enrofloxin, tetracycline and oxytetracycline are widely available to home hobbyists over the counter, without a prescription, and are relatively inexpensive. They can be very effective in treating infection such as tail rot in seahorses, but ONLY when they are ministered orally after bioencapsulation in feeder shrimp. This means they are only helpful in cases where the affected seahorse is still eating normally, which is often the case with tail rot in the early stages. (The tetracycline antibiotics are useless when added to the aquarium water in a saltwater tank, because calcium and magnesium bind to the medications and deactivate them when the pH is 7.6 or above.) So the only way tetracycline antibiotics can be used effectively with seahorses is to gutload feeder shrimp with the medication or, alternatively, to soak frozen Mysis in the proper concentration of the medication, and then feed the medicated Mysis to the seahorses.

If you can obtain live adult brine shrimp, the feeder shrimp can be gut loaded with the tetracycline antibiotics and then fed to the seahorses. In that case, the best way to administer the tetracycline would be to bioencapsulate it in live adult brine shrimp and then to feed the medicated shrimp to the ailing seahorse.

Many times the most effective way to administer antibiotics orally is by bioencapsulating or gutloading them in live shrimp, which are then fed to the seahorses. The easiest way to gutload antibiotics is to bioencapsulate them in live adult brine shrimp (Artemia spp.), as described below. The recommended dosage of antibiotic for this varies between 100-250 mg per liter or about 400-1000 mg per gallon of water. Stay within that range and you should be all right.

In the case of tetracycline, I recommend using 500 mg per gallon of freshwater for bioencapsulating the antibiotic in adult brine shrimp. Tetracycline is a photosensitive drug, so keep the container of freshwater covered to shield it from the light or in a relatively dark area of the room while you are gutloading the brine shrimp.

If the antibiotic you are using comes in tablet form, crush it into a very fine powder (you may have to use a household blender to get it fine enough) and dissolve it in freshwater at the dosage suggested above. Soak the adult shrimp in freshwater treated with the antibiotic for 30 minutes and then feed the medicated shrimp to your seahorses immediately. (Don’t let your pumps and filters “eat” all the brine shrimp!)

The brine shrimp are soaked in freshwater, not saltwater, because in theory the increased osmotic pressure of the freshwater helps the antibiotic solution move into their bodies via osmosis. But in fact nobody knows for sure whether the antibiotic is diffusing into the brine shrimp or they are ingesting it in very fine particles (brine shrimp are filter feeders and will take in whatever is suspended in the water with them) or whether the brine shrimp merely become coated with the antibiotic while they are soaking in it. But that’s not important — all that really matters is that gut-loading adult brine shrimp with medications this way is effective.

The antibiotics I would recommend for gutloading in most cases are tetracycline or oxytetracycline. Tetracycline is widely available for aquarium use, so you should easily be able to get a product at your LFS in which the primary ingredient is tetracycline, such as Maracyn-TC by Mardel Labs or Tetracycline MS by Fishvet. These products generally include 250 mg capsules or tablets of tetracycline, or packets of 500 mg tetracycline powder, which would make it easy for you to determine the right amount to add to 1 gallon of freshwater in which to soak your brine shrimp to gutload them with the antibiotic. (Just add two of the 250 mg capsules or crushed up tablets — i.e., 500 mg worth — of the tetracycline to a gallon of water.) Or in the case of the Tetracycline MS, use one 500 mg packet per gallon of freshwater.

Although tetracycline and oxytetracycline generally work very well when administered orally, they are all but useless when used as bath treatments for marine fish. This is because the calcium and magnesium in hard water or saltwater bind to tetracycline and oxytetracycline, rendering them inactive (Yanong, US Dept. of Agriculture). In addition, tetracycline and oxytetracycline are photosensitive drugs and will decompose when exposed to light. So these drugs are very useful for seahorses when they are administered via bioencapsulation, but they are utterly ineffective when added to the water in a saltwater aquarium are hospital tank (Yanong, USDA). This is another reason why you must soak the live adult brine shrimp in freshwater when gutloading them with tetracycline or oxytetracycline.

Gutloading the adult brine shrimp in freshwater has several advantages. First of all, it disinfects the brine shrimp (the osmotic shock in going from concentrated saltwater to freshwater will kill off any protozoan parasites the brine shrimp may have been carrying). Secondly, the freshwater increases the effectiveness of the gutloading process by allowing some of the medication to enter the body of the brine shrimp via osmosis. And gutloading the adult brine shrimp in freshwater saves the hobbyist from having to mix up fresh saltwater every day in order to medicate the adult Artemia. Just use dechlorinated/detoxified freshwater as described above, and everything should go smoothly. But the most important reason that you gutload the adult brine shrimp in freshwater when you are using tetracycline or oxytetracycline is that these medications will be deactivated in saltwater and rendered useless if you attempted to bioencapsulate the medication in adult brine shrimp that are in saltwater.

I would feed your seahorses their fill of adult brine shrimp gutloaded with tetracycline once a day for 7-10 days. Gutload a new portion of the adult brine shrimp each day for the seahorses’ first feeding of the day when they are the most hungry. So that would be a total of 7-10 feedings, one per day, using adult brine shrimp gutloaded with the tetracycline. Give the seahorses a second feeding of frozen Mysis enriched with Vibrance later in the day. The Vibrance includes beta glucan as an active ingredient, which is in an immune stimulant that will help the seahorses to fight off any infections.

It is impossible to determine precisely what dosage of medication each individual fish ingests when gutloading, but the tetracycline antibiotics are very safe to use for this application and you really cannot overdose a seahorse using this method of treatment. Feeding each seahorse its fill of shrimp gut-loaded with tetracycline for 7-10 days assures that they receive an effective dose of the medication. As long as each seahorse is getting its share of the medicated brine shrimp every day during the treatment period, you needn’t be concerned if one of the ponies is eating more than the others.

As I mentioned above, tetracycline in oxytetracycline can be effective treatments for tail rot when they are administered orally. However, they are useless as bath treatments for marine fishes. This is because calcium and magnesium bind to tetracycline and oxytetracycline, rendering them inactive (Roy Yanong, US Department of Agriculture). Adding tetracycline or oxytetracycline to saltwater in a hospital tank is therefore completely ineffective (Yanong, USDA), but administering the antibiotics orally can produce good results.

Minocycline Antibiotic

Minocycline is another helpful antibiotic for treating white tail disease (i.e., tail rot). It is the active ingredient in Maracyn-Two Powder Saltwater by Mardel Labs (Maracyn-Two consists of minocycline together with a complex of B. vitamins). Maracyn-Two is readily available over the counter from aquarium stores and pet shops that carry fish.

Maracyn-Two Powder Saltwater by Mardel Labs
Active Ingredient
Each powder packet contains 20 mg Minocycline activity. 15.00 Pantothenic Acid, 8.60 mg Riboflavin, 2.60 mg Thiamine Mononitrate, 2.60 Pyridoxine Hydrochloride.
NOTE: Be sure to treat for the full duration recommended, even if symptoms disappear after a few days. DO NOT overdose. Follow dosage directions as detailed on the product packaging.
Dosing Instructions
First day, add 2 packets per 20 gallons of water. On the second through fifth day, add 1 packet per 20 gallons of water.
Repeat this 5 day treatment only once if needed.
Special Notes on Diagnosis
Diagnosis of bacterial infections and parasitic infestations in salt and freshwater fish is very difficult, even for the most advanced aquarist.

For best results, consider combining Maracyn-Two with MarOxy by Mardel Labs. It can be difficult to determine whether tail rot is due to a bacterial infection, a fungal infection, or a mixed infection, and the combination of Maracyn-Two plus MarOxy will be helpful regardless of the nature of the underlying infection:

MarOxy by Mardel labs
Safe, stable and non-staining, MarOxy treats fungal as well as bacterial diseases, such as clamped fins, swollen eyes, and patchy coloration. Use of a hospital tank is recommended. Active ingredient: stabilized chlorine oxides. 1/2 teaspoon per 10 gallons daily, for no more than 5 days. 1 oz. treats 25 gallons for 5 days. For fresh and saltwater.

Sulfa drugs combined with trimethoprim can also be very helpful for treating tail rot. The most potent of these synergistic combinations are Sulfa 4 TMP and TMP Sulfa.

Sulfa 4 TMP Powder

USE: this is a special blend of four different sulfas that all have different absorption rates and solubility. The sulfas are combined with trimethoprim, which potentiates each other’s ability to kill bacteria. The result is a wide spectrum antibiotic with less chance of resistant strains developing.

DOSAGE: 1/4 teaspoon per 20 gallons of water. (1/2 pound treats 3640 gallons of water.)

TMP Sulfa (trimethoprim and sulfathiazole sodium)

USE: for treating bacterial infections, both gram-negative and gram-positive. The combination of trimethoprim plus sulfathiazole sodium retards resistant strains from developing. It exerts its antimicrobial effect by blocking 2 consecutive steps in the biosynthesis of the nucleic acids and proteins essential to many bacteria.

DOSAGE: add 1/4 teaspoon per 10 gallons of water every 24 hours, with a 25% water change before each daily treatment. Treat for a minimum of 10 days.

(1/4 pound treats approximately 940 gallons of water.)
*More effective than triple sulfa.

Both Sulfa 4 TMP and TMP Sulfa can be obtained online without a prescription from National Fish Pharmaceuticals at the following URL:

http://www.fishyfarmacy.com/products.html

As an alternative, Maracyn Plus by Mardel Labs is another effective medication that combines a sulfa drug with trimethoprim to combat tail rot, and which is commonly available at pet shops and fish stores:

Maracyn Plus by Mardel labs
Directions for Use:
Add one capful (10ml) per 10 gallons of water. Treat on days 1, 3, and 5. Use as soon as the first signs of disease are noted. Treated water may appear cloudy at first due to the presence of the microscopic spheres. All cloudiness will be gone within 30 minutes to 1 hour after treatment. Maintain normal filtration and air during treatment.
Active Ingredients: Sulfadimidine and Trimethoprin
General Information:
Maracyn Plus is a broad-spectrum antibiotic for controlling the bacteria that cause mouth fungus, fin and tail rot, Popeye, dropsy and ulcers.
Benefit: Maracyn Plus makes use of a revolutionary technology that delivers the antibiotic directly to the fish. Multi-layered micro-spheres attach to the fish and break down one layer at a time releasing the antibiotics in a controlled regulated manner. A filming agent, Chitosan, which has a molecular structure similar to the natural mucous coat of a fish, seals the treatment in contact with the tissue surface.
Use: Contains two powerful broad-spectrum antibiotics that are effective against the bacteria that cause Fin and Tail rot, Popeye, Dropsy, Ulcers, and “Mouth and Body Fungus”. As the bio-spheres attach to the fish, they form a protective medicated layer over the fish’s skin that kills the infecting bacteria and prevents re-infection. The healing properties of chitosan speed up the regeneration of damaged tails, fins, mouths and skin. For use in fresh and saltwater aquariums.

Neosulfex and Neo3 — both broad-spectrum antibiotics consisting of neomycin combined with sulfa compounds to produce a potent synergistic combination of antibacterials — are the antibiotics home hobbyist choose to rely on most often for treating tail rot. Unfortunately, neither of these combination medications are available any longer.

However, many hobbyists have been getting similar results by creating their own version of these medications by combining neomycin sulfate with various sulfa compounds. One that seems to work well is combining neomycin sulfate with triple sulfa. You may be able to get neomycin sulfate and triple sulfa compound at a well-stock LFS. If not, you can obtain both neomycin sulfate powder and triple sulfa powder from National Fish Pharmaceuticals without a prescription. You can order them online at the following site:

http://www.fishyfarmacy.com/products.html

Kanamycin sulfate used alone or in conjunction with neomycin sulfate would also be an excellent choice for treating tail rot, both of which can be combined safely with triple sulfa.

Kanamycin sulfate powder

USE: Gram-negative bacteria for resistant strains of piscine tuberculosis and other bacterial infections. Works especially well in salt water aquariums.

DOSAGE 1/4 teaspoon per 20 gallons of water. Treat every 24 hours with a 25% water change before each treatment. Treat for 10 days. For piscine tuberculosis, use for up to 30 days.

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.

Neomycin sulfate powder

USE: Gram-negative bacteria (Pseudomonas), piscine tuberculosis and other bacterial infections. Works well in freshwater or saltwater aquariums.

DOSAGE 1/4 teaspoon per 10 gallons of water. Treat every 24 hours with a 25% water change before each treatment. Treat for 10 days. For piscine tuberculosis, use for up to 30 days.

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.

Triple Sulfa Powder

USE: for treatment of gram-negative infections, fin and tail rot, mouth fungus, collapsed fins, columnaris.

DOSAGE: add 1/4 teaspoon per 10 gallons of water every 24 hours, with a 25% water change before each daily treatment. Treat for a minimum of 10 days.

You can get both kanamycin sulfate and neomycin sulfate, as well as triple sulfa, from the following vendor:

http://www.fishyfarmacy.com/products.html

Furan 2

Furan2 is a good combo medication that consist of two nitrofuran antibiotics (nitrofurazone and furazolidone), often combined with good old methylene blue. That gives it both bacteriostatic and bactericidal properties, and makes it active against various gram-negative and gram-positive bacteria. The methylene blue stains the water in the treatment tank as and prevents the photosensitive nitrofuran antibiotics from being deactivated by light. Methylene blue is effective in preventing fungal growth, and it has antiprotozoal and antibacterial properties as well, by virtue of its ability to bind with cytoplasmic structures within the cell and interfere with oxidation-reduction processes. This makes the combination of methylene blue, nitrofurazone and furazolidone very broad spectrum and quite potent. Furan2 is especially effective for treating mild skin infections.

However, you have to take special precautions when administering nitrofuran antibiotics such as Furan2 because they are photosensitive and can be deactivated by light. That means you’ll need to darken the hospital tank while you treat the seahorse(s). Do not use a light on your hospital tank, cover the sides of the tank with black construction paper or something similar, and keep an opaque lid or cover on the aquarium during the treatments. Remove this cover from the aquarium only long enough to feed your seahorses.

Furan2 can be administered either as a bath (less effective) or orally via gutloaded feeder shrimp (best). Here are the instructions for both methods (again, courtesy of and at the org):

FURAN-BASED MEDS (immersion) Dosage and Preparation Instructions for a 10g/38L Hospital Tank
Active Ingredients: Nitrofurazone and Furazolidone
Indication: bacterial infection
Brand Names: Furan-2, Furanase, Binox, BiFuran+, Fura-MS, Furazolidone Powder
Dose daily for 10 days. Disregard package info concerning dosing frequency and water changes.
Replace the medication in ratio to the amount of water changed daily as needed to control ammonia.
This product is best administered by feeding it to adult live brine shrimp, then in turn. feeding those animals to the Seahorse. If this is not an option, it may be administered as follows.
DAY 1 of Treatment
• Thoroughly mix the medication with about 1 cup of marine water.
• Pour the mixture into a high-flow area of the hospital tank.
DAYS 2 – 10 of Treatment
• Perform a 50% water change.
• Thoroughly mix the medication with about 1 cup of marine water.
• Pour the mixture into a high-flow area of the hospital tank.

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

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.

A very effective technique for gut loading live adult brine shrimp with Furan2 is to set up a clean, plastic pail or bucket filled with 1 gallon of freshly mixed saltwater, and then to add one packet of Furan 2 to the bucket of water. Next, add a generous portion of well-rinsed adult brine shrimp and let them soak in the bucket of medicated water for at least two hours, in order to bioencapsulate the antibiotics in the brine shrimp.

You will be performing a 50% water change in your 10-gallon hospital tank daily to maintain good water quality, and you should be sure to include the 1 gallon bucket of medicated water and all of the live adult brine shrimp that have been soaking in it as part of this water exchange. (In other words, the bucket of medicated water will account for one of the 5 gallons of newly mixed saltwater you add to the 10-gallon hospital tank daily.) This way, you will be adding the excess Furan 2 from the medicated bucket of water to the treatment tank as well as the gutloaded adult brine shrimp, thus helping to assure that the affected seahorse receives a good dose of the medication.

Nitrofuracin Green (equivalent to Furan2)

This is National Fish Pharmaceuticals’ special formula of nitrofurazone, furazolidone, methylene blue, and sodium chloride.

USE: anti-microbial, anti-protozoan, antibacterial, and anti-fungal. Wide spectrum. Good for newly arrived fish in quarantine situations. Also be good for healing wounds and ammonia burns on newly arriving fish. Widely used for shipping or packing water. Works well for sores on fish in Koi ponds.

DOSAGE: add 1/4 teaspoon per 20 gallons every 24 hours, with a 25% water change before each daily treatment. Treat for 10 days.

Okay, those are good antibiotics to consider when treating a case of white tail disease or tail rot, seahorsegirl. The antibiotics you are using (neomycin sulfate + sulfa drugs) are good place to start, so be sure to complete the regimen of these antibiotics you are adding to the water in the hospital tank.

At the same time, begin treating the seahorse with metronidazole and a nitrofuran antibiotic orally by feeding them frozen Mysis that have been medicated using Seachem Metronidazole, Seachem Focus, and Seachem Garlic Guard, as we discussed previously in this post.

Best of luck resolving this tail problem and restoring your seahorse to good health again, seahorsegirl.

Respectfully,
Pete Giwojna, Ocean Rider Tech Support

Dear seahorsegirl:

Yes, I think you are on the right track and that we should treat this tail problem using broad-spectrum antibiotics together with a good antiparasitic medication (i.e., metronidazole) administered orally, rather than using the Diamox.

You did the right thing by isolating the seahorse and treating the hospital tank with the medication you chose. It sounds like you detected the problem early on and began treatment without hesitation, so hopefully you’ll have a good outcome. As you said, beginning the treatment while the seahorse is still eating and able to keep its strength up is very important and allows us to administer medications orally that we would be otherwise unable to use this time.

As long as the seahorse is still eating well, so that the medications that we mix with its frozen Mysis will be ingested, this should be a very helpful treatment regimen, seahorsegirl.

And it’s great to see that you have such a well-stocked medicine cabinet in case further treatment is required.

Best of luck restoring your seahorse to good health again, seahorse girl keep up the good work!

Respectfully,
Pete Giwojna, Ocean Rider Tech Support

Dear Seahorsegirl:

Okay, I understand that the condition of your female has not shown any signs of improvement despite the medications we have been using to treat her tail problem. She is still eating well but having the same sort of clumsiness and awkwardness using her tail to cling to a convenient perch. As you put it, it is almost as if she had suffered a minor stroke affecting her tail and lost some of the prehensility and ability to control the muscles in her tail normally.

I would complete the full 10-day regimen of Seachem Metronidazole/Focus/Garlic Guard nonetheless. Even if it does not appear to be helping significantly, it is important to complete the full regimen of the medication once you begin in order to minimize potential problems with disease resistance.

And I can tell you that it is encouraging that she is showing no signs of tail rot other than the abnormal clumsiness using her tail. It’s a very good sign that there has been no whitening of the tail tip or peeling of the skin or open sores developing on her tail (ulcerative dermatitis).

I still don’t have a very good idea of exactly what is causing this problem or what to expect down the road, Seahorsegirl. When treating tail rot and other tail infections, it often requires long-term medication with broad-spectrum antibiotics lasting several weeks or even months (multiple treatment regimens) in order to resolve the problem. But this does not seem like a typical tail rot infection…

One thing that can result in nerve damage and loss of muscle control is the formation of gas emboli that occlude veins and arteries, which is often seen in seahorses during episodes of gas bubble syndrome (GBS). When that happens, it can cause problems similar to the “bends” that can afflict divers if they ascend too quickly from depth, which can include nerve damage and paralysis (almost as if they had suffered a stroke).

In seahorses, the tail in particular is vulnerable to problems with gas bubble syndrome, so it is conceivable that your female could have experienced such a development, although I think it’s very unlikely. (Male seahorses are highly vulnerable to problems with GBS, whereas females are normally quite resistant to such problems. If none of the males in your tank have experienced problems with GBS, it would be very unusual for a female seahorse to be afflicted with gas emboli.)

As you know, gas bubble syndrome is believed to be caused by gas emboli forming within the tissue of heavily vascularized portions of the seahorse’s anatomy — the placenta-like brood pouch of males, the eye, the muscular prehensile tail — and it can take several different forms depending on where the bubbles or emboli occur. When it occurs in the brood pouch of the male, chronic pouch emphysema or bloated pouch results, leading to positive buoyancy. (Chronic pouch emphysema is by far the most common form of GBS and is, of course, restricted to males only.) When it occurs in the capillary network behind the eye (choroid rete), Exopthalmus or Popeye results, and the eye(s) can become enormously swollen. When it affects the capillary network of the gas bladder (the rete mirabile), hyperinflation of the swimbladder occurs, again resulting in positive buoyancy. When it affects the tail or snout, external gas bubbles (i.e., subcutaneous emphysema) form just beneath the skin and look like raised blisters. When intravascular emboli occur deep within the tissue and occlude blood flow, generalized edema results in the affected area. Or extravascular emboli may cause gas to build up within the coelom, often resulting in positive buoyancy and swelling or bloating of the abdominal cavity (internal GBS).

Different parts of the body can thus be affected depending on how the initial gas emboli or micronuclei form, grow and spread. During an episode of GBS, bubbles may initially form in the blood (intravascular) or outside the blood (extravascular). Either way, once formed, a number of different critical insults are possible. Intravascular bubbles may stop in closed circulatory vessels and induce ischemia, blood sludging, edema, chemistry degradations, or mechanical nerve deformation. Circulating gas emboli may occlude the arterial flow or leave the circulation to lodge in tissue sites as extravascular bubbles. Extravascular bubbles may remain locally in tissue sites, assimilating gas by diffusion from adjacent supersaturated tissue and growing until a nerve ending is deformed or circulation in nearby capillaries and vessels is restricted. Or, extravascular bubbles might enter the arterial or venous flows, at which point they become intravascular bubbles. Extravascular bubbles can thus become intravascular bubbles, and vice versa, via diffusion and perfusion. This is important because it means that under certain conditions extravascular seed bubbles or micronuclei can enter the bloodstream and migrate from their birth site to other critical areas as intravascular bubbles. If untreated, the gas bubbles worsen and the condition is fatal.

For instance, the prehensile tail of the seahorse is often affected when conditions are favorable for the formation of such gas emboli because it has a rich blood supply via the dorsal aorta and caudal vein (hence plenty of carbonic anhydrase to induce the formation of intravascular gas bubbles) and because the tail is the site where seahorses tend to store their limited fat reserves (the extravascular seed nuclei or emboli that trigger GBD form most readily in adipose tissue due to the higher solubility of certain gases in lipids than in aqueous tissues). Intravascular bubbles are seen in both the arterial and venous circulation, with vastly greater numbers detected in venous flows (venous gas emboli). The far more numerous venous bubbles are believed to first form in lipid tissues draining the veins. Lipid tissue sites possess very few nerve endings, possibly masking critical insults at first, and veins, which are thinner than arteries, appear more susceptible to extravascular gas penetration.

So it is remotely possible that your female seahorse could have developed deep-seated gas emboli in the upper part of her tail or the midsection of her tail, resulting in nerve damage and loss of muscular control in the affected area, and if that’s the case, treatment with a carbonic anhydrase inhibitor such as Diamox might be helpful. But I am very hesitant to suggest resorting to your Diamox, Seahorsegirl, because it can be harmful to inhibit the enzymatic activity of a healthy seahorse and because it seems so very unlikely that your female is having problems with gas bubble syndrome. When the tail of a seahorse is affected by GBS, it normally takes the form of external GBS or tail bubbles, which appear like upraised, translucent, blisterlike gas bubbles that form just beneath the skin (i.e., subcutaneous emphysema).

If none of your male seahorses have had any problems with GBS, and your female has had no problems with tail bubbles, and there is no noticeable swelling of her tail, it seems very unlikely that she is suffering any sort of paralysis to her tail due to deep-seated gas emboli. And if that’s the case, treating her with the Diamox could actually be harmful and counterproductive.

So for now I would just continue the 10-day regimen of Metronidazole/Focus/Garlic Guard and we can go from there. None of the other medications you presently have available in your fishroom medicine chest seem likely to produce better results. The KanaPlex is a good drug, but the active ingredient is kanamycin sulfate, a broad-spectrum aminoglycoside antibiotic that is similar to the neomycin sulfate in the NeoPlex you have been using. Likewise, Furan2, which is a combination of two different nitrofuran antibiotics, has been found to be helpful in treating some cases of tail rot, but you are already treating the seahorse with furazolidone, a nitrofuran antibiotic contained in the Seachem Focus, so I don’t believe the Furan2 would produce any better results.

There are one or two other medications you do not have at this time that might be worth a try, but it may well just be that we need to repeat multiple treatment regimens of the medications we have been using in order to get your female past this issue. If we can just keep her condition from worsening, she may be able to eventually recover on her own, just as stroke patients can regain their normal function in time following a minor stroke. Or, if it is an underlying bacterial and/or parasitic infection that is causing the problems, long-term treatment with the medications we have been using may be inhibiting the growth of these organisms, keeping them in check, which can eventually allow the immune system of the seahorse to gain the upper hand and resolve the problem.

Good luck. Please keep me posted regarding any progress (or lack thereof) and we will see how things develop…

Respectfully,
Pete Giwojna, Ocean Rider Tech Support

Dear Martin:

No, sir, you do not want to use the acetazolamide (brand name Diamox) to treat the main tank with all of the seahorses. Although the Diamox is an effective medication for treating most common forms of gas bubble syndrome (GBS), it functions as a carbonic anhydrase inhibitor, and it can be harmful to inhibit the enzymatic activity of the healthy seahorses.

You’ll need to administer the medication in a hospital tank or quarantine tank or a treatment container of some sort, which needs to be well aerated and oxygenated, but which does not need to have biological filtration, since you will be performing 100% water changes daily throughout the treatment period.

If the seahorse is still eating, you could consider administering the Diamox orally via feeder shrimp that have been injected with a solution of the Diamox, Martin, in which case you could safely treat the seahorse in the main tank providing you are able to assure that the healthy seahorses won’t ingest the medicated Mysis or feeder shrimp. Giving the Diamox orally is very effective when treating tail bubbles or subcutaneous emphysema, and is sometimes helpful for treating chronic pouch emphysema as well, although pouch emphysema is best addressed by performing a medicated pouch flushes, in my opinion.

Also, Martin, you should be aware that the acetazolamide 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.

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, Martin.

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:
in any
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, Martin, 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, Martin. 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, Martin.

(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, Martin, 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, Martin, 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, Martin:

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, Martin, 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), Martin. 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.

Best of luck resolving your stallion’s problem with GBS, Martin.

Respectfully,
Pete Giwojna, Ocean Rider Tech Support

Dear Martin:

You’re very welcome to any and all of the information I can provide to help keep your seahorses happy and healthy, sir.

It’s good to hear that you were able to obtain some of the acetazolamide (brand name Diamox) but be advised that online sources for such medications are not always trustworthy and reliable, Martin…

Unfortunately, obtaining Diamox (the tablet form of acetazolamide) can often be a Catch-22 situation for hobbyists. It is 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. Regrettably, Veterinarians are often unfamiliar with using Diamox to treat gas bubble syndrome in seahorses — it is sometimes used by vets to treat glaucoma and cats or dogs or as a diuretic to treat certain conditions in horses (the four-legged kind), but your veterinarian 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 always exhaust those possibilities first before I considered an alternative source for the Diamox. Do a search for “carbonic anhydrase inhibitor” on the “Seahorse Life and Care” discussion forum on the Ocean Rider website (www.seahorse.com), and print out some of the detailed information that’s been posted regarding gas bubble disease and how it’s treated using Diamox and present that to your family veterinarian and/or your family practitioner. Bring photographs of your stallion with the positive buoyancy problem and be prepared to bring the seahorse 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 ailing seahorse in for a quick checkup to get the desired results.)

If your veterinarian is unfamiliar with Diamox, Martin, then I would recommend ordering the medication from Drs. Foster’s and Smith at the following URL, in which case Pet Pharmacy will then contact your vet for you in order to obtain the necessary prescription authorization:

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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 overseas 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.

Best of luck obtaining the Diamox if you need to resolve your stallion’s gas problems once and for all, Martin.

Respectfully,
Pete Giwojna, Ocean Rider Tech Support

Dear Darrell:

It’s good to hear that the timed-release form of the Diamox works equally well, sir, and great to hear that the Diamox tablets are available through the Target pharmacies since nearly everyone has a Target nearby!

Best of all, you have an open-minded veterinarian who is willing to provide the medication for an aquarium fish, Darrell – vets like that are worth their weight in gold to us seahorse keepers, sir!

Thanks for sharing your encouraging experience with us all, Darrell! Here’s hoping that your seahorse remains in good health from now on and never has a need to make use of his file at your local pharmacy ever again!

Respectfully,
Pete Giwojna, Ocean Rider Tech Support

Dear Martin: Thanks for the update, sir! It’s great to hear that your stallion made a full recovery, Martin, and is already back in business of courting and mating. That’s a sure sign that he is feeling much better. Best wishes with all your fishes, Martin! Respectfully, Pete Giwojna, Ocean Rider Tech Support