ulcer/cyst looking thing on Pony

Dear Barbara:

I’m sorry to hear about the problem that your seahorse developed while you were away. Can you describe the ulcer or cyst and its location on your seahorse in a little more detail?

I would consider an ulcer to be an open sore or wound that exposes the underlying tissue (i.e., an ulceration), whereas a cyst would be an upraised growth like a pimple or a wart, so if you could clarify the nature of the growth or injury a little better, it would be very helpful in diagnosing this issue.

If the eraser-sized mark on your pony is more like a blister that might develop after your burned your finger, then it could be a subcutaneous emphysema (external gas bubble syndrome). Subcutaneous emphysema look like raised blisters but are actually bubbles of gas that build up just beneath the skin and they often have a translucent or even semi-transparent appearance. Subcutaneous emphysema form most often on the tails or heads of seahorses, but they can appear on any part of the body. These blisterlike bubbles are soft and yielding because they are filled with compressible gas.

So if the mark or growth on your seahorse seahorse is more like a blister or a bubble beneath the skin, then you should treat your seahorse for subcutaneous emphysema, which responds very well to Diamox (the tablet form of acetazolamide) administered orally or in a series of baths.

But if the growth on the snout of your seahorse is more like a pimple that a blister — that is, if it’s more solid rather than appearing like it upraised blister that’s filled with fluid or gas — then it is most likely a bacterial lesion and you will want to treat it with a good broad-spectrum antibiotic in your hospital tank.

If the suspicious cyst or lump was an external parasite of some sort, then the formalin baths should have destroy the parasite or at least caused to drop off its host, so I think it’s unlikely that the problem is due to an ectoparasite.

A picture of the affected area would also be very helpful in making an accurate diagnosis of this problem, Barbara. Here is a copy of a post from one of our members that explains how to display photos on this forum if you can get a digital photograph showing the cyst or ulcer:

<Open quote>
1st you have to host the photographs(s) you would like to post somewhere like photobucket or in my case AOLmyspace but you must make it small as the board will only take a small photo.

You click on the orange Img tag in the reply window and add your address of the hosted PIC etc.. Wherever.com newseahorse.jpg

Make sure to hit the close all tags tab after you are finished and then preveiew your post to see if it worked that way you can keep trying till you get it right without posting.

An image resize tool is very helpful.

For a larger image you could add a link with URL tab to the hosted photo. In some cases it will not work for all people but will for others it will (I never understood that) prob an AOL issue in my case!

HTH,

John
<close quote>

Or you can always send the photographs to my personal e-mail address ([email protected]) if you have any trouble posting them on this forum.

Please get back to me as soon as possible with a photo or a better description of the suspicious mark or cyst your seahorse has developed, and I will be happy to give you my best advice for treating the problem, Barbara.

Respectfully,
Pete Giwojna

Dear Barbara:

Okay, that’s encouraging. The gas bubbles are treatable and respond well to Diamox (the tablet form of acetazolamide). Unless you have a veterinarian who is willing to administer acetazolamide injections (I can provide instructions for such a procedure, if you do), it is actually the tablet form of Diamox that works best for home hobbyists. As I was advising Kent and Liam in their post on this page titled "sick pony," the Diamox tablets can either be used as a series of baths in your hospital tank or can even be administered orally (via feeder shrimp that have been injected with the solution made from the crushed up tablets).

In your case, if the affected seahorse is still eating normally, I would recommend administering the Diamox orally since this can be done while the seahorses in the main tank, where it is the most comfortable, amidst familiar surroundings and in the company of its tank mates. 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.

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 GBD 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. There 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 you may want to consider trying that first before you resort to the Diamox baths.

Diamox or Acetazolamide can also be administered as a 7-10 day series of baths, as explained below:

Diamox Baths (prolonged immersion)

The recommended dosage is 250 mg of Diamox per 10 gallons with a 100% water change daily, after which the treatment tank is retreated with the sole light at the dosage indicated above (Dr. Martin Belli, pers. com.). Continue these daily treatments and water changes for up to 7-10 days for best results (Dr. Martin Belli, pers. com.).

The Diamox 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 7-10 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 affects 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 seahorse usually show improvement of the tail bubbles within three days. Dr. Martin Belli reports they nearly 100% success rate when this treatment regimen is followed for 7-10 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.

Unfortunately, obtaining Diamox (the tablet form of acetazolamide) can often be a Catch-22 situation for hobbyists, Barbara, as you discovered. 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. If you can get Diamox tablets from your Vet, Barbara, that would be ideal.

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 this forum, and how it’s treated using Diamox, and present that to your family veterinarian and/or your family practitioner. Bring photographs of the boyant seahorse 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 Charlie Horse in for a quick checkup to get the desired results.) If they are agreeable, your veterinarian or family physician could also provide you with a suitable syringe and needle for injecting the Diamox solution into feeder shrimp.

If not — if neither your Vet or family physician will prescribe Diamox — then there are places you can order Diamox online without a prescription, but save that for a last resort. (You can’t always be certain of the quality of the medications you receive from such sources; in some cases, you even need to be concerned about counterfeit drugs, although Diamox certainly shouldn’t fall into that category.) The medications will take a week or two to arrive, which is troublesome when your seahorse is ailing and needs help ASAP. And, as you know, customs officials can confiscate such shipments, although that very rarely happens with this particular medication.

If you ultimately need to go that route, Barbara, the following source is the one most seahorse keepers have found works best:

Click here: Inhouse Drugstore Diamox – online information
http://www.inhousedrugstore.com/neurological/diamox.html

They offer 100 tablets of Diamox (250 mg) for around $20 US, but they ship from Canada by mail, which usually takes a little under two weeks for delivery. That’s why it’s best to plan ahead and line up the medication now, before it’s actually needed.

While you are working to line up the Diamox, Barbara, there are a couple of other things that you can do to provide the seahorse with buoyancy problems with some immediate relief in the meantime. For example, gradually reducing the water temperature and lowering the salinity of the aquarium can minimize problems with pouch emphysema and other forms of gas bubble syndrome (GBS), and will also make the seahorse less buoyant, which will make it easier for it to swim and eat.

Gradually lowering the salinity or specific gravity is done as if performing a normal water change, except that the replacement water is simply treated tap water or RO water without the salt (Don Carner, pers. com.). (If the replacement water is RO/DI or other softened source, then a buffering agent should be employed to prevent pH and alkalinity drops; Thiel, 2003.) Make sure the freshwater you add is thoroughly mixed with the remaining saltwater in the tank as you proceed. This will assure that your salinity/specific gravity readings are accurate. Monitor the lowering closely so as to not reduce it too fast. Achieving the desired specific gravity (1.015-1.017) over a period of several hours is fine (Don Carner, pers. com.). The bacteria colony in the biofilter will survive, the seahorses and fish will survive just fine, and your cleanup crew should also be unaffected (Don Carner, pers. com.).

CAUTION! When lowering the salinity or specific gravity in your seahorse tank, be very careful as you add the freshwater when you approach the target salinity. You do NOT want to overshoot the mark and drop the salinity too far! Seahorses tolerate low salinity very well up to a certain point, but they cannot withstand salinities below 13.3 ppt (specific gravity = 1.010) indefinitely. Salinities below 1.010 may be fatal to seahorses in a matter of days, if not hours. Just take care when the specific gravity in your seahorse tank is nearing the desired level of 1.015-1.017 and you should be in great shape. There is a big enough difference between a specific gravity of 1.015-1.017 and the dangerous level of 1.010 to provide a large margin for error and make this process very safe.

Once you have reduced the specific gravity in your seahorse tank to 1.015-1.017, you can maintain it at that level indefinitely thereafter. When it aquarium has had an outbreak of gas bubble syndrome, reducing the specific gravity to 1.015-1.017 has many benefits. It makes it easier for the seahorses to osmoregulate, increases the amount of dissolved oxygen the water can hold it makes it easier for the seahorses to breathe, helps eliminate protozoan parasites and ectoparasites in general, and helps to minimize problems with gas supersaturation and therefore GBS.

But if you should want to return the specific gravity in your seahorse tank to normal at some point for any reason, be sure to do so very gradually. In that case, when you are ready to return the system to normal salinity, simply reverse the process, remove some of the low salinity water in the aquarium and replace it with high salinity water. Take your time and raise the salinity slowly and gradually. Fish can become dehydrated if the salinity is increased too rapidly, so be methodical and raise the salinity over a period of several days. Don’t hesitate to take a full two weeks to return the specific gravity to normal levels again in small increments. The salinity can be reduced relatively rapidly very safely, but it must be raised again very gradually in order to avoid the risk of dehydration.

Gas bubble syndrome (GBS) is not at all contagious since it’s an environmental disease rather than an infectious disease, but I would wait until your seahorse has recovered and your aquarium is back to normal again before you consider adding any more seahorses, Kent and Liam. When that time comes, your 30-gallon aquarium should be able to accommodate one more pair of seahorses but I would not add any more than that since the tank is already home to several gobies as well as the seahorses.

Best of luck treating the buoyant seahorse and getting him or her back to normal again, Barbara! Where on the body of the seahorse, exactly, have you noticed the gas bubbles? Does the gas build up a period to be confined to one or both sides of the pouch, or is the suspicious mobile/growth elsewhere on the pony’s body? A picture would be very helpful, if possible.

Respectfully,
Pete Giwojna

Dear Barbara:

Okay, this new development changes the clinical picture and diagnosis dramatically. If the suspicious growth on the seahorse was not a gas-filled pseudocyst and the seahorse is having no buoyancy problems, then you are probably not dealing with gas bubble syndrome (GBS), Barbara. Rather, if the lesion produced a pus-like exudate, then it sounds like a pyrogranulatomous cyst, which is a clear indication of a bacterial infection. That’s very important to know because the Diamox will have no effect on a bacterial infection, and whereas GBS is an environmental disease that is not infectious and does not spread from seahorse to seahorse, a bacterial infection such as this is typically highly contagious.

The appropriate treatment under these circumstances is to isolate the affected seahorse and treat him using broad-spectrum antibiotics in your hospital tank. If you can gradually reduce the water temperature in the treatment tank, this will also help to reduce the growth rate and possibly the virulence of the bacteria.

The most useful antibiotics for treating such infections are normally chloramphenicol, Baytril, doxycycline, kanamycin, oxytetracycline (only if it can be a minister orally), neomycin sulfate, sulfonamide or streptomycin, or Furan2 or Nitrofuracin Green (in mild cases that are detected early). As with other bacterial infections, lowering the water temperature during the course of treatment can help a great deal. This is your best course of action when you are confident that the problem is due to a bacterial infection (Giwojna, Nov. 2003).

Chloramphenicol is the treatment of choice but must be handled very carefully and is probably not going to be available to you. It can be given orally or used as a bath (Prescott, 2001c). Therapeutic baths lasting 10-20 hours are administered in a chloramphenicol solution consisting of 40 mg per liter of water (Prescott, 2001c). If the seahorse is still eating, the chloramphenicol can also be bioencapsulated by gut loading feeder shrimp or ghost shrimp with flake food soaked in the antibiotic solution. Even if the affected seahorses does not eat, feeding medicated shrimp to its tankmates is a good way to help prevent this contagious disease from spreading to the healthy seahorses (Prescott, 2001c).

The treatment protocol for Chloramphenicol or Chloromycetin is as follows:

Chloramphenicol can be used to treat bacterial infections at 40 mg/ litre of water (which comes out to about 150 milligrams per gallon) in a bath for 10-20 hours. It is important to watch the quality of the water, and if it starts to become turbid, the water must be changed. It is best to treat in a separate tank. In stubborn cases, a series of such baths may be necessary to resolve the problem, in which case a complete water change should be performed before the medication is redosed.

Chloramphenicol can also be used as an additive to the feed, if the fish are still eating (all to often in a major infection they will refuse to eat, but this treatment may be most useful in preventing the horizontal spread of the infection). When used as an addition to the feed use 500 mg per 100 gram of feed. (In the case of seahorses, the flake food medicated with chloramphenicol in this way would first be bio-encapsulated in live feeder shrimp, which would then in turn be fed to the seahorses.)

If you do obtain the chloramphenicol, be sure to be very careful when handling it. Remember, in a few rare individuals exposure to chloramphenicol can cause a potentially fatal side effect (aplastic anemia). These are rare cases and almost always involve patients who were being treated with the medication, but I would use gloves when handling it as a precaution and if you crush crush up tablets of chloramphenicol, be very careful not to inhale any of the power.

Because of this side effect, which affects one in 100,000 humans, chloramphenicol is no longer available as a medication for fishes and can therefore be difficult to obtain. If you find that is the case, your next best alternative is to obtain doxycycline and kanamycin from National Fish Pharmaceuticals and use them together to form a synergistic combination of antibiotics that is often very effective in treating Vibrio infections.

Doxycycline hydrochloride

USE: broad spectrum antibiotic derived from oxytetracycline. Use for both gram-positive and gram-negative bacterial disorders, including fin and tail rot, septicemia, and mouth rot. Unlike tetracycline antibiotics, it will not be deactivated by the high pH levels found in marine aquaria. Works in a similar manner to chloramphenicol.

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

Kanamycin sulfate

This is a potent broad-spectrum, gram+/gram- aminogylcoside 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 certain other antibiotics such as doxycycline or neomycin (as well as metronidazole) to further increase its efficacy. Like other gram-negative antibiotics, it will destroy your biofiltration and should be used in a hospital tank only.

USE: gram-negative bacterial infections and resistant forms of piscine tuberculosis (mycobacteria). Works especially well in saltwater aquariums.

DOSAGE: add 1/4 teaspoon per 20 gallons. Treat every 24 hours and perform a 25% water change before each treatment. Treat for 10 days. (When treating piscine tuberculosis, treat for 30 days.)

Both the doxycycline and kanamycin can be obtained online from National Fish Pharmaceuticals at the following URL:

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

Baytril is another good antibiotic for treating ulcerative dermatitis and tail rot, but it is a prescription medication that you would need to obtain from your family Vet. It would be your next best option if you cannot obtain the chloramphenicol or the doxycycline hydrochloride + kanamycin sulfate.

Baytril is a potent new broad-spectrum antibiotic that is effective against both gram-negative and gram-positive bacteria and is widely used to treat marine fish. However, it is a prescription medication and you would need to obtain it from a veterinarian. A 7-day treatment regimen for the liquid form of Baytril is recommended as follows:

Day 1: a five hour bath in Baytril at a concentration of 22.7 mg/ml.
Day 2: perform a 50% water change in the treatment tank and administer a 5-hour bath in Baytril at half strength (11.4 mg/ml).
Days 3-7: repeat the procedure for day 2 — a 50% water change followed by a five hour bath in Baytril at a concentration of 11.4 mg/ml.

If you cannot obtain Baytril, then treating the seahorse with with Furan2 + acriflavine or with Nitrofuracin Green would probably be the next best option.

Furan2 is a good combo medication that consist of two nitrofuran antibiotics (nitrofurazone and furazolidone) plus 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 fairly potent.

Best of all, Furan2 can be safely combined with Aquarium Pharmaceuticals antiparasitic medications such as acriflavine to increase its effectiveness and guard against secondary infections.

Thus, when combined with an effective antiparasitic medication, a good combination drug like Furan2 can be the ultimate weapon in your medicine cabinet. It is effective against a wide range of diseases, making it a versatile shotgun for restoring order when trouble breaks out in your tank. When you suspect an infection is at work, but don’t know whether you’re dealing with fungus, bacteria, protozoan parasites or a mixed infection, Furan2 + Aquarium Pharmaceutical acriflavine is an effective combination that produces good results! Furan2 is especially effective for treating mild skin infections.

However, Barbara, you have to take special precautions when administering nitrofuran antibiotics such as this 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. Do not use a light on your hospital tank, 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 seahorse.

You should also be aware that Furan2 will cause discoloration of the aquarium water, turning it a shade of blue-green. This is harmless and can be removed after the treatments using activated carbon filtration.

Nitrofuracin Green is another combo medication with similar ingredients that is equivalent to Furan2. The instructions for using it are as follows:

Nitrofuracin Green

A special formula consisting of two nitrofuran antibiotics (nitrofurazone and 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.

In summation, Barbara, I would recommend isolating the affected seahorse and treating him aggressively with antibiotics in your hospital tank as soon as possible. The following antibiotics have proven to be effective in treating such infections when they are detected early (I have listed them in order of preference):

Chloramphenicol (i.e., Chloromycetin)
Doxycycline hydrochloride + kanamycin sulfate
kanamycin sulfate used alone or in conjunction with neomycin
Baytril
Furan2 + acriflavine
Furan2 or Nitrofuracin Green

Best of luck obtaining an appropriate antibiotic and treating this infection, Barbara.

Respectfully,
Pete Giwojna