Marine Depot Forums / TEAM Marine Depot / Disease, Health and Wellness - by Kelly Jedlicki / Expert Advice Needed re: Very Emaciated Puffer / Latest Posts

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Thu, 01 May 2008 08:06:19 GMT

Great News!! Thanks for the updates!

Any recent pics?

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Tue, 29 Apr 2008 14:59:51 GMT

This fish's health has progressed at a fantastic rate! At this point he's completely filled in and gets a bulge near his tail every time we feed him. Puffer Queen, thanks so very much for your advice. You can put this case in the happy ending tray.

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Mon, 28 Apr 2008 07:15:27 GMT

Pufferpunk (4/27/2008)

I have not and will not use clove oil due to recent reports (NCSU Fish Health Conference 2007) of suffocation/brain injury....I have posted a thread on this forum as well.

Do you have a link for this? I may have to stop recommending clove oil for trimming teeth.

Here are two links to threads I posted after attending the conference.

http://forum.marinedepot.com/Topic76425-10-1.aspx?Highlight=clove+oil

http://www.thepufferforum.com/forum/viewtopic.php?f=3&t=9749&p=98339&hilit=clove+oil#p98339

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Mon, 28 Apr 2008 07:10:11 GMT

Thanks for the continued updates/sharing.

Sorry for the delay - My dog died Thursday and I spent Friday in the hospital passing a kidney stone.

Please keep us posted.

RE: Expert Advice Needed re: Very Emaciated Puffer

Pufferpunk — Sun, 27 Apr 2008 23:53:49 GMT

I have not and will not use clove oil due to recent reports (NCSU Fish Health Conference 2007) of suffocation/brain injury....I have posted a thread on this forum as well.

Do you have a link for this? I may have to stop recommending clove oil for trimming teeth.

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Thu, 24 Apr 2008 19:23:46 GMT

The medications and other items you recommended for tube feeding are now on order. Based on continued progress we may not need these but we'll have it on hand if it is needed.

We found a local source of powdered metranadozole + praziquantel which we used as if it were praziquantel alone in a 3-hour dip as you advised. The medication was 250mg metronidozole 75mg praziquantel per packet. We're not sure if the metronidozole in the dip would be helpful this way but felt it was unlikely to do harm. We also soaked some clam in a concentrated mixture of the same medication, but suspect that the oral dose was probably very sub-therapeutic.

He is continuing to eat larger pieces and more at a time but is still very limited in what size he can swallow and how much he'll eat at a time. The largest size he can swallow now is about the diameter of cooked spaghetti noodles where originally the food had to be cut to a much smaller diameter than a raw noodle. Rather than eating no more than one small piece at a time, he now eats 2-3 slightly larger ones 3-4 times per day. We gut loaded some Ghost Shrimp with vitamin enriched food and gave him some of these as well. It takes him a lot of time and effort to catch each one but were almost certain he is eating some of these even though we find some chewed up shrimp in the water or stuck to the filter.

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Wed, 23 Apr 2008 13:25:28 GMT

FishFan (4/23/2008)[/b]

...We did note your recommendation for a 1-3 hour praziquantel dip. The dose you recommended is about 3 times the 2.5mg/l leave-in bath rate for Prazipro ( I think, I'll double check this to be sure before we proceed.
[/quote]
I checked to be sure I was going to use the rate you recommended if I used the PraziPro at triple strength. It turned out that I was mistaken, the dose you recommended was not 3 times the one given on the bottle. You gave the praziquantel rate as mg per *gallon* while Prazipro gives the rate at mg per *liter*. Converting the PraziPro rate of 2.5mg/liter to mg/gallons results in 10.4mg/gallon. This concentration the Prazipro label gives as a leave in treatment is greater than the concentration you recommended for a 1-3 hour bath (7.6 mg/gallon).

CONCLUSION: Based on the treatment concentration and duration you recommended, our first PraziPro leave-in treatment was long enough even though we changed the water at the end of the day. As you suggested, we still may use praziquantel with tube feeding if he doesn't continue to improve during the period where we are waiting for the mail ordered ingredients.

Thanks again for your all your help!!

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Wed, 23 Apr 2008 07:12:51 GMT

FishFan (4/23/2008)

We have an order prepared for National Fish Pharmaceuticals® (http://www.fishyfarmacy.com/products3.html) praziquantel and metronidazole powder and their product called Tranquil for sedating fish. We have no idea what's in the latter or if it is needed for tube feeding. We thought perhaps you'd know. As soon as we have your feedback as to what products are acceptable at NFP or elsewhere, we'll place an order. NFP charges a lot for their products and doesn't list the ingredients for some of them (see below). We're open to ordering the products we need from any US supplier.

NFP, has two products called Paracide -D and Paracide-X. We've been unable to find the ingredients or single use dosing instructions for these products which are intended to be fed to the fish. If you are familiar with either of these and think they'd be beneficial, just let us know. If you have a recommendation for different products, again we have no preference for NFP.

You mentioned other things, such as vitamins, that could be helpful to the fish's health if tube fed. If we're going to tube feed we should get the maximum possible benefit. Is there an appetite stimulator of some type?

Sorry I can not give any first hand experience or knowledge of the above mentioned medications.

For newly acquired, sick or injured fish, I always give beta glucan daily for at least 7 - 10 days to hopefully boost the immune system.

If I am tube feeding, I always add beta glucan, vitamins (Selcon, Garlic Elixr, Fish Solution, Marin Vit or Boyd's Vita Chem). If they have not been dewormed, I will add a dewormer as well.

Vitamin B12 has been successfully used as an appetite stimulant.

I will not buy any product that does not list the ingredients. I have not used Tranquil or Paracide. I use Finquel aka MS 222 for sedating fish. I have not and will not use clove oil due to recent reports (NCSU Fish Health Conference 2007) of suffocation/brain injury....I have posted a thread on this forum as well.

Best of luck.

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Wed, 23 Apr 2008 06:32:33 GMT

FishFan (4/23/2008)

Oh yes, I forgot. We did note your recommendation for a 1-3 hour praziquantel dip. The dose you recommended is about 3 times the 2.5mg/l leave in bath rate for Prazipro ( I think, I'll double check this to be sure before we proceed). We plan to do the equivalent of a dip by adding the triple dose to the tank just prior to his next water change. A 3/4 water change will take level down a bit below the bath (leave in) rate from the bottle's instructions. Praziquantel is well enough tolerated that I don't have a worry about giving it as a dip, a bath, and again later when we have the products needed for tube feeding. Worst case, we'll be killing any eggs that might survive the earlier treatments.

Thank you very much for all your help!

R&A

The praziquantel dose for monogean treatment is even higher. I have used this dose without problems.

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Wed, 23 Apr 2008 06:21:33 GMT

FishFan (4/22/2008)

This could be due to muscle atrophy/wasting and weakness due to nutritional deficiencies. These develop over time.

At this point we've given him very small pieces of clam, squid, shrimp, silversides, and scallops. The only one of these he is eating is clam, and then he only swallows very thinly cut pieces. He seems not to see tiny food such as live brine shrimp and frozen Mysis shrimp. He caught, chewed, and then spit out one of the 5 small White Clouds we offered. He ignored the other 4 even after they died due to the salt water. White Clouds die in minutes, in contrast to Ghost Shrimp which survive for 3 days or more in salt water.

He always chases Ghost Shrimp and seems to hunt for them checking nooks and crannies where he found them previously. He is clearly motivated to eat Ghost Shrimp but we are not 100% sure he is swallowing them. After we put 10 or so in his tank we see him chasing them. It is obvious that he eventually catches them because we find chewed up Ghost Shrimp floating around in the water or stuck to the filter intake. Based on the number we find chewed up he is probably swallowing the first one or two then spitting out additional ones. Even if he is spitting out every Ghost Shrimp he catches, we feel the Ghost Shrimp are beneficial. The hunt and the chase provides an increase in activity, entertainment, and stimulation that is good for his mental and physical health and aids adjustment to his new environment. The problem with the Ghost Shrimp is that they are reported to be empty calories (provide no nutrition).

I have seen studies about non gut loaded brine shrimp being empty calories.

BTW, can you point us to any studies that document the low nutrition of glass shrimp? Please pardon our asking, but there are many confidently stated "truths" we've encountered in this hobby that we know are not true. For example, several very knowledgeable people at our LFSs told us that the ammonia in glass cleaner can pass through glass and kill fish. I devised an experiment to test this assertion using a thin-walled 10 gallon aquarium. Even after 24 hours with the bottom of the aquarium soaking in ammonia glass cleaner there was zero ammonia in the tank water.

Gut loaded ghost shrimp are nutritious and I have seen good results with gut loaded ghost shrimp. As far as published research - I have not seen any - not to say there aren't any but I have not looked into it further as I have seen only positive results.

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Wed, 23 Apr 2008 05:41:51 GMT

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Wed, 23 Apr 2008 05:30:29 GMT

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Tue, 22 Apr 2008 19:58:15 GMT

We have no apprehensions about tube/gavage feeding but have no idea how to go about it. He still only swallows very thin pieces of food and eventually spits out all larger pieces. This fish's continued difficulty with swallowing larger food suggests to us that there is an eating problem such as pain, swelling, or obstruction. At this point we've given him very small pieces of clam, squid, shrimp, silversides, and scallops. The only one of these he is eating is clam, and then he only swallows very thinly cut pieces. He seems not to see tiny food such as live brine shrimp and frozen Mysis shrimp. He caught, chewed, and then spit out one of the 5 small White Clouds we offered. He ignored the other 4 even after they died due to the salt water. White Clouds die in minutes, in contrast to Ghost Shrimp which survive for 3 days or more in salt water.

He always chases Ghost Shrimp and seems to hunt for them checking nooks and crannies where he found them previously. He is clearly motivated to eat Ghost Shrimp but we are not 100% sure he is swallowing them. After we put 10 or so in his tank we see him chasing them. It is obvious that he eventually catches them because we find chewed up Ghost Shrimp floating around in the water or stuck to the filter intake. Based on the number we find chewed up he is probably swallowing the first one or two then spitting out additional ones. Even if he is spitting out every Ghost Shrimp he catches, we feel the Ghost Shrimp are beneficial. The hunt and the chase provides an increase in activity, entertainment, and stimulation that is good for his mental and physical health and aids adjustment to his new environment. The problem with the Ghost Shrimp is that they are reported to be empty calories (provide no nutrition).

BTW, can you point us to any studies that document the low nutrition of glass shrimp? Please pardon our asking, but there are many confidently stated "truths" we've encountered in this hobby that we know are not true. For example, several very knowledgeable people at our LFSs told us that the ammonia in glass cleaner can pass through glass and kill fish. I devised an experiment to test this assertion using a thin-walled 10 gallon aquarium. Even after 24 hours with the bottom of the aquarium soaking in ammonia glass cleaner there was zero ammonia in the tank water.

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Tue, 22 Apr 2008 03:13:48 GMT

Thanks for updating/sharing.

My first choice for praziquantel administration is the oral route. If the fish is not eating and I do not want to tube/gavage, my second choice is short term immersion baths.

Many medications will lose their potency with exposure to saltwater, air, and light. As many medication degrade, they can affect water parameters/quality. This is why I prefer not to dose treatment tanks and prefer baths.

The dose that I have used for over 10 years for deworming is: 7.6 mg/gallon for 1 - 3 hours (Dr E Noga).

Looking forward to more progress and updates.

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Mon, 21 Apr 2008 12:35:05 GMT

Just for the fun, here is a photo showing this fish right after purchase (April 17) and another taken yesterday (April 20). His stomach "notch" is filling in.

Note that the second photo shows his right side rather than left. We mirror imaged the photo to facilitate comparison.

Today we used Prazipro a second time because much of the medication was removed in the two water change following the first treatment (We are doing water changes daily with synthetic salt (Instant Ocean) + RO water so as to maintain high water quality). During this second treatment, the prescribed concentrations will be maintained for the three days the manufacturer recommends by adding the appropriate amount of Prazipro to the replacement water. We're not sure this is necessary, but it is unlikely to cause harm (For interested readers, in the past short dips of a few hours were used to treat fish using praziquantel sold for use with dogs).

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Mon, 21 Apr 2008 09:18:25 GMT

Without viewing under a microscope, I can say for sure what they are but they are highly suspicious for worms. My first guess looking just at the pics is nematodes as I can't appreciate the head or segments that are classic for cestodes. Nematodes have a pointy end and a rounded end - head and tail. Praziquantel is a good dewormer for cestodes but can eradicate nematodes. Fenbendazole is a good dewormer for nematodes.

Monitor food intake carefully and remember small meals and build up slowly. If the food intake continues on this current path of progression, I would hold off on tube feeding. But remember if he wastes a lot of energy chewing/spitting and only taking in a small amount - this wastes calories and the food ingested will not meet caloric/metabolic needs.

The passage of stool is a good sign. If undigested food is passed. .....decrease the amount and/or frequency of feeds.

Thanks for the updates and the pics.

Please keep us updated.

Best of luck.

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Sun, 20 Apr 2008 09:57:24 GMT

More new developments. He is now eating twice as much at a sitting compared to yesterday. We're now also certain he is keeping the food down and not just spitting it out when we aren't looking. Additionally, we've now observed that he is defecating. What is coming out is whitish liquidy jets of what looks like very digested clam strips and mucus.

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Sun, 20 Apr 2008 09:11:50 GMT

Also, if you think tube feeding is necessary, how would you go about it. After my last post I also noticed some possible parasites stuck to the outside of the filter intake (see photo). Do the white objects in the photo look like parasites that you would expect to be passed after treatment with Prazipro. I apologize for the fuzzy photos, the magnification is considerable. I hope the photos actually work, I'm not sure that the method I used is what the site designers intended. .

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Sun, 20 Apr 2008 08:08:49 GMT

In the last 24 hours there has been one very noteworthy change. We've been offering him the firm fleshy feet from live clams purchased at our grocery store. He shows more interest in this food than any other we've offered other than live Ghost Shrimp. It seems that if I trim the pieces so they are long and thin (like a short piece of spaghetti noodle) he is able to swallow them. Today we think he ate 4-5 of these. Once he eats one of these "clam strips", if a second piece is offered it is either chewed up and spit out or ignored altogether. After 2-3 hours if we offer him food again, he seems willing to take it. Today we'll continue to offer him these "clam strips" every 2-3 hours and observe longer to see if he is really keeping them down. It is possible he is chewing the pieces up and spitting them out after we stop watching (after 10 min.-15 min or so) and the pieces are small enough they fit through the filter's intake screen.

If he is getting the food in that we think he is, do you think we should go ahead with force feeding?

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Sun, 20 Apr 2008 05:56:55 GMT

Thanks for sharing/posting the pics. Other than the extreme emaciation, the skin and eyes do look good.

If possible, I would not wait any longer to tube (gavage) feed. The longer the body (organs) are deprived of nutrition, the more irreversible damage can occur. I understand the stress factor and there comes a point of no return. The longer the puffer goes, the weaker it will become and even if it takes in a bite here and there....it is not enough.

Normally with a 75 gm fish, one would feed 2-4 % of body weight - 1.5 - 3 ml. This weight is extrememly low for this puffer, but I would not base feedings on a higher weight. I would not feed more than 1.5 ml per feeding per feeding for at least a couple days as the stomach is shrunken and the body will not be able to adequately digest/process the food. Overfeeding at this stage can be harmful....it is a catch 22. You see the same scenario is starved dogs as well as people. Feeding should be slow and consistent.

I would add the metronidazole to the tube feeding. If you can get your hands on another product with metronidazole that would be better - acriflavine is not used in saltwater and I would not administer this product via a feeding. If you find a product with praziquantel and/or another dewormer, that would be fine to feed as well.

Please keep us updated.

Best of luck.

RE: Expert Advice Needed re: Very Emaciated Puffer

FishFan — Sat, 19 Apr 2008 21:12:57 GMT

We are aware of the crises you've been having with your pets and appreciate your effort helping us with our new fish. We read your last post and have taken action in response to your recommendations where needed.

We saw this fish twice in the LFS's tanks, once after it was there a month, and again at two months. We knew of this species' tendency to starve in captivity and its propensity for heavy IP loads. The LFS had not treated for IPs. We purchased this fish during our second visit because of this and the improvement we observed over the last month. We felt there was hope that proper treatment and some TLC could bring this fish back to good health.

Here are some photos of this fish posted in connection with a discussion elsewhere:

He puffed in the 5 gallon bucket used to transport him from the LFS to home, so we were worried about puffing air during an attempt to get his weight. We used a method that seemed likely to minimize this possibility. We scooped him up in a glass bowl half filled with water, weighed the bowl, then quickly transferred him back into the aquarium and weighed the bowl again. Allowing 5 grams for the water that moved with him during the very quick bowl to tank transfer, his weight is about 75 grams. Fortunately, getting his weight took at most 15 seconds and didn't seem to stress him much.

In retrospect the head slime noted in our previous post, and which is no longer present, was most likely a result of the differences in water properties following purchase or possibly prophylactic copper use by the seller. The latter of these is speculative since we don't know if this seller uses copper prophylactically.

Since our last post we offered frozen mysis shrimp. He didn't seem to notice it. Also, today we offered him the foot from a live clam about 1/8"x1/4"x1/16" and didn't find it chewed up in the tank later. Our impression is that he is getting some food in, though we have not seen any feces yet proving that food is being "processed".

We have Metronidazole in the form of Jungle's Parasite Clear fizz tabs (praziquantel, Metronidazole, diflubenzuron, and acriflavine. The package doesn't mention use in salt water. Is this an appropriate medication for this fish?

RE: Expert Advice Needed re: Very Emaciated Puffer

Puffer Queen — Sat, 19 Apr 2008 06:00:45 GMT

Welcome to the MarineDepot.com forums!

FishFan (4/18/2008)

This species of puffer is very prone to internal worms and parasites. Was this puffer eating well at the LFS? The reason why I ask this is that this species of puffers is also known to literally starve to death in captivity. Many do not adapt to aquarium life and prepared foods, This is why I discourage this species being brought into the hobby. For every one that is successfully kept there are unfortunately too many that do not make it past the first few weeks/months.

The problem we see us that this fish is very eager to eat, but can't swallow, food is chewed and efforts to swallow are obvious, but very little seems to make it to his stomach. We've never seen a fish this starved look so alert, it has definitely not given up on life.

This is a common observation which can often be observed in this species even before they become emaciated. Once they have become emaciated, this "feeding" behavior becomes more pronounced. The puffer often becomes too weak and organs begin to fail/shut down.

Some sliminess may be coming from the fish's head mouth or gills, its hard to say where.

Stress from malnutrition versus disease process as the puffer's immune system is too weak to fight off opportunistic pathogens? Or a combination of both?

This fish swims about attentively 100% of the time (so far) and gets excited when people approach his tank. He seems very relaxed considering he was moved yesterday. He takes food offered from our hands, bites fingers through the glass, and chases after ghost shrimp when he sees them.

Once again, this is commonly observed and is so frustrating as the puffer is active.

Treatment so far: Prazipro per instructions on bottle (day 1 = yesterday).

I would follow the directions on the bottle. I would also consider adding metronidazole treatment.

Foods offered: Ghost Shrimp, feet pulled from live clams, (accepted but most comes back out)

Make sure you are gut loading the ghost shrimp to make them as nutritious as possible.

Dried Krill and blood worms reconstituted with Gel Tek for parasites (refused)

I would steer away from these.

Available foods not yet offered: Shrimp, squid, earthworms, frozen krill/misis shrimp/brine shrimp

I would not recommend earthworms as there is a potential for pathogens.

Shrimp, squid, mysis are good food options.

Brine shrimp is not a good nutritional source unless gut loaded.

Fish is in a 29 Gallon QT tank
Tank set up yesterday has:
-a single rock (hiding place - not used so for)
-magnum filter loaded with live rock
-18" air stone with a dual output dedicated air pump.

Make sure you have the airstone and filter secured away from the puffer. Weak puffers can get stuck to filter intake caps. Also, the puffer could chew on the intake or dislodge it and get sucked in .....I have seen this many times. Might consider separating this equipment from the rest of the tank with a plastic lighting screen. This allows adequate water movement/filtration without danger to the puffer or the equipment.

Any treatments or suggested strategies that could help us get some weight on this fish would be appreciated.
Is assisted (inject into mouth) feeding of a vitamin enriched and or medicated food slurry a reasonable option?
Thanks,
R&A

At this point, I would recommend tube feeding this puffer. I would recommend very small feedings 2 - 3 times a day. You do not want to feed large volumes as the puffer's digestive system will not be able to handle it. The other problem is the stomach has shrunken and overfeeding can lead to vomiting. Any idea how much the puffer weighs?

If you go this route, you might also consider adding the medications to the food as this would ensure that the puffer is getting it.

Please keep us updated.

Best of luck.

Expert Advice Needed re: Very Emaciated Puffer

FishFan — Fri, 18 Apr 2008 04:11:49 GMT

This 5" Spiny Box Puffer (C. shopfi) was rescued from a fish store where it was kept for about two months. It is so severely emaciated that it is highly inverted on the bottom; the condition is so bad that we wonder how the fish could still have viscera at all. However, the fish is bright-eyed, interactive and eager takes food in to eat. This was not true a month ago when we visited the same store, which is why we felt this fish needed some individual TLC. The store did not treat the fish for internal parasites, which we feel certain is at least part of the problem.

The problem we see us that this fish is very eager to eat, but can't swallow, food is chewed and efforts to swallow are obvious, but very little seems to make it to his stomach. We've never seen a fish this starved look so alert, it has definitely not given up on life. Some sliminess may be coming from the fish's head mouth or gills, its hard to say where. This fish swims about attentively 100% of the time (so far) and gets excited when people approach his tank. He seems very relaxed considering he was moved yesterday. He takes food offered from our hands, bites fingers through the glass, and chases after ghost shrimp when he sees them.

Treatment so far: Prazipro per instructions on bottle (day 1 = yesterday).

Foods offered: Ghost Shrimp, feet pulled from live clams, (accepted but most comes back out)
Dried Krill and blood worms reconstituted with Gel Tek for parasites (refused)
Available foods not yet offered: Shrimp, squid, earthworms, frozen krill/misis shrimp/brine shrimp

Fish is in a 29 Gallon QT tank
Tank set up yesterday has:
-a single rock (hiding place - not used so for)
-magnum filter loaded with live rock
-18" air stone with a dual output dedicated air pump.

Any treatments or suggested strategies that could help us get some weight on this fish would be appreciated.
Is assisted (inject into mouth) feeding of a vitamin enriched and or medicated food slurry a reasonable option?
Thanks,
R&A