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Hi Kelly,
My wife and I are stumped in treating our 9 inch Annularis Angel, and would appreciate any insights which you may have 
As background, the display tank (375 gallon FOWLR) had an attack of marine velvet 14 months ago, and we lost a six line wrasse. The display tank sat fallow for 12 weeks. We then added four butterfly fish after they spent 8 weeks in QT. About 8 months ago, we discontinued our reef tank, and moved three additional fish into the FOWLR tank. Save for those additions, no livestock or rocks have been added, excepting two batches of Tigger Pods from Reef Nutrition (also about 8 months ago).
Symptoms with the Annularis began about 2 months ago, with slightly swollen and red gills. Breathing was not laboured and no behavioural changes were noted. At this point, the Annularis was in the display tank so we began adding Beta Glucan to the feedings and including scallops (the Annularis’s favourite). Within about two weeks, the Annularis stopped eating, and that evening was seen attempting to scratch its gills against the sand. The next day transfer to a QT tank (75 gallon bowfront filled with 60 gallons) ensued … let’s just say that the aquascaping required a fair bit of dismantling and time to catch the patient.
We began treating the Annularis with Furan 2, using a 30 minute bath at 380 mg/gallon in a 2 gallon container, followed by a five day prolonged immersion. We also repeated the 30 minute bath on the third day. During this period, the Annularis’s condition worsened, with the gills becoming more swollen and red. The gill cover gaped from ¼ to ½ inch at all times, and the mouth took on an extended position with no closing. Even then, the gill rate was not excessive, perhaps 1.5 per second. Daily water changes of 20-25 gallons were performed to keep ammonia levels in check.
We then treated with praziquantel, assuming flukes. The first day we tried a bath of 76 mg/gallon, but bailed when the Annularis showed distress after 30 minutes. The following day we went with 38 mg/gallon for 3 hours, and completed the entire bath. The gill swelling began to subside within a couple days, and a second 3 hour bath was completed. Not surprisingly, the Annularis was also showing weakness and body thinning (no eating since transfer into the QT).
With growing concern over the lack of eating, we began to tube feed the Annularis to increase its strength (feeding 1% of 300 gram body weight). We fed cyclop-eeze, Hikari mysis, Beta Glucan, garlic, Selcon, 15 mg praziquantel, and other vitamins. Not having any Tricaine for sedation (which was rush ordered), we used clove oil, but were reluctant to repeat this the next evening given the dangers attributed to clove oil. Instead, given the Annularis’s weakened state, we were able to capture it in a basket, confine its movement, and successfully feed it through the openings in the basket side. Unfortunately, there was still some struggling in the basket and the Annularis received bruises and nicks in its mouth region, so we held back any more feeding until the Tricaine arrived two days later.
With Tricaine in hand, the first two daily feedings included kanamycin sulphate to aid in healing the mouth (praziquantel discontinued). Within a week, the Annularis was looking close to normal (mouth healed, exploring the tank, good colouration, responding to people around the tank), but still no eating, and the start of some disconcerting swimming behaviour. Approximately two days after the clove sedation, and with increasing strength and swimming speed from two days of food, the Annularis began swimming the length of the tank upside down on an occasional basis. We’re unsure if this is a sign of boredom in the bare tank, or a medical symptom, but balance is not a problem as correct swimming dominates. We kept tube feeding every second day or so for another week, but the Annularis still only watches the regular food (scallop pieces and PE mysis) and will follow it for a second or two, but not take it.
One other observation; we noticed a white bump or round lesion 4-5 mm in size on the gills located behind the opercular spine on one side. The intensity of its whiteness seemed to correspond with the severity of the Annularis’s condition. It has since become less white and started to blend into the regular gill colouring, but the size does not appear to have changed.
Right now, we are somewhat stumped as to why the Annularis is still not eating (we are wary of the lesion), so are doing three daily one hour baths of 200 ml/l formaldehyde with Formalin-3 on the chance that a fluke that was resistant to praziquantel is still present. That regime ends tonight, so we will be back on tube feeding on Monday (we prefer not to do a bath treatment and sedation in the same evening).
We are confident that our feeding regime can sustain the Annularis in order to let nature take its course on healing, but cannot think of any further treatments which might aid the process.
The display tank remains clear of any symptoms, with every fish still having a healthy appetite (Beta Glucan added). That leads us to suspect we are dealing with a species specific fluke (per Noga) or some physical problem unrelated to bacteria, viruses or parasites that also irritated the gills (or some combination?). We are keeping particular watch on our Blueface angel in the display tank given its genus relationship with the Annularis.
Any thoughts or questions appreciated 
Lyle
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Lyle
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During the tube feeding tonight, we attempted to take a photo of the lesion, and were only moderately successful given the focusing. Of more concern, is the continued deep colouration of the gills.
Any suggestions on speeding the healing, I assume that time is the solution at this point ...
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Lyle
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Pansy-Paws (7/27/2008)
Hi Kelly, My wife and I are stumped in treating our 9 inch Annularis Angel, and would appreciate any insights which you may have Thanks for sharing and I will try to help.
As background, the display tank (375 gallon FOWLR) had an attack of marine velvet 14 months ago, and we lost a six line wrasse. The display tank sat fallow for 12 weeks. We then added four butterfly fish after they spent 8 weeks in QT. About 8 months ago, we discontinued our reef tank, and moved three additional fish into the FOWLR tank. Save for those additions, no livestock or rocks have been added, excepting two batches of Tigger Pods from Reef Nutrition (also about 8 months ago). Were those additions quarantined or treated before adding to the 375?
Symptoms with the Annularis began about 2 months ago, with slightly swollen and red gills. Breathing was not laboured and no behavioural changes were noted. At this point, the Annularis was in the display tank so we began adding Beta Glucan to the feedings and including scallops (the Annularis’s favourite). Within about two weeks, the Annularis stopped eating, and that evening was seen attempting to scratch its gills against the sand. The next day transfer to a QT tank (75 gallon bowfront filled with 60 gallons) ensued … let’s just say that the aquascaping required a fair bit of dismantling and time to catch the patient. I could only imagine!
We began treating the Annularis with Furan 2, using a 30 minute bath at 380 mg/gallon in a 2 gallon container, followed by a five day prolonged immersion. We also repeated the 30 minute bath on the third day. During this period, the Annularis’s condition worsened, with the gills becoming more swollen and red. The gill cover gaped from ¼ to ½ inch at all times, and the mouth took on an extended position with no closing. Even then, the gill rate was not excessive, perhaps 1.5 per second. Daily water changes of 20-25 gallons were performed to keep ammonia levels in check.
We then treated with praziquantel, assuming flukes. The first day we tried a bath of 76 mg/gallon, but bailed when the Annularis showed distress after 30 minutes. The following day we went with 38 mg/gallon for 3 hours, and completed the entire bath. The gill swelling began to subside within a couple days, and a second 3 hour bath was completed. Not surprisingly, the Annularis was also showing weakness and body thinning (no eating since transfer into the QT). My first 'guess' would have been flukes. What type of aeration did you have in the bath? Was there any observed flukes or material noted after the baths? Did you try a freshwater bath at any point?
With growing concern over the lack of eating, we began to tube feed the Annularis to increase its strength (feeding 1% of 300 gram body weight). We fed cyclop-eeze, Hikari mysis, Beta Glucan, garlic, Selcon, 15 mg praziquantel, and other vitamins. Can you share with others reading, what size & type of tube are you using? How far are you inserting the tube? Not having any Tricaine for sedation (which was rush ordered), we used clove oil, but were reluctant to repeat this the next evening given the dangers attributed to clove oil. Instead, given the Annularis’s weakened state, we were able to capture it in a basket, confine its movement, and successfully feed it through the openings in the basket side. Unfortunately, there was still some struggling in the basket and the Annularis received bruises and nicks in its mouth region, so we held back any more feeding until the Tricaine arrived two days later.
With Tricaine in hand, the first two daily feedings included kanamycin sulphate to aid in healing the mouth (praziquantel discontinued). Within a week, the Annularis was looking close to normal (mouth healed, exploring the tank, good colouration, responding to people around the tank), but still no eating, and the start of some disconcerting swimming behaviour. Was the angel in the QT or display tank? Have you tried adding Vitamin B12 to the water or tube feeding. I have had good luck 'jump starting' fish with this. Approximately two days after the clove sedation, clove or tricaine? and with increasing strength and swimming speed from two days of food, the Annularis began swimming the length of the tank upside down on an occasional basis. We’re unsure if this is a sign of boredom in the bare tank, or a medical symptom, but balance is not a problem as correct swimming dominates. I have seen this with some fish in a bare bottom tank. We kept tube feeding every second day or so for another week, but the Annularis still only watches the regular food (scallop pieces and PE mysis) and will follow it for a second or two, but not take it. Have you tried gut loaded live adult brine shrimp. I have seen this jump start even large puffers. The other option may be gut loaded ghost shrimp.
One other observation; we noticed a white bump or round lesion 4-5 mm in size on the gills located behind the opercular spine on one side. The intensity of its whiteness seemed to correspond with the severity of the Annularis’s condition. It has since become less white and started to blend into the regular gill colouring, but the size does not appear to have changed.
Right now, we are somewhat stumped as to why the Annularis is still not eating (we are wary of the lesion), so are doing three daily one hour baths of 200 ml/l formaldehyde with Formalin-3 on the chance that a fluke that was resistant to praziquantel is still present. That regime ends tonight, so we will be back on tube feeding on Monday (we prefer not to do a bath treatment and sedation in the same evening). I agree that I would not do both in one evening. Could do one in the AM and one in the PM. I would probably continue the formalin (200 ppm) baths for 5 days and make sure it is well aerated. I would also consider repeating the praziquantel baths if the lesion remains. Anyway you can use a magnifying lense or scrape the area to see if it is a defect, lesion or actual fluke attached? Might also consider maybe a well aerated freshwater bath with methylene blue - at least 30 minute duration to see if it is a fluke that it may dislodge. We are confident that our feeding regime can sustain the Annularis in order to let nature take its course on healing, but cannot think of any further treatments which might aid the process. The display tank remains clear of any symptoms, with every fish still having a healthy appetite (Beta Glucan added). That leads us to suspect we are dealing with a species specific fluke (per Noga) or some physical problem unrelated to bacteria, viruses or parasites that also irritated the gills (or some combination?). We are keeping particular watch on our Blueface angel in the display tank given its genus relationship with the Annularis. Any thoughts or questions appreciated Lyle I would definitely have to agree that this could be one of those nasty flukes. I agree with continuing the tube feeding regimen and trying to eradicate the potential (probable) fluke. This is very intriguing. Thanks for sharing and PLEASE keep us updated. Best of luck. Kelly
Kelly
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Hi Kelly,
Thanks for your comments ... we'll keep trying the baths and add B12 to the routine. We don't have a local source of adult brine shrimp or ghost shrimp, so if you have any other suggested menu items, let us know.
Upon closer inspection of the gills during sedation, I would say the term lesion that I used previously is not accurate, what we have appears to be more of a cyst or a growth. We are still trying to get a better photo of it using the Macro setting of our camera, and will upload one when we have it (probably over the weekend). The Annularis' sedation will need to be a bit deeper than we've been doing in order to allow more gill handling.
I've attached a couple photos of the catheter setup, it's an 8 French (2.7 mm outside diameter), and we insert it 6.5 mm (2 5/8 inches), getting about 1/4 inch past the end of the gills. We attach a 1 ml syringe (without the needle), and feed 3-5 syringe fulls per session. We picked up the catheter from our local vet, who in addition to treating our cat and dog, also has a file for our fish.
As to some of your other questions:
- the fish which were added from the reef tank 8 months ago did not go through any new QT, having gone through the routine upon their arrival.
- for the baths, we have an airstone for aeration, driven by a Hagen Optima air pump
- after our first praziquantel bath, we did notice some detritus in the container afterwards, but couldn't really ID it ... looked like small bundles of cotton balls (2mm dia).
- no freshwater baths have been tried, and for clarity, all treatments have been in the QT (bare bottom)
- we used clove sedation once, and have had 6 sessions of Tricaine sedation
Well, time to get some sleep.
Cheers
___________
Lyle
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| Thanks for sharing - posts like these help those hobbyists that are unsure of if they can really do it....the more that people share/post, I feel that more will attempt to tube feed and more fish will be saved. Hmm....you mentioned cottony growth or cyst.....could be a tumor? still could be a fluke or isopod? could be lymphocystis? could be an abcess? Is there anyway your vet can help with a biopsy? Again, thanks so much for sharing. Please keep us updated.
Kelly
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We hope it's not wishful thinking, but the growth (cyst) seems to be shrinking in size, and certainly is not as white as two weeks back. The Annularis is still not eating on its own though.
Tonight we took the following photo, and plan to test the growth for texture, firmness and movability tomorrow rather than taking photos. We tube fed tonight, giving 5 ml (1.7% body weight).
Two daily formalin baths have also been completed, and we'll keep these going.
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Lyle
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| Thanks for updating, sharing and posting. I wish we could get a biopsy or slide of this so we would know what we are dealing with. Please keep us updated. Again, thanks for sharing. Best of luck.
Kelly
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Just a short update ...
We've completed a new round of Formalin (daily baths for 8 days) with 2 fresh water dips of 10 minutes thrown in during the same period. The growth/tumor appears to be about half the size it had been (and not bright white any more), but doesn't appear to be shrinking any further. We are exploring the biopsy route.
The Annularis has started to get a bit interested in food again, and ate 3 PE mysis pieces tonight, and then occasionally picked at the remaining pieces for about 15 minutes ... but spit them out each additional time. We've had about 3 tube feedings during the past week, trying to balance between sustaining a hunger drive and keeping energy levels up. Our thinking is that a daily feeding of 1.5% body weight would suppress the desire for more food ... Kelly, from your experience, is this a realistic concern?
We tried a larger syringe last night, to enable a 5 ml feeding with a single throat insertion. Unfortunately this approach caused the food to be dispensed in a surging fashion due to the build up in tube pressure (larger diameter syringe into a smaller diameter tube), and the Annularis threw up the meal. So, it's back to the 1 ml syringe which is approximately the same diameter as the 8 French tube.
Cheers
___________
Lyle
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Pansy-Paws (8/11/2008)
Just a short update ...
We've completed a new round of Formalin (daily baths for 8 days) with 2 fresh water dips of 10 minutes thrown in during the same period. The growth/tumor appears to be about half the size it had been (and not bright white any more), but doesn't appear to be shrinking any further. We are exploring the biopsy route.Where are you located?
The Annularis has started to get a bit interested in food again, and ate 3 PE mysis pieces tonight, and then occasionally picked at the remaining pieces for about 15 minutes ... but spit them out each additional time. We've had about 3 tube feedings during the past week, trying to balance between sustaining a hunger drive and keeping energy levels up. Our thinking is that a daily feeding of 1.5% body weight would suppress the desire for more food ... Kelly, from your experience, is this a realistic concern? Normally I feed 2 - 4% of body weight - but the majority of fish that I feed are predatory and they usually have a larger stomach and normally don't graze like tangs and angels. I would try holding off on a feeding and see if that stimulates the angel to eat.
We tried a larger syringe last night, to enable a 5 ml feeding with a single throat insertion. Unfortunately this approach caused the food to be dispensed in a surging fashion due to the build up in tube pressure (larger diameter syringe into a smaller diameter tube), and the Annularis threw up the meal. So, it's back to the 1 ml syringe which is approximately the same diameter as the 8 French tube. Might try have a couple of the 1 ml syringes with food and switching syringes as one is emptied.
Kelly
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We are seeing slow improvement, with the Annularis now taking up to eight small scallop pieces in an evening feeding. And by small, I mean a cube of scallop approximately 1/8 inch in size. The throat is either constricted (maybe with a growth) or is still sore from the gill inflammation (or the catheter - see below), as the Annularis has trouble with larger pieces, repeatedly spitting them out and taking them back in. Sometimes, the Annularis loses interest if the scallop does not break up into smaller pieces after a couple of tries.
We then follow this with tube feeding of 1.5% body weight, which now doesn't seem to reduce the interest for scallops the next evening. We've added kanamycin sulfate into the food on two occasions, with praziquantel included once.
Regarding catheter irritation, until last week we had used a catheter that was simply cut it half (and the new end smoothed), but became concerned that this was causing abrasions in the throat. We have since taken a new catheter, cut the middle of the tube out and taped the two ends together. We're much more comfortable now that the closed, rounded end is being used. This may be an additional (human induced) cause of the slow return to normal feeding.
We live in a suburb of Vancouver, B.C., and don't expect that we will have a problem finding the assistance and diagnostics necessary to get the biopsy. Our former vet (David Huff, since retired) was the head vet for the Vancouver Public Aquarium. Our current vet worked in his practice, so she will have similar contacts. She's previously located a source for a necropsy, but that is obviously not our plan
We are also keeping our fingers crossed, as we are going away on holidays for a week, and will be having our house sitter do just the scallop feedings while we're gone. She's a vet assistant and has done this for us over the past three years, so is experienced. Even so, we've grown attached to the Annularis and its antics, and would hate to lose it for lack of trying or not being there.
To provide some further description of the tube feeding process into this forum, I'll have my wife describe the process from the tube insertion perspective when we have some time. There does seem to be some knack to getting the tube in correctly, and not have it go out the gills.
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Lyle
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