Re: At a complete loss any insight appreciated.

[Rule62]

Name: Boo
Species: Pao Palembangenisis
Age: Approx 2+ years (we acquired her in October, history unknown prior to that)
Tank inhabitants: Boo & 2 guppies. Several pest snails.

Tank conditions (API liquid tests within the past hour; last 50% water change 24 hours ago)
Temp: 75 (normally kept @ 78 but temp lowered for treatment)
Ammonia: 0 (see discussion)
Nitrites: 0
Nitrates : 0 – 5 range (see discussion; always kept <20)
PH: 8.0 (has Epsom salts affected this; water has consistently been a PH of 7.6)
EDIT: PH dropped to 7.8 after 1st water change today to remove Epsom salts
KH: 7 – 8 degrees (doesn’t quite complete colour shift on 7 drops)
GH: 23 (tested consistently in 12-13 degree range prior to epsom salt treatment. Tested prior to water change today. Will retest shortly).
EDIT: GH dropped to 18 degrees after 1st water change to remove Epsom salts.

It's a long post. Wanted to provide all the insight I could. Google drive image links at end of post (will add more)

History: (Please note that I am caring for an individual with long term complex health issues. Boo & her original 20 gallon tank was a spontaneous acquisition, over my reluctance to acquire her before I had a tank ready. I have done my best to mitigate the impact).
We acquired Boo in early October from an individual we assumed was a reliable caring keeper. Of note, we were informed that she was treated for worms about a week before we got her. She was originally housed at 78 degrees in a standard 20 gallon tank (it came with her, the previous owner assured us the tank was more than sufficient for her). Water parameters throughout have remained as noted above, with the exception of some ammonia fluctuations. At no time has the ammonia been allowed to exceed 0.25 ppm. Although I used media to seed the tank, it took 2 weeks of constant monitoring, water changes and the use of Prime to neutralize any ammonia between changes, to get the water parameters reasonably stable.

She did not accept food for the first 8 days and showed signs of stress from the move. Once she started to accept food, I had to deal with minor ammonia spikes 8-12 hours after feedings. Again these were addressed with water changes if required, however, I tended to neutralize with Prime and allow the bacteria to respond. Levels tended to rise for the first 12 hours and then return to zero within 24 hours. I know none of this was ideal.
On the advice of the previous owner, we fed Boo a diet frozen raw shrimp and pest snails. We also kept her tank fairly brightly lit. Regrettably, I trusted that his advice was solid (he did keep several puffers, so I mistakenly assumed we were caring for her properly until problems started to develop. Her diet and lighting has since been addressed.

Aside from the stress of moving, the first thing we noticed was a pea-sized white patch on her back about a week – 10 days after we got her. However, over the next week this patch faded and I assumed all was well. At the time we thought she might possibly have burned herself on the heater.

It became very clear to me within a week of acquiring her that she needed a larger tank asap. I would note that we are low income, so any purchase takes some planning. I planned to purchase a new 40 gallon breeder within a month, but by early November I saw a used one on Kijiji advertised for an excellent price. When we arrived to purchase it, the seller could not locate it (huh?), however, he did have a 46 gallon bowfront in excellent condition, along with a stand, canopy and heater, again for an excellent price. Although I was set on 40 gallon breeder (a little less water in trade for the bottom area of a larger tank) I again acquiesced at the insistence of my roommate (plus the increased water volume would hopefully help offset and wobbles with the ammonia). I purchased an AC 70 HOB, cleaned and set up the tank and 24 hours later, transferred Boo and the filter media to the new tank. That was Nov 3rd or 4th.

Again Boo showed some pretty serious stress signs at being moved to her larger tank, refusing to eat again for 5 days. She also displayed fear if we stayed near the front of the tank for too long, or made any sudden movement anywhere near her tank. This was the first time I began to question her past care. Her reaction to being netted and moved, when everything was taken into consideration, seemed excessive. I would note that when we first got her, her previous owner did remove her from her tank with the net to bag her. There have been other developments since that have led me to believe her care was not as great as I first assumed. I'll leave it at that, except to say I recently learned he traded his *beloved* puffers away for another fish.

Two weeks or so after her move (mid-November) I noticed that she again developed 2 white patches on her back, each about the size of a pea. This is when I started to research puffer care (beyond the typical cookie cutter care sheet) and potential disease problems. Needless to say, given the wide range of mis-information available, this led to mostly confusion and stress. Eventually I began to question whether it was columnaris. When I looked into treatment I found out about the issues acquiring antibiotic treatment in Canada. That’s when I came across a site in the US that could ship Kanaplex and their alternative to Furan-2 (a 5 gram pouch of Nitrofurazone that also contains 1 gm of Acriflavin). I posted to their (private) FB discussion board, described the history and provided photos. They recommended the treatment I suspected was required, although they never did actually suggest a diagnosis. 7 days of shipping hell and customs clearance later, the meds arrived on December 1st. Meanwhile, Boo stopped eating around November 30th. Her last poops was also right around that time.

I treated Boo with the meds as per their instructions. They were to treat with Kanaplex every 2 days and once with their proprietary Nitrofurazone + Acriflavin, followed by a 2nd dose after 3 days if required. Boo received 3 doses of Kanaplex & 2 doses of Kanaplex. The medication was added to the tank as Boo was refusing food. Water changes were done as per instructions. At the end of treatment there was no noticeable difference in the appearance of the white spots.

I removed half the filter media during that treatment, then replaced it after 2 50% water changes. I did see some ammonia again (always less than 0.25 ppm, always addressed with water changes & Prime to neutralize).

Their recommendations (on a separate sheet for columnaris) also suggested 60 minute salt baths, followed by 60 minute methelyne blue baths. However, Boo condition by this point, combined with her clear stress levels, made me reluctant. When she didn’t show any major change following the antibiotic treatment, I did give her two methelyne baths before discontinuing. I had also read several articles that stated the prescribed meds had to be administered with food because they would not be absorbed. Unsure about this, I also followed a recommendation in one article that said if she wasn’t eating, to fill a bath to about ½ her height, and to put her in it for a minute. It stated that this would force her to actually swallow some of the medicated water. It may well be solid advice, however, I need to state that with a pufferfish in a state of very clear distress, and by now, extremely fearful of being netted, this was both as traumatic for us to administer as it was for her to receive. So she received one bath half-submerged in Kanaplex-medicated water and 2 methelyne blue baths. The last one was Sunday morning.

Following the bath treatment, she started breathing extremely hard. It didn’t let up until Wednesday. We’ve kept her tank half-covered since the weekend to try to relieve her stress.

She has been recovering from that experience ever since. I am extremely reluctant to expose her to any more experiences like that. I dreaded doing it even before we finally decided we needed to try it. I dread the thought of ever putting her through that again 
She is still not eating, however, through all of this she has NOT lost weight. At times she appears a little bloated. I am now suspecting internal parasites. Out of concern for her not eating (along with everything else) I began treating her with Epsom Salts Monday and treated her until yesterday. I gave her a 60% water change this morning to start diluting the Epsom salts. No sign of any poop so far. No sign of any worms hanging from her anus.

I managed to source some Levamisole. It arrives today.

She remains extremely stressed and often retreats when one of us approaches the tank. Her tank is half-covered so she has the option to retreat completely. I offer her food daily. She doesn’t immediately retreat when food is offered, so long as I don’t make any fast movement. She does eventually retreat. Three days ago when I did a water change, she swam as if trying to escape the tank. She’s definitely scared.

One other thing I forgot to include: At times we have noticed what I would described as clear mucus dripping form her belly. We notice it when it occurs because it picks grains of sand, otherwise I doubt we would have spotted it. It’s infrequent, but should be mentioned. I’ve been watching her gills, but see no sign that they’re the source.

My current thought is to perform a 2nd water change this evening to further dilute the Epsom salts. Then treat her tank with Levamisole. It would seem that resolving what’s stopping her from eating is the first priority? We have entertained force-feeding more than once (including as a way to get medication in her) but given the history of her trauma (and I suspect an unknown history or trauma), I’m not sure the experience wouldn’t actually kill her at worst, make her worse at best.

Starting yesterday, she has started swimming more and spent most of yesterday and last night in the top half of the tank, behind the tank cover. No sign of attempting to hug the surface, no laboured breathing.

I’ve plowed through so much online trying to figure this out. I’m probably as stressed as Boo. FYI I used to have 2 tanks when I was in my teens. That was 50 years ago. It was a different world then and there was very limited resources, especially living in a small town.

Meds are not easy to source in Canada. At present I have Levamisole (about to arrive), a limited amount of Kanaplex & proprietary Nitrofurazone (enough to dose the tank once or provide numerous doses administered with food. Antibiotics, along with de-wormers, are very difficult to source, often involving a week+ shipping and the dreaded Customs clearance.

Nov 25th
https://drive.google.com/file/d/1SmrxAQ ... sp=sharing

Nov 27th (note clear mucus on tail fin)
https://drive.google.com/file/d/1SlopZg ... sp=sharing

[Rule62]

This is a link to a mp4 video clip taken today. Hopefully this works.

I turned the light on to take the video & a couple pics. Otherwise the tank light isn't on (her previous keeper kept her tank light on). Note how disturbed she is by my presence close to the tank. Before treating her in a separate bin, she had adjusted to us and would even swim up to greet us. There is now clearly a peeling slime coat? or mucus? in the vicinity of the spots on her back.

https://drive.google.com/file/d/1cI13Ll ... sp=sharing

[Pufferpunk]

I'm sorry, I cannot open those files. You did describe the issue very well though. I'll try to address as much as I can.
Are the white spots fuzzy, like cotton?
For external/skin issues, there is absolutely no reason you have to get the meds inside the fish. Only for external parasites.
I'm afraid you have gotten terrible info about that 1/2 container soaking, as your poor puff could easily inhale air in there.
Does it appear that way?
I am not the best person to offer medicine advice but if the white spot healed by itself before, it should do it again.
I'm glad you got a larger tank. I have often considered my 46g bowfront for this species.
The meds you added are very strong, so it is a good idea to keep an eye on parameters. I'm not sure why Epsom salt would contribute to ammonia.
How much were you using?
Here are some good articles to read:
https://www.pufferfishenthusiastsworldw ... -caresheet
library/feeding/feeding-your-puffers/
library/feeding/problems-feeding-your-puffer/

[Rule62]

Hi, thanks for replying

The white spots are not fuzzy or cottony. They are flat in appearance. Sorry, I thought the link to google drive would work. I'll repost through something like tinypic.

Yes, I was terrified of the half-full container method to try to get her to swallow meds. I don't think she swallowed any air, based on the posts I've read. She is able to navigate around the tank without any problems and is not showing any swimming or buoyancy issues.

The white spots do appear to be healing. When she got the first one we wondered if it might be heater burn, as when she was in the smaller tank she liked to lie on the substrate (white quartz pool sand) right below the heater. The second ones appeared after we moved her though, and she doesn't really go near the heater the same way in her new tank.

I must have mis-communicated about the ammonia, I didn't think it had anything to do with the epsom salts. I believe the ammonia issue is due to the filter/tank not being mature enough. I do work really hard to with water changes to quash any ammonia, and use prime to neutralize it if it shows before I even do a water change. The epsom salts treatment was 1 tbsp per 10 gallons, I started her with a half dose, increasing it on subsequent water changes.

Let's try this - images from Nov 27th if the links work now
https://drive.google.com/file/d/18fd6qL ... sp=sharing
https://drive.google.com/file/d/1aGeE2M ... sp=sharing

and 2 images taken yesterday, shows how much her belly has bloated, keeping in mind she hasn't eaten in over 2 weeks
https://drive.google.com/file/d/1cqYxFx ... sp=sharing
https://drive.google.com/file/d/1co0uCP ... sp=sharing

[Rule62]

Taken Nov 27th




Next image is Nov 27th, the one after was yesterday. Yesterday's image shows how much she's bloated.

[Rule62]

After a 50% water change yesterday morning and another in the evening, the PH is back down to ~7.5 and GH to 13°(in the normal stable range for both). Ammonia tested at 0 ppm, same for nitrites.

Measured out 1 gr of Levamisole, which according to the supplier, is half the dose required to treat 40 gallons. I then divided that again so that in effect, I had 2 quarter doses. I dosed her tank with the first quarter, with no real visible reaction. 30 minutes later I administered the second quarter. She turned quite dark but did not exhibit any other signs of stress.

This morning (9 hours later) when I looked at her, her belly was white as could be. No sign of any poop. She is definitely still bloated. She did put on a swimming display at the surface when I came close to the tank, almost as if she was trying to splash me. She has done that a couple times in the past at feeding time. I offered a piece of frozen silverside. She showed interest, but didn't take it. Ammonia and nitrites again testing at 0 ppm.

I'm going to divide the remaining half-dose of levamisole HCL and add it 30 minutes apart. Keeping the light low in the room. BTW we stopped using any tank light quite a while ago. She did live in a brightly lit tank before we got her. In our ignorance we kept her like that for the first while, until I noticed she always reacted positively when the tank light was turned off. The only time I use the tank light now is for photos and to inspect the substrate surface at times like this morning.

[Rule62]

Ok about 4 hours after I did the increase I noticed Boo starting to experience a few difficulties with swimming. Did an immediate 75% water change and put charcoal in the filter. She responded pretty quickly and appears to be ok.in fact while i was adding water back she came right up to where i was pouring water in the tank and stayed there, almost as if to watch the proceedings. If nothing else, there have been several positive signs that she's overcoming the fear from the bath experience.

I'll update in a while on any signs of change in her overall health.

[Rule62]

We watched Boo closely through the evening. She looks better this morning, the bloat has subsided somewhat but it's not resolved. No sign she is passing worms or anything else. She has really started to respond to us positively the past couple days, swimming up to greet us at times, although she is still easily spooked if we move too fast. She still hasn't eaten. Over the past few days she's been offered pieces of shrimp, silversides (smelts), clam, oyster and worms (nightcrawler & red wiggler). We've offered it soaked with sliced garlic clove, not soaked with sliced garlic clove and soaked with Garlic Guard. There are also several pest snails & 2 guppies in the tank. It will be 3 weeks on Sunday since she last took food if she doesn't eat before then

She has clear mucus-like threads hanging off her at times. It's definitely not white. This has actually been present for a while now, We only notice it because it will get grains of sand suspended in it, otherwise we would probably never have spotted it. It appears to have become a little more frequent since the treatment with epsom salts and then levamisole. You can actually spot it in the 2nd-last pic I posted above. I will post a better pic if I can manage to take one that shows it clearly, but Boo is definitely NOT a ham for the camera of late.

[Pufferpunk]

If you think the bloating may be due to constipation, you can add 1 tbsp Epsom salt/10g & then add that same dose the next day.