Different QT and Treatment methods we try

mikeintoronto

Well-known member
I thought it might be interesting to discuss the different methods we use to quarantine and treat our new fishes. The methods outlined on this board are sound but I don’t think we all follow them exactly. We make adjustments based on experience or materials or whatever.

I guess I’ll discuss mine and the reasons I do things.

Basically I do a 2-day TTM with copper. I place the fish in a 5 gallon wide mouth plastic tub. It’s pharma grade from my old work but I’ve used Home Depot totes. In it I use an air stone and a preset heater. That’s all.
Day 0 - new fish is home. Add roughly 60 mg of metro (which is a lot, I know)
Day 1 - 1/3 therapeutic dose (TD) of copper
Day 2 - Move fish to a new tub with 2/3 TD copper and 60mg metro
Day 3 - Add another 1/3 TD copper to get to full TD (3/3 TD)
Day 4 - move fish to a new tub with TD copper + metro
Day 6, 8, 10, 12, 14 - repeat (although I might skip metro on day 14)
Day 15 - move fish to glass observation tank with 4 black mollies. Sponge filter only.
Day 15 - 30 - observe twice a day when dark with a flashlight to look for spots because I see them best in the dark for some reason.
I’m also dose twice with prazipro but I find it bothers the fishes so I tend to do it later in the observation like day 20 and 27.

All items I use between transfers are soaked in bleach solution for those two days. I usually have enough heaters but when I don’t (too many QTed fishes) I soak them for an hour before I return them to the tubs. The tubs are rinsed with hot water and air dried. I mention more about this below.

So the reason I do this is that I found my fishes were very prone to secondary infections if the water wasn’t pristine. And I found cleanliness hard to do when I left the fish in the same water for 15 days. I never had a secondary infection once I started this and it means I don’t need antibiotics. The sponge sits in my sump until I need it. Between treatments I wash it in the washing machine in case a QT failed. I have several sponges so they are well aged (usually with aiptasia stuck to them).

I use the DIY copper sulphate + citric acid solution and I know exactly how many drops are required to get the TD. If I test it I get 0.27 ppm which seems to be my magic number. I need it to be above 0.20 but I aim for 0.25 since the tolerance on the Hanna checker is 0.05. The fishes tolerate this solution really well.

I’ve had a couple people contact me regarding how to QT and I mention how I do it and they have also had success. It takes away some of the guess work with cleaning and drying tubs between TTM because even if an encysted parasite survived the cleaning, it won’t do much damage once it hatches into copper again.

This method is A LOT of work. No lie. But it’s been 100% so far and I’ve treated several dozen fishes (mostly anthias).
 

Jessican

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Do you want to keep this to full QT only, or is it okay to post if our methods are somewhat alternative?

Edit: I’m not trolling you, it’s a serious question. If you want to keep this to full QT methods only, I’m happy to respect that. 😊
 
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mikeintoronto

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Thread starter
Do you want to keep this to full QT only, or is it okay to post if our methods are somewhat alternative?

Edit: I’m not trolling you, it’s a serious question. If you want to keep this to full QT methods only, I’m happy to respect that. 😊
Me? Oh anyone can post anything they’d like. It’s all about being helpful. Sometimes we fail at a treatment and give up but it’s good to know how others do things and why.
 

Jessican

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I've tried the standard QT methods a number of times now, both for treating actively sick fish, and for prophylactic QT of new fish. And honestly, I wouldn't consider it very successful. With chloroquine phosphate, I had at least five fish end up seemingly brain damaged, that ultimately didn't survive. With copper + metro treatment, I had fish just die for no apparent reason a couple of weeks into treatment. And I kept running into mystery (possibly bacterial) issues that just kept returning, no matter what treatments I tried. And then ultimately, I still ended up with yet another outbreak in my main tank, despite QTing everything and even having separate equipment for all four DTs. It felt like I constantly had sick and/or dying fish, and empty tanks. It was heartbreaking, and about drove me out of the hobby.

What finally worked for me? Peroxide. And it changed my whole philosophy regarding fish health.

I've come to believe that prophylactic QT with heavy medications is detrimental to the long-term health of the fish - disease-free doesn't necessarily mean healthy. I think exposure to things like copper and antibiotics destroys the immune system of the fish, and leaves them vulnerable. So, my tactic now is to give the fish the cleanest start possible without exposing them to medication, and then protect them while they built up immunity to anything that might be present in their environment.

So here's my method:
- I only source new fish that I would consider reasonably clean to start with (such as Diver’s Den or Biota/ORA)
- New fish gets a 150ppm peroxide bath for 30 min
- New fish goes into the display, with UV running 24/7
- For at least a month after, I dose peroxide at 1mL/5gal, 3x a day
- After the month is up, I stop the peroxide but keep running the UV

Using this method, I’ve successfully added the following fish to my tanks, without any outbreaks or losing any existing inhabitants:
- Rainford goby
- Swales Swissguard basslet
- Bluestreak cleaner wrasse
- Blue throat triggerfish
- Hooded fairy wrasse (this one didn’t get the initial bath because she was already QT’d)
- Bicolor foxface
- Orchid dottyback
- Banggai cardinal
- Melanurus wrasse
- Ocellaris clownfish

My thought process here is that the peroxide knocks off most (if not all) of anything the new fish might be carrying, without damaging their internal gut bacteria or their immune system, and then the dosing in the tank keeps anything that's either lurking in the tank or that came in on the fish from getting to out of control levels. Over that month of dosing, the fish's immune system builds until they're protected from anything that might still be present. I think low level exposure to pathogens is a good thing - I don't think a sterile environment is a healthy one.

Is it conventional? No, but I think it's a healthier approach. I don't blast myself with medications unnecessarily, why would it be healthy to do that to the fish? Is it perfect? No, but neither is any other QT method - I've lost far fewer fish this way than with traditional QT. Is it for everyone? No, it's admittedly still experimental and requires accepting a certain amount of risk. But my fish are happy, fat, and healthy - one of my clownfish pairs is even getting ready to spawn - and isn't that what's really important?
 

Humblefish

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I've had success using this protocol on anthias and other hard to QT fish:
  1. 45 minute formalin bath upon arrival, and then into a "preconditioning tank" (no meds) where all I do is power feed them small meals 5-6x daily. I also use lots of vitamin supplements. The point is to bulk them up for a couple of weeks before running them through copper. The formalin bath should knock off the worst parasites anyway, and in the future I will experiment with using a H2O2 bath instead.
  2. After 2 weeks of preconditioning, I run them through therapeutic copper for 2 weeks. I also deworm 2x by using prazi. I do not treat with metro, because the formalin bath should have eliminated any Brook or Uronema. If I saw white stringy poo during the preconditioning process and I'm still seeing it in QT, I food soak General Cure for 2 weeks. I continue to power feed them small meals 5-6x daily.
  3. After 2 weeks in copper/medications, I transfer them into conditioning tanks where I continue to power feed + monitor their condition. Sometimes I have to continue on with food soaking General Cure. If all is well after 2 weeks I consider them good to go. (y)
^^ Even after all that, my success rate with anthias is still only ~ 70%. (The deep water species are the hardest to QT.) Although I think sometimes they kill one another, and really need to be isolated to small individual QTs until they can re-join in a DT environment with lots of rock. The above is feasible for a hobbyist because you just need two tanks to do it or can do tank transfers if needed. But on a commercial level you would need 3 separate systems because you can't sterilize your QTs in-between every batch of fish (not cost effective).
 

drstardust

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I'm currently at a crossroads regarding how to proceed moving forward.

For years I did standard QT with meds prophylactically for 30 days in one QT, etc. After having numerous failures--both with fish loss in QT and ich making it through the process (I can def see how the ich is in every tank myth could be believable!)--I've decided to go a different route. I'm trending toward Jessica's method, though I'm not there yet.

Currently I do this:

Day 1 fish arrives and gets 30 min bath in methylene blue, then 30 mins peroxide (unless contraindication such as obvious sores, etc), then 90 minute Rally bath. This process is likely redundant, but given that these are overall well tolerated short term baths, I don't see the harm in that.

Afterwards fish goes into the FICU (fish intensive care unit lol) with copper power at 1.5ppm. I raise to 2.2-2.5 after about 48hrs. I keep it there for 10 days. I dose metro every other day for the 10 days, 2 doses of which are GC ~6 days apart.
Then, fish go into observation tank (aka "step-down" - those of you with medical background will likely find my terminology as amusing as I do :p). They stay there for 2 weeks. I feed GC-laced foods during this time. If all is well, they go into DT.
DT is dosed with peroxide 1mL/3 gal twice per day. I have not made a final decision on how long to do this for after a new addition, but I think 2-3 months is reasonable. I plan to add a UV at some point.

I'm in the early stages of this protocol. I'm not sure if I'll continue this or modify it moving forward. If I modify it, it would likely be in the direction of less medication rather than more. So far I've done it with 7 fish successfully: 2 clowns, 1 yellow tang, 1 hippo tang, 1 longnose hawk, 1 chromis, 1 YWG. I've had one loss, a genicanthus angel. She declined after making it to DT for unclear reasons, with no obvious parasite affliction.
I don't know for a fact that I have ich in DT currently, but I most recently only went fallow for 6 weeks after seeing it, so I recognize that it's possible. Previously had done up to 3 months, with ich still making it 😭. Decided it just wasn't fun anymore, so decided to mitigate risk of things worse than ich, and avoiding adding new strains of ich, as best I could without driving myself nuts.
 

AndyR83

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This is my QT workflow:
QT Workflow.jpg
 

CindyKz

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This is an interesting thread, thanks to all for sharing.

Currently, I do 30 days observation in a "permanent" display with rock and sand, and move to a hospital tank and treat if necessary. I tried prophylactic meds and failed miserably, most fish didn't make it through quarantine. In retrospect, I think this has more to do with poorly or uncycled tanks and the unnatural surroundings (no rock or fake plants, etc) than the actual meds. I was brand new in the hobby at the time and didn't have a sense of the importance of those factors (especially using good, cycled media).

That being said, I tend to agree with Jessica in that I don't like to just treat every fish the same across the board. I don't think it's healthy, there are risks with ALL meds, and we don't know what the long term effects. We know certain meds affect appetite and energy levels in a negative way. Who knows what else?

Humans aren't all treated the same way, medically speaking, but different conditions have different protocols and we treat humans prophylactically in certain situations, such as pre-operative antibiotics or people with the BRAAC gene undergoing elective mastectomies to prevent cancer.

So why don't we treat our fish this way - based on risk factors and presentation? We all know tangs tend to be more susceptible to cryptocaryon, because their thinner mucous coat makes them susceptible. Chromis tend to get uronema. And so on. Obviously it requires a lot of observation time, and a lot of self education. We don't all have that kind of time on our hands or the knowledge base.

As my fish population grows (ie I keep setting up more and bigger tanks LOL) I am more and more risk -averse, but at the same time I want to do right by the fish I quarantine.

Just my thoughts....
 

AndyR83

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I do agree with the concept of adapting management strategy to fit the specific needs of a given situation.

The correlation to (human) medicine is a good one. Most of the published recommendations from recognized authorities are referred to as “clinical practice guidelines.” It’s understood that the clinician exercises a degree of judgement when constructing a plan of care informed by these recommendations (in other words, he/she is well within his/her authority to deviate from the guidelines if some aspect of the situation warrants it.) A good example of this is the American Heart Association’s clinical guidelines for CPR and advanced resuscitation. There are certainly algorithms for managing cardiac arrest, fast heart rates, slow heart rates, etc., but there have also been countless situations I can recall wherein failing to identify the uniqueness of the situation at hand and merely following the “recipe” would’ve killed my patient. For this reason, I always advocate for adhering to a standardized approach unless there’s a good reason to go “off protocol” (but also recognizing and embracing the fact that this does indeed happen, particularly among more highly experienced individuals.)

So I guess if I was to wrap that all up in a nutshell... I’m a big fan of a algorithms that work for the majority of cases, so long as there’s also a mechanism to deviate from the established pathway if the situation demands it.
 

CindyKz

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I do agree with the concept of adapting management strategy to fit the specific needs of a given situation.

The correlation to (human) medicine is a good one. Most of the published recommendations from recognized authorities are referred to as “clinical practice guidelines.” It’s understood that the clinician exercises a degree of judgement when constructing a plan of care informed by these recommendations (in other words, he/she is well within his/her authority to deviate from the guidelines if some aspect of the situation warrants it.) A good example of this is the American Heart Association’s clinical guidelines for CPR and advanced resuscitation. There are certainly algorithms for managing cardiac arrest, fast heart rates, slow heart rates, etc., but there have also been countless situations I can recall wherein failing to identify the uniqueness of the situation at hand and merely following the “recipe” would’ve killed my patient. For this reason, I always advocate for adhering to a standardized approach unless there’s a good reason to go “off protocol” (but also recognizing and embracing the fact that this does indeed happen, particularly among more highly experienced individuals.)

So I guess if I was to wrap that all up in a nutshell... I’m a big fan of a algorithms that work for the majority of cases, so long as there’s also a mechanism to deviate from the established pathway if the situation demands it.

The bummer is, clinical practice guidelines are typically based on systematic reviews or other high levels of evidence. If that evidence is available for our hobby I wish I could find it. It either only exists for certain topics (ie UofF research on cryptocaryon and TTM), I'm searching incorrectly (very possible) or I don't have access to the correct resources (also possible).

I feel like I'm usually acting on the advice of expert opinion, single studies, or anecdotal evidence. Taken together they are very useful, but not the level of evidence I'd like to see.
 

Humblefish

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I'm a big fan of repeatability, and this is why QT has always made sense to me. Although we have to accept that nothing works 100% of the time, QT protocols can be followed and success can be duplicated. We also need to remember that fish quarantine, like everything else in this hobby, requires time & experience to improve your skill set. Not too many hobbyists are successful trying to grow acros or with keeping a clam in their very first tank. ;)

Those who do not QT and profess nothing ever dies in my tank are a) Lying b) Cannot usually articulate how they accomplish this. So, there's no How To "guide" on how to replicate their success. It's usually just a big mystery. "My fish don't get sick because I don't let them get sick" (not picking on you Paul) is something I cannot wrap my mind around.
 

Jessican

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Those who do not QT and profess nothing ever dies in my tank are a) Lying b) Cannot usually articulate how they accomplish this. So, there's no How To "guide" on how to replicate their success. It's usually just a big mystery.
I know that my current method dances right in the edge of the line for whether it can actually count as a QT process, just like my peroxide dosing is on the line between actual treatment and just management. That’s why I generally don’t advise anyone to try it unless they specifically ask for an alternative - I know there’s likely a healthy dose of unrepeatable luck in my success - but it’s also why I tried to be as thorough as possible in my documentation, in the hopes that if there is any viability to what I’m doing, it can be repeated by others.
 

CindyKz

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I know that my current method dances right in the edge of the line for whether it can actually count as a QT process, just like my peroxide dosing is on the line between actual treatment and just management. That’s why I generally don’t advise anyone to try it unless they specifically ask for an alternative - I know there’s likely a healthy dose of unrepeatable luck in my success - but it’s also why I tried to be as thorough as possible in my documentation, in the hopes that if there is any viability to what I’m doing, it can be repeated by others.
I don't think what you described, or what I do "dances on the edge". It is still a quarantine in the definition of the word, just not as it is often used by our hobby. I don't know about you, but I know there are certain repeatable steps I take, such as matching temp and salinity on introduction, minimum 15 minutes each day observing the quarantine tank, so on. Mine just exclude meds, unless I need them.

I do need to get a LOT better about documentation though. I keep starting spreadsheets and then not keeping them updated.
 
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CindyKz

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I see many have formalin listed as a bath - I like Humblefish's idea for using it on specific species. Does Ruby Reef Rally have enough formalin in it to do the trick?
 

Humblefish

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I know that my current method dances right in the edge of the line for whether it can actually count as a QT process, just like my peroxide dosing is on the line between actual treatment and just management. That’s why I generally don’t advise anyone to try it unless they specifically ask for an alternative - I know there’s likely a healthy dose of unrepeatable luck in my success - but it’s also why I tried to be as thorough as possible in my documentation, in the hopes that if there is any viability to what I’m doing, it can be repeated by others.
But your methods do have something tangible (and backed up by science) to them: A peroxide bath before the fish enters the DT and an in-tank dosing protocol if something were to slip through. So, a primary plan and a backup plan. I can also get on board with those who plumb in a pool grade diatom filter, oversized UV or use an oxydator to manage the presence of diseases in their DT. Since nothing is 100% anyway, they're just putting their stock in a DT management system vs. a QT protocol.

I see many have formalin listed as a bath - I like Humblefish's idea for using it on specific species. Does Ruby Reef Rally have enough formalin in it to do the trick?
According to the MFG, Rally only contains a small amount of formalin that is used as an "activator". The other two active ingredients are antiseptics: Acriflavine and Aminoacridine. IME; Rally does a heck of a job of clearing Brook, as a pre-treatment for Velvet, and can help a fish's immune system overcome a stubborn bacterial infection. (y)
 

intense37716

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I’m curious as to what others think of observing as I believe even after treating with Cu then observing in a sterile tank ich was still present on the fish the entire time, so did it go dormant (possibly incorrect terminology) or a carrier.

I also believe that dosing h2o2 failed for me for the reason being that one tank had ich but kept velvet controllable and the other tank wasn’t dosing enough after building up and had velvet, brook and uronema.
 
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