# Round White Lump



## mark4785 (17 Oct 2011)

My mikrogeophagus ramirezi has recently developed a white lump just above one of his eyes. Initially it looked like a displaced scale in that I could see something the same colour has the other scales bulging outwards. However, now it's just a small lump that looks like its filled with white puss. 

Behaviourally, fish is still eating a lot and acting normally.

I have provided a picture below and adjusted the colours has best as I can. Unfortunately the fish gets stressed when it sees the camera so I couldn't get a good close up.

Picture: (Note: it is in PNG format so you can further edit the colours)






Any help with identifying what it is would be appreciated.

Note: a black neon tetra of mine recently died after having a similar white lump though I think that was a bite mark from the Ram. It eventually died naturally and the Ram decided he'd eat it's tail fin and both it's eyes so I'm hoping the Ram hasn't contracted a disease. None of my other Tetra have this problem.


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## dw1305 (18 Oct 2011)

Hi all,
I can't tell from the photo, but it sounds like "Hole in the Head Disease", _Hexamita_. Rams are very prone to it, despite what you may read on the web.

cheers Darrel


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## Gfish (18 Oct 2011)

I agree, and it's a mystery condition that folk blame everything for!
At the end of the day, stress of some sort will most likely be the cause. 
All you can do is look at your tank maintenance, tankmates, etc and look to improve things. Foods with earthworm and garlic will most likely help heal the wound , but in general offer it a better quality of life (food and water) for a while and hopefully thinks will heal up.
Is the fish old? Has it spawned? I personally think all kinds of stresses affect a cichlid at sexual maturity. The need to spawn! 
Best of luck.
Cheers

Gavin


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## mark4785 (18 Oct 2011)

Gfish said:
			
		

> I agree, and it's a mystery condition that folk blame everything for!
> At the end of the day, stress of some sort will most likely be the cause.
> All you can do is look at your tank maintenance, tankmates, etc and look to improve things. Foods with earthworm and garlic will most likely help heal the wound , but in general offer it a better quality of life (food and water) for a while and hopefully thinks will heal up.
> Is the fish old? Has it spawned? I personally think all kinds of stresses affect a cichlid at sexual maturity. The need to spawn!
> ...



Water quality is excellent; fish would definitely be rubbing/flicking if there was anything unsuitable about the levels of ammonia, nitrite, nitrate, PH, GH or KH. 50% water changes are conducted weekly as has been the case for 2 years.

The fish is going to about 2.5 years old now; he has fertilised some eggs before but decided to eat them. He has made two burrows at the bottom of the tank and when within them he turns the same colour that he normally would when fertilising female GBR eggs so i'd agree that there is probably a need to spawn.

Fish is fed blood worms soaked in vitamins (weekly), his fed twice a day with a variety of ocean nutrition flake food which is rich in vitamins and protein etc.

He commonly chases after the black neon tetras if he thinks they are taking his food but whether this constitutes stress or not, I don't really know.

EDIT: I have now noticed that there are 2 white lumps, and 5 lumps that are the same colour has the skin. They do not look like hole-in-the-head because they are circular rather than varied. They are around 1mm in diameter. All of the spots are above the eye or in line with the eye on ONE side of the head.


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## mark4785 (18 Oct 2011)

Here are some much clearer pictures of the ailment. I really am struggling to diagnose what's wrong so I'm just hoping that somebody out there can identify the problem has being a specific ailment so I can go about treating it.

Picture with circles identifying ailment:





Ordinary picture:





Flash-enabled image:





Thanks in advance to anybody who can help. I really don't want to lose this fish. I know treating ailments in fish is best done at an early stage so I'm fighting against time to diagnose and treat.


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## Gfish (18 Oct 2011)

It's always guesswork as to what has caused HITH or 'Hole In The Head' but I'm not experienced enough to suggest anything else it could be.
What Id suggest is google it and look at pics of other fish to see for yourself if it looks like your fish problem.

Have you always fed bloodworm? This is a topic that's been discussed on BCA forum a number of times. A few of the dwarf cichlid breeders swear it's very bad for Rams, although I think it's to do with frozen more than live bloodworm. One things for sure though, he's an old boy! 2.5 years is a good existence by all accounts, for this particular specie. 

If you'd like a few more opinions and perhaps further advice, try starting a thread on the above forum.

Not doubting your water quality, but I lost my rams when I went away for 5 days and a neighbour overfed. I came back to whitespot on tetras and my pair of Rams, one suffering Pop eye, the other HITH. They'd lived very healthy for almost 2 years before this


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## mark4785 (19 Oct 2011)

Gfish said:
			
		

> It's always guesswork as to what has caused HITH or 'Hole In The Head' but I'm not experienced enough to suggest anything else it could be.
> What Id suggest is google it and look at pics of other fish to see for yourself if it looks like your fish problem.
> 
> Have you always fed bloodworm? This is a topic that's been discussed on BCA forum a number of times. A few of the dwarf cichlid breeders swear it's very bad for Rams, although I think it's to do with frozen more than live bloodworm. One things for sure though, he's an old boy! 2.5 years is a good existence by all accounts, for this particular specie.
> ...



Hi,

I have actually googled HITH and it shows larger cichlids with it; each mark is varied in shape. On my fish, they are consistently circular and they do not resemble a inward pit.

If I was to be bold and diagnose it myself now, I'd say I'm dealing with whitespot but I just do not want to go about treating if there is somebody that has a lot more experience than myself and could spot what the problem is from some distance.

I haven't heard of that blood worm issue before; I always feed gamma eradicated frozen blood worm; I place the icecube of blood worm in tank water in a plastic cup, take 3-4 worms out and dip them in 20ml of vitazin and then introduce to the tank. They have barely any nutritional value, which is why I dip them in a vitamin solution, and I only feed them due to the fact that the fish is an omnivore. I think the Ram has teeth in it's throat so it gives it the opportunity to chew.


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## mark4785 (19 Oct 2011)

Anybody else want to put forward their opinion of what disease is causing the spots?

Thanks,
Mark.


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## mark4785 (21 Oct 2011)

Well i'm two days into treating the aquarium with octozin on the presumption that it is a case of HITH. On the first day of treatment the fish was behaving normally and eating, however, today (2nd day in) he is staying at the base of the aquarium and the mouth/gill movement is ever so slightly faster.

Could the fish be responding badly to the treatment or does HITH cause this to happen?


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## mark4785 (21 Oct 2011)

Bump.


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## mark4785 (23 Oct 2011)

The Ram is now coming up to the surface and eating flake though hes always spitting it out. He has been ill before and I've noticed that it can take 2-5 days before he gets the appetite back after the illness.

The HITH spots are still on his face. How long will it take for them to disappear? Anybody know?

Thanks,

Mark.


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## mark4785 (25 Oct 2011)

Not sure if anybody is reading this thread, but I'll continue..

Fish is still coming up for food but spitting it out. HITH treatment is doing jack ****.

Any suggestions on something that I can do that WILL rectify the problem?

Thanks.


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## Gfish (25 Oct 2011)

Wish I could help you mate, I've never treated for HITH, I've only used different foods and additional waterchanges. I think the marks can take a long time to go completely and often the scars don't disappear completely.


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## mark4785 (26 Oct 2011)

Gfish said:
			
		

> Wish I could help you mate, I've never treated for HITH, I've only used different foods and additional waterchanges. I think the marks can take a long time to go completely and often the scars don't disappear completely.


I know that that is a highly recommended to provide more nutritious food as it is said that low nutrition foods cause low immunity, which in turn increases the likelihood of developing HITH. However, the ram has been eating highly nutritious flake food (typically containing 50%+ protein, vitamins etc) by Ocean Nutrition as well has blood worm and beef heart treats.

I think because i'm providing good food, his immunity may have been compromised purely by his age. He could possibly be 3 years old.

As for W/C frequency, I don't see it has necessary as I've not changed anything with regards to the water changing regime (i.e. frequency or quantity) that would make nitrates rise considerably which supposedly also hinders the immune system. The nitrate level has been around 40 ppm for around 1.3 years so this is quite consistent. 


I'm still treating the tank with octozin but the spots are spreading to the other side of his face and one might be starting to rupture. If it does rupture I think I will have to transfer the fish to a quarantine tank containing myaxin to prevent bacterial/fungal infection. I've been trying to get ahold of medtronidazole to treat HITH and/or its causes due to it being a highly recommended treatment but have failed so far.


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## Gfish (26 Oct 2011)

Just to be sure, take a water sample to your LFS.
You'd not be the first experienced fishkeeper to believe all is fine with their water.
Worth eliminating this I suppose, but yes, he could just be an old boy on his last er... Fins :-/


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## mark4785 (26 Oct 2011)

Gfish said:
			
		

> Just to be sure, take a water sample to your LFS.
> You'd not be the first experienced fishkeeper to believe all is fine with their water.
> Worth eliminating this I suppose, but yes, he could just be an old boy on his last er... Fins :-/



My nearest reliable LFS is about 15 miles away and they will only do what I have already done; test the water for ammonia, nitrite, nitrate and PH. I've not tested KH or GH as they never change and won't have changed since I haven't put anything in the tank that wouldl cause a change.


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## dw1305 (26 Oct 2011)

Hi all,
It could well be age related, I've not kept Rams for a while (and when I did I used to kill them on a fairly regular basis), but my older male _Apistogramma cacatuoides_ tend to go the same way at about 2 & 1/2 years, they just slowly lose condition and one morning you fish them out dead. I've had several females live to 4, but all the males will have died younger than that.

I'd definitely try and feed a more varied diet, I'm convinced that cichlids do better with some natural, ideally live, food. I give mine live blood-worms, Daphnia, Grindal worms, Earth-worms, Mosquito larvae, Cherry Shrimps etc. and when I'm short of live food I give them some shrimp based frozen food ("European shrimp Mix" from <http://www.cichlid-forum.com/articles/food_recipes.php>) for dry food I alternate between feeding earthworm flake & spirulina flake and the Astax Red crumb from TA Aquaculture. 

It is the same with water, I'm a fairly fanatical water changer. It isn't easy to prove that this helps, but it works for me.

cheers Darrel


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## mark4785 (27 Oct 2011)

dw1305 said:
			
		

> Hi all,
> It could well be age related, I've not kept Rams for a while (and when I did I used to kill them on a fairly regular basis), but my older male _Apistogramma cacatuoides_ tend to go the same way at about 2 & 1/2 years, they just slowly lose condition and one morning you fish them out dead. I've had several females live to 4, but all the males will have died younger than that.
> 
> I'd definitely try and feed a more varied diet, I'm convinced that cichlids do better with some natural, ideally live, food. I give mine live blood-worms, Daphnia, Grindal worms, Earth-worms, Mosquito larvae, Cherry Shrimps etc. and when I'm short of live food I give them some shrimp based frozen food ("European shrimp Mix" from <http://www.cichlid-forum.com/articles/food_recipes.php>) for dry food I alternate between feeding earthworm flake & spirulina flake and the Astax Red crumb from TA Aquaculture.
> ...



If it is age related I bet the fishes immune system is responsible for this HITH out break.

On the positive side, I have managed to speak with a nearby veterinary centre who will be able to provide metronidazole tablets for the Ram but by lay they first have to see the fish for themselves and give me a veterinary prescription. This metronidazole is apparently applied to the HITH holes to kill the parasites and heal the wound. Someone from the vet should be coming to the house to review whats wrong with the fish; I will make the most of the visit and ask them what they think is wrong, prognosis etc.

Also, the fish is eating small high protein pellets as opposed to flake so he will not waste away providing he continues to eat the pellets. I am not putting blood worm in or anything else which basically provides nill protein and 5% moisture as this sort of food will not support the immune system enough.

For now, and until i've seen the vet, I'm continunig to add vitazin to the water and Octozin.


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## mark4785 (27 Oct 2011)

Just providing a quick update to say the Ram is behaving normally now in that he is chasing the black neon tetras and eating. He will only eat small pellets though; he is spitting out flake food which he used to like. I guess this is to be expected given that they are known to be fussy eaters.

The white spots are still visible, one is protuding outward quite a bit. I'm hoping the white bits fall off after the wound underneath has healed.

Vet has yet to contact me back about this Metonidazole treatment; not sure whether they don't take fish health has serious has something with fur and claws. They have promised twice to contact me regarding a home visit to assess the fish and have not made contact.


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## dw1305 (28 Oct 2011)

Hi all,


> Just providing a quick update to say the Ram is behaving normally now in that he is chasing the black neon tetras and eating.


 Well done, I thought he would probably go down hill and die, so that is really good news.

cheers Darrel


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## mark4785 (28 Oct 2011)

dw1305 said:
			
		

> Hi all,
> 
> 
> > Just providing a quick update to say the Ram is behaving normally now in that he is chasing the black neon tetras and eating.
> ...



Thanks - I won't feel good until the spots have gone. Pity my local vet don't have time to make a 2 minute phone call with me to help me understand how I can go about treating the spots so they disappear.


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## mark4785 (29 Oct 2011)

Update: Vet has contacted me and I'm scheduled to pick up the metronidazole on monday. I am to de-frost some blood worm, place the blood worm in the metronidazole solution and re-freeze. De-frost again and try to get the fish to eat it. Apparently it's an anti-parastic and antibiotic in one.

Fish is still acting normal but eating slightly less pellet. HITH lesions are not spreading in response to Octozin.


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## mark4785 (13 Nov 2011)

Well things have gone down hill a bit since my last post. The Ram is refusing to eat any kind of high nutrition flake/pellet, including fine pellets with garlic which is supposed to be a highly attractive ingredient to fish.

He will only eat blood worm. Since he is only eating blood worms I have been trying my best to inject a fish medicine into the actual blood worm that contains methylne blue, formalin etc which is a good anti-parasite.

The fish is still acting normally behaviourally and even comes up for any kind of food but once he recognises the food to be a pellet/flake, he just stares at it.

Should I consider putting him in a uncycled 30 litre aquarium with a different kind of HITH treatment? I have been using waterlife octozin for 2-3 weeks now and although it's stopping the spread of the white spots, the fishes appetite is dreadful. Other treatments tend to contain non-plant/filter friendly medicines which is why I'd ideally need to place him in a separate 30 litre aquarium.

Unfortunately, I chose not to go to the vets to pick up the metronidazole as the fish appeared to be getting better but then went down hill. I've enquired into whether I can go and pick up the metronidazole via phone but they have told me the vet who authorised the metronidazole is on a "2 week holiday" and he has "not left any notes regarding the possibility of prescribing metronidazole".


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## mark4785 (15 Nov 2011)

My Ram is still with me, however, he will only eat blood worm and inner layers of a pea. I have started injecting Esha Hexamita treatment (contains: acriflavin and methyline blue) into both of these foods and afterwards I noticed he started to perk up and chase the tetras which is characteristic of him when he is healthy. 

He produced white faeces just yesterday which I think was only expelled due to the feeding of peas. The fish continues to refuse to eat 5 different kinds of pellet of differing sizes (some even containing garlic) and 7 different kinds of flake. I think if he continues to be picky with the food I'm going to have to transfer him to a 20 litre and put the eSHA hexamita treatment into the water column (something I'm not going to do in the main, cycled tank as it contains chemicals which can cause ammonia spikes).

The water column of the main tank is being treated with Octozin which is not compatible with the eSHA product which is why I am injecting the latter product.


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## mark4785 (23 Nov 2011)

Still dealing with the hexamita problem. He is still colourful despite having lived on blood worm, peas and eating the odd high protein pellet for around 4 weeks now. 

Does the fact that he is very selective in what he chooses to eat, show signs of internal digestive problems caused by the hexamita?


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