Approaching a case

[AroMedics]

There are 2 parts to the initial approach of a sick fish.
firstly, u have to collect a good history.
Then, u should examine the fishes( perform a physical exam)

History Checklist:

1)Basic description of the aquarium and fish:

-Where is the tank situated( busy traffic, bright/dull location, windows, outdoors etc)
-Dimensions of the tank
-Actual volume of water in the tank
-How long has the tank been setup
-How many fishes
-Species and sizes of fishes
-Any other tanks


2)Presenting problem:

-What's wrong with the fish(es)
-When did it first occur/first noticed
-How severe( any deaths, how many affected/died)
-How sudden did it happen
-Has it progressed


3)Previous problems:

-Any previous problems in the past
-Any treatments/medications used in the past
-Any fishes dying every now and then
-Any problems with other fishes in another tank


4)Water quality:

-Temperature
-Ammonia
-Nitrite
-Nitrate
-pH
-Hardness( general /carbonate)
-Other water parameters if available( oxygen, carbon dioxide, chlorine, copper, iron etc)
-Frequency of water changes
-Volume of water changed each time
-Detailed description of how you perform a water change ( picture yourself performing one right now, and describe every detail of it, from turning on the tap, ketapang, salt, chlorine, aeration, process of aging( where, how, what, how long etc), temperature adjustment, etc)
-Description of your filtration system ( number of filters, type, size, nature of media etc)
-Detailed description of filter maintenance( when was the last time it was cleaned? again, picture yourself cleaning it)
-Mention any airpumps/airstones, powerheads, waterfalls, other equipment that provide aeration to the tank



5)Diet.....

-What do you feed the aro( please mention EVERYTHING that goes into the aro¡¯s mouth. If the diet changes with time, please provide a rough time map of how long ago a previous food was used etc)
-How much do you feed each time
-How many times per day
-How do you store the food
-How long has the food been stored or opened



6)Other environmental aspects:

-Please give a brief description of any plants, rocks, wood, gravel and other structures in AND outside the tank ( lighting etc)



7)Management aspects:

-Do you quarantine new fishes( If yes, please describe procedure)
-Do you have any shared equipment between tanks, or equipment that has recently been transferred between tanks( nets, airstones, plants, buckets, siphon, fishes, snails, filter etc)
-Do you disinfect any equipment
-Can you identify any recent stress or changes that have happened
-What else do you routinely do to the aquarium( cleaning glass, trimming plants, cleaning gravel, siphoning bottom etc)
-What else happens around the tank( fly spraying, painting etc)

Physical Exam:

Key points to remember:

-Get close-up and personal. Stick your nose against the glass if necessary, without scaring the fish.

-Have good lighting. Turn on the lights. A pen-torch might come in handy.

-Always check both sides of the fish. Compare and contrast.

-Scan the fish from nose/barbel to tail.

-Be organize and systematic. Follow the checklist below so you won¡¯t miss a thing.

-Describe and not interprete any abnormalities found.

-If in doubt, check the gallery for normal photos of aros.

-Take you time. The fish will not complain. Spend up to 5 minutes per fish.

-Check all fishes in the tank.

Checklist( here's what to check for. make sure u cover each of these bits):

1 Swimming pattern
2 Posture/position
3 General colour
4 Abnormal behaviour
5 Appetite
6 Faeces/poo
7 Body condition
8 Breathing( depth and rate)
9 Barbels
10 Nostrils
11 Mouth, jaws, teeth( if visible)
12 Eyes
13 Skin and scales on head
14 Gills( if visible)
15 Gill covers / operculum
16 Skin and scales on body
17 All fins
18 Lateral line
19 Swellings/deformities on body or spine
20 Size/shape of abdomen/belly
21 Anus





If you find ANY abnormalities in ANY fish from the above checklist, please DESCRIBE the findings using the guidelines below. You'll know you've done a good job if anyone can read your description and picture the sick fish clearly in their head.

----Precise location of the problem( e.g upper left gill cover, bottom-centre of right eye, left pectoral fin etc. Use the following diagrams for anatomical locations if unsure)

-----Number ( e.g about 7 spots, one single area, 2 discrete areas

----Size( measuring 5mm in diameter, occupying about 50% of skin on head, 40% of the lower part of the caudal fin is gone, each about 2 by 4 mm in size

----Shape( round, circular, raised, nodular, flat, triangular, rectangular, linear,etc

----Colour( brown, red, pale green, creamy, white, translucent

----Consistency( rough, irregular, smooth, bumpy, appears soft, hard, spongy etc)

----Margins( well demarcated/discrete vs joining together/coalescing)

[AroMedics]

If u have some spare time, and would like to learn more about approaching a sick aro, the following posts give a more thorough description of what to look out for during a physical exam in an aro.

Some points were derived from the scientific literature, while others were based on personal experiences and observations on arowanas. It is meant only as a guide, with specific relevance to aros.

The first thing to do when examining any fish, is to stand back and look at it as a WHOLE.
the first 7 points on our checklist should be covered during this initial observation.

Swimming pattern
Posture/position
General colour
Abnormal behaviour
Appetite
Faeces/poo
Body condition
Breathing( depth and rate)


--Swimming pattern/Posture/ Behaviour- -
most aros swim close to the water surface. The behaviour of individual fishes will vary, so the important thing is to recognise ANY CHANGES from its usual routine. some aros will bottom-sit/rest/remain stationary, but are quickly roused when someone walks by. others are virtually in constant swimming mode throughout the day. others like to scavenge and scan the
bottom of the tank for food etc others r mainly surface dwellers......u get inbetweens...... so know your aro's habits and be suspicious if anything changes.e.g depression, inactivity, resting for prolonged periods than usual. bumping into objects...

it's hard to describe how a fish normally swims... u have to get a 'feel' for your own aro. generally, check that it's using both pectoral fins for balancing/steering, fins are nicely spread out, the fish uses it's body to undulate and propel, the fish is upright and not tilting to either side.........

postural changes are usually obvious. the fish might have a humped back, head-standing, etc. such postural/ behavioural changes are nonspecific, but are often the first signs to appear when things go wrong. some behavioural changes can provide useful diagnostic information----head-standing often implies a bounyancy problem, rubbing/scratching almost always imply skin
diseases.

the important thing is to DESCRIBE what you see, and not just
interprete/state what u see. e.g don't just say your aro is itchy or
scratching. describe what it's actually doing too....fish dives to the
bottom of glass tank, leans onto one side, bends it's body sideways and pushes off the ground in a quick jerk, the whole action lasting about 3-5 secs. does it once every 10 mins or so. swims normal inbetween. now anyone reading this description can be very sure that the fish is actually scratching. this is very important, esp since only u can see the fish, while others can't.

Mistakes can happen easily, imagine if the fish had a brain infection and was circling around non-stop. this might b
mistakened for scratching, and antibiotics not given soon enough.
so remember, DESCRIBE what u see too. This applies to anything abnormal u find while completing the rest of the checklist.


--Colour changes
are self explainatory. there is too much to cover at this stage. it will be covered in detail under skin diseases. colour changes are usually diffuse/generalised... the aro turns paler when afraid, sick aros turn darker etc....blind aros r often darker in colouration. colour changes however may be localised, e.g only the head turns darker. this usually occurs with nerve damage, and is uncommon.the thing to remember is that aros, especially large aros do not display obvious colouration changes, compared to other fish species. this is probably becasue melanophores play a small role in aro skin pigmentation.



--Body condition:
Focus on the belly!

animals that walk on the ground need stronger bones to support their weight.
when these terrestrial animals loose weight and have a poor body condition,
it becomes really obvious-bones sticking out! think of a picture of a starving child. you can see his/her ribs, facial bones, shoulder and pelvic bones etc. turn the child around and his/her spine sticks out prominently.

does this happen in fishes? not to such an extend. emaciated/thin fishes
usually only have a tucked in or flattened belly. they may appear smaller than siblings of the same age. you will not see obvious muscle atrophy and bones sticking out at you. rather, the organs in the abdomen become smaller.
so focus on the belly.

in aros, it's a bit different. they have a very narrow V-shaped belly, as opposed to a more rounded, broad barrel-shaped belly of most other fishes. This makes it a bit more tricky to access body condition in aros.

a well-fed aro, which recently ate a large meal, might have a U-shaped belly. as it goes without food for 24 hours, it becomes V-shaped. If your aro has a U-shaped belly but hasn't recently had a large meal, it probably has a pathological abdominal distention--most often ascites/peritonitis associated with bacterial infection.

As it starves further, the 'hands' of the V will become steeper and more upright( do this with your hands. place your hands together in a V-shape. then slowly bring your palms together as if praying. notice how the bottom of your palm( closer to your wrist) touches together first, then your finger-tips. so the bottom will look like a straight-vertical/upright line when viewed from the front. this lines gets longer until your hands finally clap shut, and your entire hand becomes a long straight line. obviously,
this line is quite thick.

in aros, this line at the bottom should not get any higher than the level of the base of the pectoral fins. As it gets higher, it means that the V is closing up and becoming a straight line----V becomes |


so, to summarise,
- check body condition by looking at the belly.( it's necessary to check from the FRONT, BOTTOM and SIDE )

- where is the belly?? the belly starts BEHIND the pectoral fin base, and ENDS at the anus. the bit in front of the pectoral fin base is where the heart is located.do not look at this area. it is often buldges out more than the belly.

- Aros have a narrow V-shaped belly.

- normal aros can have a narrow V-shaped belly even with an upright line at the bottom, depending on how much food is in the stomach/intestines.

- healthy aros have a V-shaped tummy with an upright line at the bottom that does NOT extend beyond the level of the base of the pectoral fins. the aro is considered emaciated if this occurs.

- An aro with a U-shaped belly has abdominal distention. This distention might be due to a recent large meal, a female full of eggs, or various diseased conditions.

[AroMedics]

--Breathing.
2 things to consider = rate and depth.
Breathing rates of fishes vary tremendously according to various
factors....fishes will breathe faster after a meal, when frightened, and in numerous disease states.
we only worry if the aro is PERSISTENTLY breathing more rapidly than normal.

A normal rate has not been worked out for aros or most other fishes, so we usually just access rate QUALITATIVELY---faster, slower, than normal.....however, if u 'feel' your aro is breathing faster, pls count how many breaths it takes in a minute.

the easiest way to access depth is to check how wide the MOUTH opens with each breath. usually, an aro only opens it's mouth ever so slightly, forming a narrow slit where it's teeth are just barely visible. again, you have to 'know' and have a 'feel' for your aro as to what is normal and what is not.

Slight increases in depth and rate may be difficult to detect, so OBSERVE CAREFULLY and report anything suspicious. you'll be surprised how often owners miss and fail to see that their fish has some difficulty breathing.
train youself, observe how breathing rate and depth changes the next time you feed your aro.

Another way of checking breathing depth is to watch the operculum/gill cover. As an aro opens its mouth to take in water, the operculum will swell outwards. As the aro closes its mouth, the swelling will further increase slightly and finally 'burst', as the opercular seal breaks. Water then pours out through the operculum/gill slits before the operculum straightens out/flattens.

Have a look at your aro and appreciate how the operculum changes in shape with each breath.
When an aro breaths harder, the bursting will be more explosive and violent than usual.

most of the other points on the checklist rely on CLOSER observation.


--Barbels. don't forget these structures. look at them closely, from tip to base. check the edges and all surfaces. perhaps the best guide is to compare both barbels with each other. they should be symmetrical. check for colour changes, swelling, broken bits, deviation, growths etc. DESCRIBE any abnormalities seen.


--Nostrils and head canals. most fishes have 2 nostrils on each side of their face. this means they have a total of 4 holes. on each side, water enters the one on the front, and exits from the one further back. again, check for any abnormalities, and compare between both sides. they should be symmetrical in size and shape.

the main relevance of nostrils is to avoid confusing them with head canals.
head canals are tiny pin-prick holes scattered all over the face of an aro( they are much smaller than nostrils and are difficult to see). they become more obvious as the fish grows, and are just an extension of the lateral line system. remember, these holes are much tinier and should also be symmetrical on both sides. they can be confused with various skin diseases and hole-in-the-head disease. if unsure, simply describe what u see.


--Mouth, jaws, teeth--it is rare to find oral and dental diseases in fish. occasionally, tumours can cause lumps and bumps within the mouth. trauma commonly cause lesions around the lips( upper and lower) and teeth. so check for any colour changes, swellings, asymmetry etc. lip/barbel lesions can be a good clue when u suspect the aro has had a recent unobserved traumatic
event. again, pls describe what u see.


--Eyes. a tricky organ to examine. firstly, look at both eyes as a whole. check mainly for dropeye(DE) and popeye. DE is usually unilateral( can be bilateral), occurs progressively over a period of time, and results in the eye being permanently fixed in a downward position( looking down constantly). if the DE only occurs in the dark when the aro is asleep, it
isn't technically DE, but just a normal happening in fishes.

popeye is more difficult to access, especially in mild and early cases. most aros will have a certain natural degree of popeye, where the eyeballs protrude out to a certain degree from the eye-socket. i stress again, this is natural in most aros, and will vary a wee bit between fishes( remember your telescopic goldfishes with their natural popeye). it is easy when the popeye is severe, and happens only on one side( so u can compare with the
other side and note the difference). however, popeye can often be bilateral.

the trick is to check the BOTTOM EDGE OF THE EYEBALL. they should be at the same level as the eye-socket. if they protrude out beyond the socket, then the eye is probably 'popped'. try not to look at the top edge of the eyeball, because it is always protruding beyond the socket, even in normal
aros.

once u have checked for these, we can then start screening the eye closely, from the outer layers to the deeper layers. the most superficial/outside layer is the cornea. this is a transparent structure that is in CONTACT WITH the water. check for any cloudiness, growths etc and describe any abnormalities. CHANGE YOUR VIEW! check from multiple views( top, side, oblique, bottom etc) to be sure that the lesion is located on the outside layer- cornea and not deeper within the eye.

check the pupil and the iris. the iris is the coloured ring that gives an aro's eyes its colour. it might b red, pink, greenish etc depending on the fish. the pupil is the black hole in the middle. it is actually a hole leading to the back of the eye. check the surface of the iris for any swellings, discolouration, growths etc. the pupils should be nice, big and round. they should have a smooth outline. Again, always compare both eyes for symmetry. DESCRIBE any abnormalities seen.

the lens is a common part of the eye to be affected. where is it? it is actually a tiny transparent ball which fits perfectly into the pupil! half of it sits inside the pupil( we cannot see this), the other half sits in front of the pupil. we can see this front half.

it is best appreciated when the eyes are seen at an angle from the side or the top or bottom( u can't see it straight-on from the front). you should be able to see a roundish curved transparent/jelly-like structure coming out of the pupil( like a ball
cut into half). the lens often becomes cloudy-cataracts, and this has to be distingushed from corneal cloudiness--commonly called cloudy eye. can u see your aro's lens? try other fish species. they should also be visible.

Finally, if u think about it, there is actually a space in front of the iris and behind the cornea. this is called the anterior chamber. it is usually filled with a watery fluid and appears transparent. sometimes, it might have blood, pus or even tiny air bubbles in it, so look closely.

[AroMedics]

--Gills. When you think of gills, u think of breathing, oxygen.....This organ is equivalent to our lungs, but also exhibits certain properties that are similar to our intestine, liver and kidney! It not only exchanges gases, but also absorbs drugs and toxins from the water,and excretes/flushes our
various toxins such as ammonia from the fish's body.

When an aro yawns or chews, you might be able to catch a quick glimpse of the gills. They should be bright to dark red in colour( blood red) smooth and shouldn't stick together. Pale gills, grey-bluish gills, or any other colour changes/blood spots, swellings, growths, or anything abnormal should be described. It is not easy to pick out gill abnormalities in a physical exam, unless the lesions are severe and obvious. Therefore, the fish is often breathing more rapidly and deeply by this stage. Some infectious diseases affect both gill and skin tissue( e.g ich), so keep a close eye on the skin too.


--Gill covers / operculum. The normal opercular function has been described above. The operculum is partly bony and partly cartilagenous. It is possible but rare for the operculum to be damaged traumatically during fights, knocks etc. The most common opercular defect in aros is gill curl, where the tips
of the operculum curls outwards during all phases of breathing i.e The curl is consistently present during the entire breathing cycle. The condition is not a diagnostic challenge, and in this case, a description is not necessary.

Because the operculum is covered by skin, various skin diseases can first present on the opercular surface. See the next section for more detail.


--Skin and scales. Firstly, almost the entire surface of a fish is covered by skin, including the face, jaws, operculum, belly, body and fins etc.
Therefore, skin changes can occur at any of these sites. Because we can easily see the skin, it is without doubt the most common organ with a problem. Anyone had an aro with a skin problem? raise their hands...most of us will have experienced this before, at some stage.

The next important thing to remember is that skin diseases are often fatal if left untreated in fish. This is different in mammals. How often do u hear of someone dying from a skin infection? Anyway, skin changes are common and are not only unsightly but pose a potential health risk to an aro. So, SCAN your fish from head to tail, and look for possible lesions.

The types of skin changes are too varied to describe at this stage. They will be covered in more detail later, but include colour changes, growths, swellings, black spots, cotton wool, white patches, excess mucus, white spots, gold dusting, ulcers, bubbles, haemorrhage/blood spots, loss scales etc. But the take home message is not to stop here......If your fish has
white spots, don't just say it. Say it, PLUS DESCRIBE IT. use the guidelines provided ( location, numbers, size, shape etc).


--All fins. The fins are actually covered by an epithelium similar to skin.
Clinically, they should be regarded as an extension of the skin. So make sure you check all the fins on both sides. Check the edges and all surfaces.
They should be smooth and regular. You should be familiar with the anatomical names of each fin. This will b illustrated in the photos.
Describe any abnormalities found( colour, growths, shape, texture etc).


--Lateral line. This consist of a row of holes spanning across both sides of the body of an aro. It starts at the top edge of the operculum, and dips down abruptly to run along the midline of the body, finishing at the caudal puduncle( base of the tail). The holes are fairly large and should be easily visible. Infections of the lateral line can occur but are exceedingly rare.
The lateral line is not clinically important in aros.


--Swellings/deformities on body or spine. These occur occasionally, and are blindingly obvious. They are usually due to spinal defects, but are occasionally due to tumours in deeper soft tissue. Remember to check the aro from the TOP during a physical exam. Get up, remove the tank cover, turn off glaring lights and surface agitation and observe. watch for asymmetry, or a
bent/kink of the spine that is persistent. DO NOT access for DE or popeye.
remember, the top margins of the eyeball protrudes outwards in normal aros.
you need to view from the side to check for DE/popeye.


--Anus/vent. The anus( the more appropriate term is vent) is situated just in front of the anal fin. It is the exit hole where poo and pee are produced. Blood spots are often found on the skin surrounding the anus, or along the belly. They are almost always associated with a nasty bacterial or viral( not confirmed in aros) infection that is often fatal.
Anal prolapse is a fairly common complaint in aros. In this poorly described condition, the mucosa/inner lining of the anus protrudes out as a tube-like structure from the anus. Some species of fish( e.g angel fishes) produce a tube-like
structure( ovipositor-tube) from their vent as part of normal breeding behaviour. This hasn't been reported in breeding aros.