still lost on quarantine protocol

Lasse · Apr 18, 2019

Nathan Milender said:
Evidence on disease manifestation. I treat disease for a living. I have treated a lot of it, just not in non-humans

Are you saying your a doctor and use prophylactic treatment on humans?

Sincerely Lasse

Nathan Milender · Apr 18, 2019

MnFish1 said:
i have read humble fish's article - and am also quite familiar with human disease and microbiology. I never considered you a nutcase lunatic. So please dont put words in my mouth... I would ask a rhetorical question - if you see people with no symptoms - how would you diagnose them with a disease (note I'mnot requesting an answer).

When you talk about screening in medicine - my understanding - on this you can correct me - is that the value of screening depends entirely on the population being screened. For example 20 years ago - it was thought that screening for lung cancer with a chest X-ray was 'valuable' because it found cancer. Then it was shown that that test was of little value in a general population. The problem with 'screening' is that there are false positives and false negatives. In the case we're talking about - screening frankly is a non- issue - unless you are doing gill biopsies?

It is common to treat without knowing exactly what it is going on. This is called empirical treatment. Most of the treatments you receive for common ailments are done this way. Even when cultures or tests are performed it is not unusual to start statistical based treatment before answers are had. There are also screens for disease that do not involve pathogens at all. Use of the screen is determined by weighing cost/risk vs benefit. The problem here is that there are no screens I am aware of for fish that do not damage or kill the fish. That is the argument for empirical treatment to eradicate the most common infections seen in this hobby.

Gill biopsies would provide useful information at the cost of causing serious harm to the animal. For this scenario the screen would have to be less invasive. The gill biopsy would more likely play the role of the gold standard used to develop trust in a new screening tool. False negatives and positives do happen. Whether or not that risk is too high or low is ultimately decided by an 'expert' panel in people. High risk disease will tolerate a lot erroneous results. High risk treatments will not tolerate a screen with high error. In this case we all get to decide for our own systems what that risk should be. It is a value judgement you have to make for yourself about what risks are too risky and what has value for how you think your system works.

In people, the argument is more nuanced because money and politics also come into play. I do not think those aspects are really what this forum is intended to discuss. For myself, I accept that there may be hidden pathogens I cannot identify. Those pathogens may or may not manifest disease on the animal I am looking at. Even if no disease is manifested, they could still cause major disease in other animals that contact that pathogen and never harm the original animal. I am comfortable with treating illness and I believe that cells and microbes have somewhat similar behaviors in aquatic systems compared to mammalian systems. Thus I QT as I outlined above. There is no non-anecdotal proof either way that I am aware of.

Nathan Milender · Apr 18, 2019

Lasse said:
Are you saying your a doctor and use prophylactic treatment on humans?

Sincerely Lasse

It is common. Vaccines are prophylactic and arguably the most successful treatments ever invented. Antibiotics for conjunctivitis, sinus infections, and many rashes are often not needed at all and done without proof of bacterial presence. Travel medicine is also full of treatments for malaria and travelers diarrhea which are initiated prior to even leaving.

Nathan Milender · Apr 18, 2019

Jekyl said:
However you wouldn't start treating for those diseases without something to make you believe they may exist right? Otherwise a healthy diet and exercise is the standard doctor recommendation. (Devils advocate lol) I love a good debate and I'm learning a ton from this article.

Good standard recommendations but yes, screening with no symptoms is exactly the point of screening. Sometimes a symptom will also make you perform a test to determine the presence of a disease. That is not exactly screening. The difference with an aquarium animal is that there is no screening tool that is not damaging. There needs to be pathological behavior which is a late sign, a lesion, or an immobile fish under magnification. The disease manifests or it does not. If the disease is caused by a pathogen, where did the pathogen come from in the closed system? Some say pathogens remain invisible to the naked eye and manifest when able to take advantage of sick fish. Pathogens definitely behave this way and there is merit to the thought that a healthy system will never have a problem.

Others consider the closed system and think even if the fish are ill, if there are no pathogens, there will not be widespread disease. This is the way I lean. Bacteria cannot be eliminated from a tank without killing it. Many of the catastrophic fish pathogens however are not bacteria and can be eliminated. Some feel better doing that. This thread was started concerning clown fish. These are susceptible to uronema. I have never treated it, but my understanding is that it is a protozoan. Once it is in a tank it cannot be eliminated by agents that do not kill coral as it does not need to have a fish to live on. That would be an example of something I would want to kill even though I cannot see it on a fish. To ensure that I do not introduce it to the tank I treat all fish coming into the tank with a low risk (unlikely to harm the fish) treatment so I have one less thing to worry about down the road.

MnFish1 · Apr 18, 2019

Nathan Milender said:
It is common. Vaccines are prophylactic and arguably the most successful treatments ever invented. Antibiotics for conjunctivitis, sinus infections, and many rashes are often not needed at all and done without proof of bacterial presence. Travel medicine is also full of treatments for malaria and travelers diarrhea which are initiated prior to even leaving.

Vaccines are prophylactic. Malaria treatments are indeed prophylactic. Cipro for Travellers diarrhea is prophylactic.

I might disagree with you about antibiotics for conjunctivitis, sinus issues and rashes - in that there are symptoms that are being treated. These are empiric treatments. The difference here is that recommending empiric copper treatment - which can cause significant illness - is different than prescribing cipro or chloroquine or a tetanus bvaccine

Nathan Milender · Apr 18, 2019

MnFish1 said:
Vaccines are prophylactic. Malaria treatments are indeed prophylactic. Cipro for Travellers diarrhea is prophylactic.

I might disagree with you about antibiotics for conjunctivitis, sinus issues and rashes - in that there are symptoms that are being treated. These are empiric treatments. The difference here is that recommending empiric copper treatment - which can cause significant illness - is different than prescribing cipro or chloroquine or a tetanus bvaccine

The symptomatic disease are a bit different, it is true. They are empiric when an antibiotic is used assuming there is bacteria when those are almost always viral and the antibiotic often offers only risk. Not an endorsement, just a recognition that it is common.

Copper is toxic. I believe it is specifically neurotoxic. It is dangerous because it has a narrow therapeutic index as well as a complex drug interaction profile which requires precision and caution. The increased risk of copper definitely cautions one to consider whether or not there is enough value in using it. This is the value judgement. Do you feel that the occult present of ectoparasites and the damage they can cause is worth the risk/cost of using copper? I generally do not which is why I use chloroquine unless there is a contraindication and then use copper instead.

For me, the risk/cost of chloroquine (especially since I can simultaneously run metro flakes and prazi) is less than the risk of introducing a pathogen I cannot later remove from my DT. It's easy and well tolerated. Getting a ich or velvet infested fish out of my DT before it is near death and slow is very difficult. The exponential release of parasite into that tank while I attempt to catch the fish over several days endangers all my fish. The idea of killing my coral to save the fish also seems like a bad idea. So I take what I believe to be a small risk of treating common disease in captive fish that have been mixed with thousands of other fish from around the world and treating them even though I see no disease in a low stress environment. I do this because I also believe that fish may have an organism on it that I cannot see without magnification and live fish are not compliant with microscopic exams. This is the rationale for this approach.

MnFish1 · Apr 18, 2019

Nathan Milender said:
It is common to treat without knowing exactly what it is going on. This is called empirical treatment. Most of the treatments you receive for common ailments are done this way. Even when cultures or tests are performed it is not unusual to start statistical based treatment before answers are had. There are also screens for disease that do not involve pathogens at all. Use of the screen is determined by weighing cost/risk vs benefit. The problem here is that there are no screens I am aware of for fish that do not damage or kill the fish. That is the argument for empirical treatment to eradicate the most common infections seen in this hobby.

Gill biopsies would provide useful information at the cost of causing serious harm to the animal. For this scenario the screen would have to be less invasive. The gill biopsy would more likely play the role of the gold standard used to develop trust in a new screening tool. False negatives and positives do happen. Whether or not that risk is too high or low is ultimately decided by an 'expert' panel in people. High risk disease will tolerate a lot erroneous results. High risk treatments will not tolerate a screen with high error. In this case we all get to decide for our own systems what that risk should be. It is a value judgement you have to make for yourself about what risks are too risky and what has value for how you think your system works.

In people, the argument is more nuanced because money and politics also come into play. I do not think those aspects are really what this forum is intended to discuss. For myself, I accept that there may be hidden pathogens I cannot identify. Those pathogens may or may not manifest disease on the animal I am looking at. Even if no disease is manifested, they could still cause major disease in other animals that contact that pathogen and never harm the original animal. I am comfortable with treating illness and I believe that cells and microbes have somewhat similar behaviors in aquatic systems compared to mammalian systems. Thus I QT as I outlined above. There is no non-anecdotal proof either way that I am aware of.

Actually - this was my question - what exactly do you recommend for QT 0n this forum - in fact I apologetically asked you in the first post - what do you recommend - because it was really unclear - no offense.

MnFish1 · Apr 18, 2019

Nathan Milender said:
The symptomatic disease are a bit different, it is true. They are empiric when an antibiotic is used assuming there is bacteria when those are almost always viral and the antibiotic often offers only risk. Not an endorsement, just a recognition that it is common.

Copper is toxic. I believe it is specifically neurotoxic. It is dangerous because it has a narrow therapeutic index as well as a complex drug interaction profile which requires precision and caution. The increased risk of copper definitely cautions one to consider whether or not there is enough value in using it. This is the value judgement. Do you feel that the occult present of ectoparasites and the damage they can cause is worth the risk/cost of using copper? I generally do not which is why I use chloroquine unless there is a contraindication and then use copper instead.

For me, the risk/cost of chloroquine (especially since I can simultaneously run metro flakes and prazi) is less than the risk of introducing a pathogen I cannot later remove from my DT. It's easy and well tolerated. Getting a ich or velvet infested fish out of my DT before it is near death and slow is very difficult. The exponential release of parasite into that tank while I attempt to catch the fish over several days endangers all my fish. The idea of killing my coral to save the fish also seems like a bad idea. So I take what I believe to be a small risk of treating common disease in captive fish that have been mixed with thousands of other fish from around the world and treating them even though I see no disease in a low stress environment. I do this because I also believe that fish may have an organism on it that I cannot see without magnification and live fish are not compliant with microscopic exams. This is the rationale for this approach.

Again - we have no real disagreement - I don't like copper - I favor chloroquine. I dont know why the protocols recommended here don't use it. I was just asking for your protocol....?

Nathan Milender · Apr 18, 2019

MnFish1 said:
Vaccines are prophylactic. Malaria treatments are indeed prophylactic. Cipro for Travellers diarrhea is prophylactic.

I might disagree with you about antibiotics for conjunctivitis, sinus issues and rashes - in that there are symptoms that are being treated. These are empiric treatments. The difference here is that recommending empiric copper treatment - which can cause significant illness - is different than prescribing cipro or chloroquine or a tetanus bvaccine

Also, do not discount the risk of those mentioned treatments. Vaccines have risks, they are just less than the horrible diseases they prevent. Check out the label change warning on Cipro from about three years ago concerning neurological symptoms and chloroquine can also do some weird things to people, it's just better than malaria. For fun look up the origin of the gin an tonic.

MnFish1 · Apr 18, 2019

MnFish1 said:
Again - we have no real disagreement - I don't like copper - I favor chloroquine. I dont know why the protocols recommended here don't use it. I was just asking for your protocol....?

And btw - most of the arguments against prophylactic treatment focus on the toxicity - I concur - chloroquine has much less toxicity.

MnFish1 · Apr 18, 2019

Nathan Milender said:
Also, do not discount the risk of those mentioned treatments. Vaccines have risks, they are just less than the horrible diseases they prevent. Check out the label change warning on Cipro from about three years ago concerning neurological symptoms and chloroquine can also do some weird things to people, it's just better than malaria. For fun look up the origin of the gin an tonic.

Well - to me the risk of cipro is much more related to tendon issues - as compared to neurologic issues.

Nathan Milender · Apr 18, 2019

MnFish1 said:
Again - we have no real disagreement - I don't like copper - I favor chloroquine. I dont know why the protocols recommended here don't use it. I was just asking for your protocol....?

I tend to run three weeks of chloroquine with a week of prazi at the end. Many say ten days is enough but since I want more than ten days of observation, the chloroqune does not seem to degrade, and it is well tolerated, I run at least three weeks. Copper, if used, needs three weeks. If three full weeks of cholorquine is done and I have some other problem I will remove the chloroquine and treat.

From what I read, the major barrier to chloroquine on these postings is availability. It is difficult to get a prescription. I did not use it until I was able secure a source of veterinary grade drug which did not require a prescription. I see no advantage to copper unless an animal cannot tolerate chloroquine.

MnFish1 · Apr 18, 2019

Nathan Milender said:
I tend to run three weeks of chloroquine with a week of prazi at the end. Many say ten days is enough but since I want more than ten days of observation, the chloroqune does not seem to degrade, and it is well tolerated, I run at least three weeks. Copper, if used, needs three weeks. If three full weeks of cholorquine is done and I have some other problem I will remove the chloroquine and treat.

From what I read, the major barrier to chloroquine on these postings is availability. It is difficult to get a prescription. I did not use it until I was able secure a source of veterinary grade drug which did not require a prescription. I see no advantage to copper unless an animal cannot tolerate chloroquine.

Thanks.....

Nathan Milender · Apr 18, 2019

MnFish1 said:
Well - to me the risk of cipro is much more related to tendon issues - as compared to neurologic issues.

I have never seen cipro cause a tendon rupture in spite of all the hype (I have read some case studies). I have seen neurological changes (reversible) that I believe were caused by it.

MnFish1 · Apr 18, 2019

Nathan Milender said:
I have never seen cipro cause a tendon rupture in spite of all the hype (I have read some case studies). I have seen neurological changes (reversible) that I believe were caused by it.

I have.

Mortie31 · Apr 18, 2019

Nathan Milender said:
It is common to treat without knowing exactly what it is going on. This is called empirical treatment. Most of the treatments you receive for common ailments are done this way. Even when cultures or tests are performed it is not unusual to start statistical based treatment before answers are had. There are also screens for disease that do not involve pathogens at all. Use of the screen is determined by weighing cost/risk vs benefit. The problem here is that there are no screens I am aware of for fish that do not damage or kill the fish. That is the argument for empirical treatment to eradicate the most common infections seen in this hobby.

Gill biopsies would provide useful information at the cost of causing serious harm to the animal. For this scenario the screen would have to be less invasive. The gill biopsy would more likely play the role of the gold standard used to develop trust in a new screening tool. False negatives and positives do happen. Whether or not that risk is too high or low is ultimately decided by an 'expert' panel in people. High risk disease will tolerate a lot erroneous results. High risk treatments will not tolerate a screen with high error. In this case we all get to decide for our own systems what that risk should be. It is a value judgement you have to make for yourself about what risks are too risky and what has value for how you think your system works.

In people, the argument is more nuanced because money and politics also come into play. I do not think those aspects are really what this forum is intended to discuss. For myself, I accept that there may be hidden pathogens I cannot identify. Those pathogens may or may not manifest disease on the animal I am looking at. Even if no disease is manifested, they could still cause major disease in other animals that contact that pathogen and never harm the original animal. I am comfortable with treating illness and I believe that cells and microbes have somewhat similar behaviors in aquatic systems compared to mammalian systems. Thus I QT as I outlined above. There is no non-anecdotal proof either way that I am aware of.

Yes but treating undiagnosed illness/ disease in humans is based on hundreds of peers, scrutinising best practice and evidence sources and a consensus is built from that combined bank of experience.. and they still get it wrong... there is no such bank of experts or peer scrutiny pertaining to CI in this hobby, so to imply some empirical link is tenuous and going out on a limb at best...

Lasse · Apr 19, 2019

Nathan Milender said:
It is common. Vaccines are prophylactic and arguably the most successful treatments ever invented. Antibiotics for conjunctivitis, sinus infections, and many rashes are often not needed at all and done without proof of bacterial presence. Travel medicine is also full of treatments for malaria and travelers diarrhea which are initiated prior to even leaving.

Vaccine have not been discussed here because it is of another level than the chemical medicines. Vaccine is built on your (or the organisms) own immune system - it does not kill pathogens - it strengthens your immune system and make you produce specific antibodies. Vaccine is the way to go – but there is few – if any - vaccines for aquarium fishes. However – you can vaccine your newcomer in a natural way if you in the last part of an observing QT slowly change water in the QT with water from you DT. IMO – it is as common with your fishes infect newcomers as newcomers infect your fish.

As I say – I do not se vaccination as prophylactic treatment in the way that chemical prophylactic treatment is and I´m not against that if there will be vaccines for fish diseases. During time before that – I will use the best alternative way – natural vaccination

Prophylactic treatment (other than vaccination) before a travel is discussed in many countries in the scale of risk – benefits. Here in Sweden – only chemical prophylactic treatment of malaria is common, and it is very regulated and based on an infection rate of P. falciparum caused malaria greater than 1/10,000 visits to the current destination. This for people born in Sweden (we have not have any own malaria cases since 1930) People born in infected areas that have lived in Sweden for many years and have lost their immunity are often recommended medical prophylactic treatment if they travel back to their home countries because new investigations have shown that these people have a higher risk for new infections. (by the way – @Paul B should be glad to see this – because it strengthens his theory that fishes need to be faced with their parasites in order to continue to be immune).

Use of antibiotics as prophylactic will cause us a disaster – leaving us with no defence against lethal bacteria infections and it is banned in some countries – Sweden is among them. Is as bad as using chemical prophylactic treatment for our fishes. This include narrow banded antibiotics like Metronidazole – by the way – this drug was not used as an antibacterial drug from the beginning – it was developed as antiparasitic which has since gained broad use as an antibacterial agent for some anaerobic gut bacteria. Its antibacterial characteristics was discovered by accident in 1962 and from around 1970 it have been used against both gram negative and gram positive anaerobe gut bacteria. And I personally know its importance in volvulus surgery – not as a doctor but lying on the other side of the knife – 3 times! I was also among these people that was first to test out Metronidazole as an effective cure against the flagellate caused type of African bloat. Back in late 1970 – around 99 % of al Tropheus species (and other algae eaters from the great lakes of eastern Africa) die in a mystic disease when they arrived at Sweden. 1977 we had an effective cure against this – based on Flagyl. Because of the easy way to use this treatment – no one try to figure out the real reason for the infections and as usual – it was not before resistant flagellates occur that someone solve the basic problem – the food we give the fish. These fishes was mainly vegetarians and at least with Tropheus, Tanganyika clowns and similar species a strict vegetarian diet was the solution.

My basic attitude is that you should not use any treatment without indication of disease. The long-term risk is to high IMO. There is to major concerns with using complex medication of fat-soluble chemicals just because of. The breakdown pattern in the MFO system and combination of drugs - here is one example

Ecotoxicological concern is interesting too - This article – Ecotoxicological evaluation of the antimalarial drug chloroquine – is enough for me to not use it as a prophylactic method for aquarium fishes. With indications – yes – I would probably use it. This part of the article may say something

To conclude, following the EU guideline for classification, packaging and labelling of dangerous substances (Commission Directive, 2001), CQ should be classified, according to our obtained results, as “R52/53 Harmful to aquatic organisms and may cause long-term adverse effects in the aquatic environment”.