View Full Version : Fish still flashing after TTM

09/05/2017, 02:45 AM
I recently did 2 lots of TTM due to ich on my fish and they are now in QT while the DT remains fallow for 90 days. After a week or so in QT I can see a few of them flashing their gills on rare occasions. I am hoping the TTM has cured the ich they had and I can't see any white spots although I know that is not 100% since ich can go unnoticed in gills. Again, hopefully that is not the case since I just finished TTM. Given that I have just finished TTM and all visible spots are gone is it safe to assume they have flukes and need treated for that? I was dosing the QT with paraguard for the last couple of days, could that be irritating their gills? Just not sure what to do next so advice from more experienced folks would be welcome.

09/05/2017, 02:58 AM
I would assume flukes, definitely treat with prazi. You could have treated with prazi while doing ttm.

09/05/2017, 04:53 AM
Ok good.
I have some veterinarian praziquantel based stuff (in UK no prazi) called Vetark that is supposed to be good. Any guidance how long I need to discontinue paraguard before I can start the fluke treatment? It says not to use with other treatments but how long will it hang around in the tank before I can start something else?.

09/05/2017, 06:35 AM
Ok good.
(in UK no prazi)

Sera Tremazole or Discus Fluke solve. Both available from AAC in Essex.


09/05/2017, 09:06 AM
I don't know a lot about Paraguard so maybe do a good water change and it should be good.

09/05/2017, 09:09 AM
Discus Fluke solve.

Thanks, that's the one I have so happy days:fun4:

09/05/2017, 09:11 AM
a good water change

Would a 50% change and add carbon for a week be considered good enough?

09/05/2017, 01:11 PM
I don't know if you have to go all that distance but I'm sure that would clear out the paraguard. You could always ask on the searches website too.

Louis Z
09/05/2017, 08:47 PM
What about a clan freshwater or formalin dip . Freshwater dip does remove skin flukes

09/06/2017, 04:45 AM
A FW dip will remove some of the flukes but not all. It would be a great way to confirm if he has flukes. Since the fish were never treated for flukes and they're flashing, a fluke treatment should be done.

I don't know if formalin is sold in the UK.

09/06/2017, 08:28 AM
I have veterinarian fluke treatment so I think I will use it and see where I am. I was interested to see if folks agreed that it was likely flukes before doing another treatment and that seems to be the case.

09/08/2017, 04:24 AM
Put fluke treatment in the tank last night. Maybe I am being optimistic but it seemed like the fish calmed down a fair bit within an hour. Would/could this stuff work that fast... wow!

How long do I need to leave before a follow up treatment to catch any hatched eggs missed by this first go?

09/08/2017, 11:28 AM
Follow up treatment in 5-7 days, do not go before 5 or longer than 7 or you'll have to start over.

Praziquantel will kill most of the flukes in a matter of hours, but letting it run for at least 48 hours is recommended. After that, you can do a water change if needed. Definitely do one before the second dose.

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09/08/2017, 01:55 PM
Yes, I think what you're seeing was actually the prazi working. Happy to hear good news.

09/09/2017, 12:19 PM
Paraguard is inactive after 24 hrs. WC will speed this up. Also keep in mind that ttm does nothing for velvet or Brooklynella so keep those fish in qt for an additional 2-3 weeks to make sure it was ick. Prazipro works in 24 hrs however as theshocker mentioned 5-7 days is best then do a 25 % WC and redose for another 5-7 days. When paraguard is dosed at 5 mls per 10 gallons I e never seen it cause irritation however I have seen it cause irritation when used as a bath 3 mls per gallon

09/11/2017, 08:42 AM
I used Paraguard in 5mls per 10 gallons so was probably not the cause of irritation.

I spoke too soon though. My Exquisite Wrasse is still pretty erratic and flashing. Second dose of Prazi on Wednesday might do the trick. Fingers crossed.

09/11/2017, 08:54 AM
What's your water peramiters? Also what dose are you using of praziquantel? This can be a source of irritation also Api general cure is a good choice for sensetive fish it is a lower dosage of praziquantel but still thereputic it also contains metronidazole. Metronidazole is good for anerobic bacteria and Protozoa like ick. One more ? Ttm how did you perform it?

09/11/2017, 09:59 AM
Metro will not treat ich, it is an antibiotic. It does however work with brooklynella and uronema.

Some flukes are prazi resistant so after your second dose, if it doesn't clear things up, then perform a third. Let's wait and see what the second dose does first.

09/11/2017, 10:08 AM

MetroPlex™ is an effective and safe treatment for several protozoan and anaerobic bacterial diseases of fish (Cryptocaryon, Hexamita, Ichthyophthirius). It does not adversely affect the filter bed and is easily removed with carbon. It can either be dosed into the water or combined with Focus™ in a medicated food mix. It will treat both internal and external infections regardless of the delivery method. When used in a medicated food mix, it is excellent for treating parasites in tanks that contain invertebrates. MetroPlex is gentle and there little danger of overdosing.

Types of Infections Treated

Parasitic Fungal Bacterial Viral

Dosing in Water

Remove all invertebrates - these are extremely sensitive to medication. Turn off UV filters, ozone filters, and remove chemical filtration like MatrixCarbon™ and Purigen™. Use 1-2 measures (included) per every 40 L (10 US gallons). Repeat this dose every 48 hours for up to 3 weeks or until symptoms disappear.

Dosing in Food

Feed the medicated food mix (recipe below) every day until the infection clears or up to 3 weeks. This medicated food can be refrigerated or frozen between feedings.

1 scoop MetroPlex
1 scoop Focus™
1 tbsp food (preferably pellets or frozen food)
A few drops of water if using a dry food
To enhance palatability use with GarlicGuard™ or Entice™.

After Treating

When the treatment period is over, MetroPlex™ can easily be removed using activated filter carbon like MatrixCarbon™. It does not linger in the substrate or filter media of the tank.

Active ingredients: metronidazole (70%)Inactive ingredients: excipients (30%)


5 g, 100 g

Common Fish Diseases Treatable with MetroPlex

Ich (White Spot)
Ichthyophthirius (freshwater) / Cryptocaryon (saltwater)
Looks like salt sprinkled on the fish’s body and fins. Usually accompanied by twitching, flashing, and other signs of stress and irritation. Several parasites are grouped under this name, but the symptoms are almost identical. Ich is among the most common infections of fish, and is entirely treatable with diligence and attention to water quality.
Suggested Treatment Period:
14-28 days
Special Considerations
It is very important with this parasite to continue dosing for the full treatment period. A break in the medication allows the parasite to multiply and reinfect the fish.
Hole in the Head / Head and Lateral Line Erosion
They’re not always on the fish!

Ich, velvet, and many other parasites spend a large portion of their life cycle as a cyst that is immune to medication and hiding in the substrate of your tank. Remember that you need to finish the full treatment even if you can’t see parasites on the fish any more!

09/11/2017, 10:10 AM
Now this is not my first choice for ick or velvet however metroplex will treat Protozoa

09/11/2017, 10:21 AM
It does not treat ich!

There are only a few options with ich:

Hypo(not the greatest IMO)
TTM(also do not like because a tomont can live in fish gills)

As seachems website states, it treats everything. It's funny that it doesn't state that it treats brook and uronema. I will consider metro to fall in with all the reef safe remedies to treat ich. It states that it is excellent for treating parasites for tanks with inverts. If that was the case Jdub, metro would be the first reef safe cure all. It simply does not treat ich nor velvet!

09/11/2017, 10:32 AM
Metroplex has not been proven to treat ich (at least not by anyone I trust personally) It does have some anti-parasitic properties, but there are no current accounts of anyone actually "curing" their fish of crypto using metroplex alone. It may help as an "ich management" tool, in providing temporary relief until a fishes immune system can take over.

Copper or CP are the only tested and true medication options if your goal is eradication vs. management.

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09/11/2017, 10:50 AM
I can say that I've gotten crypto while feeding all of my fish metroplex for intestinal worms so in my own experience it's great for worms...not so much for ich.

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09/11/2017, 12:26 PM
It does not treat ich!

There are only a few options with ich:

Hypo(not the greatest IMO)
TTM(also do not like because a tomont can live in fish gills)

As seachems website states, it treats everything. It's funny that it doesn't state that it treats brook and uronema. I will consider metro to fall in with all the reef safe remedies to treat ich. It states that it is excellent for treating parasites for tanks with inverts. If that was the case Jdub, metro would be the first reef safe cure all. It simply does not treat ich nor velvet!
Hmmm very valid point for reef safe treatment I stand corrected on ick however my reason for suggesting general cure is more on the lines of 1- he has obtained an praziquantel from a vet ( it sounds like ) and we don't know what the concentration or the dose he's using. Wrasses are on the sensetive side for meds so general cure is a powder form less mgs yet still thereputic and with the addition of metronidazole if his ttm was done correctly then we could be dealing with brooklynella or velvet or flukes general cure will cover two of the three listed. It's very possible the wrasse is being exposed to a higher than thereputic dose of proziquental also. Keep in mind unless your getting a rx from a fish specialist your getting a general dosing instructions.
The statement I made on metroplex was general I didn't mean to imply his fish still have ick but his procedure for ttm needs to be stated and water perimeters need to be stated also because we are assuming the tank is 0ammonia because he mentioned ttm

09/11/2017, 01:17 PM
I agree with your recommendation, I just didn't want people to read this and assume you could treat ich with metro.

I don't know what options the OP has, he is in the U.K., which is why he had the Rx based prazi. I have used general cure before on an overly sensitive flame wrasse and agree that it works well in some situations.

As of now, I would still wait to see what the second dose of prazi does. I don't see it as a reaction because the initial dose seemed to help a lot. I believe this to be the second batch of eggs that have now hatched.

09/12/2017, 04:55 AM
Thanks folks for the discussion and ideas. I was trying Paraguard as a general cure but it wasn't helping after TTM I still had a little flashing. I agree there is a risk I could have a tomont come through TTM in a gill however the fish are QTing for another 8 weeks so I will see if ick returns. I did have a couple of fish that were badly infected with loads of white spots (the wrasse was one of them) and they came out of TTM looking clean and eating well so I assumed the ick was cured (although can't be 100% at this point). Maybe it has just been knocked back but still lingered in a gill or two. I will see if that's the case. I think I need to complete the fluke treatment now. I am just not keen on another general cure because I see no symptoms on any of the fish of any disease or parasite only occasional flash from the gramma and wrasse with the likley cause being untreated fulkes or worms.
My TTM was done following closely the directions given on this site - 2 sets of everything, no cross contamination, 4 transfers with 72 hour hold in between for 13 days. Worst affected fish was my blenny and he has no spots and no flashing anymore.
The prazi that I have is Dicus Fluke Solve because that is the only way I can get prazi based meds in the UK. Here are the details:
Fluke-Solve for killing tapeworm & flukes
Ornamental fish such as discus can harbour a variety of parasites, and often they remain undiscovered until they have been introduced into a new aquarium. This can be a particular problem with fish which have originated from the wild.

Flukes belong to the group of parasites known as Monogean trematodes. The commonest affecting pet fish are the Dactylogyrus species and Gyrodactylus species.

These parasites, called cestodes or tapeworms, are internal parasites which affect a wide variety of fish species including carp as well as aquarium fish such as discus.

For aquarium tanks, again it may be tricky to have a complete clean out of the system, so annual treatment with Fluke-Solve Aquarium will ensure that the fish remain free of these parasites

Stress can also be a major threat to these fish because of the complete change in their habitat and lifestyle, and so any parasite treatment must be efficient and safe - frequent treatments will not only stress these fish further, but can also pose a risk of the very parasites you are trying to treat developing resistance to some treatments.
Fluke-Solve™ is a specially designed fluke treatment for Discus and other aquarium fish. It contains 50% pure praziquantel in a unique solublising presentation.

Comes in a handy 10 grams sachet to treat 2500 litres (550 gallons)
Easy to use - dissolves quickly without boiling or solvents
Effective - one dose kills adult flukes and larvae
Simple double dosing regime takes care of fluke eggs as well
Measuring scoop for small tanks

These products are all licensed veterinary medicines under the SAES Scheme.

I rang Vetark to ensure this was ok for Marine and they said it was. I have been advised by other UK reef folk that this is good for marine (not inverts) as well.

I am going to do a second dose tomorrow after a water change and see where I am then. I don't think another general cure will improve my decision making at this point. It does mention a second dose required for hatched eggs and the fact my wrasse "calmed" down for a while before starting to flash again has me fairly convinced some eggs were left and hatched after the first treatment.

Good point about ammonia level in my water. To be honest I haven't checked it and will do but wouldn't I be seeing all 7 fish showing signs if that was a problem?

09/12/2017, 09:28 AM
+1 on your treatment I would dose the second time as you mentioned. Some fish are more sensetive wrasses being one of them so it's more common to see them react to lower levels of ammonia or a medication. If the wrasse continues to flash after treatment I would do a WC and observe see if the praziquantel is causing the irritation, like wise the paraguard might have irritated him also

09/12/2017, 09:47 AM
If there was an ammonia spike, not all fish will necessarily show signs of ammonia burns. Also the gills are usually pretty red if that was the case.

09/12/2017, 09:53 AM
I've used that same Prazi medication a few times now and haven't had any problems.

It would not surprise me if the Paraguard had irritated the gills of the fish. I used it on some chromis the other week and it made them act 'stunned'; flashing on things and darting around as if the lights in the room had just been switched on. They lost their appetite for a few days after treatment also.

09/14/2017, 03:14 AM
Ok so I did the second prazi treatment yesterday evening. I watched the fish more closely for a longer period after treating this time. It seems like the prazi is causing a bit of irritation because after about 30 mins or so a few of the fish, especially the wrasse I have been mentioning, were swimming in sharp motions and flashing once or twice. All are still feeding well which is a good sign. I will leave the prazi in the tank until the weekend then do a water change and put in some carbon to remove it. Then I am not going to do anything else only observe the fish for at least a week. By that time any irritation should be gone and with the second treatment the flukes and worms should be gone too. I expect zero flashing or sharp swimming at the end of the week. Does this sound reasonable?

09/21/2017, 06:31 AM
Following second prazi treatment and a few days now to have a water change done and settled unfortunately I am still seeing some flashing. I have seen the gramma flash twice in about 4 hours of observing and the firefish flashed once in the same timeframe. Still no signs of ich returning thankfully. Is this normal? What next? Advice appreciated.

09/21/2017, 12:42 PM
Some flukes are resistant to prazi and require a third dose. I think I mentioned this to you in a prior post. How long has it been since your last dose?

09/21/2017, 04:15 PM
I would continue treatment for 5-7 days it's possible a third dose might be needed. Are you only seeing flashing, respiration is normal? Prazi don't kill flukes it causes them to spasm and fall of the fish then they die cus no host. But these flukes cause small wounds to the fish and as they spasm it can cause irritation also as the wounds heal they itch just like a wound on us. Generally they will scratch on stuff but flashing can also occur. Have you tested the water for ammonia yet? Nitrite unless it's over 2ppm I wouldn't worry to much and nitrate would also have to be high to cause irritation

09/21/2017, 05:31 PM
Have you done a fw dip? That would confirm whether or not flukes are still the issue.

As mentioned above, sometimes when fish are healing they will continue to flash because they are simply itchy from all the bites. Think fleas on a dog.

If you do a freshwater dip and find flukes, you may have to switch gears and try formalin baths or hypo-salinity. If you don't find flukes and the flashing persists...you might actually be dealing with something else or the ich is not actually gone :/

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09/21/2017, 07:31 PM
He is from the U.K. No formalin there unfortunately.

09/21/2017, 08:29 PM
No formalin in uk at all? Kordon's Rid ick contained formalin, or fomalin ms and paraguard contains aldehyde not formaldehyde but I believe gluderaldahyd. Which he has tried already

09/23/2017, 09:26 AM
Ammonia and Nitrite are both 0. It's been 8 days since last prazi treatment. All fish are eating and behaving ok except for the flashing/scratching/flicking off things. Still no signs of any white spots thankfully. The 7 fish are a bit cramped so I expect they are all a bit stressed. My discus fluke solve is prazi based and says 50% prazi on it. If I start a second course treating every 6 days at double dosage do you think that would be good?

09/23/2017, 10:01 AM
Do not double dose prazi if your product reccomends a double dose it is probably for a bath for 30 minutes or so that is the only way you can safely double dose. I can't remember all your details in your post however treat with prazi 5-7 days do a WC then re dose 5-7 days you can do a 3 dose of you think it's needed. Fish can continue to scratch after flukes because the sores left behind are healing you could try a Acriflavine bath to help with healing it can be found in Acriflavine ms or ruby reef rally to name a few

09/23/2017, 10:53 AM
I got my formalin from eBay. Maybe see if they are willing to ship to U.K.? You never know.

09/23/2017, 04:13 PM
I'm pretty sure it's a federal ban on formaldehyde in the UK except in professional situations.

09/24/2017, 06:21 AM
When dosing praziquantel I put in the dose per volume as directed. Then do I repeat that every day for 5 days or do I leave the single dose in the tank for 5 days then WC and redose? Just want to make sure I'm doing it right. Also need advice with Paraguard treatment. Should I be dosing everyday or does treat for a week mean a single dose then leave it in there for 7 days? I think I'm confusing myself...

09/24/2017, 10:36 AM
Prazi is dosed once (on day 1) then a WC 5-7 days later then repeated for another round. Paraguard is dose every day I would recommend treatment for 30 days

09/24/2017, 01:55 PM
I can't remember, have you FW dipped your fish, maybe after your last treatment.

09/26/2017, 05:47 AM
I haven't done freshwater dip because last time I completely stressed out my clownfish. Not keen to do it unless completely unavoidable.
Good to know about the Paraguard treatment. Last time (when I thought it didn't work) I had only used it for a few days then gave up! Trying it again and if no joy will redo prazi. My DT is fallow for another 6 weeks so I have time to try both again like this.
My blenny is scratching his belly rather than his gills but I don't know if that is a red herring for diagnosing why they are still scratching. Any thoughts on that or is 30 days Paraguard then 3 treatments with prazi sensible enough at this point? All still eating well and no white spots.

09/26/2017, 10:08 AM
Here's the thing without a freshwater dip to confirm flukes we don't know if we're treating it's only a guess. Freshwater dip is much more stressful on the pet owner than the fish as long as it's done correctly. This is how I do it, I use ro/Di water I float my dip container in my qt to bring up to temp during this time I use an air stone in the container to aerate, I donot worry about ph once to temp add the fish for 5 min done! The fish should breath rapidly during treatment it may sink on its side, play dead ect but it will be fine. Then check the container very closely for white opaque flukes if there is no flukes then we can suggest a more appropriate treatment. Good luck

09/26/2017, 01:16 PM
The dip is necessary to confirm if you still have them. They could possibly just still be irritated from the bite marks, hence the flashing.

10/02/2017, 10:07 AM
I have been treating with Paraguard now for 7 days. Still some flashing. The Gramma has some "cloudy" patches on his scales but I have been reading a lot and it is unlikely to be Brook or Uronema because he has always had this I just assumed it was symptom of the ich. Surely Brook would have killed him and Uronema would have gone to red sores. I am now getting some Sterazin and Formalin to treat once I quit on the Paraguard again. I am getting frustrated by this and hope it is not something sinister that is lingering in the background waiting to bite my stock. I have read some parasites can cause flicking/flashing but do no harm... sigh...

By the way I find it equally frustrating that although this site is brilliant and provides a lot of help, it seems disease treatment threads just stop! No updates and no follow up.

10/02/2017, 10:28 AM
What we do on our end is try and help people like you from our experiences and readings. We can only offer advice to the best of our knowledge. As much as I would like for people to get back and update their threads, to let others know if the treatment we offered helped, we can't make them.

I look at things as no news is good news. If there were still problems (like in your case) they would come back asking for more help.

I honestly would ditch the Paraguard because it has obviously not worked, and I see a lot of other people having no luck as well. You need to FW dip to confirm flukes or not, this will give us the confirmation we need to give further advice.

Freshwater dips are stressful, but not as much as you would think. I've done plenty, in my experience the only fish adversely effected were already on their way out.

10/02/2017, 11:04 AM
I can't remember all the details on your post and we're getting up
To 50 responses which is a lot of reading so I'm going to make another suggestion on treatment. At some point you need to reasses your treatment and at this point here's what I would do. "Do a fresh water dip" if there is no flukes I would stop all meds and give that poor fish a break while he's recouping do all the water tests amonnia nitrite and nitrate if any of these are out of whack correct these. Do a WC and observe the fish to see if the symptoms worsen. This could be the fish are getting agitated with all the meds.

10/02/2017, 02:20 PM
I would agree with the last two comments about paraguard and since it is not helping I would discontinue using it and let the fish be with no meds and observe for about a week and see how it does. then you can do a fresh water dip and see if anything falls off. But honestly I think maybe certain flukes dont really come off with fw dip or are so small that they are hard to see if/when they fall off. I think I read somewhere that certain gill flukes are resistant to fw dip but not sure.
If still not resolved do a formalin (37%) bath for about 40-50 min max and place fish in a brand new sterile tank. then I would treat with two rounds of general cure 7 days apart and then final formalin bath 7 days latter.
I know you did prazipro but you might get better results with general cure since its in a powder form. Pour it in a cup with some tank water, mix it for a few minutes and add it slowly to the qt.
also some times the scratching could be due to environment factors like if someone using cleaning supplies in the same room and some vapor of it maybe getting into the tank or anything else that can irritate the fish and their gills kinda like when we have allergies and get itchy runny nose.

10/04/2017, 04:27 AM
Ok thanks.
I will stop Paraguard again although I was told to use it for 30 days... I don't know anymore. I will do a 50% WC and leave things for a week or so. I have Formalin and Sterazin on their way to me. If after the week flicking persists I will fresh water dip to check again for flukes. If none I will do Formalin (I hope I can treat the QT tank not just a dip) treatment. I don't have another sterile tank so I will treat the QT with Formalin. I guess it will kill the filter too though, what a pain.
Maybe I am being over sensitive about the flicking. As suggested here it could be something that further medication won't fix. If occasional flicking is the only symptom and the fish are eating well can they go back in the DT at the end of its fallow period?

10/04/2017, 02:24 PM
Can you post a video of it?

10/05/2017, 08:03 AM
I would not treat with formalin in the QT, it's better as a bath/dip. One, it's a carcinogen so ideally you'd want to limit exposure as much as possible. Two, it will muck up your water quality pretty quickly.

If you do a freshwater dip and find that prazi-resistant flukes are to blame...you could go the route of hypo-salinity vs. formalin. All you need is 5 days at .009 to kill them, and a new sterile QT wouldn't be necessary.

Just make sure the drop and rise is gradual to prevent osmotic shock, especially the rise.

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10/23/2017, 06:45 AM
I have just completed 12 days of Sterazin treatment with a few water changes in between and I think it has sorted the problem. I am going to continue treating for another week or so to be sure. Fingers crossed.

10/23/2017, 01:12 PM
Good news! I’m assuming this is a product from the UK as I’ve never heard of it here in the states. Hopefully this works, you’ve been dealing with this for a bit now.

10/25/2017, 10:54 AM
Thanks, yes it has been a while. I think I am paranoid about seeing flicking out of the corner of my eye. I suppose because it has been a while. Sterazin is a liquid gill and fluke treatment by Waterlife here in the UK.