Taking care of sick Koi
Pond guys and Koi dealers typically have no experience in treating Koi that have attained pet status. First, they do not hold any fish for long enough to experience problems. Second, for economic reasons, they use Euthanasia as first defense for cheap and small Koi and a combination of Potassium Permanganate and 3% salt bath if significant number of Koi are sick. If the sick fish is very large and expensive, they might inject Baytril or Amikacin.

Most people who resort on salt as a cure-all, do not remember that kidney is NOT an isolated organ in Koi body. Koi kidney works in conjunction with their heart and respiratory system to maintain the electrolytic balance between the body and the water outside so that the fish doesn't explode or implode. The job of Kidney and respiratory system is to maintain a balance of all positive ions (calcium, potassium, magnesium, sodium etc) and negative ions (chloride, bicarbonate, phosphate etc) between the body and water. if you increase any one of these ions in water, you are making kidney and respiratory system rework the homeostasis. For example, if bicarbonate increases in blood, fish will have to breathe hard so it can expel as much carbon dioxide (bicarbonate is an ionic form of carbon dioxide gas). When sodium is excreted, it carries some water with it and fish can get dehydrated. Electrolytic balance is extremely complicated and it is best not to mess with it. Salt also is a stress factor and thus produces adrenalin in fish which in turn raises blood glucose (reducing their appetite) and blood pressure. Research has shown that long term exposure to salt made fish stunted. Salt does have use. Like all other medications, it must be used sparingly.

All chemicals are bad for Koi and will have side effects. In a healthy body, Liver and kidney work hard to detoxify the irritants, chemicals, medications and excrete the end products. And the process of detoxification and excretion uses a lot of energy. So, more chemicals you feed or expose the Koi to, more prone your fish are to kidney and liver failure. Similarly, more energy they use for the detoxification process less energy they have for growth.

Do not rush to feed them antibiotics as soon as you see a raised scale. Avoid harsh products like potassium permanganate paste or salt dips. Remember that Koi live in water. If they have a wound, and you pack it with potassium permanganate, you are destroying the mucus present on the wound and the surrounding area on their skin. As soon as you release the Koi into water after your “treatment”, all of that area is an open invitation for parasites, fungus and bacteria. If you really want to help Koi, you may apply neomycin ointment and spray liquid bandage over it. But even to do this, first treat for parasites and wait for a week. Most raised scales heal in a week of two. If the situation doesn't get worse, leave the fish alone.

If koi are in water between 70*F - 78*F, they fight most problems. When they fight against a strain of bacteria or fluke and recover, they will have natural immunity against that parasite because their immune system learns the weakness of that enemy. So, give them a chance to fight but keep a watch on them.

What should you have in your Koi Medicine Chest?
Anti-Protozoan Parasites
1. Malachite Green
2. Proform C or Terminate: To treat parasites (ciliates and protozoa)
3. Supaverm or Praziquantel: Flukes
4. Metronidazole: Internal hexamita, worms
5. Quinine Sulfate or Chloroquin: resistant Ich, Hexamita, Oodinium
6. Methylene Blue: Bacteriocidal, anti-protozoan powder
7. Acriflavine: Bacteriocidal, anti-protozoan powder
8. BiFuran: Antibacterial, anti-protozoan powder
9. Sulpha TMP 4: Bacteriocidal powder
Antibiotic powders
10. Kanamycin
11. Doxycyclin
12. Erythromycin
13. Tricide-Neo: Bacteriocidal powder for dips
14. Solar salt: water softner with no additives (available at Home Depot and Lowes) for mucus removal
15. Neomycin ointment
16. Denture Powder
17. Liquid Bandage
18. Hydrogen Peroxide
Medicated Food
19. Medikoi: medicated food
20. DeBride Anti-parasitic Food

If you are a beginner, it is best to grow your Koi in an Intex pool until you become familiar with their ailments, Keeping their water clean is easy, If they get sick, it is easily noticeable and you get a close-up view without lifting them out of water. Treatments cost less. Initially, you may need a microscope to diagnose flukes and parasites because Koi defense is only mucus. So, they produce a ton of mucus and rub/flash in response to bad water quality, parasites, flukes and bacterial infections. If your Koi develop a thick mucus coat, it can be any one of these. But once you get to know your koi, you will be able to guess the cause of their illness from their behavior and symptoms. Not all koi behave alike. Some may flash, others may rub, some may do nothing when they have parasites.

The first step to any treatment should be testing water for Ammonia, pH changes (early morning vs noon), alkalinity, Nitrite and Nitrate. Second step should be making a 25% water change to reduce contaminants and algae. Third step should be chemical treatments. If Koi have a lot of parasites, you must feed antibiotics for 3 days before you begin parasite treatments and then continue antibiotics for 7-10 days.

Even if you diagnose parasites, you are most likely to treat them with one of two medicines - Formalin & Malachite Green (Proform C or Terminate) to treat single cell parasites or Fluke medicine like Supaverm/Praziquantel. As for bacterial infections, you need to send a swab to a laboratory to find the bacterial species. By the time you get results, the Koi may be dead. So, in most circumstances, care taker’s choice is to try shotgun treatments. So, why scrape and scope?

Avoid taking Koi out of water, especially when they carry eggs or when they are sick. It takes nearly a month for Koi to recover from  the hypoxia (lack of oxygen) their brain suffers when you lift them out of water ( it is equivalent to choking an infant for a couple of minutes).

Proform C/Terminate treats almost all protozoan (single cell) parasites that infect Koi. You must make sure that their water is clean and they have plenty of aeration. Proform C/Terminate has 2 chemicals - Formaldehyde and Malachite Green. Read when NOT to use Formalin & Malachite Green in your pond.

If the Koi have gill flukes, they stay at the top or shake their heads (they also shake their heads to shed their worn out teeth)  or make chewing/yawning movement now and then to clear their gills. They may even gulp air. In this case, you have to use supaverm for 14-21 days when water temperature is above 70*F (or more in colder water).

When improperly used, or used for a long time, or used frequently, any medication will damage koi. You must remember that when you treat with Formalin & Malachite Green or Supaverm, your koi will have open wounds/cuts after the flukes/parasites fall off/die. And those wounds will be infected by fungus and bacteria. Dechlorinators like Sodium thiosulphate (hypo)/Pond Prime/Ultimate will inactivate Supaverm and Praziquantel.

Shotgun treatment: This should be used only after you have tested water parameters and done a significant water change and still see more than 2-3 koi flashing or rubbing or gulping or sitting on the pond floor. You can also use this as a quarantine procedure before releasing the Koi into pond.

Day 1: Start feeding antibiotic pellets. Make a major change in water (50-75%) using Pond Amquel Plus or Ultimate. Wait for 2 days to inactivate the dechloriantor.

Day 3: Bypass UV, Carbon filter, Protein Fractionator. Add Proform-C or Terminate according to instructions.

Day 5. Make 25% water change. Add Proform-C or Terminate according to instructions.

Day 6: Add Supaverm according to instructions.

Day 10: Start UV, carbon filter, Protein fractionator.

Day 11: Make 25% water change. Repeat procedure for Day 3-6

Day 17: Start UV, carbon filter, Protien fractionator.

Day 18: Make 25% water change. Repeat procedure for Day 3-6


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