Treating Wounds and Ulcers

How to anaesthetise fish and apply topical wound ointment.
To assist members I have prepared a step by step guide on the procedure of anaesthetising koi and applying topical treatments. The Sanke shown in this article hit its head on a circulation pump tucked right in the corner of the pond. It took a 2 cm wide chunk out of its Tancho spot, worst luck. Such an injury will heal itself in good water conditions but it pays to have topical wound ointment in your cupboard and ready for use at the first sign of infection. We ran out of Wound Med so for these photos we used 'Koi Doc' ointment which is now out of production,
but is the same medication.
Preparation.
It's important to thoroughly prepare and have everything ready and close at hand before you start. You only have 5 minutes maximum to safely keep your fish sedated, so you don't want to waste time searching for the paper towels and cotton buds when your fish is on the operating table. Always have an assistant during the procedure.
Operating table.
You need to set up a clean operating table in a shaded, sheltered position preferably close to your pond, near a power supply for the blow/hair dryer and air pump. Place down a large wet towel folded over to put your fish on. Use wet hand towels or cloth nappies to place over the fish leaving only the operating site exposed. Use pond water to wet all towels.
Operating equipment.
Scalpel, small surgical scissors, cotton buds, kitchen paper towels, surgical gloves, sterilizer, blow dryer, a watch for time-keeping and WoundMed ointment. Don't put these items on operating table as they will get wet. Never use tissues or cotton balls as they break up and leave remnants behind on the fish. To avoid spreading infections you must ensure all equipment is clean and sterilized after each use. We use 'Isocol' alcohol rub. Use disposable items like cotton buds only once on the one fish then discard.
Anaesthetising tub.
We use a large rectangular tub for large fish or a 20 litre round tub for smaller fish. Accurately measure pond water into this tub to a level which just covers the koi. Large koi use 30 litres water which requires 6 mls (180 drops) of oil of cloves maximum. Small koi = 10 litres/2 mls oil of cloves.
Anaesthesia solution.
Oil of cloves is available from the AKA supply officer. The recommended rate in the KSA handbook is 6 drops of oil of cloves per litre of water which I have converted to 1 millilitre per 5 litres water. This is a strong dosage so don't use any more. The AKA supplied oil of cloves recommends 8 drops per 5 litres of water. You can measure with an eyedropper but the drops don't mix well when dropped on the surface of the water. I prefer to use a syringe which is immersed under the water first then shoot in the oil of cloves quickly, this mixes well. Fish become unconscious much faster in summer than in the cold water of winter.
Recovery tub.
Use pond water and put in a couple of air stones to help your fish breathe more easily and wake up, you will need a small air pump and air stones. Koi take about the same time to wake up as they do to go to sleep.
Operating procedure.
Step I. Catch your sick fish and put into the anaesthetising tub -start timing. After about 90 -120 seconds the fish will roll upside down as it loses control of its equilibrium. Leave the fish in a bit longer. This is a good chance to thoroughly inspect the fish for further infections especially underneath, around fins and mouth. Fish take at lease two to three minutes to go to sleep. Before placing the fish on the operating table you need to be sure the fish is properly sedated and will not move while you are working on it. Lift the fish out and hold it just over the top of the water for about 20 seconds. If the fish moves it's not ready and must go back into the tub for more sedation. A jumping fish on the operating table is impossible to work on. Always handle fish with wet hands.
Step 2. When the fish is sedated lay it on the wet towel on the operating table and start your timer. Place smaller wet towels over the fish, especially the face, leaving only the wound site exposed for operating. This will keep the fish calm and sheltered from any drying breeze. Monitor fish breathing closely (assistant's job) -its gills should go in and out. If breathing becomes very slow, laboured or stops, immediately put the fish into the recovery tub.
Step 3. Bacterial infections/ulcers -on the first occasion you operate on the fish you must clean the infection site very thoroughly. This involves cutting out or simply scraping away all infected flesh, leaving raw but healthy flesh. With application of WoundMed ointment the wound will improve and start to grow new skin which you don't scrape away during future ointment applications. New skin growth indicates the wound is healing so don't damage this new growth or its back to square one. Fresh wounds or injuries, like this Sanke, may not require any cleaning prior to ointment application.
Step 4. Pat the cleaned wound site dry with kitchen paper towel. Apply the Wound Med ointment, which has a handy spray applicator, to the whole wound site and over all the edges. Keep the ointment away from the gills, eyes and mouth -it must not be ingested. Use a cotton bud to apply WoundMed in areas close to the eyes, gills and mouth.
Step 5. Dry the WoundMed onto the wound site using a blow drier on low speed and low heat. Make sure the rest of the fish is covered with wet towels while doing this, especially the eyes, gills and mouth. If you don't dry the WoundMed it will come off as soon as you put the fish back into water, so the drier the better. If there are several wound sites on a fish threat the worst one first and get your helper to do the blow drying while you commence cleaning the next wound site. You'll have to work faster with more wounds.
Step 6. Once you are satisfied the WoundMed ointment is dry or you have run out of time, with wet hands place the fish carefully into the recovery tub. Take care not to handle and rub off the WoundMed ointment. Keep the koi upright and position an air stone under its gills so that air and water circulates through them which will bring the fish around. Once the fish can stay upright itself let it go and monitor for about five minutes until you are satisfied it has recovered. If you return your fish to the pond too quickly it will just sink to the bottom upside-down and you cannot tend to it if there is a problem with recovery. While the fish is recovering this is a good time to catch your next fish, if necessary.
Step 7. Once recovered return your koi to the pond being very careful not to abrade the wound area because the WoundMed will rub off.
Important points.
...Monitor the wound and repeat ointment application weekly until the skin is growing back and you are satisfied with the wound's progress.
...Always allow a break of at least 4 days between treatments to allow the fish to recuperate.
...Don't carry out this procedure in direct sunlight, very hot days or in windy conditions. It's best done early morning.
...Don't feed your fish the day before, they handle the procedure better on an empty stomach.
...Use surgical gloves and don't get any WoundMed on yourself as it may contain Malachite Green, which is poisonous carcinogen. If so, wash off immediately.
...NEVER, EVER leave a fish in the anaesthetising tub unattended. If you forget, it's dead, too much anaesthetic kills. Only attend to one fish at a time. I have heard of someone placing their next fish in the anaesthetising tub (to save time) while working on a fish on the operating table. But they got distracted with the operating process and forgot about the fish in the anaesthetising tub. Sad end.
...Most important is to work out why you have an ulcer or finrot problem in the first place. Most common reason is poor water quality. You must test your Ph, ammonia, nitrite and nitrate regularly. Anything outside the normal levels will stress the fish which lowers their resistance to harmful bacteria. Ph should not go under 7 and you should have zero ammonia and nitrite if your bio filter is . working properly. Ph naturally goes down as a bi-product of the biological process so add bicarb of soda to maintain between 7.2 to 7.8 .Nitrate is also the end product of the biological process and can be reduced by regular water changes, plant filter or Clarity unit -BUT don't change too much water at once as the slime coat on the fish will reduce and they will break out with infections. If you have no bottom drain the ammonia levels will be higher on the bottom of the pond where everything settles so take your water sample from the mid bottom.
...If your fish are constantly injuring themselves check the pond for sharp objects, obstacles or protrusions and remove these risks. If your fish keep jumping out they are not happy with the water quality so do all water checks, especially copper, and make adjustments. If you can't find the problem you will need advice and you may need to have a professional investigate.
We are happy to share our koi experiences but we are not qualified vets. Although the procedure we follow is the product of much research and experience, and I'm happy to say we have never lost a fish, and all wounds/ulcers/fin rot have been cured. My advice is to inspect your fish regularly while they are eating or through a glass window if you have one. If necessary catch a suspect fish, put in a plastic bag, hold it up and inspect the fish from all angles. If you see an ulcer or fin rot, treat it straight away with WoundMed, don't wait.