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
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Evidence on disease manifestation. I treat disease for a living. I have treated a lot of it, just not in non-humans
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?
Are you saying your a doctor and use prophylactic treatment on humans?
Sincerely Lasse
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.
Vaccines are prophylactic. Malaria treatments are indeed prophylactic. Cipro for Travellers diarrhea is prophylactic.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
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.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.
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....?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.
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
And btw - most of the arguments against prophylactic treatment focus on the toxicity - I concur - chloroquine has much less toxicity.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....?
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.
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....?
Thanks.....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.
Well - to me the risk of cipro is much more related to tendon issues - as compared to neurologic issues.
I have.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.
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...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.
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.
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”.