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This is what I find to be a classic case of the "death spiral"!
Starting with the idea that we are not really too good at finding the true disease to fight is important to me. Thinking of how little has been done to understand fish disease compared to human disease, combined with how often doctors do treat for the wrong disease in humans, gives me the idea that we are often going to be wrong in our diagnosis!
So, if I'm not going to be very successful in treating disease, I work far more on preventing it. So let's look at what might be done better?
I see step one as having a case of ich. Prevent ich from ever reaching the main tank by using a QT tank. Before we get into what it takes to get and keep a QT, think of what it costs to treat the result of NOT having a QT??
Step two of the spiral is not understanding what ich does during and after treatment. All the time it is in the tank, the fish are getting tons of tiny wounds, all over their body. So we treat the ich and feel fine, we got rid of that, but at the same time the small wounds are open to every known fungus or bacteria that floats by in the air or water!! So is it hard to see that you may have several different diseases at one time and that makes it nearly impossible to diagnose and treat correctly? Step three of the spiral is when we really, really want to save the fish and throw every known med we can at the disease in the hope we get it right. Meds are hard on fish, just as they are hard on humans.
I find it works out far better to NOT buy the meds and use the time, effort, and money to avoid the death spiral. That means I do keep a spare tank ready for any fish that needs it and certainly before new fish go in with the rest. The QT can be as simple as an empty tank in the closet to be pulled out when needed.
I had to be whacked in the head several times before I came around to this thinking. Keeping them healthy is far easier than getting them there after they are sick but if they do get sick, I'm quick to cull one to avoid losing the whole tank!
 
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