Goldfish and Aquarium Board Articles
WendyLove's Renal Cysts
WendyLove is an 18 month old peach cap, calico oranda I purchased last summer (2005) at a local fish store. This article documents the problems Wendy was having and her diagnosis and treatment.
Here are two pictures of Wendylove in happier times last year. She was about a year old.
Around the beginning of February 2006, I noticed a transparency and swelling on Wendy's right side. She would stare for hours at the tank wall, seemingly at nothing. Shortly afterwards, she developed buoyancy problems. First tilting towards the right and then swimming upside down. She also appeared lethargic, at times sitting on the tank floor in a corner. While these problems were developing, I was researching and trying various things to help her. The following picture is a right lateral (side) view of Wendy. You can clearly see the transparency of her right side and the swelling.
The following two photos also show the swelling apparent in her abdomen.
A rear (caudal) view.
I found Koivet and Jo (EBay Queen) referred me to her aquatic vet--Dr. Helen Roberts. I was also provided with medicated food, sound advice and a lot of support from her and some other very nice people. Prior to Wendy's appointment on Feb. 6th, she spent a good part of her day in a large net at the top of the tank. She had to be hand fed and she was using a lot of energy to try and stay upright. Wendy was transported to the vet's office in a five gallon bucket. I did not have a portable bubbler at the time, but soon obtained one as the water needs to be oxygenated.
Here she is in her bucket waiting to see the doctor.
During this first examination Wendy had a skin scrape and gill snip done to check for parasites while sedated. She had gill flukes. When she came home she and the tank were treated with prazipond (praziquantel). A stool sample was also collected and found to be normal.
Here is a photo of Dr Roberts and her assistant preparing Wendy for gill snip and skin scrape.
Here is a photo of Dr. Roberts performing the gill snip and scrape. There is some bleeding.
Dr. Roberts also x-rayed Wendy to help figure out what is going on. The x-rays below show the two lobes of the swim bladder. The large white area you see is Wendy's cyst. In the second x-ray you can see how it protrudes to the right in her abdomen. The cyst was causing her problems.
Dr. Roberts suggested aspirating the cyst to help with diagnosing her problem and to relieve some of the pressure that was believed to be causing her bouyancy issues. It would also help to identify the type and origin of the cyst. Here is a photo of Dr. Roberts preparing to do the aspiration of Wendy's cyst.
Dr. Roberts aspirated approximately 30 cc's of clear fluid. Our hope was that the cyst would not refill and her buoyancy problems would resolve with the pressure taken off the swim bladder. We discussed possible reasons for the cyst and treatment options. Wendy was scheduled for a follow-up appointment March 3rd.
Wendy's recovery was slow though she no longer had buoyancy problems. She spent a lot of time sitting on the bottom of the tank staring at the tank wall. Her belly was boggy when she swam from the deflation of the cyst. By the 17th of February she was back to herself--eating, swimming and playing normally.
Here she is feeling herself. Note the reduction in the size of her abdomen.
After Dr. Roberts conferred with several of her peers on the findings of the exam and x-rays, the consensus was that the cyst was either:
An x-ray with contrast media was recommended to rule out GI involvement and then possible exploratory surgery. Exploratory surgery was eventually ruled out after weighing the risks and benefits for Wendy.
Dr Roberts performed another cyst aspiration on March 3rd. To prepare for the aspiration, Wendy was placed in a plastic container filled with a gallon of water. Equal parts of Finquel and baking soda were added (The baking soda buffers up the water as the finquel makes it acidic). During her first visit she was sedated easily due to her decompensated state, however, this time she put up more of a fight
It took some time to sedate her. She required two doses of Finquel.
She is finally sedated.
This photo shows Dr. Roberts aspirating fluid from Wendy's cyst. The cyst occupies her whole right side.
Another syringe of fluid is taken from the cyst.
Here is Dr. Roberts aspirating the final syringe of fluid. During this visit a total of 16 cc's of clear fluid was removed. Dr. Roberts took care not to remove too much of the fluid. If the fluid had contained a lot of protein there was risk of shock from fluid balance being disrupted.
Here are two of the syringes of fluid that were aspirated.
This photo shows Dr. Roberts waking Wendy up in fresh oxygenated water. It takes approximately five minutes before she is fully alert.
Here is Dr. Roberts at the microscope checking the fluid from the cyst. The fluid showed no or little protein. Protein would have helped identify the origin of the fluid. Wendy was also given a shot of Baytril, an antibiotic. She was scheduled for a follow-up visit April 4th.
The following two photos show the reduction in the size of the cyst following aspiration.
A rear view.
By March 21st, Wendy's belly was swollen again. She was staying on the bottom of the tank and her appetite was poor.
She returned to see Dr. Roberts March 22nd. A few weeks earlier than anticipated. The plan was to aspirate the cyst and test the fluid for ammonia to rule out polycystic kidney disease.
Dr. Roberts swabbing the injection site with betadine.
She used a 22 gauge butterfly vacutainer.
As you can see below the return was bloody fluid. Not what we expected to see and not a good sign. Wendy's gill plates were examined by Dr. Roberts initially and were found to be lighter red than they should be. Another sign of polycystic kidney disease. The fish becomes anemic from the disease and the gills become paler in color.
The fluid removed was spun down on a centrifuge and tested positive for ammonia using a master water test kit. A tentative diagnosis of polycystic kidney disease was made. Necropsy is the standard for diagnosing PKD. Very little information is available regarding treatment. PKD is a autosomal disease that is inherited. There are no medications or procedures for this diagnosis today for fish. The long term prognosis is poor. She was scheduled a follow-up visit April 14th.
Wendy's cyst started to re-fill. I decided to attempt the aspiration armed with moral support from the gab. On April 4th i sedated her with finquel; 1/3 the recommended dose. Approximately 6 cc's of clear fluid was aspirated from her cyst. She and I both survived the procedure.
She has been doing very well. Eating, playing, swimming. Being a fish. She has had no recurrences of buoyancy problems.
Her appointment on April 14th went well. No fluid was aspirated as she was asymptomatic at the time. Her gills are still pale, however, they are not worse. It was recommended she come back in three months.
I will be performing the aspiration of fluid from her cyst as it becomes necessary between vet visits. As of April 24th she remains asymptomatic.
She is a spunky little fighter with a lot of personality and as long as she is not suffering I'll support her fight.