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His water is clean & clear, and stays that way without too much attention from me.
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What do you mean? You don't do many water changes? How much and how often do you do them?
Yes, the ratio is very different for large fish. Obviously a 5" Oscar is going to produce way more waste than 5 neon tetras, right?
I'm afraid 10 gals is not nearly big enough for him even now. Oscars produce a lot of waste and quickly become poisoned by the toxins in small tanks. Hole-in-the-Head is believed to be caused by poor nutrition and/or overcrowding and/or bad water quality.
This poor fish has been through too much and urgently needs a large tank and clean water right now. I can't stress that enough. Rescuing is wonderful, and your hearts are certainly in the right place, but does the fish no good if his living conditions are still bad to the point of him getting this disease.
Yes there are medications and foods that are used in the treatment of this disease, but aren't going to be of much benefit while he's in this tank.