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Hey Jen, are those spots still look like a salt grains? If yes then the medications that you are using don't help or you need to use it for the longer time. Not sure why the heater can keep the temp only to 23*? What is capacity is the heater? Is it adjustable one? Ich is very easy to treat with 88* which is 31*c. Is there anyway the heater can heat to this temperature?
If not you need to use medications for longer time. Ich is fatal if you don't get rid of it he will die. And its not good when its coming back , meaning that they attached to the body again and reproduce.
What kind of medications you been using? What are the ingredients?
As for first help
1. remove the filter.
2. Do daily water changes
3. Tell me please if the spots look like salt grains
4. Need to raise the temperature if you can't you need to use medications. Try to buy another heater. You can buy the heater capacity for 5 gall or bigger. Buy adjustable one
5. Tell me what medications you been using?
6. When you do full water change make sure you acclimate betta to the new temp. I am going to give you instructions on acclimation. You need to make sure you don't shock him with new water temperature. Be aware bettas are good jumper so when you take him out of the tank or have him in his changing cup cover it so he don't jump out
7. Is he darting around? Is it looks like he is scratching on objects?
 

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There are many ways to do a water change and acclimate (reintroduce) your fish back into the tank. Here is a few variations that's pretty simple:
1. can have betta in the changing cup with about 15% of the water and keep adding small amount of the new water about every 5 min for about 5-6 times -this way you he will get used to the temperature:)

2. Note the temperature of the water.

Using a plastic cup, scoop him, along with some of his water, into the cup.
Clean out the tank. Refill with water at the SAME temp. Be sure to add the correct amount of water conditioner.
Float his cup in the tank for about 15 min. (Study during this time. If he sits longer, it's OK.)
Add a SMALL amount of NEW water to the cup. (Several tablespoons, or about 1.5 ounces.)
Let his cup float for about 10 min. (Study during this time. If he sits longer, it's OK.)
If the cup starts to fill too much, remove a SMALL amount of water from the cup. Discard it.
Repeat steps 5-7, until about an hour has passed. (If he sits longer because you're studying, that's OK.)
Gently release him into the tank.

3. To do a water change, use a little cup like a plastic solo cup - this cup must be only for him and have never been used with soap or other chems. Scoop him up in this cup (keep him in the cup about 1/4 full of water - it doesn't need to be much because he won't be in it for long) and leave him in the cup while you change his water. To do the 50% use a turkey baster - dedicated only to him that has never seen soap or chems - and drag it through the gravel and try to suck as much of the poop out as possible, in addition to 50% of the water. Use a thermometer under the running tap to get it to be the same temp as the water that is normally in his tank. When the thermometer says the flowing tap is the right temp, fill back up his tank. At this point, add the conditioner (dose for how much water you change - if you change half the water you add half gallon worth of conditioner, If you do a 100% water change dose for the full gallon change). Float his plastic cup with him in it in the new water. Slowly add a couple tablespoons of the new water into his cup every 10 minutes for at least an hour. Finally, dump him in gently but try to get as little of the old cup water back into the tank as possible. When you do the weekly 100% you will do mostly the same thing except empty his tank fully and rinse everything in it very well under warm water but never use soaps or chemicals. Once it's fully cleaned/rinsed you can refill it and repeat the cup/acclimate phase.

4. When I change the water I put him in the cup I got him in then I take everything out of the tank, rinse everything with warm tap water. Then I put everything back in the tank, fill it with dechlorinated new water, and then turn the heater on. When the tank water is the same as the cup water , then take the dirty cup water out and a little at a time and put clean tank water in the cup. After that I put the cup in the tank and he swims out.
 
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