Holly Helbig, DVM, is the owner of Hawthorne Hill hunter/jumper boarding and training facility and Hawthorne Veterinary Clinic in Dublin, Ohio. She is a woman who didn’t start vet school until the age of 29, then was determined to make her veterinary career suit her life. And she has!
A graduate of The Ohio State University College of Veterinary Medicine, Helbig is not only a successful private practitioner, but she trains and rides hunter-jumpers and serves as a licensed FEI veterinarian. In addition, she created a mobile pharmacy and store that supplies clients with many different products at shows where she is the attending veterinarian.
Helbig is the official veterinarian for the World Equestrian Center (WEC) in Ohio for 32 weeks a year. She also is the official vet for The Kentucky Horse Shows in Lexington, Kentucky, and Brave Horse in Johnstown, Ohio. She serves as an attending FEI veterinarian.
Helbig admitted that she works long and hard to maintain all that she does, but she said she is happy with her challenging career. “So many vets said I couldn’t do this, but I worked my butt off and paved my own path,” said Helbig.
“I don’t know anyone else who runs a training facility, is a trainer and is a full-time veterinarian,” she said. “I love to train. I love to ride, and I love being a vet.”
Helbig was a horse trainer and a pharmaceutical rep prior to attending vet school. Her love of training and riding hunter/jumpers has stayed with her throughout her life, and she has created a career that allows her to practice as well as train horses to upper levels of competition.
Using Stablelab® in Practice
This article gives you insights into how Helbig has used Stablelab (from Zoetis), which is a stall-side test that measures and quantifies Serum Amyloid A (SAA) in <10 minutes. This biomarker is very low to unmeasurable in the blood of healthy horses, but it increases rapidly and dramatically with inflammation caused by infection. That makes it useful to veterinarians in identifying infection that might require additional diagnostics and treatment as well as monitoring of disease and response to treatment.
When Helbig works at the WEC, she has 14- to 16-hour days at the horse show. She had been using Stablelab in her practice for a variety of scenarios, such as fever of unknown origin, sudden onset of cough or nasal discharge, cellulitis, colic, etc. She said, “For me, Stablelab is a quick way to say, ‘Yes, we need to run more diagnostics. Do we need to take a respiratory panel? Do we need to quarantine this horse? Do we need to refer this horse?
“Imagine being at a horse show with 1,000 horses,” she continued. “You have a horse with a fever. It’s not something obvious. Is it influenza? Herpesvirus? The other one [a case where she uses Stabelab] is a horse that is coughing in the ring. Is it infectious? Is it allergy or secondary to environmental changes? You have a horse getting off a trailer; are we concerned about shipping fever? I’ll run an SAA on them.
“The ones with a fever, they’re going to have an elevated SAA,” she noted.
She said for those show horses with fever or coughing, the owners are happy to pay a nominal price to find out what is going on. “My clients say, ‘That’s no big deal; just run it!’ They are happy—and so am I—to have a value in 10 minutes even if we are going to pursue more diagnostics.”
Helbig noted, “Because we dealt with influenza at the World Equestrian Center—I had to run a quarantine there—I have become pretty comfortable with the levels of SAA and how to interpret them. I have a good feeling based on what the levels are for what we are dealing with.
“It’s a quick, 10-minute way to aid in making a decision in the best interest of not only the horse but the horse show,” she concluded.
Helbig said she uses Stableab “quite often” on cellulitis cases because “I want to know how severe they are, and I want to know if they are responding to the treatment. I also use [Stablelab] sporadically on colics. I don’t use them standardly, but I will on those really painful ones. Any that are elevated, I ship them right away. If they are that painful, they are probably going to be shipped anyway.”
Influenza Challenge
A big challenge that Helbig faced prior to the new worldwide familiarity with respiratory outbreaks due to the COVID-19 pandemic in humans was a 2019 outbreak of equine influenza during a horse show.
“When we had the influenza outbreak, I was running the [Stablelab] tests like crazy!” said Helbig. “And it worked! That is how I determined who went into quarantine and who didn’t. The horses that we put in quarantine—anyone that was above a value of 50 [µg/mL]—they all tested positive on the nasal swab. It worked. There was no question that it worked.”
She reminded that all USEF-sanctioned horse shows require vaccinations for influenza and equine herpesvirus types 1 and 4 within six months. Helbig reminded her colleagues that FEI has more complicated and in-depth requirements, so it behooves veterinarians with clients in FEI-sanctioned events to review the requirements.
“I can’t emphasize enough the importance to stay current on your vaccines,” said Helbig. “If you skip a year, then you need to start over. It only takes one unvaccinated horse to spread a disease.”
Helbig also reminded her colleagues that even though all the horses are vaccinated, it doesn’t mean horses are not carrying a disease to the show. And no vaccines are 100% effective in preventing disease, although proper vaccination can reduce the risk of clinical signs and shedding of viruses.
“We had horses test positive for influenza that had every type of vaccine,” noted Helbig. “But we were fortunate that they were all properly vaccinated so we didn’t lose a horse.”
Helbig stressed that horses with influenza should have one week away from training and showing for every day of fever. “Flu affects the tissues of the trachea and lungs,” she said, noting that it takes time for those tissues to recover fully. “It’s important that the horse is fully rested before it goes back to work. Scar tissue can be created during exercise if those tissues aren’t fully healed.”
Unfortunately, that time off means trainers and riders will miss out on training and showing while the horse is recovering from influenza. “It takes time to build back up when they’ve been off,” said Helbig. “For a trainer, that’s a lot of exercise and training time. For a rider, that could be two horse shows. That time is valuable!”
She also advised that putting a horse with influenza on a trailer to ship home puts the horse at risk. “We worry about secondary bacterial infection—shipping fever,” Helbig noted. “And you don’t want to put a horse with flu on a trailer nose-to-nose with healthy horses. That’s not good. And most horses at the shows are a long way from home. That travel can be impactful” to the overall health and well-being of those horses.
Follow-up Use of Stablelab
Helbig said that using Stablelab for follow-up is different for her because the horses from the shows go home and she doesn’t see them again. It would, however, be something to speak to their regular veterinarian about repeating when they get home.
“I do follow those cases like cellulitis with Stablelab,” she noted. “I wait two to three days to run it. I use it for follow-up, especially if I don’t feel like they are responding like they should to antibiotics.”
Recommendations for Management
EquiManagement asked Helbig what she would recommend to a veterinarian working at a horse show when it comes to monitoring potential infectious/contagious disease.
“In my opinion, if they were positive for influenza, within 24-48 hours after exposure those horses did eventually test positive,” said Helbig. “My criteria was anyone over the level of 50 [µg/mL]—even if they were 70 or 80 and they are really close—we would do two levels of quarantine: symptomatic and non-symptomatic. So, the symptomatic with elevated SAA in one group, even if they were 70 or 80, we did nasal swabs on them and they did test positive.
“So, for me, anyone who was exposed and wanted to have an SAA run, we did,” she said. “Some people chose to take all of their horses home and quarantine them together, which was fine. Some people had horses they needed to take home where there [were] maybe young foals on the ground or they didn’t have the ability to quarantine. Some people were trying to decide who to leave and who to take home. So, we just ran it [Stablelab test] on all of their show horses, and some stayed and some left. The ones that stayed … the barns where we kept anyone who had a value over 50 [µg/mL] those horses did have influenza. And the ones they took home, they did not.
“And as far as I’m aware of, they did not take flu home to their barns,” she noted.
Helbig said veterinarians are going to have owners who don’t want to do the Stablelab test. “That’s part of the world we live in,” she concluded.
“In a perfect world, you would test everything,” she added. “In a really perfect world, you would test everything the minute they drove into the horse show. And one day we might get there.”
Next, EquiManagement asked Helbig how she thinks Stablelab has improved the quality of vet care she can provide at home and at events.
“For me it’s customer satisfaction,” she stated quickly. “They love getting a value in 10 minutes. That is a game changer for us. And I love having this tool to help guide them in the right direction for treatment.
“It used to be if you sent the blood out or did a nasal swab and got the results 24-48 hours later, you were lucky,” Helbig said. “For horses that are coughing or have some nasal discharge, the fact that you can say in 10 minutes ‘Hey, you can go show later that day or tomorrow,’ it gives people that peace of mind.
“Stablelab has improved my practice because it helps me make better decisions for the animal,” Helbig stated. “Even though it doesn’t tell you what’s going on, most of the time you have a pretty good idea. To have a value sometimes tells you how aggressive you need to be in treating the horse or whether the horse needs to be referred.
“Really, when you are at an event with that many horses and you have to make a decision, that 10-minute time is an incredible customer satisfaction piece of information to have,” she said.
She noted that when something is wrong with a client’s horse, “It gives them something to hold on to. It might not be black and white, but it gives them something. And that gives them peace of mind.”
Based on her experience with influenza, “The horses range from the low 100s to the upper 500s” on the Stablelab test,” she said. “Unlike a cellulitis or Potomac horse fever I’ve tested for—or other things that go into thousands—influenza hangs around in 100-500 or 600 unless horses develops a secondary pneumonia.”
In addition to infectious respiratory concerns, Helbig has also used it for a couple of horses that I wondered if they had infected joints, and they came back zero. They ended up not being infected. “I have tapped a couple of joints with ‘flares’ and people were concerned, and they were zero and they were fine,” she said.
Overall, Helbig said she was very happy with using Stablelab for her private practice and especially at equine events. “It really helped me make some decisions for the owners and the horse show,” she concluded.
More about Stablelab® and SAA
The following information is provided by Zoetis.
https://www.stablelab.com/pages/serum-amyloid-a-blood-test
SAA is a major acute-phase protein that is produced by a horse’s liver in response to infection; its concentration in the blood can indicate the severity of an infection. SAA can start to elevate above normal, often before clinical signs appear, giving the veterinarian an indication to run additional diagnostics and get a jump start on treatment. Additionally, repeat SAA testing over the course of treatment allows the veterinarian to monitor whether the treatment is effective or not.
The key to interpreting Stablelab results is a firm understanding of the typical response curve and awareness that a single test result provides important information but cannot identify where a horse is in the disease process.
- A normal, healthy adult horse will have a SAA level of 0 µg/mL.
- When a systemic infection is present, SAA levels will rapidly and dramatically rise—often into the 100s or 1000s mg/mL—while noninfectious inflammatory conditions rarely elevate SAA at all.1-4
- SAA concentrations will peak within 24-48 hours after infection and will remain elevated until the systemic stimulation is resolved (either by treatment initiated by the veterinarian or the horses own immune response), at which point SAA concentrations will drop by about 50% every 24 hours.4
You also can download this infographic from Zoetis by clicking on the graphic below.
Equine Influenza
Biosecurity and vaccination are two key cornerstones to preventing equine influenza in horses and to prevent outbreaks of this disease.
Zoetis’ Fluvac Innovator® EHV 4/1 was recently tested in 40 vaccinated horses against 14 recently isolated (2021) equine influenza virus strains from various parts of the country. The 2021 field isolates came from: California, Colorado, Florida, Iowa, Kentucky, Minnesota, Missouri, Mississippi, North Carolina, Ohio, Pennsylvania, Washington, Wyoming and British Columbia (Canada).
Fluvac Innovator was shown to be highly immunogenic in stimulating a cross-protective titer against all 14 circulating strains isolated in 2021 tested by the North America OIE reference lab.9 Of additional note, these results are consistent with studies conducted over the last 5 years showing cross-protective titers against 66 equine influenza viruses isolated from 30 states, Canada and Europe.5-9 These observations provide veterinarians vital immunogenicity data demonstrating that Fluvac Innovator was well-matched against a broad population of EIV field strains recently causing disease. Vaccines showing immunogenicity against a broad spectrum of contemporary EIV isolates is a crucial factor in helping reduce equine influenza morbidity and outbreak risk.
Dr. Helbig has a contractual relationship with Zoetis, whereby she is compensated as a member of the Innovator’s Circle.
References
1. Belgrave, R., et al. Assessment of serum amyloid A testing of horses and its clinical application in a specialized equine practice. JAVMA, 2013:243(1);113-119.
2. Oertly, M., et al. The accuracy of serum amyloid A in determining early inflammation in horses following long-distance transportation by air. AAEP Proceedings, 2017;460-461.
3. Anhold, H., et al. A Comparison of Elevated Blood Parameter Values in a Population of Thoroughbred Racehorses. JEVS, 2014;34(5):651–655.
4. Ludwig, E., et al. Serum and Synovial Fluid Serum Amyloid A Response in Equine Models for Synovitis and Septic Arthritis. Veterinary Surgery, 2016;45(7):1-9.
5. Data on file, Study Report No. 18EQRGBIO-01-02, Zoetis Inc.
6. Dilai, M., et al. Serological investigation of racehorse vaccination against equine influenza in Morocco. Veterinary Microbiology. 223. 2018. 153-159
7. Data on file, Study Report No. 19EQRGBIO-01-02, Zoetis Inc.
8. Data on file, Study Report No. 21EQRGBIO-01-01, Zoetis Inc.
9. Data on file, Study Report No. 22EQRGBIO-01-01, Zoetis Inc.
Important Information
The following important information is provided by Zoetis.
All trademarks are the property of Zoetis Services LLC or a related company or a licensor unless otherwise noted. Stablelab is a registered trademark of Epona Biotech Limited, used under license.
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