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To support the diagnosis, it is helpful to document elevations of muscle enzyme concentrations in the blood. The two most commonly evaluated muscle enzymes are creatine kinase (CK) (also known as creatine phosphokinase, CPK) and aspartate aminotransaminase (AST) (also known as serum glutamate transaminase, SGOT). CK has a shorter half life and therefore will become elevated sooner and return to normal range sooner after an acute episode of muscle damage and is therefore the preferred muscle enzyme to evaluate when diagnosing and monitoring muscle recovery. Horses with PSSM may have normal or elevated CK concentrations prior to exercise. After exercise the concentrations of CK will rise to higher levels than normal horses . One recommended protocol for diagnosis is to measure CK concentrations 4 hours after after mild walk/trot exercise for 15 minutes. A CK concentration greater than 800U/L would suggest significant muscle damage. While elevated CK concentrations are not diagnostic for PSSM, since any condition that damages muscles can elevate CK, elevations would be supportive of the diagnosis and warrant pursuing a definitive diagnosis by muscle biopsy.