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Geno 507
March 14th, 2008, 01:03 PM
Hello all-
I'dike to say I am totally devastated by the news I've been told my beautiful long haired domestic female Paula, has CRF
She was placed in Florida vet. hospital about 2 weeks ago with creatine and bun readings of 11.5 and 75, was placed on IV fluids for 5 days and her values dropped to 3.5 on creatine and 45 on bun. But since, after daily injections of Sub Qs, her values have gone back up to creatine 8.8 and bun 78.
I now have her at the local vets office back on IV drip during the day, about 8hours and sub qs on the wekends.
I,ve also started her on something called azodyl, which is supposed to help with the control of these two values. She is still eating, but not much.
I'm currently in Florida, and returning to New York state about the 3rd week in April. I'm wondering if anyone knows how long cats can survive with this condition? I'm very concerned about the trip back to NY as I am pulling a large RV, and it usually takes me to the 4th day arriving home.
I cannot get myself to give my beauty the sub q fluids, as I know I wouldn't like those needles stuck in me either. Any suggestions greatly appreciated.
Regards, Geno 507

March 14th, 2008, 01:07 PM
Welcome to :thumbs up and I am sorry to hear about Paula. :sad: One of the members here (Growler) has a kitty with the same problem and has an ongoing thread with lots of excellent information. I'll go and find it for you.

March 14th, 2008, 01:11 PM
Growler and Sugarcatmom are both very knowledgable about cat nutrition. I hope this thread will be of some help to you....

I hope you decide to stay and let us know how Paula is doing. :fingerscr Also, once you are able to attch photos we would love to see some pics. :goodvibes:

Geno 507
March 14th, 2008, 07:27 PM
I thank you Rainbow for trying to help me, I dread the coming days ahead, knowing the eventual out come. My heart is breaking....Geno

March 14th, 2008, 11:53 PM
Hi Geno I'm sorry to hear about Paula.:grouphug:

I think especially with your trip back to NY coming up it is in your & Paula's best interests to have the vet or tech show you how to administer fluids, you can also find info here having it shown first hand is best though that way the vet can guide you & you have the opportunity to ask questions. Most cats will be less stressed @ home while you are giving fluids rather than the strange environment of the clinic.

Is there anyway to delay the trip until you feel more comfortable giving fluids? She will need them on the trip home OR ask your vet about rigging up an IV line in your vechicle for the trip. Is there someone else traveling with you to monitor Paula while you're driving?

Paula needs to eat as much as she can give her anything tasty that would tempt her, though try to limit the fish. If you can pick up some Grain Free Wellness Turkey Canned food or Eagle Pack Holistic Chicken, most cats like the taste, it is free of chemical, additives and unneccessary grain. Warm it up alittle with some added warm water to make it smell more appetising.

Please feel free to ask questions & keep us updated on how she's doing.

Sending :pray: :goodvibes: for Paula :grouphug:

Geno 507
March 15th, 2008, 03:12 PM
Thank you Growler for the great idea of rigging an IV in my vehicle, I never thought of that, I will ask the vet about this, what i'm wondering is how the flow would be controlled from the bag into her leg, as it is controlled now by a machine at I think 20 mils an hour. As far as eating, she seems to like dry food only, we mix her I AMS with K/D renal pellets, altho I must admit she 's not crazy about the K/D.
My main worry is 6 weeks from now, if she will still be with us, as her kidney values don't seem to want to come down. Yes My wife could monitor her while I drive back. Again, thank you. Geno

March 15th, 2008, 06:49 PM
what i'm wondering is how the flow would be controlled from the bag into her leg, as it is controlled now by a machine at I think 20 mils an hour.

You would be giving the fluids subcutaneously, not intravenously. So basically you pull the skin on Paula's scruff up into a "tent", insert the needle parallel to her body, and moderate how much she gets with a valve in the tubing. The article that Growler linked to explains it all.

As far as eating, she seems to like dry food only, we mix her I AMS with K/D renal pellets, altho I must admit she 's not crazy about the K/D.

If there's any way you can transition her over to wet food, that would really be best. Read this link on why wet food is better for cats (and *especially* kidney kitties): There are tips on it for making the switch from dry to wet.

As for the K/D, one of the reasons she probably doesn't like it is because it's very low in protein, and cats need protein. The premise that protein is hard on cat kidneys is an outdated one and may actually do more harm than good. Unfortunately much of the veterinary community hasn't caught on to this yet. It would be more desirable to keep phosphorus intake low (either with diet or with phosphorus binders). But the most important diet change you can make is to boost moisture intake via wet food. You may even be able to postpone having to administer subQ fluids if you can find a flavour of canned food that she'll eat.

You might also want to read this (and check out the links at the bottom) for some good CRF info:

Fingers crossed that she pulls through this. :fingerscr

Geno 507
March 16th, 2008, 10:37 AM
Well i've returned from the vet this morning who was willing to come in sunday morning to adminster sub- qs to Paula...She is down in weight from 7 lbs to 6.4. I'm taking her back tomorrow morning for 5 days on intervenious fluid from 8am to 430pm.
I'm not liking the vets opinion on my baby though- She's already talkin of putting her down and isn't giving me any positive signs.
I would just like to get her back to home in NY alive for a while, I plan on going home earlier in April then was originally planned. She is still eating some, and luvs the outdoors . I keep her confined to a small area, that she can't wander away from. Just wondering if anyone has any opinions on the vets negative approach to my baby...Regards, Gene

March 16th, 2008, 12:20 PM
Just wondering if anyone has any opinions on the vets negative approach to my baby...

Welcome to the forum!

This Vet's response is so unfortunately typical of many of them...

What you need to know is that, with careful attention and appropriate "treatment", the overwhelming majority of cats diagnosed with kidney insufficiency are able to, not only survive the initial crash, but go on to live happy, sometimes shorter, lives.

More importantly, you need to know that cats do NOT suffer pain due to the CRF itself. So, don't let that argument - should you get it from any Vet or anyone else - sway your decisions around what's best for Paula.

You have been given some good information sites.

The one I would highly recommend is here
It is quickly becoming recognized as the authority in CRF information/ education.

The woman who owns it also hosts an online practical support group - the members truly do know more about treating CRF than the majority of Vets. I would urge you to join it don't have to "participate" right away, but you can read other peoples' stories, the problems they post and the replies from knowledgeable CRF caregivers...then, when you're comfortable make your own posts. EDIT: here's the sign-up page

Most people are just as devastated as you feel right now. The learning curve can be just as challenging. HOWEVER, being part of a group like this can guide you step-by-step through a treatment process to a successful outcome in managing a difficult condition while giving Paula a good quality of life.

Oh. the Sub-Q fluids can be a breeze...once you get over the psychological hurdle! Most kittys actually PURR during the process! You've got to get there first, though, so you're not passing your stress along to Paula. A couple of "quickies" on this: make sure you use Lactated Ringers Solution (LRS) as often the silly Vets will give a solution which "stings", use Terumo #20 needles and warm the fluid first. The CRF website has the whole fluids thing here

So, take a few big deep breaths...join that group may be a rollercoaster ride for a while but, chances are, you'll both be fine.

Geno 507
March 16th, 2008, 03:11 PM
Thank you Rusty Cat, if you could see me now, I'm having a hard time seeing the screen, as the tears are just streaming down my face :( I am a highly emotional person, and I feel like I'm living in a night mare that I can't wake up from....God bless you all, Geno

Deda Brada
March 17th, 2008, 09:07 AM
I am so sorry to hear your Paula suffers from CRF. I know you live hell these days. I experienced that with my late kid Ljutko ("Angry"), who passed away on the 20th of February 2007. I can't give you any prognosis, because I don't know his creatinine and urea values (Europeans use mmol/l instead of mg/dl, and I don't know to convert it). If I knew, I could tell you pretty exact prognosis, according to my experience. On the other side, it is a great deal individual. I wish you and your Paula all the best, but it's upon you to be realistic and realize when it's the end. Do not torture poor little for selfish reasons, like I did, which I'll regret till the end of my life.

If Paula eats by her own will, without any stimulants, and if she doesn't vomit every bite and sip she eats or drinks, than you still got time.
One important thing about nutrition: your cat, first of all, must eat. Veterinary foods for managing CRF are not very palatable, so vast majority of cats don't want to eat them. It is more important to let your cat eat the food which she likes, than to insist on veterinary food. Veterinary foods are low in phosphorus (you can use phosphorus binders instead) and lower in proteins (b/c of ammonia, i.e. urea).
There are many things you must try besides administering fluids. I won't write about it because there are two sites, among many, which you should visit and see what else you can and should do for her:

I believe that you already visited sites which Sugarcatmom suggested.

Don't blame your vet for her attitude. Maybe she has enough experience with this syndrome, so she can't be optimistic. Anyway, if Paula ...(bold letters), don't hurry. If you feel she doesn't suffer yet, let her live. And for heaven's sake, let her live her last days the way she likes. Let her roam and everything else she wants.

Geno 507
March 17th, 2008, 02:24 PM
Growler, do you know where I can find grain free wellness turkey and eaglepack holistic chicken in Florida? What stores might have it? Thank you.

Geno 507
March 17th, 2008, 02:26 PM
Thank you Deda Breda for your input- I appreciate it.....Geno

March 17th, 2008, 02:42 PM
Growler, do you know where I can find grain free wellness turkey and eaglepack holistic chicken in Florida? What stores might have it? Thank you.

Here's the Wellness site
The toll-free # 1-800-225-0904

For Eagle Pack:
Toll-free 1-800-255-5959

Geno 507
March 17th, 2008, 07:44 PM
Thank you RustyCat I appreciate the info very much-
I was trying to post a photo of my Paula from a website, but all I get is a red x where the photo should be :(
Regards, Geno

March 17th, 2008, 08:17 PM
Thank you RustyCat I appreciate the info very much-
I was trying to post a photo of my Paula from a website, but all I get is a red x where the photo should be :(
Regards, Geno

Geno--check the url in the tags--in your other thread there were two "http://"s--growler (I think) fixed it on a quote and the picture shows in [I]her post. :thumbs up (She's a gorgeous kitty, by the way...and very lucky to have you.)

Geno 507
March 17th, 2008, 09:25 PM
Thanks Hazelrunpack I'll check that out.....

March 17th, 2008, 10:20 PM
Growler, do you know where I can find grain free wellness turkey and eaglepack holistic chicken in Florida? What stores might have it? Thank you.

Here's the Wellness site
The toll-free # 1-800-225-0904

For Eagle Pack:
Toll-free 1-800-255-5959

Thanks Rustycat :thumbs up

Geno, here is the store locator for Wellness in FLA (

For Eagle Pack Holistic - enter the zip code from the vet & this will show you where to buy within a radius you specify, but the stores that carry Wellness most likely will have Eagle Pack as well

How's your sweet girl today after her IV fluids? :goodvibes: :fingerscr

Geno 507
March 18th, 2008, 04:15 PM
So far she is holding in there Rusty- after 2 sessions of SQ again today.
Tehy are giving her 200 mils a day, once in the AM and once in the PM.
Every day. I hope this is not to taxing on her kidneys, there is so little that I know. I know her values are high really. Thanks for the kitty food info....Geno

March 18th, 2008, 07:32 PM
Geno 507 - Check your private messages

Geno 507
March 24th, 2008, 08:29 PM
Hello friends,
Well here we are on the 24th of March, Ive not good news concerning my Paula....They did blood work again today, and creatine and bun levels are up to 8.8 from 7.3 on the 17th creatine, and bun is up from 57 to 74 also since the 17th.
She is eating less and less as time goes by, and the vet continues to say she should get 200 mils of sqs a day, plus the capsule azodyl and pepsin.
She don't seem to be peeing as much as she did earlier, I'm wondering if I will get her back to NY with us....We are leaving Florida the 12th of April, and I have Vet info at the 3 motel sites we stay at on the way home. I'm hoping and praying, and I'm a physical wreck this grief is laying on my shoulders...
Take care friends, Geno

March 24th, 2008, 08:53 PM
Geno I'm so sorry to hear Paula's numbers are higher still.:grouphug: I would think she should be on IV fluids daily right now not subq, is she still in hospital?

There is a fishy treat that can be added to her food that hopefully will encourage her to eat, called Kitty Kaviar ( this is dried Bonito flakes just add to the top of her food. I know I mentioned earlier to try to limit the fish, but right now what is more important is to get her to eat. Kitty Kaviar can be found at the same stores that carry the Wellness & Eagle Pack.

Have you asked the vet about homeopathic treatments in combination with what she is getting now?

Lots of :pray: :goodvibes: :fingerscr and :grouphug: for Paula, you and your wife

March 25th, 2008, 05:09 PM

I am so sorry you are going through this. I really hope you can get her numbers down with the fluids. Like the other posters said, there is very good hope for animals with long as it is managed properly!

I have a dog with CRF, so I understand your frustrations and fears right now, it can seem so overwhelming. Someone already suggested the Yahoo CRF boards. They are amazing. They have them for dogs too and I learned so much from there! I have shocked my vet with the knowledge I have now!

that k/d stuff is just awful! poor paula! Is it possible to maybe home feed? that's what many of us with CRF dogs do. It really makes a difference. I know cats have different nutritional needs. And remember it is PHOSPHOROUS you need to worry about, not protein. Check out for good deals on meds/fluids. THere's stuff there to help your cat eat. And once she pulls through, sub-q fluids will become part of your life! It does truly help believe me! It's a little scary at first poking your kitty with the needle..but you'll become a pro in no time I promise!

The consensus for the most part is unfortunately many vets aren't up on the latest and greatest and thanks to communities like these we are able to educate each other and take care of our pets.

While kidney disease isn't 'curable'. It can be managed, and your girl can have a good quality of life. Good luck to you and please keep us posted!! We are all rooting for you!! :pray:

March 25th, 2008, 06:34 PM

Can you syringe feed your kitty while you are travelling at least? I purreed (sp?) canned k/d food with filtered water and used a large bore syringe to feed our dear Oscar three times a day, just to insure he ate enough (whether he liked it or not, poor boy). I got the syringes from the drug store. They were about 10 cents a piece. We managed to maintain his weight or at least slow down the weight loss this way.

About the Sub-Q fluids, if I can do it anybody can. In the long run, it was easier on Oscar having it done by us at home rather than the vet in that scary place. You can squeeze the bag and deliver 200 mils in just a few minutes. I did find it helpful to have two sets of hands.

The whole process, combined with the way you are feeling, is so sad and draining. My thoughts are with you. :fingerscr

Geno 507
April 10th, 2008, 08:47 PM
Hello everyone,
And thank you for the kind words of support. I am leaving Florida monday morning, headed back to NY, and I have vet appointments set up in Ga, NC, and PA as we travel along. I still feel they can adminster the fluids and meds
she is on better then I can, so thus the appointments made.
She is doing fairly well as of now, although I don't know her numbers, (not sure if I want to know) She's been getting 200 mils every other day and 100 mils on the in between days....along with Azodyl, pepsin, and reglan for nausea. I discovered she really likes baby food, stage 1, chicken and chicken broth, ham and ham broth, haven't tried the turkey yet. My biggest anxiety is getting her to the vets on time as I can, as I'll have to unhook my RV at the various motel stops and leave it there while I drive her to the vets address. I hope there is nothing wrong with giving her the baby food, as she likes it, and supplements the IAMS dry food that she also likes.
Just an update for now, will have no computer contact as of Sunday afternoon, as will be taking down and loading things up. Take care friends,
Luv from Paula and myself....Geno

Jim Hall
April 10th, 2008, 10:50 PM
THe best of luck on your journey Plaese let us know how you made out

April 11th, 2008, 12:08 AM
Geno thanks for checking in I was wondering about you & Paula :grouphug:

Wonderful that you have appts set up along the way :thumbs up

Babyfood is fine provided there are no onions.

My :pray:ers are with you & sweet beautiful Paula

I'm expecting updates along the way ;) when you can :D

:goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes:

Geno 507
April 12th, 2008, 09:29 PM
I need help please!
My Paula the past few days has been raising a ruckus at the vets office when they try to administer her sub qs....its as if enough is enough and she can't put up with it anymore. 5 straight weeks of sub qs every day and pills
including the large azoydl capsule being forced down her throat is got to be stressful to say the least. Now I am so scared when I go to take her to the various vets along the way back to NY....This morning she vomited twice riding to the vets office, and when I told them what happened, they didn't giver her her azoydl capsul, and pepsin tablet. They gave her a shot of Reglan under the skin, and only about 70 mil of sub qs today. I don't know whats going to happen tomorrow when I take her to the emergency vets center here in florida for treatments of sub qs and meds. Anyone with any ideas on how to make this a little easier on her would be greatly appreciated.
take care, Geno

April 12th, 2008, 09:47 PM
Any chance you could give her the sub q's, Gene? My sister's cats were always so much more relaxed and comfortable when she administered the fluids at home than when she had the vet do it.

April 12th, 2008, 09:47 PM
Ask the vet there if they have Rescue Remedy aka Bach Flower Essences/Remedy it is a natural calming mixture of flower essences. Before giving to Paula please ask the vets incase there is any confliction with the pills she is currently receiving.

I'm wondering if she is stressing abit because she knows you are stressed about the trip home, animals are so sensitive to our mood & feelings. Try to remain calm & think positive happy thoughts when you are around Paula ~ I know it maybe hard to do but if you believe I think it makes a difference.


:goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes: :goodvibes:

Geno 507
April 13th, 2008, 09:13 AM
Thanks people, but I just CAN,T get myself to stick those needles into her, much less trying to get her to swallow her pills, especially the azoydl capsule. maybe it would be better if i left the room when they do it, and then I would wonder if they really did give her her pills....I guess I have to learn to trust people, oh my...Geno

April 13th, 2008, 11:19 AM
Couple of things come to mind about the subQs:

First of all, at the vet clinics they don't have time to warm the fluids, so Paula could be reacting to the strange sensation of slightly coldish liquid going under her skin. I really think it makes a difference to use body temperature fluids instead, which is why I prefer to do subQs at home.

The other problem could be the size of the needle they use. Again, at a vet clinic they're trying to get the job done as fast as possible, so they tend to use big fat 18 gauge needles to let the fluids flow faster. These things are harpoons! But there are better options. If you can track down some Terumo Ultra Thin Wall 20 gauge needles, it will be much more comfortable for Paula and the flow rate is not much slower. You can ask the clinics to use them instead of the 18g ones (if you bring your own, I doubt a lot of clinics stock them). Here's a link showing the needle differences:

And of course the stress of being in a strange vet clinic could be adding to the problem. Are you sure you can't get one of the tech's to show you how to do fluids yourself? Yes, it's scary at first, but just think of Paula and how you're doing it for her benefit. You can give her treats while you do it, and talk to her calmly, explaining what you're doing and why. You have the resources to make it a more relaxing experience all around. I'm sure she'll appreciate.

I wish I could help you with the pilling, but my guy is a terror when it comes to getting stuff down his throat.

All the best to you, and keep giving us updates!

April 13th, 2008, 11:55 AM
I know exactly how you feel about the needles, Gene. I've been known to pass out at the mere sight of them. :rolleyes: :o But after we got Macie and found out she had demodectic mange, we had to try to reduce her stress. And since she hated going to the vet, that meant we had to give her her vaccinations at home.

I remember the day I did it for the first time--I practiced in my head and with hand motions for over an hour: pull up the scruff, insert needle, hit the plunger, withdraw...over and over and over again. And finally, heart racing, mouth dry, light-headed, I decided it was time. Guess what happened? After all that practiced insert-hit-the-plunger-withdraw, I put the needle in and froze, waiting for an ear-splitting shriek. :eek:

It took me about 5 seconds before I realized it wasn't coming. :o Macie just didn't care. :dog: So I hit the plunger, got the needle out and Macie licked my nose...

Now it's not a big deal. :shrug:

But really, don't sell yourself short! You can do this, Gene--honest! If woossy ol' hazel can do it...and if hazel's even woossier little sister can do subQ's on her kitties, you can! Honest!

After the first time, it gets lots easier. :thumbs up You might even find that both of you enjoy it as a special time together. My sis's last kitty actually would come over for his subQs and purr the whole time.

Good luck, Gene. Such a hard thing. :grouphug: But if you can manage it, I think Paula will appreciate it!

April 13th, 2008, 01:54 PM
Oh I hope all will work out for you.

September 12th, 2008, 10:14 PM
My cat just had her tests run... There were two tests. One measured the CREA and BUN. The other test was a Hematology and I think it also measured Anemia.

Hematology test showed everything in a normal range. The vet said that if she was in extreme renal failure that these would be elevated also. I believe this is the test for Anemia. And if she was in extreme renal failure ; it would show up here.

The other test included the Bun and Creatine.
Her Bun is at 84 and Crea is 4.1
And yes they are high but they have been coming down.
I put my cat on Purina veterinary KF Kidney Function.
Supposedly it is the quality of food that can affect these levels.
The vet also provides me with metoclopramide. It is a liquid medication that I give twice a day to my cat. It prevents her from throwing up.

Even though the Bun and Crea are considered high, they are improving from last time just due to the food and because I am administering the medicine.
By preventing her from throwing up it improves the dehydration.

These two simple things are improving her levels.
She told me to come back in six months... or if the medicine is not preventing her from throwing up. That means that she is not getting worse and that the medicine is effective.

Don't let a vet put your friend to sleep. Find a doctor that will help you. My last vet put my other cat to sleep. They told me he was suffering and that I should put him to sleep. He was gaining weight, and would go on walks with me. They made me feel that I was torturing him. If the Doctor said to put the cat to sleep.... GET A SECOND OR THIRD OPINION!!!!!!
And get Vet approved food.

September 12th, 2008, 11:33 PM
natasha499 have you spoken to your vet about sub-q fluids yet? Those numbers are quite high and if your cat is having trouble with nausea it is a good idea to give them the extra boost of fluids.

The vet diets even the kidney formulas are really not the best food for cats. There is very little protein in the food and that is not good for an obligate carnivore, cats need high quality protein. When consistently fed a low protein diet this can lead to muscle wasting and weakness - 2 common issues in the CRF cat. The latest studies in CRF have shown high quality protein is better than low levels of protein for maintaining the health of the cat, high quality protein will naturally have lower levels of phosphorus.

Have a look at the ingredients in what you are feeding and compare that to the ingredients in Wellness Canned Turkey

Purina Veterinary Canned NF: Water sufficient for processing, liver, beef, poultry by-products, trout, rice, animal fat preserved with mixed-tocopherols (form of Vitamin E), ground yellow corn, animal digest, pea fiber, wheat flour, calcium carbonate, potassium citrate, fish oil, potassium chloride, magnesium citrate, taurine, choline chloride, ferrous sulfate, zinc sulfate, Vitamin E supplement, niacin, thiamine mononitrate, manganese sulfate, copper sulfate, calcium pantothenate, Vitamin B-12 supplement, pyridoxine hydrochloride, riboflavin supplement, biotin, folic acid, Vitamin D-3 supplement, calcium iodate, sodium selenite, menadione sodium bisulfite complex.

The highlighted red are ingredients I question - the corn, wheat, pea fibre and rice are unneccessary fillers and are the cause of many allergies in pets, "poultry" "animal fat" "animal digest" and "fish oil" do not give the animal source, there are several types of poultry and fish and what source are they using for "animal...."? For example many pets are allergic to chicken by are okay with Turkey in this food there is no distinction between these 2 types of poultry.

Wellness Canned Turkey: Turkey, Chicken Liver, Chicken, Chicken Broth, Carrots, Natural Chicken Flavor, Sweet Potatoes, Squash, Zucchini, Cranberries, Blueberries, Guar Gum, Carrageenan, Ground Flaxseed, Potassium Chloride, Calcium Carbonate, Dicalcium Phosphate, Taurine, Iron Proteinate (a source of Chelated Iron), Beta-Carotene, Zinc Proteinate (a source of Chelated Zinc), Vitamin E Supplement, Choline Chloride, Cobalt Proteinate (a source of Chelated Cobalt), Thiamine Mononitrate, Copper Proteinate (a source of Chelated Copper), Folic Acid, Manganese Proteinate (a source of Chelated Manganese), Niacin, d-Calcium Pantothenate, Sodium Selenite, Vitamin D-3 Supplement, Pyridoxine Hydrochloride, Riboflavin Supplement, Vitamin A Supplement, Vitamin B-12 Supplement, Potassium Iodide, Biotin.

You will find a lot of information and links in my cat's kidney failure thread here:

I have been dealing with this disease for over a year now, my 17 year old cat is maintained very well on whole food supplements and a raw meat diet. She has no issues with nausea & is showing no symptoms except the usual extra drinking & peeing that goes with the territory.

If you have any questions please let me know I will be happy to help. :goodvibes: for your cat