Blog Archive

Sunday, July 31, 2016

Ever wonder? Creating a factor product

In this week’s blog we’re highlighting a short video that shows an inside look at the process that goes in to making ADVATE [Antihemophilic Factor (Recombinant)], a treatment option for hemophilia A. As always, please stay informed about all treatment options and proactively discuss with your physician what may be right for you.

Over its 12 year history as an available treatment option for hemophilia A, there have been more than 24 billion units* of ADVATE distributed worldwide!1,2 Have you ever wondered who made all those units of ADVATE and how? On the ADVATE [Antihemophilic Factor (Recombinant)] website you can get a behind the scenes look at one of the manufacturing facilities to see the process including production, aseptic manufacturing and packaging of the final product. Watch the video here! 
ADVATE is a medicine used to replace clotting factor (factor VIII or antihemophilic factor) that is missing in people with hemophilia A (also called "classic" hemophilia).

ADVATE is used to prevent and control bleeding in adults and children (0-16 years) with hemophilia A.
Your healthcare provider may give you ADVATE when you have surgery.
ADVATE can reduce the number of bleeding episodes in adults and children (0-16 years) when used regularly (prophylaxis).
ADVATE is not used to treat von Willebrand disease.
You should not use ADVATE if you:
  • Are allergic to mice or hamsters.
  • Are allergic to any ingredients in ADVATE.
Please see Detailed Important Risk Information below. For full ADVATE Prescribing information, visit
ADVATE is a medicine used to replace clotting factor (factor VIII or antihemophilic factor) that is missing in people with hemophilia A (also called "classic" hemophilia).
ADVATE is used to prevent and control bleeding in adults and children (0-16 years) with hemophilia A.
Your healthcare provider may give you ADVATE when you have surgery.
ADVATE can reduce the number of bleeding episodes in adults and children (0-16 years) when used regularly (prophylaxis).
ADVATE is not used to treat von Willebrand disease. You should not use ADVATE if you:
Are allergic to mice or hamsters.
Are allergic to any ingredients in ADVATE.
Please see Detailed Important Risk Information below (or on page 2). For full ADVATE Prescribing information, visit: insert link,ADVATE is a medicine used to replace clotting factor (factor VIII or antihemophilic factor) that is missing in people with hemophilia A (also called "classic" hemophilia).
ADVATE is used to prevent and control bleeding in adults and children (0-16 years) with hemophilia A.
Your healthcare provider may give you ADVATE when you have surgery.
ADVATE can reduce the number of bleeding episodes in adults and children (0-16 years) when used regularly (prophylaxis).
ADVATE is not used to treat von Willebrand disease. You should not use ADVATE if you:
Are allergic to mice or hamsters.
Are allergic to any ingredients in ADVATE.
Please see Detailed Important Risk Information below (or on page 2). For full ADVATE Prescribing information, visit: insert link,Want to learn more?
Watch video stories from those at different points in their journey with hemophilia A

Download helpful resources designed to help you reach your personal goals

Review CoPay program information to see if you’re eligible to receive financial assistance to help cover medication costs

*As of 2016

ADVATE [Antihemophilic Factor (Recombinant)] Important Information

ADVATE is a medicine used to replace clotting factor (factor VIII or antihemophilic factor) that is missing in people with hemophilia A (also called "classic" hemophilia).
ADVATE is used to prevent and control bleeding in adults and children (0-16 years) with hemophilia A.
Your healthcare provider may give you ADVATE when you have surgery.
ADVATE can reduce the number of bleeding episodes in adults and children (0-16 years) when used regularly (prophylaxis).
ADVATE is not used to treat von Willebrand disease.
You should not use ADVATE if you:
  • Are allergic to mice or hamsters.
  • Are allergic to any ingredients in ADVATE.
Tell your healthcare provider if you are pregnant or breastfeeding because ADVATE may not be right for you.
You should tell your healthcare provider if you:
  • Have or have had any medical problems.
  • Take any medicines, including prescription and non-prescription medicines, such as over-the-counter medicines, supplements or herbal remedies.
  • Have any allergies, including allergies to mice or hamsters.
  • Have been told that you have inhibitors to factor VIII (because ADVATE may not work for you).
Your body may form inhibitors to factor VIII. An inhibitor is part of the body's normal defense system. If you form inhibitors, it may stop ADVATE from working properly. Consult with your healthcare provider to make sure you are carefully monitored with blood tests for the development of inhibitors to factor VIII.
You can have an allergic reaction to ADVATE.
Call your healthcare provider right away and stop treatment if you get a rash or hives, itching, tightness of the throat, chest pain or tightness, difficulty breathing, lightheadedness, dizziness, nausea or fainting.
Side effects that have been reported with ADVATE include: cough, headache, joint swelling/aching, sore throat, fever, itching, dizziness, hematoma, abdominal pain, hot flashes, swelling of legs, diarrhea, chills, runny nose/congestion, nausea/vomiting, sweating, and rash.
Tell your healthcare provider about any side effects that bother you or do not go away or if your bleeding does not stop after taking ADVATE.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088.
To see the Full Prescribing Information, go to

1.     Data on file. Westlake Village, CA; Baxalta Healthcare Corporation.
2.     Grillberger L, Kreil TR, Nasr S, Reiter M. Emerging trends in plasma-free manufacturing of recombinant protein therapeutics expressed in mammalian cells. Biotechnol J. 2009;4(2);186-201.

Shire, Baxalta, and Advate are trademarks of Shire plc, its subsidiaries or affiliates.
Baxalta, now part of Shire, provided the content of this blog and sponsored its publication.

Sunday, July 24, 2016

WFH Congress: "Life chose this for us"

This week, for the first time in 26 years, the World Federation of Hemophilia is holding its biannual Congress on American soil. Gathered in Orlando, Florida are about 3,000 healthcare workers, patients and representatives from patient national organizations who want to learn from each other to advance care for bleeding disorders in their countries. Tonight was the opening ceremony, much toned down from years past. The focus was entirely on the 75% of the world's 400,000 with hemophilia who have little or no access to care. What a huge change! The WFH--and the NHF, which held its annual meeting just last week--are together committing to help the world's poor get access to the medication they need. This is the first time the NHF and WFH are holding meetings back to back, creating the largest gathering of bleeding disorder patients in history.

A crammed, enormous audience sat quietly listening to interviews with four speakers during the opening ceremony: Alain Weill, president of the WFH, and Jorge de la Riva, chair of NHF. Then, Alain Baumann, CEO of WFH and Val Bias, CEO of NHF. Jorge's opening speech was passionate and focused on what he experienced when his son was born with hemophilia 21 years ago. "I am willing to fight for my son with my dying breath, for his health, his future, his life," he revealed to the crowd. "Life chose this for us," he remarked, but hemophilia would not dictate their life. Jorge acknowledged that his son is privileged to grow up with plentiful access to factor, but is cognizant of the underserved globally. He quoted Olympic skater Scott Hamilton, who also had a chronic disorder: You can succumb to it, adapt to it, or evolve and become better because of it. This latter is what we want to focus on in our community. Evolve. Jorge added, "It can be a gift, which can spur you to action, for something bigger than ourselves."

At Save One Life booth: Martha Hopewell (executive director),
Agnes Kisakye (Uganda), and Usha Parasarathy (our India liaison)
That "bigger than ourselves" needs to be the developing world, where children suffer daily from untreated bleeds. The WFH showcased a film (produced by Patrick Lynch of Believe Limited) which portrayed a mother and a young man who grew up in Africa. Over and over the mother said, "I'm tired." Tired of pain, of sleepless nights, of living day to day. It's for them that we work so hard at the WFH, at Project SHARE, at Save One Life, to find ways to bring them care, to help them gain access to factor so they can live normal lives. I'm truly pleased to see that WFH is working now in tandem with NHF to bring care to other countries. And we at LA Kelley Communications will also work more closely with NHF, WFH and the Novo Nordisk Haemophilia Foundation to offer what we can. We've been assisting developing countries for 20 years, since 1996, and it's amazing and gratifying to see all the groups coming together. For only together can we solve the problems of bringing factor and treatment to all.

We have four days of meetings, symposia and networking ahead of us. Then two weeks from today, I start my ascent up Mt. Kilimanjaro! Why? To fundraise for Save One Life, to bring attention to the plight of the poor in developing countries with hemophilia, to summit and unfurl our banner on the highest peak in Africa, and the highest freestanding mountain in the world. It's a metaphor for our work in other countries: a long, hard climb with no amenities, but the view at the top makes it all worthwhile.

Fun scenes from close of NHF Conference last week:

Sunday, July 17, 2016

Introducing Team Novo8™

Have you ever wanted to connect with someone who is going through a similar experience as you? Well, Team Novo8™ patient ambassadors are here to share their personal stories with the hope of encouraging, motivating, and providing support in your journey living with and managing hemophilia. Team Novo8™ consists of a variety of people who have hemophilia and who want others affected by hemophilia to know that they are not alone.

Team Novo8™ is involved in the hemophilia community and actively participates in speaking engagements and community initiatives on behalf of Novo Nordisk. Team Novo8™ patient ambassadors hope to learn more about the needs of the hemophilia community and better understand the challenges and personal successes they have experienced.

Meet one of the Team Novo8™ patient ambassadors—Shawn. He is an energetic public speaker, writer, musician, and health education instructor. When he was 2 years old, Shawn was diagnosed with moderate hemophilia A after his parents noticed some unexplained bruising. Because he was diagnosed at such a young age, Shawn developed lifelong relationships with his doctors and nurses. He travels with his partner, Gwenn, to speak at colleges about nurturing loving relationships while living with medical conditions.

Brian, Alfredo, Arther, Shawn, Daniel, Tyler, and Eric
(clockwise from top left) live with hemophilia A
Team Novo8™ offers a unique perspective on managing hemophilia. Overall, patient ambassadors from Team Novo8™ have found that Novoeight® fits into their lifestyle and they want to help inspire other patients and caregivers with their stories. Learn more about the patient ambassadors on Team Novo8™ by visiting

A Hemophilia Community Specialist (HCS) is also an excellent source of support and can direct you to many helpful resources, including learning more about the Team Novo8™ ambassadors. Find your local HCS by visiting

Team Novo8™.
Personal stories. Authentic connections.

Indications and Usage
Novoeight® (Antihemophilic Factor [Recombinant]) is an injectable medicine used to control and prevent bleeding in people with hemophilia A. Your healthcare provider may give you Novoeight® when you have surgery.

Novoeight® is not used to treat von Willebrand Disease.

Important Safety Information
You should not use Novoeight® if you are allergic to factor VIII or any of the other ingredients of Novoeight® or if you are allergic to hamster proteins.

Call your healthcare provider right away and stop treatment if you get any of the following signs of an allergic reaction: rashes or hives, difficulty breathing or swallowing, tightness of the chest, swelling of the lips and tongue, light-headedness, dizziness or loss of consciousness, pale and cold skin, fast heartbeat, or red or swollen face or hands.

Before taking Novoeight®, you should tell your healthcare provider if you have or have had any medical conditions, take any medicines (including non-prescription medicines and dietary supplements), are nursing, pregnant or planning to become pregnant, or have been told that you have inhibitors to factor VIII.

Your body can make antibodies called “inhibitors” against Novoeight®, which may stop Novoeight® from working properly. Call your healthcare provider right away if your bleeding does not stop after taking Novoeight®.

Common side effects of Novoeight® include swelling or itching at the location of injection, changes in liver tests, and fever.

Please click here for Prescribing Information.

Novoeight is a prescription medication.

You are encouraged to report negative side effects of prescription drugs to the FDA.  Visit or call 1-800-FDA-1088.

Sunday, July 10, 2016

Choice: Once Upon a Time

By Chris Ingram

Chris Ingram and family
There was a time when we could choose a specialty pharmacy that not only could obtain the factor brand we needed, but understood hemophilia, knew us personally, and gave us the best customer service we had ever received. How did they understand hemophilia and its challenges so well? Maybe someone at that pharmacy or their loved one had hemophilia. We were always connected by the common diagnosis. To me, it seems like those times were just a fairytale.

Now specialty pharmacies are being chosen more often by the insurance company, run by healthcare professionals who claim to understand hemophilia. I am here to tell my story about how much of a nightmare it can be to have a specialty pharmacy that does not “get” hemophilia and our needs. I hope in the future no one ever goes through what I did just to get factor.

The hemophilia specialty pharmacy I had been using for two years, operated by people with hemophilia, closed. I decided to try another one (I’ll call it “Hemophilia Pharmacy”), also operated by people with hemophilia. I found out that they were not in network and my insurance company (I’ll call it “Big Payer”) wanted me to use their own specialty pharmacy (“Payer SP”). Hemophilia Pharmacy started getting contracted with Big Payer, which is a lengthy process. In the meantime, I still needed a specialty pharmacy.

I called “Salud SP” here in Arizona.  They started the process to get the precertification so they could service me. They were not in network. So that is now two pharmacies I have looked into with no luck. On to the next pharmacy.

I then decided to contact “National SP,” which knows hemophilia well and is contracted with my plan. By this time I was running really low on factor; I had only three doses left and just had oral surgery two weeks prior. National SP could not get my factor brand! I guessed it was due to my using a new factor brand that was only recently made available. National SP told me I had better use “Pet SP,” the payer’s specialty pharmacy.

 So that was the third specialty pharmacy that I had struck out on!

Every time I tried to use a specialty pharmacy that knew hemophilia, I was told that Big Payer wanted me to use Pet SP. So I called Pet SP and start the enrollment process with them. I also told them that I need the factor to be processed under the medical benefit not the pharmacy. They told me that they bill under the pharmacy, unless it does not get approved (then they will bill under medical). Under pharmacy, I would be responsible for 50% of my factor costs! My out of pocket cost would be $45,000 every month. I did get transferred to a representative who listened to me, and said if I ask to process under medical, then they will do that first. Then he told me something unbelievable. Pet SP cannot get my factor brand!

I must use Pet SP but it cannot get my factor! So Pet SP told me to use their sister specialty pharmacy, “Sister SP.” I called Sister SP, related my story, and asked about my factor brand. They told me I was given wrong information. They ended up calling Pet SP, and asking them why I was told this information when it was false.

At this point I was furious. I called up Big Payer; I told them I want answers. Why is it no specialty pharmacy can obtain my medicine? They said they would look into it, an answer I thought was unacceptable. I firmly told them they have until tomorrow to give me an answer or I will be calling the state insurance commissioner to step in and I will also be calling a lawyer.

 When I hung up I began researching different lawyers and trying to get a consult to see if I have a case. I had been working with Big Payer for three weeks with no solution; I felt like I was being neglected. I did not hear anything from Big Payer the next day. The following day I took the day off of work to make more calls. The state insurance commissioner called back to learn more, and two different lawyers called who were interested in the case. The supervisor for Big Payer called, and said she was going to make sure this got taken care of. By now I was out of factor.

Several hours passed by and I finally got a call from the Big Payer supervisor. She found a specialty pharmacy in California that could get my factor to me the next day.

I told her this was unacceptable; I needed factor today-- no exceptions. I had told them that Salud SP was in Arizona and could get me my factor brand within hours of getting an approval. The situation escalated to involve Big Payer’s medical director, who approved a one-time, 30 day authorization for Salud SP. I had my factor two hours later!

This is not the first time I’ve had an issue with my insurance company, but this is the first time it involved my factor brand accessibility. Is choice of specialty pharmacy—and maybe factor brand—just a fairytale now?

Chris Ingram is a certified professional coder (CPC) who
currently works at UnisLink. He’s worked as a medical biller
and coder for the following medical specialties: anesthesiology,
urgent care, pain management, gastroenterology, internal
medicine, pediatrics, ob/gyn, orthopedics, and trauma surgeons.
He has also taught medical billing and coding at two colleges.
In his spare time, Chris loves attending car shows and doing
car detailing for family and friends. Chris has severe hemophilia
A and lives in Arizona. Contact Chris at


Sunday, July 03, 2016

Ape Over Hemophilia

During my Uganda trip in April, I spent two days visiting the amazing Bwindi Impenetrable Forest, which hosts the largest number of mountain gorillas in the world. These are different than the ones you see at the zoo, which are Lowland gorillas. Mountain gorillas are protected by law, and Uganda has done a spectacular job at warding off poachers and protecting these highly intelligent, family-oriented animals. With limited numbers of passes each year, I was lucky to get one and view two different families. Below is my experience with one of them.

When our guide told us that gorillas share 98.8% of our DNA, I was shocked. I wondered, can gorillas get hemophilia? I imagine they could. There are less than 1,000 of them, living in four national parks in three countries. If 1 in 5,000-10,000 human males are born with hemophilia, perhaps there are no gorillas with hemophilia… yet?

Thursday, April 28, 2016   Bwindi Impenetrable Forest

The rains are bathing everything in moisture, which heightens the colors of the emerald forest and yellow flowers. I hear birds repeating their songs, the constant background of cicadas, the gentle rains. Every now and then one of the workers at the Gorilla Forest Sanctuary—Nicholas, Eli, Judith— stops to see how I am, and how the day was. It has been a marvelous day.

I awoke this morning in my safari tent to the distinct three-note sound of a local bird, and the whirring crickets. It’s peaceful here. The day was overcast and cool. After breakfast, I skipped down the red stones of the Sanctuary, took a left on the gravel road and within a few hundred feet reached the sloping driveway of the Ugandan Wildlife Authority. I was the only one from our lodge; a few people from other outfitters joined us, milling about on the lawn. We were to track the “Rushegura family” of apes. This is an active group, on the move, comprised of 19 family members. (Read more about this family here)

Our group was: Stephanos and Leeza from South Africa; Ali, blonde, from the UK, who had asthma and was probably my age or a bit younger; a young woman from Israel; Gladys from the UK, who had a swishy ponytail and riding boots that looked wrong for this kind of hike; a tall guy, my age, with glasses and was very happy; and a German lady, tall and blonde.

Our guide was Gad, a dark-skinned man with a chiseled face and thin mustache, small but wiry, donning his army green wildlife outfit. As we set out on a long, flat dirt road for 30 minutes, we had a chat. I asked him how long he had been a guide. He replied 19 years, which seems a long time. “You must have been here pretty much when the forest was opened, right?” I surmised. “Yes, back in 1997. I know a lot of stories about the gorillas.” I asked if he then knew of Thor Hanson, author of The Impenetrable Forest, which I had just read.

“I know him!” exclaimed Gad. “You know when he writes about that family whose bananas were being eaten by the gorillas?” Yes! I told him, Chapter 16. The gorillas kept raiding the village farmers’ field, particularly banana trees, as they love the pulp (and not the bananas, contrary to pop culture). It was delightful to share my enthusiasm about the book (which is well written) with someone. He shared some stories about him being attacked by a gorilla, and still carrying the puncture wounds. We fell in to chatting quite a bit, and I told him he should write a memoir about his years: how the forest has grown as a tourist business; who were some of his memorable guests?

We started hitting dense forest after an hour. The gravely dirt road became a trail, and the real hike began. I have never experienced any hiking like this. For the next two hours, we hacked, stumbled, slipped, hauled, crawled and grabbed our way up the mountainside.

“The gorillas keep movin’,” one of the guides said, translating from the walkie-talkie conversation he just had with the trackers. The four trackers—armed with machetes for the undergrowth, and rifles for the wildlife— were far ahead of us, scouting for the Rushegura family. This meant we would have to follow them up the mountainside. It’s not called the Impenetrable Forest for nothing. The trail very quickly turned into a 45° hike, through thick vegetation designed by Nature to keep trespassers out. The light chitchat that bounced back and forth between the trekkers petered out, as each person focused on where each foot would land. It was an exercise in pedestrian strategy: if you put your foot on a root as a launch pad, you might slip from its slimy covering, or it might twist suddenly free and ensnare you. If you fall, you crash on more roots, downed branches, wild vines. You put your foot up on the hill sideways (you can’t often go straight on because the angle is too steep), ducking to avoid creepers, vines, branches above you and at face-level; you reach up, dig your walking stick with the carved gorilla head on it into the muddy ground above you, pull and push, then steady yourself by grabbing a tree to hoist yourself. Ouch! The trees are covered with moss and usually thorns from some of the creepers. You quickly learn which trees and creepers to avoid. All the while you ascend, more and more, higher and higher. Sweat pours off you, the trees above drip on you, the mud splatters you. “Trampled Underground” played in my head.

The trail, barely qualifying for that title, is strewn with rotted vegetation: brown leaves, moldy green ones, moss, and a cat’s cradle of vines that twist and ensnare. At times you lose your balance, and start to waver downwards. When you overcompensate and pitch forward your foot most likely is entrapped in the vines and roots, holding you back, so you start to fall faster into the muddy hillside. I lost my balance many times and once fell forward on the narrow and treacherous hillside trail, but couldn’t right myself because anywhere I put my hands I hit thorns. “Give me a hand up,” I pleaded to the South African couple near me and they righted me. We then had to stamp on the vindictive vines until my foot was free.

This was just one small step for mankind. We still had two more hours of this just on the way up.

As each of us focused on the botanical traps at our feet, we were surrounded by a primeval forest, which only knew how to attack and defend. Creepers encircled trees, trying to reach the top of the canopy to get sun, and strangling some trees over time. Certain trees grew immensely big, while saplings sprung up like mushrooms underneath. Every type of green thing known to humankind seemed to grow here, with no inch spared for space, except for what we hacked.

The trackers thwacked away with their two-foot long machetes, called pangas; branches lopped off trees in seconds. It seemed horrifying to watch them mutilate trees this way; in the States we try not to harm our trees. But you soon want a machete yourself to protect your arms and hands from the insidious thorny trees and stinging nettles.

I saw a sort of slo-worm, plump, blind and primitive, lying on the sodden trail. I pointed it out and our guide told us it was a neera. To amuse and shock them I picked it up; it worked. Suddenly my hands felt stinging and I hastily put it back. I couldn’t imagine why it stung me until I saw the safari ants crawling all over it. Later I saw a white shell, a smaller version of the ones we find at the beach, curled over and over to form a funnel. It was empty, and once belonged to a snail, probably a long forgotten victim of the safari ants as well.

We stop only once briefly, to catch our breaths as we are all heaving now, to sip water, and to listen to the walkie-talkie chatter of the trackers ahead. Gorillas still on the move. We wipe off sweat and start again. There is no small talk from anyone now; we are in our own little endurance trek. Ali leaned against a tree, seemingly defeated. We still have an hour to go. “Altitude sickness,” she says, but I’m not sure that’s it. We are up a high mountain for sure, but not the 13,000 feet where this sickness would manifest. It’s just a very strenuous hike and someone should be relatively fit to tackle it.

The hired porters kindly hold hands with the women in the group. My porter, Stifa, is a girl younger than my youngest and I hired her as a community investment. Local porters depend on tourist dollars to help their community.

Eventually we meet up with the trackers on flat ground, and they look as exhausted as we do. Now we are all gathered in a small clearing; there are big potholes of mud around us. “Elephant,” one of the trackers said. Yes, elephants live up this wild mountain! Now the trackers hack the vines and branches trying to keep us from the gorillas, with a vengeance. They feel the gorillas are close by. Another 30 minutes of hacking, stepping, climbing.

At long last, after three solid hours, we hear the grunting of the gorillas. Sure enough, around a tree caged with vines and smaller trees, is a lone gorilla, stripping leaves off a branch with his teeth. We circled about and watched as he munched. He was not concerned with us; behind us, the Rushegura group. The silverback, “Mwirima,” lay on his back, one foot high in the air. Two babies, just a few months old, their wobbly heads trying to focus on us, lay in their mothers’ arms. One had a wildly wooly mane of hair. The struggle to get here took the wind out of us, and the gorillas were somnolent and lazy. But we stood about, snapping photos, quiet and respectful. None came near us. They are habituated to humans, meaning that over time, the park rangers have approached the group every day for an hour, for years, to get them accustomed to humans. They are wild, no doubt, and dangerous. One gorilla could easily kill you. The silverback weighs about 400 pounds. But they have been trained to be in the presence of humans and tolerate them. To visit them you must be quiet, move slowly, don’t go near them (though they might come near you), do not set off any flash photography (it frightens them, reminding them of lightning). And you can’t trek to see them even if you have a bad cold. Because gorillas share 98.8% of our DNA, they are susceptible to catching our germs. This made me wonder about hemophilia; can they develop it? No one seems to know.

The gorillas had feasted on the forest and were sleepy. Only the infants tried to break away and were very curious about us. Each time they tried to climb down off their sleepy mothers, the mothers gently took their arm and placed them back in their hold. The mothers were incredibly tender towards the infants.

A crackling noise revealed Ali made it after all! I quietly congratulated her and she immediately credited Gad for getting her there. “I have been a guide for 19 years,” reminded Gad. “I know people want to come see the gorillas. So I know how to make them come up the hill.”

Eventually, thunder burst overhead, warning us that a downpour was imminent. Gad politely suggested it was time to move. We all donned rain gear, which would prove useless within minutes. We bade the gorillas silently good-bye and began a slow march down the mountain. It took us only 90 minutes, half the time, but was every bit as treacherous. The rain burst like water sliced open from a huge camelback bladder in the sky. It hammered us relentlessly. My hood—I had forgotten to flip it up after I put on my trekking hat. When I did, of course it was filled with cool rainwater, which slid down my back uncomfortably. Within 15 minutes we were soaked to the skin, and soon no one cared anymore that we were wet. We had to focus on our feet again. Gravity pulled us, but the roots and vines weren’t done yet. Somehow I sped ahead of the group, keeping up at all times with the trackers. Through the rain, I watched as the lead tracker followed a series of yellow slashes on the trees, and neatly halved saplings; these were his markings for finding our way out. Otherwise, how would he know? They don’t use GPS or even compasses.

At one time he held onto a sapling as he walked, pulling it toward him then releasing it suddenly. It snapped back and whipped my left thumb painfully. Another time, I slipped in the mud—no surprise as now a stream of mud, clogged with decomposing leaves, became our trail, and the sudden thought that these beheaded saplings could easily impale someone. I vowed not to fall again.

There was time to enjoy the beauty of the rainforest. Everywhere you look, there was green: jade, emerald, forest… all shades and types. Ants crawled on the ground, birds occasionally chirped, but mostly the forest was deathly quiet, except for the rush of rain. The stinging nettles still caught on my pants relentlessly, and you released them like a cat’s claws, pulling them back first and then letting go. All of our clothing had minute holes in them from the nettles, and the next day, I would awake with dozens of small bumps on my legs, itching furiously where the nettles stung.

I descended rapidly, well ahead of the group. We eventually came to the waterfall, about 40 minutes from the Uganda Wildlife Authority building. The rain tapered off and we took photos in front of the falls. The falls pounded the rocks like white foamed fists. Nicholas had dashed ahead of us, and had stripped off his shirt to clean the mud off him in the pool. He looked so happy, and there was a certain simplicity about everything. Wet, muddy, sweaty, we were happy. Gad wanted to know what we wanted to do: eat lunch in our raincoats, in the rain, next to the waterfall, or continue? I wanted to continue on, not interested in eating. Everyone stood about, not able to make a decision. I simply said, all in favor of eating lunch here? The South African couple raised their hands hopefully. All in favor of moving on? Everyone else raised their hands. “Sorry!” I offered not apologetically. On we trekked!

The rest of the excursion was easier, even in the now light rain. The trail evened out but remained muddy, rocky, slippery, serpentine. It eventually spit us out on the main road again, that led to the UWA. Gad exclaimed, “You’re fast! Do you want to be a tracker?” Of course, I replied!

When we got back to the main building, I thanked Stifa, gave her most of my lunch, a big tip and pay, and then walked back to the Sanctuary, soaked, muddy and sweaty… and thrilled.

See photos of the gorillas here.