This past weekend I went climbing with a few friends at Elizabeth Furnace up in Northern Virginia. On Saturday we hit up a small roadside crag called Talking Headwall where we cranked over some pretty fun well protected roofs. We wore ourselves out and then the next day went to go climb Buzzard Rocks on some classic slab routes, a nice two mile hike up the mountain from Talking Headwall. It was a great weekend with some super fun climbing ranging from crimpy face climbs to juggy overhangs to featureless slab but you may deduce from me writing about it that in classic Grayson adventure fashion, things didn’t quite go as well as intended. Continue reading Rock climbing Buzzard Rocks near accident
We’ve all contemplated death I assume. I can’t imagine there’s anyone out there who hasn’t pondered their demise, who wonders how it might happen, and when. Death is a theme that hangs over every patient interaction in the hospital, no matter how benign. Even the patient’s coming in for a broken arm are asked, “If your heart was to stop beating, or your were to stop breathing, would you want us to pound on your chest and put a tube down your throat?” And in my chosen hobbies I am challenged to overcome or navigate around deadly obstacles and hazards all the time. I joked with a friend this past week when we were navigating around avalanche prone slopes, trying to find a way out of blustering cold, near white-out conditions, “I’m gonna pick up golfing when I get back. Or bowling.” But in rock climbing and mountaineering, open ocean sea kayaking, road cycling, mountain biking, etc, there is always the chance of not making it home. In mountaineering and rock climbing there is even an accident report compiling all the accidents and deaths of the year. It comes in pdf format and paperback for some light coffee table reading. Continue reading Reflecting on the dangers of mountaineering
Nearly constantly people are trying to talk me out of doing the things I love. My mom cringes when she hears plans for the next adventure. My aunts and family friends comment on facebook pictures demanding that I come home right this instant. Park rangers warn me of the dangers up above, ski patrol reminds me they won’t rescue me, hikers exclaim how dangerous rock climbing is and how many people die doing it. They’re not wrong to have those thoughts and I’ll admit that to reconcile those sentiments and my own fears with my cravings and love for adventures in the backcountry is a constant struggle. It’s the mountaineers dilemma to balance life at home and family with our own very selfish need to explore. Continue reading Balancing adulting vs adventuring
We were dilly dallying, procrastinating on packing, wanting to be there but not wanting to do the 6.5 hour drive to actually get there. So we farted around, took dogs for a walk, got some dinner, took dogs for another walk, and finally around 6pm we were ready to go. We were headed to Looking Glass Rock in southwest North Carolina, closer to Birmingham, Alabama than to Richmond, Virginia. We had deliberated for a while on where to climb. We knew we wanted something the trees, something south facing, some place warm-ish for late December, and ideally some place for trad climbing. Stone Mountain in NC had been our original goal but highs in the low 30s thwarted our desire compared to highs in the low 40s at Looking Glass Rock. So we committed to a longer drive for warmer temperatures and cruised southwest. Continue reading Climbing Looking Glass Rock
1. James Pearson on “The Walk of Life”
James Pearson making the first ascent of The Walk of Life with runout poorly protected featureless slab with a HUGE whipper. Doesn’t get any better than this. “You start off and you climb almost 10 meters with no gear and then you get a really, very bad nut which is, maybe you’d hang your coat of it.”
The myths of why hands swell while hiking
You’re five miles into a hike with a group of friends. You’ve never been hiking before and it sounded adventurous and fun and a great way to to get out and have fun with friends, enjoy being outside, and relax for a bit. And you’re having a great time with the exception of a weird feeling in your hands. Your wedding ring and watch are getting tight and your skin feels taut. Your arms feel bloated and you look down and sure enough you’ve got big old sausage fingers. Are you dying? Do you need to turn around and race to the hospital? Maybe you have cell service and after you post a quick pic to insta you do a quick WebMD search. It says you have heart failure or this weird thing called thrombosis. Now you’re worried and want to go back so you can do more internet searching before you head to the ER. When you get home you dig deeper in your internet searching and get more specific. Instead of just searching hand swelling, you search had hands swell while hiking and find an Outside Magazine article, where you may learn that you’re suffering from hyponatremia. You find a facebook thread of loads of confident expert internet commenters recommending the cure-all tip of hydration or electrolytes.
But nearly all this information you’ll find is absolutely, jarringly, painfully wrong, so I hope this article becomes the one to top out on the google searches so maybe some people will learn the real answer, and learn a real solution. You don’t have heart failure, you’re not alone, and you don’t need to hydrate.
The real reason your hands are swelling
The reason your fingers are swelling is multifaceted but actually pretty simple. Before I explain I just want to clarify again that you’re fine, it happens to everyone and it’s totally normal and reversible.
The vasculature in your body is just a giant network of leaky plumbing. Imagine your body being a greenhouse with a sprinkler hose with hundreds of little holes running through it. The water that didn’t leave the hose is simply looped back around, much like your veins bring blood back to your heart. That hose brings essential fluid to the plants in that garden. Your vasculature in your arm is very similar to that garden hose. It runs down your arm, releases water into that tissue, and the excess water drains back to be recycled. When you step on that garden hose, aka put backpack straps on your upper arms, it increases pressure and increases the rate of that fluid shooting out of the uncountable tiny holes in the hose.
This is one cause of the swelling. Another cause is that the backpack straps essentially dam up the return flow like putting a wall in the trough. Now imagine there’s a drainage trough alongside the garden which returns the excess water from the soil to a pool where it can be recycled back into the hose to continue watering the plants. That is comparable to something in your body called the lymphatic system, which, much like a drainage trough, is a series of ducts which drain extra water in that extravascular space and recycles it back to your heart. By clamping down on those lymphatic ducts with backpack straps, it dams the trough, preventing fluid from draining from that extravascular space.
There’s another thing at play though. And if you’ve ever hiked with trekking poles while still wearing a hand swelling inducing backpack, you may be able to reason through that there has to be something else going on by the fact that trekking poles totally fix the problem. When we hike with trekking poles, even if we have the heaviest of backpack straps constricting our upper arms and shoulders, we don’t experience the swelling really at all. So it can’t just be the backpack straps causing it, especially since some people have this issue without wearing a backpack at all.
Something interesting about the cardiovascular system is that the blood pumping through our arteries, the big pulsating vessels we feel when we check our pulse, are almost entirely pumped by the heart. The heart contracts, much like squeezing a balloon full of water, and blood comes out of the hole. However, when the blood is returning back to the heart to be cycled again the blood is to a significant degree pumped because of contracting muscles in our limbs. They have one way valves in them so when we contract a muscle that is wrapped around a vein, it pumps the blood forward. And when that contraction ceases, the blood is unable to flow backwards. That repetitive contraction of our legs and arms pushes the blood forward, back to our heart. The reason we don’t experience edema in our legs on long hikes isn’t simply because of no backpack straps compressing the vasculature, but mostly because of our constantly contracting and relaxing leg muscles. When we use trekking poles, we continually contract the muscles in our arms and push that blood back toward the heart, preventing pooling by overcoming those barriers created by the backpack straps.
Additionally the trekking poles also likely benefit the swelling by shifting our shoulders frequently, releasing the pressure of the backpack straps on the upper arms, even if just for a second at a time. There could be an electrolyte component to it, but I find it exceedingly unlikely that this is a primary cause because the swelling would be consistent throughout the body, including the face, and I’ve only ever experienced and heard of people having swelling in their arms. Additionally, it takes a tremendous blow to knock the body’s electrolyte balance off. The body is very good at maintaining electrolytes in the blood in a very narrow range of values and the hyponatremia it would take to cause swelling would not only cause significant additional symptoms like nausea, vomiting, confusion, seizures, death, etc., but it’d also take a significant blow or underlying medical disorder to cause it.
Additionally, if dehydration were the issue, once again the swelling wouldn’t be isolated to the arms, and it’s also very uncommon for water to collect in the extravascular space when there is an overall deficit of water in the body. It can definitely happen but it’s rare and comparable to a dry paper towel sitting in a pool of water. The paper towel is going to soak up the water like our body is going to soak up that swelling.
Also, definitely not gravity as the primary culprit. If that were the case our legs which are much longer and have a much harder battle against gravity back to the heart so if gravity were the culprit our feet would be as thick as elephant stumps. And definitely not altitude: just go for a hike at sea level; it stills happens and there’s no reasonable mechanism. And just for completeness sake, it’s not temperature’s fault either. Once again, if that were the case, there’s no reasonable explanation for why it would be isolated to the hands and arms.
How to keep your hands from swelling
Now that I’ve explained the pathophysiology of hand swelling while hiking, I have a couple solutions. My first recommendation is using trekking poles, for so many reasons in addition to totally preventing the hand swelling. They help prevent injuries, make hiking easier, faster, and enable you to bounce down gnarly trails like a mountain goat. You’ll look dumb to everyone who has never used them but hey you already look dumb to everyone back at home relaxing on their sofas.
If you absolutely refuse to use trekking poles or simply don’t hike often enough to drop the dough, I recommend you do some exercises while hiking. Take your hands and put your thumbs on your backpack straps and lift them off your shoulders. This will contract your muscles as well as relieve the pressure. It’ll also elevate your forearms to help promote some of that return flow. If you want to look extra special you could wave your hands in the air like you just don’t care, maybe show off your guns and flex a little for the single does prancing through the forest. If you want to look sooooper cool you could whip out the compression sleeves but I can’t imagine that helping much.
Or just get trekking poles and accept your fate that it’s impossible to look cool while hiking.
I’m no stranger to ruffling a few feathers on the subject of backpacking. I’ve had a good time over the past couple years reflecting on some of the commentary of other backpackers criticisms of some of my decisions in the backcountry. While nothing I’ve ever done has directly affected anyone else on the trail, some of those choices have created some impassioned critiques and alternatively strong supporters. Continue reading Backpacking is not that badass
“We talked about how we were the only two people in our family with any background in healthcare. I said to him, ‘In a little less than three years, I’ll be Dr. Cobb, how crazy is that?’ He looked up from his lost gaze and said ‘I hope I’m here to be able to call you that,’ and for the first time in my life I understood that he may not actually make it that long, that he was dying.”
I wrote that sentiment two years ago today and while my granddad never had the chance to call me Dr. Cobb, reading through these words today made me feel immensely better about his passing. A little over two months ago he died of respiratory failure after contracting pneumonia. I was studying for my board exam when my mom called me to let me know I should come into town. I packed up my things and was there with him and my family when he breathed some of his last breaths. Continue reading Questions of a disoriented third year medical student
So with the first realization that I might not get to stand on the summit, I was pretty friggin bummed. But I still had hope despite the horribly gloomy outlook. Snow was coming down hard now and we were getting destroyed by the wind. But I understood that the weather wasn’t the problem. We could bundle up and proceed no problem. But where we were, where we had to go, and where we had come from all had a risk of avalanches, especially after large snowfall. We climbed for probably another 45 minutes to an hour and it got much worse. Continue reading Chimborazo Part 3: A really big dummy
But in classic high altitude diuretic fashion, I had to rise to pee about 10 times in the middle of the night. Compared to the night prior when the refugio was full, now we only had about 10 people for the nearly 40 bed bunkhouse. When the other climbers got up at 9pm to pack and have breakfast and get started I got up to go pee. An Australian climber who would attempt the summit the day after me woke up too and stumbled down in his boxers. As he walked by me he mumbled, “Good morning,” and then kept on walking. Oh the joys of an oxygen starved brain. Continue reading Chimborazo Part 2: Because you’re a dummy, Grayson