Category Archives: Medicine and Health

Why your hands swell while hiking: the real reason

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.


I highly recommend the Black Diamond Distance Z trekking poles.

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.

Questions of a disoriented third year medical student

“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

My granddad, Donald Cobb

A few days ago, as I sat watching my granddad take some of his last breaths, I couldn’t help but want to fight and resist the reality that was quickly transpiring. He had developed pneumonia over the last few days and it was progressing quickly. As he reached for each breath with every muscle in his body, I thought of all the medical measures they could do to save him. But he wouldn’t want to be saved at all costs and despite my desire to have him around for eternity, I respected that. But it was so hard for me, as someone who has been learning about all the ways to interfere in the process to just sit back and accept what was happening. Continue reading My granddad, Donald Cobb

Free will and its impact on our political views

The last few weeks I’ve been trying to pinpoint the difference between liberals and conservatives in the United States and kept coming back to the idea of free will. I want to get at the fundamentals of where we differ, not superficial policy debates, not fiscal arguments, but basic fundamentals of how we see the world. And the first thing that stood out to me is how we see equal opportunity. How do we view our ability to succeed in this world as compared to someone of a different race, gender, socioeconomic status, etc? While conservatives, for the most part, believe that we can ‘pull ourselves up by the bootstraps’ and believe in equal opportunity to the top, liberals fundamentally disagree. Liberals believe that we are staggered from the gun and some people are given a head start. What we are disagreeing on, fundamentally, is the impact of free will and politics. Continue reading Free will and its impact on our political views

3/8 MD

Last year at this time I was out in Colorado living out of my car climbing 14,000ft peaks. I was single, voluntarily homeless, and smelly. I had left school for a 10 month leave of absence just a couple months earlier and was taking advantage of that time to spend some introspective time out in the backcountry. But this year things have been going a lot differently and I couldn’t be more thrilled about it. Continue reading 3/8 MD

How to prevent another Trump presidency

Trump’s electoral college win this month and the failure of logic and reason to prevent a Trump presidency will probably go down in history as nearly analyzed as much as Hitler’s rise to power. In only two weeks I’ve read proposed hundreds of reasons for his success, from lying news to liberal arrogance. And it’s taken me a while to compose myself enough to analyze it and get past the pure vitriol and disgust I have for anyone who voted for that man. But while we cling to simple answers and quick solutions, and of course if we changed any one element of the campaigns and election, the outcome could have and should have been drastically different. I’m not sure though that my thoughts on the matter constitute a simple answer, because the question I’m asking myself is not how he won, but rather how he got any votes at all. And the answer to that question, the source of Donald Trump’s rise to power stems not from liberal media bias or Hillary’s slip ups, but rather from the ignorance, lack of education, and inability to think critically that plagues humanity. And the only way to prevent another Trump presidency is to combat all those things. Continue reading How to prevent another Trump presidency

M2 round two

Today was my first day of round two of M2 and as I sat through repeat classes I realized I can do this. While it’s certainly daunting, second year of medical school feels much more manageable this time around. I watched all my friends move on and progress in their studies, pass the first step of their board licensing exams, and their success gives me confidence.

Read about M2 round one here!

Continue reading M2 round two

Heading home

I’d been sitting in the Walmart parking lot in Cortez, Colorado for nearly 24 hours, with only one break to make a run to the Cold Stone at the shopping center across the street. It’s walking distance, especially considering my ridiculous standard of “walking distance” but I drove. It’s dumping snow out there, wet snow, and I didn’t want to have to change clothes and switch out my moccasins for boots. I’ve been alternating between lying in my backseat and sitting up front. I pull up front when I want to turn the heat on and charge my iPad. I’m watching YouTube clips of climbers and comedians, a strange combination, and using the WiFi that spans across the entire parking lot. My windshield is covered in snow so I have a bit of privacy as shoppers get in and out of their cars on either side of me. But I’m exhausted and tired of this set-up. Continue reading Heading home

Rescue on Quandary Peak

It’s Christmas day and I’m in Colorado living in my car. I’m out here on my own accord. I want adventure, I crave adventure, so I came out to these sub zero temps to climb some mountains, do some snowboarding, and actually have a white Christmas instead of the warm drizzle back on the East coast. But I’m in Starbucks in Breckenridge now and I miss my family and miss my home.

This morning I began an ascent of Quandary Peak just south of Breckenridge. It’s one of the 52 Colorado 14ers and is decidedly the easiest winter route. With a long gradual, broad east ridge it allows the hiker to stay out of avalanche terrain for the duration of the climb with no pitches greater than maybe 30 percent. Continue reading Rescue on Quandary Peak

8 tips for first year medical students

1. They’re done trying to weed you out

You’ve made it to medical school, congrats! Admissions looked at you extremely thoroughly, analyzing nearly every element of the past few years of your life. They are confident that you’ll make a great doctor. Now they’re going to support you in every way they can to get you the residency spot that you want. At this point it’s seen as a failure of the school if you don’t make it, so take a deep breath and relax knowing that all the your school wants you to succeed. Continue reading 8 tips for first year medical students