Shaking Hands

One of my first problems with RA – in that period of time between when I first saw my PCP and when I was finally diagnosed by a rheumatologist – had to do with greeting people.

In our society, when you meet somebody new, introductions are made; people shake hands.  A lot of information is conveyed in that handshake.  A firm grip says one thing, a limp noodle says something completely different.

I found it to be a particular problem on Sunday mornings.   In some churches, people turn around and shake hands with the people sitting directly in front of, and behind them, then sit down.  Not mine.  Everybody spends fifteen minutes walking around and shaking hands with everyone else.  Not fun when your hands hurt.

That led to my first consultation with Dr. Google:  “How can I politely avoid shaking hands?”  For such a common problem, I found a disturbing lack of tips.  Avoiding the situation is next to impossible – especially when you work.  I asked others with more experience, and set about compiling coping strategies for handshakes.

  • Turn hand 90 degrees, palm down.  The people with whom you’re shaking hands will automatically rotate their own hand to compensate, thus they don’t grip so tightly.  This is easy for women, but might be awkward for men; one man I know turns his hand palm-up and that works just as well for him.
  • Use two hands for an extra-friendly handshake.  People don’t set out to prove who’s strongest when you do this.
  • Wear gloves.  Compression gloves are said to help sore hands, but I’ve found that people give a more gentle handshake even if I’m wearing driving gloves.  Once I forgot my driving gloves and wore wool gloves.  This works if you’re indoors and everyone else is bare-handed; it does not work outdoors.
  • Some people recommend offering your left hand instead of your right.  You’d think that this would provoke questions, but that doesn’t seem to be the case.  People just assume there’s a reason you’re being non-traditional, and don’t squeeze as firmly with their left hand.  I know a man who just flips his left hand upside down so that others can still shake with their right.
  • Wear an ace-bandage or wrist brace.  The drawback to this is that then you have to answer the question, “What did you do to your hand?”
  • Hold something lightweight in your hand.  Keys, pencils… anything that can be used to stab people who try to hurt you!
  • Instead of stepping forward to shake hands, step back slightly and bow (Asian style).  Smile, and carry on with the conversation.

A few I wouldn’t want to try in a place of employment, but work well in a casual setting:

  • Step back, laugh, and make a cross with both hands (as if you’re warding off a vampire).  Explain that you’re coming down with (or just getting over) a cold and don’t want to spread the germs.
  • Don’t shake hands; just smile and wave – even if you’re only two feet apart.

Final tip:  carry a small bottle of hand sanitizer in your pocket so that (once greetings are over and nobody’s looking) you can kill all those germs you just collected!

The good news is that it gets better.  As your meds kick in and work their magic, shaking hands isn’t usually painful.

Any other maneuvers you’d like to share for making socially mandatory handshakes less painful?

Getting Along

Raising children, teaching them how to get along with others, provides an interesting perspective.  One of my kids in particular gets focused on demanding his rights.  I have the right…  (Yep.  You do.  How’s that working out for you?)   That child is slowly learning (with lots of teaching and lots of practice) that life is a lot more pleasant if he sometimes gives up his rights and works amicably with others.  The more he does it, he’s discovering that when he doesn’t insist on always getting what he has the right to have, that others are sometimes willing to give up their rights to help him out, too.

From what I’ve read in a comment thread recently, that’s a lesson that will stand him in good stead his whole life long, and one that too many people still need to learn.

As a person who’s been unwillingly thrust into a role I never signed on for, I’ve learned a ton about our healthcare system that I never dreamed of a few short years ago.  I know that the things I’ve learned are just the tip of the iceberg, so when a doctor is willing to give tips to patients on how to make the most of medical encounters, I’m all ears.  Recently, in A Letter to Patients With Chronic Disease, Dr. Rob said,

There is something that you need to understand that, while it won’t undo your pain, make your fatigue go away, or lift your emotions, it will help you.  It’s information without which you bring yourself more pain than you need suffer; it’s a truth that is a key to getting the help you need much easier than you have in the past.

Excellent!  This sounds like tips worth reading.  A quick summary (since I’m guessing my readers also read the linked blog):

  1. Don’t come on too strong
  2. Show respect
  3. Keep your eggs in only a few baskets
  4. Use the ER only when absolutely needed
  5. Don’t avoid doctors
  6. Don’t put up with the jerks
  7. Forgive us

Pretty basic, really, but fleshed out to be a powerful post.  When I first read it there were no comments.  I wanted to think about my response, so left the blog open in my browser to return to later. 

Life happens (quite a bit recently), and when I finally got back to it there were tons of responses.  And I was shocked.  Not that there were comments, but that so many people were upset about the post.  Because, you see, I don’t think this gives different criteria for people with chronic diseases than for healthy  people.  I thought this sounded like a pretty basic reminder for everyone.

  1. Don’t come on too strong because you only get one chance to make a first impression.
    So… pick what you want that impression to be.  Be aware of how specific behaviors are likely to be interpreted and decide if that’s how you want to present yourself.
  2. Respect – Ever read the book All I Really Need to Know I Learned in Kindergarten?
  3. Don’t doctor-hop
  4. The EMERGENCY room is for EMERGENCIES

And so on.  This is basic stuff, and some people were offended.  If that’s how very many people with chronic illnesses are, it’s no wonder that there are doctors who would rather not deal with us.  Nobody enjoys being around people who walk around with a chip on their shoulder.

I hope I’m not like that — and that I never get that way.  I realize that I’ve been really lucky to get terrific doctors, and sometimes wonder if I’d feel differently if I’d had numerous bad experiences seeking medical care.  Maybe.  But part of me wonders if sometimes people don’t create their own bad luck.  I don’t really know, but if I’d had more than a handful of bad experiences, I’d start to think maybe the problem wasn’t all those bad doctors after all, but was perhaps staring back at me from my mirror every morning.

But I don’t know, because I’ve been blessed with terrific doctors.  My rheumy writes a report to my PCP every time she sees me so both doctors know what the plan is.  If I need to call either doctors’ office, the nurse calls me back (usually the same day).  If someone in my family is sick and needs to be seen, they work us in — my PCP holds spaces in his schedule for same-day issues so that he can work people in.  My family physician has gone above and beyond the call of duty in providing exemplary medical care for me and my family.

So I, for one, am very happy to read Dr. Rob’s tips.  I’d do anything I could to make things easier on my doctor.  If it gets me help more easily than I’ve gotten it in the past… well, I honestly don’t see how that would be possible, but I’ll file this post away for the sad day that my doctor retires and I’m stuck searching for a new one.

Defense Mechanisms

Over at Dr. French Fry’s blog, I read this:

In psychiatry there is something known as a defense mechanism.  Defense mechanisms can be mature, neurotic, or immature, they are ways that people deal with feelings of anxiety, pain, and internal conflict.  One of my personal favorites is suppression.  It’s classified as a mature defense mechanism, and is defined as conscious burrying of troubling thoughts so that you can continue to function.  Just push it out of your head an keep on truckin’. Acting out is an immature defense mechanism. Projection is transference of anger to a more acceptable recipient.  Intellectualization is when one can’t wrap his head around a painful thought or uncomfortable experience so he finds a rational way to process the info.  A classic example always given the text books is that of a man who finds out he has cancer.  This causes him to learn everything he can about the pathophysiology of the disease and instead of telling his son he has cancer he teaches his son about the aberrant cell cycle, P53, and the Rb gene.

My kids are getting used to hearing me burst into laughter about something I read on various blogs.  If I keep laughing, they’ll usually peer over my shoulder to share the moment.  Nobody understood why I thought the quoted passage was funny!

It explains so much.