RheumaBlog

Same dragon, different day.

I had an appointment this morning with an occupational therapist at the VA, referred by the physical therapist I’d seen a few weeks ago. I came away from today’s appointment both pleased and thoughtful.

The appointment was focused on my hands and wrists, since that’s where I’m having the most trouble. Jennifer was friendly and welcoming; this has been my experience, almost without exception, since I first started getting my medical care through the VA. We hear all kinds of terrible things about universal health care – about having to wait months for appointments, possibly years for elective surgery, and (as my Mom warned me the other day) about  indifferent, on-the-cheap care that might do little good and perhaps some great wrongs. Mom watches Fox News religiously; sadly, she’s been convinced that health care reform will lead to, at the best, poor quality care for everyone and, at the worst, wicked socialism for America.

This, however, has not been my experience with the VA.

Jennifer the OT spent an hour with me, showing me ways to do things around the house and in the kitchen that will help me use the joints in my hands, fingers and wrists more gently. Ways that will, hopefully, help me to maintain the integrity of my hands as time passes.

Fortunately, I have little deformation thus far. I cannot curl the fingers of my right hand into a tight fist anymore, and my ring finger on that hand is beginning to sway to the right just a bit. I still have a decent grip in both hands when they’re not terribly sore.

But Jennifer said she was glad that I’d come to see her now, before my hands get bad. “You wouldn’t believe the number of older people I see whose hands are terribly deformed and weak,” she said. “I work with them and teach them ways to be more comfortable, and to be more safe, but I wish they could have come to me sooner. Maybe they wouldn’t be quite so disabled now.”

She pulled out a catalog – North Coast’s Functional Solutions – and went through it with me, pointing out the many kitchen implements and gadgets, redesigned for people with arthritis, that are available for purchase. Then she excused herself, saying she’d be back in a couple of minutes.

Some of what she taught and showed me I’ve either learned on my own the hard way or I’ve read about over the last year or so. Things like using both hands to pick things up; using the palm or the back of my hand or forearm to close drawers and cupboards; tying loops of cloth or yarn to drawer pulls and the refrigerator door so that I can slip my hand through and pull them open with my arm, rather than with my hand.

But there were some things I’d never thought of, so it was good to learn about them. While she was out of her office I browsed through the catalog, noting the high prices with a sinking heart. Well, some of these things, I thought, I might be able to budget for. A lot of them, though, not so much.

Jennifer returned with a an Oxo jar opener. A knife, fork and spoon with thick rubber handles. A buttoner-thingy, for times when my fingers are too stiff and sore to button a jacket or jeans or a shirt.

“You can take these with you today,” she said with a big smile. “Even when you’re not hurting, try to use them, because they’ll reduce the everyday stress on your joints. Now, let’s check out that catalog and see if there are others things you can use. There’s a limit, but we can order some of them for you through the VA.”

My mouth dropped open. “REALLY?”

She nodded and opened the catalog to the kitchen section. “Do you cook a lot?”

I said that I do. In fact, I love to cook, but it has become a much more difficult chore now that I’m fighting painful, stiff hands most of the time. So she suggested a chef’s knife with an upright handle; a cutting board with spikes sticking up that help hold a vegetable in place for slicing; and a rocking chopping blade. And she showed me how to stir a pot using my whole arm, rather than my wrist, and ordered a fat holder I can put on a long spoon.

And then, for other parts of daily life: a set of fat, easy-to-grasp holders for keys. Little thingies to put on lamp knobs to make them larger and easier to twist. A hair brush with a 22-inch handle for those times when my shoulders flare and I can’t raise my arms very high.

Finally, she suggested that along with my Thermagloves, I should wear soft wrist-and-thumb splints. “Wear them all the time,” she said. “That way, your joints are kept warm and protected, and just having them on will remind you to be careful.” She ordered those for me, too.

Then she told me what a pleasure it was to work with me. “You’re so open!” she said. “So many of my patients are so negative. They think that they don’t need to do things differently, and they’re resistant to change. But really, I think it’s all a matter of attitude. You get out of OT and PT what you put into it, and a good attitude really makes a difference.”

I agreed. Mr Wren is one of those people who goes to the VA for his health care with a negative attitude. For years, he’d come home after appointments there, telling me how this went wrong, or that doctor was stupid, or how his records were misplaced or how he had to wait for hours, and how rude the doctors and nurses were. So when I decided to apply for VA health care myself after being laid off and losing my health insurance, I did so with some some trepidation. Still, I figured even if it wasn’t very good, VA health care sure would be better than no health care at all.

But you know, it’s almost like we’re going to two different places. I’ve had very few problems. And while I’ve had to wait for some appointments, like this one with Jennifer, and PT, and an upcoming eye appointment, none of them has been for something that I couldn’t wait a couple of months for. If I need immediate care, they have an urgent care center attached to their emergency room. Sure, I’ll have to sit and wait if I don’t have a life-threatening problem. That’s just fine. The point is that if I need to see a doctor urgently, I can.

As I was leaving, Jennifer handed me the things she’d gathered for me, along with a copy of the catalog to take home, and her card. “If you have questions, call me,” she said. And then, with a little grin and a tip of her head, she said, “welcome to universal health care.”

I’ve said it before and I’ll say it again: If the care I’ve received at the VA Medical Center in Sacramento is “universal health care,” then I’m all for it. Sure, it’s not perfect. And there are definitely a lot of VA facilities across America that need to be renovated, upgraded and better staffed. But that’s happening, slowly, under the Obama administration. We could do a lot worse than to look to the VA as a working model of health care that could be available to all Americans who need it.

3 thoughts on “A helping hand

  1. Helen says:

    I’m glad you’ve had such a positive experience with the VA.

    Speaking as a long-term and frequent consumer of Canadian healthcare, I’ve always been satisfied with and confident in the care I’ve received, and the speed with which I’ve received it. I try to stay out of debate because I just get worked up, but I did want to say I’m very happy you’re receiving such excellent care – and also that you’re in to see an OT. Mine was really helpful to me when I saw her.

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  2. Cathy says:

    So happy that you had a good visit. 🙂

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  3. Clare says:

    i have to catch up on your blog! have to comment here though. i’ve had OT for my wrists too. i DO have damage in them, but not the fingers. as i’m learning with my ankle, RA stinks when it’s active in a joint. that said, i was one of the bad patients. i ignored dr’s advice to stop weight lifting. now, my wrists are FINE in terms of pain, dare i say normal. i am hoping the ankle takes the same path. but hopefully your wrists will run their course and end up ok too!

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