Do you feel confident in your hand pain toolbox? In this episode, occupational therapists Cheryl Crow & Hoang Tran go in depth on how and why the human hand is so complex, and how people with inflammatory arthritis can take good care of their hands to relieve hand pain and improve function.
This episode includes an in depth exploration of what it’s like to see a hand therapist, why hand therapy helps people with arthritis, what people with rheumatic diseases need to know about hand anatomy, and how to advocate for yourself to get an interdisciplinary team supporting you (in addition to your rheumatologist).
They also take a deep dive into how rheumatoid arthritis can transition to a more orthopedic issue long term, and Cheryl & Hoang share their best advice & tips for newly diagnosed patients.
Video of Discussion
Medical disclaimer:
All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Episode Sponsors
Rheum to THRIVE, an online course & support group program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. Learn more here!
Speaker Bios:
Hoang Tran
I’m an OT and Certified Hand Therapist. I own a private clinic in Miami, Florida as well as an education company where I teach and mentor other OT’s and PT’s to become experts in helping people with hand and arm injuries. I’ve worked with many people who suffer with various types of Arthritis. I hope to share with you and your listeners some ideas and my perspective on how to minimize pain and increase function.
Cheryl Crow
Cheryl is an occupational therapist who has lived with rheumatoid arthritis for nineteen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.
Episode links:
- Links to things mentioned in episode or additional listening
- Find a certified hand therapist: https://www.htcc.org/find-a-chtÂ
- What is occupational therapy: https://www.aota.org/about/what-is-otÂ
- Self compassion dr kristin neff https://self-compassion.org/
- Where to follow Hoang
- Cheryl’s Arthritis Life Pages:
- Arthritis Life websiteÂ
- Youtube channel
- Instagram @arthritis_life_cherylÂ
- TikTok @arthritislife
- Arthritis Life Facebook Page
- Cheryl on Twitter: @realccÂ
- Arthritis Life Podcast Facebook Group
Full Episode Transcript:
Cheryl Crow:
So, I’m so excited today to have Hoang Tron, who is a certified hand therapist and occupational therapist to help us understand some hand therapy secrets. Everyone a with arthritis should know. Thank you so much for being here.
Hoang Tran:
Thank you for having me. I’m so excited.
Cheryl Crow:
Yeah. And I would love to hear just a quick intro, like where do you live and what is your relationship to arthritis relationship In this sense, being very broadly defined as Yes. Maybe experiences you’ve had with people with arthritis. Yeah.
Hoang Tran:
Perfect. Well again, my name is Hoang and I really appreciate you having me on this, on your podcast, Cheryl, because for a long time I’ve been talking about how I feel like we need to get more information out to the people who in the world that have arthritis. And I have a clinic, my clinic is Hands on Therapy Services in Miami, and I specialize in helping people with hand, wrist, elbow, shoulder types of injuries. And my relationship to arthritis is really just the experience I’ve had over the last over 20 years working in hand and upper extremity rehab, working with people with various types of arthritis and a and rheumatoid arthritis being one of the, one of the worst types that we experience as a therapist. You know, in helping those types those people with that type of diagnosis and the, the different injuries or complexities that they have, you know, when it comes to rheumatoid arthritis.
Cheryl Crow:
Yeah. Yeah. And I think, you know, I’m constantly surprised how when I bring up to a patient whether it’s just on social media, casually, I’ll say, Hey, have you seen, has your doctor referred you or have you seen a certified hand therapist? And even if someone’s like, the reason that I bring that up is because they’ve said like, let’s say on social media, Hey, does anyone know any tips or tricks for, you know, I’m a professional artist and I wanna modify how I’m doing things because it’s hurting my hand, holding the paintbrush. And I’m like, oh my gosh. That’s like what, why hand therapists exist, right? Is to help people make little gadgets and tools and, and, anyway, so I’m going off on a tangent already, but yeah, it’s really, to put it in summary, you know, I think hand therapists are grossly underutilized, right? In, in chronic conditions in general, because with an acute injury, right? Someone like gets in a motorcycle accident, their hand is all torn up and messed up. Of course they’re gonna be, you know, they’re hospitalized and they get a series of therapy. But yeah. But with chronic, like, I guess, yeah, okay, I’m already going off my script. There’s yeah, there’s
Hoang Tran:
A sense, there’s a sense of urgency, right? Yes. So there’s a sense of urgency when you have an accident, saw accidents, I fell out, I broke something, I cut something, you are bleeding. Mm-Hmm. <affirmative>. So there’s a sense of urgency that you must get something done to save your hand, save your life not get it, have it get worse. So when you have an accident, there’s a sense of urgency. And so it’s a very small population of people who essentially have that at some point in their life. And everyone is laser focused on that. Mm-Hmm. <affirmative>. And there’s so many resources, so many topics around it. And it’s just because there’s a certain amount of sensationalism around it. Like, oh my God, you’re bleeding. We’ve gotta save your life, we’ve gotta help you. Chronic illnesses are largely unseen. Would you say that to be true?
Cheryl Crow:
You mean unseen, like in terms of the unseen by medical practitioners, or unseen by the world? Yeah. Yeah. Un
Hoang Tran:
Seen by both. Unseen by both. Yes. Like, yeah, if you cut yourself, you see blood. Mm-Hmm. <affirmative>. If you have rheumatoid arthritis, that is your Oh, yeah. And invisible your information to keep, right? Mm-Hmm. <affirmative> mm-hmm. <Affirmative>. So until, of course, you start to have deformities until you start to have flare up and your knuckles turn red and they get swollen mm-hmm. <Affirmative>, and you lose motion, then nobody sees that. Right. It’s,
Cheryl Crow:
Yeah.
Hoang Tran:
So rheumatoid arthritis and various types of arthritis are, or chronic injury or chronic processes like that are largely unseen. And they’re given the word chronic for a reason. Because you can get diagnosed and you have to deal with that from an emotional standpoint.
Cheryl Crow:
Yeah.
Hoang Tran:
Right. You have to deal with that from an emotional standpoint. There’s changes that you have to make in your life, right? There’s that mental, emotional issues that you have to deal with as a therapist, as an occupational therapist, certified hand therapist, majority of the time we see them once they’ve been living with it for so long.
Cheryl Crow:
Yeah.
Hoang Tran:
We see them once they’ve had surgery, multiple surgeries. We see them when they already have the deforms have set in and they’re just not really sure what they can do about it. And I was hoping to come onto your podcast to talk about what sometimes people can do beforehand.
Cheryl Crow:
Exactly. And that’s the, it’s this tragic situation. Cuz I think the majority of people I interact with, at least, you know, again, a lot of it’s social media, a lot of it’s through my support groups. Yeah. They’re, they’re ready and raring. Like, just tell me what I can do to proactively manage this. So there’s like a disconnect between the referring of patients, you know, to hand therapists. But let’s take, before we delve into the things, the, the nuggets of wisdom, just in case people listening don’t know what what is a certified hand therapist or what Yeah. How do you define that?
Hoang Tran:
<Laugh> <laugh>, thanks for asking that question. Yeah. What certified hand therapist can be either an occupational therapist or a physical therapist and certified hand therapists have to have so many years of experience treating hand types of injuries like hand and arm types of injuries. They have to have a minimum of, currently right now we, they have to have a minimum of three years. Mm-Hmm. <affirmative> as an experienced therapist, they cannot be an assistant, they can’t be a massage therapist. They have to have the designation, occupational therapy, or certified hand therapy. They have to have a minimum of 4,000 hours in working with people with handon arm types of injuries. And they have to then pass the national board certification, which is extremely hard. It runs about 60% pass, 40% fail in some years it’s 50 50. So there’s only in the whole world, probably about roughly 8,000, either a little bit less or a little bit more, I can’t remember 8,000 certified hand therapists, majority of them being in the United States.
Cheryl Crow:
Yeah. And the majority, last time I checked, at least for the statistics, the majority are occupational therapists. But physical therapists can also specialize.
Hoang Tran:
Yes. Majority of them are occupational therapists. But yes, some of them are physical therapists. But really at the end of the day, when you’re looking for a certified hand therapist, I think in the chronic community that we’re talking about, I think that it comes down to you as the person look, looking for the therapist, looking for the specialty. A lot of times we live in, we live in a very hierarchy medical world where doctors are the gatekeepers. And before the doctor’s insurances are the gatekeepers. And so, coming from a private practice that I started over 10 years ago and I run, we we work in a very particular way. But depending on your state, you may not need a prescription. You may not require the prescription. Right. So you
Cheryl Crow:
Yeah. From a physician.
Hoang Tran:
Yeah. Yeah. From a physician, you yourself, as a person who’s in pain, who’s limited in motion, limited in ability to function in your life, you yourself can seek out a specialist, can seek out a therapist that can help you. Now, if your state does require the prescription, you seek them out still anyway. Mm-Hmm. <affirmative>, and then go to your doctor and you can go to any doctor. You don’t have to just go to a rheumatologist. You don’t have to just go to an orthopedic, you can go to your primary care. Right. But you have to be a lot more proactive and say, yeah, I have pain. I am losing my motion. I no longer can class my bra, undo my buttons, open a jar, open the door, my shoulder hurts. I can’t sleep. I can’t do those things. So I need to be proactive and say, well, you know, let me see if I can find a therapist. Let me see if I, you know, a lot of times people think of the doctors first, cuz we all grew up going to a doctor’s. I mean, the minute you’re born, you have a baby. I have a baby. Mm-Hmm. <affirmative>, the minute they’re born doctors, which doctor are you taking them to? So in our brain, in our society, we’re accustomed to going to doctors. But if we keep in mind that, you know, doctors are human beings too mm-hmm. <Affirmative> that they don’t know everybody. <Laugh>.
Cheryl Crow:
Right.
Hoang Tran:
Right. They’re not super social all the time. They don’t know everybody. So if you’re not getting the help or the advice that you’re seeking, I would encourage you to look, keep looking.
Cheryl Crow:
Yeah. Another thing I would just add to that is that no, no daily living challenge is too small to be addressed by an occupational therapist in general and or a certified hand therapist who has more expertise again, in the hand, because Yeah. A lot of times people will say to me, oh, well it’s maybe it seems trivial to say, well I just, I, I’d love to be able to turn the pages in the children’s book when I read it to my daughter or granddaughter or Yeah. You know, or in, I’m a teacher and it’s hard for me to hold the chalk, you know? Yeah. On the chalkboard. And that’s old school of me. But now everyone has the smartboard. But you know, the, it’s hard to hold the stylist and you Yeah. I think the, the magic words, if you are going to be talking to your doctor about it, and I do recommend people talk to their doctors, just especially to say like I’m having a problems with these specific areas of daily living.
Do you have any occupational therapists or certified hand therapists you recommend? Cuz sometimes they have one that they Right. Know is good with your condition. Right. But and then go back to them afterwards and you can explain like, one of the, the students in my, I’m calling her student, but in My Room to Thrive program, she is a professional artist. She’s the one I was alluding to earlier, but she was just blown away by all the tips and tools that her hand therapist gave her. And sh I was like, make sure to tell your doctor that so that they remember what Right. You know, to refer anyway.
Hoang Tran:
Yeah. And I, I agree with you in the sense that if you have a chronic issue, you’re going to your doctor anyway. It doesn’t hurt you to ask them. But don’t be surprised if they don’t know I work. Oh yeah. I have been here for over 20 years in the same community, <laugh> mm-hmm. <Affirmative>. And there’s tons of rheumatologists that don’t know other therapists or believe it or not, don’t see the value.
Cheryl Crow:
Well, yeah. I’ve had a rheumatologist tell me, oh, well we don’t really need to refer to OT or CH hts, CHT is short for certified hand therapists anymore because the medications are so good. I was like, right. But the re current research shows that 70% of patients do really well on the current meds. That’s 30% don’t. So that’s of 1.3 million adults in the US who have rheumatoid arthritis. That’s like, yeah. 300, 400,000 people. Are you gonna say, oh well, just cuz the majority are doing well. Yeah, yeah. It’s really shortsighted to not give people, obviously we’re both completely unbiased cuz we’re both occupational therapists. <Laugh>.
Hoang Tran:
Yeah. But you’re right, you’re right.
Cheryl Crow:
But so
Hoang Tran:
This is, this is the awareness part, right? Yes. We get to bring the awareness to, cause there are people who would like to just know about options. But, you know, I I also think that the options are explored, explored when there’s an episode mm-hmm. <Affirmative> mm-hmm. <Affirmative>. I have someone currently that I’m working with. She knew she had it. She made the changes. She, you know, and she, until she had an episode that really messed up her hands and her arms, she really didn’t think anything of it. Mm-Hmm. <affirmative>. And I believe her, you know, her, the, her Dr. May have sent her to a therapist or she looked at, she looked them up on her own and sought different therapy services and certain ones didn’t help. And so after going to several different therapists, she found out mm-hmm. <Affirmative>.
Cheryl Crow:
Right.
Hoang Tran:
And, you know, she’s got a slew of issues. And one of the things that I always do is it’s not just the current problems that you have mm-hmm. <Affirmative>, let’s keep in mind the potential future problems that can come down the road. Because with rheumatoid arthritis, when you start getting certain degenerative changes, it falls into a very particular pattern. And we have to have a certain amount of foresight to anticipate those problems. We can’t always stop ’em, but we can certainly slow them down. Mm-Hmm. <affirmative> mm-hmm. <Affirmative> and we could teach you red flags to look for.
Cheryl Crow:
Yeah. Yeah. That’s well said. Yeah. So let’s jump into them. Like what, in general, what are some of the top things you think people with, you know I mean, arthritis is an umbrella term for over a hundred conditions, you know? Yeah. Just means joint inflammation, which can be caused by lots of different things. But you know, this, the purpose of this podcast is really more on the inflammatory arthritis side. Right. But some, there’s like a Venn diagram that overlaps, right. Some of the things for joint protection for osteoarthritis are the same for rheumatoid or psoriatic, but Yeah. What, what are some of the things that you find are like kind of the greatest, greatest hits of ways people can take better care of their hands?
Hoang Tran:
Well, one of the best things that you could do is get early treatment, right? Mm-Hmm. <affirmative>. And we can say that all day until we’re blue in the face. But again, it’s the sense of urgency needs to be there. Mm-Hmm. <affirmative> when you’re red and an inflamed and really painful, that’s not necessarily the best time to get it because you’re red and inflamed. <Laugh>. Yeah. But once as that starts to fade, then the best time to get therapy is right as that starts to fade out. Because what you want to learn is what you need to do with the residual edema that’s left. Mm-Hmm. <affirmative>.
Cheryl Crow:
And what is edema?
Hoang Tran:
Edema is when you’re swollen and you see like there’s like some, sometimes the most common places it happens in the back of the wrist on the back of the knuckles. And that’s the swelling. That can be the puffiness that’s there. Mm-Hmm. <affirmative> it can feel kind of soft and squishy mm-hmm. <Affirmative> or it could feel a little bit firmer and dense. Mm-Hmm. <affirmative>, sometimes it hurts, sometimes it doesn’t. It really depends on the person. But the, the swelling that remains from a flare up can cause a lot of different problems. That cause tendon ruptures. Mm-Hmm. <affirmative>. So the tendons are in the back of your wrist, open your fingers mm-hmm. <Affirmative> and left ignored sometimes can rupture over time. Like kind of deteriorate the tendon. And once they rupture you can’t open your fingers anymore. Yeah. Once that happens, you require surgery. Mm-Hmm.
Cheryl Crow:
<Affirmative> you wanna avoid surgery.
Hoang Tran:
<Laugh>, sometimes they won’t. Yeah. I would imagine majority of people want to avoid surgery. And one of the reasons why you wanna take care of certain things early, cuz you just don’t have the luxury of waiting mm-hmm. <Affirmative> is that when you treat it early, your, your tendons have better. Let’s say the tendons have, if, if you were to require surgery, the quality of your tendon can be better when you take care of something early versus waiting. I actually met a therapist who ignored all of the signs because, you know, we’re all human and when things happen they don’t feel good. We tend to ignore and hopefully it goes away. Cause maybe at some point in the past they have gone away. Right. This time it didn’t go away and it ruptured tendon. Wow. The surgery required from it. Because a quality of the tendon was not good, it re requiring a second cert. So there’s certain things that if you find a trusted therapist that you can go to time and time again for different episodes. It can really help you to manage some of those symptoms like the swelling. They can help you manage the loss of motion that you could have. Mm-Hmm. <affirmative>. So for example, with rheumatoid arthritis, most of the time the therapist, the therapist, most of the time the person doesn’t have a problem bending the finger, it’s that they can’t open
Cheryl Crow:
Mm-Hmm. <Affirmative>, sorry, I’m doing it while you’re doing it.
Hoang Tran:
<Laugh>. Yeah. So they can’t open. So the fingers start to kind of lag down a little bit. Yeah. Not the wrist, the fingers, the, at the big knuckle. Oh yeah. So when you can open like that. Yeah. You see so what happens is we have, I always draw my fingers when I teach, but we have, we have these, we’re called, they’re called collateral ligaments. They’re ligaments in between that give support to our big knuckles mm-hmm. <Affirmative>. And then we have these tendons on the back of the hands that open up our big knuckle mm-hmm. <Affirmative>. And when you have an episode and it erodes at the quality of the tissues of your big knuckle, your joints will start to fall. Mm. They’ll fall down into the palm mm-hmm. <Affirmative>. And that’s why you can’t open as well. And they’ll also do what’s called ulnar drifting. This is the ulnar side of your hand and your fingers will start to drift. So we understand that with rheumatoid arthritis, there’s a certain pattern that takes place and it’s a zigzag pattern. So your fingers go like this, then your metacarpals go like that and your wrist goes like that.
Cheryl Crow:
So yeah. And she, the owner side for those li on listening to the audio, that’s what just the pinky side’s, what I call
Hoang Tran:
That’s the pink. Yeah. That’s the
Cheryl Crow:
Pinky side. And the metacarpals are the knuckles. Yeah. We have the majority of you are listening to our patients, but we also have a lot of Yeah. You know, OTs listened to. Yeah.
Hoang Tran:
Yeah. So, so we tend to start seeing like a, a zig exact pattern in the, in the fingers and in the wrist mm-hmm. <Affirmative>. And when it comes to a splint and braces, they can do a wonderful job for certain phases and periods. But y you wanna be careful with where time schedule, how long you’re wearing something for mm-hmm. <Affirmative> because worn too long, just like with any worn too long, you’ll lose motion.
Cheryl Crow:
Yeah. Yep.
Hoang Tran:
Blocking certain things that don’t need to be blocked. Mm-Hmm. <affirmative> will cause other issues, solve one problem, create another one,
Cheryl Crow:
It. No. And that’s I think something that’s just striking me, again, trying to keep things in the basics. For the listeners especially, maybe someone is newly, newly diagnosed, the hand is an extremely complex part of the body. And I I’m gonna post a link to this in the comment or the comments in the, in the show. But one thing that I was really struck by in occupational therapy school learning about is, is that you have like a sensory and motor cortex on both sides. Sensory is like feeling stuff and motors moving stuff. And the amount of space that’s taken up by the human hand as well as like the lips and tongue. Right. With the homunculus, which is like a visual representation. It’s huge. And there’s what isn’t there 23 muscles that, that go into the hand or something like that? Like half of them are intrinsic, half of them are extrinsic. Something in the mid twenties. Yeah. Half of them originate beyond the hand earlier up in the body, like the elbow ish. I’m not a hand therapist by the way, <laugh>.
Hoang Tran:
So the, i the intrinsic, the intrinsic muscles are the muscles that start in the hand and end in the hand. Mm-Hmm. <affirmative> mm-hmm. <Affirmative>. And the, and they’re the ones that help you go like wa wa wa like that. Mm-Hmm. <affirmative>, they can help you open your fingers right here. Their thumbs move, your fingers move. It allows you to have dexterity, meaning you can move things in inside your hand and you can use things to little things to pick things up. And then you have your extrinsic muscles that start outside of your hand, usually at your elbow and they come into the hand. They’re the ones that pull your tendons, your knuckles down all the way down. So make a Okay. Right. Yeah. They also help your thumb to come all the way down. They’re the muscles that cross your wrist to get into your hand. So when we look at the hand, we always have to consider what is the wrist doing.
Cheryl Crow:
Yeah. Yeah. And that’s why a lot of people get confused because they’ll say, well let’s say my pinky hurts or my ring finger and pinky hurt. Why is this therapist up here in my elbow? Well because, you know, why are they saying it’s a wrist issue? It doesn’t hurt in my wrist. It hurts in the fingers. Well it could be because the nerves are being impinged somewhere higher up. Yeah. And so there’s just, it just yeah, same old soapbox. But you know, it’s extremely complex and that the sensory cortex also the part of your brain that’s like, I need to process what things are feeling like hot, cold temperature, you know, and that also is devoted, has devoted a ton of space more than the surface area you would expect. Yeah. and that’s why your hands, this is my explanation, but you know, why can hands hurt so much when they’re so small? It’s cuz your brain pays a ton of attention to them. Right. <laugh>,
Hoang Tran:
It’s cuz all your nerves
Cheryl Crow:
Were there and, and there’s a ton of Yeah. Yeah. I mean, your nerve
Hoang Tran:
Endings, if you, if you don’t have the nerves working correctly, you won’t feel hot cold. You won’t feel when something is metal or plastic or rubber mm-hmm. <Affirmative>, you won’t feel the density. You drop things outta your hands because the brain is no longer connected to the hand to say hold that. Squeeze it because the information goes from the tips your, from the, to your brain and sent back to say, squeeze it a little bit harder because it’s heavy. Mm-Hmm. <affirmative>, squeeze it a little bit lighter because it don’t need to kill it. You’re gonna, you’re gonna break that flower if you squeeze too hard. <Laugh>. Yeah. So there’s a lot of feedback goes very quickly. It’s complex, but at the end of the day, the hand does everything for you in your everyday life. And it is probably more <laugh> taken for granted than anything else. Yes. Yes. Until, until, until it is taken away from you.
Cheryl Crow:
Yeah. And I, I’ve used this example before. I wanna be careful how I say this, but I did, I just did a three month my internship in spinal cord rehab. And, and that’s where people, you know, have a variety of different kinds of injuries can happen to the spinal cords. You could have a lower, you know, very lower thoracic one where you are completely paralyzed from the, you know, lower waist, like below the belly button down and you’ll relearn how to do everything and be completely independent, go back to your job, you know, and then there’s ones higher cervical ones where they have to have, you know, assistive assistance with breathing and like, you know, a mouth operated power wheelchair, stuff like that. But one of the things that really struck me is we had one patient with central cord syndrome, which is where you I hope I’m saying, I hope I’m remembering the name of it, right.
I’m pretty sure it was central cord where it wasn’t a full spinal cord transaction where it’s like half your body is paralyzed or Yeah. Three quarters. It was that her, her legs were a hundred percent fine. Her arms were fla that she lost. Yeah. I don’t think she lost everything. It was like she lost motor control, but she still had sensation in her arms. And it was really interesting because in our society being in a wheelchair is seen as like, that’s the worst possible outcome. People will say that to me all the time. I just don’t wanna end up in a wheelchair. And I really, I think it’s helpful to question that assumption because this particular patient, and I can’t, I could imagine many others found that the ability to not, the inability to use your hands was so, such a devastating effect on her daily life and her ability to function.
She couldn’t each, couldn’t put her clothes on, she couldn’t do, whereas the person with the, who couldn’t walk as long as they were in their wheelchair and learned how, and again, I’m not saying that being in a wheelchair from a lower level, you know smoke cord injury is a picnic. It’s totally devastating as well. But I think people in that situation, it’s like people might, someone might look at her and be like, oh my gosh, she’s able to walk. Like she’s not disabled. But actually she was very disabled from not being able to use your hands. So sorry, <laugh>. Yeah,
Hoang Tran:
No, you’re, you’re right. I, it’s, it’s always perspective.
Cheryl Crow:
Mm-Hmm.
Hoang Tran:
<Affirmative>, it’s always perspective. When we lose our legs, we’re like, this is the worst thing ever when your back and you cannot even roll, breathe, or, you know, pee. Right. Every, it is the worst thing that can happen to you. You no one with a hand injury, you know, like a severe one. Or even someone with both hand injuries would ever say that that’s worse because they now have a new perspective. Mm mm-hmm. <Affirmative>. Right. So I think it’s just perspective. I worked with someone, she actually came to me from the UK couple of visits cuz she had a very particular type of nerve spinal injury due to an infection. Mm-Hmm. <affirmative> and it messed up her arms, her legs, everything, but she was getting a lot of her legs back. But her arms, she was, she didn’t have a lot of control. She didn’t have strength, she didn’t have coordination.
And she is an artist. Oh. And she couldn’t draw the way she used to draw cuz she used to do little mini like micro types of sketching. Mm-Hmm. <affirmative> needed fine tune movements and stuff like that. And it is not until something happened to you, I mean, I, I treat it all the time mm-hmm. <Affirmative>, so I see it all the time. So it’s always my perspective, which is to say that when you lose your hands, you lose, lose function. I’m working with a young woman right now, rheumatoid arthritis. She is experiencing the, the problems in the hands. She did, you know, she did the therapy that she was supposed to do, but it wasn’t, she wasn’t getting results. So that’s the other thing outside of outside of getting early treatment, just because you don’t have the luxury to wait is finding a trusted therapist, even if it requires you to look around, even if it requires you to maybe consider paying for someone out of pocket, out of insurance mm-hmm. <Affirmative>.
Because if you’re not getting the results, you should recognize that really quickly and look for another one. Because when you find a trusted therapist in your area, then you can go back to them time and time again. Mm-Hmm. <affirmative> young woman, she came in her elbow, her, she had a flare up in her elbow, the most recent one in her elbow and in her big knuckles. And once we started working with it, I asked her if, you know, if she wanted help and the other parts of her arms that I was noticing had issues and I didn’t want her to, you know, necessarily ignore that or think that I couldn’t help her with it. Cuz she has shoulder issues and they’re all, if your elbow does not work well, you cannot turn your palm up and down, right? Mm-Hmm. <affirmative>, if your elbow does not work well, you cannot turn your palm up and down. And the act of turning your palms up and down have an effect on how your wrist moves.
Cheryl Crow:
Mm-Hmm. <affirmative>
Hoang Tran:
And how your hands move. <Laugh> a direct effect on how your wrist moves. So everything is connected and your shoulders woo. Well, we can talk about those things for days. Yeah. But you know, if I’m talking to your audience, your people, right, who listen to you, who have rheumatoid arthritis, who have any form of arthritis, when you have the pain, when you have the continuous pain, when you have the continuous limitations, find a trusted therapist. And the third thing is something is always possible, right? Mm-Hmm. <affirmative> something that’s always possible. It may not be perfect cuz sometimes let’s face it, when you have rheumatoid arthritis, sometimes the changes in certain joints are permanent, right? Mm-Hmm. <affirmative> recognize which ones are permanent and know which ones are possible to get back and to strengthen around.
Cheryl Crow:
Yeah. I call that like the solvable problems versus the unsolvable. That’s right. Like in the, and the unsolvable ones doesn’t doesn’t mean that like, therefore you give up. It just means that, okay, I’m not gonna remediate the underlying problem. How can we work around it? Can we use an assistive technology device or a gadget? You know? Yes. and I think that’s what, you know, what’s just striking me about this is that I wanna make sure people know that the first appointment that you go when you go establish care with like a certified hand therapist or occupational therapist, the first step is always an evaluation if you’ve never been through this before. And what, and so can you, can you actually like walk through what is an evaluation like? Because the reason I think this is so important is that a lot of times people jump to conclusions like, okay, my hand, my finger hurts and I have rheumatoid arthritis.
It must be because of my rheumatoid arthritis. But the evaluation is what tells us, okay, that might be our working hypothesis, but I’m gonna test all these different things. I’m gonna test your strength, I’m gonna test range of motion, and then we’re gonna see maybe it’s actually something else. And you can’t on your own as a layperson, you know, we do, there is a saying in chronic conditions, which I agree with, which is that patients become experts in their care. Like over time, you’re, you do, but you, when it comes to something as complex as the hand, it’s invaluable to have someone who’s spent years and years and years literally like obsessing over the hand. Like, I will not do be doing that. That’s my, at least you’ll come back and laugh at me if I change. But I’m not <laugh>, it’s too tedious for me. So I’m so glad there’s people out there like you who do specialize in the hand anyway, so Yeah. Yes. What would it, what is involved in that evaluation?
Hoang Tran:
So I, I love what you just said there about you become an expert and it’s not so much that you’re an expert, but I believe more so that you’re an advocate for yourself.
Cheryl Crow:
Yes. Yeah. Yes, yes.
Hoang Tran:
An advocate
Cheryl Crow:
For yourself. Who else is gonna do it?
Hoang Tran:
Thank you, Cheryl. Thank you. Oh, sorry, who else? Yeah, who else Yeah. Is gonna do that, but you, you know, so you have to be an advocate for yourself. Mm-Hmm. <affirmative>, even if you’re not necessarily an expert in X problem. Mm-Hmm. <affirmative>, one of the things I say is you need extra eyeballs, right. Because when you’re inside the jar Yeah. You cannot read the label on the outside.
Cheryl Crow:
Oh, I love that. Yeah.
Hoang Tran:
Mm-Hmm. <Affirmative>, you need extra eyeballs, you can’t, you see what you see, but you cannot see what I see.
Cheryl Crow:
Yeah. <laugh>. Yeah. No,
Hoang Tran:
That’s
Cheryl Crow:
So
Hoang Tran:
True. In an evaluation. I just, I do mine very, very specifically. Not everyone does it, but this is how I do it. I listen to and ask various questions around what the person’s problems are, what they can do, what they cannot do, what they have tried, what has worked, what has not worked. Mm-Hmm. <affirmative>, because everything that you’ve done until the point that you see me is helpful information. Cause I’m not gonna do the same thing that you didn’t like, I’m not gonna do the same thing that didn’t work for you. Or maybe I have an ego and say I’ll do it a little bit better, but <laugh> Yeah.
Cheryl Crow:
Well what’s true, right? The devil’s in the details. Yeah. Yeah.
Hoang Tran:
So that’s one of my favorite things. Oh,
Cheryl Crow:
Well. Cause it’s, and I’ve had people say, well, I tried hand therapy, it didn’t work for me. Totally understand. Like having one bad experience and thinking that it won’t work. But I’m like, that therapist and that particular experience didn’t help. It didn’t work. That doesn’t mean, and it’s, it’s actually a little scary, I have to say. And I, I tend, I have an anxiety disorder. And so for me, the fact that there is so much variability, it’s kind of icky to me and like makes me anxious. Cause I’m like, but why don’t, why doesn’t everyone know everything <laugh>? Why can’t they just all know everything and just be good? And it’s like, because life is messier than Yeah. We would like, well, so anyways,
Hoang Tran:
They know. They know. Right. But the application of knowledge is different cuz personalities are different.
Cheryl Crow:
That’s true. That’s kind of you to think that they know. There are, I definitely know that there’s, especially when it comes to cer, certain health providers have just given out outright Yes. Like misinformation to patients. Sure. Like you can’t be medicated during a pregnancy for rheumatoid arthritis. Like that’s just out and out wrong with the covid use the outdated way of thinking. But yeah, you’re right. I mean, yeah. Yeah. So, yeah. Yeah. So you are, this is your style of the hand therapy. That’s
Hoang Tran:
My style evaluation. So I find out what’s going on, I find out what’s going wrong, and then I look at all the motions. So do a complete evaluation, A complete assessment. So do you mind if I look at, you know, cause the elbow’s connected to the shoulder that’s connected to the hand mm-hmm. <Affirmative>. So do you mind if I look at everything? Oh my god. Really? Yeah, because most therapists, if you follow the prescription and you follow only what the insurance says, and the thing says elbow, look at the elbow, then the therapist can have blinders on and say, I’m only allowed to look at the elbow. Oh yeah. So this is why it’s so important when you go and find someone, I didn’t say just find any therapist. I, I said find a trusted therapist. So it takes time to find that trusted therapist. It takes time to build that trust. Mm-Hmm. <affirmative>. So that’s why I say that you have to, you know, when you have a chronic condition, not only are you an expert on that condition, but you’re an advocate for yourself. So you must continue to look, because again, the mindset is something is always possible for me because the flip side is nothing as possible for me. So which, which side of the coin would you like to live on?
Cheryl Crow:
Mm-Hmm. <affirmative>. I love that. Like a little mantra to repeat like something is possible. Yeah. I either can, like, let’s say in terms of pain, which pain is so complex, but you know, I can find ways to either reduce the sensation of pain currently, you know, or mm-hmm. <Affirmative>, I can find ways to have a different relationship to the pain, cope differently and as opposed to Yeah. Having this and I think sometimes when patients hear chronic, they think, well that means it’s no matter what I do, I have rheumatoid arthritis, so why do anything? It’s like, it’s true that until there’s an actual cure, you’re going to have rheumatoid arthritis. Yeah. Even if you’re in remission, you still have that diagnosis and condition still, you still have that fall in that umbrella of more likelihood to develop illness, drift more likelihood to, you know, have X, Y, Z. But it’s still yeah, yeah. Anyway, growth mindset. Yeah.
Hoang Tran:
<Laugh>. Yeah. So I, I, that’s how I look at it. I look at the whole arm, I look at the whole thing. I look at both hands. Mm-Hmm. <affirmative>, I look at both arms because rheumatoid usually hits a person bilaterally, meaning both sides. Mm-Hmm. <affirmative>. So sometimes what you can see on one side, you can see that something is coming down the pipes on the other side. Mm-Hmm. <affirmative>. So if, usually when I see someone for one thing, I say, what can I do? Not just to help you today, but what else can I do to help you tomorrow?
Cheryl Crow:
Mm-Hmm. <affirmative>. Yeah. So true. So true. And, and I, I have a history of one side consistently being worse than the other. Sure. But it’s like the, the, the worst side is like the red ha or not the red hang, the canary in the coal mine. Like when that side starts flaring again, I know pretty soon. Like, you know, the other side will. And okay, so yeah. Then you get, you get all these measurements and for those people who like data, it’s really, I mean, I’m such a nerd, obviously a, like I’m an ot, but I think it’s actually really neat to get like a hand therapy evaluation because then you could have this document that you keep and you see, this is how much my joints can move. Right. Uhhuh, <affirmative>, this is my strength. These are like numbers we can actually assign to things.
I know the most important things aren’t really measurable, but then Yeah. You know, if you do therapy, then you can feel like, oh, I’m improving. Like, or yeah, you can just feel like there’s, I think this is just me going off, but like with rheumatoid arthritis, it’s such a fluctuating condition. It can feel like you’re just so much is outta your control that I think sometimes having numbers to put to things Yeah. Is helpful. I actually have a, a a member in my room thrive group right now who has type one diabetes and rheumatoid arthritis, which if you have one auto, you know, type one diabetes is autoimmune, and if you have one autoimmune, you’re more likely to have another. But she said, I said to her, you know, I’m like, I have this, this is a grass is always green or thing, so I want you to tell me if this is not true.
But I was like, I ha it feels to me like if I could, like the way that you could measure your blood sugar, I know that that doesn’t necessarily cor blood sugar doesn’t correlate necessarily perfectly to like what you’re feeling. Yes. But I’m like, but it’s like, is there some sort of like relief to that? You know, as opposed to like rheumatoid arthritis, there’s like so few things you can measure. She’s like, oh my gosh. Yes. So that’s what my end of one, she agreed with me that like <laugh>, it’s hard to have something so like ephemeral. So
Hoang Tran:
You create systems to measure, you create your own metrics. Right? So for example, when I’m talking to, you know, my patient, my client and say, okay, this is a red flag, right? So we can have you, you have, you know, how much pain do you have? And there’s various types of pain mm-hmm. <Affirmative> and there’s various ways in which you could feel pain. So you can either have consistent pain or, or intermittent pain. Mm-Hmm. <affirmative>. So there’s ways to measure. So if we can work to get rid of or rid of your pain, how, how long can it last? Right? Right. That’s a measurement. How long can we keep the pain away? How low can the pain be in terms of its intensity? What type of pain can we look for? That is okay, but not in others. Right. So like if you have rheumatoid arthritis, you might always have like this dull achiness that you know something is wrong, but there’s no sense of urgency to it because you develop such a high level of tolerance.
Right. So that level is okay, but when you do something and it’s sharp and it’s pinchy and it stabs and radiates, that is not an okay pain. Because what happens with rheumatoid types of problem is everything essentially becomes an orthopedic issue. And when I say orthopedic issue, it’s means that your joints fall out of alignment. Mm-Hmm. <affirmative>, if your joints fall outta alignment, then when you move and the two bones are hitting into each other, you get what’s called an impingement. If it’s in the shoulder mm-hmm. <Affirmative>, you get what it, you know, called something else when it’s in the hand or in the wrist. When your joints fall out of alignment, they no longer sit what we call congruently together, then your muscles only get long and only get short. So now your muscles are imbalance. So what is actually a rheumatoid type of problem versus a orthopedic type of imbalance. So there’s something to work on.
Cheryl Crow:
Mm-Hmm. <affirmative>. No, that’s so, so important. And I know that there’s plenty of patients who, who’ve had it for the long, you know, long term. Who then do develop, you know, osteoarthritis. I didn’t even realize till my doctor just mentioned offhand that I have a little bit of osteo on my toe actually, which isn’t, it’s interesting how deformities don’t always correlate to pain. I think if they’re more off the mild. Cuz I’m like, it actually, it’s like, I don’t know if we could probably, the deformity in my, I have my second toe is bigger than my big toe and it’s longer Really? It’s longer is
Hoang Tran:
But
Cheryl Crow:
It’s fatter. Sorry, it’s was longer and now it’s shorter cuz it’s curled up like this. Okay. Yeah. So, oh. And yeah, so I was, I insisted to my doctor initially that was from my hammer toes from playing soccer my whole life. I was like, no, no, no, that’s just from soccer. She’s like, this is literally like rheumatoid arthritis. Like I can see it <laugh> like, but anyway point being it doesn’t act that doesn’t hurt me too much, but there’s other things where it’s like this tiny, tiny minor imbalance that can cause pain. So all, all the more reason to say that, you know, getting an evaluation to help you suss out like yeah, is it muscular? Is it tendon? Is it, yeah. Mm-Hmm <affirmative>, what can I do about it?
Hoang Tran:
What can you do about it? Cuz there’s always something to do. Even the toes. I always say the toes are like the hand and they
Cheryl Crow:
Really are
Hoang Tran:
In my architecture clinic. Yes. It’s, it’s in my clinic, I, I treat everything. So usually when I, when I get someone for their hands and arm, they end up treating everything else, including their toes.
Cheryl Crow:
<Laugh>, we’re all,
Hoang Tran:
Yeah. And I’m like, oh, what that, you know, your toes are just like your hands <laugh>, you know, if you’re lucky like me, I, I’ve picked things up with my toes. I mean, but not everyone can do that.
Cheryl Crow:
<Laugh> not every, yeah, you can learn but <laugh>. Yeah. And so, okay, we talked about the, what the evaluation is like and we’ve talked about a little bit of the treatments, part of the treatment you were mentioning. I would involve like patient education, like that’s another thing patients might not know is that like learning, like having a therapist, like an like, like Hoang teaching you about the hand and about ways you can protect your hand and also make sure to keep moving your hand. Learning which braces in splints might help learning how to wear them. That’s all part of occupational therapy and certified hand therapy. Right. So that can be something that is part of your, it’s not just like, I think there’s a lot of times people hear like therapies, well first of all they hear OT and they think it’s just like pt and then it might just be like, oh, they’re just gonna put me on like a hand exer a hand bike or something.
Like Yeah. A lot of education can go on. Yeah. And yeah. And what are some of the other, like, I know I’ll just give you one of the FAQs that I get. In terms of people’s, like most patients wanna develop their own pain toolbox, right? Or their flare up toolbox, like what mm-hmm. <Affirmative> they wanna set of tools for what to do when they get those prac pretty much inevitable. I hate to tell you, inevitable, unless you’re the one, the one lucky ones that does go into remission long term. You know, things like hot versus cold, some patients wear by hot. What do you, what, what do you say when someone’s like, I don’t know when to use hot or when to use cold. Yeah. How do you help them make sense of that?
Hoang Tran:
So usually with, Ooh, sorry.
Cheryl Crow:
No worries.
Hoang Tran:
What do I have? Oh on. No, I, it’s just my timer went off for whatever reason. <Laugh> I probably said it in incorrectly for our meeting today. <Laugh>, and it’s like an hour late. <Laugh>.
Cheryl Crow:
Oh right, no, I do that. Yeah. <laugh>.
Hoang Tran:
So what do I say about hot and colds? Well, normally cold is used for an acute problem. Inflammation, redness, swelling, and heat is used for when you feel really stiff and tight. Right. So in a flare, when you have a flare up, a cold compress can be helpful to reduce your pain because when you have a flare up, you have so much pain, so much redness, so much swelling. And you need to reduce that. You need to, to calm that down, you need to be able to live and and tolerate that. So a cold compress can be really nice and ease, ease you out of that pain. During your flare ups, you can just do gentle motion that is within the limits that you can tolerate in terms of moving and just every once in a while, checking your joint, let’s say it’s your elbow bending it and straightening it. Not like a lot of repetitions or anything like that mm-hmm. <Affirmative>, but just making sure that it moves. Right. Right. And when as it starts to reduce and you feel that stiffness or you might have lost emotion there because of the swelling your body is extending, not only is it attacking itself, but then it’s sending you know, the low workmen there to repair. Right. What it attacks. Right, right,
Cheryl Crow:
Right,
Hoang Tran:
Right. So you have both, I call it junk, you know, you know, flood comes in and the flood goes out and when it goes out, it leaves junk there, it leaves debris. So right now what you have is you end up having some debris and it’s through gentle motion in the right way. With the right intensity to get you to return to as much motion as possible. Mm-Hmm. <affirmative>. Now the reason why I say, you know, there’s a lot that you could do on your own as a, as somebody who has that injury, right? Mm-Hmm. <affirmative>, I do advocate and advise if you can go somewhere, even if it’s a couple times. Cause I know like you have, you know, people have so many medical appointments, they’re like, oh God, therapy is such a drag, I really want to go. But if you find a really good supportive therapist, they can show you and you, you, you wanna advocate for yourself and ask too.
One of the things that I always ask my patients, but I do this, not everyone does. So like, how much do you want me to help you? Mm. Do you want to, do you want to come in and have me do majority of the work or do you want to also learn what to do at home so every week we can make some progress and, and keep progressing towards a goal that you said that you wanted? Or did you wanna just come in once or twice and figure out what to do and you’re on your own, right? Mm-Hmm. <affirmative> mm-hmm <affirmative>. So I give people choices if they say I just wanna come once or twice. Well, I know a lot, but you are only giving me one to two mm-hmm. <Affirmative> times to help you. So here’s as much as I can provide and then I can’t, I can’t keep continue to help you because you’ve, you’ve said you don’t want my help.
Mm-Hmm. <affirmative>. Mm-Hmm <affirmative>, most of the time people say, I wanna learn what you’re doing. Mm-Hmm. <affirmative>. Mm-Hmm <affirmative>, I will teach you what I’m doing. I will show you the issue with someone with rheumatoid arthritis is that it’s happened to both your arms. So when you’re using one arm to help the other arm, it’s not gonna like you that much. Mm-Hmm. <affirmative>, right? Mm-Hmm. <affirmative>, when you have the problem, you can’t stop other, all the other body parts that are helping to compensate. Cuz your body is extremely smart. Yes. For example, when I work with the elbow, I’ve got to pin that shoulder down. I’ve got to move, you know, isolate just the elbow and then we’ve got to move with the forearm, right? Mm-Hmm. <affirmative> and we can move the joints, we can work the tissue so that you can have several levels of comfort, pain relief, motion, tissue work, you know that Right?
When I have my two hands compared to your one hand can be a lot more effective, faster. Mm-Hmm. <affirmative>. Mm-Hmm. <affirmative>. Mm-Hmm <affirmative>. And then there’s some things that you can do on your own, like support that motion to keep it from one visit to the next. Mm-Hmm. <affirmative>, there’s tissue work, right? So a lot of times therapists might call it retrograde massage, meaning mm-hmm <affirmative>, we’re gonna move the tissue, we’re gonna move the swelling from one end to the other end. Mm-Hmm. <affirmative> there’s, they can call it myofascial release, they can call it faci work, whatever manual therapy techniques, all the fancy words mm-hmm. <Affirmative> that you want to use. Basically it’s just you know, moving the debris, moving the swelling out of the area so that you will have less pain because every problem beco has become an orthopedic problem where your joints don’t move as well. Your li’s got really tight, your tendons and muscles got kind of shorts and your skin and and fascia are not as flexible as they could be to allow you to move in a pain-free range.
Cheryl Crow:
Yeah. That’s why early you know, early aggressive treatment is so recommended in rheumatoid arthritis because initially when the immune system mistakenly attacks like the synovial fluid in the joint, which is like that super lubricating, I know that you know what it is, but I’m telling the audience the lubricating, you know, material, did you know? Yeah. So around the joint,
Hoang Tran:
Let’s assume I know
Cheryl Crow:
General, but but yeah, what it does is it, it just creates inflammation initially. There’s like, you know, stuff from your immune system comes in, tries to like quote unquote attack the foreign invader and initially it doesn’t, it doesn’t immediately. Right. Cause mechanical issues in the joints, it’s o only when it’s left for a, the way I think of it’s almost just like there’s only so much space in the joint for the swelling to go. Eventually it compresses just kind of like when you have, and this is a maybe, I don’t know why I’m thinking of this analogy, but like, you know, in the skull if the brain is swelling, there’s only so much, you know, only so many places it can go. But in the joint cuz things are moving around it, you know the bones and everything’s moving around it, then it’s creating friction and then that’s contributing to the wear and tear.
So, you know, the medications for so many people are so helpful because they can really slow down the initial disease process more quickly than any anything else. But because the medications aren’t perfectly effective for everyone or they’re, like for me, where I was in complete medication remission with no symptoms and no disease progression for six years and then my immune system changed cuz immune systems like to just change sometimes <laugh> Wow. And, you know, develop antibodies to meds or then I, you know, with my pregnancy, my immune system changed again. I’m out of that full remission. I’m not in, I’m in the gray zone. I’m not in a complete remission, I’m not in a complete flare up. I’m in the moderately well controlled but not perfectly controlled disease activity. Yeah. Then we wanna combine the medicine with the manual techniques, the therapies, anything that we can do lifestyle wise, you know, exercise, nutrition, sleep. Yeah. Stress management. Sorry. Yeah. I just went off on my lifestyle on tangent.
Hoang Tran:
But <laugh> definitely lifestyle. Lifestyle is huge. I spend a lot of time talking about that with my own patients. Mm-Hmm. <affirmative> and we might incorporate some of certain exercises in it to support them. Mm-Hmm. <affirmative> like, you know, core strength is essential, so your hands have to work so hard if your elbow doesn’t move well and your shoulder is not strong enough to stabilize mm-hmm. <Affirmative>. So the pain that someone might feel like the per the, you know, my patient that I’m currently working with, I’m working with her whole, whole body essentially. Mm mm-hmm. <Affirmative>. But in order to fix the shoulder pain, we had to fix the elbow first she came in for her elbow, but then she was like, but this hurts and this hurts. And I’m like, I get it. Let’s focus on getting better motion in your elbow mm-hmm. <Affirmative>. And from there we can stabilize and make sure that the shoulder isn’t so painful.
Mm-Hmm. <affirmative>. Because what’s happening with the shoulders is because the elbow compensates, right? So the elbow doesn’t move, the shoulder will compensate for the elbow not moving. So she’s developed a shoulder impingement, meaning the two bones are hitting into each other and solely over time, left untreated, ignored, will eventually tear away at your rotator cuff, right? Mm-Hmm. <affirmative>. Mm-Hmm. <affirmative>. Mm-Hmm. <affirmative>. So we’re getting that stabilized. We’re working on that. And she was like, but my elbow feels better. My shoulder’s feeling better, can sleep on it now. But my hands, I said, well we’ve got, you know, we’re getting to hands, but we’ve still need to stabilize a little bit more so that we can get to the wrist in the hands because the wrist, in the hands currently doing so much work right now mm-hmm. <Affirmative> cause we don’t have enough stability. Mm-Hmm. <affirmative>. And then she was complaining of numbness to her fingers.
These are not necessarily rheumatoid arthritis problems. These are orthopedic problems brought on by the rheumatoid disease process that affected the joints that now you’re longer move as well. Mm-Hmm. <affirmative>. Mm-Hmm. <affirmative>, you can become a little bit, I call it, there’s two types of body types. You’re loosey-goosey people and you’re stiff as aboard people. So you’re loosey-goosey people. The ligaments aren’t, they’re not tight enough to hold you together. Mm-Hmm. <affirmative>. So think about your skeleton and you’re like too wobbly and you, you kind of like the, the wind blows and your, you know, your skeleton falls apart, right? Mm-Hmm. <affirmative> crumbled to the floor. Well, in order for you to be held together, you need your muscle, your muscles hold your body together and gives you that stability and gives you that strength, right? Mm-Hmm. <affirmative> and it allows your joints to move better. Mm-Hmm. <affirmative> so with someone who has rheumatoid arthritis. Core strengthening, key core strengthening is really important. And again, it’s so important to go to a therapist that has an awareness of this because if you just work out, like everyone else works out, you’re gonna be jamming your wrist. And not every person with rheumatoid arthritis can be putting the level of weight on their wrists that you might see in free YouTube exercises, right?
Cheryl Crow:
Yeah. Yeah. <Laugh>,
Hoang Tran:
You, you, you have to essentially at some point learn certain exercises in a modified way, but maybe not miss certain core ones. It’s not that someone doesn’t know any exercise, the fact that you know, certain ones you can take back to your therapist, I’m doing these, what other strength in the exercises am I missing that I could do? Your therapist could help you with that.
Cheryl Crow:
Right, right. No, that’s, so this is so helpful. So I hope, you know, we’re calling this episode No Hand Therapy Secrets. Everyone With Arthritis Should know. But you know, these aren’t necessarily like literally things that only us know, but they’re things that, you know, we’ve talked about advocating for yourself, building a team, being proactive and establishing, you know, care, including a hand therapist early, learning about the anatomy of the hand and getting an understanding, you know, of what might, what’s the root cause of your issue, even though you have a diagnosis of rheumatoid arthritis. It, like you’ve mentioned numerous times. Yeah. It may not be that it’s that that disease is actually causing the current issue, or it might be causing one of your six issues been on all of them. Yeah. <laugh>, you know, and yeah. Developing a that’s right toolbox. And then I think the part about the mindset, to me that’s, I I just love talking about the mindset, but yeah. Saying that, you know, in something, some improvement is always possible. Yeah. I think that that’s all just like super helpful. And I just wanna end by asking, do you have any advice, just in general for newly diagnosed people newly diagnosed with rheumatoid arthritis? I guess first of all, listen to this episode <laugh>, which you probably are, if you’re listening right now, you’re already listening. But yeah, in general, what do you find as helpful for them to, to remember or know?
Hoang Tran:
I think that, oh gosh, in my experience when I’ve spoken to people, I speak to them so late in the game.
Cheryl Crow:
Oh
Hoang Tran:
Yeah. And sad, they always, cuz that’s the nature of my job, right. <Laugh> unfor, like
Cheryl Crow:
Which shouldn’t be though the nature of your we should be getting hand therapy. This should be part of the post-diagnosis process, in my opinion.
Hoang Tran:
Yeah. But, you know, the way, you know, perfection isn’t the way of the world.
Cheryl Crow:
No. <laugh>, I’ve been really good. Set for 41 years. Yeah,
Hoang Tran:
Yeah. Yeah. So, you know, I think that if there’s anything that I could say, someone who is newly diagnosed as someone who works with people late in the game, is that the people who I speak to always regret taking late action. Yeah. But never has anyone ever said that they regret taking early action.
Cheryl Crow:
That that makes sense. That is, no, I actually just literally know I’m getting chills because That’s so true. And I just did a video earlier this morning about you know, all the different kinds of grief people can have with this kind of diagnosis. And you know, a lot of times people say, talk about grieving your old normal or the old you. But I also think, and I’ve seen it in myself and others, that you can regret the way that you manage your condition. Yeah. Because it really is a, a one hindsight’s 2020 Yep. To like, know better, do better. It’s okay. Like, and there’s people who’ve, I mean, I mention this all the time, but I see a lot of the times with the autoimmune forms of arthritis, people get sw they get really excited about the all natural claims people make, you know, just do this diet.
You don’t have to take the scary meds. And then they, the, the natural methods don’t work for them. And then they take the meds and they immediately feel better and are like, oh my gosh, I just, I I have irreversible joint damage. Yeah. And I could have prevented this. And there’s a lot of, we have to learn to just sit with that grief and know that like, there’s no changing of the past and all. We can con, you know, we can give ourselves self-compassion in that moment and then Yeah. You know, focus on the present and the future, which is the only thing we have any control over. Yeah. So
Hoang Tran:
Usually my patients talk about that and regret that and mm-hmm. <Affirmative> yeah. And it’s, it’s really sad to see, you know, because they, there’s, there’s, there’s not just a regret, but the mindset of what next, what next? Like, it’s gonna be bad again. Right. So I think the second thing is no one regrets taking early action, but also to be gentle to yourself. I teach a lot of students and I, you know, as a, as a certified hand therapist, I, I run hand therapy cigarette. I started and run hand therapy cigarettes where I train other therapists. Right. Yeah. And one of the things that I see in the therapy world is that we are not gentle with ourselves. Please. I’m not gentle with myself. Like, I’m not even a gentle person. <Laugh>.
Cheryl Crow:
Well, you gotta do you, oh, you gotta be true to yourself.
Hoang Tran:
Yeah. Like I’m, you know, I’m like, I’m high, high energy, high level, high, you know, like all, like I can shoot off like a rocket. Yeah. It’s my personality. Right. So high energy person and I can see it, I can see it in myself now more than I ever saw before, but I only started to pay attention because I’m, I see it in other people. Mm. So yeah. That we are, we are not gentle beings <laugh> to ourselves. So if I’m working with therapists and they’re not gentle to themselves when when they’re striving for certain things. So to the patient cuz who’s, what’s a patient? A patient is a person, just like a therapist is a person. And when I work with any kind of patient, with an injury, with anything, they’re not gentle to themselves either because one, they shouldn’t have gotten the injury in the first place. Two they want to get better. Yesterday, <laugh>
Cheryl Crow:
<Laugh>, I am part of that in, in the inpatient, inpatient people, anonymous <laugh>.
Hoang Tran:
Right, right. We all are. So, you know, taking that into consideration of like how we are as human beings, then it doesn’t matter what you have, you have rheumatoid, you can have whatever you have. And you have to remember to be gentle to yourself. And it is a work in progress and it is a certain level of awareness that you have to have and continuously work on. I mean, I can’t say it any, any other way. I, I do it. I have to, I brought that into my practice last year. <Laugh> like into myself, into me into Huang. Yeah. Yeah. I have brought that into myself. I often will forget it, but then I have to bring it back. So last year was very intentional Hmm. On that, even at the speed in which I want to work. Yeah. Even at the speed in which I want to accomplish things I have to be gentle to myself. So if you are someone who newly diagnosed, you have to become an advocate and, you know, an expert of your own you know, disease and process. Two, you never regret early action. Mm-Hmm. <affirmative> and three, to remember to be gentle with yourself, to yourself at all times.
Cheryl Crow:
Yeah. And I, the, I’ve recommended her before, but I cannot recommend highly enough. Dr. Kristen Neff, that’s k r i s t i n n e f f. She is a psychologist who specializes in self-compassion. She has a couple books. The latest one I think is called like Fierce Self-Compassion, talking about the different self-compassion sounds like la la la I love myself. And that is actually part of it, but part of it’s also standing up. Sometimes that means having boundaries. Sometimes that means saying no to things because you are prioritizing, you know, your own mental health. And the second thing I would say is or just adding onto the, being gentle with yourself, is that you know, getting mental health support is really important with, with rheumatoid arthritis, if you’re having, you know, anxiety or depression, which are very, very common in in people with autoimmune diseases in general, but particularly rheumatoid arthritis, psoriatic ankylosing spondylitis.
And I did not go to therapy in, in for any problems in my life until it was postpartum. Mm-Hmm. <affirmative>. And I always mentioned that because I think that there’s been a lot of amazing work in the United States done to de-stigmatize postpartum depression, postpartum anxiety. And I felt like, well, society thinks it’s okay to get therapy for postpartum issues, postpartum. I just call it like postpartum yucky feeling. Like I didn’t Yeah. Doesn’t really feel like, well, I felt irritable and I felt overwhelmed, you know? And so I guess that’s irritability is a symptom of both anxiety and depression. So I didn’t feel sad. I didn’t feel Yeah. Worried. I just felt like what I felt like I just got hit by a train. Like,
Hoang Tran:
Do you mind if I ask you personal questions?
Cheryl Crow:
Oh, of course. Yeah.
Hoang Tran:
What was your breaking point that said, I’m gonna get help because this irritation? Cause I mean, who isn’t irritated and who isn’t overwhelmed at certain stages or certain parts of the days? Right. Like, that’s where I’m kind of curious.
Cheryl Crow:
Okay. There were two point was, yeah, there were two really specific moments I can remember. One is that one of my close friends gave birth 10 days after me. So we’d gone for a pregnancy together. And I remember her saying just offhand at like nine months postpartum when I had a, a lot of friends gave birth around the same time. And we were just kind of sitting there like you know, venting. Oh, my husband doesn’t get it. La la la. You know, like that kind of thing. And and then she was like, I kind of weirdly feel, and she wasn’t bragging, she was just literally saying the truth. Like, I feel like me and my spouse are like closer than, like, closer than we were before the baby. Like, and she was like genuinely surprised by that cuz she was expecting to be like, kind of some of the others us who were like, oh my gosh.
You know, like, like I’d and I just, I try not to talk about, you know, I don’t talk about my husband a lot, only because he’s a lot more private than I am, you know, and just, yeah. And so I don’t, it’s, it’s my story and I love sharing my story, but it’s also his story, you know? Yeah. But I felt like we went from this happy couple to, I just became this, I just, I’m like swatting away at him, like, go away, but also help me, but I don’t wanna teach you how to help me. Ugh. Like, I just felt just like a totally different person. Like literally. Yeah. And, and he asked me one time, like basically kind of check in, like, what do you hate me? He literally said something like that. And I was like, I hate myself right now.
And that, and that has never, I’ve never felt that way before. I am like a like happy temperament. Yeah. I was a happy baby. I’m a happy child. Like, yes, I’ve had anxiety. You strike me as being a very happy, I’m bubbly. I’ve literally felt like, and actually the other thing that, so I was like, this isn’t like a couple’s counseling problem. Like this is a me problem. Although of course I think I’m a big proponent if you’re Yeah. Having marital, like, it was more just kinda like, he could tell like something, he’s like, are you like, what? You know, and he wasn’t like, you should go to therapy. He was kind of just like, is there something I could do? And I was like, yeah, something happened to me. Like my brain is different now and I don’t like it and I don’t, yeah.
And I’ve always loved myself and loved being me. And, and, you know, my parents were amazing and, you know, self, they, they really kind of just, you know, encouraged me constantly and were like, you’re perfect just the way you are. You know, that’s self-esteem movement of the eighties, you know, <laugh>. But, so I knew that that was, that that was not me, but I still didn’t get therapy. Because I’m an optimist and I’m stubborn, and my husband and I are both stubborn and both optimists, which is the best and the worst because we will not give up ever, even if it’s something that should be given up on. Right. Yeah. So <laugh>, so you’re like so then I was like, okay, well, it’s about to get better. I just kept convincing myself when he gets to know, oh, when he walks, okay. When he’s, we, we, when we wean him, when he’s on bottles, when blah, when he sleeps this mile, blah, blah, blah.
I ca and then I got to 12 months and it was like, and then my, I ended up a then a friend of mine had also had gone to therapy and was raving about it. So I asked her for her therapist, her name, and I went to the therapist and she was like, I said, I feel so dumb, because it was like, th at this point it was, i i 12 months. I was like, it’s not better. It’s not like he turned one and it’s magically better. And then I was like, but wait a minute, is this even considered postpartum depression because, or postpartum, whatever, because he’s not a, he’s not an infant. But, and my, of course I was in the middle of a huge ra flareup, but I kept minimizing that. Okay. But yeah, I know. I’ll get it under control.
It’s about to get under control. Yeah. It’s okay. We’re fine. Yeah. And then, anyway, so this is a little longer story, but then I went to her and I was like, I, I said, this is weird because I’m like, it’s 13 months postpartum. And she was Cheryl, I cannot tell you the number of women that come to me in the 13, you know, 12, 13, 14 months. Cuz they all say the same thing. I just wanted to make it to a year. Just make it to a year postpartum, then it will get better. And then it doesn’t. And then, but the other thing I just was gonna say, resolving the issues around, you know, postpartum adjustment, adjustment to being a mom and adjusting to my understanding, like she taught me that irritability is a symptom of anxiety and my anxiety is about things I can’t control.
And an infant and a baby is inherently on, not on your control. Yeah. Those things that took, that didn’t take a huge amount of time, but I ended up going to her for a number of years because we ended up processing a lot of my rheumatoid arthritis and my journey around that and the medical gaslighting I’d experienced a lot of things I had like suppressed. Yeah. And I really wished after going to her that I had done it earlier, but I didn’t, in my mind, rheumatoid arthritis wasn’t quote unquote a bad enough quote unquote justification for quote unquote needing therapy. Like, all of those statements are problematic. Like you don’t need any justification other than, Hey, I don’t feel great. And there’s people whose literal job it is to like help you with that <laugh>. So anyway,
Hoang Tran:
Thank you. So that’s
Cheryl Crow:
My last story. Yeah.
Hoang Tran:
No, I love it. Thank you so much for sharing that. As I was listening to you, it made me think about my rheumatoid arthritic patients Yeah. Who follow the same trajectory of it’s gonna get better. It’s gonna get better.
Mm-Hmm. <affirmative>. I just wait until that flare up goes down. And if, you know the, the idea of going somewhere to get help, I can do it myself.
Cheryl Crow:
Yep. Yes.
Hoang Tran:
I can do it myself. I’m gonna keep trying, gonna keep trying. I’m gonna do it myself. Cause I’m not a giver upper mm-hmm. <Affirmative>.
Cheryl Crow:
Mm-Hmm. <Affirmative>.
Hoang Tran:
There’s the
Cheryl Crow:
Toughest people. The toughest people I know. Tough. They the toughest people, honestly,
Hoang Tran:
The toughest people.
Cheryl Crow:
Right. But that’s a problem. We need to ask for help. Like
Hoang Tran:
The things that help us are exactly the same thing that eventually will hurt us, our stubbornness mm-hmm. <Affirmative> mm-hmm. <Affirmative> mm-hmm. <Affirmative> because you are stubborn enough, you are strong enough to get through this mm-hmm. <Affirmative>, but your strength and your stubbornness stop you from getting help when you could have gotten help. And then once you got help you’re like, oh shit. Wish I’d done this earlier.
Cheryl Crow:
Yeah. Well, and I think, like, I think I just have a really, my therapist literally referred to my childhood upbringing as like a positive outlier. Like I truly had and idyllic childhood, no trauma, no anything. So I think also I had this misconception that like, therapy is only for people who’ve had like a trauma or again, trauma. Yeah. Something terrible,
Hoang Tran:
Terrible life. Yeah.
Cheryl Crow:
Like, and I had to, and I also had this story, I kept repeating to myself that like, my life is perfect other than rheumatoid arthritis. Like that’s a little mis perfet over here. You know? Yeah. And being able to have that humanity to say like, no one’s perfect, you know? And I, I thought, oh, I figured out rheumatoid arthritis. I just take my medicine and Yeah. Okay. Yeah. I had no, like, people got, people asked me so many times like, were you, like, did it, was it hard to decide whether to have a baby with rheumatoid arthritis? I was like, no. <Laugh>. Yeah. I was just like, I’m doing it. Yeah. Yeah. People can do it. My, my doctor says, you know, lots of people have a healthy normal pregnancy with rheumatoid arthritis. Yeah. What’s the problem? Yeah. Like, but that’s, it sounds so functional to say that. Right? Yeah. And it seems like she’s optimistic. She’s got a great attitude, but optimism sometimes is like a form of denial. Right. I am choosing not to look at the negative possibilities here. Yeah. I’m only looking at positive, positive blah. Yeah. Yeah. And then, and I did have a great pregnancy for the record. Yeah. But you know, there’s a reason we don’t have another child. Yeah. You know? Yeah. We, things might really south afterwards and Yeah. With my health and
Hoang Tran:
Yeah.
Cheryl Crow:
So anyway. Yeah. <laugh> for what? That sort
Hoang Tran:
<Laugh> when you, when you listen back, like, like I was listening to you cuz I’m again an outsider listening in onto your story and so much of it sounds so familiar Yeah. With people who come to me with rheumatoid arthritis, types of pains, limitations, fears, worries. Mm-Hmm. <affirmative>. And they think that there’s a lot of things that they could do and tackle on their own. Yeah. And they sometimes don’t know where to look, don’t know who to go to. Finding that trusted person. You were very fortunate cuz you asked somebody who knew someone who could refer to you. Yes. Not everyone has that. One of my, one of my patients, you know, usually people find me on Google. Mm-Hmm. <affirmative>, they search me up. They, they look for a certified hand therapist. They, again, like I said, I’m in Miami. So they look me up there.
They’ve usually tried several other therapy clinics prior mm-hmm. <Affirmative>, we just, we work a little bit differently. We’re completely independent clinics. Mm-Hmm. <affirmative>, we’re not high to any surgeon, any doctor that says, oh, whatever that doctor says. Like, I can give you an incom, like a completely independent mm-hmm. <Affirmative> mm-hmm. <Affirmative> assessment of where you’re at, where you wanna go, what do you wanna do based on what your values are. Mm-Hmm. <affirmative> mm-hmm. <Affirmative> that align with the, what my values are, which is I can help you to be more active, to not have pain and to avoid things like pills, injections, and surgeries. Right? Mm-hmm. <Affirmative> mm-hmm. <Affirmative> pills meaning pain pills, not Yeah. Medication pills that can not disease process
Cheryl Crow:
<Laugh>. Yeah. Yeah. No, thank you for that clarification. Cause there is, I definitely have this crusade against, you know, that it a lot of people are very an, you know, they have it, I understand the bias against medication that the natural is better. Fallacy is like a documented logical fallacy, you know, that a lot of people fall under and that Yes. If there was a way to Yeah. Naturally control rheumatoid arthritis as well as medication, I would do it. You
Hoang Tran:
Know. Yeah. Most people would, right? Yeah. Just, but there some, some, some things require medication. Mm-Hmm.
Cheryl Crow:
<Affirmative>, there’s no
Hoang Tran:
Shame. Some things require medications and some things you can’t avoid. I have a good friend who he’s a physical therapist, does a lot of manual therapy’s actually in Washington state, but not in the same area. But he owns a clinic and he has rheumatoid arthritis and it’s, oh, I didn’t know that it’s actually hereditary. Mm-Hmm. <affirmative>, his, his mom has it. He has it, his brother has it. And I always, you know, when we used to get together for like, business meeting stuff and, you know, I, my hand therapist so I can’t help it. I’m like, your hands look good. Like, I
Cheryl Crow:
Know. Yeah.
Hoang Tran:
I think what, you know, like, your hands look good too. Right. So I’m like, Hey, look good. You know, a lot of people who do manual therapy always ask me about my hands and my hands feel good, right? Mm-Hmm. <affirmative>. So I was like, what’s up with your hand? And I was like, I don’t see you. And he goes, well ever since he was diagnosed, he takes some medication. He, he has a very particular diet that he sticks to that he has found works. Yeah. Yeah. And he manages and controls a lot of his his weight. He controls his weight, he controls his activity level. He mm-hmm. <Affirmative> like the things that he can’t control. He has controlled and Right. That takes not just discipline, but habit. Mm-Hmm. <affirmative>. And he has a brother who complete opposite overweight, doesn’t take medication, doesn’t stay active, eats like crap already at a very tender age in the forties, already have like hip surgeries, hip replacement, shoulder surgery. Mm-Hmm. <affirmative>, like, so you can, you can run the gamut. Every, everything is on a bell curve. <Laugh>. Yeah. Yeah. Right. Everything’s on a bell curve. But really at the end of the day, you, you, when you advocate for yourself, you find out what works for you.
Cheryl Crow:
Yeah, yeah. Yeah. And it’s, it’s really a team effort. I have done some try to do some work. I’m say, I don’t wanna be too ambitious with what I’m saying, but, you know I’ve done some work with other disciplines like social works, you know, in, in the American College of Rheumatology’s Association for Rheumatology Health Professionals, which is like the A O T A for people in rheumatology who are not rheumatologists. So Okay. You know, nurses, O T P T. Yeah. Psychologists, counselors, pharmacists. Yeah. nurse practitioners who work in rheumatology. Yeah. That’s an as, that’s an association. And I’m, even though, again, my work is very non-traditional right now, but I’ve joined, joined them try to like and I’ve done some talks to help like kind of highlight the multidisciplinary team and know that your team is not just you and your doctor.
It’s, you know, when it, when it’s a chronic condition, your family members are part of your team, you know friends can be part of your team. Friends can help you, you know, support your habits and behaviors and routines. You know, your friends might remind you, Hey, remember how you notice that whenever you sleep really well, you know, your pain is less. Maybe, you know, the accountability partners and then everyone else. But anyway. But I know we’ve gone over, but thank you so, so much. And I I wanna make sure that I, everyone knows the o admin, I’m gonna put links to your social media accounts and website. But do you wanna just say if any, if people wanted to find you online, where what, where do you want them to go?
Hoang Tran:
Sure. my name is Han. I’m an occupational therapist and certified hand therapist. And you can find my clinic. I’m located in Miami and it’s called Hands-On Therapy Services. And if you are an occupational therapist and you’re listening to this in want to dive into the world of hand therapy or just explore hand therapy, you can find me in hand therapy secrets across all channels about YouTube channel, Instagram, Facebook.
Cheryl Crow:
You’re so smart to get the, you name it, handle. I didn’t do it. I did not do that. I didn’t get the same handle. And now it’s, it’s like fun.
Hoang Tran:
It’s not, it’s just like, it’s just like, you know, I, I do hand, like that’s, that’s my thing. So hands on. I don’t know why I thought it would be like, yeah, that’s exactly what I do. Cause I’m hands on <laugh>.
Cheryl Crow:
Yeah. I love
Hoang Tran:
It. It’s a long title. I wish I had like, gone with another name or whatever HandsOn Therapy Services and then hand therapy seeks, because in the hand therapy world, there’s always this, I don’t know, this rhetoric and the story of like, it’s so hard and I don’t believe that it needs to be hard. And sometimes people hold things to their chest, meaning like, I just, like, I have to hold it in. I tell anyone my secrets and I’m like, well, let’s share it and let’s actually get more people, more occupational therapists with the opportunities with, you know, building their careers, advancing their skills. And I can only help so many people in the South Florida area, but when I help occupational therapists around the world those therapists help everyone else in their community and
Cheryl Crow:
Uhhuh <affirmative>. Hundred percent. It’s
Hoang Tran:
Just a bigger, it’s bigger impact. So.
Cheryl Crow:
Well, and I guess, I mean, I’ve tried to make the case cause I, I’m like, I want more occupational therapists in general and certified hand therapists to actively, you know, seek people with rheumatoid arthritis because, you know, and psoriatic, you know and so I’ll just be like, hey, from, I mean, I, I don’t know if this is like crass to say, but like from a business perspective, like you’re missing out on money for people that could be, you know, it’s on like both sides. Like the patients are missing out on the care that they deserve. Yeah. And the providers, if nothing else, like, you know, seek out this population the goodness of your heart, but also from the fact that, you know, it could help your, you know, business be viable. And just because you’re not seeing as many patients with rheumatoid arthritis post, you know, hand surgery doesn’t mean that there’s not a lot of patients who have significant functional deficits. Yes, I hear it every day. People are, can’t perform their basic activities of daily living Yeah. And don’t understand how to protect their hands and
Hoang Tran:
Yeah.
Cheryl Crow:
Need help. So
Hoang Tran:
My you know, as someone who’s been in business Yeah. And I’ve seen other people in business
Cheryl Crow:
<Laugh>. Oh yeah.
Hoang Tran:
I think that as a business owner, the only thing that we could do is say that we are here, that we have this specialty, or we have this ability to help X, Y, z I have the ability to help you. I have the, the intimate knowledge, the experience that if you are someone with rheumatoid arthritis, any form of arthritis, and you want to get rid of pain, you want to be more active and you wanna avoid surgeries in the future, then I can help you. So from a business standpoint, I’m here and mm-hmm. I think to a certain extent, I have to be here and make myself visible so that people in my community can find me. And that’s how people have found me.
Cheryl Crow:
That’s awesome.
Hoang Tran:
Because surgeons will send to their own therapist. Mm-Hmm. <affirmative> not necessarily the best therapist surgeons will send to, or doctors will send to people based on their own assumption. Mm-Hmm. <affirmative> not no assumption.
Cheryl Crow:
Right. Right, right,
Hoang Tran:
Right. And then people have their own limitations of like self-inflicted limitations. I am a one clinic location and you have to be willing to drive to my clinic. And where I’m located in Miami, Florida, I’m d I’m in this municipal called dal, and it’s very close to the airport, central to mm-hmm. <Affirmative> Miami. But people are willing to drive to me from all areas of Miami because we are specialized and we provide a particular level of care in a particular way that they cannot get elsewhere.
Cheryl Crow:
Right. Right,
Hoang Tran:
Right. So the person has to be willing to make the effort who comes. Right.
Cheryl Crow:
Right. You
Hoang Tran:
Also have to be willing to pay, because again, we are not an in-network facility mm-hmm. <Affirmative> because if we were an in-network facility, we might function like every other place where you might have already been unhappy with.
Cheryl Crow:
Yeah. Right.
Hoang Tran:
We get to provide a, a premium level of care mm-hmm. <Affirmative> that is unmatched
Cheryl Crow:
And they can still maybe, can they still submit, reimburse for reimbursement to Absolutely. Yes. Or submit the super
Hoang Tran:
Bill. Absolutely. There’s different ways in which we work with people, but I think that from a point of view of if you have rheumatoid arthritis mm-hmm. <Affirmative>, if you have already tried in network, if you have already tried these type of meal places where, I don’t know how it is in Washington or around the world, but you are, you might be sitting in places where you are there, like the patient to therapist ratio is not conducive to you getting
Cheryl Crow:
Yeah. The personalized
Hoang Tran:
Care, the care, and the, you know, being able to hit the goals that you want. Right. Right.
Cheryl Crow:
Right. Not every
Hoang Tran:
Therapist is willing to put into, pour into themselves to learn about rheumatoid arthritis, to develop the skills that are necessary to work with people of various stages of rheumatoid arthritis, because you’re going to have everyone who comes in at every stage and every person looks completely different even if you fall into a particular pattern of deformities. Right. Right, right. So the two have to coincide and match Right. In order to in order for it to work. So, so yeah. I would, that’s why I say like, you know, as someone like you who advocates, advocates for people with rheumatoid arthritis and people with, you know, any type of arthritis that are chronic in nature you advocate for them. Right. And you talk in a way that helps them to one, keep a mindset open, but educate them at the same time. And you have this platform that you provide someone like me who comes on and, and has an ability to reach even more people that I don’t normally reach.
Cheryl Crow:
Right, right. Well, I’m, I’m really grateful that you took the time today. This is awesome. Like the, we covered a lot of the things we planned on, but also went on some interesting roads. I think all roads eventually do lead to mental health for me at least, you know, because we are feeling human feeling beings, you know, <laugh>. Yeah. But so I’m really glad we were able to address that cuz a lot of times when people think of hand therapy, they think of just the hand. But she said the hand is connected to the rest of the body. <Laugh>
Hoang Tran:
Every, every person, every
Cheryl Crow:
So
Hoang Tran:
Connected to the person
Cheryl Crow:
Yeah. To the person and their life and what’s important to them. And yeah. So thank you so much and thank you. I look forward to seeing people’s questions if they have any follow up questions. Yes. So thanks again. Bye-Bye for now.
Hoang Tran:
Bye bye.
