The "crazy old man thumbs-up" is because of his injuries sustained at the hands of the V.C. when he was a POW, Game. Same as Bob Dole's constant pen holding was from a war injury. McCain can't lift his arms up high enough to wave at people and he probably gets very self conscious of the fact that the only comfortable position for his arms to be in leave his hands in frame of any camera shot taking place, so he does stuff like thumbs up and finger pointing to make sure his hands are always doing something and look less conspicuous.

I don't like McCain, but I still recognize that the dude served this country and was crippled as a result. Knowing you I'm guessing you didn't think about this fact because you've never really been a dude who rips on our vets and their disabillities.

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If you kill me it's self defense
And if I kill ya' then I call it vengeance
Spit in your eye I will defy
You'll be afraid when I call out your name