It all started in the balls of Pauline’s feet – a stinging, painful sensation that she thought was caused by wearing high boots and shoes.

However, a blood test showed the cause to be more serious.

“I thought it was the platform shoes,” says Pauline.

“Naturally, at 19, you’re not thinking of anything like arthritis, but the blood test showed I had a raised ESR* and the diagnosis of rheumatoid arthritis was made then.”

SHOCKED AT THE DIAGNOSIS

Pauline, from Ballygowan, Piltown, County Kilkenny, now in her 50s, was shocked with the diagnosis, believing that only old people got arthritis.

“However, I realised the minute I went to the rheumatologist that there are lots of young people with RA. Babies are even born with it. You don’t know any of these things until you go into the zone of the condition you have. Then you realise.”

Pauline was immediately put on pain and anti-inflammatory medication and she continued to work as a receptionist in Clover Meats in Waterford for many years.

“As the years went on though, it got worse, with my wrists and shoulders most affected,” she says.

Faced with the challenge of living with rheumatoid arthritis, Pauline says she made an important decision two or three years after she was diagnosed.

“I decided that I had two choices – that I either sit in a chair and moan about this or I just get on with my life and be as positive as I can.

That’s the attitude I have taken and it has helped tremendously. One’s pain tolerance becomes greater because you accept it more. There are bad, ‘why me’ days, of course, when I’m very fed up, but I am always aware that there are lots of people out there worse off,” she says.

“In Cappagh, it’s amazing what you see,” she adds, “young people with shoulders, fingers, elbows, ankles, hips and knees replaced. I feel guilty to even complain.”

DEVELOPED DIABETES

Pauline also developed type 1 diabetes in 1993 and this may or may not have been the result of the pain medication she was on, she believes.

OPERATION IN AUSTRALIA

Pauline got married and moved to Australia in 1994, but the following year was a very difficult one for her.

“My right shoulder was in a bad way by this stage and I’d had a lot of steroid injections into it to get it moving. It was a shock to be told that it would have to be replaced. I had never heard of shoulder replacement but I knew it sounded complicated because of the 360 degree movement and all the connecting tendons and ligaments. But I had no choice but to get it done because I was in so much pain.”

CAPPAGH HOSPITAL

Pauline had a few good years after that, she says, and returned to live in Ireland in 2001.

“I went to Cappagh hospital for the first time soon after that. My other shoulder, the left one, was now giving the same kind of trouble as the right one. The minute the surgeon, Dr Darragh Hynes, saw it, he knew I needed a total shoulder replacement as the bone was totally diseased. That was done in 2003 and intense physiotherapy followed.

HER LEFT SHOULDER RE-REPLACED

But more difficulty followed and Pauline had to get her left shoulder re-replaced.

“The prosthetic (artificial shoulder) that had been put in in Australia had come loose as the bone was getting more and more diseased and I was in severe pain,” Pauline says.

The re-replacement involved Dr Hynes liasing with the Sydney surgeon who had done the surgery in 1995.

“It was a big operation to take out the old one and put in a new one, but the operation was successful.”

A further two years of physiotherapy followed.

FOURTH SHOULDERREPLACEMENT

Pauline has now had her fourth shoulder replacement.

All through her surgery, family, friends and neighbours have been wonderful, she adds, helping out with cooking and cleaning when she couldn’t do anything.

“We couldn’t have managed without them,” she says.

After the fourth shoulder replacement, Pauline says she now has to respect her limitations.

“Jobs around the house such as vacuum cleaning or straining potatoes are almost impossible. I use a gadget to help me wash my hair as I can only get my hand up to my forehead. I make do as best I can — I’d use my nose to switch on a light if I couldn’t get my hand up to it, as trying to keep my independence is very important to me,” she says.

Her husband, James, has put all the kitchen units and cooker down to waist level to make them accessible for her.

Pauline is now back driving again – something she is thrilled about.

“Managing this was a huge challenge for me and a great incentive to keep me motivated at the physio sessions. Not being able to drive totally takes away your independence and you’re relying on everybody to bring you to clinics, appointments and so on. It took me three and a half years to get back on the road. It’s short trips for the moment but I’m delighted.”

MEDICAL ROUTINE

Pauline attends Cork University Hospital’s rheumatology department every three months for a check-up and the pain relief clinic there whenever she gets a flare-up.

She attends Cappagh National Orthopaedic Hospital for a check-up every six months. She also gives herself humira injections once a fortnight.

“This injection has changed my life to a degree,” she says.

“My control of my arthritis is now much better than it was 20 years ago because it prevents further degeneration of the bone, as well as being for pain and inflammation.”

Pauline also feels reassured that there are other drugs available if humira doesn’t continue to work.

“Hopefully I won’t have to have my hips and my knees replaced,” she says. “If I had to have my knees replaced I’d be snookered because I couldn’t use crutches, but I don’t dwell on that.”

A very modest lady, Pauline only agreed to do this article if it would help increase awareness of the work of Cappagh National Orthopaedic Hospital. “There are so many people sick with different things. I’m not exceptional,” she says.

*ESR means Erthrocyte Sedimentation Rate and is a common blood test used to diagnose autoimmune diseases and conditions associated with acute and chronic inflammation.

THE HISTORIC HOSPITAL

• In 1908, Cappagh House was bequeathed by Lady Martin to the Religious Sisters of Charity. It was used as a convalescent home for Temple Street Hospital children suffering from rickets and TB.

• A school was later set up in Cappagh for long-stay patients.

• It was used as an open air hospital between 1921-1961 for TB patients. An operating theatre was also opened.

• In 1971, a new operating theatre with clean air facilities was added and total hip replacement operations commenced. The operating theatre was only the third of its kind in the world.

• In 1989/1990, two similar theatres were added.

• Further developments include a bone bank in 1996.

Each year Cappagh National Orthopaedic Hospital carries out:

• 1,000 hip replacements.

• 800 knee replacements.

• 300 shoulder replacements.

Based in Finglas, it treats over 2,500 inpatients, 9,000 day cases and 11,000 outpatients every year.

• 90% of admissions are now adults.

• 21 orthopaedic surgeons now work there.

Pauline recently raised £1,620 for the hospital for their 3T scanner appeal. A three-year fundraising campaign is now underway by the Cappagh Hospital Foundation to improve facilities at the hospital. Seewww.capagh.ie