Joseph Kapler
Diabetes Diagnosis Delayed due to Lifelong Pain
By Mark Odlum
At 11 years old, Joseph was diagnosed with juvenile rheumatoid arthritis, and years of unhelpful treatments followed. Tired of waiting for someone else to solve the problem of his constant pain, he began his own research and attempted to gather information on his growing list of health conditions.
Joseph was born in Edmonton, Alberta, in Canada, but spent some of his childhood in the United States and Venezuela. At 16, he joined the Canadian Army Reserves. About a year later, he was recruited by the U.S. Naval Intelligence after word reached them of a young Canadian with an uncanny knack for intelligence. Based in Norfolk, Virginia, he quickly earned a raise in rank to chief petty officer, 1st class, and was given his own command as a senior analyst and field operator, gathering raw intelligence in the Middle East.
During his time in the service, Joseph saw a golden opportunity to find more answers for his pain. He was accepted to one of the top-rated medical schools in the United States, hoping to become a pain management specialist. Yet despite everything he learned, he couldn’t address his own pain. At 22, he received an honorable medical discharge from the Navy, losing his school funding and pension and needing to return to Canada before being able to complete his medical degree.
His health only worsened as he dealt with pain and complications from Ehlers-Danlos syndrome, osteoarthritis, osteoporosis, chronic obstructive pulmonary disease (COPD), fibromyalgia, and post-traumatic stress disorder stemming from his time in the military.
With some close friends, Joseph started a chronic pain support group. He used the knowledge and experience he had gained from years of living with pain and attending medical school to support and advise others, always urging them to confirm his suggestions with their own medical providers.
For much of that time, he was also unknowingly living with diabetes and diabetic peripheral neuropathy (DPN)—contributing further to his pain.
A DELAYED DIAGNOSIS
Joseph was diagnosed with type 2 diabetes in 2020 when he was hospitalized for exacerbated COPD.
“The management of my multiple health conditions is staggering to many of my physicians,” he explains. “There are just too many to properly manage at one time. They generally prioritize the specific issues that are impacting my health at that time.”
During this hospital visit, the main focus was on managing his COPD—but an ER nurse inadvertently noticed that Joseph’s blood sugar levels were high. At the age of 54, he was diagnosed with type 2 diabetes and referred to a diabetes clinic. Doctors told him his diabetes “had remained untreated for a very long time.”
A year later, Joseph also was diagnosed with DPN—one answer for the pain he was experiencing.
“Being diagnosed with diabetes was like a rude awakening, or a cold shock to the system,” he shares. “I had to face a whole new lifestyle.”
Because of his time in medical school, Joseph was familiar with the daily management that his diabetes care would require, including multiple checks of his blood sugar levels and insulin injections four times a day. He keeps his blood sugar in check with medication and a diet and exercise regimen, and has built a rapport with his internal medicine physician at a diabetes clinic, using his medical school background to inform ideas for his treatment.
“The fact that [the diabetes] was not discovered earlier is frustrating,” he admits. “However, I was able to face the fact that with my multiple health issues, physicians are not always able to identify new issues without the proper diagnostic symptoms or results.”
FINDING WHAT WORKS
Years ago, Joseph shared a comment with his wife that was so representative of his journey that she suggested he write it down and frame it: “Too much pain to fail.”
That’s his philosophy when it comes to living with pain and finding solutions—he can’t stop. So he won’t.
He diligently documents his pain to assess what helps and what doesn’t. Over the years, through his own research and through working with a pain management specialist, he identified a variety of treatments that help him manage his pain, including the painful diabetic neuropathy he experiences in his feet.
Doctors advised him to reduce his sodium intake, and to stay off his feet and rest after extended periods of standing.
Although rest is a major element, walking also became a key pain management tool for Joseph after his DPN diagnosis, improving his endurance and helping minimize his pain flares. “I try to walk it off,” he says. “The more you walk, your feet learn to handle the pain.” He found it helpful to set a timer on his phone to remind him to get up and walk.
He learned that the pregabalin he takes for his fibromyalgia also helps with his DPN pain, particularly after his doctors increased the dose. He has also found some relief with steroid injections.
Foot baths help increase blood flow to Joseph’s feet and help ease his neuropathic pain, while physical therapy and physiotherapy help strengthen and rebuild his muscles to increase blood flow in his legs and feet.
He also uses electrical stimulation therapy to ease pain in his calf muscles from overcompensation due to the neuropathy pain in his feet. Acupuncture has been an effective tool as well.
SWITCHING GEARS
Due to complications, falls, and injuries related to his COPD and osteoporosis, Joseph now uses a wheelchair. Unfortunately, that means he can no longer walk, which was one of the best tools to ease his DPN pain.
He once again had to shift his focus. He began to further explore pain management strategies he could do in a wheelchair, such as deep tissue massage and meditation. “I recommend that you do all you can to meditate,” he says. ”It does wonders in helping you to manage your pain.”
To help with depression and PTSD brought on by his military experience and lifelong health and pain challenges, Joseph began seeing both a psychologist and psychiatrist.
The support of his wife, Anita, has been vital, Joseph says. “She’s there for me emotionally, she listens when I need to blow off my frustrations, and she ignores me when I complain about the constant pain,” he shares. “Mostly, she just cares.”
Following his medical discharge from the Navy, Joseph worked several government and private sector jobs in Canada before his pain forced him to stop working around 2010. Recently, though, determined to return to the workforce, he underwent his own process of gathering intelligence about potential jobs that could coexist with pain.
Now, he is an associate at an investment brokerage firm, training to get his license to become an independent agent. Working in finance offers the opportunity to work from home, stay off his feet, set his own hours, and take time off if he’s not feeling up to par.
Because his various health challenges led to a delay in his diabetes diagnosis, Joseph urges others living with multiple painful conditions or other health issues to be aware of warning signs of diabetes.
“If you suffer from a condition that affects your heart, brain, and kidneys that is getting worse for no apparent reason, please consider the possibility of prediabetes or full-fledged type 2 diabetes,” he says. “Ask your primary care physician to run some tests to look for the possibility of prediabetes or type 2 diabetes.”