From the Editor’s Desk: Mid-2026 Health Check-In Update ⭐

A few weeks ago, I wrote about three pending health-related issues I needed to resolve while we were in Pennsylvania. I wasn’t expecting to provide an update this quickly, mostly because these things often drag out interminably, and we’ve since come back to Mexico for a short (for us) one-month trip. Basically, I figured it would be a while.

But that’s not what happened. I already have some updates, and it’s mostly good news. Excellent news, really.

🦵 Knee

The most concerning issue, perhaps, was my knee. I had torn the anterior cruciate ligament (ACL) in both of my knees, separately, over a two- or three year period in the late 1980s and early 1990s, and I had had both surgically repaired. I went on to play basketball regularly into my early 50s, and that was that. I’ve never had any issues, major or minor, with my knees, but I have had this cloud of sorts hanging over me ever since the surgeries because I was told they would one day result in some form of arthritis, something I could just put off until I was old. That, I am good at.

But as I wrote back in May, something finally happened. In late December, I think, my right knee started giving out in a way that was disturbingly familiar to the experiences I had had over 30 years ago with my torn ACLs. I hadn’t worried too much that I would ever reinjure one of my surgically repaired knees, especially in recent years since I’d stopped playing basketball and don’t ski all that often. But now I was worried that I had somehow reached the expiration date on one of them.

This is problematic for all the obvious reasons, but I rely on regular lengthy walks when we’re in Mexico City to keep my weight down and my cardio fitness in reasonable shape, and the high altitude here helps too. But our last two big trips here, for a few months in late 2025 and then four months in early 2026, were a wash. Or worse. My wife had broken her foot last year, slowing us both down, and then I had my knee issue, making it even worse. And sure enough, I’ve gained about 15 pounds over that time, cutting into the weight loss I had previously achieved. No bueno.

I caught up with my doctor during an appointment when we got back to Pennsylvania in late June and explained this situation and the other issues I was experiencing. And so she yanked on my knee, as my surgeon had done multiple times over three decades ago, and with the same result. “Oh yeah,” she said immediately. “You tore the ACL.” So she referred me to an orthopedic specialist, and I finally got that appointment, which was surprisingly difficult, last Monday, just three days before we flew back to Mexico.

I had a few surprises waiting for me.

Before I even saw the doctor, I had some X-rays, which seemed pointless to me since a tendon or ligament tear would only show up on an MRI. (In both knees, my torn ACL was replaced with a tendon from the front of a lower leg.) That went quickly; these things are much more efficient than they were when I was younger. The technician said something confusing: “You got a lot of hardware in there.”

“Hardware?”

Yeah, he explained, he could see all the metal screws from my two ACL surgeries in the X-rays he was taking.

“But I don’t have any screws in my body,” I replied, stupidly.

“Yeah you do.”

I had no idea. For 35-ish years, I had assumed that my ACL surgeries, which were arthroscopic in nature, had occurred without me needing any screws or whatever else; the tendons that went in there fuse to the bone and can heal. Thinking about this now, I’m not even sure what I thought had happened, some kind of dissolving material perhaps. But not screws. Screws? I’d gone through any number of metal detectors in my life and I can’t recall a single time that I set one off in a way that made me suspect my knees. This was confusing.

And it’s still confusing, honestly, about a week later. But when I finally met this doctor, who inquired about when and where I had had my surgeries and actually knows the surgeon who had performed them–this was an interesting moment–he also mentioned hardware immediately. I needed to see this. So he showed me the X-rays on a screen and, sure enough, there are four screws around each knee, two attached to the bottom of each femur and two attached to the top of each tibia.

Well there you go.

The surprises continued. After pulling on my knee like my primary care physician had, he told me that I hadn’t torn my ACL. Stop. This was … inconceivable. My knee gives out so badly that I’ve fallen down. Twice. Plus, I’d had this injury before. And how on earth could he tell this from an X-ray? Wouldn’t I need an MRI?

Nope. The problem was that I had was water on my knee, he told me.

Water. Come on.

Also, how?

He told me that thanks to my ACL surgeries, I would indeed have arthritis in both knees and the X-ray showed him that this process had, in fact, already started. That sounded bad, even though I knew it was inevitable. But he said it was in just the earliest of forms so far, and that this could cause my knee to give out, and that it was easily treatable. Plus, it will be many years before the arthritis will be serious enough to require surgery, probably in the form of a knee replacement. Awesome.

OK then. So … what’s the treatment?

He said he could just drain the water from my knee and apply a small steroid shot, and that this would be quick and mostly painless. And if this ever started happening again, on either knee, he could just do it again. He said that perhaps I would need to do this every 6 months. Or every year. Or whatever. It’s different for everyone.

Go for it, I told him. So he spray-froze the side of my knee, jabbed it with a small needle that caused just a moment of discomfort, and within 30 or 40 seconds, he showed me a vial of light yellow water that had come out there. It was small, nothing like my experience from the first ACL incident over 35 years ago. And he said it was completely clean, with no blood or pus or whatever. No issues.

OK. But that can’t be it.

That was it. He said I would be fine and suggested I hop off the table and stand up. Which I did and … It immediately felt fine. Normal. Too normal. Impossibly normal. I walked in circles a bit. This couldn’t be real. I was positive I had an ACL surgery in my near future. My wife and I had already discussed possible schedules.

But no. I walked out of the office. Walked to the car in a daze. Drove home and walked in. Walked around our place a lot, up and down stairs. Walked for 40 minutes the next morning like nothing had ever happened on uneven terrain, up and down hills. Nothing. It didn’t give out once, didn’t even hint that there had been an issue that I had been living with, hobbling me, for over 7 months. Seriously. 7 months.

So that is spectacular. I’ve resumed my usual walking regime in Mexico City, which is excellent. And me not needing surgery now is likewise excellent. I’m still shocked by this.

Sorry for the length there. But the next two are more quickly explained.

🪮 Psoriasis

In the previous update, I mentioned that my doctor discovered I had psoriasis, which triggered a sometimes brutal scaling and dandruff-like issue on my scalp. And though it had started small, as things often do, it had spread to most of the top of my head. Anyway, she prescribed a steroid-based gel and an oil that I have to put in my hair when I go to bed and then wash out in the morning. I got the gel that day and the oil the next day and went to work.

The results were immediate. That first day, I saw some improvements right away and by the next day, it was clear the psoriasis had been beaten back. It was like it had never happened. This, too, felt miraculous. Impossible.

And to some degree, it is. You can’t be cured of psoriasis. But you can manage it. And I quickly slowed down the application of these medications and will see how often I really need to use them. So far, it’s not very often. I forget about it for several days in a row and there are no issues. Crazy.

🩸 Glucose

Those first two issues are solidly in the win column, but it will be a while before I know what’s going on with my blood sugar. But as noted previously, the solution is well understood, and I just have to do it. It being reverting to a keto/low-carb diet and, for now, monitoring my blood sugar. So I bought two continuous glucose monitors (CGMs), jabbed one into my upper arm and went to work.

The CGM lasted the expected two weeks, so that was good timing: On Thursday morning I switched over to the second CGM, and then we flew to Mexico City that afternoon. So I had two weeks on one in PA and will have two weeks on one here, where I will continue testing my reaction to foods and basically just monitor the situation. But even my short stint using the first one in PA was interesting. On a few different levels.

If you’re concerned about high glucose or big spikes in your blood sugar levels–and perhaps have pre-diabetes or diabetes–a CGM is incredibly useful. It syncs with an app on your phone and gives you a real time picture of your blood sugar and you can log events like exercise or meals so you can easily see the correlations over time. One obvious use, which I’d done in the past, is to just eat normally, log each meal, and then see what happens.

But the CGM also has a side benefit that I find useful and I think many others will too. Because I know this thing is stuck in my body, is constantly monitoring my blood sugar, and can’t be faked out or paused or whatever, it’s changed my behavior. I went into this assuming I would simply test foods, as I had in the past, but I already know, in general, that foods high in carbohydrates and sugar will spike my blood sugar. And I find myself not wanting to spike my blood sugar. So just wearing this thing has changed what I’ve eaten.

This undercuts the testing aspect, though I’ve still done some of that. I tested a baked potato cooked normally and a twice-cooked potato, the latter of which does not spike blood sugar, for example. But I find myself making different decisions, and that is helping me transition back to a low-carb regime. When we went to the bar/restaurant we go to each Wednesday in PA for a trivia night we do with friends, I got a Philly cheese steak sub, but without the bread, and a glass of red wine, not white wine. And that worked out fine.

There are foods I like to eat that I know are fine. In PA, we have salads with chicken every work day, and that’s good. Roast chicken, and then leftover chicken heated up with mayonnaise. Chicken broth, also made from the leftover roast chicken. On our first night here in Mexico City, we walked around the corner to DEMI, which makes literally the best hamburger we’ve ever had in our lives, and though this was confusing to our waiter friend, who was delighted to see us, I got it without the homemade bun they use. (“Mi nueva dieta,” I explained. He nodded sagely, even Mexicans wouldn’t question such a thing.)

Alcohol is not keto, of course. But it can be low-carb, hard alcohols like Bourbon or cocktails with no sugar. Red wine is typically lower-carb than white wine. That kind of thing.

Unless the food or drink is devoid of carbs or sugars, like meat, your blood sugar will rise afterward, but the goal here is gentle curves and then a return to normal, and not sharp spikes, especially big spikes. So far, it’s been good, though some of the tests did spike the blood sugar as expected. There are some common foods I eat here and in PA that do cause a curved rise in blood sugar that goes above the healthy range, but that, too, is normal and it’s OK. It’s the spikes that do the damage.

Anyway. I’ll keep going. Keep walking, which I can actually do again. And hopefully I will keep seeing good results. What else can you do?