The good news: in the first month of my "new start", I lost 19 pounds. Of those, 12 were in the three weeks after my first doctor's appointment, and thus, count against Cigna's 5% requirement. Since that only comes to 25 pounds or so, I'm clearly going to have no trouble getting there in six months. It seems I might even be able to get to the target weight that the MGB surgeons would prefer for doing my surgery laparoscopically (the only way MGBs are done).
The bad news: my HbA1c (a measure of long-term blood glucose levels) went up from 8.0 to 8.2. Now, that's not much; it's actually within the plus-or-minus of the test. But it's an increase when it should be a decrease. I'm not too worried, though. My tests have shown a slow but steady decrease, about what I expected. After all, I'm not aiming primarily for fast BG reduction this time around. My exercise regimen is limited by my pain, and my reluctance to push myself too hard and make myself stop. And my diet regimen is limited by the dietitian's insistence on adding fruits and vegetables despite the fact that their carbs will bring up my BG. I expect slow progress, but progress, and that's what I've been seeing. I suspect the HbA1c just isn't showing it yet, but will by my next test.
It's kind of hard to really feel invested in it now. I have a dose of short-timer's syndrome. After the surgery, odds are good my blood sugars will be a simple non-issue. It's easy to get thinking of this process as not being about my blood sugar, but simply about checking boxes on Cigna's checklist. The doctors would be horrified at that attitude; they want all my efforts to be based on the idea that the surgery will never happen. I'm trying to strike a balance. I care about my blood glucose, but if the long-term goal of eliminating diabetes and achieving significant weight loss requires me to have slower improvement in my BG and HbA1c right now, that's fine, too.
Anyway, the exercise part, which I've always said is the linchpin of everything else, is still in a preliminary state. Still not seen the physical therapist, and still using the same equipment, so the fact that I'm keeping it up at all, even at this reduced level, is an impressive achievement. (Not that the doctors even realize that, let alone give me credit. All they see is that it's not as much as they'd like. But I'd much rather be able to sustain doing some-but-not-enough than to push too hard and end up stopping.)
Next week's physical therapist appointment is a hopeful step. The arrival of the recumbent stationary bike I ordered, expected in the next two days, is an even more hopeful one. The hope they point to is being able to keep my exercise regimen more thorough and complete without a lot of pain. That'll lead to better improvement in blood glucose, and sustaining the weight loss.
On the other side is the process of arranging the surgery itself and its insurance coverage. The doctors keep talking about this like it's routine, and asking us when our surgery date is, but it's likely to be quite a struggle. We're not sure if it's better to start working with Cigna now, in hopes of getting the lengthy process of them losing our paperwork and issuing spurious random rejections to happen in parallel with our six-month weight-loss regimen; or if it'd be better to wait until we have that regimen, and all our other ducks, in a row, before we even draw ourselves to Cigna's attention, to make it harder for them to come up with ways to reject us. I wish we had a tactics guide for that kind of thing.
The other problem is getting local support. A surgery like this requires a lot of follow-up in case of problems and to make sure we're doing what we need to do. Yet it is, like many other kinds of surgeries, specialized enough that you can't get it locally, you have to travel for it. Since we can't fly out to High Point, North Carolina every few months (or even every few years) for routine follow-up, we need a way to get local follow-up, which means we need a local practitioner to agree to do it.
What exactly "follow-up" comprises seems to be hazy. Other long-distance patients of High Point seem to get by on "get my bloodwork done locally and have results copied to High Point", combined with the usual possibility of emergency care in case of catastrophe. Yet our doctor's office blanches at the idea of agreeing to provide this kind of care, perhaps because they imagine that they'd be called on to do more than they actually would, or perhaps it's me who is underestimating how much they'd have to know or do.
Why won't someone just write me a check for $34,000 so I can avoid all this insurance stuff and just get it done? It'd just be done.