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Clinical Notes: Jake Graham, Restauranteur***, Detroit, Michigan, Age 31, 5'8'' 250lbs:  Goal 160 pounds, Mildly active, willing to devote 6 months passionately to OJW.  Email address: Norwegianjakes@aol.com  jwgdirect1@aol.com and jgraham@norwgianjakes.com

Hello Dr.
       It was a pleasure speaking to you this morning and I am very excited about this endeavor.  Once again I have been writing a former patient of yours from Ohio and she recommends it highly. This OJW.   I have already arranged and am being seen and will continue to see  Diet Doctors at a local but highly decorated hospital in Metro Detroit (Beaumont Hospitals).  They have a supplement they are going to put me on called HMR 800**. plus supplemental vitamins.  The main reason I am having this procedure done is health reasons.  I have high blood pressure and a disease called Meniere's disease which is a disease of the ear nerve endings and believe it or not weight and diet is a trigger.  I am attaching the consent form, please have one of your receptionists contact me so I may schedule a Friday appointment.  Thank you.
Jake Graham
 

January 17, 2003:
    Examination of teeth, gums, all soft tissues, extent of movement of jaws, and TMJ  reveals that Jake is in good health. His medical dental history indicated that he had Menier's disease. (The Temporo-Mandibular Joint (TMJ)) is a "ball and socket" joint. The "ball" is the top part of your lower jaw and is called the "condyle". You can feel them by putting your fingeres just in front of your ears when opening and closing your mouth.

 Learn more about the TMJ: [Information source number 1], [Information source number 2].

 No X-ray was deemed necessary. Nevertheless, it was decided to take an X-ray which proved fruitless due to technical difficulties. I proceeded noting to him that in OJW the jaws are wired together but the teeth of the upper an lower jaw do not touch each other. Consequently, no pressure is placed on the joint. He had previously signed the the informed consent for jaw wiring . He came alone. and was provide a review of the entire procedure and  was advised of the dangers he might encounter and how to avoid them. the informed consent and the FAQ's were reviewed. "Begg" brackets were bonded on upper teeth 4,5,6 and 11, 12, 13 and lower teeth 29,28,27 and 22,21, and 20. (the canines and first and second premolars). All of the teeth to which brackets were bonded had normal enamel with no fillings or crowns. The brackets were "double bonded", in that a second layer of adhesive was place on the flanges of the bracket.  Jake was shown the wiring method and practiced on the intraoral wiring training device under Dr. Ted's supervision with precautionary advisements. Finally, he was asked to put his teeth gently together and the wiring was done with .017 clear plastic fishing line in the same manner as usual.[SEE PHOTOGRAPHS BELOW.] He observed the wiring technique and then cut out the wire as a practice procedure which he did with ease in about 5 seconds. He was then wired closed on the right and left sides. He agreed to follow the recommended protocol: After 4-5 weeks snip off the wires, exercise (especially chewing gum) for 3-5 days and return to the office for evaluation, cleaning and rewiring.  He said his jaws were very comfortable and that the jaw "wires" permitted him a slight bit of jaw movement. He was given instructions and practice regarding how and when to remove the wire. He was given instructions on how to exercise his jaws  during the 3-5 days he would be released from the wires and advised regarding the possibility of the joint becoming more limited in motion over time (two fingers of opening rather than 3 fingers).  He was counseled to adhere to a 1400 calorie  low/no salt liquid diet.  He was advised to always carry his wire-cutter with him. Lacking a wire cutter a simple fork could accomplish the emergency removal of the wire. He  was provided with instruments to assist in the removal and replacement of the wires.  


Ps.  when training him to rewire the jaws I wanted to show him using my intraoral training device that I could do it with MY EYES CLOSED on myself. It was the first time I had ever tried doing that on myself.  I had difficulty. I was more successful with a light and mirror. Jake was provided with a kit of instruments and supplies. Finally I tested the degree to which Jake's ability to speak was impaired. He sounded very clear and declared that he would not be impaired in any way from doing his work.

SPECIAL NOTE:

He requested that we use clear-transparent braces and I consented to try it at least on the two upper front canines along with an invisible wire (monofilament fishing line..."Trilene" from Berkely).  We had discussed the possible benefits and disadvantages beforehand.  He brought with him an ultra-clear fishing line 20 lb test, .017" diameter.  I had proposed that .020' diameter would serve him the best, however he could not find that thickness.

** HMR 800 (Health Management Resources) for weight loss is a powder in various flavors which when mixed with water "whips into an extra thick rich, delicious and creamy shake". It comes in various flavors and the vanilla tastes like tapioca pudding. It is produced by Health Management Resources Corporation*, located at 194 Hanse Avenue, Freeport, NY 11520-4679. Each pouch of the supplement is 170 calories. and costs $36/box of 30 pouches (just under a week's supply). Jake consumes 5 pouches each day.

January 18

        Today I prepared the HMR 800 shake that Jake had given to me.  It was excellent. It was thick and the vanilla flavor pleased me.

**Home page of HMR
http://www.yourbetterhealth.com

January 20

    Jake Graham enjoys communicating. Today we exchanged some words:

Hello Doctor Ted,
       Firstly let me start by saying it was an extreme pleasure meeting you and your delightful staff.  Never before have I been to a doctors, dentist or orthodontists office of any sort where I was made to feel more at home.  It is now 3 days since my procedure and I am back home now, actually I am in my office located in Detroit, MI.
Thus far everything is "A-O.K."  I was very much pleasantly surprised to find out actually how LITTLE time it took to complete the actual procedure.  However I do appreciate the lengthy time you took out of your schedule to answer all of my questions and concerns AND for taking such an interest in my personal desires with regard to the OJW and the clear wire.  "Clearly the better alternative"
You certainly made this patient very happy!     
My speech is almost perfect,  I have no discomfort.  It does take some getting use to however nothing devastating by any means. 
When you first have the procedure done and the Brackets are being glued on your teeth, there is an unpleasant chemical taste in your mouth for a short period of time but that is gone within hours after the procedure.   Talking is quirky at first, because you have a natural tendency to try to open your mouth when you go to speak.  You get use to that and have it mastered within a day.  Eating - well that is something all together different.  I am on a liquid diet from a local hospital but more on that later.
Brushing my teeth -- no prob, I just can't do the inside teeth.  I brush after each time I eat (drink I mean) and gargle with Listerine twice a day.  I try and stay away from Ice Cold drinks as they tend to be a bit uncomfortable.  A little cold is OK however Ice cold isn't pleasant, sensitive teeth and all.  Carry some chap stick or blistex, because you cant lick your lips they get dry nothing serious tho'.
       I am in the food business and both my partner and I are medically obese. 
He recently had the bariatric surgery.  This is his second time having this procedure done.  Both procedures were similar but different.  After his first surgery he lost a tremendous amount of weight, however, he gained it all back Bariatric Surgery is not a cure all.  This time he is having the latest in procedures with regard to the bariatric surgery, where they make your stomach the size of a large grape.
       I needed to do something also as my health was going down hill.  I do not enter into things lightly.  I researched all of my options for quite some time.  I did not want to gamble with my life and to me Bariatric surgery is a BIG BIG gamble.  (The death rate is 1/1000).The odds of dying are very high and besides they cut you open like a tuna.  Huge scar.  They have a new procedure with Bariatrics, where they make a very small incision and use a type of rubber band that they place around the stomach,["Gastric Banding"],[and see also the story of E.A. a "graduate" of OJW who went on to have the gastric banding procedure] and see
  [Info source 1], [Info source 2], [Info source 3]  however, a member of the Detroit city council just died from this same procedure.  Bariatric surgery - Big gamble on your life during the surgery And you can gain the weight back.
No thanks.  {Ps Bariatric surgery "the big one" is $30,000, Lap-band surgery is at least $16,000}.
       I decided to join a strict regimen of supplements and medical support though a program in our largest most respected hospital here in Michigan, Beaumont Hospital's Medical Weight loss clinic. This program is very thorough and intense.  The diet includes supplements (liquid), no food in my case.  Nutritional Training,  exercise,  Psychiatric therapy support, group sessions and Doctor visits every week, sometimes twice a week.  You are closely monitored.   They are so successful that their average patient maintains a weight loss of 50lbs four years later.  THIS IS MY DIET.  JAW WIRING IS NOT MY DIET.  The jaw wiring is simply my safety net that I have no slip ups, my crutch if you will.  It has only been 3 days since the procedure as well as the start of my diet and I have already lost 4lbs, water weight I am sure, nonetheless I am thrilled.  My goal is to loose my weight, get off all of my medication and maintain the weight loss.  I have tried all the diets.  You name it I''ve done it. Seriously!
       Doctor I love the Web page you have devoted to my procedure, it looks great.  I shall keep you posted on my progression, please please please feel free to send people my way that may have questions.  If I can help them decide one way or another I would love to do so.  I know this email is long however I can't help myself because I am so excited.  Also, I just want to mention what a great time I had while I was in NYC, coupled with an event that is changing my life for the better, WOW what a great trip.  I hope all is well Doc,
Best Thoughts to you and your staff.
Jake Graham
Director of Operations
Norwegian Jakes Mountain Food and Gear LLC
Texas Taco Ventures LLC 
    


Dr.  Ted writes:
       Just got up from a nice nap... If ever you want to call and talk it's perfectly ok any time.  If I'm taking care of  a patient  a teamie will tell tell you so. I'm always interested in knowing how you feel. Ted 
Ps. I fast from Sunday evening to Tuesday morning. Sometimes I'll break the fast in the evening with something very light.  I began doing this more or less religiously about 6 months ago.  PPS the shake was very good. Sometimes if I'm "bad" I will punish me by skipping 2 meals (self -flagellation) These days I want to stay just under 170 and I like the spiritual feeling of denying myself food...


In a message dated 01/20/2003 2:52:21 PM Eastern Standard Time, Jwgdirect1 writes:
 

Jake responds:

Hmm interesting.  I am not fasting I am simply denying myself solid food. 
I have heard from various people that fasting feels good.  I have several friends from Bosnia that are Muslim.  They fast during Ramadan and they say it brings them closer in spirituality and makes them feel great?  I have never done that as I have a serious addiction to food...my cocaine so to speak.  I think I will have a greater difficulty with this than the average person as my whole life revolves around food.  My livelihood, my passion, my pastime, etc. I appreciate the offer to call at anytime and who knows I may.  If you feel the need please do so also.  You have my cards.   I will send this stuff off to you and keep you posted as to my developments.  Doctor if this thing all works out.  You will have made it possible for me to once again live a more healthy and hopefully long life.  As much as I enjoyed meeting you and having this done in NY, it would have been great if I only had to go a couple of miles from home.  Hopefully more orthodontists will take off the blinders and look at the opportunity to provide a service that can help patients and make a buck.  Nothing wrong in that.  I applaud you in your insight and thorough research into this field and weighing the options.  Maybe you will rub off on others. P.S.  You really should offer it in a total package: procedure; accommodations; travel, etc., and make money all the way around and offer the NEW clear alternative.  Who knows could be a whole new revenue stream.  Talk to you later Doc.
Jake

Jan 21, email
    JG reports weight loss of 7 pounds.

Jan 23, email
    JG reports ""wire on left side  broken perhaps due to? Had some difficulties rewiring for the first time, however they were overcome taking about 15 minutes to accomplish.
 

Jan 31, email
Good Morning Doctor,
       Well I was contacted for the first time yesterday from someone who is considering the OJW.  He wanted to know the Pro's and Con's.  I told him a little about my story and replied to him offering my phone number if he had any questions and I haven't heard from him yet. Maybe today.
hmmmmmmm.......lets see I did loose a "clear" wire two days ago.  It only took me about 2 1/2 minutes well OK, maybe 3 minutes to rewire myself.  I couldn't tell if the line broke to do abrasions or to something inherent with the plastic fiber?  So It would be safe to say that the clear wire only has a life in the mouth of about 1 1/2 weeks per string.  The good thing is they don't go at the same time so your never completely UN wired.  I am down 16lbs now and am in my 3rd week, Yahoo.  Only 10 more to go.
I met yesterday with my "Diet therapist" and am going to start meeting with the Nutrionalist very soon.  I am looking forward to that.  I have also been in the gym every other day hitting the treadmill and lifting light weights.
Talk to you soon,
I hope all is well. 
P.S.  Please tell Brian we received his sisters email on our website about the backpack lunch and Thank you.  We will be in NY very soon.
Best Thoughts
Jake

Dr.  Ted writes:
Top "O" the morning to you Jake,

The patient you referred/provided guidance to, now has an appointment for OJ"W" ;-). The '"W" refers to the fact that you have plastic filament not wire. Anyway thank you for referring him. He comes from New Jersey and I hope he will be one of those patients that returns to the office regularly for rewiring rather than rewire himself. He said that you were the one that convinced him. As for the pros and cons, I referred him to to the pros and cons page on the drted.com site.  Concerning the wire breaking, I wager that if you can get .020"diameter  monofilament plastic thread instead of the .017" that you are are using you will have less frequent breakage and it will last much  longer. Regarding the "Backpack " lunch sample you gave me, I had given Brian the "meal in a tube : backpack lunch" your company developed to try, and he said that he liked it a lot. I'm glad there was some kind of feedback to you.  Happy to hear that in three weeks you have shed 16 pounds.  Sometimes events take over and you run into a "wall" of progress impedance, so don't despair if/when that happens. As for Beaumont Hospital where you are being helped, I took the initiative and established a dialogue with Dr. Peter McCollough, the Director there in the Weight control clinic. He referenced my work in a follow-up response, but made no additional remarks one way or the other. I am very proud of you for having the good sense to have a "Nutritonalist" and a Diet therapist on your team... hats off to you.  I am encouraged by your exemplary goal-directed approach.  Have a good day. With care, Dr. Ted

Dr.  Ted writes:

Good Morning Doctor,
       Well I was contacted for the first time yesterday from someone who is considering the OJW.  He wanted to know the Pro's and Con's.  I told him a little about my story and replied to him offering my phone number if he had any questions and I haven't heard from him yet. Maybe today.
hmmmmmmm.......lets see I did loose a "clear" wire two days ago.  It only took me about 2 1/2 minutes well OK, maybe 3 minutes to rewire myself.  I couldn't tell if the line broke to do abrasions or to something inherent with the plastic fiber?  So It would be safe to say that the clear wire only has a life in the mouth of about 1 1/2 weeks per string.  The good thing is they don't go at the same time so your never completely UN wired.  I am down 16lbs now and am in my 3rd week, Yahoo.  Only 10 more to go.
I met yesterday with my "Diet therapist" and am going to start meeting with the Nutrionalist very soon.  I am looking forward to that.  I have also been in the gym every other day hitting the treadmill and lifting light weights.
Talk to you soon,
I hope all is well. 
P.S.  Please tell Brian we received his sisters email on our website about the backpack lunch and Thank you.  We will be in NY very soon.
Best Thoughts
Jake

Febraury 11 email

I am approaching the 1 month mark and about to start the second month.
       Thus far I have dropped 25 pounds and I am feeling great.  I have found a tremendous added benefit to this procedure and I'm so very excited!  Normally I would be bummed out if a wire broke however last week one did and I looked forward to getting home that night to rewire or should I say re string?  I went home stood in the mirror and decided to take the other off; clean the teeth; exercise the jaw and have a little nibble.  I was going to cheat.  Well, everything went fine until the little nibble part.  Eating with these brackets on your teeth was such an uncomfortable and new experience I was totally and absolutely turned off from the meal.  Food got caught in the brackets and on the sides of my mouth.  Now maybe its just because I have never eaten with them on and I suppose it would be just as if I had braces on nonetheless I was turned off with food.  Yuck I couldn't continue eating it was so unpleasant.  I started to think "Wow is this great, even with the wires off, the procedure still has added weight deterrence."  Doc I am so excited about this I cant wait to tell others.  By the way, as time goes by my urges to binge and eat are decreasing and the craves are much shorter and fewer far between.  It seems the craves go in cycles and each time are much easier to cope. 
       Also I told you about my business partner who had the bariatric surgery who lost 90lbs.  Well, he is gaining.  I asked him why and he said "Jake, I have simply learned to adapt.  Instead of eating a lot at one time.  I can only eat a little bit at a time, however I have learned to eat more often, much more often.  I have learned ways around the fact that I have a tiny stomach to fulfill my big appetite."
Plus may I remind you Doctor he has a scar that is the length of an average forearm  down the center of his chest.  Now I dont know for sure because I am still in the middle of the program and this just may be a short term solution but right now
I am convinced this is the best way to go when considering the other so called "extreme options to weight loss"
Best to all,
Jake
P.S.  I would like to schedule an appointment to come back to see you for the removal of the brackets in early May.

Febraury 12 email

Dear Jake:

I love your enthusiasm, and I thank you for providing information that could be of use to others. Looking forward to seeing you return. The visit to remove the brackets and clean the teeth is done without charge. Any orthodontist will remove them. So I assume that when you return you will want to add some pleasurable thing to do in NY.  I suggest you have dinner with me (and on me).   May 3-10 I will be in Hawaii for the international orthodontic conference. We will arrangee an appointment for you just after that. Cordially, Dr. Ted

March 6 email From Jake

      
It has been a few weeks since our last correspondence so I am writing you to say hello and give you the latest brief.  It is Tuesday, March 4th 03.
       I took my wires off after the first month for the 4 day sabbatical and while cleaning my teeth broke a bracket off.  The office manager was kind enough to send me out some Glue and I repaired the bracket myself.  I probably could have done a better job however its on and the bracket is fixed. 
It took me about 10 minutes to replace the bracket on my teeth.  No problem.  You were a good teacher.  During the time I had the wires off, (my four day "no wire" jaw exercise period), I watched what I ate and once again it really wasn't all that pleasant eating so I didn't over do it. 
       However, my four days of no wires turned into 10.  I became use to eating without them on and found myself in Pizza parlors.  I tried jogging to take my mind off of the food but I kept running into restaurants?  Well, after ten days I said "That's It" and I have been rewired now ever since.  I did not gain any weight and seeing my "Diet Shrink" definitely helped things as did the Gym.
      
I am down 31lbs. and cant tell you enough how excited I am about this program.  Now this procedure is not without its ups and downs, but it works! I am almost half way to my goal.
I hope all is well


March 6 email response to Jake From Dr. Ted

       I am very proud of you. A weight loss of 31 pounds is a VERY SIGNIFICANT accomplishment. Make a sign 12" x 12" and put it somewhere on the outside (?inside?) of the front door of YOUR HOUSE. Change the sign each time the loss number gets larger.  If you dont already have a graph 3 feet long by 2 feet high make one and and use a fat felt marker to chart your JOURNEY to a healthier being and A LONGER LIFE!.  Keep it in the KITCHEN. Think of it as the sun shining on you. Think of the GOAL AT LEAST 10 TIMES EACH DAY. Yes I mean obsess about it (THE GOAL). I can't remember the exact fact but for every pound of weight you lose your heart has 25 less miles of blood vessels to pump blood through..or is it 250 miles? I'm off to work. Thanks for the update. I am glad to know that you were able to replace the bracket.

***In Howell MI: Texas Taco and in Warren, MI: Norwegian Jakes Mountain Food and Gear.

Jake with brackets and jaws "wired"...see anything?

Side view no wire: note upper canine with clear bracket.

Jake  "wired" with monofilament fishing line. See anything?

Time to say au revoir.

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