Clinical Notes: Tamia M, child care worker, Westchester, NY, Age 26, 4'11'' 260 lbs:  Goal 200 pounds, Moderately active, willing to dedicate 3 months, and if successful 3 more months to jaw wiring for weight loss.  Weight loss if Tamia perseveres with discipline: 48 pounds. Email address: Tamia898@aol.com

February 15, 2002:
    Examination of teeth, gums, all soft tissues, extent of movement of jaws, and TMJ (Temporo-Mandibular joints) reveals that Tamia is in good health. Her medical dental history is unremarkable and the informed consent for jaw wiring has been signed and dated. No radiographs were warranted. She came with her friend Cheryl. Tamia was provide a review of the entire procedure and  was advised of the dangers she might encounter and how to avoid them. the informed consent and the FAQ's were reviewd. 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.  Cheryl was shown the wiring method and practiced on the intraoral wiring training device under Dr. Ted's supervision with precautionary advisements. Finally, Tamia was asked to put her teeth gently together and the wiring was done with "deadsoft" .016 inch diameter stainless steel round wire.  Cheryl and Tamia observed the wiring technique and then Tamia cut out the wire as a practice procedure which she did with ease in about 5 seconds. Since she lived relatively near she agreed to follow the recommended protocol: After 4-5 weeks snip off the wires, exercise for 3-5 days and return to the office for evaluation, cleaning and rewiring.  She said her jaws were very comfortable and that the jaw wires permitted her a slight bit of jaw movement. She was given instructions and practice regarding how and when to remove the wire. She was given instructions on how to exercise her jaws  during the 3-5 days she would be released from the wires and advised re the possibility of the joint becoming more limited in motion over time (two fingers of opening rather than 3 fingers).  Tamia was counseled to adhere to a 1400-1500 calorie  low/no salt liquid diet.  She was advised to always carry her wire-cutter with her. Lacking a wire cutter a simple fork could accomplish the emergency removal of the wire. She was provided with instruments to assist in the removal and replacement of the wires. Special note: Tamia had recently completed orthodontic treatment and her upper right and left premolars were finished in a "cross bite".  The occlusion was analyzed for possible problems. None were foreseen.

February 16, 2002  In a message dated 2/15/2002 10:03:51 PM Eastern Standard Time, TAMIA898 writes:

HELLO DR.TED
SO FAR SO GOOD. I WOKE UP A LITTLE SORE, BUT ONCE I BRUSHED MY TEETH AND GOT READY FOR MY DAY, IT QUICKLY WENT AWAY. I'M GETTING A LITTLE COLD, BUT ITS NOT BOTHERING ME. I TOOK THE DAY OFF THOUGH JUST TO GET USED TO TALKING THROUGH MY TEETH AND GET OVER THIS COLD. I HAD A CUP OF COFFEE FOR BREAKFAST, SHAKE FOR LUNCH. ANOTHER FOR DINNER. SO FAR SO GOOD
THANKS.
Dear Tamia:
I am relieved to know that you are feeling fine. I am always pleased to have communications from you that let me know your state of mind. I tried to reach you at work yesterday and instead got to talking with a senior colleague of yours at work named Elsie. We ended up having a very pleasant conversation. I told her how you were in the process of of helping yourself and what the jaw wiring was all about. I think I have paved the way for you in having this particular person by sympathetic and understanding about the jaw wiring and why you will be talking differently than usual. I think you will find her to be an ally. Best wishes, Dr. Ted Ps. I do hope I did the right thing for you. You are going to encounter people who are totally unfamiliar with what you are doing. I believe it is best to let people know what you are doing and what the process is all about and how it works. Of course they will see for themselves as you begin to lose weight. With care, Dr. Ted
Ps. I thought it would be useful to have a letter that introduces employers to what an OJW patient-employee is going through [See the letter.]

February 23
    Telephone conversation with E., senior employer here Tamia works. When queried re T's performance at work said. " She's been a bit quiet, but other than that no problem."  Gave her my coordinates, left a message for T, and asked her to call me if any problems arise.

March 5
    Email:  ...I'M SO BUSY WITH WORKING TWO JOBS AND TRYING TO GET A LITTLE EXERCISE IN BETWEEN. I HEAD STRAIGHT TO MY BED. BUT NOW FOR THE GOOD NEWS. YOU WON'T BELIEVE IT, I STILL CAN'T BELIEVE IT. I'M DOWN 20 POUNDS. I KNOW MOST OF IT IS WATER WEIGHT BUT A POUND IS A POUND AND I'M HAPPY ABOUT IT.
I'VE BEEN DRINKING A SHAKE BREAKFAST & LUNCH SLIMFAST OR ATKIN. FOR DINNER I HAVE SOUP. SOUPS LIKE TOMATO OR CREAM OF MUSHROOM I BROUGHT A SOUP COOKBOOK WITH GREAT RECIPES. THIS WEEK I FOUND A GREAT READY MADE SOUP WITH LOW SODIUM/LOW FAT AT THE HEALTH FOOD STORE. I JUST POUR IT IN A BOWL OR MUG, HEAT IT AND DRINK IT DOWN. IT SAVES ME LOTS OF TIME. I'M FEELING GOOD... 
Dear Tamia: I would recommend 1.5-2 pounds maximum per week. If your teeth mouth and jaw joints are feeling well that is good. Dr. Ted  Ps. Congratulations, but be careful and try to be "moderate" in this endeavor.

March 27
    Email:  I'M FEELING GREAT DOWN 30 POUNDS. TAKING IT SLOW LIKE YOU SUGGESTED. I STARTED GOING BACK TO THE GYM ON THE WEEKENDS. THAT WAS A HARD STEP TO TAKE. I'D STOPPED GOING TO THE GYM TWO YEARS AGO. THAT'S WHEN I STARTED GAINING THIS WEIGHT. I WAS NEVER A THIN PERSON, BUT I USED TO WORKOUT ALMOST EVERYDAY JUST TO STAY A SIZE 14/16. I DON'T HAVE TO TELL YOU THERE ARE SOME BEAUTIFUL WOMEN AND MEN THERE. AND THEY  MAKE YOU FEEL BAD FOR BEING THIS WAY. SO I KEPT PUTTING OFF GOING, TELLING  MYSELF I NEEDED TO LOSE WEIGHT FIRST BEFORE I GO TO THE GYM TO LOSE MORE WEIGHT. THAT'S FUNNY I KNOW. BUT THAT IS WHAT KEPT ME FROM GOING. BUT I FINALLY GOT OVER THAT. I NEED TO STOP THINKING OR WORRYING WHAT OTHERS MIGHT THINK OF ME. I'M NOT WORRYING ANYMORE. I JUST WANT TO FEEL GOOD INSIDE, NOT JUST  LOOK GOOD OUTSIDE.  
THANKS AGAIN
TAMIA

April 2
    Weight loss 30 pounds.  Today cleaned  teeth and rewired with .016" dead-soft wire. All brackets were intact. Tamia is confident and optimistic. She said that when she had released her jaws after a period of 6 weeks she experienced a limitation of the extent to which she was able to open her mouth.  After 2 days the range of motion returned to normal. I advised her to release her wiring every 4 weeks.
  

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