Join Study

All Interested in the Fall 2016 Yoga vs. Osteoporosis Study Should Fill-out the Following:

Download Study Form Here

Information sheet

In order to participate in the Yoga vs. Osteoporosis study headed by Dr. Loren Fishman, we require that you purchase  the DVD for $25 on sciatica.org, and complete the following studies. They can be obtained when your physician next draws blood and takes urine. If you need a separate prescription to direct an independent lab such as Quest or Athena to conduct the proper tests, please email or fax us. Otherwise, just give this paper to your physician, and fax or email the results to:

Ms. Tina Paul

Attn: Yoga Vs. Osteoporosis

Email: ms.tinapaul@gmail.com

Fax:  (212) 472-4127.

Necessary Lab tests (done within 6 months of study entry)

TSH (Thyroid stimulating hormone)

PTH (Parathyroid hormone)

ESR (Erythrocyte sedimentation rate)

SMA – 18 (standard electrolyte, liver and kidney function tests)

Vitamin D 25 – OH

Vitamin D 1,25 – Dihydroxy

Urine NTX (a measure of reabsorbed collagen cross-linkages)

Each applicant must also supply a current DEXA scan done within 6 months of application, and a second DEXA performed at least one year in the past.

When we have received the entry information form, the laboratory reports, your bone mineral density test or DEXA scan, and recent hip and lumbar spine X-rays, you will be inducted into the study and we will mail you a DVD. Please allow one week for processing.

If there are questions, please email Loren@sciatica.org

Yoga vs. Osteoporosis Entry Information                  

Date: _____________________________________

Name: ___________________________________

Phone: ___________________________________

Email Address: ___________________________

Date of Birth                              F     M       Weight               
Height             Greatest Height                      

 

  1. Hysterectomy? Yes No   First monthly period___/___ Last monthly period___/____
  1. Orchiectomy? Yes No
  1. Do you take Calcium? Y   N *Daily Dose                   Brand/Type               Date started                
  1. Do you take Vitamin D? Y   N          *Daily Dose                    Brand/Type               Date started                
  1. Do you take Magnesium? Y   N          *Daily Dose                    Brand/Type               Date started                
  1. Other medicine for osteoporosis? Y   N *Daily Dose Brand/Type               Date started                
  1. Previous medicines for osteoporosis? Y   N *Daily Dose Brand/Type Date started                
  1. Names, Dosage of all other medicines/supplements/vitamins::                                                                                                                                                           
  1. Exposed to Steriods?   Y   N   Dosage and Dates:
  1. Birth Control? Y   N Daily Dose Brand/Type                Dates taken                  

 

  1. Hormone Therapy? Y   N Daily Dose Brand/Type                Dates taken                  
  1. Unusual Nutrition: (e.g., vegan for 20 years)
  1. History of Bone Fractures?
  1. a. Years of Yoga__________________________________________________________________
  2. Type of yoga (e.g., Vinyasa, Iyengar) ______________________________________________
  3. How often and how long? (e.g., 1 x per week, 30 min) ______________________________

 

How consistent? (e.g., never miss, miss every few weeks, skip weeks at a time, etc)

                                                ___                                                      __       

  1. a. Other Exercise (what Type, eg, Swimming) ___________________________________
  2. How often? (eg, 1 x per week) __                                                                    ______
  3. How long per session?______________________________________________________
  4. How consistent? ______
  1. a. Last DEXA scan_______________________
  2. Last Hip/Lumbar X-rays________________

 

  1. Family History (Please mention an family History of Osteoporosis): __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
  1. Medical Conditions, including hip and spine surgeries: __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
  1. Comments:
      ___________________________________________________________________________________________________

 

      ___________________________________________________________________________________________________

 

      ___________________________________________________________________________________________________

 

      ___________________________________________________________________________________________________

 

      ___________________________________________________________________________________________________

Please scan the results into an email and send them to Tina Paul, MS at ms.tinapaul@gmail.com.

 

If the results of any of the blood or urine studies is abnormal, we will direct you to the proper type of physician to help bring your values in line.  Once that has occurred, you will be admitted to the study.