An Alana HealthCare Publication Spring 2010 www.alanahealthcare.com
A Tough Balancing Act: A Look Inside Caregiver Stress Understanding IVIg: Demystifying Intravenous Immunoglobin Treatment
Letter from the Chief Executive Officer Dear Readers, Welcome to our first issue of Wellness 360. Close to one year has passed since Jason Shiflet invited me to visit the Dickson Medical Equipment office, just west of Nashville. In the weeks that followed, we constructed the outline of a diverse healthcare services provider that capitalized on our collective experiences in home medical equipment and specialty pharmacy sales and service. We believed that reform of the U.S. healthcare system, especially changes in reimbursement levels and the ability to provide to patients of government programs, was inevitable. We decided to focus our efforts on bringing diverse services to the Dickson Medical network of referring physicians. These services include: (1) home medical equipment for patients in need of respiratory therapy, mobility products, wound therapy and continuous positive air pressure (CPAP) devices; and (2) specialty pharmacy services for patients that require injectables and/or infusion products for chronic illnesses, such as auto-immune disorders, rheumatoid arthritis, multiple sclerosis, hemophilia, and also antibiotic therapies, TPN and chemotherapy. As this issue of Wellness 360 goes to press, much of our collective dream has become reality. Alana Healthcare, LLC was accomplished through the merging of Dickson Medical Equipment and Alana Healthcare Pharmacy, LLC. We provide services to thousands of patients of 250+ referring physicians in Middle and Western Tennessee, most by door-to-door delivery through our fleet of delivery vehicles. Our respiratory therapists, nurses, pharmacists and technicians service those patients from our 9 locations. By the fall edition of Wellness 360, we will have completed our first venture into setting up a turnkey infusion suite, in conjunction with a
medical clinic and its 35 physicians. This infusion suite is the first of several that we will launch through the end of 2011. We are also adding to our product and service offerings. Wound therapy is a new and fast growing part of our DME operations. We have expanded our orthotics and prosthetics operations by moving the lab to Clarksville and adding to the management. It is our intention to use this business as a launching point for creating a diabetes services business for the patients of our referral network. Every week we are offered opportunities to expand our DME footprint through strategic acquisitions and it is our plan to take advantage of these opportunities to grow our business in a way that best serves our patients and doctors. As you will no doubt see from this issue, Wellness 360 reflects the mission of our business. The articles in this and future issues illuminate current topics in healthcare, educate readers on different diseases and treatments, cover the latest trends in medical developments, and offer support through informative stories. We welcome your feedback and hope you enjoy reading Wellness 360 as much as we enjoyed putting it together. In future issues of Wellness 360, Amy Massey, our Director of Marketing and the Publisher of this newsletter, and Cory Schneider, the Editor-in-Chief, will be introducing the team members of Alana Healthcare that are the true engines of our growth, and the future leaders of the company. Thanks, Steven Schneider, Chief Executive Officer Jason Shiflet, President
Table of Contents
Letter from the CEO ................................................... 2
Wellness 360Â° An Alana HealthCareâ„˘ Publication
Understanding IVIg: ................................................... 3 Demystifying Intravenous Immunoglobin Treatment
Editor: Cory Schneider Graphic Designer: Barbara Morris Contributor: Janet Brewer, M.Ed
A Tough Balancing Act: ............................................. 6 A Look Inside Caregiver Stress COPD ......................................................................... 10 Did You Know .......................................................... 12
Publisher: Amy Massey 507 E. College Street Dickson, TN 37055 Toll-free: (877) 796-9679 Fax: (615) 375-1132 www.alanahealthcare.com Steven A. Schneider, CEO Jason Shiflet, President
Wellness 360TM is published by Alana HealthCare. The information provided in this newsletter in no way replaces the information and advice provided by a health care professional. A doctor or nurseshould be contacted regarding the diagnosis and treatment of any medical condition. Websites and reference information are provided for your convenience only, and Alana HealthCare neither endorses nor supports the statements they contain in any way. Alana HealthCare does not verify the authenticity of these websites or the content they provide.
Understanding IVIg: Demystifying Intravenous Immunoglobin Treatment
By Cory Schneider
f you are living with a disease that inhibits your immune system, IVIg therapy is probably not new to you. Your physician may have recommended the treatment or you may have come across it in the course of researching your condition. The science behind the therapy and its uses are complex, so you are bound to have questions about it. What is it exactly and how does it work? Should you wait for your doctor to prescribe it or should you bring it up? What are the side effects? According to Eric Lowe, Chief Operating Officer of Comprehensive Health Education Services (CHES), these are exactly the questions you should be asking yourself and your doctor. CHES is a company that provides educational services to people living with chronic conditions and the companies that
produce, supply, and administer their treatments, so Lowe has several years experience with IVIg and the patients who use it. He warns that while it is essential to be informed about your potential (or ongoing) medical options, it is always best to speak with your physician before pursuing a course of treatment.
What is IVIg? IVIg, or Intravenous Immunoglobin, is a medicinal form of antibodies used to treat patients affected by faulty immune systems. IVIg is extracted from plasma that has been pooled together by thousands of donors, meaning that it is categorized as a blood product. The therapy provides temporary relief for patients, but is not a correction for symptoms or a cure. It is used across a broad range of medical specialties, including Pediatrics, Neurology, Dermatology,
Immunology, OB/GYN, Infectious Disease-Urology, and HematologyOncology. Most commonly, however, IVIg is used in these eight FDA-approved conditions: • Bone Marrow Transplants • Kawasaki Disease • Idiopathic Thrombocytopenic Purpura (ITP) • Pediatric HIV • Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) • Chronic Leukemia (CLL) • Kidney Transplants • Primary Immunodeficiencies, such as: – Common Variable Immunodeficiency (CVID) – Agammaglobulinemia (XLA) – IgG Subclass Deficiency – Specific Antibody Deficiency – Severe Combined Immunodeficiency (SCID) IVIg continued on page 4
IVIg continued from page 3
IVIg is a medicinal form of antibodies used to treat patients affected by faulty immune systems.
These are also the situations in which your doctor will most likely be comfortable prescribing the therapy. It is also worth noting that IVIg has been used for several offlabel conditions. The rarity of these conditions—ranging from Lupus to Muscular Dystrophy—has made it difficult to conduct any conclusive patient studies. Lowe explains that while the therapy did not truly catch on for treatment use until the 1980s, it has existed in some form since the 1940s. At that time, researchers thought it could prevent and treat infection, but ultimately realized its potential use for patients with autoimmune diseases. Since the 1980s, then, the treatment’s recognition has grown due to a number of factors. “On the upside, the list of off-label uses for IVIg continues to grow. In addition, the awareness of the product has significantly increased over the past couple of decades,” says Lowe. “Unfortunately, safety concerns, low insurance
reimbursement rates, unknown product effectiveness, the physician’s hesitancy to prescribe IVIg, and product availability (at times) can all become issues that restrict its use.” Finally, IVIg therapy is most often used as a secondary treatment option, because most conditions it serves already have products specifically manufactured for them. “IVIg directly affects the immune system making it difficult to predict its response to each individual,” notes Lowe. “This is why most physicians will try other drugs before prescribing IVIg.” The exceptions to this rule tend to be in cases of primary immunodeficiency, where doctors will recommend IVIg as a firstline treatment for patients with Kawasaki disease, ITP, GuillainBarré Syndrome, and Fetal Alloimmune Thrombocytopenia (FAIT).
How does IVIg work and does it have side effects? Because it is difficult to predict how IVIg will react with an individual patient’s immune system, its results vary across patients. When it does work, the therapy acts as an immunomodulator. Lowe explains that IVIg “can balance the immune system, strengthen the immune system, and/or reduce activity in an overactive immune system.” This balance is what brings patients temporary relief, often in combination with other treatments they are receiving. On the other hand, there can be side effects. Most commonly, patients may experience: headaches, chest pain, shortness of breath, rash, allergic reaction, renal failure, venous thrombosis (or, blood clots in veins that may cause an embolism), aseptic meningitis, or a pulmonary edema (a buildup of fluid in the lungs). Again, your doctor can better explain the risks and benefits to you as an individual patient as you embark on this course of treatment.
IVIg therapy is most often used as a secondary treatment option
Armed with the right information, you should feel confident and empowered to speak with your doctor about IVIg therapy.
When will IVIg be brought up in your doctor’s office? According to Lowe, physicians will likely be the first to bring up IVIg with patients. But that is not always the case due to the treatment’s varied success with patients, so he says that it is important for patients to stay aware and informed. “Unless the patient is proactive in advocating for himself, he most likely won’t know what IVIg is, let alone that it’s a treatment option,” says Lowe. “When it comes to Primary Immunodeficiencies, Kawasaki disease, ITP, GuillainBarré syndrome, and FAIT, patients should be encouraged to ask their physician about the IVIg option as soon as possible.” And if you do decide to inquire about it, be sure to ask your doctor these important questions: • What are the risks? • What is my expected outcome? • What are the success rates for someone taking IVIg with my medical condition?
And if you and your doctor decide to pursue IVIg as a course of treatment, keep the potential side effects in mind so you can let your doctor know should you begin to experience anaphylactic reactions. “Specifically, patients should report issues of decreased urine output, sudden weight gain, shortness of breath, and/or fluid retention as these could all be signs of kidney damage,” says Lowe. He adds, “Flulike symptoms could potentially develop.” It is also important to keep in mind that you will need to make certain that your insurance company covers the therapy for your specific use, and what additional costs you may be responsible for. Armed with the right information, you should feel confident and empowered to speak with your doctor about IVIg therapy. After all, it is becoming increasingly essential that patients know the right questions to ask—and the right answers to listen for.
A Tough Balancing Act: A Look Inside Caregiver Stress By Janet Brewer, M.Ed
s a caregiver for someone with a chronic condition, you are constantly being bombarded with information. On any given day, you might read or hear about healthcare, maintaining a healthy lifestyle, insurance changes, and so on. But where are the articles and information on how to manage your emotional and physical health when you are the primary caregiver of a loved one with a chronic condition? If you are feeling overwhelmed by responsibilities to your chronically ill loved one, you are likely experiencing caregiver stress, simply defined as the emotional strain of caregiving. The effects of caregiving can be felt in many ways—emotionally, physically, and economically—and in all facets of your life, including in your job and relationships. The statistics about caregivers are mind-boggling: •M ore than 50 million people provide care for a chronically ill, disabled or aged family member during any given year •T he median incomes of families with one member that has a disability are more than 15% lower than non-caregiving families
•C aregivers experiencing extreme stress are shown to age prematurely, resulting in as many as 10 years coming off their lives • F amily caregivers providing care more than 36 or more hours weekly are more likely than non-caregivers to experience symptoms of depression or anxiety •A pproximately 75% of caregivers are women
Self checkup: are you experiencing caregiver stress? Ask yourself these questions: 1. Do you have problems sleeping or do you want to sleep all of the time? 2. Have you lost of gained too much weight? 3. Are you tired or do you feel like you have no energy? 4. Have you lost interest in activities you used to enjoy? 5. Do you feel the need to control all aspects of your life and the life of your loved one? If you answered yes to any of these questions, see our box on seeking help to find a support network to suit your needs.
Do you put off your own health and emotional needs to care for a loved one? Studies show that by doing this you often end up feeling angry, isolated, and anxious. There
are a series of questions you can ask yourself to find out if you may be experiencing caregiver stress. (See the Self Checkup box for these questions.) Truthful answers may help you recognize the impact of the strain that caring for your loved one is taking on you. Identifying, acknowledging, and embracing the role you play as the family caregiver is the first step to creating more balance in your life. Caregiver stress comes on in the absence of balance. It is important to remember, however, that you are not alone and that your feelings are normal. Rather than giving into the despair caregiver stress can lead to, realize that there is hope for restoring balance. The loved one you are caring for is affected mentally, physically, socially, and spiritually, and so are you. The active role that you play in her life is truly a gift that requires an open mind and a willing heart. The key to becoming a successful caregiver—and maintaining balance—is to remember to ACT.
A: Acknowledgement Acknowledge that your family member has a chronic condition. His diagnosis will affect you too, and it is understandable to feel upset, angry, disappointed, and perhaps helpless at times. It is
Caring for the caregiver Oftentimes, restoring balance comes from finding a support network that understands what you are going through and gives you a safe space in which to share your feelings. Several support groups exist for caregivers. One easy way to find the resources available in your state is to visit the Family Care NavigatorSM at caregiver.com, the website for the Family Caregiver Alliance. You can access the system through their website or by using this direct URL: http://caregiver.org/caregiver/jsp/ fcn_content_node.jsp?nodeid=2083. Family Caregiver Alliance’s website also features many other useful resources for caregivers. Here are some other tips for locating support groups: • Ask other caregivers you know if they go to any groups; word of mouth is often the easiest way to find support • Check local chapters of diseasespecific organizations • Ask your local religious service agencies • Talk to the social service department of your hospital. • Contact the Well Spouse Foundation (800-838-0879; www. wellspouse.org) for a list of available support groups near you
okay to express these feelings and recognize that the diagnosis may put a dent in your future activities or plans. While you absorb the feelings of those around you, do not forget to acknowledge that as a caregiver your emotions are valid and worth sharing.
As a primary caregiver, you will learn new and exciting things as long as you are open to doing so. Ensure that you are aware of the diagnosis, severity, treatment protocols, physician, and medical alert identification. Educate yourself, read everything provided to you, and do not be satisfied with only that. Search the web, find
and attend support groups, and educate members of your extended family so they may be a source of support for you. Insufficient knowledge breeds fear: what we do not understand is scary. Arming yourself with as much information as you can negates this fear and allows you to take back control.
Caregiver Stress continued on page 8 www.alanahealthcare.com
Caregiver Stress continued from page 7
The best gift you can provide your loved one is an emotionally, spiritually, and physically healthy you.
what symptoms she might be experiencing, as well as to share your observations and thoughts. Remember, your medical staff is only as good as you help them to be in treating the specific condition. If you have questions, ask. If you have a difference of opinion or information you have learned from outside resources, respectfully share this with physicians. As the caregiver, you become the expert as you live each day with your loved oneâ€™s condition. Teaching and modeling these skills will allow your loved one to become better equipped to manage his or her own care.
C: Communication Communication is the single most important way to learn anything, and not just about chronic conditions. Communication will
make a situation with no possible resolution easier to figure out. As the caregiver, your role is to communicate with the loved one you are caring for in a positive manner. She needs to know that she has an outlet. Initially, it will be your role to explain to the doctor and other health professionals
The second part of communicating is to ask for what you need from your spouse, significant other, trusted friend, or family member. Try to remember that those around you care about you and, in most circumstances, genuinely want to help. They will not know what you need unless you tell them. When you are stressed or overwhelmed, it is so easy to develop a mindset that it is easier to do things yourself rather than going through the steps of explaining to others what is needed. But that mind-set results in to two negative patterns of behavior: you shut out the very people who are trying to help you, making them feel inadequate and less willing to provide assistance in the future; and you become more
Putting yourself first is not selfish if it means that both you and your chronically ill loved one will remain emotionally and physically healthier.
angry and resentful. By opening the lines of communication and letting others help, you allow them to feel good about themselves. Open communication results in an emotionally healthier environment, again contributing to the future success of your loved one and improved relationships with the family and friends who surround you.
Putting yourself first is not selfish if it means that both you and your chronically ill loved one will remain emotionally and physically healthier. The relationship and bond you have created with the family member you are caring for have their foundations in trust. Your loved one trusts you to always be
Keeping balance: some tips for caregivers
Treatment refers not only to the treatment of a loved one with a chronic condition, but also to the treatment of the caregiver. If you do not take care of yourself, who else is going to? And if you neglect your own well-being, you may become unable to perform the “duties” of the caregiver. Then who will take care of your loved one? The best gift you can provide your loved one is an emotionally, spiritually, and physically healthy you. The research is very clear and shows that caregiver stress has been shown to affect immune systems, making caregivers more prone to chronic illnesses.
• R eward yourself with respite breaks often
Depression and anxiety can affect our ability to not only make informed decisions, but to concentrate and maintain the stamina and ability to function on a daily basis. Left undiagnosed and untreated, depression can impact your overall desire to live.
• B e mindful for signs of depression, and contact a professional for help if you need it • A ccept offers of help and suggest specific things that others can do • B e open to technologies and ideas that promote your loved one’s independence • Trust your instincts • B e good to your back, because you are bound to do a lot of heavy lifting Source: Adapted from National Family Caregiver’s Association “10 Tips for Family Caregivers”
there when he needs you. Taking time to do something relaxing for yourself affords you the opportunity to return more energized and refreshed. It also serves as a way for your loved one to see you as a person beyond himself once again enabling him to live a more successful, independent life.
So how do you work on your treatment? First and foremost, be flexible. Medical incidents happen and they usually happen at the worst possible times, such as holidays, planned activities, and family gatherings. Modeling flexibility creates resilience in your loved one. If that loved one is unable to leave home and your family cannot go to grandma’s to celebrate that big birthday, why not switch the party to your house – and asking everyone to pitch in? Remember, it is about spending time together and not where you are spending it that is important. This flexibility will underscore for your family and loved ones that you all care enough to make sacrifices for the greater good. Next, keep your priorities straight. Is it important that your home looks like something out of a home and garden magazine when everyone comes to celebrate that birthday at your house? No. While you should certainly strive for order, you do not have to achieve perfection. As a caregiver, you need to remember to stay focused on the tasks at hand and not on what others may think of you. Finally, maintain a sense of humor. You cannot get through most things—and certainly not chronic illness—without one!
COPD 365: Coping with Chronic
Obstructive Pulmonary Disease through Seasonal Changes By Cory Schneider
f you are living with Chronic Obstructive Pulmonary Disease (COPD), also commonly known as Chronic Obstructive Lung Disease (COLD), you know that even the slightest changes of temperature or environment can affect how you are feeling. From balmy days to wintry nights, your condition often hinges on conditions outside of your control. Because of this, it is important to be aware of your surroundings and your body’s reaction to them. Vigilance, in combination with regular
Read the signs: identifying exacerbations Concerned that you may be suffering from COPD? Check to see if you are experiencing one or more of the following symptoms and get in touch with your physician: • Constant coughing, sometimes called “smoker’s cough” • Shortness of breath while doing everyday activities • Producing a lot of sputum (also called phlegm or mucus) • Feeling like you can’t breathe or take a deep breath • Wheezing Source: National Lung Association
consultation with your physician and following your prescribed medication program, is your best tool in combating potentially irritating and sometimes incapacitating seasonal changes. COPD refers to chronic bronchitis and emphysema, a pair of diseases characterized by narrowed airways in the lungs that make it increasingly difficult for patients to breathe over time. More than 95% of patients who have COPD are diagnosed with these two conditions. According to the American Lung Association, the disease is the fourth leading cause of death in the United States. Most often, COPD is brought about by tobacco smoking, when noxious particles of gas trigger an abnormal inflammatory response in the lungs. Chronic bronchitis is clinically diagnosed when patients regularly cough up matter such as mucus or phlegm. Emphysema is the term used to describe the destruction of the tissues of the lung. While there is no cure for COPD, the good news is that it is treatable. Management strategies include smoking cessation, vaccinations, and rehabilitation. According to Jim Anderson, a respiratory therapist with Dickson Medical Equipment, physicians will also most likely prescribe twopronged medication programs. “The first medication patients use is a preventative, generally an inhaled steroid or artificial Symbicort, which mimics a steroid,” said Anderson.
“These are anti-inflammatories. You always take them whether you’re in an exacerbation or not. That’s what keeps the swelling and secretion of excess mucus down. The other medication patients will be prescribed is a bronchodilator, such as Albuterol.” Bronchodilators decrease airway resistance to facilitate airflow by enlarging the bronchi and bronchioles. Anderson stresses, however, that all medication programs should be prescribed and administered by physicians.
From cold air to dry heat The ways in which seasonal changes in temperature and weather affect the experience of COPD vary from patient to patient. Cold weather poses two threats: cold air and the risk of infection. Breathing cold, dry air shrinks the airways in some people with emphysema, making breathing more difficult. Cooler temperatures and strong winds can trigger exacerbations, as well as fatigue. Moreover, many of the germs that cause respiratory diseases, some as simple as the common cold, are spread by coughing and sneezing. If you are prone to exacerbations in the cold weather of late fall and winter, make sure you do your best to stay healthy. Get your flu and pneumonia
From balmy days to wintry nights, your condition often hinges on conditions outside of your control.
Self checkup: preventing COPD Though COPD is treatable to patients who have it, it is also highly preventable. Here are four things you can do if you think you are at risk for COPD: • Talk with your healthcare provider about shortness of breath, chronic cough, or decline in activity level • Get a simple breathing test, also known as spirometry • Quit smoking. Speak to your doctor for help with the process • Avoid pollutants or fumes that can irritate your lungs Source: National Heart, Lung, and Blood Institute
shots and keep your doctor in the loop if you are feeling irritated. “In the cold, stay in early and late, and do what you need to do in the afternoon when it’s the warmest,” said Anderson. “Always bundle up and wear a scarf so you’re not inhaling the cold air.” Spring and summer bring their own complications. Dry heat, especially in the summer, can exacerbate the lungs of many COPD patients.
While there is no cure for COPD, the good news is that it is treatable.
“If the heat of the summer is a trigger, then do what you need to do early in the morning or in the late afternoon,” advises Anderson. “Do what you can to avoid the heat of the day.” Anderson adds that the best means to avoiding irritation is to pay particular attention to when and how you are exacerbated. “The main thing is to think about what you were doing in the past that may have contributed to an exacerbation,” he said. “Were you trying to rake damp leaves in the fall when they might have had mildew? If that triggered an episode, in the future you can wear a respirator mask and premedicate before you go out.”
Staying well 24/7 Maintaining good health and habits year-round will help to ensure that you avoid or limit the number of exacerbations you experience. Much of the work of avoiding exacerbations lies in common sense. “Pay attention to your triggers and premedicate, if necessary,” said Anderson. “If you know that cats are a trigger for you, and you’re going to see Aunt Sally who has eight cats, premedicate and make it a short visit.”
A sensible exercise program is also a wise COPD management strategy. Work with your physician or a trainer to figure out a program that helps you keep good muscle tone. You should also consider learning breathing techniques that help you breathe through your diaphragm and not your chest muscles. And most importantly: quit smoking! The keys to breathing – and living – better are in your hands. Planning ahead and regularly consulting with your doctor will ensure that you can enjoy the day come rain or shine.
Did You Know… Buy yourself some peace of mind Developed by a former paramedic and a former police officer, Rescue Facts Medical Information Straps are designed to be attached to a seat belt strap, backpack, walker, cane, or even the strap of a purse. The straps are an affordable ($10) way to alert respondents to your medical history in case of emergency. The strap wraps around seat belts, medical equipment or clothing, and is secured by Velcro. Inside is a pocket that contains a paper medical information card included with every strap. If an emergency occurs, first responders will immediately be able to see the red and black Rescue Facts strap when administering aid and become aware of important medical information including, name, address, phone number, primary care physician, allergies, blood type, “consent to treat” form, and other potentially lifesaving information. For more information or to order Straps, visit http:// www.rescuefacts.com
Support charities by searching and shopping the Web Did you ever think that you could raise money for your favorite charity by searching and shopping on the internet? When you use the Yahoo powered search engine GoodSearch at http://www. goodsearch.com you are doing just that. On the GoodSearch homepage, choose from thousands of organizations or add your favorite cause to their list. Each time you use the GoodSearch engine to search or shop on the web, they donate half of their revenue (which amounts to approximately a penny a search) to the American charities designated by its users. – Amy Massey
Corporate Headquarters Alana HealthCare, LLC 507 East College Street Dickson, Tennessee 37055 Telephone: (615) 375-1094 Fax: (615) 375-1132 Toll-free Phone: (877) 796-9679 Toll-free Fax: (877) 471-2484 www.alanahealthcare.com
Subsidiaries Alana HealthCare Pharmacy: Alana HealthCare Pharmacy, LLC 507 East College Street Dickson, Tennessee 37055 Telephone: (615) 375-1094 Toll-free Phone: (877) 796-9679 Toll-free Fax: (877) 471-2484 Dickson Medical Equipment, Inc: DME of Dickson DME of Clarksville 760 Hwy 46S 1817 Madison St. Suite 5 Dickson, TN 37055 Clarksville, TN 37040 Office: (615) 446-7444 Office: (931) 503-1309 Fax: (615) 446-7483 Fax: (931) 503-1313 DME of Jackson DME of Erin 117 North Conalco 15C North Boone St. Jackson, TN 38305 Erin, TN 37061 Office: (731) 660-5080 Office: (877) 342-6107 Fax: (731) 660-0025 Fax: (931) 289-3947 DME of Union City DME Orthotics and Prosthetics 1200 B South Bishop St. 127 Crestview Park Dr. Ste 104 Union City, TN 38261 Dickson, TN 37055 Office: (731) 885-2122 Office: (615) 740-0177 Fax: (731) 885-2177 Fax: (615) 740-1154 DME of Dyersburg DME Orthotics and Prosthetics 1083 Vendall St. 1817 Madison St. Suite 5 Dyersburg, TN 38024 Clarksville, TN 37040 Office: (731) 286-1000 Office: (931) 503-1309 Fax: (731) 286-1001 Fax: (931) 503-1313