Bi-monthly Newsletter of Northern Virginia Chapter 200

Mending Ways Volume 23 Issue 5 Sep/Oct 2012

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A negative attitude has long been shown to be detrimental to cardiovascular health, but new information is proving that a positive psychological well being is a powerful player in reducing the risk of heart attacks, strokes and other cardiovascular events. And optimism may be particularly important for women who are at a higher risk of the severe impact cardiovascular disease (CVD) presents.

As heart disease continues to be the leading cause of death of women in the United States, studies are uncovering interesting links to why this disease threatens the female population and what can be done to reduce its risk. One of the more prevalent findings is showing that contentment can promote a happy heart.

In the first and largest systematic review on how positive psychological characteristics are related to heart health, Harvard School of Public Health (HSPH) researchers found that factors such as optimism, life satisfaction and happiness are associated with reduced risk of CVD regardless of a person’s age, socioeconomic status, smoking status, or body weight. The study showed that the most optimistic individuals have an approximately 50-percent reduced risk of experiencing an initial cardiovascular event compared to their less optimistic peers.

But the reality is that depression and heart disease are very common and often coexist, and about twice as many women as men experience depression. If you have already been diagnosed with depression, this

news may be disheartening, but Cleveland Clinic psychiatrists believe these findings may be the first step in increasing your heart health.

“There is a still an unknown psychological mechanism as to why women are more predisposed to depression. Women with depression can frequently experience guilt, anxiety, disturbed appetite and sleep, as well as weight change,” says psychiatrist Leo Pozuelo, MD. “This study shows that positive feelings augment a resiliency to prevent or reduce the risk of heart disease.”

What the studies are showing

In the HSPH study published in Psychological Bulletin (April 16, 2012), 200 studies published in two major scientific databases were reviewed. Researchers found that there are psychological assets, like optimism and positive emotion that afford protection against cardiovascular disease. The study also shows that these factors slow the progression of the disease. The researchers found that individuals with a sense of well-being also engaged in healthier behaviors such as exercising, eating a balanced diet, and getting sufficient sleep. Greater well-being also was related to better biological function, such as lower blood pressure, healthier lipid profiles and normal body weight.

Researchers have also acknowledged that women may be more predisposed to depression and its impact on

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Smile: It Really Is Good for Your Heart and Mind

Mending Ways

About “Mending Ways” “Mending Ways” is the bimonthly newsletter of Mended Hearts, Northern Virginia Chapter 200, Annandale, Va., a non-profit organization of Mended Hearts, Inc., Dallas, Texas, which is “Dedicated to Alleviating the Trauma Associated with Heart Disease and Surgery.” Other Mended Hearts chapters may reprint without prior permission any portion of the contents herein, pro-vided proper author, title, and publication credits are given. For more information about this publication or about our chapter, please call (703) 248-1733.

The Heart Walk The 2012 Greater Washington Region Heart Walk will take place at Nationals Park on Saturday, No-vember 10, 2012. If you choose to attend, you can select the 1 or 3 mile option. Each year, through the participation of members, families, and friends, Mended Hearts Chapter 200 helps raise funds for heart research and education. The American Heart Association has more information available on its site at www.greaterwashingtonheartwalk.org.

Should you wish to join the Mended Hearts team as a participant at the walk and/or make a donation to AHA please visit their website and select “Register”, then "Join a Team", then enter "mended hearts", fol-lowed by "Join a Team", where you can complete the required information. At that point you will be registered for the walk and as a member of our team. If you choose to donate and prefer, you may write a check payable to the American Heart Association,

noting Mended Hearts #200 on the front and mail it to our office. The address is: Mended Hearts Chap-ter 200, PO Box 897, Annandale, Va. 22003. If you would like to walk with us, Kevin Houlihan will again lead the Chapter’s contingent. For further information on where and when to meet, please call him at (703) 729-0467.

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Observation Dome Viewing Available By Appointment

The surgical observation dome in the INOVA Heart and Vascular Institute is a remarkable learning experience, espe-cially meaningful to those of us who have had a similar procedure. The Dome’s angled windows are ar-ranged in a circular format to permit viewing of cardiac and vascular surgery. Accompanied by closed circuit monitors, this enables observers to watch the proce-dure unfold and marvel at the precision of a cardiovascular surgical team. To arrange an observation, please contact the Community Affairs Division of the INOVA Health System at 703-698-2573.

Mending Ways Who We Are

Mended Hearts Chapter 200 in Northern Virginia is a Non-Profit Service Organization of Mended Hearts, Inc., Dallas, Texas, which is dedicated to inspiring hope in heart disease patients and their families. We of Mended Hearts are grateful for the miracle of heart surgery since it has given us a new awareness of the joy of living. Offering help and encouragement to others who are faced with or have had heart surgery is what the Mended Hearts organization is all about! We are unique, living proof of a productive life following heart surgery. We are aware of the kind of help that is necessary to sustain heart patients in time of questioning before and after surgery. Those who are interested in helping other heart patients are invited to join Mended Hearts. Membership consists of people who had heart surgery and/or any heart procedures, their spouses, relatives, medical professionals, and others interested in the purpose of Mended Hearts. We are grateful and happy to live the organization’s motto: It’s great to be alive—and to help others!

Monthly Meeting Schedule

Chapter Meeting: 1st Saturday of the month, beginning at 11:00 am Executive Committee Meeting: 3d Saturday of the month, beginning at 10:00 am These meetings take place at the:

Heart & Vascular Institute Conference Center INOVA Fairfax Hospital

3300 Gallows Road Falls Church, Virginia

As you enter the main campus of the INOVA Fairfax Hospital from Gallows Road (Gray Entrance), the Main Hospital building will be on your right. Proceed past that building; and on the right just beyond the INOVA Heart and Vascular Institute, park in the Gray Garage. Take the elevator to the Ground Floor (G) and walk to the lobby. Pass the fountain and the Patient/Visitors Information Desk, take the first hallway on the left (the overhead sign will read IHVI Conference Center). You can ask for directions at the Patient/Visitors Information Desk or follow the Mended Hearts signs. From within the Main Hospital building, follow the gray sign to the Inova Heart and Vascular Institute.

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Note: Mended Hearts Chapter 200 is a participant in the Combined Federal Campaign (# 65140) and the United Way (# 9436).

Mending Ways

But research shows too few people regularly practice healthy habits

Your doctor tells you repeatedly to get more exercise, eat a healthy diet and watch your blood pressure, because those are among the key steps toward a healthier heart and a longer life. Now a recent study shows just how much those healthy behaviors can help.

A study of nearly 45,000 adults found that those who met more of the seven recommended cardiovascular health behaviors (see chart) had a significantly lower risk of death compared to those who met fewer factors. Researchers, who published their findings online March 16 in the Journal of the American Medical Association (JAMA), also noted that a low percentage of study participants actually practiced all seven heart-healthy behaviors.

Leslie Cho, MD, Director of Preventive Cardiology and Rehabilitation at Cleveland Clinic, praises the study because it shows that every factor contributes

significantly to your cardiovascular health.

“I think it is an important study because it is again stressing the importance of controlling all the risk factors,” she says. “We shouldn’t feel good about controlling just one. We should be hyper-vigilant about all of them.”

Unfortunately, researchers found that only about 1.2 percent of the study participants met all seven cardiovascular health metrics. Younger participants, women and those with higher education levels tended to be the most vigilant about their heart-healthy behaviors.

What’s holding us back?

A separate survey, also released in March by the American Heart Association (AHA), found that about 12 percent of American adults regularly practice healthy habits such as eating a healthy diet, exercising for at least 150 minutes a week and practicing recommended oral care (brushing and rinsing twice a day, and flossing once daily). In the survey, people who said they didn’t engage in healthy behaviors regularly cited a “lack of time” as the most common reason for not practicing those habits.

For many people, though, there is a disconnect between the amount of time they think it will take to exercise more or eat healthier, and the actual time commitment these behaviors require. AHA spokeswoman Tracy Stevens, MD, says that small changes you start working into your everyday life can lead to big improvements in your health.

“Whether it is simply adding a 30-minute brisk walk to your day, eating a few more fruits and vegetables with your meals, balancing your calories and physical

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Meeting Greater Number of Heart Health Factors Extends Life

Mending Ways

Would You Like to Make a Difference? A popular and often quoted saying is “one person can make a difference and every person should try.” And, very frankly, Mended Hearts Chapter 200 is asking for you to consider being that one person. No free lunches or store discounts, but your time and talents will help others. If you decide it’s time to give back, here are a few ideas for you: The Pillow Program

We are fortunate to have organizations that volunteer their time and talents to make the pillows. However, the inventory of pillows must be maintained to supply Fairfax, Alexandria and Arlington hospitals. The organizations making the pillows generally provide the fabric but we order, supply and deliver the pillow fill, and are responsible for the storage of the pillows. We need assistance in picking up the finished pillows at various churches and bringing them to the storage facility.

Speakers Program

Four times a year we have a guest speaker on heart-health issues. We encourage you to contact us with suggestions for speakers or topics.

Office Assistance Our telephone number requires monitoring and the message passed on to the responsible person. This can be done from your home and every other day is sufficient. We are fortunate to have an office and the use of office equipment at the American Heart Association headquarters. We have the use of their equipment for the necessary copying and collation of Mended Hearts material.

American Heart Association Liaison (located in Ballston by the Metro)

A major fund raising effort for the American Heart Association is their Heart Walk. They need assistance from organizations like Mended Hearts to work their phone banks. This does not involve solicitation, but offers thanks and encouragement to the Captains.

On occasion American Heart asks Mended Hearts to participate in a health fair. The assistance is telling the story of your heart situation—again, no soliciting.

Mending Ways Newsletter

If you have ever helped with your HS, college or workplace newsletter, you would enjoy helping out with Mending Ways. Whether it is suggesting an article, authoring a column, or proofreading, for example, there are many ways we can use your help.

Please call Mended Hearts at (703) 248-1733 or send an email to MH200Mail@gmail.com if you have decided it’s time to give back.

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Mending Ways Mending Ways Mending Ways

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ANNUAL HOLIDAY LUNCHEON Mark your calendar now for 12:00-2:00 on Saturday, December 1, 2012. That’s the date of our annual holiday luncheon at the Brio Tuscan Grille, located at 7854L Tyson’s Corner Center, McLean, Virginia. This luncheon, like all our past holiday luncheons, will combine fellowship with a great meal—and a few door prizes. Appetizer: Field Greens Salad or Zuppa Del Giorno Entrée: Your choice of Chicken “Under the Brick” (boneless, skinless chicken breast, grilled and pressed under a brick and served with Marsala mushroom sauce); or Grilled Salmon with Citrus Pesto; or Penne Mediterranean, tossed with sun-dried tomatoes, mushrooms, spinach, carmelized onions, feta cheese and pine nuts. Dessert: Either Tiramisu or fruit Please call Tara Greenwood at (703) 444-1248 with any questions, or if you need additional information. We hope you to see you there.

CHAPTER 200 ANNUAL HOLIDAY LUNCHEON The Annual Chapter 200 Holiday Luncheon will take place at Noon on Saturday, December 1, at the Brio Tuscan Grille, 7854L Tyson’s Corner Center, McLean, Virginia. The cost of the luncheon is $27 per person, which includes tax and tips, and will include salad or soup, a main course of either Mezza Chicken Under the Brick, Penne Mediterranean, or Grilled Salmon with Citrus Pesto, and either a devilish dessert or one that is more heart healthy: Your check must be mailed to Mended Hearts, Chapter 200, P.O. Box 897, Annandale, Virginia 22003, prior to November 26, 2012, so that we can notify the restaurant for seating arrangements and meal preparation. Name ____________________________ @ $27 = ______ Name ____________________________ @ $27 = ______ Additional guests ___________________ @ $27 each = ______ TOTAL = ______

Mending Ways

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Here's what you need to keep in mind.

If you have a heart condition or concern, your doc-tor may discuss different ways to diagnose or moni-tor it, including an electrocardiogram (ECG), car-diac catheterization, echocardiogram (ultrasound), radionuclide stress test, coronary CT angiogram, radionuclide myocardial perfusion imaging, or car-diac magnetic resonance imaging (MRI). These tests provide valuable guidance in diagnosing and treating heart disease. But some of them also ex-pose you to ionizing radiation, which can poten-tially damage cells and increase the risk of cancer. Although no direct link between cardiac imaging tests and cancer has been confirmed, doctors are taking steps to limit the amount of radiation these tests deliver.

"Until 10 years ago, we didn't appreciate how much radiation exposure was incurred by certain tests. Now we know. Moreover, we understand that it's not only the dose that raises risk, but also when and where the radiation is given," says Dr. Warren Manning, chief of noninvasive cardiac imaging and testing at Beth Israel Deaconess Medical Center and a professor at Harvard Medical School. "One or two CT scans over a lifetime is appropriate. But if you have a condition that requires repeated moni-toring, a test that does not expose you to ionizing radiation, like cardiac ultrasound or MRI, may be preferable," he adds. A Cumulative Problem We receive low doses of radiation from the sun and slightly higher doses when we ride in airplanes or visit higher altitudes. There is no evidence that this

type of exposure is dangerous. "If it were, pilots and flight attendants would have an increased risk of cancer, but they don't," says Dr. Manning.

Studies of Japanese atomic bomb survivors and nu-clear power plant accident survivors suggest that cancer risk increases as exposure to radiation accu-mulates. For this reason, the American College of Radiology has set the lifetime radiation exposure limit at a conservative 100 millisieverts (mSv): one mSv is equivalent to the average amount of radia-tion a person receives in a year. "Below this level, we believe there is no meaningful risk," says Dr. Manning. Why You Should Care Some cardiac imaging tests emit very high doses of radiation (see box). Physicians are particularly con-cerned about CT scans, since the popularity of these tests has grown exponentially, exposing large numbers of people to significant doses of radiation. When the amount of radiation from a CT scan is added to that received from dental x-rays, chest x-rays, mammograms, tests performed for other medical reasons, and those done in the past, it's easy for an individual to reach or surpass the 100 mSv mark.

Because cancer develops very slowly after radia-tion damage occurs, your age at the time of expo-sure matters. "If you are in your 80s, you will probably outlive the danger. But if you are young, it is particularly important to limit radiation expo-sure," says Dr. Manning.

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Radiation From CT, Other Cardiac Tests Can Be a Problem

Mending Ways

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continued from page 4 activity to achieve a healthy body weight or creating routine oral care habits—it all contributes to an overall healthier lifestyle,” Stevens says. Dr. Cho suggests that for some people, it’s a lack of information about the importance of these lifestyle choices, while for others, it may be a lack of moti-vation or self-discipline. “Some patients are very proactive and others are not,” she observes. “However, it is crucial that we tell our patients, how important it is to control all their risk factors.” With that said, however, Dr. Cho adds that smoking cessation may be the single biggest choice you can make to help achieve a longer life, and that it’s never too late to quit. “It is critical that patients with cardiovascular dis-ease quit smoking,” she says. “Also, blood pressure control is important.” Getting Started As Stevens says, committing to a healthier lifestyle can be done with just a few changes here and there at the beginning. Don’t think that you need to over-haul your life in one day or even one month. The key is just sticking with your healthier choices. And Dr. Cho stresses the value of having some pro-fessional guidance to get you started and keep you on track. “The most important thing is to ask for and then seek help,” she says. “I really believe that all pa-tients with heart disease should have good nutrition and exercise counseling to help them. We often think we know what healthy eating is but we really don’t. Also, doctors aren’t always the best resources when it comes to dietary and exercise counseling, so

that is why it is important to seek out a nutritionist or dietitian with experience in working with heart patients. Exercise specialists who are knowledge-able about heart disease are also very helpful.” And in case you think that your family history of cardiovascular disease has sentenced you to an un-avoidable future of heart problems, Dr. Cho notes that previous research suggests that about 90 per-cent of heart disease is based on controllable risk factors and only 10 percent based on genetics.

Excerpted from Cleveland Clinic Heart Advisor, July 2012

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Risk Management With the heightened awareness of cancer potential from cumulative exposure, medical societies have stepped up efforts to minimize the risk.

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Radiation From Common Tests

Echocardiogram 0 mSv

MRI 0 mSv

Chest x-ray 0.05 mSv

Mammogram 0.7 mSv

Calcium scoring test 1-2 mSv

Cardiac catheterization 7 mSv

Chest CT 10 mSv

Coronary CT angiography 3-14 mSv

Radionuclide sestamibi stress test 10-12 mSv

Radionuclide dual isotope

myocardial perfusion imaging

25 mSv

Mending Ways

continued from page 1 heart health due to grief over the death of a loved one. “Death by broken heart” was first studied in a 2005 report in The New England Journal of Medi-cine that described 19 patients, mostly older women, who developed classic heart attack symp-toms after suffering severe emotional stress. Re-cently, research in Circulation (Jan. 9, 2012) showed that grief over the death of a significant per-son was associated with an acutely increased risk of a heart attack in days following the death—further validating the impact of grief on women who among people age 65 and over are three times more likely to become widowed. “The Circulation study emphasizes how we need to be aware of the impact acute psychological stress has on the increased risk of cardiovascular events,” explains Dr. Pozuelo. “Most importantly, it showed that the incidence rate of acute myocardial infarc-tion onset was elevated 21.1 fold within 24 hours of the death of a significant person and declined stead-ily on each subsequent day – clearly demonstrating that mental stress and depressive symptoms in-creased the risk of heart disease.” Emphasizing the positive While the obstacles for gaining and maintaining a positive attitude may seem overwhelming due to the daily challenges women face, such as caregiver stress and hormonal changes, news from recent re-search should actually be seen as helpful guidance. “By understanding why women are predisposed to depression and the detrimental impact it has on car-diovascular health we are able to proactively diag-nose heart disease and depression,” stresses Dr. Po-zuelo. “By incorporating treatment such as cogni-tive behavioral therapy and, in some cases, anti-depressant medications there can be a marked im-provement in the coping with heart disease. And if

you emotionally feel better, you will physically be better able to take care of your heart, adopting good wellness behaviors.”

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continued from page 8 The American College of Radiology now empha-sizes the importance of conducting tests with as lit-tle radiation as possible. Significant changes have resulted, including substituting the agent sestamibi for thallium in nuclear scans. This cuts radiation in half. New protocols allow cardiac CT scans to be performed with one-sixth the conventional radiation dose. The American College of Cardiology Foundation collaborated with imaging societies to reduce the number of exposures people receive by recommend-ing how often specific tests should be done and en-couraging physicians to use radiation-free tests, such as ECG, echocardiography, and MRI, when-ever possible. These tests pose no radiation risk. It all adds up to an experience that allows heart dis-ease to be diagnosed, treated, and monitored with greater safety.

Excerpted from Harvard Heart Letter, July 2012

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It’s Great to Be Alive, and to Help Others

Mending Ways .

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Thank You Nurse

It is 5 am, my bed light comes on and a smile greets my morning. It is time to get ready for our trip downstairs. Another smile greets me in preop, and another smile preps me for surgery. A smile and a gentle touch on my forehead are the last things I remember. A smile and a gentle touch on my forehead greet me as I awaken. I am on a respirator and cannot speak- fear grips me momentarily. Her gentle words and touch calm me. "You are doing great and are going to be just fine. Better than ever." The nurses never left my side for my entire eighteen hour stay in cardiac surgical intensive care. They were my nurses. For five more days my nurses encouraged me and pushed me to sit up, stand, walk, walk and walk some more. They monitored me and followed my doctors' orders. At the end of my twelve hours with atrial fibrillation, my nurse came running into my room waving my EKG strip in the air and joyfully exclaiming- - "normal sinus rhythm- here's a souvenir for you". She was more excited than I was. My night nurses were especially comforting, they knew the psychological impact of what I had been through, six bypasses and the fear of being alone at night. I never felt that I was alone. It was time to go home, when insurance said it was time to go home and my nurses gathered around to hug me goodbye and wish me God speed. My home health nurse supported me for about a week before setting me free or rather weaning me off all of the TLC. To all the nurses here tonight..."Never stop caring and never stop smiling." Thank you from all of the patients out there and especially from the one up here.

Dr. Richard Faircloth Professor Emeritus

Distinguished Senior Lecturer Nurses' Pinning Ceremony, May 2000 & 2002

continued from page 9 While clinical trials have not clearly shown drug therapy or psychotherapy to clearly decrease the rate of cardiac death in depressed patients, the treatment combination improved depression, adherence to drug therapy and quality of life. Participating in a cardiac rehabilitation program also promotes healthy lifestyles through education and individually tailored exercise programs. “Addressing the psychological as well as the physi-cal needs presents a complete picture of treatment for heart disease. With a thorough review of how

depression may be impacting a cardiac event, pa-tients can be aided through problem-solving therapy and lifestyle changes to maximize the opportunity for a positive well-being,” Dr. Pozuelo says.

Excerpted from Cleveland Clinic Women’s Heart Advisor, July 2012

The Mended Hearts, Inc. Northern Virginia Chapter 200

P.O. Box 897 Annandale, VA 22003

www.mendedhearts200.info

Membership Application * Membership includes subscriptions to the Mended Hearts quarterly journal,

HEARTBEAT, the bimonthly Chapter newsletter, Mending Ways, and Mended Hearts insignia pins (one for individual membership and two for family memberships). Please make a print copy of this application, check the appropriate box below, complete the requested information, and mail this form along with your check to Mended Hearts Chapter 200, P.O. Box 897 Annandale, VA22003. Please make checks payable to: The Mended Hearts, Inc.

Membership Type Membership Dues Schedule Total Annual Renewal ( ) Individual Nat’l $17.00 + Chapter Dues $5.00 $22.00 $22.00 ( ) Family Nat’l $24.00 + Chapter Dues $8.00 $32.00 $32.00 ( ) Nat’l Life - Individual Nat’l $150.00 + Lifetime Chapter $30.00 $180.00 $0 ( ) Nat’l Life - Family Nat’l $210.00 + Lifetime Chapter $44.00 $254.00 $0

Please Print Legibly Name: __________________________________________________________________________ (Last Name) (First Name) (Spouse’s Name) Address:__________________________________________________________________ City:____________________________________ State:______ Zip Code:_____________ Phone #: (____)_____-________E-mail Address: ________________________________ Occupation: ___________________ Retired? Yes ___ No ___ Date of Birth: _______

Volunteer! If you have some spare time, help us help others fight heart disease. Volunteer! I want to help by: ( ) Visiting Patients ( ) Office Help ( ) Other Support Committees

(Refer to our web site at www.mendedhearts200.info for information on the Chapter’s committees). How did you learn about Mended Hearts? ________________________________________________________________________

{ } I am not a heart patient but wish to support the work of Mended Hearts. { } I am not prepared to join Mended Hearts but enclose a contribution of $___________. _______ *Members may be victims of heart disease and/or other individuals who wish to assist in the purposes of this organization and have paid the required dues. Family memberships are encouraged. They include two or more members of an immediate family living at the same address. If applicable, include names and pertinent information for each family member on a separate sheet of paper. National membership is required for chapter affiliation – this application covers both.

Note: Mended Hearts Chapter 200 is a participant in the Combined Federal Campaign (# 65140) and the United Way (# 9436).

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Northern Virginia Chapter 200 P.O. Box 897

Annandale, Virginia 22003

Address Service Requested

Printed as a Public Service by The INOVA Heart and Vascular Institute

at INOVA Fairfax Hospital, Falls Church, Virginia

Non-Profit Org. U.S. Postage Paid Annandale, VA Permit No. 327

It’s great to be alive- - - -and to help others!

The Mended Hearts, Inc.

Mended Hearts, Incorporated, Dallas, Texas Dedicated to Alleviating the Trauma Associated with Heart Disease and Surgery

John Maiorana, Mid-Atlantic Region Director Don Arvay, Asst. Region Director

Northern Virginia Chapter 200

A Non-Profit Service Organization of Mended Hearts P.O. Box 897, Annandale, VA 22003 (703) 248-1733

Visit us on the Web at www.mendedhearts200.info Contact the Editors at the address above or email us at mh200Editor@gmail.com

2012/2013 Executive Committee

President, Gaylord Draper….…... (703) 385-3376 Newsletter Editor, Gaylord Draper….. (703) 385-3376 Vice Pres, Howard McAnany…... (703) 736-0863 Hospitality, George Bogart………….. (703) 684-1065 Pillows, Jack Underhill……..........(703) 573-2056 Publicity, John Salamone…..…..……. (703) 924-6244 Secretary, Ray Linares……….…. (703) 554-4801 AHA Liaison, Kevin Houlihan…...….. (703) 729-0467 Treasurer, Peter Greenwood……. (703) 444-1248 Refreshments………………….INOVA Health System Office Manager, Tara Greenwood. (703) 444-1248 Visiting Chair, Gaylord Draper

INOVA Fairfax Hospital Visiting Coordinator, Gaylord Draper………….……..(703) 385-3376 Virginia Hospital Center (Arlington) Visiting Coordinator, Eileen Bradner...…..(571) 276-0938 INOVA Alexandria Hospital Visiting Coordinator, George Bogart ……………..(703) 684-1065