Interview of Mary Ann Wilson,RN,host of DVT Awareness in Motion

Abstract

To kick off the seventh annual Deep-Vein Thrombosis (DVT) Awareness Month, the Coalition to Prevent DVT is introducing the DVT Awareness in Motion national educational program. Working with Mary Ann Wilson, RN, founder and host of the PBS program, “Sit and Be Fit,” the Coalition has developed an educational video that features simple movements to help increase blood circulation. The movements featured in the video are tailored to settings where mobility is usually restricted, such as a hospital bed, in the work place, in assisted living and rehabilitation facilities, and during travel. The program goes beyond building traditional awareness of the signs and symptoms of DVT and emphasizes the importance of preventative care in these everyday settings. The following is a brief interview with Mary Ann Wilson to explore this initiative further. Sample exercises follow the interview.

—Renay D. Tyler, MSN, ACNP, CNSN

Associate Editor

Participants:

Renay D. Tyler, MSN, ACNP, CNSN

Associate Editor

Bariatric Nursing and Surgical Patient Care

Mary Ann Wilson, RN

Executive Director

Sit and Be Fit

Renay Tyler: Mary Ann, what drew you to the Coalition to Prevent Deep-Vein Thrombosis (DVT)?

Mary Ann Wilson: As a registered nurse and the creator of the PBS series Sit and Be Fit I have seen firsthand how movement really helps people to improve their overall health and well-being. It was that work which brought me to the Coalition to Prevent DVT, and this year we have worked together to create an educational program called DVT Awareness in Motion. It is designed to help reduce the risk of DVT by encouraging movement. Whenever mobility is restricted, movement can help improve circulation. DVT Awareness in Motion goes beyond general education of signs and symptoms of the condition and emphasizes the importance of preventative care through movement, and I feel honored to be a part of this effort.

Renay Tyler: How did you go from nursing into this exercise product niche?

Mary Ann Wilson: I began exercising on my own, not as a youngster, but as an adult after I lost my husband at the age of 36 from a heart attack. I had four children to raise, and this tragedy put the brakes on my nursing career. I started taking aerobic classes, and I realized it was the best thing I could have done for myself mentally, spiritually, and physically. I became a real cheerleader for movement and for exercise.

At a certain point, I had the opportunity to design a program for seniors at a community college, and one thing led to another. I became a certified instructor through the American College on Exercise and started to take part in continuing education courses. Interestingly, the people joining my classes seemed to be getting older and older, and I realized I could help them in ways that other exercise classes couldn't. My classes taught ways to become functionally fit, and I was really zeroing in on that aspect of exercise.

I began to see people leaving class refreshed, relaxed, and with remarkable outcomes, like being able to use their arthritic hands to write. It was a great beginning but I knew I could help so many more people if the program were televised.

So, I went to all the television stations in my area. They all thought it was a great idea, but there was only one network, PBS, that actually shared my vision. I wanted to come into people's homes and not just be a friend to them, but show them how they could make their lives better, how movement was going to really help them feel better.

During our first year on public television, the program went national. The testimonials we received were unbelievable, and it was the primary reason I began to renew the program year after year.

Each year, to keep the program fresh, I consult with a number of physical therapists, doctors, and exercise physiologists. I attend conferences and participate in continuing education programs to learn what is new and how I can use the information to make my message clearer. The program has evolved, and I still love doing it. I love seeing the improvement in people's health. I know that if we can send a clear message that the movements we are asking them to do are easy, simple, and so important, it will encourage more people to do them. I like them to feel they have a friend and encourage them in a fun way. I do everything to music on my program, and that seems to make the time go quickly; people have fun, and they feel good. The proof is in the pudding, you know.

Renay Tyler: Since patients may not understand the concept of DVT, how can we best explain the risks to our patients? Adherence to a prevention strategy is so important.

Mary Ann Wilson: Yes, it is. So just setting the scene and letting patients know that any time the body is restricted mobility-wise, they are at risk to develop a DVT. It is critical that hospitalized patients remember any movement can help them recover. When the legs are inactive, blood has a tendency to collect in the lower extremities, resulting in an increased risk of developing a DVT. Also, during hospitalization, they are eight times more likely to develop a DVT.

I just recently had a friend who passed away. She was ready to go home from the hospital, and she had a pulmonary embolism before she could even get out the door. So, patients need to realize that the first month after discharge is still a critical period. They need to be aware of the importance of movement, stretching, and staying well hydrated throughout that time.

It's also important to know that certain individuals may be at increased risk for developing DVT; however, it can occur in almost anyone. When someone has three or more risk factors, it should serve as a warning that the person could develop a DVT. Obesity and restricted mobility are two DVT risk factors.

Renay Tyler: I do not think we always do a good job educating our patients about the sequelae following a DVT.

Mary Ann Wilson: I think it is important to have that conversation with your doctor prior to the surgery, because that is the other part of our campaign—not just developing awareness for the consumer, but also initiating that dialog between the doctor and patient to discuss any predetermined DVT risk factors. Your healthcare professional can go over why he or she is doing an assessment, and if he is not doing an assessment, he should be. Patients need to remember to do as much as possible for themselves by asking questions and taking an active role in their healthcare.

Renay Tyler: I agree that a multidisciplinary discussion needs to happen early on with the providers who are interacting with the patient, especially in bariatric surgery.

I believe that sometimes adherence is hindered by a patient's misunderstanding of what can happen if you do develop a DVT. In other words, what is a pulmonary embolus? What is the incidence of death related to a pulmonary embolus, and what is the treatment?

Mary Ann Wilson: A pulmonary embolism is one of the most serious complications of DVT. It can occur when a blood clot moves from a deep vein into the lungs. It can potentially block circulation to this vital organ creating a life-threatening condition known as pulmonary embolism, or PE. This situation is severe and requires immediate medical attention. After the event, the patient may need to take additional precautions such as using compression stockings or taking anticoagulants anytime mobility is restricted.

Approximately 600,000 Americans are hospitalized each year for DVT and its primary complication, PE. Approximately 300,000 die from PE, the majority of which result from DVT.

DVT is truly a public health crisis, and movement is just one way to prevent the condition. There are other things people can do to help reduce the risk for developing a DVT, such as avoiding smoking and staying hydrated. The hope is that healthcare providers address some of these preventative measures beforehand so complications following a surgery can be prevented.

Renay Tyler: Let's talk a little bit more about the Coalition to Prevent DVT. Can you give us some background on what that entails, and what is planned for the next campaign in 2010?

Mary Ann Wilson: The Coalition to Prevent DVT aims to increase awareness about DVT among the general public and to drive healthcare professionals to assess patients for their risk of developing DVT. The organization was founded following a public health leadership conference in 2003. Later in 2005, a resolution was passed in the Senate officially declaring March as “DVT Awareness Month.” And more recently in 2008 the Surgeon General issued a call to action, declaring DVT a national public health priority. As a result of all of these efforts, the coalition has continued to grow. In 2009, the second Tuesday of every March was proclaimed national screening day, kicking off the activities during DVT Awareness Month.

Also, shortly after the coalition was formed, in 2003, Melanie Bloom suffered a tragic event when her husband, former NBC correspondent David Bloom, died from a pulmonary embolus while traveling with a military convoy in Iraq. The following year, in 2004, Melanie came on board as the National Patient Spokesperson for the coalition and has worked to create an awareness of DVT risk and prevention.

As mentioned earlier, this year the coalition is adding a special piece, DVT Awareness in Motion. The program will include simple movements that may help reduce the risk of DVT by improving blood circulation with exercises that can be done anywhere, anytime—standing, sitting, or lying down. For example, if you are hospitalized you can help reduce your risk by turning over in bed frequently, wiggling your toes, lifting your legs, among other simple exercises. An educational video will be available in the spring on our website, www.preventDVT.org, that features some of these movements.

We are also encouraging people to take an online DVT risk assessment and learn as much as possible about their personal risk factors. We want to encourage everyone to talk to their doctor about DVT, especially if they are going to have surgery.

The coalition wants to make sure everyone is aware of the different environments where a DVT can occur. In addition to the hospital, there are other places, such as an office setting where people are spending long periods of time at their computers and are unknowingly at risk. There are many things office workers can do to help themselves. For example, while engaged in a phone conversation they can wiggle their toes and do some ankle circles. It would be a good idea to get up every hour, walk around the office, and do a few stretches before sitting back down.

Another critical setting to keep in mind is when you are traveling by car, bus, train, or plane; it does not really matter the type of vehicle. The issue is that you are seated for a long period of time. Just standing up and sitting down will be a big help, but there are so many exercises that you can do right there without disturbing the person sitting next to you. For example, simply sitting up tall and taking several deep belly breaths will improve circulation. Rocking the toes forward and back is another easy way to get the blood pumping.

It is also important to remember there are risks of developing a DVT in assisted living settings and in retirement homes. There are many programs for patients or residents, yet many are seated activities—playing cards, doing puzzles, or playing some other type of game. It is important to remember to incorporate movement into these sedentary activities. It could be as simple as taking time before breakfast, lunch, or dinner to stand up and sit down five times. Stretching your legs under the table or pumping your toes are good exercises to incorporate anytime, anywhere. Stretching alone is going to relax the muscles and improve circulation. The coalition has many different ideas to share about how to get people moving. I am just excited to be included in this wonderful venture.

Renay Tyler: With some of our very large patients, they will say that joint pain will prevent them from exercising. But these exercises can be done in the bed or sitting in the chair, correct?

Mary Ann Wilson: Exactly. I remember saying on one of my very early shows, after having had that excuse given to me, “You know, if you can roll your shoulder like this, there is something simple enough in this program to help you.” Do as much as you can without pain. Avoid any exercise your doctor or physical therapist has told you not to do. I think giving patients permission to adjust and modify their exercise to whatever is appropriate for them helps greatly with compliance. As they feel better, they do more. This is a foundation or a building block to encourage exercise, because it should be fun. And it should make you feel better.

Renay Tyler: You mentioned the DVT screening tool. Is that something that is online or is it a paper-based form? What exactly is it?

Mary Ann Wilson: The DVT risk assessment tool can be found online at www.preventdvt.org. Patients can complete the assessment online, print it, and take it to their doctor. Once that is done, the healthcare professional can determine if additional screening in required.

Renay Tyler: Should this brief screening be done anytime a patient is seen in a healthcare setting?

Mary Ann Wilson: Yes. It is important to get as many public health workers involved in our work and make sure they know what an important part they play. Without a risk assessment, it is difficult to know the patient's DVT risk factors.

Renay Tyler: How would our readers be able to obtain a copy of the DVD?

Mary Ann Wilson: Anyone can log onto our website (www.preventdvt.org) to request a copy of the DVD in March. People can also place a request with the coalition for a printed copy of the movements.

Renay Tyler: How can our readers become more involved?

Mary Ann Wilson: Everyone can become more involved just by being aware of DVT risk factors and how to access the educational resources available We all know someone who is either going into the hospital, embarking on a long trip, living in an assisted living community, or in any number of relevant scenarios. This is not information to keep to ourselves. It is something that we can share in church groups, in social organizations, and so on.

Renay Tyler: Many of our readers are educators for patients or for colleagues. From an educational standpoint, I think that we would want to stress they are educating their patients with each interaction that they have, but also educating each other.

Doing onsite in-services, displaying posters, wearing the DVT pins—I think these things go a long way to knowing that people are supporting the mission. If we can help prevent the tragedy that happened to David Bloom and his family, we have done a great thing.

Mary Ann Wilson: Yes. That is certainly true.

Sample exercises to help reduce the risk of deep-vein thrombosis.