Brenda Turner, tPA Stroke Treatment

Brenda Turner was just about to eat a piece of cake at her granddaughter Shelby's 3rd birthday party three years ago when her world went gray.

"Up to then I felt all right," said the 64-year-old Cooper Township resident. "I was sitting in a chair, the cake in my lap, when it just happened. It was like a roaring in my ears and my vision narrowed."

Brenda's daughter—and Shelby's mother—Rachael Mendham said that her mother looked "a little confused," but that she went to the kitchen for more cake.

Others, however, noticed that one side of Brenda's face was drooping and became concerned.

Rachael returned and touched her mother. "I thought she was having a heart attack," Rachael said, "I said, 'No! No!' and we called 9-1-1. They were there in a few minutes."

"I couldn't say anything," Brenda said. "The next thing I knew someone was helping me into the chair. I remember hearing an ambulance and somebody asking me if I could move. The next thing I remember I was in the hospital."

While Brenda's memory is hazy, her family distinctly remembers the events surrounding what turned out to be a serious stroke.

"It was a pretty bad stroke," said Brenda's husband, Ted. "It didn't look good."

Fortunately, the hospital where Brenda was sent was Borgess Medical Center where stroke care is a top priority. Emergency physicians and the medical team quickly determined that she had had a stroke and that it was caused by a blood clot blocking an artery in her brain.

Eight out of every 10 strokes are caused by a blocked brain artery. The rest are the result of a ruptured blood vessel and internal bleeding. The distinction is critical since the primary treatment for a stroke caused by a blocked blood vessel can be fatal if administered to someone with a bleeding—or hemorrhagic—stroke.

Once it was determined that a clot was blocking blood flow, Brenda's family was told that a drug called tPA—for tissue plasminogen activator—may help dissolve the clot and return blood flow. tPA is often called a "clot-buster."

Rachael and sister Cleta, who drove to the hospital together, conferred with other sisters—all six Turner siblings are women—and they agreed to have their mother treated with tPA.

"The ER doctors said it could be life-saving," Rachael said. The drug worked quickly. "It was very amazing," she said. "Within a half hour mom was awake and trying to talk."

Dr. Michelle Crooks, a neurologist, was on-call when Brenda arrived at Borgess and set in progress the complex series of tests to determine the nature of the stroke and the best treatment options.

"It fit the criteria for a stroke—sudden onset, inability to speak, right-side paralysis," Crooks said. "We needed to determine first if it was a bleed or a block."

Once it was clear that Brenda had a blocked brain artery, and since Brenda couldn't talk, Crooks and her team asked the family questions to determine if a clot-buster would be appropriate: Did Brenda take anti-coagulants? Did she have recent bleeding?

"There are so many inclusions and exclusions that need to be addressed before administering tPA," Crooks said. "You want to get the drug quickly when appropriate, but you have to be careful."

Once it was clear that the drug was appropriate and the family gave permission, Brenda was treated and good results followed rapidly.

"I was amazed how much improvement there was in such a short time," Crooks said. "It really makes you a believer (in the drug)."

tPA has been used at Borgess for a number of years and the hospital has a specific set of guidelines that must be followed before the drug can be administered. There are also specific time-frames for optimal benefits.

Crooks said that Brenda was the first patient at Borgess who met all the criteria for administering the tPA within the critical time-frame.

While the paralysis on Brenda's right side abated fairly quickly, she did have speech and memory problems that lingered. Brenda remained in Borgess for about 10 days and underwent speech and other post-stroke therapy for some time.

"The stroke affected her motor skills only a little," Ted said, "but her speech and her short-term memory were not good. She also lost some vision in the corner of her right eye."

Therapy, he said, "was almost like starting as a child again, working up to first, then second grade."

Brenda, however, was determined.

"I was an avid reader before the stroke," she said, "and would read two or more books a week.”

"At first after the stroke I couldn't read. I could see the words but they didn't register. But I read constantly. I wanted to read my books."

Today Brenda is reading a book a week on average and talking as much as possible. "The more I practice reading and the more I practice speaking, the better I get at it," she said. "I still have a little trouble with short-term memory and I lose my train of thought. And I'll sometimes forget a word or use the opposite of word I want. But the improvements keep coming."

"We're all so proud of her," Rachael said.

Brenda has returned to work at the Parchment Harding's Market bakery, where she worked before the stroke. "It's a good thing because I have to talk with the customers, use the cash register and take telephone numbers," she said. "Everybody at Harding's is helpful."

On most days, Brenda feels good. And while there are occasional bad days, she said she is grateful that she was taken to Borgess where they were ready to use the clot-buster medicine. "Some hospitals don't have it," she said. "For me it's a miracle.”

"I saw a young woman the other day who had left-side paralysis. When I saw her I thought, 'That that could be me—or worse.' "

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