Kenneth Carpenter, tPA Stroke Treatment

Kenneth Carpenter was walking to answer the front door October 16 when his world went topsy-turvy.

"I was a little bit dizzy," he said. "I could walk but I couldn't keep my balance. I got across the living room to the door and as I reached for the door knob my legs collapsed and I crashed to the floor."

What happened next was a remarkable series of happenstance and timing that turned what could have been a life-altering moment into what Carpenter's wife Ann calls simply a "miracle."

Ken, 66, and Ann had been at a family gathering all day that Sunday in October and had returned home for the evening with their daughter, Julie, and her husband Erik Cabble, a physician assistant at the University of Michigan. They were visiting for a hour before driving home to Dexter.

Earlier in the day, Ken had sold some firewood to Dale Kwasniewski, who returned that evening to pay for the wood. It was Kwasniewski's knock that had sent Ken toward the door.

When Ken fell, Erik was at his side immediately. "I tried to tell him that I was OK, that I had just fainted," Ken said. "But the words didn't come out right. People didn't understand me."

While Erik knelt next to Ken, Dale's wife, Peg Kwasniewski, ran up as well. Peg is a nurse at Borgess Medical Center and knew immediately that Ken had had a stroke.

"Dale had hardly gotten to the door when he came running back to the car, his arms flying," Peg said. "He said, 'Come on, come on. Quick.' I ran to where Ken was and saw that his left side was flaccid and he was speaking with a garbled voice.

"I said, 'Note the time,' since I knew it was critical in treating a stroke."

Ann looked at her watch: 7:31 p.m.

"Julie called 9-1-1 and ran to the street to direct the ambulance," Ann said. "We live back from the road. It only took the ambulance crew a few minutes but it seemed like an eternity."

Ken was put inside the ambulance and Erik, the physician assistant, rode with him to Borgess.

"We wanted him to go to Borgess," Ann said. "We heard that they had a wonderful stroke program."

For Ken, the urgency seemed remote. "I vaguely remembered being picked up," he said.

By the time Ann and the rest of the family arrived at Borgess, Ken had already had a CT scan that showed he suffered a stroke caused by a blocked artery. That meant that Ken was a candidate for a medicine called tPA that dissolves artery-blocking blood clots.

tPA must be administered within a certain time-frame to be effective. That's why Peg's call to "mark the time" was so important.

Had his stroke been the result of a burst artery that caused internal bleeding, tPA treatment could have been devastating. About 80 percent of all strokes are caused by blocked arteries, called an ischemic stroke. One that causes bleeding in the brain is called a hemorrhagic stroke.

Still, tPA treatment is not without a slight risk and the Carpenter family had to make a decision on its use. The CT scan could have missed a small bleed that would have been worsened by the tPA. About 6 to 8 percent of scans miss the small bleeds.

"Dr. (Rashmi) Kothari was there when we arrived," Ann said. "We were so fortunate because he is the stroke man. Erik said that as soon as he heard that Dr. Kothari was the doctor, he felt so much better because of the kind of care he knew Ken would receive."

Kothari is medical director of emergency medicine research and an emergency physician.

While the family discussed the benefits and potential small risk of tPA treatment, Ken Carpenter realized that he could not move his left side. "I was aware that people were around and I could recognize people and see their concerned faces," he said.

Ann Carpenter said the decision to go with tPA was difficult. "We talked about it with the family and we prayed about it," she said.

Kothari urged the family to make a decision since the window of opportunity to use tPA was rapidly closing. "He told us not to waste time talking and to make a decision," Ann said.

When he was asked, Ken said he wanted the tPA. Treatment was begun.

"As I remember, the IV was in me for about a half-hour," Ken said. "I was trying to move my left foot and left hand, but nothing happened. I wasn't afraid. I knew I definitely was in the right place. And I knew somehow -- medically or with therapy -- I would get use of my left side back sometime."

About 10 p.m. Ken was moved to the intensive care unit. He managed to tell his family to go home and get a good night's sleep, and they left.

Once he was alone with only the nurses and other professionals, the miracle began.

"I think I slept some," Ken said. "Every time I woke up I tried to move my left hand or foot. At 10 minutes to 1 I woke up and I could wiggle my toe a little bit. I thought, 'That's good.' And I could move my hand a little. Each time I tried it got a little better."

About 1:30 a.m. a resident physician who had seen Ken arrived earlier at the ER stopped by to see how he was doing. "I raised my left hand and waved at him," Ken said. "His eyes got real big and he got all excited. He said he had never seen anyone recover so fast."

That morning Carpenter's son Tim was the first to arrive and witness the dramatic improvement. "When I walked in," Ann said, "Ken was eating Jello with his left hand. Tim was so excited. He said it's hard eating Jello with your good right hand."

"It was a miracle. Totally a miracle."

By then Ken had regained nearly full use of his left side. "Later that day they got me out of bed," he said. "I was somewhat weak at that point but I could walk."

Ken's stroke was on a Sunday night. On Wednesday he was discharged for home.

"I was careful for the first week," Ken said. "I would go for short walks."

"I had to tell him to take it easy," Ann said.

The relief Ann had following the remarkable recovery more than erases the fear and worry she felt in the first few minutes that Sunday night.

"When I saw him go down I thought about when I had to care for my mother, who had a stroke," Ann said. "She couldn't speak and was tube-fed. I was so scared, but remained calm.

"I am so thankful that Erik was there and my daughter and Peg. It was a too-perfect scenario."

Once at Borgess, she said, "we knew Ken was in good hands. I felt very confident that things would be OK. How can you describe Dr. Kothari? He was caring and competent and he instilled excitement and confidence in him. He made me feel like this is the person to deal with my husband."

Ken said he, too, felt Kothari's confident manner and he also praised the nurses in the intensive care unit. "Overall, we got very good treatment at Borgess," he said. "They are so quick and efficient."

"I tell people that if they have the same experience, note the time and go to Borgess."

A retired construction electrician, Ken Carpenter met Ann at a Halloween party 46 years ago. "It worked out," he said, noting that the couple have been married for 43 years. Besides Julie and Tim, they have a third son, Dan.

The Carpenters raise and sell Christmas trees and corn and Ken is a tractor buff.

"When Ken was in the hospital I wanted him to get better so he could drive his new Kobota tractor," Ann said.

His recovery is an enormous relief for her.

"I don't know what I would do without Ken," she said. "We do so much together. We have a partnership. I know that if the stroke had been worse he would have wanted to be home. But how would I have taken care of him? I can't lift him. And he would have been so unhappy. It's a horrible thought."

And an unnecessary one.

"I thank God and the doctors every day," Ann said. "There's not much Ken can do now that would make me mad. He's very important to me."