COINCIDENCES GET FARM TECH DAYS EXHIBITOR THE HELP HE NEEDS TO FULLY RECOVER
William "Bill" Rupnow was at the right place at the right time.
Rupnow survived what could have been a debilitating and life-threatening stroke, but a series of amazing coincidences got him the help he urgently needed.
The healthy, 75-year-old "semi-retired" dairy farmer from Ixonia, near Oconomowoc, was an exhibitor at the recent Farm Technology Days near Loyal. Just before 10 a.m. Wednesday, he left his wife JoAnn at the exhibit they were staffing to browse. Suddenly, Rupnow's leg went numb and he could not move. "I felt a sudden wooziness," he said. "I couldn't stand. There was pain but it wasn't excruciating."
While he leaned on a tractor, others nearby saw his plight and called for emergency medical technicians (EMTs). As if on cue, the Spirit Medical Transportation Services helicopter of Saint Joseph's Hospital just landed since it was scheduled to be on exhibit. The crew that day was Phil Doherty, flight medic; Lisa Johnson, RN, flight nurse; and Todd Lepper, pilot.
The rotors did not stop. "We intentionally left the aircraft running to decrease on-scene time," Doherty said. "This was an ideal situation in light of this man having an onset of symptoms within minutes of our arrival, an on-site medical team providing a rapid exam, EMS care instantly available by Loyal EMTs and our flight program on site. It was obvious to us that if any stroke patient was being given a chance at intervention, Mr. Rupnow was that patient."
Loyal EMTs and Spirit personnel whisked Rupnow into the helicopter. EMTs located JoAnn, herself a neurology nurse at a Milwaukee hospital, and got her to the helicopter. She immediately knew what happened. She gave her husband a kiss and then shouted as the copter lifted off: "Make sure he gets tPA!"
tPA, or tissue plasminogen activator, is a clot-busting drug which is recognized as the clinical standard for treatment of stroke and must be administered within three hours.
Within minutes the Spirit arrived at Saint Joseph's Hospital, and Rupnow was immediately under the care of Marshfield Clinic Neurologist Kenneth Madden, MD, PhD. "Time is brain," Madden said. "You want to salvage as much of the brain as possible and the longer it takes a person to seek treatment the more irreparable the damage."
Time was on Rupnow's side. His symptoms started at 10 AM. He was in the Hospital's Emergency Department at 10:55. tPA was given at 11:50 AM and he was enrolled in a research study and given a research study drug at 1:15 PM. Rupnow is now nearly recovered.
He also is the first patient enrolled in Marshfield Clinic's arm of a new national clinical research study called SAINT II (Stroke-Acute Ischemic-NXY Treatment), of which Madden is principal investigator. Marshfield is one of three study locations in the state, along with Milwaukee and Madison. The study, Madden explained, is meant to demonstrate how effective a drug called NXY-059 is on disability and neurological recovery, and to evaluate safety when it's given to patients with acute ischemic stroke within six hours of symptom onset.
Rupnow received care in a medical complex with a state-of-the-art neurosciences center. "This is what sets Marshfield apart," Madden said. "A hallmark of our neuroscience center is having immediate emergent ability to address these issues. This is a wonderful example of stroke care in action at Marshfield and Mr. Rupnow's recovery is a tribute to the efficient team-oriented approach to this devastating condition."
Because of this immediate care at Marshfield, patients can be enrolled in state-of-the-art research studies. "It's very important to find more therapies and treatments for stroke," Madden said. "Neuroprotective drugs may help the brain tolerate longer periods of time without blood during a stroke."
Madden said his patient is doing so well because of immediate response. "It's critical that people suffering stroke seek care immediately," he said. "The biggest reason most people don't get the established therapy for stroke is they wait too long. Suffering a stroke is a painless process, so someone with symptoms may not rush to treatment.
No matter how fast we move after someone arrives in the Emergency Department, if they don't get here soon enough there is only so much we can do. People come in right away when they suffer a heart attack because it hurts. With a "brain attack," if they don't have pain right away they give it time to see if it gets better on its own. If they get to a hospital quickly, rapid response makes a difference, but if they don't, we can't do that much."
Doherty added: "We interact with a significant number of stoke patients every year and there are so few who meet all prerequisites for drug intervention. The stroke patient is one whose future quality of life may well be improved or destroyed in minutes." He saw Rupnow the following day. "He could speak and move his right arm. We knew that someone had been looking out for him and everything had worked the way it was supposed to."
JoAnn said the event "was a miracle from start to finish." She also reiterated the importance of people getting care immediately. She's told her husband to watch for signs of stroke for her, since three of her siblings died because of strokes. Rupnow is grateful for what he and his wife call the "spooky circumstances" that got him back to health, including meeting Al Bakke, a Saint Joseph's Hospital Emergency Department nurse, the day before at Farm Technology Days.
"If I hadn't been where I was..." Rupnow said. "I was fortunate. If I'd been out in a field I'd have been two miles away from anything. If I hadn't gotten treatment I'd be paralyzed. I should be 100 percent all right. I was blessed, but it was the network of all the people that gave me another chance."