Puzzle master Will Shortz pieces together his recovery after a stroke

CNN
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On a Sunday evening in February, Will Shortz was sitting at his desk at home in Pleasantville, New York, when he leaned to his left and realized he could no longer sit up straight.

“I knew immediately that I had had a stroke,” he told CNN.

The stroke occurred on the right side of his brain, leaving the left side of his body “completely incapacitated” and making his speech slurred, Shortz, 72, said.

It didn’t affect his ability to solve and complete puzzles, he said — a gift to the millions of people who enjoy his work as crossword editor of the New York Times and puzzle master of NPR’s “Weekend Edition Sunday,” roles he has held for decades.

With a right brain injury, “his ability to say the right words, to write and sign correctly, and to understand those things is probably not going to be affected,” said Dr. Sanjay Gupta, a practicing neurosurgeon and CNN’s chief medical correspondent. But the other side of the body has been affected, leaving Shortz with weakness on his left side.

A stroke is caused when a blood clot blocks blood flow to the brain or, less commonly, when a blood vessel ruptures and causes bleeding in the brain. According to the U.S. Centers for Disease Control and Prevention, it is estimated that nearly 800,000 people in the United States suffer a stroke each year, and more than 165,000 people die from stroke, making it one of the nation’s leading causes of death.

Patients can recover, even completely, with the help of months of rehabilitation work.

Eight months into his recovery, Shortz said he “feels great, but it’s just that my body isn’t perfect yet.” He shared with CNN the details of his rehabilitation, what he wishes he had done differently from the start and how the strategies he uses to tackle crossword puzzles have helped him through some of the toughest parts of recovery.

That evening in February, Shortz knew he needed emergency treatment quickly. But because it was winter and he had dressed for a game of table tennis – another of what he calls his “obsessions” – he decided to put on warmer clothes and use the toilet before going to the hospital.

It was there that he “collapsed to the ground,” he said. Without his phone and unable to get back up or even crawl, Shortz began to worry. But somehow he said he was able to wriggle into his office “like a worm on my back” to pick up his phone and call his partner, who came immediately and called an ambulance.

Even with the 15 minutes he spent on the ground, he was at the hospital within an hour, Shortz said. Such prompt care, stroke experts emphasize, is critical.

“Time is a brain,” says Dr. Michelle Lin, a neurologist at Mayo Clinic Hospital in Jacksonville, Florida. “For every minute of delay in presentation to a doctor or emergency room, approximately 2 million neurons die.”

Lin said she recommends people who suspect they have had a stroke to call 911 for an ambulance to get emergency care as quickly as possible.

One way to recognize stroke symptoms, she said, is to use the mnemonic BEFAST. This stands for:

If people notice changes in balance or vision, weakness or numbness in their face or arms, or problems with speech, it is important to seek emergency care as soon as possible, Lin emphasized.

Shortz said he spent more than a week in the hospital emergency room, where staffers helped him get back on his feet “as quickly as they could.” From there he spent several weeks in a rehabilitation center doing both occupational and physiotherapy, before moving to a ‘sub-acute’ facility for a month. There he did 2.5 to 3 hours of therapy every day.

“That’s the kind of physical and occupational therapy that we hope all of our patients can get,” says Dr. S. Andrew Josephson, professor and chairman of the Department of Neurology at the University of California, San Francisco. “It’s a long process for the brain to repair and rewire, but we have more and more science telling us that these types of aggressive rehabilitation approaches ultimately help people achieve better outcomes.”

One thing Shortz wishes he had done differently is train his left arm as early and as much as he worked on everything else. At first, he said, he treated it like you would treat an injury that needs rest to heal on its own.

“I didn’t use it much,” he recalls. “But if you’ve had a stroke, you want your brain to reconnect or reconnect with your neurons, your nervous system. So I should have used my arm as much as possible from the start.”

In April, Shortz was confronted with an important event, one he had not missed since he founded the organization in 1978: the annual American Crossword Puzzle Tournament. He left the sub-acute rehabilitation facility, went home and went to the tournament in a wheelchair.

“I’m so glad I did that,” Shortz said. “When I was wheeled into the ballroom with almost a thousand people, there was a standing ovation, which was very worthwhile.”

Since then, Shortz said, he has continued therapy seven days a week. He does outpatient physical and occupational therapy twice a week at a nearby hospital, works with a therapist at home and goes to a local place called Rehabologym, which has an approach he particularly enjoys: “You play games and do exercises,” Shortz said. He also continued to play table tennis.

Varying exercises in that way is an important part of strengthening the brain, Gupta said.

“The best way to exercise the brain is to work different parts of it – so adding exercise, like Will, and doing new activities is what keeps the brain growing and working at optimal levels,” said he.

Shortz said he can now walk with a cane and have some use of his left hand, and he feels he is still improving.

“I’ve heard and read that all the progress you can make in stroke recovery will happen within three to six months,” he said. “Many stroke victims have since written to me saying that that is not true, that you continue to make progress, actually for the rest of your life.”

It is true that the recovery may extend beyond what was previously seen as the “golden window” of the first six months, Lin said. “I don’t think there’s a time stamp on recovery because our brains are actually quite plastic,” she said.

Josephson agreed. “We know that the brain continues to heal for many years to come,” he added.

Shortz said the hardest times in his recovery were when he hit a plateau and started wondering, “Is this how I’m going to have to be for the rest of my life?”

At that time, he said, “it’s like any time you’re faced with a problem that seems insurmountable or very complex: All you have to do is just pick a small part of it and work on it.”

“I’ve been working on this forever, and then I have another breakthrough,” Shortz said.

If that sounds a lot like trying to solve a crossword puzzle, that’s no coincidence.

“Just like solving a crossword puzzle,” Shortz said, “even if you don’t know some of the things in the puzzle, tackle what you do know. Get that under your belt. And every thing you do will lead to something else you can do. And then when you’ve solved the puzzle, you think, ‘Wow, I didn’t know I could do that.’