Solving the Stroke with Will Shortz

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katie Peters. And this is the Brain & Life podcast.
Welcome to all. It's time for the podcast, and it's time to also see how smart Dr. Correa is. So how smart is Dr. Correa?

Dr. Correa:
Whoo.

Dr. Peters:
So you're ready?

Dr. Correa:
Okay.

Dr. Peters:
Okay. So can you name the longest word?

Dr. Correa:
I got to go with Mary Poppins, supercalifragilisticexpialidocious.

Dr. Peters:
I think that's a really good one, really good one, but I will have to tell you, it is smiles, because there's a mile between the Ss.

Dr. Correa:
Oh, man.

Dr. Peters:
Did I get you?

Dr. Correa:
Yes, definitely. I would not have thought about that one. I was trying to think of a word that was longer than supercalifragilisticexpialidocious.

Dr. Peters:
Okay, let's do another puzzle. This is sort of more of a riddle. So not on the earth, not in the sky, I'm always far away for when you have arrived at where I lie. I've again moved far away. What am I?

Dr. Correa:
I'm seeing a horizon, a sunrise, a fun puzzle for me and a peaceful image in a moment on a stressful day.

Dr. Peters:
Ding, ding, ding. 100 points for Dr. Correa. You won. So yeah, it is definitely puzzle time, and particularly word puzzles. I love doing puzzles, whether it's on my phone, doing the different word puzzles. How about you? Do you enjoy doing little puzzles on your phone, or-

Dr. Correa:
I do The New York City Wordle.

Dr. Peters:
Go, you. Go, you. I love Wordle. I love doing The New York Times crossword puzzle. I grew up using a magazine called Games Magazine, and they would have these amazing cartoon rebuses where you'd have to uncover what the hidden meaning is in the images. And I always had so much fun. You'd actually would submit it for a contest. And I was really excited because my dad and I would always do these together. And one time we got like nine out of 10. It was like a big deal. I think we may have won a T-shirt, but it was really exciting.
And the person behind the Games Magazine and all these word puzzles is puzzle master himself, Will Shortz. He is the crossword puzzle editor for The New York Times. He recently had a stroke, and he talks about his recovery and how he is continuing to write puzzles. And I just had so much fun. And in fact, he gave me a word puzzle at the end of the podcast, so stay tuned to see if I figure it out.
Hello, podcast listeners. And I want to welcome Will Shortz to the podcast. He is an American puzzle creator and editor who is the crossword puzzle editor for The New York Times. He graduated from Indiana University with a degree in the invented field of enigmatology, which we plan to learn more about. After starting his career at the Penny Press, and then one of my very favorite magazines as a kid and also as an adult, Games Magazine, he was hired by The New York Times in 1993. And the Shortz American Crossword Puzzle Tournament is the country's oldest and largest crossword tournament I would like to welcome Will to the Brain & Life podcast. Welcome.

Will Shortz:
Thanks a lot, Katie. Great to be here.

Dr. Peters:
Wonderful. And where are you joining us from today?

Will Shortz:
I am in my home. I live in Pleasantville, New York, which is about 30 minutes north of New York City. It's a sweet town, I guess. And when I was looking for a house in Westchester County, I found my house, and I loved it so much, I bought it immediately.

Dr. Peters:
I gave a short introduction, and I will say that I'm a huge fan of everything you've done. My father and I used to go on a pilgrimage, because I'm from rural Tennessee, to find The New York Times just to get your Sunday crossword puzzle. So I remember those great trips with my dad to find the lone paper, because they were never in our small town. So I just want to thank you for many, many wonderful Sundays and everything you did with Games Magazine. So thank you.

Will Shortz:
Oh, thanks a lot. Nowadays, it's so much easier; you can get the puzzles online, so you don't have to travel anywhere to pick up that lone copy of The New York Times and hoping that no one else got it before you.

Dr. Peters:
Yeah, that was the thing, if somebody else got it before us. So can you tell us a little more about yourself?

Will Shortz:
Yeah, well, I grew up on an Arabian horse farm in Indiana. And I've been crazy about puzzles my whole life. I started making them when I was eight or nine. I sold my first one when I was 14, to my national Sunday School magazine. And then when I was 16, I became a regular contributor to Dell Puzzle magazines. As a kid, I used to joke about majoring in puzzles when I got to college, never imagining that that was possible. But Indiana University has a pioneering program called the individualized major program, and if you're accepted, you can major in absolutely anything. So I devised an entire curriculum in puzzles, word puzzles, math puzzles, logic puzzles. My thesis was on the history of American word puzzles before 1860. So I'm the only person in the world ever to major in puzzles.

Dr. Peters:
And that's what enigmatology is, correct?

Will Shortz:
The study of puzzles, yes. It's an old word that goes back to the 18th century. Originally, it just meant the study of riddles or enigmas. I broadened it to include the study of puzzles of all sorts.

Dr. Peters:
So how did you land on crossword puzzles as sort of, I guess, a career later on?

Will Shortz:
Well, as I mentioned, I've been crazy about puzzles my whole life. I don't know, I love the ingenuity of them. I like to use my brain, and I love words. I love to play with numbers and shapes. So I'm interested in all kinds of puzzles. And I tell you, I love the people I come in contact with through puzzles because they tend to be smart, interesting, quirky people with lively minds. So when you go to a crossword tournaments, for example, you talk a little about puzzles I guess, but you talk about everything in the world, because you're meeting people with similar minds.

Dr. Peters:
I completely agree. My dad just would devour those puzzles. I was always impressed that he was able to complete them and finish them usually in that Sunday that he got the puzzle. So thank you so much.
Now, what are the first steps in creating a crossword puzzle? Do you think of a theme? Do you have certain words you want include? What are those first creative steps?

Will Shortz:
Right. Well, it depends on what kind of crossword you're making. In The New York Times, the Monday to Thursday puzzles always have themes. The Friday and Saturday puzzles are themeless puzzles, just interesting vocabulary with very few black squares, lots of long answers. So if you're making a Monday or Thursday puzzle or a Sunday puzzle, which has a theme, you come up with your theme idea first and you find the examples of it.
And as you probably know from being a crossword solver yourself, the crossword diagrams are symmetrical, which means if you rotate them 180 degrees, the pattern of black squares will look the same as it does right side up. So for example, if you have a 11-letter theme answer in the upper-left corner of your grid, you have to have one in the lower-right corner of your grid to balance it symmetrically. So once you place your theme answers in the grid and plot your pattern of black squares into chunks in the grid so that you think you can fill them with a good vocabulary, then you actually construct the grid with interesting colorful words with as little obscurity as possible. And then when you're all done, you write your clues. That's how you make a puzzle. It's much harder to do than I just explained, but that's the process.

Dr. Peters:
Well, I think that's wonderful. I just love learning that. And do you have a favorite puzzle that you've ever created?

Will Shortz:
Well, my favorite puzzle that I ever created, it wouldn't be a crossword puzzle. It's something I made for Games Magazine back in 1981 called the Equation Analysis Test, where they look like equations, like 7 = AW; no, sorry, 7 = equals W of the AW. And you had to figure out what words those letters stand for. And in this case, seven equals wonders of the ancient world. You had to solve the equations like that. So 5 = S would be senses, or what if I said 5 = D in a ZC? You would say digits in a zip code. That's how you solve the puzzle.
So after this appeared in Games Magazine, it sort of went viral in that old-fashioned way where people would photocopy the puzzle and send it to other people. And after about six months, I started getting photocopies of my own puzzle sent back to me saying, "We saw this cool puzzle. Have you thought about running it in Games Magazine?" And I thought, "Yeah, I thought about it. In fact, that's mine." And US Magazine named it one of their ... They had an annual What's Hot issue. They named it something in their what's Hot in the Country.

Dr. Peters:
That's wonderful. I'm going to have to look. Is it just one game or was it a theme? Because I can see you could go everywhere where that. It could be the Seven Dwarfs. It could be one-

Will Shortz:
Exactly. And it probably was one of the, DW; or sorry, DD would be Disney dwarfs.

Dr. Peters:
Right.

Will Shortz:
You can go onto Wikipedia, they have a different name for it now, but if you go into Wikipedia and search on Equation and Analysis Test, you'll find it. There are lots of other examples there.

Dr. Peters:
So I do a little bit of cognitive neuroscience in addition to seeing my patients with brain tumors. And a lot of that is doing neurocognitive testing. And a lot of our testing is puzzles, if you can believe it, where we do a symbol that is linked to a certain action or to a certain color. And patients have to figure out, what are the patterns associated with it? And I always find those testing can be very stressful for our patients, but I always tell them, "Have fun with it. Have fun when you're doing those testing."

Will Shortz:
Absolutely. After I had my stroke in February, I was at a well-known rehabilitation center in my area called Burke Rehabilitation Center, and they gave me cognitive tests. And one of them was to name as many animals as I could in 60 seconds. And the therapist told me afterward that I named more animals than anyone else had ever told her. In fact, I named some animals she had never even heard of.

Dr. Peters:
Oh, that's wonderful. That's a common test I use day-to-day in clinic. So I'm sure you had quite a number up there. So you mentioned your stroke that you had. This happened in early just this year, is that correct?

Will Shortz:
That's correct.

Dr. Peters:
So can you tell us for our listeners, since they're also patients or they have loved ones that have had a stroke, can you tell us a little bit more about your sort of journey and experience?

Will Shortz:
Yes. I had finished playing table tennis. I was back in my home. I was at my desk, working. I leaned to the left, and I realized I couldn't lean back to the right. And I had drool coming down the side of my mouth. So I knew immediately that I had had a stroke. And it was February, and I was still in a T-shirt and shorts. I knew in New York you can't go out in the winter in a t-shirt and shorts. So I was able to walk into my bedroom and put on long pants. Then I decided I needed to go to the bathroom before I went, because who knows when I'd have a chance to do this again? So I went and used the bathroom, but then I couldn't flush the toilet. And I crumpled to the floor. I was on my back and I couldn't get up on my hands and knees.
I knew I needed help. So it took me 15 minutes; I squirmed my way into my office where my phone was. And I called my partner, who was in a different place. And he came and got me within, well, within three minutes; called an ambulance. And I actually recovered somewhat by the time the ambulance arrived. I was able to walk down about 20 steps to the street and get into the ambulance myself. They took me to a hospital. As you know, when you've had a stroke, one of the important things to do is get help as fast as you can. And I was able to get to the hospital within 60 minutes of having my stroke.

Dr. Peters:
Wonderful.

Will Shortz:
And to start getting help immediately. They give you a test there to loosen the blockage in the brain that caused the stroke. And there's, I understand, 4% or 5% of cases that there's a negative reaction. And unfortunately, I was one of those negative people. That caused another stroke. And so I was in the waiting room at the hospital, talking with my partner. And he noticed that my speech started to become slurred.
So I'd had a second stroke, but the hospital was very good. I was there for 10 days. And one of the nice things about the hospital, after I started to recover a little, they had a therapist who got me on my feet and helped me walk a little. Then as I mentioned, I went to the Burke Rehabilitation Center, where I was for 20 days. And they have very good therapists there. They have OT and PT. And they showed you, first of all, how you can continue with your life when you're at home after you've had a stroke. And also, they did exercises to start to get my arm and my leg working again, because I couldn't use the left side of my body. After that, I went to a subacute facility near my home, which was very good. It's one of the few places I've ever seen that actually under-promised. They promised two hours of therapy six days a week, and actually, I got two and a half to three hours of therapy seven days a week.

Dr. Peters:
That's great.

Will Shortz:
All sorts of things that got me stronger, helped my balance and helped me get some functionality back. And after that I went home, but I'm still doing therapy seven days a week. I'm an outpatient at a local hospital twice a week, and three times I go to a new facility near me called Rehabologym. They call themselves a neuro robotic rehabilitation center.
And they have all sorts of machines that you play games on that help you regain, functionality in my case, in my arm and my leg. And there are games you play that measure how well you did, so the next time you play the game they can tell exactly how much you've improved, how much progress you've made. And then I hire a therapist to come to my house twice a week for two-hour sessions on weekends. And my partner turned our home office into sort of a gymnasium with all sorts of equipment that you would normally find in a rehab facility, but we now have it in our house. So when the therapist comes here, we have lots of stuff to do, plus my partner works with me. I'm determined to get back to my former physical self, and I'm doing everything I possibly can to do that.

Dr. Peters:
Well, it sounds like you're really busy doing all that recovery and that rehab. How do you think it's going? How are you feeling?

Will Shortz:
Just within the last week, I've started to feel like myself again. I still have a long way to go, but I'm getting some functionality back in my left hand, so I can turn on and off light switches. I can open a toothpaste tube with my left hand. I do some dishes with my left hand; with both my hands, I should say. When I first started walking, it was with a broad quad cane, a cane that has four parts. Then I graduated to a narrow quad cane. Now, I'm using just a regular cane. My big handicap, I still can't bend my knee when I walk. So all the therapists are trying to figure out what they can do to help me start bending my knee and walking naturally. That's my next big challenge.

Dr. Peters:
And I think one of the things that you mentioned is you started to have some rehab early in the hospital, then you went to that special rehab place, and then to a subacute facility, and then finally at home. Can you talk about how each of those differed for you, and how is your recovery? Is it plateauing? Is it still going up? Where are you at?

Will Shortz:
Gotcha. So at the hospital, I was in intensive care there, so their main job was to just keep me well. But there was a little therapy, so I give them credit for that. And at Burke Rehabilitation Center, that was very helpful. They got me walking. I would walk using the thing at the side where I'd hold my hand onto the wall, and I'd walk along the wall. And then I graduated to canes, as I say.
I never get depressed, but there've been a few times when I've thought I've plateaued. But then after that, I start going up again and start getting better. I think my balance now is pretty good. As I may have mentioned, I'm fanatical about table tennis, and I'm back to playing table tennis again.

Dr. Peters:
Wonderful.

Will Shortz:
I can't actually move my feet left and right, so I just stand at the table. But I have pretty good stroke. I shift my weight from my right leg into my left leg. And I had pretty good stroke. And I think table tennis is as good as a mind activity too, because it's so fast. You have to react to the ball that's coming over and the spin that's put on it. So all these activities are good.

Dr. Peters:
I assume you're right-handed then, is that correct?

Will Shortz:
Fortunately, I'm right-handed, yes.

Dr. Peters:
Okay, all right. Can you do a backhand now, too, for-

Will Shortz:
Yes, I do forehand and backhand. And sometimes people do forehand, backhand, forehand, backhand, so I have to go back and forth within a single rally.

Dr. Peters:
Do you feel like there's certain ... you mentioned that you're back playing table tennis, which I think is so wonderful. But there definitely were some activities that you mentioned, particularly with some games. Do you find that those are more engaging than just sort of doing the regular physical therapy?

Will Shortz:
Yes. Games are very motivating. There's machines at Rehabologym, where firstly you put your arm in a device and it measures how much range you have, either left and right or forward and back. And then you play the game within that range. So one of them has baby birds that are falling down from a tree, and I maneuver a basket at the bottom of the screen to catch the birds. And if I miss, then the birds die. So I want to catch all the birds I can.
And another one, there's actually a ping pong game where there's a paddle on the other side of the screen hitting a ball at me. And I move my hand left and right to hit the ball back. Oh, they have a skiing game where there are gates on the left, middle and right side of the screen. I have to maneuver as if I'm going downhill, and I have to get between the two gates. There's all sorts of games. Obviously, they make it fun. And I know that those games have improved me.

Dr. Peters:
Yes, I think those are always very helpful. And if you're somebody who likes games ... You're in the science of games, and you've elevated that science. And how you can use those to engage people and to engage them in their recovery, I just think are so important. So I would just say congratulations on your recovery, and just keep on going.

Will Shortz:
Oh, thanks a lot. I would have one bit of advice for anyone else in my situation.

Dr. Peters:
Sure.

Will Shortz:
When I was in the hospital, my partner's ... he was so worried about me. His own therapy sort of was figuring out how he was going to help me once I got home. So he went on to Amazon, and he did a lot of research on stroke victims and equipment that would be useful when I got home. So when I got home, he had arranged ramps at the front of the house so that I could get in. And he arranged this ingenious device in the bathtub where I sit outside and then it pushes me into the bathtub so that I can shower while I'm sitting. And he turned our office into a gymnasium with a mat and with bars and THERABANDs on all sorts of other equipment. So I would recommend that if you're in my situation, do research on what equipment would help you work out when you're home. And some of it's very inexpensive, and it's all available on Amazon.

Dr. Peters:
Yeah, I completely agree. I would always encourage patients and their loved ones to do their research. And for our Brain & Life magazine, there's a lot of resources in there about how to tap into those. And sometimes we also have home health agencies that can come into the house and that also can help. But I agree with you, there's a wealth of information out there, and even videos, that they can help people sort of maneuver. So it sounded like it wasn't just about doing puzzles and rehab, but also a little bit of engineering.

Will Shortz:
Exactly. And you're right, there's a lot of videos on YouTube from therapists who are very good. They're just sharing their knowledge on what you can do at home to help yourself or help your loved one regain strength and functionality.

Dr. Peters:
And that's why I love being involved in this podcast, because of, Will, what you're sharing, it's going to help other patients and their loved ones. I'm going to tap into those resources. I'm going to check out what was there before, what those videos are, what those services are, what kind of products you can get other places. Now, how do you think your day-to-day life has changed since you've had this stroke?

Will Shortz:
Wow. Yeah. Well, first of all, everything is slower, because it used to be I would just jump into the shower and I'd be out in 6, 7, 8 minutes. And now I need a little help getting in and out. And I can shower by myself completely now, but it really helps to have someone dry me. And just walking takes longer, because I'm using a cane. Fortunately, my mind is not affected, so I can still make puzzles like I used to.

Dr. Peters:
Great.

Will Shortz:
I guess the big thing I can't do is touch type, because my left hand is not good enough. I don't have the functionality yet to touch the keys the way I want. So I'm now a hunt-and-peck typist, which is much slower. Maybe that's the biggest thing, just everything takes longer.

Dr. Peters:
But keep on working at it. I have a lot of faith.

Will Shortz:
I will.

Dr. Peters:
In this short time talking to you, you're going on a great trajectory, so I'm very hopeful. Now, are you seeing any physicians to sort of monitor your condition since you've had a stroke? Do you go to see a neurologist and have tests and things monitored?

Will Shortz:
When I first came home, yes. I went to a doctor and a neurologist to have tests done. And really, in every way I'm fine except for the effects of the stroke. I've always had a high blood pressure. I have known that, but I don't smoke and I don't drink. And my family has no history of heart disease. And I exercise a lot. I'm in pretty good shape, and I'm thin. So I always felt that I was superhuman, that I was immune to any problem like this. And unfortunately, I wasn't. I should have been taking some medicine long ago to reduce my blood pressure. So that's the big lesson that I've learned, is to take care of myself, take care of my body. And right now, of course I'm taking medicine, aspirin, to reduce my blood pressure. I'm sure I'll be doing that for the rest of my life.

Dr. Peters:
Yeah, definitely go have your blood pressure checked, talk to your PCP. Those are all good lessons. Sometimes when we're feeling really good and we're living our lives, it's hard to go to the doctor, but I think it's a good lesson to know at least get those basic things checked out.

Will Shortz:
Yes.

Dr. Peters:
Now, you mentioned that you're a little slower with making those puzzles. Have you made any puzzles since you are recovering?

Will Shortz:
Yes. I've made lots of puzzles. When I say slower, I meant physically. Mentally, I think I'm the same as before. So I've made dozens and dozens of puzzles. And I still do puzzles every Sunday morning on National Public Radio. Those are original. I do that every week.

Dr. Peters:
That's wonderful. And I agree with you, puzzles are great for your brain. And if you're somebody who likes to use your brain, definitely I think puzzles are the way to go. I know that I play them really daily, whether it's The New York Times app on my phone, which I do like to do all of those puzzles and all the different word puzzles, because they're like little crosswords. And of course there's Wordle, which everybody's been enjoying. And even Sudoku is on the phone. I use The New York Times app. That's a plug for the app.

Will Shortz:
Nice. Okay. I'll give you a little puzzle, and I'm not expecting you to answer it, just think about it later, is to take the word elation, E-L-A-T-I-O-N, and rearrange those seven letters to name part of the human body.

Dr. Peters:
Elation, E-L-A-T-I-O-N.

Will Shortz:
Right. I'll just leave that to you.

Dr. Peters:
That's going to happen. Is it toenail?

Will Shortz:
Wow, I'm so impressed. Wow, wow, wow. You got it.

Dr. Peters:
I've been a puzzler for a long time, Will. This is like ...

Will Shortz:
Pat yourself on the back. That is impressive, how fast you got that.

Dr. Peters:
Well, you heard it here. Will Shortz thinks that I'm impressive [inaudible 00:27:15]. No, I think you're impressive, Will. This is really amazing. Thank you so much for sharing about your recovery, about going through your stroke and what you're doing to recover and then what you're doing to still thrive with your puzzle-making. And just thank you for your time, and I really appreciate it. It

Will Shortz:
It was good to be here, Katie. Thanks a lot.

Dr. Peters:
Thanks.

Dr. Correa:
Can't get enough of the Brain & Life podcast? Keep the conversation going on social media when you follow @NeuroDrCorrea and @brainandlifemag, or visit brainandlife.org.

Dr. Peters:
Welcome to our podcast, listeners, and thank you so much for joining us today. I hope you're doing well. As always, I'm your co-host, Dr. Katie Peters, and I'm so honored to introduce our medical expert today and also my former residency director when I was a little resident, Dr. Argye Hillis. Welcome.

Dr. Hillis:
Thank you. Good to see you again, Katie.

Dr. Peters:
Absolutely. So Dr. Hillis is a professor of neurology with joint faculty appointments in the physical medicine and rehabilitation and cognitive science. She is the Sheikh Khalifa Stroke Institute Professor of Acute Stroke Diagnoses and Management, and she serves as the executive vice chair of the Department of Neurology, along with being the director of the Cerebrovascular Division of Neurology at Johns Hopkins.
Prior to medical training and neurology residency, Dr. Hillis worked as a speech language pathologist and conducted clinical research focusing on understanding and treating aphasia and hemispatial neglect. She has brought these areas of experience to impact her clinical research and neurology, particularly in regards to cognitive dysfunction and neuroimaging studies of aphasia and hemispatial neglect in patients that have had acute stroke. And I'm so lucky to have been trained by her when I did my residency at Johns Hopkins. So again, welcome.

Dr. Hillis:
Thank you so much.

Dr. Peters:
Now, Dr. Hillis, where are you joining us from today?

Dr. Hillis:
Well, I work at Johns Hopkins, and it is a distinct pleasure to have been there for all of my training as well, and stayed there just throughout the ranks of being a professor. I went to medical school there as well. And even when I was a speech pathologist, I was with Johns Hopkins Rehabilitation Medicine for at least the first several years.

Dr. Peters:
Baltimore is such a great town, and I would say that the people that live there are so wonderful to take care of. Don't you agree?

Dr. Hillis:
I agree. They're just salt of the earth people.

Dr. Peters:
Absolutely. I enjoyed my time there so much. So I always thought it was wonderful how you worked as a speech language pathologist before becoming a stroke neurologist. Can you tell us a little bit more about that journey and what it's meant to you professionally?

Dr. Hillis:
Sure. So when I was a speech pathologist, I worked primarily with stroke patients, some people with traumatic brain injury as well, but mostly people with stroke. And I loved it. I just loved the people. I was doing a lot of research on aphasia and also hemispatial neglect after right hemisphere stroke. And I thought, "I really want to do this kind of research and work with these people my whole life."
But about that time, this was in the late '80s, people were talking about potential treatments of stroke, neuroprotective agents and thrombolytics, things that would actually reverse the stroke before it caused too much damage. And I thought, "Wow, I'd like to be involved in that part of treatment, but I also want to continue research and clinical work my whole life." I didn't particularly enjoy administration, and by that time I was doing more administrative work as a director of neurologic rehabilitation. So I knew that doctors could do research and education and clinical work their whole lives. And so I decided I would go to medical school. And my dream was really to become the director of a stroke center. And so in fact, that's what I am. So I really did exactly what I wanted to do.

Dr. Peters:
That's wonderful, and so lucky for our patients and for our trainees at Johns Hopkins. Now, stroke is just very common. It's a very serious disorder. My father had a stroke, my mother's had a stroke. And we know that someone can have a stroke almost every 40 seconds in the United States. So for our listeners, can you give us the basics of what is a stroke?

Dr. Hillis:
Sure. There are really two kinds of stroke. The most common kind is when a clot stops up blood vessels so that it can no longer deliver blood and oxygen to part of the brain. So that part of the brain dies, for lack of oxygen and glucose. And it can either be caused from a clot that came from somewhere else in the body, like the heart, or it can a clot that forms in the vessel itself, due to atherosclerosis. But that's basically the main kind of stroke. The other kind of stroke is when a blood vessel bursts and causes bleeding into the brain.

Dr. Peters:
And a lot of times my patients will talk about having a TIA or a transient ischemic attack. What's the difference between that and a stroke?

Dr. Hillis:
So a TIA is almost like a stroke that didn't quite happen. It almost did. So it's a real warning sign. Sometimes a small clot can become lodged in a vessel, cause the same symptoms of a stroke, but then spontaneously resolve. And so when that happens, the symptoms also resolve. Typically, it lasts five to 10 minutes. By definition, the symptoms have to last less than 24 hours, but usually it's even less than an hour.

Dr. Peters:
So sometimes I hear the term mini-stroke. I feel like that's a very controversial term. Sorry to throw that out there. What do you think about the term mini-stroke?

Dr. Hillis:
Yeah, I think that's a confusing term because some people mean TIA by mini-stroke, and other people mean a lacunar infarct. That is a very small stroke caused by a small vessel disease. And there's a difference. So TIA is not going to leave any mark on the brain. You won't see it on MRI. You can't ever really prove that it happened. Whereas a lacunar stroke is a stroke caused by a small vessel that gets clogged. It will leave a mark on the brain. Sometimes it causes symptoms, sometimes it doesn't. So sometimes people will have an MRI of the brain for migraine or something else and they find out they had an old lacunar stroke that didn't really cause deficits. So if it's in part of the brain that is not really critical for a major function, it may have caused symptoms that weren't recognized at the time, so maybe transient fogginess or transient visual problems or something like that. And the person won't have known they had a stroke until they got the MRI.

Dr. Peters:
For our listeners, what are some of the early signs of a stroke where they or their loved ones need to react?

Dr. Hillis:
Sure. So basically anything on half of the body, so weakness or numbness on one half. And that's just because each half of the brain controls the opposite side of the body. Also, loss of vision on one side or loss of vision in one eye can be a stroke. But the main thing we ask people to remember is the acronym FAST. So F is for face. If you have a droopy face on one side, that could be a stroke. A is for arms. So if you hold your arms up and one of them drops, that could be a stroke.
S is for speech. So if there's sudden change in your speech, either slurred speech or difficulty thinking of words or making no sense at all or not understanding other people's speech, that could be a stroke. And T is for time. If you have any of those symptoms, you have to call 911. Don't wait for your wife or husband to come home. Call 911. Get to the emergency room as soon as you can, because those kinds of strokes can often be treated. If we see the clot that's causing the stroke, maybe we can pull it out or we can give some kind of clot-buster medication intravenously.
Now recently, people have expanded the acronym FAST to BE FAST. So B is for balance. If you suddenly lose balance, that could be a stroke like in the cerebellum, but really balance so bad you can't walk. And E is for eyes. So again, if you can't see on one side, that could be a stroke. If you can't see in one eye, that could be a stroke in the retina of the eye. And even something like double vision could be sign of a stroke. Now, people have a little bit of harder time remembering the whole acronym, BE FAST. So if you can't think of anything else, remember FAST: face, arm, speech, time.

Dr. Peters:
Absolutely. And listeners, BE FAST. FAST. Remember those acronyms, write them down, tell your loved ones. It could be something if your loved ones want to learn something new from you today, you say, "This is what I learned on the podcast with Dr. Hillis, FAST or BE FAST, for the signs of stroke." You alluded to some of the clot-busting drugs. What are some of the other acute treatments for stroke?

Dr. Hillis:
So the single most effective treatment we have now is endovascular treatment. And this means taking a catheter, usually from the femoral artery, sometimes more brachial arm arteries, up to the carotid artery and into, if necessary, the middle cerebral artery, the arteries inside the brain, and pulling out the clot. Sometimes that's with something that can be snagged. Sometimes it's almost like a suction that pulls it out. But there's various ways of getting the clot out. And then the blood flow is restored and that causes a significant improvement in function and reduction in the ultimate size of the stroke. So that's the most important kind of treatment these days.

Dr. Peters:
And we are all about brain health on this podcast. We've done several episodes on it. What are some modifiable risk factors that you can share with the audience that they can work on to decrease stroke risk?

Dr. Hillis:
Well, first of all, if they smoke, they've got to stop. That's the single most important thing.

Dr. Peters:
Yes, stop smoking.

Dr. Hillis:
It is very important to get exercise. That's one thing Americans probably don't do enough of, walking or bicycling or swimming. Aerobic exercises a very effective way to prevent stroke. The other one is diet, so a Mediterranean style diet. Lots of fruits and vegetables. Fish more than red meat. Avoid fried foods, avoid sugar. If you do eat anything sauteed, use olive oil instead of butter or corn oil. So those are all extremely important ways to prevent stroke. Another, if you have sleep apnea, treatment of the sleep apnea is very important. That is usually with CPAP, but if you can't tolerate CPAP, there are other treatments of sleep apnea. So that's important as well.

Dr. Peters:
All great lessons. And the listeners may remember that Dr. Correa and I shared some heart healthy or brain healthy recipes, particularly in regards to the Mediterranean diet. So we're always happy to share those, and you can look those up. Now, for someone who's had a stroke, and we interviewed a patient and who was our guest, Mr. Will Shortz, he really worked with his loved one and partner about stepping towards recovery, what are those steps to really recover from a stroke?

Dr. Hillis:
The most important is to stay active. So one of the problems with stroke is it makes it difficult to do what you did before in terms of exercise and walking and talking. Social activities are harder, they're more fatiguing. And so people tend to avoid them, but that's the worst thing that you can do. The more you're engaged, the more you try to get back to doing normal activities, the sooner you will get back to doing those more normally. And so even if you were kind of a couch potato before, pushing yourself to exercise and do active things, working on the computer or doing things, anything except watching television can be very good for you.

Dr. Peters:
So we need to get out there and move and keep on moving?

Dr. Hillis:
That's right, exactly.

Dr. Peters:
I like that. And what about in particular for your past specialty with being a speech pathologist, any tips about those particular patients that may have trouble speaking after a stroke?

Dr. Hillis:
Absolutely. It's pretty much the same thing, is get back to talking. Read out loud to your cat or dog, they like the sound of your voice, or your grandchildren. Talk as much as you can. And also, there are a lot of computer programs, like even free computer programs that help you try to practice thinking of words and things. So there's one called www.aphasiatherapyonline, and it's got exercises in multiple different languages. It's free, doesn't require any sign up, has things for reading and spelling and naming and comprehension. Those are good. The New York Times puzzles are good. Play Wordle and crossword puzzles.

Dr. Peters:
I agree.

Dr. Hillis:
Those kinds of things will keep you cognitively engaged. Connections, all of those are really good ways to stay engaged and continue to challenge your mind. But probably social activities are the most important to get back to talking. So don't avoid them. Your friends don't care if it takes you longer to express yourself. Just tell them, "Just have patience and I'll get it out." Or use writing or drawing or gesturing to communicate.

Dr. Peters:
I tell my patients that so often. Again, I treat mostly patients with brain tumors, but they're at risk of having stroke also. We've actually done extensive research to suggest that there's certain types of patients after having radiation will be more apt to have strokes. And I'm always telling them, "Please talk. Use it. It's just like another muscle, another exercise to continue those activities, and also don't become socially isolated. It's really important to get out there." I find that our patients are sometimes their harshest critics, particularly in regards to language.

Dr. Hillis:
Absolutely.

Dr. Peters:
So I love the idea of talking to your pets, because I seriously doubt that they're going to even be upset if you miss a few words. They probably just are waiting for that magic word "treat" or "ball."

Dr. Hillis:
That's right. And some of my patients who can't go back to work actually benefit from doing volunteer activities that keep them communicating just at a slightly different level. So I've had people with aphasia who have volunteered at a horse rescue or at a dog rescue, things where they can interact, but with both animals and people, but it's not such a critical environment.

Dr. Peters:
So how should we support our caregivers, the ones that are caring for ones that have just suffered a stroke? What should we do to support them?

Dr. Hillis:
The most important thing is to let them have some time to themselves. So they're spending often full time just helping their loved one with various activities. And they may have taken on a lot of things they didn't do before, maybe cooking or the finances or the driving. So they're very busy. If friends and family can just give them time off, say, "I'll stay with dad or John for the afternoon and we'll go to a movie together, a museum together. And you can go have lunch with your friends or get some gardening done." Time off by yourself is very important. We call that respite. And that's terribly important for caregivers, because if caregivers burn out or have a heart attack or something, they can't be a good caregiver. And so it really is important for both the person with stroke and the person taking care of them, for the caregiver to have that some time off.

Dr. Peters:
Yeah, I learned from one of our other guests who was a caregiver. She said, "Self-care is care, and you need to remember you need to give that care to yourself." So definitely. Now, Dr. Hillis, you do research in the area of stroke. What is new and hopeful and exciting for patients that are recovering from stroke or even preventing stroke?

Dr. Hillis:
For stroke recovery, there are a lot of new interventions and some that aren't maybe so new but are becoming more used. One of them is non-invasive brain stimulation. So transcranial direct current stimulation is a non-invasive, non-painful stimulation over the skull that reduces the threshold of activation of neurons under the area that's stimulated. And that can help what we call neuroplasticity. So it can help healthy areas of the brain to take over for the damaged parts of the brain. Transcranial magnetic stimulation is another one. Especially the transcranial direct current stimulation needs to be done along with an activity like language production if you're trying to improve language, or motor exercises if you're trying to improve motor function.
And then there are also sort of innovative therapies. For example, a lot of therapy now is being done remotely. We found out during the pandemic that you didn't actually have to always go to the speech therapist's office, for example. It can be done over the internet. You can get the same kind of feedback and exercises. So I think we'll be seeing a lot more of that and sometimes combined with computer-delivered therapies.

Dr. Peters:
Well, that's fascinating. I think that gives so much hope to both patients and their loved ones, because they worry about the recovery journey. But Dr. Hillis, this has been a great discussion. And I really appreciate your time, your expertise to help discuss stroke and recovery with our patients, our loved ones, and of course our listeners.

Dr. Hillis:
Well, thank you. It's really been a pleasure, and great to see you again, Katie.

Dr. Peters:
Absolutely. And everyone, have a great day, and thank you so much. To our listeners.

Dr. Correa:
Thank you again for joining us today on the Brain & Life podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life magazine for free at brainandlife.org. Don't forget about Brain & Life en Espanol.

Dr. Peters:
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Dr. Correa:
You can also find that information in our show notes, and you can follow Katie and me and the Brain & Life magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea.

Dr. Peters:
And Dr. Katie Peters joining you from Durham, North Carolina and online at Katie Peters, MD, PhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Correa:
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Solving the Stroke with Will Shortz

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