July 25, 2026
I know, I know…that always gets me into trouble.
I tend to overdo it. Thinking, that is. It doesn’t yield any worthwhile results, but it does help kill the time.
Now especially …when me old noggin ain’t at its best… is probably not a good time to indulge the nasty habit, and it’s sure as hell not a good time to share the fruits of that belabored labor.
Still, no one ever mistook my thinking for wisdom so, what the hell; let’s share a few post surgical thoughts. In no particular order.
First…let’s talk about planning. I think it was the Prussian General Helmuth von Moltke the Elder…not to be confused with his lightweight son Helmuth the Junior… who said, “No battle plan ever survives contact with the enemy.” This notion was later stated far more eloquently by the famous American philosopher Mike Tyson, who said,
Well said, Mike.
My plan was simple.
Walk.
Walk some more.
Walk all night, the night before surgery. The only way to suppress my convulsing restless legs when off medication is to walk. So , I figured if you’re not going to sleep anyway Rob, you might as well be as comfortable as possible and walk into the hospital the next morning so exhausted sedation might not even be necessary.
My surgery was planned for 10:00 Thursday. My doctor instructed us that I should eat no later than midnight on Wednesday, so at 10:40 I ate a miniature carton of Ben & Jerry’s chocolate ice cream from the hotel snack bar freezer (it seemed a good choice for a last meal if things went wrong) and set out for the fitness center one floor beneath our room. Since the fitness center is conveniently open 24/7 to hotel guests, I slipped in at 10:45 and between 11:00 and 2:00 I plugged in my earbuds, fired up my playlist, and peddled the hotel’s trusty Life Fitness stationary bike like I was flying through the Kansas sky with Todo in my basket about to transform into the Wicked Witch of the West.
My plan was to break it into half hour segments and figured if I could string six half hour sessions together, at a leisurely pace of 5 miles every half an hour, I could get a good three hour 30 mile start on a long night.
Around 2:00 I got off the bike and considered a similar regimen on a treadmill. But I was getting a little punchy and thought it best to stay off the treadmills where I might hit the wrong button and fly off the back like George Jetson walking Astro at the start of The Jetsons.
At 2:15 I took the first of two showers in our room (a shower also helps when my restless legs act up), dressed and returned to the spacious lobby of the Marriot where I fired up Dune- Part Two on my iPad and walked while watching the movie.
I figured a movie that lasted 2 hours and 46 minutes, while too long to endure sitting in a theater, was just right for my early morning ambulatory needs in the Marriot lobby. It would distract me to just before 5:00 when I was to take another shower and wash my head with some pink antibacterial concoction. then wait another two hours before wiping down my body from head to toe with some creepy antibacterial wipes.
At 7:00 I fetched an Americano from the restaurant bar for Cathy and and she kindly administered the antibacterial swipe down. I had to stand motionless while the icky stuff dried leaving a sticky feeling all over.
About 8:00 I drank my last liquid, a strawberry flavored pre surgical Ensure. Cathy and I then went for a walk around the hotel until Kate and Sam arrived.
The kids distracted me with stories of my grandchildren and the four of us ventured off to the hospital just before 10:00.
The haircut part went fine. Diana, my right hand throughout the process, a former Army Master Sgt with a heart of gold and a quick wit, was wonderful. She first threatened to leave me with a new wave Mohawk and then teased me about the pet gerbil she left in my lap.
She then threatened to leave me with a Rudy Guliani dye job with a Trump inspired color choice.
So far so good.
My plan was working.
The flaw in my plan was assuming all I had to do was survive the haircut sitting up in bed and soon after they would plug in an IV that would give me some magic stuff that would quiet my legs’ crazy urge to move while sitting and lying down.
WRONG.
Interesting little physiological/anatomical/pharmacological teaching point for those of you interested in such things…
Deep brain stimulation surgery is generally done with you sedated but not under general anesthesia, because you need to be responsive enough to help— checking tremor suppression, side effects, speech, etc. That means they use light sedatives that do not fully knock out motor activity.
Sedatives that are good for calming anxiety and inducing drowsiness, don’t address dopamine deficiency. My leg movements, especially off meds, are substantially dopamine-driven. A sedative cocktail can make you drowsy while the dopaminergic circuitry underneath is still misfiring — so you can be “sedated” and still thrashing.
Withdrawal amplifies the thrashing. Going off my meds doesn’t just let my baseline PLMD/RLS rerturn — it can produce something called “rebound akathisia” which is worse than your normal off-med state. That’s a different, more intense phenomenon than routine sedation is built to handle.
Periodic limb movements are generated at the spinal cord and brainstem level, not just cortically. Sedatives that work at the cortical/thalamic level to produce drowsiness don’t necessarily suppress movement generators sitting lower in the nervous
I know what you’re thinking, Probably the same thing I was thinking…
‘I WANT MY EPIDURAL”
Turns out, that’t not an option either.
Bottom line: I was…let’s just say… a challenge… for my anesthesia team. Finding the right mix that would enable me to be awake to participate, but quiet my thrashing legs apparently was a tall order.
I remember some parts.
I remember the part where they screwed the tire rim to my head. And I remember my head being clamped in place, and I remember the drilling-the-hole part (that part actually wasn’t too bad), but most of all I remember my fucking legs convulsing like someone took one of those reflex hammers, only this time the size of a carpenter’s framing hammer and ball peened a periodic seismic twin leggedconvulsion from my waist to my feet while my head was clamped in place.
All I could think was, “Would someone please let me stand up? I just want to stand up and walk. I know how to stop this. Just let me walk.”
But my head was in a vice. My lower body was trying desperately to get away, but the clamp aound my head wouldn’t let it. And no one was listening to what seemed to me a simple solution. “Just let me stand up.”
The last thing I remember thinking was “Rob, you’re pretty good at enduring discomfort. You ran cross country. You did four 200 mile solo bike rides in one year where you were in the saddle alone for 15 hours. You summitted long bike climbs above 12,000’ in the Rockies in Colorado. You rode the Obliteride, the Death Ride and climbed the worst part of Mt. Shasta up down and up again on Agony Hill in one day. You’re pretty tough old man, but I just don’t think you can do this anymore and I’m pretty sure no one else could. Then I thought, “What would Cathy tell me?” That’s when I remember mumbling to the surgical team “GET ME OUT OF HERE.”
Apparently, that was just about the same time my surgeon and anesthesiologist decided to change plans, go full general anesthesia on me and forego the audience participation potion of the program.
The outcome, we are assured, was excellent. The wires were placed where needed. My help proved unnecessary. Thanks to my surgeon’s experience, the anesthesiologist’s wizardry, and the skill and experience of the entire Kaiser Neuro team all of whom couldn’t have been kinder or more supportive, we did what we set out to do.
Here I was in recovery.
Nicelook, don’t you think?
It took me a long time to come out of it. Cathy, Kate and Sam reported my legs were still thrashing when they saw me. Damn things wouldn’t give up the fight.
No plan survives the first encounter with the enemy.
My enemy happened to be my own legs. The same ones I had relied on so many times before to get me through hard times.
Here I am at home.
Now, three days later at home, it’s time to rest up for the next one. The good news is I won’t have to go off meds the near time. They’ll put me under from the start. No need for treadmills or long movies or early morning strolls in hotel lobbies.
Cathy says she’s found just the right gift for me.
She says it goes with my new wannabe Anthony Tucci look.
Can't Hold Still 