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Doctors paralyze part of Ali's brain
Ali Nowotny answers questions about her health as a nurse preps her for a Wada test later in the morning early on Wednesday at St. Mary's Hospital at Mayo Clinic in Rochester, Minn. (Photo by Kristina Barker, Journal staff)

ROCHESTER, Minn. - With frigid darkness still draped over Rochester, Ali and Craig Nowotny arrive Wednesday morning at Mayo Clinic's Saint Marys Hospital.

Wearing Lady Cavalier sweats and a University of South Dakota sweatshirt, Ali waves from her spot in the admissions line. The "Ali Tough" motto that friends shaved into the back of her hair stands out against her black dye job.

"I got called a fella yesterday," Ali says with a big smile. "The first time, it was sir. Yesterday, it was fella."

(Editor's note: This the second in a series of stories on Rapid City teenager Ali Nowotny, who is being treated at Mayo Clinic in Rochester, Minn., for epileptic seizures caused by a brain tumor. On Wednesday, Ali underwent a relatively rare brain procedure called the Wada test. The Rapid City Journal is at Mayo with Ali, documenting her journey.)

Ali's chameleon-like hairstyle has become her trademark and a way to deal with her upcoming brain surgery. She and friends dyed and cut it over the course of several weeks in November and December. But people at Mayo don't really take much notice. Most every patient here has a story, and all are hoping for a good ending.

Ali's story started in 2006, when she began to have epileptic seizures. She hopes this chapter of her story will end at Mayo when doctors remove the golf-ball-size tumor causing those seizures on Friday.

But first, Ali must get through the Wada test.

The Wada procedure was developed in the 1940s and is most commonly used to treat seizure disorders such as Ali's, according to Dr. E. Paul Lindell, a neuroradiologist at Mayo Clinic.

During the test, doctors essentially put half the brain to sleep to locate the dominate language and memory areas in the brain. It's a tough test, mainly because the patient must be fully cognizant as doctors essentially paralyze part of their brain.

After Ali is settled into her room at Saint Marys, nurses check her vital signs, weight and height and neurologic reactions.

When a nurse asks about Ali's headaches, Ali describes them this way: "It feels like my brains are loose and conking on the inside of my skull."

When nurses ask her about her seizures, her father, Craig Nowotny, quickly produces the calendar marking her last "black out" in October.

The chatty Ali of the past several weeks slowly becomes more quiet as her Wada preparations continue. When a nurse mentions the risk of femoral artery bleeding after the Wada, Ali asks seriously, "When I get up, will it bleed?"

Assured by the nurses that they will try to prevent that, Ali looks over her right shoulder at her dad, who is sitting quietly in a chair by the window. "I'm scared," she says with a small smile.

"You're scared?" he asks.

"Yeah, I'm scared," she answers back.

Once prep is complete, the nurses leave the room. Ali turns on the television to watch the movie "Baby Mama" and begins her wait. But she's only half watching. A nurse has brought in a pamphlet explaining her procedure. Ali's eyes flit between the pamphlet and the television. And she grows quieter.

Around 8 a.m., a pleasant woman in a blue Mayo jacket comes for Ali. Craig Nowotny walks along as Ali is wheeled to the procedure room. She will have a moment of tears there, alone with her dad and her nurse. The headiness of the coming days has sunk in.

Dr. Lindell arrives at the family waiting area shortly. Already wearing scrubs, he runs down the procedure again.

The Wada test isn't done at many hospitals in the country, but Mayo does about one every other week, he says.

Lindell and Max Trenerry, a neuropsychologist, will work together during the procedure. They will anesthetize the right side of Ali's brain to see if the major work of language and memory is being done with the left side.

If Ali does poorly answering the questions, it might mean that her right temporal lobe can take more of the burden of language and memory in case her left lobe, where the tumor is, is affected during surgery. "I want her to fail this test badly," Lindell said.

It's finally time for the Wada.

The Wada

Inside a neuro-angiographic suite, Ali lies on a table, her head taped into position. A catheter has been inserted into her right femoral artery in her groin and snaked up into her neck.

Two X-ray machines point at her head, one from above and the other on her left side.

Mayo X-ray technician Mark Santjer watches two computer screens from an adjoining room as Lindell slowly injects iodine into the catheter. The dye highlights the vessels in Ali's brain. Gradually, images that look very much like the branches of a tree glow to life on the computer screens. Lindell uses the dye to ensure that the anesthetic he injects will go to the appropriate part of Ali's right hemisphere.

"How are you doing, Ali?" he asks.

"Good," she offers quietly.

After Lindell ensures that the catheter is in the correct location, Lindell is ready for the next step. "Alright, Max. We're ready."

Trenerry has been visiting with a fellowship doctor in the adjoining room. He quickly takes a bag of items and joins Ali and the medical team.

Trenerry, a silver-haired guy with an easy smile, leans over Ali. She smiles at him. "The right side of your brain is going to take a nap, now," he explains.

But first, Ali mentions that her left arm feels "weird." Trenerry uncovers the arm and checks her strength. "You're the one who throws your friends to the top of the pile," he says, referring to Ali's award-winning cheer and dance teams from St. Thomas More. Ali makes sure he understands she's a cheerleader and not a tumbler.

Once the distinction is clear, the procedure continues.

Lindell gives Trenerry a nod and a point and then slowly injects the anesthesia into the catheter as Ali begins counting backwards from 100.

Within seconds, her speech becomes slurred and garbled. The left side of her face droops. It's an unsettling thing to witness. Even doctors, when they first begin doing the procedure, are bothered by it, Trenerry says later. "Because what it looks like is a stroke."

Ali seems unaware, beginning a series of yawns.

Trenerry quickly begins his assessment. "Squeeze my hand," he says. Ali's left arm and hand hang limp.

Trenerry begins pulling everyday items from a tray, holding them above Ali's head and asking what they are. She identifies all but one. Her speech is already returning to normal.

Trenerry asks her to smile. Ali's smile emerges evenly. "So the potion is wearing off," he says.

The entire procedure lasts no more than five minutes.

Not realizing that her arm had been essentially lifeless just seconds before, Ali asks Trenerry, "Was my left hand twitching?"

Trenerry explains.

After Ali has a few minutes to fully return to normal, Trenerry runs through the items again, asking Ali to remember what she saw during the procedure. Again, she does well.

The results of the tests are essentially what they expected, Trenerry and Lindell say later. For most people, the left hemisphere controls language and memory. Ali is no different. And while they had hoped the right brain was doing a little more of the language and memory work, they are not discouraged. The Wada results are simply one more piece of the medical puzzle doctors will use to treat Ali, Lindell said.

After 20 minutes or more of recovery, nurses wheel Ali from the suite. Her father meets her at the door. She is silent, offering a tiny smile. They make their way through the maze of hallways to Ali's room. After Ali is settled in, her nurses bring her food. She starts with the banana.

Ali is surprised to learn her speech slurred during the procedure. To her, it felt as if the right side of her face became numb and droopy, but she hadn't realized her voice had changed.

After a few moments, Ali turns the television on and looks for "Baby Mama." When she realizes she can't get back to where she left off, she decides to start the movie at the beginning again.

About three hours later, Ali and her father leave the hospital, returning to their hotel for the night. Ali is instructed to lay low for the night, keeping off her feet. Later, looking over cards from St. Elizabeth Seton fourth-graders, her spirits pick up.

Today is her final MRI and a consult with pediatric neurologist Elaine Wirrell and neurosurgeon Nicholas Wetjen.

Then, on Friday morning, Wetjen will do his best to remove the Ali's tumor.

Contact Lynn Taylor Rick at lynn.taylorrick@rapidcityjournal.com or 394-8414.

Title: Ali's Journey

Date: December 16th, 2008

Follow Ali Nowotny's journey as she travels to Minnesota to undergo brain surgery to remove a brain tumor.

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