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  • New Clinic for Leptomeningeal Disease at Wellstar Georgia Cancer Center
Article Category: Newsroom

New Clinic for Leptomeningeal Disease at Wellstar Georgia Cancer Center

Published on August 03, 2023

Last updated 08:19 AM August 03, 2023

A friendly image of nurse helping patient

When a family member receives a cancer diagnosis, you want the absolute best cancer care for them. Having multiple family members impacted by cancer and neurological conditions inspired Dr. Gerald Wallace to pursue neuro-oncology and to create the Leptomeningeal Disease Clinic at Wellstar Georgia Cancer Center. The goal of the clinic is to diagnose, treat and raise awareness of the life-threatening disease.

“Neurology and cancer have deeply impacted my life for as long as I can remember,” said Wallace, an assistant professor in the division of Hematology/Oncology at the Medical College of Georgia. “I love doing this job; everything about it is just fascinating to me.”

Leptomeningeal disease is a type of metastatic cancer. The leptomeninges are two layers of tissue within the meninges that cover the brain and spinal cord. They are the innermost layers, which line the surface of the brain, blood vessels and surround the cerebrospinal fluid. Researchers estimate that 5% to 8% of people with cancer will develop leptomeningeal disease. It is also estimated that of the nearly 54,000 Georgians diagnosed each year with invasive cancer, as many as 4,000 are at risk of developing leptomeningeal disease. While there is still much that is unknown about the disease, experts do know that it is life-threatening. Without treatment, most patients will only live another six to eight weeks. With treatment, people can live well for months and, in some cases, years.

“That six to 12 months is the next graduation, the next wedding, the next birth of a child… at the end of the day I think we are all just fighting for time to spend with our loved ones. So, we should do something. Treatment is not that bad; it is quite tolerable,” said Wallace.

Possible symptoms that are associated with leptomeningeal disease are visual changes, stiff neck, trouble walking, headache that worsens when lying down, urinary/bowel incontinence, and memory issues. Wallace is concerned when he sees a patient with neuropathies or new neurological symptoms that do not connect to a patient’s known disease. When he hears or sees these sorts of symptoms, he sends patients to get tested. He thinks leptomeningeal disease is easily missed because most patients will already have had cancer for months or years. For these patients, symptoms may be attributed to treatment rather than cancer in the leptomeningeal space.

“If you have problems with one nerve here and one nerve over there, and I cannot connect the two… that really makes me nervous. Something is going on in a more global space than would otherwise be indicated in, say, a tumor that was sitting in the visual cortex and you cannot see well,” he said.

There are treatment options for patients diagnosed with leptomeningeal disease. The first step is to confirm the diagnosis. Contrasted MRI of the brain and spinal cord is used to see if there is anything suspicious or out of the ordinary. MRI is followed by two lumbar punctures to see if there is cancer in the cerebrospinal fluid. Once the diagnosis is confirmed, the next step is radiation of the brain and possibly the spinal cord. Finally, patients meet with a neurosurgeon to discuss placement of an Ommaya reservoir. An Ommaya reservoir is a special port that allows access to the cerebrospinal fluid in the brain. It sits under the hairline on the scalp and is an easier way to give chemotherapy, evaluate spinal fluid and decrease intracranial pressure.

Wallace uses a variety of medications that are given through the Ommaya reservoir to treat leptomeningeal disease. The choice of medication depends on the type of cancer, specific mutations in the cancer and, most importantly, the ability of the patient to tolerate therapy. Patients start off going weekly for treatment for a few months. If they see good results, they can start going every other week, then monthly.

In recent years there have been major breakthroughs for drugs that may be able to treat leptomeningeal disease. Wallace is excited about their potential and is working to create clinical trials at the Wellstar Georgia Cancer Center to assess that potential. As people live longer with cancer, the likelihood of a cancer survivor being diagnosed with leptomeningeal disease also increases.

“I think there is great potential to make big strides in survival and quality of life for patients with leptomeningeal disease,” he said.

If you are concerned about leptomeningeal disease, you can schedule an appointment with Wallace and his team by calling (706) 721-2505.

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Highlights

Health Equity in Action

The Weekly Check-up Atlanta


When Dr. Earl Stewart thinks about health equity, he thinks about patients who delay care because they can’t take time off work, who are seniors silently battling chronic disease in food deserts and who live in communities hit hard when summer heat bears down on the South.

“Health equity,” he said on  The Weekly Check-Up podcast, “means making sure every person, regardless of ZIP code, income or background, has access to the care they need delivered with dignity.”

Dr. Stewart is the medical director of health equity at Wellstar and an internal medicine physician. He’s at the forefront of building a more just healthcare system rooted in listening, proactive outreach and community-based care. His work is redefining what community health looks like in practice.

Health equity starts with access

One of the biggest misconceptions about health equity is that it’s only about insurance coverage. But that’s just the starting point.

“Access doesn’t mean only having a clinic nearby or having insurance,” Dr. Stewart said. “It means that care is affordable, culturally competent, geographically reachable and provided in a way that meets people where they are.”

In Georgia, especially in urban and rural areas, barriers to healthcare can have many forms: long travel times to the nearest physician, language barriers, gaps in preventive care and social factors like food insecurity and housing instability. Each of these affects whether patients seek care at all and what happens when they do.

That’s why Dr. Stewart is helping lead efforts at Wellstar to address care beyond hospital walls, including thinking outside the traditional healthcare model.

Food as medicine for chronic disease

Health happens everywhere, not just in exam rooms. For example, conditions like diabetes and hypertension, wo diseases that disproportionately affect ethnically minoritized and low-income populations, are directly linked to access, or lack of access, to healthy food options.

Wellstar is working to reduce the health impact of food insecurity and chronic disease across the state through:

  • Fresh food as medicine initiatives
  • Mobile Markets in partnership with Goodr
  • Partnerships with local organizations

“If you don’t have access to healthy foods, your ability to control your blood pressure or manage your blood sugar is already compromised,” Dr. Stewart said.

By addressing food insecurity head-on, Wellstar isn’t only treating illness—we’re preventing it through community investment and education.

Mobile health removes barriers

For patients who can’t easily get to a clinic or pharmacy, Wellstar is bringing the clinic to their neighborhoods. Through mobile health programs, including pop-up clinics and food markets, patients can get screened for high blood pressure, pick up healthy groceries or receive preventive education.

“These programs reflect a shift in strategy—from reactive to proactive and from system-centered to patient-centered care,” Dr. Stewart said. “This is PeopleCare in action.”

“Mobile care gives us the chance to address healthcare access in a tangible way,” he added. “It removes barriers before they become complications.”

Health risks presented by climate

In a season of extreme and dangerous weather events, Dr. Stewart noted the connection between climate and health risks, especially for older adults and low-income populations.

“We see emergency department visits spike when the temperatures rise,” he said. “Older adults, people who work outdoors and people with chronic heart and lung conditions are especially vulnerable. Heat isn’t just a weather issue—it’s a health equity issue.”

For communities with limited cooling, transportation or healthcare providers, rising temperatures create a dangerous, often deadly situation. Dr. Stewart sees climate resilience as part of the activities needed to build health equity, calling for stronger connections among climate data analytics, care strategies and community outreach.

Leading with empathy & listening with intention

Health equity starts with listening. Dr. Stewart grounds his leadership in the belief that every patient story matters and empathy is as important as data to the future of healthcare.

With Wellstar Mobile Markets, social determinants of health screenings and mobile health outreach units, Dr. Stewart, the Wellstar Center for Health Equity team and Wellstar clinicians are working to transform healthcare from the inside out.

“Equity is not just the right thing to do morally,” he said. “It’s how we get better outcomes for everyone.”

Hear the full conversation.

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Man sleeping soundly and comfortably

Highlights

Inspire Implants Introduce Better Sleep Apnea Care

If you have sleep apnea, waking up tired may be your norm. Even if you wear a CPAP every night, you might not get the good night’s rest you need. Thankfully, there’s a different option available.

Positive airway pressure (PAP)—CPAP and BiPAP therapy—is the most common treatment for sleep apnea. It pushes pressurized air through a mask to keep your airway open so you can sleep better. But it doesn’t work well for everyone.

“For years, countless patients who have been intolerant of CPAP or BiPAP therapy have had few options for treatment,” said Dr. Michael Vick, an otolaryngologist with Wellstar. “What we have done in the past has been painful and unpredictable.”

Fortunately, if you don’t respond to PAP therapy, there’s good news. Wellstar is a multidisciplinary Center of Excellence for Inspire Implants—the first with the designation in Georgia and the second in the country. This hypoglossal nerve stimulator can reduce sleep apnea without the bulky mask.

What is sleep apnea?

Sleep apnea is a sleeping disorder. It causes you to stop breathing off and on while you’re asleep. It can happen when something blocks your airway (obstructive sleep apnea) or if your brain doesn’t send the right signals to the muscles that control your breathing (central sleep apnea). Either way, your body doesn’t get enough oxygen.

To kickstart your breathing, your body triggers a survival reflex. The jolt wakes you up just enough for you to start breathing again. But it also breaks your sleep cycle, meaning you’re tired the next day. And without proper treatment, you can develop high blood pressure or other heart problems that can be life-threatening.

How is sleep apnea diagnosed?

You may have sleep apnea if you snore, wake up frequently at night or stop breathing when you sleep. An at-home or overnight in-clinic sleep test can diagnose you accurately.

At-home tests use a finger monitor to measure and record your airflow, blood oxygen level, breathing pattern and heart rate. We may suggest an in-clinic test called a polysomnogram if we think you have central sleep apnea. This test uses electrodes placed around your body to evaluate your arm and leg movements, blood oxygen level, brain activity, breathing, and heart and lung activity while you sleep.

Common treatments for sleep apnea

Oral appliances can treat mild sleep apnea, and surgery can address treatment-resistant sleep apnea. But two types of PAP therapy have long been the most common treatments for most people with moderate-to-severe sleep apnea:

  • Continuous PAP (CPAP): A machine delivers constant air pressure through a mask to keep your airway open during sleep.
  • Bilevel PAP (BiPAP): A similar machine uses a mask to deliver higher air pressure when you inhale and lower air pressure when you exhale.

More advanced sleep apnea treatment

PAP therapy is uncomfortable for many people. If it doesn’t work for you, an Inspire Implant can reduce your sleep apnea without the mask. The two-piece implant involves a sensor in your chest and a receiver that wraps around the hypoglossal nerve that controls your tongue.

Our ear, nose and throat (ENT) specialists partner with lung and sleep medicine experts to place the device. They perform a minimally invasive procedure that requires two small incisions. This outpatient surgery requires minimal recovery time.

Once in place, the implant works simply. When turned on at night, the sensor sends a signal to the receiver that gently stiffens your tongue and palate with each breath, so your airway does not become blocked—all without waking you.

According to Dr. Vick, Inspire has been a breakthrough for many patients who cannot tolerate CPAP or BiPAP therapy. While success rates can vary depending on individual health factors such as body mass index (BMI), Inspire generally delivers higher satisfaction, fewer complications and a more comfortable recovery than previous surgical options.

“With Inspire, we have a successful and convenient treatment option with a high patient satisfaction rate. While it is a surgically placed device, there is far less risk of complications and downtime than anything we have previously offered,” he said. “If you cannot tolerate PAP therapy, you should consider Inspire.”

Learn more about Inspire at Wellstar and find an ENT who’s right for you.

Keep reading
At 26, Maria receives chemotherapy as part of her breast cancer treatment plan, determined to complete her interior design degree on time.

PeopleCare

MariaCare

Maria Fernanda Ortiz was a college junior, pursuing a degree in interior design. But at just 26 years old, her life took an unexpected turn. She discovered a lump in her breast, which led to a cancer diagnosis and expert, multidisciplinary care at Wellstar that would shape her professional aspirations in the future. Maria feels her hopeful attitude and compassionate care team at Wellstar helped her come through treatment with positive outcomes.

Feeling heard in healthcare

After Maria discovered a lump, she initially saw a doctor who went through the motions but didn’t seem to take her concerns seriously. 

“He was so sure it was nothing because I am so young,” she remembered. “I didn’t think it was cancer, but I wanted someone who would get to the bottom of it.”

She then saw her OB/GYN who referred her to Dr. Laura Pearson, a Wellstar breast surgeon at Wellstar North Fulton Cancer Center, for a second opinion. 

Maria got what she was looking for: a doctor who listened and would help her find answers. 

“Maria is the perfect example of a patient advocating for themselves,” Dr. Pearson said. “She did exactly what she was supposed to do for someone her age who finds a lump. When it didn’t go away, she got it looked at. When she didn’t feel like she was being heard, she didn’t let it go.”

 

A surprising cancer diagnosis

Dr. Pearson immediately performed an ultrasound in the office, followed quickly by a biopsy, which came back positive for cancer. 

"The diagnosis was scary," Maria said. “Dr. Pearson made it as simple as possible to understand by making sketches. She took the time to answer my questions—and she gave me hugs.”

Dr. Pearson added, “I try hard to be methodical and build a story: ‘This is what this means. This is how it applies to you.’ It’s important for patients to understand their plan and how it’s based very specifically on their situation.”

Maria was diagnosed with stage 2A breast cancer, meaning it was a small tumor but had spread to a nearby lymph node. 

“The stage helps us understand how the patient is going to do with standard treatment,” Dr. Pearson explained. “At stage 2A, we’re looking at a 90% survival rate.”

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