Peggy Kapadia had tried to quit smoking. She knew it was unhealthy, to put it mildly. She set aside guilt for fleeting moments of pleasure with her husband after work enjoying cigarettes with coffee to unwind.
The 57-year-old from Williamston had smoked for 40 years.
Sheldon Wortinger, a 53-year-old from Seneca, had smoked nearly as long even though he’s younger.
He wanted to stop, too. As he cut back, though, he was quick to anger, and he often took it out on his wife. The struggle was painful.
He and Kapadia tried prescriptions and numerous methods, but they didn’t do the trick. Like thousands of people across the Upstate and northeast Georgia, like countless more worldwide, they were held in the grip of addiction.
Until they got the motivation they never wanted.
Wortinger was putting in a pool in his back yard and looking forward to warm days and good times with family and friends. Kapadia was excited about her youngest grandchildren moving to just down the road.
That’s when they faced the specter of the leading cause of preventable death in the U.S., as it’s described by the Centers for Disease Control and Prevention. They were told they had lung cancer.
Then action was taken, perhaps just in time.
Early detection and intervention for lung cancer sparked by new tool at AnMed
"I thought for sure I would die," Kapadia said through tears as her husband, Bhavesh, reached across the couch to touch her. She immediately held his hand.
"My dad told me that that word, 'cancer,' doesn't mean the same thing until somebody puts your name with it, and he's right," Kapadia said. "When it's your own life, it's terrifying."
Data published in November by the American Lung Association shows the rate of new lung cancer cases in South Carolina remains significantly higher than the national average.
As for Kapadia, she feared something serious was wrong when she couldn’t keep up with her grandkids while walking on the sand in Indian Shores, Florida, in August. Her doctor referred her to get a low-dose computed tomography, also called a low-dose CT scan, of her lungs. It showed a small, concerning nodule in her right middle lobe.
In the past, the recommended course of action might have been to monitor the spot with regular scans and follow-up. Biopsy would have been difficult.
“Previous and older technology was adequate for larger lesions, but as spots become smaller with earlier detection, more accurate procedures, such as with the Ion robotic-assisted bronchoscopy system, are needed,” said Dr. Chet Walters, the critical care, internal medicine and pulmonary medicine specialist at AnMed who ultimately received Kapadia’s referral.
Thankfully, AnMed had begun use of the Ion endoluminal system recently. It secured the biopsy that led to the early diagnosis that led to the lobectomy that Dr. Bill Buice (https://anmed.org/providers/william-s-buice) performed in November.
Now Kapadia seems to be cancer-free. And she does not smoke.
Bronchoscopy success improves with use of Ion system
“I feel so very fortunate,” Kapadia said. “I'm very lucky. I had a good support system. I have wonderful kids and a wonderful husband who have helped me through the whole process. And the doctors at AnMed are just amazing. I don't think I could've gotten better care anywhere. I had wonderful nurses, and I had wonderful doctors.”
Dr. Walters said the rate of successful biopsies with previous bronchoscopic systems was about 60–65% while AnMed is enjoying near 90% success with its new Ion system. A successful biopsy would be determined by securing an accurate diagnosis.
“During Ms. Kapadia's procedure, the Ion system worked perfectly,” Dr. Walters said. “We had pathologists at the bedside, looking at her biopsy specimens immediately after performing the procedure to ensure we were getting accurate biopsies. This real-time feedback helps to minimize the duration of the procedure and help ensure we are seeing the results that we strive for.”
Dr. Abhijit Raval, who helped lead implementation of the new system at AnMed, said the Ion tool is going to make a difference in many patients’ outcomes.
“We screen a lot of people who have smoked, and we’ve found small spots we haven’t been able to do anything about them, so we continued to observe them, which created a lot of anxiety in patients’ minds,” Dr. Raval said. “With this new Ion system, we can go behind these spots, obtain a tissue sample and diagnose cancers in earlier stages – and hopefully provide a cure with a surgical resection – while we minimize the anxiety of continuous follow-up.”
SC rate of smoking higher than national average
While the prevalence of cigarette smoking has significantly decreased in recent decades, South Carolina has a rate of smoking that’s higher than the national average. Anderson County has ranked third in the Upstate, behind Cherokee and Union counties, in prevalence of smoking, according to recent SC Adult Tobacco Survey estimates published by the state Department of Health and Environmental Control.
Oconee County has ranked fourth in the 11-county Upstate region, and Pickens County has ranked in a tie for sixth.
Kapadia and the doctors at AnMed want to see all those rates fall.
So does Wortinger.
Cigarette smoking causes more than 480,000 deaths each year in the U.S. – more than AIDS, alcohol, car accidents, illegal drugs, murders and suicides combined, according to the National Institutes of Health.
Wortinger said it killed his father. He took his father to chemotherapy and radiation treatments as he battled lung cancer, but his father couldn’t beat the disease.
“He wasn’t as fortunate as me,” Wortinger said.
Robotic lung resection produces less pain, quicker recovery
Wortinger had smoked since he was a teen, and his father’s ordeal underscored that he needed to quit. He tried pills that he was prescribed. He tried patches and gum.
“I know everyone is different, but all of those things made it worse for me,” he said. “I got the shakes. I had nervousness and anger issues. My wife – it nearly devastated her having to deal with me.”
A conversation about his struggle led his doctor to refer him for a scan. Ultimately, what he viewed as a “family curse” of lung cancer was detected.
That provided a push to quit smoking, an accomplishment that Wortinger said is one of the hardest things he’s done in all his life. But it also called for intervention.
Soon, on Oct. 23, Dr. Vasant Jayasankar performed the first robotically assisted lung resection at AnMed to rid Wortinger of his squamous cell carcinoma.
“Robotically assisted lung surgery offers the advantage to the patient of a minimally invasive approach with just a few tiny incisions on your chest wall, which decreases pain significantly and allows a much quicker recovery and discharge from the hospital,” Dr. Jayasankar said. “For me as the surgeon it provides high-resolution three-dimensional imaging and extremely precise control of my operative instruments, making the surgery safer.”
New surgery options available at AnMed
The robotically assisted lung resection is among a host of new capabilities brought to AnMed by Dr. Jay, as many of his patients call him. Removal of mediastinal tumors, removal of the thymus gland for patients with myasthenia gravis, a condition of weak and rapidly fatigued muscles, and thoracic sympathectomies for hyperhidrosis, a condition of excessive sweating, are also performed with robotic assistance.
Another minimally invasive procedure brought to AnMed by Dr. Jayasankar is the thoracoscopic maze procedure to treat atrial fibrillation, a surgery that provides great benefits when other treatments fail. It’s performed with video thoracoscopy similar to laparoscopy in the abdomen, and it’s not currently performed by any other surgeon in South Carolina.
“I can’t say enough about AnMed and what they did for me,” Wortinger said. “They moved so fast. And what they did – words can’t say enough. Dr. Jay actually cares about the patients. He had long discussions with me and was sympathetic with my struggles. That was important to me, because I was scared, to have that relationship with the doctor.”
Now Wortinger’s outlook is very good. He’s following up to make sure he’s cancer-free.
He and Kapadia said they encounter brief moments when they want a cigarette. They still get struck by the mood. A habit, routine or scenario will spark an urge they matched with smoking for years and years. But the urge has been coming less often. And they haven’t given in.
They want smokers – however occasional they are, however long addicted – to do everything they can to avoid needing the resources now available at AnMed.
“Just stop,” Kapadia said. “You’ll be glad you do.”