High Chemo Costs with Oncologist Dr. Mark Lewis

KKH Trailer Wide


Dr. Mark Lewis: [00:00:00] Knock, knock. 

Will: Hi,

knock, knock. Hi. Hello. Welcome to Knock-knock High with the Glock Flecks. I am Will Flannery, also known as Dr. Glock Flecking. I 

Kristin: am Kristin Flannery, also known as Lady Glock Feckin. And 

Will: what a show do we we have for you. Uh, today we’re talking, uh, with Dr. Mark Lewis, someone that we know, um, quite well, and we’ll talk about that in a second.

But first, uh, we got some mail yesterday. Mm-hmm. We’ve been getting some bail because we are preparing for a, a very long place. The biggest trip that we’ve ever taken as a family, we are going 

Kristin: as a person. I 

Will: think for me That’s me too. Yeah. We’re going to Australia. Yes. We are spending some time in, in Sydney and of Adelaide and I, I’m going, I’m speaking at a conference there, but we’re turning it into a, Family vacation.

Family [00:01:00] vacation. So we get this big box in the mail and um, I open it or Kristen opens it and I look in and, and I’m kind of confused and I ask her, what is this? And she says, oh, those are my neck pillows. Like multiple. Mm-hmm. And so what you had decided to do was in order to try to sleep on this 17, 18 hour flight mm-hmm.

We have to take mm-hmm. Gotta make sure I have a good neck on. You wanna do experience with the different Yes. Types of neck 

Kristin: pillows? Correct. Okay. So for context, I have to back up. First of all, for myself and for our younger daughter, um, if we are awake for too long, like, you know, we’re talking, it’s been, this is another reason I could never have become a doctor because if it’s at like our, you know, 18 19, 20 18, right.

If it, if it’s coming on 24 hours of, of awakeness, uh, we will just, um, throw up. 

Will: Just uncontrollably. I’ve seen it happen. Mm-hmm. It, I would not say uncontrollably, 

Kristin: but No, I just [00:02:00] mean like, we can’t control how this, like, it’ll happen. It’s just going to happen. So 

Will: anyway, so yes. Yes. So they, they have this weird, like 

Kristin: vomit.

I don’t know if you know what that is out there. Some, somebody listening or watching deprivation equals tell me vomit because I would like to fix it. So, um, anyway, in order to combat this, so we have this, so it’s very important yes, that we get some sleep on the plane. Otherwise we will both be vomiting over the Pacific Ocean in a tube that we can’t escape from.

Will: So, all right. We understand the implications of this. So what have you done to try to prevent 

Kristin: this? So, okay, so that’s, that’s background number one. Background number two is that I have, you know, some joint issues, uh, due to my hypermobility. And so, you know, I’ve had a neck surgery, I’ve had to have a cervical disc replacement.

I have a lot of just chronic pain up and down my spine, right? And my neck is a, a common offender, so, I also need, not only do I need something that’s comfortable enough to sleep, I need something that’s [00:03:00] not going to debilitate me. So you need something ergonomic. I need something that’s very supportive and in specific way.

Will: So just to, to fast forward here, the things that she ordered are hilarious. 

Kristin: Yeah. So I got, I don’t know, six or eight. I Googled to see like, what, what are the best ones? And I couldn’t decide just from reading on the internet, so I had to try them. So I just got all of them and I figured I can try them all out and then just return the ones I don’t wanna keep.

So one 

Will: of them is just your typical like neck pillow. But another one is, is this, um, large. Of what shape is it? I, I don’t even know. Oval, oval shape thing that goes over her head and, and then she leans on. It’s like designed to like lay or like tray table. Scene on the tray table. Yeah. But what you look like is, it’s called one the Ostrich.

Okay. It’s called the ostrich. But you look like one of the zombies from the last of us, uh, if you’ve [00:04:00] seen that show the clickers, like that’s what she looks like. Um, or even like from Pan’s Labyrinth that Oh, that’s a good one. Where the guy with the, the eyeballs on his hands. Mm-hmm. That guy freaked 

Kristin: me out.

Yeah. That’s what you look like with the ostrich on your head. Yeah. Cuz it like goes over your head as an oval and then up at the, up at the top. On either side of your head, it’s got holes because it’s meant like, remember you’re, you’re leaning over a tray table, so your forehead’s on the tray table, and then your hand is in these holes right above your, both of your hands are in the holes above your head so that you have somewhere to put your arms.

Will: I support whatever it is you need to do to avoid vomiting on our trip. So, uh, whatever, however much money you feel like you need to spend investigating 

Kristin: these options, like see, you gotta be able to, sometimes you just have to try it out. So, well, it’s gonna do it. We’ll 

Will: report back. Perfect. Yeah, let’s, I’m sure everyone’s gonna be just waiting on pins and needles for that.

All right, let’s get to our guests. We have Dr. Mark Lewis, who is a [00:05:00] medical oncologist, who is the director. Of gastrointestinal oncology at Intermountain Health and Chair of Digital Engagement for National Cancer Research groups. And we actually just interacted with, uh, we met Mark in person for the first time a couple weeks ago.

Kristin: Yes. Yeah. We’ve known him from Twitter for a few years. Uh, but he was in town for a conference and so we met up for dinner and um, what we had a lovely dinner and good conversation. We went out for ice cream afterward. We brought our kids with us and it was just this really, really good time. Um, and I think that it speaks to the character of Dr.

Lewis, um, that when we left on our way home, and this is well past the kids’ bedtime at this point, right? Well, on our way home, normally our eight-year-old would be complaining about something or another cuz she’s eight. That’s what they do. But what she did after the lovely evening that we had, is she just side really contentedly from the backseat went.

I love you guys. That [00:06:00] was just, to me, that is the epitome of what an experience with Mark Lewis is like. So, uh, we go into, in the episode a little more about how we know each other, but that is the kind of person that he is and the kind of physician that he is. So really, really good episode 

Will: today. Maybe also had a little bit something to do with ice cream.

Could have. I’m just saying. Could, I’m just throwing that out there, you know, but, uh, yeah, certainly the medical, medical oncologist guest was helped. Yes. You know, our eight-year-old help, you know, enjoy the, enjoy the evening. Uh, but, uh, yeah, had a great time. So let’s get to it. All right, let’s do it. Here is Dr.

Mark Lewis.

Mark Lewis. Dr. Lewis, thank you so much. I feel it’s so formal calling you Dr. Lewis. I can’t do it. I’m just gonna call you Mark feel right, because we’ve uh, we’ve interacted a handful of times and, um, our families know each other. Yes. And, and so our, our first question I have for you, are you a white coat guy?[00:07:00] 

Yeah. There’s, there’s different schools of thought here because like, there’s some doctors be like, you know, as soon as they’re done with training or med school, you’re like, ditch the white coat, never again. Mm-hmm. Some people are very attached to their white coat. . There’s no wrong answer. I’m just curious what your philosophy is.


Dr. Mark Lewis: tell you my philosophy. Will, is it, and thank you by the way, for, it’s lovely to see you guys, and this is just a tree to be here. It, it helps me project, and I mean this quite seriously actually. It helps me project some. Sensor gravitas. Mm-hmm. Um, because as we’ll talk about like, what I do for a living is, um, serious in its implications.

And I know I still look young and, you know, maybe give off the impression that I haven’t done this long enough. Um, and so I know it sounds almost like a prop, but to set the stage without coming across as intimidating, I do wanna come across as semi-conscious. Sure. And I’m talking to you guys, uh, in, um, in a clinic day.

Mm-hmm. And, and it’s, this is absolutely delightful sort of break, um, from some of the things I’ve been addressing. But, but that’s why I wear the white coat. [00:08:00] And, and the other thing that’s helped, if I’m honest, will, is as I’ve gotten older, I’m getting visibly grayer, and literally it’s been years since a patient asked me how old I am, and I take that actually with a tiny bit of, um, sort of satisfaction.

One of my colleagues and I, we call it gray vitas, meaning that yes, the gray hair gives you just a tiny bit of seniority, and then people are more likely to listen to you. But in all seriousness, it all comes back to establishing trust with the patient. Making sure they feel comfortable with me. Cuz if you don’t have that rapport, and I’m gonna be giving you chemo and I know we’re jumping right into the meat of the conversation.

Sure. You know, it’s gonna be a very difficult sort of therapeutic alliance. So that’s, that’s the real reason. Yeah. It’s 

Kristin: been a while since anyone asked you about how old you used to get those comments. Well, 

Will: I, I did, I, I, no, I did, I got, I got those comments a lot. Yeah. And then I had a cardiac arrest. Kind developed, a bit developed, I develop, developed a lot of gray hair after that.

And all of a sudden I, I wasn’t, uh, being asked, I was, I was more being asked, are you okay? Are you, [00:09:00] 

Dr. Mark Lewis: I I was literally at a restaurant, uh, this weekend and then had a sign on the wall and it said, if you’re under 30, Prepared to be carded. And I was sitting there kind of waiting to see if they would ask nothing.

So they’re like, all I’m old, man. Come on through. So, yeah, we’re past that. 

Will: We’re past that. Well, I’m glad you could, uh, join us on, uh, clinic day. You certainly look like you’ve just been in clinic, uh, with your wearing a stethoscope and you’re white coat and, um, yes sir. And so, yes, as we’ve alluded to already, you, you are an oncologist.

Yes. And, uh, you, uh, are the director of gastrointestinal oncology. That’s right. And also this, you have this other title, the Chair of Digital Engagement for National Cancer Research Groups. Yeah. What is that? I’m not sure what that is. What, okay. Cause it 

Dr. Mark Lewis: sounds fancy. Does well, yes. So let me, let me disabuse you of that notion.

Uh, will. So I’ll, I’ll say, you know how Google has this. Auto complete feature, right? So allegedly, we’re in the era of search engine optimization. But if you go to Google and you start typing in a [00:10:00] phrase, it’ll finish, it’ll finish your search strength, right? So a couple years ago, I was really curious, how does the general public perceive what I do?

And so I put in the phrase oncologists are, and frankly I was enlightened, but horrified by the results. It said literally. And I can send you, I have a screenshot of this. It says, oncologists are, Murderers. Oh, right. Yeah. So we have a little bit of a PR problem right off the bat. Sure. That’s right.

Oncologists are poisoners and I can kind of see where they, they came, came in there. I mean, 

Kristin: in a literal sense. 

Dr. Mark Lewis: Sure. Yeah, yeah, yeah. Uh, and thank you. Yeah, that’s, that’s fair. And then, you know, I think on oncologists or, or criminals, it, it went on. Oh my gosh. Yeah. Wow. And I thought, gosh, we have a lot of work to do to rehabilitate our, our image.

And so, well, to, to answer your question, you know, semi seriously what digital engagement means is reestablishing at least a fraction of the public trust. And there’s actually really good research and, you know, you and I have [00:11:00] actually both had cancer. There’s really good research that, you know, when someone’s first diagnosed and if they have, you know, the luxury of internet access, 97% of people, and this is no surprise, will look up their diagnosis, um, on the internet.

And 94% of them will use Google. And so to me it’s actually very relevant, uh, what search results are gonna be yielded if you’re doing these sort of broad-based, um, investigations. So what we are looking to do with digital engagement is humanize oncologists, and I’ll come back to thanking you for your role in all this, but also specifically making people aware that clinical trials are not about making people Guinea pigs.

Uh, I, that’s one term I really wanna try to jettison. It’s more about, mm-hmm. We know that what we’re doing right now is not good enough. How do we make it better? And short of sheer blind luck, the only way we make it better is by asking really thoughtful research questions. And the final piece of the puzzle is, you know, we respect ethics, we respect autonomy.

If you’re gonna enroll in a trial back to actually what we [00:12:00] were saying in the beginning, you better trust. The clinicians. Yeah. And the scientists are taking care of you. This is a huge, uh, sort of self-sacrifice that you’re making. Again, usually you’re hoping to get something back, but you better think of oncologists as something a lot more than just as murderers, you know, so, right.

It’s a very long answer to your question, but one of the reasons I’m the chair of digital engagement, and specifically why my Twitter activity sometimes come, comes across as looking a little silly or frivolous, is I am trying to soften sort of our, our public persona and make us feel, and I hope this is authentic, come across as, as more, uh, authentic and uh, and approachable.

Will: Well, you’re talking to the king of frivolous, uh, content, so 

Kristin: don’t even, although I’m sorry to tell you you this, but usually mark’s Twitter feed makes me laugh more than yours does. I 

Will: don’t, I don’t because you’ve heard all, all my jokes a thousand times. It’s been many 

Dr. Mark Lewis: years now. Makes sense. I’ll let you talk to my wife and you get completely the same answer, so Yes.


Will: Well, so it’s, it’s actually, it’s surprising to me hearing [00:13:00] about this PR problem that oncologists have, because from my perspective as a physician, like it’s, it’s like oncologists have some of the hardest jobs in medicine because it’s such a growing field so quickly have all these new therapeutics, like all the time that are coming out.

So it just seems like a very challenging field. You have to have a lot of empathy and so it’s, it’s surprising to me that maybe the general public has a, a negative, you know, image of an oncologist. 

Dr. Mark Lewis: I mean that’s really very kind of you to say. Um, will and I, I think the difference is one, you’re inside healthcare.

Yeah. Two is you and I guess not really that indirectly, Kristen have, have benefited hopefully from an oncologist taking care of you. Mm-hmm. Mm-hmm. Um, obviously she was the one that had to bring your heart back. There wasn’t an oncologist present when you, uh, when you’re arrested at home. But, um, but I think it does take some sort of personal brush with the disease, whether it’s you or your family member actually, to kind of see [00:14:00] what it is that we do.

And one of the things we can discuss is oncology is actually a lot more than chemo. Thankfully. It’s becoming a lot more than chemo. Mm-hmm. Um, but for many years it’s fair to say that, you know, if you were to describe my work in maybe two words, you could say, you know, chemo doctor. Mm-hmm. And I think what actually happened with our negative image is I think we, the people.

The doctors got conflated with the nasty, nasty toxicity of our drugs. And, and full disclosure, like I, I know chemo is horrible. No one ever wants chemo. I don’t want to give chemo. In fact, you know, part of my job is to convince people when they need chemotherapy and then when they do need it to try to make it as tolerable as possible.

So I think you’re, you’re very kind to say that. I think that’s where some of this reputational trouble came from. And then, as I was also alluding, if we’re not extremely careful in how we describe clinical trial, we will come across as mad scientists who are sort of, You know, playing fast and loose with people’s [00:15:00] lives, and that’s mm-hmm.

The farthest thing from what we’re actually doing. How, how do 

Will: you come up, how, how do you have that conversation? That’s, that’s interesting to me. Just because it could, it, I understand it would be, it seems like it’d be very easy to, to, to mess it up, portray that as experimental, right. Yeah. And that’s a scary word for people.

Yeah. Especially when you’re talking about 

Dr. Mark Lewis: conversation, you know, cancer. Yeah. I, I think the way I put it is that the only way forward is sort of rational, um, and, and, and careful experimental design, because again, I’m lucky enough, I’ve, I’ve had, as we’ve discussed, a relatively short, uh, Midland career at this point, and I’ve seen it change so much.

Literally, I had a great fellowship, a great training. I kid you not, if I practiced exactly the way I was trained now and I’ve been out more than 10 years, it would be malpractice. That’s how much it’s changed. Wow. And I think what we’ve all signed up for on our side of the table is lifelong learning.

We’ve basically said, listen, nobody wants to be practicing [00:16:00] oncology the way it was, you know, 20, 30 years ago. Heck, even five years ago. We wanna be better than that. However, the only way to get better is essentially crowdsourcing our knowledge. And, and it’s tough because, you know, some patients have to go first.

It’s like, I, I, we can get into this too. When I was having my pancreas surgery, I was meeting my surgeon, you know, or surgeons the week beforehand, and one of them was his first operation here at my institution. I remember thinking, huh, this is kind of an interesting situation to be in, where I know that I am, for one of a better phrase, my, you know, my surgeon’s first.

Right? No one ever wants to really be first, right? On the other hand, we know that sort of. Again, pioneering is necessary because the status quo is not nearly, uh, good enough. So the way I couch it is I talk about the standard of care. I say, listen, the standard of care, what we know now can get us this far.

But, you know, I’m honest with them that I, I think we are still in, if not the infancy of this field. It’s adolescents. And the only way to fully mature is through trials. So if you just take a little bit of time and try to again, dissuade [00:17:00] them of this notion that, you know, trials mean that you are totally guessing and it’s completely improvisational, um, then, then they tend to come around.

And also, if you can demonstrate the potential value for that person, that tends to be very powerful. I, I’ve actually taken care of some complete altru people who say, listen, Dr. Lewis, I realize that the odds of me benefiting here are slim to none. I still wanna do it. Because I wanna make it better for the people that come after me.

And that’s the kind of selflessness that you see all the time in this field. Wow. Yeah. And it’s just some touching, you know, like, who, who does that? And the answer is, patients with cancer do that. They are, um, among the most noble people I’ve ever met, there is something 

Kristin: about the experience of having cancer that just, and the you two know it better than I do, um, as former cancer patients yourself, but the, it really adjusts your perspective on life and on what you want to do with your time and with your own life.

So that, that doesn’t surprise me at all. I mean, it’s unfortunate, but it’s, it’s not 

Dr. Mark Lewis: surprising. There, there’s an intentionality to it, Kristin, [00:18:00] and I think you guys, or I guess I’ll include myself in our group, like, you know, relatively young ages. Mm-hmm. You know, we’ve had to confront mortality. And, um, my father actually had a great quote about this.

So, um, he was a, he was a minister, he was a theologian, and he was referencing a PSM where it talks about, you know, the average life expectancy being three square years in 10. And he said, you know what? Our life, uh, expectancy, that’s not a guarantee, that’s an average. And in any bell curve distribution, some people will fall on the long part, the desirable part, and some people will be on the very abbreviated and undesirable short part.

And he was actually tragically, um, the latter. So he wrote, when he was in his early to mid forties, he said, I’m having a midlife crisis with his cancer that may prove closer to its end than his middle. And he was absolutely right. And so I think from a very early age, I realized, and then it was really, you know, brought upon me when I had my cancer.

Boy, you know, there are no guarantees here. Mm-hmm. Uh, and I won’t even pretend to understand what you guys went through with the sort of [00:19:00] hyperacute, you know, shock of your cardiac arrest. Will and, and Kristen again, kudos to you for your remarkable resuscitation efforts. But, you know, I think it just shakes you.

And this is stuff people don’t wanna talk about. Mm-hmm. Like, denial is so powerful. Like you wanna believe, especially when you’re young, that you have something approaching. Immortality. Mm-hmm. And I think the other thing that that really changes your perspective is when you have a parent that gets ill, Um, you know, I think when we’re young, it’s, it’s actually comforting, almost necessary to imagine that your parents are going to live, if not forever, for a very, very long time.

Mm-hmm. And it’s like the scales fall from your eyes when you realize that yes, they’re, they’re human, um, in, in every sense of the word, but also that they are, um, not just fallible, but they are, they’re mortal, they’re vulnerable. And I think that that’s a change in perspective that you get either, again, having a serious illness yourself or witnessing a loved one go through it.

And again, from a very young age, I saw my dad go through it. I saw my mom mm-hmm. Support him. And Kristen, we can certainly talk about [00:20:00] caregivers and the vital role you play, but I think that’s the difference. I think once you’re confronted with your own mortality, it quickly moves from some abstraction in like a future you problem where you’re gonna be in a retirement home five decades from now to something like, wow, this is, this is a clear and present danger to me and my family and I have to face.


Will: I, I, you know, spent a lot of time processing. My mortality and my, you know, at times tenuous mortality, it seems, uh, through, through humor, through jokes. Uh, I’ve, no, I’ve noticed Will, I’ve noticed this. You’ve noticed if you’ve noticed that, if you could tell. Um, but whenever I woke up in the ICU after my cardiac arrest, I, um, pretty much immediately started tweeting and talking about it.

Uh, which I was very, I’ve been very proud of myself for quite a while. And then, uh, that, that I was able to do that. Mm-hmm. Uh, but then I learned that you actually live tweeted through your Whipple surgery, [00:21:00] which made my accomplishments, uh, not, not seem quite as impressive. 

Kristin: Well, I feel like there’s a caveat coming here.

What. Mark, you go ahead. Well, I didn’t break it. Break it to 

Dr. Mark Lewis: him gently. Yes. Well, I think the caveat might be the, the other people were tweeting for me that may be the most important. But Kristen, I’m glad you’re clarifying because if I had it to do over again, you’re supposed to like, come on, 

Will: you’re supposed to like, let people think maybe he was able to life tweet through his own surgery.

I mean, come on. 

Dr. Mark Lewis: What people thought. So I, the, the biggest mistake I made and, and I have a wonderful social media team here and I’m happy to tell you like how it all went behind the scenes, but basically I gave them control. Of my Twitter account and maybe like the one time in my life I’ve seated control of that to someone else.

And I had friends around the country who were using this to follow my surgery. So again, people that care about me, who I know and they thought this is true, this is true. Kristen, some of my non-medical friends thought that they were waking me up from general anesthesia. Oh my gosh. Sort of like tweet me, like comment on what was going on, uh, [00:22:00] tweeting and then putting you back to sleep.

And I’m like, listen, know I dopamine addiction. It’s not quite that bad. Alright. You can just, you can put me out and someone else can do it. But no, it was a remarkable experience and you know, from my wife, I mean, again, exceptional circumstances, but that’s how she got updates on this. Yep. Surgery, which took six and a half hours.

The surgeon didn’t have to come outta the operating room and be like, Hey listen, this is how your husband’s doing. Surreal for her as it was, she was getting live updates just like everyone else. And, you know, 99% of the feedback we got that day was, was wonderful and positive. And I woke up from surgery, I thought I was hallucinating.

I was looking at my phone, there was all these like notifications from people I’ve never met. There was like 3 million, oh my gosh. Messages or something. It was, it was unbelievable. And um, and, and the fact that, you know, we did it that way was obviously very exhibitionist. But the reason I did it, if I can be very serious for a second.

Yeah. So the surgery I had is the only chance of cure for most, uh, patients with pancreas cancer. And in my clinic, if I [00:23:00] can get my patients sort of team effort, if I can get ’em to the point where they are candidates for the surgery I had, that is something to be celebrated. And yet I cannot tell you how many of them are afraid of the operation.

This surgery mm-hmm. Is really complicated. The other reason I tweeted it, if I’m honest, is I wanted to see how it was done. Like I wanted to kinda a step-by-step, because what it does is it completely rearranges. The anatomy of your upper gut and so much so the way I’ve described it is the surgeon does to your abdomen what Picasso did to faces, like takes, takes the parts that you could recognize and then like rearranges them and then when you’re done, you’re like, oh yeah, I can kind of see like a, a liver here.

Yeah. And part of a cubist. 

Kristin: Yeah. 

Dr. Mark Lewis: Track a cubist gesture. Thank you Christy. Yes. And so I, I, I’m a big believer that things are less scary if they are illuminated. I think monstrous are less frightening in the dark. And I thought if I wake up from this and I honestly did not do it for clout, it’s the worst [00:24:00] reason to possibly have Whipple surgeries for cloud.

Yeah. Don’t, don’t try this at much easier ways to get cloud. Don’t do that. Yeah, exactly. Um, I thought if, if I can convince one person that the Whipple operation is um, right for them mm-hmm. Then this was all worthwhile. And, and, and it has been, it’s been a remarkable tool. I use it in clinic. I use it as an example of, Not, you know, look at me and I got through it, but this is, these are the steps that you would need to go through and really kinda lets the patient have open eyes as to the complexity of the surgery, its recovery.

I was also very, uh, forthcoming about the fact that it was not a straight linear road to recovery. It was actually extremely bumpy. Um, I couldn’t eat for five weeks. I was fed through an iv. I had a tube in my nose. Um, and again, it opened my eyes to all these outcomes of what we do as doctors that aren’t that easily captured in labs and scans the actual patient experience and the caregiver experience.[00:25:00] 

My wife, Kristin, you’ll appreciate this. I woke up one morning after my surgery and it was extremely romantic. I was vomiting bile. Okay. Ooh, yes. 

Kristin: And just, just what you wanna wake up to in the morning. 

Dr. Mark Lewis: Yeah, I know. You know, I bet When, when you took your vows in sickness and in health and when I took my vows and sickness in health.

Yeah. This is not exactly what you envisioned right now. Vomiting bile 

Will: was you’re vomiting bowel. Yeah. 

Dr. Mark Lewis: Yeah. But my wife’s a doctor, and specifically she’s a pediatrician, and she looks at me and she said, listen, you have two options. She said, number one, we can go back to the emergency room and you know what they’re gonna do, or, or you can let me handle it here at bedside.

Mm-hmm. And, and I, I knew what she meant. So what I needed at that point was I needed a tube reinserted. Down my nose to my stomach to, to drain out all that lovely bile. Would you let me do 

Will: that for you? An NG tube. An NG tube, that’s right. Um, I, that’s one of those things along with a fully catheter that I’m terrified having, having put in several of those and of each of those, [00:26:00] I, that’s, it’s just something I never want done to me.

Mm-hmm. But I understand that it’s necessary. So, so, 

Dr. Mark Lewis: so, so for both of, you’ll appreciate this so well, I agree. I didn’t really want it either, but I also really didn’t wanna go back to the hospital and I, I love and trust my wife, so, and you 

Will: wanted to stop vomiting bile, so 

Dr. Mark Lewis: this is true. Yes. That was kind of priority number one.

Um, and so I was like, sure honey, go right ahead. And, uh, this is the best part. So we had it in, in, in GTU, because of course we do, we’re a two physician couple and, um Oh, oh, you had it in your house? Yeah. I just, you know, handy medicine cabinet 

Will: does 

Kristin: got Agich in here. Yes. All 

Dr. Mark Lewis: speculums all kinds of stuff.

Yeah. Um, so she’s threading this tube. Into my nose. Now remember, she’s a pediatrician, right? So she’s different. She’s used to a slightly different caliber of nostril. So she’s, she works, she, she, she’s putting it into my nose and she goes, mark, your nostrils are huge. And, uh, you know, at the time, you know, I’m still vomiting the bile, but I’ve been trying to laugh at the same time.

And anyway, it’s all relative. So bottom line is, oh my goodness, my wife saved me. [00:27:00] Two went down. And, but, but again, these are the parts of the, I kind of don’t like the word journey cuz it implies this was some sort of voluntary trip. Yeah, we signed up for farthest thing from it. But these are parts of the experience that, and will, I know you know this un until you go through it yourself.

Yeah. You can be the best, most well-read doctor in the world. You can know your journalists, you can know your textbooks. It’s just not the same. The, the analogy I use is, it’s the difference between a bird and a pilot. Okay? A pilot understands lift and yaw and pitch and all these principles of how it’s actually working.

The bird doesn’t have to think because the bird has a visceral understanding mm-hmm. Of how their wings work. It’s the same with us. Like you and I got a completely separate and arguably more important education being patients ourselves than I would argue that we got in, you know, the finest medical school or training program.


Will: Uh, but I, I’m still kind of stuck on this cell, uh, like home MG tube thing. Um, so, [00:28:00] so, but there’s gotta be suction associated with it. 

Dr. Mark Lewis: Ah, yes. So yes, we didn’t, we’re not, we’re not so hardcore that we have in wall suction at 

Will: all. Like what on earth did you attach it to? Yes, 

Dr. Mark Lewis: we had, we had a bag and we used to, we used gravity.

Kristin: Did you have one of those, uh, baby things where you, what is that called? Do you remember those? Oh, the, 

Will: the, the thing that you sucked the stuff out of. 

Kristin: Yeah. Where you have to clear their nose and you stick a tube up there and then there’s a filter. 

Dr. Mark Lewis: Yeah, yeah. Bulb as well. Yeah. Yeah, yeah. Yeah. It was a very lovely, and I’m giving you a very skewed view of our marriage cuz it’s, honestly, it’s, it’s usually lovely and wonderful.

But I, it was, it was such a, I I 

Will: think, I mean, of course it’s lovely and wonderful. You, you’re able to, you’re willing to put in g tubes in, in each other’s 

Kristin: noses rights. I’m sure it says something about where you’re, you’re starting from, I don’t know 

Will: if you could do that for me. I’d 

Kristin: do it if I had to. I mean, as with most things, I will do it if I have to.


Will: actually not, if I go, it’s so hard to, to put in, I, I remember that. Um, 

Dr. Mark Lewis: what, what Christian, I think you’ve earned lifetime [00:29:00] credit for. That’s true. Successful, out of hospital CPR without breaking any ribs. I think like you’re, you’re good on a bed. I 

Will: need to stop. Don’t I need to start giving you more credit?

That’s right. 

Kristin: Absolutely. I’m good in a pinch. I, I mean, if I don’t ha, if I’m not in a pinch and I don’t have to do it, oh, I’m not stupid. I’m not, I’m not gonna do it. In that case, 

Will: So the other thing I wanted to follow up with though on this, this, which is an incredible story, um, is who exactly was tweeting for you?

So is obviously it was people in the operating room Yes. I assume, right? Yes. So did you enlist like a bunch of like students and residents and nurses and, well, I, 

Dr. Mark Lewis: I’ll tell you, there’s a little bit backstory here too, which is that I had had a, uh, surgery several years prior during my training. Uh, so I was doing my fellowship at the Mayo Clinic.

That’s where, you know, as you do, I diagnose myself with cancer. Yeah. Uh, and I was having my first surgery, which was on my neck. And the, the endocrine surgeon who, who does this part. And as much as I love my wife and trust her skills, e [00:30:00] even, I wouldn’t trust her to do this part of my mm-hmm. Uh, my care. So this guy was cutting open my neck.

And, uh, and he said, listen, this came across almost like a pickup line. He’s like, listen, your, your, your, your glands are huge. And I was like, thank you. Okay, great glands. I said, um, yeah, great glances. He said, I’d like to make a training video. You can see where the seed is being planted here. He said, I’d like to, I’d like to make a training video for my fellows, because they won’t often get to operate on someone that has the parathyroid glands that you do.

So anyway, bottom line Will, this was on Vhsc, like top 

Will: 1% of parathyroid glands. You’re just thrill. 

Kristin: That’s right. Did you out for dinner and a glass of wine afterward, you 

Dr. Mark Lewis: knows. Very charming. And, uh, and this video that got produced was absolutely fascinating to me. And, and he gave me a copy, like on vhs and I watched it with like morbid curiosity.

And it was just, it was so interesting, and I realized, you know, if this is an educational resource for his fellows, you know, fast forward to where social media is becoming a little bit more [00:31:00] mainstream. Said, maybe there’s a way we could do this when I go through my bigger surgery, which is on my pancreas, and it could be more of a public audience.

So to answer your question, well, uh, this is where I have to give due credit to my employer. So my employer is Intermountain Health. They have a very forward-thinking social media department. Clearly because with about a week, yeah, with about a week’s notice. Um, they, and my surgeon, and this was the key part, came to an agreement when my surgeon told me, and I, I, I’m actually curious to know if this is your mindset when you’re in the or.

He said, listen, I don’t care what is going on in the rest of the world when I am operating. I am laser focused on the field. And he, and he said, and I, I needed his permission clearly. He said, I don’t care if you bring in cameramen and people who are gonna tweet. It doesn’t affect my concentration. I was like, well, that’s all I needed to hear.

And so it was this whole team of professionals and, and again, the fact that a major hospital system Yeah. Was willing to do this Yes. Actually taught me a lot about the legitimization of docs using social [00:32:00] media. Admittedly, not everyone uses it the way you and I do. Right. Um, and, and I I think it’s important that you be authentic and have your own identity, but I, I found that quite legitimizing That was 2017.

Will: Wow. That was, yeah. That’s incredible. That’s, and I, I totally agree, but you know, with my surgeries, I only have to focus, have laser focus for seven minutes at a time. So, you know, we’re talking a six, seven hour surgery. Uh, yeah. But that’s, ah, man, that’s pretty intense. That’s incredible. Yeah. Yeah. Well, let’s take a quick break and be right back with Dr.

Mark Lewis.

Hey, Kristen. I have a PSA for you and all of our listeners from our friends from Tarsis. Let’s hear it. You know how sometimes you can get red, itchy, irritated eyelids? Okay. Well, do you know what that might be? What. Eyelid mites. No. Yeah, it’s true. No, it’s a disease that’s called dex blepharitis. That’s disgusting.

It’s pretty common. That’s horrifying. So if you have itchy, red, irritated eyelids, go talk to your [00:33:00] eye doctor. They can take a look at you, tell you if you’re not alone. That’s right. But don’t freak out. Just get checked out. All right. To find out more, go to eyelid check.com. Again, that’s eyelid check.com to get more information about Demodex blepharitis.

All right, we are back with Dr. Mark Lewis. Uh, mark. So there’s a lot that I don’t know about the world of oncology and. Um, one thing I, I am aware of and, and mainly it’s through my of research and the videos I’ve put together regarding the US healthcare system and the, the exorbitant costs of everything.

And one thing that always comes up whenever I’m trying to like, put together all this dialogue between, you know, JIMY and, and UnitedHealthcare is like the cost of prescription medications, right? And, um, it’s probably no surprise to anybody listening, maybe [00:34:00] it is, but Oncology care has some of the highest, most expensive treatments, medications, chemotherapy that’s out there.

Um, is this, is this a before I I get into kind of the little, the little thing we’re gonna do here. Um, Is this a, a source of frustration for oncologists? I imagine it is, uh, because you have to talk about these things with patients and, and the very expensive kind of cancer care that, that they often have 

Dr. Mark Lewis: to have.

Yeah. It’s, it’s a frustration. Well, and, and more than that, it’s a, it’s a concern because financial toxicity is such a real, and even now under captured outcome of what we do. Like literally when I’m sitting down with someone, now, not only do I have to think about, okay, how do I help this person with their cancer?

It’s like, how do I make this affordable to sustain them? Because it’s double jeopardy, right? Like in this country, for the most part, people’s [00:35:00] healthcare coverage is tied to their jobs. And you get these people Yeah. Who almost always through no fault of their own get diagnosed with a serious illness in a, my clinic, you know, by definition has cancer.

So now they’re worried about keeping their insurance and juggling all the rigors of this diagnosis and its treatment. So I, you more than anyone else, I think, have, have kind of cast in a sharp belief that the true injustices and, and sort of unbelievable, um, sort of leaps of logic that the system entails.

And you basically got this collision between what I call the practice of medicine, which is what I do and the business of healthcare, which is what you rightly satirize. So, yes. Long, long as your question is, there are some medicines in oncology that are so ludicrously expensive that it actually gives you pause Yeah.

Before you prescribe them. I’ll tell you a true example. When I was in fellowship, There was actually an oncology drug that was so expensive. There was a single physician at the Mayo Clinic who was allowed to prescribe it. [00:36:00] Like, unless you were this one doctor, nobody else could actually click. Wow. Yes. So to really kind of, yeah, put a number on it.

A single vial of this drug was $300,000. Oh my gosh. And I actually remember thinking, it’s good that they’ve got this system because one errand click on my mouse and I’m gonna be doing my indentured servitude here the rest of my life. Like, I’m never gonna be able to pay this off. So, um, that’s how ludicrous, uh, it’s gotten.

Will: So, so I wanna talk about some of the, the cost of some of these. So I went on. Uh, what I could find GoodRx for some of them. Yes. Uh, drugs.com. Yeah. I don’t know. Just googling around, you know, press releases because everybody loves talking about the price of some of these medications. Yeah. Um, so I’m gonna give you a, a medication and you just have, I just want you to guess in, in US dollars, um, uh, how much, how much it costs.

Okay. Some of these will, you know, have been around for a while. Some of these are new. Okay. All right. We’re gonna start at methotrexate. Ah, for like a 30 day supply. How much do you think that is? [00:37:00] Gosh. 

Kristin: Um, but you have to tell me what retail, what kind are these all like these are all 

Will: chemotherapy. Okay.

Medications. They, a lot of them have multiple uses. Okay. It’s not just cancer, but they are, they are, there’s different classes of chemotherapy. Okay. Drugs. But, um, this is would be one of them. 

Dr. Mark Lewis: Okay. Okay. Um, Can I just ask, is this prices right rules? Like do I get going over or, 

Will: uh, no, you just, I just, uh, ballpark.

Okay. Just 

Dr. Mark Lewis: ballpark. I actually don’t use methotrexate in my practice anymore, but I, if I had to guess, I would think a 30 day supply would probably cost you in, I would hope somewhere, maybe around a thousand low thousands is what I’m guessing. It’s 

Will: actually much cheaper than that. Oh, wow. Metho methotrexate is, is quite cheap.

About a hundred bucks, no. Hundred bucks Norex. Perfect. No, please. There you go. I 

Kristin: mean, it’s, no, that is not medical advice, but it’s, 

Will: it’s been around a 

Dr. Mark Lewis: while. It’s been around a while. My legal team is telling me that I must strike that from the record. Yeah, 

Will: yeah, yeah. All right. How about, uh, How about, and some of, I’m sorry.

Some of these probably you don’t, you don’t use frequently, but, um, [00:38:00] Tamoxifen, 

Dr. Mark Lewis: ah, oh, I actually, I used to use Tamoxifen quite a bit. Um, I, for a 30 day supply, well, I think probably in the hundreds of dollars, I would guess. Yeah, about 

Will: a hundred bucks. Okay, so its similar to methotrexate. Is this pre or post 

Kristin: insurance?

No, this is, this is just like 

Will: sticker price. This is just like, you don’t have insurance, you go into the pharmacy and some of these are, you can get it at the pharmacy. Some are, are not available. Um, how about cyclophosphamide? Oh, uh, so this is, this is one. Uh, do you still, I mean that’s like a, is that still used?

Oh yeah. 

Dr. Mark Lewis: Often. Definitely still used. Yeah. Yeah. Okay. Um, again, it’s, uh, it’s an oldie, but in the right setting, a bit of a goodie. I think we’re probably still in the couple hundred dollars range. 

Will: Yeah. 3, 300, 400 bucks. Okay. All right. Um, how about, here’s one that I’ve been seeing a lot of commercials about.

Ah, key Keytruda. Yes. Keytruda. What is Keytruda? What is that 

Dr. Mark Lewis: used for? Okay, so Keytruda by another name is Pembrolizumab, and so that suffix anytime. So anytime an oncologist sort of vomits syllables at you, the most important syllable [00:39:00] is the last one. So the suffix tells you a lot says suffix, mab, that means monoclonal antibody.

And to give it it’s fair due Keytruda is one of these new immunotherapy drugs and it’s most famous use or success until very recently has been Jimmy Carter. So President Carter, unfortunately, I think is now in hospice care, but that man has been alive for I think six, seven years with a metastatic melanoma that went to his liver in his brain in his nineties.

And so this drug, pembrolizumab or Keytruda. It’s an intravenous immunotherapy that actually teaches your body, Hey, this cancer is not you. This is not self, this is something foreign that needs to be attacked like an infection. So, long story short, very famous drug, there’s no, uh, surprise you’ve seen on television.

Um, but when now we’re rapidly escalating costs and, um, I think we’re probably into the tens of thousands, I, I usually would tell someone that for a full course of Keytruda and we could talk about how long that is. I mean, now we’re into the hundreds of thousands, [00:40:00] so, but a 30 day supply I think would probably run you, I don’t know, 30, 40, something like 

Will: that actually in the tens of, so about, uh, 15,000 per month.

Yeah. The bargain basement. Let’s go. Go. Not too bad, right? Alright, here’s another one. Uh, Gar Zumab. 

Dr. Mark Lewis: Excuse me. 

Will: Yeah. Yeah. Gar Garci. 

Dr. Mark Lewis: Garci. Okay. I’m actually not familiar with that one. Will, you’re educating. 

Will: That’s because I made it up. Yes. All right. That’s because I made it up. Yeah, that’s very tricky.

Dr. Mark Lewis: Changing the 

Will: rules. Yes. Yeah. Okay. And then at this point, and my research, I was like, look, these numbers are getting very big, so let’s just look at like the most expensive Yes. Chemotherapeutic drugs out there. Can you guess? Some of the, some of the, oh, just no, the names of some of the more expensive, the most expensive ones out there.

Well, the 

Dr. Mark Lewis: one I was mentioning earlier, albeit not by name, was the one at Mayo that required essentially this, uh, unbelievable, complicated system of ordering. So it was, eculizumab is a, [00:41:00] uh, monoclonal antibody used in paroxysmal and nocturnal hemoglobin area, all of which just rolls off its tongue. And that was, that was 300 K per vial.

Um, so I’m guessing whatever drug you’ve come up with probably ends in that MAB again. Um-huh. Because those are the, there may be an IB in there too, but, uh, the mAbs and ibs, the MAs and ibs. Yeah. If you, again, for your videos, those of 

Will: them are, uh, are also these, you know, brand names, right? Yeah. Because, you know, that’s, that’s what they’re marketing ’em as.

And, uh, I have to say that the most expensive one out there, um, is, uh, an ophthalmology medication. Ooh. So it’s called Chem track. You ever heard of Chem Track? No. Do tell It’s for Uveal melanoma. 

Dr. Mark Lewis: Oh, yes. Do you have its generic name by any chance? Oh, you know what, I do 

Will: not. 

Dr. Mark Lewis: Okay. I think, I think one of my colleagues, 

Will: I’m a bad doctor.

I don’t have the generic names. No, no. 

Dr. Mark Lewis: You’re, you’re the last person that anyone would accuse of being in the pocket of pharma. Well, don’t, right. So, uh, no. One of my colleagues who treats UV melanoma, I think uses that drug, but [00:42:00] they use a, a different, uh, designation for it. Yeah. I’ve heard is quite, I mean that 

Will: $81,000 per month, 81.

Dr. Mark Lewis: Thousand dollars per month. So, so I think, I think your larger point is we have to be incredibly selective in who gets these drugs and we cannot be putting the entirety or even the majority of the bill on the patient. Correct. Maybe the, the, and I realize this is taking your, your game and, and putting a very serious spin on it.

The other thing, address, that’s the point. Okay. 

Will: Good. Is less, less of a game. I rather just a way to complain about things. No, this is 

Dr. Mark Lewis: great. You’ve, um, it’s the, the Trojan horse of your comedy, you’ve gotten the message in there. Um, it’s not sustainable, it’s non-sustainable on a system level. It is absolutely non-US sustainable on a patient level.

Because short of people that are truly independently wealthy who can afford any of this, how’s anyone supposed to do 

Kristin: that? Yeah. Right. It’s just, it’s not possible. Is that how much they cost to make or is there some ridiculous markup happening? Well, um, I’m afraid 

Dr. Mark Lewis: I already know this. I 

Will: certainly wanna like recoup the, [00:43:00] their costs of making it.

I think part of the problem was also how rare the disease is. Right? Because some of these are like orphan 

Dr. Mark Lewis: drugs. Yes. As a general rule, the rare, the disease and, and here’s the thing, right? We do walk a very tricky tightrope here. We don’t want our pharmaceutical colleagues who are not, by the way, are not.

Universally bad or Agich, we literally can’t do our work without them. I, I, I have to say that quite authentically. Um, but we have to be so thoughtful about, uh, who we give this to and to your point, uh, Kristen Price point. So the company align, literally the company line that you usually hear. Is if we didn’t charge this mu much, we wouldn’t be able to reinvest in, in research and development.

Okay? Mm-hmm. But then when you actually look at where the money goes, I mean, these are for-profit companies for the most part. They have shareholders who they’re beholden to, and those people are, you know, respect expecting, you know, quarterly profits. Right. So, I hate to be so cynical in my answer, but I’m gonna tell you my, my honest, uh, feeling about this is that I do think there’s [00:44:00] considerable markup and I think it’s mm-hmm.

What is the system willing to pay and our day of reckoning is coming if it isn’t already here. Medical bankruptcy, and this is horrible to say, is the number one reason that Americans go into bankruptcy right now. Uh, it’s not home foreclosure, it’s not anything else. It’s it’s bills. And, and you know, will, I know you had your own, you know, nightmare after your cardiac arrest.

My dad, back in the late eighties, early nineties, fought a, I think a $30,000 bill. Um, and, and, and it, it pained me to watch him. Obviously I was very young at the time, but I was aware that was, it was certainly money we didn’t have. It was also energy. This man didn’t have, like, he didn’t need to be using his, his time on this.

And he was so nice and like endlessly patient with these people. And I think there was a part of him that, you know, at, at base wanted to believe that they weren’t driven by greed. That they still wanted their money and because he hadn’t played by the rules and some prior ath hadn’t gone through properly, like the patient ends up [00:45:00] on the hook.

And I hate a system that does, that puts the onus of responsibility on, on the wrong patient. And the last thing I’ll say, well before we move on, is a, a lot of cancer drugs these days are pills. And that’s particularly a problem because while it sounds more convenient, You’ll appreciate that a lot of prescription plans don’t cover pills.

I was literally on the phone with an insurer last week and they were like, Hey, uh, Dr. Lewis, uh, you prescribed X, Y, Z uh, this patient doesn’t have pill coverage, but they do have IV coverage. And I said, well, that would be great, except the medicine I wanna prescribe literally doesn’t have an IV formulation.

It’s only oral. And the patients didn’t have coverage for it. So we’re having to, you know, go and beg the drug company essentially to give it to us for free. Sure, yeah. 

Kristin: Who cares what form it comes in, just pay for the drug. Like, so I 

Will: don’t, that’s so dumb. So, you know, and some of these, I’ll just, you know, some of these chemotherapy drugs, I was, you know, the numbers are, you know, 70,000 per month, 60,000, you know, 20, 30,000.

And [00:46:00] what I kept thinking about is just from the perspective of a cancer patient. Yeah. Because, you know, We, we really tout our, develop our, our science and development and r and d that we have in, in this country that allows us to have these incredible therapeutics Yes. That, uh, can take a, uh, that we have gene therapy now that, you know, and we have an ophthalmology in other areas.

And so the fact that we have the ability to, to treat these, these, uh, fatal diseases. Um, but unfortunately the, the financial cost is so great that makes them sometimes unavailable for people. It’s, it’s really, um, and they’re 

Kristin: taking advantage of people just thinking about in such a vulnerable position because for many people, You’ll do anything right?

To anything you can do at all to keep living. 

Dr. Mark Lewis: So yeah, the, the, the fact that [00:47:00] the, that my patients starting GoFundMe for their treatment, ah, that’s not the exception. That’s nearly the rule and it breaks my heart every time. Yeah. And, and then Kristen, into your observation, one of the things that hits me, like, you know, like a, a fist every time I hear it is sometimes I’ll present to my patients their treatment options and they will forego one of these treatments that will has listed off, not because they have doubts about its effectiveness, but because they don’t want to deplete their nest egg.

They wanna leave something in their inheritance for their family. And that is just like, oh, that’s heartbreaking. It’s absolutely heartbreaking, right. To have to make that choice. Right. And usually what’ll happen is the relatives will pipe up and say, oh, don’t worry about that. We’ll be okay. But then I feel this is kind of, maybe kind of the kernel of your pressure, though.

I feel. I have to be thinking about that too and mm-hmm. You know, there’s the science part, but there’s also the, you know, sort of implementation part and, and the two have to find some sort of harmonious coexistence. All right. 

Will: [00:48:00] Let’s take, uh, one more break and we’ll come right back with Mark Lewis.

Okay, we are back and ready to look at some of our favorite medical stories that were sent in by the listeners, and we still have, uh, Dr. Mark Lewis here, uh, with us to react to these stories as well. So we have Trish. Trish, uh, says I am a radiographer in Sydney, Australia, and I’m also the educator for our department.

I really enjoy my job and one of the best parts is showing students the ropes. A few years back I had a first year radiology student on her first placement with me, and she was super keen to get stuck in round on recess, uh, resuscitation. So I’m guess she wanted to 

Kristin: see some of that. Yeah, she wanted to see some 

Dr. Mark Lewis: happening.

Will: Okay, so we get a page for a trauma call and grab the x-ray machine and head over there just as we walk into recess this area. The first thing we’re greeted with is the ed perf, uh, team performing a lateral can [00:49:00] autotomy on a severely injured patient. What’s a canmy? So it’s where, um, there’s facial trauma and you have to cut the eye.

Eyelid. Nope. Don’t 

Dr. Mark Lewis: wanna know. Release pressure, 

Will: nevermind to provide blindness. That’s what it’s my student whispers. Can I go to the lou and shuffle and shuffles off? When I caught up with her about a half hour later she apologized and sheepishly, sheepishly said, is it always like that? And I reassured her that, no, thankfully that’s not a common sight.

She was fantastic after that initial moment of terror. I She didn’t pass out though. Well, yeah, because that’s, that was a common thing that happens for people. That’s, in fact, that’s how a lot of students realize they don’t want to go in certain areas of medicine. Right. 

Kristin: Whatever makes you go vasil vagal.

Will: The, yeah, you get the Vasil vagal. But I will say a lateral can Autotomy is a, um, Challenging procedure to watch if you’ve never seen something like that. Yeah. Because people already have weird eyeball stuff. Have you ever seen a lateral can autotomy 

Dr. Mark Lewis: [00:50:00] done? Yeah. And I’m grimacing because Better you than me and my friend.

Like I, I, I, listen, I love what you do. I, I, I know I couldn’t do it. And my first reaction was absolutely Kristin, that give me, gimme the, um, the patient who’s got septic shock in the ICU any day I can manage them, but give me a lateral canmy and I’m gonna call Dr. And there’s 

Will: a lot of, it’s very vascular, the face in the eye, so you get a lot of bleeding when you do that.

Okay. So we have Jed, this is our second story. There was a guy I knew in the Navy, you know, this is gonna be a good story. Yeah. 

Kristin: Just from that beginning. Buckle 

Will: up. He had testicular cancer and had a prosthesis. The Navy is an. Interesting culture to work in. That’s what he says. And this was on a submarine, which is a unique environment, even by Navy standards, and was all male at the time.

The uniform at sea is just coveralls, which zip from the groin on up. This guy was known to occasionally unzip his coveralls, put his testicles on top of, if I [00:51:00] remember correctly, the giant steel case of the main engines, which had a big. A bit, a bit of a wide ledge around waist height and take a hammer to his fake testicle.

My gosh. For the purpose of freaking everyone out, that’s not 

Kristin: where I thought that was going. I thought he was gonna zip them up, but he took it to a whole different level. 

Will: This is a little Navy prank, crushing your fake testicle with a hammer, you know? Not a bad prank, to be honest. Yeah. 

Kristin: Yeah. Here go. It’s, he 

Will: says it worked.

If you’re gonna have testing, I, I you’re have any kind of cancer, you, you know, having fun with it, I think is always something that’s right. That, that we should support. She’s silver 

Dr. Mark Lewis: lining. I’m feeling so short changed. I only have half a pancreas. I can’t pull any pranks. Like I have to go. Oh, no. Multiple jokes.

Will: That’s, uh, sound Grapes. Grapes, yeah. Brainstorm something for you. Okay. Maybe that’ll be the, the, the game next time is come up with, with cancer pranks. Yes. All right. Uh, well thank you for those stories. You can send us yours, knock, knock [00:52:00] high@humancontent.com. Mark, thank you so much for joining us. It’s always a pleasure to talk with you and, uh, um, do you have something you wanna promote?

I, I, in fact, I would love to promote this as well. Um, March. Is, uh, colon cancer Awareness month, right? Yes. Yes. So we’re recording this now. It’s in March. This will ha go out in in May, but, uh, I want you to just let everyone know what, what should they know? What should the general public know about colon cancer?

Oh, you’re 

Dr. Mark Lewis: very kind of, let me do this and thank you for, um, sharing your platform. So we know that colon cancer is shifting earlier in age of onset, and again, this is something no one really likes to think about or talk about, but just in the last couple years, the guideline for when people should start screening the colon is not 50 anymore, it’s 45.

So my message is if you are 45 years old, it is very reasonable to talk to your doctor about what’s the best way of doing this. And there’s really two approaches, one of which is colonoscopy, which everyone is familiar with. The [00:53:00] fact that requires prep. You have to clean the colon before you can see the colon.

That said, once the prep is happened, the easy part actually, relatively speaking, is a doctor using a camera. A flexible camera to look at your colon. And it’s two for one. I like to say it’s not just screening, it’s prevention. Because if the doctor finds a polyp, they remove the polyp. And there’s very few tests of medicine that are quite so efficient in identifying and then getting rid of your issue.

The other way you can do it, and I know this is lovely to talk about, but I have a feeling this is the right podcast to do it, is to test your stool. So these days we have some pretty sophisticated home tests. So will, you’ll remember that one of the more, uh, glamorous parts of medical training mm-hmm. Is you and I probably had to do plenty of, uh, digital rectal exams.

We had to put Yes fingers in people’s rectums. Turns out that’s actually somewhat traumatic in every sense of the word. Yes. And what I mean by that actually is it has the potential to introduce even microscopic amounts of blood, just that, that digital trauma. Oh, gotcha. So we don’t actually encourage testing that way as a routine anymore.

The better way of doing it, and it [00:54:00] sounds so weird at first, is to provide the patient with a home kit, which they complete and the privacy of their own bathroom, and they mail off. Now here’s the key. If that kit comes back showing blood or showing, uh, we’re actually sophisticated enough now, we can sometimes find pre-cancerous DNA in stool.

Mm-hmm. That then essentially requires a follow-up colonoscopy. It’s an incomplete screen. If we see there’s something wrong in the stool, we’re not just gonna say, okay, come back in 10 years. In fact, stool testing is annual, but the, the positive stool test has to be followed up with a colonoscopy. So thank you so much for letting me Yeah.

Talk about this. And, and I’ll say the, the, maybe the last word is this is all about screening. It’s a completely different story. If you have symptoms, and again, no one wants to talk about this, right. Um, but if you’re having blood in your stool, it’s very easy to be like, oh, that must be hemorrhoids. It’s nothing to worry about.

But unfortunately it’s not always quite that straightforward, so it’s definitely worth bringing to the attention of your doctor. Um, for all the jokes that we [00:55:00] make, um, you know, we will treat your encounter with complete confidentiality, um, and make sure that you’re well taken care of. And so, uh, this is an important time to talk about colon cancer awareness is no longer for people.

50 and up. It’s actually for 45. 45. Yeah. Okay. 

Will: No, that’s not too far 

Kristin: off. I know I’m getting 

Will: uncomfortably close. Uh, you know what, I’m gonna get my colonoscopy and you’re gonna life tweet it. Okay. Deal. 

Dr. Mark Lewis: That’s what I literally have the same deal with my wife. That’s 

Will: fantastic. Yeah, because I’m getting that sweet, sweet propofol.

Um, um, I’m gonna be out and you’re gonna be watching my colon kach on a, a tiny, and I’m gonna be telling everybody about it. Yep, that’s right. Well, mark, again, thanks so much for, for, for being with us and, uh, It’s always pleasure, pleasure to talk to you. 

Dr. Mark Lewis: Listen, you guys, I, I know it seems like I’m paying you lip service cuz I’m on your podcast.

Thank you legitimately for what you do for, uh, will, for you for humanizing doctors because, you know, I shared that Google search earlier, it’s actually terrifying to me that there are people out there [00:56:00] with a serious illness like cancer who are almost as afraid of the physician as they are of the disease.

And I realize that you have a tremendous amount of, uh, you know, talent that goes into your craft. But I want you to know that one of the real world impacts, I really mean this, is you are helping to, uh, not under minor image, but soften our image. And that means the world to me as a medical professional.

So for me to you, thank you. Appreciate it. And, uh, Kristen, for you, um, you know, I saw my wife and frankly my mother, um, sometimes with the best intention, doctors almost get sidelined. Like, you know, focus understandably at the time was on me or my father. But that can’t happen at the expense of completely forgetting about the caregiver.

And I’m not saying anyone out there listening to this has to be, you know, performing medical procedures on their loved one at home. My wife is an exception, as are you, uh, with Will. Um, but no thank you for what you’ve done because, you know, I, I’ve tweeted about this, I’ll say it now. On your platform, [00:57:00] COVID was a case of, you know, not realizing what you’ve got till what’s gone.

And during the really scary times of near quarantine where my patients, when they were in the hospital, they were not allowed to have visitors. Yeah. I realized not only are they isolated, I can’t do my job as well. Like the, the patient’s friends and family are their therapeutic allies. And yes, you may not have a formal place in the medical record the way that the patient does, but we cannot forget about you guys.

And in fact, we owe you a tremendous debt of gratitude. So again, from the bottom of my heart, um, thank you for what you’ve done. I am a huge believer, as you know, of the co survivor. Sort of movement and the attention you brought to that. Thank you. And again, I, I know this is kind of a turning into a love fest, but it’s one that comments are in the most, um, genuine of places.

So thank you guys both. Oh, thank you. Appreciate 

Will: that. Thank you. And people can find you on Twitter. Um, and what’s your, what’s your handle? 

Dr. Mark Lewis: Oh, it’s extremely creative. It’s at Mark Lewis md. There you go. 

Will: Easy to remember. Yep. That’s good. Exactly. And thank you. [00:58:00] And, um, uh, you also are working on a memoir.

Understand. Oh 

Dr. Mark Lewis: man. I am actually both terrified and, and actually really glad that you asked me this, because, because now you have to do it. No, it’s puppet. So everyone that walks to my office, I’ll even, I’m turn my camera for a second. I’ve got this like beautiful mind situation going on where I’ve been scrolling notes on this whiteboard for like a couple years and people literally think I’m having some sort of, you know, nervous breakdown.

They’re like, are you okay? And I’m trying to turn this mess, which is in my own illegible handwriting by the way. Trying turn this into a book. And I’m so inspired by, uh, people that have written medical memoirs. I’m inspired by my dad. He wrote one Yeah. Mm-hmm. When he was dealing with cancer. And so I better get pen to paper and finish mine.

So thank you for, thank you for seeing And what’s this called? So his is actually a theology book called The Tween Cross and Resurrection. It’s a, his enormous credit. He spends about 10 pages out, 450 something talking about himself cuz he didn’t wanna be the center of attention, but the fact that he wrote it on a typewriter lady night after chemo sessions [00:59:00] was like that to me is my fuel.

Yeah. And uh, and so thank you for saying that. And now will, I gotta finish the book, so thank you. There you go. All 

Will: right. Yeah. Well thanks again, mark. Thanks. Bye. Appreciate it.

Well, that’s our episode 

Kristin: for today. Yes. Dr. Lewis, he is such a good human being and does a lot of really good things in his practice. 

Will: And we didn’t, we didn’t mention this, but, but my, my mom has been going through cancer treatment. Mm-hmm. And I’ve talked about this on social media a little bit. And, uh, she’s now friends with Mark.

Yes. And, and they, they’ve been talking with each other. He’s just a, a just a fantastic person and uh, yeah. Really is, helped out our family quite a bit. So, um, definitely check him out on social media. 

Kristin: Well, and we were just telling our producer that your mom and his mom are now pen pals too. They are through all of this.

They are just really adorable. She, your mom lives in Houston and his mom lives in Scotland. So it’s a, it’s a long distance relationship. And 

Will: my mom’s got a very, uh, [01:00:00] quite thick, uh, Texan accent. Yes. So, and so 

Kristin: the between the must be interesting 

Will: between the Texan accent and the Scottish. Right. So that’s, that’s probably a fun, probably no one understands them.

Like maybe for a future episode we just get the two of them to talk to each other for a 

Kristin: while. Yeah. Bonus episode. That would be hilarious. 

Will: Well, uh, thank you all also for these stories, for your own stories and, um, and let us know what you thought of the episode and what areas of medicine do you like to hear about because, uh, you know, I wanna try to hit up every part of medicine and yeah.

Have different doctors from different specialties. And, uh, so let us know what, what you’re looking for, what you, what you like hearing, um, or what we haven’t touched on that you want to hear more of. Yeah, there’s lots of ways to hit us up. Uh, email us, knock knock high human content.com. Uh, we’re on social media, pretty much everything.

Instagram, TikTok, uh, Twitter, YouTube. Uh, you can also hang out with our Human Content Podcast family on Instagram and TikTok at Human Content Pods. Shout out to all the [01:01:00] great listeners leaving awesome feedback for us. All the reviews. We love it. If you subscribe and comment on your favorite podcasting app, we’re on YouTube.

We can give you a shout out like SPR on YouTube said, it’s so cool that Lady Glock and Flecks Grandpa invented the baby vacuum. The baby vacuum, the disposable. We don’t want to get, give credit to the 

Kristin: Yeah, I think there’s probably a more technical term for it. It’s the vacuum extractor. The vacuum. That’s what it’s, that’s 

Will: what it’s called.

A type of vacuum extractor. Yes. But yes, baby vacuum works. Yeah. Yeah, 

Kristin: right. He invented a, a specific, we don’t have to get into that, but yes, it is so cool. 

Will: And Spring says, Uh, I had a vacuum assisted delivery just one month ago, and while my baby still had, has a knot on his head, I am grateful that we were able to avoid a forceps or cesarean delivery.

Thanks, grandpa. Yeah, thanks grandpa. Full episodes of this podcast are up on YouTube, my YouTube channel at d Glock Flecking. We also have a Paton, lots of cool perks, bonus episodes or react to things, [01:02:00] medical shows, movies, hang out with other members of this community. We’re active there, uh, posting, uh, videos and, and comments and, and all the things.

Uh, and we have early ad-free episode access for you. Interactive q and a livestream events, a lot more. patreon.com/glock flein or go to glock flein.com. Speaking of Patreon, community Perks, new members, shout out to Leah D. Thank you Leah. Welcome. Also, shout out to the Jonathans as always, Patrick Lucia, C Sharon, S Omer, Edward, K Steven, G Robox, Jonathan f Marion W, Mr.

Granddaddy Caitlin, C Brianna, L Dr. J Chav W Jonathan A and Leah d Patreon, roulette Time. This is, uh, where we give a shout out to somebody in the emergency medicine tier of Patreon. So our general, please. 

Kristin: I can’t do it. You just try it. I wanna hear it. No, I have, I got dental work done recently. 

Will: Shout out to Chris M [01:03:00] for being a patron.

And shout out to Kristen’s dentist. We are your host Will and Kristen Flannery, the Glock Flecks. Special thanks to our guests today, Dr. Mark Lewis. Our executive producers are Will Flannery, Kristin Flannery, Aron Korney, Rob Goldman, and Shahnti Brooke, editor and engineers, Jason Porto. And our music is by Omer Ben-Zvi.

To learn about our Knock-Knock highs program disclaimer, ethics, policy submission verification, and licensing, terms of HIPAA release terms, you can go to glock clicking.com or reach out to us at Glock or knock knock high@humancontent.com with any questions, concerns, fears, hopes, dreams, or medical puns.

Knock-knock high is a human content production,

Dr. Mark Lewis: knock,

Will: knock.[01:04:00]