Q&A with Lewis Wexler, MD, Fogarty Institute Board Member

The strength of a board comes from the diverse experiences of its members, their passion for the mission and their ability to provide sage advice. Lewis (Lew) Wexler, MD, one of the Fogarty Institute’s inaugural members, joined the board as the organization’s mission and structure were still being formed and over the years has been a staunch ally and supporter of its educational approach.

At the age of 80, his professional involvement remains remarkable. In addition to being on the Institute’s board, he continues to be active at the Menlo Medical Clinic in the radiology department since his retirement from Stanford in 2000.

Originally from Brooklyn, N.Y., Dr. Wexler entered undergraduate school at the young age of 15 and attended Upstate Medical Center in Syracuse, N.Y., when he was only 18. He completed his residency in diagnostic radiology at Stanford University School of Medicine right before joining the U.S. Air Force with the rank of captain, spending two years as a radiologist in Turkey. He followed his military service with a fellowship in cardiovascular physiology in London.

During more than 30 years in medical education, Dr. Wexler had an illustrious tenure at Stanford, serving as chief of cardiovascular radiology, co-director of the Stanford Catheterization and Angiography Laboratories and professor of radiology. He also acted as a special assistant on health for then-Senator Dan Quayle and Congressman James R. Jones during a sabbatical leave between 1982 and 1983.

His bibliography includes an impressive collection of over 200 published articles, book chapters and abstracts on various aspects of cardiac and vascular imaging and interventions.

Throughout his career, Dr. Wexler has held many public service positions, including being an original founder of the American Heart Association (AHA) Council on Cardiovascular Radiology and the president of the North American Society of Cardiac Imaging (NASCI). He received the first Gold Medal award from NASCI in 2002 and was also named Physician Volunteer of the Year by the California affiliate of the AHA, among other distinctions.

We had the pleasure of catching up with Dr. Wexler to get his insight on the evolution of radiology and its role in healthcare, as well as hear a little more about some of the moments that have stood out during his distinguished career.

Q. How has radiology evolved since you entered the field?

When I first decided to go into this field after medical school, radiology was still “conventional,” in that we were looking at simple radiographic images, before it really evolved with the development and introduction of the first CT scans, ultrasounds and MRIs.

The idea of using a catheter to access vessels percutaneously had just been described by a Swedish radiologist, Sven-Ivar Seldinger, in what became known as the Seldinger technique. This innovative method led to the emergence of minimally invasive procedures. Radiologists were among the first to employ this technique, using the catheter to primarily access the aorta in the abdomen or chest to inject dye and provide a better view of the vessels. We analyzed which were the best dyes and film changers to use to see anatomic structures more clearly.

Further developments ensued when new film-changing devices and ciné came to market; initially they were made in Europe but then more U.S.-based companies joined the industry. Injectors and x-ray impulses had to be synchronized with radiographic exposures, a process that required technological advancements in films, shutters and screens and, ultimately, the introduction of digital techniques. The challenge wasn’t in introducing the catheter, but in getting the right angulation and positioning for optimal imaging of specific arteries.

Catheters also vastly improved. When I first started, I had to shape, flare and sterilize the catheters to fit each patient. Thankfully, they later came premade and sterilized, but they did not always fit the anatomic variations of a patient’s body – so the skills I learned early on came in handy when I had to help others mold the catheter for a specific body type.

When coronary angiography began, my team at Stanford was one of the first to perform this procedure, which then led to improvements in cardiac surgery and, ultimately, in cardiac interventions.

Q. What were the most interesting and rewarding moments in your career?

Spending two years in Turkey while I was in the Air Force was a really eye-opening experience. I learned a lot about Middle East politics, which I still follow today and it also gave me a more profound understanding of people, respect for different cultures and a stronger realization of what is truly important in life.

The time I spent in London as an advanced Fellow in the cardiovascular research unit following my years of military service was also very formative and where I discovered my interest in vascular and cardiac diseases. We studied the effects of nicotine on blood vessels at a time that cigarette smoking was not yet recognized as dangerous.

It was also very rewarding to be among the first to be part of the evolution of angiography and at the forefront of finding new techniques to achieve the best images.

But what perhaps I most enjoyed were my years of teaching. I taught cardiology and radiology fellows, and had the privilege of introducing students like Fred St Goar, Paul Yock and John Simpson to the ins and outs of coronary angiography. The idea that I could help individuals become better experts in the field and then seeing their many accomplishments over the years and the impact they have made on others and the industry is tremendously rewarding.

And lastly, I enjoyed the time I met and worked with Tom Fogarty, which was when I was specializing in vascular and cardiac imaging. We worked together to try new approaches and come up with new ideas and creative ways to take the best images for the surgeries he was performing. I was happy to join the Fogarty Institute, as I was a big proponent of the educational aspect of the program — helping entrepreneurs learn different aspects of innovation and shaping a company to eventually help advance patient care.

Q. What is your favorite piece of advice?

I often encourage radiologists to stay involved with patient care. They need to see the patient, learn about them, talk to them afterwards – that’s the approach I took when I taught the cardiology and radiology Fellows – whatever you do has to relate to the patient.

Also, it’s important to achieve a good work/life balance, which is not easy to do. There is more to life than spending it in a cath lab or to focus solely on succeeding in academics. It’s hard to do it all, but it’s important to achieve that balance and nurture the other parts of your life that matter.

Q. What are your favorite hobbies and books that inspired you?

I am a life-long learner – I still take many courses at Stanford and I am very interested in history, particularly the Classical World, Middle Eastern and Ottoman history. I am also very interested in architecture and am a member of a committee at Stanford that gives advice about the design of new buildings on campus. My wife, an artist, and I enjoy theater, opera, ballet, visiting museums and traveling. Italy is one of our favorite locations. We recently celebrated our 60th wedding anniversary.

Some of the books I read early on were Of Human Bondage, by W. Somerset Maughman and The Last Angry Man, by Gerald Green. I was very young when I went to medical school and got married, and these books were a source of inspiration to me at the time.

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