Throughout most of her life, Brenda Mortensen had always been one of those people who never seemed to get sick.

In fact, she didn’t miss a day of work for 24 years—despite not putting much effort into taking care of herself.

And then it all changed.

Her first clue of trouble came when she felt a twinge of pain while working under her car.

“I felt a funny tearing in the right side of my chest and thought it was a torn muscle,” Mortensen, 69, said.

The pain, pressure and shortness of breath intensified over the next several weeks.

In January 2019, she experienced severe trouble breathing.

She headed straight to the emergency department at Spectrum Health Butterworth Hospital, where she quickly learned her troubles were much greater than a pulled muscle.

Her lung had collapsed. Fluid in her chest had made her short of breath.

And, most concerning, doctors found a tumor.

They placed a large tube into her chest, but it didn’t help much for the shortness of breath.

She soon met with interventional pulmonologist John Egan, MD, who told her he could help if she would be willing to try a different type of treatment.

Dr. Egan, along with cardiothoracic surgeon Geoffrey Lam, MD, recommended a pleuroscopy, also known as medical thoracoscopy.

It involves the insertion of a small scope between the ribs to examine and biopsy the pleural space, the area between the chest wall and lungs. At the end of the procedure, they leave a catheter in place.

“After we are done, we leave a short drain in, which isn’t connected to anything,” Dr. Egan said. “So the patient can go about their day and wear normal clothes.

“Then, two or three times a week, a family member will help the patient drain fluid into a bottle.”

Pleuroscopy, first used to treat patients with tuberculosis 100 years ago, became less widely used after the development of anti-tuberculosis medications.

The procedure has regained popularity nationally because it’s minimally invasive, safe and accurate, Dr. Egan said.

Teams at Spectrum Health reintroduced it to patients in recent years. When Mortensen underwent a pleuroscopy in 2019, she became the eighth Spectrum Health patient to undergo the procedure.

Dr. Egan and interventional pulmonologist Gustavo Cumbo-Nacheli, MD, have since performed the procedure dozens of times.

Dr. Egan credits the success to support from Dr. Lam and interventional pulmonology nurse Christine Burkhard, BSN, who helps patients with outpatient care of their pleural drains.

Genetic clues

Tissue obtained during Mortensen’s pleuroscopy revealed the diagnosis: stage 4 non-small-cell lung cancer.

Feeling quite ill and facing a grim prognosis, she retired from her job answering phones at a call center.

While she was in the hospital, oncologist Yuanbin Chen, MD, of Spectrum Health Hospitals Lung Cancer Program and Multispecialty Clinic, met Mortensen and planned to use both chemotherapy and immunotherapy until her biomarker results became available.

Fortunately, the results arrived before treatments began.

With help from the Spectrum Health Molecular Diagnostics Laboratory, Dr. Chen discovered Mortensen had an ALK mutation, a rare, genetic alteration that accounts for only about 5% of new lung patients each year.

This detailed genetic information opened the door for Dr. Chen to focus her treatment on personalized, targeted therapy—what he describes as “giving the right cancer drug to the right patient at the right time.”

“Identification of this mutation makes the cancer very, very treatable,” Dr. Chen said. “There are multiple FDA-approved cancer drugs to treat this very specific gene mutation.”

In Mortensen’s case, it came in the form of a pill, Alectinib, which she took twice take daily for a year with no noticeable side effects.

The results were remarkable. Mortensen returned to work again part-time.

But in spring 2020, her health began to turn.

She felt exhausted and suffered bloating and pain in her abdomen. A new biopsy revealed she had peritoneal carcinomatosis—her abdomen was full of cancer.

A biopsy confirmed that her original lung cancer had metastasized, or spread, to the abdomen.

She started chemotherapy with the hope of controlling the cancer while awaiting results of more molecular cancer.

It didn’t seem to work. She was declining rapidly.

“At that time, we decided to do some detective work,” Dr. Chen said.

Dr. Chen ordered quick turn-around molecular testing, called Guardant 360 liquid biopsy, which tests the blood and provides results in just seven days.

This revealed a gene mutation of her lung cancer. In short, her lung cancer had become resistant to the drug she’d been taking.

The new mutation proved even much more rare than her first type.

The good news? It could be treated with another FDA-approved, oral medication called Brigatinib, which Dr. Chen believed could be effective based on the best knowledge available.

It made all the difference.

Within a week, Mortensen had more energy and her abdominal pain disappeared.

She could finally stop taking all of those pain medications.

Her improved health has allowed Mortensen to get back to working part time again, along with enjoying hobbies of reading thrillers, sewing and taking walks with Lola, her very vocal rat terrier.

‘Miracle patient’

Dr. Chen calls Mortensen a “miracle patient.”

“It’s a beautiful and exciting story to be able to show how cancer treatment has advanced,” he said.

Throughout her illness, Mortensen has received ongoing support from Kim Mohr, BSN, RN, one of two Spectrum Health nurse navigators who walk beside lung cancer patients in their health journey.

As a nurse navigator, Mohr can help patients steer through the health care system and understand their diagnosis and treatment. She can also refer them to ample resources, everything from acupuncture to pet therapy and yoga.

Mohr and Mortensen have had face-to-face meetings, although now, due to COVID-19 restrictions, they stay in touch via phone to discuss upcoming CT scans, bi-monthly checkups and any other concerns that arise.

“She’s doing so well,” Mohr said. “The newer targeted therapies not only extend patients’ lives, they improve their quality of life. Brenda is a perfect example of this.”

Mortensen spent many years healthy and strong before her health journey took a sharp turn.

She now offers a word of caution to others: Pay attention to what your body tells you.

“If anything feels off, I don’t care what it is, go to a doctor,” she said. “I would not have been in that bad of shape if I had gone in sooner. If it doesn’t feel right, get it checked.

“I’m just one of the lucky ones,” she said. “I figure I’m good for another 10 or 15 years, maybe longer.”