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As questões 31 a 46 referem-se ao Texto I.

Texto I

A Diagnosis Update: A Young Woman’s Extreme Muscle Pain Persists

By Lisa Sanders, M.d.

1. In April, I shared the story of Angel, a 23-year-old woman who for nine years has suffered from repeated episodes of
2. extreme muscle pain and injury. Although she has been hospitalized nearly 30 times and has seen numerous doctors,
3. no one understands why this is happening to this otherwise-healthy young woman.
4. In an interview in the spring, Angel explained that she has had episodes of pain in her muscles for as long as she can
5. remember. As a child, she was told that they were just growing pains. But one night, at age 14, she suddenly
6. developed excruciating pain in the muscles of her leg, worse than anything she had ever experienced before. Her
7. parents rushed her to the hospital in her hometown, Las Vegas. Doctors there found that the pain was caused by the
8. destruction of her muscle fibers — something known medically as rhabdomyolysis, or rhabdo. During this episode,
9. as well as most of those that followed, her urine turned as dark as Coca-Cola, from pigments that make muscle red.
10. This pigment, along with other byproducts of the destroyed muscle, are removed from the body through the kidneys,
11. a process that can damage these essential organs.
12. There was nothing the hospital could do to stop the muscle breakdown. That process stopped on its own. But the
13. hospitalization was essential; she needed intravenous fluids to flush out these destructive pieces of broken-down
14. muscle to prevent any permanent injury to her kidneys.
15. Rhabdomyolysis is not an uncommon problem. Anything that destroys muscle tissue, like trauma or even excessive
16. exertion, can cause some degree of rhabdo. And after that initial hospitalization, she and her parents were told that it
17. was unlikely to happen again. But it did — over and over. It took several hospital admissions for her doctors to
18. acknowledge that these episodes of muscle pain may represent some underlying disease.
19. Today, Angel has had dozens of admissions to her local hospital to be treated for her repeated episodes of muscle
20. pain and rhabdomyolysis. She isn’t sure what triggers these painful crises. Sometimes it seems to be set off by
21. illness. But other times, Angel has been ill and hasn’t been crippled by subsequent muscle pain. Other times,
22. strenuous exercise might bring on the muscle pain and blackened urine. And yet she has been able to run and hike
23. and play soccer many times without that happening.
24. I told Angel’s story four months ago and asked New York Times readers to help us find the cause of these terrible
25. episodes of rhabdomyolysis. The results were amazing. Within hours, hundreds of individuals submitted their
26. thoughts on possible diagnoses for Angel. Others offered sympathy and advice on how to manage her symptoms.
27. Still others heard echoes of their own experiences in Angel’s story and wrote to share their stories and reassure
28. Angel that she was not alone. Over the next few weeks more than 2,000 suggestions came to us.
29. Many readers offered recommendations on where to look for the underlying disease process. One of the most
30. common observations was that this disorder, whatever it was, seemed to be genetic, as the first symptoms started so
31. early in life. Others suggested that Angel’s symptoms could be a reaction to her environment — either her physical
32. environment, or a food she ate or medications she was exposed to. Another popular approach was to suggest possible
33. mechanisms underlying her disorder, of which autoimmune disease was the most common suggestion. And finally, a
34. significant number of you suggested either specific diseases or classes of diseases. Of these, diseases affecting the
35. processes that provide energy to muscles, disorders known as metabolic myopathies, were the most popular.
36. Disorders caused by difficulties getting rid of the waste products of cells, including diseases like porphyria, were
37. also suggested.
38. Angel was surprised and moved by the response. She reached out to several individuals whose stories touched her.
39. She also spoke with doctors and patients who suggested diseases they knew well through professional or personal
40. experience.
41. I spoke to Angel recently, and she confessed that getting a diagnosis still seemed to her like a long shot. Until this
42. year there were so many doctors, and so few answers. But she was excited by the many strong leads the
43. crowdsourcing process brought to her. She is still following up on several with her doctors and the documentary
44. team. It has been a nerve-racking process — so many ideas, so many possible answers — but she has been buoyed
45. by the support she has had from everyone she has talked to. The results of Angel’s search and all the diagnostic
46. twists and turns will be featured in the Netflix documentaries when they air next year.
47. In the meantime, life goes on. Just weeks after her story appeared here, Angel completed her studies to become a
48. nurse. Her friends and family joined her as she received her nursing pin from Altierus College.
49. This Summer she passed the exam to get her nursing license, and she is now a nurse at Montevista Hospital in Las
50. Vegas. Being a nurse is a goal she has worked toward for years, and she is relieved and proud. She is determined that
51. the episodes of pain in her legs, arms and back will not keep her from being the nurse she has dreamed of becoming.
52. She and her boyfriend, Mac, continue to work toward having a normal life. Recently they traveled to Seattle to visit
53. friends and family. She will not allow this disease to limit her or define her. Still, she wants a diagnosis. She longs to
54. understand what’s going on in her body and, if possible, to prevent the pain and destruction of her muscles.
55. If you have any suggestions, please share them in the comments section. Let me know what you think, and see if you
56. can help Angel on her medical journey.

Available at:< https://www.nytimes.com/2018/08/10/magazine/a-diagnosis-update-a-young-womans-extreme-muscle-pain-persists.html>. Acess on: Aug. 10, 2018