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