The Unexpected Present

The Prognosis: Music Is the Best Medicine

Yuri and Pat Guadagno

We have several “Aha” moments going on in our lives. Most recently, I believe I’m onto the reason behind how and why Yuri was hit by vasculitis and the worst kind, ANCA vasculitis. If it wasn’t for an impromptu visit by Pat Guadagno, Jersey’s Own troubadour and Yuri’s longtime music compadre driving up here for a music video shoot, I wouldn’t have taken to cleaning the lower level, Yuri’s music studio. It was practically abandoned for the 18 months since the second Covid shot and the subsequent chain of life-threatening events. Thankfully, he’s out of the acute phase and working on getting back to where he was playing A-list level. All he wants to do now is get back to playing music again.

It is a rather long POV as to what probably happened. I tried to make the medical terms more understandable for me as well. During our regular cocktail hour discussions, I could put the pieces together and get the whole puzzle worked out. It’s a theory, but finally, one that makes sense to us. Here goes. Deep breath. Deep dive.

On the Causes of ANCA Vasculitis at website states that Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) and therefore ANCA Associated Vasculitis (AAV) is a group of autoimmune diseases characterized by inflammation of small blood vessels. That’s not a correct interpretation and is misleading.

According to Johns Hopkins Vasculitis Center website, the immune system normally protects the body. It becomes hyperactive in vasculitis because of some unknown stimulus, leading to inflammation within the body’s tissues. Inflammation in blood vessel walls leads to the narrowing of the vessels and the inadequate blood supply to a particular tissue or organ results in damage.

The ANCA Vasculitis News website: This inflammation is caused by white blood cells called neutrophils that erroneously attack the cells lining blood vessels. In most cases, neutrophils go haywire because patients produce self-reactive antibodies called ANCAs that attach to these immune cells and wrongly activate them. 

This is also misleading. The inflammation is not caused by white blood cells, rather it’s the result of something that starts possibly as an irritant turning into inflammation that can become a chronic illness or worse an autoimmune attack. An autoimmune attack is what we believe happened to Yuri.

The ANCA Vasculitis News website: Since small blood vessels are present nearly all over the body, AAV can cause many different symptoms. For each patient, the symptoms will depend on the organ or tissue involved. 

This is important. Yuri has one kidney (a congenital issue over 50 years ago) so his kidney was hit hard, but so were his lungs and we couldn’t figure it out until now we have a possible reason for why it happened to him and not to me.

The ANCA Vasculitis News website: Although scientists understand how AAV damages the body, the factors causing immune system malfunction are “largely unknown.”

That’s used all the time. We found that no one seems to know anything despite studies pointing to a combination of genetics and environmental factors, such as exposure to pollutants and certain drugs, as well as microbial infections.

According to study data published in Arthritis & Rheumatology and Johns Hopkins Vasculitis Center website: There are certain types of vasculitis that can be due to infection where the bacteria/virus/fungal directly invade the blood vessel wall. Other types of vasculitis may be due to an allergic-type reaction to medications or toxins. BINGO.

Drug-induced Vasculitis (DIV) vascular injury due to drugs is recognized as a distinct entity under the Chapel Hill Consensus Conference 2012 definitions for vasculitis. It may affect various types of vessels some most commonly seen in association with antibiotics and non-steroidal anti-inflammatory drugs. In recent years, more cases of DIV have attracted people’s attention. In previous cases, it has been recognized that almost all pharmacological classes of drugs are potentially associated with the development of DIV.

Microbial Infections agents, such as viruses and bacteria, Staphylococcus aureus, are found in about 70% of AAV patients. Infections are common in community-acquired and hospital-acquired settings where treatment remains challenging to manage due to the emergence of multi-drug resistant strains. Most MRSA infections occur in people who’ve been in hospitals or other healthcare settings, such as nursing homes and dialysis centers. BINGO.

ANCA vasculitis remains poorly understood, yet researchers believe that their ability to change which genes are active and to which extent is potentially what causes autoimmunity. That’s what the mRNA Pfizer vaccine does. Its spike protein spots weaknesses as potential for elimination and teaches the body to attack, sometimes itself.

Now, it doesn’t happen to everybody. It didn’t happen to me. According to friends in the medical field working in critical care, especially during the worst times of Covid surges, the vaccine saved many more people from untimely deaths than if they did not take the vaccine. Currently, there are fewer deaths in hospital and nursing home situations, so what could it be?

Seasonality — when something changes with the seasons — such as the weather or exposure to ultraviolet (UV) radiation. This past spring’s pollen counts were awful for people with allergies. We thought Yuri may have become sensitized to allergies.

Genetics – a family of genes containing information to produce proteins with a key role in the immune response. Yuri and I come from the same background, so why wasn’t I affected that way?

Pollutants – There is evidence for the role of silica — a compound present in sand, soil, and rock that stimulates inflammatory reactions — in the development of AAV. Workers involved in construction jobs are potentially exposed when handling the materials. Wood? Wood dust? What was Yuri doing more and consistently that I wasn’t? BINGO. The wood pellet stove comes to mind.

When we moved to this place on a lake surrounded by trees and experiencing extreme winter coldness from the lake effect, the absentee landlord bought the property without thought that there wasn’t adequate heat for the large open space layout built primarily for summer vacation. We were forced to buy a wood pellet stove to offset the cost of electric usage, the only energy source available. Yuri was preoccupied with the stove and pellets. He meticulously maintained it daily sometimes during the night hours and as soon as it started to get cold -from mid-October, throughout the winter extremes, and into the late spring months. The cleaning took time with an Ash Vac and he had to empty the dust out of it on a regular daily basis. I didn’t like the dust proliferation, and rarely got involved. There was no warning to wear a mask.

OSHA website: Wood dust becomes a potential health problem when wood particles from processes become airborne. Breathing these particles may cause allergic respiratory symptoms, mucosal and non-allergic respiratory symptoms, and cancer. The extent of these hazards and the associated wood types have not been clearly established but excessive amounts are considered to have an irritant effect on the eyes, nose, and throat in addition to pulmonary function impairment and are considered a human carcinogen. Western red cedar dust has also been shown to cause asthma. The health effects associated with wood dust come not only from the wood dust itself but also biological organisms such as mold and fungi which grow on the wood, and chemicals such as formaldehyde, copper naphthanate, and pentachlorophenol used in the processing of some woods.

By-products or waste material for the sawmill would cost money to dispose of until these smaller pieces are ground down to wood fiber, or in some cases, a fine powder. A pellet mill is essentially a large press that forces the wood fiber through a die to create the desired size pellets. The process involves heat and extreme pressure to force the wood fibers through the pellet-sized holes in the die to produce pellets on the opposite side. The pellets stay together due to the heat used during the manufacturing process. Some pellet manufacturers use waste lumber from industries that make wood products. Materials for making pellets hold more of a risk for introducing chemically treated wood into the process.

Wood contains a natural product called lignin, which melts under the heat produced during the pressing process. The melted lignin (a renewable material made of much the same chemical building blocks as those found in petroleum-based materials) hardens after the pressing process and acts as the binding agent to keep the pellet together and retain its shape. There’s a lot more about the chemical structure of lignin, a complex phenolic biopolymer present in plant cell walls and a by-product of the cellulose pulping industry. Ultimately, it may pose risks to human health and additional toxicological evaluations are needed.

Although severe reactions are quite uncommon, western red cedar has been reported as a sensitizer, the more we are exposed to a wood’s sawdust or other fine particles, the more sensitive we get to its exposure, and the more severe and adverse the reactions become. Most common reactions simply include eye, skin, and respiratory irritation, but can include runny nose, asthma-like symptoms, and nervous system effects.

On PubMedHealth, Hypersensitivity pneumonitis (extrinsic allergic alveolitis, EAA) is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dust. Nasopharyngeal carcinoma, basically, is a cancer of the upper area of the pharynx or “throat,” where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. A great number of woods are listed as irritants and do have the potential to do is cause allergic reactions in sensitive individuals. 

On a response to a person’s inquiry: Thanks for your feedback. We do not add any glue to our pellets in any of our manufacturing plants. Our pellet quality exceeds the PFI (Pellet Fuels Institute) requirements for a premium grade fuel and we proudly use 100% wood sawdust to make our pellets. Wood is all-natural, so there could be variation year to year depending on the wood feedstocks we’re able to source. You may be able to get a more complete burn with some adjustments to the airflow settings on your stove. -Lignetics Social Team

We only did research on the “premium quality” of this product, had been purchasing Lignetics wood pellets, and didn’t read everything on the bag including “Lignetics is not responsible for damages from improper burning of this fuel.” Guess what? There is a California Proposition 65 WARNING on the bag.

Proposition 65 requires businesses to provide warnings to Californians about significant exposures to chemicals that cause cancer, birth defects, or other reproductive harm. Exposure to these chemicals may take place when products are acquired or used. Exposure may also occur in homes, workplaces, or other environments in California. By requiring that this information be provided, Proposition 65 enables Californians to make informed decisions about their exposure to these chemicals. Proposition 65 requires California to publish a list of chemicals known to cause cancer, birth defects, or other reproductive harm published in 1987 and must be updated at least once a year. It now includes over 900 chemicals.

Finally, getting back to the last potential reasons for Yuri being hit by vasculitis. Medications. Medications are being thrust upon us by specialist doctors to put Yuri on a “maintenance program” to protect him from another attack, but these powerful chemo drugs would wreak havoc suppressing his immune system and there are no guarantees that these same treatments would not cause another AAV attack. He could get infections more easily, IMURAN may cause a serious brain infection that can lead to disability or death. Azathioprine (the active ingredient) may cause some unwanted effects. 

Another alternative offered is METHOTREXATE with listed side effects such as the inability to have or keep an erection, increased hunger or thirst, indigestion, irritation in the mouth, large, flat, blue, or purplish patches in the skin loss of sexual ability, desire, drive, or performance, loss of consciousness, night blindness. Not an option. I read that patients usually have a good prognosis if the disease-causing agent is discontinued immediately. Patients improved with discontinuation of the possible, potential culprit drug.

In essence and conclusion to this forensic investigation, and answers the question of what does Yuri have as a medical condition? He doesn’t have anything other than a deep desire to play live music again. We also decided that love is the drug of choice and Yuri making music again is the best medicine.

Lignetics bag

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