How Two Veterans Developed The Same Rare Brain Condition
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Hey shortwavers, NPR's Brain Guy and Sometimes Shortwave's substitute host is with me today. Hello, John Hamilton. Hello, Regina Barber. So you've been on the pod many times with me, also substituting for me while I was away. Thank you very much. Thank you for making fun of me.

I had a great time making fun of you. Not that I want you to go away again or anything. Of course. I mean, people can't live without me. We're going to turn things a little bit more serious, though, today, John. You're actually joining us today to follow up on an episode we did actually a few months ago, right? Right, Gina. Back in August, we talked about how some people who fired powerful weapons in the military can end up with brain damage. We talked about concussions or maybe a more serious traumatic brain injury.

And then there's this early research about arteriovenous malformations or AVMs. Yeah. Can you remind me what an AVM is? Yeah. It's this malformed tangle of veins and arteries that can cause a stroke. So usually, you know, blood from the heart travels through the arteries and then through these tiny blood vessels called capillaries before it goes back to our veins and then back to the heart. Those capillaries act as a kind of a buffer.

They take this turbulent, high-pressure blood from the arteries and they smooth it out before it reaches the veins, which really aren't made to handle all that pressure and turbulence. In an AVM, blood from the arteries goes directly back to the veins, and that can lead to a hemorrhage in the brain. That's devastating.

And you talked to a Marine named William Wilcox, right? I did. And today I want to bring you a story just about AVMs. It's with Wilcox and another Marine, both of whom had this rare condition. I talked to them both about their experiences, which have some remarkable parallels.

William Wilcox. I went to his house in Virginia. I talked to him and his wife. And then the other man, Michael Lozano, he lives in Colorado and runs the War Horse Ranch, which offers what's known as equine therapy to veterans and other people who are recovering from trauma. So today on the show, veterans and a rare brain condition called an AVM.

Well, here are John's really powerful reporting written up for our companion show, All Things Considered. It'll be told with the voices of these two veterans, William Wilcox and Michael Lozano, and one of their doctors and some researchers about whether firing heavy weapons may have caused their AVMs. I'm Regina Barber. And I'm John Hamilton. And you're listening to Shortwave, the science podcast from NPR.

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Michael Lozano and William Wilcox have a lot in common. I originally was a tow gunner. I was a tow gunner from 97. I served in two different units at Camp Lejeune. I was part of 2nd Combat Engineer Battalion at Camp Lejeune. I went to 29 Palms. Two weeks out of the year, we did 29 Palms. Each trained extensively with weapons like the tow, a missile system small enough to mount on a Humvee and potent enough to disable a tank.

Wilcox says the most intimidating weapon was a shoulder-fired rocket launcher called the SMAW. Imagine a 300-pound linebacker hitting you in the chest at full speed. Boom! It rattles your cage. Also, your brain. Gunners like Wilcox and Lozano place their heads just inches from the explosion that propels a missile or rocket from its launch tube.

The blast creates a pressure wave strong enough to kill anyone standing directly behind the weapon, and there's growing evidence that repeated exposure to these blast waves can damage the brain. Wilcox lives in southern Virginia with his wife Cynthia and their dog Leia.

His mementos from the military include a single-use launch tube about three feet long. This is actually an AT-4. It's obviously inert. Wilcox fired lots of anti-tank weapons after joining the Marines in 1992, especially during one training exercise at 29 Palms in the California desert. Our Humvees are loaded with missiles, and we go out on this mobile assault course, and we're firing them like crazy. And, you know, as young men...

It's like Fourth of July on crack. We're just loving every minute of this, never thinking in the future that some of these things could potentially impact us. The headaches began when Wilcox moved from Camp Lejeune to Quantico in Virginia. They kept getting worse even after he left the firing ranges to become a computer systems specialist. I took Excedrin basically like candy. I used to drive home during lunch every

and pop some Excedrin, take a nap or whatever, you know, just to get the headaches to go away. In 2000, Wilcox moved to the private sector. Despite the headaches, he thrived. Fast forward to 2014. Wilcox and some friends go to Penn State for homecoming. They're watching a band. Wilcox feels a headache coming on. I go out of the bar. I sit down on a bench. I put my elbows on my knees like this.

And I noticed that I'm losing control of my arms. His brain was bleeding. The cause? A tangle of abnormal blood vessels called an arteriovenous malformation, or AVM. The condition sends high-pressure blood from the arteries directly into fragile veins, which can leak or burst. Wilcox recalls an ambulance ride to a local hospital, then a helicopter ride to the medical center in Hershey.

Emergency surgery removed the AVM and probably saved his life. I spent about three weeks at Penn State Hershey, relearning how to walk, cognitive therapy. Wilcox got better, but not enough to go back to his computer job.

He has a big scar, several titanium screws in his skull, and memory lapses. I don't know if I already mentioned this. Sorry, I do have brain damage. But Wilcox says his biggest challenge is epilepsy. When I have, you know, a cluster of seizures, it's brutal. It wears me out physically, emotionally. I take a tremendous amount of medicine. For years, Wilcox did not connect his brain hemorrhage with his military service. Then a friend told him about another Marine gunner with an AVM.

Michael Lozano and his wife Valerie run the War Horse Ranch near Steamboat Springs, Colorado. It's a place for people who've experienced trauma. We have 10 horses and a donkey, so we have to have the donkey. Where's the donkey? He's out here somewhere. He's probably right back here. Lozano grew up in Ventura, California, skating, surfing, a happy childhood. So when I turned 18, actually 17 and a half, I joined the Marine Corps.

That was in 1991. More than a decade later, after 9-11, he was sent to Iraq. Lozano shows me a video. His squad is rescuing a disabled tank on a bridge. Lozano is in a Humvee. I'm looking back. I'm firing my M16. I look over to the side, and then this tank just lights one off right next to us.

You could feel the blast. The Humvee shook, and then I go sideways, and I'm kind of out of it. Lozano left the Marines in 2004. Then came the hard part. I wasn't the same. America was different. I experienced PTSD, which I did not know I had until years later. And there was a lot of headaches. Also anger and alcohol.

Lozano's first marriage ended. He entered a law enforcement training program in Georgia where he met Valerie. The headaches continued, though, and Valerie Lozano noticed other signs. He wasn't completing the files that we needed to for work. I started noticing him just becoming forgetful at home. It just got to the point where, in my brain, I was like, you know, something is not right. She got her husband to the Barrow Neurological Institute in Phoenix. And they found an AVM on the front...

The front... What is it? Oh my gosh. The frontal lobe, yes. Surgeons removed the AVM, but couldn't fix Lozano's memory. There's compelling evidence that the pressure waves from powerful weapons can cause concussion-like symptoms in the people who fire them. Those symptoms include the sort of headaches and memory problems experienced by both Lozano and Wilcox. But could all those blasts also have contributed to their AVMs? There's a couple...

Theories about AVM. That's our horse. That's Monty. You can either be born with it or your brain can experience some type of trauma which damages the vessels. Lozano leans toward trauma. Lozano's surgeon, Dr. Michael Lawton, has doubts. My initial answer is it's probably not related. It's probably coincidence. Because most AVMs are caused by genetic changes that affect the growth of blood vessels.

But Lawton, the president of Barrow Neurological Institute, says recent studies suggest that blast waves can alter genes in the brain. And it may be that the more we study this, we find that blast injury could be contributing to the same sorts of genetic abnormalities. The evidence is stronger for blood vessel changes less extreme than an AVM.

Dr. Ibolya Chernak of Belmont University in Nashville has spent decades studying the health effects of blast waves. We are gathering more and more information that indeed primary blast does cause vascular changes in the brain. Chernak says even a single blast can leave blood vessels in need of repair. But after repeated blast,

these repeated repair mechanisms could malfunction. In rats, this has led to malformed blood vessels that resemble AVMs. Much of the research on blast waves is supported by the military, which has taken steps to minimize blast exposure, especially in training. But that won't help veterans like Wilcox and Lozano. So they are learning to live with their disabilities.

For Lozano, that often means assisting veterans in the corral at War Horse Ranch. When someone starts getting vulnerable, the horse will pick up on that and he'll come over and just either put his head on your shoulder, stand right behind you, kind of helps you calm down. Even if your brain is still recovering from blast waves. ♪

This episode was produced by Rebecca Ramirez, edited by Giselle Grayson, and fact-checked by me, John Hamilton. The engineer was Kweisi Lee. Beth Donovan is our senior director, and Colin Campbell is our senior vice president of podcasting strategy. I'm Regina Barber. I'm John Hamilton. Thanks for listening to Shortwave from NPR. ♪

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