How Two Veterans Developed The Same Rare Brain Condition

Some weapons used by the U. S. military are so powerful they can pose a threat to the people who fire them. Today, we meet two Marines, William Wilcox and Michael Lozano, who spent years firing missiles and rockets, then developed the same rare brain condition: arteriovenous malformation, or AVM. The condition sends high pressure blood from a tangle of abnormal blood vessels directly into fragile veins, which can leak or burst. Most AVMs are caused by genetic changes that affect the growth of blood vessels, so the connection between weapon blasts and AVM isn't always immediately clear. But NPR's brain correspondent Jon Hamilton reports that recent research suggests that blast waves can alter genes in the brain — and that the evidence is even stronger for less extreme blood vessel changes. Have questions or story ideas? Let us know by emailing [email protected] mailto:[email protected]! Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:22Regina Barber?

  Hey, Short Wavers. NPR's Brain Guy and sometimes Short Wave's substitute host is with me today. Hello, Jon Hamilton.

• 0:29Speaker 02

  Hello, Regina Barber.

• 0:30Regina 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 on the show.

• 0:38Speaker 02

  I had a great time making fun of you. Not that I want you to go away again or anything.

• 0:43Regina Barber?

  Of course. I mean, people can't live without me. We're going to turn things a little bit more serious, though, today, Jon. You're actually joining us today to follow up on an episode we did actually a few months ago, right?

• 0:53Speaker 02

  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.

• 1:11Regina Barber?

  Yeah, can you remind me what an AVM is?

• 1:14Speaker 02

  Yeah, it's this malformed tangle of veins and arteries that can cause a stroke.

• 1:20Speaker 02

  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.

• 1:43Regina Barber?

  Okay.

• 1:43Speaker 02

  In an AVM, blood from the arteries goes directly back to the veins, and that can lead to a hemorrhage in the brain.

• 1:51Regina Barber?

  Oof, that's devastating.

• 1:54Regina Barber?

  And you talked to a Marine named William Wilcox, right?

• 1:57Speaker 02

  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 Warhorse Ranch, which offers what's known as equine therapy

• 2:22Regina Barber?

  Cool.

• 2:22Speaker 02

  to veterans and other people who are recovering from trauma. So today on the show, veterans and a rare brain condition called an AVM.

• 2:33Regina Barber?

  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.

• 2:49Speaker 02

  And I'm John Hamilton, and you're listening to Short Wave, the science podcast from NPR.

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• 4:24Speaker 02

  Michael Lozano and William Wilcox have a lot in common.

• 4:27Speaker 04

  I originally was a tow gunner.

• 4:30Speaker 05

  I was a tow gunner from 97.

• 4:32Speaker 04

  I served in two different units at Camp Lejeune.

• 4:35Speaker 05

  I was part of Second Combat Engineer Battalion at Camp Lejeune.

• 4:38Speaker 04

  I went to 29 Palms.

• 4:40Speaker 05

  Two weeks out of the year. We did 29 Palms.

• 4:43Speaker 02

  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.

• 4:56Speaker 04

  Imagine a 300-pound linebacker hitting you in the chest at full speed. Boom! It rattles your cage.

• 5:05Speaker 02

  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.

• 5:26Speaker 02

  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.

• 5:35Speaker 04

  This is actually an AT-4. It's obviously inert.

• 5:39Speaker 02

  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.

• 5:49Speaker 04

  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.

• 6:07Speaker 02

  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 system specialist.

• 6:18Speaker 04

  I took Excedrin basically like candy. I used to drive home during lunch and pop some Excedrin, take a nap or whatever, you know, just to get the headaches to go away.

• 6:29Speaker 02

  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.

• 6:44Speaker 04

  I go out of the bar. I sit down on a bench. I put my elbows on my knees like this, and I notice that I'm losing control of my arms.

• 6:54Speaker 02

  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.

• 7:19Speaker 04

  I spent about three weeks at Penn State Hershey, relearning how to walk, cognitive therapy.

• 7:26Speaker 02

  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.

• 7:36Speaker 04

  I don't know if I already mentioned this, sorry, I do have brain damage.

• 7:38Speaker 02

  But Wilcox says his biggest challenge is epilepsy.

• 7:41Speaker 04

  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.

• 7:50Speaker 02

  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.

• 7:59Speaker 02

  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.

• 8:07Speaker 05

  We have 10 horses and a donkey. So, we have to have the donkey.

• 8:12Speaker 02

  Where's the donkey?

• 8:12Speaker 05

  Oh, he's out here. Oh, he's probably right back here.

• 8:15Speaker 02

  Lozano grew up in Ventura, California, skating, surfing, a happy childhood.

• 8:20Speaker 05

  So, when I turned 18, actually 17 and a half, I joined the Marine Corps.

• 8:25Speaker 02

  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.

• 8:37Speaker 05

  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.

• 8:55Speaker 02

  Lozano left the Marines in 2004. Then came the hard part.

• 9:00Speaker 05

  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.

• 9:10Speaker 02

  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.

• 9:23Speaker 06

  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.

• 9:35Speaker 02

  She got her husband to the Barrow Neurological Institute in Phoenix.

• 9:39Speaker 05

  And they found an AVM on the front. The front, what is it? Oh, my gosh.

• 9:47Speaker 02

  Frontal lobe?

• 9:48Speaker 05

  The frontal lobe, yes.

• 9:49Speaker 02

  Surgeons removed the AVM, but couldn't fix Lozano's memory.

• 9:54Speaker 02

  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?

• 10:10Speaker 05

  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.

• 10:24Speaker 02

  Lozano leans toward trauma. Lozano's surgeon, Dr. Michael Lawton, has doubts.

• 10:29Speaker 07

  My initial answer is it's probably not related. It's probably coincidence.

• 10:34Speaker 02

  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.

• 10:47Speaker 07

  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.

• 10:55Speaker 02

  The evidence is stronger for blood vessel changes less extreme than an AVM. Dr. Iboya Chernak of Belmont University in Nashville has spent decades studying the health effects of blast waves.

• 11:07Speaker 06

  We are gathering more and more information that indeed, primary blast does cause vascular changes in the brain.

• 11:15Speaker 02

  Chernak says even a single blast can leave blood vessels in need of repair.

• 11:19Speaker 06

  But after repeated blast, these repeated, repeat mechanisms could malfunction.

• 11:26Speaker 02

  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 Warhorse Ranch.

• 11:51Speaker 05

  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.

• 12:02Speaker 02

  Even if your brain is still recovering from blast waves.

• 12:16Speaker 02

  This episode was produced by Rebecca Ramirez, edited by Gisele Grayson, and fact-checked by me, John Hamilton.

• 12:23Regina Barber?

  The engineer was Kwasi Lee. Beth Donovan is our senior director, and Colin Campbell is our senior vice president of podcasting strategy. I'm Regina Barber.

• 12:31Speaker 02

  I'm John Hamilton. Thanks for listening to Short Wave from NPR.

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