JUANA SUMMERS, HOST:
Military personnel who fire certain powerful weapons may put their brains at risk.
MICHAEL LOZANO: A piercing headache, like a pin, like a needle.
SUMMERS: Symptoms can show up years after they leave the service.
WILLIAM WILCOX: I happened to be literally at the right place at the right time when my head exploded.
SUMMERS: NPR's Jon Hamilton has the story of two Marines who spent years firing missiles and rockets, then developed the same rare brain condition.
JON HAMILTON, BYLINE: Michael Lozano and William Wilcox have a lot in common.
W WILCOX: I originally was a TOW gunner.
M LOZANO: I was a TOW gunner from '97.
W WILCOX: I served in two different units at Camp Lejeune.
M LOZANO: I was part of a second combat engineer battalion at Camp Lejeune.
W WILCOX: I went to 29 Palms.
M LOZANO: Two weeks out of the year, we did 29 Palms.
HAMILTON: 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.
W WILCOX: Imagine a 300-pound linebacker hitting you in the chest at full speed. Ooh. It rattles your cage.
HAMILTON: Also your brain. Gunners like Wilcox and Lozano placed 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.
CYNTHIA WILCOX: Hi.
HAMILTON: Hi. I'm Jon.
C WILCOX: Hi. I'm Cynthia.
(SOUNDBITE OF DOG BARKING)
HAMILTON: 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.
W WILCOX: This is actually an AT4. It's obviously inert.
HAMILTON: 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.
W WILCOX: 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.
HAMILTON: 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.
W WILCOX: 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.
HAMILTON: 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.
W WILCOX: 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.
HAMILTON: 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.
W WILCOX: I spent about three weeks at Penn State Hershey relearning how to walk, cognitive therapy.
HAMILTON: 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.
W WILCOX: I don't know if I already mentioned this. Sorry. I do have brain damage.
HAMILTON: But Wilcox says his biggest challenge is epilepsy.
W WILCOX: 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.
HAMILTON: 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.
(SOUNDBITE OF METAL CLINKING)
HAMILTON: Michael Lozano and his wife, Valery, run the Warhorse Ranch near Steamboat Springs, Colorado. It's a place for people who've experienced trauma.
M LOZANO: We have 10 horses and a donkey. So we have to have the donkey...
HAMILTON: Where's the donkey?
M LOZANO: He's out here. He's probably right back here.
HAMILTON: Lozano grew up in Ventura, California, skating, surfing - a happy childhood.
M LOZANO: So when I turned 18 - actually, 17 1/2 - I joined the Marine Corps.
HAMILTON: 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.
M LOZANO: 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.
(SOUNDBITE OF MISSILE FIRING)
M LOZANO: You could feel the blast. The Humvee shook, and then I go sideways, and I'm kind of out of it.
HAMILTON: Lozano left the Marines in 2004. Then came the hard part.
M LOZANO: 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.
HAMILTON: Also anger and alcohol. Lozano's first marriage ended. He entered a law enforcement training program in Georgia, where he met Valery. The headaches continued, though, and Valery Lozano noticed other signs.
VALERY LOZANO: 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.
HAMILTON: She got her husband to the Barrow Neurological Institute in Phoenix.
M LOZANO: And they found an AVM on the front - what is it? Oh, my gosh.
HAMILTON: The frontal lobe.
M LOZANO: Frontal lobe, yes.
HAMILTON: 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 headaches and memory problems experienced by both Lozano and Wilcox. But could all those blasts also have contributed to their AVMs?
(SOUNDBITE OF HORSE SPUTTERING)
M LOZANO: There's a couple theories about AVM.
(SOUNDBITE OF HORSE SPUTTERING)
M LOZANO: That's our horse.
HAMILTON: Yeah, that's...
M LOZANO: That's Monty. You can either be born with it, or your brain can experience some type of trauma which damages the vessels.
HAMILTON: Lozano leans toward trauma. Lozano's surgeon, Dr. Michael Lawton, has doubts.
MICHAEL LAWTON: My initial answer it's probably not related. It's probably coincidence.
HAMILTON: 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.
LAWTON: And it may be that the more we study this, we find that blast injury could be contributing to the same sort of genetic abnormalities.
HAMILTON: The evidence is stronger for blood vessel changes less extreme than an AVM. Dr. Ibolja Cernak of Belmont University in Nashville has spent decades studying the health effects of blast waves.
IBOLJA CERNAK: We are gathering more and more information that, indeed, primary blast does cause vascular changes in the brain.
HAMILTON: Cernak says even a single blast can leave blood vessels in need of repair.
CERNAK: But after repeated blast, these repeated repair mechanisms could malfunction.
HAMILTON: 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.
M LOZANO: 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.
HAMILTON: Even if your brain is still recovering from blast waves. Jon Hamilton, NPR News.
(SOUNDBITE OF MARC RIBOT'S "SOLARIS") Transcript provided by NPR, Copyright NPR.
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