BOSTON -- A litany of physical or emotional problems spill out as Iraq and Afghanistan veterans make their way, one by one, to the 11th floor of a VA hospital in the Jamaica Plain neighborhood.
The tragic signs of post-traumatic stress disorder or battlefield concussion are all too evident. Even more alarming for researchers is emerging evidence that these newest American combat veterans - former GIs and Marines in their 20s and 30s - appear to be growing old before their time. Scientists see early signs of heart disease and diabetes, slowed metabolisms and obesity - maladies more common to middle age or later.
"They should have been in the best shape of their lives," says William Milberg, a Harvard Medical School professor of psychology and project co-director. "The big worry, of course, is we're going to be taking care of them until they're in their 70s. What's going to happen to them in the long run?"
The research is in its early stages, and scientists with the Department of Veterans Affairs are rushing to understand it. If what they're seeing is a form of early aging, it seems most common to those with both blast-related concussion and PTSD- about 30% of the veterans being studied in a long-term research effort. There is even imaging evidence of diminished gray matter in high-functioning areas of the brain, changes that shouldn't happen for decades, if at all.
Scientists say their theory may not be proved until they can study these veterans over the next few years, and it remains unclear how these findings might impact policies on the length and number of combat deployments.
However, the Army, mindful of the strain, is allowing troops more time between combat deployments - something possible as the war in Afghanistan winds down - and has shortened deployments from a year to nine months. The numbers suffering brain injury and PTSD continue to grow. The Pentagon says that since 2000, 244,000 servicemembers have suffered traumatic brain injuries ranging from mild to severe, both in and out of combat. Since the 9/11 attacks, the VA has treated about the same number of war-era veterans for PTSD.
"We're looking at people who are going to be having cognitive problems much earlier than they should be having them," says Regina McGlinchey, a neuropsychologist and project co-director.
Stresses of modern warfare
A study last month from the Centers for Disease Control and Prevention found that veterans ages 25-64 had more than twice the rate of diabetes, hypertension, heart disease and cancer than non-veterans.
Milberg says the people researchers are seeing in Boston "really have a lot of things going on at the same time. It's hard to know where one problem ends and another starts."
He and the other scientists say early aging might stem from the nature of the Iraq and Afghanistan Wars, where troops served long and repeated deployments at an unprecedented rate. This meant living under a high state of vigilance, managing stress over many months or even beyond a year, then doing it all over again and again with each subsequent combat tour.
Like a candle burning twice as bright, but also burning twice as fast, the effect of this prolonged stress on the human brain and body can wear it down, researchers say.
"Deployments are punctuated by very serious life-and-death exposures," says Ann Rasmusson, a psychiatrist and neurobiologist, "that when they reach a certain level, change the internal chemistry, the physiology of people's bodies."
A life in and out of war
Medical technician Marge Ahlquist straps a blood-pressure cuff around Matt Pierce's left bicep, the one with the wrap-around Arabic script tattoo he got after his combat tour in 2006. Translated, it reads, "For those I love I sacrifice."
She notes he is patient No. 245 in the VA study underway since 2010. The two chat about how Pierce, who left the Marines in December, bears a resemblance to actor Sean Astin, the fresh-faced lead in the 1993 football film Rudy.
Then she frowns. Pierce's blood pressure is 150 over 92, well into hypertension range. Pierce sheepishly explains he recently ran out of heart medication and hasn't had it refilled.
"Good Lord," Ahlquist says. "Seriously, I would call them (his doctors) and tell them that you were in and that your blood pressure was elevated."
For the next several hours, researchers will take a medical history from Pierce and administer a regimen of tests. They will learn about how he enlisted in 1999 and did three tours to the U.S. Embassy in Kabul as a handler for a bomb-sniffing Belgian Malinois, then three more tours as an explosive ordinance disposal, or EOD, specialist, disarming roadside bombs in Iraq and Afghanistan.
"I hate to use the word adrenalin junkie, but it's kind of what it was; it excited me," he says before the day begins. "The thought of - if I made a mistake at all, I could be dead - it thrilled me."
The researchers will learn about the three marriages, his 5-year-old son from the second relationship and newborn due in January. Two marriages failed, he says, because he was away at war so much.
He will be asked to detail each blast he survived that left him with a mild traumatic brain injury - the time three artillery rounds detonated under his armored vehicle, blowing out the engine and leaving him briefly unconscious; and the time he was pulling a disarmed improvised explosive device, or IED, out of the ground and a secondary booby trap detonated, knocking him off his feet.
"I never remember the sound," he says.
Then there is that day in 2007 in Iraq. He and a close friend, Sgt. Justin Noyes, were on either side of a road moving a barbed-wire barrier in preparation for disarming a buried bomb when Noyes stepped on another IED no one saw, and Pierce saw his friend blown apart.
He will explain to a psychologist about graduating from EOD school in 2004 with Noyes and two other Marines. How they grew close. And how Pierce is the only survivor.
"A lot of bad things happened to really good people," he explains later.
He will talk about the nightmares, vivid images in his mind of the carnage he witnessed after suicide bombers detonated explosives and dozens of civilians died, many of them children he and other Marines rushed in trying to assist.
"(I'm) waking up screaming, fighting, kicking (at) nothing in the dark. It just feels like I'm re-enacting everything that happened," he says.
Finally, he'll say he will return to Afghanistan as a civilian contractor, again handling a bomb-sniffing dog - both because the money is good, $105,000 a year before bonuses and overtime, and because life there makes sense.
"It's a simpler life over there," he says at the end of the day. "All you're really worried about is the welfare of yourself and the people around you. And all the little petty things - all that Facebook, all that stuff - it doesn't matter. It doesn't exist."
That he is heading back into the war zone with a body that - if the scientists' theory is correct - might be aging too quickly, leaves Pierce with a sense of resignation. "I have to agree," he says. "I have high blood pressure, I hurt all the time, and even if I don't like to admit it, I am carrying some extra weight."
For Kendall Pierce, who married her husband last December, these signs of aging seem frightening and unfair. He has already sacrificed so much, she says, something evident any night when she shakes him out of one of his terrible dreams.
"You can see the fear on his face. And, oh my gosh, it's just heartbreaking," she says. "He can look at me and realize, 'OK, I'm at home. I'm with Kendall. I'm OK.' Some nights, he'll talk about it. And sometimes, he'll just sit there and squeeze me with one of those big bear hugs and not let me go."
Like a coiled spring
The human mind has an amazing capacity to deal with fear, scientists say. It produces molecules that can tamp down emotional responses - the adrenalin that causes people to fight or flee when horror happens.
But these molecules can become depleted with prolonged and repeated exposure to trauma. The unregulated flow of adrenalin, combined with damage from traumatic brain injury, can lead to emotional responses that trigger too easily or become stuck in the "on" position, researcher Rasmusson says.
The possible result, scientists say: The body ages.
For Ed Fox, 31, the dead bodies he saw during convoy duty and the nightly mortar attacks during his second combat tour to Iraq as a National Guard soldier in 2004-05 took their toll.
That tensed-up sense of vigilance, like a coiled spring, that carried him through those nights waiting in the silence to hear where a mortar round would land didn't go away when he came home.
"No one tells you how to shut it off," Fox says on the morning he arrives at the VA hospital to begin his examination. "I spent a lot of time dealing with my demons."
For Sharee Holmes, 38, who also served with the Massachusetts National Guard in Iraq, the theory about aging makes sense.
Diagnosed with anxiety and depression, Holmes says that after working at a higher rpm in the war zone, she brought irritability and impatience back to the slower rhythms of life at home.
"All those adjustments on your brain, your body - it's a lot," she says.
'Boy, look at this'
It was a former soldier, younger than 40, with brain lesions that first got a research team member thinking something was terribly different about these veterans.
The veteran came through in the summer of 2010, a few months after the program was initiated, suffering from obesity, high blood pressure and diabetes. Most striking were the magnetic resonance imaging, or MRI, scans that looked more like they belonged to someone in their 70s, Harvard researcher Milberg recalls.
"That's when we got alerted that maybe we were going to see something like these precursors we associated with old age, (but) in a younger population," he recalls.
And there were the letters they were sending out. Each time blood tests came back showing unhealthy readings, a letter went out in the mail alerting the veteran: "Your lab results are outside of the normal range. Please see your physician."
Suddenly, McGlinchey says, "we were sending out a lot of these letters, and it started feeling like, 'Boy, look at this.' "
The scientists are rushing to publish their findings, not even sure what this aging syndrome - if they confirm that is the case - should be called.
"We don't have a name for it," Milberg says.
His colleague Rasmusson says whatever is happening to these young veterans, the hope is to get ahead of the problem.
"If we can hop on this generation early," Rasmusson says, "rather than waiting out 20 years to see them wind up with early death and stroke and cardiovascular disease, then we can prevent them from having shortened lifespans."