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Last Update: November 25, 2007 6:08 PM

ERIK HILL / Anchorage Daily News

Staff Sgt. Dustin Heger was diagnosed with post-traumatic stress disorder after his return from working as an Air Force protective services agent in hot spots such as Pakistan, Afghanistan and Iraq. His work included protecting and driving Gen. George William Casey Jr., former commander of Multinational Force Iraq, and Gen. John Abizaid, former head of the U.S. Central Command.

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Like a lot of troops serving overseas, Staff Sgt. Dustin Heger had a high-stress job. Like the paratroopers now returning home from Iraq to Fort Richardson, he needed to remain vigilant, or people could die. At the same time, Heger's particular responsibilities were unique.

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Stationed in Qatar as an Air Force protective services agent guarding Gen. John Abizaid, the head of the U.S. Central Command, he traveled with the commander's entourage from hot spot to hot spot -- to Afghanistan, Pakistan and Iraq. Once there, he sat behind the wheel of Abizaid's armored limousine, driving the general wherever he wanted to go.

Doing so, the 31-year-old airman needed to pay constant attention to the drivers of any nearby vehicles to determine if they posed a danger -- jamming his foot down on the accelerator if he ever thought they did.

It was a habit that became so ingrained that Heger eventually brought it home with him to Alaska when his six-month deployment -- his third -- ended a year ago this month. Along with it, his wife says, he also brought home a dramatically different personality.

"Mostly he was just withdrawn and not his normal happy self," Shanie Heger said. "He was in his own little world. It was like, 'I'm here, but just leave me alone.' "

Heger didn't sleep well in his home near Wasilla. He had wild dreams. He angered easily and avoided spending time with his wife and daughters. He gained weight, which added to his general sense of depression.

"I ate nonstop from sunup to sundown and never felt satisfied," he told a room full of Anchorage mental health practitioners recently at Elmendorf Air Force Base. "I had fits of anger and rage, and I couldn't explain why."

He also had bouts of road rage while driving on local highways, Shanie said. He usually drove fast. If slowpokes blocked him he got mad. If anyone dared to pass him he stared them in the face.

"He was just constantly watching to see what everybody was doing," she said. "I was almost scared to ride with him."

ROCKY RETURN

Welcome to Battlemind, that anti-social head-place where returning troops sometimes teeter awkwardly between behaviors necessary in combat and behaviors appropriate for home. Nearly all combat troops experience the syndrome to some degree.

That's because war changes people. But some soldiers come home changed more seriously than others, suffering wounds that aren't readily visible -- from traumatic brain injuries to stress disorders to profoundly broken hearts.

That might be especially true for the 3,500 paratroopers in the 4th Airborne Brigade Combat Team now making its way home to Fort Richardson following the unit's 15-month deployment in Iraq.

Its battalions saw some of the fiercest fighting in the war while stationed in volatile areas south and west of Baghdad. The brigade lost 53 soldiers, while nearly 350 more were wounded badly enough to receive Purple Hearts.

Which might pale numerically in comparison to what comes next, commanders and medics here say.

At a mid-November luncheon attended by local civilian neurologists, psychologists and mental health providers, they warned that as many as 400 of the returning soldiers might be suffering the after-effects of traumatic brain injuries, or TBIs, due to their proximity to roadside bomb blasts, which for some blew out their eardrums.

Symptoms of TBI include dizziness, irritability, vertigo and memory loss.

And they anticipate that hundreds more soldiers -- perhaps as many as a thousand -- are at risk for post-traumatic stress disorder, or PTSD, characterized by flashbacks (re-experiencing the trauma), hyper-vigilance, anger, avoidance and depression.

That's what the doctors said Sgt. Dustin Heger had.

It's treatable, they told him, and the prospects for full recovery are good. But if it's left unchecked, PTSD also has ruined the lives of many other warriors and veterans -- resulting in job loss, divorce and even suicide.

MOOD SWINGS

The Hegers met 12 years ago in Nebraska. Dustin was a young airman stationed at Offutt Air Force Base. Shanie was a 20-year-old local. While they were dating, he left on a six-month deployment to Kuwait, where he served as a security officer in the peaceful post-Gulf War days of the mid-1990s. They got married when he returned.

For Heger, there was no trauma in his first deployment. Nor was there any in his second, in early 2005 -- after the couple transferred to Elmendorf , where he was assigned to the 3rd Security Forces Squadron and sent to Qatar for six months.

Back then he always enjoyed returning to Shanie and his two young daughters, Heger says. But returning home from his third deployment following the high-stress experience in Iraq last year was different.

"There was a lot of numbness, physically and emotionally," he said. "That family connection that you always hope for while you're deployed never happened for us."

Back in Alaska, he suddenly found his moods swinging wildly from deep funks to states of hyper-vigilance, reminiscent of all those days driving the general when his mind had to remain on constant alert. Then he'd fall into easy fits of rage, like the blowup he had with Shanie last March that led to a domestic crisis.

There wasn't any physical violence involved, but Heger realized he'd lost control of his emotions.

"A lot of these feelings I'd never experienced before," he said. "That's when I decided there was something definitely wrong and I need to talk to somebody about it."

FAMILIES WOUNDED, TOO

It's not just the returning paratroopers who might need help with mental health issues in the coming year. Potentially, it's spouses and children as well.

That might require all the medical assistance -- both civilian and military -- that Anchorage can muster, said Brig. Gen. Thomas Tinsley, commander of the 3rd Wing at Elmendorf.

"This is not just an Elmendorf effort -- this is a community effort," said Tinsley, who oversees the base's hospital and medical facilities that serve all local Army and Air Force personnel, as well as the area's veterans.

To help meet that demand, said Tinsley, 32 more warrior medics will soon arrive on base, with eight more expected this summer.

Still, that won't be sufficient to meet the soon-to-be-spiraling caseload, especially since the hospital at Elmendorf is already operating at capacity, Tinsley said.

Credit the 4th Brigade for filling most of the beds.

In the past year, the brigade deployed in Iraq has sent 145 soldiers home to Anchorage to receive surgical and medical care at Elmendorf, according to Col. Eli Powell, commander of the 3rd Wing medical group.

Just that many alone resulted in 2,300 outpatient appointments. Now thousands more troops are coming home.

As soon as they arrive, medics here will screen the soldiers for both TBI and PTSD -- then re-examine everyone in 90 days, then again in 180 days.

That's because a lot of the troops inevitably insist they feel fine as soon as they step off the plane -- only to realize a couple of months later that they're not , said Maj. JoAnn Wilder, a psychiatric nurse at Elmendorf who conducts some of the screening.

"On arrival they just want to kind of blow it off and say, 'Well, there is nothing really wrong with me. I'll be all right,' " Wilder says.

The military medics who served the Stryker brigade that returned to Fort Wainwright last year saw their post-deployment caseload increase steadily for the first 12 months, said Capt. Richard Barker, a clinical psychologist at Elmendorf.

At first, the soldiers there merely reported problems with insomnia and alcohol abuse. But a couple months later, as other symptoms accumulated, the diagnoses of full-blown PTSD began to roll in.

CATCH IT EARLY

Heger heard his own PTSD diagnosis in March.

The treatments he's received at Elmendorf since then -- psychiatric counseling, relaxation techniques, anti-depressants -- have all helped. He's learned to talk himself out of certain emotion-wrought situations. Even the road rage.

"Sometimes you still get flashbacks, and there is a way to ground yourself and tell yourself, 'You know, you're safe. You're in a good place. You're back home,' " Heger said.

Speaking to a luncheon hall filled with officers and doctors, he noted that the very fact that he could stand before them and tell his story in public said a lot. He hopes anyone like him among the 3,500 soldiers returning to Fort Rich is as fortunate.

"We recognized the problems early on," he said. "Hopefully, after today, some of you will have the chance to recognize problems in the soldiers coming back."


Find George Bryson online at adn.com/contact/gbryson or call 257-4318.


Iraq combat stress

Combat experiences reported by members of U.S. Army and Marine Corps after deployment to Iraq or Afghanistan, 2002, 2003

95% Saw dead bodies or remains.

93% Were shot at.

86% Know someone seriously injured or killed.

Reluctance to seek help

Perceived need for and use of mental health services among soldiers and Marines who met screening criteria for major depression, anxiety or post-traumatic stress disorder.

86% Acknowledged a problem.

45% Said interested in seeking treatment.

21% Received treatment from a mental health professional the following year.

Reasons for not seeking help

Perceived barriers for seeking mental health service among soldiers and Marines.

65% "I would be seen as weak."

55% "Difficult getting time off for treatment."

50% "It would harm my career."

Source: "Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care," by Charles W. Hoge, M.D., et al., published July 2004, New England Journal of Medicine.

Symptoms of post-traumatic stress disorder, or PTSD

• Flashbacks (re-experiencing the trauma)

• Hyper-vigilance (edgy, unable to sleep)

• Avoidance (anti-social, withdrawn from family)

Prevalence of PTSD*

(Among Vietnam vets)

30% of vets (to 18 percent in separate studies)

28% for "median level of combat"

65% for "highest level of combat"

*from National Vietnam Veterans Readjustment Survey Study

Increased risk for vets with PTSD

(Compared with vets without PTSD)

• Substance abuse (primarily alcohol) -- 2-fold increase

• Major depression -- 5.5-fold increase

• Suicide -- 3-fold increase

em>Source: National Center for PTSD, U.S. Dept. of Veterans Affairs

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