A decade after returning from Iraq, Josh Heldt's battle continues.

The 37-year-old Iraq veteran, suffering from post traumatic stress disorder (PTSD), isn't alone.

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Bob Nelson, Crow Wing County director of veterans services, said a strong percentage of National Guard members have dealt with PTSD.

"More than I probably would have initially anticipated," Nelson said.

Often the veteran isn't the one who realizes the problem. Nelson said it can be hard to assess one's self, but family members can see the anger, the triggers, even rage.

"He doesn't realize how bad it is," Heldt's wife Marcie said this summer. They've know each other since high school and married after he returned from his tour. They share a house with three active young children ages 2 to 5 and a 13-year-old.

Everything in their lives revolves around post traumatic stress disorder (PTSD), from what they eat to where they go to how they fall asleep. Loud sounds, food smells, a napkin left on a floor, a teenager walking into the house wearing headphones - all could set off the anger, which may be followed by days or weeks without talking.

He didn't want to be around people. He shut down. Decisions on social events had to include how many people might be there. Even when he was happy, his family would be tense not knowing when he would explode next. It was like walking on eggshells all the time, Marcie said. Even going to sleep meant an entire production of having things just right. Having a Kindle at the wrong angle might mean no sleep for hours. Marcie began sleeping on the couch to avoid the situation. When their daughter fell and made a horrible noise, he went into an instant rage. Those kinds of episodes made her wonder what would happen someday if he wasn't able to stop the rage.

"This isn't right," she said. "This isn't how it should be."

At the same time she knows that's not how her husband wants to be.

"Who wants to be that guy?" Josh said. "It's horrible."

Leaving the house is a challenge. Somedays, it's a struggle to get up in the morning. Josh became a master of coming up with excuses not to do something. Even with his children, he would pick a park to go to that he knew was underutilized so he wouldn't have to be near other people. If the children wanted to go to the beach, Marcie had to go with them alone.

She had to think about each word she used in casual conversation because using the wrong one, even asking him to take something out for dinner, could set him off. At first, he questioned why he couldn't be angry if he felt like it. It took awhile for him to see that being mad all the time wasn't how people react in a normal relationship.

"So a couple of years ago I embraced the fact there is a problem," Josh said. "I don't know if you ever fix it - you just try to deal with it. ... For me it's just always there."

While the military asks the veterans how they are doing and hear everything is fine and normal in the post deployment checkup, perhaps more should be done to reach their loved ones who have a different perspective, Marcie said.

"I'm always thinking about Iraq," Josh said. Serving, he said, was a great experience. "Now I feel like an outsider who's seen things." In Iraq, Josh said he was working for something greater than himself in places he could never have imagined seeing firsthand. He had close friends - battle buddies.

The young man who went into the service enjoyed social encounters and engaged with people.

"I used to be the outgoing guy, center of everything who wants to do stuff all the time," Heldt said. "I used to have friends all over."

All that was changed when he came back.

He joined the Minnesota National Guard out of a desire to go to college. No Brainerd unit had been called up since World War II until his generation. Heldt served with the 1st Combined Arms Battalion, 194th Armor Regiment that was part of the 34th Infantry Division - the Red Bulls. His first marriage didn't survive the deployment.

In Iraq

Josh left the base and was outside the wire daily. He can became the most animated in recalling service in Iraq. He said he wasn't in the most dangerous positions and has come to the conclusion taking someone out of their element and putting them in the war zone situation for so long takes its own toll. Every decision was made for him 24 hours a day.

"When you try to put them back in, it doesn't work," he said of returning to his life before the deployment. "When you are in a war zone it changes things."

For Marcie it's been a long, exhausting road.

"I always feel like I'm failing," she said. "I can't do this anymore."

She sought help from the Veterans Administration. Counseling was available to veterans and their dependents through Lutheran Social Service. It helped, but it hasn't ended their struggles.

"I wish I would have known about it before we got to this bad spot," Marcie said. She found a PTSD support group on Facebook and that led to more options.

In the last few years, Josh's symptoms began getting worse. And things started going downhill after he took part in the Bataan Memorial March this spring. Out of the service and uniform, he felt like an outsider there as well. Soon it felt like hitting rock bottom. Then Marcie got a text from Josh at work. The suicidal thoughts were coming back to him. The text read: "I love you and the kids but I just want to be done."

Josh said he was at a point where he started to think it would be better if he wasn't around. Everything felt like an uphill battle.

"I just didn't want to deal with it anymore," he said. "I was at that place I was one other time when I came back. I knew I had a huge problem, but I wouldn't have sought help. It was Marcie."

Between calls to the VA, the Crisis Line and the police department, Josh went to a 72-hour hold at the VA in St. Cloud. Josh said even his own parents and siblings weren't aware of how deep his struggles were. It bothered him that his parents never talked to him about Iraq and then people he might know very little would ask how many people he killed. His family all came to see him at the VA. He said he felt he needed to stay there to get better.

"It was a humbling experience," Josh said. He thought hitting rock bottom may be a blessing in disguise.

Medication helped with the depression, at least at first. By late summer, Heldt was feeling better. He said talking to his parents, who told him they were advised not to bring Iraq up with him, helped. It bothered him that people didn't talk to him about the war, but Marcie understood that people may be hesitant to approach the topic not knowing how he may feel about discussing his time in Iraq.

In mid-summer Josh was visibly more relaxed.

"I'm at peace with myself a little bit," Josh said. "I'm happy inside. Before I was just happy on the outside."

Marcie said it was like having her husband back. Things seemed easier. She'd been thinking her husband was going to be a statistic, a sad veteran's story. Now she saw a happy outcome. They both said they knew there would be work to do and bad days ahead but they were optimistic.

"It's OK to say I need help," Josh said. "It's OK for a wife to say you need help and go get it."

Marcie said now when there was a family challenge, like a vehicle that broke down, she felt she had a partner to deal with it again and wasn't on her own trying to keep things from escalating.

Now as he talked about Iraq, Josh said he didn't have many good memories from his deployment and saw things most people never will. Moments went from positive times when 20 kids surrounded the truck making soldiers think they were the best ever to having bombs go off and ceremonies for dead soldiers. Iraq, he said, was a good experience because he knows they were able to save lives. But it came at a cost. Their convoy would take a route one day. The next day another group replaced them on the route and a truck exploded and three soldiers were killed.

"It got to a point at our camp where people were dying left and right," Josh said.

Soldiers who worked convoy duty had experiences viewing everything along the roadside as a threat, a potentially fatal encounter. Nelson said he often hears from veterans who served in convoy duty and felt they should have been the one injured or killed when another guy was hit.

Some had to deal with running over people and being unable to stop as the convoys continued down the road, Nelson said. When soldiers came home they were still in a mode of driving down the center of the road as fast as they could looking for possible threats. Nelson said even though they know they left the war behind, the intense experience was ingrained on their responses.

What has helped this generation of soldiers, Nelson said, is a lessening of the idea that seeking help after experiencing combat is a stigma.

"It isn't the same label it used to be," Nelson said. "Some people it affects greater than others. Early intervention is the key in getting a life back. It can be manageable."

Anger is common. Nelson said the intensity of the deployment and its length can create a combination where everything is amplified and there isn't a chance to decompress.

"You learn to be hyper-vigilant," Nelson said. In a car crash, a person may find their heart skips a beat every time they return to the same spot. For a combat veteran, that experience may continue long after they've left the desert of Iraq behind.

Josh said his work at Cub Foods has always been supportive, first of his deployment and then as he deals with depression and PTSD.

Even after they thought the worst might be behind them, Josh said the medications that were helping seemed to stop at the beginning of October. After medications were adjusted, he said things went downhill quickly. The suicidal thoughts returned and he was back in St. Cloud.

"So it's kind of frustrating," Josh said, adding he felt at a crossroads where things would either start to go really well or not at all. "... I can see the good days, I just can't get to them quite yet."

PTSD symptoms

The National Center for PTSD reports it isn't clear why some people develop PTSD and others do not. Symptoms usually start soon after a traumatic event but may not appear for months or years. How intense the symptoms are depends on how intense a traumatic situation is or how long it lasts or how much support was received after the event. Everyone reacts differently to trauma.

Symptoms may include bad memories or nightmares, flashbacks that can leave the individual feeling as though they are reliving the events. Those with PTSD may avoid memories as a way to distance themselves from memories of traumatic events. They may avoid people or group settings. They may prefer work that lets them be alone.

"You may feel fear, guilt or shame," the national center reports. "Or you may not be interested in the activities you used to enjoy. This is another way to avoid memories. You may be jittery or always alert and on the lookout for danger. Or you may have trouble concentrating or sleeping."

When the symptoms last, cause great distress or interfere with home or work life, they may have PTSD.

Nelson said programs can help veterans understand PTSD and the triggers that are affecting them.

"As hard as it is to seek help, the sooner the better. My Vietnam vets will say that," Nelson said. Earlier generations coped by throwing themselves into work and perhaps self-medicating with alcohol to take the edge off. Some World War II vets are described by spouses as suffering from night sweats and waking up screaming.

"We look back now and we say that is PTSD," Nelson said. "Now it's more open."

Seeking help isn't a sign of weakness, Nelson said, it's a sign of strength. Post traumatic stress disorder won't disappear, but Nelson said people can live with it and cope. "It will take time but it is manageable for most people."

Josh hopes his story will help others seek the help they may need and know they aren't alone in the struggle.

Help exists

The veterans service office helps veterans navigate the system and get help.

"That's what we are, we are their advocate," Nelson said. There are support groups at the Brainerd Community Outpatient Clinic in west Brainerd for veterans and their spouses. Heldt said he was the sole veteran who served in Iraq in his support group of about 20. He said it would be nice to see some of the veterans of Iraq or Afghanistan there as well. When he started attending group sessions, he was the youngest veteran in the group by nearly two decades. Heldt said the sessions helped but then seemed to wear off.

A 45-day inpatient treatment program is offered at the VA in St. Cloud. Marcie Heldt said the program has been effective but her husband is no longer sure he could do that right now. He worries his family won't be there when he gets out.

"I know it's the right thing to do, but to commit to it is tough," Josh said.

Marcie can't see another, better option. She now goes with Josh for appointments and when he's tempted to say things are good, she can provide details of their lives that point the other way. At the VA recently, Marcie said she heard hope for the first time from a psychologist that she may get her husband back.

"She said Josh learned to not sleep because if he fell asleep hard he could die. He has the skill to drive down the middle of the road as fast as he can and whoever was in his way would get out because if he didn't do that in Iraq he would die," Marcie said. "If he hears a loud noise and he doesn't jump out and freak out he could die. It's learning those skills over again. He learned them so well to keep himself alive in Iraq he just has to relearn those basic skills that we can't really understand. ... I've been told by so many people I'll never have my Josh back. She's the first one that said you can have him back. 'We can have him back for you we just have to work at it.'"

Talking has helped, Josh said. For years he said his family had no idea because he laughed everything off. Now he's not afraid to bring things up.

A week ago, Marcie talked to one of the psychologists.

"I said I feel like my choice is a suicidal, abusive time bomb or a zombie because he is so drugged up and doesn't get out of bed," Marcie said, weeping. "We just can't keep going like this with him. It's hard for him because doesn't see it. He's in it so he doesn't see it."

Not having Josh go into inpatient treatment isn't an option for Marcie.

"You just watch him slip lower and lower every day until you get the phone call again 'I want to be done.' He's still depressed. He still struggles a lot. That's what's hard to watch," she said, wiping away tears. "He promised me he would get help and fix this. I'm going to hold him to it."

For more information on PTSD, go to The National Center for PTSD at www.ptsd.va.gov or the Veterans Crisis Line is 800-273-8255. Locally, the Crow Wing County Veterans Service Office is at 824-1058 or 866-507-1058. The Brainerd Community Outpatient Clinic may be reached at 855-1115 or the Veterans Administration at 800-827-1000.

By the numbers

• 19.6 million - number of military veterans in the U.S.

• 9.3 million - number of veterans who are 65 or older.

• 7 million - served in the Vietnam era.

• 5.2 million - served during the Gulf War era (from August of 1990 to the present).

• 3.6 million - veterans with a service-connected disability on a scale from 0 to 100 percent.

• 1.6 million - number of veterans younger than 35.

• 58,445 - living veterans who served during Vietnam era and both periods of the Gulf War era - 1990 to 2001 and 2001 or later.

• 39,890 living veterans served during World War II, the Korean War and Vietnam era.

Source: U.S. Census Bureau and are from 2013.