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    {
      "speaker": "Leah Bucholz",
      "startTime": "2.1599998",
      "endTime": "17.915",
      "body": "Hey, guys. It's Leah B from Prestige Veteran Medical Consulting. I am a US Army veteran physician assistant and former CNP examiner. Alright. So today, I wanna come on and discuss a kind of an important topic, and that's why do some veterans feel sick, but tests keep coming back normal."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "17.915",
      "endTime": "30.85",
      "body": "Right? So have you ever been told your labs are normal, your imaging looks fine, there's nothing seriously wrong, but you just don't feel fine? You're exhausted. You're in pain. You feel inflamed."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "30.85",
      "endTime": "42.690002",
      "body": "Your body doesn't feel like it used to. Today, I wanna explain something that is very important. So normal test results do not always mean nothing is wrong. This is educational only. This is not legal advice."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "43.355",
      "endTime": "52.875",
      "body": "This is not medical advice either, so make sure you guys follow-up with your doctors. Alright? Let's talk about what could actually be happening. So first, test measure specific things. Right?"
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "52.875",
      "endTime": "87.485",
      "body": "So medical testing is designed to measure things like structural abnormalities, organ functioning, blood markers, hormone levels, imaging, visible pathology, right, with your MRIs, your X rays, things like that. But many physiologic processes occur at a level that standard testing don't fully capture. So just because a test is within range does not mean that the system is functioning optimally. It means it falls within statistical reference, patterns or parameters. Those are not the same thing."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "88.07",
      "endTime": "104.255",
      "body": "So the nervous system can be dysregulated without structural damage. You can have autonomic dysfunction. You can have sympathetic overreaction. We've talked about that a lot, especially in our PTSD videos, that fight or flight issue. So you can have poor vagal tone."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "104.255",
      "endTime": "136.63501",
      "body": "You can have central sensitization without abnormal MRI findings. The nervous system, you know, abnormal MRI findings or other findings. Right? So the nervous system can regulate things like heart rate, blood pressure, digestion, pain processing, energy regulation. If it becomes dysregulated, especially after trauma, prolonged stress, or repeated injuries, symptoms can be real, and they can be persistent even if imaging looks normal."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "136.955",
      "endTime": "175.40999",
      "body": "So chronic stress, the physiology of chronic stress, there's a lot of things to consider. So prolonged stress changes can impair cortisol patterns, inflammatory signaling, sleep architecture, insulin sensitivity. These changes may not show up on a single lab panel, but over time, they can produce a lot of a lot of effects in the body. They can produce fatigue, brain fog, muscle pain, things like headaches. You can have GI disruption, you know, heartburn, diarrhea, things like that."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "175.40999",
      "endTime": "197.34502",
      "body": "You you can have blood pressure fluctuations. The system can become strained even if it hasn't crossed the diagnostic threshold. Low grade inflammation can occur, and inflammation exists on a spectrum. So you can have subtle inflammatory signaling that can increase do things like, you know, increasing your pain sensitivity. We've talked about a that a lot recently."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "198.545",
      "endTime": "227.195",
      "body": "Worsen fatigue, impact cognition without dramatic lab or abnormalities. You can have things like your CRP or your, you know, reactive proteins that can technically be normal but trending higher than your personal baseline. The immune system may be activated without meeting criteria for an autoimmune disease. Early dysregulation doesn't always show up clearly. Central sensitization, this is a big one."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "227.67",
      "endTime": "239.82999",
      "body": "Right? So after repeated injuries, stress, or trauma, the nervous system can become hyperresponsive. Right? We see that in physical injuries and, you know, emotional issues. Right?"
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "239.82999",
      "endTime": "248.66501",
      "body": "It's all interrelated. So the pain threshold can lower. Signals can amplify. Fatigue increases. Sensory input can feel overwhelming."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "248.82501",
      "endTime": "281.055",
      "body": "This can occur in things like chronic back pain, migraines, fibromyalgia, k, post traumatic pain, like, post traumatic arthritis, post traumatic pain syndromes. Standard imaging often looks unimpressive, can look unimpressive, but the nervous system has changed. That change is functional and not necessarily structural all the time. Sleep as a it can be a hidden driver as well. So many veterans have disrupted sleep even if they don't realize how severe it is."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "281.29498",
      "endTime": "296.88",
      "body": "Sleep disruption affects things like pain tolerance, hormone regulation. Your immune balance can be impacted, your mood, all kinds of stuff. Cognitive clarity. Can are you thinking clearly? Right?"
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "297.04",
      "endTime": "314.265",
      "body": "You can feel profoundly unwell simply from chronic sleep fragmentation. And unless a formal sleep study is done, this may go undetected. So not everything it's it's important to realize that not everything is missed. Let's say balance. I think it's always important to say that."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "314.59",
      "endTime": "339.435",
      "body": "If symptoms are severe or worsening, further evaluation is always important. You know? I I hope most of you guys are enrolled in VA health care. I know it gets knocked all the time, you know, using secure messaging, following up with your provider, you know, explaining what's going on. Medicine must rule out things like autoimmune diseases, endocrine disorders, structural injuries, infections, you know, different metabolic conditions."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "339.675",
      "endTime": "359.615",
      "body": "But once serious pathology is ruled out, persistent symptoms do not automatically mean that nothing is wrong. They may reflect dysregulation rather than destruction. That is an important distinction. So why you know, this feels so frustrating to many veterans, and I completely understand. I'm a veteran."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "359.615",
      "endTime": "382.85",
      "body": "I have chronic pain from a variety of things as well. When tests are normal, patients often feel dismissed. But normal means we have we have not identified structural failure. It does not mean that your nervous system is perfectly regulated, that your inflammation, your inflammation is ideal, your stress response is optimal. The body is more complex than a single lab range."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "383.365",
      "endTime": "403.68",
      "body": "Right? So that's important to remember that these lab ranges are just reference ranges, and medicine is continuing to evolve. So you can feel genuinely unwell even when imaging and labs appear normal. The nervous system, immune system, and endocrine system, and stress response are deeply interconnected. This regulation can exist before overt disease develops."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "404.47998",
      "endTime": "430.49",
      "body": "Understanding that doesn't replace proper medical evaluation, but it can help explain symptoms. It can explain it can help explain why symptoms can be real even when standard tests are just sort of unremarkable. If you've ever felt confused or dismissed because your tests were normal, I hope this helps provide clarity. The body does not operate in a black and white, you know, category. It's not in a funnel."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "430.49",
      "endTime": "444.45502",
      "body": "You can't look at these things like that. It operates on a spectrum and regulation. And sometimes symptoms reflect dysregulation before they reflect structural disease. That said, this video is for educational purpose only. It is not medical advice."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "444.45502",
      "endTime": "469.55",
      "body": "If you are experiencing persistent or worsening symptoms, please please follow-up with your primary care doctor or another qualified medical professional for individualized evaluation and care. Every situation is unique, and proper medical assessment is essential. K? If this was helpful, please consider liking and subscribing. I regularly break down complex medical topics related to VA disability in a clear evidence based way."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "470.085",
      "endTime": "475.765",
      "body": "And I will see you guys in the next video. Please drop some comments, and I'll see y'all soon. Okay. Bye."
    }
  ]
}