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Doctor Q&A for Dr. Robert Jacoby

A 22-year-old female asked:
Dr. Robert Jacoby
Neurology 32 years experience
Big question: Start with what kind of diplopia - horizontal, vertical or skewed. That will help tell you which eye muscles are involved. Pain with eye movement is worrisome. Diplopia that gets worse with fatigue may be a muscle issue. Vertigo and diplopia makes one think of inner ear or brainstem difficulties, but these can be hard to differentiate. Trauma can cause horizontal diplopia
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A male asked:
Dr. Robert Jacoby
Neurology 32 years experience
Absolutely: Many drug screens look at classes of chemicals first and then there are specific tests that break that down further. There is always a confirmatory test that helps with false positive drug screens. Talk to your doctor!
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A 30-year-old male asked:
Dr. Robert Jacoby
Neurology 32 years experience
Be happy!: It is probably not related to the shot - B12 injections usually don't work that quick. Either way it doesn't matter! The key is you are feeling better and this is what is most important.
A 20-year-old female asked:
Dr. Robert Jacoby
Neurology 32 years experience
Stop!: For a tumor to cause headaches and tinnitus it usually has to be fairly large or in a critical area that you would have other neurological signs or symptoms. Things such as balance problems, walking problems, weakness, double vision, altered vision. While tumors can be tricky the chances are low. Either way you should get checked out so you don't worry!
A 22-year-old male asked:
Dr. Robert Jacoby
Neurology 32 years experience
Usually not serious: For the most part up to 5 small hyper-intense signals are considered in the normal range and can occur from lots of different causes. It could be a illness as child, migraines, mild traumaor hypertension. At your age they are probably not worrisome and you now have a good baseline MRI to compare to future ones if needed.
A 27-year-old male asked:
Dr. Robert Jacoby
Neurology 32 years experience
Depends: Xanax (alprazolam) is a fast short acting anti-anxiety medication. I would take it 30 mins before take off or earlier if anxious at the airport. Take the lowest dose that reduces your anxiety. Its always easy to add a 1/2 tablet if needed but if you take to much you wont feel well. Always take a test dose before the flight in the safety of your home because you need to know how your body reacts to the med
A 32-year-old male asked:
Dr. Robert Jacoby
Neurology 32 years experience
Usually Yes...: For some people Tylenol (acetaminophen) can help with muscle tension headaches. Don't take more than 2 grams (3 max) per day since that can cause liver damage. If your headache doesn't get better or changes then talk to your doctor.
A 50-year-old female asked:
Dr. Robert Jacoby
Neurology 32 years experience
Depends...: If you are doing well and not having seizures then that level is usually fine. If you are having breakthrough seizures then that means that there is room to increase the dose if needed. Timing of last dose and the blood draw can affect the blood value. The old adage "Treat the patient not the lab value" applies well here
A 17-year-old female asked:
Dr. Robert Jacoby
Neurology 32 years experience
No: Multiple sclerosis is an autoimmune disease where your immune system attacks nerves and nerve wires in your brain and spinal cord causing many different symptoms. Scoliosis usually refers to excessive curvature of the bony part of the spine and not the spinal cord. Scoliosis can present with pain
A 33-year-old female asked:
Dr. Robert Jacoby
Neurology 32 years experience
Old nerve damage: The EMG, where a needle is inserted into muscle tells the doctor how healthy the muscles are and if they are getting enough nerve signal. If there is early nerve damage then the muscle at rest will make noises, while if the damage is chronic then the muscle will be quiet at rest. Chronic damage will also sound different when the muscle is contracted. This allows the doc to tell when damage was
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