Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

See all office information »

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Overview

If you have anemia, you may feel tired or weak because your body is not getting the oxygen it needs. With anemia, you have lower than normal numbers of red blood cells in your body. Red blood cells contain hemoglobin, an iron-rich protein that helps transport oxygen from the lungs to the rest of your body and removes carbon dioxide. Hemoglobin gives red blood cells, which are made in the bone marrow, their color.

Anemia is the most common blood disorder, affecting more than 3 million people in the United States. Although there are many different types of anemia, the condition is usually caused by 1 of 3 things: blood loss, lack of red blood production, or higher than normal rates of red blood cell destruction in the body.

Anemia may be short-term or long lasting. It may be mild, moderate, or severe. Many things can cause anemia, including diet, chronic illness, pregnancy, blood loss, infections, or hereditary conditions. 

Some people with mild anemia may not feel any symptoms. Others may feel exhausted, dizzy, weak, or short of breath. Left untreated, severe anemia can damage the heart, brain, or other organs and may even be life-threatening. Anemia is treated differently depending on its underlying cause. Sometimes you can prevent anemia with a good diet.

Causes

Anemia can be caused by any of the following:

  • Iron deficiency, the most common cause (your body doesn’t have enough iron to make hemoglobin)
  • Vitamin deficiency, such as lower than normal levels of vitamin B12 (called pernicious anemia), or folate
  • Lower levels of the hormone erythropoietin, which stimulates red blood cell production 
  • Chronic diseases such as kidney disease, cancer, or rheumatoid arthritis
  • Infectious diseases, such as HIV/AIDS
  • Pregnancy
  • Heavy menstrual bleeding
  • Bleeding in the digestive tract or Crohn’s disease
  • Blood loss from an accident or surgery

Some other less common causes include sickle cell anemia, when red blood cells are abnormal, and thalassasemia, when red blood cells cannot mature. Aplastic anemia, when your body does not make enough red blood cells, and hemolytic anemia, when your body destroys red blood cells, are also rarer forms of the condition.

Risk Factors

While anemia can occur in both men and women, some populations are more at risk for developing the condition. At-risk populations include:

  • People eating a diet low in iron, vitamins, and minerals.
  • Menstruating or pregnant women.
  • Premature infants. 
  • Infants fed only breast milk or formula that isn’t iron-fortified or children who drink more than 16 to 24 ounces of cow’s milk daily. Cow’s milk can interfere with the absorption of iron.
  • Adults 65 and older. Approximately 10 percent of adults older than 65 have anemia.

Symptoms

If you have mild anemia, you may not notice any symptoms. In more moderate cases of anemia, you may experience any of the following symptoms:

  • Fatigue or weakness
  • Pale, yellow skin or brittle nails
  • Headache, chest pain, or dizziness
  • Irritability
  • Coldness of hands or feet
  • Shortness of breath or a fast or irregular heartbeat
  • Depression or difficulty concentrating

Diagnosis

To diagnose anemia, we first take a medical and family history and conduct a physical exam. We may also order any of the following tests to determine what is causing your anemia:

  • Blood tests, including measuring the level of iron in your blood, such as serum iron and serum ferritin tests
  • Blood tests to measure vitamin B12, folic acid, or other vitamins and minerals
  • Hemoglobin electrophoresis, a blood test to examine your hemoglobin
  • Reticulocyte count, a blood test to measure your young red blood cells
  • Stool sample (fecal occult blood test, or FOBT) to see if there is blood in your stool
  • Bone marrow tests

Treatment

Anemia is treated differently depending on its underlying cause. If your anemia is the result of diet, we may recommend dietary changes or prescribe iron or vitamin supplements. Do not take iron supplements on your own, as taking too much iron can be dangerous. Once we determine what is causing your anemia, we may prescribe any of the following treatments:

  • Dietary changes
  • Iron, B12, or mineral supplements
  • Hormones to control menstrual bleeding
  • Antibiotics
  • Medicine to prevent your body from destroying red blood cells

In severe cases, blood transfusion or surgery may be required.

Lifestyle Management

Diet and the foods we eat can play a role in maintaining healthy iron levels and preventing anemia. If dietary changes are appropriate for you, we may suggest increasing your intake of certain foods. The following foods are high in iron:

  • Leafy green vegetables such as broccoli, spinach, kale, turnip greens, and collard greens
  • Peas, lentils, kidney or lima beans, chickpeas, soybeans, and tofu
  • Dried fruits such as prunes, raisins, and apricots
  • Meat such as beef, pork, and lamb and organ meats such as liver
  • Poultry such as turkey, chicken, and duck, especially dark meat and duck liver
  • Seafood, especially shellfish such as clams and oysters
  • Iron-fortified pastas, grains, rice, and cereals

The following foods are high in vitamin B12 and folic acid, other important nutrients in maintaining health:

  • Meat, especially beef liver 
  • Poultry, fish, and seafood, especially clams
  • Eggs
  • Milk and other diary products
  • Fortified breakfast cereals
  • Spinach, broccoli, corn, and peas
  • Lentils and peanuts
  • Bananas, papayas, oranges, orange juice, and tomato juice

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

How We Coordinate Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit.
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed.  Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at our medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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