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

Chronic obstructive pulmonary disease (COPD) is preventable and treatable. If you have COPD, you may feel short of breath because less air flows through your lungs. Your breathing tubes become narrow and damaged. COPD can cause other changes in your lungs that cannot be reversed. If you have a severe case you may need oxygen therapy and  COPD can lead to respiratory failure. The most common cause of COPD is smoking. 

There are 2 main types of COPD:

  • Chronic bronchitis causes a productive cough (brings up phlegm) for 3 months or more in 2 consecutive years.
  • Emphysema causes destruction of some of the normal lung tissue.

Some people with COPD also have asthma. Some people will have a mix of both types of COPD and asthma. COPD can be prevented and treated.

Additional References:

Causes and Risk Factors

We know that smoking is a major cause of COPD. However, we do not fully understand what causes every case. While many factors may increase your risk of developing COPD, about a fifth of people with the condition have no known risk factors.

Common risk factors include: 

  • Smoking. Smoking tobacco or marijuana increases your risk. Most people with COPD are smokers.
  • Genetics. History of COPD in your family can increase your risk for developing COPD.
  • Exposure to pollution or secondhand smoke.
  • Allergies. Allergies to hay fever, grass, tree pollen, and/or house dust can increase your risk.

Prevention

Here are steps you can take to reduce your risk of developing COPD: 

  • Avoid smoking tobacco or marijuana or secondhand exposure to both.
  • Avoid exposure to dust, gases, or fumes.
  • Increase your level of physical activity.
Additional References:

Symptoms

The symptoms of COPD vary between different people. Common symptoms of COPD include:

  • Shortness of breath, usually with exercise, at the onset of COPD. It can worsen over time so that shortness of breath occurs even at rest.
  • Chronic cough with sputum production, beginning in the morning, and then with time, progressing throughout the day. 

More frequent respiratory infections, including acute chest infections like a bad cold or other infection. These can cause the cough to get worse or result in sputum production that is often yellow-green in color, wheezing, and more shortness of breath.

Some people have no symptoms and are diagnosed with COPD as a result of a routine chest X-ray or other tests. Others may not recognize symptoms because they do not exercise enough to cause shortness of breath.

Diagnosis

A diagnosis of COPD can be made based on your symptoms, medical history, lung function and chest X-ray.

Lung function test: Spirometry

We may recommend lung function testing, or spirometry. Spirometry is the most accurate way to diagnose COPD.

Spirometry checks your lung function. It looks at how air flows into and out of your lungs, and how oxygen goes back and forth between your lungs and your blood.

Here it is how it is done: 

  • You blow into a mouthpiece attached to a machine (spirometer).
  • The machine measures the rate of flow and volume of the air in your lungs.
  • We may give you inhaled medication during the test. Your response to this medication will help us determine if you have COPD or asthma.

Chest X-ray

Chest X-ray may be helpful in the diagnosis of COPD. We can also use X-ray to look for, and to rule out, other reasons that may be causing  shortness of breath such as pneumonia or lung cancer. 

Pulse oximetry

We use a pulse oximeter, a small device placed on a finger, to measure your level of oxygen saturation at rest, or with exertion, depending on your situation. If you have severe COPD, this test helps us determine if you need home oxygen therapy.

Treatments

The treatments we recommend will depend upon the severity of your symptoms and your medical history. There are treatments for chronic COPD and treatments for flare-ups of COPD. The goal of treatment is to decrease your symptoms and to improve your ability to enjoy your life. We specifically want to decrease the possibility of flare-ups and increase your ability to exercise.

Medications

Commonly used medications include:

  • Beta-agonists or anticholinergics to help keep your breathing tubes open.
  • Inhaled glucocorticoids or corticosteroids to help reduce or prevent inflammation of the lungs.
  • Combinations of beta-agonist, anticholinergic, and glucocorticoid medications can also be used to control COPD.
  • Oral steroids (such as Prednisone) may be used in severe cases. Steroids  can cause problems including thinning of the bones, increase in blood sugar levels, cataracts, and an increased susceptibility to infection. As a result, we only prescribe them  for severe cases and  during flare-ups.
  • Theophylline (a bronchodilator) is rarely used because it is metabolized by the liver, side effects are common, and it interacts with other drugs that you may take.
  • Mucolytics, or medications that thin or break down mucus, are not very effective, so we don’t prescribe them often. 

If you are at risk for heart disease, we may also recommend that you take a statin drug (medication to reduce cholesterol).

Vaccinations are important to prevent COPD from flaring up. We will recommend these vaccinations for you, if you have COPD:

  • Annual influenza vaccine.
  • Pneumonia vaccine, at least once.

Other Treatments

Oxygen. Prescribed for most patients with severe COPD who have low oxygen blood levels. It can improve lifespan and quality of life. 

Surgery. People with emphysema, mainly in the upper part of the lungs, who have a low ability to exercise, may benefit from lung volume reduction surgery. 

Lung transplant. We recommend lung transplant only for people  with severe COPD whose symptoms do not respond to  medical treatment and oxygen. Not all patients qualify for a transplant.  This process requires detailed evaluation and various tests to make sure it is a safe approach in your case. 

Treatment of Flare-Ups

The most common cause of flare ups are viruses and bacteria. Other causes include exposure to pollution or secondhand smoke. If you are experiencing a flare up you may need to go to the emergency department. Adding an inhaler, oral steroids, antibiotics or oxygen are used to treat flare ups. 

Additional References:

Lifestyle Management

Quitting smoking is an important part of your treatment. We can help you find resources that will work for you.

Maintaining an active lifestyle can help prevent loss of lung function. Comprehensive pulmonary rehabilitation, which includes exercise training, may be helpful to improve ability to exercise, decrease shortness of breath, and increase self-care.

Your Care with Me

As your hospital medicine physician, my first contact with you will be either in the Emergency Department or in your hospital room.  Together we will go over your medical history and medications you are currently taking, perform a physical examination, and come up with a treatment plan.

While you are in the hospital

I will work closely with your bedside nurse and patient care coordinator each day of your stay to improve your health and to plan for a safe return home. We will also inform your family members of your care plan. If you are having symptoms that concern you when you are in the hospital, please inform me or one of the hospital staff immediately.

If specialty care is needed during your hospital stay, I may contact one of my specialty colleagues and discuss your care with them.

If I prescribe medications

During your hospital stay, we will work together to monitor and assess how your medications are working and make adjustments over time. Before you leave, we will go over each new medication, how to take it, and when/if to stop the medication. At the time of discharge, all medications can be picked up at the discharge pharmacy. 

After you are discharged from the hospital, you will have a follow up visit with your primary care clinician. You may also receive a follow up phone call from one of the hospital staff to see how you are doing once you are at home.

If you are having symptoms that concern you and you are not currently in the hospital:

  • You may contact your personal physician, who will evaluate your health and symptoms.
  • If you have urgent concerns or issues or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice and make an appointment with your doctor if needed.  
  • If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating 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 that 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.

This applies especially to your primary care physician, who will be notified electronically when you are hospitalized, and may review the care you are receiving while in the hospital. Upon discharge, your doctor will receive a summary of your care in the hospital, including some tests or imaging results that may still be pending.

Care After Hospital Discharge

If you require further testing and medications, or are having symptoms after leaving the hospital, we recommend that you contact your primary care physician.
You can also call the Appointment and Advice line. Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location. The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.

If refills are needed in the future after you leave the hospital, you can:

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

For lab tests that are needed after discharge, 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. Your primary care physician will follow up on these results unless your condition needs immediate attention. In addition, you can view most of your laboratory results online, along with any comments that your primary care physician may have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, I will make an electronic referral to the appropriate department and they will contact you for an appointment.

If Surgery or a Procedure is a Treatment Option

Occasionally, a procedure and/or surgery can be postponed until you are healthier and have recovered from your hospitalization. Then I will refer you to the appropriate service and they will follow up with you once you are discharged from the hospital.

If you are considering a procedure or surgery, please take a moment to go to the “Tools & Classes” tab above and select the “Prepare for Your Procedure - Emmi” link. There you can watch videos about different procedures.

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 most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages to your primary care physician and specialist.
  • 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.
  • Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures of common conditions we take care of in the hospital.
  • 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 every 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.

Related Health Tools:

Interactive Programs
Videos

See more Health Tools »

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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