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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Heart disease is a major health problem in the United States. The medical term for heart disease is coronary artery disease (CAD). 

CAD develops over years. Usually people don’t have active CAD symptoms until after middle age, or for women during or after menopause. 

CAD symptoms can be frightening and uncomfortable. Sometimes they may signal a heart attack. Our aim is to detect and treat CAD early, to help prevent a life-threatening crisis.

CAD develops when plaques (cholesterol and calcium deposits) build up inside the heart’s arteries (atherosclerosis). Arteries can become narrowed or completely blocked, so that the heart doesn’t get the blood flow and oxygen it needs.

If not treated, over time CAD can cause:

  • A type of chest pain called angina, when arteries are narrowed.
  • Heart attack, when arteries are blocked.
  • Heart failure, when the heart is too weak to pump blood properly.

We urge everyone to learn how to improve their heart health.

Additional References:


Coronary artery disease is the number 1 cause of death in both men and women in the United States.

The Framingham Study taught us a lot about CAD’s causes and risk factors. This study tracked health factors in a large group of men and women over more than 4 decades.

Men have a higher risk for CAD than women before age 50. During and after menopause, women’s CAD risk increases. Risks for angina and heart attack go up for everyone as they age, but women’s risks rise about 10 years later than men’s.

Women and heart disease

It’s especially important for women to have regular heart health checkups from the start of menopause onward. CAD and heart attack symptoms are somewhat different in women than in men. This has delayed proper care for women, in some cases. 

More than a third of women who have a heart attack die within one year, compared with a fourth of men.

Less typical, subtler symptoms of heart disease or possible attack can also occur in people with diabetes and in older men and women.

CAD and heart attack

Coronary artery disease is the most common cause of heart attack. CAD develops when plaques (cholesterol and calcium deposits) build up inside the heart’s arteries (atherosclerosis). Arteries can become narrowed or completely blocked, so that the heart doesn’t get the blood flow and oxygen it needs.

When triggered by physical or emotional stress, a plaque area can break open and form a clot. A clot can suddenly and totally block an artery, immediately causing a heart attack.

Heart attack triggers can include:

  • High blood pressure
  • Severe infection
  • Major emotional distress

Risk Factors

Some risk factors that increase your risk for CAD can be improved if you make lifestyle changes. Other factors are outside your control. We can help you make positive lifestyle changes.

Your chance of having CAD is higher if you:

  • Are male.
  • Are female and older than 55 or in menopause.
  • Have a family history of heart disease.
  • Are overweight.
  • Have an inactive lifestyle.
  • Smoke or use other tobacco products.

Health conditions that increase risk for CAD include:

  • High cholesterol
  • High blood pressure
  • Diabetes


You may be able to avoid a heart attack or heart failure if you know what symptoms to watch for. Since CAD develops slowly over many years, you’re more likely to have symptoms as you age.

Symptoms of angina usually last several minutes and can include:

  • Chest pain or pressure brought on by your normal activities, exercise, or hard work.
  • Chest pain that feels like stabbing or pulsating, in women.
  • Tingling or numbness behind your breastbone or across your chest, which may travel to your neck, jaw, shoulders, shoulder blades, or arms.
Know your angina pattern

You may notice that your angina attacks occur in a pattern. It’s important to tell us about your angina pattern and anytime you notice changes in: 

  • Cause(s)
  • Frequency
  • Severity
  • Attack length
  • Sensations
  • What helps it go away

Tell us if you:

  • Have any symptoms you haven’t told us about yet.
  • Usually have some pain during exercise, and start having pain while resting, or that wakes you up while sleeping.
  • Have had an angioplasty or stent, bypass surgery, or other procedure to open your coronary arteries yet continue to have pain.

Silent ischemia or heart attack. Unfortunately, sometimes the first sign of CAD is a heart attack. Some people have no symptoms, even when their hearts aren’t getting enough blood flow and oxygen. This is called "silent ischemia." Rarely, people can even have a heart attack without symptoms, which is called a "silent heart attack."

Heart attack symptoms

Symptoms often continue for more than 20 minutes. A heart attack can cause:

  • Pain like angina with aching, crushing, squeezing, or burning sensations over the chest.
  • Difficulty breathing.
  • Dizziness, or feeling faint or very weak.
  • Excessive sweating or “cold sweat.
  • Nausea or vomiting.
  • Fast or irregular heartbeat.
  • A sense of coming doom.


To help us find out whether you have angina, we may ask these questions about your chest discomfort:

  • When it started
  • How long it lasts
  • What it feels like
  • Whether it spreads to any other parts of your body
  • What activities bring it on
  • What makes it feel better or go away

Your chest pain may be due to heartburn or another cause. 

We’ll give you a full physical exam and ask about your medical history. We may also recommend these methods to prevent angina:

  • Start you on medications. 
  • Create a heart-health plan with you to reduce your CAD risk factors.
  • Order tests to check for possible causes of your chest pain, such as heartburn, a stomach ulcer, or blood clots in the lungs. 

Tests to check your heart’s functions  may include: 

  • An electrocardiogram (EKG/ECG)
  • A treadmill exercise stress test
  • A radioactive scan of the heart (perfusion scan), if an exercise stress test is not possible
  • An echocardiogram 

If necessary, we may also recommend you have further evaluation in a hospital’s emergency room the same day.


If we find you’ve had a heart attack, your treatment in the emergency room will depend on:

  • How long ago your chest pain started.
  • Your ongoing symptoms.
  • The severity of the attack and what areas of your heart are affected.
  • Your blood test results.
  • Your electrocardiogram (ECG/EKG) results.

If we find no problem with your heart and your chest pain symptoms are stable, we will send you home with follow-up care instructions.

Additional References:

When to Call

 If you think you may be having a heart attack:

  • Stop what you’re doing.
  • Sit or lie down.
  • Take nitroglycerin (if you have a prescription). Place 1 tablet (0.4 mg) under your tongue. Let it dissolve. Do not chew or swallow it. Do not take nitroglycerin if you have taken Viagra, Levitra, or Cialis in the past 72 hours (3 days).
  • Continue to put one nitroglycerin tablet under your tongue every 5 minutes until your symptoms are relieved or an ambulance arrives.
  • Chew one adult strength (325 mg) uncoated aspirin tablet or 4 "baby" aspirins (81 mg each) if you are not allergic to aspirin and aren’t already taking daily aspirin.

If heart attack symptoms go on for longer than 5 minutes, get medical help.

  • Call 911 first, before doing anything else.
  • Call someone to take you to the nearest emergency room.
  • Do not drive yourself. You could endanger yourself and others around you.

Getting medical care within an hour of a heart attack can save your life. It can also minimize damage to your heart.

Your Care with Me

If you think you may be having a heart attack, or if you have chest pain or pressure that lasts more than 5 minutes, call 911 or seek other emergency services immediately. This is not the time to e-mail or call your doctor.

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 a cardiologist’s 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 together we will create a treatment plan that is right for you.

If you have been seen before by a cardiologist outside of Kaiser Permanente, please bring those medical records with you. Also, please bring with you all your containers with any prescription medications and any over-the-counter medications you are taking.

I may order additional tests to be completed at a subsequent visit. I may also prescribe medications, and I will talk to you about how to take the medications.

If I prescribe nitroglycerin for you, keep a fresh prescription (filled within the past 6 months) with you at all times. If you have chest pain or discomfort, sit down and rest, and take the nitroglycerin as directed. If your chest pain does not get better in 5 minutes, call 911. 

If you have had a recent heart attack, heart surgery, or a procedure on your heart, I may refer you to our MULTIFIT cardiac rehabilitation program or other cardiac classes or programs to help you with your recovery. The nurse or pharmacist care manager will contact me regularly about your health. A good place to start is by attending a heart health class. If you have a weakened heart muscle, I may refer you to our Heart Failure Care Management Program. The nurse or pharmacist care manager will adjust your medications to help improve the function of your heart. We also have a series of classes to learn about heart failure.

Contacting Me

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, 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.

Seek immediate medical care if: 

  • You are having chest pain of more frequency, duration, or severity than usual.
  • You feel lightheaded or dizzy, have palpitations (sense that your heart is racing) for greater than 15 to 20 minutes, or feel you might faint.
  • You are having worsening and/or sudden shortness of breath.

Also Call 911 if you have signs of a stroke. These may include:

  • Sudden numbness or weakness in your face, arm, or leg, especially on only one side of your body
  • New problems with walking or balance
  • Sudden vision changes
  • Slurred speech
  • New problems with confusion, speaking, or understanding simple statements
  • A sudden, severe headache that is different from past headaches

If you had surgery or a procedure, please call me if you notice any swelling, bleeding, redness, pain, or discharge at the incision site.

Take your medication exactly as prescribed. If you are having problems with or have any questions about any of the medications I have prescribed for you, let me know. Do not stop taking them without notifying me.

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, 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 over time. 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

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If Surgery or a Procedure Is a Treatment Option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

If you are considering surgery or a procedure or want more information about your heart problem, please review our health tool called “Preparing for Your Procedure” (Emmi). Emmi programs are available for the following cardiology topics:

  • Anesthesia for an Adult
  • Angiogram with Possible Angioplasty
  • Atrial Fibrillation Overview
  • Aortic Valve Replacement
  • Cardiac Catheter Ablation (SVT)
  • Cardiac Catheter Ablation (VT)
  • Cardiac Pacemaker
  • Coronary Artery Bypass Surgery (CABG)
  • Defib (Cardiac Resynchronization Therapy Defibrillator)
  • Defib (Implantable Cardioverter Defibrillator)
  • Mitral Valve Repair or Replacement
  • Taking Warfarin (Coumadin®)

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.
  • 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 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.

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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