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

The heart is a muscle that functions much like other muscles in your body. It contracts and relaxes to pump blood continuously to every part of the body. 

Heart failure means that the heart does not pump normally or does not pump enough. It does not mean that your heart has stopped working or is about to stop working. 

With heart failure, either the heart is pumping less blood than your body needs (low output); or it is pumping with raised pressure so that fluid backs up (fluid congestion). 

Backed-up fluid can accumulate in your lungs, ankles, abdomen, or elsewhere in your body. Some people with heart failure have fluid congestion and low output. 

Types

There are 2 main categories of heart failure.

Heart failure with reduced ejection fraction (HFrEF).

The heart’s main pumping chamber is called the left ventricle. HFrEF develops when the left ventricle is too large and does not contract as often as it should. This means that the amount of blood squeezed out with each heartbeat is too low. We call this a reduced ejection fraction. 

A normal ejection fraction is between 50 and 65 percent. You have HFrEF if your ejection fraction is below 40 percent. We sometimes call this systolic heart failure.

Heart failure with preserved ejection fraction (HFpEF).

Heart failure can also occur when heart contractions and the ejection fraction are normal. HFpEF develops if the left ventricle does not relax properly. This may be caused by a stiff ventricle muscle. When this happens, the heart does not get enough blood. 

Fluid can also back up in other parts of the body. We sometimes call this diastolic heart failure or a “stiff” heart.

Symptoms

Symptoms of heart failure include:

  • Difficulty breathing or shortness of breath. This may happen while you are resting, exercising, or lying flat. It occurs because fluid is backing up into the lungs.
  • Weight gain. This can be caused by fluid retention. Weigh yourself daily. Call us if you gain more than 2 pounds in one day or 5 pounds in one week.   
  • Swelling (edema) in your legs, ankles, feet, hands, or abdomen. This is caused by fluid retention. 
  • Fatigue or sudden decrease in ability to do usual activities. 
  • Coughing or wheezing. It may mean fluid is building up in your lungs. 
  • Fast or uneven heartbeat. The heart may work harder to pump blood.  
  • Loss of appetite.
  • Increased urination may happen, especially at night. Your body may retain fluid during the day and get rid of it at night.
  • Dizziness or fainting can be caused by reduced blood flow, low blood pressure, or heart rhythm disturbances (slow or fast heart rate).

Causes

Heart failure can be caused by:

  • Heart valve abnormalities. Normally, the heart valves open and close, keeping blood moving. Abnormal valves either allow blood to leak or fail to open completely. 
  • Disturbances of the heart's electrical rhythm. This may cause the heart to beat too fast, too slowly, or irregularly. 
  • Coronary artery disease. A buildup of plaque and fatty substances block or slow down blood flow in the arteries that supply the heart. This can cause a heart attack that can damage the heart muscle and cause heart failure. 
  • High blood pressure makes the heart work harder to circulate blood. The heart muscle becomes thicker and stiffer and unable to pump effectively.
  • Cardiomyopathy is an abnormality of the heart muscle. It can weaken the heart's contraction. 
  • Congenital heart defects. Heart chambers and/or valves may not be normally formed at birth.
  • An abnormally fast heart rate. 

Stages

Stages of heart failure

Heart failure is a chronic condition that gets worse over time. Medications cannot cure heart failure but they can lessen symptoms. They can also prolong and improve the quality of your life.

Class I

No symptoms

Class II

Symptoms during intense activity (beyond typical daily actions)



Class III

Symptoms during everyday activity

Class IV

Symptoms much of the time, even while at rest

Please report any and all symptoms when you have phone or in-person visits with us. Tell us right away if symptoms worsen or change. This may mean that your heart failure is progressing.

Diagnosis

We diagnose heart failure based on your symptoms and a physical exam. During your visit, we will discuss your symptoms and order additional tests to confirm the diagnosis. These tests may be done in the Emergency Department if your symptoms are severe.  

Blood Tests

A complete blood count (CBC) measures many things including the number and size of red blood cells. It also tells us if you are anemic.

A brain natriuretic peptide (BNP) test. Higher levels of BNP in the blood may suggest more severe heart failure. High BNP can be also be caused by:

  • Chronic kidney disease 
  • Pulmonary embolism 
  • Acute illness

Creatinine testing tells us how your kidneys are working. Heart failure and the medications used to treat it affect the kidneys. Monitoring creatinine is important when your condition or treatment changes.

Potassium can be affected by heart failure medications and changes in kidney function.

A lipid panel measures cholesterol levels. Cholesterol can contribute to the buildup of plaque and blockage of arteries. Managing cholesterol reduces your risk of heart attack or stroke. 

Thyroid-stimulating hormone (TSH). High TSH levels indicate that your thyroid hormone level is low (hypothyroidism).  We monitor TSH because low thyroid hormones can: 

  • Increase your risk of developing heart failure. 
  • Cause symptoms that look similar to heart failure symptoms.

Additional Tests

An EKG/ECG (electrocardiogram) shows the electrical activity of your heart as a series of spikes and dips. This shows the rhythm of your heart. This may suggest changes to the structure of your heart that could have been caused by a prior heart attack.

An echocardiogram uses sound waves to look at the size, shape, and functioning of your heart. This test may be done while you are at rest or before and after exercise. We place an ultrasound probe on different points of your chest.

Cardiac catheterization looks at the arteries that supply blood to the heart muscle. The test determines whether there is a buildup of plaque that is blocking blood flow and causing heart failure.

Stress testing is a noninvasive procedure to evaluate the blood flow to your heart.

Treatment

Treatment for heart failure can prolong your life and help you to feel better. Treatments focus on lessening symptoms and slowing the progression of the illness. 

Looking after yourself is crucial. This includes making regular exercise and a healthy diet part of your lifestyle every day.

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:

Classes and Coaching
Interactive Programs
Podcasts
Prepare for Your Procedure
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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