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

Methicillin-resistant Staphylococcus aureus, or MRSA, is an infection caused by Staphylococcus aureus (staph) bacteria. It is most commonly spread through contact with an infected person and can cause serious infections. MRSA is resistant to methicillin and other related antibiotics that we usually use to treat infections. Alternative antibiotics sometimes need to be used to cure infections caused by MRSA. 

Staph are often found on the skin; inside the nose; or in the armpit, groin, or genital area. In most cases, staph does not cause any problems or may cause minor infections such as pimples or boils. These infections usually happen because of small breaks in the skin from a cut or wound. In some cases, staph can cause more serious infections such as pneumonia (lung infection), bloodstream infections, or surgical wound infections. These kinds of infections often require treatment with an antibiotic or a combination of antibiotics.

MRSA used to cause infections mostly in patients in the hospital or other health care settings. However, MRSA infections can occur in the community, and now most commonly affect people who are healthy and have not been recently hospitalized. If you have a MRSA infection, it does not mean you have poor hygiene. People who wash their hands often and keep their bodies clean can still get MRSA infections.

Symptoms and Diagnosis

Symptoms

You may notice the infection is related to a cut or injury to your skin. However, it is also common to notice a skin infection without being aware of a cut or injury. Skin infections with MRSA often look like:

  • A spider bite that is red and tender.
  • A boil or tender lump (called a carbuncle) that drains pus.
  • Pimplelike bumps in a group or cluster.

Without treatment, the infected area can become larger, redder, swollen, and tender. You may also experience symptoms such as a fever, feeling very tired, or pain at the site of the infection.

Diagnosis

If you have a boil or skin infection that has swelling, we may decide to drain the liquid and pus from it. Draining it helps to cure the infection. To see if MRSA bacteria are growing in the infection, we may also send a culture (tiny sample of liquid from the infection) to the lab. If you have symptoms of a serious infection in your body or bloodstream, we will order a blood test. This test will tell us if you need an antibiotic to cure a MRSA infection in your blood.

Causes and Risk Factors

Causes

MRSA is an infection caused by a type of staph bacteria that is resistant to the usual antibiotics we use to treat skin infections. Healthy people normally carry some staph bacteria on their skin or in their nose, and it usually does not make them sick. However, healthy people can still pass bacteria to others who may then become ill.

MRSA is most commonly spread by close contact with an infected person. The staph bacteria can rub off the skin of the infected person and onto the skin of another person when they have prolonged skin-to-skin contact. The bacteria can also spread from infected skin onto objects such as towels, soaps, and sheets. The next person who uses these objects may become infected. It is important to know that pus and drainage from wounds and skin infections are very contagious and can easily spread infections.

Certain bacteria in our environment such as MRSA have developed resistance to usual antibiotics. Over time, bacteria can naturally evolve to become resistant to certain antibiotics. In addition, years of over-prescribing antibiotics has led to changes (mutations) in bacteria that can then develop into resistant strains. This is one reason to take antibiotics only for treating bacterial infections, and not for treating viral infections. Taking an antibiotic when you have a virus does not cure the virus and can lead to more resistant bacteria in our environment. Taking only part of your antibiotic prescription can also lead to the development of resistant bacteria.

Risk factors

Anyone can develop a MRSA infection. This infection used to be more common in patients in hospitals or other health care facilities. However, now MRSA occurs in people who are normally healthy and have not been hospitalized. Patients in the hospital and people with weakened immune systems are at higher risk for having serious complications related to MRSA.

Treatment

If you have a boil, we will drain it and often send a small sample of the liquid (culture) to the lab. Usually, treating the boil in this way is enough to cure the infection and you may not need antibiotics.

If you have a skin ulcer (open, inflamed infection), we may send a culture (by swabbing a small sample of the infection) to the lab to see if MRSA is present. We will decide if you need an antibiotic that treats MRSA. To cure your infection, it is important to take all the antibiotic pills according to the directions, even if you are getting better. After 3 days, let us know if the infection is not healing or is becoming larger, redder, or more tender. This can be a sign that we need a different antibiotic to treat your infection.

For certain types of infections with MRSA that do not respond to oral antibiotics (pills), we will recommend intravenous antibiotics. We usually use intravenous antibiotics for infections in the blood or in organs inside the body.

Prevention

If you are diagnosed with a MRSA infection, you can help prevent spreading MRSA by following these guidelines:

  • Wash your hands frequently with soap and water or use an alcohol-based gel hand sanitizer.
  • Do not share personal items such as razors, towels, sheets, soaps, or clothing.
  • Disinfect surfaces that may be touched by others like counters, phones, and computers.
  • If you have a wound that we have treated, follow our instructions for keeping it clean and covered with bandages or dressings.

To prevent spreading germs, it is important to frequently wash your hands during daily activities. Always wash your hands:

  • After coughing or sneezing
  • After going to the bathroom.
  • Before preparing food, eating, or drinking.
  • Before applying make-up or handling contact lenses.
  • Before and after handling bandages.

If you participate in athletics or sports, here is how you can help prevent the spread of MRSA:

  • Do not play if you have a skin infection that is swollen, red, or tender.
  • Shower and use soap right after athletic activities.
  • Do not share towels or other personal equipment.
  • Clean athletic equipment before and after use with sanitizer.
  • Wash athletic clothing after wearing.

In the hospital, all care givers should wash their hands before touching you. It is okay to remind a care giver to wash their hands before caring for you.

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.

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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