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

Sepsis is an illness in which the body has a severe response to bacteria or other germs. Sepsis is usually caused by a major bacterial infection, although it may also be caused by viral or fungal infections. The symptoms of sepsis are not caused by germs themselves. Instead, chemicals the body releases cause the response. It can spread more aggressively if you have a weakened immune system, often because of another underlying disease, such as heart disease, diabetes, pneumonia, or kidney failure. People being treated for AIDS or undergoing chemotherapy may also be at risk for developing sepsis.

The earlier we can diagnose sepsis, the more effective the treatment. Sepsis is treated with antibiotics, fluids, given through an IV (intravenously, through a vein), and other emergency life-saving measures. When it becomes a life-threatening situation, the condition is often known as septic shock.

Sepsis is an emergency condition, requiring immediate treatment. Septic shock requires prompt treatment in a hospital intensive care unit (ICU). If sepsis or septic shock is treated promptly, most people will recover from sepsis. Even with timely treatment, there is a risk of organ damage or death.

Symptoms

A person who is suffering from sepsis may notice a change in mental alertness. Their breathing may become very rapid. These are often the earliest signs of sepsis. Other common symptoms of sepsis include:

  • Very low blood pressure
  • Rapid heartbeat
  • Confusion, lightheadedness, and agitation
  • Decreased urine output
  • Diarrhea
  • Difficulty breathing
  • Fever

If you are in the hospital, please let us know as soon as possible if you are experiencing any of these symptoms.

Call 911 or go to the nearest Emergency Room immediately if someone near you exhibits signs of sepsis, especially if the person:

  • Has had an organ transplant
  • Has AIDS or diabetes
  • Is undergoing chemotherapy or radiation treatment
  • Is an infant or elderly person

Causes and Risk Factors

Sepsis is normally caused by a serious bacterial infection, although it may also be caused by viral or fungal infections. Pneumonia, a lung infection, abdominal infections such as appendicitis, skin infections, meningitis, infection around the brain, or even an untreated urinary tract infection can potentially develop into sepsis.

If an infection is severe enough, any person can develop sepsis. Some people at higher risk for sepsis include people who have organ transplants, those with kidney or liver failure, or those who are being treated with immunosuppressive medications. In addition, if you have suffered from burns or are undergoing cancer treatment, you may also be at risk for severe infection that could lead to sepsis.

Diagnosis

Sepsis is normally diagnosed with a careful history taken from the patient and/or the patient’s family. We may perform a range of tests, including blood tests that can check for signs of infection and kidney and liver function tests.

Other laboratory tests may include a spinal tap to check the spinal fluid for meningitis or other infections, urine testing to check for urinary tract infection, or a wound fluid or secretion sample test, if appropriate, to identify the type of infection. This will help us to determine the most effective antibiotic treatment.

Imaging tests, such as X-rays or computed tomography (CT) scans can help pinpoint particular organs or areas that may be actively infected. Your doctor will determine which tests are appropriate for your situation.

Treatments

Sepsis is an emergency condition, requiring prompt treatment. Medical treatment for sepsis will normally include:

  • Intravenous antibiotic medication and life sustaining fluids.
  • Medication to increase blood pressure.
  • Oxygen through a nasal tube, mask, or tube inserted down the throat, to maintain blood oxygen levels.

Depending upon your other symptoms, treatment may also include the use of insulin to help stabilize blood sugar levels, and medicine like prednisone to reduce inflammation.

In the case of severely limited kidney function, kidney replacement or dialysis may also accompany other treatments for sepsis. Surgery may also be needed to clean or drain the site of the infection.

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.

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.

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.

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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