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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A stroke occurs when blood flow to a part of the brain is impaired. This can happen because the arteries become restricted due to artherosclerosis (narrowing of the blood vessels), a clot closes off an artery, or there is bleeding in the brain. If nerve cells in the affected area of the brain go without oxygen for 5 minutes or so, they can become damaged. The location of the stroke determines what types of impairments you may have as a result.

A rehabilitation program can help prevent or treat medical complications and enhance your function and quality of life.

Your rehabilitation program will begin in the hospital as soon as you are medically stable. After leaving the hospital you may need care in an inpatient rehabilitation facility or a skilled nursing home. Alternatively you may receive stroke rehabilitation services in your home or in an outpatient clinic, depending on the severity of the stroke. 

Stroke rehabilitation is a team effort involving you, your family and social support system, and health care professionals including physicians specializing in physical medicine and rehabilitation (PM&R). We will assist with diagnosis, treatment, and coordination of the rehabilitation services you will need after a stroke. In addition, we can prescribe medications to help with physical changes caused by the stroke or provide other treatments to help you function optimally.


Nearly all cases of stroke require treatment in a hospital. Once the initial stroke has been treated, long-term symptoms may remain. The symptoms will depend on the severity of the stroke and the areas of the brain that were damaged. Symptoms include:

  • Trouble moving, feeling, or using one side of the body
  • Muscle weakness and changes in muscle tone
  • Dizziness or vertigo
  • Visual difficulty
  • Balance problems or lack of coordination
  • Pain, numbness, or loss of sensation
  • Difficulty performing everyday activities such as eating, dressing, or bathing
  • Difficulty swallowing
  • Problems speaking and understanding
  • Changes in cognitive function – your ability to think, learn, and remember – that you might not be able to recognize
  • Changes in behavior, mood, communication or interpersonal relationships
  • Problems with bowel and bladder function

Screening and Diagnosis

We will ask you, and your family members and caregivers, about your symptoms and perform a comprehensive examination. This will help us to confirm your diagnosis and impairments before we decide what treatment plan to recommend. We will also evaluate your activity limitations and ability to participate in your life roles by looking at the relationship between your functional abilities and your environment at home and at work.

Once  we have a clear diagnosis, we will develop a plan to help you perform specific tasks, improve your quality of life and get back to the activities you enjoy to the greatest extent possible.


We will work with you, your family members, and your personal physician to reduce your risk of another stroke and prevent secondary complications such as:

  • Aspiration pneumonia
  • A clot in your legs or in your lungs (pulmonary embolus)
  • Abnormal, often permanent, contractions of a weak muscle (contractures)
  • Depression or other mood disorder
  • Pressure ulcers caused by confinement to a bed or a wheel-chair for extensive periods of time
  • Urinary tract infection
  • Constipation
  • Injuries due to falls or other causes

Treatments and Medications

There are a number of treatments and medications that we may prescribe to support your rehabilitation program. These will depend upon your symptoms and condition.

Treating muscle stiffness or spasticity

We may prescribe a muscle relaxant to treat muscle stiffness. Since these drugs can cause fatigue and weakness, we will monitor you closely and adjust your dosage so you can continue to participate in your usual daily activities.

Botulinum toxin injections can also reduce stiffness. However we use this medication cautiously since it can cause weakness.  

Alleviating pain

The pain treatments we suggest will depend on the type of pain you are experiencing. Some people experience nerve pain while others feel pain in a weak or paralyzed part of the body. In addition to prescribing pain medications and nerve stabilizing agents, we may advise you to treat stiff or painful muscles with cold or hot packs, or with gentle exercise. We will also encourage you to get plenty of sleep and relaxation as this can help reduce your perception of pain.

Dealing with depression

It is common to feel depressed after a life-changing event like a stroke. Because of this, it is important that you and your family let us know if you are feeling down or depressed.  We can refer you for individual or group therapy and refer you to a stroke support group. We may recommend an antidepressant medication if your symptoms are severe.

Helping you sleep

Some people experience problems sleeping after a stroke. We will assess your sleep issues and evaluate possible causes, including sleep apnea. Sleep apnea can increase the risk that you will suffer another stroke and taking sleeping pills to help you sleep can be harmful. We may recommend that you use a CPAP (continuous positive airway pressure) machine that provides breathing support to improve your sleep and prevent future strokes.


We will work with you and your family members to plan a rehabilitation program to help you improve your function and quality of life. We bring together clinical practitioners from many disciplines that use different medical and therapeutic approaches. The team includes physical therapists, occupational therapists, speech therapists, rehabilitation nurses, neuropsychologists and nutritionists. Our aim is to promote your abilities so you can go back to your normal life at home, at work, and in the community to the greatest extent possible.

Rehabilitation aims to improve your:

  • Mobility
  • Ability to carry out activities of daily living
  • Cognitive function – your memory and reasoning abilities
  • Swallowing ability
  • Bowel/bladder management


A rehabilitation program will include therapies and exercises that are designed to address muscle weakness and spasticity, improve your ability to move, and promote your safety at home and in the community.

  • Physical therapy. The primary goal of physical therapy is to help you learn how to get around and move safely, for example, when getting out of bed or a chair, or transferring from a wheelchair into a car. To maximize your mobility, we will teach you exercises to strengthen and condition your muscles and to improve your balance. In addition, we will help you develop a fitness program that matches your physical abilities and needs.  Regular exercise is essential for improving and maintaining your overall health. Your activity program may include range-of-motion exercises, weight training, stretching, land- and water-based strengthening and balance exercises and aerobic exercise. 
  • Splinting. We may use splints to prevent spasticity or weakened muscle groups from permanently forcing your muscles and joints into abnormal positions known as contractures.
  • Medical equipment. Devices are available to help you compensate for coordination and balance problems.  We can prescribe the equipment that works for you.
  • Preventing falls. A stroke can test your coordination and balance. Living and working in a safe environment can reduce your risk of falling. We can teach you a number of things you can do to make your home safer and prevent falls.

Activities of Daily Living

Language/communication difficulties

Stroke can cause speech changes or prevent speech altogether.  Some people find they cannot understand spoken or written language. If you have speech or comprehension problems, we will refer you to our team of speech therapists. A speech therapist helps you to improve speech clarity by helping you to practice certain exercises.  If required, he or she can also help you use technological devices to improve your ability to read, express yourself, and understand speech.   For example, s/he may recommend a speech generating device that allows you to type in the words you wish to say, and then "speaks" the words for you. 

Self Care

A stroke can affect your ability to carry out your usual self-care tasks such as bathing, dressing and eating.  An occupational therapist can work with you to regain your ability to perform these tasks.  S/he can advise you on articles of clothing that are easier to put on fasten, and help you practice dressing and bathing.  S/he can also recommend, or provide, adaptive devices that can help you complete tasks.  Examples include specially designed kitchen accessories and bathing and dressing aids. 

Additional References:

Your Care with Me

If you experience a stroke you will usually be treated in the Emergency Department and then admitted to the hospital.  Your first visit with a rehabilitation specialist like me will usually be in the hospital where your rehabilitation will begin.

When I first see you, we will discuss your medical and family history and I will perform a comprehensive examination. This may consist of tests to assess your cognitive function, speech, nerve functioning, and reflexes. I will review any lab tests ordered by other members of your health care team and order any further tests that may be necessary to complete a thorough diagnosis.

I will explain the findings of your exam and answer any questions or concerns you or your caregivers may have. I will also prescribe medications that you need and work with you to minimize side effects. We will discuss treatment options, and together we will create a rehabilitation plan that is right for you.

Depending on the severity of the stroke and degree of impairment, I may recommend that you continue your rehabilitation in an inpatient rehabilitation facility or a skilled nursing home.  Alternatively we may arrange for you to receive rehabilitation services in your home or in an outpatient clinic.

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.

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.

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.

Related Health Tools:

Interactive Programs

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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