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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Hospital-acquired pneumonia (HAP) is an infection in your lungs. It develops during your hospital stay. HAP is a serious illness that may become life-threatening. 

Many different types of germs (bacteria and fungi) cause pneumonia. The germs that are in hospitals tend to be harder to treat than germs you are exposed to in your daily life. Also, your immune system may be weaker and less able to fight the germs when you need hospital care. 

HAP symptoms include:

  • Cough that produces greenish mucus.
  • Fever.
  • Sweats that drench you.
  • Chills.
  • Shortness of breath.

HAP is treated with antibiotics, oxygen therapy, and lung treatments. To reduce your risk, follow the instructions we give you before, during, and after your hospital stay.

Additional References:


The best treatment for HAP is to try to avoid getting it in the first place. HAP can be prevented. 

Follow the instructions that we give you before, during, and after your surgery and hospitalization to significantly reduce your risk of getting HAP.

For example, to reduce your risk:

  • Use an incentive spirometer to keep your lungs active and strong.
  • Brush your teeth regularly.
  • Keep your hands washed.
  • Stay physically active.
  • Sit upright in a chair for meals.
  • Remain upright for 30 minutes after eating.

Before Your Hospital Stay

Before your scheduled surgery or hospital stay, lower your risk of developing HAP. 

Use your incentive spirometer to exercise your lungs. This device tells us how well your lungs are working. It’s important that you use it as instructed to lower your risk of HAP. 

Stop smoking and avoid using alcohol and drugs. If you, smoke, ask us about resources to help you quit.

Get regular physical activity. Begin by walking a short distance 3 times a day. Slowly increase the distance and how often you walk.

Brush your teeth at least 2 times each day, and use mouthwash on the morning of your surgery or hospitalization. The bacteria in your mouth can move into your lungs and cause pneumonia. 

Wash your hands for at least 20 seconds each time to remove germs that can cause HAP.

During Your Hospital Stay

During your hospital stay, you can lower your risk of HAP with these steps. 

Use your incentive spirometer as instructed. Use it every 2 hours while you’re awake to keep your lungs strong. 

Manage your pain. When you have pain, it can be difficult to move or take deep breaths. Taking deep breaths helps open your airways and prevent fluid from building up in your lungs. Ask for pain medications before your pain becomes stronger. 

Oral care. Brush your teeth to reduce the number of bacteria in your mouth that might move to your lungs. Brush your teeth at least 2 times each day before, during, and after your hospital stay. You may be given a special mouthwash to use. 

If you have dentures or partials, bring them to use when you start eating during your hospital stay. 

Move and walk. Moving encourages faster healing and helps prevent HAP and other complications. If you’re not able to walk, change your position often and do exercises in bed. 

Sit up during meals. After you eat, sit upright for at least 30 minutes. This reduces the risk of inhaling food or liquid into your lungs. 

Raise the head of your bed. Keep the head of your hospital bed raised at least 30 degrees. This helps you breathe better and reduces your risk of HAP. 

Wash your hands with warm water and soap for at least 60 seconds each time.

After Your Hospital Stay

To prevent pneumonia, continue to follow the discharge instructions when you go home from the hospital. 

Use your spirometer as instructed. Be sure to breathe in deeply and hold your breath for 5 seconds before exhaling. Use the spirometer at least 10 times during every 2 hours that you are awake. 

Practice good hygiene. Continue to wash your hands thoroughly. Brush your teeth well at least 2 times each day. 

Avoid smoking and using alcohol or drugs. 

Move or walk. Sit up during meals, and get regular movement and gentle exercise during each day. When you continue to lie flat in bed for long periods of time, you’re at greater risk of developing pneumonia. Regular activity helps you heal. 

Raise the head of your bed. If possible, have someone raise the head of your bed up by 30 degrees so you’re not lying flat when sleeping. Otherwise, use several pillows to prop up your head, shoulders, and chest when resting or sleeping.

Symptoms and Diagnosis

Let us know if you develop any symptoms of pneumonia. The most common signs of HAP include:

  • High fever and chills.
  • Difficulty breathing or shortness of breath.
  • Cough that produces mucus or a greenish-colored phlegm (sputum).
  • Profuse sweating that may drench your clothing.
  • Loss of appetite.
  • Nausea or vomiting.
  • Sharp pain in your chest when you breathe in deeply. 

If we suspect that you have HAP, we may test a sample of your mucus from your cough (sputum) to identify the germs causing the infection. 

We might also order tests to measure the oxygen level in your blood (and other blood tests) to see if the infection has spread. 

A CT scan or chest X-ray might also be used to check your lungs for pneumonia.

Causes and Risk Factors

When we breathe, a small number of germs naturally enter our lungs. The types of germs in hospitals tend to be harder to treat than the usual causes of pneumonia. 

When you’re sick or recovering from surgery, your body also can’t fight off germs as easily. For these reasons, HAP tends to be more severe and may become life-threatening. 

Your risk for getting HAP increases when you:

  • Are using a breathing machine (ventilator).
  • Have substance abuse problems (alcohol or drugs).
  • Recently had chest or another type of major surgery.
  • Have a chronic illness (such as cancer) or a severe injury.
  • Are an older adult.
  • Are not able to chew or swallow well and inhale food or liquid into your lungs.
  • Have general anesthesia during surgery, which decreases your ability to breathe deeply. 

We have many safety rules in place to avoid spreading germs in hospitals, such as wearing gowns and washing hands before and after examining each person. However, nurses, doctors, and other hospital workers may unintentionally pass germs to you from their hands or clothing. 

While we’re well-trained to maintain good hygiene, we encourage you to ask hospital staff if we have washed our hands before we examine you.


HAP is treated with medication, oxygen, and lung exercises. You may need to remain in the hospital during treatment. We must closely monitor you during treatment because HAP is a serious illness. 

Treatment usually includes:

  • Antibiotics through a vein (IV) or as pills that you swallow. You may be given more than one type of antibiotic.
  • Oxygen therapy, until you can breathe more easily on your own.
  • Lung treatments with the incentive spirometer to increase your lung activity, open your airways, and strengthen your lungs. We may use other lung treatments to break up and remove the mucus in your lungs. 

The best treatment for HAP is to try to avoid getting it in the first place. 

HAP can be prevented. Follow the instructions we give you before, during, and after your surgery to significantly reduce your risk of getting HAP.

Additional References:

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.

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:

Interactive Programs
Prepare for Your Procedure

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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