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

A pressure ulcer (previously called bed sores or pressure sores) develops when an area of skin presses against a surface, such as a bed or a chair. It is important to be aware of the risk of pressure ulcers because they can be difficult to prevent, treat, and heal.

We use a team approach in the hospital to prevent and promptly treat pressure ulcers. Regularly checking your skin, frequently changing positions to take the strain off of your skin, keeping your skin clean and dry, and eating a healthy diet can help prevent this condition.

Pressure ulcers usually develop on the skin over the bony areas of your body, such as your hips, tailbone, buttocks, elbow, ankles, and heels. The constant pressure cuts off the blood supply to the tissue, muscles, and skin in that area, which causes the tissue to die and an ulcer to develop. Pressure ulcers may first look like a red, purple, or dark area. They may also appear as an open wound.

Treatment for pressure ulcers may include reducing pressure on the affected area, keeping the area clean and dry, removing damaged tissue, and sometimes surgery to repair injured tissue, muscle, and skin. We may also prescribe medications, such as antibiotics and pain medicine.

Causes

Pressure ulcers often appear after you’ve been lying or sitting in the same position. The contact of the skin against a bed or wheelchair cuts off blood supply to the area. Your risk is greater if your skin is thin, either due to aging or an injury.

When your skin is dragged across surfaces, including bed sheets and wheelchair seats, it creates friction (resistance to motion). Moist skin may make friction worse. Wet skin loses its elasticity and is more vulnerable to pressure ulcers.

Your skin might also weaken when your skin moves in the opposite direction of the surface you are sitting or lying on. For example, if the head of your bed is raised, you may slide down your sheets. This creates shear (two objects moving in opposite directions). While your tailbone slides down the raised bed, your skin may remain in the same place, which causes stress on the underlying muscle and tissues and can cause damage to these tissues and tiny blood vessels under your skin.

Risk Factors

You are at greater risk for developing pressure ulcers if you are:

  • An older adult.
  • Have poor nutrition.
  • Severely overweight or severely underweight.
  • Unable to control your bladder or bowel movements.
  • A smoker.
  • Sweaty or have skin that is too dry or too moist.
  • In a wheelchair.
  • Suffering from a chronic illness or are in poor health.
  • Recovering from an injury, illness, or surgery in bed.
  • In a coma or have poor mental clarity.

Your risk of developing pressure ulcers is also higher if you are not able to feel pain or discomfort, such as from a spinal cord injury or a neurological disorder.

Other risk factors include weight loss, muscle weakness, or a medical condition, such as diabetes. Smoking and having a condition that causes muscle spasms, such as cerebral palsy, also puts you at risk of pressure ulcers.

The areas of the body that are most at risk for pressure ulcers are where the skin covers bony areas, including your tailbone, buttocks, shoulder blades, hips, ankles, heels, and elbows.

Symptoms

Symptoms of pressure ulcers are categorized in the following ways:

  • The skin is intact. In light-colored skin, you may notice a red spot. In dark-colored skin, you may notice a blue or purple spot. The skin might be tender, soft, and warmer than the skin around it.
  • You develop a shallow open sore or fluid-filled blister on the skin.
  • The wound becomes deeper and looks more like a crater. There may be some yellowish-colored or dead tissue in the wound. The tissue around the sore might also become affected.
  • You have a large amount of tissue loss. You may see bone, muscle, and other tissue around the sore and dark, dead skin inside the wound. Healthy tissue and skin surrounding the wound is now also becoming damaged.
  • Suspected Deep Tissue Injury or SDTI: The skin is dark red or purple but intact. It is not obvious by looking at the area how deep the injury may be but the concern is that it may be deeper than just the skin.
  • Unstageable: The ulcer is black, brown, or yellow. It is unclear exactly how deep the ulcer is. These may need to be examined by a surgeon to assist with healing.

Screening and Diagnosis

Pressure ulcers are diagnosed by a physical examination. If we believe necessary, we may ask for a culture or a sample of a small piece of tissue to view it under a microscope to determine if the area is infected. Blood tests may be ordered to help us identify a possible infection and help determine whether you are getting proper nutrition to help your body heal.

Although rare, tissue damaged from severe pressure ulcers may become cancerous. We may order a biopsy to check for cancerous tissue in wounds that do not heal.

Treatment

The sooner you receive treatment for pressure ulcers, the easier they are to treat and heal. Let us know immediately (or your hospital nurses or other care team member when you are in the hospital) if you notice any tender or red areas on your skin.

Early treatment 

Early treatment includes relieving pressure from the areas of your skin where you have pressure ulcers. We will regularly reposition your body, and might use a special air mattress, cushion, or bed to assist in redistributing your weight . 

We regularly clean your wounds to prevent infection. We usually cover the pressure ulcers in a bandage or other dressing to keep the wound moist and the skin around the wound dry. In this case, moisture in the wound actually helps the wound heal much faster.

Medications 

After reviewing your medical history and doing a physical exam, we may need to prescribe medications. Depending on your condition these may include:

Pain medications to reduce pain associated with serious pressure ulcers, dressing changes, and during procedures to remove dead tissue. The types of pain medications we may use include ibuprofen (Advil, Motrin, or a similar generic medicine) and naproxen (Aleve or equivalent generic). We might also prescribe something that you apply directly to your skin.

Antibiotics to treat infected pressure ulcers. We will make an assessment regarding whether the wound is infected or not. If the wound is infected, you may need an antibiotic topically, by mouth, or by IV. We may also use an antimicrobial dressing for your wound care.

Muscle relaxants to reduce muscle spasms that can put pressure on your skin and make pressure ulcers worse. We may prescribe medication such as diazepam (Valium) or dantrolene (Dantrium).

Remove dead tissue 

The process of removing damaged or dead tissue is called “debridement.” When pressure ulcers damage the skin or tissue under the skin so that it will not heal, we must remove the dead skin and tissue. There are several ways we may perform debridement:

  • Autolytic. Uses your body’s natural process of removing dead tissue with enzymes. We keep the wound moist and wrapped during the process.
  • Mechanical. Use of special tools (such as a whirlpool bath) to remove the dead skin and tissue.
  • Enzymatic. Applying chemical enzymes to your wound to remove the damaged tissue.
  • Surgical. Cutting away the dead tissue and skin during a surgical procedure or at the bedside.
Surgery to repair severe pressure ulcers 

Very rarely, pressure ulcers get worse instead of better with treatment or they stay the same and “stall.” In these cases, we may have to remove the dead tissue, muscle, and skin and replace it with skin, tissue, or muscle from another area of your body (graft). The type of surgery depends on the location and severity of the pressure ulcers. Surgery allows your body to heal, treats infection, and can prevent further damage to the skin, muscles, and tissue.

It may take several weeks or months to successfully treat pressure ulcers. It will be important for you to remain diligent in your self-care during this time.

Prevention Methods

When you have an illness or injury that makes you bed-bound or wheelchair-bound you can reduce your risk of developing pressure ulcers by practicing prevention methods.

Prevention basics 

The best way to reduce your risk of getting pressure ulcers is to regularly change your position. If you are unable to move on your own, ask a caregiver or loved one to help move your body, (every 15 minutes if you are in a wheelchair or every 2 hours if you are in bed).

If you are in a wheelchair, there are special cushions to sit on that will prevent pressure ulcers.

If you are in bed, you may rest on a special mattress that reduces pressure on your skin. It is very important that you do not slide across your sheets or rub your skin when changing positions.

Other prevention methods include quitting tobacco use, eating a healthy diet, and getting regular physical activity. Certain kinds of activity may not be possible for you, depending on your illness or requirements of your recovery.

During a hospital stay we may recommend that you meet with one of our physical therapists to learn daily exercises to help prevent pressure ulcers or assess your wheelchair for cushion recommendations.

Get good nutrition 

Eating a healthy diet is important to maintain the health of your skin. You may need additional fluids, protein, and calories while you recover from pressure ulcers. Drink plenty of water to keep your skin healthy. We might also prescribe a daily dose of vitamins and minerals or a protein supplement.

Prevention While in a Hospital Bed

During a hospital stay we regularly evaluate your risk of getting pressure ulcers. Our nurses and team of care providers will work with you to help prevent pressure ulcers. We will encourage you to do the following:

Change positions. We may raise the head of your bed and elevate your legs so that you lie at an angle with pillows under your back, side, or knees for support. Whether in bed at home or in the hospital, change your position every 2 hours.

Provide correct support. Avoid lying directly on your hip to protect the bony areas underneath your skin. We might also place cushions under your calves and ankles to relieve pressure on your heels.

Use devices. You may need a special device, such as a trapeze bar, to lift your upper body and reposition yourself in bed. We might also place bed sheets underneath you to lift you into a new position to avoid creating friction against your skin.

Use a special mattress. We may use foam cushions or wedges or a special air mattress to reposition your body.

Prevention While in a Wheelchair

If you must remain in a wheelchair, it is important to follow these steps to prevent pressure ulcers from developing:

Frequently change positions. We recommend that you shift your weight every 15 minutes on your own. We can help you reposition your whole body every 60 minutes.

Use a special cushion. A special cushion filled with air or gel can help redistribute the pressure in the buttock area of your body.

Build strength. Wheelchair push-ups and other physical activities can help to build upper body strength.

Use a special wheelchair. These wheelchairs tilt your hips, back, and bottom to change the way you sit in the chair. By changing your position frequently, it redistributes the pressure on the skin.

Proper Skin Care

Regular care of your skin can both prevent and treat a pressure ulcer. Remember to:

Check your skin. Look for signs of pressure ulcers, such as a change in skin color, red spots, pimples, or sores. You may use a mirror to see all areas of your skin or ask for the help of a caregiver or loved one. We regularly do a thorough check of your skin while you are in the hospital.

Keep your skin dry. Use talcum powder on areas of skin that are sweaty or moist. If you have problems with bowel or bladder control (incontinence), regularly change urinary pads, and use a moisture barrier cream several times a day to help protect your skin.

Practice good hygiene. Clean your skin with a mild soap, and warm water every day and gently pat your skin dry. After you bathe, while your skin is still moist, is the best time to apply a moisturizer. Another option may be the use of a no-rinse cleanser.

Protect dry skin. Even though moisture is harmful to your skin when avoiding pressure ulcers, dry skin can also increase your risk. If you have dry or itchy skin, be sure to apply a lotion or cream twice a day. Lotions or creams that contain dimethicone will provide the best moisturization. And as stated above, it is best to apply these just after you bathe while your skin is still damp.

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:

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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