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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We use cardiac computed tomography (CT) to diagnose coronary artery disease, heart valve disease, and other heart conditions. 

CT is an advanced X-ray scan. It provides a detailed, 3-dimensional (3-D) view of your heart and blood vessels without inserting a scope, tube, or device into your heart.

If we find heart or vascular disease, your cardiac CT scan allows us to assess the severity of it and to plan treatment. We also use CT to check how well treatment is working. 


The 2 parts of a CT scan are coronary calcium score and coronary CT angiogram. Depending on your symptoms, you may have only a calcium score, or both tests.

Coronary calcium score

Cardiac CT can detect small calcium deposits (calcifications) in the coronary artery walls. These blood vessels carry blood to the heart muscle.

If calcium is detected, it means there’s plaque in the artery. Plaque, made of cholesterol and fat, can harden or break open. This can narrow or block blood vessels in the heart.

Calcifications can be detected before symptoms of coronary artery disease (CAD) develop. The calcium score:

  • Tells us that blockage in the blood vessels is likely, if the score is high.
  • Can’t absolutely predict your risk of heart attack or other heart problems, because not all plaque has calcium deposits.

You may need only a coronary calcium score test, if you:

  • Have high blood pressure or other risk factors for CAD.
  • Don’t have CAD symptoms, such as chest pain or shortness of breath.

Coronary CT angiogram

Coronary CT angiogram can detect blockages in the coronary arteries. We will inject contrast dye intravenously (IV). This makes the heart’s blood vessels easier to see, so we can identify plaque and calcium buildup.

Why It Is Done

A cardiac CT scan can help us diagnose specific heart problems or monitor existing heart conditions. We also use scan results to plan your treatment.

A coronary calcium score and a coronary CT angiogram can help us detect or assess these conditions.

Coronary artery disease (CAD). This condition occurs when plaque builds up in the coronary (heart) arteries, causing artery narrowing that reduces blood flow to the heart. Angiogram makes it easier to see narrowed or blocked arteries. CAD can lead to:

  • Heart attack
  • Arrhythmias (irregular heartbeat) 
  • Heart failure 

Pulmonary embolism. This is the sudden blockage of a lung (pulmonary) artery. It’s often caused by a blood clot. The pulmonary arteries carry blood from the heart to the lungs to receive oxygen.

Pulmonary vein problems. Problems with these veins can cause atrial fibrillation (irregular heartbeat). The pulmonary veins transport oxygen-rich blood from the lungs to the heart.

Heart valve problems. The heart’s 4 valves open and close with each heartbeat to keep blood flowing properly through the heart and out to the body. Echocardiography is the main test to diagnose heart valve disease. We can use cardiac CT instead of or along with echocardiography.

Aortic aneurysm and aortic dissection. A bulge in the aorta is called an aortic aneurysm. The aorta is the body’s main artery that carries oxygen-rich blood from the heart to the body. We use cardiac CT to detect:

  • An aneurysm at risk for bursting and causing life-threatening bleeding.
  • Aortic dissection, a tear in the aorta’s inner layer that causes bleeding into and along the wall of the aorta.

Pericardial disease. The pericardium is the thin sac that surrounds the heart. CT images can show thickening or calcification of the pericardium.

Recovery after surgery. For example, we may check whether the blood is flowing normally after coronary artery bypass graft surgery.

How to Prepare

Follow these important steps before your cardiac CT. 

The day before and day of the scan, do not take:

  • Diet or energy pills.
  • Erectile dysfunction drugs.
  • Products that contain caffeine, even in small amounts, or drink caffeinated beverages.

If you have diabetes, talk to us about adjusting your medications before your CT scan.

Tell us and your CT technicians if you have:

  • Ever reacted to iodine-based contrast dye. We can give you medications to reduce the risk of an allergic reaction.
  • Kidney problems, asthma, or are allergic to any medications, shellfish, or iodine. These problems may increase risk of a reaction to the iodine-based contrast dye.

If you are pregnant or may be pregnant, have kidney problems, or a known allergy to iodine, talk with us about having an alternative test instead of CT scan. 

The day before a cardiac CT scan, you should:

  • Drink plenty of water.
  • Take your regular medications and any medications your doctor prescribes to you for the test.

The morning of a cardiac CT scan, you should:

  • Not eat for 4 hours before the scan.
  • Drink water, but no other liquids.
  • Take your regular medications, except for metformin (Glucophage).

What to Expect

Knowing what to expect during a cardiac CT can help you feel more comfortable. We follow these steps during your 10- to 15-minute scan:

Before the scan, we will: 

  • Ask you to wear a hospital gown.
  • Clean a few areas on your chest and apply sticky electrode patches to the skin. 
  • Connect these small patches to an electrocardiogram (ECG/EKG) machine that records your heart’s electrical activity during the scan.
  • Start an intravenous (IV) line.
  • Administer medication to lower your heart rate, if needed. Images are clearer when the heart moves less.

During the scan, you will:

  • Lie on a sliding table that goes inside the machine. Your head and feet remain outside the scanner. 
  • Keep your arms raised over your head, if we ask you to.
  • Hold your breath for short periods while each picture is taken, if we ask you to. 
  • Lie still during the scan, as movement can blur the images.

A nurse may give you nitroglycerin medication under your tongue, to open your blood vessels. Headache is a common, temporary reaction after receiving nitroglycerin.

We operate the CT scanner from the next room. We can see you through a glass window and communicate through a speaker. 

We determine the correct starting position, then the table moves slowly through the CT scanner. The X-ray tube rotates around you, taking a series of pictures of your heart. 

For a coronary CT angiogram, we inject a contrast dye through the IV line. You may have a metallic taste in your mouth or feel a warm sensation. Usually these go away quickly. 

Tell us immediately if you feel:

  • Shortness of breath.
  • Tingling of the face or lips. 

These symptoms may mean you’re allergic to iodine.

The images are transferred to a computer that creates a 3-dimensional image of your entire heart. Usually, your doctor has your results by the end of the day.

After the scan, you:

  • Will be monitored for 5 to 10 minutes before going home.  
  • Can resume your normal activities, including driving, immediately. 

If you had a coronary CT angiogram, drink plenty of water all day, to flush the contrast dye out of your body.


Cardiac CT is very safe, though there are possible risks.  

Radiation-related complications. There’s a small increase in cancer risk related to X-ray radiation. Risk increases if you have many CT scans over time. We keep your radiation exposure as low as possible. Pregnant women shouldn’t have CT scans due to potential X-ray damage to the fetus.

Allergic reaction to iodine-based contrast dye. People with asthma, kidney problems, or allergies to medications, iodine, or shellfish may have higher risk for allergic reaction. If you have an allergic reaction that causes breathing problems, it will need to be treated. 

Kidney dysfunction. We test your kidney function before the CT scan, to minimize your risk of damage from the contrast dye. 

Your Care with Me

If you think you may be having a heart attack, or if you have chest pain or pressure that lasts more than 5 minutes, call 911 or seek other emergency services immediately.

If you have emergency symptoms as described above, do not use this website to e-mail your doctor, but instead call us immediately.

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If cardiologist’s care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you have been seen before by a cardiologist outside of Kaiser Permanente, please bring those medical records with you. Also, please bring with you all your containers with any prescription medications and any over-the-counter medications you are taking.

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.

If Surgery or a Procedure Is a Treatment Option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

If you are considering surgery or a procedure or want more information about your heart problem, please review our health tool called “Preparing for Your Procedure” (Emmi). Emmi programs are available for the following cardiology topics:

  • Anesthesia for an Adult
  • Angiogram with Possible Angioplasty
  • Atrial Fibrillation Overview
  • Aortic Valve Replacement
  • Cardiac Catheter Ablation (SVT)
  • Cardiac Catheter Ablation (VT)
  • Cardiac Pacemaker
  • Coronary Artery Bypass Surgery (CABG)
  • Defib (Cardiac Resynchronization Therapy Defibrillator)
  • Defib (Implantable Cardioverter Defibrillator)
  • Mitral Valve Repair or Replacement
  • Taking Warfarin (Coumadin®)

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.

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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