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 colonoscopy is a procedure to examine the inside of your colon. Your colon is your large intestine. This is where your body stores food waste between bowel movements.

The procedure will include these steps:

  • We insert a long, flexible tube called a colonoscope into your rectum. The tube is about the thickness of a finger and contains surgical tools and a camera. 
  • We move the tube slowly along the colon. 
  • The camera sends images to a monitor so we can see anything abnormal such as a polyp. We may remove a polyp or take a small sample for testing. 

A colonoscopy takes about 30 minutes.

Why It Is Done

We use colonoscopy to screen for colon cancer. We can also remove pre-cancerous or cancerous growths during the procedure. This helps prevent or treat cancer. Screening typically begins at age 50. If you are at high risk for colorectal cancer, we may recommend starting earlier. 

Colonoscopy can also help us diagnose other conditions such as:

  • Ulcerative colitis
  • Crohn's disease
  • Iron deficiency anemia

Colonoscopy is usually an outpatient procedure. It can be done in the hospital or emergency room. In these cases, the procedure may be used to:

  • Investigate blood in the stool
  • Investigate rectal bleeding
  • Look for infection or inflammation of the intestines

Alternatives

There are other screening tests available before a colonoscopy. If one of these tests suggests an abnormality, we will schedule a colonoscopy. Colonoscopy is the only way to biopsy or treat an area inside your colon. Alternative screening tests include:

  • Fecal occult blood test (FOBT or FIT). This is a very quick test that requires no preparation. You collect a sample of stool at home and send it to us for testing.
  • Flexible sigmoidoscopy. This is similar to a colonoscopy, but examines only the lower part of the colon. It requires less preparation. You will use an enema or oral laxative to clear your lower colon and rectum. We’ll also ask you to change your diet the day or two before the exam.
  • Barium enema. We insert a thin tube into your colon through your anus. We fill the tube with a contrast liquid (barium). Then we X-ray your abdomen. The barium highlights the colon and any abnormal areas. Preparation is the same as for a flexible sigmoidoscopy.

How You Prepare

Your colon needs to be completely empty before the procedure. This allows us to see inside and identify any abnormal areas. You will need to eat in a certain way for a few days and drink a strong laxative. Follow the preparation instructions exactly.

If you take regular medications, ask your doctor if you can continue taking them. It's fine to continue most medications before the procedure. However, you may need to stop or adjust certain medications temporarily, such as blood thinners and ibuprofen.

Additional References:

The Exam

Wear comfortable, loose-fitting clothing. Leave all valuables and jewelry at home. Please bring your Kaiser Permanente member ID card, a photo ID, and your procedure copay with you.

You will be given an IV sedative medication to help you feel comfortable. You won't be completely asleep, but you may not remember much about the procedure. It's very important that you do not drive after your colonoscopy as it takes at least 12 hours for the sedative to leave your system. If you do not have a driver, we will reschedule your procedure.

How It Is Performed

You will lie on your left side. First we insert the colonoscope into your rectum and inflate the colon with a puff of air. We move the colonoscope slowly along the colon, stopping at the small intestine. We retract the scope, examining the colon walls for abnormal tissue or bleeding. If we find abnormal tissue, we will either take a small sample for testing or remove it. This is painless, because there are no nerve endings inside the colon. Any bleeding is stopped surgically or with medication.

We will do our best to make you comfortable. When the scope is inserted, some people feel an urge to go to the bathroom, but that feeling usually passes quickly. Others describe pressure as the scope moves along the colon, similar to gas pains or bloating.

After the Exam

You can go home after an hour or so in the recovery area. The sedative doesn't wear off completely for at least 12 hours. That's why it is important to arrange a ride home and avoid driving until the following day. 

The air that inflated your colon may cause some discomfort. However, it usually passes as gas in the first few hours after the exam.

Rest and relax for a day or even two. You may continue to have cramps, feel bloated, and pass gas. This is all normal. Drink liquids and eat if you are hungry. Avoid caffeine as it can cause cramps.

You should feel mostly normal within a couple of days after a colonoscopy. However, it can take up to a week for your colon to recover completely and for your bowel movements to return to normal. You may notice a little bit of blood in your stool, but it should stop after a day or two.

Risks

Colonoscopy is a very safe procedure. However, there are some risks:

Bleeding. We will monitor you to ensure you are not bleeding before you go home. In rare cases, bleeding happens after leaving the hospital. If bleeding doesn’t stop, or becomes worse, surgery or another colonoscopy may be needed.

Damage to your colon. There is a small risk of a puncture or tear in the colon wall. Usually, this can be repaired right away. In rare cases, a tear may not be detected until later. It's important to let us know immediately if you have a fever of 101 degrees or higher, significant rectal bleeding, or persistent stomach pain.

Missed lesions. A colonoscopy is quite accurate, but it is not perfect. There is a small (5 percent) risk of polyps or cancers not being detected during a colonoscopy.

When to Call Us

Any pain or bleeding should stop in the first few days. Contact us if:

  • You have a fever of 101°F or higher.
  • You experience persistent, severe pain.
  • You have heavy rectal bleeding, with or without stool.
  • Your belly is tender, firm, or swollen.

Repeat Colonoscopy

Sometimes we may recommend that you have another colonoscopy. The reasons for this include:

  • Inadequate preparation. When the colon is not cleaned out properly, we can’t see the inside very well. We may not be able to move the colonoscope all the way to the small intestine.
  • Blockage or obstruction. This can prevent us from seeing the entire colon. Blockages can be caused by scar tissue or diverticular disease. Severe colitis or inflammation can also obstruct the colon.
  • Extensive tissue removal. If we removed many, or very large polyps, we may need to look at your colon again to confirm the procedure was successful.

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
Videos

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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