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

Thoracentesis is a procedure that removes excess fluid from the space between your lungs and chest wall (pleural space). This space normally contains a small amount of fluid. When you have extra fluid in this area, it’s hard to breathe.

Fluid may build up between your lungs and chest wall for any of these reasons:

  • A lung infection
  • Heart disease
  • A growth (tumor) 

Thoracentesis helps us diagnose the cause.

To perform this procedure, we first numb the area. We then insert a needle and a thin, flexible tube into the space to drain the excess fluid. The procedure usually takes 30 to 45 minutes.

Once we know what’s causing your fluid buildup, we may recommend further treatment.

Causes

Common causes of fluid buildup are infection, cancer, and heart disease. Other possible causes are:

  • Pneumonia
  • Tuberculosis
  • Blood clot in the lungs
  • Congestive heart failure
  • Liver disease
  • Kidney disease
  • Noncancerous tumor

Less common causes include:

  • Exposure to asbestos
  • Reaction to certain medications
  • Underlying health conditions (pancreatitis, thyroid diseases, and conditions that cause inflammation)

Therapeutic Thoracentesis

When fluid builds up between your lungs and chest wall, your lungs may not fully expand. This makes breathing difficult and painful. You might also have shortness of breath. This procedure can relieve these problems.

You may need routine (therapeutic) thoracentesis to remove regular fluid buildup. Certain long-term conditions (cancer and heart disease) can repeatedly cause fluid to build up in the space.

Risks

Thoracentesis is a safe procedure. Possible risks are:

  • Pain and bruising where we insert the needle.
  • Excessive bleeding or infection at the needle site.
  • Air leaking into the pleural space (pneumothorax), making it hard to breathe.
  • Trouble breathing (respiratory distress).
  • Fluid buildup in your lungs.

Rare complications include injury to the liver and spleen from the needle.

How to Prepare

You don’t need to do anything special to prepare for this procedure.

Before the procedure, it’s important to tell us:

  • About all medications, vitamins, and herbal supplements you take. We may ask you to stop taking blood thinners or other medications.
  • About any allergies to medicines or latex.
  • If you’re pregnant or plan to become pregnant.
  • If you had previous bleeding problems after surgery or other procedures.

We can safely perform this procedure:

  • At your bedside in the hospital.
  • In a radiology suite.
  • In our clinic.

What to Expect

The procedure usually takes 30 to 45 minutes. Removing high fluid volumes may take longer.

You’ll be awake and sitting with your arms and head resting on a table in front of you.

  • First, we numb the area with local anesthesia.
  • Next, we use ultrasound to find the fluid buildup.
  • After you’re numb, we carefully insert the needle into your back or side.
  • The needle is replaced with a thin plastic tube attached to a vacuum system that withdraws the fluid.

Be sure to tell us if you have shortness of breath or chest pain while we remove the fluid.

It’s extremely important not to move, cough, or breathe deeply during this part of the procedure. Let us know if you feel you can’t control these urges. 

After the procedure, you’ll be able to breathe easier. We’ll also take a chest X-ray to see how much fluid was removed.

Carefully follow all discharge instructions that you’re given after this procedure.

Results

After the procedure we’ll:

  • Send a fluid sample to a laboratory to identify the cause of fluid buildup.
  • Know the results within 2 weeks, or earlier.

Once we know the cause, we can talk about your treatment plan together. For example, you may need antibiotics to treat a lung infection.

For more serious conditions (such as cancer or heart disease), we’ll talk about how best to treat your condition. It’s possible you might need routine removal of regular fluid buildup.

When to Call Us

Call us right away if you develop signs of infection, such as:

  • Redness, swelling, and tenderness around the needle site
  • Fever
  • Pain at the needle site

Call 911 or seek urgent care if you develop:

  • Shortness of breath
  • Sudden difficulty breathing

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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