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

Fainting (syncope) means you suddenly and briefly pass out (lose consciousness). Most people fully recover within a few minutes. About one-third of all people faint at some point in life.

Just before or after fainting, you might:

  • Feel lightheaded and confused.
  • Hear sounds as if they’re far away.
  • Lose muscle tone and fall down.

Fainting is most often caused by reduced blood flow to the brain, such as when blood pressure suddenly drops. Other causes include:

  • Loss of fluids (dehydration)
  • Too warm (overheated)
  • Exhaustion
  • Grief
  • Stress
  • Illness

Fainting can be:

  • Heart-related (cardiac), which may be a sign of heart or circulation problems.
  • Noncardiac, which is more common and rarely dangerous. 

Call your doctor right away if you faint, especially if it’s the first time.

Noncardiac Syncope

Most fainting isn’t dangerous or related to heart problems.

Vasovagal syncope is a common type of fainting. Something triggers the nerve (vagus) that connects your brain and abdomen. This causes your:

  • Heart rate to slow.
  • Blood vessels in the legs to expand.
  • Blood to pool in the lower part of your body.
  • Overall blood flow to the brain to decrease.

Orthostatic (postural) syncope is a type of fainting that happens when your blood pressure suddenly drops. Common triggers are:

  • Sudden standing after sitting or lying down (especially after eating), or standing for too long.
  • Pressure from tight-fitting clothes or a bowel movement.
  • Emotional stress or response, such as to severe pain or the sight of blood.
  • Dehydration.
  • Caffeine, alcohol, and drug use.
  • Medicine that affects blood pressure.

Other common causes of fainting can be serious. Call your doctor if you faint.

Cardiac Syncope

Cardiac syncope occurs when the heart has trouble pumping blood to the brain. Warning signs include:

  • Tightness in the chest
  • Irregular heartbeats
  • Feel fluttering in the heart
  • Strong, pounding heartbeats
  • Shortness of breath

This type of fainting can be a sign of:

  • Heart damage
  • Valve disease
  • A blood clot
  • Problem with the heart’s electrical system 

It’s more likely to happen in older people. Younger people rarely faint from a heart problem. If they do, their condition may be due to a congenital disorder of the heart.

Other causes of cardiac fainting can be:

  • Rapid blood loss.
  • Clogged blood vessel that leads to the brain, which is a rare but serious cause of fainting.

Even if you don’t remember having symptoms before fainting, you may still have a heart condition. Contact your doctor right away if you faint.

Symptoms

You may have symptoms just before fainting, such as:

  • Lightheadedness, dizziness, or confusion
  • Nausea
  • Feel hot, sweaty, or weak
  • Pale skin
  • Tunnel vision or “seeing stars”
  • Tunnel hearing (sounds are far away)

Seek immediate medical care if you faint and:

  • Have a history of heart problems, diabetes, or are pregnant.
  • Fall and are injured or bleeding.
  • Aren’t alert within a few minutes.
  • Have chest pain, pressure, or discomfort.
  • Have a pounding heart, irregular heartbeat, or shortness of breath.
  • Experience loss of speech or vision.
  • Are not able to move or lift things.

If you aren’t sure if it’s serious, contact the advice nurse or your regular doctor.

Diagnosis

We’ll ask you about your medical history and what happened in the days before you fainted. We’ll also give you a physical exam.

We may monitor you in the hospital if we suspect a serious cause. We’ll also order medical tests, such as:

  • Routine blood tests.
  • Electrocardiogram (EKG) of the heart.
  • An ultrasound to check the heart valves (echocardiogram).
  • Heart monitoring (telemetry).
  • Lab tests to rule out low blood levels, heart attack, or electrolyte abnormalities.
  • Vital sign monitoring overnight.
  • Heart rate and blood pressure monitoring when standing, sitting, and lying down.

While fainting doesn’t usually indicate a serious problem, we want to rule out any serious underlying condition.

Treatment

Once we know the cause of fainting, we’ll recommend appropriate treatment. Some causes are easier to treat than others. We may:

  • Ask you to drink more fluids.
  • Monitor your blood sugar levels.
  • Prescribe medicine (such as beta blockers).
  • Change your medications.

If you’re an older adult with recurrent fainting triggered by the vagus nerve, we may recommend that you:

  • Change positions more slowly, such as take 5 minutes to stand up.
  • Wear special socks (TED hose). The socks improve blood flow to your brain when you change positions.

Cardiac Syncope Treatment

When fainting is related to heart problems, we’ll recommend treatment for the specific condition.

For example, if your heart beats too slowly (bradycardia) we may:

  • Adjust your medications.
  • Place a device that continuously monitors your heart’s rhythm (pacemaker).

A pacemaker may be an option if your condition doesn’t improve with medication. If your heartbeat drops below a certain number of beats per minute, the pacemaker delivers an electrical pulse.

If your heart beats too rapidly (tachycardia), we may recommend:

  • Medication to control irregular heartbeat or underlying disease.
  • Placement of flexible, thin tubes through blood vessels and into the heart. We use a special heat to destroy tiny areas of tissue that send abnormal signals to the heart (catheter ablation).
  • A controlled electric shock that restores the heart’s normal rhythm (cardioversion).
  • The placement of a device that continuously monitors the heart, similar to a pacemaker. It delivers a life-saving shock when needed (cardioverter defibrillator).

Caring for Someone Who Faints

It can be frightening when someone near you faints. Keep in mind they usually quickly recover.

First, immediately:

  • Check to see if they’re breathing.
  • Make sure their airway remains open.
  • Call 911 if they’re not breathing. Begin CPR and rescue breathing.

If the person awakens within 2 to 3 minutes, keep them resting for at least 10 to 15 minutes. Help them to lie down in a cool, quiet place. Or help them sit in a chair with their head between their knees.

Also help the person:

  • Loosen tight clothing, especially at the neck.
  • Raise the feet higher than the heart.
  • Turn the head to one side, if vomiting.

When to Call Us

Seek immediate medical care if you faint and:

  • Have a history of a heart problem.
  • Have fallen and are injured or bleeding.
  • Are pregnant.
  • Don’t quickly become alert within a few minutes.
  • Are diabetic.

Also seek urgent care if you faint and:

  • Have chest pain, pressure, or discomfort.
  • Have shortness of breath.
  • Have a pounding heart or irregular heartbeat.
  • Experience loss of speech or vision.
  • Lose the ability to move or lift things. 

Let us know when you faint, especially for the first time, so we can determine if you need further testing.

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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