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

We’ll prescribe anticoagulation (blood-thinning) therapy with warfarin if you have:

  • Artificial (mechanical) heart valves
  • Deep vein thrombosis (DVT), a blood clot in the leg
  • Pulmonary embolus (PE), a blood clot in the lung
  • Irregular heart rhythms, such as atrial fibrillation
  • Clotting factor disorders (thrombophilia)
  • Some congenital heart defects

These conditions increase the risk of a blood clot causing a stroke or pulmonary embolus, which can cause sudden death.

Warfarin (Coumadin) helps control blood clot formation. We prescribe warfarin to prevent clots from forming or treat harmful clots that have already occurred.

We’ll monitor you while you’re taking warfarin to prevent excessive bleeding and clotting.

Treatments

Warfarin is taken in pill form (by mouth). We use 2 blood tests to find the correct dose for you:

  • INR (international normalized ratio)
  • PT (prothrombin time)

We repeat these tests regularly, to ensure your dosage is correct.

How long you stay on warfarin depends on the condition we’re treating. For example: if you have:

  • Deep vein thrombosis (DVT), you take warfarin for a few months.
  • Conditions where your risk for a blood clot is high, such as mechanical heart valves, you may need to take warfarin for the rest of your life.

Do not change your warfarin dose on your own based on the lab results you may see on our website. It’s very important to talk with us before making any dose changes. This is so we can closely monitor your treatment.

Take the exact amount of warfarin prescribed for you, at the same time every day. It’s best to take this medication in the evening.

If you miss the scheduled time, you may take your dose later, within 12 hours of your scheduled time. If more than 12 hours have gone by, do not take the missed dose.

Lifestyle Recommendations

Lifestyle factors can affect how well your treatment works for you. Follow these guidelines to help prevent possible bleeding complications while taking warfarin.

Maintain a safe diet

Some foods can change your body’s response to warfarin. It’s very important to continue to eat the same foods as when you first started taking warfarin. You can use these tips to stay on a safe diet.

Do not make big changes in how often you eat foods that have high levels of vitamin K. This vitamin is important for the formation of blood clots. If you eat foods with high levels of vitamin K, warfarin may not work effectively. These foods include:

  • Leafy green vegetables 
  • Salads 
  • Soy products 

Talk with us before you make any major dietary changes, such as:

  • Starting a low-fat diet.
  • Drinking or taking oral nutritional supplements.

Avoid alcohol or drink in moderation. Alcohol can affect the way warfarin works in your body. It also increases your risk for injury and bruising. Please notify the Anticoagulation Clinic if you have more than 1 drink per day. One drink is equal to 12 ounces of beer, 4 ounces of wine, or 2 ounces of hard liquor.

Avoid risk of physical injury by:

  • Always wearing shoes.
  • Wearing gloves when using sharp tools, such as for woodworking or gardening.
  • Using an electric razor to shave.
  • Using a soft-bristle toothbrush and waxed dental floss. 

Notify all health professionals who care for you by: 

  • Telling all your doctors and dentist(s) that you’re taking warfarin.
  • Wearing a Medic-Alert identification bracelet or necklace that states you’re on warfarin. Carry a completed Medic-Alert history card in your wallet.

Manage your prescription closely by following these guidelines:

  • Don’t take aspirin, or products containing aspirin, unless instructed by your doctor.
  • Don’t stop taking warfarin on your own.
  • Order prescription refills at least 1 week before you’d run out.
Additional References:

When to Call Us

If you are on anticoagulants, call 911 or go to the nearest hospital if you have symptoms of major bleeding, such as:

  • Coughing up blood.
  • Vomiting blood or what looks like coffee grounds.
  • Bowel movements that are black (tar) colored, or contain blood.
  • Urine that is dark brown or contains blood.
  • Continuous or excessive bleeding.
  • Excessive menstrual bleeding, for example soaking through a pad every 15 minutes for 1 hour. (If you are soaking through a pad every hour for 4 hours, call us for an appointment). 

Call us if you also have symptoms of blood clots or stroke, such as:

  • Sudden weakness or numbness of the face, arm, or leg on one side of your body.
  • Sudden slurred speech or being unable to speak.
  • Vision changes or loss of sight in either eye.
  • Sudden, severe headache with no known cause.
  • Any fainting or loss of consciousness.
  • Severe pain or swelling in an arm or leg.
  • Shortness of breath or chest pain with no known cause.

Call your doctor now or seek immediate medical care if you have:

  • New, severe bruises or blood spots under your skin.
  • Severe and long-lasting back pain.
  • Swelling and tenderness or pain in your abdomen or stomach.
  • A fall or blow to the head (even if you do not lose consciousness or have a headache).
  • Bleeding in the whites of your eyes (contact your ophthalmologist).

If you have any of the following for more than 24 hours, call the Anticoagulation Clinic:

  • Fever (over 101˚F) 
  • Flu
  • Decreased appetite
  • Viral or bacterial infection
  • Diarrhea
  • Vomiting
  • Swelling in your legs or feet, or other fluid retention, if you have heart failure

Your Care with Me

Take your medication exactly as prescribed. If you are having problems with or have any questions about any of the medications I have prescribed for you, let me know. Do not stop taking them without notifying me.

If you had surgery or a procedure, please call me if you notice any swelling, redness, pain, or discharge at the incision site.

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

If a 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 develop 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.

While you are taking warfarin, I will refer you to a pharmacist who will monitor and adjust your dose based on regular lab tests to get the best effects and prevent complications. The pharmacist will keep me informed of your condition.

If you have had a recent heart attack, heart surgery, or a procedure on your heart, I may refer you to our MULTIFIT cardiac rehabilitation program or other cardiac classes or programs to help you with your recovery. The nurse or pharmacist care manager will contact me regularly about your health. A good place to start is by attending a heart health class.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with non-urgent issues from this web site whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have more immediate concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

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.

Related Health Tools:

Classes and Coaching
Interactive Programs
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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