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 Jonathan Volk

Jonathan Volk, MD

Infectious Diseases

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

San Francisco Medical Center
Appt/Advice: 415-833-2200

See all office information »

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Osteomyelitis is a bone infection. It is caused by bacteria or a fungus. Different bones are affected in children and adults:

  • In children, infection usually occurs in the long leg or arm bones.
  • In adults, the spine, hips (pelvis), or feet are most often affected.

A bone infection can start:

  • After an injury or surgery.
  • As a result of infection in a skin sore or wound. People with diabetes are at higher risk if they have foot ulcers.

It’s important to diagnosis osteomyelitis early and treat it with antibiotics. This helps:

  • Lower the risk of infection spreading to other bones or tissues.
  • Prevent chronic osteomyelitis problems.

When osteomyelitis is serious or chronic, we often need to the infected bone with a cast or perform surgery.


A bone infection is a serious health condition. Call us immediately if you are worried that you may have osteomyelitis. Common symptoms include:

  • Bone pain
  • Fever or chills
  • Flu-like symptoms or general discomfort
  • Swelling, redness, or tenderness of the skin that covers the infected bone

Some people also experience:

  • Excessive sweating
  • Nausea
  • Swelling in the ankles, legs, and feet.
  • Back pain, if the infection affects the spine

Many other conditions can cause these symptoms. We base your diagnosis on your physical exam and test results as well as symptoms.


Your immune system usually stops infection from spreading. But if your system is weakened for any reason, an infection can:

  • Start in your skin or muscle
  • Get into your bloodstream
  • Spread to a bone

Bacteria called Staphylococcus is the most common cause of osteomyelitis. Less often, it’s caused by another bacterial or fungal infection.

An infection deep in the body can be more difficult to diagnose and treat. Sometimes an infection spreads beyond the bone. The infection can be resistant to the drugs we use for treatment.

Tests and Diagnosis

We will ask you about symptoms. We’ll check the wounded area for tenderness, swelling, and redness. Often we’ll ask you:

  • When and how your problem started.
  • What, if anything, makes your symptoms better or worse.
  • Whether you’ve recently had surgery or an injury.

If we think you may have an infection, we’ll begin treatment. We may also order one or more tests.

Blood tests. We use a blood culture test to detect a bacterial or fungal infection. Other tests show the level of inflammation in your body caused by infection:

  • Complete blood count (CBC)
  • Erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP)

Imaging scans tell us about the health of your bone. We may order one or more of these:

  • X-ray
  • MRI
  • CT scan
  • Bone scan

We may take a tissue or bone biopsy (small sample) for testing.

Tissue biopsy: We may remove some fluid or a small piece of tissue from the problem area, using a thin needle. Then a laboratory checks the sample for osteomyelitis.

Bone biopsy. This test tells us about the affected bone. We will:

  • Give you instructions on how to prepare for this procedure.
  • Numb the area with a local anesthetic.
  • Use a needle to obtain a bone sample.

Sometimes, it’s better to have a surgeon remove a piece of bone. In either case, the sample is checked for osteomyelitis by a laboratory.

Risk Factors

Injury or trauma. Infection is more likely if you have a fractured bone or deep skin wound that heals slowly.

Surgery to repair a broken bone or replace a joint can bring bacteria into the body. Spleen removal also increases risk.

Circulation problems make it harder for your body to deliver infection-fighting cells. This slows your healing response. Blood circulation problems can be caused by:

  • Sickle cell disease
  • Diabetes
  • Cancer
  • Peripheral artery disease.

Medical procedures can allow infection to enter your body. Procedures include:

  • Kidney dialysis
  • Chemotherapy
  • Intravenous catheter

Substance abuse increases risk when users:

  • Share needles
  • Use unsterilized needles
  • Don’t sterilize their skin before injections

Please tell your care practitioner if you’re using street drugs, so we can connect you with help.


We can usually cure early or acute-stage osteomyelitis using antibiotics. Your overall health and the infection type also affect treatment success.

Early osteomyelitis is a bone infection of 4 weeks or less. Longer infections are called chronic. They may take longer to treat and require surgery. Even when treated, chronic osteomyelitis can recur years or decades later.

Additional References:

Your Care with Me

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

If specialty care is needed, your personal physician or hospitalist 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 need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website 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 urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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.

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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