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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Sepsis is an illness in which the body has a severe response to bacteria or other germs. Sepsis is usually caused by a major bacterial infection, although it may also be caused by viral or fungal infections. The symptoms of sepsis are not caused by germs themselves. Instead, chemicals the body releases cause the response. It can spread more aggressively if you have a weakened immune system, often because of another underlying disease, such as heart disease, diabetes, pneumonia, or kidney failure. People being treated for AIDS or undergoing chemotherapy may also be at risk for developing sepsis.

The earlier we can diagnose sepsis, the more effective the treatment. Sepsis is treated with antibiotics, fluids, given through an IV (intravenously, through a vein), and other emergency life-saving measures. When it becomes a life-threatening situation, the condition is often known as septic shock.

Sepsis is an emergency condition, requiring immediate treatment. Septic shock requires prompt treatment in a hospital intensive care unit (ICU). If sepsis or septic shock is treated promptly, most people will recover from sepsis. Even with timely treatment, there is a risk of organ damage or death.


A person who is suffering from sepsis may notice a change in mental alertness. Their breathing may become very rapid. These are often the earliest signs of sepsis. Other common symptoms of sepsis include:

  • Very low blood pressure
  • Rapid heartbeat
  • Confusion, lightheadedness, and agitation
  • Decreased urine output
  • Diarrhea
  • Difficulty breathing
  • Fever

If you are in the hospital, please let us know as soon as possible if you are experiencing any of these symptoms.

Call 911 or go to the nearest Emergency Room immediately if someone near you exhibits signs of sepsis, especially if the person:

  • Has had an organ transplant
  • Has AIDS or diabetes
  • Is undergoing chemotherapy or radiation treatment
  • Is an infant or elderly person

Causes and Risk Factors

Sepsis is normally caused by a serious bacterial infection, although it may also be caused by viral or fungal infections. Pneumonia, a lung infection, abdominal infections such as appendicitis, skin infections, meningitis, infection around the brain, or even an untreated urinary tract infection can potentially develop into sepsis.

If an infection is severe enough, any person can develop sepsis. Some people at higher risk for sepsis include people who have organ transplants, those with kidney or liver failure, or those who are being treated with immunosuppressive medications. In addition, if you have suffered from burns or are undergoing cancer treatment, you may also be at risk for severe infection that could lead to sepsis.


Sepsis is normally diagnosed with a careful history taken from the patient and/or the patient’s family. We may perform a range of tests, including blood tests that can check for signs of infection and kidney and liver function tests.

Other laboratory tests may include a spinal tap to check the spinal fluid for meningitis or other infections, urine testing to check for urinary tract infection, or a wound fluid or secretion sample test, if appropriate, to identify the type of infection. This will help us to determine the most effective antibiotic treatment.

Imaging tests, such as X-rays or computed tomography (CT) scans can help pinpoint particular organs or areas that may be actively infected. Your doctor will determine which tests are appropriate for your situation.


Sepsis is an emergency condition, requiring prompt treatment. Medical treatment for sepsis will normally include:

  • Intravenous antibiotic medication and life sustaining fluids.
  • Medication to increase blood pressure.
  • Oxygen through a nasal tube, mask, or tube inserted down the throat, to maintain blood oxygen levels.

Depending upon your other symptoms, treatment may also include the use of insulin to help stabilize blood sugar levels, and medicine like prednisone to reduce inflammation.

In the case of severely limited kidney function, kidney replacement or dialysis may also accompany other treatments for sepsis. Surgery may also be needed to clean or drain the site of the infection.

Your Care with Me

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

If specialty 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 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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