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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Tuberculosis (TB) is a bacterial infection (Mycobacterium tuberculosis) that usually settles in the lungs. The infection can also attack other organs, such as lymph nodes, kidneys, and the brain. 

TB can be active or inactive:

  • Active TB spreads through the air when an infected person coughs, laughs, talks, sneezes, or sings. However, you’d have to spend a lot of time near this person before you become infected.
  • You can’t spread the inactive type to others. 

TB isn’t spread from toilet seats, kissing, shaking hands, or having sex. It’s also not spread by sharing drinks, food, or toothbrushes.

Although it’s a serious infection, TB can be cured with proper treatment. TB is treated with medications. Left untreated, active TB can be deadly.

Additional References:


The most common type is inactive (latent) TB infection (“LTBI”). You don’t have symptoms and can’t spread LTBI to others. 

Active TB makes you feel sick and is contagious. Some people with TB develop active TB, which: 

  • Can start when the immune system is weakened by another illness.
  • Is seen more often in babies and older adults.
  • Is contagious only when in the lungs or airways in the throat.
  • Can be deadly if left untreated.

Multidrug-resistant TB (MDR-TB) is a rare but more serious type of TB. It’s difficult to treat and causes more serious health problems.

You can get MDR-TB:

  • From a person who has this condition.
  • If you don’t take your TB medicines as directed.

Risk Factors

You can be exposed to TB bacteria without knowing it. 

Your risk of developing active TB is higher if you:

  • Have a weakened immune system (such as from diabetes, cancer, lupus, or HIV/AIDS).
  • Were infected with TB bacteria in the last 2 years.
  • Have poor nutrition.
  • Smoke or abuse alcohol or drugs.
  • Are an infant or older adult.
  • Have traveled in countries where active TB is common (Asia, Africa, Central and South America, and Eastern Europe).

You’re at higher risk for active TB, recurring TB, or MDR-TB if you:

  • Were exposed to TB in the past.
  • Had active TB and were not properly treated.
  • Are in close contact over a long period of time with someone who has active TB.


LTBI (inactive) doesn’t cause any symptoms. 

Active TB can cause:

  • Persistent cough, lasting 2 weeks or longer
  • Cough that produces blood or mucus (phlegm)
  • Fever and chills
  • Fatigue and weakness
  • Loss of appetite and weight loss
  • Night sweats
  • Chest pain and wheezing

When TB spreads to another area of the body, you may also have:

  • Joint pain
  • Swollen abdomen
  • Low blood iron (anemia)
  • Swollen, tender glands (lymph nodes) in the neck, armpits, and groin

Let us know if you have these symptoms or if you’ve been exposed to someone with TB.


TB symptoms are similar to other conditions, which can make it difficult to diagnose. You also might not have any symptoms if you have LTBI (inactive TB).

To diagnose LTBI, we may order a:

  • Skin test to look for a reaction that indicates TB.
  • Blood test to identify the infection. 

To diagnose active TB, we:

  • Test samples of your mucus to find out if you’re contagious.
  • Repeat this test to make sure your treatment is working if needed. 

We may recommend other tests, depending on your symptoms. For example, we may recommend a chest X-ray to help diagnose LTBI or active TB. The X-ray is usually normal for LTBI but abnormal for active TB.


LTBI is usually treated with one antibiotic for 9 months to prevent active TB. 

Active TB is often treated with several daily antibiotics for 6 to 12 months. Treatment depends on your symptoms and tolerance of side effects. 

You should begin to feel better within a few weeks, and you’ll no longer be contagious. 

It’s important to continue taking your medicine exactly as prescribed. If not, TB can continue or worsen. You’ll also be contagious again. 

MDR-TB can cause serious illness and is more difficult to treat. 

The infection is resistant to common TB antibiotics. You may need to take several different antibiotics that can cause side effects. You’ll be closely monitored.  

Let us know if you’re taking HIV/AIDs medicines. Some can make TB antibiotics less effective.

Lifestyle Changes

To fully recover and prevent spreading TB to others:

  • Avoid public places. Stay home until you’re not contagious.
  • Sleep in a separate room, away from family members.
  • Have visitors and caregivers wear masks.
  • Take your medicine exactly as prescribed.
  • Attend all clinic appointments.
  • Cover your mouth with a tissue when you cough, sneeze, or laugh. Place tissue that contains mucus in a closed bag before throwing out.
  • Stop smoking. Your lungs must be strong to fight TB.
  • Avoid alcohol.

You may need to stay alone in your home until you can’t spread TB to others. The Department of Public Health works with us to determine when isolation is needed. They might also want to watch you take your medicine (called directly observed therapy).

When to Call Us

Contact your doctor if you have any of these symptoms:

  • Loss of appetite
  • Nausea and vomiting
  • Abdominal pain
  • Weakness and fatigue
  • Fever
  • Unexplained bruises
  • A tingling sensation in your hands or feet
  • Vision or hearing changes
  • A rash or hives

For Caregivers

If you’re in close contact with someone with active TB, we recommend that you get tested. It’s important to get early treatment for both LTBI and active TB.

We may ask you to wear a mask while caring for someone with active TB. This is especially important during their first few weeks of treatment, when they’re still contagious.

Make sure the person with TB:

  • Covers their mouth and nose with a tissue when sneezing or coughing.
  • Washes their hands regularly.
  • Takes medicines exactly as prescribed. You may want to keep track of when they take medicines.
  • Takes medicines with small meals, if the antibiotics upset their stomach.
  • Contacts their doctor if medication side effects, such as nausea and vomiting or fever, become severe.

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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