This guide will help you get ready for your ventriculoperitoneal (ven-TRIH-kyoo-LOH-PAYR-ih-toh-NEE-ul) shunt surgery at MSK. It will also help you know what to expect as you recover.
Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will use it as you learn more about your recovery.
About your VP shunt surgery
A VP shunt is a device used to drain extra cerebrospinal fluid (CSF) from your brain. CSF is the fluid that surrounds your brain and spinal cord. It’s made in the ventricles (hollow spaces) inside your brain.
CSF protects your brain and spinal cord by acting as a cushion. It also brings nutrients throughout your brain and carries waste away. But when you have too much CSF, it puts pressure on your brain and skull.
Extra CSF fluid can be caused by different things, such as a brain tumor, or it can be present when you’re born. This extra fluid also makes your ventricles grow bigger (see Figure 1). This is called hydrocephalus (HY-droh-SEH-fuh-lus).
Figure 1. Brain without (left) and with (right) hydrocephalus
Symptoms of hydrocephalus
The most common symptoms of hydrocephalus include:
- Headache.
- Fatigue (feeling more tired or weak than usual), drowsiness (not able to stay awake or focus), or both.
- Nausea (feeling like you’re going to throw up) and vomiting (throwing up).
- Irritability (feeling angrier than usual).
- Problems with thinking and memory, such as confusion.
- Trouble with balance and walking.
- Not being able to control when you urinate (pee).
About your VP shunt
A VP shunt will be placed into your head to help drain the extra CSF from your brain. The VP shunt works by taking the fluid out of your brain and moving it into your abdomen (belly), where it’s absorbed by your body. This lowers the pressure and swelling in your brain.
A VP shunt has 3 parts (see Figure 2):
- A one-way valve with a reservoir.
- A short catheter (thin, flexible tube).
- A long catheter.
The valve controls the flow of CSF fluid. It’s attached on one end to the short catheter so it can drain the fluid away from your brain. The short catheter can be placed in the front, back, or side of your head.
The reservoir collects a small amount of CSF which your doctor can use to sample your CSF for tests if needed.
The long catheter is attached to the other end of the valve. The long catheter is placed under your skin, behind your ear, down your neck, and into your abdomen (belly).
As the VP shunt drains extra CSF and lessens the pressure in your brain, it may ease some of your symptoms. Some symptoms will stop right after the VP shunt is placed. Others will go away more slowly, sometimes over a few weeks.
The amount of fluid that’s drained by your VP shunt depends on the shunt’s settings. If you have a nonprogrammable VP shunt, your doctor will program the shunt’s settings and they cannot be changed. If you have a programmable VP shunt, the settings can be changed by your doctor if needed. Your doctor will decide which type of VP shunt is best for you.
Figure 2. VP shunt
About your VP shunt surgery
Your VP shunt surgery will take place in the operating room while you’re asleep. The surgery will take about 1 hour.
Once you’re asleep, the doctor will shave off some hair near the area where they will make the incision (surgical cut) on your head. Your entire head won’t be shaved.
Your doctor will make 3 small incisions: 1 in your head, 1 in your neck, and 1 in your abdomen. These incisions will help guide the catheter so it can be placed correctly. The doctor will close the incisions with stitches or staples.
You won’t be able to see the catheter because it will be under your skin. But you may be able to feel the shunt catheter along your neck.
Once all the parts of the shunt are connected, it will start draining the extra CSF as needed to reduce the pressure in your brain.
Before your VP shunt surgery
This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.
As you read this section, write down questions to ask your healthcare provider.
Getting ready for your surgery
You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.
Always be sure your healthcare providers know all the medicines and supplements you’re taking.
-
I take an anticoagulant (blood thinner), such as:
- Aspirin
- Heparin
- Warfarin (Jantoven®, Coumadin®)
- Clopidogrel (Plavix®)
- Enoxaparin (Lovenox®)
- Dabigatran (Pradaxa®)
- Apixaban (Eliquis®)
- Rivaroxaban (Xarelto®)
-
I take an SGLT2 inhibitor, such as:
- Canagliflozin (Invokana®)
- Dapagliflozin (Farxiga®)
- Empagliflozin (Jardiance®)
- Ertugliflozin (Steglatro®)
- I take any prescription medicines, including patches and creams. A prescription medicine is one you can only get with a prescription from a healthcare provider.
- I take any over-the-counter medicines, including patches and creams. An over-the-counter medicine is one you can buy without a prescription.
- I take any dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia (A-nes-THEE-zhuh) in the past. Anesthesia is medicine to make you sleep during a surgery or procedure.
- I’m allergic to certain medicines or materials, including latex.
- I’m not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
- I use recreational drugs, such as marijuana.
About drinking alcohol
It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medicine to help prevent them.
Here are things you can do before your surgery to keep from having problems.
- Be honest with your healthcare providers about how much alcohol you drink.
-
Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
- Get a headache.
- Feel nauseous (like you’re going to throw up).
- Feel more anxious (nervous or worried) than usual.
- Cannot sleep.
These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.
About smoking
If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.
Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.
About sleep apnea
Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.
OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.
Using MyMSK
MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.
If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.
Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.
Within 30 days of your VP shunt surgery
Presurgical testing (PST)
You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location. Visit www.msk.org/parking for parking information and directions to all MSK locations.
You can eat and take your usual medicines the day of your PST appointment.
It’s helpful to bring these things to your appointment:
- A list of all the medicines you’re taking, including prescription and over-the-counter medicines, patches, and creams.
- Results of any medical tests done outside of MSK in the past year, if you have them. Examples include results from a cardiac stress test, echocardiogram, or carotid doppler study.
- The names and telephone numbers of your healthcare providers.
You’ll meet with an advance practice provider (APP) during your PST appointment. They work closely with MSK’s anesthesiology (A-nes-THEE-zee-AH-loh-jee) staff. These are doctors with special training in using anesthesia during a surgery or procedure.
Your APP will review your medical and surgical history with you. You may have tests to plan your care, such as:
- An electrocardiogram (EKG) to check your heart rhythm.
- A chest X-ray.
- Blood tests.
Your APP may recommend you see other healthcare providers. They’ll also talk with you about which medicine(s) to take the morning of your surgery.
Identify your caregiver
Your caregiver has an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.
For caregivers
Caring for a person going through cancer treatment comes with many responsibilities. We offer resources and support to help you manage them. Visit www.msk.org/caregivers or read A Guide for Caregivers to learn more.
Fill out a Health Care Proxy form
If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.
A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.
- To learn about health care proxies and other advance directives, read Advance Care Planning for People With Cancer and Their Loved Ones.
- To learn about being a health care agent, read How to Be a Health Care Agent.
Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.
Do breathing and coughing exercises
Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. To learn more, read How To Use Your Incentive Spirometer.
Do physical activity
Doing physical activity will help your body get into its best condition for your surgery. It will also make your recovery faster and easier.
Try to do physical activity every day. Any activity that makes your heart beat faster, such as walking, swimming, or biking, is a good choice. If it’s cold outside, use stairs in your home or go to a mall or shopping center.
Follow a healthy diet
Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.
Tell us if you’re sick
If you get sick before your surgery, call the doctor who scheduled your surgery. This includes a fever, cold, sore throat, or the flu.
7 days before your VP shunt surgery
Follow your healthcare provider’s instructions for taking aspirin
Aspirin can cause bleeding. If you take aspirin or a medicine that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.
To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
To learn more, read Herbal Remedies and Cancer Treatment.
2 days before your VP shunt surgery
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.
1 day before your VP shunt surgery
Note the time of your surgery
A staff member will call you after the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by , call 212-639-5014.
The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.
This will be:
The Presurgical Center (PSC) at Memorial Hospital
1275 York Ave. (between East 67th and East 68th streets)
New York, NY 10065
Take the B elevator to the 6th floor.
Visit www.msk.org/parking for parking information and directions to all MSK locations.
Instructions for eating
Stop eating at midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.
If your healthcare provider told you to stop eating earlier than midnight, follow their instructions. Some people need to fast (not eat) for longer before their surgery.
The day of your VP shunt surgery
Instructions for drinking
Between midnight (12 a.m.) and 2 hours before your arrival time, only drink the liquids on the list below. Do not eat or drink anything else. Stop drinking 2 hours before your arrival time.
- Water.
- Clear apple juice, clear grape juice, or clear cranberry juice.
- Gatorade or Powerade.
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Black coffee or plain tea. It’s OK to add sugar. Do not add anything else.
- Do not add any amount of any type of milk or creamer. This includes plant-based milks and creamers.
- Do not add honey.
- Do not add flavored syrup.
If you have diabetes, pay attention to the amount of sugar in these drinks. It will be easier to control your blood sugar levels if you include sugar-free, low-sugar, or no added sugar versions of these drinks.
It’s helpful to stay hydrated before surgery, so drink if you are thirsty. Do not drink more than you need. You will get intravenous (IV) fluids during your surgery.
Stop drinking 2 hours before your arrival time. This includes water.
Take your medicines as instructed
A member of your care team will tell you which medicines to take the morning of your surgery. Take only those medicines with a sip of water. Depending on what you usually take, this may be all, some, or none of your usual morning medicines.
Shower
Shower and wash your hair with baby shampoo the morning of your surgery. Do not use conditioner or any other hair products such as hair spray or hair gel.
Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Do not wear any metal objects. Take off all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
- Leave valuable items at home.
- If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. We’ll give you disposable underwear and a pad if you need them.
What to bring
- Your breathing device for sleep apnea (such as your CPAP machine), if you have one.
- Your incentive spirometer, if you have one.
- Your Health Care Proxy form and other advance directives, if you filled them out.
- Your cell phone and charger.
- A case for your personal items, if you have any. Eyeglasses, hearing aids, dentures, prosthetic devices, wigs, and religious articles are examples of personal items.
- This guide. You’ll use it to learn how to care for yourself after surgery.
Once you’re in the hospital
When you get to the hospital, take the B elevator to the 6th floor. Check in at the desk in the PSC waiting room.
Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.
We’ll give you a hospital gown, robe, and nonskid socks to wear when it’s time to change for surgery.
Meet with a nurse
You’ll meet with a nurse before surgery. Tell them the dose of any medicines you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medicines, patches, and creams.
Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist (A-nes-THEE-zee-AH-loh-jist) will do it in the operating room.
Meet with an anesthesiologist
You’ll also meet with an anesthesiologist before surgery. They will:
- Review your medical history with you.
- Ask if you’ve had any problems with anesthesia in the past. This includes nausea (feeling like you’re going to throw up) or pain.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you’ll get.
- Answer questions you have about anesthesia.
Get ready for surgery
When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.
You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of the operating room team will help you onto the operating bed. They’ll put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.
Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.
During your surgery
After you’re fully asleep, your care team will place a breathing tube through your mouth into your airway. It will help you breathe. They’ll also place a urinary (Foley) catheter in your bladder. It will drain your urine (pee) during your surgery.
Your surgeon will close your incisions with staples or stitches once they finish your surgery. They may also place Steri-Strips™ (thin pieces of surgical tape) or Dermabond® (surgical glue) over your incisions. They’ll cover your incisions with a bandage.
Your care team will usually take out your breathing tube while you’re still in the operating room.
After your VP shunt surgery
This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.
As you read this section, write down questions to ask your healthcare provider.
In the Post-Anesthesia Care Unit (PACU)
You’ll be in the PACU when you wake up after your surgery. A nurse will be keeping track of your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a tube resting below your nose or a mask over your nose and mouth. You’ll also have compression boots on your lower legs.
Pain medicine
You’ll get pain medicine while you’re in the PACU.
Moving to your hospital room
You may stay in the PACU for a few hours or overnight. How long you stay depends on the type of surgery you had. A staff member will bring you to your hospital room after your stay in the PACU.
In your hospital room
The length of time you’re in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 1 to 2 days.
In your hospital room, you’ll meet one of the nurses who will care for you during your stay.
Your care team will teach you how to care for yourself while you’re healing from your surgery. They will do things such as:
- Ask you questions such as where you are and what time of day it is.
- Ask you to move your arms and legs.
- Shine a small light into your eyes to check the response of your pupils.
Managing your pain
You may have a mild headache or feel discomfort around your incision for the first few days after your surgery. At first, you’ll get your pain medicine through your epidural catheter or IV line. Once you can eat, you’ll get oral pain medicine (pain medicine you swallow).
We will ask you about your pain often and give you medicine as needed. Tell one of your healthcare providers if your pain is not relieved. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain can help you recover faster.
You’ll get a prescription for pain medicine before you leave the hospital. Talk with your healthcare provider about possible side effects. Ask them when to start switching to over-the-counter pain medicine.
Moving around and walking
Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed.
To learn more about how walking can help you recover, read Frequently Asked Questions About Walking After Your Surgery.
To learn what you can do to stay safe and keep from falling while you’re in the hospital, read Call! Don't Fall!.
Exercising your lungs
It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.
- Use your incentive spirometer 10 times every hour you’re awake. Read How To Use Your Incentive Spirometer to learn more.
- Do coughing and deep breathing exercises. A member of your care team will teach you how.
Eating and drinking
You will get ice chips to eat after your surgery. You will start with a liquid diet and then you can start eating your normal foods again, as tolerated.
If you have questions about your diet, ask to see a clinical dietitian nutritionist.
Imaging scan
You may have a computed tomography (CT) scan (imaging scan) of your head 1 to 2 days after your surgery. This is to make sure your shunt is in the right place. Your nurse will give you more information about the scan before it’s done.
Caring for your incision
You will have bandages over your incision. Your doctor will take them off 1 to 2 days after your surgery. After that, you can leave them uncovered. Don’t get your incision wet, and don’t put any lotions, creams, or powders on it for 5 days after your surgery.
Planning for your discharge
A physical therapist will work with you before you leave the hospital and help decide if you need help at home, such as special medical equipment or a home care nurse. If needed, your case manager will work with you to arrange for home care visits after you’re discharged from the hospital.
A caregiver should help you at home for a few days after your surgery while you recover.
Leaving the hospital
Before you leave, look at your incision with one of your healthcare providers. Knowing what it looks like will help you notice any changes later.
On the day of your discharge, plan to leave the hospital around Your healthcare provider will write your discharge order and prescriptions before you leave. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave.
If your ride isn’t at the hospital when you’re ready to leave, you may be able to wait in the Patient Transition Lounge. A member of your care team will give you more information.
At home
Read What You Can Do to Avoid Falling to learn what you can do to keep from falling at home and during your appointments at MSK.
Managing your pain
People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medicine. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean something is wrong.
Follow these guidelines to help manage your pain at home.
- Take your medicines as directed and as needed.
- Call your healthcare provider if the medicine prescribed for you does not help your pain.
- Do not drive or drink alcohol while you’re taking prescription pain medicine. Some prescription pain medicines can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
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You’ll have less pain and need less pain medicine as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil or Motrin) are examples of over-the-counter pain relievers.
- Follow your healthcare provider’s instructions for stopping your prescription pain medicine.
- Do not take too much of any medicine. Follow the instructions on the label or from your healthcare provider.
- Read the labels on all the medicines you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medicines. Taking too much can harm your liver. Do not take more than one medicine that has acetaminophen without talking with a member of your care team.
- Pain medicine should help you get back to your usual activities. Take enough to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.
- Keep track of when you take your pain medicine. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.
Some prescription pain medicines, such as opioids, may cause constipation. Constipation is when you poop less often than usual, have a harder time pooping, or both.
Preventing and managing constipation
Talk with your healthcare provider about how to prevent and manage constipation. You can also follow these guidelines.
- Go to the bathroom at the same time every day. Your body will get used to going at that time. But if you feel like you need to go, don’t put it off.
- Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
- Exercise, if you can. Walking is a great type of exercise that can help prevent and manage constipation.
- Drink 8 to 10 (8-ounce) cups (2 liters) of liquids daily, if you can. Choose water, juices (such as prune juice), soups, and milkshakes. Limit liquids with caffeine, such as coffee and soda. Caffeine can pull fluid out of your body.
- Slowly increase the fiber in your diet to 25 to 35 grams per day. Unpeeled fruits and vegetables, whole grains, and cereals contain fiber. If you have an ostomy or recently had bowel surgery, ask your healthcare provider before changing your diet.
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Both over-the-counter and prescription medicines can treat constipation. Ask your healthcare provider before taking any medicine for constipation. This is very important if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medicines for constipation are:
- Docusate sodium (Colace®). This is a stool softener (medicine that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Do not take it with mineral oil.
- Polyethylene glycol (MiraLAX®). This is a laxative (medicine that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
- Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.
Caring for your incisions
- It’s common for the skin below your incision to feel numb. This happens because some of your nerves were cut during your surgery. The numbness will go away over time.
- Keep your incisions clean and dry for 5 days after your surgery. Don’t shower for 5 days after your surgery. Avoid baths, hot tubs, and swimming pools until your doctor tells you it’s OK.
- Don’t use a hair dryer, creams, ointment, or hair products on your incisions until they’re completely healed. This takes about 6 weeks.
Call your healthcare provider’s office if:
- The skin around your incision is very red or getting more red.
- The skin around your incision is warmer than usual.
- The area around your incision is starting to swell or getting more swollen.
- You see drainage that looks like pus (thick and milky).
- Your incision smells bad.
If you go home with staples in your incision, your healthcare provider will take them out during your first appointment after surgery. It’s OK to get them wet.
If you have Steri-Strips or Dermabond on your incision, they’ll loosen and fall or peel off on their own. If they haven’t fallen off after 10 days, you can take them off.
Showering
Do not shower for 5 days after your surgery. You may take a sponge bath during this time, but do not get your incision wet. Do not use dry shampoo, creams, or lotions near your incision.
After 5 days, take a shower every day to clean your incision. If you have staples in your incision, it’s OK to get them wet.
Use mild shampoo, such as baby shampoo and soap during your shower.
After you shower, pat the area dry with a clean towel and leave your incision uncovered. Do not put any creams, lotions, or powders on your incision.
Eating and drinking
You can eat all the foods you did before your surgery, unless your healthcare provider gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.
It’s also important to drink plenty of liquids. Try to drink 8 to 10 (8-ounce) cups of liquids every day. Choose liquids without alcohol. Limit liquids with caffeine.
If you have questions about your diet, ask to see a clinical dietitian nutritionist.
Physical activity and exercise
Your incision may look like it’s healed on the outside when you leave the hospital. It will not be healed on the inside. For the first 4 to 6 weeks after your surgery:
- Do not lift anything heavier than 10 pounds (4.5 kilograms).
- Do not do any high-energy activities, such as jogging and tennis.
- Do not play any contact sports, such as football.
Doing physical activity, such as walking and stair climbing, will help you gain strength and feel better. Try to get 20 to 30 minutes of physical activity at least 2 to 3 times a day. For example, you can walk outside or indoors at your local mall or shopping center.
It’s common to have less energy than usual after surgery. Recovery time is different for everyone. Do more activity each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery.
Driving
Ask your healthcare provider when you can drive. Most people can start driving again 4 to 6 weeks after surgery. Do not drive while you’re taking pain medicine that may make you drowsy.
You can ride in a car as a passenger at any time after you leave the hospital.
Going back to work
Talk with your healthcare provider about your job. They’ll tell you when it may be safe for you to start working again based on what you do. If you move around a lot or lift heavy objects, you may need to stay out a little longer. If you sit at a desk, you may be able to go back sooner.
Going back to your normal activities
You can go back to doing your normal activities when your doctor tells you it’s OK. If you plan to exercise, ask your doctor if it’s safe.
Traveling
You can travel by bus, train, or car. Do not travel on an airplane until your doctor says it’s OK.
When traveling a long distance, don’t sit for long periods of time. Stop every 2 hours and walk around. This will help keep blood clots from forming in your legs.
Follow-up care
Your first appointment after your surgery will be 7 to 10 days after your surgery. Call your doctor’s office to schedule your appointment.
You will have regular visits with your neurologist, neurosurgeon, or both. They will check on the function of your VP shunt over time.
Managing your feelings
You may have new and upsetting feelings after a surgery for a serious illness. Many people say they felt weepy, sad, worried, nervous, irritable, or angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.
The first step in coping is to talk about how you feel. Family and friends can help. We can also reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. We’re here to help you and your family and friends handle the emotional aspects of your illness. We can help no matter if you’re in the hospital or at home.
Safety guidelines to follow with your VP shunt
Carry your wallet card
Your nurse will give you a wallet card that says you have a VP shunt. You can also print it from Hydrocephalus With Shunt (Wallet Card). Carry the card with you at all times. If you need emergency medical care, show it to the medical workers.
Precautions with magnets
The pressure setting of some VP shunts may accidently change if you get too close to a magnet. This depends on the model of your shunt.
Ask your doctor if you need to take precautions (safety measures) when you’re near magnets. Follow the VP shunt manufacturer’s guidelines for magnets specific for your type of shunt. Your doctor will go over these guidelines with you.
Here are some general guidelines for many shunts.
- Keep all electronic devices including laptops, tablets, and smartphones that may contain magnets at least 6 inches (15 centimeters) away from your shunt valve implant site (your head).
- Do not use magnetic therapy pads and pillows.
Precautions with magnetic resonance imaging (MRI)
Some VP shunts are affected by MRI scans. Ask your doctor if your shunt is. If it is, follow the guidelines in this section before having an MRI.
Depending on the model of your VP shunt, the magnet in the MRI scanner may change your shunt’s pressure setting. After your MRI, your shunt’s pressure setting will need to be checked, reprogrammed, or both. You may need to have X-rays to help see if the pressure setting has changed.
You do not need to take any special care if you’re having a computed tomography (CT) scan, positron emission tomography (PET) scan, or X-ray. These scans will not affect your VP shunt.
If your VP shunt type needs to be reprogrammed after an MRI, you must schedule an appointment with your doctor or nurse to reprogram your VP shunt after your MRI. Your shunt should be reprogrammed within 4 hours after your MRI.
Before having an MRI:
- Tell the MRI technologist you have a VP shunt before your MRI appointment. They will need to know your shunt’s model and setting. Show them your wallet card.
- Make an appointment with your neurosurgeon to have your shunt reprogrammed within 4 hours after your MRI scan.
- Do not have an MRI scan if you cannot get an appointment to have your shunt reprogrammed after your scan, if needed. Wait to have your scan until you can schedule an appointment to have your shunt reprogrammed.
Tell your doctor if you need abdominal surgery
You should always ever need to have abdominal surgery, tell your neurosurgeon. Tell the doctor doing the surgery that you have a programmable VP shunt.
Tell your neurosurgeon if you have peritonitis or diverticulitis. Peritonitis (PAYR-ih-tuh-NY-tis) is swelling in the lining of your abdomen. Diverticulitis (DY-ver-TIH-kyoo-LY-tis) is swelling in the lining of your colon. You may need emergency surgery or antibiotic treatment.
Wear MedicAlert® jewelry
You should always wear a MedicAlert bracelet or necklace that says you have hydrocephalus and a programmable VP shunt. This will help emergency service workers care for you if you’re ever badly ill or hurt and need medical help.
You can buy a MedicAlert bracelet or necklace at most drug stores. You can also ask a member of your care team for an application. Visit the MedicAlert website at www.medicalert.org to learn more.
When to call your healthcare provider
Call your healthcare provider if:
-
You have any of these signs that your VP shunt is not working:
- Vomiting (throwing up) with little or no nausea.
- A headache that will not go away.
- Problems with your eyesight, such as blurry vision, double vision, or trouble seeing.
- Fatigue (feeling more weak or tired than usual).
- Loss of coordination or balance.
- Trouble staying awake or waking up.
- Swelling or redness around your shunt.
-
You have any signs of a VP shunt infection. This can happen if bacteria gets in the tissue around your shunt. This can make the VP shunt stop working and increase pressure in your brain. These signs include:
- A fever of 100.4° F (38° C) or higher.
- Swelling or redness around your shunt.
- Pain around the shunt or around the shunt catheter from the head to the abdomen.
These warning signs can happen quickly. If you have any of these warning signs, call your healthcare provider right away.
Contact information
If you have questions or concerns, contact your healthcare provider. A member of your care team will answer Monday through Friday from to Outside those hours, you can leave a message or talk with another MSK provider. There is always a doctor or nurse on call.
If you’re not sure how to reach your healthcare provider, call 212-639-2000.
Support services
This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.
As you read this section, write down questions to ask your healthcare provider.
MSK support services
Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.
Anesthesia
212-639-6840
Call if you have questions about anesthesia.
Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.
Bobst International Center
332-699-7968
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.
Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medicine to help if you feel anxious or depressed. Ask a member of your care team for a referral or call the number above to make an appointment.
Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. Talk with a member of your care team or call the number above to learn more.
Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care. For example, we offer music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to make an appointment for these services.
You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They’ll work with you to make a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment for a consultation.
MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.
Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.
Patient and Community Education
www.msk.org/pe
Visit our patient and community education website to search for educational resources, videos, and online programs.
Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.
Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.
Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call to learn more.
Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.
- Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. Call Rehabilitation Medicine (Physiatry) at 646-888-1929 to learn more.
- An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. Call Rehabilitation Therapy at 646-888-1900 to learn more.
Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.
This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.
Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.
- Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems such as premature menopause or fertility issues. Ask a member of your MSK care team for a referral or call 646-888-5076 to learn more.
- Our Male Sexual and Reproductive Medicine Program can help with sexual health problems such as erectile dysfunction (ED). Ask a member of your care team for a referral or call 646-888-6024 to learn more.
Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.
Our social workers can also help refer you to community agencies and programs. If you’re having trouble paying your bills, they also have information about financial resources. Call the number above to learn more.
Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).
MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.
Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call to learn more.
Virtual Programs
www.msk.org/vp
We offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.
Sessions are private, free, and led by experts. Visit our website to learn more about Virtual Programs or to register.
External support services
Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.
Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.
American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
Cancer and Careers
www.cancerandcareers.org
646-929-8032
A resource for education, tools, and events for employees with cancer.
CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.
Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.
Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.
Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medicine that’s part of the Good Days formulary.
HealthWell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medicines and therapies.
Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.
LGBT Cancer Project
www.lgbtcancer.com
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.
LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.
National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)
National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medicines.
NYRx
www.health.ny.gov/health_care/medicaid/program/pharmacy.htm
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Patient Access Network (PAN) Foundation
www.panfoundation.org
866-316-7263
Gives help with copayments for patients with insurance.
Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
Professional Prescription Advice
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medicines.
Red Door Community (formerly known as Gilda’s Club)
www.reddoorcommunity.org
212-647-9700
A place where people living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medicines they have trouble affording.
Triage Cancer
www.triagecancer.org
Provides legal, medical, and financial information and resources for cancer patients and their caregivers.
Educational resources
This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.
As you read these resources, write down questions to ask your healthcare provider.
- A Guide for Caregivers
- Advance Care Planning for People With Cancer and Their Loved Ones
- Call! Don't Fall!
- How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil
- Frequently Asked Questions About Walking After Your Surgery
- Herbal Remedies and Cancer Treatment
- How to Be a Health Care Agent
- How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal
- How To Use Your Incentive Spirometer
- What You Can Do to Avoid Falling
