What are the side effects of having a shunt?

Cincinnati Children's Hospital Medical Center provides the following warning signs of shunt malfunction:

•  Headaches 
•  Vomiting  
•  Lethargy (sleepiness)  
•  Irritability  
•  Swelling or redness along the shunt tract  
•  Decreased school performance  
•  Periods of confusion  
•  Seizures 

This guide will help you get ready for your surgery to have your programmable or nonprogrammable ventriculoperitoneal (VP) shunt placed at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.

Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

About Your Surgery

A VP shunt is 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. However, when you have too much of it, 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-dro-ceph-a-lus).

Figure 1. Brain without and with hydrocephalus

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)

VP shunt

To help drain the extra CSF from your brain, a VP shunt will be placed into your head. 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.

Figure 2. VP shunt

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.

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 inserted. 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 settings on the shunt. If you have nonprogrammable VP shunt, your doctor will program the settings in advance and they can’t 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.

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’ll 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. However, 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 excess CSF as needed to reduce the pressure in your brain.

Getting Ready for Your 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 through this section, write down questions to ask your healthcare provider.

Getting Ready for Surgery

You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you’re not sure.

• I take a blood thinner, such as:
  • Aspirin
  • Heparin
  • Warfarin (Jantoven® or Coumadin®)
  • Clopidogrel (Plavix®)
  • Enoxaparin (Lovenox®)
  • Dabigatran (Pradaxa®)
  • Apixaban (Eliquis®)
  • Rivaroxaban (Xarelto®)
  There are others, so be sure your healthcare provider knows all the medications you’re taking.
• I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
• I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
• I take 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’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.
• I’m allergic to certain medication(s) 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, e-cigarette, or Juul®.
• I use recreational drugs.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

• If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medications to help keep them from happening.
• If you drink alcohol regularly, you may be at risk for other problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

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. As always, all your medical information will be kept private.

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.

MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

About Sleep Apnea

Sleep apnea is a common breathing problem. It causes you to 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 a procedure. Please 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 procedure.

Within 30 days of your surgery

Presurgical Testing (PST)

You’ll have a PST appointment before your surgery. The date, time, and location will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your appointment.

It’s helpful to bring these things to your appointment:

• A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
• Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
• The names and telephone numbers of your healthcare providers.

During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care. Examples are:

• An electrocardiogram (EKG) to check your heart rhythm.
• A chest X-ray.
• Blood tests.

Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery.

Identify Your Caregiver

Your caregiver plays 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 from the hospital. They’ll also help you care for yourself at home.

For Caregivers

‌  Caring for a person going through cancer treatment comes with many responsibilities. MSK offers resources and support to help you manage them. For information, visit www.mskcc.org/caregivers or read A Guide for Caregivers.

Complete 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.

• For information about health care proxies and other advance directives, read Advance Care Planning.
• For information about being a health care agent, read How to Be a Health Care Agent.
• If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

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. For more information, read How To Use Your Incentive Spirometer.

Exercise

Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. 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 develop any illness (such as a fever, cold, sore throat, or the flu) before your surgery, call the doctor who scheduled your surgery. This includes .

7 days before your surgery

Follow Your Healthcare Provider’s Instructions for Taking Aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop Taking Vitamin E, Multivitamins, Herbal Remedies, and Other Dietary Supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop Taking Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. NSAIDs can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Note the Time of Your Surgery

A staff member from the Admitting Office will call you after 2 p.m. 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 7 p.m., call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

This will be the following location:

Presurgical Center (PSC) on the 6th floor
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY 10065
B elevator to 6th floor

Sleep

Go to bed early and get a full night’s sleep.

Instructions for eating and drinking before your surgery

 

Do not eat or drink after midnight.

The morning of your surgery

Take Your Medications As Instructed

A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower

Shower and wash your hair with baby shampoo the morning of your surgery. Don’t use conditioner or any other hair products such as hair spray or hair gel. After showering, don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.

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.
• Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
• Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
• Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
• If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

• Your breathing device for sleep apnea (such as your CPAP device), if you have one.
• Your incentive spirometer, if you have one.
• Your Health Care Proxy form and other advance directives, if you completed them.
• Your cell phone and charger.
• Only the money you may want for small purchases (such as a newspaper).
• A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
• This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.

Where To Park

MSK’s parking garage is on East 66th Street between York and 1st venues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.

There are other parking garages located on:

• East 69th Street between 1st and 2nd avenues.
• East 67th Street between York and 1st avenues.
• East 65th Street between 1st and 2nd avenues.

Once you’re in the hospital

When you get to the hospital, take the B elevator to the 6th floor and check in at the desk in the PSC waiting room.

You’ll be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.

Get dressed for surgery

When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet With a Nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight and the time you took them. Make sure to include prescription and over-the-counter medications, 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 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 you if you’ve had any problems with anesthesia in the past, including nausea 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 your questions about your anesthesia.

Get Ready For Your Surgery

When it’s time for your surgery, you’ll remove 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 your care team will help you onto a bed. They will 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 to make you fall asleep. You’ll also get fluids through your IV during and after your surgery.

During Your Surgery

After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. A urinary (Foley) catheter will also be placed to drain urine (pee) from your bladder.

Once your surgery is finished, your incision will be closed with staples or sutures (stitches). It may be covered with a bandage.

Your breathing tube is usually taken out while you’re still in the operating room.

Recovering After Your 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 through this section, write down questions to ask your healthcare provider.

In the Post-Anesthesia Care Unit (PACU)

When you wake up after your surgery, you’ll be in the PACU. 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 covering your nose and mouth. You may also have compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Pain medication

While you’re in the PACU, your pain will be managed with medications.

Moving to your hospital room

Once you recover from the anesthesia, a staff member will take you to your hospital room. The length of time you’ll stay in the PACU may also depend on when your hospital bed is ready for you.

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.

When you’re taken to your hospital room, you’ll meet one of the nurses who will care for you while you’re in the hospital. While you’re in the hospital, your nurses will teach you how to care for yourself while you’re recovering from your surgery.

For the first few days after your surgery, your nurses will do simple tests to make sure your brain is working well. They’ll 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.

Read the resource Call! Don't Fall! to learn about what you can do to stay safe and keep from falling while you’re in the hospital.

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 pain medication in your IV line. Once you’re able to eat normal food, you’ll get oral pain medication (medication you swallow).

Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.

You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications.

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.

Read Frequently Asked Questions About Walking After Your Surgery to learn more about how walking after surgery can help you recover.

Read Call! Don't Fall! to learn what you can do to stay safe and keep from falling while you’re in the hospital.

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. For more information, read How To Use Your Incentive Spirometer.
• Do coughing and deep breathing exercises. A member of your care team will teach you how.

Eating and drinking

You’ll be given ice chips to eat after your surgery. You’ll 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

To make sure your shunt is in the right place, you may have a computed tomography (CT) scan (imaging scan) of your head 1 to 2 days after your surgery. Your nurse will give you more information about the scan before it’s done.

Caring for your incision

You’ll 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

By the time you’re ready to leave the hospital, your incision will have started to heal. Before you leave the hospital, look at your incision with your nurse. Knowing what your incision looks like will help you notice any changes later.

On the day of your discharge, you should plan to leave the hospital around 11:00 a.m. Before you leave, your doctor will write your discharge order and prescriptions. You’ll also get written discharge instructions. Your nurse will review these instructions with you before you leave.

If your ride isn’t at the hospital when you’re ready to be discharged, you may be able to wait in the Patient Transition Lounge. A member of your healthcare team will give you more information.

At home

Read the resource What You Can Do to Avoid Falling to learn about what you can do to stay safe and 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 medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean that something is wrong.

Follow these guidelines to help manage your pain at home.

• Take your medications as directed and as needed.
• Call your healthcare provider if the medication prescribed for you does not help your pain.
• Do not drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
• As your incision(s) heal, you’ll have less pain and need less pain medication. 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 medication.
  • Do not take too much of any medication. Follow the instructions on the label or from your healthcare provider.
  • Read the labels on all the medications you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Do not take more than one medication that has acetaminophen without talking with a member of your care team.
• Pain medication should help you get back to your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active.
• Keep track of when you take your pain medication. 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.

Pain medication may cause constipation (having fewer bowel movements than what’s normal for you).

Caring for your incisions

• Check your incisions daily for any signs of infection, including redness, swelling, or drainage.
• 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 okay.
• Don’t use a hair dryer, creams, ointment, or hair products on your incisions until they’re completely healed. This takes about 6 weeks.

It’s normal for the skin below your incisions to feel numb. This happens because some of your nerves were cut during your surgery. The numbness will go away over time.

Call your healthcare provider if:

• The skin around your incisions is very red.
• The skin around your incisions is getting more red.
• You see drainage that looks like pus (thick and milky).

If you go home with staples or stitches in your incisions, your doctor will take them out during your first appointment after surgery. This is usually 7 to 10 days after your surgery.

Showering

Do not shower for 5 days after your surgery. You may take a sponge bath during this time, but don’t get your incision wet. Don’t use dry shampoo, creams or lotions near your incisions.

After 5 days, take a shower every day to clean your incision. If you have staples in your incision, it’s okay to get them wet.

Use a 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. Don’t put any creams, lotions, or powders on your incision.

Physical activity and exercise

When you leave the hospital, your incision will look like it’s healed on the outside, but it won’t be healed on the inside. For the first 4 to 6 weeks after your surgery:

• Don’t lift anything heavier than 10 pounds (about 4.5 kilograms).
• Don’t do any strenuous activities (such as jogging and tennis).
• Don’t play any contact sports (such as football).

Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Walk at least 2 to 3 times a day for 20 to 30 minutes. You can walk outside or indoors at your local mall or shopping center.

It’s normal to have less energy than usual after your surgery. Recovery time is different for each person. Increase your activities 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 doctor when you can drive. Most people can start driving again 4 to 6 weeks after surgery. Don’t drive while you’re taking pain medication 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.

Traveling

You can travel by bus, train or car. Don’t travel on an airplane until your doctor says it’s okay.

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.

Managing your feelings

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and 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. Your healthcare providers can 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. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. 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.

For help, watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. You can also contact the MyMSK Help Desk by emailing or calling 800-248-0593.

Going back to your normal activities

You can go back to doing your normal activities when your doctor tells you it’s okay. If you plan to exercise, ask your doctor if it’s safe.

You’ll then have regular visits with your neurologist, neurosurgeon, or both. They’ll check on the function of your VP shunt over time.

Safety Precautions for Your VP Shunt

Precautions with magnets

The pressure setting of some VP shunts may accidentally change if you get too close to a magnet. This depends on the VP shunt model.

Ask your doctor if you need to take precautions (safety measures) when coming into contact with magnets. Be sure to follow the VP shunt manufacturer’s guidelines for magnet precautions specific for your type of shunt. Your doctor will go over these guidelines with you.

Here are some general rules for many shunts:

• Keep all products with magnets at least 2 inches away from the valve implant site (your head).
• Don’t use magnetic therapy pads and pillows.

Precautions with magnetic resonance imaging (MRI)

If you need to have magnetic resonance imaging (MRI), you must tell your MRI technologist that you have a VP shunt before you have the test. Your technologist will need to know the model of your shunt and its setting.

Your nurse will give you a wallet card with this information. Carry it with you at all times. You can show your technologist the wallet card.

Depending on the type of VP shunt you have, the magnet in the MRI machine may change your shunt’s pressure setting. In this case, after your MRI, the pressure setting will need to be checked and may need to be reprogrammed by your doctor or nurse practitioner. In some cases, you may need to have x-rays to find out if the pressure setting has changed.

Some types of VP shunts aren’t affected by MRI. Ask your doctor or nurse if your shunt will need to be reprogrammed after an MRI. No matter what type of VP shunt you have, you won’t need to take any precautions if you’re having a computed tomography (CT) scan, positron emission tomography (PET) scan, or an x-ray.

If your VP shunt needs to be reprogrammed after you have 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.

Precautions for abdominal surgery

If you ever need to have abdominal surgery, you must tell your doctor so that precautions can be taken. Tell your doctor if you have peritonitis (a condition in which the tissue that covers your abdomen is inflamed) or diverticulitis (a condition in which small, bulging pouches develop in the intestines or colon) and you need emergency surgery or antibiotics..

MedicAlert® jewelry

You should always wear a MedicAlert® bracelet or necklace that says you have hydrocephalus and a VP shunt. If you’re ever very sick or hurt and need medical help, MedicAlert jewelry will let emergency service workers know about your VP shunt.

You can purchase this type of bracelet or necklace at most drug stores. For more information, visit the MedicAlert® website at: www.medicalert.org.

When to Contact Your Healthcare Provider

Call your healthcare provider if you have any of the following signs and symptoms that your VP shunt isn’t working properly:

• Vomiting with little or no nausea
• A constant headache that won’t go away
• Problems with your vision (eyesight) (blurry vision, double vision, or loss of vision)
• Irritability
• Fatigue
• Loss of coordination or balance
• Swelling, redness, or both, of the skin that runs along the shunt path
• Difficulty waking up or staying awake

Call your healthcare provider if you have signs and symptoms of a VP shunt infection.

A VP shunt infection can happen when bacteria infect the tissue around your VP shunt. When the tissue is infected, it can cause your VP shunt to stop working properly and increase pressure in your brain.

The signs and symptoms of a VP shunt infection include:

• A fever of 100.4° F (38° C) or higher
• Redness, swelling, or both, of the skin that runs along the shunt path
• Pain around the shunt or around the shunt catheter from the head to the abdomen

These warning signs can happen quickly. If any of these symptoms develop, call your doctor or nurse immediately.

On Monday through Friday from 9:00 a.m. to 5:00 p.m., contact your healthcare provider.

After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider.

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 through this section, write down questions to ask your healthcare provider.

MSK Support Services

Visit the Cancer Types section of MSK’s website at www.mskcc.org/types for more information.

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
888-675-7722
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.

Caregivers Clinic
646-888-0200
www.mskcc.org/caregivers
At MSK, the Caregivers Clinic provides support specifically for caregivers who are having difficulty coping with the demands of being a caregiver. For more information, call Dr. Allison Applebaum’s office at 646-888-0200.

Counseling Center
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 medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Female Sexual Medicine & Women’s Health Program
646-888-5076
Cancer and cancer treatments can affect your sexual health, fertility, or both. Our Female Sexual Medicine & Women’s Health Program can help with sexual health problems, such as premature menopause or fertility issues. We can help before, during, or after your treatment. Call for more information or to make an appointment.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
www.mskcc.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call 646-449-1010.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550.

Male Sexual and Reproductive Medicine Program
646-888-6024
Cancer and cancer treatments can affect your sexual health, fertility, or both. Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). We can help before, during, or after your treatment. Call for more information or to make an appointment.

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 LibGuides on MSK’s library website at libguides.mskcc.org

Nutrition Services
www.mskcc.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. To make an appointment, ask a member of your care team for a referral or call the number above.

Patient and Caregiver Education
www.mskcc.org/pe
Visit our Patient and Caregiver Education website to search for educational resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
It can be comforting to talk with someone who has been through a treatment like yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. Your conversations are private. They can be in person or over the phone.

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 for more information.

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.

Social Work
www.mskcc.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. They also have information about financial resources, if you’re having trouble paying your bills.

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.mskcc.org/tobacco
212-610-0507
MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

Virtual Programs
www.mskcc.org/vp
Our Virtual Programs 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 for more information 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
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.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

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 medication 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 medications 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
http://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 Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

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 medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance 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.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

Educational Resources

This section has the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.

As you read through these resources, write down questions to ask your healthcare provider.

• Call! Don't Fall!
• How To Use Your Incentive Spirometer
• What You Can Do to Avoid Falling

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If you have any questions, contact a member of your care team directly. If you're a patient at MSK and you need to reach a provider after 5 p.m., during the weekend, or on a holiday, call 212-639-2000.

How serious is having a shunt put in?

Can you live a normal life with a shunt?

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