About Your Whipple Procedure

This guide will help you get ready for your Whipple procedure (pancreaticoduodenectomy) 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

The Whipple procedure is done to remove a tumor in the head of your pancreas, your ampulla, or the first part of your duodenum. These organs are located in the back of your abdomen (belly) behind your stomach and just above your small intestine (see Figure 1).

About your pancreas and surrounding organs

• Your pancreas makes enzymes that help digest the food you eat, including fats. It also makes insulin and glucagon, which are hormones that help regulate your blood sugar levels. Your pancreas has 3 parts: the tail, the body, and the head. The head of your pancreas is attached to your duodenum.
• Your gallbladder stores bile. Bile is a liquid that’s made in your liver that helps digest fats. When you eat food, your gallbladder sends stored bile to your duodenum to help with digestion.
• Your common bile duct is a small tube that carries bile from your liver to your gallbladder to be stored, then from your gallbladder to your duodenum when you eat.
• Your ampulla (also called the ampulla of Vater) is a small sac where your common bile duct and your pancreatic duct meet. It’s located outside your duodenum, near the head of your pancreas.
• Your duodenum is the first part of your small intestine. It’s directly attached to your stomach.
• Your jejunum is the second part of your small intestine.

Even though part of your pancreas will be removed during your surgery, there’s usually enough of it left after your surgery to make hormones (insulin and glucagon) and digestive enzymes.

• If your pancreas doesn’t make enough digestive enzymes after your surgery, you may have diarrhea. If this happens, you may need to take enzyme pills when you eat.
• If your pancreas doesn’t make enough insulin after your surgery, you may have high blood sugar. This is rare. If you do have high blood sugar after your surgery, your healthcare team will help you.

About the Whipple Procedure

The Whipple procedure is done using 1 large incision (surgical cut) in your abdomen. Sometimes, before making the large incision, your surgeon will make several small incisions and put a small video camera into your abdomen. They’ll use the camera to look at your organs to see if the cancer has spread outside of your pancreas. This is called a diagnostic laparoscopy.

If the cancer has spread, your surgeon may decide not to continue with your surgery. If the cancer hasn’t spread, your surgeon will make a large incision and continue with the Whipple procedure to try to remove the tumor.

During your surgery, your surgeon will remove the head of your pancreas, your duodenum, the end of your common bile duct closest to your duodenum, and your gallbladder. Sometimes, part of your stomach must also be removed.

After these organs are removed, your surgeon will connect the rest of your common bile duct and your remaining pancreas to your jejunum (see Figure 2). This is so the pancreatic enzymes and bile will flow into your small intestine, like they did before your surgery.

Your surgery will take about 4 hours.

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.

About Enhanced Recovery After Surgery (ERAS)

ERAS is a program to help you get better faster after your surgery. As part of the ERAS program, it’s important to do certain things before and after your surgery.

Before your surgery, make sure you’re ready by:

• Reading this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your healthcare provider at your next appointment, or you can call their office.
• Exercising and following a healthy diet. This will help get your body ready for your surgery.

After your surgery, help yourself recover more quickly by:

• Reading your recovery pathway. This is an educational resource your healthcare provider will give you. It has goals for your recovery. It will help you know what to do and expect each day during your recovery.
• Starting to move around as soon as you can. The sooner you get out of bed and walk, the quicker you can get back to your normal activities.

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.msk.org/caregivers or read A Guide for Caregivers.

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 more about health care proxies and other advance directives, read Advance Care Planning.
• To learn more 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.

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 6^th floor
1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065
B elevator to 6^th floor

Shower with a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. Your nurse will give you a bottle to use before your surgery.

The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.

Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Sleep

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

Instructions for eating before your surgery

‌  
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.



 

The morning of your surgery

Instructions for drinking before your surgery

• If your healthcare provider gave you a ClearFast drink, finish it 2 hours before your scheduled arrival time. Do not drink anything else after midnight the night before your surgery, including water.
• If your healthcare provider did not give you a ClearFast drink, you can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.

 
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

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 with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

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.
• 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

• Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can accommodate this swelling.
• Your breathing device for sleep apnea (such as your CPAP device ), 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 66^th Street between York and 1^st avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66^th 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 6^th floor. 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 (including prescription and over-the-counter medications, patches, and creams) and the time you took them.

Your nurse may give you medication to help with pain after surgery. If they do, they’ll give you information about the medication before you take it.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse doesn’t 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.

Your doctor or anesthesiologist may also talk with you about placing an epidural catheter (thin, flexible tube) in your spine (back). An epidural catheter is another way to give you pain medication after your surgery.

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 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). You may also have Steri-Strips^™ (thin pieces of surgical tape) over your incision. Your incisions will 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

You’ll get epidural or IV pain medication while you’re in the PACU.

• If you’re getting epidural pain medication, it will be put into your epidural space (the space in your spine just outside your spinal cord) through your epidural catheter.
• If you’re getting IV pain medication, it will be put into your bloodstream through your IV line.

You’ll be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. For more information, read the resource Patient-Controlled Analgesia (PCA).

Tubes and drains

You’ll have 1 or more of the tubes and drains below. Your healthcare provider will talk with you about what to expect.

• You’ll have a Foley catheter in your urethra going to your bladder. This tube drains urine from your bladder so your care team can keep track of how much urine you’re making. Your Foley catheter is usually removed 2 days after your surgery.
• You may have a nasogastric (NG) tube in your nose going into your stomach. This tube drains the fluid that naturally collects in your stomach. It will help keep you from vomiting (throwing up). If you have a NG tube, it’s usually removed the first day after surgery.
• You may have a drainage tube in your abdomen to drain fluid from the area. If you have this drainage tube, it’s usually removed a few days after surgery, but you may still have it when you’re discharged from the hospital. Read the “Caring for Your Tubes and Drains” section for more information.

Moving to your hospital room

You’ll stay in the PACU overnight. After your stay in the PACU, a staff member will take you to your hospital room.

In your hospital room

The length of time you’re in the hospital after your surgery depends on the type of surgery you had and your recovery. Most people stay in the hospital for 6 days after having a Whipple procedure.

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. Soon after you arrive in your room, your nurse will help you out of bed and into your chair.

While you’re in the hospital, your healthcare providers will teach you how to care for yourself while you’re recovering from your surgery. You can help yourself recover more quickly by doing the following things:

• Read your recovery pathway. Your healthcare provider will give you a pathway with goals for your recovery, if you don’t already have one. It will help you know what to do and expect on each day during your recovery.
• Start moving around as soon as you can. The sooner you’re able to get out of bed and walk, the quicker you’ll be able to get back to your normal activities.

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’ll have some pain after your surgery. At first, you’ll get your pain medication through your epidural catheter or IV line. You’ll be able to control your pain medication using a PCA device. Once you’re able to eat, 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.

If you had a minimally invasive surgery, you may have pain in your shoulder. This is called referred pain. It’s caused by the gas that was put into your abdomen during your surgery, and it’s normal. If you have pain in your shoulder, tell your healthcare provider.

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

During your surgery, some of your digestive organs were moved or removed. After your surgery, your digestive system needs time to heal and adjust to the changes. You’ll slowly go back to drinking and eating. The table below is a guideline. Follow your healthcare team’s instructions.

An inpatient clinical dietitian nutritionist will visit you in your hospital room to plan your diet with you before you’re discharged.

For more information about your diet and nutrition after your Whipple procedure, read Eating After Your Gastric Bypass Surgery or Whipple Procedure.

Caring for your tubes and drains

Your nurse will help you care for your tubes and drains while you’re in the hospital.

If you have a drainage tube in your abdomen, your healthcare team will keep track of how much fluid is draining from the tube. Once the amount is low enough, they’ll remove the tube. This usually happens a few days after surgery, but you may still have the drainage tube when you’re discharged from the hospital. Your healthcare team will tell you what to expect.

If you’ll still have the drainage tube when you’re discharged, your nurse will teach you how to care for it at home. They’ll also give you the supplies you’ll need. Your case manager may also arrange for a home care nurse to visit you at home to help you.

Showering

You’ll be able to shower on the first day after your surgery. A member of your healthcare team will help you.

Leaving the hospital

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

On the day of your discharge, plan to leave the hospital around 11:00 a.m. Before you leave, your healthcare provider will write your discharge order and prescriptions. You’ll also get written discharge instructions. One of your healthcare providers 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.

Your first appointment after surgery will be in 10 to 14 days after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.

Filling out your Recovery Tracker

We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account. We’ll send them every day for 10 days after you’re discharged. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information. Sometimes, we may ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. To learn more, read About Your Recovery Tracker.

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 as they recover. This doesn’t mean that something is wrong. But, if it doesn’t get better, contact your healthcare provider.

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.

Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual).

Preventing and managing constipation

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.

• 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.
• Exercise. Walking is an excellent form of exercise.
• Drink around 8 (8-ounce) glasses (2 liters) of liquids daily, if you can. Follow the instructions in the resource Eating After Your Gastric Bypass Surgery or Whipple Procedure.

If you haven’t had a bowel movement in 2 days, call your healthcare provider.

Managing diarrhea

If your pancreas doesn’t make enough enzymes to digest your food, you may have diarrhea. If this happens, contact your healthcare provider. You may need to take enzyme pills when you eat. Your healthcare provider will give you more information.

Caring for your incision

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

The staples in your incision will be removed during your first appointment after surgery. This is usually about 2 weeks after you’re discharged. While the staples are in your incision, you may feel some tightness or a tugging feeling along your incision. This is normal. Doing gentle stretching can help.

If you go home with Steri-Strips on your incision, they’ll loosen and fall off by themselves. If they haven’t fallen off within 10 days, you can take them off.

If the area around your incision is red or puffy or if you have any drainage from your incision, contact your healthcare provider.

Showering

Shower every day. Taking a warm shower is relaxing and can help ease muscle aches. You’ll also clean your incision when you shower.

When you shower, use soap to gently wash your incision. After you shower, pat the area dry with a clean towel. Don’t rub over your incision. Leave your incision uncovered, unless there’s drainage.

Don’t take tub baths until talking with your healthcare provider at your first appointment after your surgery.

Eating and drinking

After your surgery, you may have a smaller appetite (desire to eat) or no appetite at all. You’ll probably feel full quickly after eating. These are expected and should get better over time.

If you find your appetite isn’t good at first, try having meals that include your favorite foods and high-calorie foods. It’s important to get enough calories and protein to promote healing keep from losing weight. You should think of food as being as important as your medications.

Follow the eating and drinking guidelines in the resource Eating After Your Gastric Bypass Surgery or Whipple Procedure. If you have questions, you can reach a clinical dietitian nutritionist by calling 212-639-7312.

Weight changes

Many people lose weight after their surgery. You may not get back to your pre-surgery weight for some time. Your goal should be to stay at your new weight. If you have questions or concerns about your weight, talk with a member of your healthcare team.

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.

• Don’t lift anything heavier than 5 pounds (2.3 kilograms) for at least 8 weeks after your surgery.
• Ask your healthcare provider before starting strenuous exercises (such as jogging and tennis).

Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. You can walk outside or indoors at your local mall or shopping center. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. You can also keep doing your coughing and deep breathing exercises and using your incentive spirometer.

Managing fatigue

Fatigue is having less energy or feeling more tired than usual. It’s normal to feel fatigued after your surgery. This may last for 6 to 8 weeks after surgery, but it will get better slowly over time. Try to increase your activity level every day to help manage your fatigue. Get up, get dressed, and walk. You may need a nap during the day, but try to stay out of bed as much as possible so you’ll sleep at night.

It’s important to go back to your usual activities after surgery. Spread them out over the course of the day. You can do light household tasks. Try washing dishes, preparing light meals, and other activities as you’re able.

Your body is an excellent guide for telling you when you’ve done too much. When you increase your activity, monitor your body’s reaction. You may find you have more energy in the morning or the afternoon. Plan your activities for times of the day when you have more energy.

Driving

While your incision is healing, you may not be able to twist your body as well as usual. This can make it hard for you to drive. You also shouldn’t drive if you’re taking pain medication that may make you drowsy. During your first appointment after surgery, your healthcare provider will tell you if it’s safe for you to start driving again.

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

If you’re traveling a long distance, try to get up once an hour to walk around. This will help prevent blood clots. Remember to drink around 8 (8-ounce) glasses of liquids every day, even when you’re traveling.

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 [email protected] or calling 800-248-0593.

When to Contact Your Healthcare Provider

Contact your healthcare provider if:

• You have a fever of 100.5 °F (38 °C) or higher.
• You have chills.
• You’re having shortness of breath.
• The skin around your incision is warmer than normal.
• The skin around your incision is getting more red.
• The area around your incision is starting to swell.
• Swelling around your incision is getting worse.
• You have pus-like (thick, yellowish, or foul-smelling) drainage from your incision.
• You have any sudden increase in pain or new pain.
• You have nausea and vomiting.
• You have diarrhea.
• You have constipation that isn’t relieved within 2 days.
• You have any new or unexplained symptoms.
• You have any questions or concerns.

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.msk.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
www.msk.org/caregivers
646-888-0200
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
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 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.

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.msk.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.

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

Patient and Caregiver Education
www.msk.org/pe
Visit our Patient and Caregiver 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 for more information.

Rehabilitation Services
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. To learn more, call Rehabilitation Medicine (Physiatry) at 646-888-1929.
• 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. To learn more, call Rehabilitation Therapy at 646-888-1900.

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. For more information or to make an appointment, call 646-888-5076.
• Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). For more information or to make an appointment, call 646-888-6024.

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. 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.msk.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.msk.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 25^th & 26^th 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
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.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.

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

• Advance Care Planning
• Call! Don't Fall!
• Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
• Eating After Your Gastric Bypass Surgery or Whipple Procedure
• Herbal Remedies and Cancer Treatment
• How To Use Your Incentive Spirometer
• Patient-Controlled Analgesia (PCA)
• What You Can Do to Avoid Falling
• About Your Recovery Tracker