About Your Ventriculoperitoneal (VP) Shunt Surgery for Pediatric Patients

This information will help you prepare for your surgery to have your programmable or nonprogrammable ventriculoperitoneal (VP) shunt placed. 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 Memorial Sloan Kettering (MSK), including the day of your surgery. You and your healthcare team will refer to it throughout your care.

For the rest of this resource, our use of the words “you” and “your” refers to you or your child.

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 like a cushion. However, when you have too much of it, it puts pressure on your brain and skull. This extra fluid also makes your ventricles grow bigger (see Figure 1). This is called hydrocephalus (hy-dro-ceph-a-lus).

To drain the extra CSF from your brain, a VP shunt can be inserted into your head. The shunt takes the fluid out of your brain and moves it into your abdomen (belly), where it’s absorbed by your body. This decreases the pressure and swelling in your brain.

Symptoms of hydrocephalus

The most common symptoms of hydrocephalus include:

• Headache
• Nausea and vomiting
• Fatigue, drowsiness, or both
• Irritability
• Personality changes
• Problems with thinking and memory (confusion)
• Trouble with balance and walking
• Poor coordination
• Loss of control over urination
• Visual disturbances, including blurred vision, double vision, or having your eyes turn downward with the whites showing above
• Seizures
• Increased head size and bulging soft spot in infants
• High pitched cry in infants
• Poor feeding in infants

As the VP shunt drains extra CSF and decreases the pressure in your brain, it may relieve your symptoms. Some symptoms will disappear immediately after the VP shunt is inserted. Others will go away more slowly, sometimes over a few weeks.

About your VP shunt

A VP shunt has 3 parts (see Figure 2):

• A one-way valve and reservoir that controls the flow of fluid.
• A short catheter (thin, flexible tube) that drains the fluid away from your brain. It’s attached to the valve and can be placed in the front, back, or side of your head.
• A long catheter that moves the fluid into your abdomen. It’s attached to the valve and tunneled under your skin, behind your ear, down your neck, and into your abdomen.

The amount of fluid that’s drained by your VP shunt depends on the settings on the shunt.

• With a nonprogrammable VP shunt, the settings are made in advance by your doctor and can’t be changed.
• With a programmable VP shunt, the settings can be changed by your doctor.

Your neurosurgeon will talk with you about which type of VP shunt is best for you.

What to expect during your VP shunt surgery

The surgery to place your VP shunt will be done in the operating room. Before your surgery, you will get anesthesia (medication to make you sleep during your surgery). Once you’re asleep, a nurse will shave the hair in the area where your incisions (surgical cuts) will be. Your entire head won’t be shaved.

Your neurosurgeon will make small incisions in your head. Sometimes, incisions are also made in your neck and abdomen. These incisions will be used to help guide the long catheter so it can be placed correctly.

Your incisions will be closed with sutures (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 tubing along your neck.

Once all the parts of the shunt are connected, it will start draining the extra CSF to reduce the pressure in your brain.

Your surgery will take about 1 hour.

Possible complications from surgery

Possible complications from VP shunts and the surgery to place them can include:

• Infection
• Shunt malfunction that results in too much or too little drainage of CSF
• Bleeding

Your neurosurgeon will explain all the possible risks and complications before your surgery.

Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for your surgery

You and your healthcare team will work together to prepare 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 aren’t sure.

• I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your doctor knows all the medications you’re taking.
• I take prescription medications, including patches and creams.
• I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I have had a problem with anesthesia in the past.
• I am allergic to certain medication(s) or materials, including latex.
• I am not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke.
• I use recreational drugs.

About drinking alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.

• Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help prevent them.
• If you use alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and longer hospital stay.

Here are things you can do to prevent problems before your surgery:

• Be honest with your healthcare provider about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or can’t sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
• Tell your healthcare provider if you can’t stop drinking.
• Ask us any questions you have about drinking and surgery. As always, all of your medical information will be kept confidential.

About smoking

People who smoke can have breathing problems when they have surgery. Stopping even for a few days before 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 disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.

Within 30 days of your surgery

Presurgical testing

Before your surgery, you will have an appointment for presurgical testing (PST). Depending on your age, your testing can take place in a variety of places. The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

Your PST appointment will probably be at one of these two locations:

• Pediatric Ambulatory Care Center (PACC)
  1275 York Avenue (between East 67th and East 68th Streets)
  Take the B elevator to the 9th floor

• Presurgical Testing (PST)
  160 East 53rd Street (at Third Avenue)
  Tale the Elevator to the 7th floor

You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your NP may also recommend you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s very helpful if you bring the following with you to your PST appointment:

• A list of all the medications you’re taking, including patches and creams.
• Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
• The name(s) and telephone number(s) of your doctor(s).

Parking at the PACC

The PACC is located at Memorial Hospital (MSK’s main hospital).

Memorial Hospital
1275 York Avenue
(between East 67^th and East 68^th Streets)
New York, NY 10065

MSK’s parking garage is located on East 66^th Street between York and First 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 located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital.

There are also other garages located on East 69^th Street between First and Second Avenues, East 67^th Street between York and First Avenues, and East 65^th Street between First and Second Avenues.

Parking at PST

PST is located in the Rockefeller Outpatient Pavilion, also known as MSK 53^rd Street.

Rockefeller Outpatient Pavilion
160 East 53^rd Street (at Third Avenue)
New York, NY 10022

There are several options for parking during your PST appointment. The Bristol Garage offers discounts to patients. To receive the discount, have your parking ticket validated at the concierge desk in the Rockefeller Outpatient Pavilion. There is a shuttle that goes from the Bristol Garage to the Rockefeller Outpatient Pavilion every 20 minutes.

The Bristol Garage
300 East 56^th Street (between First and Second Avenues)
New York, NY 10022

There are also other garages located on East 53^rd Street between Second and Third Avenues and East 54^th Street between Second and Third Avenues.

Talk with your social worker about housing, if needed

The Ronald McDonald House provides temporary housing for out-of-town pediatric cancer patients and their families.

MSK also has arrangements with several local hotels and housing facilities that may give you a special reduced rate. Your social worker can discuss your options and make reservations.

Tell us if you’re sick

If you develop any illness before your surgery, call the doctor who scheduled your surgery. This includes a fever, cold, sore throat, or the flu.

10 days before your surgery

Stop taking vitamin E

If you take vitamin E, stop taking it 10 days before your surgery, because it can cause bleeding. For more information, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

7 days before your surgery

Stop taking certain medications

If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

Stop taking herbal remedies and other supplements

Stop taking herbal remedies and other supplements 7 days before your surgery. If you take a multivitamin, ask your doctor or nurse if you should continue. For more information, read Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking certain medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil^®, Motrin^®) and naproxen (Aleve^®) 2 days before your surgery. These medications can cause bleeding. For more information, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

1 day before your surgery

Note the time of your surgery

A clerk from the Admitting Office will call you after 2:00 p.m. the day before your surgery. If you’re scheduled for surgery on Monday, you will be called on the Friday before.

The clerk will tell you what time you should arrive at the hospital for your surgery. They will also tell you where to go the day of your surgery.

If you don’t receive a call by 4:00 p.m., please call 212-639-7056.

Your surgery will be at one of the following locations:

• Pediatric Ambulatory Care Center (PACC)
  B elevator to 9th floor
• Presurgical Center (PSC)
  B elevator to 6th floor

Both locations are at 1275 York Avenue between East 67^th and East 68^th Streets.

The night before your surgery

Shower

Unless you’re given other instructions, you can shower and wash your hair. Do not apply any hair products such as hair spray or hair gel.

Sleep

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

Instructions for eating and drinking before your surgery

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Do not eat or drink anything after a certain time on the night before your surgery. This exact time is based on your age and any other medical problems that you may have. Your NP will talk with you about what you can and cannot eat before surgery.

If you do not follow the instructions you are given, your surgery may be cancelled.

The morning of your surgery

Take your medications as instructed

If your doctor or NP instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications. Starting 2 hours before your surgery, do not take any medications.

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Do not eat or drink anything the morning of your surgery. This includes water, hard candy, and gum. Take any medication as instructed with a sip of water.
 
 

Things to remember

• Don’t put on any lotion, cream, deodorant, makeup, powder, or perfume.
• 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.
• Leave valuables, such as credit cards, jewelry, or your checkbook at home.
• Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.
• Wear something comfortable and loose-fitting.
• If you wear contact lenses, wear your glasses instead.

What to bring

• Your breathing machine for sleep apnea (such as your CPAP), if you have one.
• Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
• Your cell phone and charger.
• A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles, if you have it.
• This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Parking when you arrive

For information about parking at MSK’s main hospital, read the “Parking at the PACC” section above.

Once you’re in the hospital

You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or 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 non-skid socks to wear.

Meet with your nurse

You will meet with your nurse before your surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Meet with your anesthesiologist

Your anesthesiologist will:

• Review your medical history with you.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you will receive.
• Answer any questions you may have about your anesthesia.

Prepare for surgery

You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line, MediPort^®, or central line.

Once you’re asleep, your surgery will begin. You won’t feel any pain during your surgery.

After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your stay and after you leave. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

What to expect

When you wake up after your surgery, you will be in the Post Anesthesia Recovery Unit (PACU).

It’s normal to feel very tired after surgery. Your PACU nurse will make sure you are comfortable and answer all of your questions.

You may have a mask over your face that will give you air and help you wake up after surgery. You will be attached to machines that will monitor your vital signs (body temperature, heart rate, blood pressure, and oxygen level). You will also have dressings (bandages) over your incisions.

Once you’re fully awake, you will be moved to your hospital room. Your room will be in one of the following places:

• The Pediatric Intensive Care Unit (PICU)
• The Adult Intensive Care Unit (ICU)
• The Neurology Advanced Care Unit (NACU)

The place that your room is depends on your age and condition.

After 24 hours, you will mostly likely be taken to the pediatric or neurology floor for continued care. Your doctor will also remove the bandages over your incisions about 24 to 48 hours after your surgery. After the bandages are removed, your incisions will be left uncovered.

While you’re in the hospital, you will frequently be asked to move your arms, fingers, toes and legs. Your nurse will check your pupils with a flashlight and ask questions such as “What is your name?”

Depending on your treatment plan, a physical therapist may visit you and begin to work with you. Over the next few days, you will increase your activity until you’re ready to go home.

Commonly asked questions

Will I have any pain?

You may have a mild headache or feel discomfort from your incision lines for the first few days after your surgery. Your nurse will give you pain medication. Tell your nurse if the medication isn’t helping your pain.

You may have a sore throat after your surgery. This is caused by the breathing tube that was used during your surgery. Your nurse will give you cool liquids to drink and lozenges to suck on to help with the discomfort.

How long will I be in the hospital?

Most people stay in the hospital for 1 to 3 days, but this will depend on your recovery.

Parents can call the inpatient unit at any time. Ask your nurse for the phone number. Because of privacy concerns, staff will only give information to parents or spouses. Please tell friends and other relatives not to call the inpatient unit for information.

When will I be able to eat and drink?

You will be given ice chips to eat after your surgery. You will start with a liquid diet and then progress to solid food.

When will my sutures or staples be removed?

The sutures or staples in your incisions will be removed 7 to 10 days after your surgery. They may need to stay in longer if you have had this surgery before. Your doctor or NP will remove them during your follow-up visit at the clinic.

How do I care for my incision?

• Check your incisions daily for any signs of redness, swelling, or drainage.
• Keep your incisions clean and dry for 5 days after your surgery.

When can I shower?

• You can shower or take a bath within 24 hours after your surgery. When you wash your hair, use a gentle shampoo, such as baby shampoo.
• For the first 5 days after your surgery, don’t let your incision(s) get wet.
• Don’t let your incisions soak in water. Avoid baths, hot tubs, and swimming pools for at least 2 weeks after your surgery.
• Don’t use a hair dryer, creams, ointments, or hair products on your incisions until they’re completely healed. This takes about 6 weeks.e a hair dryer, creams, ointments, or hair products on your incisions until they are completely healed. This takes about 6 weeks.

When can I go back to work?

Your doctor will tell you when you can go back to work. This depends on your age, type of work, medical condition, and other factors.

When can I go back to school?

You can go back to school as soon as you feel ready. Tell your school nurse that you have a VP shunt.

When can I go back to my normal activities?

You can participate in all noncontact sports (such as swimming and running), exercise, and go to the gym 2 weeks after your surgery. You can’t participate in any contact (collision) sports (such as football, boxing and wresting). Remember to wear a helmet to decrease the risk of head injury, if needed. Ask your neurosurgeon for specific guidelines on wearing a helmet.

When can I swim?

Don’t swim for at least 2 weeks after your surgery. If your incisions need more time to heal, you may need to wait longer. Your neurosurgeon or NP will tell you when it’s okay to swim at your first follow-up appointment after your surgery.

When can I travel?

Don’t travel on an airplane until your doctor says it’s okay.

What follow-up care will I receive?

You will have regular visits with your neurologist, neurosurgeon, or both. They will monitor the function of your VP shunt over time.

What precautions do I need to take if I have a programmable VP shunt?

Magnets

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

Ask your neurosurgeon if you need to take precautions when you’re near magnets. Be sure to follow the manufacturer’s guidelines for magnetic field precautions specific for your type of shunt.

Here are some general rules for many shunts:

• Keep all products with magnets at least 2 inches away from the valve implant site.
• Don’t use magnetic therapy pads and pillows.
• Don’t use the iPad 2 if you have a Medtronic Strata® programmable VP shunt.
• Don’t use audio headsets without checking the shunt manufacturer’s guidelines.

Magnetic resonance imaging (MRI)

If you’re having a MRI scan, tell your MRI technologist that you have a programmable VP shunt before you have the scan. Your technologist will need to know the shunt’s model and 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 model of your programmable VP shunt, the magnet in the MRI scanner may change your shunt’s pressure setting. After your MRI, the pressure setting will need to be checked, reprogrammed, or both by your neurosurgeon or nurse practitioner (NP). You may need to have x-rays to help see if the pressure setting has changed.

Before you have your MRI, make arrangements with your neurosurgeon or NP to have your shunt reprogrammed after your MRI. Your shunt should be reprogrammed within 4 hours after your MRI.

Some types of programmable VP shunts aren’t affected by MRI. Ask your neurosurgeon or NP if your shunt will need to be reprogrammed after an MRI.

You don’t need to take any precautions if you’re having a computed tomography (CT) scan or x-ray.

MedicAlert^® jewelry

You should always wear a MedicAlert bracelet or necklace stating that you have hydrocephalus and a programmable VP shunt. If you’re ever seriously ill or hurt and need medical help, it will inform emergency services workers about your programmable VP shunt.

You can buy a MedicAlert bracelet or necklace at most drug stores. For more information, visit the MedicAlert website at: www.medicalert.com

Abdominal surgery

If you ever need to have abdominal surgery, tell the doctor doing the surgery and your neurosurgeon so that precautions can be taken.

Tell your neurosurgeon if you have peritonitis or diverticulitis requiring emergency surgery or antibiotic treatment.

What precautions do I need to take if I have a nonprogrammable VP shunt?

You don’t need to take any precautions if you have magnetic resonance imaging (MRI), a computed tomography (CT) scan, or x-rays.

MedicAlert^® jewelry

You should always wear a MedicAlert bracelet or necklace stating that you have hydrocephalus and a nonprogrammable VP shunt. If you’re ever seriously ill or hurt and need medical help, it will inform emergency services workers about your nonprogrammable VP shunt.

You can buy a MedicAlert bracelet or necklace at most drug stores. For more information, visit the MedicAlert website at: www.medicalert.com

Abdominal surgery

If you ever need to have abdominal surgery, tell the doctor doing the surgery and your neurosurgeon so that precautions can be taken.

Tell your neurosurgeon if you have peritonitis or diverticulitis requiring emergency surgery or antibiotic treatment.

When should I call my doctor or NP?

Call your doctor or NP if you’re having any of the following signs and symptoms that your VP shunt isn’t working properly:

• Vomiting with little or no nausea
• A constant, unrelieved headache
• Vision problems (blurry, double vision, or loss of vision)
• Irritability
• Fatigue
• Personality changes
• Loss of coordination or balance
• Swelling, redness, or both, along the shunt path
• A bulging soft spot on an infant’s head
• Difficulty waking up or staying awake
• Decrease in school performance

Call your doctor or NP if you’re having signs and symptoms of a VP shunt infection. A VP shunt infection can cause the VP shunt to stop working properly and increase pressure in your brain. The signs and symptoms of a VP shunt infection include:

• A temperature 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 tubing from the head to the abdomen

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

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If you cannot wake your child, call 911 or go to the nearest emergency room immediately. 
 

Contact Information

If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 a.m. to 5:00 p.m. at (212) 639-7056.

After 5:00 p.m., during the weekend, and on holidays, please call (212) 639-2000 and ask for the pediatric neurosurgery fellow on call.

Support services

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.

As you read this section, write down questions to ask your healthcare provider.

MSK support services

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
332-699-7968
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Caregivers Clinic
www.msk.org/caregivers
Our Caregivers Clinic provides support for caregivers who are having a hard time coping with the demands of being a caregiver. Call Dr. Allison Applebaum’s office at 646-888-0200 to learn more.

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medicine to help if you feel anxious or depressed. Ask a member of your care team for a referral or call the number above to make an appointment.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. Talk with a member of your care team or call the number above to learn more.

Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care. For example, we offer music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to make an appointment for these services.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They’ll work with you to make a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment for a consultation.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.

Patient and Community Education
www.msk.org/pe
Visit our patient and community education website to search for educational resources, videos, and online programs.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call to learn more.

Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

• Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. Call Rehabilitation Medicine (Physiatry) at 646-888-1929 to learn more.
• An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. Call Rehabilitation Therapy at 646-888-1900 to learn more.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.

Our social workers can also help refer you to community agencies and programs. If you’re having trouble paying your bills, they also have information about financial resources. Call the number above to learn more.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).

MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Virtual Programs
www.msk.org/vp
We offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website to learn more about Virtual Programs or to register.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
646-929-8032
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 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.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medicine that’s part of the Good Days formulary.

HealthWell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medicines and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
www.lgbtcancer.com
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medicines.

NYRx
www.health.ny.gov/health_care/medicaid/program/pharmacy.htm
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Patient Access Network (PAN) Foundation
www.panfoundation.org
866-316-7263
Gives help with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

Professional Prescription Advice
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medicines.

Red Door Community (formerly known as Gilda’s Club)
www.reddoorcommunity.org
212-647-9700
A place where people living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

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

Triage Cancer
www.triagecancer.org
Provides legal, medical, and financial information and resources for cancer patients and their caregivers.

Educational resources

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

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

• How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil
• Eating Well During Your Cancer Treatment
• Herbal Remedies and Cancer Treatment
• Information for Family and Friends for the Day of Surgery