With MASH, managing pain after a major surgery is tricky

It’s been two and a half weeks since I had a total knee replacement, and I’ve been managing a lot. Mostly, that’s been pain, but I’m also deeply concerned about taking care of my liver as much as my new knee. You might not think metabolic dysfunction-associated steatohepatitis (MASH) has much to do with recovery from surgery, but you’d be wrong.

My biggest concern is medication. I’ve mentioned before how frustrating it is to have so few pain-relief options. I miss the days when ibuprofen could shoot down inflammation in 30 minutes flat. Now, because of my MASH diagnosis, nonsteroidal anti-inflammatory drugs are off the table. That leaves me with Tylenol. It works, but only to a point, which is usually when my pain is about halfway gone. To be blunt, it sucks.

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October 28, 2025 Columns by Kathryn Hudson

Surgery with liver disease is risky, but I’m holding steady

Before my surgery, people wished me well and joked about the “good drugs,” meaning opioids. Sure, they can wipe out pain like magic, but they come with a price. Addiction is the most well-known risk, but for people like me with liver disease, the bigger threat is hepatic encephalopathy, a serious condition that opioids can trigger.

If you’ve never had an episode of this, count yourself lucky. When I was diagnosed with cirrhosis, hepatic encephalopathy came along for the ride, and we became instant enemies. Dizziness, weakness, memory loss, constant dehydration — it’s brutal.

Yet nothing eases the pain from surgery quite like an opioid would have. These days, I do my best to tough it out. After a week or two, the nausea alone makes me grateful for my daily acetaminophen limit — 2 grams a day — and I pray it will somehow be enough. It rarely is. Those little earthquakes of pain shake me daily as I rehab my sore, shiny new knee. Every time I reach for the prescription bottle, I pray it’s the last time. The pain may not be done with me, but I’m usually done with the tiny white pills that promise hope in a bottle.

The good news? I’m better than I was that first week. They say the first two weeks are the worst, and I can confirm that. This morning, my knee gave me a 5 a.m. wake-up call after yesterday’s physical therapy session nearly brought me to tears. I only made it through without crying because the pain meds left my mouth and eyes too dry for tears.

Tomorrow, I’ll drag myself back to the rehab clinic, smile bravely at my physical therapist, and march into what I affectionately call “the torture chamber.” I’m kidding — mostly. The pain is punishing, but I know it’s part of the process. My goal now is simple: heal enough to kick the painkillers to the curb and never look back.

I sincerely wish that no one would have to experience this kind of pain.

Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.

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