I have slightly high liver enzymens but that's due to too many years of eating fast food. I never tell a doc I just make sure I stay under the 4,000 mg limint and achamedaphine and it is not a problem

Why are you being forced to take the short term meds with tylenol? I found that my primary would also only give me the same things. They are skittery about stronger meds so I realized I had to do the PM route. Did he tell you to avoid fats? My hubs has a fatty liver but we know it is probably paying for all the years of beer drinking. What a died in the wool Irishman is he lol!

Laura,
Instead of lowering your pain medication doses and causing your even more pain prior to your surgery, your doctor should be switching you to a medication, such as oxycodone immediate release, aka roxycodone, the active narcotic ingredient in Percocet but available without acetaminophen. Witout acetaminophen it will NOT harm you liver.

There is absolutely no reason for you to suffer because your doctor doesn't have a good plan for managing your pain without acetaminophen. OxyIR comes in 5 mg tablets; it's generally prescribed as 1-2 tablets every 4-6 hours as needed for breakthrough pain. It's stronger than Norco or Vicoden, so you may need less and your liver will not be getting any acetaminophen. Please go back to your doctor tomorrow and be VERY adament that his plan of just reducing your pain medication is NOT effective or acceptable, and recommend one that is (e.g. using oxycodone as the breakthrough medication to be taken along with your Opana).

As for the fatty liver disease, I just did some on-line research on fatty liver disease and could not find any correlation between acetaminophen use and fatty liver disease. There is a correlation between the consumption of alcohol and alcoholic fatty liver disease, but that's not your issue. And there is a correlations between the increased consumption of fat-laden foods and fatty liver disease, but the increased use of acetaminophen seems to be entirely unrelated. Have you seen a gasteroenterologist about your liver issues or is this just your pain doctor or another physicial who's stating you have fatty liver disease due to acetaminophen?

However, as you know, long-term use of acetaminophen can cause other forms of liver damage, so it's important to limit the amount of acetaminophen you are taking. I believe we discussed this in your posting about pre/post surgical pain management, and switching to an opiod that doesn't have any acetaminophen in it (e.g. oxycodone immediate release, aka roxycodone, which is equivalent to Percocet without the acetominophen). There is no comparable option using hydrocodone; all fomulations combine hydrocodone and acetaminopen or aspirin and doctors tend to stay away from the aspirin derivatives due to the increased risk to the kindeys and of course the acetaminopen based ones due to the increased risk to the liver.

This may also be a good time to have a conversation with your gasteroenterologist, as soon as possible, both to get a definite diagnossis (do you really have fatty liver disease; it takes more than just an imaging study to make a diagnosis; a GI specialist will also take into account symptoms and labs as well. In addition, your gasteroenterolist can supplement/support your recommendations for proper pain management from the perspective of protecting the liver while giving you the pain relief you need.

Here's a comprehensive article from emedicine link for Fatty Liver disease; they are a very reputable website for medical information.

Don't just let your doctor idly cut back on your breakthrough meds; he needs to replace them with something that doesn't have acetaminophen and oxycodone immediate release is your best option (oral morphine is not well absorbed, there are no hydrocodone options and hydromorphone (dilaudid) is going too high if you haven't already been on the immediate release oxycodone for a period of time).

Call tomorrow and demand an appointment, then come in armed with your list of options and be adament that cutting down on the Norco/Vicoden is NOT a solution.

I wish you all the best.

Hi Laura ~ I think it's ridiculous that he cuts BACK your dosage ~ that kind of thinking is juvenile! What's the matter with this doctor? Can't he think of anything else to give you? You SHOULD be taking an opiate! You need a long acting type med so you aren't in pain all the time, and also a short acting med in between doses! This guy must be opiate-shy. The DEA has him scared to death or something.

You deserve PROPER pain control. If he won't give it to you, ask for a referral to a pain management doc. Of course, there are many of those now who aren't even prescribing meds at all. Weird, huh? Best of luck, but you've got to convince him to give you better meds. God bless. Hugs, Lee

My first observation on your doctor's reaction is simple. He's now freaked out. So his best recourse is to be conservative from now on.

My question though is, why not just get blood work done once a month as you would with any other medication that may have an effect on your liver? Can you do a cleanse? Can you drink green tea for natural anti-oxidants? There's only so much diet can do I understand, but try combating the issue from different angles. Don't stop moving! Use breathing techniques to get through your new situation. Any and every form of positive reinforcement must be applied, including advocating for yourself and reminding your doctor that this is YOUR life and he's just made things worse. But that's just my personality and opinion. You must do what's best for you.

Best wishes for relief.
pRu

I do have problems w/ my liver enzymes and also my kidneys. I do know that from doing research alot of meds can cause this problem. And even anti depression meds can also. Before I got sick I use to transport people to n from dialysis and cancer treatments etc and I had one lady on Dialysis and I asked her, do you mind telling me what happen w/ your kidneys shutting down and she said from taking anit depression. So I think all meds know matter what it is, we all need to make sure out doc's keep up on our blood work for the liver n kidneys. hope this helps

Hi Laura,

You have received some decent replies. However, 4000 mg per day is NOT okay for people on Tylenol long-term. That is an old guideline for once-in-a-while users of Tylenol. Even at 1000 mg per day, Tylenol causes problems for diabetics. It is also a highly personal and individual thing, based on your genetics, metabolism, weight, height, sex, etc...

I would prefer not to take any Tylenol, since it does nothing for me. It is in my Norco however, so I take about 1400 mg per day.

I agree with the comments that you should get short-acting meds without Tylenol as a precaution. They are out there so use them! I agree that your doc is kind of punishing you for speaking up. Drug abusers prefer non-Tylenol meds so that they can inject them. It is just crazy that all these docs think we are all drug abusers. Geez!

I agree that you should go back and say that you are in pain on a smaller opioid dose and want to try Tylenol-free opioids.

Hi Laura, have they actually done any blood tests? If not well they should ! Good Luck !

Many medications can affect liver enzymes. Some people's livers (hello) get overwhelmed more easily than other people's do. Probably the most common cause is Gilbert's Syndrome - that shows up as elevated bilirubin and, if extreme, jaundice. Milk thistle might help the liver process meds better.

Laura,

great advice from ihavepkd, and also like others have said milk thistle.

best of luck hun,

Ok My liver enzymes are back to normal. Unfortunately the pain is bad again. I convinced my Dr to go up on the meds but I have had to add tylenol but I am trying to limit it as much as possible.Its amazing to me how depressed & moody I get when the pain reaches a certain level & wont stop. My back has been acting up in addition to my knee now.I have tried the milk thistle but it irritated my stomach. Its very sensitive anyhow. I am holding off on the Mobic for now. Thanks for all your help! Hugs, Laura