@gaylea1 The biggest telltale signs for me were my stomach really hurt -- it wasn't nausea, it was pain -- and I felt tired. When I felt like this I got myself home immediately, I never went far from home alone, just in case. Oftentimes my stomach would hurt and then I would be fine so I got to figuring that sometimes a stomachache is just a stomachache but in retrospect I wonder if I may have been on the brink of an HE episode that did not materialize into a full-blown one, since I generally do not get stomaches for no reason. Of course when I had cirrhosis I had a lot of ailments "for no reason".
I have come to realize though that we all differ a lot. Some people are in a constant fog, I was not. My episodes were isolated, would come on, go, and I would be fine again. That was a huge plus for me. No one ever said I had to stop driving because I was very cognizant most of the time and could predict an episode fairly accurately.
It's always best to be safe, and if you are out and even think remotely that you may be on the brink, get home.
It's a scary way to live, never knowing when you get up in the morning if one might occur that day. It's so wonderful to have that behind me. I know I have said this before, but when I think back on those episodes I actually do get tears in my eyes. After the hepatologist put me on xifaxan I went almost a year with no episodes, that was wonderful. When I did have one again, there were three factors that I had seen listed as possible causes: recent surgery - I had just had a very difficult ablation; infection - I had a case of norovirus, and not taking your meds - I was so sick when I had the norovirus that I am sure I was not holding my medications down. My son referred to that episode as being from "the perfect storm", and my husband and I agreed but to be cautious the NP at the hepatologist made me resume taking lactulose thinking that maybe it was because my condition had worsened, and that could have been the cause too.
JK