Becky, I also had HE, misdiagnosed for one year, before I reached out to the MAYO in Phoenix. My Ammonia Level was in the high 200's.I also took 2 Xifaxan tablets daily plus lactulose. It worked for almost one year, as I was working with the MAYO to get on the transplant list. At the end of the process it became serious, as I needed a 300 mile emergency transfer and as I was in the Mayo system, they insisted that I would be transferred to them. I was very fortunate in that after 9 months of testing, I was placed on the list and received my transplants (liver and kidney) in less than 24 hours. I did have to stay very near for 2 months. Take HE very seriously (as I got into a position where I was in a coma like state) and start the process for a transplant approval. Look at hospitals that have the best success rates, better waiting periods, etc.. The first few months were rough (mainly because of my kidney), however now after 8 months, I feel better than I have in years. I know it's scary, however speak with your transplant coordinators,Doctors, Social Workers. etc., You will need a Team and they all will be there to explain in detail, support you and do whatever helps you. Follow their instructions – Exactly – and know there are many others that have been down the same road.