Thank you for your response. We were never given a MELD score (I assumed because he was not a transplant candidate due to his age) and have not been given current lab results (we are having a hard time getting his liver doctor to even call back when we ask for results). We are also unsure of the cause of his cirrhosis. He was a heavy drinker and had hep B, but has not had issues with drinking or the hepatitis in 40 years. He also has schogrens and there is a history of autoimmune diseases in the family (two of his children with Lupus and another with Schogrens). He was diagnosed with fatty liver about 10 years ago in which he stopped drinking all together (but only drank very occasionally before that once recovering from alcoholism years before). We were also never told his liver cancer staging except that it was one lesion that was 2.5cm at the time if chemoembolization and no other lesions. His Dr. at the time said he was a perfect candidate for the embolization because his bloodwork was in good shape and also mentioned that his cirrhosis "wasn't severe". His oncologist was quite pleased with the results in December and showed us his MRI where there was a black hole where the tumor had been. He lives in a small city and travels to Dallas to see his oncologist (about 5 hours away) but he is currently too weak to make the trip to his six month check up scheduled for May 20. We have been told all of his bloodwork is still stable (latest bloodwork was three weeks ago and six weeks before that) except for lower sodium that was still within the normal range. He is still on the lowest dose of spirnalactone as well as 10 of lasix every other day (we try to hold off on it because his HE seems to flare up when he takes a full 20mg pill and his edema is minimal and seems controlled by this dose of half pill every other day) and 4 doses of lactulose now xifaxan as well. The only other meds he takes are megace (he had no appetite after the pneumonia and lost a lot of weight) vitamins and blood pressure medicine he has been on for 40 years. Thank you for any insight your can give.

I do have a couple more questions if you don't mind. After being stable for more than a year, in the last month, his encephalopathy has gone from completely managed with 2-3 doses of lactulose to unmanageable with 4-5 doses plus xifaxan. We are very much on top of his diets and meds. I initially saw the change when he started lasix but he has cut back on those significantly (one full dose per day to one half dose every other day). Then he was put on xifaxan and did great for about 7 days. He then began to have constipation followed by diarrhea every day (it now takes 3 doses of lactulose over 6 or 7 hours to produce a bowel movement which is then liquid). All of this plus the extreme loss in strength (from independent with a cane to barely managing with a walker... He even seems to tire speaking) has seemed like a very rapid decline when he was essentially stable after recovering from the pneumonia. He hasn't lost weight since beginning the megace (although he still eats very few calories) and his blood results are stable as well (checked his hemoglobin and it was on the low side of normal). We would be greatful for any insights and suggestions you might have. Here are my specific questions:
When a person has this seemingly unmanageable encephalopathy is there a way to stabilize it again or is this what we can expect from now on? What specifically could cause such a rapid decline (from no noticeable symptoms (or at worst mild fogginess) for over a year to major episodes weekly (with disruption in sleep patterns, confusion, agitation, change in personality, weakness)? Can these episodes have a cumulative or permanent impact? Could the episodes of constipation and diarrhea be causing some symptoms and if so what could be causing it and how do we fix it?
Thank you again for your insight