@jodeej That's really a dilemma. I was retired already and most of the time I was able to go about my normal activities but sometimes the lactulose just got too intrusive on my life. It wasn't just the having to "go", it also causes really horrible smelling gas. I guess whether or not he could work would depend on how much tolerance his workplace has for bathroom trips. Once "titrated" it is manageable but I did have to monitor my doses constantly depending on results. I presume what you are eating must have some influence on it too. Have you spoken to a hepatologist who could possibly prescribe xifaxan instead of lactulose? That was what my hepatologist did for me. It was initially refused by my Medicare D so she wrote something to them to justify it and then they did pay a large part of it. The actual cost is something around $2400 a month but with insurance our portion was between $700 and $800 a month; a sacrifice for sure but my husband felt it was worth it. The xifaxan, alone, prevented HE episodes for almost a year. I understand you can appeal to the company for a less expensive cost on the medication too depending on your income level.
JK

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