My dad had Bulbar Palsy. If there is any info I can help you with let me know. Kind of been there did that. And it all sucks...As hard as it is to believe, this ALS was the kindest one to have. My dad first slurred, we thought he had a stroke at first. This strand of ALS(believe it or not, blessing in disquise) seems to work opposite of other ALS strands. It started at the top and worked it's way down My dad still drove til the day he went to "The Party in the Sky"He also had a feeding tube towards the end. This made eating alot faster and easier on him. Don't wait to long for him to get the PEG, he can always get it and not use it til he needs to. The surgery took about 20 minutes, they have to do it quick to be able to get the breathing tube out, or your dad will be stuck with it. It helps keep weight on. ONE THING TO KEEP IN MIND, THE INSURANCE COMPANY WILL NOT COVER THE SURGERY IF HE CAN STILL EAT.Talk about cruel.