Since my last post my husband has finally agreed to home health services - just last week. The first visit went good-he was happy with the nurse and has agreed to two weekly visits to check in on him. Home health also set up a speech therapist to help him learn to swallow better. He is having just awful acid reflux which, with Bulbar ALS, is very frightening. He cannot cough up anything in his throat - it gets stuck - and he cannot swallow. Anyway, the speech therapist came and told him there was nothing she could do for him but was going to recommend to his physician that a tube be place in his throat so he could get rid of the reflux and excess salva. I am a bit confussed - I wasn't there but ---is this a traceostomy she is talking about?