Rock...
I'm sorry for your dad's diagnosis. People progress at very different rates from one another. The fact that your father's previous EMG's were clean is a good indication that much of what is going on with him right now is upper motor neuron, rather than lower. This is a positive thing.
By him not being able to hold air in his mouth, I'd think he has some weakness in his lips. I have lip weakness, but so far it has only impacted me by making drinking without dribbling down the front of me even more of a challenge than it was before. I also can no longer whistle, which isn't a great loss.
If he decides to leave work, he may feel better. I know that people in general, and men in specific do equate a lot of their own self image with what they do for an occupation. If he still feels like working, then he should if he wants until his speech gets to be more of a hindrance. From a personal stance, I did leave work, and I feel much healthier since, although it is still difficult for me to accept that I won't be going back. When people ask me what I do for a living, I don't know if I should say I "am" or "was" a flight attendant.
The laughing episodes you referred to is a condition called emotional lability, and it also is an upper motor neuron affect. Socially it may be awkward in some situations. There is a new drug in trial right now to help control this, and several members on the forum are participating in it. BethU and Brendapals are two. I was invited to begin it as well, but have not started yet, mainly because of the extra clinic visits needed if one participates, and I live several hours from there.
There are members on the forum that have been living with bulbar ALS for quite a while. Patricia1 was diagnosed 10 years ago.
A decision about relocating is a personal one. I do know that I wish I'd lived closer to my dad and spent more time with him before he passed away (not from anything remotely related to ALS). Four hours, although its a drive, isn't like a ten hour drive though, it can be done in a day without too much misery. So, maybe give it some time, see what they find with your dad's next appointment, and let the newness of the situation have a chance to sink in.
This particular forum, the PBP one, isn't as active as some of the others. You will benefit from reading on the other forums I think.
Good luck to you and your family. :smile: