Hi Martha my husband has bulbar on set and has it for 2 years he finds paper and pen quicker for communication he has predictable on an iPad but finds it too slow. We were advised not to use straws as the risk off choking is high so he keeps away from that, he has a peg recently fitted which he only flushes through each day but is ready there if needed he still manages food as his swallow is still ok. As for drinking he could not drink fluids without thickened which he uses with tea, coffee etc. We have a high powered blender which he makes fruit thick shakes with drinking yoghurt (the more fruit the thicker the drink) so these he can still mange without thickener it's a bit of trial and error. There are build up powders that are out there too which add more calories to the shakes so you could give them a try too, hope it goes well,