I have bulbar onset ALS and my first symptom was dysphagia, followed by speech problems. I needed a PEG tube early in my course and now use it for all of my nutrition, eating and drinking minimal amounts. Having the tube placed is done under anesthesia, but doesn’t involve any incisions. I wanted to swim during the summer and put off having the tube placed until my pool closed for the year. Once it has been in for a couple of months it can be changed to a Mic-Key tube and then swimming is allowed and it has a low profile which isn’t seen through your clothes.
For me it has been a blessing since I was choking so often, I am sure I would have had pneumonia by now without it.