Interesting topic. I recently saw my PALS friend, and within the short time span ,I tried to visually assess the situation, and gently touch to determine the 'worm like' movement Al and some others have experienced. No snakes under the skin I could determine, but I was purposely looking at his hands for any signs of disability. What struck me was they looked puffy. The fingers did, but more so the top of the hand. I would have never equated that with ALS, not sure I can, beginning to think he doesn't have ALS at all. But that is another story. By the way, his hands were at rest when I saw him, but they had not been prior to...so, could the swelling for those who have ALS and are experiencing it, be a result of this heat, drinking more fluids, or a by product of any medication they are taking?