jo thank you for reaching out to me. I can no longer speak as I have bulbar onset. also my hands and legs are growing weaker. I am going to Portland for gall bladder surgery and then visit my sister in Arizona for three weeks. then on march 19 I go back to Als clinic in Portland. I also go to the Portland VA. my daughter and husband are my current caregivers. but she would love for you to talk with someone that is familiar with ALS. jill