Doctor: So let's start from the beginning.
Patient: Okay.
Doctor: You're seventy nine years old, correct?
Patient: Yes.
Doctor: Right or left handed?
Patient: Right.
Doctor: Do you remember when you had your first fall? 
Patient: Hm about a year and a half ago I fell while trying to walk from my bed to the living room.
Doctor: Did you feel lightheaded prior? 
Patient: Uh yeah I did have some lightheadedness and I was a bit confused. I was aware of my surroundings though. My legs just gave out and the next thing I knew I was on the floor.
Doctor: I see. Did you lose consciousness? 
Patient: No, thank goodness.
Guest_family: He got up by himself and felt fine afterwards. The strangest thing.
Patient: Yeah. I was good until my legs gave out on me July third of O eight. 
Doctor: Did you experience the same lightheadedness as before?
Patient: Not this time.
Guest_family: We had to rush him to the hospital after that.
Patient: I was later diagnosed with pneumonia. The fall was blamed on the pneumonia.
Doctor: Got it.
Patient: To be on the safe side, I started using a walker from then on.
Doctor: Did you need any type of walking assistance prior to your falls?
Patient: Nope. I used to walk about two miles a day before all of this stuff started happening to me. This isn't even the end of it. My legs gave out on me again August O eight. No lightheadedness beforehand, but they did find that I had pneumonia again. 
Guest_family: They admitted him to the hospital and later sent him for rehab.
Doctor: Did rehab help?
Patient: Yeah. I was able to use my walker after that.
Doctor: Did you return to your previous health?
Patient: Uh not really, no. I had another fall in October O eight.
Doctor: Did they diagnose you with pneumonia again?
Patient: Yeah. I also had shingles.
Doctor: Are you currently living at home?
Patient: I'm living in a Chronic Rehab Unit. I can't use my walker anymore. I'm confined to a wheelchair. 
Doctor: I'm sorry to hear that. 
Patient: On top of that, I've noticed that my hands have been numb for the past three weeks.
Doctor: Is it all of your fingers or only some?
Patient: All.
Doctor: Are you noticing any other symptoms along with the numbness in your fingers?
Patient: Yes. I feel like I've lost quite a bit of muscle in my hands. They're also much weaker than before. My strength hasn't been the same since July O eight. It's definitely getting worse.
Doctor: I see.
Patient: I've had muscle twitching in my legs since August O eight.
Doctor: Fasciculations?
Patient: Yes. In my lower legs and thighs.
Doctor: Any cramping or problems swallowing?
Patient: No.
Doctor: Any difficulty breathing?
Patient: No. 
Doctor: Any constipation or diarrhea?
Patient: Both actually. It tends to alternate.
Doctor: But no loss of bowel or bladder control?
Patient: No. I've noticed that my blood pressure has been out of whack. I also feel like I'm about to faint anytime I stand. 
Doctor: Okay.
Patient: I don't think I have much feeling in my feet. They feel like sponges.
Doctor: How long has that been going on?
Patient: Uh nine months or so. I lost joint position sense in my feet around that time, too.

Clinical note:
Symptoms: Falls, lightheadedness prior to falls, confusion, numbness in fingers, muscle weakness in hands, muscle twitching (fasciculations) in legs, constipation alternating with diarrhea, blood pressure drops upon standing, loss of feeling in feet, loss of joint position sense in feet.
Diagnosis: N/A
History of Patient: The patient is a 79-year-old right-handed man who has experienced multiple falls over the past few years, with associated lightheadedness and confusion. He has a history of pneumonia and shingles. He currently resides in a Chronic Rehabilitation Unit and relies on a wheelchair due to inability to use a walker. He experiences numbness and muscle weakness in his hands, muscle twitching in his legs, constipation alternating with diarrhea, blood pressure drops upon standing, loss of feeling in feet, and loss of joint position sense in feet.
Plan of Action: N/A