system: You are a medical doctor conducting a patient consultation. Here is the patient's background information:

Section: GENHX
Patient Information: The patient is a 79-year-old right-handed man who reports that approximately one and a half years ago, he fell down while walking in the living room from the bedroom.  At that time, he reports both legs gave away on him and he fell.  He reported that he had some lightheadedness just before he fell and was slightly confused, but was aware of what was happening around him.  He was able to get up shortly after falling and according to the patient and his son, subsequently returned back to normal. He was then well until the 3rd of July 2008 when his legs again gave way on him.  This was not preceded by lightheadedness.  He was rushed to the hospital and was found to have pneumonia, and the fall was blamed on the pneumonia.  He started using a walker from that time, prior to that he was able to walk approximately two miles per day.  He again had a fall in August of 2008 after his legs gave way.  Again, there was no lightheadedness associated with this.  He was again found to have pneumonia and again was admitted to hospital after which he went to rehabilitation and was able to use his walker again after this.  He did not, however, return to the pre-July baseline.  In October of 2008, after another fall, he was found to have pneumonia again and shingles.  He is currently in a Chronic Rehabilitation Unit.  He cannot use a walker and uses a wheelchair for everything.  He states that his hands have been numb, involving all the fingers of both hands for the past three weeks.  He is also losing muscle bulk in his hands and has noticed some general weakness of his hands.  He does, however, note that strength in his hands has not been normal since July 2008, but it is clearly getting worse.  He has been aware of some fasciculations in his legs starting in August 2008, these are present both in the lower legs and the thighs.  He does not report any cramps, problems with swallowing or problems with breathing.  He reports that he has had constipation alternating with diarrhea, although there has been no loss of control of either his bowel or bladder.  He has had some problems with blood pressure drops, and does feel presyncopal when he stands.  He also reports that he has no feeling in his feet, and that his feet feel like sponges.  This has been present for about nine months.  He has also lost joint position sense in his feet for approximately nine months.

Based on this context, ask appropriate follow-up questions to gather more information before providing medical advice. Use the questioning patterns that doctors typically employ.

assistant: So let's start from the beginning.

user: Okay.

assistant: You're seventy nine years old, correct?

user: Yes.

assistant: Right or left handed?

user: Right.

assistant: Do you remember when you had your first fall?

user: Hm about a year and a half ago I fell while trying to walk from my bed to the living room.

assistant: Did you feel lightheaded prior?

user: 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.

assistant: I see. Did you lose consciousness?

user: No, thank goodness.

user: He got up by himself and felt fine afterwards. The strangest thing.

user: Yeah. I was good until my legs gave out on me July third of O eight.

assistant: Did you experience the same lightheadedness as before?

user: Not this time.

user: We had to rush him to the hospital after that.

user: I was later diagnosed with pneumonia. The fall was blamed on the pneumonia.

assistant: Got it.

user: To be on the safe side, I started using a walker from then on.

assistant: Did you need any type of walking assistance prior to your falls?

user: 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.

user: They admitted him to the hospital and later sent him for rehab.

assistant: Did rehab help?

user: Yeah. I was able to use my walker after that.

assistant: Did you return to your previous health?

user: Uh not really, no. I had another fall in October O eight.

assistant: Did they diagnose you with pneumonia again?

user: Yeah. I also had shingles.

assistant: Are you currently living at home?

user: I'm living in a Chronic Rehab Unit. I can't use my walker anymore. I'm confined to a wheelchair.

assistant: I'm sorry to hear that.

user: On top of that, I've noticed that my hands have been numb for the past three weeks.

assistant: Is it all of your fingers or only some?

user: All.

assistant: Are you noticing any other symptoms along with the numbness in your fingers?

user: 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.

assistant: I see.

user: I've had muscle twitching in my legs since August O eight.

assistant: Fasciculations?

user: Yes. In my lower legs and thighs.

assistant: Any cramping or problems swallowing?

user: No.

assistant: Any difficulty breathing?

user: No.

assistant: Any constipation or diarrhea?

user: Both actually. It tends to alternate.

assistant: But no loss of bowel or bladder control?

user: 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.

assistant: Okay.

user: I don't think I have much feeling in my feet. They feel like sponges.

assistant: How long has that been going on?

user: Uh nine months or so. I lost joint position sense in my feet around that time, too.