Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: no known allergies / adverse drug reactions attending: chief complaint: neck pain major surgical or invasive procedure: 1. open treatment of pathologic fracture dislocation c7, t1, t2, t3. 2. posterior arthrodesis c4-t6. 3. posterior instrumentation t4-t6. 4. application of allograft. 5. left iliac crest bone graft, morselized. history of present illness: this is a patient with a history of metastatic breast cancer to her cervicothoracic junction. she was seen at an outside institution by a spine specialist who did not recommend any further intervention. she has muscle spasms and scapular pain. she is in a cervicothoracic brace since or since early . her past medical history is diagnosis of breast cancer in with lumpectomy, chemo and radiation, not brca 1 or 2. she was diagnosed with spinal metastases in and had radiation. her other medical problems are hypertension and high cholesterol. no other significant medical issues. her medications included lisinopril, folic acid, crestor, calcium, multivitamin, arimidex, exgeva, ativan, and tegretol. she has no known drug allergies. she has a husband and two children. she does not smoke. she is currently not working. review of systems is negative. however, she is 5 feet 4 inches, 147 pounds with systolic blood pressure 172/105, pulse 89. no chest pain, headaches, nausea, or vomiting. notes were reviewed from mccm from from . it is noted that she was using duragesic patches at that time. she remains neurologically intact. she was on femara at that point. a pet scan done on shows extensive metastases, no visceral metastases. she was on hormonal therapy as well as exgeva. studies were reviewed. pet scan done from done at medical center, department of radiology shows markedly improved appearance since the last exam _____ vast majority of previously recent osseous lesions no longer demonstrating hypermetabolism with residual uptake destructive lesions in t1-t2. the images were reviewed. unfortunately, the cervicothoracic junction is a cutoff point for the thoracic and no other cervical study, no good overlap study is noted. on physical examination, she appears to be tolerating her brace well. she is neurologically intact in upper and lower extremities. no spasticity. no atrophy. distal pulses intact. fine hand motor function is intact. gait is within normal limits. in brief, this is a patient with multiple osseous metastases from breast cancer status post radiation to her spine as well as hormonal therapy. i recommended a new ct of her cervicothoracic junction and follow up with me. the goal of the reconstruction would be to free her from her brace. i do think her life expectancy is significant enough to consider surgical stabilization given the remaining option, which would be to leave her in a brace indefinitely. past medical history: see hpi social history: see hpi family history: see hpi physical exam: see hpi pertinent results: 09:02pm glucose-170* urea n-13 creat-0.5 sodium-130* potassium-3.7 chloride-97 total co2-22 anion gap-15 09:02pm calcium-8.0* phosphate-3.3 magnesium-1.3* 09:02pm wbc-7.0 rbc-3.07* hgb-10.3* hct-28.9* mcv-94 mch-33.5* mchc-35.5* rdw-12.5 01:25pm wbc-5.3 rbc-3.71* hgb-12.5 hct-34.7* mcv-94 mch-33.7* mchc-35.9* rdw-12.5 01:25pm plt count-192 brief hospital course: patient was admitted to the spine surgery service and taken to the operating room for the above procedure. refer to the dictated operative note for further details. the surgery was without complication and the patient was transferred to the icu in a stable condition. after a 24 hours observation in icu the patient was transferred to the floor. teds/pnemoboots were used for postoperative dvt prophylaxis. intravenous antibiotics were continued for 24hrs postop per standard protocol. initial postop pain was controlled with a pca. diet was advanced as tolerated. the patient was transitioned to oral pain medication when tolerating po diet. foley was removed on pod#2. physical therapy was consulted for mobilization oob to ambulate. she had significant episodes of orthostatic hypotension on pt. medical consult was sought, who suggested restriction of free fluid intake due a suspicion on siadh. over a period of one week this improved and patient is able to move the chair without symptoms of dizziness of hypotension. hospital course was otherwise unremarkable. on the day of discharge the patient was afebrile with stable vital signs, comfortable on oral pain control and tolerating a regular diet. medications on admission: lisinopril, folic acid, crestor, calcium, multivitamin, arimidex, exgeva, ativan, and tegretol. discharge medications: 1. carbamazepine 100 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). 2. rosuvastatin 5 mg tablet sig: two (2) tablet po daily (daily). 3. anastrozole 1 mg tablet sig: one (1) tablet po daily at 5 pm (). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*180 tablet(s)* refills:*0* 11. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain. 12. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* discharge disposition: extended care facility: - , me discharge diagnosis: 1. metastatic breast cancer. 2. pathologic fracture with instability and dislocation at c7, t1, t2, t3. 3. status post radiation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: immediately after the operation: - activity:you should not lift anything greater than 10 lbs for 2 weeks. you will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. - rehabilitation/ physical therapy: o 2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. you can walk as much as you can tolerate. - swallowing: difficulty swallowing is not uncommon after this type of surgery. this should resolve over time. please take small bites and eat slowly. removing the collar while eating can be helpful ?????? however, please limit your movement of your neck if you remove your collar while eating. - cervical collar / neck brace: you need to wear the brace at all times until your follow-up appointment which should be in 2 weeks. you may remove the collar to take a shower. limit your motion of your neck while the collar is off. place the collar back on your neck immediately after the shower. - wound care:remove the dressing in 2 days. if the incision is draining cover it with a new sterile dressing. if it is dry then you can leave the incision open to the air. once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. do not soak the incision in a bath or pool. if the incision starts draining at anytime after surgery, do not get the incision wet. call the office at that time. if you have an incision on your hip please follow the same instructions in terms of wound care. - you should resume taking your normal home medications. - you have also been given additional medications to control your pain. please allow 72 hours for refill of narcotic prescriptions, so plan ahead. you can either have them mailed to your home or pick them up at the clinic located on 2. we are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. in addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - follow up: o please call the office and make an appointment for 2 weeks after the day of your discharge if this has not been done already. o at the 2-week visit we will check your incision, take baseline x rays and answer any questions. please call the office if you have a fever>101.5 degrees fahrenheit, drainage from your wound, or have any questions. physical therapy: see discharge instructions treatments frequency: see discharge instructions followup instructions: provider: , md phone: procedure: dorsal and dorsolumbar fusion of the anterior column, anterior technique other excision of joint, other specified sites other cervical fusion of the anterior column, anterior technique excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique repair of vertebral fracture other cervical fusion of the posterior column, posterior technique insertion of interbody spinal fusion device fusion or refusion of 9 or more vertebrae fusion or refusion of 4-8 vertebrae diagnoses: pure hypercholesterolemia unspecified essential hypertension personal history of malignant neoplasm of breast other disorders of neurohypophysis secondary malignant neoplasm of bone and bone marrow hip joint replacement neoplasm related pain (acute) (chronic) orthostatic hypotension pathologic fracture of vertebrae trigeminal neuralgia 

Answer: The patient is high likely exposed to