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: percocet / labetalol / felodipine attending: chief complaint: refractory right hip pain major surgical or invasive procedure: intramedullary nail stabilization of right femur history of present illness: this is a 54 year old male with pancreatic cancer diagnosed in s/p total pancreatectomy, ccy, splenectomy; solitary recurrence in liver in s/p rfa/hemihepatectomy; second liver recurrence in s/p rfa; t5 metastasis induced cord compression in s/p partial vertebrectomy and xrt; refractory to treatment with cycles gemcitabine, erlotinib, and capecitabine; presenting now with severe refractory right hip pain related to a right femur met. he was scheduled to have an outpatient right femur stabilization procedure to help his pain on but the pain became too much to bear at home and he required admission for pain control. at home he takes oxycontin 140mg tid and dilaudid 8mg q3 prn pain which has not been enough to maintain his comfort. he says the pain starts in his upper right leg/hip and radiates to his coccyx. he has no other complaints and is clearly uncomfortable precluding a thorough history. he had a recent admission for similar hip pain from during which time his pain meds were titrated up. he remains weak, but denies any bowel/bladder incontinence or saddle anesthesia. he denies fever, rash, uri symptoms, cough, new abdominal pain, or vomiting/diarrhea. . in the ed his initial vitals were 99.1, 93, 153/80, 16, 100% ra. he was clearly uncomfortable and given iv dilaudid with minimal effect on his pain. leukocytosis to 20 was noted on laboratory studies, with a negative infectious review of systems. it was felt that this represented stress demargination from severe pain. blood cultures were drawn and a chest x-ray obtained. he was transferred without any further intervention to the floor for further pain management. past medical history: past oncologic history: incidental finding of dilated pancreatic duct in after undergoing routine ct imaging for work-up of myeloproliferative disorder. he underwent pancreatectomy, cholecystectomy and splenectomy on by dr. . pathology demonstrated an intraductal carcinoma with an invasive component measuring 8mm, t1n0mx, without lymphovascular invasion or positive surgical margins. % lymph nodes were removed and did not involve carcinoma. -in , he developed recurrent disease in segment vi of the liver, which was treated with radiofrequency ablation. in , he underwent right hepatectomy pathology demonstrated almost completely necrotic 2.8 cm focus of metastatic adenocarcinoma. -in , he developed recurrence disease at the resection site within the right lobe of the liver and underwent radiofrequency ablation again. -in , he developed upper back pain and was found to have large destructive metastatic disease at t5 causing compression of the spinal cord. biopsy confirmed metastatic adenocarcinoma of pancreatic origin. -in , he underwent t5 vertebrectomy and posterior lateral arthrodesis t2 through t8 with local autograft and completed radiation therapy in involving the t3 through t7 area. -in , port was placed and he was started capecitabine and oxaliplatin on clinical protocol which was complicated by development of severe enteritis and colitis. -in , he started gemcitabine and erlotinib and completed a total of eight cycles until new disease was demonstrated in the twelfth rib with increased fdg avidity of widespread osseous metastatic disease. monthly zometa infusion was added to his regimen on . the patient continued to have evidence of worsening metastatic disease involving the bones. -he underwent radiation therapy of the right clavicle, right iliac bone and left hip, which was completed on . the patient has not received further zometa in the setting of renal insufficiency. . other past medical history: -metastatic pancreatic cancer -coronary artery disease -- stent implanted for "blocked secondary artery" -htn -- baseline bps 130s/80s -hypercholesterolemia -diabetes mellitus total pancreatectomy -polycythemia -- pseudohyperkalemia caused by myeloproliferative syndrome with thrombocythemia -kidney stones -gerd -liver abscess, enterococcal bacteremia in -small secundum asd on echo. discharge summary past medical history signed , d wed 2:22 pm past medical history: ==================== metastatic pancreatic cancer (see below) coronary artery disease -- stent implanted for "blocked secondary artery" htn -- baseline bps 130's/80) hypercholesterolemia diabetes mellitus total pancreatectomy polycythemia -- pseudohyperkalemia caused by myeloproliferative syndrome with thrombocythemia kidney stones gerd liver abscess, enterococcal bacteremia in small secundum asd on echo. . past surgical history: elbow surgery on nerve basal cell ca (r cheek) surgery total pancreatectomy vental hernia surgery right hemihepatectomy vats t5 vertebrectomy social history: lives w/ wife and two sons. as a contractor. no etoh since pancreatectomy. smoked 2 packs per day, quit many years ago. no history of iv drug use or other illicits. family history: -father died of metastatic carcinoma to the liver, age 59. -paternal grandfather thought to have stomach cancer. -mother had a gi tumor removed early in her life, but lived for many years afterwards. physical exam: admission: constitutional: uncomfortable male lying in bed heent: normocephalic, atraumatic, pupils equal, round and reactive to light, oropharynx within normal limits, supple neck chest: clear to auscultation, left chest port cardiovascular: rrr abdominal: soft, nontender gu/flank: no costovertebral angle tenderness extr/back: 2+ radial/dp pulses, no cyanosis, clubbing or edema skin: warm and dry neuro: speech fluent, alert and oriented x3, normal sensation . discharge: constitutional: comfortable appearing male lying in bed in nad heent: normocephalic, atraumatic, eomi, small but reactive pupils, oropharynx clear, supple neck chest: clear to auscultation, left chest port cardiovascular: rrr abdominal: soft, nontender, mild bowel distention, hypoactive bowel sounds gu/flank: no costovertebral angle tenderness extr/back: 2+ radial/dp pulses, no cyanosis or clubbing, trace-1+ pedal edema skin: warm and diaphoretic neuro: speech fluent, alert and oriented x3, noted to have difficulty with dorsiflexion of right foot and left foot drop, otherwise motor strength and sensory equal and intact bilaterally pertinent results: 01:52pm glucose-192* urea n-27* creat-1.2 sodium-134 potassium-4.6 chloride-97 total co2-29 anion gap-13 01:52pm wbc-20.1* rbc-3.76* hgb-9.5* hct-29.1* mcv-78* mch-25.3* mchc-32.7 rdw-19.3* 01:52pm neuts-85* bands-1 lymphs-2* monos-12* eos-0 basos-0 atyps-0 metas-0 myelos-0 04:46am lactate-1.0 . femur ap/lat: four views of the right femur: again seen are numerous lytic lesions, with slightly dense internal components seen in the right inferior pubic ramus and ischium, the intertrochanteric region of the right femur, and the right iliac . these do not appear significantly changed since the prior study. there is no evidence of pathologic fracture. the distal femur demonstrates no definite metastatic lesion. impression: multiple metastatic lesions, without evidence of pathologic fracture. . cxr: impression: no evidence of focal lung opacities. . ct head: impression: no acute intracranial process. if there is clinical concern for ischemia or infarction, an mri may be obtained for further evaluation. brief hospital course: this is a 54 year old male with pancreatic cancer diagnosed in s/p total pancreatectomy, ccy, splenectomy; solitary recurrence in liver in s/p rfa/hemihepatectomy; second liver recurrence in s/p rfa; t5 metastasis induced cord compression in s/p partial vertebrectomy and xrt; refractory to treatment with cycles gemcitabine, erlotinib, and capecitabine; presenting now with severe refractory right hip pain related to a right femur met. . #. right hip/back pain. the patient has a known right femur met that is the likely cause of his pain. he was scheduled to have an orthopedic procedure as an outpatient on to help stabilize the femur with the goal of helping to improve his pain; however, his pain became too much to bear at home on his oral pain regimen and he required admission for iv pain control. he was recently admitted from for pain control related to this same pain in his right leg/back which required dilaudid pca. this admission, his dilaudid pca was titrated up to 0.5mg q6 minutes, but mental status changes were noted and he was titrated back to 0.37mg q6 minutes. the ortho/oncology service was consulted and recommended right femur plain films which ruled out pathologic fracture. he was taken to the or on for intramedullary nail to stabilize his femur with a goal of improving pain and preventing pathologic fracture. his post-op course was complicated by delirium in the pacu secondary to poor pain control which required a brief icu stay. he was started on a dilaudid drip in the icu and his delirium quickly resolved. he was then transitioned from a dilaudid drip back to dilaudid pca at 0.37mg q6min and then to 4-8mg of po dilaudid q3 hours prn. lovenox 40 mg sc qd was started for dvt ppx starting which was one day post-op. he was continued on his home oxycontin 140mg tid and baclofen 5-10mg prn spasms. his home anagrelide for essential thrombocytosis was held during his hospitalization for pre- and post-op prevention of bleeding, but the surgery service recommended restarting it on day of discharge. he will need to remain on anagerlide given his high risk for clot with essential thrombocytosis. pt was also on lovenox for dvt ppx, which needs to be continued for 1 month post-op. pt's pain regimen was ultimately titrated up to oxycontin 180mg tid plus dilaudid 12-20mg q4h prn which gave adequate control, ensuring that the pt does not require any iv dilaudid. pt was also given bowel regimen. . #. htn. the patient's verpamil was uptitrated to 240mg daily during his last admission. his blood pressure remained elevated up to 190s systolic likely secondary to acute pain. he was continued on verapamil 240mg daily and hydralazine 25mg was administered q6 prn for bp>180 as the patient had an allergy documented to labetalol. pt was also started on lisinopril 10mg daily for better bp control. . #. leukocytosis. likely due to stress reaction from acute pain as patient has no signs of underlying infection. he also has essential thrombocytosis which is associated with increased wbc counts in situations of inflammatory stress. blood and urine cultures remained negative and several cxrs showed no evidence of pneumonia. no antibiotics were initiated. . #. diabetes. continued home iss and glargine. . #. hyperlipidemia. continued home simvastatin. . #. depression. continued home citalopram. . #. pt was on a regular diet, on lovenox for dvt ppx. pt was full code. medications on admission: -verapamil 240mg po qam -agrylin 3mg qam and 4mg qpm (on hold prior to surgery) -zocor 40mg qpm -celexa 20mg qam -pancrease 4500mg 7 capsules with meals -humalog 5-15 units sliding scale with meals -lantus 15 units qpm -trazodone 50mg qhs prn -baclofen 5-10mg tid prn muscle spasms -dilaudid 8mg q3 prn pain -oxycontin 140mg tid -zofran 8mg po tid prn nausea -compazine 10mg po q6 prn nausea -lorazepam 1-2mg q6 prn nausea -omeprazole 20mg qd -penicillin 500mg qid prn open wounds -multivitamin qam discharge medications: 1. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous daily (daily) for 25 days. disp:*25 * refills:*0* 2. verapamil 240 mg tablet sustained release sig: one (1) tablet sustained release po q24h (every 24 hours). 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 6. baclofen 10 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for muscle spasms. disp:*15 tablet(s)* refills:*0* 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): hold for diarrhea. disp:*60 tablet(s)* refills:*0* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily): hold for diarrhea. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 11. oxycontin 60 mg tablet sustained release 12 hr sig: three (3) tablet sustained release 12 hr po every eight (8) hours. disp:*90 tablet sustained release 12 hr(s)* refills:*0* 12. hydromorphone 4 mg tablet sig: 3-5 tablets po q2h (every 2 hours) as needed for pain. disp:*120 tablet(s)* refills:*0* 13. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) sig: one (1) cap po tid w/meals (3 times a day with meals). 14. agrylin 0.5 mg capsule sig: six (6) capsule po every morning. 15. agrylin 0.5 mg capsule sig: eight (8) capsule po every evening. discharge disposition: home with service facility: / vna discharge diagnosis: primary diagnosis: -right femur pain secondary to bony metastasis s/p . secondary diagnoses: -metastatic pancreatic cancer -coronary artery disease -hypertension -diabetes mellitus -essential thrombocytosis -gerd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to for pain control related to refractory right hip pain from known metastases. pain control was established with dilaudid and oxycontin. you were subsequnetly taken to surgery for stabilization of your right thigh bone with the goal of preventing future fractures and helping control your pain. you developed some altered mental status after the procedure which required a brief stay in th icu for more aggressive pain control. all in all, you tolerated the procedure well and are now back to an oral pain control regimen. . the following changes have been made to your home medication regimen: start enoxaparin 40 mg subcutaneous daily for 25 days start acetaminophen 500 mg tablet two tablets every 6 hours start baclofen 10 mg 3 times a day as needed for muscle spasms start senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day), hold for diarrhea start docusate sodium 100 mg po 2 times a day, hold for diarhhea start bisacodyl 10 mg delayed release daily, hold for diarrhea start lisinopril 10 mg daily start oxycontin 60 mg sustained release 3 tablets every eight hours start hydromorphone 4 mg 3-5 tablets every 2 hours as needed for pain continue your other medications as before, including agrylin if you find yourself using the hydromorphone more than four times a day for breakthrough pain, please call dr. /dr. so that they can readjust your long-acting pain medication. followup instructions: please keep the following appointments: provider ortho xray (scc 2) phone: date/time: 11:25 provider , md phone: date/time: 11:45 provider , md phone: date/time: 4:00 please also call dr. /dr. at ( to make a follow-up appointment next week. please also call dr. at to make a follow-up appointment with him. procedure: internal fixation of bone without fracture reduction, femur diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension hyposmolality and/or hyponatremia percutaneous transluminal coronary angioplasty status ostium secundum type atrial septal defect other acquired absence of organ old myocardial infarction other constipation personal history of malignant neoplasm of other gastrointestinal tract delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow leukocytosis, unspecified neoplasm related pain (acute) (chronic) other acquired deformities of ankle and foot other lymphatic and hematopoietic tissues postsurgical hypoinsulinemia 

Answer: The patient is high likely exposed to