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: "bowel and bladder problems" major surgical or invasive procedure: t4 laminectomy abd t1 to t7 posterior instrumented fusion history of present illness: mr. is a 50y/o gentleman with end-stage castrate-resistant prostate cancer refractory to treatment who was admitted from clinic after complaining of saddle anesthesia and urinary retention concerning for cord compression. his initial presention was in late with hip pain from bone mets, and has been tried on pamidronate/lupron, bicalutamide, ketoconazole and ydrocortisone, docetaxel, cabazitaxel, and most recently zometa/lupron q12wk and samarium (, ). he has chronic pain between his shoulder blades, on his lateral ribs, and his right pelvis/hip for which he requires chronic narcotic pain medications. he feels that the samarium has helped to relieve his pain. he was feeling fine until early when he had fecal impaction requiring hospitalization from to . since then, he has been on laxatives and has noticed loose stools. he does note that he feels less muscle control, but but he denies any loss of bowel continence. with regards to urinary retention, he has had chronic issues with urinary hesitancy from his prostate disease, but he has never had urinary retention. on the day he presented to st. , he had urinary retention requiring foley placement, but after disimpaction this resolved. he has urinated fine since then, but is now concerned that he has not urinated since last night. also, when he coughs he has noticed pain radiating down his back to his legs as well as his scapula. he has noticed left buttock numbness for the past week and bilateral foot paresthesias for the past 4 days. . review of systems: (+) per hpi. also has noticed subjective weight loss since eating less (he was told to start with liquids and advance his diet as tolerated, and he has been hesitant to do so in light of his recent fecal impaction). in addition, he has chronic daily vomiting of unclear etiology. (-) review of systems: gen: no fever, chills, night sweats, recent weight gain. heent: no headache, sinus tenderness, rhinorrhea or congestion. cv: no chest pain or tightness, palpitations. pulm: no cough, shortness of breath, or wheezing. gi: no abdominal pain. no hematochezia or melena. gui: no dysuria. msk: no myalgias. derm: no rashes or skin breakdown. neuro: no weakness. psych: no anxiety. all other review of systems negative. past medical history: past oncologic history: end-stage castrate-resistant prostate cancer, s/p treatment with: -pamidronate/lupron -bicalutamide -ketoconazole and hydrocortisone -docetaxel -cabazitaxel -current regimen: zometa/lupron q12wk, samarium . other past medical history: -reconstructed eardrum due to chronic ear infections -chronic constipation (on narcotic pain meds), s/p fecal impaction requiring hospitalization at st josephs in social history: he was smoking until last week; he has smoked 1-2 packs a day since the age of 20. no etoh. used to work as a mechanic. he is originally from , . he is here today with his wife. his sister is rn. he and his wife had one son, who died in a car accident at the age of 16, the same year as the diagnosis of prostate cancer. family history: significant for lymphoma in his mother and thyroid cancer in his father, who died at age 47 and had disease in his lymph nodes, thyroid and bone. physical exam: admission physical exam vs: t96.8, bp 118/68, rr 18, pain gen: aox3, nad, breathing comfortably heent: perrl. mmm. no lad. no jvd. neck supple. no cervical, supraclavicular, or axillary lad cards: s1/s2 normal. no murmurs/gallops/rubs. pulm: no dullness to percussion, ctab no crackles or wheezes abd: bs+, soft, nt, no rebound/guarding, no suprapubic fullness or tenderness extremities: wwp, no edema. dps, pts 2+. skin: no rashes or bruising neuro: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl. sensation to lt intact on trunk, upper and lower extremities. rectal: normal tone, left-sided saddle anesthesia, brown stool, guaiac negative upon discharge: motor full, incision cdi with staples and suture at drain site pertinent results: admission labs 12:55pm blood wbc-7.1 rbc-3.48* hgb-10.6* hct-30.8* mcv-89 mch-30.6 mchc-34.5 rdw-14.7 plt ct-154 12:55pm blood urean-8 creat-0.7 na-139 k-4.4 cl-107 hco3-29 angap-7* 12:55pm blood alt-26 ast-24 ld(ldh)-151 alkphos-112 totbili-0.3 12:55pm blood albumin-4.2 calcium-9.2 phos-4.1 mg-2.2 06:45am blood caltibc-229* vitb12-887 folate-11.8 ferritn-396 trf-176* 12:55pm blood psa-130.0* mri c/t/l spine impression: 1. interval development of metastasis involving the t4 vertebral body with epidural extension and high-grade spinal canal narrowing with spinal cord edema. 2. interval worsening of metastatic involvement extending from t7 through t11 with new epidural extension and moderate-to-severe spinal canal narrowing. abnormal cord signal is difficult to assess at these levels secondary to technical factors. 3. interval progression of lumbosacrsal and iliac bone metastatic disease with no evidence of high-grade spinal canal narrowing or epidural involvement in the lumbar spine. ct thoracis spine brief hospital course: brief hospital course: mr. is a 50y/o gentleman with end-stage castrate-resistant prostate cancer refractory to treatment who was admitted from clinic with saddle hemianesthesia, intermittent urinary retention, and radicular pain with strain that were concerning for cord compression/cauda equina syndrome. mri showed evidence of cord compression; neurosurgery was been consulted and he underwent t4 laminectomy and t1-7 fusion. . active issues: . #. cord compression: mri showed new lesion at t4 and mild canal compromise at t10, which was causing spinal canal stenosis and foraminal stenosis. mr. has known spine mets that are more extensive on bone scan compared to 2 years ago. he has not had bowel incontinence, and his urinary retention last week resolved after disimpaction but overall, his saddle hemianesthesia, intermittent urinary retention, and radicular pain with strain were concerning. upon admission, he was started on dexamethasone 10mg and was continued on 4mg q6h. neuro checks were done q4h and his neuro status did not change. he was transferred to neurosurgery on . pt underwent t4 laminectomy with t1-t7 fusion. he tolerated this procedure well and was transferred to the icu for continued care. he did require multiple blood transfusions to keep his hct greater than 25. he extubated without difficulty on . his surgical site pain was somewhat difficult to control and he was started on a dilaudid pca on with good result. he was transferred to the floor in stable condition. on he jp drain was removed and a simple stitch was placed. he was mobilized oob and had upright x rays that showed good placement of surgical hardware. he was seen by the pain managment team and his oxycontin was increased to 120mg tid and he was started on oxycodone 15-20mg q4 prn pain. this regimen seemed to help and he was able to come off of the pca. he was able to get oob to chair on and ultimately able to stand for upright x rays. he ambulated well with pt and pain was controlled with oral meds. he will be a candidate for radiation therapy one week after surgery. . #. metastatic prostate cancer: poor prognosis overall. he has extensive bony mets and has not responded well to multiple chemotherapies. he does feel symptomatic relief in his pain since the samarium. his current regimen is zometa/lupron q12wk as well as prednisone 5mg daily. he did receive one dose of lupron in house; his prednisone was held in the setting of dexamethasone use. he continued his home pain control regimen (fentanyl patch, oxycontin, oxycodone). he will follow up with his oncologist. . #. chronic constipation: in the setting of chronic opiate medication use. required hospitalization recently but since then he has been moving his bowels daily, though stools are loose. he was continued on an aggressive bowel regimen (senna, colace, miralax, lactulose) and had no issues with constipation or excessive loose stools. . #. anemia: normocytic. baseline hct seems to be ~36 but now it is 30.8. is on chemo and this could cause bone marrow suppression. in addition, he is chronically ill and likely has anemia of inflammation. he was guaiac negative and has been constipated, so gi loss is possible but less likely. his iron studies do not suggest iron deficiency; his anemia is most likely due to recent chemo/samarium. his hct was trended daily and was stable. . #. tobacco use: he was actively smoking until hospitalization at st. . he was continued on nicotine patch. . transitional issues: # communication: patient and wife/hcp h, c # code: dnr/dni (discussed with patient, his wife, and the attending) medications on admission: fentanyl - 200 mcg/hour patch td q72 hr oxycontin - 80 mg tid oxycodone - 15 mg q3-4 hours as needed for pain leuprolide (3 month) - next due prednisone - 5 mg tablet - 1 tablet(s) by mouth daily lorazepam - 1 mg tablet - 1 tablet q 6 hours as needed for for nausea ondansetron - 8 mg tablet, rapid dissolve - 1 tablet every 6 hours as needed for nausa ranitidine hcl 150 mg terazosin - 5 mg capsule - 1 capsule(s) by mouth at bedtime docusate sodium polyethylene glycol 3350 prn sennosides prn lactulose - 10 gram/15 ml solution - 1 tablespoon -qid nicotine patch - 21mg daily discharge medications: 1. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*10 patch 72 hr(s)* refills:*0* 2. terazosin 5 mg capsule sig: one (1) capsule po hs (at bedtime). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. tizanidine 2 mg tablet sig: 1-2 tablets po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 5. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 6. lorazepam 1 mg tablet sig: one (1) tablet po qid (4 times a day) as needed for anxiety. disp:*50 tablet(s)* refills:*0* 7. oxycodone 15 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for breakthrough pain. disp:*120 tablet(s)* refills:*0* 8. dexamethasone 2 mg tablet sig: one (1) tablet po three times a day for 6 days: 1 tid x 2 d then 1 x 2d then 1qd x2d then dc. disp:*12 tablet(s)* refills:*0* 9. oxycodone 40 mg tablet extended release 12 hr sig: three (3) tablet extended release 12 hr po q8h (every 8 hours). disp:*126 tablet extended release 12 hr(s)* refills:*0* discharge disposition: home discharge diagnosis: metastatic prostate cancer to thoracic spine urinary retention discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ?????? do not smoke ?????? keep wound clean / no tub baths or pools until seen in follow up/ begin daily showers ?????? no pulling up, lifting> 10 lbs., excessive bending or twisting for two weeks then increase as tolerated. ?????? limit your use of stairs to 2-3 times per day ?????? have a family member check your incision daily for signs of infection ?????? take pain medication as instructed; you may find it best if taken in the a.m. when you wake if you experience muscle stiffness and before bed for sleeping discomfort ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, ibuprofen etc. for 3 months to promote fusion. ?????? increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation ?????? clearance to drive and return to work will be addressed at your post-operative office visit followup instructions: please follow up with dr in days for staple/suture removal. follow up with dr regarding future treatment. procedure: local excision of lesion or tissue of bone, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique fusion or refusion of 4-8 vertebrae diagnoses: acidosis anemia of other chronic disease tobacco use disorder other opiates and related narcotics causing adverse effects in therapeutic use spinal stenosis, thoracic region opioid type dependence, continuous long-term (current) use of other medications malignant neoplasm of prostate other constipation secondary malignant neoplasm of bone and bone marrow vomiting alone other specified retention of urine myelopathy in other diseases classified elsewhere encounter for therapeutic drug monitoring vascular myelopathies family history of other specified malignant neoplasm antineoplastic chemotherapy induced anemia family history of other lymphatic and hematopoietic neoplasms other joint derangement, not elsewhere classified, other specified sites 

Answer: The patient is high likely exposed to