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: patient recorded as having no known allergies to drugs attending: chief complaint: transfered from osh for evaluation of intracranial and extracranial vasculature for possible surgical intervention after stoke major surgical or invasive procedure: colonoscopy history of present illness: mr. is a 69-year-old right handed male with diabetes, hypertension, hyperlipidemia, obesity and prostate cancer status post resection, s/p radiation treatments who presents with slurred speech and right hand weakness which began acutely on . on he was talking with his wife on the phone when he noticed the slurred speech. he also had word finding difficulty. he could think of what he wanted to say but was having trouble getting the words out. he did not have trouble understanding others. the word finding trouble improved over 4 days. he still has intermittent dysarthria. on he also had acute onset of right hand weakness. he was having trouble holding onto objects. this right hand weakness improved over several days and is now 100% better. he also had 3-4 episodes of several minutes of horizontal diplopia. this resolved if he closed either eye. he had diplopia if he looked either to the right or left. he has never had diplopia before. pt denied headache, vertigo, dysphagia, gait unsteadiness. he takes aspirin 81mg daily at home. his family took him to on and he was admitted to the floor. on exam he had dysarthria and right pronator drift. ct brain did not show an acute infarct or bleed. neurology consult was concerned about a lacunar stroke causing clumsy hand/dysarthria syndrome. he was started on plavix 75mg daily and aspirin 325mg . his blood pressure meds were held originally. later his lisinopril 10mg and metoprolol 25mg was restarted. on his sbp was 110's -120's. zocor was given at 80mg qhs but was decreased to 40mg qhs. mri/mra brain showed a subacute infarct of the left cortical motor strip near the hand region. he has severe stenosis of the m1 and m2 branches of the left mca. there is 100% occlusion of the left common carotid artery and greater than 90% occlusion of the right internal carotid artery. his right vertebral artery is stenotic. his left vertebral artery is patent. patient was in acute renal failure, probably prerenal in etiology. his cr was 2.1 and improved to 1.2 with iv hydration. on admission he was anemic with a hct of 30. on his hct dropped to 26. he was hemodynamically stable. patient was guaic positive in the ed, but did not appear to be actively bleeding. patient has complained that at home he was having bright red blood in the toilet bowl four days per week. on patient was transferred to the trauma icu. ros: +bright red blood per rectum occuring four days per week. + weight loss. denies fever, chills, chest pain, sob, coughing, diarrhea, constipation, nausea, vomiting. rest of review of systems was negative. past medical history: 1. diabetes. 2. hypertension. 3. hyperlipidemia. 4. obesity. 5. history of prostate cancer status post resection. prostate cancer was diagnosed in . he has received 37 radiation treatment 6. glaucoma social history: he quit tobacco 20 years ago, prior to that he smoked 20 packs per day x20 years. he drinks alcohol occasionally. he denies illicit drug use. he lives at home with his wife. has 2 step-daughters. family history: mother has a history of mi. physical exam: vs: sbp 153/65 p 65 r 18 02 98% gen: obese heent: supple neck, no carotid bruits, no lymphadenopathy chest: lungs clear to auscultation bilaterally, no wheezes, rales, or rhonchi heart: regular rate and rhythm, no murmurs, abd: soft, non-distended, non-tender, no mass, positive bowel sounds ext: no cyanosis, clubbing, or edema skin: no erythema neuro: ms: alert and oriented x3, fluent, intact comprehension, intact naming, repetition, knowledge, spelling, follows crossed body commands, no neglect cn: visual fields full to confrontation, pupils equal, round, and reactive, extraocular movements intact, intact light touch, mild asymmetry of right corner of his mouth, otherwise no facial symmetry, intact t/u/p, scm and trapezius motor: normal tone and bulk of all four extremities, no tremor d b t we wf fe ff left 5 5 5 5 5 5 5 right 5 5 5 5 5 5 5 ip q h df pf left 5 5 5 5 5 right 5 5 5 5 5 sensory: intact light touch and pinprick of all four extremities intact proprioception of le no extinction romberg deferred reflex: t br b k a toes left 1 1 2 2 2 down right 1 1 1 2 2 mute coord: intact finger-nose-finger, heel-shin bilaterally gait: deferred pertinent results: 10:08pm blood wbc-7.9 rbc-3.41* hgb-9.8* hct-28.0* mcv-82 mch-28.6 mchc-34.9 rdw-14.0 plt ct-262 02:59pm blood wbc-7.6 rbc-3.44* hgb-10.0* hct-28.6* mcv-83 mch-29.0 mchc-34.9 rdw-14.2 plt ct-259 10:08pm blood pt-12.0 ptt-24.0 inr(pt)-1.0 10:08pm blood glucose-99 urean-28* creat-1.3* na-138 k-4.5 cl-106 hco3-23 angap-14 02:54am blood glucose-118* urean-24* creat-1.2 na-138 k-5.0 cl-104 hco3-27 angap-12 10:08pm blood alt-14 ast-15 ld(ldh)-157 ck(cpk)-65 alkphos-69 totbili-0.2 10:08pm blood ck-mb-notdone ctropnt-<0.01 02:54am blood ck-mb-notdone ctropnt-<0.01 10:55am blood ck-mb-notdone ctropnt-<0.01 10:08pm blood albumin-3.5 calcium-9.2 phos-3.5 mg-2.0 12:34pm blood %hba1c-6.3* brief hospital course: mr. was admitted to the icu for closer monitoring. his hospital course by problem is as follows: neuro: his cta showed total occlusion of the left internal carotid artery, marked stenosis at the right common carotid artery bifurcation and occlusion of the proximal right vertebral artery. his perfusion studies showed a prolonged mean transit time consistent with left middle cerebral arterial territory ischemia. outside hospital mri was reviewed, and confirmed small cortical subacute infarcts in the mca distribution. it was discussed with him that the likely mechanism for his symptoms was a stroke due to total occlusion of the right ica. after discussion of the risks and benefits with the patient, it was decided to start heparin/coumadin for 4-6 weeks till the clot from the r ica stabilizes and then switch to an antiplatelet. this was instituted after discussion with gi, given the brbpr. the l ica could be considered for surgery in months after he has recovered from his current stroke and is more stable for surgery. he continued to have brbpr and after discussion anticoagulation was stopped and he was started on aggrenox (no sxs of angina) his blood pressure was target at sbp 120-180. keep sbp <220 and dbp <110 and map < 130. the hob was initially maintained less than 30 degrees. he was switched from asa/plavix to aggrenox . his a1c was 6.3 and his ldl was 48. his zocor was kept at 80mg and not decreased given concern for potential increased risk of stroke after reductions in statin dose. his ldl should be maintained less than 70 over the long term. he will need op follow-up of lft's ldl and tg. he was also maintained euthermic and euglycemic. his a1c was 6.3. he was also monitored on tele without events and ruled out for an mi with ce x 3. a tte was negative for a pfo and his repeat carotid dopplers showed 80 to 99% stenosis of the r ica and complete occlusion of the l ica. vascular surgery was consulted and recommended a cea in week. neurology advised to postpone for 3 months to reduce the risk of futher complications given the recent stroke. after a colonoscopy for his gi bleeding he was started on a heparin drip with a goal ptt maintained between 50 and 70. he had an episode of brbpr on with about 50cc of stool and blood. he remained hemodynamically stable and his hct was also stable. the heparin was stopped. he was discharged on aggrenox given his apparent bleeding complication to full anticoagulation. he will follow up with dr. in vascular clinic in 4 weeks to discuss likely cea. gi: he was admitted with a history of gi bleeding but no prior colonoscopy. he therefore had the procedure on which showed radiation proctitis, multiple avm's, as well as a clot which was cauterized. he was started on mesalamine pr per gi for proctitis. the patient was anticoagulated, but then had recurrent gi bleeding (hemodynamically stable), and heparin was stopped. gi did not feel repeat colonoscopy would be of value. there were polyps noted on his colonoscopy, and he will require a repeat colonoscopy for purposes of polypectomy in a few months as arranged by his pcp. cardiovascular: the patient's metoprolol and lisinopril were held on admission. his lisinopril was re-started at a low dose prior to discharge. his metoprolol was held given his recent episodes of gi bleeding. his bp medications will require further titration as an outpatient. heme: he was anemic on admission, and therefore was tranfused 1 unit prbc on . serial hematocrits following the transfusion were stable. fe studies were consistent with iron deficiency as well as chronic disease. his retic count was normal. endo: given his recent stroke and renal insufficency at the osh, his oral hypoglycemics where held on admission. he was treated with ssi as needed and restarted on glucophage on . rheumatology: the patient reported a history of gout in his left great toe, and reported similar pain in his left ankle. the joint was noted to be warm, edematous with marked tenderness to palpation in the absence of trauma or infection. he was not started on on colchicine for this likely exacerbation of acute gouty arthritis due to his anticoagulation and gi bleeding. he was started on a short course of prednisone for gout. he was also provided a short course of vicodin for pain control. he was instructed to call his pcp if the left ankle pain should worsen, or if he should develop any fevers or rashes. ophtho: he was maintained on his home regiment of glaucoma medications. medications on admission: transfer medications: 1. zocor 40 mg daily. 2. aspirin 325 mg daily. 3. plavix 75 mg daily. 4. insulin sliding scale. home medications: metoprolol 25 mg p.o. b.i.d. metformin 500 mg p.o. t.i.d. lisinopril 20 mg daily, aspirin 81 mg daily, glipizide 20 mg p.o. daily, cosopt eye drops 1 drop ou b.i.d. alphagan eye drops ou b.i.d. lumigan eye drops ou q.h.s. discharge medications: 1. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 2. brimonidine 0.15 % drops sig: one (1) drop ophthalmic (2 times a day). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 5. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 6. metformin 500 mg tablet sig: one (1) tablet po tid (3 times a day). 7. mesalamine 1,000 mg suppository sig: one (1) suppository rectal daily (daily). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 1 days. disp:*1 tablet(s)* refills:*0* 10. dipyridamole-aspirin 200-25 mg cap, multiphasic release 12 hr sig: one (1) cap po twice a day. 11. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 12. vicodin 5-500 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain for 3 days: do not drive or operate machinery while taking this medication. disp:*8 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: left mca cortical infarct bilateral carotid stenosis gastrointestinal bleeding acute gout discharge condition: stable, right pronator drift. slight r nasolabial flattening. discharge instructions: you were admitted for a stroke and found to have narrow arteries leading to your brain as well as gastrointestinal bleeding. your bleeding was stopped with cauterization during colonscopy and you were started on coumadin to prevent further strokes. please take all medications as prescribed. call your doctor or 911 immediately if you have any blood in your stoool, unusually dark or black stools, dizziness, palpitations, sweating, shortness of breath, chest pain, new weakness, difficulty speaking, tingling, numbness or any other concerning symptoms. followup instructions: please see your primary care doctor (dr. ) next week, you should have a repeat hematocrit checked and discuss your treatment for gout. you will need a follow up colonscopy in months (off aggrenox 1 week prior) for removal of polyps noted on your colonoscopy performed here in the hospital. you have a follow up appointment with the stroke center at , building, . with dr. phone: date/time: 4:00 please call dr. (vascular surgery) for a follow up appointment in four weeks to plan a carotid endarterectomy. office phone: ( md procedure: endoscopic destruction of other lesion or tissue of large intestine diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled gout, unspecified personal history of malignant neoplasm of prostate occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction other and unspecified hyperlipidemia iron deficiency anemia, unspecified angiodysplasia of intestine with hemorrhage benign neoplasm of colon other specified disorders of rectum and anus benign neoplasm of rectum and anal canal 

Answer: The patient is high likely exposed to