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: codeine attending: chief complaint: bladder cancer, inguinal hernia, pulmonary embolism major surgical or invasive procedure: operation : radical cystectomy, ileal conduit urinary diversion. intraoperative repair of left inguinal hernia with mesh. history of present illness: hpi: 84 year old male with ckd (cr baseline 1.4) with invasive bladder cancer, refractory urinary incontinence here for cystectomy with ileal conduit. past medical history: pmh: dvt s/p turp in 's, now s/p ivc filter htn ?tia off aggrenox tx since psh: turp right hernia repair total knee replacement social history: shx: no tobacco, etoh, id family history: fhx: non-contributory physical exam: wdwn male, nad, avss abdomen obsese, non-tender ostomy pink extremities w/out pitting edema pertinent results: 07:15am blood wbc-7.2 rbc-3.50* hgb-10.8* hct-31.8* mcv-91 mch-30.9 mchc-34.1 rdw-16.2* plt ct-255 04:32am blood wbc-7.1 rbc-3.49* hgb-10.9* hct-31.0* mcv-89 mch-31.3 mchc-35.4* rdw-16.3* plt ct-288 07:15am blood pt-21.8* inr(pt)-2.0* 01:59pm blood pt-22.2* inr(pt)-2.1* 04:32am blood glucose-103* urean-19 creat-1.2 na-142 k-3.6 cl-110* hco3-21* angap-15 04:20am blood glucose-110* urean-21* creat-1.3* na-139 k-3.6 cl-111* hco3-20* angap-12 03:01am blood alt-18 ast-19 ld(ldh)-201 ck(cpk)-53 alkphos-103 totbili-0.4 dirbili-0.2 indbili-0.2 04:32am blood calcium-8.5 mg-1.6 brief hospital course: on pod 1, the patient was started on subcutaneous heparin and gotten out of bed, patient was started on sips to help with irration from the ngt. on pod 2 the ngt was removed and the patients diet was advanced to clears. on pod 3 the patients diet was advanced to regular, and the cvc was removed. on pod 4 he was transfused 2 more units of prbc's for continued low hct, to which he responded appropiately. cr from the jp drain was checked and found to be 1.2. pod 5 the patient was switched to po medications and sliv. on pod 5,6 the patient underwent extensive urostomy care training in preparation for discharge. . on pod 7 at 10:40 while the patient was ambulating in the hallway he experience, "dizziness, with chest pressure and sob" and stopped ambulating leaning against a wall. the patient was helped back to his bed by nursing staff. nursing paged md. upon arrival the patient was diaphoretic, with a hr in the 90 sinus rhythm. bp was in the high 80s to 90s systolic, with 4l of o2. lungs were clear to auscultation bilat, no carotid bruits were heard, no new heart murmurs. dp pulses were 2+ bilat. patient was alert and responsive. patient was put on oxygen, iv fluids were restarted, and ekg was ordered, labs were sent. . while he was walking with pt he had acute sob, diaphoresis, pre-synope, and chest pressure. ekgs showed st depressions in the lateral leads and st elevation in avf that resolved after 30 min. the patient wsa noted to be hypotensive to 90s (baseline 140s-150s), tachycardic (high 90s/low 100s) and hypoxic 90-95% on 4 l (previously no o2 requirement). code stemi was called, the patient was started on hep gtt and ivf and then transferred to the cath lab where he was found to have clean coronaries. aspirin 325 mg was given. . pt was continued on heparin drip for to ? pe which was restarted 6 hours post cath. he had bil le us that as per team report was negative w/ the plan for vq scan today given that he has hx of ckd w/ elevated creatine and recent dye load from cath lab. he was feeling well with stable vs. he then walked to the bathroom with the nurse and on his way back he felt diaphoretic and lightheaded. he then became unresponsive, pulseless, cpr was started and a code blue was called. after ~ 1 min of cpr he became responsive, initial trace was bradycardic with wide complex beats (4-5 beats). on tele, pt looked to have junctional rhythm then asystole. ekg- showed sinus in the 90s w multifocal pvcs and pacs. repeated ekg showed sinus with occ pac in the 80s. he states to feel well, except for mild chest discomfort from chest compressions. this was a similar episode from prior day when he was working with pt yesterday. he felt as if he was going to ??????pass out??????. this has never happened before prior to yesterday. he had received metoprolol post op to maintain his hr < 100 as per urology. this was stopped on and he was switched to his home dose of captorpil. he received this on . the patient underwent a radical cystectomy ileal conduit urinary diversion, intraoperative repair of left inguinal hernia with mesh on . the procedure was complicated by significant blood loss (~2300ml) and the patient was transfused 3 units of prbcs during the procedure. the patient did well in the post operative period. on pod 1 the patient was started on subcutaneous heparin and gotten out of bed, patient was started on sips to help with irration from the ngt. on pod 2 the ngt was removed and the patients diet was advanced to clears. on pod 3 the patients diet was advanced to regular, and the cvc was removed. on pod 4 he was transfused 2 more units of prbc's for continued low hct, to which he responded appropiately. cr from the jp drain was checked and found to be 1.2. pod 5 the patient was switched to po medications and sliv. on pod 5,6 the patient underwent extensive urostomy care training in preparation for discharge. on pod 7 at 10:40 while the patient was ambulating in the hallway he experience, "dizziness, with chest pressure and sob" and stopped ambulating leaning against a wall. the patient was helped arrival the patient was diaphoretic, with a hr in the 90 sinus rhythm. bp was in the high 80s to 90s systolic. lungs were clear to auscultation bilat, no carotid bruits were heard, no new heart murmurs. dp pulses were 2+ bilat. patient was alert and responsive. patient was put on oxygen, iv fluids were restarted, and ekg was ordered, labs were drawn including chemistries, coags, cbc, type and cross, troponin. serial ekg were collected. the patient had st depressions in leads v4, v5 and t wave changes. aspirin 325 mg was given. the patient continued to have some chest pressure, that was diminishing in intensity. his sob was improving with oxygen and rest. he denied any visual changes, or pain elsewhere. at this point medicine and cardiology services were consulted. heparin was started and iv fluids were bolused. cardiology initated stemi code. patient was taken to cath lab. on , patient had a troponin bump, and had a cta which showed multiple lobar, segmental and subsegmental pulmonary emboli. echo showed a dilated and hypokinetic rv consistent with a medium-large pe. venous duplex showed dvt of bl posterior tibial veins, of which the left may be chronic. could not be started on lovenox because of high cr (had gotten contrast twice for cath and cta). on , patient had a - f/u final leni: thrombosis of bilateral posterior tibial veins, left may be chronic. - talk to urology re: lovenox -> wait until cr settles out (contrast x2 for cath and cta) - pm hct drop: will get hemolysis labs, fibrinogen, coags, retic with am labs -> having some hematuria in foley and urostomy bag but no clots - got a picc - f/u cath report - needs icu consent - urology: ntd, monitor for clots if + and obstructive, call urology - transfused 2 units overnight after having melena (200cc) and gross hematuria -> decreased to ptt goal 50-60, rechecking labs at 10am: hct 29. hds - 1700 labs: ptt 66.9 --> changed gtt to 850, hct 27 --> 26 continues to be hd - gi consulted: ngl recommended against, think it's the anastamotic site - f/u hit ab - ?rml and lul opacity on cxr -> f/u ct read (resolved on today's cxr) -- on review of ct looks like pleural plaques : - okay to be out of bed with assist and close monitoring - pt consult in - + orthostatics: lying down 137/66, sitting 113/55 - f/u with urology about stent removal, and recs are to hold off for now, will continue to reassess - thrombocytopenia-? hit (pnd results, but unlikely) - pt to walk him in the unit - pt continue to have small amounts of melena, hct has remained stable (goal >25) - advance diet as tolerated- currently on - ? about ivc filter - vascular study - by the end of the week - iv access picc and 2 ivs - gi: they talked with him and he doesn't want any more procedures, just watch him for now - urology: call out to their service; sign out recs for vascular study; needs repeat echo in wks - hcts - hit is negative : mr. returned to the general urology floor where the remainder of his hospital course was unremarkable. he was bridged from heparin drip to coumadin, advanced to full diet and continued with his therapy. he was ultimately discharged with explicit instructions for follow-up with his clinicians for inr monitoring, ostomy care, etc. medications on admission: captopril discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. oxycodone 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for break through pain > 4. disp:*20 tablet(s)* refills:*0* 3. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 4. captopril 25 mg tablet sig: one (1) tablet po tid (3 times a day). 5. centrum oral 6. warfarin 1 mg tablet sig: 3.5 tablets po once daily at 4 pm: goal inr . disp:*120 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: preoperative diagnosis: bladder cancer and refractory urinary incontinence, bilateral hydronephrosis, and renal failure postoperative diagnosis: bladder cancer and refractory urinary incontinence, bilateral hydronephrosis, and renal failure. intraoperative discovery of left inguinal hernia. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: -please refer to visiting nurses (vna) for management of the ileal conduit. please also assist with skin care for stage ii sacral decub. please draw inr and send to pcp, . , phone # -you may take tylenol or narcotic for pain control. use tylenol, replace tylenol with prescribed narcotic (percocet or vicodin) for break through pain >4. please note the maximum dose of tylenol per day is 4 gms. the prescribed pain medication also contains tylenol this needs to be considered when monitoring your daily dose. -please do not drive, operate dangerous machinery or consume alcohol while taking pain medications -colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication, discontinue if loose stool or diarrhea develops. you may use milk of magnesia to help you have a bowel movement. -you may shower 2 days after surgery, but do not tub bathe, swim, soak, or scrub incision for 2 weeks -you will see dr. next week. call dr. office to schedule this appointment. -you have been started on coumadin. this is a blood thiner. you will need to have your blood check frequently to monitor your inr. your primary care doctor will monitor this. -no heavy lifting for 4 weeks (no more than 10 pounds) medical attention for fevers (temp>101.5), worsening pain, drainage or excessive bleeding from incision, chest pain or shortness of breath. please resume your pre-admission medications. avoid nsaids like aspirin, ibuprofen, aleve for two weeks time. followup instructions: please contact dr. office upon discharge to arrange follow up appointment . please call with any questions. please see your primary care doctor next week to monitor inr. he has been contact and is aware of this. procedure: venous catheterization, not elsewhere classified coronary arteriography using two catheters left heart cardiac catheterization radical cystectomy formation of cutaneous uretero-ileostomy other and open repair of indirect inguinal hernia with graft or prosthesis diagnoses: thrombocytopenia, unspecified acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, stage iii (moderate) hemorrhage complicating a procedure other specified cardiac dysrhythmias cardiac arrest surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation blood in stool personal history of venous thrombosis and embolism gross hematuria hydronephrosis knee joint replacement other pulmonary embolism and infarction urinary incontinence, unspecified inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) other ureteric obstruction malignant neoplasm of other specified sites of bladder 

Answer: The patient is high likely exposed to