52 years old. 6'3" / 300 lbs, obese. I started working out and clean eating 4 weeks ago and lost 15 lbs. Lost 2 inches in my waist. 
Medical problems include liver and spleen problems (non alcoholic fatty liver), weird electrical abnormality in my heart, 6 knee surgeries (all arthroscopies sp?), spondalolisthesis sp? and lower back problems with sciatica.
I get a yearly physical and am under the care of a cardiologist as well as my gp. All have cleared me for physical activity.
The testosterone thread has helped me tremendously. My GP has put me on Clomid and my T has gone from the lower 300's to the mid 800's in 3 months. She is pro TRT injections if I need it. 

Goals, get down to a healthy weight. Get stronger. 
Activity level. Semi retired, light daily farm work. Travel frequently. 

Workout:
MTTF Push Pull weight routine.
3 sets 10 reps
Monday / Thursday Push / squats / toe raises / bench / mil press / cable triceps (2/12)
Tuesday / Friday Pull / leg curls / dead lifts / rows / pull downs / cable curls (2/12)
Pre lifting warmup / treadmill 1/2 mile @ 3.5 mph.
Post lifting / treadmill 1 mile @ 4 mph using incline to keep 75-85% max heart rate. 
I've added about 20% in plates in a month, getting stronger.

Nutrition.
Multi vitamin / omegas
C4 pre workout / 50 mg protein post workout / creatine 
Sensible Portions double paleo 1300-1500 cals per day along with kirkland protein bars or extra protein smoothies not to exceed 2300 cals.

I have read about and considered SS / 5/5 / 3/5 / 5/3/1, etc. But I hate to stop my routine because I am feeling great and getting solid. 
Should I decrease my reps and lift heavier? I've considered counting macros but that has me all . I have been finding paleo with keto combined is working out well.
Any comments are greatly appreciated. 

Sounds like you are taking good steps man. The biggest thing is finding a plan/program that you can stick to. Results are the sum of dedication and discipline over time. You can get good results from any variety of good nutrition + workout plan. So I'd say just stick to what is working for now and get hooked on the lifestyle. Once you start to plateau then you can start optimizing and making good changes to your plan. The only thing that you said that made me lift an eyebrow is taking C4 when you have some heart stuff going on, but as long as your Dr said its cool and you feel fine, right on.

49, 5"10", gained 8 lbs over the winter bringing me to 200, recovering long course triathlete/bike racer/runner

1.  Most of diet is weight loss.  If you're willing to pay the price for someone to make your meals, that site doesn't seem bad.  I'd ditch the extra protein bars and smoothies.  Make up the calories with real, low carb, high fat food like bacon, avocados, coconut, macadamia nuts, etc.  Protein bars are candy masquerading as health food - significantly responsible for my fat gain over the past month as I indulged.  Most of weight loss is diet and IMO, you have too much protein (50g post workout plus bars or extra smoothies). 

2.   Strength routine is decent.  Personally, I prefer Starting Strength (alternates between Squat 3x5/Bench 3x5/Deadlift 1x5 and Squat 3x5/Overhead Press 3x5/Deadlift 1x5 done 3 days per week.  I wouldn't do deadlifts the day after squats - they work the same lower body and core muscles.

3.  Endurance routine is decent as well, but my personal preference would be to do an hour-ish of easy walking (3-4 miles) daily.  Consider adding HIIT when you get to 250 or so.

I don't like fish oil pills because recent studies show no long term (>1 year) benefit and increase in some risk over the long term.  Eat canned sardines or herring a couple of times per week instead.  Also, as someone with fatty liver, you should consider eating liver a couple of times per month or weekly to obtain nutrients vital for liver health.

Take any of what I wrote for what it cost - nothing.  You're making progress, but if I were in your shoes, I'd cut protein and supplements, simplify my workout and lift a bit heavier, and do lower intensity endurance work, preferably outside to get some Vitamin D and fresh air. 

Cut your carbohydrates back to <50 gm per day.

All the other shit is unnecessary.

Working out ain't going to make you lose weight, but it may help in other ways. Just don't go apeshit, and damage something.

While you are at it, cut out sugar.  Especially high fructose corn syrup.

Also, anything with hydrogenated oil should be thrown at your neighbors house that you hate.

Check out the official Keto thread.

ARFCOM Keto Thread

less than 50 grams a day of carbs moderate protein eat lots of fat.

you will burn out quickly on that exercise routine imho. i like starting strength.

Workout:

I would stick with a program for a year and see what happens.  Beyond 5/3/1 with some added volume, depending how you set it up, or Tactical Barbell are good starting points and good programs by themselves. Around 4 exercises a day for 50 minutes to 75 minutes a day max for the workout with the added cardio for 4 days a week is enough by far..

Cardio: I would either do none or do a simple hiit program for 10-15 minutes at the end of your workout. C2 rower: 2 min warmup 20 sec on/40 sec off for 6-8 rounds, 2 min cooldown.  Similar for treadmill: light jog 2 min warmup, sprint 20 sec on 40 off for 6-8 rounds then walk 2 min cooldown.

Nutrition:

MVI if you have to, probably ditch the rest or at the most keep the creatine.

Ditch the protein bar/powder and eat real food.  Probably start at 2500-2700 calories a day and see how it goes for 2-3 weeks, then adjust.  Keep it at 1-2 pounds lost a week.  Don't be afraid of carbs being at 150-200 grams a day unless you are sold on keto/low carb.  If you are try 90-100 carbs a day and keep protein/fats high.  Eat single ingredient items that you make, either singly or mixing together.  Eat no fruit, sugar, grains, or processed items.

Thanks guys for the advice. Just what I was looking for. I'm headed for the big island next week and will start working on adjustments when I return. This will be my last week doing sensible portions. I think I know enough now to be able to put together my own meals. I have been following the keto thread as well. Lots of good stuff there.  Keep the advice coming please. Thanks again

Yea, the C4 was an experiment. Makes my scalp tingle, . I drink coffee every morning, it seems the C4 doesn't do too much more than black coffee. I bought Starting Strength and Practical Programming to read on my trip to Hawaii. I found a local gym near where I'm staying that has day rates. I'll hit it 3 or 4 times during my stay. I cleared a spot in my air conditioned shop for a gym area. I bought a used power cage from a local boy. I have a treadmill and an elliptical I'm putting in there. All I need now is a set of olympic weights and I'm gtg. 

I've had really great results with Paleo, when I'm about 90% strict. It's easy and you get results. I'd also consider following an actual program. You have a lot of wasted time doing cable pull downs and such when you should be focused on big lifts. You may want to separate squats and deads too.