Lets get on with more of the business: SANTA'S MEDICAL Case Report: Unique Case of Aerial Sleigh-Borne Present-Deliverer's
Syndrome Source: North Pole Journal of Medicine, vol 1 no.1, December 1997 Author: Dr. Iman Elf, M.D. On January 2, 1997, Mr. C, an obese, white caucasian male, who appeared
approximately 65 years old, but who could not accurately state his age,
presented to my family practice office with complaints of generalized
aches and pains, sore red eyes, depression, and general malaise. The
patient's face was erythematic, and he was in mild respiratory distress,
although his demeanor was jolly. He attributed these symptoms to being "not
as young as I used to be, HO! HO! HO!", but thought he should have
them checked out. The patient's occupation is delivering presents once a
year, on December 25th, to many people worldwide. He flies in a sleigh
pulled by eight reindeer, and gains access to homes via chimneys. He has
performed this work for as long as he can remember. Upon examination and
ascertaining Mr. C's medical history, I have discovered what I believe to
be a unique and heretofore undescribed medical syndrome related to this
man's occupation and lifestyle, named Aerial Sleigh-Borne
Present-Deliverer's Syndrome, or ASBPDS for short. Medical History: Mr. C. admits to drinking only once a year, and only
when someone puts rum in the eggnog left for him to consume during his
working hours. However, I believe his bulbous nose and erythematic face
may indicate long-term ethanol abuse. He has smoked pipe tobacco for many
years, although workplace regulations at the North Pole have forced him to
cut back to one or two pipes per day for the last 5 years. He has had no
major illnesses or surgeries in the past. He has no known allergies.
Travel history is extensive, as he visits nearly every location in the
world annually. He has had all his immunizations, including all available
vaccines for tropical diseases. He does little exercise and eats large
meals with high sugar and cholesterol levels, and a high percentage of
calories derived from fat (he subsists all year on food he collects on
Dec. 25, which consists mainly of eggnog, Cola drinks, and cookies).
Family history was unavailable, as the patient could not name any
relatives. Physical Examination and Review of Systems, With Social/Occupational
Correlates: The patient wears corrective lenses, and has 20/80 vision. His
conjunctivae were hyperalgesic and erythematous, and Fluorescein staining
revealed numerous randomly occurring corneal abrasions. This appears to be
caused by dust, debris, and other particles which strike his eyes at high
velocity during his flights. He has headaches nearly every day, usually
starting half way through the day, and worsened by stress. He had extensive ecchymoses, abrasions, lacerations, and first-degree
burns on his head, arms, legs, and back, which I believe to be caused
mainly by trauma experienced during repeated chimney descents and falls
from his sleigh. Collisions with birds during his flight, gunshot wounds
(while flying over the Los Angles area) and bites consistent with reindeer
teeth may also have contributed to these wounds. Patches of leukoderma and
anesthesia on his nose, cheeks, penis, and distal digits are consistent
with frostbite caused by periods of hypothermia during high-altitude
flights. He had a blood pressure of 150/95, a heart rate of 90
beats/minute, and a respiratory rate of 40. He has had shortness of breath
for several years, which worsens during exertion. He has no evidence of
acute cardiac or pulmonary failure, but it was my opinion that he is quite
unfit due to his mainly sedentary lifestyle and poor eating habits which,
along with his stress, smoking, and male gender, place him at high risk
for coronary heart disease, myocardial infarction, emphysema and other
problems. Blood tests subsequently revealed higher-than-normal CO levels,
which I attribute to smoke inhalation during chimney descent into
non-extinguished fireplaces. He has experienced chronic back pain for
several years. A neurological examination was consistent with a mild
herniation of his L4-L5 or L5-S1 disk, which probably resulted from
carrying a heavy sack of toys, enduring bumpy sleigh rides, and his
jarring feet-first falls to the bottom of chimneys. Mr. C. had a swollen
left scrotum, which, upon biopsy, was diagnosed as scrotal cancer, the
likely etiology being the soot from chimneys. Psychiatric Examination and Social/Occupational Correlates: Mr. C's
depression has been chronic for several years. I do not believe it to be
organic in nature-rather, he has a number of unresolved issues in his
personal and professional life which cause him distress. He exhibits
long-term amnesia, and cannot recall any events more than 5 years ago.
This may be due to a repressed psychological trauma he experienced, head
trauma, or, more likely, the mythical nature of his existence. Although
the patient has a jolly demeanor, he expresses profound unhappiness. He
reports anger at not receiving royalties for the widespread commercial use
of his likeness and name. Although he reports satisfaction with the sex he
has with his wife, I sense he may feel erotic impulses when children sit
on his lap, and I worry he may have pedophillic tendencies. This could be
the subconscious reason he employs only vertically-challenged workers ("elfs"),
but I believe his hiring practices are more likely a reaction formation
due to body-image problems stemming from his obesity. The patient feels
annoyed and worried when he is told many people do not believe he exists,
and I feel this may develop into a serious identity crisis if not dealt
with. He reports great stress over having to choose which gifts to give to
children, and a feeling of guilt and inadequacy over the decisions he
makes as to which children are "naughty" and "nice".
Because he experiences total darkness lasting many months during winter at
the North Pole, Seasonal Affective Disorder (SAD) may be a contributor to
his depression. Treatment and Counselling: All Mr. C's wounds were cleaned and dressed,
and he was prescribed an antibiotic ointment for his eyes. A referral to a
physiotherapist was made to ameliorate his disk problem. On February 9, a
bilateral orchidectomy was performed, and no further cancer has been
detected as of this writing. He was counselled to wash soot from his body
regularly, to avoid lit-fire chimney descents where practicable, and to
consider switching to a closed-sleigh, heated, pressurized sleigh. He
refused suggestions to add a helmet and protective accessories to his
uniform. He was put on a high-fibre, low cholesterol diet, and advised to
reduce his smoking and drinking. He has shown success with these lifestyle
changes so far, although it remains to be seen whether he will be able to
resist the treats left out for him next Christmas. He visits a
psychiatrist weekly, and reports doing "Not too bad, HO! HO! HO!". Conclusions: Physicians, when presented with aerial sleigh-borne
present-deliverers exhibiting more than a few of these symptoms, should
seriously consider ASBPDS as their differential diagnosis. I encourage
other physicians with access to patients working in allied professions
(e.g.Nightly Teeth-Purchasers or Annual Candied Egg Providers) to
investigate whether analogous anatomical/ physiological/ psychological
syndromes exist. The happiness of children everywhere depend on effective
management of these syndromes.