A New Case Report.....

[truern]

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, H O! H O! H O!", 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, member,

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 Counseling: 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, H O! H O! H O!".

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.