From: kevinsp8@ac.dal.ca (Kevin R. Speight)
Date: 9 Dec 94 14:04:34 -0400
Organization: Dalhousie University, Halifax, Nova Scotia, Canada
Message-ID: <1994Dec9.140435.31199@ac.dal.ca>
Newsgroups: sci.med,rec.humor

Case Report:  Unique Case of Aerial Sleigh-Borne Present-Deliverer's Syndrome

Source:  North Pole Journal of Medicine, vol 1 no.1, December 1993

Author:  Dr. Iman Elf, M.D.

     On January 2, 1993, 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 (delivered
by homeowners mistaking him for a burglar) 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-in, 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.

-Kevin Speight

