Christmas Medical Report

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Case Report: Incidence 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 could not state his age with complete certainty, presented to my family practice office. He complained of generalized aches and pains, sore red eyes, depression, and imprecise malaise. The patient’s face was florid, and he was in mild respiratory distress, although his overall demeanor would best be described as jolly. His attributed his symptoms to the fact that he was “not as young as I used to be, HO! HO! HO!,” but that Mrs. C had convinced him he had better have himself checked out.

The patient’s occupation is delivering presents once a year, on December 25th, to deserving clients worldwide. He flies in a sleigh pulled by eight reindeer, and gains access to the homes he visits by way of chimneys. He has performed this work for as long as he can remember.

After an extensive physical examination, and gathering a comprehensive medical history, I have uncovered what I believe to be a unique and heretofore undocumented medical condition related to this man’s occupation and lifestyle, namely Aerial Sleigh-Borne Present-Deliverer’s Syndrome - ASBPDS for short.

Medical History:
Mr. C admits to only drinking alcohol once a year, and then only when someone puts rum in the eggnog left for him to consume during his working hours. However, I believe his bulbous nose and florid complexion may be indications of long-term ethanol abuse. He has smoked pipe tobacco for many years, although recent changes to workplace environmental regulations at his North Pole toy factory have reduced his consumption to one or two pipes a day, during the last two years. He has had no major injuries or surgery in the past, and suffers from no known allergies. His travel history is extensive, as he has occasion to visit practically every country on the earth on an annual basis. His immunization record is up to date, including inoculations for known tropical diseases. He leads a sedentary lifestyle, exercising little, and eats sizeable meals, high in sugar and cholesterol. An alarmingly high percentage of his calorie intake is derived from saturated fats (he subsists all year on the food he consumes during his annual flight, which consists primarily of eggnog, Cola drinks and cookies) A family history was unavailable, as the patient could not name any relatives.


Physical Examination and Review of Findings, With Socio-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. These lacerations have apparently been caused by dust, debris and other particles which come into high velocity contact with his eyes during his annual flight. He suffers from severe headaches on a daily basis, generally with their onset part way through the day and worsened by stress.

Mr. C exhibited extensive ecchymoses, abrasions, lacerations, and first-degree burns on his head, arms, legs, and back, which I believe to have been caused primarily by blunt trauma experienced during repeated chimney descents and falls from his sleigh. Collisions with birds during his flight, gunshot wounds as a result of being mistaken 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 extended periods of hypothermia during high-altitude flights.

The patient had a blood pressure of 150/95, a heart rate of 90 beats per minute, and a respiratory rate of 40. He has experienced shortness of breath for several years, which worsens during exertion. While there was no evidence of acute cardiac or pulmonary distress, it was my opinion that he was quite unfit, due largely to his sedentary lifestyle and poor dietary habits which, along with his levels of stress, smoking, and male gender, place him at high risk for coronary heart disease, myocardial infarction, emphysema and other conditions. Subsequent blood tests revealed higher than normal levels of CO, which I attribute to smoke inhalation experienced during chimney descent into non-extinguished fireplaces.

He has experienced chronic back pain for several years. A neurological examination produced results consistent with a mild herniation of his L4-L5 or L5-S1 disc, which probably resulted from carrying a heavy sack of toys, enduring bumpy sleigh rides, and his jarring feet-first plunges to the bottom of chimneys.

Mr. C had a swollen left scrotum, which, upon biopsy, was diagnosed a scrotal carcinoma, the likely etiology being the soot from chimneys.

Psychiatric Examination and Socio/Occupatioal Correlates:
Mr. C has struggled with chronic depression for several years. I do not believe it to be organic in nature, rather, he has numerous unresolved issues in his personal and professional life which cause him distress.

He exhibits long-term amnesia, and is unable to recall any events prior to five years ago. This may be due to a repressed psychological trauma he experienced, head injury, or, more likely in my opinion, part of a self-imposed defense mechanism, created as a way of dealing with the mythical nature of his own existence.

Although the patient manifests a jolly demeanor, he expresses profound unhappiness. He reports anger at not receiving recognition or royalties for the widespread use of his likeness and name. Although he claims to enjoy a satisfactory sex life with his spouse, I sense he may experience erotic tendencies when children sit on his lap, and I am concerned he may have pedophillic inclinations. This could be the subconscious reason behind his policy of only employing vertically-challenged production workers (elves), though I suspect his hiring practices are more likely a reaction to personal body-image perceptions stemming from his own obesity. The patient feels threatened and frustrated when he is reminded many people deny his existence, and I am concerned this may develop into a serious identity crisis if the issue is not satisfactorily dealt with. He reports great stress at having to select which gifts to give to children, and feelings of guilt and inadequacy over the determinations he is forced to make over which children are “naughty” or “nice.”

Because he is subjected to extended periods of total darkness lasting many months during winter at the North Pole, Seasonal Affective Disorder (SAD) may be a contributing factor to his depression.

Treatment and Counseling:
All of Mr. C’s wounds were cleaned and dressed, and an antibiotic ointment was prescribed for his eyes. A referral was made to a physiotherapist to assist in ameliorating his chronic disc problems. On February 9, a bilateral orchidectomy was performed to deal with the scrotal carcinoma, and no further cancer has been detected as of this writing. He was instructed to wash soot from his body on a more regular basis, and to avoid lit-fire chimney descents whenever practical. He was advised to investigate the possibility of employing a closed-cab, heated, pressurized sleigh. He was resistant to the notion of adding a helmet and other protective accessories to his uniform.

Mr. C was put on a high-fibre, low cholesterol diet, and admonished to reduce or eliminate his smoking and alcohol consumption. He has demonstrated success with these lifestyle changes to date, although it remains to be seen if he will be able to maintain his resolve when faced with the treats left out for him next Christmas.

He has undertaken a program of weekly therapy sessions with a clinical psychologist and reports doing, “Not too bad, HO! HO! HO!”

Conclusions:
Physicians, when faced with aerial sleigh-borne present-deliverers exhibiting more than a few of these symptoms, should seriously consider ASBPDS as their differential diagnosis. I would encourage other practitioners with access to patients employed in allied professions (e.g. Nocturnal Tooth Purchasers, or Annual Candied Egg Providers) to consider whether analogous anatomical / physiological / psychological syndromes exist. The happiness of children everywhere depend on effective management of these conditions.