Case Report: Unique Case of Aerial Sleigh-Borne Present-Deliverer’s Syndrome
Source: North Pole Journal of Medicine, vol 1 no.1, December 2003
Author: Dr. Iaman Elf, M.D.
On January 2, 2003, Mr. Claus, an obese, white caucasian male, who appeared
approximately 65 years old, but who could not accurately state his age, came 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. Claus’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. Claus. 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, 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. Claus. 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. Claus’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. 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
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. Claus’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!
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.
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