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.
 
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