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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-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.