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

Source:  North Pole Journal of Medicine, vol 1 no.1, December 1998

Author:  Dr. Iman Elf, M.D.

On January 2, 1998, 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 

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