[Elfsea] FW: [SCA-Chirurgeon] Seasonal SOAP notes....

Richard Threlkeld rjt at softwareinnovation.com
Fri Dec 28 21:25:21 PST 2001


Forwarded from the Chirurgeon list.
Caelin

-----Original Message-----
From: Ann Totusek [mailto:charis_doula at worldnet.att.net]
Sent: Friday, December 28, 2001 7:18 PM
Subject: [SCA-Chirurgeon] Seasonal SOAP notes....




>
>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 Counseling: 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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