If Santa Were Your Patient, What Would You Do?

Let’s pretend for the moment that you were in my shoes and had to be Santa Claus’ doctor.  Time is getting short, Christmas is near and he has to be in tip-top shape to make his rounds on Christmas eve. The pressure is on.  Here is what I did when Santa came for his annual pre-Christmas physical.

First, history taking is most important - don’t pretend to know everything about the guy just because he is so famous.  1) Santa says he has had a long-standing problem with rosy cheeks and a bright red nose that glows like a cherry. Mrs. Claus regularly applies some of her cold creme.  2) Sweets are difficult to avoid and thus the round little belly that shakes when he laughs like a bowlful of jelly.  Though over-weight, he claims to still be lively and quick.  I asked about his diet since anyone can see he is a bit on the chunky side.  He said most of the year he eats pretty well, but on Christmas Eve he’s off his diet and might consume 750,000 cookies and 46,875 gallons of milk.  3) Nick says he has developed a bit of cough which he attributes to work-related exposure to ashes and soot.  He made no comment about the pipe he held tight in his teeth.  4)  I asked about abnormal bleeding and Santa said, “no, none of that!  And stop try to get me to have one of those colon tests!”  5) what about pain anywhere?  “Well, I have spent hundreds of years lugging heavy sacks of toys to millions of houses so I get a spell of back pain this time every year.”  6) I asked the jolly old elf if he ever uses alcohol and he informed me that drinking and flying don’t mix so he avoids the “egg nog for adults.”  7)  Lastly, I asked if he ever experienced fluid congestion, irregular or pounding heart beat.  He laid a finger to the side of his nose and smiled at me.  “Son that’s a silly question; have you ever tried to rise up a tight chimney then spring into a sleigh and fly like the down of a thistle?”  OK!       The physical exam yielded no new information and his lab work was perfect.  Santa seemed as fit and robust as ever.  Here are some possible diagnoses with the defining characteristics.  Pick one and see if we agree.

1. 1.     Rosacea - a bulbous nose (rhinophyma), red cheeks with pimply complexion.  Eye irritation.
2. 2.     Obesity/Metabolic Syndrome -  Though weighing in at 250 pounds and measuring 4 foot 3 inches tall, his BMI of 67 just doesn’t fit the picture of such a spry old elf.  Cholesterol and blood sugar will both be out of range for normal.
3. 3.     Christmas Disease - also known as Hemophilia B, this is a blood clotting problem.
4. 4.     Nutmeg Liver (cirrhosis) - enlarged liver and increased alcohol intake.
5. 5.     Cardiomegaly - enlarged heart

What’s your pick? (see below for the answer)

Medical Tip from Dr. Charles Driscoll, VASSAR State Surgeon

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References:

1. https://www.osmosis.org/blog/if-santa-claus-were-your-patient#Nutmeg_Liver_or_Cirrhosis  
2. https://www.teachervision.com/christmas/twas-the-night-before-christmas-full-text-of-theclassic-poe

     Everyone knows Santa has a big heart!