Referral request for S. Claus
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* Y. Ingrid Goh

**To:** Dr. Yull Tyde

**From:** Y. Ingrid Goh*

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/171/12/1441/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/171/12/1441/F1)

Figure. Photo by: Earthlore

Please examine Mr. Claus for the following illnesses during his next physical examination. Please ensure he understands that these work-related risks affect his health. It is highly recommended that Mr. Claus consider an alternative mode of transportation and adapt a healthier lifestyle.

## Caisson disease

Mr. Claus has only 24 hours to deliver Christmas presents; therefore, he must travel at a minimum speed of 6.25 million km/h in order to cover the Earth's land surface area of about 150 million km2. Given this speed and the need to fluctuate between high and low altitudes in an unpressurized vehicle, his body has little time to adjust to the changes in air pressure.

## Meniere's disease

The constant ringing that Mr. Claus hears may not be Christmas sleigh bells. This symptom may be a secondary manifestation of caisson disease.

## Respiratory problems

Mr. Claus has descended many chimneys over many years. The constant acute exposure to soot and ash would certainly predispose him to respiratory problems, including asthma, emphysema and chronic obstructive pulmonary disease.

## Obsessive–compulsive disorder

Mr. Claus is constantly preoccupied with making lists of children's names and checking them twice.

## Heartburn

Given the rapid pace of travel and the expectation placed on Mr. Claus to eat the milk and cookies left for him at every stop, indigestion is unavoidable. Please remind him to chew his food thoroughly.

## Obesity

Mr. Claus' polyphagia inevitably contributes to his plumpness. A well-balanced diet and daily exercise routine is highly recommended.

## Hyperglycemia

The large amount of sugar found in the immense quantity of milk and cookies he eats may predispose him to diabetes. Secondary complications to diabetes would include heart, kidney and nerve problems. Please have him ask children to leave him healthier snacks.

## Hypertension and dyslipidemia

Once again, Mr. Claus' erratic and unhealthy eating habits predispose him to these conditions. Diet modification is highly recommended.

## Thermal burns

Mr. Claus may suffer burns owing to absent-minded people who forget to extinguish their fireplace. Perhaps this is why he is often described as having a rosy complexion. Please ask him to consider an alternative route of entrance.

## Frostbite and hypothermia

Travelling at high speeds in an open vehicle leaves Mr. Claus susceptible to very cold temperatures. This may account for his waxy complexion.

## Cervid diseases

Please bring to Mr. Claus' attention that his reindeer may be at risk for malignant caterlal fever and chronic wasting disease. In addition, please ensure that his herd of reindeer has been vaccinated against rabies virus.