Tuesday, December 16, 2008

Cost of gaining height

You may recall that few months ago I had posted about a man who looked like a boy.He was 23 years old but had the features only of 12 years of age.His height was 123 cms and his body feature were like a small boy.He was a case of Pituitary Dwarfism. Let me tell you what happened since.

The hormone tests proved that he is having a deficiency of Growth Hormone and Male sex hormone called Testosterone.Then I took a series of Radio graphs[Xray films] to see whether his growing ends of bones had fused.In normal males it will fuse anytime between 18 and 21 years.He is 23 now,so chances are it might have fused.But fortunately the radio graphs showed it had not fused.

That meant there is a chance that he may gain in height if given injections of Growth Hormone.That was good news,but the bad news was the injections are expensive. 15 day course of injections will cost around 8000 Rupees.He may have to take such injections for several months.

The family was very poor.The patient's father was a manual labourer and have to support a large family.My first thought was not to burden them by telling them about costly injections.As he was already 23 the chances of gaining much height is very less.The hormones injected may cause the growth plate of the bones to fuse thereby preventing further gain in height.

Bur not telling their options was unethical.So I gave a long explanation which his father listened with rapt attention. From the vacant look I could realise that he did not understand much.
He put everything on my head. Saru parayunathu pole cheyyam.[Will do whatever sir say]
Now I have the added responsibility of deciding for that family.

So I decided.Let us try the medicines for 2 months and see.You tell me when you have the money ready for 15 days medicines.I will order it and give it to you directly.We can save some money by doing that.He agreed.

After a week he called me and said the money for 15 days of injections is ready.I ordered the medicine and company couriered it in my address.I taught the father how to take the injections. The money had to be send to the Company office by cheque or draft.I asked him to do that.He confessed that he do not know anything about Banks and asked me to do it for him.I did not know what to do.He just gave me the cash and left.

After 15 days he came again with his kid.There was no increase in height[ as it may take few more weeks to get the effect].Cash was ready and I handed over the medicine.
After the end of next 15 day period he called and said there is a cash shortage.They were planning to sell a piece of land,but was not able to get a good price.I asked him to come to see me with his son.

I measured the height.There was an increase of 2 cm.All of us were happy to see the increase.

He asked me for few days time to get the cash ready. I told him that a gap in therapy was not good.

Should I volunteer to give him a loan? If he asked for a loan what should I do? I was wondering.
But he did not ask for a loan.He assured me he will get the money in few days.

I know that the father was struggling hard to get money for the injection for his son. Few more months of injections may further increase his height by few centimetres. But at what cost?


Seema said...

That was so generous of you to even think about volunteering a loan. If it would make any positive development I can sponsor one of his 15 day course (if it doesn't hurt the father's pride of course)

Charakan said...

Thank you Seema for the offer.Very generous and kind.I should be the first to sponsor right?But when you see several such patients you will realise sponsoring is not the answer.
Also I am not absolutely sure whether he will gain in height and if so by how much.Now after a gap they has bought the 3rd refill which may last another 15 to 18 days.I have told them to apply for Prime Minister's or Chief Minister's relief fund.As Parliament election is coming good things can happen but may take time.I am also trying with Pharmaceutical Company People to give some more reduction.[Now they are paying 6000 for each refill against an MRP of around 8000]

kochuthresiamma p .j said...

What dilemma doctors face!
at what cost? if he can gain normal height and stop feeling 'special', the cost is worth it, i guess.
but then, what do you do if u dont have the resources.

Charakan said...

Yes KPJ, while treating poor people this question arises again and again. At what cost are you gaining and is it really worth it. A difficult decision for a doctor.

mummyjaan said...

The very fact that the father and family are doing so much to come up with the money only proves how important this is to them.

If this post had been recent, I would have sorely been tempted to send in a donation. But I guess your patient doesn't need it anymore?

okay, this is my last comment before you shoo me off from here.

Interesting blog, Malayalidoc!

Charakan said...

mummy jan welcome here.
The patient took the Growth Hormone injection along with male sex hormone injection for 4 months. There was minimal gain in height,but his male sexual characters developed well.Then they stopped coming most probably because they cannot afford further injections.