QUESTIONS FOR YOUR DOMINICAN DOCTOR.
A word of warning and advice. A topic to discuss with your surgeon (or any physician) in the Dominican Republic….PAIN MANAGEMENT. What medications does he propose to use to control post operative pain? Heart Attack? Kidney stone? Just to mention a few items. I have found from personal experience that the knowledge of pain management is woefully lacking in Dominican physicians. Routine medications used in the USA are lacking or non existent in many clinics of the D.R. They ( the physicians) treat everything and I mean EVERYTHING with “diclofenac”. A non-steroidal based medication that is therapeutically equivalent to ibuprophen (Advil). Personal observations; a friend in Clinica Abreu with a heart attack suffered pain for THREE days and the only medication that was administered was diclofenac. Treatment of choice for heart attack…Morphine to allay the pain and relieve the anxiety. Another friend recently underwent cosmetic liposuction. Post operative pain management…Diclofenac. He said it did not even take the edge off the pain. And finally, the mother of a dear friend was dying of ovarian cancer. She was already in the terminal stages. Treatment…Diclofenac!!!! This poor woman definitely needed Morphine. The reason they gave for not administering the Morphine…they did not want to risk making her an addict! She was dead in three months. Addiction was not even an issue!! These are just personal cases that I am familiar with. Kidney stones and middle ear infection are the two most painful conditions a patient will experience. Treatment of choice is HEAVY doses of narcotic (Morphine or Demerol) and even then you sometimes only make the condition tolerable and never completely relieve the pain. How many others suffer here, who knows. I do know that Dominican physicians are totally unaware and unfamiliar with modern, acceptable methods of pain management. Most do not even know the dose of Demerol or Morphine, let alone how to prescribe or use it. Just be wary of your case management and have an open discussion BEFORE you submit to procedures. To give you a further idea about Diclofenac (marketed under some 75 different names in Latin America alone) it is not recommended for children under age 6. If you can give it to a 7 year old …what is the analgesic effect in a robust 22 year old? No difference in recommended dosage for either.
One can purchase diclofenac over the counter without a perscription either injectable or tablet form. It is not a controlled substance and that should clue one just how effective of a pain reliever it really is. Advil is not a controlled substance either.
Sorry, I have no hidden agenda. I just do not like to see patients suffering needlessly when competent physicians should able to abate the pain and make them comfortable. That is the first duty of the physician. Relieve the patient’s pain!
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