Chapter 5 Cold Turkey
Does any of the readers know what the slang “cold turkey” means? This word is used when quitting a drug instantly. I remember being puzzled when one of my patients asked, “I found the word ‘cold turkey’ on the U.S. atopic dermatitis patients’ mailing list. It seems to mean stopping steroids abruptly. Do you know what this word means?”
Does any of the readers know what the slang “cold turkey” means? This word is used when quitting a drug instantly. I remember being puzzled when one of my patients asked, “I found the word ‘cold turkey’ on the U.S. atopic dermatitis patients’ mailing list. It seems to mean stopping steroids abruptly. Do you know what this word means?”
I looked into this word and found the following explanation:
The etymology derives from the phrase talk turkey, in which someone deals matter-of-factly with a subject. Some, however, believe the derivation is from the comparison of a cold turkey carcass and the state of a withdrawing addict — most notably, the cold sweats and goose bumps. It is often preceded by the verb "to go," as in "going cold turkey." Yet another suggestion of origin is that cold turkey is a dish that needs little or no preparation. "To quit like cold turkey" would be to quit in the same way a cold turkey is served, instantly just as you are without preparation.
The reason why I referred to “cold turkey” is that this word is also used in Dr. Kligman’s paper on Steroid Addiction in 1974.
----- Excerpt -----
For stalwart, stoical patients, we have used "cold turkey" replacing the steroid with lubricating cream, applied liberally q.i.d. to induce dehydration. The first few weeks will be a “living hell”. The time required for the skin to return to normal depends on the degree of atrophy. Long-term addicts may have damage which cannot be completely reversed, but for the most part great improvement can be anticipated over a period of months. It is not wise to underestimate the time required.
For most patients, we follow a weaning protocol, using first 2.5% hydrocortisone for several weeks with a warning that this may not completely prevent a rebound flare. Eventually we drop to 1.0% hydrocortisone and finally we substitute lubricating cream, at which time a minor flare is not unusual.
----- End of excerpt -----
“Isn’t it risky stopping steroids abruptly” was a frequent question I got when I was engaged in treatment for TCS withdrawal support. It was difficult to make doctors asking such a question understand my intention, how many times I may have explained. I always let patients take the initiative in choosing what kind of treatment they want to undergo: stopping steroids or not, or stopping instantly or gradually. I thought patients should be provided with such decision-making rights.
And I did accept and support patients whenever they chose to stop “cold turkey.” If I had recommended gradual reduction over time indicating the harshness of stopping cold turkey and rejected to see patients who did not follow my advice, patients who could not help choosing “cold turkey” out of mistrust in medical service that caused steroid addiction would have lost the place to seek help and carried out the withdrawal by themselves at home. It was medically a very dangerous thing I had to avoid by all means. I have never recommended patients to stop at once.
Some may wonder what on earth I was doing as a dermatologist. But I’d like to ask what the doctor’s job is all about. Is it only deciding a type or dosage of TCS? I thought it far more important to prevent an infection, check for complications in the eyes and give mental support. The same as with other addiction cases, successful rates are higher when patients are given initiatives. Some chose a gradually reducing approach and successfully withdrew from addiction.
I was really encouraged by Dr. Kligman who referred to both approaches of stopping cold turkey and tapering gradually in his paper.
I believe doctors should always be prepared to answer each patient’s desire.
The etymology derives from the phrase talk turkey, in which someone deals matter-of-factly with a subject. Some, however, believe the derivation is from the comparison of a cold turkey carcass and the state of a withdrawing addict — most notably, the cold sweats and goose bumps. It is often preceded by the verb "to go," as in "going cold turkey." Yet another suggestion of origin is that cold turkey is a dish that needs little or no preparation. "To quit like cold turkey" would be to quit in the same way a cold turkey is served, instantly just as you are without preparation.
The reason why I referred to “cold turkey” is that this word is also used in Dr. Kligman’s paper on Steroid Addiction in 1974.
----- Excerpt -----
For stalwart, stoical patients, we have used "cold turkey" replacing the steroid with lubricating cream, applied liberally q.i.d. to induce dehydration. The first few weeks will be a “living hell”. The time required for the skin to return to normal depends on the degree of atrophy. Long-term addicts may have damage which cannot be completely reversed, but for the most part great improvement can be anticipated over a period of months. It is not wise to underestimate the time required.
For most patients, we follow a weaning protocol, using first 2.5% hydrocortisone for several weeks with a warning that this may not completely prevent a rebound flare. Eventually we drop to 1.0% hydrocortisone and finally we substitute lubricating cream, at which time a minor flare is not unusual.
----- End of excerpt -----
“Isn’t it risky stopping steroids abruptly” was a frequent question I got when I was engaged in treatment for TCS withdrawal support. It was difficult to make doctors asking such a question understand my intention, how many times I may have explained. I always let patients take the initiative in choosing what kind of treatment they want to undergo: stopping steroids or not, or stopping instantly or gradually. I thought patients should be provided with such decision-making rights.
And I did accept and support patients whenever they chose to stop “cold turkey.” If I had recommended gradual reduction over time indicating the harshness of stopping cold turkey and rejected to see patients who did not follow my advice, patients who could not help choosing “cold turkey” out of mistrust in medical service that caused steroid addiction would have lost the place to seek help and carried out the withdrawal by themselves at home. It was medically a very dangerous thing I had to avoid by all means. I have never recommended patients to stop at once.
Some may wonder what on earth I was doing as a dermatologist. But I’d like to ask what the doctor’s job is all about. Is it only deciding a type or dosage of TCS? I thought it far more important to prevent an infection, check for complications in the eyes and give mental support. The same as with other addiction cases, successful rates are higher when patients are given initiatives. Some chose a gradually reducing approach and successfully withdrew from addiction.
I was really encouraged by Dr. Kligman who referred to both approaches of stopping cold turkey and tapering gradually in his paper.
I believe doctors should always be prepared to answer each patient’s desire.