by tyler | Apr 10, 2024 | CNN, health
After Prince Harry’s accounts of a troubled relationship with his brother, Prince William, in his memoir, “Spare,” made waves, you may have wondered if there was any hope for a relationship so fraught — especially if you’re navigating a similar sort of rift.
Though strong relationships among siblings have been linked with greater health and happiness, sibling estrangement is probably more common than schisms between parents and adult children, said Joshua Coleman, a psychologist in private practice in the San Francisco Bay Area and a senior fellow with the Council on Contemporary Families. Parents are more highly motivated to repair those relationships because of their role and the shame and sadness that can come from being on the outs with a child, Coleman said.
“For siblings, there aren’t the same kind of expectations of staying in touch,” said Coleman, author of “Rules of Estrangement: Why Adult Children Cut Ties and How to Heal the Conflict.” “Siblings don’t have the same kind of role violation that can produce shame that can serve as a motivator or as an impetus towards repair.”
Distancing or ending a relationship with a sibling can still feel difficult or shameful, but people who initiate estrangement feel there are benefits, according to Coleman.
“Assuming they’ve done their due diligence and the (other) sibling remains either unable or unwilling to modify or change their behavior, a break from the relationship may be better for mental health than a continuance,” Coleman said.
For cases that aren’t so clear-cut, Coleman has guiding principles for knowing when the relationship is worth saving and when cutting ties is better.
This conversation has been edited and condensed for clarity.
CNN: What are the most common triggers for sibling estrangement?
Coleman: Typical reasons why sibling rifts or estrangement begin include perceived or objectively differential treatment by parents, which can cause one sibling to distance themselves because they feel less valued. A history of emotional, physical or sexual abuse by a sibling can be traumatizing, especially if they haven’t made amends or if the hurt sibling hasn’t been able to forgive. Sibling rivalries — sometimes sparked by one feeling jealous of or threatened by the other’s success — also can drive a wedge.
Sometimes a sibling might begin by estranging themselves from parents, but if the other sibling doesn’t ally with them or is critical of their estrangement, that can produce a feeling of, “Well, you’re either for me or against me.”
CNN: What’s the first step when faced with repeated conflict?
Coleman: You have to do due diligence on the relationship, in that you have to give people the opportunity to repair and communicate your needs in a way that really invites self-reflection and empathy on the other person’s part, rather than more hurt and defensiveness.
You might feel hurt, shamed, humiliated, criticized or diminished by your sibling’s behavior. I think it’s reasonable, then, to say, “I need you to change this to continue to have a relationship with me. I feel like my ask of you is very reasonable, and it’s my strong preference that we change how we communicate. Maybe there are things you might want me to work on as well. But I am beginning to feel that if this isn’t something that you’re able to work to modify, I need to be out of contact for perhaps a significant period of time with you.”
Certainly, someone who is abusive is out of control and requires strong limits to counteract their behavior. That doesn’t mean they should never be given the chance to repair or reconcile, but only after they’ve shown a willingness to commit to making amends and changing.
CNN: When is the relationship worth repairing?
Coleman: When estranged siblings are seeking reconciliation, typically one person is more motivated to heal it than the other and therefore takes more of a leadership role in repairing the dynamic — just kind of showing empathy, being willing to make amends or take responsibility, etc.
If the other person is showing genuine empathy and is willing to not be defensive, to commit to change, to be respectful of your boundaries or requirements for a healthy relationship, those are really the key ingredients to any healthy relationship that’s in need of repair.
CNN: When is cutting ties the best thing to do?
Coleman: I really struggle with that question because I feel like our culture is too endorsing and too quick to cut ties, so every person has to make that decision for themselves.
When someone is contemplating something so consequential, it requires a degree of self-reflection. Are you too sensitive to everyone? Are you constantly ghosting people in every aspect of your life? Are you accusing everybody of gaslighting you if they don’t agree with your perception of events? Are you just cutting out one more person because you can’t tolerate conflict?
Sometimes taking a break from the relationship can be useful if you feel too enmeshed with them to be able to separate your own identity from what gets triggered. For some people, some period of distance in which they’re not constantly being triggered or reminded about things about themselves they don’t like or feel upset about could be useful.
Assuming you’ve done all the other steps of due diligence, sometimes ending contact for a while might be a good wake-up call for that sibling.
CNN: How much of a grace or trial period should someone give?
Coleman: Nobody’s going to be 100% perfect once new boundaries are in place. The goal is to agree that the new dynamic will be worked on together, because maybe the person who’s engaging in the hurtful behavior isn’t aware of it or needs to be educated in an ongoing way.
Give it a few months at least, during which you continue to engage and debrief after interactions. You might say, “I thought it went great. However, I am triggered or upset when you start defending Mom and Dad to me or get competitive with me about something.”
CNN: How should people distance or end the relationship?
Coleman: Say, “I feel like I’ve tried to explain to you the problems I see in the relationship, and to give you an opportunity to respond to or work on them. And it feels like you either haven’t been able to or haven’t been that motivated to, so it decreases my desire to spend time with you. So, for the time being, I’d like to take a break from the relationship. And I can let you know if or when that changes.”
CNN: What do people tend to experience after changing or severing a sibling relationship, and how can they cope?
Coleman: Typically, the person who ended the relationship isn’t in as much pain as the person who was cut off. The person who ends things may feel relieved or happy.
It isn’t always all upsides, though. Ending the relationship means we’re not only losing contact with the parts of them we don’t like, we’re also losing contact with the parts we do like. There can be a feeling of loss or sadness about giving up or recognizing the person may not be willing to change.
They might also feel shame and guilt if the other family members are upset with them or pressuring them to be back in contact.
Remind yourself of the effort you put in and that if you’re shaming yourself for your decision, you’re only adding insult to injury. You did give that person a reasonable period for due diligence, so this isn’t something you’ve done in some capricious or selfish way.
CNN: What if the estrangement causes issues with other family members?
Coleman: Be empathic about their pain while firmly stating that you’ve worked hard to get your sibling to respond differently to you, but they’ve been either unwilling or unable — so this isn’t a decision you’ve made lightly. You can’t just maintain a relationship with your sibling because your parent wants you to.
by tyler | Apr 4, 2024 | CNN, health
Here’s a look at mpox, formerly known as monkeypox, in the United States. Mpox is a viral disease caused by infection with the monkeypox virus. In 2022, an outbreak was declared a public health emergency of international concern by the World Health Organization (WHO). The virus originated in Africa and is the cousin of the smallpox virus
In November 2022, WHO announced that “mpox” is now the preferred name for monkeypox after working with International Committee on the Taxonomy of Viruses to rename the the virus using non-stigmatizing, non-offensive social and cultural nomenclature.
(Source: Centers for Disease Control and Prevention)
Mpox is a poxvirus. It generally causes pimple- or blister-like lesions and flu-like symptoms such as fever. The disease is rarely fatal.
Mpox spreads through close contact. This includes direct physical contact with lesions as well as “respiratory secretions” shared through face-to-face interaction and touching objects that have been contaminated by mpox lesions or fluids. The virus may also pass to a fetus through the placenta.
Anyone can become ill from mpox, but the US Centers for Disease Control and Prevention (CDC) says that more than 99% of mpox cases in the United States in the 2022 outbreak have been among men who have sex with men. However, mpox is not generally considered a sexually transmitted disease.
Mpox is usually found in West and Central Africa, but additional cases have been seen in Europe, including the United Kingdom, and other parts of the world in recent years. Those cases are typically linked to international travel or imported animals infected with the poxvirus.
CDC Mpox Map and Case Count
WHO Situation Reports
Timeline and 2022 Outbreak
1958 – Mpox is discovered when monkeys kept for research cause two outbreaks in Copenhagen, Denmark.
1970 – The first human case is recorded in Zaire (now the Democratic Republic of Congo).
2003 – An outbreak in the United States is linked to infected pet prairie dogs imported from Ghana and results in more than 80 cases.
July 16, 2021 – The CDC and local health officials in Dallas announce they are investigating a case of mpox in a traveler from Nigeria. “The individual is a City of Dallas resident who traveled from Nigeria to Dallas, arriving at Love Field airport on July 9, 2021. The person is hospitalized in Dallas and is in stable condition,” the Dallas County Department of Health and Human Services says in a statement.
May 17, 2022 – The first confirmed US case of mpox in the 2022 outbreak is reported to the CDC in a traveler who returned to Massachusetts from Canada.
May 19, 2022 – WHO reports that death rates of the outbreak have been between 3% and 6%.
May 23, 2022 – The CDC announces the release of mpox vaccine doses from the nation’s Strategic National Stockpile for “high-risk people.” In the United States, the two-dose Jynneos vaccine is licensed to prevent smallpox and specifically to prevent mpox.
May 26, 2022 – CDC Director Dr. Rochelle Walensky announces that the United States is distributing the vaccine to states with reported cases and recommends vaccination for people at highest risk of infection due to direct contact with someone who has mpox.
June 22, 2022 – The CDC announces a partnership with five commercial laboratories to ramp up testing capacity in the United States.
June 23, 2022 – New York City launches the first mpox vaccination clinic in the United States.
June 28, 2022 – The US Department of Health and Human Services (HHS) and the Biden administration announce an enhanced vaccination strategy and report that more than 9,000 doses of vaccine have been distributed to date.
July 22, 2022 – Two American children contract mpox – a first in the United States. According to the CDC, the two cases are unrelated.
July 23, 2022 – WHO declares mpox a public health emergency of international concern, “an extraordinary event that may constitute a public health risk to other countries through international spread of disease and may require an international coordinated response.”
July 27, 2022 – After weeks of mpox vaccines being in limited supply, more than 786,000 additional doses are made available in the United States, according to HHS.
July 29, 2022 – New York declares a state disaster emergency in response to the mpox outbreak.
August 1, 2022 – California and Illinois declare states of emergency. California has reported more than 800 cases, while Illinois has had more than 500, according to data from the CDC.
August 2, 2022 – An mpox response team is created by the Biden administration. President Joe Biden names Robert Fenton from the Federal Emergency Management Agency (FEMA) as the White House national mpox response coordinator.
August 2, 2022 – A report from Spain’s National Institute for Microbiology indicates two men, ages 31 and 44, who died from mpox in unrelated cases had both developed encephalitis, or swelling of the brain, which can be triggered by viral infections. Encephalitis is a very rare condition known to be associated with mpox. It has been reported in people with mpox in West Africa and in a patient in the United States in 2003 during the small outbreak linked to imported prairie dogs.
August 4, 2022 – The Biden administration declares the mpox outbreak a national public health emergency.
August 5, 2022 – A report published by the CDC finds that 94% of cases were among men who had recent sexual or close intimate contact with another man. Further, 54% of cases were among Black Americans and Latinos.
August 9, 2022 – In an effort to stretch the limited supply of the Jynneos mpox vaccine, federal health officials authorize administering smaller doses using a different method of injection. The new injection strategy allows health-care providers to give shallow injections intradermally, in between layers of the skin, with one-fifth the standard dose size instead of subcutaneously, into the fatty layer below the skin, with the larger dose.
August 18, 2022 – The White House announces the acceleration of the HHS vaccine distribution timeline, with an additional 1.8 million doses of the Jynneos vaccine being made available. Additional vaccines will be distributed to communities hosting large LGBTQI+ events.
August 19, 2022 – Washington’s King County, which includes Seattle, declares mpox a public health emergency, with more than 270 recorded cases.
September 12, 2022 – The first US death due to mpox is confirmed in Los Angeles County, California.
May 11, 2023 – WHO declares the mpox outbreak is no longer a global health emergency.
October 26, 2023 – CDC’s Advisory Committee on Immunization Practices, or ACIP, votes unanimously to recommend that certain individuals ages 18 and older who are at high risk for getting mpox continue to get the vaccine as a routine part of their sexual health care.
by tyler | Apr 2, 2024 | CNN, health
Here’s a look at mpox, formerly known as monkeypox, in the United States. Mpox is a viral disease caused by infection with the monkeypox virus. In 2022, an outbreak was declared a public health emergency of international concern by the World Health Organization (WHO). The virus originated in Africa and is the cousin of the smallpox virus
In November 2022, WHO announced that “mpox” is now the preferred name for monkeypox after working with International Committee on the Taxonomy of Viruses to rename the the virus using non-stigmatizing, non-offensive social and cultural nomenclature.
(Source: Centers for Disease Control and Prevention)
Mpox is a poxvirus. It generally causes pimple- or blister-like lesions and flu-like symptoms such as fever. The disease is rarely fatal.
Mpox spreads through close contact. This includes direct physical contact with lesions as well as “respiratory secretions” shared through face-to-face interaction and touching objects that have been contaminated by mpox lesions or fluids. The virus may also pass to a fetus through the placenta.
Anyone can become ill from mpox, but the US Centers for Disease Control and Prevention (CDC) says that more than 99% of mpox cases in the United States in the 2022 outbreak have been among men who have sex with men. However, mpox is not generally considered a sexually transmitted disease.
Mpox is usually found in West and Central Africa, but additional cases have been seen in Europe, including the United Kingdom, and other parts of the world in recent years. Those cases are typically linked to international travel or imported animals infected with the poxvirus.
CDC Mpox Map and Case Count
WHO Situation Reports
Timeline and 2022 Outbreak
1958 – Mpox is discovered when monkeys kept for research cause two outbreaks in Copenhagen, Denmark.
1970 – The first human case is recorded in Zaire (now the Democratic Republic of Congo).
2003 – An outbreak in the United States is linked to infected pet prairie dogs imported from Ghana and results in more than 80 cases.
July 16, 2021 – The CDC and local health officials in Dallas announce they are investigating a case of mpox in a traveler from Nigeria. “The individual is a City of Dallas resident who traveled from Nigeria to Dallas, arriving at Love Field airport on July 9, 2021. The person is hospitalized in Dallas and is in stable condition,” the Dallas County Department of Health and Human Services says in a statement.
May 17, 2022 – The first confirmed US case of mpox in the 2022 outbreak is reported to the CDC in a traveler who returned to Massachusetts from Canada.
May 19, 2022 – WHO reports that death rates of the outbreak have been between 3% and 6%.
May 23, 2022 – The CDC announces the release of mpox vaccine doses from the nation’s Strategic National Stockpile for “high-risk people.” In the United States, the two-dose Jynneos vaccine is licensed to prevent smallpox and specifically to prevent mpox.
May 26, 2022 – CDC Director Dr. Rochelle Walensky announces that the United States is distributing the vaccine to states with reported cases and recommends vaccination for people at highest risk of infection due to direct contact with someone who has mpox.
June 22, 2022 – The CDC announces a partnership with five commercial laboratories to ramp up testing capacity in the United States.
June 23, 2022 – New York City launches the first mpox vaccination clinic in the United States.
June 28, 2022 – The US Department of Health and Human Services (HHS) and the Biden administration announce an enhanced vaccination strategy and report that more than 9,000 doses of vaccine have been distributed to date.
July 22, 2022 – Two American children contract mpox – a first in the United States. According to the CDC, the two cases are unrelated.
July 23, 2022 – WHO declares mpox a public health emergency of international concern, “an extraordinary event that may constitute a public health risk to other countries through international spread of disease and may require an international coordinated response.”
July 27, 2022 – After weeks of mpox vaccines being in limited supply, more than 786,000 additional doses are made available in the United States, according to HHS.
July 29, 2022 – New York declares a state disaster emergency in response to the mpox outbreak.
August 1, 2022 – California and Illinois declare states of emergency. California has reported more than 800 cases, while Illinois has had more than 500, according to data from the CDC.
August 2, 2022 – An mpox response team is created by the Biden administration. President Joe Biden names Robert Fenton from the Federal Emergency Management Agency (FEMA) as the White House national mpox response coordinator.
August 2, 2022 – A report from Spain’s National Institute for Microbiology indicates two men, ages 31 and 44, who died from mpox in unrelated cases had both developed encephalitis, or swelling of the brain, which can be triggered by viral infections. Encephalitis is a very rare condition known to be associated with mpox. It has been reported in people with mpox in West Africa and in a patient in the United States in 2003 during the small outbreak linked to imported prairie dogs.
August 4, 2022 – The Biden administration declares the mpox outbreak a national public health emergency.
August 5, 2022 – A report published by the CDC finds that 94% of cases were among men who had recent sexual or close intimate contact with another man. Further, 54% of cases were among Black Americans and Latinos.
August 9, 2022 – In an effort to stretch the limited supply of the Jynneos mpox vaccine, federal health officials authorize administering smaller doses using a different method of injection. The new injection strategy allows health-care providers to give shallow injections intradermally, in between layers of the skin, with one-fifth the standard dose size instead of subcutaneously, into the fatty layer below the skin, with the larger dose.
August 18, 2022 – The White House announces the acceleration of the HHS vaccine distribution timeline, with an additional 1.8 million doses of the Jynneos vaccine being made available. Additional vaccines will be distributed to communities hosting large LGBTQI+ events.
August 19, 2022 – Washington’s King County, which includes Seattle, declares mpox a public health emergency, with more than 270 recorded cases.
September 12, 2022 – The first US death due to mpox is confirmed in Los Angeles County, California.
May 11, 2023 – WHO declares the mpox outbreak is no longer a global health emergency.
October 26, 2023 – CDC’s Advisory Committee on Immunization Practices, or ACIP, votes unanimously to recommend that certain individuals ages 18 and older who are at high risk for getting mpox continue to get the vaccine as a routine part of their sexual health care.
by tyler | Apr 1, 2024 | CNN, health
Here’s a look at mpox, formerly known as monkeypox, in the United States. Mpox is a viral disease caused by infection with the monkeypox virus. In 2022, an outbreak was declared a public health emergency of international concern by the World Health Organization (WHO). The virus originated in Africa and is the cousin of the smallpox virus
In November 2022, WHO announced that “mpox” is now the preferred name for monkeypox after working with International Committee on the Taxonomy of Viruses to rename the the virus using non-stigmatizing, non-offensive social and cultural nomenclature.
(Source: Centers for Disease Control and Prevention)
Mpox is a poxvirus. It generally causes pimple- or blister-like lesions and flu-like symptoms such as fever. The disease is rarely fatal.
Mpox spreads through close contact. This includes direct physical contact with lesions as well as “respiratory secretions” shared through face-to-face interaction and touching objects that have been contaminated by mpox lesions or fluids. The virus may also pass to a fetus through the placenta.
Anyone can become ill from mpox, but the US Centers for Disease Control and Prevention (CDC) says that more than 99% of mpox cases in the United States in the 2022 outbreak have been among men who have sex with men. However, mpox is not generally considered a sexually transmitted disease.
Mpox is usually found in West and Central Africa, but additional cases have been seen in Europe, including the United Kingdom, and other parts of the world in recent years. Those cases are typically linked to international travel or imported animals infected with the poxvirus.
CDC Mpox Map and Case Count
WHO Situation Reports
Timeline and 2022 Outbreak
1958 – Mpox is discovered when monkeys kept for research cause two outbreaks in Copenhagen, Denmark.
1970 – The first human case is recorded in Zaire (now the Democratic Republic of Congo).
2003 – An outbreak in the United States is linked to infected pet prairie dogs imported from Ghana and results in more than 80 cases.
July 16, 2021 – The CDC and local health officials in Dallas announce they are investigating a case of mpox in a traveler from Nigeria. “The individual is a City of Dallas resident who traveled from Nigeria to Dallas, arriving at Love Field airport on July 9, 2021. The person is hospitalized in Dallas and is in stable condition,” the Dallas County Department of Health and Human Services says in a statement.
May 17, 2022 – The first confirmed US case of mpox in the 2022 outbreak is reported to the CDC in a traveler who returned to Massachusetts from Canada.
May 19, 2022 – WHO reports that death rates of the outbreak have been between 3% and 6%.
May 23, 2022 – The CDC announces the release of mpox vaccine doses from the nation’s Strategic National Stockpile for “high-risk people.” In the United States, the two-dose Jynneos vaccine is licensed to prevent smallpox and specifically to prevent mpox.
May 26, 2022 – CDC Director Dr. Rochelle Walensky announces that the United States is distributing the vaccine to states with reported cases and recommends vaccination for people at highest risk of infection due to direct contact with someone who has mpox.
June 22, 2022 – The CDC announces a partnership with five commercial laboratories to ramp up testing capacity in the United States.
June 23, 2022 – New York City launches the first mpox vaccination clinic in the United States.
June 28, 2022 – The US Department of Health and Human Services (HHS) and the Biden administration announce an enhanced vaccination strategy and report that more than 9,000 doses of vaccine have been distributed to date.
July 22, 2022 – Two American children contract mpox – a first in the United States. According to the CDC, the two cases are unrelated.
July 23, 2022 – WHO declares mpox a public health emergency of international concern, “an extraordinary event that may constitute a public health risk to other countries through international spread of disease and may require an international coordinated response.”
July 27, 2022 – After weeks of mpox vaccines being in limited supply, more than 786,000 additional doses are made available in the United States, according to HHS.
July 29, 2022 – New York declares a state disaster emergency in response to the mpox outbreak.
August 1, 2022 – California and Illinois declare states of emergency. California has reported more than 800 cases, while Illinois has had more than 500, according to data from the CDC.
August 2, 2022 – An mpox response team is created by the Biden administration. President Joe Biden names Robert Fenton from the Federal Emergency Management Agency (FEMA) as the White House national mpox response coordinator.
August 2, 2022 – A report from Spain’s National Institute for Microbiology indicates two men, ages 31 and 44, who died from mpox in unrelated cases had both developed encephalitis, or swelling of the brain, which can be triggered by viral infections. Encephalitis is a very rare condition known to be associated with mpox. It has been reported in people with mpox in West Africa and in a patient in the United States in 2003 during the small outbreak linked to imported prairie dogs.
August 4, 2022 – The Biden administration declares the mpox outbreak a national public health emergency.
August 5, 2022 – A report published by the CDC finds that 94% of cases were among men who had recent sexual or close intimate contact with another man. Further, 54% of cases were among Black Americans and Latinos.
August 9, 2022 – In an effort to stretch the limited supply of the Jynneos mpox vaccine, federal health officials authorize administering smaller doses using a different method of injection. The new injection strategy allows health-care providers to give shallow injections intradermally, in between layers of the skin, with one-fifth the standard dose size instead of subcutaneously, into the fatty layer below the skin, with the larger dose.
August 18, 2022 – The White House announces the acceleration of the HHS vaccine distribution timeline, with an additional 1.8 million doses of the Jynneos vaccine being made available. Additional vaccines will be distributed to communities hosting large LGBTQI+ events.
August 19, 2022 – Washington’s King County, which includes Seattle, declares mpox a public health emergency, with more than 270 recorded cases.
September 12, 2022 – The first US death due to mpox is confirmed in Los Angeles County, California.
May 11, 2023 – WHO declares the mpox outbreak is no longer a global health emergency.
October 26, 2023 – CDC’s Advisory Committee on Immunization Practices, or ACIP, votes unanimously to recommend that certain individuals ages 18 and older who are at high risk for getting mpox continue to get the vaccine as a routine part of their sexual health care.
by tyler | Mar 26, 2024 | CNN, health
While the fate of mifepristone, one of two drugs used for medication abortions, is in the hands of the US Supreme Court, the drug continues to be available in states where abortion is legal.
“While many women obtain medication abortion from a clinic or their OB-GYN, others obtain the pills on their own to self-induce or self-manage their abortion,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
“A growing body of research indicates that self-managed abortion is safe and effective,” he said.
Mifepristone blocks the hormone progesterone, which is needed for a pregnancy to continue. The drug is approved to end a pregnancy through 10 weeks’ gestation, which is “70 days or less since the first day of the last menstrual period,” according to the FDA.
In a medication abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available at pharmacies for decades.
Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of the abortions in the United States, according to the Guttmacher Institute, a research group that supports abortion rights.
“Some people do this because they cannot access a clinic — particularly in states with legal restrictions on abortion — or because they have a preference for self-care,” said Grossman, who is also the director of Advancing New Standards in Reproductive Health, a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman’s health.
READ MORE: With US Supreme Court abortion drug hearing looming, study shows how self-managed abortion became more common post-Dobbs
What happens during a medication abortion? To find out, CNN spoke with Grossman. This conversation has been condensed and edited for clarity.
CNN: What is the difference between a first-trimester medication abortion and a vacuum aspiration in terms of what a woman experiences?
Dr. Daniel Grossman: A vacuum aspiration is most commonly performed under a combination of local anesthetic and oral pain medications or local anesthetic together with intravenous sedation, or what is called conscious sedation.
An injection of local anesthetic is given to the area around the cervix, and the cervix is gently dilated or opened up. Once the cervix is opened, a small straw-like tube is inserted into the uterus, and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is done before nine weeks or so, there’s nothing in the tissue that would be recognizable as a part of an embryo.
The aspiration procedure takes just a couple of minutes. Then the person is observed for one to two hours until any sedation has worn off. We also monitor each patient for very rare complications, such as heavy bleeding.
A medication abortion is a more prolonged process. After taking the pills, bleeding and cramping can occur over a period of days. Bleeding is typically heaviest when the actual pregnancy is expelled, but that bleeding usually eases within a few hours. On average people continue to have some mild bleeding for about two weeks or so, which is a bit longer than after a vacuum aspiration.
Nausea, vomiting, fever, chills, diarrhea and headache can occur after using the abortion pill, and everyone who has a successful medication abortion usually reports some pain.
In fact, the pain of medication abortion can be quite intense. In the studies that have looked at it, the average maximum level of pain that people report is about a seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be brief, peaking just as the pregnancy is being expelled.
The level of cramping and pain can depend on the length of the pregnancy as well as whether or not someone has given birth before. For example, a medical abortion at six weeks or less gestation typically has less pain and cramping than one performed at nine weeks. People who have given birth generally have less pain.
CNN: What can be done to help with the pain of a medication abortion?
Grossman: There are definitely things that can be used to help with the pain. Research has shown that ibuprofen is better than acetaminophen for treating the pain of medication abortion. We typically advise people to take 600 milligrams every six hours or so as needed.
Some people take tramadol, a narcotic analgesic, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research I was involved in found medications like tramadol can be helpful if taken prophylactically before the pain starts.
Another successful regimen that we studied combined ibuprofen with a nausea medicine called metoclopramide that also helped with pain. Other than ibuprofen, these medications require a prescription.
Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medication abortion. It works through pads put on the abdomen that stimulate the nerves through mild electrical shocks, thus interfering with the pain signals. That’s something people could get without a prescription.
Pain can be an overlooked issue with medication abortion because, quite honestly, as clinicians, we’re not there with patients when they are in their homes going through this. But as we’ve been doing more research on people’s experiences with medication abortion, it’s become quite clear that pain control is really important. I think we need to do a better job of treating the pain and making these options available to patients.
CNN: Are there health conditions that make the use of a medication abortion unwise?
Grossman: Undergoing a medication abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside of the uterus. It’s rare, happening in about two out of every 100 pregnancies — and it appears to be even rarer among people seeking medication abortion.
People who have undergone previous pelvic, fallopian tube or abdominal surgery are at higher risk of an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can raise risk, as does smoking, a history of infertility and use of infertility treatments such as in vitro fertilization (IVF).
If a person is on anticoagulant or blood thinning drugs or has a bleeding disorder, a medication abortion is not advised. The long-term use of steroids is another contraindication for using the abortion pill.
Anyone using an intrauterine device, or IUD, must have it removed before taking mifepristone because it may be partially expelled during the process, which can be painful.
People with chronic adrenal failure or who have inherited a rare disorder called porphyria are not good candidates.
CNN: Are there any signs of trouble a woman should watch for after undergoing a medication abortion?
Grossman: It can be common to have a low-grade fever in the first few hours after taking misoprostol, the second drug in a medication abortion. If someone has a low-grade fever — 100.4 degrees to 101 degrees Fahrenheit — that lasts more than four hours, or has a high fever of over 101 degrees Fahrenheit after taking the medications, they do need to be evaluated by a health care provider.
Heavy bleeding, which would be soaking two or more thick full-size pads an hour for two consecutive hours, or a foul-smelling vaginal discharge should be evaluated as well.
One of the warning signs of an ectopic pregnancy is severe pelvic pain, particularly on one side of the abdomen. The pain can also radiate to the back. Another sign is getting dizzy or fainting, which could indicate internal bleeding. These are all very rare complications, but it’s wise to be on the lookout.
We usually recommend that someone having a medication abortion have someone with them during the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medication abortion because they can be surrounded by a partner, family or friends.
Most people know that the abortion is complete because they stop feeling pregnant, and symptoms such as nausea and breast tenderness disappear, usually within a week of passing the pregnancy. A home urine pregnancy test may remain positive even four to five weeks after a successful medication abortion, just because it takes that long for the pregnancy hormone to disappear from the bloodstream.
If someone still feels pregnant, isn’t sure if the pregnancy fully passed or has a positive pregnancy test five weeks after taking mifepristone, they need to be evaluated by a clinician.
People should know that they can ovulate as soon as two weeks after a medication abortion. Most birth control options can be started immediately after a medication abortion.
by tyler | Mar 20, 2024 | CNN, health
Just as spring is a time for rebirth, the Persian New Year is a time to celebrate new life. Nowruz is celebrated on the spring equinox, which Tuesday, March 19.
This celebration of spring is filled with symbolism around rebirth and renewal, because spring is a time when life is coming back after a long, cold winter, said Yasmin Khan, the London-based human rights campaigner turned author of “The Saffron Tales: Recipes from the Persian Kitchen,” “Zaitoun: Recipes and Stories from the Palestinian Kitchen,” and “Ripe Figs: Recipes and Stories from the Eastern Mediterranean.”
These three cookbooks from Khan inspire and provide a window into the cultures and stories of people from the Middle East through food.
The conversation has been edited and condensed for clarity.
CNN: What are some of Persian New Year’s traditions and rituals?
Yasmin Khan: On the last Tuesday before the New Year, there is a tradition to make small bonfires in your garden. Traditionally people jump over the bonfires, and it’s supposed to be a symbol of purification, challenges of the year gone by, and energetically cleansing you and preparing you for the year ahead.
A key tradition is to set up an altar in your house called a Haft-seen, which means seven S’s in Farsi. You place seven things on your altar that begin with the letter S in Farsi, which are symbols or qualities you’d like to invite in for the year ahead. You can have apples for good health, candles for light, eggs for fertility, wheatgrass for rebirth and renewal, vinegar for wisdom, and a gold coin for abundance and prosperity. Each person chooses items that have meaning for them.
The festival lasts two weeks. At the end of the festival, you take the wheatgrass you’ve been growing on your altar and you take it down to some running water somewhere. You tie knots in the wheatgrass then throw it into the running water. It would float off along with all your hopes and dreams for the year ahead.
CNN: What food is important for the holiday?
Khan: Like all cultural celebrations, food is a really integral part. Because it’s a festival celebrating spring, we eat lots of green and fresh herbs. For example, there’s this dish called Kuku Sabzi (see recipe below), which is a gorgeous herb and spinach frittata that we always eat on the first day of the year in our house. The frittata is fragrant and aromatic and is served with flatbreads, sliced tomatoes and pickles.
The first meal of the Persian New Year is always fish served with herb-flecked rice filled with dill, parsley and chives in it. The two-week festival is a time of celebration with people you know … traditionally you go to people’s houses and eat lots of delicious sweets and pastries.
CNN: What are some easy ways people can join in the celebrations?
Khan: Cooking is probably the easiest and most fun way to celebrate the new year. I really recommend that people give some Persian recipes a go. As well as being delicious, they’re healthy and vibrant with all the herbs that are packed in them.
In the weeks before the new year, we do a big deep spring cleaning called “shaking down the house” in Farsi. It’s really lovely to have a focus and have something that is about bringing in new life, renewal and rebirth during this difficult time.
And no one regrets a spring clean, so I think that’s also a really great idea. I think this is a beautiful kind of nonreligious festival that everyone can join into and that we can all relate to. It’s a time where we really try and let go of any difficulties that we’ve had in the past year and try to start the new year with a clean slate.
This Iranian frittata is a sensational deep green color and tastes like spring on a plate, bursting with fresh herby flavor. It is incredibly quick to throw together, will keep for a few days in the fridge, and can be enjoyed hot or cold.
Serve as an appetizer or as part of a mezze spread, wrapped up in a flatbread with some slices of tomato and a few salty and sour fermented cucumber pickles, or add some crumbled feta and lightly toasted walnuts for a more substantial main.
Makes 4 servings as a main or 8 servings as a starter
Prep time: 15 minutes | Total time: 35 minutes
Ingredients
7 ounces|200 grams spinach
1 3/4 ounces|50 grams fresh parsley
1 3/4 ounces|50 grams fresh dill
2 2/3 ounces|75 grams fresh cilantro
5 medium eggs
1/2 teaspoon turmeric
2 tablespoons all-purpose flour
1 teaspoon sea salt
1 teaspoon freshly ground black pepper
1 teaspoon dried fenugreek leaf
2 teaspoons sunflower oil
2 garlic cloves, crushed
Instructions
1. Wash spinach, parsley, dill and cilantro, then dry well on paper towels or in a salad spinner. Squeeze out as much moisture as possible; if the greens are wet when they are cooked, they will make the kuku go spongy. Chop finely or blitz in a food processor, in a couple of batches.
2. Heat broiler to high. Crack eggs into a large mixing bowl. Add turmeric, flour, salt, pepper and fenugreek leaf. Stir in the chopped spinach and herbs.
3. Heat oil in a large ovenproof skillet. Add garlic and gently fry over low heat to soften, about 2 minutes.
4. Make sure garlic is evenly distributed around the skillet, then pour in the egg mixture. Cook over low heat until kuku is almost cooked through, 5-8 minutes. Finish off in hot broiler.
5. Let kuku cool slightly, then cut into triangular slices to serve.
Makes 4 servings
Ingredients
Marinade
2 garlic cloves, minced
1/2 cup dark soy sauce
Juice of 1 medium lemon
3 tablespoons extra-virgin olive oil
Pinch of cayenne pepper (optional)
4 salmon fillets
Mixed herb rice
1 3/4 cups white basmati rice
Sea salt
Pinch of saffron strands
Pinch of granulated sugar
2 tablespoons freshly boiled water
1 small bunch fresh parsley, finely chopped
1 small bunch fresh coriander, finely chopped
2 tablespoons fresh dill, finely chopped
2 tablespoons bunch fresh chives, finely chopped
1 garlic clove, crushed
Sunflower oil
2 tablespoons unsalted butter, divided
Instructions
1. To make the marinade, combine garlic, soy sauce, lemon juice, olive oil and cayenne pepper, if using, in a deep bowl. Add salmon, turn to coat well, cover with plastic wrap and let marinate in the fridge for at least 30 minutes.
2. Rinse and parboil rice and prepare the saffron liquid. Place saffron in a pestle and mortar with sugar and grind until you have a fine powder. Add just-boiled water and let steep for 10 minutes.
3. Very carefully, fold rice, chopped herbs, garlic clove and 1 tablespoon oil together, being careful not to break the rice grains.
4. Preheat oven to 400°F/Gas 6. Place an 8”-wide nonstick saucepan with snug-fitting lid over a medium heat. Melt 1 tablespoon butter with 2 tablespoons oil. Add 1 tablespoon saffron liquid and season with a pinch of salt. Once the fat is hot, sprinkle a thin layer of rice over the bottom and firmly press down to line the base of the pan. Using a large spoon, gently layer the rest of the rice on top, building it up into a pyramid shape. Using the handle of a wooden spoon, make 4 holes in the rice. Dot remaining 1 tablespoon butter into holes and then pour over the rest of the saffron liquid.
5. Place a clean tea towel or 4 paper towels on top of the pan and fit the lid on tightly. Tuck in the edges of the tea towel, or trim paper towels to fit, so they won’t catch the flame. Cook over medium heat for 5 minutes, then reduce heat to very low and cook 15 minutes more. Take rice off heat and let sit. Do not be tempted to sneak a peek while it is cooking as this will disturb the steaming process. When rice has been cooking for 10 minutes, place salmon on a baking tray and bake skin side up until cooked to your liking, 10-15 minutes.
6. Once rice has cooked, fill sink with 2” cold water and place saucepan – with lid still tightly on – in the water. This will produce a rush of steam that should loosen the base of the rice. Remove lid, place a large plate on top of pan and quickly turn rice over. Present the herbed rice with the fish and serve immediately.
This recipes are adapted from Yasmin Khan’s book “The Saffron Tales: Recipes from the Persian Kitchen.”
