Netflix's new documentary, Shania Twain: Not Just a Girl, follows the country singer from Nashville newcomer to international icon. Twain is the best-selling female country artist of all time, with three diamond-certified albums.
One of the more poignant moments of the documentary comes when Twain talks about a health issue she had back in 2003. While horseback riding, she was bitten by a tick and contracted Lyme disease.
"My symptoms were quite scary because before I was diagnosed, I was on stage very dizzy. I was losing my balance. I was afraid I was gonna fall off the stage," she explains. "I was having these very, very, very millisecond blackouts, but regularly, every minute or every 30 seconds."
She was so fearful that she started standing further back on the stage to avoid falling off the edge.
Perhaps the most devastating symptom to Twain was the effect it had on her speaking and singing voice. "My voice was never the same again. I thought I'd lost my voice forever," she says.
In an interview on the TV show ," Twain noted that, "It was a good 6 or 7 years before a doctor was able to find out that I had sustained nerve damage to my vocal cords, directly caused by Lyme disease."
Over time, Twain began to believe that she would never be able to sing again. However, through two "open throat" vocal cord surgeries, as well as vocal therapy, her voice started to come back.
In 2011, Lionel Ritchie decided that he wanted Twain to redo his classic duet, ," with him. Although she was initially resistant, he finally coached her through their sessions, and her voice started to come back. She was eventually able to return to the stage in 2012, with a residency at Caesars Palace in Las Vegas.
Lyme Disease
Lyme disease is the most common vector-borne disease in the U.S. It is caused by the bacterium Borrelia burgdorferi and in more rare cases, . It is transmitted to humans through the bite of infected blacklegged ticks. The most common tick is an Ixodes genus tick, and in particular Ixodes scapularis.
In the U.S., Lyme disease is most common in the Northeast and upper Midwest, including Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin, with an incidence of approximately 40 per 100,000 people. Lyme disease most commonly occurs from late spring to early fall.
Sporadic cases have also been reported on the West Coast.
Symptoms
Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection -- early (3 to 30 days post tick bite) or late (days to months post tick bite).
Early symptoms include fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes.
that are fairly common in Lyme disease. They occur in approximately 70% to 80% of infected individuals, and begin at the site of a tick bite after a delay of 3 to 30 days (average ~ 7 days). These rashes expand gradually over several days, reaching up to 12 inches or more horizontally. They may feel warm to the touch, but are rarely itchy or painful. They sometimes clear as they enlarge, resulting in a target or "bull's-eye" appearance, which can appear on any area of the body.
Late symptoms of Lyme disease include:
- Severe headaches and neck stiffness
- Additional erythema migrans rashes on other areas of the body
- Facial palsy
- Arthritis with severe joint pain and swelling, particularly in the knees and other large joints
- Intermittent pain in tendons, muscles, joints, and bones
- Heart palpitations or an irregular heartbeat ()
- Episodes of dizziness or shortness of breath
- Inflammation of the brain and spinal cord
- Nerve pain
- Shooting pains, numbness, or tingling in the hands or feet
Diagnosing Lyme Disease
Lyme disease can be difficult to diagnose for several reasons. First, many of the common symptoms (headache, dizziness, joint/body pain) are nonspecific and occur in many other illnesses. The traditional erythema migrans rash doesn't occur in about a fourth of patients. In addition, early diagnosis may be limited by the sensitivity of current testing, based on the detection of anti-Lyme antibodies, which may take some time to rise to detectable levels.
The a two-step approach to Lyme disease testing: a conventional enzyme-linked immunoassay (ELISA) test, followed by a Western blot test. The ELISA is a blood test that detects antibodies, but does not test for B. burgdorferi itself. A positive result from this first-level screening may suggest current or past infection. The ELISA is designed to be very sensitive, meaning that almost everyone who has Lyme disease (and some people who do not) will test positive. If the screening test is negative, it is highly unlikely that the person has Lyme disease, and no further testing is recommended. If the screening test is positive or inconclusive, a Western blot test should be performed to confirm the results.
Used appropriately, the Western blot test is designed to be specific, meaning that it will usually be positive only if a person has been truly infected by B. burgdorferi. If the Western blot is negative, it suggests that the ELISA test was a false positive.
Of note, antibodies can take several weeks to develop, so patients may test negative if infected only recently. In addition, antibodies normally persist in the blood for months or even years after the infection is gone; therefore, the test cannot be used to determine cure.
Treatment of Lyme disease
Early diagnosis and treatment of Lyme disease is important as it can help prevent late Lyme disease symptoms.
Specific treatment is dependent on the age of the patient and the stage of the disease. For patients older than 8 years with localized disease, doxycycline is recommended for 10 days. Children under 8 can be given amoxicillin or cefuroxime for 14 days. Doxycycline can cause tooth discoloration in younger children. Doxycycline should not be used in pregnant women for the same reason.
Patients with more severe manifestations, such as arthritis, AV block, carditis, meningitis, or encephalitis, may require longer courses and/or parenteral antibiotics.
Treatment for patients with early disease is usually curative.
Post-Treatment Lyme Disease Syndrome (PTLDS)
Approximately 5% of patients will have lingering symptoms of fatigue, pain, joint or muscle aches, and difficulty thinking after treatment. This can last more than 6 months after the completion of 2 to 4 weeks of oral antibiotics.
The cause of PTLDS is unknown. Some researchers believe that B. burgdorferi can trigger an autoimmune response, causing symptoms that last well after the infection itself is gone. This would be similar to other autoimmune responses seen in infections such as Campylobacter (Guillain-Barré) or strep throat (rheumatic heart disease). Some experts believe PTLDS results from a persistent but difficult-to-detect infection, or that the symptoms of PTLDS are due to other causes unrelated to the patient's B. burgdorferi infection.
There is no proven treatment for PTLDS, although patients usually get better over time.
Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children's Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.