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Singer Shania Twain had to stop performing for awhile due to what she says were the long-term effects of chronic Lyme disease. Getty Images
  • Singer Shania Twain says the long-term side effects of Lyme disease damaged her vocal cords, causing her to stop performing for awhile.
  • Experts say Twain’s illness is one example of the long-term health problems that confront 10 to 15 percent of people who contract Lyme disease.
  • Experts say people with chronic Lyme disease face skepticism from some in the medical community who don’t believe the long-term illness is a real thing.

Country music star Shania Twain suffered a singer’s worst nightmare — losing her voice — and the cause of the problem was eventually traced to an unlikely source: a tick bite.

The singer’s struggle with Lyme disease highlights the side effects of the disease and how they can manifest in unusual ways.

Those effects also can sometimes emerge years later, even among people who have been treated and presumed to be “cured” of the tick-borne bacterial infection.

In an interview with The Independent, Twain recalled contracting Lyme disease from a tick bite in Virginia in 2003.

“I saw a tick fall off me,” she said. “I was on tour, so I almost fell off the stage every night. I was very, very dizzy and didn’t know what was going on. It’s just one of those things you don’t suspect.”

Twain was diagnosed with Lyme disease at the time. She was treated, but her troubles were apparently just beginning.

Twain is among the 10 to 20 percent of people that experts say can develop long-term health problems despite being treated with antibiotics to kill off the Borrelia burgdorferi bacteria that causes the illness.

“You have a very short window to catch it and then treat it and then even when you treat it, you could still very well be left with effects, which is what happened to me,” Twain said.

Twain lost her voice for several years and ultimately took a 15-year break from performing. She eventually was diagnosed with dysphonia, a kind of vocal cord muscle paralysis, suspected of being related to her Lyme infection.

“When I realized that I could barely sing at all anymore, I was like, ‘I’m humiliating myself. I can’t get out there and do this. I have to stop until I figure it out.’ I thought that it was just fatigue or burnout,” she told People magazine in an interview. “But no — Lyme disease commonly affects the nerves.”

After a pair of surgeries, Twain was able to return to performing in 2017 and recently launched a series of concerts in Las Vegas.

Vocal cord problems related to Lyme disease are unusual, but they are not unheard of either.

“I have seen several cases of vocal cord paralysis in my practice, so it’s not as unusual as it seems,” Dr. Tania Dempsey, a Lyme disease treatment specialist based in Purchase, New York, told Healthline. “Lyme presents differently depending on how the immune system responds and whether other co-infections are present.”

The classic symptoms of acute Lyme infection are relatively well known.

They include a bullseye rash at the site of the tick bite, flu-like muscle aches and fatigue, and, for some people, headaches and “brain fog” cognitive impairment.

Chronic symptoms of Lyme are a much longer list and may include vertigo, ringing in the ears, short-term memory loss, light and sound sensitivity, mood swings, anxiety, depression, heart palpitations, and serious cardiac problems.

Dempsey, while stressing that she has not been involved with Twain’s treatment, suspects that the singer’s dysphonia may have been the result of an untreated Lyme co-infection.

In addition to the Borrelia burgdorferi bacteria, ticks can also transmit a variety of other pathogens, including anaplasmosis, babesiosis, Powassan virus, and B. miyamotoi, according to the National Institutes of Health.

Co-infections are common.

Jason Bobe, MSc, an associate professor at the Mount Sinai Icahn School of Medicine, notes that a study by epidemiologist W. Ian Lipkin at Columbia University in New York found that nearly 60 percent of ticks in a sample gathered in the Northeast contained Borrelia.

Four other co-occurring pathogens that can cause illness in humans were also detected (Anaplasma phagocytophilum, Borrelia miyamotoi, Babesia microti, and Powassan virus).

Dempsey said that while the antibiotic doxycycline is commonly prescribed to treat an acute Lyme infection, other antibiotics and even herbal remedies may be effective in treating chronic Lyme or co-infections.

“Lyme has to be treated clinically and for long enough,” she said

For example, researchers have experimented with using the drug disulfiram, most commonly prescribed as an anti-alcoholism medication under the brand name Antabuse but originally developed as an anti-parasitic medication.

Dempsey added that researchers at schools such as Johns Hopkins University in Maryland also are looking at herbal remedies and essential oils as potential treatments for tick-borne illnesses.

“The key is not to believe that this is just a post-Lyme syndrome,” she said. “If paralysis occurs long after treatment it has to be a co-infection or Lyme that is still active in the body.”

Part of the challenge in treating Lyme and related diseases is a lack of basic research, particularly “gold standard” placebo-controlled, double-blind studies on the illness, its symptoms, and possible remedies, according to Timothy J. Sellati, PhD, chief scientific officer of the Global Lyme Alliance, a non-profit group dedicated to finding a cure for Lyme disease.

“There is no such thing as rock-solid symptoms of Lyme disease,” said Sellati. “The bacteria that causes it mimics other diseases.”

Even the classic bullseye rash doesn’t appear in all people, for example, and other symptoms, such as Lyme arthritis, can commonly be mistaken for other illnesses, such as rheumatoid arthritis.

Early detection of Lyme infection is hampered by diagnostic tools based on the presence of antibodies to the Borrelia burgdorferi bacteria, which the body can take up to two weeks to produce — and some people don’t produce them at all, said Sellati.

A better test, he said, would look for the presence of the bacteria itself.

People like Twain also face continued skepticism from some in the medical community who don’t believe chronic Lyme disease is a real thing, according to Sellati.

Bobe, who pairs researchers and patients as part of Mount Sinai’s LymeMIND study, said that the SLICE (Studies of Lyme disease Immunology and Clinical Events) research at Johns Hopkins estimates that 10 to 20 percent of people treated for Lyme continue to have symptoms after the end of antibiotic treatment.

And that does not account for people who never got treated because they did not realize they had received a tick bite.

There are at least 30,000 cases of Lyme disease cases reported in the United States annually to the Centers for Disease Control and Prevention (CDC). The organization estimates as many as 300,000 people may actually contract the illness.

In 2018, the National Institutes of Health spent $23 million to study Lyme disease. Although funding has increased the past two years, some experts say the funding isn’t near what is needed to do adequate research.

“We don’t have the capacity to study the long tail of this disease,” Bobe told Healthline.