Shania Twain’s Lyme disease | MedPage today

The new documentary from Netflix, Shania Twain: Not just a girl, follows the Nashville country singer newcomer international icon. Twain is the best-selling female country artist of all time, with three diamond-certified albums.

One of the most poignant moments in the documentary comes when Twain talks about a health problem she had in 2003. While horseback riding, she was bitten by a tick and contracted the disease. of Lyme.

“My symptoms were quite scary because before I was diagnosed, I was very dizzy on stage. I was losing my balance. I was afraid of falling off the stage,” she explains. “I had these very, very, very millisecond blackouts, but regularly, every minute or every 30 seconds.”

She was so scared that she started to stand further back on the stage to avoid falling off the edge.

Perhaps the most devastating symptom for Twain was the effect it had on his speaking and singing voice. “My voice was never the same again. I thought I had lost my voice forever,” she says.

In an interview on the TV show “Cowardly womenTwain noted that, “It took 6 or 7 years before a doctor could find out that I had suffered 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, thanks to two “open throat” vocal cord surgeries, as well as voice therapy, her voice began to return.

In 2011, Lionel Ritchie decided he wanted Twain to redo his classic duet, “Endless Love,” with him. Although she resisted at first, he eventually dragged her through their sessions and her voice started to come back. She was finally 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 United States. It is caused by bacteria Borrelia burgdorferi and in rarer cases, Borrelia mayoni. It is transmitted to humans through the bite of infected blacklegged ticks. The most common tick is a Ixodes genus tick, and in particular Ixodes scapular.

In the United States, Lyme disease is most common in the Northeast and upper Midwest, including Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, L New York State, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin. with an incidence of about 40 per 100,000 people. Lyme disease most often occurs in 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 after tick bite) or late (days to months after tick bite).

Early symptoms include fever, chills, headache, fatigue, muscle and joint pain, and swollen lymph nodes.

Erythema migrans is a fairly common rash 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 (mean ~ 7 days). These rashes spread gradually over several days, reaching up to 12 inches or more horizontally. They can be warm to the touch, but are rarely itchy or painful. They sometimes disappear as they enlarge, giving a bull’s-eye or “bull’s-eye” appearance, which can appear on any area of ​​the body.

Late symptoms of Lyme disease include:

  • Severe headaches and stiff neck
  • Additional rashes of erythema migrans on other parts of the body
  • Facial paralysis
  • Arthritis with severe joint pain and swelling, especially in the knees and other large joints
  • Intermittent pain in tendons, muscles, joints and bones
  • Heart palpitations or irregular heartbeat (Lyme carditis)
  • 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

Diagnose Lyme disease

Lyme disease can be difficult to diagnose for several reasons. First, many of the common symptoms (headaches, dizziness, joint/body pain) are non-specific and occur in many other illnesses. The traditional erythema migrans rash does not occur in about a quarter of patients. Additionally, early diagnosis may be limited by the sensitivity of current tests, based on the detection of anti-Lyme antibodies, which may take some time to reach detectable levels.

The CDC recommends a two-step approach to testing for Lyme disease: a standard enzyme immunoassay (ELISA), followed by a Western blot test. ELISA is a blood test that detects antibodies, but does not test B. burgdorferi himself. A positive result from this first level screening may suggest a current or past infection. The ELISA is designed to be very sensitive, which means almost everyone with Lyme disease (and some people who don’t) 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 it will usually only be positive if a person has actually been infected with B. burgdorferi. If the Western blot is negative, it suggests that the ELISA test was a false positive.

It should be noted that antibodies can take several weeks to develop, so patients may test negative if they were only recently infected. In addition, antibodies normally persist in the blood for months or even years after the infection has cleared; therefore, the test cannot be used to determine cure.

Lyme disease treatment

Early diagnosis and treatment of Lyme disease is important because it can help prevent later symptoms of Lyme disease.

The specific treatment depends on the age of the patient and the stage of the disease. For patients over 8 years of age with localized disease, doxycycline is recommended for 10 days. Children under 8 years old can be given amoxicillin or cefuroxime for 14 days. Doxycycline can cause tooth discoloration in young 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 treatments and/or parenteral antibiotics.

Treatment of patients with early disease is usually curative.

Post-treatment Lyme disease syndrome (PTLDS)

About 5% of patients will experience persistent symptoms of fatigue, pain, joint or muscle pain, and difficulty thinking after treatment. It can last more than 6 months after completion of 2-4 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 long after the infection itself has cleared. 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 that 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 condition. B. burgdorferi infection.

There is no proven treatment for PTLDS, although patients generally improve 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. Its mission is both journalistic and educational: to report on common diseases affecting uncommon people and to summarize the evidence-based medicine behind the headlines.

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