In a new Netflix documentary, Shania Twain revealed that she would regularly "black out" on stage during live shows and feared she would never sing again due to Lyme disease, a tick-borne illness.
The 56-year-old Canadian country music star has previously opened up about her Lyme disease diagnosis and how it has impacted her vocal cords, but she shares new details in the documentary about her health scares during live performances in the 2000s.
According to Twain, she became infected while on tour for her hit album "Up!" The tour ran from September 2003 to July 2004.
"It was nearing the end of the tour. ... I was horseback riding, and I was bit by a tick. The tick was infected with Lyme disease," Twain said in the documentary titled “Not Just A Girl,” released Tuesday.
“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 going to fall off the stage,” Twain recalled.
“I was having these very, very millisecond blackouts, but regularly — every minute or every 30 seconds," she added.
Lyme disease, which is the most common tick-borne disease in the United States, is spread to humans through the bite of an infected blacklegged tick, according to the U.S. Centers for Disease Control and Prevention.
Typical symptoms include fever, headache, fatigue and a characteristic "bull's eye" rash. Most cases of Lyme disease can be treated by taking antibiotics for a few weeks, but if left untreated, the infection can impact the joints, heart and nervous system, according to the CDC.
After being infected with Lyme disease, Twain said her voice was "never the same again," and that she struggled to control her airflow. "I thought I’d lost my voice forever. I thought that was it," Twain said.
In an interview on the U.K. talk show “Loose Women" in 2020, Twain said it took seven years for doctors to realize that the changes to her voice were due to nerve damage to her vocal cords caused by Lyme disease.
According to Mayo Clinic, Lyme disease "can cause inflammation and directly damage the nerves in the voice box," which may result in vocal cord paralysis.
Twain previously revealed to TODAY that she thought her career was over after she was diagnosed with the vocal cord disorder in 2011.
"It was devastating," she said in a March 2020 interview on Sunday TODAY. “I was very, very sad about it, to the point where ... I felt I had no other choice but to just accept it."
Twain said she underwent a number of "invasive" throat surgeries, and though she eventually recovered her voice, it was not the same. But Twain said she did not give up, and with encouragement from fellow musicians like Lionel Richie and David Foster, she eventually got back into music.
"I’ve learned that I could get my voice into a certain place with a lot of effort," said Twain, who now has a residency in Las Vegas, in the documentary.
"I’m never going to have my old voice again. I’m OK with that. I’ve found a new voice. And I like it," she added in the 2020 interview.
A recent study found that over 14% of the world's population has been infected with Lyme disease. The best way to prevent Lyme disease is to reduce your exposure to ticks, according to the CDC. This includes avoiding tick-infested bushy or grassy areas, staying on the trail while hiking, covering up your arms and legs when outside especially in wooded areas, using EPA-approved insect repellent, and thoroughly checking your body for ticks when returning inside.