Shania Twain has opened up about contracting Lyme disease and the frightening symptoms she suffered while on stage.
The country singer and songwriter, 56, has revealed her battle with the illness and the devastating effect it had on her career in her new Netflix documentary Not Just a Girl.
While getting ready to go on tour to promote her much-loved music in 2003, she went on a life-changing horseback ride in the forest, getting bitten by a tick.
"The tick was infected with Lyme disease, and I did get Lyme disease," Twain says in the documentary.
"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... I was having these very, very, very millisecond blackouts, but regularly, every minute or every 30 seconds."
The illness also had a huge impact on the Canadian star's instantly recognisable voice, as she started to lose control over her vocals.
"My voice was never the same again," she says. "I thought I'd lose my voice forever. I thought that was it, [and] I would never, ever sing again."
"You start avoiding speaking on the phone, you start avoiding places with ambient noise where you have to speak over others, it's very debilitating," she previously said on Loose Women.
"Our voice is such a huge part of our self-expression and for a vocalist, a singer... it's devastating in so many ways."
After many years, a doctor eventually confirmed she had suffered nerve damage to her vocal chords directly caused by Lyme disease, but she then persevered with trying to heal and making music again.
As this journey included having surgeries, she said in an interview on Sunday Today with Willie Guest, " [Getting back to singing again] was little by little because the surgery is invasive. It's given me more room to play, to be honest."
And after previously "mourning the expression" of her voice, she added, "I have gravel...I think it's kind of sexy. I'm never gonna have my own voice again – I'm okay with that. I've found a new voice and I like it."
Twain recently stunned crowds at Coachella in the US with her surprise duet with Harry Styles, showing just how much she's overcome in her battle with the Lyme disease. But what exactly is it and what are the symptoms?
What is Lyme disease?
Lyme disease is a bacterial infection that can be spread to humans by infected ticks, according to the NHS. It's usually easier to treat if it's diagnosed early.
While not all ticks in England carry the bacteria that causes the disease, it's still important to be aware of them and know how to safely remove them incase.
Ticks that can cause Lyme disease are still found across the UK. High-risk places include grassy and woodland areas in southern and northern England and the Scottish Highlands.
Symptoms of Lyme disease
A circular or oval shape rash around a tick bite can be an early symptom of Lyme disease to look out for, the health service advises.
You could spot the rash up to three months after being bitten by an infected tick, but it usually appears within one to four weeks, and can last several weeks.
To help distinguish it from a normal rash, it can have a darker or lighter area in the centre and might gradually spread. It's unlikely to be hot or itchy.
Instead, it might be flat, slightly raised, look, pink, red, or purple in appearance when it appears on white skin. Meanwhile, it can be harder to see the rash on brown and black skin and may look like a bruise.
Some other tell-tale signs are that it could look like a bullseye on a dartboard, or the edges might feel slightly raised.
You might also experience flu-like symptoms a few days or weeks after being bitten by a tick infected with the disease. These could include:
a high temperature
muscle and joint pain
tiredness and loss of energy
You could experience more severe symptoms months or years later, especially if treatment is delayed. These could include:
pain and swelling in joints
nerve problems – such as pain or numbness
trouble with memory or concentration
For more information see our useful guide on how to reduce the chances of getting a tick bite, how to remove a tick safely and treatments.
If you've been bitten by a tick or visited an area in the past three months where infected ticks could be and have flu-like symptoms and/or a round or oval rash, see a GP. Make sure you tell them if you've been in forests or grassy areas.
Watch: Expert gives tips on how to avoid Lyme disease and ticks