To celebrate Addison's Disease Day 2025, we speak to Joyce and Ruth, sisters living with Addison's disease who perform together as "Sephira – The Irish Rock Violinists".

Addison's Disease Day 2025

They share their journey of touring the world, all while managing Addison’s and other health challenges. In their "cortisol check-in," they offer insights on recognising when to updose or follow the Sick Day Rules, and explain how they stay prepared for emergencies — including carrying injection kits right in their violin cases!

---

Hi, we’re sisters Joyce and Ruth O’Leary, and together we perform as “Sephira – The Irish Rock Violinists”. 

We’ve toured the world, released multiple albums, and performed in extraordinary venues as well as at private events for clients including royalty and Hollywood elite. Behind the scenes, we live with Addison’s disease - a condition that affects the body’s ability to respond to stress and can become life-threatening if not managed carefully.

For many years while touring, we were undiagnosed - pushing through intense exhaustion, unexplained symptoms, and repeated medical emergencies. Joyce was later diagnosed with Primary Biliary Cholangitis (PBC) and manages a cluster of other chronic-health conditions that complicate her Addison’s care. Ruth, meanwhile, suffered with debilitating migraines from age six, often leading to vomiting - a dangerous scenario that quickly becomes life-threatening for anyone with Addison’s, as it prevents cortisol tablets from being absorbed. After several adrenal crises, we were finally diagnosed - and that diagnosis changed everything.

We both also manage chronic sinusitis. It can trigger migraines and infections, which in turn can push us into crisis. It’s a mix of health challenges that make recognising low cortisol symptoms critical. Unfortunately, these aren’t always obvious. 

---

Our Cortisol Check-In: A Personal Step-by-Step

Over time, we’ve developed our own internal checklist to spot when our cortisol might be dropping. It's difficult to tell the difference between regular tiredness and adrenal insufficiency - these are our red flags:

1. Sudden energy crash
A heavy, dragging sensation. Even the smallest task feels impossible.

2. Headache, neck ache, muscle pain
Pains across the head, neck, chest, shoulders or back appear without clear cause - an early sign for us. Heat packs ease symptoms.

3. Nausea
Low cortisol nausea.

4. Aches, chills, low-grade fever
Often earliest signs of infection brewing.

5. Dizziness/light-headedness
Suggests low blood pressure/falling cortisol levels.

6. Salt cravings, emotional fog, a feeling of impending doom
Unmistakable signs of severe cortisol deficit.

7. Disproportionate anxiety
Feeling overwhelmed/tearful over small things that usually wouldn’t bother us.

8. Inability to make decisions/complete tasks/overwhelmed by simple questions
A mental block/stuckness or fog that feels out of character.

9. Avoiding social interaction
Talking or texting feels overwhelming. 

10. Denying the need for an up-dose or injection
If we’re mentally underestimating how unwell we are, that’s often the most dangerous sign. Confusion/apathy signal a potential adrenal crisis.

When these symptoms appear, we have to work out what are the best next steps. We have no way of measuring our cortisol levels - so we rely entirely on reading personal symptoms and patterns we’ve learned over time.

---

What We Do When We Spot the Signs

We act fast. Depending on what we’re feeling:

• Double oral hydrocortisone as per Sick Day Rules, or take a smaller bump if caught early.
• Rest and hydrate, cancelling all plans if necessary.
• Take electrolytes, ginger tea with lemon, and use heat packs to soothe pain.
• If symptoms escalate or vomiting begins, we inject hydrocortisone and call an ambulance.
• Keep an emergency protocol sheet by the front door for anyone assisting us.

---

Everyday Preparedness

Managing a performance career with chronic illness takes planning. Here's how we stay prepared:

• Medic alert bracelets connected to a 24/7 emergency line. We use www.medicalert.org.uk.
• ICE contacts, Seat belt pouches & windscreen signs in our cars with full medical information.
• Injection kits in handbags, violin cases, and backstage.
• A dedicated medical folder at home near the door, listing all medication and emergency procedures

---

Frequently Asked Questions

1. How do you remember to take your tablets?
Set alarms on our phones/watches adjusting them for time zones when travelling.

2. How do you carry your injection kits?
Bright pouches in handbags, violin cases, and cars — always close at hand.

3. What type of medical ID do you use?
MedicAlert bracelets (medicalert.org.uk)

4. How do you perform with a condition that limits stress tolerance?
Before diagnosis, Ruth frequently collapsed after shows - her body couldn’t cope. Now, we follow stress-dosing guidelines and up-dose before every performance.

After diagnosis, we became Guest Entertainers on luxury cruise ships, performing one night per week. It was perfect: enjoying life as guests on board luxury liners, focused work, rest between, and peace of mind knowing there was always a medical unit onboard.

5. What does your everyday life look like now?
Our pace is slower and more grounded. We still perform at select private events, compose music for placement in TV and film and founded Sephira School of Music to teach young musicians using our confidence-building Sephira Method.

Joyce and her husband have just welcomed their first baby boy, and Ruth is raising her 7-year-old daughter. Life isn’t simple - but it’s ours, and we feel incredibly lucky.

---

Take a Moment for You

As Sephira, our debut album Believe features calming original music, often compared to Enya. We invite you to grab a cuppa, take a calming moment to listen at sephira.ie/music. If it brings you comfort, we’d love to hear from you. It’s our dream to create more music to support fellow Addison’s warriors.

---

Why We’re Sharing This

We went too long without answers. If our story helps one person recognise Addison’s disease or take action - it’s worth it. Some people aren’t diagnosed until it’s too late. Without urgent treatment, an adrenal crisis can be fatal. Early recognition saves lives.

Living with adrenal insufficiency means walking a fine line. But with knowledge, preparation, and support from ADSHG, we’ve found a way to keep doing what we love - differently, but safely.

Thank you for shining a light on this condition. We’re proud to be part of the Addison’s community.

---

---

Whether you're newly diagnosed or have lived with the condition for years - please join our community and support our cause! You'll receive the latest expert advice, guidance and ADSHG news, whilst being part of our inspiring and supportive community. Become a member today! 

Join the ADSHG 

Connect on social media! Follow us on X/Twitter, Bluesky, Facebook, Instagram, LinkedIn, Threads, TikTok and YouTube.