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A few hours before Of Mice and Men are scheduled to hit the stage in Auburn, Washington, vocalist Austin Carlile leans back against his tour bus and breaths a contented sigh.

"I'm so glad to be back on the West Coast," he says as his band heads into the final stretch of a tour opening for Slipknot and Marilyn Manson. "The sun's out and there are no clouds. I feel great!"

Slipknot Singer Talks Marilyn Manson Gross-Out Contest, Tour

"I remember throwing up in a cup and drinking it in front of Manson and he kind of freaked out," Corey Taylor says

Carlile doesn't take feeling great for granted. And it doesn't happen too often. The singer suffers from a rare genetic condition known as Marfan syndrome that affects his connective tissue and causes weakness in his heart, lungs, ears, joints and muscles.

"I had a C.T. scan the other day and my doctor said, 'You have the back of a 70 year old," reveals the vocalist, who's just 28. "I have so much arthritis from this condition I'm in chronic pain from my wrists to my elbow. My spine and back hurts, my ribs hurt and my legs cramp up at night."

Since he was diagnosed with Marfans at age 17 – shortly after his mother died from the condition – Carlile has endured surgeries to his ears, hip, head and feet, and he sleeps with a machine that regulates his breathing. His condition doesn't usually affect his performances. Onstage, he jumps in place between verses, lunges forward when he sings and bangs his head throughout the set. Basically, he looks as healthily pissed off and energized as most metalcore singers. Occasionally, however, Carlile overexerts himself – like during a show in Denver earlier this month when he suffered a collapsed lung during the band's fourth song.

"I couldn't breathe right and I was gasping," he recalls. "I managed to do the rest of the show. Then the medics came and gave me oxygen and the lung somehow kind of naturally re-inflated. But things like that happen every day and I've just learned to deal with them. The best laid plans for Of Mice and Men often go awry. I can't plan for much because I feel like life is always going to throw me a curve ball."

Cold World (out September 9th), reflects Carlile's frustration through lyrics like, "Pain/Every day that I awake/In my blood and through my veins." Yet the album is the band's most accessible and musically diverse. The heavier tracks, including "Pain," "Like a Ghost," "The Life," and "Relentless" are reminiscent of Slipknot and Bring Me the Horizon, while songs like "Game of War," "Real" and "The Hunger" bring to mind moodier, less-aggro rock outfits such as Tool and Linkin Park.

Musically, Cold World, builds upon the strong writing and pristine production of 2014's Restoring Force, which debuted at Number Four on the Billboard album chart. With the help of producer David Bendeth (who also helmed Restoring Force), Carlile explored more clean singing techniques and, through the album's lyrics, the Orange County, California, band – rounded out by bassist-vocalist Aaron Pauley, guitarists Alan Ashby and Phil Manansala and drummer Valentino Arteaga – address a new range of political, social and personal themes.

Pauley was inspired to write "Game of War" after the terrorist attack at the Inland Regional Center in San Bernardino, California, that killed 14 and seriously injured 22. And Carlile wrote "The Lie" as an indictment of the pharmaceutical industry, which he says would much rather treat symptoms than find cures.

"The medical world doesn't make money if people get better," he insists. "If you stay sick, they keep making the money. "It sucks because there are so many other alternatives and there are so many other treatment methods, from a healthy diet to CBD oil, which is a form of marijuana, but without the THC, so it doesn't get you high, it just cures your seizures or your chronic pain. There are so many other things you can do besides taking this addictive medication."

Carlile speaks from experience. For more than 10 years he took daily doses of OxyContin for pain, Ritalin to stay awake and a variety of antidepressants to combat severe depression, a common side effect of Marfan syndrome. When Of Mice and Men began to put together the songs for

Cold World, the singer decided to wean himself off the drugs he had become reliant on and find other ways to treat his symptoms. Taking turmeric root for inflammation and devil's claw root for pain worked, but kicking prescription drugs was agonizing and debilitating, contributing the agony in some of Carlile's vocals.

"I decided I wanted to be off all the drugs and feel the pain every day and deal with it, rather than not feel anything at all," he says. "In January, I stopped taking anything and the next three months were the worst of my life. I would throw up in the middle of the night and lie there shaking in my bed, moaning and screaming. The pain was unbearable. I did physical therapy four times a week and aqua therapy three times a week while I was coming off the stuff and at the same time I'm recording the record. I'd rather have heart surgery again than go through that again."

The heart surgery Carlile is referring to took place in 2010 when doctors discovered he had an enlarged valve in his aorta. It was the closest the vocalist has come to dying from his condition and led to a year-long hiatus from the band.

"Doctors saw an enlarged part of my aorta and they said if I didn't get it fixed I would be at risk of an aneurysm, which is what killed my mom," he says in a matter-of-fact tone. "They had to put a fake valve in, so they cut my chest open from my neck to my sternum. They had to stop my heart while they did the surgery. They had my head on ice so I wouldn't go brain dead, but I was technically dead for three hours. Before I went under, I was looking forward to maybe seeing my mom or having visions or something, but I didn't see anything. It was just black."

More recently, in June 2015, Of Mice and Men canceled a pair of headlining shows after Carlile ripped open his Dural sac, a mass of tissue that keeps the brain encased in fluid. "I was headbanging too hard over the course of the tour and the sac tore in the back of my neck at the bottom of my head," he reveals. "All the fluid from my brain cavity was leaking into my spine. I have a team of doctors at Stanford [Center for Marfan Syndrome and related Aortic Disorders], and I flew out there and got it fixed. At the same time, they operated on my ribs, because they became displaced. When I was singing onstage a rib would snap out of place and I'd have to push it back in."

Austin Carlile onstage, Berlin, Germany, March 2015 Frank Hoensch/Getty

The new Of Mice and Men song "Real" has a more hopeful, positive vibe than many of the tracks on

Cold World. For the video, the band worked with the Marfan Foundation, Living the Dream Foundation and St. Jude Children's Research Hospital.

"We shot it in Portland, Oregon, during a day off from tour," Carlile says. "We asked fans to submit footage holding up poster boards that explain what makes them feel real. The images that pop up mention everything from music to foster care activism to the Marfan's Community to St. Jude's hospital. And some people wrote stuff like, 'Reading,' 'My friends,' 'Family.' We even had some fans in the studio while we were recording, just to include them more in the process."

Carlile pauses for a moment to recalibrate, then addresses the deeper meaning of the song. "People always try to change things and take away what makes you who you are, and we wanted to write a song saying that you can be who you no matter what other people think. It doesn't matter if you fit in or if other people accept what you want to do. You have to stay real to yourself, and in the end that's all that matters."

It's an ethos that Carlile lives by every day he spends with Of Mice and Men. Many of Carlile's doctors have told him that he's exacerbating his illness and risking his life by touring and performing. They've encouraged him to at least stay in California and work on music there. But Carlile doesn't believe in half-measures.

"I know what I'm up against, but I'm saying I'm going to deal with because if I don't, I'm just gonna sit here and be miserable," he concludes. "It's very easy to take the drugs, do what they tell you, sit in your hospital bed, don't go to the gym, don't scream your heart out onstage. But in my head I set my own boundaries. Some of the older people who have Marfan syndrome only live to be 62. That's fine with me. I don't care if I die when I'm 45 as long as I'm doing something that makes a difference and that I love."

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