Since he was 19, Amandeep had been struggling with a stiff, weak right shoulder that made it difficult for him to lift objects or raise his arm. Testing indicated a problem with the nerves in his shoulder muscle and he began to see a nerve injury specialist. In the meantime, he also noticed that his voice was growing hoarse and that his throat was so dry that he was finding it difficult to swallow. His concerns grew when he started to become unsteady on his feet, with episodes of light-headedness, hearing loss and headaches. A throat examination indicated a paralyzed right vocal cord, which led to CT and MRI scans revealing a large tumour in the right side of the base of his skull causing significant compression on the brain stem.

Within five months, Amandeep had two operations to remove the tumour, yet residual tissue remained. He then had surgery to place an implant to repair his vocal chord. His doctor proposed both fat and Botox injections, yet Amandeep was doubtful. Three years after his surgery, an MRI showed signs that the tumour had grown again. Amandeep’s neurosurgeon recommended further surgery followed by proton beam radiation. At a time when most young people are focused on studies, new careers and socializing, Amandeep had been through multiple surgeries and was still trying to manage several different medical conditions. Frustrated and unwilling to accept having a weak voice and shoulder for the rest of this life, he decided to access Best Doctors.

Getting in touch

Amandeep’s case was incredibly complex and the Best Doctors team of trained nurses and health professionals decided they had to refer his case for an in-depth medical review performed by world experts in three different specialties: brain surgery, laryngology and shoulder surgery.

Expert in brain surgery

The report provided full backing for Amandeep’s neurologist and the proposed treatment plan. Reassuring Amandeep that the tumour had a low grade of malignancy, the expert provided alternatives to proton beam therapy, as well as advice on how to ensure optimal follow up after treatment.

Because my case was so complex and involved three experts, Best Doctors arranged a follow-up call with one of their Harvard-trained doctors in Boston to go over each point in the reports and make sure everything was clear.

Expert in laryngology

The expert believed that Amandeep’s voice and swallowing problems were a consequence of the tumour and multiple surgical procedures. He recommended further testing to identify if his implant had either shifted out of place or if the fit had been altered. Cautioning against Botox, which would make Amandeep’s throat even drier, the expert recommended further tests and a procedure to improve voice function.

Observing that Amandeep’s swallowing studies suggested a muscle segment in his oesophagus that was failing to relax when he swallowed, he provided instructions on testing to rule out this and other conditions before proceeding with any surgery. As for fat injections, these should only be considered as a last resort. The expert then provided Amandeep with advice on making sure he was adequately nourished and monitored throughout all treatments.

Expert in shoulder surgery

The expert explained that, as with the nerves in this throat, the nerves supplying his shoulder muscle had been affected by the tumour and subsequent surgery. This explained why his shoulder was so weak. Before considering treatment, it was crucial that Amandeep undergo specific tests to verify his range of motion and muscle strength. Depending on the results, he should either continue with physical therapy or consider surgery. Cautioning that any surgical option should be delayed until Amandeep had completed and fully recovered from his tumour treatment, the expert went over the kind of procedure to consider when he was ready, covering the advantages and disadvantages of each variation. As surgery would be highly demanding and complex, he urged Amandeep to seek out a specialist with experience in that specific type of operation.





Working with local doctors

From a situation in which he had been facing a future marked by poor quality of life and an on-going struggle with three different medical conditions, Amandeep was provided with a clear way forward and reassurance that he could successfully manage his health. The three expert reports made it easier for him to consult with his local treating doctors and he is now following the recommendations. Feeling confident and finally in control of his life, he is much more positive about the future.

Best Doctors collaboration a success for Amandeep