Medical Advisory, Scientific, & Review Board

Dr. James Wymer, MD
neuromuscular Medicine-neurology

Cauda Equina Foundation Chief Medical Officer, Board Chair for the Medical Advisory, Scientific, and Review Board (MARSB)

As a neurologist and professor at The University of Florida in Gainesville, Florida I specialize in the diagnosis and management of neuromuscular diseases including amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease, muscles diseases and peripheral neuropathies. I have experience in clinical research and have been the principal investigator in numerous clinical trials including studies of ALS, diabetic neuropathy, multiple sclerosis, migraine headaches and epilepsy. I am a fellow of the American Academy of Neurology (AAN) and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM).

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I have worked on several national consortiums to research neuropathic pain and ALS. My mission as a researcher is “To push the boundaries of clinical care by developing cutting edge therapeutics and integrated multidisciplinary care. To accomplish this with a patient centered approach that provides consistent high-quality results". From the first visit a patient is directly involved in their own care. Education is critical to this and trying to improve communication one of my goals. 
 
When not at work I am spending time with my family, riding my bike, and listening to music.

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Dr. Jason Hwang, MD- Radiology
​Radiologist

Cauda Equina Foundation Director of Radiology
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Adventist Health Sonora Radiologist; Volunteer Clinical Faculty a UC Davis; Department Head of Radiology, Lead Interpreting Mammographer, Virtual Colonographer Leader at US Naval Hospital Guam, Founding Member of Cauda Equina Foundation, Inc. Medical Advisory and Review Board, Principal Investigator on Imaging of the Tethered Spinal Cord. In: Tethered Cord syndrome. The American Association of Neurological Surgeons Publications Committee. 2009, Principal Investigator of Cauda Equina Syndrome Indications for MRI in the Emergency Setting, Cauda Equina Foundation Medical Advisory and Review Board, 2019, Principal Investigator Cauda Equina Foundation, Inc. Medical Advisory and Review Board.

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​CES History and Post Operative Update:
In early August 2016, I had been digging tree holes all week and I started having progressive back pain with numbness in my right leg.  By the time Friday hit, I woke up and my whole leg was numb and I was having severe back pain.  As the day progressed, the numbness moved to my whole lower half and the pain was so unbearable I could only stand for a few seconds.  I waited until Sunday morning before coming to the realization that this was only getting worse and I needed emergent care.  I had surgery the following day on Monday.
 
5 1/2 months out from L4-5 microdiscectomy
After the surgery, I didn't think it would be possible to ski, but last week I went skiing with my daughters for 3 days. I would just like to encourage anyone with recent surgery to do whatever you have to get your body back to stuff it was used to. I know everyone's case will be different, but I can share a little bit of my story. My cauda equina nerve roots at L4/5 were completely crushed. I mean the surgeon said when he got to the disc, it was under so much pressure it kept on spontaneously extruding out.  I had surgery about 72hrs from onset of symptoms. After surgery, my feet were so numb it felt like walking on ice cubes. My whole lower extremity was numb and as I got stronger I kept on discovering new motor deficits I hadn't known about. My right calf was basically dead (I had absolutely no muscles tone) and I couldn't do a calf raise unless my whole body was submerged in water. I couldn't fan my right toes. I couldn't dorsiflex my left toes, especially the big toe (EHL). The first week I got around slowly with a walker and then I graduated to a cane. I ditched the cane after a couple of weeks and just limped around. The limping was due to my weak right calf, which didn't allow me to push off properly.
 
So here is what worked for me:

1. Before the injury I was an avid road and mountain biker.  At 4 weeks post-op, I got on my bike trainer and started pedaling again.  It was really awkward because I couldn't feel my feet and it would take me forever to try to clip into the pedals. Then, if I tried to stand and pedal, my right leg would just drop because of my weak calf.  However, I started slow by just spinning and I just kept at it basically forcing my muscles to remember what they're supposed to do (muscle memory is huge).
2.  I also did a lot of strengthening of my calf in the pool when I could take all the weight off. It is so slow, you don't think it's getting better, but I kept at it.
3. I think at 8 weeks I started physical therapy, which continued to strengthen everything.
4. As soon as I felt safe, I started actual biking outside. This was very depressing because it was something I was so used to doing, but now I questioned if I could ever get my strength back. But, I kept on telling myself muscle memory and forcing the body to do what it did before.
5. After 10 weeks or so, I could finally tell my calf was getting stronger, which was encouraging and made me keep on working at getting it stronger.
6. I also tried to walk almost everyday, especially hills. It's not fun to limp around, but I just kept telling myself I have to do whatever I can to make the muscles come back.

 
Now, my calf strength feels close to normal. I know it's not 100%, but it doesn't hinder me anymore. I can walk normal. I still have dorsiflexion weakness in my left toes, but functionally that really isn't limiting me. I'm happy to say the numbness, including the saddle anesthesia all went away. It was all slow going, but it seemed like every week, one toe would get better, almost like a glove was getting taken off. As the numbness improved, so did my balance. There would be times when I would just lose my balance and have to grab onto a nearby wall. My ankles, which were so tight and stiff, are back to normal. 
 
Unfortunately, this disease affects everyone differently. It can be so depressing at times. I have 3 daughters, the youngest was a little over a year when the injury happened. It was the most devastating thing for me when she would walk up to me wanting to be carried, but I couldn't do it until several months after the surgery. I would just encourage everybody to try to stay as active as possible. I don't think there is anything more important than muscle memory. You have to basically tell your body, "I know this doesn't feel right and it doesn't seem to work, but this is what you used to do and I'm forcing you to do it again!”

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Dr. Dan Krichbaum, Pharm D
Pharmacist, Medical REsearcher

Cauda Equina Foundation Co-Chief Medical Officer & Scientific Board Chair
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Retired from Pfizer, Inc. where he served most recently as a Senior Director, Team Leader, on the Field Medical Director Group for the  Inflammation & Immunology Team, North American Medical Affairs. He is also a Principal Investigator at the Cauda Equina Foundation, Inc. and a member of the Medical Advisory and Review Board.

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Dan Krichbaum, PharmD was a Senior Director, Team Leader for the Inflammation & Immunology Field Medical Director (FMD) Team. In this role he led the 20 colleague Field Medical team activities in support of in-line medicines for Inflammatory Bowel Disease (IBD) and oversaw the teams medical communications for the Pfizer pipeline medicines. Dan has 21 years of pharmaceutical experience in medical affairs and has held several different roles in various therapeutic areas over that time.

Dr. Krichbaum earned his BS in 1984 and Doctor of Pharmacy degree in 1986 – both from the University of Illinois College of Pharmacy. He specialized in cardiovascular drug therapy and worked 13 years as a clinician, researcher and educator in teaching hospitals with an academic appointment at the University of Illinois before joining Pfizer in 1999.

His experiences prior to industry include serving as an IRB Chairman at an academic medical center and as Director of Research at a Site Management Organization. He served as a Principal Investigator on 12 clinical trials and as sub-investigator on over 80 trials. He was Board Certified in Pharmacotherapy by the Board of Pharmaceutical Specialties in 1994. He has held membership in a number of medicine and clinical pharmacy organizations and has over 20 scientific publications.

CES Story 
My cauda equina syndrome was diagnosed at my first visit to a University Hospital in September 2018 in Chicago. I was hospitalized 2 weeks later and diagnosed with non-Hodgkins lymphoma. We still don’t know exactly what the caused the CES although it is most likely a paraneolastic response to the lymphoma. I went through six cycles of chemo including high dose methotrexate and came out completely deconditioned. As I worked on my conditioning in the summer of 2019 I was getting stronger and walking independently by the Fall. However, my health took a turn for the worse in the beginning of 2020 with decreasing control of my lower extremities, more balance problems and progressive numbness and pain in my lower extremities. I was also experiencing increased saddle pain to the point where sitting became intolerable. So my doctors decided I had an underlying autoimmune disorder and started me on IVIG and Rituxan. The pain continued to progress and I was offered a spinal cord stimulator in March of 2021.

Foundation Involvement
The way I got involved with the foundation was also through a simple Google search. At the time there wasn’t much information at the level of detail I was looking for. So I had a discussion with Amanda who I quickly realized there was a potential win-win opportunity for both of us. She invited me to join the medical advisory board.

Fun Facts and Hobbies 
As far as fun, I love to hang out with my wife and adult children, play golf and take vacations. I come from a family of seven and I have been to every state in the US (except 3) at least once. And I have been working from home for the last 21 years.

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Chuck Nitsch, PT, CEEAA
Physical Therapist

Cauda Equina Foundation Research Advisory Committee 
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My name is Chuck Nitsch, I live in St. Augustine, Florida, the nation's "oldest city."  As a retired Physical Therapist and Certified Exercise Expert for Aging Adults, I was involved in clinical practice in home care and outpatient orthopedics for over 40 years. I spent 10 years as adjunct faculty in the Doctor of Physical Therapy program at The University of St. Augustine for Health Sciences.

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My CES started in July 2018 from a spinal abscess. 

I have been involved with the Cauda Equina Foundation medical advisory board for about 4 months and look forward to contributing in the future.

Hobbies: outdoor recreation and cooking
Pre-COVID Hobbies: ocean and river cruising  

Fun Fact: I spent 5 years as a high school wrestling coach

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Dr. Heather S. Rader, PT, DPT, PRPC, BCB-PMD- 
​Pelvic Floor Physical Therapist

Cauda Equina Foundation Director of Pelvic Floor Physical Therapy Department
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​Dr. Heather Rader is a pelvic physical therapist, clinic owner, educator, and advocate for pelvic and abdominal health.

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BACKGROUND

• A physical therapist since 1994, she graduated from the University of Miami with a Master’s degree in Physical Therapy, and in 2011, she completed her Doctorate in Physical Therapy from the University of St. Augustine.  
• She has been board certified in the use of Biofeedback for Pelvic Muscle Disorders since 2006.  She was awarded the Pelvic Rehabilitation Practitioner Certification in 2014 and served as a subject matter expert and question writer for the PRPC examination.

PELVIC HEALTH PRACTITIONER

• She is the owner of Rader Pelvic Physical Therapy, a practice devoted to the treatment of pelvic, abdominal, and maternal health concerns, located in Mt. Dora, FL. 
• Dr. Rader provides physical therapy for childbirth related pain and dysfunction, urinary and fecal incontinence, pelvic organ prolapse, constipation, pelvic nerve disorders, and spine, hip, abdominal, and complex pelvic pain conditions.

EDUCATOR

• She is a senior faculty member with the Herman & Wallace Pelvic Rehabilitation Institute, teaching courses in the Pelvic Floor Series and Pregnancy Series, and is the author of the Geriatric Pelvic Floor and the Home Health Pelvic Floor courses.  
• She had authored multiple Pelvic Health online courses through MedBridge Education to include Functions and Dysfunctions of the Pelvic Girdle and Pelvic Floor, Orthopedic Connections to the Pelvic Floor, Evaluation Strategies,  and Treatment Techniques for the Pelvic Girdle and Pelvic Floor. 
• Her new online 4 course series, Postpartum Rehabilitation, will be released in 2022 and will include Early Postpartum Rehab in the 4th Trimester,  Postpartum Abdominal Rehab, Postpartum Pelvic Floor Rehab, and the Postpartum Athlete.

ADVOCATE

• Her mission is to assist in the national expansion of qualified pelvic health therapists and promote awareness of pelvic floor and abdominal dysfunction to medical professionals and the community at large. 
• She runs a social media site on Facebook called “Team Pelvic Floor”, which posts articles and facts about pelvic floor rehab while promoting a team approach to treating pelvic dysfunction. 
• She writes a blog called the “Pelvic Defender” which highlights pelvic and abdominal health conditions and their treatments.
• She is a practice consultant and a mentor to therapists wishing to incorporate pelvic rehabilitation into their practice. 
• In 2019, she presented a TedxTalk about Overactive Pelvic Floor Dysfunction called, “How to Save Someone from a Pelvic Floor Muscle Attack.”

She resides in her hometown of Mt. Dora, FL.  She lives with her husband, who is an English professor and writer, and their two cats, Daisy and Tim.  They are avid Phillies baseball fans, love going to Dave Matthews Band summer concerts, and as “foodies”, enjoy cooking together and dining out with friends and family.  She has been a pelvic health advocate for years, and after witnessing firsthand how often pelvic floor issues are overlooked in the CES population, she was inspired to join the CEF team.  She was honored to be invited to sit on the Medical Board, and hopes her contribution from the field of pelvic physical therapy can help bring about meaningful change in the care and treatment for those with cauda equina syndromes.

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Amanda proctor, bs-rrt
Registered Respiratory Therapist
President & CEO

Medical Advisory, Scientific, & Review Board Research Committee

Amanda Proctor founded Cauda Equina Foundation after being diagnosed with Cauda Equina Syndrome in August of 2012.

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​Seeking answers and peer support she realized there was a clear and evident need for research, education, and advocacy in the field. Amanda received her bachelor's degree from The University of Central Florida in Cardiopulmonary Science. As founder, she is responsible for sharing her vision for the foundation with the governing board voting at board meetings. Amanda is a Registered Respiratory Therapist with experience in critical care and emergency medicine.  She brings experience in the development of clinical practice guidelines, and clinical education and research.

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