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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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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Brett H. Simmons, B.S. Biochemistry
CQA Quality and Compliance Oversight for Clinical Trials

Brett works as a Senior Quality Auditor for Precision for Medicine, a Clinical Research organization in which he provides Quality Oversight for Clinical Trials for Oncology and Rare Disease programs. Before joining Precision for Medicine, he spent 17 years as an accomplished pre-clinical drug discovery scientist for Pfizer, Inc. Brett earned his Bachelor of Science in Biochemistry at University of California, San Diego in 2001. He is a Certified Quality Auditor (CQA) as well as a member and former volunteer for San Diego Regulatory Affairs Network (SDRAN). He currently lives and works in San Diego, California.  ​

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Dr. Jessica stewart, DVM

Dr. Jessica Stewart is a veterinarian with 7+ years practicing as a licensed companion animal veterinarian and 25+ years of animal handling experience.  She obtained her doctorate with Phi Zeta Honors and a Practice Excellence Award from Western University of Health Sciences in 2015. While attending veterinary school, she also took courses for a Masters in Public Health through The University of Minnesota, which she finalized by taking the Certification in Public Health Exam in 2018. She received her Bachelors in Animal Science/Minor in Biology with high honors from Cal Poly, San Luis Obispo in 2010. 

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Her most treasured experience as a veterinarian was volunteering for Veterinarians Without Borders in Uganda, Africa. There she assisted farmers and veterinarians in applying biosecurity methods, educating them on identifying disease & communicating with stakeholders, and promoting surveillance techniques to prevent disease outbreaks. 

A close second favorite was assisting in the conduction of endocrine laboratory technique training and the development of research projects at two giant panda breeding facilities in China. 

Additional Information:
For her Masters in Public Health, she developed a research study on Toxoplasmosis. It is the second leading cause of foodborne death in the United States, and fourth leading cause of foodborne hospitalization. Specifically, she created and analyzed results of an epidemiological questionnaire and the blood levels of toxoplasma gondii antibodies. 
Dr. Stewart was a Veterinary Medical Officer for the United States Department of Agriculture (USDA), Animal Import Center between 2015 - 2017. During her role there, she became a supervisor and traveled nationally for training. She became a certified foreign animal disease diagnostician, specifically with highly infectious animal diseases that have huge economical and ecological consequences.  

In addition to the USDA, she has gained experience working for small business private veterinary practices, large corporate veterinary practices, emergency clinics, specialty clinics, humane society's, and shelters.

She has over 5-years of experience performing high volume spay and neuter services and delivering preventative medicine for non-profits in Southern California. These include The Humane Society of San Bernardino Valley, SNPLA, and The Pasadena Humane Society & SPCA. Dr. Stewart has a passion for working with nonprofits, especially animals in need.  Thus, she recently started a 501c (3) called The Veterinary Rescue Alliance with a good friend and veterinary colleague.  

During her undergraduate studies and veterinary school, Dr. Stewart also tutored fellow students in the year below her. 
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She loves mentoring, teaching, gardening, and spending time with her dog and two cats.