LOW WATER INTAKE and high consumption of red meat are the primary causes of kidney stones in Kuwait.
Dr Jaganath R. Chodankar, Urologist at the Armed Forces Hospital, was talking to the Arab Times on some of the commonly found urological diseases in Kuwait. He also dwelled on some prostate gland related ailments, among them Nocturia, an irritative disorder that can trigger a potentially baneful cycle of events including dozing off while driving. Dr Jaganath is actively involved in social work, being the former General Secretary of IDF, and currently its executive member. In a strange quirk of fate, years after adopting a home for children of special needs in Goa, India, Jaganath realized that his own child was autistic, which only strengthened his resolve to work more for these children. He was conferred the Community Leadership Award by the Indian Minister of External Affairs, Vyalar Ravi in March 2008.

Question: You are working as a Urologist in the Armed Forces Hospital in Kuwait. Tell us something about the hospital as it’s off limits for the common man?
Answer: It’s a hospital dedicated to the military of Kuwait. This includes personnel from the National Guard and anybody who is in the military irrespective of rank and also all officers in the Ministry of Interior. You need a special ID card to enter. So, even if you are the brother or sister of an individual in the military, you will not have access to this hospital. Only the concerned person and his dependents like parents, wife and children can get treated here. The admission formalities are strict, and so it’s more disciplined. There is military police all over the hospital.

Q: In urology, what sort of problems do you encounter on a day to day basis?
A: Urology deals with the medical & surgical management of problems associated with the urinary tracts of males and females, and on the reproductive system of males. The biggest bulk of our patients come with stone diseases. Stones in the kidney, ureter or bladder or whichever part of the urinary system it is in. Another commonly found problem includes the prostate gland, which involves the geriatric male population. We also deal with erectile dysfunctions & sexual problems, this part of urology comes under Andrology and we also treat infertility wherein the fault lies in the male factor. If there is an infertile couple, and if the problem lies with the male, we offer treatment. If it is due to some female factor, we refer them to a gynecologist.

Q: What are the causes of kidney stones? Are there any factors involving lifestyle in Kuwait that creates kidney stones?
A: If you really don’t want kidney stones, you will have to live on love and fresh air, which means anything and everything, can cause kidney stones. Nobody is immune to it. But there are definitely certain things that can make you more prone to developing kidney stones. The geographic location of Kuwait, which is a desert region with hot and humid conditions, is in some ways a cause because people perspire a lot here and consume less water. I would say low consumption of water is one of the biggest factors for kidney stones here, combined with excessive water loss due to heat and humidity.
The second biggest factor is the high consumption of red meat & seafood. Red meat & seafood is very rich in Purines, which is very rich in Uric Acid. Invariably, almost all the stones in kidneys have uric acid as their nucleus. So, the initiating factor for stones is uric acid. Beef, mutton, camel, sheep and so on are all forms of red meat.
As far as Kuwait is concerned the biggest factor for stones is less water intake and high purine consumption.

Q: But I was wondering why is it that when people perspire a lot they don’t tend to increase the intake of water. Thirst is a very basic urge in humans?
A: Yes, despite that, the water consumption in Kuwait doesn’t match the water loss. Probably, it’s because people sweat it out in the sun and then immediately enter air conditioned rooms, cooling themselves and not feeling the need for water.
Every person should consume at least two liters of water per day. We just have water for breakfast, lunch and dinner, and that too a glass of water. So the maximum you might consume per day is from 750 ml to 1 liter. This is the maximum, and that’s not good enough. You need to consume at least 1.5 to 2 liters of water per day to avoid kidney stones. This is for a normal individual. Once you develop stones, then we advise 2.5 to 3 liters per day.
We tell our patients to see to it that every time you pass urine, your urine looks like water. If urine looks yellow, then the water consumed is probably not sufficient. Your urine should never look yellow. When there is sufficient water consumption, you can prevent stones, unless the factor is metabolic in nature, which is only in 10 to 20 percent of the cases. 80 percent of the problem is due to less water intake.
And for people who are always in air-conditioned rooms, there is hardly a tendency to drink water, because you are never thirsty. The tendency is only to have coffee, tea or Gahwa.

Another interesting fact is that studies have shown that drinking the normal tap water, supplied by the ministry is the best to prevent stone formation. It’s far better than all the bottled mineral water available at least, with reference to urinary stone formation. This routinely supplied water is better as far as the PH and salt content is concerned. Yes, mineral water is good for certain people. For a person who is suffering from vitamin or mineral deficiencies, one who is old, yes, mineral water might be good for him. But as far as urinary stones are concerned, it is the government supplied tap water, purified, which is much, much better than all these mineral waters put together.
Of late I came across a water company, which has zero salt content and has a PH value of 8. The higher the PH value of water, the better it is to prevent stone formation. The lesser the PH value is, the more acidic your urine becomes. When the urine is more acidic, then there is more tendency for kidney stones.
Once the kidney learns to develop stones, then you will have tendency for recurrent stones for the rest of your life. Therefore, once you get stones, then even if you are cured, you have to concentrate on further prevention of stones. After your kidney stone is treated & cured, you may get a new stone again anytime within the next 6 months or in the next 60 years.

Q: You said something about kidney learning to make stones? Can you explain that a little more? Is it something genetic?
A: It’s like adding salt into a glass of water. At one point, the salt will stop dissolving in the water. That’s because the salt concentration has reached a saturation point in the water. The salt content in your urine too can reach a saturation point, and not get dissolved in the urine. This excess salt forms crystals. And if there is some cell debris or other crystals, these salt crystals get attracted to it and start depositing on it. This is the reason we need to study the core of a stone when we are investigating it in order to prevent recurrence. Things that get deposited on it might all be normal crystals of calcium, magnesium, uric acid and so on thus leading to different forms of stones like Calcium, Phosphorous, Magnesium, Oxalate etc.

Q: Tell us something about the other common illnesses you see at your hospital?
A: B.P.H. also called Benign Prostatic Hypertrophy, any male, above the age of 40 is prone to prostate problems. There are two sets of symptoms: obstructive and irritative. Irritative symptoms refer to frequency, urgency with or without incontinence and nocturia. Frequency refers to going to the bathroom frequently every fifteen minutes to one hourly. Then there is urgency, which is the sudden & immediate urge to pass urine and you have to pass it then and there. Then there is urge incontinence. Supposing you want to pass urine, and you don’t rush immediately, you might leak in your pants. Lasltly, there is Nocturia, which is getting up from sleep in the night three or four times to pass urine. This leads to disturbed sleep, poor performance the next day and so on. So, this is a very important symptom.
These are the irritative symptoms of prostate problem: frequency, urgency, urge incontinence and Nocturia. And then you have obstructive symptoms, which include straining, hesitancy, intermittent urinary stream, weak urinary stream and sense of incomplete voiding. Straining is when you go to the bathroom, you have to force the urine out; you can’t just relax and pass urine. Sometimes the urine comes out intermittently, in broken streams. Or sometimes the stream is very thin. Or sometimes, you come out of the bathroom and feel there is still some urine remaining in your bladder.

But among all these symptoms, Nocturia is the most troublesome symptom as it makes a person get up at lest four to five times in the night. This causes a cycle of events. When you keep getting up to pass urine, you have disturbed sleep. When you have disturbed sleep, you can’t perform the next day. This affects your job, your driving and so on. Many traffic accidents caused by drivers who fall asleep happen because of Nocturia.
Anybody above 40 can enter this bracket of symptoms. For some people, the onset may be as late as 80, and for some it may start bang on 40. Luckily today, we have a lot of drugs to deal with the problem.
Today, medical science has advanced and we can do prostate removal surgeries endoscopically, and the procedure is far less complex than what it used to be until some years ago. The patient can go home by the second or third day itself. The patient will only suffer mild burning sensation while passing urine and will pass blood for a few days, because there is wound inside and it will take some time to heal.
As you go higher up the age group, the incidence of prostate problem becomes much higher. In the age group of 80 to 90, almost 80-90% of the male population will be having this problem.

Q: But once the gland is removed then you will not have this problem, isn’t it?
A: If the gland is removed well, yes. If it is removed completely, and the surgeon has done a good job, usually it doesn’t recur but if the removal is only partial or incomplete, the symptoms may recur after some time.

Q: But it does recur?
A: Not exactly, if you do a good job endoscopically, it may take about a decade or two for symptoms to recur, as in endoscopy, it’s like you’re just removing the core of the apple, leaving the skin behind. If it is an open surgery, then you remove the whole apple. So, you might not have a problem for 20 or 30 years, depending on how well you’ve done the job. All said and done, it all depends upon how well the surgery is done.

Q: What limitations will a patient suffer when he loses his prostate gland?
A: Once you remove the prostate you cannot conceive a child. For that reason people here are very hesitant to undergo a surgery. The prostate gland has a valve that lets the semen out go only in the outward direction. When the gland is removed, this valve is destroyed and all the semen goes into the bladder during ejaculation. For this reason you can’t father a child. Here men are potent even at 50, and it’s quite normal to have babies even at that age.

Q: Are there any preventive measures to avoid prostate problems?
A: There is no documented way to prevent oneself from developing symptoms of prostatic enlargement. However, one measure that can ease the prostate problem is green tea. It is known to have a very soothing effect on the prostate gland by the various anti-oxidants it contains. The Chinese herbal green tea has been documented to have some herbs that have a very relaxing effect by acting on the growth factors and proteins of the prostate gland. Even if you are having mild symptoms and you start consuming green tea, you may observe some improvement.

Q: Tell us something about your activities in Indian Doctors Forum. Are you still the General Secretary of IDF?
A: I was the General Secretary during the tenure 2008-2010. Now, for two years I am just an executive member. I’ve got a new baby, and so I am more focused on him right now. May be later on, I will take up some post. I was part a founder member of the team that formed the forum wherein I was the Website Manager and was involved in the initiation & launch of the website www.indiandoctorsforum.org.
Eight years down the line, I think IDF is a great organization. It has brought together so many professionals from the medical fraternity. Today, it is definitely one of the most respected Indian organizations in Kuwait. IDF has been a means for me to serve the community and the common man. Working as a Urologist in the Military Hospital, my access to the common man is very limited. Through IDF, we conduct frequent medical camps and I am able to serve the community at large.

We had health camp last week. We had about 450 patients and I looked into nearly 20 cases of urology. The important thing in these medical camps is the psychological benefit for patients. They feel so relieved to be able to talk to a doctor and explain all their problems in vernacular language. There was a patient who had underwent a renal surgery for cancer, and he was very insecure and scared that he is going to lose his second kidney also due to the same cancer. Luckily he had all the reports in place with good follow up with his doctor, and I was able to convince him that he was in very good shape and that he had nothing to worry. That’s what I mean when I say psychological effect.

I was also part of CLUB 9, which is an abbreviation for Care and Love for the Underprivileged Born, and 9 because we were a group of 9 members. We had adopted an orphanage in Goa called Daddy’s Home, which is looking after 88 special needs children, physically and mentally handicapped. We raised funds regularly in Kuwait and sent it to the orphanage for the benefit of these special children.
And as if a by a quirk of fate, we found that our second child was also autistic, and we were able to all the more appreciate the mental agony of parents of special needs children. Now, we have started another club which called the Goan Heritage Club, and we are just second year in the running now with the similar objectives in mind. We have identified another special needs home in Goa called Disha Charitable Trust, which also looks after special need children and we have decided to support them on a regular basis. We have decided to support them and also try to identify more such establishments in India which we can offer help to.

After we came to know that our second child is autistic, we realized that there are hardly any Indian schools where we can cater to such children. We desperately want to do something to help parents of such children. There are hundreds of such expatriate children in Kuwait, and most of them are helpless, because they have nowhere to go. I am now on the lookout for similar likeminded people to come forward and initiate steps to start something in the right direction for the benefit of these children in Kuwait who do not have access or cannot afford to support them, ultimately making their children imprisoned in their own homes.

biography
Full Name: Dr Jaganath R Chodankar
Current Designation: Urology Specialist, Armed Forces Hospital, Kuwait.

Educational Qualifications
MBBS: Jawaharlal Nehru Medical College, Belgaum, Karnatak University, Dharwad, Karnataka, India. (July 1989-July 1995)
M.S. (Gen Surgery): Jawaharlal Nehru Medical College, Belgaum, Karnatak University, Dharwad, Karnataka, India. (September 1995-September 1998)
University Dip Lap Urology: European Institute of Telesurgery, Louis Pasteur University, Strasbourg University, Strasbourg, France. (June 2008)

Clinical Experience
Senior Registrar (Urology): Department of Urology, K.L.E.S. Hospital and Medical Research Centre, Belgaum Karnataka, India. (September 1998-April 2001)
Urology Specialist: Urology Unit, Department of Surgery, Armed Forces Hospital, Kuwait. (September 2001-August 2010)

Awards and Honors
* First rank to the Dharwad University in the final year of M.B.B.S. Examinations held in 1994 at Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
* Best outgoing student of J.N. Medical College for the year 1994.
* Awarded the title of Mr JNMC in the year 1993.
* American Medical Association Physician’s Recognition Award January 2003, Camp Doha, Kuwait
* Community Leadership award conferred on March 2008 by Hon. Minister of External Affairs of India H.E. Vyalar Ravi

Leading Posts Held
* Organizing Secretary of Workshop “Ultrasound Guided Urological Procedures” held at K.L.E.S. Hospital & Medical Research Centre, Belgaum, Karnataka, India in February 2000.
* Organizing Secretary of Karnataka Urology Association Conference (K.U.A.C.O.N.) held in 1998, conducted by the Department of Urology, K.L.E.S. Hospital & Medical Research Centre, Belgaum, Karnataka, India in October 1998.

* Organizing Secretary of Continued Medical Education (C.M.E.) and Post-Graduate Course conducted by the Department of Surgery, J.N. Medical College, Belgaum, Karnataka, India in January 1998
* Cultural Secretary at the J.N. Medical College, Belgaum during the year 1994-1995.
* Website Administrator for the Indian Doctors Forum (IDF), Kuwait form the period 2004-2006, during which it was officially launched.
* President of CLUB 9 (Care & Love for Underprivileged Born) from July 2006 onwards.
* General secretary of Indian Doctors Forum in Kuwait from June 2008-June 2010