FRIDAY, Feb. 7, 2003 (HealthDayNews) -- There may be trouble bubbling beneath the waters of those supposedly soothing spas.
German doctors report that a 36-year-old German man with kidney disease apparently injured his left kidney while soaking in a whirlpool tub.
Although this is an isolated incident and no other cases have been reported, the authors of a letter appearing in the Feb. 8 issue of The Lancet warn that whirlpools could pose dangers for people with high blood pressure or who are on dialysis.
Whirlpools have already been connected with outbreaks of Legionnaire's disease and bacterial skin infections.
The man in this case had end-stage renal disease and went swimming in an indoor pool on the advice of his physician. He then decided to relax in the hot tub.
Eighteen hours later, when he underwent his usual dialysis, nothing seemed amiss. An hour after that, however, the man started experiencing severe abdominal pain.
He was admitted to the hospital and treated initially with laxatives and pain relievers for constipation. The discomfort went away for a while but reappeared the next day. At that time, a computerized tomography (CT) scan showed internal bleeding from the man's left kidney into the abdominal cavity.
Doctors managed to stop the bleeding and the patient resumed his normal routine -- although whirlpooling will not be part of that routine for a long time to come.
According to the man's doctors, the tub provides the most likely explanation for the incident -- specifically, the supposedly therapeutic streaming jets of water. "The patient said it was really heavy, so I assume that the mechanical stress was strong enough to injure the kidney of the patient mechanically," says Dr. Lutz Liefeldt, a physician with Humboldt University's department of nephrology in Berlin and one of the authors of the letter.
"Heavy," Liefeldt explains, is a word often used in Germany to denote "strong" or "hard to accept."
Although the whirlpool probably caused the internal bleeding, it apparently only manifested after dialysis because of the blood-thinning agents used in that procedure. "Dialysis requires anticoagulation, which makes a high risk of bleeding," Liefeldt says.
Not only renal patients are at risk, Liefeldt says, but people who use anti-clotting drugs such as heparin. People with high blood pressure who use this class of drugs are at particular risk. "That combination is troubling," Liefeldt says. "High blood pressure is a common situation in renal patients and, in the case of end-stage renal disease, patients require dialysis anticoagulation. It's a bad combination, but you can't avoid it."
Phone calls to the National Spa and Pool Institute, a trade group representing makers, were not returned. Jacuzzi, one of the leading makers of spas, declined to comment.
More information
The Centers for Disease Control and Prevention has information on whirlpools and Legionnaire's Disease. For more on end-stage renal disease, visit the National Institute of Diabetes and Digestive and Kidney Diseases.
