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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CASE NOTES Programme no. 2 - Gardening
RADIO 4
TX DATE: TUESDAY 5TH AUGUST 2008 2100-2130
PRESENTER: MARK PORTER
REPORTER: ANNA LACEY
CONTRIBUTORS: CHRIS LOVELL
LIZ DAUNCEY
STEVE LONGWORTH
PRODUCER: HELEN SHARP
NOT CHECKED AS BROADCAST
PORTER
"Gardening can seriously damage your health" is not the sort of headline you expect to see on the front page of a medical journal like the Lancet. But that's exactly what happened in June when the editor decided to highlight the case of a middle aged man who had developed a fatal infection after tending his borders. An illness his wife suspected was triggered when he inhaled some dusty compost.
CLIP
She felt that his whole illness could be timed into when he had been helping in the garden of their house and had been opening up several sort of sacks of old rotting compost - mulchy type stuff - and when that happened it was literally seen that there was almost like a cloud of dust that came out of these bags at the time he did this.
PORTER
More about that case later on in the programme. Before then, what other hazards lie unnoticed in our gardens?
Dr Chris Lovell is a consultant dermatologist at the Royal United Hospital in Bath, and author of Plants and the Skin - a reference work on the diagnosis and management of skin rashes caused by vegetation - a common problem.
Angus Bourgoyne gets trouble every time he mows the lawn.
BOURGOYNE
When I mow the lawn after about 10 minutes I start getting itchy hands and that then spreads to my neck which then comes up in hives. I wash my neck and hands in cold water and that seems to calm it down and stop the swelling and if I sit down and just do nothing for a time it goes away.
LOVELL
That sounds very much like an immediate reaction to plants, probably grass. There are two main types of reaction: initially people can react within minutes and develop a nettle rash or hives, as he describes, and that usually gets better in a few hours, clearing within a day. The other type of reaction we see is a more delayed one which people often get to members of the daisy family and various other plants and that produces an eczema which can last for several days and more disabling in the long run.
PORTER
But looking at this immediate reaction likely triggers in that case would be - is it the grass pollen or grass fragments or what's likely to be triggering that and what other triggers are there?
LOVELL
Could be either. We often do see it with pollen, anything that causes hay fever can cause skin reactions as well. We also see it in food handlers - people who eat kiwi fruit sometimes get nasty reactions from it. And people who handle foods - chefs, cooks - can react to paprika, all sorts of different vegetables, they all cause immediate reactions like that.
PORTER
So if you get an immediate reaction like that from mowing the lawn what precautions can you take to reduce the reaction that you get?
LOVELL
It's a great alibi for not mowing the lawn actually. The best thing one can do is perhaps take an antihistamine beforehand and that might well help prevent the attack or reduce it, certainly reduce the itching and certainly take an antihistamine after if a reaction still persists.
PORTER
Okay, we've got another case study for you now.
SMITH
It was a lovely hot day so I decided to take my two sons to the White Cliffs of Dover, we've been there before and they love to run around in the plants, look for bugs and snails and generally have an adventure. We had a lovely day, we were out till about 2.30 and then on Saturday morning we noticed my youngest son had blisters on his right hand, one very big one on his thumb and lots of little ones between his fingers. So we took him to the doctors and the doctor said it was an allergic reaction. We then saw a friend who's a skin specialist and he said it was an allergic reaction to a plant that snails like and the mixture of that and the sunlight caused the blisters.
LOVELL
This sounds very much like what we call a photo toxic reaction. This can occur in anybody, you don't have to be allergic to the plant, and what happens - the plant sap comes into contact with the skin and if the skin is then exposed to long wave ultraviolet light, which we have in sunlight, the patient gets a toxic reaction which can produce blistering, often can be painful and it sometimes leads to increase pigmentation of the skin afterwards. It's very common in children who are playing in undergrowth and things where these types of plants are common. But it can occur in anybody.
PORTER
And the sort of culprits likely to cause it?
LOVELL
The common culprits are the sort of fluffy things you see in hedgerows at the moment, things like cow parsley, hedge parsley - the white sort of things that people sometimes attack with strimmers in their gardens at the edge of the gardens.
PORTER
Yeah at this time of year we often see what I refer to - not being a dermatologist - as strimmers' rash and this is a presumably a similar sort of reaction?
LOVELL
That's right, those string trimmer tools actually release a kind of buckshot spray of plants which attacks the person wielding the instrument. And if they're not properly protected they can get little spots all over the skin in the areas where the sun gets to them.
PORTER
So this definitely requires a combination of contact and sunlight?
LOVELL
It requires contact with the sap and sunlight. And in children it can be very streaky and sometimes be misdiagnosed as child abuse because they're being abused by a plant rather than by an adult.
PORTER
And is there a delayed reaction, assuming it's sunny on the day that you're exposed, do you come out in blisters or a rash immediately?
LOVELL
No this reaction usually comes within hours, it's painful - it all comes up at once - unlike an allergic reaction which tends to evolve gradually. And then it tends to settle within perhaps two or three days. But often leaves pigment change in the skin for some time afterwards.
PORTER
One of the problems that we sometimes see in practice is people who've been exposed in this way and then the next time they go out in the sun, maybe four or five days later, the rash comes back again.
LOVELL
Well certainly the skin can be sensitive to sunlight for several days or even weeks after.
PORTER
And in terms of treatment how would we treat this?
LOVELL
The best treatment is prevention, if you use string trimming tools put on a sunscreen which blocks out UVA. For all people outdoors, children playing in the sunlight, they should be using a sun block anyway and a sun block that contains UVA protection, that's in other words a sun block which has little asterisks on the packet, that will block the skin - block the UVA - out of the skin and so it's safer to handle these plants then.
PORTER
You say this is a problem with weeds and strimming the borders or children playing around in fields etc., but what about in our well tended gardens, are there any particular problems there?
LOVELL
Well there are even weeds in well tended gardens but the commonest plant we see in gardens is roux, which is often planted by swimming pools and patio areas. And this can cause a very nasty toxic reaction which can produce quite severe chemical burns. If you're lucky enough to have a fig tree in the garden and it happens to be a sunny autumn - two fairly unlikely events - but if you're actually harvesting the figs on a sunny day in the autumn you can get a reaction from those as well. Those are the main culprits in the gardens.
PORTER
Chris and I suppose the other common reaction that we all experience is coming into contact with plants that sting, I'm thinking principally of nettles.
LOVELL
Yes well stinging nettles have their stings as a means of defence against predators, so it's a survival mechanism on behalf of the plant. The tortoiseshell butterfly caterpillar somehow manages to get round that by eating stinging nettles. And there are relatives of the stinging nettles which grow in Australia and New Zealand and Malaysia which can produce very severe stings and rarely can be fatal, so not a plant for the garden really.
PORTER
Well since I've got a dermatologist on the line here, because I can ask you now, does rubbing dock leaves on a nettle sting help or not?
LOVELL
It doesn't seem to work, we tried - we did a little experiment on that once, it didn't seem to work. But perhaps more studies are needed.
PORTER
Urban myth is what you're saying.
LOVELL
Absolutely. Anything sort of cold and soothing will probably help to ease the pain of a stinging nettle.
PORTER
Dr Chris Lovell talking about plant induced skin reactions that will be all too familiar to botanist Liz Dauncey from the Poisons Information Service at Guy's and St Thomas'. With the help of colleagues from the Royal Botanic Gardens at Kew, she has produced a CD-Rom to help medical staff identify plants and treat the resulting problems from coming in contact with them. Anna Lacey joined Liz at Kew to find out more.
DAUNCEY
If we carry on this way I will show you - so this bit of the garden we've also got the herbaceous borders, so like a typical garden here, and one of the plants we've got is alstroemeria. It's related to lily so it has the six petal flowers, but it's one of the most allergenic plants for florists - they come into contact with the sap quite a lot and they get split fingers, pain, irritation in the fingers. Another plant over here is ruta graveolens and that's a photo toxic plant and if you come into contact with the sap of that or possibly even just brush against it and damage it a bit if it's a bright day then you will end up with blisters and you have to protect your skin for several months afterwards because you can get more pain if you expose it to sunlight again.
LACEY
So a photo toxic plant is only toxic when it comes in contact with the sun or photo ...
DAUNCEY
You need the combination of the contact and the UV light. So a good gardening practice obviously is when you've finished gardening have a good wash with mild soap and plenty of water and keep covered up as much as you can, avoid contact with sap.
LACEY
If you have a serious reaction to something in the garden it might be wise to head off to the nearest hospital, taking an all important sample of the plant with you. But even with the help of a sample many doctors, not being botanists, aren't really sure what they're dealing with. So Liz and her colleagues at Kew made a CD-Rom to help with quick and accurate identification. This is particularly important for plants with similar names like woody nightshade, black nightshade and the infamous deadly nightshade, as people often get them confused and can give out the wrong treatment.
DAUNCEY
They contain different toxins, this contains tropane alkaloids and the other two nightshades I mentioned - the woody nightshade and the black nightshade - contain solanine alkaloids and they have slightly different effects on the body, so you want to get the right one.
LACEY
Because would that mean you would need a different treatment depending on which one you'd eaten?
DAUNCEY
Your poisoning will progress in a different way and if you're anticipating one poisoning and that doesn't happen you might not really notice that you've got it wrong and you'll be treating for the wrong thing.
LACEY
Well we're going to go and try out this CD-Rom, so we just get a sample of one of the plants so you try out?
DAUNCEY
Yeah I've got my plastic bag, so I don't brush against it.
LACEY
So armed with our mystery plant, which came from a shrub with small yellow flowers, we headed inside.
DAUNCEY
Okay we're in the office now and I'll pop the CD-Rom in. It's just going to ask us a series of very simple questions and you can answer them if you want and if you don't want to answer a question you just click on the skip button. So the first question is: Which parts of the plant do you have?
LACEY
Well I have the flowers and the leaves and the stem. So I'm going to click on flower, leaf and stem. And then click okay. And it says at the bottom of the screen here 57 suspects remaining. So what's happening as every time that I click on one of these answers?
DAUNCEY
You started off with 213 suspects and every time you answer something it eliminates the plants that don't correspond to your answer.
LACEY
After a series of questions about the number of petals, the type of stem and the time of year the program narrowed down our choice to just five remaining suspects. A quick glance at the photographic line up made the choice pretty easy. Ruta graveolens.
DAUNCEY
Yes that's right.
LACEY
Also known as common roux by the looks of things here. And that is our plant. So then what would happen next, as far as treating somebody is concerned?
DAUNCEY
You click on the toxicity button and it gives you very detailed information about what we know of the toxicity, which parts are poisonous, the main toxins and then there's various tabs so clinical effects, any published case reports and treatment advice.
LACEY
Now of course prevention is always better than cure and although this CD-Rom is good for finding out exactly what someone's eaten or brushed up against is there a way that people can maybe find out how toxic certain plants are in their garden before they hurt themselves?
DAUNCEY
We did some work with the Horticultural Trades Association a number of years ago and there is a policy now in place whereby plants that you buy in a garden centre will actually be labelled if they are a problem if eaten or touched. And you can get hold of that list of plants from your garden centre and check against any plants that you already have in your garden.
PORTER
Liz Dauncey talking to Anna Lacey at Kew Gardens.
Time to change the scale now and move from macroscopic, to microscopic, and the billions of bacteria, parasites and fungi that make our gardens their home. Joining me on the line from our studio in Leicester is GP Dr Steve Longworth.
Steve let's start with tetanus - a condition, I'm pleased to say I have never seen, and never want to see. It's very rare - thanks to immunisation - but the causative bacteria could be lurking in our borders?
LONGWORTH
I've never seen it either but it's the sort of thing that one gets concerned about from penetrating injuries, in particular the sort of thing where someone steps on a nail or puts a fork through their foot and maybe gets dirt pushed deep into the skin.
PORTER
And that's because the dirt contains the causative bacterium presumably?
LONGWORTH
Yes, something called clostridium and it causes a condition known as gas gangrene, fortunately it's extremely rare - about 10 cases per year I think in the UK. But what happens is that the bug releases a toxin, a poison, into the system and this poison particularly affects muscles and makes them go into spasm. So what can happen, particularly with the head and neck muscles, is they tighten up and you can't open your mouth, hence the old fashioned name of lockjaw.
PORTER
And once you get tetanus there isn't an awful lot we can do about it.
LONGWORTH
Supportive treatments and pump you full of antibiotics and keep your fingers crossed I think.
PORTER
And it's often fatal though isn't it?
LONGWORTH
Yes absolutely. Fortunately rare.
PORTER
What sort of injury is likely to lead to tetanus? I mean the classic you hear about is the person stepping on a rusty nail in their garden.
LONGWORTH
Yes penetrating injuries - somebody puts the dirty fork through their sandals and into their foot and then the dirt gets penetrated deep into the wound. So it's very important if you have a penetrating wound that it's cleaned properly and maybe go along to the hospital and have an up-to-date tetanus toxoid or tetanus shot and some antibiotics.
PORTER
We'll come back to that in a minute because of course one of the reasons that it's so rare - and neither you and I have seen a case - is that we are routinely immunised against that now. Just remind us what's involved in that.
LONGWORTH
Well generally you have three shots as a baby and then a follow-up as a youngster a few years later and then another follow-up in your early teens, so you might have five shots in early life. And that should probably see most people through for the rest of their life, for immunity, although if you work in an at risk profession, such as being a gardener or somebody who's exposed to dirt a lot, maybe a shot to boost you every 10 years would be a good idea.
PORTER
So what happens when somebody's seen in A&E, I stick my finger on a rose thorn or a stand on a nail or a fork in my garden, what criteria would a doctor decide as to whether to give the jab or not in an A&E setting?
LONGWORTH
Well they'd look at your vaccination history first and then they'd look at the actual penetration of the wound - how deep is it - whether it can be cleaned out and then make a decision based on - for example if you've had a tetanus, up-to-date, let's say last year you probably wouldn't need another one. If it was a very dirty wound, clean it out give you some antibiotics and probably give you some passive immunity with something called tetanus toxoids.
PORTER
But the latest thinking is, is it not, that if you've had a full course of the five jabs that for most minor injuries you'd be covered?
LONGWORTH
You'd be absolutely fine for most people, if you've had the five jabs in your lifetime you'll be fine.
PORTER
Let's move on to another hazard that can lie in us all and that's the parasite toxoplasma. Now people might have heard of this in terms of cat litter but of course cat litter's not the only place that cats go, they go in the borders as well.
LONGWORTH
Yes, so that you can possibly pick up this particular parasite from anywhere in the garden and the people who are most vulnerable, as you mentioned, are pregnant women because they can pass it on to the foetus but also people with low immunity, either from disease or from drugs that are reducing their immune system. So the advice to pregnant women and to people with reduced immunity is wear gloves and wash your hands very carefully if you're going in the garden.
PORTER
Would you know if you'd come into contact with toxoplasma?
LONGWORTH
Probably not, an astonishing number of us have come into contact with toxoplasma and we don't know about it but if you go round the population and do blood tests perhaps 80% of us have had toxoplasma at what's called a sub-clinical level but we've never actually had the disease as such. Maybe a few people get some glands up and have a slightly fluey illness but for most people it doesn't actually cause any problems.
PORTER
But the bottom line is that women who are taking care over not putting out the cat litter or wearing gloves when they do should take the same precautions when they're gardening. What about the rest of us, do we need to worry about it?
LONGWORTH
Well it's always good for general hygiene purposes to wear gloves in the garden and to wash your hands carefully afterwards but I wouldn't get too hung up if you're not pregnant and not immuno-suppressed about acquiring toxoplasma.
PORTER
And if I get it would it need treating?
LONGWORTH
For the most part it will go away without treatment.
PORTER
Okay Steve. Now I'd like to go back to that case study that we mentioned at the beginning of the programme. The story of a man who was killed by a microbe in his compost. The reporting of the case in the Lancet - under the headline "Gardening can seriously damage your health" - prompted widespread coverage throughout the press and other media earlier this summer. Dr David Waghorn was one of the authors of the report in the Lancet, and part of the team at Wycombe Hopsital that tried to treat the unfortunate gardener. The man in question was initially admitted with what appeared to be a routine chest infection or pneumonia, but rather than improve with antibiotics over the next few days, his condition started to deteriorate, raising suspicions that this was no ordinary case.
WAGHORN
It was really just around this time that a couple of things all then coincided at once. His chest x-ray started to show changes that were not quite right for just an ordinary community acquired pneumonia, his kidney function had gone off quite severely and then we in the laboratory - in the microbiology laboratory - had some specimens sent to us, as we would routinely have, such as sputum samples.
PORTER
Is this stuff that he'd been coughing up?
WAGHORN
Stuff that he'd been coughing up - exactly right. And came up to the laboratory and we processed those samples. And we grew an organism up in the laboratory called aspergillus and this is a fungus. We then established this interesting history from his partner who then said that really she felt that his whole illness could be timed in to when he had been helping in the garden of their house and had been opening up several sort of sacks of old rotting compost - mulchy type stuff - they'd had a couple of trees I think cut down several weeks or months ago and the material from this had been put into bags and left in the garden and it was felt it was time to do a little bit of clearance - a little bit of early spring gardening.
PORTER
And spread it across the borders.
WAGHORN
Exactly. And when that happened it was literally seen that there was almost like a cloud of dust that came out of these bags at the time he did this. And with that history then together with what we were finding started to ring bells that maybe we are dealing with an actual aspergillus, acute aspergillus, infection in the lungs. I mean the whole purpose of us writing up the case and sending it to the Lancet is really, as all these kind of things are, is an educational purpose. We want to inform others of the kind of case that we have seen, albeit an extremely rare case.
PORTER
Well that was going to be my next question. It got a lot of coverage and obviously a lot of people are using mulch and we're encouraged to compost and things now, I mean do you see Aspergillus as a real problem?
WAGHORN
I certainly wouldn't want to give the impression that this is a real problem in our day-to-day living and in day-to-day gardening, that's for sure. We would certainly want to confirm this is an extremely rare case to have happened. There were underlying factors why we think this particular gentleman may have got the infection that he did as well. And so it is not something that we would say is going to happen on a regular basis whatsoever. As I say I've been in the world of microbiology for many years now and this is the first case of this I've ever seen. And of course when we decided to write up the case we looked in the rest of the medical literature to see how many other cases had been written up and in fact there are extremely few. So I think it is overall a rare occurrence.
PORTER
How do you make the diagnosis, I mean if I was to go into hospital with a story like this and suspicious symptoms, as a microbiologist how would you go looking for the fungus?
WAGHORN
Well I think we should probably start before that in the sense that we would very much want our junior doctors, who are usually the doctors that first see the patient, to get a good history from a patient and I think that's absolutely vital. So many times little questions can actually help you enormously with discovering little titbits, shall we say, that can help you make the diagnosis. Doctors are normally pretty good these days at asking about what occupation a patient does and particularly travel history - we all know that that can be very important - but things like have you been gardening may not be the first line of questioning.
PORTER
But if your partner was worried that your symptoms in retrospect started at that stage that would be ...
WAGHORN
Exactly, that's right and little comments like that, almost, from members of the family that might have come in with a patient should always be taken seriously and should at least be made a note of.
PORTER
But if the issue was raised how would you then confirm that?
WAGHORN
We would want the scientific confirmation of that. And what - the way we do that really is to examine the samples that are sent to us from the patient, such as the sputum samples that we got indeed from this gentlemen. And the other thing of course that we did with our patient was that once we did feel that this was his problem we can then go on and do more really specific tests like blood tests, there are one or two blood tests. The problem with those is that they take time to get the results and you can't wait for those results to come back. So what we end up doing is if we feel that this is the likely diagnosis we will start the patient on treatment immediately.
PORTER
Dr David Waghorn talking to me earlier.
Steve Longworth, what we see in our general practices changes, depending on what people are up to, what sort of things do you see that are gardening related in your surgery at this time of year?
LONGWORTH
Lots of wheezing and sneezing, insect bites, sunburn and the occasional barbecue related mishap.
PORTER
Barbecue related - accidents or food poisoning?
LONGWORTH
Well both actually.
PORTER
Let's go back to the insect bites. How - I mean by the time somebody comes to you presumably I mean only a tiny minority of people with insect bites actually come through to see us, what sort of problems are they presenting with in the surgery, is it infection or allergic reaction?
LONGWORTH
Both and sometimes it's difficult to tell the difference and you end up treating them as both. I recently had to admit a lady to hospital with a very nastily infected leg from an insect bite but that's unusual.
PORTER
So the majority of them will be allergic presumably. What can people do themselves at home before they come in and see us?
LONGWORTH
Well try and prevent it in the first place, if you're going out in the garden and you know that you're susceptible to this kind of thing, make sure that you cover up, you ca use anti-insect - insect repellent sprays - we don't often think about that in the UK do we. And if you do get them you may want to buy a mild topical steroid - steroid cream - that you can buy from the pharmacy that you can rub on to it, take an antihistamine tablet and if it's not getting better go and see your GP.
PORTER
One percent hydrocortisone which your pharmacist can sell you for insect bites. Now your special area of interest of course is backs and gardening can be a hazard for our backs.
LONGWORTH
Yes what tends to happen is that if you're like me you let the garden turn into a jungle and then over the bank holiday weekend you go out there for three days non stop trying to clear it and you overdo it. So what people should really think about is pacing themselves, not trying to get it all done in one eight hour slot over a Saturday or a Sunday. Frequent breaks and remember not to try and pick up all that big bag of rubbish when it's too heavy, get somebody to help you.
PORTER
And the other thing of course is that everything when you're doing gardening is at ground level and people don't think to kneel, do they, you don't have to do everything bent double.
LONGWORTH
Yes a very cheap investment is one of those nice little kneelers for the garden and also there's lots of now clever instruments where you don't have to bend over in order to chop the weeds down and so on.
PORTER
What do you say to people who come and see you with back pain then in terms of - I mean most cases will be a simple sprain and strain - they've overdone it at the weekend gardening - they don't really need a lot of special treatment.
LONGWORTH
No for most people we give them lots of positive advice about maintaining their activities, simple painkillers, use it or lose it, it's hurting, it's not harming, the pain doesn't mean serious damage. Lots of folk get kind of worried about their back and think it means something disastrous is going on. But if you stay active, take the simple painkillers and keep moving 99% of people will settle down very rapidly.
PORTER
There is some concern, of course, as you pointed out there, that the pain is somehow a protective response and that if they carry on doing their gardening or mow the lawn next weekend with a stiff back that they'll actually make things worse but you're saying that that's not the case?
LONGWORTH
No I would encourage people to get there again, take some painkillers but just pace it, don't do too much all in one go.
PORTER
And what sort of red flags should people be looking out for, when could back pain be a sign of more serious underlying problems?
LONGWORTH
Well occasionally you see people who are actually feeling very unwell with their back pain, so maybe they have a fever, they're losing weight, their back pain is continuous and never goes away - disturbing their sleep - these would be the sorts of things that would be concerning. Somebody, for example, who's had in the past a cancer or some other serious disease might be someone who we'd take a closer look at, who's got back pain. And anybody who comes along with persisting back pain that's worsening is something that we would again take a closer look at.
PORTER
What about people who've never been prone to back pain in the past, I mean - I don't want to stereotype the people who are out in their gardens but fortunately the older we get the more time we get to spend in our gardens and this is the age group where we're a little bit more suspicious of back pain.
LONGWORTH
Yes certainly anybody over the age of 55 who develops back pain for the first time and it's that story that it's persistent and it's not related to activity and it's getting worse and they're feeling ill, that's the kind of person we'd be taking a closer look at. Fortunately, the vast majority of people, even this older age group, have simply overdone it and with simple painkillers and maintaining their normal activity pattern things will settle down.
PORTER
I've got to say Steve that probably the biggest hazard in the garden at this moment is slipping on the mud thanks to all the rain.
LONGWORTH
Well I'm actually quite glad it's raining here in Leicester at the moment, Mark, because I'm a big hay fever sufferer and when it rains the pollen count comes down and I hate going out and cutting my lawn because if I don't take my antihistamines then I'm wheezing and sneezing for hours and hours afterwards.
PORTER
You and millions of other people I suspect. So what would you - I mean you have to get out in the garden, you have to mow the lawn, what do you do as a doctor to control your symptoms?
LONGWORTH
I make sure I dose myself up with antihistamines beforehand and occasionally have to take an asthma inhaler even, if the pollen counts very high and some other people will take eye drops as well. But the main sort of symptoms that one might get with it are very blocked up nose, the sneezing, the very itchy runny eyes and also a thing that a lot of people don't seem to know about which is the very itchy palette and itching deep inside your ears, so that you feel you want to put your ear - your finger in and scratch it out.
PORTER
And what about when you've finished mowing the lawn?
LONGWORTH
Well one of the best things to do, particularly before you go to bed, that evening is to take a shower to make sure you get all the pollen off you, otherwise you'll be continuing to sneeze and wheeze all night.
PORTER
Well Steve I hope it continues to rain for you so you don't have to mow the lawn. Dr Steve Longworth - we must leave it there - thank you very much.
Don't forget that if you have access to a computer you can listen to any part of the programme again by visiting the website at bbc.co.uk/radio4 - where you can also download it as a podcast.
Next week's programme will be coming from Chichester where I spent a day working with one of the 20 or so NHS surgeons in the UK who perform operations to help obese people lose weight. Join for me for an insider's guide to the pros and cons of stomach banding and stapling.
ENDS
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