This morning I did a Covid19 and elective surgery interview with Dr Matthew Peters who is on the council of ASPS and spend the last 24 hours busy working out what it all means. Here’s our chat.

Trish Hammond
Hello, listeners. It’s Trish Hammond here again from transforming bodies podcast . And today I’m speaking with Dr. Matthew Peters from Valley Plastic Surgery in Brisbane. Now Dr. Peters is a specialist plastic surgeon. He’s also a member of the Council of the Australian Society of Plastic Surgeons. Now we all know that the government made an announcement yesterday about what’s happening with COVID-19 and elective surgery, the updates, and the fact that they are slightly lifting some of the bans of elective surgery So Dr. Peters is going to share that with us today. So welcome, Dr. Peters.

Dr Matthew Peters
Thanks for having me.

Trish Hammond
Thank you so much for joining us. So first of all, tell us – a lot happened yesterday and I know that you had a really busy, you know, 12-24 hours, whatever it was, can you give us a little bit of a rundown Like what that actually means for patients? Because it’s as with a lot of things that the government says it can be a little bit confusing, what category what’s covered, what’s not. Can you give us like a little bit of a rundown of what the translation of that is in English?

Dr Matthew Peters
Ok, well, first of all, what it does mean is that Australians have been doing the right thing. So social distancing, all those activities that work, and numbers of Covid in the community are really low. So the overall risk to people to actually get this is low. It’s allowed our medical staff and hospitals and things like that to actually accumulate all of the equipment that we need to keep ourselves and the patients safe. So the personal protective equipment or PPE that you hear spoken about in the media, we’ve been able to get stores. So that means they’ve sort of been able to reconsider their decisions to shut things down and allow a progressive return to activity and they’re stressing the word progressive. It’s not all back on, certainly category 1 urgent things which is skin cancers and trauma and things like that, plastic surgery, they’re all still category 2, they’re urgent, but not trauma or cancer things and that’s sort of painful breast implants, or potentially an issue with ALCL and a suspicion about that. And that’s a category 2, and some of the hand cases as well. And then what they’re looking at relaxing for plastic surgery is more sort of falling into those non urgent category 2’s and category 3’s. And there’s a bit of debate because really, the only thing the government touched on yesterday was breast reconstruction. And that’s obviously the stuff that people are waiting to have done, and a lot of them need treatment. So that’s fair and reasonable. What we’re trying to work out is how it sort of falls into place for other things that essentially have an item number. So in the government circles medicare item numbers are applied to procedures that are felt taxpayer money should be utilized, because it’s a benefit to the community and people to have these procedures done. And so in plastic surgery, these are things like breast reductions, and abdominoplasties and body contouring procedures after massive weight loss, some of the upper eyelid blepharoplasty procedures if there’s visual obstruction present, so there are some of the things that they’re considering relaxing. Now we’ll know more with time and ASPS will be involved in those conversations and I guess ASAPS as well. But, at this point in time, it’s not completely clear which ones we can do, but I recommend knowing more in the next few days.

Trish Hammond
Okay, and when you say you’ll know more is that mean? Like how will you know more?

Dr Matthew Peters
I think certainly ASPS is counseling and I can’t speak so much the steps of course, because I’m on council but there’s always the motivation to be representing the patient and representing our members. And, certainly our patients are our primary concern, so the discussions are happening, to work out what is safe in the COVID era, but also what suits the patients in terms of what concerns they have, what pain they have, all of these things. And so it’s just a lobbying activity to just try and work out what we can do safely. So in terms of timeframes, I don’t have any firm timeframes. There’s still discussions about what is to be allowed. This is really evolving quite fast. There were two press releases from the government yesterday that came out at 6.47pm last night. There’s certainly a lot of restrictions they still got in place regarding how much the time can actually occur, how many theatres, how many cases, there’s a lot of rules here, which the individual private hospitals are having to consider, and work out how they can apply those so that we can get this work done. Keep in mind, these private hospitals are not just 100% plastic surgery facilities. So there’s going to be a lot of discussions involving orthopaedic surgeons maxillofacial or the general surgeons, there’s a lot of interest groups here that are wanting to lobby equally for their patients to get their work done. So here, it’s an evolving, it’s a moving feast for lack of a better phrase, and certainly, ASPS is doing what they can to think of the patients in terms of timeframes.

Trish Hammond
Okay, you know what, I’ll get you to make something clear for everyone because I wasn’t actually aware of this. Whether it was just being ignorant or not, like when I first heard about the ban, my immediate thought was, “Oh, my God having surgery at this time is dangerous for the patient” that’s what I was thinking. But it actually wasn’t that at all the reason that the ban was put on was because of them wanting the hospitals to be available. Can you explain if that’s the case? Isn’t it? Can you tell us a bit about that? Because I was like, Oh, my God, it’s not safe to have surgery. But that’s not the case at all is it.

Dr Matthew Peters
That wasn’t the case at all. So what it was about was equipment and access for people. So certainly the public sector has only got a limited number of beds, as does the private and that was a case of just looking broadly at our entire healthcare network, public and private to see what collectively our resources look like. So that if it really went ahead, we could open everything out so we could give all Australians just the best level of car. What can we possibly provide? Certainly you look at how things have played out overseas. And one of the things that was really demoralizing for the medical community was seeing that patients that would ordinarily be given care in some of those countries were not offered because there just wasn’t the equipment available. So yeah, the initial decision was mainly in relation to equipment and equity of access and maximizing access for all Australians. That was the primary thing, then it was also a case of Okay, if there is COVID in the community, asymptomatic patients and symptomatic in the surgical environment where we’re looking at putting people to sleep and all that sort of stuff. There is the risk of actually a patient, sort of spreading that disease to the anaesthetic team to the surgical team to the nursing team, and then all the other people in a hospital that process and anyone that’s had an operation knows that there’s the front desk and other people you make contact with before you go anywhere near the theatre, and then of course, on the way out as well. So there was the risk of transmitting stuff because there’s just no ability to really socially distance within an operating theatre. So it was just a high risk thing, possibly putting someone at risk in that environment. The other thing in that regard was if you do an operation on someone, and they then are in recovery in a hospital, if they are asymptomatic or they hadn’t actually worked out if the had covid or not yet because there is an incubation period there. What do you do if you’ve done a big tummy tuck on someone, and then two, three days later, they then start to develop respiratory symptoms due to covid. And that was one of those things for us. Anyone that has had a tummy tuck would know that when you repair muscles and things, that can affect your ability to do deep breaths and all these things, and if you then have that, and then on top of that a diagnosis of COVID it could put that individual back And others risk of increased harm. So, yeah, we were making decisions about equipment access, equity of access, but also in the patient who could otherwise Wait a period of time. So this is the elective surgery cohort. for that group of people. If we could just delay things we might get to a point where it’s actually safer for them just in case they contracted, have a procedure and then have to go through their routine recovery and have that on top of it as well.

Trish Hammond
So are we there yet as in like an outcome? Like if you were to do surgery on someone tomorrow, for you know, like category 2, how would you know that you’re safe that they don’t have like, Is there anything happening at the moment to test them? Five days before surgery and then just before surgery or not? Is there anything? I guess it’s kind of impossible to do that or what? What’s happening now to overcome or stop that from happening?

Dr Matthew Peters
Well, luckily within Australia Yeah, actual rates of code are really low. So the College of Surgeons or Australasian College of Surgeons had a webinar last night with the deputy chief medical officer and are talking about actual rates and it is low compared to the rest of the world, we are really fortunate. So number one within the community, the risk of getting it is low so long as we maintain our current practices of social distancing and all of that. Then in terms of having surgery and category two type stuff, We’re running off the World Health Organization, the Australian Government, Department of Health Regulations, there’s a number of colleges involved as well, who developed a number of resources which we can reference against. And I’ve been involved in creating a matrix for the Australian Society of Plastic Surgeons for how we manage patients and what sort of personal protective equipment we might utilize. And it does just come down to really just how symptomatic a patient might be, we almost have to assume that we have no testing capacity, or we can’t rely on tests to have to give us the right answer immediately before an operation. So, you know, to sort of say, okay, you’re going to have a procedure next Monday, we’ll get the patient in and get them to have a corona test on Friday. You can’t say hand on heart that, you know, a negative result is truly negative. There are some false negatives, which means that you do a test on someone and it’s come back negative, but they actually have it. So we as surgeons, and medical staff, we sort of have to just base it on how someone’s what sort of history they’ve got, whether they’ve been in contact with travellers whether they have travelled, who they’ve been around what sort of symptoms or other sort of cold and flu type symptoms they’ve had. Sort of pieced together a risk profile for that patient and then work out whether it’s safe for them and us to proceed with that operation. And that’s been one of the big things about Okay, risk benefits versus risk benefit ratio. If you’ve got an urgent category one problem, say a cancer or trauma, then you have to go ahead. So how do you handle yourself as a medical team to make sure that you’re safe, and they’re safe? And then with the elective stuff, it’s a case of really strategizing and looking at those patients individually and their symptoms and history and then saying, right, we think this is low risk, so it’s safe to proceed with this individual. At this point in time, we just cannot rely on Covid testing preoperatively to give us extra guidance, the guidelines just don’t support its use.

Trish Hammond
And I know that we’re basing all of our information on what’s already happened and I’m like watching the news and Singapore has just had a bout of COVID when they already had it kind of under control, and then all of a sudden they’ve just gone Whammo!. And they’ve just, you know, it’s just gone crazy. And I know you can’t say this definitively. But is there a chance of that happening here? Like, we do still really have to keep up with, you know, like, I think we’re becoming like, we can’t be complacent. And I know that even I’m getting a bit complacent, thinking I’ll just go to the shop again for groceries. Is there a danger of that happening now? What do you reckon we are definitely on the way down, it’s not going to get worse. We can’t even answer that question. It’s a dumb question hey?

Dr Matthew Peters
Not at all, because everyone is asking, you know, it’s in the press, it’s on Twitter. It’s everywhere. When and how are we going to come out of this? And when is it safe now? Are we becoming complacent. Personally, I know today like you sort of look at everything all the rates are really low and I don’t need to be so worried anymore. But Singapore has happened. Cairns is currently happening with an outbreak there. We saw Tasmania last week happen there. Small clusters can still happen. And certainly as a result of that, but the way that this virus can spread its infant infectivity, its replication rates more, then a small problem can become incredibly large if people don’t consider the fact that there’s still that risk there. So yeah, we are in a new norm is the easiest way to look at it. The behaviours we used to have prior to COVID are just not going to be applicable moving forward for quite some time. We will not be able to shake hands, we will not be able to have the level of interaction we’ve had, personally and professionally as for how we used to do it, things are gonna change for a long time. So yeah, we are risk of a breakout. That’s definitely the case if we drop our standards that we’ve developed, and where we’re are now Australians have been very effective. The figure the government was working on was 80% compliance in social distancing and hand hygiene. And it is in fact the census report came out on the weekend 98% of Australians are actually compliant, that’s why we’re winning. It’s because so many people have actually picked up on the problem and they are good. And so that’s why we’re seeing improvement. We can’t afford to be complacent because things can go haywire. But I think Australians have gotten that by getting the message now just keep it going. So it can try and get back to a bit of a safer society but one that’s probably as I said, it’s just not gonna have the same behaviours in place that we used to have.

Trish Hammond
Yeah, I think you’re totally 100% right like even in so far as like, because I’ve always been a little bit anal with regards to you know, cleaning the house and all that sort of thing, and I think for example my sister-in-law in particular, she’s like crazy crazy psycho with all that sort of stuff like always using disinfectant wipes and had them in the car. And now I think that kind of “OCD” it’s becoming the new normal. I know that myself even just walking in the shopping centre aisles, I kind of move away a bit from people heading near me, it’s definitely changed and that OCD stuff is becoming normal.

Corona Virus

We have instigated the following procedure at Valley Plastic Surgery

Dr Matthew Peters
And to be honest, the way we used to behave the way we used to interact with things, that’s why we had you know, so many coughs and colds and flu every year. You look at the side effect of our current behaviours, we’re gonna have a flu season that’s likely to be less than we’ve ever had before. You know, people having cold symptoms and things like that they’re going to be less and it’s all because we’re now mindful of hand hygiene, this proximity to people, simple things like that, you know, but that’s what causes the spread of disease and all those little niggles that we deal with every year and so we might actually see those OCD traits and behaviours actually been really beneficial to everyone workplaces, individuals, everything moving forward. Yeah,

Trish Hammond
That’s so true. And, and on that topic, flu shots, do you just as a personal opinion, do you think people should still have them? Because I’m gonna go and have one on Friday? And I’m like, gee, should I have this?

Dr Matthew Peters 18:01
Yeah, my personal opinion on that one. I’m pro-vaccination because of the fact it works. Okay, and the medical and science and literature fully supports that. But I’ve had my flu shot already. I had it a few weeks ago when we received the first advice to go and have it. Certainly, I couldn’t imagine anything worse than having influenza, which is a life-threatening infection. At the same time as potentially, a covid infection. To have the two at once would be just high risk. So I personally have had a flu shot. And I think that the government advice to get it done. It is valid.

Trish Hammond
Do you? What about kids because I know you’ve got a classroom full – well you’ve got four children. What about children? Do your children get to have a flu shot?

Dr Matthew Peters
Yeah. We are. So our kids, we’ve had them at home. And we’ve gone through the whole homeschooling thing, of course. But yeah, that’s one of those things that my wife and I, my wife’s a surgeon as well, and we’ve made the decision to get children vaccinated against the flu. So that’s the decision. We have not done it yet, because there has been a lack of available supplies and they’re otherwise at home. I did, the two of us have had the flu shot already. So we’re unlikely to bring the flu home. But when the stores get more available, so that we can get our kids vaccinated, and we will be doing that but first and foremost, the workers and elderly are at risk individuals with the available stores. They should be getting flu shots first. And then yeah, that’s our opinion – out there first, and then when there’s more and more availability, we’ll get our kids out of the house and get them vaccinated as well.

Trish Hammond 19:58
Yeah, and how Yeah, Would you say the youngest should be like, would you do it with a two year old child?

Dr Matthew Peters 20:14
I’m not a GP.
Yeah. And that’s the thing, these sorts of things because it’s not about flu vaccines, but it’s always a personal decision that needs to be made in conjunction with a properly qualified medical practitioner and the GP is the absolute hands-down best for this. So, you know, they’ll take into account the person’s personal medical history, at-risk features, all those things and have a proper discussion about the risks and benefits. Are they on any other medication, so those discussions do need to happen. And so yeah, when it comes to two year olds blanket statements about age groups, I’ll just say it again. Just do it right.

Trish Hammond
Yeah, yeah. No, that makes so much sense. Well we were going to talk about breast reconstruction today as well, but I but if you don’t mind, can we jump on Another time to talk about that because this is enough of a topic in itself, I want to get this transcribed and get it out there so everyone can read it as well.

Dr Matthew Peters
Ya know, I think it’s timely and it’s the stuff that we want to know that and it is a public safety thing. So yep.

Trish Hammond
Awesome. Okay, thank you so much for joining us today. Dr. Peters.

Dr Matthew Peters
That’s alright. Always nice talking to you.

Trish Hammond
Yes, and vice versa. Well, listen, if you want to know more about Dr. Matthew Peters, you can even check him out on the valley plastic surgery website. You can even search his name into the search bar on the plastic surgery hub website. He does some amazing bodywork. He’s really passionate about breast reconstruction which is what we were going to talk about today but COVID kind of took over especially because so much has happened so I’m really appreciate his time and if you want to find out more you can just check them out on valleyplasticsurgery.com.au otherwise, you can drop me an email to trish@plasticsurgeryhub.com.au and I’ll send you through some info. So thank you so much for joining us today Dr. Peters.

Dr Matthew Peters
Thanks for having me. Thank you.

Trish Hammond
Okay. All right.

Stay tuned, we will keep you updated.

Trish

Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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