Thanks. I’m just not afraid of skin cancer I suppose. I do regret the photoaging from not protecting myself better. I always used hats when climbing in Colorado but avoided sunscreen most of my life due to acne effects. I still believe in a daily dose of UV (a few minutes) and a lot of NIR (in the shade outdoors). I avoid any sunburn now but was ignorant for a long time.
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@blsm Good luck on your recovery. Issues on the face are super tough on the ego; good job addressing it. I bet you’ll hardly notice it after you let it heal. I had 100 stitches under my eye after a “touch” football game many years ago……sun block on the scar everyday for 5 years. The scar eventually vanished.
I’m hoping someone from the medical community can weigh in here about rapa. My advice would be less than worthless. My personal behavior is to avoid rapamycin while needing to heal or fight infection. I believe rapa is good for healing/ immune function in the long term but very bad in the short term.
I once made the error of taking rapa a day after contracting the flu (before symptoms arrived). Now I know what the flu is like for elderly people with weakened immune systems.
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There is an interesting question about the rate of conversion of cholecalciferol into calcifediol. It will vary from person to person, but I think it starts hitting limits around 3000iu
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@blsm OUCHIE, poor BLSM!
I know you are focused on your stitches, but all I thought was, wow, isn’t she pretty!!!
Just to share, my friend had her eyes done not too long ago, with stitches on her lid and under her eye. I was shocked by how quickly everything healed. It seems that area of the face heals faster than most. I googled and it has to do with the blood supply and thinner skin in that area. I know multiple people who have had MOHS and they all healed really well.
I also don’t know how long to be off rapa, but it would be after the stitches were out and healing was well underway. I’m so glad you caught this! You too, @Joseph_Lavelle
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My 2 cents.
Background - academic surgery training with too much transplant, Crohn’s, burn and melanoma exposure (more but what is relevant here). Finished 22 years ago so somewhat dated. First 10 years out - general surgery, last 12 bariatric surgery - did this + abdominoplasty.
Healing is incredibly variable depending on what you are talking about. Bone, tendon, fascia all are important from a strength standpoint. Most of the biologics guidelines come from Orthopedic studies. And by biologics we usually mean anti-TNF but as surgeons we like to keep it simple and clump in methotrexate etc of which Rapamycin would count.
Surgeons are also very conservative because infection and wound breakdown are something we take personally even if we aren’t blamed.
Now, skin is not nearly as important from a strength standpoint most of the time. Incision length and body part matter a lot.
Age also matters. I used to have a rule of thumb for ugly staples and it varied by age leaving them in for 1-3 weeks.
Now here is the interesting and important part. Healing equals scar. Meaning the more robust healing you have means a worse scar. As you get older, the healing is slower but the visible scar is less. Medications that impact healing also lessen scar formation. They use steroids topically when excising hypertrophic scars. Our Crohn’s patients (on steroids or remicade) would get infections like crazy but have little visible scar.
The face is special when it comes to infection and wound healing. The blood flow is so robust that infections are rare. We can close traumatic injuries much longer after they happen where other parts of the body wound get infected. We can also take sutures out very early because the wounds heal so fast - and the scarring from leaving the sutures in is far worse. Because healing=scar.
So my advice is that you don’t need to wait very long off Rapa. Make sure those sutures come out at soon as possible. Not before the surgeon wants but don’t wait.
Below the eyelids is obviously incredibly thin and I have no first hand knowledge here. It probably does not scar much at all because of the lack of dermis.
Oh yea, avoid sun. For a year. Scars are remodeling over that time period and melanocyte activity is more robust. White on white is what you want. Tan on white is way more noticable and in a scar, the tan becomes permanent.
Tension makes scars worse so no squinting - fits with avoiding sun. It is why knee replacement scars look so awful. You also want to avoid swelling so no inversion tables because swelling = tension.
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Review the following post and a published paper
Paper
“The effect of topical ramipril and losartan cream in inhibiting scar formation”
https://www.sciencedirect.com/science/article/pii/S075333221932431X
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My vit B12 came unusually high - 1400 a few months ago so I completely stopped it. Will retest in a week. My D is under 50. Heading to the South soon so hopefully it’ll increase.
High B12 is benign. Don’t stress about it. One study showed a rash but nothing else.
We drove people to >2500 - the lab limit - all the time. We did this because low B12 is so bad.
Another note is even though it is water soluble b vitamin, it falls slowly. That is why people can do once monthly shots if they don’t absorb. You may want to wait some time to retest.
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Rather than shame anyone, I wish to complement our wonderful @relaxedmeatball for using units when discussing numbers.
Units matter. Units matter. Please, folks, try to get in the habit of using them. I really can’t guess at what your test results might mean without them. (This is me with effort refraining from asking what they’re teaching kids in lab classes these days…)
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@relaxedmeatball, I will definitely start watching the UV index from now on and be more diligent in general. I get quite a bit of incidental sun exposure with my work and active outdoor lifestyle.
@Joseph_Lavelle, I’m glad to know your scar eventually faded. I definitely brought this on myself by being too lax with sunscreen. In hindsight I think I might have been a bit addicted to my detriment. I can see myself taking up the practice of sitting in the shade because I feel good being outside in the natural light.
@DavidCary, Thanks for sharing your experience which I greatly appreciate! I stopped rapa for 2 weeks prior to the surgeries was thinking of waiting 1 month post. I’m getting the stitches out in 5 days so depending on what the surgeon says I might shorten it a bit.
@Beth, thanks for letting me know about your friend. The dermatologist told me the same thing about the face healing quickly so it’s good to have that confirmed.
I certainly appreciate the compliment. When I looked at the picture I was impressed at it’s similarity to my avatar. 
@Joseph, thanks for the cream recommendation! My husband has a supply of that particular med that he no longer needs so I might try making a DIY cream with it.
My vitamin D level was 54 ng/ml last March so I should probably retest since I dramatically decreased my sun exposure last year. I have been taking 50mcg of D3 most days.
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For how long to wait? I tested last October (4 mo ago).
I agree about units. However, the units seem wrong. 39ng/dl is 3.9ng/ml which would be surprisingly low. In SI it would be 9.75 nmol/l
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Actually thinking about this i am out by a factor of ten. ie (0.39/0.975)
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6 months after a change is plenty. Time to steady state seems variable in my experience but measured in months not days or weeks like the other Bs
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I have weekly results for B12, B9 and 25OHD. That goes back for about 3 years 9 months. I have done specific experimentation with cholecalciferol, calcifediol and seeing what the serum 25OHD (calcifediol) results are. I have not experimented with B12 and B9, but I have varied the inputs and seen outputs changing and my experience is that they change moreso over a period of a week or less. I don’t do daily blood tests so I cannot say much about that.
“Vitamin B12 and D supplementation was reported to be associated with accelerated aging.”
Source: Association Between Vitamins and Slower Biological Aging
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Yet again, I want to point out that FORM MATTERS. Are we talking b12 as methylcobalamin or cyanocobalamin? Are we talking D as D2? D3? No findings matter without specifying form, and I didn’t see any of that in the source article.
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“Daily intakes of 11 vitamins were estimated using the multiple source method to account for within-person variation from two 24 -h recalls, incorporating both food and supplement contributions. Total vitamin intake was calculated as their sum.”
I couldn’t understand so much of the methodology of this paper so it doesn’t really help much to me.
So many potential confounders that aren’t really explained. Sort of p hacking also.
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My latest vitamin D test results are in: 69 (up from 42 a year ago) after taking calcifediol 30 mcg (3 pills of vitamoreD) per day for 2 months. I was previously taking 2 pills (20mcg) per day for 10 months. (no test in between; just a hunch). I’ll stay with the higher dose and recheck in a few months to see if that’s my dose or I need to back off.
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