Dan, your body uses up lots of calories just in the healing process...Packer was 118 lbs after first surgery 2 yrs ago......He`s now 185 lbs just on tube feedings, we told him he had to bulk up and he never stopped ! He used and still does, Gainer`s Fuel 2500 from Twin Labs along with his 8 cans of jevity plus........You can get Gainer`s Fuel from the Vitamin Shop..............Dee