Inability to gain weight - post sepsis, Guillan-Barre, NHL

[Shark]

Dear Doctor,
I am a 35 year old bloke who was diagnosed with NH lymphoma back in the summer of 1993. I was 20 years of age. I was successfully treated through chemo, bone marrow transplant and light radiation treatment. A month after my final cancer treatment (July 1994) I experienced a dramatic descent into acute guillan-barre syndrome (August 1994), which drove me into a complete vegetative state for 3 months. I had the tracheostomy, the plasma-feresis, the gamma globulin injections, the works. After the GB (December 1994) I weighed 45 kilos. Before the NH Lymphoma I weighed 63 kilos.
In 2000 I was diagnosed with Bronchiectasis, or something similar to it. There is chronic colonization of bacteria and aspergillus in my left lung, which is completely non-functioning. I have daily bouts of phlegm drainage, and recently (Oct-Nov 2008) was hospitalized for pneumonia and sepsis.
That is where I am today. My query is: I have a very difficult time putting on weight. I find that no matter how much I gorge myself with fat and protein rich foods I can't seem to get beyond 52-53 kilos. I know my best hope for fending off future infections, which I will be less and less able to fight off if I don't bulk up, is to increase my fat and protein consumption. WHY IS IT SO DIFFICULT? WHAT CAN I DO?
Sincerely
a scared Shark

[Dr. Tamer Fouad]

Hi there,
I hope you're feeling better. You have certainly been through a lot! It takes a lot of strength to be where you are today and survive all that.

Chronic sepsis alone can lead to loss of weight, not to mention all the therapy you are taking. Sepsis whether accompanied by fever or not leads to an increased metabolic rate. If you are at the hospital then I imagine the nutritionist should be able to adjust your calories properly. What we want to avoid is protein catabolism, where the body breaks down protein as a source of energy. However, I strongly urge you not to 'gorge' yourself with protein and fat rich foods in the hope of warding off an infection. Eating an unhealthy diet is the worst thing you can do to yourself.

Have you relayed your concern to your doctor. Have you been tested for malabsorption? Hyperthyroidism? I'm not suggesting that you need these tests, like I said chronic sepsis is a good enough cause.

My best to you!