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Delegges find balance to promote better care by Heather Woolwine Public Relations Let’s be honest right up front: while most of us adore our spouses, we don’t need or want to work with them in addition to spending our personal lives together. Where would work end and home begin?   Well, Mark Delegge, M.D., Digestive Disease Center Nutrition director and Nutrition Services medical director, and Becky Delegge, a biomechanical engineer and CEO of Hammerhead Design Inc., might not have the answer to that question for all of us, but they know one thing… it works for them.   Dr. Mark Delegge with wife Becky in the lab. Both Delegges radiate a passion for gastroenterology and are known nationwide as experts on feeding tubes and implant materials designed for patients’ nutrition in the hospital and out. But it’s the chemistry produced when they bounce ideas off one another that led to their front cover and review in the December 2005 scholarly journal Nutrition in Clinical Practice.   As co-authors, the Delegges tackled several topics within their article, most notably changes and new developments within the world of biomaterials for implantation. When patients receive feeding tube implants, one of two materials is traditionally used, silicone or polyurethane. Currently, most tubes are silicone, but mounting evidence suggests a re-evaluationof polyurethane and its risks. Once the red-headed step child of feeding tube implants, polyurethane was given a bad rap for becoming brittle and breaking early in tube-feeding use and research, according to the Delegges. But, improvements rendered the material much better for extended use and along with the Delegges’ work, other research now indicates that copolymers combining silicone and polyurethane might be the way to go.   Much thought goes into designing a feeding tube implant because this material goes directly into a patient’s body and must be well-constructed in order to best serve the patient.   It seems easy enough. Unfortunately though, feeding tube design and construction has been fraught with ups and downs throughout the years, prompting the Delegges to join forces and expertise to make a difference for patients with feeding tubes.   “It’s incredibly uncomfortable and unpleasant to deal with a tube that is breaking down,” Becky said. “The tube breaks down from the inside out so essentially bacteria and yeast begin to grow, and you have this little ecosystem there with a nasty, rotting milk smell and pin holes that decrease the nutrition that a patient is getting. The tube tarnishes and becomes green, yellow and brown. Aside from the health implications, the social stigma for these patients can be just as unbearable.”   Mark explained that for all adults and children with chronic feeding tube use, only 27 percent will have one tube for about a year before it needs to be replaced, while almost half, or 45 percent, will replace a tube within six months of the first implantation.   “You can imagine what that’s like for the patient,” he said. “And so you can understand why we’re so interested in finding the best possible materials and design. We’re looking at the fittings, tube design, the materials, everything. In the past, feeding tube implantation was very hodgepodge; I’m not joking when I say that I’ve seen patients come in with golf tees holding everything in place because of breakdown. They deserve better than that in their quality of life.”   And so, on a day in 1992, the Delegges began their collaboration of more than a decade thus far. As patient advocates, they believe in finding better materials to keep patients from living with the equivalent of a smelly, breaking appendage; and as physician advocates, they strive to introduce and research better equipment and tools for implantation.   The Delegges discussed some of the drawbacks and steps forward in recent years. “A major problem that's finally beginning to be corrected is more of a patient focus on behalf of bioengineering companies who make the products and the tubes,” Becky said. “They’ve finally realized that the physicians are not the end-users of this product and that it really is important to have these implants last as long as they can.”   “Our mission is to work together to develop tubes that are patient-friendly, physician-friendly and durable,” Mark said. “As people finally begin to realize that a feeding tube is in fact, an implant, we’ve begun to see a change in the way people think about them, treat those who have them, and how they’re designed. From a physician’s perspective, we also want to find better surgical and noninvasive techniques to benefit patients who need feeding tubes.”   For example, Mark and his colleagues work on endoscopic procedures and changes in catheter size to enable better patient outcomes.   Many factors affect a patient’s feeding tube, including activity levels and each individual’s own unique chemical make-up; hence the reason for anomalies like a patient keeping a tube for three years or someone else's breaking down in two months.   As for future endeavors, the Delegges vow to continue to work on feeding tube issues, as they are what actually brought them together in the first place.   As a bioengineer from Clemson, Becky met Mark while he finished a gastrointestinal fellowship at the Medical College of Virginia. A symbiotic relationship from the beginning, the two spent much of their early collaboration evaluating best-practices and things available on the product market. Thirty-three  patents, three children (Taylor, 14, Madison, 12, and Garrett, 11), a professorship at MUSC and a co-owned bioengineering company show that despite not being ever really free of work, the Delegges maintain a thriving professional and personal life.   “It can be hard to take time off, and even when we do, if one of us gets a thought or an idea, especially Mark, we can become, let’s just say… driven,” Becky said with a laugh.   “And sometimes it can be hard to separate a personal issue  from working together professionally, but we get over that too,” Mark said. “We’re both independent and successful in our fields so it’s always funny when I go somewhere with Becky and people say, ‘Oh you’re Becky’s husband’ or she comes with me and someone says ‘Oh, you’re Mark’s wife.’ We just do the best we can and it’s nice how well it all seems to work.”     Friday, Jan. 27, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. 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