"There are quite a few people out there," Dr. Gary M. Roggin was saying, "who have these symptoms, but they've just decided that nothing can be done.
"They've had them long enough so that they know it's nothing serious, so they really live with a certain amount of compromise to their daily activities . . . It can be quite a compromising illness."
Dr. Roggin is an enterologist. His is that sub-specialty of medicine that deals in disorder of digestion and elimination, or the physiological functions and malfunctions considered too inelegant for casual reference.
But those malfunctions -- around 100 of them, ranging from the embarassing and annoying to the life-threatening -- account for 20 million chronically ill Americans. They are the leading cause of hospitalization and the primary reason for major surgery in the United States, according to a recent report of the National Commission on Digestive Diseases.
What Dr. Roggin was talking about specifically, was a symptom complex currently known as "irritable bowel syndrome." It is what people used to call "spastic colon."
But whatever it's called, it was the single specific ailment prompting most people to call the recently instituted GUTLINE.
Gary Roggin is one of a group of gastroenterologists who volunteer to man telephones twice a week -- Tuesdays and Thursdays from 7:30 to 9 p.m. -- at the American Digestive Disease Society's GUTLINE. Under a meticulously maintained cloak of anonymity, anybody with a question about any of the digestive illnesses, no matter how seemingly trivial -- or how terrifyingly ominous -- can speak leisurely and frankly with a specialist.
The Association's specialists are drawn from private practice, from the military or from one of the area medical schools.
Since the line was opened at the end of November, 15 callers a night have been taking advantage of the program. Calls have come from all over the country -- Los Angeles, Seattle, Omaha, for example -- demonstrating to GUTLINE sponsors that, indeed, there is a need out there. So far the nonprofit association has been unable to afford an 800, toll-free, line, so out-of-town calls have been long-distance at the callers' expense, notes Miriam Ratner, association spokeswoman.
The number is, in Bethesda, 652-5524. Area code for those out of the area is 301.
Along with irritable bowel syndrome, the most often asked questions have been about a group of rather generalized digestive symptoms, principally, constipation, heartburn, gas and pain -- and what can be done about them. (Many callers are "irritable bowel people" too, as Ratner puts it, but had not been diagnosed specifically as such.)
Although GUTLINE doctors will make no diagnoses and do not handle crisis situations on the telephone, Dr. Roggin and colleagues have plenty of reassurance for callers and some advice on diet and other non-prescritpion ways of controlling symptoms.
Irritable bowel syndrome -- recurrent and varying degrees of diarrhea and constipation and attendant cramps -- has been shown in a number of well-controlled studies to be directly related to stress. Says Dr. Roggin, "I think this is a disease of the time . . . it's something that happens with the kind of activity we have in our world today."
The trouble is, says Roggin, "that of all those people walking around with half-symptoms, half-diseases, many of them have been told something that is very, very disconcerting. They've been told they have no organic disease.
"Their doctor will say something like, 'Well, I find no problems, the upper and lower gastrointestinal tracts are normal; your blood studies are normal and phsysiologically, I find nothing to be concerned about . . .'
"And he thinks he has reassured the patient.
"But then the patient may say something like, 'Well, I guess it's sort of in my head? Something I made up?' And if the physician doesn't respond firmly in a way to qualify that, the patient may leave with the misconception that 'the disease is in my head so it is something I can control in my head and I'm going to have to learn to live with it.'"
Says Roggin, "One ought not to have to live with these kinds of symptoms."
In his own practice, as well as to GUTLINE callers, Roggin tries to dispel misconceptions and ease the guilt, additional tension and psychic trauma for the patient who is unable to control the ailment. "The whole thing proliferates into a self-perpetuating disease."
"Patients," he says, "want to know and have a right to know . . . The positive part of medicine is to have enough time to make patients feel they understand (their illness), and then of course they can deal with it."
Some dietary tips that can often help include first -- significantly -- avoiding foods "that are likely to stimulate the colon."
These include caffeinated products (coffee, teas, cola drinks, even some root beers), too much fat in the diet and peppers -- black, chili, red. "The only condiment," says Roggin, "that has been shown scientifically to exert this negative influence in the gastrointestinal tract."
For some people, lactose (the sugar in milk) cannot be tolerated. If so, milk, ice cream and soft cheese must also be avoided.
Finally, Roggin urges that people suffering from irritable bowel syndrome "try to increase the bulk and fiber content in their diet." Calling this a "major recommendation," he refers to recent disclosures linking diets high in bulk to a substantially lower incidence of intestinal cancers and other bowel problems.
Of course, GUTLINE always recommends that people with even mild symptoms suggesting irritable bowel syndrome have a thorough medical evaluation, "because the same kinds of symptoms could occur with more serious diseases."
The thing both doctors and officials of the association found "really mind-blowing" about GUTLINE response was that 42 percent of the callers were male, mostly middle-aged. Says Ratner, "I think it's the fact that it is anonymous, that there's no face-to-face confrontation and they can admit that they have these worries where otherwise they could not."
"They see it," says Roggin, "as a sign of weakness to admit they might have an illness that requires additional help, that they can't just keep on denying [TEXT OMITTED FROM SOURCE]."
In any case, "One thing physicians have found," says Ratner, "is how desperate people really are, how serious their functional problems can be . . ."