Tove Titlow describes her Bethesda community near the National Institutes of Health as one "very much under siege. . . . I don't see why one of the oldest suburbs in Montgomery has to be so pushed by developers all the time."

For Titlow, president of the Sonoma Citizens Association, and other community activists in neighborhoods north of Bethesda's central business district, defense of their flanks from encroaching professional, commercial and medical developers has become something of a second full-time job.

"We're fighting a rear-guard sort of situation," said Titlow in describing a two-year effort by the community to resist plans of nearby Suburban Hospital to build a five-story office building for staff physicians.

Suburban Hospital says it needs the structure -- which it calls an ambulatory care facility -- so that staff physicians can see outpatients while holding down health-care costs by ordering chemotherapy, X-rays and other diagnostic tests at the adjacent hospital.

The community of some 320 residents stridently objects to both the size and scale of the building. Residents say Suburban is proposing a commercial medical office building in the guise of a hospital expansion while bypassing the normal needs assessment required by Maryland law for health-care providers, according to Spring Swinehart, president of the Huntington Terrace Citizens Association, the group spearheading the fight to stop Suburban's expansion.

Although the Suburban project is by far the most pressing cause of area citizens groups, preserving the whole residential flavor of Old Georgetown Road is also a big concern.

"We feel like the little Dutch boy. We don't have enough fingers to plug the dike," Titlow said.

Most, if not all, of the development in the last several years along Old Georgetown Road between Suburban Hospital and Democracy Boulevard has been medical office buildings, national medical associations or health-related groups that were granted special exceptions to build in an area zoned residential under the Bethesda Master Plan.

"It's a prestigious neighborhood, and everyone likes to be close to NIH," said Jessica Botsford, a lawyer and member of the Sonoma Citizens Association.

Botsford said "the whole way the county's planning process works does put a great burden on citizens who want to have a say. . . . We have had to hire a lawyer and a city planning and zoning expert, and many people have to take off from work to testify at hearings."

Swinehart estimates that the community has spent about $3,000 alone to oppose the Suburban ambulatory care project.

Swinehart, Titlow and others worry that many people are buying properties along Old Georgetown for future speculation, a concern echoed by residents of Battery Park, a community at the northern edge of Bethesda's central business district and about a mile south of the National Institutes of Health on Old Georgetown Road.

"The pressure's been phenomenal, especially since the coming of Metro," said George Shaffer, a lawyer and Battery Park resident.

"Our problems are more serious than those further north because we're not just being approached by the medical community. We've been bombarded by commercial outcroppings that came with Metro and by contractors or other professionals who want to use residential houses for their offices. Almost everything involves litigation or prolonged negotiations . . . ," Shaffer said.

In one case, residents fought development of the Gendelman property at the intersection of Old Georgetown and Glenbrook roads for over a decade. The resulting 2 1/2-story Old Georgetown Office Park that opened earlier this year "is a compromise design with a developer who worked extremely hard to accommodate the community's wishes," Shaffer said.

Most recently, the community has been forced to adopt residential permit parking to keep employes from that building and other offices from parking in the neighborhood, according to Theodora Ooms, president of the Battery Park Citizens Association.

"The parking is incredible. Right now we have a two-hour limit. But the people with the least amount of parking are paying other people to move their cars," Shaffer said. So, come December, parking in the area will be limited to permit-carrying residents, a move already taken by the adjacent Edgemoor community.

Now the community is worried about the recent sale of a distinctive Spanish-style house and four adjoining lots at Battery Lane and Old Georgetown Road. "It's kind of a landmark for the community, and we don't know who it was sold to," Shaffer said.

"In Battery Park, we're getting the fringes of the central business district," said Malcolm Rivkin, a city planner and resident of the community. "Real estate prices are a little better here and business firms want to be centrally located. . . . Plus, there's considerable pressure to convert homes along Old Georgetown Road to commercial uses."

But Rivkin -- who has been hired to give expert testimony for the Huntington Terrace Citizens group at its hearing before county zoning officials next Thursday -- says Battery Park has not had to contend with anything resembling the "massive addition" that the Suburban Hospital project poses to residents near NIH.

"The Suburban proposal is quite counter to the master plan. It's a massive addition to the neighborhood, and it would be impossible for a private developer to make that same size of proposal given the residential zoning there," Rivkin said.

Botsford said that besides the Suburban project, the community also is concerned about expansion under way on National Institutes of Health property at the intersection of Old Georgetown and Greentree roads and by the proposal to build a national headquarters across the street for physicians who use ultrasound techniques.

"We realize that we basically have no control over what they put on the NIH site because it's a federal facility, but any expansion on that corner will immediately affect traffic in our neighborhood" across the street and should be factored in when developers on the other side of Old Georgetown apply for projects, Botsford said.

The office building -- if built -- would be the national headquarters of the American Institute for Ultrasound in Medicine, said Michael K. Meinerz, spokesman for the group, which has about 7,000 members nationally. It would contain about 9,000 square feet on two floors with a small conference room and adjacent parking for about 28 cars, he said.

"We've worked hard on a design that we think will please the community. We plan to leave as many of the large hardwoods [trees] that we found there as possible. . . . The exterior will be brick with a gabled roof, and the whole front will be a landscaped lawn and garden," Meinerz said.

Botsford said the community has had no contact with developers of the ultrasound project and is withholding judgment until "we see what we're dealing with."