I required nocturnal oxygen using a nasal cannula for 8 years but suffered with recurrent epistaxis due to the nasal cannula. One year ago, after an acute exacerbation, I required continuous oxygen, and this presented a dilemma due to the ongoing epistaxis. My pulmonologist did not offer TTO as an alternate method of LTOT. I researched oxygen therapy on the Internet and found Transtracheal Systems. I contacted John Goodman, RRT, and after I explained my situation, he referred me to Dr Michael Schwartz at National Jewish Health in Denver, Colorado. Dr Schwartz spent a great deal of time with me on the telephone, but I felt Denver’s altitude might be problematic for me. I sought established transtracheal programs in Texas, New Mexico, and Arizona without success.