A strenuous hike (with supplemental oxygen) to the summit of Pikes Peak gives one provider a glimpse of life on oxygen.

Some fund-raisers recently asked me to walk to the top of Pikes Peak to raise money for a charity. With a clear understanding that the altitude at 14,000 feet would have my resting oxygen saturation at approximately 80%, my response was "not without oxygen."

I accepted the challenge and began the work of researching what oxygen system I would use, and how I would arrange for the oxygen. I have a lot of experience in oxygen therapy and knew what systems I might want to bring—yet even with connections and networking, I became as frustrated as many LTOT patients looking for the right system to meet their needs.

Like most LTOT patients, I wanted the lightest-weight, longest-lasting system available. Reality set in as we explained to our patients that they could have lightweight or long-lasting, yet they could not have both. So what system to use? Liquid oxygen could have been a nice option, but the logistics of getting LOX to the hotel, and then to the starting point of the hike, would not work. As we know with LOX, it is use it or lose it.

The next option was compressed gas. The best option was to use a lightweight composite cylinder that could store 3,000 psi of oxygen. I was able to get a composite cylinder, yet could not get anyone to fill it. I settled for a 2,000 psi fill, which reduced my operating time by one third. Now I needed a conserving device. Should I choose a high-dose system or low-dose? I went with both. A conserver set on a low setting will last longer, yet I wanted to have a high top-end system just in case I got into trouble and needed to turbo boost my oxygen delivery. The system I took on the trip had two M6-size composite cylinders, filled to 2,000 psi, with a high-dose oxygen conserving device (OCD). I was a respiratory therapist, armed with my best option for oxygen therapy.

THE EXPERIMENT

If you are going to do an experiment, document it. The trip was estimated to take about 6 hours from our starting point at 10,000 feet to the summit at 14,100. I was wearing oxygen, so I used a recording oximeter for the journey. My son-in-law was going on the trip, so I put a recording oximeter on him to act as a control since he was not going to wear oxygen. I brought a spot-check oximeter for the rest of our group to see how everyone was doing on the trip.

We began at about 6 am to beat the rainstorms that hit Pikes Peak in the afternoon. Our group arrived at the starting point, checked our equipment and supplies, and got a short briefing from the search and rescue people who had volunteered to follow our group. Search and rescue? What had I gotten myself into?

I brought my two oxygen systems, 2 liters of water, and some high-energy snacks in my backpack. My backpack weighed about 20 pounds due to the water. It is recommended that you bring 1 liter for every hour you will be out, yet that would be like hauling an aquarium on my back, so I decided to be a rebel and go with 2 liters.

Our patients do the same rationalizations when we tell them they need more oxygen than they want to carry. I had my recording oximeter on one wrist, my GPS compass/altimeter on the other wrist, my spot-check oximeter around my neck, my hiking poles, and my backpack. I was the respiratory geek of the mountain.

We began the journey, and I was without oxygen to start because I wanted to make my oxygen last for the whole trip (have we heard that from our patients before?). No one else was wearing oxygen, so I felt I could go awhile without it. One hundred yards into the journey, my heart was pounding, my oxygen saturation was around 86, and I was hyperventilating. I decided to not be proud and put my oxygen on.

Trying to go without oxygen to make an oxygen system last longer is what our patients do. They try to balance how short of breath they are with how long they want the system to last. I was walking in their shoes, and now I knew what it felt like.

The young bucks in our group were walking briskly while we older folks were trying to pace ourselves. I checked both the young and the old and found the oxygen saturations were similar, yet heart rate was the key difference. If you are in condition, your heart rate is lower. I wished I had trained for this adventure!

The untrained hikers were doing what our patients do—walk for a little bit and then stop to catch their breath. As they exercised more, they would stop more frequently and look for a place to sit down. I have seen this many times with LTOT patients, and now we all were walking in their shoes.

I started out at a low pulse setting to make my oxygen system last longer. Unfortunately, my respiratory rate was up and I could hear my conserver clicking away in my backpack. Even with oxygen, my saturation was low and my heart rate high. At one point, I heard my pulse dose sound change, and it felt like I was not getting enough oxygen. My son-in-law checked my tubing and found that it had kinked in the backpack. I was using a comfortable silicone cannula, which is prone to kinking.

I took my backpack off, placed the OCD outside the backpack, and zipped the cylinder part inside so the cannula was free from kinking. Again, these are everyday issues that patients deal with while wearing their oxygen.

UPHILL BATTLE

I thought the oxygen would make this climb more of a walk in the park as opposed to a battle with the mountain. The trail we were on was established yet rugged. We had to climb and go up steep inclines. I was stopping frequently to catch my breath. The older or not in condition members of the group were dropping out, and now it was the young bucks and me tackling the mountain. I would do spot checks on our group and was amazed to see saturation at 81% to 85%. Heart rates were lower, so the conditioning was what allowed these younger climbers to keep going. The halfway point was Devils Playground, named for the frequent lightning strikes. Fortunately, we had a beautiful day and there were no clouds. I was using aluminum hiking poles and had oxygen. I did not want to know what would happen if lightning happened to strike around me.

My first tank was empty. I must have been breathing 20 to 30 times a minute, which would drain the tank quickly. Again, our patients who exercise will breathe faster and need to be kept in mind when calculating tank duration or battery life for a POC. I switched tanks and bumped my pulse dose setting to 2.5. We were at 13,000 feet.

The last 500 feet of the climb was more of a boulder field than a trail. We had to climb boulders, look for the next marker, try to breathe, and not fall down. I slowly moved forward, clicking away, hoping my oxygen would not run out before I got out of this quarry. I made it and walked slowly to the peak.

My legs were rubbery, and I was totally exhausted. I turned around and saw a beautiful panorama of the Rocky Mountains, which made it all worthwhile. I still had a little oxygen in the tank, yet took off the oxygen, removed the oximeters, and headed over to take some pictures. I had a Rocky Mountain high going on and felt great, yet drained.

Then reality set in. There is a road to the top of Pikes Peak, so it is a tourist location. I tried to get some pictures of the sign at the summit and the plaque that commemorates the song "America the Beautiful," which was inspired by the view. Overweight tourists were pushing and shoving to get a picture, and several were smoking cigarettes at 14,000 feet. I was thinking that many of these people would be on oxygen in the near future and wishing they had taken better care of themselves. I took a few pictures and moved away from the crowds.

LESSONS LEARNED

• When you can't breathe, nothing else matters (American Lung Association slogan).
• You can get a lightweight OR long-lasting oxygen system—you can't get both.
• Even if you know what you want, many times you can't get it.
• You can't browbeat someone to get what you want (in the oxygen industry).
• If you breath fast with an OCD, your oxygen system drains quickly.
• When your oxygen saturation is at 80%, you can't move.
• When you push muscles without oxygen, they complain.
• Sometimes ignorance is bliss because if you see your oxygen sats at a critically low level, it is scary.
• When you get to the top of the mountain you are climbing, there is no better feeling.

I accomplished my altitude adventure and was able to feel personally what it is like to be an LTOT patient, even if it was STOT. When the oxygen therapy is personal, you make sure everything is right. To truly know what patients are feeling, take a walk in their shoes. We may have greater empathy and go the extra mile to find the best solution.

Robert McCoy, RRT, FAARC, is managing director, Valley Inspired Products Inc, Apple Valley, Minn. He can be reached via e-mail: .