Peru - Cuzco - Puno altitude sickness

Hello FT'ers!

I am heading to Peru as a part of an epic South America trip in April and was hoping to get a bit of advice on my itinerary before completely locking it in. My plan is as follows:

Day 1 Lima - Puerto Maldonado (already booked)
Day 2/3 Amazon stay (already booked)
Day 4 Puerto Maldonado - Cuzco (flight booked)
Day 5 bus or train to Puno
Day 6/7/8 Puno/Lake Titicaca
Day 9 bus/train/flight to Cuzco
Day 10-16 Sacred Valley & hike Inca Trail

My logic is that it would be smarter to start at the higher altitude with low activity and then move to lower ones with increasing activity. None of the longer tours I have seen seem to plan like that though so I am wondering if there is a flaw in my plan or they just do it differently for ease of travel or connections?

Any suggestions for travel between Cuzco and Puno?

You may want to read up on avoiding altitude sickness. There should be a lot available online and in print. I could be wrong, but I think most physicians would advise starting at lower altitudes, and gradually going up, regardless of the amount of activity, so you body can get accusomed to the altitude. Not sure tours are planned based on that.

We flew from Rio, at sea level, to La Paz, Bolivia (airport is at about 13,000' and the city a bit below), and my wife had problems with headaches, etc. Many people drink coca tea to alleviate symptoms of altitude sickness (you don't want any leftover leaves when you hit U.S. Customs, of course). We took a bus to Copacabana, Bolivia on Lake Titicaca, and then Puno. She had to go to a doctor and get oxygen, in Copacabana. I had fewer problems, in part due to taking sulfa drugs (prescribed) before the trip. She couldn't take them, due to allergies.

Neither of us had many altitude problems in Puno, but I was extremely ill (vomiting and diarrhea) My wife, a physician, thinks it was due to trout from polluted waters. We then flew to Cusco, and went on to Machu Picchu. I went by train to MP (had to get back to Rio for my job), but my wife and a friend hiked the Inca Trail. Even though they'd been at high altitudes already, they did have some problems hiking the trail. MP itself isn't particuarly high (in fact, lower than Cusco).

You might want to talk with a physician, since each person's reaction to altitude can be different.

Going straight from sea level to 10K feet is always a bad idea. The first time I went to Cusco, I went to Arequipa for a few days first and had no problems. The second time I went straight from Lima to Colca Canyon (about the same altitude) and had the worst headaches of my life. You should really try to acclimatize somewhere in between.

Thanks for the responses!

I will have one day in Cuzco to 'begin' acclimatization before taking the bus to Puno (I figured taking the bus would allow for a bit more gradual of an adjustment than flying in), but perhaps it would be better to hike the trail first then go to the higher altitude at Puno?

My problem is I am somewhat locked in by bracketing flights (in on a particular day and out on another) so I only have 11 days and of course I want to do it all! :)

As for the acetazolamide, I will hold off on purchasing that until I know the coca tea and oxygen (freely available at the hotel I want to stay at in Puno) don't work for me. From everything I can read it is rather difficult to predict who will be affected and to what degree.

I could be wrong, but I think most physicians would advise starting at lower altitudes, and gradually going up, regardless of the amount of activity, so you body can get accusomed to the altitude. Not sure tours are planned based on that.

That's right. Many tours in Peru recommend traveling to Arequipa before going to higher altitude in Cusco or spending a night in Pisac before overnighting in Cusco. Maybe the overnight in Cusco before traveling to Puno will be alright... Just take it easy the first few days and avoid eating a lot in the evenings.

There really isn't much of a difference between Cuzco and Puno; about 1000 feet. My secret is breathing. If I get a bit of a headache, I stop and think about breathing. Drink plenty of water, go slow and you'll be fine.

Frankly for me the stomach problems are more difficult. Gave immodium to a fellow traveler who was in agony.

We did Cuzco, Machu Picchu, then Arequippa and then Lake Titicaca. (We did Isquitos before that).

Exactly there is not much difference between Cuzco and Puno. I think it's better to keep hiking the trail at the end of your trip. You'll have better acclimatization to the altitude.

I like traveling by bus between Cuzco and Puno to enjoy the altiplano landscapes. Enjoy your trip!

I thought Cusco was about 9,000' but one site said 10,900'. I saw Puno's elevation listed as 12,500'. Altitude sickness is a concern for hikers, and travelers in general, all over the world, so you can read up on it and/or talk with a doctor. The elevation will put a strain on your body, even if you don't hike, so it's a good idea to get a physical before embarking on such a trip. But it sounds like a great experience.

Soroche Pills worked great for me and for the rest of the Mud Familly...
They can be bought easily in any drugstore
But the key remains in going smoothly higher and higher and i definetely advise to stay a couple of days in Arequipa before going to Cuzco

Any suggestions for travel between Cuzco and Puno?

You can go by train or touristic bus, both are almost the same road, and lasts the whole day (7am-5pm aprox), but since bus is faster, it stops at some towns, churches and inca places. So the whole trip is wonderful, includes lunch.

I recommend this agency I took, check it
http://www.inkaexpress.com/ruta_del_sol.htm

There really isn't much of a difference between Cuzco and Puno; about 1000 feet. .

Yes but you may feel the difference, it depends on your organism. I didn't feel any difference, but some people get more exhausted in Punto than Cusco, after long walks. My fathe included (well he was 76 at that time).

It's hard to predict if you'll be in trouble because of altitude. It's all relative.

as others have mentioned, it's hard to say because people are affected in different ways by the altitude.

That said, I think doing the trail at the end is a good plan. When I arrived in Cusco from Lima the altitude killed me. I was pretty worthless for the first two days and winded from a flight of stairs. I couldn't imagine being on the trail. I'm a healthy guy who runs and works out pretty consistently so it was a tough adjustment.

Also, not sure if you have Cusco itself factored into your "sacred valley" segment, but do make sure to spend at least a couple nights in town. I stayed 2 weeks and it was hard to leave.

I felt the altitude more in Puno and was alright in Cusco. I could feel my heart beating so hard and fast and I thought it would jump out of my chest! going up the stairs, like 10 steps was exhausting.
One of my friend started to get sick in Cusco all the way to Puno. Another friend became sick once in Puno. Both couldn't leave their hotel room and couldn't eat anything.
Coca sweets can help ;)

I know it might be just a 1500 ft difference between Cusco and Puno but it's true that once you get that high, going into further altitude will probably have an effect even if the altitude difference is small... Even if you're OK in Cusco you could feel sick in Puno...


PS. I've lived at 10800 ft and for a while worked at 13500 ft

Fly between Cuzco to Juliaca and gain 2 days - skip the 12hr train ride each way between Cuzco to Puno, which is boring.

I would go from from Puno to Copacabana thru Lake Titicaca, then onto to La Paz, which is a charming major city.

Buy travel insurance in case the altitude sickness medicine doesn't work and you have to cancel, it's also a good idea in case you are robbed.

As for the acetazolamide, I will hold off on purchasing that until I know the coca tea and oxygen (freely available at the hotel I want to stay at in Puno) don't work for me. From everything I can read it is rather difficult to predict who will be affected and to what degree.

Just so you know, if you don't take the acetazolamide before arriving, then don't bother taking it at all. It works by acidifying your blood, and the resulting compensation that your body undergoes is what makes it easier for your body to handle the decreased oxygen profusion. Taking it after you already are suffering from altitude sickness is of no use.

Just so you know, if you don't take the acetazolamide before arriving, then don't bother taking it at all. It works by acidifying your blood, and the resulting compensation that your body undergoes is what makes it easier for your body to handle the decreased oxygen profusion. Taking it after you already are suffering from altitude sickness is of no use.

Absolutely correct. Buy the acetazolamide in Lima from a pharmacy (no prescription necessary; just ask for "acetazolamida") and start taking them a few days before ascent.

I followed this pill regimen and flew from Santiago (1,400ft ASL) to La Paz (12,000ft ASL) and only suffered a slight headache and fatigue that went away after a day. Of course, the other posters are right; altitude sickness affects different people in different ways.

Another good thing to note: do not drink alcohol until you are acclimated.

Another good thing to note: do not drink alcohol until you are acclimated.

Also try to eat light

Take the acetazolamide before you go and still take it easy the first two days at high altitude. I took the acetazolamide before I went to Cuzco/Sacred Valley but didn't give myself enough rest time when I arrived in Cuzco and got severe altitude sickness in the Sacred Valley (Pisac to be exact). I went blind for 2 hours and had to be carried down to lower altitude by paramedics...it was not fun. Be careful!

Before I visited Cuzco, I was worried about altitude sickness. I've never been even close to that altitude and all the horror stories were scaring me.

Some members of our group took soroche pills, and got violently ill.
I didnt take anything. I was perfectly fine. Felt amazing. Never better.