South America - Adjusting to and coping with high altitude in South America

I mentioned a potential driving itinerary here:

http://www.flyertalk.com/forum/south-america/1349448-northern-south-america-preliminary-itinerary-planning.html#post18768833

LIM + drive (remember we like to drive a LOT! Several hundred miles a day is no problem) to Lake Titicaca via Nazca and Arequipa, possible side trip to La Paz, back to LIM via Cuzco, Machu Picchu,and either back through Nazca or up through Huancayo (are roads up that way OK for a small car)?


Subject to revision, of course, and I'll probably shortly be posting a separate thread asking for specifics on the itinerary, but I did have a question based on a statement by another FTer in that thread:

Is the altitude gain done during that driving tour something we should be worried about?

I will be traveling with my 78-year-old grandfather (in reasonable health). Both of us have spent time driving at ~10,000 feet in Colorado and up to the 14,000-foot-summit of Pike's Peak with no adverse effects. However, it sounds like it's impossible to determine whether the high altitude of the Andes will be something we can deal with.

Our thought was that since we're driving up over the course of a few days, that will give our bodies time to adjust to the altitude. Will that be the case, or is there still a chance that we could be left with adverse effects as we climb? If so, what options are available for dealing with that--is it a matter of stopping, resting, and heading back down to a lower altitude when able, or are there things that can be done to combat the sickness (portable oxygen, medication, etc.)?

Also, on the route outlined above, is there concern in August about the ability of a small rental car to follow the roads along that route? Or is something with four-wheel-drive absolutely necessary? Or is it advisable to can the whole idea of driving on that trip?

Thanks in advance!

As somebody who has done a fair amount of high altitude mountaineering, the truth is you never can anticipate the effect on altitude prior to a climb. Even experienced climbers have unforeseen problems.

The most common problem is sleep deprivation. High altitude sleep deprivation will ruin your vacation. You’ll be exhausted over the entire length of the trip. And, 78 years old is not going to help the situation, regardless of health and physical condition. Sorry, but the resiliency of youth is wasted on the young. Although, I’ve seen plenty of young people suffer from sleep deprivation at altitude.

My recommendation is to see your doctor prior to your trip, and get some sleeping pills. The current generation of sleeping pills is amazing. They have no “after-life”, meaning in the morning, there will none of the “hangover” effect.

The roads in rural Peru are good. Most are two lanes, and kind of like older U.S. rural roads…..well paved, good signs. I wouldn’t hesitate to drive a small rental car. August is still well in the dry season, so inclement weather shouldn’t be a factor.

As somebody who has done a fair amount of high altitude mountaineering, the truth is you never can anticipate the effect on altitude prior to a climb. Even experienced climbers have unforeseen problems.

The most common problem is sleep deprivation. High altitude sleep deprivation will ruin your vacation. You’ll be exhausted over the entire length of the trip. And, 78 years old is not going to help the situation, regardless of health and physical condition. Sorry, but the resiliency of youth is wasted on the young. Although, I’ve seen plenty of young people suffer from sleep deprivation at altitude.

My recommendation is to see your doctor prior to your trip, and get some sleeping pills. The current generation of sleeping pills is amazing. They have no “after-life”, meaning in the morning, there will none of the “hangover” effect.


would you be worried about flying to 12,000 to 12,500 feet (that is for La Paz) from buenos aires which is at sea level? We are 23 and 25 if that makes a difference.

altitude sickness is nothing to take lightly. I had it bad in Puno. I spent time in Arequipa to get aquainted with the increase of altitude and took the correct precautions and I was still sick.
As far as the roads go I disageee with the comment that roads are good. Roads are unpaved with many twists and turns and you'll see many make shift memorials on the side of these roads paying tribute to people that died on those roads. Most roads are unlit at night and narrow and usually close to cliffs. Sure the roads in big cities i.e. Arequipa and Lima are nice. However, driving in Lima is not for the faint of heart.

I will be traveling with my 78-year-old grandfather (in reasonable health). Both of us have spent time driving at ~10,000 feet in Colorado and up to the 14,000-foot-summit of Pike's Peak with no adverse effects. However, it sounds like it's impossible to determine whether the high altitude of the Andes will be something we can deal with.

I strongly recommend you must take your grandfather to a healthcheck, specially about heart, blood pressure, cholesterol, and all related to that, before coming to Peru.

It's unpredictable to know how will you react in Cusco (3400mt) or Puno (3860 mt). My father visited cusco several times and never got sick there, but when he reached 76yo, we went to Cusco and Puno again, and he got blood pressure problems in Puno (in Cusco he felt fine). He got his pills so it wasn't big deal.

Some people, old or young, need the whole first day to acclimatize. Others feel fine since the first day and do the city tour in the afternoon. It's unpredictable.

Thanks for the advice so far.

Specifically, I want to note that we will be driving up to those elevations over the course of several days. It's not like we're landing in Cuzco and embarking right on any activities straight off the plane.

I have seen it mentioned elsewhere as well as above that people often need to take "a full day" to acclimate to the altitude when flying into high-altitude regions before engaging in any activities. Since we are driving up over multiple days, I would assume that takes care of a good bit of the acclimation process (although as noted by amieuro, still leaves a potential issue).

Is that a correct assumption?

If you worry about aclimatization, I would change my routing and go up to Cuzco from Nazca and then back via Puno and Arequipa. This gives you more flexibility for adaptation as part of the sacred valley is slightly below 3000m, in case you have a problem, while being in Puno, there is nowhere near to go down. I actually did exactly that routing about 2 years ago and used stops in Abancay and sacred valley (including excursion to MP) to aclimatize before staying in Cuzco and then going further up to Puno. It's not the same driving up a mountain pass and going down within 2-3 hours or staying at almost 4000 meters with nowhere to go.

I rented a 4-weel drive at that time to have more flexibility for excursions. If you stay on the main routes, there is no need for it. But be aware that in the mountains gas stations sometimes run out of some sort of petrol. Fill up whenever you can. And make sure your spare tire is in good condition. Although I have not taken the road between Huancayo and Abancay, I would not dare so without a 4-weel drive.

I have seen it mentioned elsewhere as well as above that people often need to take "a full day" to acclimate to the altitude when flying into high-altitude regions before engaging in any activities. Since we are driving up over multiple days, I would assume that takes care of a good bit of the acclimation process (although as noted by amieuro, still leaves a potential issue).

Is that a correct assumption?

Hi Jackal,

Well, yes and no on that assumption. "Full day" is at best an estimate. Depending on the individual, there is often a "trigger" altitude where the symptoms really start coming on. However if you have a pulse oximeter on that same individual in the hours before and after passing that "trigger" altitude, you will be able to see the blood oxygenation sats drop gradually.

(Disclaimer : Not providing medical advice here)

If you are really concerned, here's a suggestion and precaution that you can take. Go to the local Walgreen's or large drug store and see if you can buy a fingertip pulse oximeter. Should cost somewhere between $40-70. Really easy to use. Try it out before your trip. Your own (and grandfather's) readings should be well in the 95+ range.

As you are driving up, periodically check at beginning and end of each day (maybe middle too) to see what those readings are. You should see them drop each time you make a significant increase at altitude. As you acclimatize, they somewhat recover but not quite. At the point when you notice a large change in readings (5 to 10 points), take a pause and take it easy for the day or next. Sparing any serious medical conditions, they body will slowly adjust.

We recently returned from a trip to Peru with my mother to celebrate her 60th birthday. It was a very aggressive itinerary (7 cities in 11 days) and I was very apprehensive as the trip approached, with altitude sickness being one of my top concerns. As stated in many posts above, altitude affects everyone in different ways so take this for what it's worth (another anecdote/data point).

Prior to our trip we ventured to nearby Mt Charleston to drive/climb up to an elevation of 9,500-10,000 ft. My mom had no problems there - we spent a total of 5 hours (including the drive and a 3 hour roundtrip hike with an elevation gain of 1,800 ft). That gave me some comfort but I was still worried.

Cusco was a breeze, as was Sacred Valley and Machu Picchu. My mom ended up having some issues only during the Puno leg of the trip. We arrived in the early evening, had dinner and then retired for the night. At night she had difficulty sleeping and had to get up several times. In the morning, she had a slight headache but reported feeling a little better. We had just a half day at Lake Titicaca and my mom's symptoms got progressively better as the day went on. We were very fortunate that her symptoms were mild. I did keep stuffing her mouth with dried coca leaves every hour and I believe it did help. :P


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I will be traveling with my 78-year-old grandfather (in reasonable health).

Thanks. Understand that nothing here should be construed as medical advice, but some good suggestions to think about.

He'll be seeing his doctor a week or so before our trip, so I'll make sure he talks to his doctor about the altitude issue and see what the doctor gives as official medical advice.

would you be worried about flying to 12,000 to 12,500 feet (that is for La Paz) from buenos aires which is at sea level? We are 23 and 25 if that makes a difference.

Not worried, but I'd take precautions before travel. The downside is a really unpleasant holiday.....try going without meaningful sleep for 4-5 days, and see how you feel.

Do your best to avoid problems upfront.

Not worried, but I'd take precautions before travel. The downside is a really unpleasant holiday.....try going without meaningful sleep for 4-5 days, and see how you feel.

Do your best to avoid problems upfront.
are there any wonder pills or any tips that would reduce the affects?

are there any wonder pills or any tips that would reduce the affects?

Broken down to it's simplest terms...feeling better = breathing better. I would suggest two things. First, asthma aids will improve lung function. A Ventolin inhaler is something I always carry in my pocket at altitude. I know others who swear by steroid inhalers such as Advair, as they will reduce any inflammation within the lungs.

Some people take acetazolamide (Diamox). My impression is its effectiveness varies.

As I originally mentioned, getting a few good sleeping pills is the best advice I can give you. You're not going to know if you have a sleeping problem until 2-3 am your first night at altitude. Having a sleeping pill, at least gives you an option at that time.

Here's a good write-up on altitude sickness.

http://anthro.palomar.edu/adapt/adapt_3.htm

Best of luck.

I'm surprised that nobody has mentioned the main risk of driving from sea level to high altitude, which is that as you climb you will likely reach a point where you will feel very tired, and falling asleep at the wheel becomes a significant risk. This effect is surprisingly strong. With me it usually happens as I approach the 4,000 metre elevation, but I have had the same thing happen at a lower elevation (around 10,000 feet) in Colorado.

This is a real risk that you should take seriously. Of course, the only thing to do is pull over and rest for a while.

As for the Peruvian road system, as previous posters have noted, there are both good roads and bad roads. You need a good road atlas (these are available in Lima) and you should always ask ahead, if you speak Spanish. Whether you are on good or bad roads you should be prepared for the unexpected, everything from landslides to livestock on the road to pedestrians in unexpected places, to the famously erratic Peruvian drivers.

It is best to plan your driving to avoid driving at night, especially on unfamiliar roads. And remember, this is the tropics, so once the sun sets it gets dark in a hurry!

I'm surprised that nobody has mentioned the main risk of driving from sea level to high altitude, which is that as you climb you will likely reach a point where you will feel very tired, and falling asleep at the wheel becomes a significant risk. This effect is surprisingly strong. With me it usually happens as I approach the 4,000 metre elevation, but I have had the same thing happen at a lower elevation (around 10,000 feet) in Colorado.


Yes but it also depends on each person. It is a risk anyway, but not everybody got asleep, some people just got a strong, or mild headache, that of course is not good if you are driving. That sickness is what we call in Peru Soroche, or Sorojchi. The symptoms could be one OR some of these: headache, fatigue (physical exhaustion), sleep disturbances, nausea, vomiting, digestive disorders, agitation and dizziness.

are there any wonder pills or any tips that would reduce the affects?

The most popular is sorojchi pills. This is the website, sorry it's not in english but you can try to translate with the google tool and at least you can see the box to recognize it later.
http://www.sorojchipills.com/

My grandfather recently (completely by chance!) ran into a physician who is the specialist at a local hospital for altitude issues with climbing Denali (and 20,320' is certainly more than we'll be hitting in Peru!).

Her prescription: it probably won't be an issue given the gradual rate we'll be climbing via automobile. It's the flying-straight-from-Lima-to-Cuzco crowd that needs to be worried. She said if you encounter any symptoms, take it easy and stop to acclimate. She also told him to DEFINITELY avoid sleeping pills (the sense he got from her was that it is extremely dangerous to take them in conjunction with altitude sickness) and to get a prescription from his regular doctor of Diamox (125mg).

Interesting how it works:

Acetazolamide (Diamox®) is a medication that forces the kidneys to excrete bicarbonate, the base form of carbon dioxide; this re-acidifies the blood, balancing the effects of the hyperventilation that occurs at altitude in an attempt to get oxygen. This re-acidification acts as a respiratory stimulant, particularly at night, reducing or eliminating the periodic breathing pattern common at altitude. Its net effect is to accelerate acclimatization. Acetazolamide isn't a magic bullet, cure of AMS is not immediate. It makes a process that might normally take about 24-48 hours speed up to about 12-24 hours.

(from http://www.basecampmd.com/expguide/diamox.shtml)

It's the flying-straight-from-Lima-to-Cuzco crowd that needs to be worried.

If you have time, a good option is to fly to Arequipa first, a 1.5 or 2 days will give you plenty of time to visit the city. Then fly to Cusco. Since it's an altitude of 2,335 meters (7,661 ft), it's a good choice to prepare before going to Cusco. And it's a nice city.

Altitude is altitude, no different in Colorado or Perú. The easiest way to adjust is - to drive or otherwise make the transition bit by bit, keep hydrated. (jackal keeps saying he is driving, and I suspect driving Peruvian roads limits sudden changes of the 3,000 m kind ;).

The more rapidly you make the transition and the greater the altitude change, and the more you exert yourself at altitude soon after arriving, the more likely you will experience symptoms (e.g. flying Lima to Cusco and then exerting yourself with a lot of trying to see it all in one day). I frankly often wonder why people to not fly to Cusco and head immediately to the Sacred Valley, see Ollantaytambo and Machu Picchu and THEN see Cusco and surrounds before flying back to Lima or on to Pto. Maldonado, etc.

As for hydration and the coca tea one is offered ubiquitously in Cusco, I am not sure coca tea (much less leaves) does much more than the water itself does, as coca tea is a very mild diuretic and stimulant, perhaps not as much as coffee - coca leaves are chewed with lime to catalyze small amounts of cocaine hydrochloride, so no worries here, friends). The big benefit of someone pouring piping hot coca tea is - if boiled and not made with safe water, it's safe now. ;)

The most likely symptoms are increased heart rate, feeling of being out of breath, headaches, fatigue, nausea, dizziness, sleeplessness, loss of appetite, Cheyne-Stokes breathing (which is why "sleeping pills" are not recommended for all at high altitude), but other things can happen - mostly counteracted by quickly descending to a lower altitude, but if not possible treated with supplemental oxygen, etc.

The problem is for some at high altitudes it can turn into HAPE (High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema) which can be, left untreated or unresolved, fatal. I am not giving any medical advice here - but do suggest familiarising yourself with the issues of AMS with some of the links below, as it can be problematic for some.

My highest hikes have been to near 18,000 MSL, I have spent plenty of time in Peruvian high places, am a diver - reverse issue with several atmospheres of pressure - and pilot; flying at or above 10,000 ft / 3,048 meters MSL we are required to use supplemental oxygen. The latter should tell you something about possible deficits in ability ability to focus on critical tasks when somewhat anoxic / hypoxic, including driving tricky roads. I've not had problems at Cusco, Sillustani and the chullpas (jackal, you should visit this place between Juliaca and Puno at ~12,800 ft / 3900 m, Puno / Lake Titicaca at 12, 507 ft / 3,812 or walking up the stairs at Taquile Island in the lake... but Lady JDiver tends to get dehydrated and had the usual AMS symptoms arriving at Cusco - headache, nausea, fatigue, anorexia so it took convincing her to drink a lot - coca tea seemed to have some placebo effect as well as the hydration, a brief use of Diamox (plenty of Cusco pharmacies carry it, and no prescription is needed,) and some rest with a good night's sleep.

I can not emphasize ascending slowly if possible, keeping well hydrated and avoiding overexertion upon arrival at higher altitudes. Conversely, there is little or no difficulty descending to sea level. And perversely, AMS can actually affect fit young people as much or more than older people on occasion. Who will be affected at a given point is fairly unpredictable, like nitrogen narcosis for deep divers.

Good information for altitude sickness / soroche / sorojchi / apunamiento / yeyoacute / puna / mountain sickness (also see above - post #13 by jaymar01):

US National Library of Medicine <link (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001190/)>

emedicine.com <link (http://www.emedicinehealth.com/mountain_sickness/article_em.htm)>

altitude.org <link (http://www.altitude.org/altitude_sickness.php)>

climbing.about.com <link (http://climbing.about.com/od/staysafeclimbing/a/All-About-Acute-Mountain-Sickness.htm)>

travel-doctor.uk <link (http://www.traveldoctor.co.uk/altitude.htm)>

It occurs to me that, as this is a frequent topic applicable to other countries in South America (Ecuador, Colombia, Bolivia, etc.) this should be in the main South America Forum for greater member utility, so off it goes.

JDiver, Senior Moderator

The most popular is sorojchi pills. This is the website, sorry it's not in english but you can try to translate with the google tool and at least you can see the box to recognize it later.
http://www.sorojchipills.com/


Waoh now. Soroche pills are indeed popular, but the last time I looked they were just aspirin and caffeine! Drink a nice strong Altamayo coffee and take an aspirin for the same results ;) . Unless you go for the placebo effect :)

Talk about this to your international travel specialist doctor when you go in for your shots.

One warning about Diamox, if you are allergic to sulfa drugs you shouldn't take it so have an alternative plan if you have problems.

Good point: o should be careful about consuming anything that may affect a pre-existing condition or allergy, whether OTC or prescription.


One warning about Diamox, if you are allergic to sulfa drugs you shouldn't take it so have an alternative plan if you have problems.

"Sorojchi pills"... each capsule contains

325 mg acetylsalisylic acid (AKA aspirin or ASA)
160 mg acetaminosalol ("salofén")
15 mg caffeine


Acetylsalicylic acid breaks down in the human body into salicylic acid, which reduces fever (anipyretic), headache (analgesic), inflammation and is an anticoagulant; acetaminosalol is an analgesic that breaks down into salicylic acid and paracetamol / acetaminophen that is frankly not used much in modern medicine; caffeine is a mild diuretic and stimulant. I'd rather go with mate / té de coca / coca tea (not so much chewing coca leaf, as there's no hydriation in it).

"Sorojchi pills" could be bad for anyone with ulcers, anyone taking anticoagulant therapy and - it may have significant interactions with Diamox, or acetazolamide, often taken by those at higher altitudes.

This is not to be construed as medical advice, but feel free to do the research...

Waoh now. Soroche pills are indeed popular, but the last time I looked they were just aspirin and caffeine! Drink a nice strong Altamayo coffee and take an aspirin for the same results ;) . Unless you go for the placebo effect :)

Talk about this to your international travel specialist doctor when you go in for your shots.

...

The most popular is sorojchi pills. This is the website, sorry it's not in english but you can try to translate with the google tool and at least you can see the box to recognize it later.
http://www.sorojchipills.com/

If you have time, a good option is to fly to Arequipa first, a 1.5 or 2 days will give you plenty of time to visit the city. Then fly to Cusco. Since it's an altitude of 2,335 meters (7,661 ft), it's a good choice to prepare before going to Cusco. And it's a nice city.

Just a warning about this: don't include the Colca Canyon with Arequipa if your purpose is altitude acclimatization. The road from Arequipa to Yanque/Colca Canyon takes you up to 16,000 feet altitude; it blasted me pretty badly on the way in.