Well the Incas certainly made it difficult for us tourists when the put Cuzco at such a high altitude. What were they thinking?!

However given that, it's difficult to get around flying into Cuzco from a lower elevation, which is the recipe for AMS. So you need to scrupulously follow the guidelines: don't overexert yourself, avoid alcohol (sorry), and force down more water than you thought was possible.

You'll certainly feel out of breath when walking uphill or up a flight of stairs. Just go real s..l..o..w then. You may get a mild headache but hopefully it doesn't progress beyond that.

For the record I've spent months on long treks and climbs above 14,000' and have some experience with this stuff. There is nothing you can do beforehand to train except try to be hydrated when you arrive.

Personally I think your time in Cuzco is a bit rushed, but if that's what you have then so be it.

Good luck and have a great trip. Machu Picchu is amazing.

I don't think it's a recipe for it - it's done all the time for cruise extensions and add ons for Galapagos trips/etc. I know your time is limited and if this is what's available to you I'd do it!

Thank you. I am filling my water bottle now.

YOu would do better if you did not sleep in Cusco on arrival, as many have advised earlier. The Sacred Valley is 2000 feet lower in elevation. Many people feel unwell with headaches, nausea, dizziness in Cusco but not in the Sacred Valley or in Aguas Calientes. I would suggest you improve your chances of being able to sightsee the next day by leaving Cusco immediately upon arrival and only returning for your flight out.

I agree with mlgb. Take a cab from the airport to Ollantaytambo and spend the night there. Your trip to MP in the morning will be lots shorter, and you will feel better having slept at a lower altitude.

Yes, do see if you can get a hotel at Olly. If not, stay hydrated, keep off alcohol and try not to do too much the first day. We flew straight to Cusco and were fine, except for DH who was a little breathless, but otherwise we had no problems. Coca tea is good, all hotels have them, or you could chew on the leaves. If you feel really bad go under the oxygen mask for 10-15 mins, don't hesitate to ask you hotel. Enjoy your trip, MP is something else

Coca tea, very good. More reasons to o/nt in Ollantytambo. Gracias.

Don't forget to bring something for headache, too.

I was going to post "don't worry too much about altitude and Cuzco" but then I read the article below. It's been a tough week for Canadians at altitude:

http://news.nationalpost.com/2012/05/24/im-on-the-side-of-a-mountain-and-theres-nothing-i-can-do/

What a sad story. Unfortunately there is no correlation to age or fitness.

The best approach is to take the time to adjust and to listen to your own body, and not push to keep up with a preset schedule or traveling partners.

The part about the women from the village touching him. What wonderful people.

Yes, very sad tragedy. Condolences to Mr. Kennedy, his family and friends.

I've seen two cases of fatal HAPE. Both were at elevations of above ~5,000 m / 17,000 ft. Not pretty.

In one case a man, not in out group, had raced up there much too fast due to limited amount of vacation time. In the other case the only way out of the basin involved a difficult 2,000 foot ascent - exactly the wrong requirement. Unfortunately, a Gamow bag did not suffice in this case.

As mlgb notes, fitness and age have nothing to do with it, and in fact good fitness may have been a factor the first case.

Cusco is below the elevation where things get this bad for most people, but it's wise to recognize serious symptoms and to descend ASAP if they persist.

Yes - on your Day 2, get a cab or arrange hotel pickup to Ollantaytambo. Lots of reasons - altitude, wonderful village, spectacular scenery. Also puts you about 2 hours closer to MP, which extends your visit to MP on Day 3 and makes for a slightly more relaxing day.

If only you had one more day for Cusco!

Just returned from Peru and from first-hand experience and what every doctor will tell you - everyone is different. You might not experience any issues with altitude. Or you might get all the symptoms and feel horrible.

In Puno/Lake Titicaca (higher than Cusco), it hit me hard. Nausea, vomiting, shortness of breath... I felt really weak. I was there for three days, then headed to Cusco and felt a 100 times better. Everyone has a different limit.

The best advice is to drink a ton of fluids. Water, tea (mint or coca is supposed to help, but not sure if it really does), Gatorade. Go slowly.

It is always interesting to read how many more people are okay in Cusco (11,100 ft) but affected at Puno (12,400 ft). The same with Cusco vs Ollantaytambo (9,100 ft).

I guess I do fairly well at altitude (went up near 5,000 meters or 16,400 feet a few times this trip). There is a big difference though between sitting in a bus and walking uphill at that altitude. Maybe some of the problems are due to walking uphill around Cusco and the Lake Titicaca islands.

I find a two=liter bottle of water per day per person about right.