Just got back from ten days in Peru: Arequipa, Colca Canyon, Cuzco, Machu Pichu. Since I was coming from sea level I was concerned about the altitude, esp. Colca, which at one point was 15K feet. My wife and I began using Diamox 125mg/2xday prior to our arrival, and it worked very well. Residual problems (slight headache) were eradicated with a wad of Coca leaves between cheek and gum. However, a certain amount of sleep apnea persisted, even after a week at altitude.
I'll post other trip details later. I have some good hotel/restaurant tips.
-N

ncanavan:
How many days before your arrival at high altitude did you begin taking the Diamox? I know you have to drink plenty of water, did you have to abstain from alcohol (wine & beer) while you were taking it? I am leaving in a few days for Lima. After 2 days I will be flying to Cusco but going directly to the sacred valley, then on to Machu Pichu and then Cusco.I have Diamox, but it is the 500mg time-released capsules which should work just as well.
What restaurants did you like in Cusco?

ncanavan: I am in the process of putting together our trip to Peru for January. I'll look forward to your trip report and thanks for the suggestion on Diamox.

Hi there.

As for the Diamox, I would ask the pharmacist to get you the 125mg tabs. The 500mg dose is for glaucoma - not that it would kill you, but I suspect that it would make your kidneys work that much harder, and require even more water (and yes, we had Pisco sours too - no problem). We started taking the drug for two days prior to our departure, and stopped four days after our arrival (I was not so much concerned about Cuzco, our 2nd stop, as I was Arequipa and Colca Canyon, our first stop. The Colca condor site is 13k feet.)
Our experience with restaurants in Cuzco was hit and miss. A sure bet is the Inca Grill, a fancy place on the Plaza de Armas. It's pricey by Peruvian standards, but dependable. There is a great cafe for breakfast/coffee/pastry on the plaza right next to the cathedral. I don't recall the name, it starts with an "A", but it's easy to spot. Terrific view, good food/price, classical music, clean bathrooms (in Peru, always bring your own paper). Right off the plaza is Los Candales, a restaurant that caters to locals. Sit in the cozy back room. Dinner for two with drinks will run about $12. Credit cards accepted.
Which brings me to another tip. Just because they have a Visa sign in the window, don't assume it's anything more than a decoration. Verify with the waiter before you order.
And one more: As in Mexico, beware fresh salad. My wife had some trouble for an evening because of either tomato, or lettuce, not sure which.
One more: There's a wonderful cafe in San Blas called Pi (actually, just the symbol for the mathmatical value Pi). Owned by ex-pats, it's part cafe, part gallery, part video movie theater (a movie every Thursday night). Alcohol and internet are available (try a shot of the local drink Mata Cuy!).

And finally, Lima. Lima I did not like. Rather than risk the downtown experience, we opted to spend our seven hour layover at the Marriot in Miraflores. It's right on the water, 45min from the airport, and the food and service is excellent.
-N

A remark from a hikers' outfitter store owner, the one drawback to Diamox is it will make anything carbonated taste like Alka-Setzer, a temporary effect.

Ardeis in Tampa
Just don't be surprised.

Hi, we are travelling to Machu Picchu and Cusco in December 2004. I am worried about altitude sickness but I have also heard the drugs are not good. I have even been given advice regarding chinese mushrooms which would help. How serious is this really? Have you gone up and experienced it? Or not? I am concerned it could ruin an expected great holiday, because we are going straight up to Cusco after Lima. Any thoughts would be welcome.

I'm not a doctor, but everyone reacts different to those medications. For instance, my fiance started taking diomox a couple of days prior to going to Cuzco, but it never worked on her. She suffered from terrible migranes, vomits, lack of sleep, cold sweats at night, etc for day and half.

Just met with my doctor and he recommended the 125mg also 2x a day and lots of water. He said at that dosage, any side effects would be lessened as well but it should still work fine. Thanks for the restaurant recs. We're staying at the Monasterio that I think is on the plaza or near it in Cusco?

We will be in Quito, Cuzco, Arequippa, and Colca Canyon in December. We're also staying at the Monasterio which seems to get rave reviews on every site.

Didn't even think about taking medication for the altitude but now we will. Since sleep is also a problem, doesn't anyone take Ambien or something like that also??

Ambien will help you get to sleep, but it will do nothing for the high altitude headache, or lack of restful sleep because you're not getting enough O2

Just thought I'd jump in with input on our experience with altitude. We did the Lake Titicaca, Arequipa, Colca Canyon, Cuzco, and Machu Pichu trip in September of 2003. We did not take anything for the altitude other than the coca tea and drinking lots of water. Our first night was at Lake Titicaca. Once we arrived I started drinking coca tea like it was going out of style after reading it was great for assisting in altitude sickness. I didn't really put two and two together, but coca tea is a stimulant (I believe) and I was up ALL night that first night. I had a horrible pounding headache all night (due to the altitude), but the next morning I was fine and had no problems the rest of the trip at all. My wife ended up getting the pounding headache the next night (one day delay), but again neither one of us had problems after the one night of headaches.

I went to a trevellers medical clinic in NY and they gave me 250 mg tablets of Diamox. Now I'm a bit worried they will be too strong and I'll get side effects. We'll be spending 2 nights in the Sacred Valley and one at MP right before going to Cuzco. Shouldn't that help us acclimatize? We'll also be staying at the Monesterio and I plan on having the oxygen pumped into the room that they offer.

Well, as others have said, everyone is different, but a group of 16, ranging in age from about 30 to 70, did the trip like that--Sacred Valley/MP before Cusco--and had no problems whatsoever. I wasn't even drinking the tea, and the only difference I noticed was that I didn't feel as rested as I normally do when I got up.

Peru is wonderful; have a great trip!

I assume that when you did Sacred Valley and MP before Cuzco, you did go to Cuzco first, but didn't stay there.

Also, in the mid-section of Sacred Valley is Urubamba, which is 9200 ft altitude, compared to Cuzco which is 11200. So please realize that there is not that much of a difference.

We flew into Cusco, of course, and then went immediately down, the only "sure cure". The difference between Cusco and Urubamba is actually pretty significant, especially considering that between 10-11,000 feet seems to be the "magic number" for most altitude sickness--and MP, of course, is lower yet. My coastal lungs were happy to get down to the Amazon, though!

Thanks Amy, that makes me feel better. We chose to go to the Sacred Valley and MP before Cuzco hoping to alleviate the symptoms of altitude sickness. And like you, after Cuzco, we're flying to Puerto Maldonado to spend five days in the Amazon Basin. Any suggestions for the jungle?

The only time I noticed the high altitude was when I first got off the plane from Lima to Cuzco. The air was noticibly thinner and I had to breathe more deeply and more often. After a day, I didn't even notice this.
For the Amazon basin, one of the things I enjoyed the most was a night time boat trip to see capybara and cayman. The capybara are amazing, nearly as large as bears. The other wildlife was interesting too, even a fer de lance that crawled on the trail a few feet ahead of me.

Interesting page:

<http://www.cdc.gov/travel/diseases/altitude.htm>

RBC, I'm almost afraid to ask, but what is a fer de lance? It's not some horrible insect, is it?
Jed, thanks for the site.

Nope, a fer de lance is a snake! Reassuring, no?

Laurieco, I was in the northern Amazon, going out from Iquitos, but I'm sure that a few things would apply to both:
1. make sure your clothes are the kind that dry out easily--nothing will ever be fully dry!
2. two words: mosquito repellant
3. enjoy the unexpected: bats in the latrine are one example of an unexpected "joy" on my trip (but hey, after a while you get used to them)