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Altitude Sickness

In Peru altitude sickness, or soroche as they say locally, is a phenomenon that happens daily to many tourists and locals
travelling from lower altitudes to altitudes high in the Andes mountains, to cities like Cusco, Huancayo, Ayacucho, Huaraz and Puno. Also those walking the Inca Trail, or other trails, or doing activites on high altitudes can suffer from it. This subject I decided to include here as a principal one; as many times the medical preparation for tourists do not include anything about altitude sickness. Many arrive unprepared to Cusco on 3300 meters (10800 feet) directly from their country with only a stop at the airport in Lima at sealevel. This has of course also to do with the quite exceptional altitudes that exist in Peru, places in the mountians of other continents, with exception of places in the Himalaya, are seldom more than 2000 meters (6561 feet) above sealevel.

Cause of altitude sickness and reaction of the body

Because of air getting less dense at higher altitudes, the concentration of oxygen is getting less also. You need oxygen for all body processes. The body reacts by producing more red blood cells to be able to have an higher absorbtion of oxygen from the thinner air and to have an higher level of oxygen in the blood vessels, this is a process that takes days. Also at higher altitudes the dehydratation process goes faster because water evaporating more quickly (This also causes water to boil earlier, at a lower temperature). Both processes affect the body and can result in several symptoms.

Symptoms of altitude sickness

How severe you will feel the symptons depends on your sensitivity to changes in atmospheric pressure, on how fast you came to the higher altitude, and also of course how long you already were at high altitude. There seems to be no relation between your physical condition and possible symptoms. My personal experience is though that persons with serious medical issues have to take care a lot. I have seen a couple of elder people with some health issues visiting Cusco, they were forced to stay at the hotel and had to visit the clinic a few times during the 2 weeks they were in the city. Also persons that already have problems on lower altitude with oxygen shortness, for example people with anemia, could suffer more. My mother, who visited Cusco like 5 times, always has suffered with anemia (low concentration of red blood cells), and the last 2 times she could not do any activities at all. She was tired all the time and her arms were swollen. The last time she went to Cusco she was 65 years old. These stories are not to make you afraid, but to indicate the need to know more about it before going to higher altitudes, especially if you have problems like the issues mentioned.
Normally, that means in most cases, people arriving at the 3300 meters (10800 feet) of Cusco or the even higher altitude of Puno and Lake Titicac of 3800 meters (12467) feet, have mild symptoms that include: headache, nausea, dizziness, tiredness, loss of appetite, upset stomach, feeling unsteady, shortness of breath, increased heart rate, difficulty sleeping, generally feeling unwell. At night this can be somewhat worse.
With these mild symptoms of altitude sickness, it is possible to do normal activities. You could continue with the Inca Trail with these symptoms for example. The symptoms start normally from within a few hours of being at altitude and start to be less after some 2 days, when the body becomes more adapted. So it is recommended to first be a few days at altitude before starting with more pysically demanding activities.

More severe and serious Symptoms

Severe headache, nausea and vomiting, increased shortness of breath, lack of co-ordination. Normal activities result difficult and symptoms can only be relieved by taking specialist medications and descending to a lower altitude. A good way to test whether someone has moderate altitude sickness is to ask them to walk heel to toe in a straight line. If they have co-ordination problems and cannot walk in a straight line, they should descend to a lower altitude immediately.
Very severe symptoms are: a persistent, irritable cough, breathlessness (even when resting), bubbling sound in the chest (caused by fluid in the lungs), coughing up pink frothy liquid, clumsiness and difficulty walking, irrational behaviour, double vision, convulsions (fits), drowsiness, confusion (caused by swelling of the brain or fluid on the brain). A person with these symptons needs as soon as possible oxygen and should be brought immediately to lower altitudes.

How to treat and avoid altitude sickness

Tips: not much activities when arriving at altitude, no exercising or so, only light activity during the day, which is better than sleeping. During sleeping the respiration decreases, so oxygen intake will be less. No smoking. Drinking enough liquid, but no alcohol. Trying to breath deeper and/ or faster will increase the intake of oxygen.
Other solutions are:
-Portable hyperbaric chambers also known as Gamow or Certec bags (an extreme solution but it works and especially recommended for expeditions to even higher altitudes)
-Some medicines as for example Acetazolamide (Diamox), and Dexamethasone, also as prevention (consult a doctor!)
-Take a coca tea when arriving at high altitude
-When you really feel bad, for example during trekking, ask for oxygen; at the Inca trail the tour companies are obliged to take oxygen with them. In Cusco you will find portable oxygen bottles for sale, see, it seems that nowadays you can get a "Free Oxygen Tank" at Cusco Airport. You can ask at medical posts, hospitals, clinics, pharmacies, drugstores and the hotels.
-Take a hotel that is equipped with oxygen supplement in the rooms; several of the luxury hotels of Cusco offer this. There is not much informatin how effective it is, but it could help of course.
-When during yout trip you go to over 3000 meters (9842 feet), like a city as Cusco, you could go first to a lower altitude; suggestion for exmaple is to first go to Arequipa which is just over 2000 meters (6561 feet). Or if you arrive to Cusco, go direclty to the Sacred Valley which is at some 2800 meters (9186 feet), for example to Pisac, Urubamba or Ollantaytambo. All those places have nice hotels and they are some 4 to 500 meter (1640 feet) lower, which could make a difference if you expect to suffer from altitude sickness.

For the source of some of the information above, for more details and tips (especially if you see potential problems with altitude sickness), and also if you plan to do intensive activities, especially if that is going to be over 4000 meters (13123), see:
NHS Choices UK
Travel Doctor
Tourists experiences

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Places in Peru and their altitude

Relatively close to the coast are mayor cities like Lima, Chiclayo, Piura, Tumbes, Trujillo, Chimbote, Ica and important places for tourism as are Nazca, Pisco and Paracas, all are at an altitude of just above sea level. The same counts for cities in the jungle like Puerto Maldonado, Pucallpa and Iquitos.

The most important cities and places at an higher altitude are:

Aguas Calientes
6690feet - 2040meters

7740feet - 2380meter

9058feet - 2671meters

8900feet - 2700meters

12400feet - 3780meters

Chivay, Colca Valley
10899feet - 3322meters

10800feet - 3300meters

10731feet - 3271meters

10013feet - 3052meters

Machu Picchu
8040feet - 2450meters

9150feet - 2790meters

Pisac village
9514feet - 2900meters

Pisac Highest point Inca ruins
11154feet - 3400meters

Puno and Lake Titicaca
12420feet - 3860meters

3382feet - 1031meters

9420feet - 2870meters