Peru partial itinerary, which is better?

From previous I believe the day before arriving in Cusco is in Arequipa (7000’)? In this sense it might be better to save the high town of Chinchero (11,000’) for the trip back from Ollantaytambo (9000’). There are 2 ruins in Ollantaytambo, I would do the main one on arrival about 11 am then the ruin on the opposite side in the afternoon. Make sure to have the cash for the tourist ticket, like 130 soles.

Yeah you are probably right. I will stick with my original idea, to go straight from Cusco to Ollantaytambo, see the ruins there, and save other sites in the in the "sacred valley" on the way back to Cusco. As for the elevation, I didn't notice a problem in Mexico City. I figure that I will be fine up to 7 to 8 thousand feet. Cusco is over 11 thousand feet but that is only 3 to 4,000 more than Mexico City. Technically I don't know whether I will be fine.

Mike L.
From someone whose daughter lives in the Sierra Nevada (altitude), the difference between 8000 and 11000 feet is quite noticeable in one's breathing. Don't underestimate and be prepared. It is not Mexico City. That being said, you should have a wonderful time!

When we did Peru, we took altitude sickness pills and it made a huge difference.

Your original idea to go straight to Ollantaytambo and see the ruins there first before continuing makes a lot of sense- Ollantaytambo is at a lower elevation than Cusco (but still high) which allows you to acclimate before you spend time in Cusco. In terms of reserving a taxi, we found there are loads just waiting for you so you don't need to book in advance (Uber is also quite common in Peru).

To prevent altitude sickness we took Alti Vital, which was recommended to us by a local person: https://altivital.com/en/home/

We didn't experience an altitude sickness- I can't confirm whether that was due to the medication or not but it can't hurt. You can buy it in local pharmacies.

Thanks for your input. I find it hard to believe I will have some dangerously serious medical problem due to the elevation of Cusco. Plenty of travelers visit the city and nearby ruins. I am actually traveling alone; I suppose in theory if my brain explodes while I am alone in my hotel room, it would take a long time for anybody to find me. A lot of the herbs or products containing herbs that are marketed as having some health benefit actually have or can have nasty side effects. Coca leaves contain cocaine, a nasty stimulant - although a serving of coca tea may have an average of 4.2 milligrams of cocaine versus 20 to 30 mg of cocaine that a typical user of powdered cocaine inhales; I won't take any coca leaves or coca tea or herbal remedies. But I also don't consume caffeine or similar stimulants - coffee, real teas, chocolate, yerba-mate, and so on, also if this should make a difference I don't smoke or do marijuana, alcohol, tobacco, and so on. My great-grandfather with my same last name had a heart attack and dropped dead 6 weeks before he would have turned 40, and his son, a great-uncle had a heart attack and died when he was 32 (they lived at a low elevation under seven hundred feet), but who knows if the problems were genetic or diet or environment or random. I vaguely remember that my grandparents on my dad's side traveled to multiple countries including Peru when they were about 60 to 85; this grandfather lived to be 96.

Mike L,
I believe most of the people who are putting out a warning re the altitude are not predicting a catastrophe for you or crying chicken little, rather feeling ill enough to put a real damper on your enjoyment of the trip. And many of those you say go to Cusco without a problem have acclimated themselves in a reasonable time frame to the altitude, or are using altitude sickness medications. Please don't let your overconfidence threaten your fun. Be wise. One's personal family histories shouldn't be part of this calculation.
All that being said, I hope you have a great time and fall into the small percentage of people who can adapt to 11,000 ft altitude quickly, without difficulty, if you choose to immediately hit the higher altitudes.
Buen viaje!

I was fine until passing 12,000’ in Puno, then had headache issues. This is even after a long acclimation process. The coca leaf tea does help with altitude headaches.

Hi Mike. I went to Peru -to Cusco and the Scared Valley- to hike and see the sights about 20 years ago so I was in my early 40’s at that time. I asked to be prescribed Diamox by my doctor after doing research about it. If I recall correctly, I had to take it a bit before I left for the trip and then for the first part of the trip to help acclimate to the altitude. Then I could just stop taking it. I get migraines so it was important to me to try to avoid those and to be able to hike and function. It worked perfectly. The concern with Peru for me was flying from Lima at sea level to Cusco which is such a drastic change in altitude that your body has no adjustment period. A few years later I found out that someone I knew went to Cusco and ended up staying in bed for days because she felt so ill. The others in her group went to tour around but she was unable. You just never know how altitude will affect you. I had a rough experience with altitude when I went skiing in the Canadian Rockies once too. No meds for that one. It wasn’t super high altitude and I never expected to have a problem. I used to live in Colorado and never had a problem there. Last summer I went on the RS My Way Alps tour and was a bit concerned about going up the lift to Mt Blanc because of the altitude but I was totally fine with that. No headache. I figured even if I got one up there I could just come back down the lift anyway.

Your MP day schedule is unclear. Is there no night in Aguas Calientes? Are you arriving at the base of the mountain, bussing up and down, and leaving Aguas all the same day?

At MP, our prescriptions were helpful, but we still had to stop repeatedly on flights of stairs. No problem level walking. Your imaginary predictions are concerning.

Info from the CDC including reference to Cusco: https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness

With my health and fitness level I never expected altitude sickness either - until.....

Yes! That’s the medication I took that’s mentioned in the CDC link. Diamox is the brand name for acetazolamide. I had some tingling in my fingers as my only side effect. I would highly recommend it if you are going from sea level in Lima up to Cusco by plane. It’s very hard for the body to adjust to that much altitude change quickly. I wouldn’t want to risk ruining my trip with altitude sickness.

Before Cusco, I am taking the bus to Nazca, spending a night in Nazca, taking the bus to Arequipa, spending a night and most of 2 days in Arequipa, taking the bus to Cusco and a taxi to my hotel in Ollantaytambo, spending 2 nights in Ollantaytambo, going to Macchu Picchu ruins as a day trip, not spending a night in Aguas Calientes. I have 3 nights in a hotel in Cusco after Ollantaytambo. Then a plane back to Lima. I am not flying straight from Lima to Cusco.

The elevation of the lawn at my apartment building is under six-hundred-fifty (650) feet. I did not perceive any altitude related problems in Mexico City in 2023. Instead of "if my brain explodes" , better medical vocabulary might be brain aneurysm, heart attack, stroke, or other problem I'm not thinking of that I probably won't have. I don't have any major or moderate known health problems.

Altitude sickness tends to become a problem around 3,000m. For comparison, Mexico City is 2,240m elevation so most people are unlikely to get altitude sickness. Cusco on the other hand is 3,400 so altitude sickness there is much more common especially if coming from sea level.