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July 11th, 2011 · No Comments · Uncategorized

I apologize in advance that some of the intricacies of WordPress escape me … but read on anyways!

This year marks the 100th
anniversary of the discovery of Machu Picchu (in Peru in case you didn’t know)
by Hiram Bingham in 1911. One of my patients mistakenly thought this was Hiram
Walker, the maker of great Canadian scotch! It also marks the 38th
anniversary of my visit there with my dear friend Dr. Howie Hamer. I must  
admit, we did not hike the Inca Trail back then. In fact, we didn’t even know
it existed. Rather, we took the “Indian train” to Aguas Calientes, and that was
more than we bargained for! Admission restrictions and security were not so
tight in those days, so we saved some soles by actually sleeping on the
terraces of the ruins. We had little pretravel advice regarding diarrhea, and
none about altitude sickness.

Fortunately, neither was a problem, as I
had developed immunity to traveller’s diarrhea in Ecuador, and we had plenty of
time to acclimatize in Peru. Most people today fly directly in to Cuzco, or
backtrack from even higher altitudes in Puno on the shores of Lake Titicaca. We
took the buses, those memorable buses, right through the Andes. I remember
those roads, on the edge of cliffs, dotted with crosses commemorating the spots
where previous vehicles had plunged over the edge. We spent a few nights in
Ayacucho, drinking chicha and breathing in the rarified air.

So the big question is … “Do you need to take Diamox (acetazolamide)
for altitude sickness when you go to Cuzco and Machu Picchu?”

I don’t think that there is a clear answer,
and I have done some amateur investigation to back up this non-committal view. Most
of those who answered my post-Peruvian questionnaire did pretty well regardless
of whether they took preventative Diamox
or not. Unfortunately it is difficult to pick out that occasional person who
really struggles with the altitude and will need medical care there.  What certainly is worthwhile at high
altitudes is to take it easy (don’t do triathalons on day 1), drink lots of
water, and partake of the coca leaf tea, which may help hydration, or have
other miraculous properties.

If you have had problems at high altitudes
before, by all means take Diamox
prophylactically or preventatively. Start it the day before arriving in Cuzco,
and feel free to take it for the first few days at high altitude, or even for
the entire time that you are “up there”. It might just help you prevent the headaches
and “hangover-like” symptoms of acute mountain sickness. In addition, it might
improve the quality of your sleep, which is often affected by “periodic
breathing”, which feels like “Oh my God,
I can’t get enough oxygen.”
This is a disconcerting, though not serious
occurrence at high altitudes. Diamox
can also be taken if and when you are having problems, and along with rest and
lots of fluids and perhaps some ibuprofen, should act fairly quickly.

There is no good way to predict who will
suffer from altitude sickness, except to say that if you have had problems at
high altitude in the past, you might have them again. Fitness, regardless of
the number of triathalons you have completed, has nothing to do to with your
reaction to high altitude.

Many travellers who visit Machu Picchu and
Cuzco also visit Puno, or Lake Titicaca or La Paz in Bolivia. These are at
about 12,000 feet, or 20% higher than Cuzco. So I give patients the option of
starting their Diamox prior to this
destination as it is more likely to cause problems.

Diamox is a good drug. It should not be used by those with allergy to
sulfa (though this is a bit controversial). It might make you pee more, it will
make your fingers and toes tingle (as if you were hyperventilating, which in
fact is what the drug helps you do) and the taste of your Coke or beer might seem a bit off. Feel free to try this medication
before you travel.

So the bottom line at high altitudes is –
take it easy, drink lots of fluids, and understand the use of Diamox, whether it be preventatively or
in the event of symptoms of altitude sickness. I don’t know if or when I will
get back to Machu Picchu, but it certainly was one of the highlights of my

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