The altitude of Macchu Picchu/Cuzco hits different people differently. I've been a couple times, and both times I've been hit with headaches within about an hour or so of landing, and started feeling a bit sluggish within about 15 or 20 minutes of being feet on the ground (off the plane).

Last time, I remember being REALLY glad I'd taken care of all my hotel, etc. accomodations prior to landing. There were several different representatives of hotels/tour groups with tables inside the airport, and I recall feeling that if I hadn't had plans already set, all their offers would have sounded really good. Basically, by the time I got my bags, I was not on top of my game.

The local advice of drinking mate de coca (coca leaf tea) worked very well for me as far as alleviating some of the discomforts of altitude and stopping or decreasing headache symptoms. I even tried chewing the leaves when I walked the Inca Trail going up to Macchu Picchu, but that was basically just nasty tasting and I really didn't find it was terribly effective (I've heard there's also a lime substance you're supposed to chew at the same time to make it more effective? I never had that with it).

When walking the trail, I went with a tour group, and I think that's probably the best way to go unless you're a fairly ambitious hiker. They'll provide porters to carry the majority of the gear, including provided tents, etc., and set up camp and tear it down and cook the meals for you.

I had a new pack and a new tent, and was determined to carry that stuff, but by the second day (I think), in the hours before we hit the highest point on the trail (Winay Wayna), I was ready to burn my pack. Several hours of walk about 5-10 steps, catch a couple breaths, repeat.

Were I to do it again, I'd only bring a daypack, filled mainly with chocolate bars and canteens/botas filled with very sweet coca leaf tea. As with anything, YMMV. My sister took a trip with her daughter, and did the trail while suffering from bronchitis. She was about 50, not an outdoorswoman, and she complained about her discomforts a lot less than I did.

However, my experience was also that once I crested the highest peak, dropping perhaps 100 or 150 yards down the other side of the trail, I felt a LOT better, and it improved because that's where our tour guides set up and cooked our lunch...sitting just a bit lower down the trail and eating a nice spaghetti meal with tea was a huge boost to body and spirit, and I never felt bad the rest of the hike.

On the last or second-to-last day of the trip, there was a long series of steps down - and the steps were narrow and LONG, like stepping down from a low tabletop, step after step. A walking stick would be good for that portion, and one of the members of our group had his knees and hips killing him from that portion of the walk.

The final night, we stopped at a "rest house" on the trail. I think it was originally meant to be a place for people to sleep, and they had food there, but it was incredibly overcrowded and loud...our group (and several others) camped outside, but it was still loud, crowded, and not terribly pleasant. Earplugs would have been good for the night's sleep. This was back in '97, so I can imagine it being way more crowded...but then again, I'd also heard there were efforts being made to limit the number of people traveling the trail at any time.

Oh, and on that final night, a few teens from another group were late coming into the final stop, and of course they had no flashlight...several guides went back to find them, but that's definitely not a situation I'd want to be in. I don't know exactly why they were so far behind. The pace set by the general group was not very difficult to keep with, but a small nagging injury might be enough to slow you down a lot, so as always a flashlight or two would be a good idea.

Good luck, and enjoy yourself.

Oh, and when in Lima, if you get the chance to get to the nearby neighborhood of Barranco, check out the "Puente de Suspiros" (Bridge of Sighs)...right along the steps fo the bridge, there is (OK, was) a stand/tiny restaurant with wonderful anticuchos (marinated cow's heart, grilled and served on skewers). I can almost taste them now.

Dave