I had the same dilemma before I went to Peru — whether to start on Lake Titikaka and then Cusco/Inca Trail or vice versa. I didn’t go to Bolivia and I skipped Lima entirely on purpose because of one can probably spend better time elsewhere (just connected planes in Lima on the way in/out).

I started in Cusco and after 3 days there (and around — we also went to the Sacred Valley), I had no problems on the Inca Trail. I was in a group with 4 of my friends. They felt acclimatized too. We did take Ginko Biloba and Diamox. Frankly, I didn’t feel much discomfort in Cusco. We took it easy on the first day (felt normal but going uphill was tiring) and on the second night my friends and I felt fine to drink beer in a bar and pretty much do anything we’d normally do.

Where do you live, Alex? I live at sea level. I wonder if that makes much of a difference. I suppose people from Denver, Colorado would have less problems upon arrival to Cusco than people from New Orleans.

Most of the stuff that I read suggested going the route that I went, so that’s why I did it. I’m glad it did, btw. Apparently altitude sickness can affect anyone regardless of age or fitness level. That being said, we met several people who arrived in Cusco just a few days before the trip and they did fine.

We flew from Lima to Arequipa, then headed to Titicaca from there. Bascially skipped Lima as well, stopping there for one night each at the beginning and end. (Mama Panchita’s, in case you’re wondering. Nice place, good European style breakfast)

With what you’re considering, while my first thought is to fly to La Paz, I’d check the cost first. Crossing the border might be much more expensive than flying to Cusco would be and I’m not sure if that is going to stay within your budget.

I live in New York – that’s about as sea level as it gets.
Sailor is correct that altitude acclimatization differs for people regardless of age, gender or physical condition. Personally I recommend Ginko Biloba and Diamox. This is what I took based on Internet research and other people’s experiences. Worked for me and from many accounts for other people too.

Ginko biloba: 120 mg orally twice a day, starting 5 days prior to the ascent, and continuing at altitude. (which means start taking before you leave New Orleans)

Diamox: 125mg every 12 hours starting 3 days prior to getting to high altitude and then for 2-3 days while at altitude or a bit longer if you still have symptoms. Apparently there are some minor side affects. Personally, I experienced none except for very slightly tingling in fingers — so minor that it’s almost not worth mentioning.

Thanks for your advice, Sailor and Alex.
Sailor, is it cheaper to buy a plane ticket now or when I get there? I don’t want to wait ‘til I get there, but I’ve read it might be a lot cheaper to do so…
And what kind of price tag are we looking at for a plane ticket from Lima to La Paz?
Alex, I’m actually from Los Angeles, not New Orleans. A different kind of insanity all together!

I don’t know what the cost is. I booked my Lima-Arequipa ticket through the travel agency at Mama Panchita. I forget what it cost.

Kolby,

From what I remember, flights in and out of La Paz are quite expensive — at least $300. If you’re looking for an alternative, you should be able to buy a cheap ticket to Juliaca once you arrive in Peru. As a city, there’s nothing to recommend it, but you can easily travel to the Bolivian side of Lake Titicaca or to La Paz from there. The nice thing about going to La Paz and Lake Titicaca first is that it’s higher than the Inca Trail. That means you’ll actually feel all enegetic and recharged when you arrive in Cuzco. I’m not in very good shape, so you probably won’t experience the altitude sickness that I did, but I was really glad that Cuzco wasn’t my first high-altitude stop. I needed a lot more than 3 days to acclimatize.

I’m not checking in here too often since I don’t have internet access at home yet. Feel free to send me an e-mail if you have any more questions.