Some people are prone to altitude sickness and others aren't. Some people can go on dozens of trips without issue and then be hit out of the blue with mild altitude nausea, etc. Hard to predict.
a mid-altitude city wont do a huge deal to help.... just go straight to cusco as I did and camp out for a few days and enjoy cusco and surrounding area.
In addition to the coca tea, get yourself a 1 soles bag of coca leaves. HIGHLY recomended. My Dr gave me a steroid for breathing similar to diamox, but I never needed to take it. Had to give some of that to our guide who had a really bad bronchial infection....
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