How effective is Diamox?

Hi

I've been trying to read as much as I can about preventing altitude sickness online as I'm flying into La Paz in January from sea level and I got quite bad altitude sickness when I was in Peru last summer. Apparently you're much more likely to get it if you've had it before so I'm a bit worried.

Just to give some background, when I flew to 2,400m (Arequipa) from Lima before, for the first day my symptoms were a headache, feeling really tired, tight chest, shortness of breath and a fever, but then the next day I just had a headache and felt wrecked.

The day after that I ascended from there to 3,600m by bus. During the trip, every time the bus went up or down I could feel it in my head, with a headache starting going up and I would start falling asleep, and then easing off and wakening up whenever it was going down. And when we got off at the highest point along the way to take photos, I had this weird floaty weightless feeling and felt dizzy and giddy.

Sleeping at 3600m I was fine initially apart from my stomach/bowels were all over the place but I didn't throw up, but then I got the worst headache of my life the next day and felt really terrible after drinking one small beer and was unable to move for nearly a day. I must have slept for about 16 hours straight as well, as I just felt completely knackered.

After that I felt better, even though I ascended slightly to 3,800 (Puno) but in both Cusco at 3400 & Puno I still felt very tired and short of breath and definitely couldn't walk uphill without feeling completely wrecked. After that I was in a few places that were 2500m+ but lower and was acclimatised by then, though still not as energetic as at home.

Particularly as I'll be flying in way higher this time, I'm wondering is there any way of avoiding feeling pretty awful again for a good bit of the trip? If I take Diamox beforehand, how effective is this likely to be? Obviously this time I would stay away from all alcohol initially, but how long is this advisable to do?

Would it make a massive difference if I flew straight from La Paz to Sucre which is 2750m, or would sleeping as low as possible in La Paz, which I think is 3,200 do the trick? Is getting oxygen in a hotel like descending i.e. can you rely on it to make you feel significantly better?

For anyone who's experienced in these things, for someone with a history of this like me, should I really plan my itinerary around it as much as possible, or will I be ok with Diamox, avoiding alcohol etc.?

Thanks :)

Just so you know headaches and shortness of breath is normal for altitude. Technically the first part of altitude sickness. I was in Bolivia for 2 weeks and I still had issues going up and down stairs etc at altitude.

The issue is if you get severe altitude sickness you have to go to a lower altitude. Diamox medication doesn't help. Diamox is basically meant to help with the typical symptoms. I found a standard pill for headaches effective to assist with sleep and headaches. Shortness of breath you just have to adjust to.

It sounds like to me you got what most people feel in some degree when flying up to altitude. When I went back down to Sucre from La Paz the shortness of breath disappeared, then back up to Potosi it reappeared but no headaches that time. So the best thing is to allow time to adjust to the altitude. Sounds like to me you didn't give yourself time to adjust, even if that means staying in your room all day.

La Paz is not ideal because its so hilly, so get a place to stay nearby things you'll need like restaurants/food.

The main thing is if you get bad altitude sickness you have to descend. Going down to Coroico or similar would be the easiest way to do so from La Paz.

I have had problems with high altitude on previous travels, but when I flew to La Paz earlier this year and traveled around Bolivia, I didn't have any symptoms except for a slight shortness of breath when walking up the slopes of La Paz during the first 2 days. So it is not sure that you will have problems this time. :-)
The most important thing for you to do is take your time to get used to the high altitude. Take a few days in La Paz to do things slowly, stay hydrated (so drink several liters of water) and don't drink any alcohol for the first few days!
Diamox could help you to adjust a bit faster but it does not work miracles. In case you have serious problems like the ones you had in Peru, it seems to me that the only solution is to go down in altitude.
And don't forget: your health is more important than your travels!

Since you've had AMS symptoms at quite low altitude the best option would be sleeping first night in Sucre - sleeping altitude is what really matters.

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..headaches and shortness of breath is normal for altitude
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Headache is never normal at altitude , the definition of AMS is headache + one more symptom , and if you continue to ascend with a headache you will get worse.

Diamox is not a guarantee , but it's effective when you take it in time - where I go normally ( Leh in the Himalayas , 3520 ) I can't recall seeing anyone with bad symptoms after taking Diamox before flying in.

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Diamox is basically meant to help with the typical symptoms
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Feeling better on Diamox comes from being better , i.e. being able to increase your breathing from the acid balance shift. This is the same mechanism as in normal acclimatization , only faster.
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stay hydrated (so drink several liters of water..
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Think around one liter extra of fluids , not just water. High fluid intake has no proven or logical effect against AMS , and binging on water only can give exactly the same effects as severe AMS from lower sodium levels in the blood.

Beware any Swedish man called Vistet with high altitude restaurants in Cochabamba, he will not eat my other arm, abominable snowman!

Thanks very much for all the advice. It's been really helpful. I went to the doctor and got a prescription for Diamox to start taking before I go and then I plan to stay in La Paz for 3-4 days to fully acclimatise before Uyuni and hopefully I'll be ok after that. Can't wait!!