DEAR DR. DONOHUE: I have been diagnosed with CPPD (pseudogout) in both knees. My treatment is colchicine, Mobic and Dilaudid. My right knee has become severely painful. My primary doctor said he is unaware of anything more to do other than increase the Dilaudid. It makes me groggy. Is there anything else I can do? — R.Z.

A: Pseudogout (false gout) got that name because it has many symptoms in common with gout. Unlike gout, it’s the migration of calcium pyrophosphate dehydrate (CPPD) crystals into a joint. With gout, the crystals are uric acid. Pseudogout’s most commonly affected joint is the knee; gout’s is the joint at the base of the big toe. Pseudogout is an illness of older people, those 65 and older. Its diagnosis can be confusing, since it often occurs in conjunction with osteoarthritis, another illness common in older people, and it’s difficult to judge which is the actual cause of pain.

Colchicine, a gout medicine, is often used for pseudogout. Mobic is a nonsteroidal anti-inflammatory drug, and members of this drug family are frequently prescribed for this condition. There are many other members, and if one doesn’t work, another might. A change in drug could be all you need.

Injecting a severely painful knee with a cortisone drug is often effective, and the cortisone drug most frequently chosen is triamcinolone. Oral cortisone medicines — prednisone, for one — can be used for a limited time to get a person over a particularly painful period.

The same approach used for osteoarthritis is taken with pseudogout. If medicines fail to control symptoms, then joint replacement is a consideration. At this point, you’d benefit from a consultation with a rheumatologist or an orthopedic surgeon.

DEAR DR. DONOHUE: In 2001, I had open heart surgery in which five heart arteries were bypassed. What happens to the five old arteries? Are they absorbed? — M.G.

A: In a bypass operation, only a section of the clogged artery is removed — the section that is obstructed. When the graft is a vein, often a large leg vein, the two ends of the artery left open after the clogged section has been taken out are bridged with the vein graft. It’s much like taking out a rusted section of plumbing and inserting a new section for the old one. You still have most of your original arteries.

If the graft is a chest artery, that artery is attached to the far section of the clogged heart artery, the section past the site of clogging. The chest artery supplies blood directly to that part of the heart artery. The clogged part is left in place, and it becomes a thin scar in time.

DEAR DR. DONOHUE: We are told we should eat plenty of fruits and vegetables daily. Is there any reason why we should not eat all our vegetables in one meal and all our fruits in another?

I am a fit, 6-foot-tall 89-year-old, and I have been eating this way for two years. I have lost 25 pounds in the process. All my exams and blood tests are normal.

For breakfast I have a large omelet consisting of egg substitute loaded with onions, mushrooms, potatoes, tomatoes, celery and whatever is in the refrigerator. For lunch I have a large bowl of all kinds of cut-up fruit. For dinner I have a protein, two vegetables and a salad.

Is there anything wrong with this way of eating? — H.T.

A: There’s everything right with this way of eating. If you choose to eat your fruits at one meal and your vegetables at another, that’s fine. Your diet consists mostly of fruits and vegetables, with little meat and little cholesterol. It’s a healthy way to eat.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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