DEAR DR. DONOHUE: All of a sudden my left knee blew up on me. It was swollen, red and hot. My family doctor thought it might be infected and sent me to a rheumatologist, who drained the knee and injected cortisone into it. The pain was better by the next day. The doc said I had something called calcium pyrophosphate dehydrate. He wrote it down for me. Have you ever heard of it? – S.R.

ANSWER: Yes, I’ve heard of it, and you might have heard of it as pseudogout – false gout. It behaves like gout in many respects, and people believe they’re having a gout attack. In gout, however, the crystals that penetrate joints are uric acid crystals. In pseudogout, they’re calcium pyrophosphate dehydrate crystals. In gout, the joint at the base of the big toe is usually the first joint to suffer an attack. In pseudogout, it’s the knee.

An attack is just as you describe. A joint suddenly swells, becomes hot and is incredibly painful. Drawing fluid from the joint, as the rheumatologist did, establishes the diagnosis when the doctor sees calcium pyrophosphate crystals with a microscope.

Pseudogout is an illness of later life. At age 65, up to 15 percent of people have evidence of these crystals in their joints. By age 85, 50 percent do.

Treatment often consists of one of the anti-inflammatory medicines, like Motrin or Indocin. Colchicine, a gout medicine, also is effective for pseudogout. An injection of one of the cortisone drugs usually puts an end to an attack quickly.

Just as gout does, pseudogout can recur time and again. If it does so more than three times in a year, taking a low dose of colchicine daily can often prevent recurrences.

DEAR DR. DONOHUE: What do you think of Zestril? I have been on it for a number of years, and it has controlled my blood pressure. I read an article that said it is a dangerous drug. I asked my doctor about this, but his response was only a shoulder shrug. I took that to mean he doesn’t believe the article. Do you think I should continue to take it? – R.H.

ANSWER: Zestril and Prinivil are two brand names for the generic drug lisinopril. It’s been around for 21 years. If it were a danger to people, it would have been pulled off the market long ago. It’s a member of the family of drugs called ACE inhibitors. These medicines lower blood pressure by stopping the body’s production of a substance that elevates pressure.

You haven’t had any side effects from the drug, and neither have millions of others. You’re unlikely ever to have any. Don’t stop taking your medicine.

DEAR DR. DONOHUE: I have atrial fibrillation and take Coumadin to prevent blood clots from forming. I also have high blood pressure and am on a low-sodium diet. I see that sodium is in Coumadin. Will that make it interfere with my blood pressure medicine? – K.R.

ANSWER: The amount of sodium in Coumadin is so tiny that it has no effect on blood pressure.

DEAR DR. DONOHUE: My son died at age 46. He was active and in good health. The autopsy indicated that he had a large heart. It weighed 500 grams. You wrote about cardiomyopathy and how it causes heart enlargement. I would appreciate more information on that. Could my son have had it? – P.J.

ANSWER: Your son’s heart was almost twice as large as the normal male heart, which weighs around 300 grams.

Cardiomyopathy is a genetic condition that causes heart enlargement. In addition, the heart-muscle fibers are in disarray, something that would be recognized by an autopsy. I don’t think your son had it, but you can ask his doctor about the possibility. It’s information that would be valuable to his children.

Silent high blood pressure enlarges the heart. Heart valve diseases can do the same. Heart infections lead to big hearts. The autopsy report should have theorized about what caused your son’s heart enlargement, not suggested that a large heart was directly responsible for his death. Do talk with the doctor who took care of your son, and ask him what caused the heart enlargement.

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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