BONE CANCER OR ALPHA-1?
In this article, Alpha-1-related panniculitis is
offered as a possible explanation for the persistent Elvis Presley bone cancer
theory. Alpha-1 could also help to explain Elvis' health problems and early
death. His mother Gladys and various members of her side of the family died in
their 40s, probably from the same condition.
The circumstances of Elvis'
death were surrounded by massive cover-ups, as we are all too well aware,
making it difficult to know what to believe. The medical examiner Dr Jerry
Francisco was particularly obstructive. One of the rumours that is still alive
and well is that Elvis was suffering from terminal bone cancer. The bone
cancer story can be found in publications by Larry Geller, Dick Grob, Charlie
Hodge and Kathy Westmoreland as well as in other sources. There are reasons
for looking into this further rather than dismissing it out of hand.
Thompson and Cole, whose
original investigation and ABC program "The Elvis Cover-Up" in 1979
landed Elvis' physician Dr George Nichopolous in trouble for over-medication,
spent ten years or more investigating the circumstances of Elvis' death and
what really killed him. Their findings are published in The death of Elvis:
what really happened (Robert Hale, London, 1991). Their conclusion was
multiple drug intake (polypharmacy) combined with an allergic reaction to
codeine. They surmised that Elvis must have mistaken codeine for Dilaudid, as
the Dilaudid which had been prescribed for him was not found in the autopsy,
but large amounts of codeine were found.
The autopsy report found
that Elvis' heart, spleen, kidneys and liver were enlarged, but that this was
not a serious condition. His liver had suffered damage through "severe
drug abuse", but that was not the immediate cause of death either. There
were signs of high blood pressure and a blood condition called "antitrypsin".
The autopsy also found his colon to be heavily impacted with a clay-like fecal
matter. Bone marrow samples were tested at the Baptist Hospital, but no bone
cancer was found. Thompson and Cole assumed that the people claiming bone
cancer were lying to distract attention from the toxicology report.
What the autopsy report
appears to have missed is needle marks on the buttocks. Did it miss, suppress
or misreport anything else? What was the condition of the skin?
Elvis was being treated for
various conditions, including glaucoma, high blood pressure, weight control,
oedema, constipation, insomnia and chronic pain. He was being given medication
to put him to sleep and to wake him up. It isn't surprising that a variety of
prescription drugs were found in his system, although the quantities seem to
have been excessive.
Dilaudid is a drug normally
reserved for terminally ill cancer patients in unbearable pain. Dr Nichopolous
was asked in 1979 why he would prescribe this drug for somebody with a minor
toothache. But Elvis did suffer pain. According to Charlie Hodge, Elvis
complained "There's pain all over my body. I can feel it alot in my hands
and up in my shoulder tonight" (Hodge, p. 186-7). Larry Geller also
reports that in the last year of Elvis' life, he was sometimes doubled over in
pain - "Why am I constantly in pain? It's just wiping me out"
(Geller, p. 245). '"Your intestines are inflamed", [nutritionist
Wilma Minor] announced' (Geller, p. 234). '[Elvis] took Demerol and Percodan
for the gnawing pain in his stomach ...' (Geller, p. 232).
Without having seen the
autopsy report, Dr Nichopolous told Elvis' father, Vernon, that Elvis had bone
cancer. Whether the doctor believed it or not we don't know, but we will
assume that he did. Elvis obviously had a painful condition which could
possibly justify the use of such a strong pain killer.
hold the answer? Alpha-1 antitrypsin deficiency (Alpha-1) is a genetic
disorder that may predispose affected individuals to several illnesses,
including lung disease, liver disease and a condition called panniculitis.
Other symptoms of Alpha-1 can be an enlarged liver and spleen and excess body
fluid - swelling in the abdomen and legs - enlarged veins in the inside of the
stomach and oesophagus (maybe the rest of the digestive tract too?). The
pressure in the veins can cause internal bleeding. Alpha-1 is a very variable
condition, and it is difficult to predict the course in any individual (Alpha
Everyone receives one gene
for alpha-1 antitrypsin from each parent. The M gene is the most common type
of gene, and it is normal. The person who inherits an M gene from each parent
has normal levels of alpha-1 antitrypsin. The Z gene is the most common defect
that causes the disorder. If a person inherits one M gene and one Z gene, that
person is usually healthy, although a carrier of the disorder. While such a
person may not have normal levels of alpha-1 antitrypsin, there should be
enough to protect the lungs. The person who inherits the Z gene from each
parent is called "type ZZ." This person has very low alpha-1
antitrypsin levels, allowing elastase to damage the lungs. Elvis had the MZ
combination of genes, and apparently there was no evidence of lung damage.
There was liver damage.
Subcutaneous panniculitis is
an inflammation of fat just beneath the skin, causing the skin to harden and
form lumps, patches, or lesions. In some patients, damage from panniculitis
may occur after an incident of trauma to the affected area. It occurs in
children as well as adults, and has been linked to the ZZ and MZ phenotypes
and possibly other alleles as well.
could account for Elvis' "all over" pain. Were there any skin
blemishes which would point to this condition? There are other types of
panniculitis, including mesenteric panniculitis - inflammation of the small
bowel, which results in bowel dilation. Panniculitis could probably also occur
in the colon. Elvis is reported to have had an inflamed colon and to have
haemorrhaged from the colon (Elvis ~ A Lighted Candle).
There is another condition
called cytophagic histiocytic subcutaneous panniculitis-like T-Cell lymphoma (SPTL)
which, as the name suggests, is a cancer with the appearance of subcutaneous
panniculitis. Cytophagic histiocytic panniculitis is a rare subtype of
panniculitis that usually follows a fatal course, with a terminal
hemophagocytic syndrome. Given the lack of awareness of the genetic disease
Alpha-1 in the 1970s, could Dr Nichopolous have diagnosed SPTL?
These are the facts as far
as we can tell: Elvis had the less severe MZ form of the genetic disorder
Alpha-1; he had enlarged organs - consistent with Alpha-1; he suffered from
fluid retention - consistent with Alpha-1; he had inflammed, dilated
intestines and haemorrhaged from the intestines - very probably caused by
Alpha-1. Elvis suffered all-over pain as well as abdominal pain, particularly
during his last year of life, and was prescribed Dilaudid which is used for
terminally ill cancer patients. Geller, Grob, Hodge and others believed Elvis
had bone cancer.
We conclude that Elvis'
painful condition is most likely to have been Alpha-1-related panniculitis.
Medical knowledge on this condition was less advanced at that time. Maybe Dr
Nichopolous misdiagnosed the condition as the cancerous Subcutaneous
Panniculitis-like T-Cell Lymphoma, although this isn't "bone"
cancer. Or maybe Elvis himself believed he had bone cancer and asked to be
treated for it. If Elvis believed he had cancer, it could explain why his
friends believed - and still do believe - it. It also supplies a reason for
the variety of drugs he was prescribed.
Alpha 1 Association,
Archives of Dermatology, "Cytophagic
Histiocytic Panniculitis and Panniculitis-like T-Cell Lymphoma: Report of 7
Children's Liver Disease Foundation,
"Alpha-1 Antitrypsin Deficiency"
Cole, James e & Charles Thompson,
The death of Elvis: what really happened, Robert Hale, London, 1991.
Elvis ~ A Lighted Candle, "Elvis: What
Geller, Larry, " Elvis' Search for
God, Greenleaf, Murfreesboro, Tennessee, 1998
Hodge, Charlie, Me'n Elvis, Castle