In August of 2001, I was presented with the following article by "Simon" (Elvis Fans in Australia). Elvis believed he had cancer, and so did some of his doctors, but the autopsy report (at least what has been made public) does not reveal any cancerous condition. Still, Elvis had severe pain and advanced cancer-like symptoms.  Either Elvis had some OTHER disease misdiagnosed as cancer, which was causing  him such severe pain, or the autopsy report that was released publicly is false. As Simon points out, in the 1970's "Alpha - 1 Panniculitis" would have been difficult if not impossible to diagnose.

 

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.

 

Could "antitrypsin" 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 1 Association).

 

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.

 

Subcutaneous panniculitis 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.

Sources

Alpha 1 Association, <http://www.alpha1.org/>

Archives of Dermatology, "Cytophagic Histiocytic Panniculitis and Panniculitis-like T-Cell Lymphoma: Report of 7 Cases"

<http://archderm.ama-assn.org/issues/v136n7/abs/dob9036.html>

Children's Liver Disease Foundation, "Alpha-1 Antitrypsin Deficiency"

<http://www.childliverdisease.org/aatd.html>

Cole, James e & Charles Thompson, The death of Elvis: what really happened, Robert Hale, London, 1991.

Elvis ~ A Lighted Candle, "Elvis: What really happened",

<http://www.freestate.net/johgrove/elc/LC_what_happened.html>

Geller, Larry, " Elvis' Search for God, Greenleaf, Murfreesboro, Tennessee, 1998

Hodge, Charlie, Me'n Elvis, Castle Books, 1988.

 

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