BONE CANCER OR ALPHA-1?
by Susan MacDougall, Canberra, Australia
written 2002, updated July 2007, July 2008
The genetic condition Alpha-1 antitrypsin deficiency syndrome (Alpha-1) is offered as a possible explanation for the persistent Elvis Presley cancer theory. Alpha-1 could also help to explain Presley's health problems and early death. His mother Gladys and various members of her side of the family also died in their 40s. Before her death, Gladys was similarly bloated in appearance, although being slim in her youth. Presley might also have suffered from Alpha-1 panniculitis, an inflammation of subcutaneous fat which could have been misdiagnosed as the cancerous Subcutaneous Panniculitis-like T-Cell Lymphoma (SPTL). This is not to deny that Presley had drug problems, but his heavy prescription drug use should be viewed in the context of his physical condition.
Thanks are due to Tom of Canada and his daughter, who is an endocrinologist, for feedback on this article. Their comments have been incorporated below.
The circumstances of Presley's 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, while large amounts of codeine were.
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 mild hypertension and a blood condition called "antitrypsin" (Thompson & Cole, 1991, opp. p. 313). 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. Not mentioned by Thompson and Cole is the fact that he also suffered from intractable migraines (MAGNUM, web site). He was being given medication to put him to sleep and to wake him up. It is not 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, 1998, p. 245). '"Your intestines are inflamed", [nutritionist Wilma Minor] announced' (Geller, 1998, p. 234). '[Elvis] took Demerol and Percodan for the gnawing pain in his stomach ...' (Geller, 1998, 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, web site).
Alpha-1 is one of a group of hereditary diseases called the "Viking Disease" because it originated in Scandanavia. The distribution of this gene matches the area of Viking conquests beginning in the 10th century, before European colonisation of North America (Ramazzini Institute for Occupational and Environmental Health Research, web site; Wikipedia, web site).
In 2002-2003 the author had some private correspondence with an Alpha-1 sufferer living in Elvis' birth town, Tupelo, Mississippi That person maintained that Alpha-1 was usually tranmitted through the maternal line, although in her case it was from her father, a full blood Cherokee. Elvis's Cherokee ancestry is well documented by Elaine Dundy (1995).
Alpha-1 antitrypsin deficiency, which is often written as Alpha-1 ATD, was first identified in 1968 (Children's Liver Disease Foundation). 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. There is also an S gene, which is marginally deficient (Alpha 1 Assocation). The reputed Mayo clinic classed Elvis's genotype as MS (Thompson & Cole, 1991, opp. p. 313), and apparently there was no evidence of lung damage (however, see next paragraph). There was some minor liver damage reported in the autopsy.
Despite the autopsy as reported by Thompson & Cole, Elvis may have had lung problems. Geller notice by the fall of 1976 Elvis was seriously ill. "Over the last year I had noticed how labored his breathing had become even when he was sitting down. He rarely spoke more than a couple of sentences without stopping to draw a long, deep, noisy breath" (Geller, 1990, p. 200).
Subcutaneous panniculitis is an inflammation of the layer of fat 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? In 1976 when providing after-show massages, Geller noticed large, dark bruises everywhere (Geller, 1990, p. 200). "They weren't concentrated in one place or a couple of spots, but all over. He [Elvis]'d awaken some days to find his face covered by strange blotches and discolorations. Elvis knew that something was terribly wrong with his body, something more than the colon, the liver or the medications". Memphis Fire Department paramedics arriving at Graceland after Elvis' death thought that Elvis "was a black man, his skin was so discolored" (O'Neal, p. 4). However, skin discoloration is not uncommon in corpses, and that observation may not be significant.
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, web site).
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 disorder 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 (not found in the autopsy, but documented in other sources) - consistent with Alpha-1; he had inflamed, 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.
Thus, the known symptoms of Alpha-1 appear to correspond with Elvis' own symptoms. As Elvis carried the MZ combination of genes consistent with this disorder, we conclude that Elvis' condition was possibly due to Alpha-1 antitrypsin deficiency. 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 as such. 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. For confirmation of the Alpha 1 theory, we have to wait for the autopsy to be released. Our advice is that a DNA test would also be required.
Thompson and Cole were so keen to expose a drug cover-up that they were blind to other evidence in the autopsy. We accept that Elvis took too many drugs, but he also seems to have had very real health problems, not all of his own making. Maybe his condition, if properly diagnosed, could have been managed successfully by a better diet and better control of prescription drug intake - who knows? Could neonatal liver disease due to Alpha-1 have been the cause of death of Elvis' twin brother Jesse? Without DNA testing and release of the autopsy report, various questions remain unanswered, for the time being at least.
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/ >
Children's Liver Disease Foundation. "Alpha-1 Antitrypsin Deficiency", <http://www.childliverdisease.org/education/liver/diseases/copy/alpha1>
Cole, James E. & Charles Thompson. The death of Elvis: what really happened, Robert Hale, London, 1991.
The Doctor's Doctor. "SubQ Panniculitis-like Lymphoma", <http://www.thedoctorsdoctor.com/Diseases/ptcl_subq.htm>
Dundy, Elaine. Elvis and Gladys, Pimlico, London, 1995.
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, TN, 1998.
Geller, Larry. If I can dream: Elvis's own story, Arrow Books, London, 1990.
Hodge, Charlie. Me'n Elvis, Castle Books, 1988.
MAGNUM: Migraine Awareness Group - A National Understanding for Migrainers. "Elvis Presley's Private Struggle With Intractable Migraines Revealed",
O'Neal, Sean. Elvis Inc.: the fall and rise of the Presley empire, Prima, Rocklin, CA, 1996.
Ramazzini Institute for Occupational and Environmental Health Research. "Genes, Ethics & Environment!", <http://www.ramazziniusa.org/oct00/genedeterminants.htm>
Wikipedia. "Norse Colonization of the Americas", <http://en.wikipedia.org/wiki/Norse_colonization_of_the_Americas>