Dr. Patrick J. Boland, an orthopedic oncologist at Memorial Sloan Kettering Cancer Center in New York, had operated on many patients with sarcomas — cancers of soft tissues — but he had never had a patient like Serena Burla, a 27-year-old elite distance runner from St. Louis. She had a potentially deadly cancer, a synovial sarcoma, that arose in and replaced one of the muscles in her right hamstring.
Treatment was to remove that muscle, the biceps muscle of her hamstring.
“You can’t stitch it back together,” Boland said. “There’s just nothing there.”
Before he operated on Feb. 26, 2010, Boland went to the medical literature to see if there was any other athlete who had that hamstring muscle removed, recovered and competed again.
He could not find one.
“We did such a radical operation,” Boland said. He was not sure Burla would be able to run, and even if she could, he doubted if she would compete again at an elite level.
She proved him wrong.
Last November, Burla competed in the New York City Marathon, her first. She came in 19th, in 2 hours 37 minutes 6 seconds. She came in second in the national half-marathon championship in January. She had planned to run in the New York City Half Marathon on Sunday, but her left hamstring — the healthy one — hurt a bit on Friday when she was doing a training workout on a track. She decided to pull out of the race rather than risk aggravating it.
“It’s a little bump in the road,” Burla said of her left hamstring injury. “In the grand scheme of things, it will pass and I will be fine. After last year, it doesn’t seem like that big of a deal.”
And Burla has bigger things in mind. She has qualified for the Olympic marathon trials next January. She loves to run. “I am very competitive,” she said.
That, said Steve Edwards, the husband and coach of Shalane Flanagan, who competed against Burla last year in the national half-marathon and in the New York City Marathon, is an understatement.
“The girl is tough as nails,” Edwards said.
Burla grew up running — her father was a high school track and cross-country coach in Waukesha, Wis. — and said she began racing short distances in the third grade. She wanted to win every race and would break down in tears if someone beat her.
“I think I drove my dad crazy,” she said. “He was like: ‘It’s O.K. You’re not going to win every time. You won’t get to run again if you don’t stop crying.’ ”
Burla ran in college, at Missouri, and was an all-American 10,000-meter runner in 2006. But after college, she stopped competing. She married her college boyfriend, Adam Burla, a shot-putter at Missouri, and moved to St. Louis, where she got a job teaching 3- and 4-year-old children in special education classes. She ran, but just for fun.
“It was my stress relief,” Burla said. “I loved it.”
She asked people in St. Louis if they knew anyone who would run with her.
“They were like, ‘I know this one guy who has run with girls,’ ” Burla said. The man, Andy Koziatek, 29, who is still her running partner, “gives me someone to chase and a supportive voice to propel me on,” Burla said. And, she added, ever the competitor, “We have a friendly rivalry of back-and-forth personal records.”
Burla also joined a running team, Riadha, after she got a call from its coach, Isaya Okwyia. He noticed how well she ran in high school and college and was recruiting athletes who “needed support.”
Burla, he said, “clearly had not realized her potential.” She wanted to run a marathon and she had what it takes, Okwyia said, and she is “fiercely competitive but incredibly patient.”
The plan was for Burla to train for a few years, then run her first marathon in the spring of 2010. But the previous fall, what had started gradually as an intermittent ache in her right hamstring became nearly constant, and agonizing.
I tried to ignore it,” Burla said. “I honestly would be hobbling around the house. My husband would say, ‘What’s wrong with you?’ I would say: ‘I don’t know. I think it’s inflammation.’ When I would run it would feel better. When I stopped it was incredibly painful.”
In January 2010, she raced in the national half-marathon championship in Houston. Okwyia was there and watched as she hobbled to the starting line. After the race, in which she finished second, just behind Flanagan, Okwyia told her: “This is really serious; we have to get it taken care of now,” Burla recalled.
She went to New York because Okwyia knew a doctor there, Daniel Hamner, who was renowned for helping runners with sports injuries.
“I thought she had bursitis or a tear” in her hamstring, Hamner said. He did an ultrasound and told Burla she had some fluid in her hamstring. But when he tried to tap it and see if it was blood or water, he could not get anything out. He sent her for a magnetic resonance imaging test the next day.
“It was painful just lying down to get the scan done,” Burla said.
When it was over, the technologist handed her the scans and told her to see Hamner right away.
“That was kind of a red flag right there,” Burla said.
She returned to Hamner’s office. He told her she had what looked like a highly malignant tumor. She was stunned.
“I had to catch a flight in an hour and a half,” Burla said. “I had to call Isaya, call my family. We were all in shock and disbelief.”
She spent the few weeks before her surgery coming to terms with what had happened to her.
“There was a fleeting moment when I was first diagnosed when I questioned, Why my leg?” Burla said. “But the answer slapped me in the face instantaneously. Had the tumor not been in my leg, it would have been ignored and chances are the diagnosis would have been too late. Running saved my life.
“There was also a day in February when I had an epiphany,” she added. “I had lived my life without regrets. I had loved with my whole heart, lived each day for all it was, done my best while doing the right thing, and I was at peace. I realized that by living without fear, I wasn’t afraid of what the future may or may not hold. If my time was up, then I could leave this earth satisfied. If I was to live another day, then I would continue according to plan.”
At the end of February, Burla was back in New York for the operation. Boland had had a conference with other experts at the hospital about how to treat her. Should she have radiation? Her tumor was on the borderline of whether she would need it or not. Radiation, though, could weaken the bones of the thigh and knee, and it would make Burla’s knee so stiff she could never run again.
But because Boland did such a radical operation and since radiation could destroy Burla’s ability to run, he decided against it. Burla’s prognosis, he said, is very good.
Mary Wittenberg, president of New York Road Runners, which sponsors New York City’s marathon and half-marathon, visited Burla in the hospital the day after her surgery.
“There she was with this huge taped leg, up and walking around with a smile and a great perspective,” Wittenberg said. “At the time she didn’t know if she would run at all, but I don’t think that was important to her.”
It wasn’t, Burla said.
“I was happy just to be alive and have a leg,” she said.
And she wanted to be there for her husband and her son, Boyd, who was 14 months old.
But, of course, she also wanted to run and said she would be happy even if her running were limited to playing with her son.
In mid-April, Burla tried to run for the first time since her operation. It was a 15-minute walk-run, with most of the time spent walking.
She was thrilled.
“I had my running stride,” she said. “It was a miracle.”
Burla stopped in to see Boland before the New York City Marathon.
“I caught him on his way into an elevator, just long enough to say hello, thank you and I’m racing on Sunday,” Burla said.
She spoke to him again, on the phone, after the race.
“I was amazed by her performance,” Boland said. In fact, he added, “I was amazed that she was in it.”