Michelle Cousino, BAS, CRA, RT(R), Radiology Manager, UH Elyria Medical Center
By Matt Skoufalos
As the radiology manager at the UH Elyria Medical Center in Elyria, Ohio, Michelle Cousino has always juggled the responsibilities of her role with the focus and perseverance of a competitive athlete.
But for the past seven years, she’s also experienced the highs and lows of training like one in her personal quest to complete an Ironman triathlon, the endurance race comprising a 2.4-mile swim, 112-mile bicycle race and 26.2-mile run, completed in sequence on a single day.
Setting aside the intense physical demands of such a contest, the science of maintaining the caloric load required to approach it, and the months of training prior to running the race, every Ironman is held in varying environments across the planet, meaning no two courses are exactly alike.
A First Attempt in Ireland
In 2019, Michelle began training for a June 2020 Ironman in Ireland, which was pushed back to 2021 during the novel coronavirus (COVID-19) pandemic, and then rescheduled a second time after the country hadn’t yet gotten its COVID-19 vaccines distributed. In the interim, Michelle signed up for Ironman Cozumel, but was sidelined for four months with a strained Achilles tendon.
She rehabbed that injury in time for the rescheduled Ironman in August 2022, but the course proved to be too much for her on the day. Michelle completed the 2.4-mile swim in Youghal Bay, but was only able to ride 80 miles on her bicycle before the afternoon cutoff for her stage.
“The swim was a lot harder than I thought,” Michelle said. “The currents were a lot harder than what they told us. I was having a lot of problems with my nutrition and cramps, and I wasn’t properly prepared for that [bicycle] course.”
“Ireland’s hills were no joke,” she said. “The elevation and the bumpy roads were terrible; they did a lot to your hands and triceps. You’re jamming the brakes, trying not to fly over the handlebars to make the turn, and then you’re climbing again.”
“So I cheered for friends and family doing the race, and then we enjoyed our trip in Ireland,” she added.
No Ironman course is easy, and Michelle was disappointed at having failed to complete the race, but just making it to the event meant she’d outlasted five other friends and family alongside whom she had planned to compete. By the time of the race, their party of nine had been whittled down to just four.
“It was very emotional,” Michelle said. “The goal of wanting to complete an Ironman never really left me.”
Three Years of Pain and Recovery
Back home, Michelle hired a triathlon coach and started training again. About two months into her efforts, she was slowed by a shocking pain that radiated down her face and neck. Michelle traced that sensation to having gotten kicked in the face during the swim portion of a prior half-Ironman race in which she’d participated a month before leaving for Ireland.
She spent the better part of three years trying to break out of a cycle of pain before she could even consider attempting another race.
“I saw so many doctors and had so many tests, but they couldn’t tell me what it was, what caused it and how to fix it,” Michelle said.
In that time, she underwent multiple MRIs, facial EMGs and a jaw surgery. She gained weight from steroid treatments intended to resolve her pain and the periods of inactivity. Even her attempts to fix the issue fell short: acupuncture, massage, red light therapy and physio-shock therapy – none of them accelerated the course of her recovery.
“It was more just letting it take its course and recover itself, which was hard to do when I had things I wanted to do,” she said. “I still manage it daily with some exercises, but I know my triggers now.”
Training for Ironman Barcelona
Once Michelle had learned how to manage the limitations of her discomfort, she registered for Ironman Barcelona in October 2026. After a year in training – this time, with a nutritionist and not a triathlon coach – Michelle dropped 53 pounds, making her some 15 to 18 pounds lighter than when she’d attempted the Ireland race four years ago.
She was supported in her efforts by a boss at UH Elyria Medical Center who afforded her a flexible work schedule to accommodate getting outside to swim in Lake Erie, ride the roads and run on good-weather days. Michelle worked out once or twice a day, six days a week, and found herself declining social invitations that interfered with her routine.
“People sometimes don’t understand why, but from the beginning, you’re building on everything you do,” Michelle said. “It’s continuous and constant; staying steady, and making sure you hit each of those workouts, because they all matter for the whole big picture of it.”
In late September 2026, she was feeling much stronger than during her 2022 attempt. Michelle is encouraged by the flatter bicycle course in Spain and optimistic that the Mediterranean Sea will be kinder to her than the waters off County Cork (which, sadly, claimed the lives of two swimmers on the same course in Ireland a year after she’d attempted it).
“I’m not nervous like I was the first time,” she said, “just figuring out logistics. Planning has been the whole journey.”
More than anything, Michelle is anticipating a break from training and the stranglehold it’s had on her mind and her time. Juggling work and family responsibilities can be daunting for people even before mixing in twice-daily workouts. Completing the event will give her a reprieve from the singular mental and physical focus required to approach it.
“The race is on your mind every minute of the day,” Michelle said, “what you’re eating, how you’re sleeping, if you’re sleeping enough. [It’s about the] satisfaction of completing a goal that I had set in 2019.”
Joining the Family’s Ironman Finishers
The victory that comes with finishing the event will be all the sweeter when Michelle can add her name to the list of Ironman finishers in the family. Her husband, Mike, has started four and completed three of the races; her son, William, joined his father for one at 18, and a year after that, Michelle’s niece Victoria completed her first of eight. The entire family has participated in a triathlon club in their Cleveland home for years, but Michelle always took a back seat to her son’s and husband’s participation in the races. She’s ready for her own moment in the spotlight.
“I get pretty emotional when I think about the finish,” Michelle said. “The finish chute is a long, red carpet lined with spectators, and you run down that carpet and up a little ramp, through an archway. As you finish, they say your name, and ‘You are an Ironman!'”
“There’s going to be a couple thousand people doing it at the same time, but I’m not competing against them; I’m competing against me and that time clock,” she said.
A Goal Years in the Making
There’s another person who’ll be in her head when she crosses the finish line, too: her late sister, who died in 2019 at the age of 47. Completing an Ironman has been Michelle’s horizon goal since then, an achievement kept just out of reach while she battled her own health challenges.
“I thought a lot about her and the life she wasn’t going to have and the things she was never going to experience,” Michelle said. “I took control of my body again with the help of my nutrition coach. It’s been an amazing decision. I’m healthier now than I was over the last 15 years.”
“I never thought I could do it,” she said. “I challenged myself to do something that scared me.”
“I’m not doing it for anybody but me.”
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