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t m c » p u l s e | m a r c h 2 0 1 8 19 peas, carrots or green beans. Her favorite snack is strawberries with cream cheese. "The portions are smaller because this diet is high in fat, so it's calorically dense," Schultz said. "Fat has more calories per gram than carbohydrates, so although the meal looks small, it's the same number of calories and you get full." Maintaining ketosis is labor- intensive, and to be successful, everything consumed must be weighed and measured. "You have to measure at a ratio to give her exactly what she needs, including fluids," Sarah explained. "Kristin is currently at a 2.5 ratio, so it's 2.5 times as much fat as every- thing else. If you don't eat every- thing in the bowl, you're not at that ratio anymore." The diet's highly restrictive nature and lack of variety makes it difficult for patients and their families. It limits social opportuni- ties, too. Kids on ketosis can't have even one sip of soda, much less Halloween candy or a celebratory ice cream cone. "When we treat epilepsy, we don't just treat the child," Schultz explained. "There are a number of individuals that help to treat the child, and families have to be invested." "It's our new normal," Sarah said. "It's our family, it's our life, and it's all she's known for so long. But initially, the biggest challenge was eating in front of her. You can't just come to dinner and sit there with your family and pile your plate with mashed potatoes and green beans. You can't just have pizza and you can't have birthday cake. You can't have all these things that are a part of a kid's life growing up. And when you have a twin sister and a brother who's 17 months older, that was a challenge." Sarah said the diet was daunt- ing at first, but ultimately became second nature. "You have to prepare and think ahead," she said. "Figure out substi- tutions. You make some sugar-free Jell-O with heavy whipping cream that's keto-approved. You take that extra step to make sure she doesn't feel left out." Schultz and Clarke work with nutritionists to tailor each patient's diet as much as possible to mini- mize disruption to their lifestyles. "It's important for kids to feel like part of the group and to be able to participate with their peers," Schultz said. "We tell parents, 'If you know that the classroom is having a party and they're going to have cupcakes, let us know, because we have recipes for ketogenic cupcakes and cheesecakes.'" A popular favorite? Peanut Butter Fat Bombs. "It's basically peanut butter with a lot of butter," Schultz said. "According to what my patients tell me, they make a wonderful, deli- cious treat." Despite the diet's potential for treating epilepsy, families often find it too overwhelming, especially when kids are picky eaters. Sarah said that in some ways, it's easier to maintain the diet because Kristin is not a typical 14-year-old. "She's not a teenager that's got to have it her way. If you're fully devel- opmentally aware, that's going to be harder, because then you're aware of what you're not getting. Ultimately, families have to make the best deci- sions for themselves, but the diet is definitely worth a try." As Sarah spoke, Kristin clutched her Elsa doll while she listened to music on her iPad. Her nails were painted a sparkly blue, another nod to Frozen, her favorite Disney movie. "She's never going to be seizure- free; we know this," Sarah said. "Our goal is just to give her the best quality of life we can, and if that means we implement five different treatments, then we do." 12 ACADEMIC MEDICAL CENTERS RECEIVED THIS PRESTIGIOUS QUALITY OF CARE AWARD. ONLY ONE IS IN TEXAS. 1. Mayo Clinic-Rochester 2. NYU Langone Health 3. Froedtert & the Medical College of Wisconsin – Froedtert Hospital 4. Rush University Medical Center 5. Penn State Health Milton S. Hershey Medical Center 6. University of Utah Health 7. UC Health University of Colorado Hospital 8. Lehigh Valley Health Network 9. The University of Texas Medical Branch at Galveston 10. The University of Kansas Hospital 11. Nebraska Medicine 12. Oregon Health & Science University Hospital The results are in. UTMB is ranked among the nation's best academic medical centers in the 2017 Vizient Quality and Accountability Study. Vizient is an impartial company that drives performance improvement in health care by measuring patient safety and care results among an elite group of 107 academic medical centers. UTMB is proud to be ranked 9th in the nation —and the only one recognized in Texas —for its superior quality and safety performance. This is one of many accolades given to UTMB for superior patient care. We have also received an A grade from the Leapfrog Group for our accomplishments in reducing errors, infections and accidents. And, again, we have received Magnet ® Recognition for meeting the highest standards in nursing. Before you decide where to be treated, take a moment to understand the quality of care differences between hospitals. It could make all the difference. Learn more at utmbhealth.com/quality.

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