Well, here comes another pre-holiday debate!

So, I have been at a number of pharmacies thus far, as I don’t have a single pharmacy to call my home. But I make sure that I counsel every patient on every prescription, new, refill, OTC, everything. And no matter where I work, I hear patients tell me, “Its just refills”, or “I never have to talk to X pharmacist about my medications”.

But how are we supposed to figure out whether a medication is working appropriately for our patients if we don’t counsel them on refills?

So my question today is:

Is it possible to change patients expectation about counseling and the role of pharmacists (or pharmaceutical care) if not all pharmacists in a practice are sending a consistent message about the importance of consultation and pharmacist monitoring??

I think that if Joe the pharmacist works T/Wed/Th and Joe doesn’t really consult very much because he wants to make the pharmacy more convenient, but he is a very nice guy and patients like him. (After all he doesn’t make them talk). Then Mary the pharmacist works M/F and she consults every patient thoroughly, will the inconsistency in the pharmacy practice make it difficult for Mary to practice utilizing more cognitive skills/services?

There are pockets of pharmacists doing some great things with pharmaceutical care. I also believe there are many out there that desire to, but because of inconsistency between providers in their organization find it much more difficult to get any progress going.

So, is there value in consistency of values within a pharmacy organization?

Niemiecki tunner zajmujący się tuningiem aut koncernu Volkswagen Group właśnie zabrał się za TT-RS, czyli za najmocniejszą jej wersje. Rozszyfrowanie skrótu “RS” to “Raczej Szybki”, albo ” Racing Sport”. Auto pierwotnie wyposażono w podwójnie doładowane TFSI o mocy 340 koni. MTM właśnie podrasował 2,5-litrowy motor i wycisną z niego najpierw 402, następnie 408, aż w końcu doszedł do 424 koni. Jednak panowie z Niemiec uznali, że zaoferują swoim klientom te 3 opcje, choć moim zdaniem opcja numer 2 nie ma najmniejszego sensu, po co płacić prawie 3 tysiące euro więcej za 6 koni. Przecież to głupota!!! Idąc tym tropem skupimy się na najmocniejszej wersji, która dysponuje maksymalnym momentem obrotowym o wartości 540 Nm, a jej prędkość maksymalna wynosi 292 km/h. A wszystko to dzięki nowej przepustnicy, katalizatorowi oraz przeprogramowaniu sterownika silnika ECU. Dodatkowo auto obklejono czarnymi nalepkami MTM, a dla zainteresowanych przewidziano także dwa nowe wzory felg 19 i 20 calowych. Cena 402-konnej wersji wynosi 1900 euro, 408-konnej 4 698 euro, a najmocniejszej 424-konnej aż 8685 euro. Rozważając dwie pierwsze opcje, oczywiste jest, że ta o mocy 408 koni nie ma racji bytu.

]]> http://marquisor.wordpress.com/2009/11/18/another-cold-novembre-morning/ Wed, 18 Nov 2009 09:26:16 +0000 marquisor http://marquisor.wordpress.com/2009/11/18/another-cold-novembre-morning/

As I have to do two exams next week, I have to spend the whole next days with learning the “Technische Betriebswirtschaft” for my master degree in “Technical Management CCI”.
The examinations will be in “materials logistics” and “management and leadership“.

I also got a phone call today, that the next months after those exams I have to write my diploma thesis.
SO the Christmas holidays are saved, no boring meetings with the relatives…

Znany niemiecki tuner aut grupy VAG postanowił zmodyfikować Audi S5 w wersji cabrio. Zmiany zewnętrzne nie rzucają na kolana, ale z drugiej strony po co radykalnie zmieniać takie piękne auto?! MTM postanowiło “przystroić” sportowe Audi. Święta tuż tuż, więc czerwone elementy nadwozia oraz nowe  felgi pasują idealnie, szczególnie że mamy do czynienia z wersją cabrio z której łatwo wyrzucać prezenty. Ale abstrahując od świąt zabieg stylistyczny jaki wykonało MTM  prawdopodobnie nie przypadnie wielu osobom do gustu. Moim zdaniem było to niepotrzebne, ale oczywiście o gustach się nie dyskutuje. Modyfikowane S5 “stoi” na 21″ calowych felgach bimoto z oponami Michelin w rozmiarze 295/25. Przejdźmy do najlepszego, czyli napędu. Niemiecki tuner zmienił w silniku 3.0 TFSI układ wydechowy  oraz przeprogramował elektronikę sterującą silnikiem. Zmiany przyniosły wzrost mocy z 333KM do 430KM. Tuner zmienił również zawieszenie i hamulce po to by bezpiecznie rozwinąć 287 km/h. Dżentelmeni nie rozmawiają o pieniądzach, więc cena takiej modyfikacji pozostanie tajemnicą.

So, some people I have talked to worry about robots and computers taking over pharmacy practice. I think they may in some circumstances.

A robot can fill faster than I can. A robot can count more accurately than I can. A computer can remember more drug interactions than I can. And do you really need a $100k/year pharmacist to do a basic final check on the prescriptions. I think a trained $14/hour technician could do quite well.

So what is the answer?!

I think this is a golden opportunity to start learning how to market MTM type skills and more ambulatory care pharmacist functions. Instead of using automation to increase to an increasingly larger maximal prescription volume, we should use that increase in efficiency to make time for clinical services in the outpatient setting.

So how will automation affect pharmacy?

Will it be its death knell or a stimulus to a greater role in our patients’ care?

The US House of Representatives is set to vote on HR 3962 – The Affordable Health Care for America Act – this Saturday night, November 7.

A great pro-pharmacy inclusion has been made by Congressman John Dingell (D-MI), which would provide much greater access to pharmacist-delivered MTM services.   The provision would provide grants to entities that will help establish a pharmacist-delivered MTM service in the context of a medical home-style collaborative care setting.  Read this letter of support from 14 professional pharmacy organizations.

I also suggest you read APhA’s response letter to HR 3962, which you can find by clicking on the logo below.  It’s a great way to quickly see how inclusive this bill is of pharmacists and where it still falls short.

Kaiser Health News sampling of reports.

Check out this article from the Washington Post talking about the climate on the Hill leading up to this major vote.

Remember the MTM RS6 R? Well, a tuning company called MFK Autosport has decided to do something similar to the old RS6.

They’ve called it the MFK Autosport Powercar RS6. Now, the press release I found is quite poorly translated from it’s original language (Which is supposedly German), and it’s quite a short and vague press release too, so forgive me if the details I provide aren’t good enough for you.

What I can make out from the press release is that they’ve given the car new tires from Dunlop and rims from Schmidt Revolution. They also played around with the softward of the twin-turbo V8 to up the power to 520hp, 80hp more than the original car. They also offer a sports exhaust system for 5,999Euros (Roughly $9,000). It is pretty damn awesome. I still prefer the MTM RS6 R though, because that chucks out a whopping 730hp in a package just as practical.

Source: Autoblog

In the market for some hardcore modifications for your GTi? Well there are lots of choices for you out there. Which would make it increasingly harder to make a decision. Fortunately there is a new kit for your VW that will make your decision making much easier. That would be the MTM Tuning Kit.

This German tuner based out of Wettstetton has prepared a kit which will take your Golf from a tame beast to a ferocious hatchback. Boosting the 2.0 TFSI engine to 270hp can do that to a car.

Alright now let’s talk turkey. How much damage will a high end kit like this do? Not as bad as one would think actually. It comes in under $45,000.

Funny the front grill kind of reminds me of my 09 STi!

Yesterday I did another MTM workout at the park.  As part of my warmup, I did Turkish getups using a 12-pound body bar – another great idea I got from MTM’s Sarah Rippel.  Normally this core-strengthening exercise is done with kettlebells, but really they can be done with any weight, or even no weight at all.

Windmills and side presses can also be done with a body bar in addition to kettlebells.  I had gotten the body bar on sale some years ago and it had been collecting dust in my workout room until Sarah gave me those great ideas; now it is one of my most-used pieces of equipment.

Instead of shopping for new fitness gadgets that I can’t afford, I’ve been “shopping” my workout room and brainstorming new ways to use old stuff.

Got a Thighmaster?  Here are some ways to exercise with it that I bet Suzanne Somers never thought of:

• Do lateral jumps over it for 1 minute
• Take it outside, throw it as far as you can, and sprint to retrieve it.  Repeat 20 times.
• Throw it as far up into a tree as you can, and climb up to get it
• Hang it over a tree branch, and do some pull-ups from it

Just some Friday fun but seriously, look around your workout room and see if you can bring your old gadgets back to life.

The Senate Finance Committee released their draft of health care reform legislation months after months of anticipation.  Some of the pharmacy highlights include:

-Medicare Advantage payment of MTM services
-DME accreditation exemption if less than 5% of total sales are from DME supplies and there are no delinquencies in the last 5 years.
-Medicaid prescription reimbursement set at 175% weighted average AMP
-Exploration of MTM services in new “Innovations Center.”
-Establishes Accountable Care Organizations and health co-ops.
-Require prescription drug coverage for categorically and medically needy Medicaid patients, and remove smoking cessation drugs, barbiturates and benzodiazepines from the Medicaid excluded drug list.  Both of these will be in effect January 1, 2014.

Check out this summary of the Senate Finance bill prepared by APhA. Pharmacy-specific issues are hi-lighted in yellow.

I’ve been doing sort of an “intuitive” exercise program for the past couple of weeks, where I just do what I feel like doing. Funny thing is, when I give myself permission to skip dread-factor workouts like pushups, I don’t mind doing them as much.

Yesterday I did some band exercises from Sarah Rippel’s MTM program. (She just completed a tri!)  Bands are fantastic for the core.  One of my favorite exercises from MTM is the dowel iso-hold.  Sarah demonstrates at about 1:00 in this video. I held the hold for 90 seconds on each side, and on the second round, my arms were shaking!  Try it, you’ll like it.

Info coming soon!

I’ve mentioned before that I consider St Elsewhere is the greatest medical drama ever seen on TV.

It was a truly groundbreaking show which rewrote the rules for its genre in the same way that its MTM stablemate Hill Street Blues did for the police drama.

Like all medical dramas, the show featured the usual routine patient-of-the-week cases and the day-to-day lives and loves of the staff - from lowly orderlies all the way up to the most senior doctors.

However, it also dealt with many controversial issues that had previously been taboo for primetime network TV, such as rape (shockingly, carried out by one of the show’s main characters) and AIDS (St Elsewhere was the first prime-time US TV show to feature a prominent, regular character with the disease – Mark Harmon’s Dr Robert Caldwell).

In addition, the show had a wicked sense of black humour and a bizarre, playfully surreal streak. The latter was most infamously displayed in the final episode, when it is implied that the entire series was imagined by Dr Donald Westphall ’s autistic son, Tommy.

And it’s Dr Westphall that is the subject of this week’s classic scene. Frustrated at the new management of St Eligius (the proper name of the hospital featured in the show – “St Elsewhere” being a derogatory nickname) and the restrictions that cost-cutting was placing on patient care, he bows out of the show in some style.

Having earlier resigned, Westphall is summoned by his bean-counting new boss Dr John Gideon (played by Deliverance and Robocop star Ronny Cox). After a pointed comment, with an obvious double meaning, about how he collects medical antiques, Gideon offers to help Westphall repair the bridges he burned by resigning and the chance to remain at the hospital – but only if he toes the party line and becomes yes-man for his new corporate masters.

Westphall responds in typically blunt style and in what was an unusually explicit manner for network TV at that time (1987).

I only recently found out that actor Ed Flanders, who so memorably brought Dr Westphall to life, killed himself in 1995, aged 60, while suffering from depression. A sad end for a man who brought so much joy. This, then, is the Choob’s tribute to him:

Thanks to a strong broad market rally, the share prices of the companies that have raised money through qualified institutional placements (QIPs) have recovered.

According to SMC Capitals, of the 24 companies, which raised money through QIPs, only five gave negative return while the remaining 19 stocks were trading well above their QIP issue prices.

However, they have underperformed the BSE benchmark index.

As against 62 per cent return posted by the BSE Sensex (since the beginning of the current fiscal), the companies’ return stood at just 35 per cent.

“On an aggregate, the current mark-to-market (MTM) value of all QIPs put together works out to an amount of Rs 23,208 crore, marking current MTM return of 35.17 per cent,” said a SMC Capitals study.

“The biggest contributor to the positive performance is the first QIP issuance by Unitech. The issuance was made at Rs 38.5 a share and the current market price is Rs 113.4, indicating a current MTM return of 194 per cent,” the report said.

Other prominent QIP issuances include Indiabulls Real Estate, Shree Renuka Sugars, HDIL and Emami.

A day before, the share prices of Network 18 Fincap, Bajaj Hindustan, and REI Agro were trading below their QIP issue prices.

Such positive returns will make sure that investor interest in QIPs will continue and many more companies will raise fund through this route, said Mr Jagannadham Thunuguntla, Head of Equities at SMC Capitals.

so damn sexy

I’ve seen every headline of every story published by the prolific Kaiser Health News this summer.  Today marks the first time I read one with a focus on the role of pharmacists’ services in health care reform!

Though the story doesn’t specifically call it “medication therapy management” or address the fact that this is not a novel concept by any means, I’ll still call it a win for the pharmacy profession!

Check it out here.

By Coleen Martinez

First, let’s begin our discussion with an explanation of what Mark-to-Market (MTM) is.  From the Forbes website, Investopedia, MTM is the following¹:

1. A measure of the fair value of accounts that can change over time, such as assets and liabilities.  MTM aims to provide a realistic appraisal of an institution’s or company’s current financial situation. 
2. The accounting act of recording the price or value of a security, portfolio or account to reflect its current market value rather than its book value. 
3. When the net asset value (NAV) of a mutual fund is valued based on the most current market valuation.

The Forbes’ website goes on to try to explain what happens in a MTM situation.  Take the “financial crisis of 2008/2009¹” (as if this crisis is ancient history) as the starting point of the following explanation.  So, as we all know, banks went around the country selling and buying lots of bad loans on houses with inflated prices.  And when the bubble burst, the loans that the banks were holding lost their value and in consequence, the banks themselves lost their value.  Forbes explains the above situation as this:

                 “Problems can arise when the market-based measurement does not accurately reflect the underlying asset’s true value. This can occur when a company is forced to calculate the selling price of these assets or liabilities during unfavorable or volatile times, such as a financial crisis. For example, if the liquidity is low or investors are fearful, the current selling price of a bank’s assets could be much lower than the actual value. The result would be a lowered shareholders’ equity.¹”

The bank bought loans for inflated values.  In turn, the bank sold shares based on the inflated values of the loans and ultimately marketed itself at an inflated price to have investors buy shares of their company so everyone could be happy and rich.   When the bubble burst, the bank would have lost its’ value because the loans lost their values, and ultimately the shareholders would lose the value of their high priced stock in the bank. 

What the Forbes quote above is trying to explain is that during a financial crisis, banks with bad loans will appear worse than they appear.  So to combat this awful situation for the banks, the MTM rule was kicked to the curb.  In April 2009, the Financial Accounting Standards Board (FASB) created “new guidelines that would allow for the valuation to be based on a price that would be received in an orderly market rather than a forced liquidation.¹”

Based on the financial industry’s faulty logic, they have concluded that during a financial crisis, they are allowed to value their assets at a price of their desire.  When doing this “magic math” banks will not lose shareholders because their only value is based on a bunch of bad loans.  Banks will instead keep all of their value and shareholders by lying about the value of their assets.  Isn’t this just fantastic!

I felt bad for not knowing about the MTM rule in the first place and not knowing about the rule’s demise in April.  I try really hard to know about current events especially when it comes to mortgage news.  Then I realized that rules disappearing and reappearing in the financial world is exactly why we had a “financial crisis of 2008/2009.¹”  It seems that while President Obama is trying to put forth new regulations in the financial industry, Wall Street is still playing their games. 

I guess that you wouldn’t be surprised to know MTM is a company also.  Check them out, they offer BPO’s (Broker Price Opinions) or as we know them as, appraisals².  I suppose that this website promises BPO’s in an “orderly market, not a forced liquidation market.¹” My personal experience tells me that the BPO’s ordered for my vacant home on the market were based on a bubble market (orderly), not a reality market (forced liquidation).

While doing research for this piece, I came across a wonderfully titled opinion piece on the Forbes website titled, “Why Mark-to-Market Accounting Rules Must Die.³” The writers complain about how terrible the rule is for banks and why we should allow the financial industry to get rid of the rule.  Clearly these writers have no clue as to the affect of not having this rule does for the average citizen. 

My house has been vacant and listed for sale since February 2008.  After 6 months on the market, I started requesting approval of short sale offers.  Every single BPO we received was entirely too high and not at all reflective of the current depressed market value of my home, of the neighborhood, and of the town.  Obviously my mortgage servicer had decided early on to ignore the MTM rule and now they can ignore the MTM rule in good conscience. 

In summary, the MTM rule has been relaxed to allow banks to value their assets as they see fit.  In a financial crisis, they can keep their assets valued high even though the assets might be low.  However, in a normal market, banks have to value their assets at face value.  The financial industry’s idea of a stable market is our idea of a bubble market, whereas our idea of a stable market is the financial industry’s idea of a “forced liquidation¹” market.       

We are still in a financial crisis.  Banks still won’t modify mortgages.  Obviously if banks modified mortgages they would be admitting that the values of their assets are lower than when they were first purchased.  As we have realized, this asset lowering in turn can lower the overall value of the bank.  Clearly this is why banks won’t accept short sales because they would have to admit that the loans are not as valuable as first thought.  This is why banks won’t refinance because typically the payment amount and interest will go down and thus lower the value of the loan.  This is why banks won’t modify mortgages that are underwater because again, they have to admit that the value of their loan has decreased.  Plus, by keeping an inflated value on mortgages, servicers earn ¼ to ½ percent per value of each mortgage⁵.  By keeping the values/mortgages/loans/assets at an inflated price, both the banks and mortgage servicers win.      

Lastly, “by allowing a property to go into foreclosure, banks have postponed the inevitable, admitting the value of their asset has decreased.⁴”  Take it from someone who knows, banks can drag out a pending foreclosure for a long time and all the while, they get to keep the same high value of their assets for as long as possible.  Plus, when the property does foreclose, banks and servicers earn fees⁵.     

I believe the MTM rule has become a joke.  Either we create a new rule or refer to the old rule and actually enforce it. 

Sources:

1. Mark-to-Market on Investopedia, A Forbes Digital Company.  Found 8/11/09
   URL: http://www.investopedia.com/terms/m/marktomarket.asp
2. Mark-to-Market. Found 8/11/09
   URL: www.marktomarket.com
3. Why Mark-to-Market Accounting Rules Must Die by Brian S. Wesbury and Robert Stein.  Posted 2/24/09.  Found 8/11/09.
   URL: http://www.forbes.com/2009/02/23/mark-to-market-opinions-columnists_recovery_stimulus.html
4. Our view on housing: On foreclosures, lenders play ‘extend and pretend’. USA Today Editorial Board.  Posted 7/28/09. Found 8/10/09
   URL:  http://blogs.usatoday.com/oped/2009/07/our-view-on-housing-on-foreclosures-lenders-play-extend-and-pretend–to-avoid-write-downs-banks-drag-feet-on.html?loc=interstitialskip
5. AP IMPACT: Government Mortgage Partners Sued for Abuses.  Daniel Wagner.  Associated Press.  8/5/09. 
   URL: http://hosted.ap.org/dynamic/stories/U/US_MORTGAGE_MIDDLEMEN?SITE=KYB66&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2009-08-05-20-52-21

Ultra-portable mini-reloading scales have become popular with shooters who reload at the range. These can be small enough to fit in a shirt pocket. While not as precise as a bench-top unit, they can deliver read-outs to within 0.2 grains. These ultra-compact scales should prove very useful for any shooter that needs to load at the range. Additionally, they are affordable enough to be used as a back-up to a larger electronic or balance beam scale. Two models, one from MTM and the other from Acculab (Sartorius) have caught our attention.

NOTE: We haven’t yet been able to comparison-test these two scales with a laboratory scale to confirm the claimed levels of weighing precision and see if there are any calibration or “drift” issues. But we’ve heard no negative reports.

MTM Mini Reloading Scale — $30
The new DS-1200 weighs up to 1200 grains. MTM claims accuracy (resolution) to plus or minus 0.1 (one-tenth) grain. You can switch measurements among grains, grams, ounces and carats .The unit features a high-impact, plastic sensor cover that doubles as a large powder pan. The DS-1200 comes with a calibration weight, two (2) CR2032 Batteries, and a foam lined storage/travel case. Up to 1200 grain capacity with To save battery power, the large, backlit display shuts off automatically after 3 minutes. Here are sources for this bargain-priced new scale:

PrecisionReloading.com Item MTDS1200 | $29.99

Acculab Pocket Pro PP-62 Mini Scale — $110
Sartorius, makers of the popular Acculab-123 scale and its Denver Instrument clone, the MXX-123, has introduced a new, portable reloading scale that is truly pocket-sized. The compact model PP-62 will work as a portable scale or a back-up for a benchscale. It measures 3.5″ long, 3″ wide, and just 7/8″ thick.

The Pocket Pro can handle a maximum weight of 1000 grains. Acculab claims resolution down to 0.1 (one-tenth) GRAM, which provides readability to 0.20 GRAINS. We like the fact that the unit runs on a single, easy-to-purchase AA battery. Battery life is up to 20 hours, if you turn off the back lighting on the LCD display. A sliding cover also protects the weighing mechanism during transport. The PP-62 offers easy one-button calibration with the supplied check weight.

Sinclair Int’l sells the new Acculab PP-62, for $117.50 (Item 10-6200). This includes battery, weighing pan, and 50 gram calibration weight. ScalesGalore.com offers the PP-62 (with battery, pan, and check weight), for $109.95.

CONSUMER ALERT: On the web you’ll find other versions of the Acculab Pocket-Pro® Scales, priced at $45-$60.00. These are the PP-201 (photo above) and PP-401. Though these scales appear identical to the PP-62 (Sinclair item 10-6200), they are NOT the SAME. The cheaper PP-201 and PP-401 are only rated to one-TENTH of a GRAM. The PP-62 is RATED to one-HUNDRETH of a GRAM — roughly 0.2 GRAIN precision.

Taken from: legis.state.ia.us

Iowa congressmen will be busy over the August recess holding town hall meetings around the state with their constituents.  Find one near you and go advocate for the profession of pharmacy!

Representatives Bruce Braley and Dave Loebsack along with Senator Chuck Grassley currently have their town hall schedules announced, and the other four legislators will likely post their schedules to their websites soon.

Check out the town hall schedule here.   (If you’re not sure who your representative is, click on the photo above to see in what district you live.)




If you need ideas for asking pharmacy-related questions in a town hall setting, check out this document prepared by APhA.

And don’t miss an opportunity to share with our congressmen the benefits of a pharmacist’s services, especially MTM!  Go ahead and print off a copy of this MTM leave-behind document to give to your congressmen or his staff.

Don’t be shy!  Legislators would much rather hear from their constituents than special interest groups any day.

With the recess bell looming, the Energy & Commerce Committee, the only remaining House committee needing to advance their mark of HR 3200, came through in a big way the latter half of last week.

Wednesday saw a major breakthrough in negotiations with the Blue Dogs which led to a committee vote on Friday, where the E & C mark passed by a vote of 31-28. Although it’s a little past Obama’s original desired timeline, U.S. Representatives were able to begin their August recess today with a renewed momentum behind their health care reform effort. Expect a merged bill to be up for a full House vote in September.

Read more about the Blue Dogs’ agreement: NPR Health article, AP article

Read more about the Energy & Commerce Committee vote: Politico article

A couple of big pharmacy-related amendments made it into the version of HR 3200 reported by the Energy & Commerce Committee Friday:

• In an amendment offered by Congressman Weiner (D-NY), PBM transparency would be required in any plan contracting with the new health insurance exchange, including any public option.  Transparency would include disclosing: payments from the plan to the PBM and from the PBM to the pharmacy, rebates and discounts from manufacturers, and information that sheds light on generic and mail-order utilization.
• E & C also voted in favor of an amendment to include an MTM grant program very similar to the one found in the Senate HELP language.  Representative Butterfield (D-NC) sponsored this amendment.

Today I did MTM again, after warming up with one-hand kettlebell swings and deadlifts with 40 pounds on my t-handle.  I’m up to doing one-minute work intervals on MTM with 30-second rests.

In gaming purse-strings news, DDR Hottest Party 2 game/mat bundle is on sale for $35 today at Amazon.  I have the first Hottest Party, and while it was great to see DDR come to the Wii, I was a little disappointed at the lack of doubles mode and training mode, as well as the confusing menus and really irritating anouncer.  I tried HP2 at a friend’s house, and they’ve improved some things, like adding a training mode, making this the DDR game to buy for Wii.

If you’re new to DDR, I would suggest you go right to the HP2 options menu and shut off the hands and gimmicks until you’ve gotten used to the footwork.  That’s another improvement they made to this edition; the game will save your preferences.  Now if the next Wii DDR, coming this fall, will add doubles, I’ll have happy feet