I played with a community band for a xmas concert a few years ago. Playing along side of me was a very elderly gentleman who had just moved into my area a few months before this. He had lived in the Cleveland area most of his life and played with some small jazz bands. I looked at his horn and noticed something odd about it. Around the middle valve just below the top cap he had a metal pipe fitting around it holding a piece of metal upright on either side of the middle valve extending slightly higher than the finger button. He saw me looking at it and figured I'd be asking about this frankenstein looking set-up. He simply held up his right hand and that explained it all. He had arthritis so bad in his hand the ends of his fingers turned at a 90 degree angle with huge knobs at the joints. He said this was the only way he could depress just one button at a time seeing as how each finger covered two buttons. BTW he was a great trumpet player. Kinda puts problems that I have playing into a different perspective.