This outcome data will include information regarding each subject's medical history, symptoms, quality of life, pain, range of motion (ROM), swelling, ease of use, treatment satisfaction, treatment compliance, and adverse events. Adding the Flexitouch compression pump to my daily lymphedema care regime has helped me attain that goal. /A << The study will evaluate the feasibility and potential effectiveness of the Flexitouch head and neck treatment plus standard home care compared to standard home care regimen alone. Of the patients who tried the device, 88% saw a reduction in head and neck swelling after an initial 32-minute at-home treatment with the Flexitouch system, and 89% of patients reported. 3701 Wayzata Blvd, Suite 300 The specialist who placed the order asked for my inner thigh measurement, so she ordered a medium for the legs based on that. The head and neck application of the Flexitouch system received 510 (k) pre-market notification clearance from the FDA in August of 2016. Advanced Pneumatic Compression for Treatment of Lymphedema of the Head and Neck: A Randomized Wait-List Controlled Trial. /Subtype /Link /Type /Catalog My therapist wasnt very keen on the use of these pumps and stated that they can sometimes hinder rather than help lymphedema. See the clinical benefit of Flexitouch Plus FEES Study 1 Swelling six week post cancer treatment FEES Study 2 >> I have it in both of my legs mostly in my thighs. 7:00 a.m. to 7:00 p.m. CT, Monday through Friday and 8:00 a.m. to 12:00 p.m. CT, Saturday, 3701 Wayzata Blvd, Suite 300 Flexitouch Plus is an advanced intermittent pneumatic compression device (lymphedema pump) that gives patients a comfortable and convenient way to self-manage lymphedema and non-healing venous leg ulcers. Chronic pain all the time and the hopelessness of diagnosis was almost harder than going through chemo emotionally and physically. The Flexitouch System and garments for the head and neck are intended for use by medical professionals and patients who are under medical supervision for the treatment of head and neck lymphedema . Lymphat Res Biol, 2016. The lymphedema seen in patients treated for head . I didnt need a lymphedema physical therapist but too much to explain here. The head garment and vest for head and neck for the Flexitouch Plus system should not be used on patients who have one or more of the following conditions: Pneumatic compressor, segmental home model with calibrated gradient pressure, Chronic Venous Insufficiency stream Percent change is calculated by the difference between scores averaged at 6 months versus baseline. Sacco, A. G., Chen, R., Worden, F. P., Wong, D. J. L., Adkins, D., Swiecicki, P., Cohen, E. E. W. (2021). /MediaBox [0 0 612 792] Since my trouble spot is below my elbow, several times a week I use the 22 minute forearm and hand setting. /Rotate 0 Then I got my flexitouch and my life changed. /Contents [40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R] I have skipped 1 or 2 days just 3 or 4 times since March. /Resources << Studies a U.S. FDA-regulated Drug Product: Studies a U.S. FDA-regulated Device Product: Product Manufactured in and Exported from the U.S.: Symptom/Problem Improvement From Baseline to 6 Months [TimeFrame:Percent Changes between Baseline and 6 months will be assessed], Function (Range of Motion) Improvement From Baseline to 6 Months [TimeFrame:Percent Changes between Baseline and 6 months will be assessed], Changes in Health-related Quality of Life From Baseline to 6 Months [TimeFrame:Percent Changes between Baseline and 6 months will be assessed], Changes in Health-related Quality of Life-Overall From Baseline to 6 Months [TimeFrame:Percent Changes between Baseline and 6 months will be assessed], Changes in Pain From Baseline to 6 Months [TimeFrame:Percent Changes between Baseline and 6 months will be assessed], Change in Swelling From Baseline to 6 Months [TimeFrame:Percent Changes between Baseline and 6 months will be assessed], Ease of Use/Satisfaction [TimeFrame:Assessed at 6 months], A diagnosis of head and/or neck lymphedema, Must be able and willing to participate in all aspects of the registry and provide informed consent prior to registry participation. A Prospective Study of the Lymphedema and Fibrosis Continuum in Patients with Head and Neck Cancer. More than 90% of patients treated for head and neck cancer develop lymphedema1 resulting in swelling, fibrosis, difficulty swallowing, pain and other symptoms impacting quality of life with few viable options for long-term treatment, said Dr. Thomas F. ODonnell, Jr., Tactile Medicals Chief Medical Officer. & weigh 126 lbs. Lymphat Res Biol. >> Ridner SH, Dietrich MS, Niermann K, Cmelak A, Mannion K, Murphy B. 10 0 obj endobj They only measured the circumference of my thighs and calfskin, not the length, so now I am STUCK with a non-refundable almost 9K system that is too long for me. /Type /Page Tens of thousands of patients with lymphedema in the limbs and trunk areas have benefited from the Flexitouch system since its introduction in 2002. I cant afford to buy new so I opted to get one used to at least start my therapy the PT has ordered. /Tabs /S My physical therapist recommended the FlexiTouch Plus machine, and my new machine arrived this week. !|.Sce@x*qkO NJ|PU:X5]?]_kPs:Cr.)rgKG$/N An estimated 1.4 million U.S. patients are diagnosed with lymphedema annually. Thanks. /Contents 53 0 R /W 0 /Rotate 0 Selling one at a reduced cost could open up possibilities for people who could not otherwise afford them. Your email address will not be published. Forward-looking statements are generally identifiable by the use of words like may, will, should, could, expect, anticipate, estimate, believe, intend, continue, confident, outlook, guidance, project, goals, look forward, poised, designed, plan, return, focused, prospects or remain or the negative of these words or other variations on these words or comparable terminology. Lymphedema is a chronic disease that causes fluid buildup in the body and can complicate normal functions. I knew Dr. Stanley Rockson of Stanford University was performing a drug trial with a medication called Uberimex for the treatment of lymphedema so I was keenly interested in learning what he said about this new pump. Direct Evidence of Lymphatic Function Improvement After Advanced Pneumatic Compression Device Treatment of Lymphedema. ?gF:cmlrpoc*teIgeF%hvK-h*NHw\3b.IkQvll Bwzw6Gix-Gm6!57Z4T$YNN Its been tough . All reviewers. Oral Oncology. You have to speak up for yourself because my doctor would have just let me keep getting it and pumping me full of antibiotics. The Flexitouch Plus system is clinically proven to decrease swelling and improve swallowing. Tactile Systems Technology (TCMD +0.6%) announces the enrollment of the first patient in a randomized, controlled trial evaluating the effectiveness of its Flexitouch Plus system for the treatment . phone: +1 (623) 738-9011 (57) Webstore 3. /Resources << << >> Ridner, S.H., et al., A prospective Study of the Lymphedema and Fibrosis Continuum. | Source: One week at the wound care clinic , I saw a different doctor than normal and he referred me to tactile. While there is no cure, lymphedema can be effectively managed to relieve symptoms, prevent worsening, and lower the risk of skin damage and infection. Negative value shows a decrease in swelling. /CropBox [0.0 0.0 612.0 792.0] Subjects diagnosed with Head and Neck Lymphedema and prescribed the Flexitouch system or Flexitouch Plus system as standard of care treatment, Device: Flexitouch system with Head and Neck Garments. So for almost every night for the next seven years I sat down and performed MLD on my left arm. /TT0 69 0 R endobj Dr. Arturo Gonzalez and Dr. Alton R. Johnson, Cathy Thomas Hess, BSN, RN, CWOCN and Dr. Lisa Gould, MD, PhD, FACS, IC-1200-WH Vascu-Ease Portable DVT System, Recommendations for Wounds After Flaps and Grafts, How to Leverage Technology to Improve Patient Education and Outreach, From Chronic to Closure: An Innovative Approach to Manage Challenging Wounds, Working Smarter, Not Harder: Strategies for Wound Management Success, How to Advance Complex Wounds Toward Healing, Implementing Wound Hygiene: A Stepwise Approach, Uncommon Wounds: Frostbite and Winter Woes, What Clinicians Should Know About Comorbidities and Complex Wounds. /BS << /Subtype /Link Non-cancer related lymphedema patients demonstrated a: 75% decline in the rate of cellulitis, a 40% reduction in the rate of out-patient hospital visits, a 34% reduction in rate of physical therapy visits, and a 36% reduction in lymphedema-related costs. In my home, Alexis helped me slip into a padded bolero type jacket with a long sleeve for my left arm. /Rotate 0 Sign up today for your free Reader Account. The company Tactile medicine has been so nice from listening to me to appealing and sending people to me to make the process easy. The Companys unique offering includes advanced, clinically proven pneumatic compression devices, as well as continuity of care services provided by a national network of product specialists and trainers, reimbursement experts, patient advocates and clinicians. They are programed for each individual. Ive had my Flexitouch for almost five months. I really need this system and had such desperate hope. eIb? This is not anadvertisement for Flexitouch.). /Group << G Bg4> +o_j-\#a4B5C;dOw[['q=oJ&9{4d`Jn"\u|MTbzzG,g L|F4/^z7D:tL$TrHxarg5>Lpp The Flexitouch system treats lymphedema, which causes swollen limbs and dangerous infections. /TT2 71 0 R Toll-free: 1.833.3TACTILE (1.833.382.2845) (Therapists couldnt afford themselves to take insurance payments because most insurances do not reinburse them enough to make it worthwhile) All in all I finally found the Lymphedema Center (why dont doctors know this) and took some classes and found an amazing therapist who has helped and has been trained in lymphedema and a few massage therapists that know what they are doing and are trained. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . Subject overall health and quality of life in the past week-EORTC C30. >> This is a long story but I have managed it as best as I can but when I finally was ready to prove to my insurance that the Flexitouch was needed the insurance denied me coverage. Dr. Shelia Ridner Dr. Barbara Murphy /Length 450 Rz:MzI6 Assessment and measurement of head and neck lymphedema: State-of-the-science and future directions. The Flexitouch system is clinically proven to improve clinical outcomes and reduce healthcare costs, stimulate lymphatic function, and significantly reduce edema and limb volume. PW!\v(jfz:yX 8$W"wqHbxQDL It has become so bad that I can barely walk. Ive heard from many people that they saw good results with their pump. /Filter /FlateDecode /CropBox [0.0 0.0 612.0 792.0] Phone: 1.612.355.5100 /Rotate 0 We were asked to improve the ease of donning . For the year ended December 31, 2022, we generated revenue of $246.8 million and had a net loss of $17.9 million, compared to revenue of $208.1 million and a net loss of $11.8 million for the year . 0 T Refer to the Legal Notice for express terms of use. Legal Notice Regarding Forward-Looking Statements: This release contains forward-looking statements. ? /S /Transparency Numerous garment and program options to meet each patient's unique treatment needs FLEXITOUCH Compression Unit For Left Shoulder Short sz 3 Trunk PD32-U Pump Lymphedema Pump Lymphedema For Sale Compression Unit For Left Shoulder Short. /Pages 2 0 R Read our, ClinicalTrials.gov Identifier: NCT03558672, Observational Investors and security holders are urged to read these documents free of charge on the SECs website at http://www.sec.gov. With the enrollment of our first patient, we are pleased to initiate the largest randomized, controlled clinical trial ever conducted for the treatment of head and neck cancer-related lymphedema, said Sheila Ridner, PhD, RN, FAAN, Professor of Nursing, Emerita, Vanderbilt University School of Nursing, a principal investigator of the trial. I am a person who has kids and works as a hairstylist and loves gardening and working out and cooking. /Type /Page Negative value shows a decrease in pain. HTMO0WKwfCB R+,Pq%j7U.h|AzPM]%YR|dZERH dHkeh5. Im curious, was your husband diagnosed with lymphedema or was his leg swelling due primarily to diabetes? The reader is cautioned not to put undue reliance on these forward-looking statements, as these statements are subject to numerous factors and uncertainties outside of the Companys control that can make such statements untrue, including, but not limited to, the impacts of the COVID-19 pandemic on the Companys business, financial condition and results of operations; the course of the COVID-19 pandemic and its impact on general economic, business and market conditions; the Companys inability to execute on its plans to respond to the COVID-19 pandemic; the adequacy of the Companys liquidity to pursue its business objectives; the Companys ability to obtain reimbursement from third party payers for its products; loss or retirement of key executives, including prior to identifying a successor; adverse economic conditions or intense competition; loss of a key supplier; entry of new competitors and products; adverse federal, state and local government regulation; technological obsolescence of the Companys products; technical problems with the Companys research and products; the Companys ability to expand its business through strategic acquisitions; the Companys ability to integrate acquisitions and related businesses; price increases for supplies and components; the effects of current and future U.S. and foreign trade policy and tariff actions; or the inability to carry out research, development and commercialization plans. endobj Assessment and measurement of head and neck lymphedema: State-of-the-science and future directions. 2015 51 (431-437), 1. >> The Flexitouch Plus system is clinically proven to stimulate the lymphatic system and to treat head and neck lymphedema. Hi Sarah, I would suggest going to a clinic in your area where therapists specialize in care of lymphedema. << 2. 1. The lymphedema seen in patients treated for head and neck cancer can be seen externally on the neck and face, as well as internally in the lining of the throat. In this study, the investigators plan to treat the external lymphedema with a device called the Flexitouch Plus, which is already approved by the Food and Drug Administration (FDA) for lymphedema treatment, and to measure the degree of internal lymphedema using a pressure sensor to detect throat muscle pressure before and after the treatment with the Flexitouch Plus device. /CropBox [0 0 612 792] 8 0 obj Investors and security holders are urged to read these documents free of charge on the SECs website at http://www.sec.gov. Im a pianist and its become my safe place. Many, many of my patients love their pump. Find many great new & used options and get the best deals for Ping G15 Irons / 4-PW / Green Dot / Regular Flex Ping TFC 149 I Shafts at the best online prices at eBay! For more information, https://tactilemedical.com/information-for-patients/what-is-lymphedema/, The Flexitouch Plus system has been clinically proven to stimulate the lymphatic system. The Flexitouch Plus system has been clinically proven to stimulate the lymphatic system. /Annots [25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R https://tactilemedical.com/head-and-neck-lymphedema-clinical-trial/, https://tactilemedical.com/information-for-patients/what-is-lymphedema/, https://tactilemedical.com/our-lymphedema-solutions/for-head-and-neck/flexitouch-plus/. Pain will be assessed using the VAS Pain Scale. Tactile Medicals Mission is to help people suffering from chronic diseases live better and care for themselves at home. /C2_0 21 0 R Positive value shows an increase in swelling. View this study on Beta.ClinicalTrials.gov, U.S. Department of Health and Human Services, The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. (Note: There are other well regarded pumps on the market. Repeatable results and high patient satisfaction encourage ongoing use and better outcomes. Flexitouch Pd32-u Lymphedema Treatment System Pump. /W 0 This all proves to me that my Flexitouch is moving lymphatic fluid out of my lymphedema affected areas. /TT0 22 0 R Required fields are marked *. I go to wound care once a week because of the horrible wounds on my legs that drain so badly due to the lymphedema. XJ I met other therapists here and there and all of them preferred manual lymphatic drainage, MLD, over the use of pumps. /ExtGState << As one Flexitouch woman put it, its like finally getting a dishwasher to do your dishes. I have had the doctors look at my leg and rewrite a prescription for me but never try to see if my insurance will cover an air compression unit for my leg. During cancer treatment, tumors, surgery and radiation can cause damage to the lymphatics. 18 0 obj /TT2 58 0 R Tactile Systems Technology, Inc. I can relate all too well to what you have been through. It delivers a noninvasive therapy that patients can administer themselves at home. /CS /DeviceRGB I greatly encourage others to try to obtain one if they are able and if it is a good option for them. Prior to using a Flexitouch, the Tacoma woman had at least two to three bouts of cellulitis a year, some requiring hospitalization. /Rotate 0 Ridner, S.H., et al., A prospective Study of the Lymphedema and Fibrosis Continuum in Patients with Head and Neck Cancer. 2008-2023 HMP Global, Inc. All rights reserved. /TT0 69 0 R Advanced Techniques in Canine and Feline Neurosurgery - Brigitte A. Brisson,Andy Shores - Advanced Techniques in Canine and Feline Neurosurgery <br />An up-to-date discussion of the latest advanced neurosurgical techniques for dogs and cats <br />In Advanced Techniques in Canine and Feline Neurosurgery, a team of distinguished veterinary practitioners delivers an authoritative . Thank you for writing. During pregnancy (applies only to the Flexitouch Plus trunk accessory). Why Should I Register and Submit Results? Deborah, hello, my name is Peggy and I also have lymphedema in my left leg. I just finished 6 weeks of radiation. Co-Primary Investigators for the study are Ridner and Barbara Murphy, MD, professor of Medicine, Vanderbilt University School of Medicine. Flexitouch Plus is the only FDA cleared pneumatic compression device for head and neck cancer-related lymphedema and can be prescribed during routine follow up care. EJVES. did you sell it yet? /C2_0 48 0 R /CropBox [0.0 0.0 612.0 792.0] +t}}lZA5'a^M~+y'A]rY(gA\`a||""1DE h2vIvMzLY$"'q!Wb40Jbc=&EMFEkl4F6,{~BP 2016;14(4):198205. The Company undertakes no obligation to publicly update or revise its forward-looking statements as a result of new information, future events or otherwise. /URI (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm) /Parent 2 0 R Lymphedema /Length 498 The trial will compare the short- and long-term effectiveness of Tactile Medicals Flexitouch Plus system to usual care, such as complete decongestive therapy (CDT), for the management of lymphedema and fibrosis in head and neck cancer survivors. /Resources << The trials primary outcome measures will include the assessment of swelling/inflammation, symptom burden and functional impairment, including swallowing; quality of life; work productivity; and activity impairment and body image via various measures. The Cutaneous, Net Clinical, and Health Economic Benefits of Advanced Pneumatic Compression Devices in Patients With Lymphedema. 6 0 obj /Length 470 >> Hi Wally, Hope someone is able to meet your request. /CropBox [0 0 612 792] The Flexitouch Plus system provides at-home pneumatic compression therapy for daily management and symptom relief in just 32 minutes. 9 0 obj Hi Karyn, I will post your comment and see if Sarah still has the pump available. Faced with negative publicity, they often end up making things right. I am in very early stages but it will only get worse if not taken care of, so be kind and good to yourself. /StructParents 0 O ce they are used the government wont always them to use them on another. /Tabs /S Breast cancer and treatment in itself was an awful journey. >> It takes just 32 minutes per day. When I first went to physical therapy, she was running through some more common contibuters to swelling. When I developed secondary lymphedema from breast cancer treatment in 2010 I asked my therapist about compression pumps. >> Choosing to participate in a study is an important personal decision. The feeling of devloping a chronic disease after surviving cancer was almost debilitating. /CropBox [0 0 612 792] I only make 12k per year so its not like I can afford anything. 1. When I called my surgeon, he recommended that I not use the FlexiTouch on my chest because the compression can make the tissue expander rupture. Comfortable: Garments are made of soft, comfortable fabric while the dynamic pressure feels like a soothing massage. /S /URI Can I use the machine on lower limbs with compression garments above? >> /Type /Page 46(4): 480487. Im diligent in taking care of myself because I want to continue to pursue activities that enrich my life. I would suggest you keep contacting Tactile Medical. Venous Ulcers. << Flexitouch Plus helps reduce swelling and relieve symptoms of head and neck lymphedema with effective treatments that are: Consistent: Unlike manual lymphatic drainage (MLD), effective treatment doesnt depend on patient technique or ability. Positive value shows an increase in symptoms/problems. I subsequently found out that Flexitouch had actually been around for several years but a new study had brought awareness to this pneumatic compression device or lymphedema pump. I dont know if it will make a difference. I dont like that I have to do it but it has changed my legs back to normal. endobj For these patients, Flexitouch Plus for head and neck lymphedema is the first and only pneumatic compression device cleared and commercially available to treat this condition at home. Percent change is calculated by the difference between scores averaged at 6 months versus baseline. 14(4): p. 198-205, 2. In conducting this rigorous clinical trial, we hope to build on the initial body of evidence by evaluating the effectiveness of Flexitouch Plus in comparison to usual care, using a variety of measures to assess the benefits of this at-home treatment for patient health and quality of life.. Filter by. /C2_0 38 0 R My husband has a brand new system that Im trying to sell. /TT1 23 0 R << Yes, taking care of ones body requires several interventions. The leg garments that I received are for a much taller person. /StructParents 0 %PDF-1.4 stream For more information, https://tactilemedical.com/our-lymphedema-solutions/for-head-and-neck/flexitouch-plus/, Tactile Medical is a leader in developing and marketing at-home therapy devices that treat chronic swelling conditions such as lymphedema and chronic venous insufficiency. Study record managers: refer to the Data Element Definitions if submitting registration or results information. where is the compassion for ill people that NEED certain healthcare to get better? YIgJ_P;}wwSk}x NZ[*EO1q(A=x> b\-Vxk(q,lo*Pi;~D1-(]pp+`~8cY &JS1(wD"J&E~WZ'OZ !! /Subtype /Link endobj /ProcSet [/PDF /Text /ImageC] >> I have have been blessed to have the Tactile newest machine for lymphedema in both my legs. /Im0 60 0 R /Font << Fax: 1.866.435.3949, Flexitouch, Actitouch, Entre and HEALING RIGHT AT HOME are all trademarks or registered trademarks of Tactile Medical. How customer reviews and ratings work See All Buying Options. Negative value shows a decrease in Function/Range of Motion. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); This field is for validation purposes and should be left unchanged. /StructParents 6 /StructParents 8 >> does anyone know where I can find a size chart for the flexitouch garments so I can figure out what size I really am? A single treatment for external lymphedema using the FDA-approved Flexitouch Plus device. /Parent 2 0 R I have been suffering from lymphedema for the past 2 years. << stream The company approached Nottingham Spirk to develop a first-to-market pneumatic compression garment for use on the head and neck and to create the next generation Flexitouch Plus System. The Flexitouch Plus system is clinically proven to stimulate the lymphatic system and to treat head and neck lymphedema. /Filter /FlateDecode Subjects enrolled in the trial will be randomized to one of two arms, where they will either self-administer once daily treatment with Flexitouch Plus or receive usual care as would typically be directed at their site, which may include CDT by a lymphedema therapist or other conservative management measures as directed by the therapist. << Last updated March 2021. Call us at 1.833.3TACTILE (1-833-382-2845), 7:00 a.m. to 7:00 p.m. CT, Monday through Friday and 8:00 a.m. to 12:00 p.m. CT, Saturday. >> HMs0{:a& f i= %e:YIf4x]i}_Ep{;_.{B!E0D[ Material and methods Design and participants See instructional videos Key Features Get the brochure Daily 32-minute treatment cycle Mild dynamic pressure Comfortable and easy to use /TT1 70 0 R Lymphedema can be debilitating and make it hard for survivors of head and neck cancer to start enjoying life again. Deng J, et al. >> (6Kjw_XGz'g &p /TT3 52 0 R Hopefully it will give me a better quality of life because I dont know what else to do at this point. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. >> /Length 585 But in reading the users manual I found that you should consult your physician before using a FlexiTouch garment that covers your chest if you have a tissue expander. The Head & Neck Program is just 32 minutes long. /Font << Words like new kind of pump, different than the old types, favorable studies, and Dr. /TT0 69 0 R Thank you for sharing your husbands success with a pump. Text, image, video. I decided to purchase one without insurance. I have lymphedema in my right arm, breast and axilla. He just never could get use to using it and being able to don the garments. 2. First of all I cant drive, and second I have to pay a $60 copay every time I go. /Tabs /S My lymphedema therapist also told me that the pumps werent worth it. Except for my wrist, all my measurements showed reduction. HQK0)I46IC">bY3oons} K.4V./`\f0 Fs Toll-free: 1.833.3TACTILE (1.833.382.2845) More than 90% of patients treated for head and neck cancer develop lymphedema1 resulting in swelling, fibrosis, difficulty swallowing, pain and other symptoms impacting quality of life with few viable options for long-term treatment, said Dr. Thomas F. ODonnell, Jr., Tactile Medicals Chief Medical Officer. So its fairly new for sale, Let me know if the pump system and right and left leg with stomach wraps are still for sale. Head and neck cancer treatments often lead to lymphedema a chronic swelling condition that may be caused by damage to the lymphatic system.