i have no idea if this is right or not, but i think he may have thyroid cancer, and knows he doesn't have long to live...
https://news.yahoo.com/putin-visited-cancer-surgeon-dozens-112724988.html
there isn't a lot of confirmation to any of this, but it seems to make enough sense to me to be plausible.
he is 70 years old, and any kind of cancer at that age isn't something you can just shrug off, radiation or chemo therapy take their own toll, and he probably doesn't want to submit to it, as it would become obvious he was ill.
i realize this has been suggested before, but it seems to become more likely to me as time passes.
most of the time thyroid cancer is pretty treatable, but as i said before, he is 70 years old, usually under a large amount of pressure, and seems to have a fair dose of paranoia...
i don't know...it's something to think about