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A 78-year-old retired farmer is brought in by his wife with four months of tiredness, vague upper abdominal discomfort and aching legs. He has lost 5 kg. He stopped going to lawn bowls three months ago, no longer reads the newspaper and has let the vegetable garden go. He wakes at four each morning. He says he is 'no different from any other old bloke' and denies feeling sad. Examination, including abdominal and rectal examination, is normal. Full blood count, electrolytes, calcium, liver biochemistry, thyroid function, C-reactive protein and faecal occult blood testing are all normal. Which one of the following best explains his decline?
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