Some time back I did a load of work on performance diagnostic work on some poorly performing Sitecore websites. (Which was the basis of a talk I gave a few times) I've recently had to look at some similar issues - but the world has moved on. I now have Visual Studio 2022 as my diagnostic tool of choice, and the websites are commonly hosted in Azure PaaS web apps. So what do you have to do these days to diagnose likely places for your code to be stuck?
Some of the most frustrating issues in IT happen when a thing which was working fine stops, and you're sure you didn't change anything. Now that very few people host their own infrastructure, these issues can be compounded because change or problems might happen in the internals of a complex infrastructure system you have no control over. I got bitten by this recently, and while I have no answers I suspect this is worth writing up just because it may help other people to realise the problem you have is not always your fault...