Would you anesthetize my dog?

I am an RVT and I trust my doctors implicitly, but I just need an unbiased opinion. I know they would put him under if I asked (with the clear understanding that he may not make it) but I need to know if I’m being an overly anxious pet parent. Despite my schooling, all my knowledge goes out the window when it comes to him.

Signalment: 13yo MN ACDx. 45lbs, BCS 3/9

Medications: Usrodiol, Desmopressin, Omeprazole

Supplements: Denamarin, MovoFlex, Welactin 3TA, Ursolyx

My dog has unspecified liver disease. Elevated liver values caught on routine bloodwork in 2020-2021. Internal medicine consult revealed vacuolar hepatopathy and I declined biopsy at that time. ACTH stim and LDDS both normal and copper storage disease ruled out. He is dog and barrier reactive, so treatments involving excessive hospitalization would be detrimental to his QOL. At this point in time we are simply monitoring bloodwork every 4-6 months for my sanity. Repeat us shows hepatomegaly and vacuoles but nothing has changed visibly. In November ‘24 he began losing muscle mass which we have concluded is due to his liver disease. He has a BCS of 3/9, but an increase in calories or protein only makes him more pot bellied and does not help with his muscle wasting. In the fall he had about a week of excessive sneezing. He was smacking his head on the ground and pawing at his face. We knocked him out to examine his mouth and flush his sinuses. Nothing came out but the sneezing ceased. Bloodwork ran in December showed his highest values yet.

ALT: 753

AST: 63

ALP: 10,174

GGT: 398

Compared to August 2025

ALT: 359

AST: 31

ALP: 5,771

GGT: 327

Recently, in the past week or so, he has developed a new strange habit. His tongue is poking out of the left side of his mouth when he gets overly excited. I first noticed it last Sunday and thought it was cute, but then he did it again on Monday. I’ve been watching him eat and while he does not favor a side when he chews, when he drinks he uses the left side of his mouth. However, I’ve never watched him drink previously so this may not be a new development. He lets me examine his mouth and there is no swelling or asymmetry in his face. He is coming up due for his yearly dental and definitely needs it, but I had already decided to forgo it due to his most recent bloodwork. I honestly did not expect him to make it this far after getting those results. This dog is my everything, but I will not let him suffer. Other than occasional inappetance treated by ondansetron he doesn’t seem to recognize his body is failing him. I don’t know if this is because I’ve been staring at him waiting for something to go wrong since December, or if this is a true change. It could be that he’s been acting this way for awhile and I just haven’t noticed. I’ve accepted that I am in end of life care for him and no drastic lifesaving measures would be taken even if something was found. Given all of this, would you anesthetize and investigate? Chalk it up to an over anxious owner staring at their dog too long? Would you be comfortable doing a dental on a dog with this significant of liver disease? Part of me wants to just ignore it and move on, knowing that if I’m ignoring something bad it could be the end of him, and part of me wants to dive in and investigate knowing this could just be a cute new quirk.